Behavior Change as One of the Most Difficult Things for People to Do - Case Study Example

Processes of Change Name Institution Course Date Processes of Change Introduction Behavior change is one of the most difficult things for people to do. This is especially so with addictive behaviors like smoking and drinking. Behavior change does not occur spontaneously but goes through a process and stages. According to transtheoretical model, these processes include conscious raising, dramatic relief, counter-conditioning; environmental reevaluation, reinforcement management, helping relationships, self-liberation, social liberation, self-reevaluation, and stimulus control (Prochaska & DiClemente, 1982). These processes are related to the stages of change, with each process relating to a certain stages. The stages of change, according to change theory, include precontemplation, contemplation, preparation, action and maintenance. In this study, analysis of two individuals who tried to quit smoking was done. It was done in terms of the processes of change they went through in their quest to stop smoking. The various stages they passed through were also analyzed. The length of time they took to pass through a particular stage was also analyzed. The reasons for failure in the case of inability to quit smoking were also analyzed. The method of collection of data used in this study was the use of interviews with the individuals responses tape recorded. The findings were analyzed and conclusions drawn. Literature review Processes and Stages of smoking termination Psychologists like Prochaska and DiClemente came up with a model that describes the stages through which an individual goes through in behavior change, from a point where the individual makes no trial to change his behavior to a stage where the individual has totally overcome the problem. This model, as related to smoking, includes five stages which are precontemplation, where an individual is not considering stopping smoking in future, contemplation, where an individual is considering stopping the habit though he/she has not, relapse, where the individual makes an attempt to quit smoking but resumes the habit again, recent quitting, where an individual manages to avoid smoking for six months since his last smoking and long term quitting where the individual now manages to completely stop smoking (Prochaska & DiClemente, 1982). In addition to stages of change, prochaska and DiClemente also described processes of change used by individuals who are involved in self initiated change of quitting certain behaviors. These processes were adopted from Prochaska’s transtheoretical analysis of systems of psychotherapy (DiClemente & Prochaska, 1982). A process of change is an activity experienced or instigated by individual in a move to modify a behavior, affect, relationships or cognitions. These processes represent change principles that are responsible for the change activities carried out by individuals determined to change their behavior. The processes represent the principles that can be applied to initiate and maintain behavior change in individuals (DiClemente & Hazelden Foundation, 2004). There are processes of change through which an individual goes through in behavior change. They include conscious raising, self liberation, self reevaluation, environmental reevaluation, counter-conditioning, stimulus control, strengthening management, dramatic relief as well as helping relationships. The first process, conscious raising, is where an individual recalls the information about changing the behavior. In the case of smoking, the individual recalls information about quitting smoking. Self liberation, which forms the second process of change, involves an individual choosing to change his/her behavior. For instance, the individual decides to stop smoking (Thombs, 2006). This is choosing and being committed to changing the problem behavior where an individual decides to do away with the problem behavior. Social liberation, as another process of change, involves an individual being aware of the alternative and problem free lifestyles in society. This process also involves the individual accepting the alternative ways of behavior that are less harmful to his/her self. In the case of smoking problem, the individual looks at the possible alternatives to smoking that are more acceptable in society and which less harmful to his health (Fiore, United States., & Centers for Disease Control and Prevention, 1996). The individual becomes aware of what the society prescribes in terms of behavior and conforms to the rules of the society by looking for alternative behaviors. The fourth process of change, self reevaluation, involves cognitive reassessment of values with respect to the undesired behavior. This is the point where the individual evaluates the value of his behavior and weighs the options and benefits of quitting that behavior. For instance, a smoker at this stage will ask himself/herself whether smoking has any befit to him/her at all and what benefits can accrue should he/she quit smoking. Self reevaluation leads to the next process, environmental reevaluation, where an individual assesses the effect of his behavior to the environment (Tucker, Donovan & Marlatt, 1999). Environment in this case refers to both the physical and social environment. For a smoker, he/she has to evaluate how smoking is affecting both the physical and social environment. After an individual has assessed the effect of the problem behavior to the self and the environment, he/she opts for substitute behaviors against the problem behavior, a process known as counter-conditioning. At this stage, an individual looks for alternative behaviors that are less harmful than the problem behavior. The next stage is the stimulus control. In this stage, the individual avoids or alters the environment to reduce the reminders of the problem behavior (Bandura, 1977). For instance, a smoker will strive