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ong the criticisms of the model are the following:

• Little experimental evidence exists to suggest that application of
  the model is actually associated with changes in health-related
  behaviors.
  
  • In a systematic review, published in 2003, of 23 randomized controlled trials,
    the authors determined that "stage based interventions are no more
    effective than non-stage based interventions or no intervention in
    changing smoking behaviour."^[43]
  • A second systematic review from 2003 asserted that "no strong
    conclusions" can be drawn about the effectiveness of interventions based
    on the transtheoretical model for the prevention of pregnancy and sexually transmitted diseases.^[44]
  • A 2005 systematic review of 37 randomized controlled trials claimed
    that "there was limited evidence for the effectiveness of stage-based
    interventions as a basis for behavior change."^[45]
    Additional research suggests that the effectiveness of interventions
    can be increased if they are tailored on all core constructs of the TTM
    in addition to stage of change.^[46]
  • According to a randomized controlled trial published in 2006, a
    stage-matched intervention for smoking cessation in pregnancy was more
    effective than a non-stage-matched intervention, but this finding could
    have resulted from the "greater intensity" of the stage-matched
    intervention.^[47]
  • A randomized controlled trial published in 2009 found "no evidence"
    that a smoking cessation intervention based on the transtheoretical
    model was more effective than a control intervention that was not
    tailored for stage of change.^[48]
  • A 2009 review stated that "existing data are insufficient for
    drawing conclusions on the benefits of the transtheoretical model" as
    related to dietary interventions for people with diabetes.^[49]
  • A 2010 systematic review of smoking cessation studies under the auspices of the Cochrane Collaboration
    found that "stage-based self-help interventions (expert systems and/or
    tailored materials) and individual counselling were neither more nor
    less effective than their non-stage-based equivalents."^[50]
  • A 2011 Cochrane Systematic Review found that there is little
    evidence to suggest that using the Transtheoretical Model Stages of
    Change (TTM SOC) method is effective in helping obese and overweight
    people lose weight.^[51]
• In a 2009 paper, the TTM model was considered to be useful but not
  more than the 4 domains of physical activity in order to promote this
  type of behaviors. ^[52]
• "Arbitrary dividing lines" are drawn between the stages.^[53]
  A continuous version of the model (Noel, 1999) has been proposed, where
  each process is first increasingly used, and then decreases in
  importance, as smokers make progress along some latent dimension. In
  this alternative view, the very notion of stage is no more necessary ^[54]
• The model makes predictions that are "incorrect or worse than competing theories."^[53]
• The model "assumes that individuals typically make coherent and stable plans," when in fact they do not.^[53]
• The algorithms and questionnaires that researchers have used to
  assign people to stages of change have not been standardized, compared
  empirically, or validated.^[55][56]
• The designs of many studies supporting the model have been cross-sectional, but longitudinal study data would allow for stronger causal inferences.^[55]
• In a 2002 review, the model's stages were characterized as "not
  mutually exclusive"; furthermore, there was "scant evidence of
  sequential movement through discrete stages."^[57]
  While research suggests that movement through the stages of change is
  not always linear, a study conducted in 1996 demonstrated that the
  probability of forward stage movement is greater than the probability of
  backward stage movement.^[58]

See also

• Change management
• Decision cycle

Notes

The following notes summarize major differences between the well-known 1983,^[59] 1992,^[60] and 1997^[13]
versions of the model. Other published versions may contain other
differences. For example, Prochaska, Prochaska, and Levesque (2001)^[18] do not mention the Termination stage, Self-efficacy, or Temptation.

1. In the 1983 version of the model, the Preparation stage is absent.
2. In the 1983 version
   of the model, the Termination stage is absent. In the 1992 version of
   the model, Prochaska et al. showed Termination as the end of their
   "Spiral Model of the Stages of Change," not as a separate stage.
3. In the 1983 version of the model, Relapse is considered one of the five stages of change.
4. In the 1983 version
   of the model, the processes of change were said to be emphasized in only
   the Contemplation, Action, and Maintenance stages.
5. In the 1983 version
   of the model, "decisional balance" is absent. In the 1992 version of the
   model, Prochaska et al. mention "decisional balance" but in only one
   sentence under the "key transtheoretical concept" of "processes of
   change."
6. In the 1983 version
   of the model, "self-efficacy" is absent. In the 1992 version of the
   model, Prochaska et al. mention "self-efficacy" but in only one sentence
   under the "key transtheoretical concept" of "stages of change."

