Table Of ContentUsing the Stages of Change to
Overcome the Top Threats
to Your Health and Happiness
CCCHHHAAANNNGGGIIINNNGGG TTTOOO
TTTHHHRRR IIIVVVEEE
JAMES O. PROCHASKA, PhD
CO-AUTHOR OF CHANGING FOR GOOD and
THE GROUNDBREAKING STAGES OF CHANGE MODEL
JANICE M. PROCHASKA, PhD
CO-FOUNDER OF PRO-CHANGE BEHAVIOR SYSTEMS, INC.
C T
HANGING TO HRIVE
Using the Stages of Change to Overcome
the Top Threats to Your Health and Happiness
JAMES O. PROCHASKA, PHD, AND
JANICE M. PROCHASKA, PHD
Hazelden Publishing
Center City, Minnesota 55012
hazelden.org/bookstore
© 2016 by James Prochaska and Janice Prochaska
All rights reserved. Published 2016.
Printed in the United States of America
No part of this publication, either print or electronic, may be reproduced in any
form or by any means without the express written permission of the publisher.
Failure to comply with these terms may expose you to legal action and damages
for copyright infringement.
ISBN: 978-1-61649-629-6
Library of Congress Cataloging-in-Publication Data
is on file with the Library of Congress.
Editor’s note
The names, details, and circumstances may have been changed to protect the
privacy of those mentioned in this publication.
This publication is not intended as a substitute for the advice of health care
professionals.
Readers should be aware that websites listed in this work may have changed
or disappeared between when this work was written and when it is read.
Alcoholics Anonymous and AA are registered trademarks of Alcoholics
Anonymous World Services, Inc.
20 19 18 17 16 1 2 3 4 5 6
Cover and interior design: Terri Kinne
Developmental editor: Sid Farrar
Contributing editor: Cynthia Orange
Production editor: Heather Silsbee
To our grandchildren, who have helped us
to thrive in so many ways.
Xavier, Bailey, Zakary, Lila, and Andrew
CONTENTS
Introduction ........................................................................ ix
The Top High-Risk Behaviors xi
Well-Being and Happiness xiii
Chapter Summaries xvi
Chapter 1: Precontemplation (Not Ready) ................................. 1
The Three Ds of Precontemplation: Don’t Know How,
Demoralized, Defensive 2
Transforming Defending into Coping 10
Moving from Precontemplation to Contemplation
(Getting Ready) 12
Chapter 2: Moving Forward ................................................. 15
From Contemplation to Preparation (Ready) 17
From Preparation to Action 19
Chapter 3: From Maintenance to Termination ........................... 23
Maintenance: A Long Time or a Lifetime? 23
Relapse or Recycling: The Spiral of Change 25
Termination 29
Chapter 4: The Principles of Progress, Part I ............................. 33
Precontemplation, Motivation, and Change 33
Staging Yourself for Healthy Stress Management 34
Making Decisions: To Change or Not to Change? 35
The First Principle of Progress: Increase Your Pros to Move
from Precontemplation to Contemplation 38
The Second Principle of Progress: Increase Your Consciousness
to Increase Your Behavior Change IQ 41
The Third Principle of Progress: Use Dramatic Relief to Move
from Precontemplation 45
The Fourth Principle of Progress: Decrease Your Cons to Move
from Contemplation 48
The Fifth Principle of Progress: Use Environmental Reevaluation
to Move from Contemplation to Preparation 50
v
CONTENTS
The Sixth Principle of Progress: Use Self-Reevaluation to Move
from Preparation to Action 54
The Seventh Principle of Progress: Make a Commitment to a Better
Life through Self-Liberation to Move to Action 57
Chapter 5: The Principles of Progress, Part II ............................ 65
The Eighth Principle of Progress: Counter Conditioning to
Use Substitutes for Unhealthy Habits to Move from
Action to Maintenance 65
ABCDs for Preventing Stress and Distress: Cognitive Counters 66
The Ninth Principle of Progress: Reinforce Your Progress by
Using Rewards to Move from Action to Maintenance 69
The Tenth Principle of Progress: Foster Helping Relationships
and Find Someone You Can Count On for Support to Move
from Action to Maintenance 73
The Eleventh Principle of Progress: Increase Personal Freedom
through Social Liberation by Noticing Social Trends to Move
to Maintenance 75
The Twelfth Principle of Progress: Practice Stimulus Control to
Manage Your Environment to Make Healthy Habits Automatic
and Move to Maintenance and Beyond 79
Chapter 6: Integrating the Stages with the Principles of Progress
and the Processes of Change ................................................. 83
Seeing How It All Fits Together 83
From Precontemplation to Termination—from Unhealthy