to avoid other smokers or will modify the environment to avoid reminders of smoking. Reinforcement management as a process of change, on the other hand, involves the individual being rewarded or rewarding himself for succeeding to overcome the problem behavior. A smoker, for instance, gets rewarded for quitting smoking. In this process, an individual is in the advanced stage of reforming from the problem behavior. After the reinforcement management, an individual graduates to the dramatic relief process (Martin, Haskard-Zolnierek & DiMatteo, 2010). In this process of change, an individual expresses emotional responses such as sadness, fear and anger towards the problem behavior. For instance, a smoker may become worried about smoking when the health warning about cigarette smoking is aired on television during the cigarette advert. This may help propel the individual to strive to quit the behavior completely (DiClemente & Prochaska, 1985). The last process is the helping relationships process where the reformed individual seeks assistance from other people to help him/her reform completely. After this stage, the individual is said to be completely recovered from the problem behavior. Related to the processes of change are stages of change. Each process of change is associated with certain stages of change. The stages of change include precontemplation, contemplation, preparation, action and maintenance. Precontemplation stage is the where an individual who has a problem does is not considering change. This is a situation where the individual is not intending to take any action towards changing the adverse behavior. The individual does not view the behavior as a problem. This is the stage of denial where an individual denies existence of a problem. Some people at stage get resigned to the problem citing that the problem is part of them (Lutzker & Martin, 1981). The contemplation stage involves the individual thinking about changing. The individual becomes more aware of the benefits of changing. However, the cost of changing often discourages people from making any effort, resulting to people remaining with the problem. For instance, a smoker might consider the cost of quitting smoking and this might discourage him/her. The next stage is the preparation stage. At this stage, the individual is mentally prepared to change and therefore start taking small steps towards the desired end. For a smoker, he/she might start smoking less each day or change cigarette brands. This the stage the journey towards change begins. The fourth stage is the action stage. At this stage, people engage fully in actions and activities that bring about change. For instance, if a person wants to lose weight, he/she starts exercising fully to lose weight. For a smoker, he/she might decide to stop smoking all together (DiClemente, 2006). The last stage of change is the maintenance stage where an individual successfully avoids going back to the former behavior and maintains the new behavior. At this stage, an individual avoids instances that can bring about temptations. Closely related to behavior change are the theories of self efficacy and outcome expectancy. Self efficacy is the belief an individual has that he/she can accomplish certain things. In relation to behavior change, it is the belief that an individual has on his capability to accomplish a certain behavior change (Miller, Heather & International Conference on Treatment of Addictive Behaviors, 1986). This is related to behavior change in the sense that the belief an individual has in him/her to change from a certain behavior greatly helps in the realization of that change by that individual. If on the other hand an individual does not trust in his capability to change, then the process of change becomes very hard to initiate. Outcome expectancy, on the other hand, is the belief one has of what will happen in the event of engaging in a certain behavior. Outcome expectancy theory states that a person behaves or acts in certain ways because they of the expected outcome of that behavior (Josendal & Aaro, 2012). People are motivated to behaving in certain ways because they expect the behaviors to produce certain outcomes. This is also the reason why some people are motivated to change from their behaviors. Method of study This study involved two individuals. Of the two, one of them was successful was successful in quitting smoking while the other failed to quit. The main method of collection of data was through interviews. The two guys were interviewed and the information tape recorded. The information was analyzed by relating the ways they used in their process of quitting with the processes of change in order to ascertain which processes were prevalent and at which stages. Both interviewees were self changers, that is, they did not attend any treatment or therapy in trying to quit smoking. The results were compared to those who had attended treatment. The roles of self efficacy and outcome expectancy were also investigated in both the quitter and the relapser. Findings From the information collected from the two interviews, it was discerned the two individuals utilized very few processes during the precontemplation stage. The main process that was emphasized during the precontemplation was the conscious raising. In the contemplation and action stages, the self reevaluation process was the most emphasized. The action stage received the highest number of processes with the individuals utilizing the helping relationships process, the self-liberation process and the reinforcement management process at this stage (Prochaska et al, 1994). The stimulus control process and the counter-conditioning process were utilized most during the action and maintenance stages. During the action stage, the respondents utilized the highest number of processes. it was also discovered that the respondents spent long at the precontemplation stage than at the other stages. This can