Prochaska, J. O., & Norcross, J. C. (2002). Stages of change. In
J. C. Norcross (Ed.), Psychotherapy relationships that work (303-313).
New York: Oxford University Press.

References

1. Prochaska, JO; Butterworth, S; Redding, CA; Burden, V; Perrin, N; Leo, M; Flaherty-Robb, M; Prochaska, JM. Initial efficacy of MI, TTM tailoring and HRI's with multiple behaviors for employee health promotion. Prev Med 2008 Mar;46(3):226–31. Accessed 2009 Mar 21.
2. Greene, GW; Rossi, SR; Rossi, JS; Velicer, WF; Fava, JL; Prochaska, JO. Dietary applications of the stages of change model. J Am Diet Assoc 1999 Jun;99(6):673–8. Accessed 2009 Mar 21.
3. Pro-Change Behavior Systems. About us. Transtheoretical model. 2008 Mar. Accessed 2009 Mar 21.
4. Prochaska,
   JO; Norcross, JC; DiClemente, CC. Changing for good: the revolutionary
   program that explains the six stages of change and teaches you how to
   free yourself from bad habits. New York: W. Morrow; 1994. ISBN 0-688-11263-3.
5. Goleman, Daniel. New addiction approach gets results. New York Times 1993 Sep 1. Accessed 2009 Mar 19.
6. Miller, Kay.
   Revolving resolutions - Year after new year, we vow to lose weight, stop
   smoking, find love or a better job -- only to fail. A few simple
   strategies could set us straight. Star Tribune: Newspaper of the Twin
   Cities 2001 Dec 29.
7. Stettner, Morey. A methodical way to change bad behavior. Investor's Business Daily 2005 Dec 19.
8. Understanding change: expect a few bumps. Washington Post 2007 Jan 2. Accessed 2009 Mar 19.
9. Carbine, Michael E. Health plans use a variety of strategies to identify and ensure compliance among diabetics. AIS's Health Business Daily 2009 Mar 6. Accessed 2009 Mar 19.
10. Armitage, CJ. Is there utility in the transtheoretical model? Br J Health Psychol 2009;14(Pt 2):195–210. Epub 2008 Oct 14. Accessed 2009 Mar 17.
11. Prochaska,
    JO.; DiClemente, CC. The transtheoretical approach. In: Norcross, JC;
    Goldfried, MR. (eds.) Handbook of psychotherapy integration. 2nd ed. New
    York: Oxford University Press; 2005. p. 147–171. ISBN 0-19-516579-9.
12. Prochaska, JO. & Norcross, JC Systems of psychotherapy: a transtheoretical analysis. 7th edition Brooks & Cole, CA 2010.
13. Prochaska, JO; Velicer, WF. The transtheoretical model of health behavior change. Am J Health Promot 1997 Sep–Oct;12(1):38–48. Accessed 2009 Mar 18.
14. Prochaska, JO;
    Velicer, WF. The transtheoretical model of health behavior change. Am J
    Health Promot 1997 Sep–Oct;12(1):38–48. Accessed 2009 Mar 18.
15. West R. Time for a
    change: putting the Transtheoretical (Stages of Change) Model to rest.
    Addiction. 2005 Aug;100(8):1036–9 Accessed 2012 Oct 31.
16. Prochaska, JO; Velicer, WF; Rossi, JS; Goldstein, MG; Marcus, BH; et al. Stages of change and decisional balance for 12 problem behaviors. Health Psychol 1994 Jan;13(1):39–46. Accessed 2009 Mar 18.
17. Prochaska, JO;
    Velicer, WF; DiClemente, CC; Fava, J. Measuring processes of change:
    applications to the cessation of smoking. J Consult Clin Psychol 1988
    Aug;56(4):520–8. PMID 3198809.
18. Prochaska, JM; Prochaska, JO; Levesque, DA. A transtheoretical approach to changing organizations. Adm Policy Ment Health 2001 Mar;28(4):247–61. Accessed 2009 Mar 20.
19. McConnaughy, EA;
    Prochaska, JO; Velicer, WF. Stages of change in psychotherapy -
    measurement and sample profiles. Psychotherapy: Theory, Research and
    Practice 1983;20(3):368–375.
20. DiClemente, CC; Prochaska, JO; Gibertini, M. Self-efficacy and the stages of self-change of smoking. Cognit Ther Res 1985;9(2):181–200. Accessed 2009 Mar 22.
21. Velicer, WF; DiClemente, CC; Prochaska, JO; Brandenburg, N. Decisional balance measure for assessing and predicting smoking status. J Pers Soc Psychol 1985 May;48(5):1279–89. Accessed 2009 Mar 18.
22. Velicer, WF;
    Prochaska, JO; Rossi, JS; Snow, MG. Assessing outcome in smoking
