In the last section, we talked about the fundamental principles and guiding laws of behavior. Classical conditioning, operant conditioning, how to increase or decrease behavior. These principles apply whether you're talking about an individual, a dyad, a community. You can easily set up a reinforcement system to increase the chances that you stick to your new exercise routine without the help of someone else. You could also set up a society so that it reinforces biking rather than driving, for example. But in this module, we're going to step back from the nitty-gritty of behavior and look at one of the models of stages of behavior change and one therapeutic strategy that's used to help people explore and begin their behavior change process. Before we get to making a behavior change plan for ourselves or for our client, we need to first see if they're even ready or wanting to make a change. The transtheoretical model of change, TTM, was put forth by James Prochaska and Carlo DiClemente in the late 1970s. It's one of the most commonly understood models of change, both in psychology and around health behaviors. The TTM highlights the need to assess and be sensitive to a client's readiness to change, rather than just jumping in with an intervention or a plan. The TTM positive five levels of change, pre-contemplation, contemplation, preparation, action, and maintenance. The first stage is termed pre-contemplation. This is the phase you are in before you even know there's something to change, or when you're not at all interested in changing your behavior. You might imagine your uncle who gives you a head tilt and a laugh when you suggest he might want to cut back on the nightly beers. The next stage is contemplation. This describes the time when people are starting to consider the possibility that they have a problem or want to change something about their behavior. However, most people in this stage are very ambivalent. They're on the fence about whether they want to make the change or not. For example, someone might be aware that drinking is causing them some problems and they might even be able to list the reasons that it's bad for their health. But even with all those negatives, they're still pretty committed to stay in the course and maintaining their behavior. They might research alcohol treatment options, might be internally weighing the pros and cons, but they definitely haven't committed to changing their drinking behavior. The next stage then is what we call preparation. At this point, well, not all the ambivalence has been resolved, it no longer poses a total barrier. Deciding to stop drinking would be the key element of the stage. All of the weighing of pros and cons, analyzings of risks and rewards has now tipped in favor of stopping drinking and the determination to make the changes present. The next thing that happens in this stage is making a plan. A commitment to change without the appropriate skills or foresight can really be a recipe for disaster. Often in this stage, an individual might work with a treatment professional to help them anticipate problems that could come up and develop concrete solutions that will become part of their ongoing treatment plan. The next step, the action step, not surprisingly, is when the individual puts their plan into action. It might involve entering a treatment program, publicly committing to not drinking, emptying their house of beer or whatever the first step and abstaining from alcohol is for that individual. The action step of behavior change is rarely a singular one. It often involves lots of steps and missteps and adjustments as the person practices new behaviors in the place of the old behavior. Then we have the maintenance stage of the stages of change model. This occurs when the individual is no longer actively working to change their behavior, but instead has really integrated their new behavior into their routine. In our example, our individual at this point might not need to actively think about driving their car away from the direction of the bar and the way home. But they may just realized they got home without even having the thought or the urge to go to the bar. Change requires building a new pattern of behavior over time that then starts to take on its own momentum so that it continues with very little outside intervention as time goes on. Now, it's important to note that most people will have lapses and relapses as they change a behavior. This is very rarely as linear process as that nice TTM diagram we just looked at suggests. This tangled web that you see here might be more of an accurate representation of what happens. We're going to talk more about maintenance and lapses towards the end of this course. But for now, just keep in mind that moving backwards or going around the circle more than once when you're working on changing a behavior is by far the norm and not an indication that there's no hope of more lasting change. Most CBT approaches were geared towards the preparation and action phases, the one circled in red. What to do when someone came in wanting to stop drinking rather than the earlier stages, like pre-contemplation where the individual who came to treatment maybe wasn't even thinking about changing their drinking at all, or where they were just starting to consider their options. Motivational interviewing is an intervention framework that fits well into this gap. Early on, the hope was that motivational interviewing would encourage or motivate patients to engage in treatment for their alcohol problems. In fact, what it did was decreased drinking in and of itself. It seemed to increase motivation to change and that in and of itself did the trick for some participants. Let's turn our attention now to learning more about the history and then some of the basic principles of motivational interviewing.
