revising of, 132–133, 150–151, 172–173, 247–248
threats to, 130, 172–173
self-liberation, 29
self-praise, 31
self-reevaluation, 26, 29
in contemplation, 55, 129–136
decision making in, 133–136, 134, 137–141, 139, 140, 149
freedom and, 285–286
goals of, 33
negative and positive appraisal combined in, 131, 133–136, 134
in preparation, 146, 147, 149–151
questions appropriate in, 129–130, 131–132
self-assessment of, 136
techniques of, 33, 131–136, 150–151
thinking process in, 131–132
serenity prayer, 154
sex, 24, 37, 40, 141
safe, 67, 286
Shakespeare, William, 130
Siegel, Bernie, 113
Skinner, B. F., 17, 26, 90, 282
sleep, 40, 76, 81
Smokenders, 175
smoking, 14, 15, 77, 105, 242–251
adolescent, 16, 242
cutting down on, 43, 66, 147
functional analysis of, 124–125, 124
government warnings vs. industry advertising on, 41, 101–102, 242
health problems and death associated with, 29, 41, 42, 51, 62, 65, 66, 78–79, 83, 84, 85, 86–88, 113, 116, 117, 133, 152, 153, 202, 242–246, 244
information about, 41, 88, 152, 153, 244–245
medical costs and, 51
statistics on, 36, 83, 86, 242
studies on, 64–66, 85, 86–88, 153, 207–208
typical reasons for, 30, 132, 247
smoking cessation:
action and, 67, 87–88, 249–250
changers’ manual for, 242–251
cold turkey, 43, 48
commercial aids to, 157, 158
contemplation and, 246–248
doctor’s counseling on, 62, 88
emotional arousal and, 28–29, 117
external pressure for, 80, 88, 113–114
groups and programs for, 32–34, 36, 42, 45, 51, 86–88, 113–114, 152, 175
importance of stages in, 64–66, 65, 87
maintenance and, 202, 205, 206, 250–251
oral cravings and, 46, 158
precontemplation and, 243–246
preparation and, 248–249
prior attempts at, 47, 48, 57, 113–114, 175, 208
resistance to, 41, 42, 47, 83, 87, 113–114
self-change, 36, 51, 52, 86–88, 157, 206
techniques of, 116, 117, 157, 206
weight gain and, 57
social liberation, 26, 28, 56
goals of, 33, 100, 103–104
motivation and, 103–104, 105
outside influences and, 104–105
in precontemplation, 82, 100–106, 108, 246
self-assessment and, 105–106
techniques of, 33, 100–102, 103–105
social mores, 31, 37, 74, 80, 81
social workers, 236–238
stages of change, 15–16, 17, 27, 37–50, 63, 73–219
awareness and readiness in, 59, 64–69, 75, 109
bogging down in, 42–43, 75, 109–112, 147
knowledge and assessment of, 15, 16, 39, 55, 60, 64–69, 77, 243
linear vs. spiral progress in, 47–50, 64–66, 226
matching processes of change with, 15–17, 27, 37–39, 41, 50, 52–60, 54, 56, 61–62, 223, 224
progress in, 100, 101, 115, 120, 162–171
relationship of pros and cons to, 162–171, 163
self-assessment of, 243
setbacks in, 47–50, 172, 221
transition between, 45, 47, 55, 68, 79, 81, 108, 115, 133, 166, 274
see also action; contemplation; maintenance; precontemplation; preparation; termination
stress reduction, 80, 83, 124–126, 128, 148, 205, 249
sublimation, 93
substance abuse, 17, 31, 36, 57–58, 85, 101–102
see also specific substance abuses
sun, overexposure to, 16, 67
support groups, 32–34, 101, 102, 147, 157, 198, 249
Systems of Psychotherapy (Prochaska), 25
Tale of Two Cities, A (Dickens), 208
temptations, 46, 192
avoidance of, 44, 45, 68, 150, 160, 177, 187–188
early stages of change and, 161–162
maintenance and, 202–205, 206–209
termination and, 277–278
termination, 15, 39, 43, 46, 66, 274–280
criteria for, 276–279
healthier lifestyle in, 279–280
maintenance vs., 46, 276–279
self-efficacy in, 278–279
self-image in, 276–277
zero temptation in, 277–278
tobacco industry, 102, 104, 132, 133, 244, 246
unconscious, 126–127
Velicer, Wayne, 162
Waiting for Godot (Beckett), 110
weight control, 14, 15, 17, 66, 105, 275–276
basal metabolism and, 27
calorie counting and, 43, 121, 122, 123, 138–139, 200
consciousness-raising and, 89, 91–92, 138–139
eating habits and, 58, 61, 121, 160
emotional arousal and, 117–118
exercise and, 121, 140, 141, 159–160, 199–201
fasting and, 138, 139
health benefits of, 140, 141, 199
helping relationships and, 160, 198
nutrition and, 121, 199–200
programs for, 46, 52, 137, 224
pros and cons of, 137–141, 139, 140
relapse and, 45–46, 73, 75, 76, 137
rewards and, 193
self-image and, 130, 137, 138, 140
sexuality and, 151, 201
smoking and, 57
social attitudes and, 80, 138
see also diets
weight tables, 67
willpower, 175
emphasis on, 60, 61, 76, 223–224
misuse of, 225
strengthening of, 152–153
testing of, 45, 209
wishful thinking, 112–114, 119, 130, 138, 147, 156, 234
Wolpe, Joseph, 26
women’s rights groups, 28
Acknowledgments
OUR COLLECTIVE fifty years of clinical and research experience behind Changing for Good have indebted us to our funding sources, students, clients, and colleagues. We gratefully acknowledge the financial support over the years of the National Institutes of Health, the University of Rhode Island, the University of Scranton, the University of Texas Medical School, and the University of Houston. We appreciate our students, too numerous to thank individually here, for their persistent inquisitiveness and research contributions. We cherish the courage and sharing of our research participants and psychotherapy clients, who have proven to be the ultimate teachers of self-change.
