I was an academic primary care & preventive medicine physician who focused teaching and research efforts on behavior change. (Ironic, eh?) Since beginning this weight loss journey in September of 2009, I have often thought about how I progressed along these behavior changes. This involved consciously using a model (The Transtheoretical Model or TTM) that predicts how people successfully change and maintain voluntary behavior change over a wide variety of behaviors. Bear with me while I reflect on how I have used the TTM and continue to use it to help me stay on course with eating (and hopefully with physical activity.)
Many people are aware of the Stages of Change that come from the TTM:
- Precontemplation – little or no intention to change in the near future
- Contemplation – thinking about changing soon. Often ambivalent and can be stuck here for a while. The pros and cons of changing and not changing should be considered. Many of us who have lost and regained repeatedly become chronic contemplators, discouraged by our prior regains.
- Preparation – ready to start taking action, make a commitment, and might be taking baby steps such as cutting down on certain foods. People in this stage need to create a realistic plan. I jumped in here right after my cholecystectomy in 2009. I couldn’t eat anyway, so why not start the weight loss I had been putting off?
- Action – actively changed the behavior in last 6 months; implementing chosen strategies, revising as needed (I just did this the last 2 months when I cut sugar/starch/grains), and working hard to keep it going even in the face of difficulties
- Maintenance – YAY! Doing the new behavior as a part of our routine existence. Weight loss folks tend to think of maintenance as having reached goal. The TTM conceptualizes this as having been in action for at least 6 months. I suppose this is where I am. BUT, for those of us with weight issues, maintenance is forever. Trust me, after 539 days, it’s finally becoming a part of who I am.
- Relapse/recycling – not exactly a stage, but a normal part of change. We yo-yo’ers are familiar with this. The good thing is that most of the time we have learned something from our experiences and recycle back to a later stage of change. Rarely do we go back to precontemplation.
- Termination – moving out of cycle of stages. For behaviors that involve quitting a “bad” behavior such as substance abuse (smoking, for example), this means finally having conquered the behavior change, being no longer tempted, feeling confident to stay on course. I don’t see this as applicable to acquisition of a healthy behavior like eating or physical activity – unless you want to reframe it as something like quitting sugar intake, for example.
The Stages only identify where people are in relationship to readiness to change a behavior. More importantly is HOW we change and how we can move forward. Since I am in the action stage and moving toward maintenance (and it’s my blog 😉 ), I want to focus on some of the Processes of Change – the engines that drive movement through the stages.
There are 10 Processes, which are divided into experiential (thinking, feeling kind of activities) and behavioral processes. In action and maintenance, it is much more important to focus on the action-oriented behavioral processes – this makes sense as I am actively working to keep on my plan and incorporate my new eating changes into my life forever. So, here are things I should be doing now:
- Reinforcement management – Reward positive change. Manicures and pedicures have been on Mrs. Brightside’s recent list. I don’t do this much, although I am considering a small tattoo when I hit goal. OK, I dream about having my boobs tacked up…
- Helping relationships – One can never have enough support, especially from those closest to us. The blogging community has boomed with weight loss and fitness blogs and forums because we are in need of such support and this is an incredibly important process to stay in action. WW, OA and other groups can be instrumental for many folks.
- Counterconditioning – substituting positive behaviors and thoughts for the problem behavior. I drink a lot of warm tea at night in the cool season as a ritual to distract me. Blogging is probably another positive behavior that takes up time that I would have otherwise spent obsessing about food. You probably have your own examples.
- Stimulus control – I remember when even commercials were intolerable. Now, it’s “Get that food out of here!” I demand that ice cream NEVER be allowed in the house. All candy must be kept hidden. No food is allowed on the counters. At restaurants, I politely shove bread out of reach. (A friend of mine pours salt on food she doesn’t want to eat.) It is, however, getting easier to tolerate triggering and tempting foods as time goes on.
- Self-liberation – this process actually is important in preparation and in action. This means accepting responsibility for and committing (or maintaining the commitment) to the behavior change. For me this has meant viewing myself as a healthy eater for life; realizing that I can eat off plan if I choose and jump right back on; understanding that no one controls what goes in my mouth but me! Wow, that really is liberating.
There are other aspects that support one’s ability to change behavior and fit well with the TTM: motivation and confidence (also referred to as self-efficacy). I’ll discuss those in another post because they are so important both for getting started and for keeping going, and I need to keep my confidence high at this point with 50 pounds and the rest of my life to go!
Do any of these processes resonant with you? What stage are you in? What suggestions would you give others for moving forward?
(Those of you interested in a more detailed explanation with references can check out this link, which is from one of the developers of the TTM.)