    cessation studies. Psychol Bull 1992 Jan;111(1):23–41. PMID 1539088.
23. Prochaska, JO; DiClemente, CC; Velicer, WF; Rossi, JS. Standardized, individualized, interactive, and personalized self-help programs for smoking cessation. Health Psychol 1993 Sep;12(5):399–405. Accessed 2009 Mar 18.
24. Prochaska,
    JO; Redding, CA; Evers, KE. The Transtheoretical Model and Stages of
    Change. In: Glanz, K; Rimer, BK; Viswanath, K. (eds.) Health Behavior
    and Health Education. 4th ed. San Francisco: Jossey-Bass; 2008. p. 105. ISBN 978-0-7879-9614-7.
25. Janis,
    I.L. & Mann, L. (1977) Decision making: a psychological analysis of
    conflict, choice and commitment. New York: Free Press. ISBN 0-02-916160-6
26. Hall,
    K.L. & Rossi, J. S. (2008) Meta-analysis Examination of the sting
    and weak principals across 48 behaviors. Preventative Medicine, 46,
    266-274.
27. Bandura, A. (1977) Self-efficacy: Toward a unified theory of behavior change. Psychological Review, 84, 191-215
28. Evers, K. E.,
    Prochaska, J. O., Johnson, J. L., Mauriello, L. M., Padula, J. A., &
    Prochaska, J. M. (2006). A randomized clinical trial of a population-
    and transtheoretical model-based stress-management intervention. Health
    Psychol., 25, 521-529.
29. Jordan,
    P.J., Evers, K.E., Spira, J.L., King, L.A., & Lid, V. (2013).
    Computerized, tailored interventions improve outcomes and reduce
    barriers to care. Poster presented at the 17th Annual International
    meeting and Exposition of the American Telemedicine Association in
    Austin, TX, May 5–7, 2013.
30. Johnson, S. S.,
    Driskell, M. M., Johnson, J. L., Prochaska, J. M., Zwick, W., &
    Prochaska, J. O. (2006b). Efficacy of a transtheoretical model-based
    expert system for antihypertensive adherence. Disease Management, 9,
    291-301.
31. Johnson, S. S.,
    Driskell, M. M., Johnson, J. L., Dyment, S. J., Prochaska, J. O.,
    Prochaska, J. M. et al. (2006a). Transtheoretical model intervention for
    adherence to lipid-lowering drugs. Disease Management, 9, 102-114.
32. Levesque, D. A., Van
    Marter, D. F., Schneider, R. J., Bauer, M. R., Goldberg, D. N.,
    Prochaska, J. O., & Prochaska, J.M. (in press). Randomized trial of a
    computer-tailored intervention for patients with depression. American
    Journal of Health Promotion.
33. Johnson, S. S.,
    Paiva, A. L., Cummins, C. O., Johnson, J. L., Dyment, S. J., Wright, J.
    A., Prochaska, J. O., Prochaska, J. M., & Sherman, K. (2008).
    Transtheoretical model-based multiple behavior intervention for weight
    management: Effectiveness on a population basis. Preventive Medicine,
    46, 238-246.
34. Prochaska, J. O.,
    DiClemente, C. C., Velicer, W. F., & Rossi, J. S. (1993).
    Standardized, individualized, interactive, and personalized self-help
    programs for smoking cessation. Health Psychology, 12, 399-405.
35. Prochaska,
    J. O., Velicer, W. F., Fava, J. L., Ruggiero, L., Laforge, R. G.,
    Rossi, J. S. et al. (2001a). Counselor and stimulus control enhancements
    of a stage-matched expert system intervention for smokers in a managed
    care setting. Preventive Medicine, 32, 23-32.
36. Prochaska,
    J. O., Velicer, W. F., Fava, J. L., Rossi, J. S., & Tsoh, J. Y.
    (2001b). Evaluating a population-based recruitment approach and a
    stage-based expert system intervention for smoking cessation. Addictive
    Behaviors, 26, 583-602.
37. Velicer, W.F., Fava,
    J.L., Prochaska, J.0., Abrams, D.B., Emmons, K.M., & Pierce, J.
    (1995) Distribution of smokers by stage in three representative samples.
    Preventive Medicine, 24, 401-411.
38. Velicer, W. F.,
    Redding, C. A., Sun, X., & Prochaska, J. O. (2007). Demographic
    variables, smoking variables, and outcome across five studies. Health
    Psychology, 26, 278-287.
39. DiClemente, CC; Prochaska, JO; Gibertini, M. Self-efficacy and the stages of self-change of smoking. Cognit Ther Res 1985;9(2):181–200. Accessed 2009 Mar 22.
