Stages of Change

Steve Carlson, Psy.D.Spectrum Community

Mental Health

“Change is the manifestation

of our ability to grow and become”

Anne Wilson Schaef

Agenda

The nature and types of change Brain injury and change Stages of change Tools and tasks that help facilitate

change in a positive direction

Why change?

“Hard work pays off in the future; laziness pays off now”

Steven Wright

Two types of change

Forced Intentional

With life there is painPhysicalEmotionalPsychologicalExistential

Pain can motivate us towards change

Or we can cope with pain by…

Avoid it Resist it Anesthetize it Minimize or deny it Blame others

Intentional change is hard work!

Too much change causes stress

Too much stability is boring

Stability Change

Coping with another’s pain

“Whenever we fix other people’s problems, we give them a bigger problem: powerlessness”

Anna Christie

Give a fish? Teach to fish!

Building motivation for change

What does not work Telling people what to do Persuading with logic Warning Reassuring, consoling The “expert” trap

So what can we do?

Spirit of Motivational Interviewing

Collaboration Evocation Autonomy

“It is the truth we ourselves speakrather than the

treatmentwe receive that

heals us” O. Hobart Mowrer (1966)

“What people really need is a

good listening to”

Create a rich environment through listening Undivided

attention Body language Eye contact Genuine interest Set aside assumptions Silence &

presence

Brain injury and change

Cognitive deficits Decreased memory and new learning Decreased attention and speed of processing Decreased judgment, insight, and planning

Behavioral deficits Depression Anxiety Impulsivity

Stages of change

Pre-contemplation “Who, me?”

Contemplation “Yes, but”

Preparation “Uh-oh”

Action “Do it”

Maintenance “The grind”

Relapse “Back to the

drawing board”

Stages of change and treatment tasks Precontemplation

Contemplation

Preparation

Action

Maintenance

Increase concern and hope for change

Tip the decisional balance

Commitment and effective plan

Problem solving; support self-efficacy

Prevent relapse; resolve context problems

Stage 1: Precontemplation “We don’t know what we don’t know”

No plan to change in the foreseeable future Usually a six

month time frame

Unaware a problem exists

Stuck in precontemplation

Five R’s Reveling Reluctance Rebellion Resignation Rationalizing

•

Treatment task for “precontemplators” Increase concern and hope for change

“It’s all grist to the mill”

Defn: “Everything can be used to move toward a profit or conclusion”. Social pressure Aging Illness Personal concerns Human development Shift in values “Cultivating seeds for change”

Stage 2: Contemplation“We begin to know that we don’t know”

To change or not to change, that is the question.

Increased instability Ambivalence Taking stock

                       

Creating an atmosphere for change

“Contemplating change in an

atmosphere of fear, hopelessness,

or exhaustion is a self-defeating

exercise”

Strategies that promote contemplation Provide feedback at the

proper time Demonstrate as much

objectivity as possible Provide feedback in the

context of concern Effective and doable

consequences that reinforce your expressions of concern

Processes of change: Cognitive/experiential

Consciousness raising

Emotional arousal

Self-reevaluation Environmental

reevaluation Social liberation “Surveying the

landscape of my life”

Treatment task for “contemplators”

The goal: A firm decision to change

The tasks:1. Gathering decisional

considerations2. Examining them3. Compare pro’s and con’s

Desired outcome: Tip the decisional balance

The hope: Increased self-efficacy

Confidence about performing a specific behavior

Payoff Matrix

Pros

Cons

Change No Change

Stage 3: Preparation“Yes, I want to change. But how?”

Preparation stage Transition stage Decision to change

is made Reduced

ambivalence Exploration of

options for change

                  

Treatment tasks for “preparation” stage

1. Making & strengthening a commitment adequate to support the attempt to change

2. Developing a plan for action that is sound, reasonable, and feasible

Action plan worksheet

1. The changes I want to make are:

2. How important is this goal (level of motivation)

3. The most important reasons to change are:

4. The steps I plan to take in changing are:

5. The ways other people can help me are:

6. I will know if my plan is working if:

7. Some things that could interfere with my plan:

8. How will you manage these barriers?

9. Level of confidence (self-efficacy)

Stage 4: Action

Breaking free from the ties that bind us to the problem behavior Physiological ties Psychological ties Social ties

Main tasks of “action stage”

1. “Breaking free” Utilizing behavioral change processes &

strategies of the plan

2. Commitment

3. Revising the plan as needed

4. Managing temptations & slips that can provoke relapse

Processes of change:Behavioral Reinforcement Counter-

conditioning Stimulus control Self-liberation Helping

relationships

Relapse

The role of relapse Relapse vs slips Trial & error learning Recycling

Regrouping before the next attempt to quit

Stage 5: Maintenance“Making change permanent”

Sustaining recovery involves developing new, strong, and healthy habits as well as repairing the damage done by the addiction.

The successful person…

1. Actively counters threats & temptations

2. Checks and renews commitment3. Makes sure decisional balance

remains negative for reengaging in the problem behavior

4. Establishes a protective environment and satisfying lifestyle

Best Practices

Exercise patience & adjust expectations Consistent routines & meeting structure Minimize distractions Learning strategies

Interactive teaching Break down information Check for understanding Summarize (you and client)

Measurable goals Step by step plans for change