Why is change so darn hard? Whether it’s shedding a few kilo’s or taking up a new fitness routine to changing jobs or careers, leaving the comfort and security of what we know is difficult. We’ve all heard the saying that change doesn’t happen overnight right? The reality is that change creeps up on us incrementally over time. Therefore, it makes sense to take a cyclical approach to change our personal behaviours from more negative old habits to new and positive ones.
Trans-theoretical model of behaviour change
Renowned psychologist, James Prochaska, proposed that our resistance to change and therefore the predicaments we find ourselves in are a result of our perception of change. The trans-theoretical model of behaviour change developed by Prochaska and DiClemente (1983) is based on the cyclical nature of change rather than a single event or discrete process. A cyclical rather than linear metaphor helps people move through different and fluctuating stages that feature motivation, commitment, and maintenance. Each of these stages or evolutions can be supported and strengthened by coaching.
When it comes to changing negative health behaviours, Adrian is a prime candidate for change. Adrian wants to improve his health and he has good reason to, he has been diagnosed with Type 2 Diabetes. Adrian is not alone in his need to form healthier habits. According to the Australian Diabetes Society, diabetes impacts almost every Australian family in some way.
“There are currently over 1.4 million people living with known, diagnosed diabetes who are registered with the National Diabetes Services Scheme. In addition, there are an estimated 500,000 Australians with silent, undiagnosed type 2 diabetes and two million Australians with pre-diabetes who are at high risk of developing type 2 diabetes in the coming years” (ADS, 2022).
How can the trans-theoretical model help Adrian work toward a healthier lifestyle? Let’s walk through each stage of change to understand what’s happening and progress Adrian’s goal of improving his health.
In this first stage, Adrian is ignoring his health challenge and does not consider that the health implications of type 2 diabetes apply to him. In other words, he has no conscious intention of altering or stopping his usual behaviour. This might be because he has not given it much thought or he has tried before but is discouraged because of failed attempts. For instance, Adrian joined the local swimming club but the aquatic facility was closed due to the pandemic. However, family pressure from his wife and sons who are aware of his diagnosis and putting pressure on him is influencing his motivation to change.
Motivation is key to progress through this stage. A coach can use motivational interviewing, a person-centred form of guiding to elicit and strengthen a clients motivation for change, to encourage Adrian to talk. Helping Adrian perceive change as advantageous is important. For instance, working on improving his knowledge of what positive outcomes change to his lifestyle habits will have and considering how his behaviour may be in conflict with his personal goals or values. For instance, Adrian played rugby in his younger years and felt proud of his ability and achievements.
Adrian is starting to see a benefit from making a change. He has visited his GP several times and this has helped him become more aware of what changes in behaviour he needs to make. At this stage, Adrian does acknowledge the problem, that he has been diagnosed with type 2 diabetes, and is debating what to do next based on his new insights. This is a difficult and frustrating stage in the change cycle because the outcomes are uncertain. Will he succeed or fail again by falling back into his old habits? Will he take a chance and commit to change? Feeling stuck is completely natural and people can remain at this stage wavering between the benefits and costs of changing their behaviour.
To move forward was worrying and ruminating, it would be helpful for Adrian to do some Structured Problem Solving. This strategy is a useful way of defining problems, identifying potential solutions, and figuring ways you can achieve these solutions. It involves defining the problem, brainstorming as many ideas and solutions as possible, evaluating them, choosing the best solution at this time, creating a detailed action plan, and then reviewing your progress.
At this stage, Adrian has decided to change his behaviour with actions that will improve his health outcomes in the immediate future. He has weighed up the advantages and found they outweigh the disadvantages and he may be experimenting with small steps like having a meat-free Monday, buying a diabetes cookbook, or joining the 10000 Steps free physical activity program. Adrian’s commitment to exploring, planning, and insuring progress are critical at this stage. In addition to Structured Problem Solving, Adrian’s coach can help him create some SMART Goals to overcome challenges, stay on track, and set him up for long term success. For example: I will take the dog for a walk each weekday morning for 45 minutes for the first week of my health change plan. Equally important is have contingency plans. What will you do if it rains or you injure your ankle or you have to quarantine? Remeber to share you committment and plans with family and friends as well as rewarding yourself for achieving your SMART goals to encourage your progress.
Everything is starting to come together for Adrian. He is making progress and starting to see significant improvements in his health like reduced fluctuations in his glucose levels and improved blood pressure over the past two to six months. It has required major adjustments to his routines, relationships, and his working habits to achieve the changes he wanted and needed. Adrian started to keep a journal at the suggestion of his coach that helps to keep a realistic and purposeful daily diet and exercise plan. Most people have been supportive of the changes he is making but he has been surprised by some close friends and workmates who are less so. Talking to his coach, Adrian has found that these negative feedback moments have made him more appreciate of the praise and encourage from others as well as helped him to check in with himself and focus on the advantages of the changes he has committed to. Acknowledgement of progress so far, being kind to yourself when things didn’t go as expected or you slipped back a step, and the gains you have made is essential. Again, the trans-theoretical model of behaviour change is of a cyclical nature of change rather than a single event. Trust yourself and get back on track.
At this stage, Adrian is seeing his desired changes come to fruition over the past six months. He is realising what seemed impossible is now a reality and the changes in his daily behaviour seem normal now with old habits less threatening to derail his progress. The maintenance stage is critical in sustaining long-term behavioural change. Relapse may seem distant but is always present and recognising triggers will continue to be important to achieving and maintaining his health outcomes. Healthy reflection is important and Adrian can draw from some of the tools he has used during his change process: his journal notes, SMART goals, and Structured Problem Solving strategy skills will help him to anticipate, notice, avoid, and overcome or improve mistakes.
Change is cyclic by nature rather than linear and those problematic behaviours are sticky. Rather than beating ourselves up over our inevitable and very ‘human’ relapses and slip-ups, we can change our narrative to recognise fluctuations in motivation and treat these stages in our progress as positive and strengthening learning experiences. Check-in with your coach or support people, review what has been helpful, evaluate your current plan, and keep moving along new avenues to reach your goals!