be attributed to their reluctance to quit smoking. This is especially so because smoking is an addictive behavior. The responses from the relapser were found to be a combination of the responses of individuals at the contemplation stage and the ones at the action stage (Kassel, Stroud & Paronis, 2003). On the issue of self efficacy, it was found that the quitter had a strong willpower and trust that he could overcome the problem. On the other hand, the relapser had doubts as to whether he can really quit smoking. He was not sure if he could survive without smoking. This explains the two different outcomes. The outcome expectancy was also found to have played a role in determining how the two respondents addressed their problems. For the quitter, the need to lead a healthy life is what motivated him to quit smoking. For the relapser, the need to have the good feeling and the stimulation obtained after smoking was what motivated him to go back to smoking. Discussion The results obtained from this study provide essential data that can help one to understand self change in smoking. This can also help in the development of a more integrative model that can be used to initiate change. As predicted in the trans-theoretical model, individuals trying to change behavior employ minimally the processes of change at the precontemplation stage. Specifically, individuals use about two processes only at the precontemplation stage. The other processes are used very minimally at this stage (Shiffman, Balabanis & Paty, 2000). This implies that at the precontemplation stage, smokers process little information on the issue of smoking, take less time in the reevaluation of their selves as smokers, experience less emotional reactions about the negativity of smoking and they do very little to avert their attention or of the environment in which they live in away from smoking. The factor that moves individuals from the precontemplation to the contemplation stage where they now start thinking seriously about quitting smoking is not known (Prochaska et al, 1988). However, when individuals get in the contemplation stage, individuals start responding to education and give feedback to information concerning smoking. At this stage, people become more conscious about the behavior of smoking. In addition to being open to information on smoking, people at the contemplation stage report about thinking and feeling of themselves and the problem behavior that they have (Prochaska et al, 1991). The contemplation stage is also characterized by self reevaluation where individuals also reflect about themselves and their problem behavior. For instance, the respondents claimed to have taught about themselves and their habit and how it was affecting them. The self reevaluation process also tends to be carried on into the action stage. At this stage, the respondents became upset enough to commit themselves to quit from smoking. This was after careful reflection on their lives and how smoking was affecting them. At the action stage, the smokers employed both the stimulus control procedures and counter-conditioning procedures in changing their environment and smoking behavior (Ahijevych & Wewers, 1992). They depend on helping relationships process for support and understanding. At this stage, the respondents report their dependence on social reinforcement and the self for the changes they experience. At the maintenance stage, the respondents experience reduced reinforcement. However, they still emphasize on stimulus control and counter-conditioning processes to overcome the temptation to smoke again. The results from this study also give a view of how people respond after relapsing following quitting of smoking. The respondent who relapsed after quitting smoking reported using the processes used mostly at the contemplation and stages. More specifically, the relapse reported using the conscious raising process as much as the quitter, self reevaluation as much as the quitter, helping relationships as much as the quitter and stimulus control as much as individuals in the maintenance and action stages (Cook, 2012). The possible explanation for such a phenomenon is that the relapser might have been preparing himself to stop smoking again. He may also be trying to avoid complete relapse. This explains his use of the maintenance and action processes so that he can control his current level of smoking. The results of this study support the hypothesis postulated in the transtheoretical model. The results suggest that it is not emotional experiences that move people to act but rather a combined affective or cognitive reevaluation process that acts as a transition from the contemplation stage to the action stage. In addition, the results imply that self-liberation process is more pronounced during the action stage. This is contrary to earlier findings which suggested that commitments are made only after action has been taken (Perkins et al, 2012). Finally, the stimulus control and counter-conditioning processes appear to act as bridges between action and maintenance stages. This implies that maintenance stage is in reality an active stage and not an absence of change. The results found in this study can be used to improve the effectiveness of programs designed to help people with smoking problems as well as maximizing on the self help approaches. Instead of assuming that all smokers seeking treatment are ready to take action towards cessation of smoking as is always the case with most of the behaviorally based programs, patients can be grouped in terms of the stage of change a particular individual is in. consequently, these groups would receive different modes of treatment (Gwaltney et al, 2005). For instance, smokers at the contemplation stage might begin with self-reevaluation and conscious raising processes, while those who are ready in the action stage would be subjected to more behaviorally based processes. Self efficacy and outcome expectancy