The development of the transtheoretical approach has been a collaborative effort involving many dedicated individuals who have made invaluable contributions. These include Drs. Wayne Velicer, Joseph Rossi, David Abrams, Ellie McConnaughy, Diane Grimley, Unto Pallonen, Joseph Fava, Colleen Redding, Michael Goldstein, William Rakowski, Raymond Niaura, Bess Marcus, Geoff Greene, Robert Laforge, Laurie Ruggiero, Susan Rossi, Karen Emmons, Gabrielle Reed, and many more. Others making special contributions include Elaine Taylor, Gabrielle Riley, Guy Natelli, and the entire staff of the Cancer Prevention Research Consortium. Collaborating investigators in Houston included Drs. Jack Gordon, Joseph Carbonari, Michael Gibertini, Nancy Brandenburg, Sheryl Hughes, Chris Lovato, Michael Eriksen, Patricia Mullen, and Mary Velasquez.
Maria Guarnaschelli, our editor, committed her creativity and vitality to help transform our vision into a reality. We treasure her mission of reducing the distance between professionals and the public. The assistance of the William Morrow staff was particularly appreciated by the thre
e of us—all novices in the process of publishing a book for the public.
Our families are the foundation for creative inspiration and personal support. Each of our spouses, Jan Prochaska, ACSW, Nancy Caldwell-Norcross, ACSW, and Lynn Dahlquist, Ph.D., are dedicated professionals, parents, and partners. Experiencing unconditional caring is a hallmark of successful self-change, and our spouses are remarkably good models of such consummate care. We dedicate Changing for Good to our children, who have changed our lives in so many good ways.
About the Authors
JAMES O. PROCHASKA, Ph.D., is a professor of psychology and director of the Cancer Prevention Research Center at the University of Rhode Island. JOHN C. NORCROSS, Ph.D., is professor and former chair of psychology at the University of Scranton. CARLO C. DICLEMENTE, Ph.D., is professor and chair of the department of psychology at the University of Maryland, Baltimore County. Their model for self-change has atttracted attention worldwide and has been applied in programs sponsored by such organizations as the National Cancer Institute and the National Institute of Drug Abuse.
Visit www.AuthorTracker.com for exclusive information on your favorite HarperCollins author.
Copyright
Writing contributions from Mark Beitman and Brian Crawleey.
CHANGING FOR GOOD. Copyright © 1994 by James O. Prochaska, John C. Norcross, and Carlo C. DiClemente. All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the non-exclusive, non-transferable right to access and read the text of this e-book on-screen. No part of this text may be reproduced, transmitted, down-loaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins e-books.
The Library of Congress has catalogued the hardcover edition as follows:
Prochaska, James O.
Changing for good / James O. Prochaska, John C. Norcross, Carlo C. DiClemente.
p. cm.
1. Behavior modification. 2. Change (Psychology). I. DiClemente, Carlo C. II. Norcross, John C., 1957. III. Title.
BF637.B4P65 1994 93-44897
158’.1—dc20 CIP
EPub Edition © March 2010 ISBN: 978-0-06-201038-4
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* Each theory of psychotherapy has its own sphere of excellence. Psychoanalysis, for example, is the preferred approach for raising awareness of both conscious and unconscious motivations, or consciousness-raising. Behaviorism, on the other hand, is demonstrably the most effective approach for modifying discrete problem behaviors.
As you can see, each system is especially useful at one or two stages of change. The transtheoretical model, which builds on the respective strengths of these systems, integrates the best of each into a coherent whole.
† These techniques are included here for the informed reader, although they are not explored in the text.
† These techniques are included here for the informed reader, although they are not explored in the text.
† These techniques are included here for the informed reader, although they are not explored in the text.
† These techniques are included here for the informed reader, although they are not explored in the text.
† These techniques are included here for the informed reader, although they are not explored in the text.
* These are primarily professional techniques used by psychotherapists. Throughout Part II you will learn the most creative and effective techniques that self-changers use to apply each process.
* These are primarily professional techniques used by psychotherapists. Throughout Part II you will learn the most creative and effective techniques that self-changers use to apply each process.
* These are primarily professional techniques used by psychotherapists. Throughout Part II you will learn the most creative and effective techniques that self-changers use to apply each process.
* These are primarily professional techniques used by psychotherapists. Throughout Part II you will learn the most creative and effective techniques that self-changers use to apply each process.
* These are primarily professional techniques used by psychotherapists. Throughout Part II you will learn the most creative and effective techniques that self-changers use to apply each process.
* These are primarily professional techniques used by psychotherapists. Throughout Part II you will learn the most creative and effective techniques that self-changers use to apply each process.
* These are primarily professional techniques used by psychotherapists. Throughout Part II you will learn the most creative and effective techniques that self-changers use to apply each process.
* These are primarily professional techniques used by psychotherapists. Throughout Part II you will learn the most creative and effective techniques that self-changers use to apply each process.
* These are primarily professional techniques used by psychotherapists. Throughout Part II you will learn the most creative and effective techniques that self-changers use to apply each process.
* Adapted from the Defense Mechanism Inventory (Gleser & Ihilevich, 1969).
* The notion of decisional balance is discussed at length in the book Decision Making, by Irving Janis and Leon Mann (New York: Free Press, 1977).
* Mechanic, 1962.
* A T point is a certain statistical unit of measure; you need not understand the unit it represents to understand these principles of progress.