Stages of Change

1. Stages of Change Steve Carlson, Psy.D. Spectrum Community Mental Health

2. “Change is the manifestation of our ability to grow and become” Anne Wilson Schaef

3. 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

4. Why change? “Hard work pays off in the future; laziness pays off now”Steven Wright

5. Two types of change • Forced • Intentional

6. With life there is pain • Physical • Emotional • Psychological • Existential Pain can motivate us towards change

7. Or we can cope with pain by… • Avoid it • Resist it • Anesthetize it • Minimize or deny it • Blame others

8. Intentional change is hard work! • Too much change causes stress • Too much stability is boring Stability Change

9. 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!

10. 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?

11. Spirit of Motivational Interviewing • Collaboration • Evocation • Autonomy “It is the truth we ourselves speak rather than the treatment we receive that heals us” O. Hobart Mowrer (1966)

12. “What people really need is a good listening to”

13. Create a rich environment through listening • Undivided attention • Body language • Eye contact • Genuine interest • Set aside assumptions • Silence & presence

14. 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

15. 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

16. 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 Stages of change and treatment tasks

17. 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

18. Stuck in precontemplation • Five R’s • Reveling • Reluctance • Rebellion • Resignation • Rationalizing

19. Treatment task for “precontemplators” • Increase concern and hope for change

20. “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”

21. 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

22. Creating an atmosphere for change “Contemplating change in an atmosphere of fear, hopelessness, or exhaustion is a self-defeating exercise”

23. 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

24. Processes of change: Cognitive/experiential • Consciousness raising • Emotional arousal • Self-reevaluation • Environmental reevaluation • Social liberation “Surveying the landscape of my life”

25. Treatment task for “contemplators” • The goal: A firm decision to change • The tasks: • Gathering decisional considerations • Examining them • Compare pro’s and con’s • Desired outcome: Tip the decisional balance • The hope: Increased self-efficacy • Confidence about performing a specific behavior

26. Payoff Matrix Change No Change Pros Cons

27. 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

28. Treatment tasks for “preparation” stage • Making & strengthening a commitment adequate to support the attempt to change • Developing a plan for action that is sound, reasonable, and feasible

29. The changes I want to make are: How important is this goal (level of motivation) The most important reasons to change are: The steps I plan to take in changing are: The ways other people can help me are: I will know if my plan is working if: Some things that could interfere with my plan: How will you manage these barriers? Level of confidence (self-efficacy) Action plan worksheet

30. Stage 4: Action • Breaking free from the ties that bind us to the problem behavior • Physiological ties • Psychological ties • Social ties

31. Main tasks of “action stage” • “Breaking free” • Utilizing behavioral change processes & strategies of the plan • Commitment • Revising the plan as needed • Managing temptations & slips that can provoke relapse

32. Processes of change:Behavioral • Reinforcement • Counter- conditioning • Stimulus control • Self-liberation • Helping relationships

33. Relapse • The role of relapse • Relapse vs slips • Trial & error learning • Recycling • Regrouping before the next attempt to quit

34. 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.

35. The successful person… • Actively counters threats & temptations • Checks and renews commitment • Makes sure decisional balance remains negative for reengaging in the problem behavior • Establishes a protective environment and satisfying lifestyle

36. 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