are significant to behavior change. People with low levels of self efficacy about their ability to change from a problem behavior tend to often fail to change. A smoker who does not believe in his capability to overcome the problem tends to go back to smoking even after trying to quit (Carmody et al, 2012). The outcome expectancy, on the other, also motivates one to change behavior. a smoker would be motivated to quit smoking because of the benefits one gets from leading a smoking free life. Further Research The results from the study provide support for the transtheoretical model as well as providing suggestions for modification of the model (Armitage, 2009). However, further research is required in the field to ascertain the predictive strength of the model as people progress through the stages. Other problem behaviors also require to be studied to determine the differences in the use of the processes of change at different stages as individuals strive to overcome certain behaviors. This will help develop ways in which every problem behavior is addressed differently, instead of having only one standard way of addressing all problem behavior. This will in turn help reduce cases of relapsing. Conclusion The study was a success and the results obtained provide support for the postulates advanced in the transtheoretical model. The results of the study showed that self changers also utilize the processes of change at various stages although the emphasis on each process at a particular stage varies. The results also showed minimal use of the processes at the precontemplation stage while the action stage received most of the uses (Callaghan & Herzog, 2006). The respondents also reported spending most of their time of change at the precontemplation stage. Self efficacy and outcome expectancy were also discovered to have an impact on the outcome of a behavior change process. References Ahijevych, K. & Wewers, M.E. (1992). Processes of change across five stages of smoking cessation. Addictive Behaviors, 17, 17-25 Armitage, C.J. (2009). Is there utility in the transtheoretical model? British Journal of Health Psychology, 14, 195-210 Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215 Berstein, D.A. (1970). The modification of smoking behavior: A search for effective variables. Behavior Research and Therapy, 8(2), 133-146 Callaghan, R.C. & Herzog, T.A. (2006). The relation between processes-of-change and stage- transition in smoking behavior: a two-year longitudinal test of the transtheoretical model. Addictive Behaviors, 31, 1331-1245 Carmody, T.P., McFall, M., Saxon, A.J., Malte, C.A., Chow, B., Joseph, A.M., Bekham, J.C. & Cook, J.W. (2012). Smoking outcome expectancies in military veteran smokers with posttraumatic stress disorder. Nicotine & Tobacco Research, 14(8), 919-926 DiClemente, C. & Prochaska, J. (1985). Processes and stages of self-change: coping and competence in smoking behavior change. Orlando: Academic Press DiClemente, C. C. (2006). Addiction and change: How addictions develop and addicted people recover. New York: Guilford Press. DiClemente, C. C., & Hazelden Foundation. (2004). The clinical innovators series on stages of change and addiction. Center City, MN: Hazelden. DiClemente, C.C. & Prochaska, J.O. (1982). Self-change and therapy change of smoking behavior: A comparison of processes of change in cessation and maintenance. Addictive Behaviors, 7, 133-142 Fiore, M., United States., & Centers for Disease Control and Prevention (U.S.). (1996). Smoking cessation. Rockville, Md.: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Centers for Disease Control and Prevention Gwaltney, C.J., Shiffman, S., Balabanis, M.H. & Paty, J.A. (2005). Dynamic self-efficacy and outcome expectancies: Prediction of smoking lapse and relapse. Journal of Abnormal Psychology, 114(4), 661-675 Josendal, O. & Aaro, L.E. (2012). Adolescent smoking behavior and outcome expectancies. Scandinavian Journal of Psychology, 53, 129-135 Kassel, J.D., Stroud, L.R., & Paronis, C.A. (2003). Smoking, stress, and negative affect: Correlation causation and context across stages of smoking. Psychological Bulletin, 129(2), 270-304 Lutzker, J. R., & Martin, J. A. (1981). Behavior change. Monterey, Calif: Brooks/Cole Pub. Co. Martin, L. R., Haskard-Zolnierek, K. B., & DiMatteo, M. R. (2010). Health behavior change and treatment adherence: Evidence-based guidelines for improving healthcare. Oxford: Oxford University Press. Miller, W. R., Heather, N., & International Conference on Treatment of Addictive Behaviors. (1986). Treating addictive behaviors: Processes of change. New York: Plenum Press. Perkins, K.A., Parzynski, C., Mercincavage, M., Conklin, C.A. & Fonte, C.A. (2012). Is self- efficacy for smoking abstinence a cause of, or a reflection on, smoking behavior change? Experimental and Clinical Psychopharmacology, 20(1), 56-62 Prochaska, J.O. & DiClemente, C.C. (1982). Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395 Prochaska, J.O., DiClemente, C.C., Fairhurst, S.K., Velicer, W.F., Velasquez, M.M. & Rossi, J.S. (1991). The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59(2), 295-304 Prochaska, J.O., Velicer, W.F., DiClemente, C.C. & Fava, J. (1988). Measuring processes of change: Applications to the cessation of smoking. Journal of Consulting and Clinical Psychology, 56(4), 520-528 Prochaska, J.O., Velicer, W.F., Rossi, J.S., Goldstein, M.G., Marcus, B.H., Rakowski, W., Fiore, C., Harlow, L.L., Redding, C.A., Rosenbloom, D. & Rossi, S.R. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13(1), 39-46 Shiffman, S., Balabanis, M.H. & Paty, J.A. (2000). Dynamic effects of self-efficacy on smoking lapse and relapse. Health Psychology, 19(4), 315-323 Thombs, D. L. (2006). Introduction to addictive behaviors. New York: Guilford Press Tucker, J. A., Donovan, D. M., & Marlatt, G. A. (1999). Changing addictive behavior: Bridging clinical and public health strategies. New York: Guilford Press Read More