Stimulus Control to Healthy Stimulus Control 85
Four Effects That Predict Long-Term Success 90
Chapter 7: The Breath of Life ................................................ 93
Precontemplation: Raising Your Awareness 95
Contemplation Stage: Decreasing Key Cons to Progress
to Preparation 103
Preparation: Using Self-Reevaluation to Prepare to Quit 106
Taking Action: Counter Conditioning—Substituting Healthy
Alternatives to Counter Smoking 112
Maintenance: Staying Free from Smoking 126
Toward Termination: Being Free from Smoking 131
vi
CONTENTS
Chapter 8: Well-Being and Alcohol Problems .......................... 133
David’s Story 134
Assess Your Alcohol Use to Determine Your Current
Stage of Change 135
Increasing Your Pros to Change Your Drinking Habits
and Move from Precontemplation to Contemplation 140
In Contemplation, Lower the Cons for Changing
Your Drinking Habits 146
Progressing to Preparation 148
Make a Commitment to Move from Preparation to Action 150
Go to Action by Using Counter Conditioning to Substitute
Your Drinking Habits with Healthy Habits 151
Developing New Habits to Move toward Maintenance 152
Chapter 9: Healthy Eating for Well-Being and Weight ................ 161
Predicting Success 164
Harry’s Story 164
Increasing Consciousness: What Is New That Can Help You
Win with Weight? 167
Assess Your Eating Habits to Determine Your Current
Stage of Change 168
How to Progress from Precontemplation to Contemplation:
The Pros of Healthy Eating 169
Use Dramatic Relief to Pay Attention to Your Feelings 176
Reduce the Cons to Reduce Weight 176
Use Environmental Reevaluation to Notice Your Effects on Others 178
Use Self-Reevaluation to Create a New Self and Body Image and
Move to Preparation 179
Use Self-Liberation to Make a Commitment to Increase Your
Willpower 181
Choosing Your Best Weight-Loss and Healthy Eating Option(s) 182
In Preparation, Share Your Commitments with Others 183
Use Counter Conditioning to Change Your Unhealthy Eating Habits
in Action 183
A Family That Cares 195
Progressing from Action to Maintenance 198
vii
CONTENTS
Chapter 10: The Impact of Exercise ...................................... 203
Increase Your Pros to Move from Precontemplation 204
Progressing in Contemplation: Use Environmental Reevaluation
to Notice Your Effects on Others 215
Progressing to Preparation 217
Moving in Maintenance: Use Stimulus Control to Manage
Your Environment 223
Chapter 11: Using Less Energy to Change Multiple Behaviors ....... 225
Changing a New Behavior: Sleeping Better by Breathing,
Drinking, Eating, Moving, and Feeling Better 227
Using Coaction to Change Multiple Habits 230
Chapter 12: Reducing Multiple High-Risk Behaviors ................. 235
Improving Your Physical Well-Being 235
Improving Your Emotional Well-Being 237
Improving Your Social Well-Being by Sharing Your Changes 243
Improving Your Purposeful Well-Being 246
Improving Your Financial Well-Being 249
Epilogue: A Life of Well-Being ........................................ 253
Acknowledgments ...................................................... 263
Notes ..................................................................... 265
About the Authors ...................................................... 271
viii
Introduction
More than thirty-five years ago, Carlo DiClemente and I (James
Prochaska) developed the Transtheoretical Model of Behavior Change,
more commonly called “TTM” or “Stages of Change,” to describe how,
for most people, behavior change occurs gradually as they move (some-
times cycling back and forth) through a process of identifiable stages.
Imagine a deep canyon carved by a wild river. Now think of one side
of the canyon as “need for change” and the other side as “change.” To
get from one side to the other, we need to build a bridge. That’s where
the Stages of Change and this book, Changing to Thrive, come in.
The six Stages of Change, which will be discussed more thoroughly
throughout the book, are
1. Precontemplation—
not ready; not intending to take action in the next six months
2. Contemplation—
getting ready; intending to take action in the next six months
3. Preparation—
ready; ready to take action in the next thirty days
4. Action—
have made the behavior change but for less than six months
5. Maintenance—
doing the new healthy behavior for more than six months
6. Termination—
confident with the change; not tempted to relapse
This model revolutionized the addiction, mental health, and wellness
fields because professionals who embraced the concept now under -
stood how to approach the great majority of people who wouldn’t
ix