40. Velicer, WF; DiClemente, CC; Prochaska, JO; Brandenburg, N. Decisional balance measure for assessing and predicting smoking status. J Pers Soc Psychol 1985 May;48(5):1279–89. Accessed 2009 Mar 18.
41. Velicer, WF;
    Prochaska, JO; Rossi, JS; Snow, MG. Assessing outcome in smoking
    cessation studies. Psychol Bull 1992 Jan;111(1):23–41. PMID 1539088.
42. Prochaska, JO; DiClemente, CC; Velicer, WF; Rossi, JS. Standardized, individualized, interactive, and personalized self-help programs for smoking cessation. Health Psychol 1993 Sep;12(5):399–405. Accessed 2009 Mar 18.
43. Riemsma, RP; Pattenden, J; Bridle, C; Sowden, AJ; Mather, L; Watt, IS; Walker, A. Systematic review of the effectiveness of stage based interventions to promote smoking cessation. BMJ 2003 May 31;326(7400):1175–7. Accessed 2009 Mar 18.
44. Horowitz, SM. Applying the transtheoretical model to pregnancy and STD prevention: a review of the literature. Am J Health Promot 2003 May–Jun;17(5):304–28. Accessed 2009 Mar 18.
45. Bridle, C; Riemsma, RP; Pattenden, J; Sowden, AJ; Mather, L; Watt, IS; Walker, A. Systematic review of the effectiveness of health behavior interventions based on the transtheoretical model. Psychol Health 2005;20:283–301. Accessed 2009 Mar 18.
46. Prochaska JO. Moving beyond the transtheoretical model. Addiction 2006 Jun;101(6):768-74
47. Aveyard, P; Lawrence, T; Cheng, KK; Griffin, C; Croghan, E; Johnson, C. A
    randomized controlled trial of smoking cessation for pregnant women to
    test the effect of a transtheoretical model-based intervention on
    movement in stage and interaction with baseline stage. Br J Health Psychol 2006 May;11(Pt 2):263–78. Accessed 2009 Mar 18.
48. Aveyard, P; Massey, L; Parsons, A; Manaseki, S; Griffin, C. The effect of transtheoretical model based interventions on smoking cessation. Soc Sci Med 2009 Feb;68(3):397–403. Accessed 2009 Mar 18.
49. Salmela, S; Poskiparta, M; Kasila, K; Vähäsarja, K; Vanhala, M. Transtheoretical model-based dietary interventions in primary care: a review of the evidence in diabetes. Health Educ Res 2009 Apr;24(2):237–52. Accessed 2009 Mar 19.
50. Cahill, K; Lancaster, T; Green, N. Stage-based interventions for smoking cessation. Cochrane Database Syst Rev. 2010 Nov 10;11:CD004492. PMID 21069681. Accessed 2011 Feb 15.
51. Tuah, N; Amiel, C; Qureshi, S; Car, J; Kaur, B; Majeed, A. Transtheoretical model for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev. 2011 Oct 5;10:CD008066.pub2. PMID 21975777. Accessed 2011 Dec 7.
52. Sallis, J. Physical Activity and Food Environments: Solutions to the Obesity Epidemic. Milbank Q. 2009 Mar; 87(1): 123–154. Accessed 2010 Mar 30.
53. West, R. Time for a change: putting the Transtheoretical (Stages of Change) Model to rest. Addiction 2005 Aug;100(8):1036–9. Accessed 2009 Mar 19.
54. Noel, Y. Recovering unimodal latent patterns of change by unfolding analysis: Application to smoking cessation Psychological Methods, 1999, Vol 4(2), 173-191.
55. Sutton, S. Back to the drawing board? A review of applications of the transtheoretical model to substance use. Addiction 2001 Jan;96(1):175–86. Accessed 2009 Mar 19.
56. Adams, J; White, M. Why don't stage-based activity promotion interventions work? Health Educ Res 2005 Apr;20(2):237–43. Accessed 2009 Mar 22.
57. Littell, JH; Girvin, H. Stages of change. A critique. Behav Modif 2002 Apr;26(2):223–73. Accessed 2009 Mar 19.
58. Martin, R., Velicer,
    WF, Fava, JL. Latent transition analysis to the stages of change for
    smoking cessation. Addictive Behaviors 1996, 21(1):67-80
59. Prochaska, JO; DiClemente, CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 1983 Jun;51(3):390–5. Accessed 2009 Mar 18.
60. Prochaska, JO; DiClemente, CC; Norcross, JC. In search of how people change. Applications to addictive behaviors. Am Psychol 1992 Sep;47(9):1102–14. Accessed 2009 Mar 16.