These processes represent change principles that are responsible for the change activities carried out by individuals determined to change their behavior. The processes represent the principles that can be applied to initiate and maintain behavior change in individuals (DiClemente & Hazelden Foundation, 2004). There are processes of change through which an individual goes through in behavior change. They include conscious raising, self liberation, self reevaluation, environmental reevaluation, counter-conditioning, stimulus control, strengthening management, dramatic relief as well as helping relationships.

The first process, conscious raising, is where an individual recalls the information about changing the behavior. In the case of smoking, the individual recalls information about quitting smoking. Self liberation, which forms the second process of change, involves an individual choosing to change his/her behavior. For instance, the individual decides to stop smoking (Thombs, 2006). This is choosing and being committed to changing the problem behavior where an individual decides to do away with the problem behavior.

Social liberation, as another process of change, involves an individual being aware of the alternative and problem free lifestyles in society. This process also involves the individual accepting the alternative ways of behavior that are less harmful to his/her self. In the case of smoking problem, the individual looks at the possible alternatives to smoking that are more acceptable in society and which less harmful to his health (Fiore, United States., & Centers for Disease Control and Prevention, 1996).

The individual becomes aware of what the society prescribes in terms of behavior and conforms to the rules of the society by looking for alternative behaviors. The fourth process of change, self reevaluation, involves cognitive reassessment of values with respect to the undesired behavior. This is the point where the individual evaluates the value of his behavior and weighs the options and benefits of quitting that behavior. For instance, a smoker at this stage will ask himself/herself whether smoking has any befit to him/her at all and what benefits can accrue should he/she quit smoking.

Self reevaluation leads to the next process, environmental reevaluation, where an individual assesses the effect of his behavior to the environment (Tucker, Donovan & Marlatt, 1999). Environment in this case refers to both the physical and social environment. For a smoker, he/she has to evaluate how smoking is affecting both the physical and social environment. After an individual has assessed the effect of the problem behavior to the self and the environment, he/she opts for substitute behaviors against the problem behavior, a process known as counter-conditioning.

At this stage, an individual looks for alternative behaviors that are less harmful than the problem behavior. The next stage is the stimulus control. In this stage, the individual avoids or alters the environment to reduce the reminders of the problem behavior (Bandura, 1977). For instance, a smoker will strive to avoid other smokers or will modify the environment to avoid reminders of smoking. Reinforcement management as a process of change, on the other hand, involves the individual being rewarded or rewarding himself for succeeding to overcome the problem behavior.

A smoker, for instance, gets rewarded for quitting smoking. In this process, an individual is in the advanced stage of reforming from the problem behavior. After the reinforcement management, an individual graduates to the dramatic relief process (Martin, Haskard-Zolnierek & DiMatteo, 2010). In this process of change, an individual expresses emotional responses such as sadness, fear and anger towards the problem behavior. For instance, a smoker may become worried about smoking when the health warning about cigarette smoking is aired on television during the cigarette advert.

This may help propel the individual to strive to quit the behavior completely (DiClemente & Prochaska, 1985).

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