Further reading

• Patterson, D. A. & Nochajski, T.H. (2010) Using the Stages of
  change model to help clients through the 12-steps of Alcoholics
  Anonymous. Journal of Social Work Practice in the Addictions, 10(2),
  224-227.
• Patterson, D. A., & Buckingham, S. L. (2010) Does motivational
  interviewing stages of change increase treatment retention among persons
  who are alcohol and other drug dependant and HIV-infected? Journal of
  HIV/AIDS and Social Services, 9(1), 45-57.
• Prochaska, J.O., Wright, J. A., & Velicer, W.F. (2008).
  Evaluating Theories of Health Behavior Change: A hierarchy of Criteria
  Applied to the Transtheoretical Model. Applied Psychology, 57(4),
  561-588. doi:10.1111/j.1464-0597.2008.00345.x
• Prochaska, JO; DiClemente, CC. The transtheoretical approach:
  crossing traditional boundaries of therapy. Homewood, IL: Dow
  Jones-Irwin; 1984. ISBN 0-87094-438-X.
• Miller, WR; Heather, N. (eds.). Treating addictive behaviors. 2nd ed. New York: Plenum Press; 1998. ISBN 0-306-45852-7.
• Connors, GJ; Donovan, DM; DiClemente, CC. Substance abuse treatment
  and the stages of change: selecting and planning interventions. New
  York: Guilford Press; 2001. ISBN 1-57230-657-2.
• Velasquez, MM. Group treatment for substance abuse: a stages-of-change therapy manual. New York: Guilford Press; 2001. ISBN 1-57230-625-4.
• Burbank, PM; Riebe, D. Promoting exercise and behavior change in
  older adults: interventions with the transtheoretical model. New York:
  Springer; 2002. ISBN 0-8261-1502-0.
• DiClemente, CC. Addiction and change: how addictions develop and addicted people recover. New York: Guilford Press; 2003. ISBN 1-57230-057-4.
• Prochaska, JO; Norcross, JC. Systems of psychotherapy: a
  transtheoretical analysis. 6th ed. Australia: Thomson/Brooks/Cole; 2007.
  ISBN 978-0-495-00777-7.
• Glanz, K; Rimer, BK; Viswanath, K. (eds.) Health behavior and health
  education: theory, research, and practice, 4th ed. San Francisco, CA:
  Jossey-Bass; 2008. ISBN 978-0-7879-9614-7.

External links

Wikimedia Commons has media related to Transtheoretical model.

Wikiversity has learning materials about Public health

• Cancer Prevention Research Center, University of Rhode Island. Summary overview of the transtheoretical model.
• HABITS [Health and Addictive Behaviors: Investigating Transtheoretical Solutions] Lab, Psychology Department, University of Maryland Baltimore County. The transtheoretical model of behavior change.
• Lenio, James A. Analysis of the transtheoretical model of behavior change. University of Wisconsin–Stout, Journal of Student Research, Fifth Edition, 2006.
• Pro-Change Behavior Systems, Inc.
  Company founded by James O. Prochaska. Mission is to enhance the
  well-being of individuals and organizations through the scientific
  development and dissemination of Transtheoretical Model-based change
  management programs.
• Zimmerman, GL; Olsen, CG; Bosworth, MF. A 'stages of change' approach to helping patients change behavior. Am Fam Physician 2000 Mar 1;61(5):1409–16.

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Health and wellness education in schools

ong the criticisms of the model are the following:

• Little experimental evidence exists to suggest that application of the model is actually associated with changes in health-related behaviors.
  • In a systematic review, published in 2003, of 23 randomized controlled trials, the authors determined that "stage based interventions are no more effective than non-stage based interventions or no intervention in changing smoking behaviour."^[43]
  • A second systematic review from 2003 asserted that "no strong conclusions" can be drawn about the effectiveness of interventions based on the transtheoretical model for the prevention of pregnancy and sexually transmitted diseases.^[44]
  • A 2005 systematic review of 37 randomized controlled trials claimed that "there was limited evidence for the effectiveness of stage-based interventions as a basis for behavior change."^[45] Additional research suggests that the effectiveness of interventions can be increased if they are tailored on all core constructs of the TTM in addition to stage of change.^[46]
  • According to a randomized controlled trial published in 2006, a stage-matched intervention for smoking cessation in pregnancy was more effective than a non-stage-matched intervention, but this finding could have resulted from the "greater intensity" of the stage-matched intervention.^[47]
  • A randomized controlled trial published in 2009 found "no evidence" that a smoking cessation intervention based on the transtheoretical model was more effective than a control intervention that was not tailored for stage of change.^[48]
  • A 2009 review stated that "existing data are insufficient for drawing conclusions on the benefits of the transtheoretical model" as related to dietary interventions for people with diabetes.^[49]
  • A 2010 systematic review of smoking cessation studies under the auspices of the Cochrane Collaboration found that "stage-based self-help interventions (expert systems and/or tailored materials) and individual counselling were neither more nor less effective than their non-stage-based equivalents."^[50]
  • A 2011 Cochrane Systematic Review found that there is little evidence to suggest that using the Transtheoretical Model Stages of Change (TTM SOC) method is effective in helping obese and overweight people lose weight.^[51]
• In a 2009 paper, the TTM model was considered to be useful but not more than the 4 domains of physical activity in order to promote this type of behaviors. ^[52]
• "Arbitrary dividing lines" are drawn between the stages.^[53] A continuous version of the model (Noel, 1999) has been proposed, where each process is first increasingly used, and then decreases in importance, as smokers make progress along some latent dimension. In this alternative view, the very notion of stage is no more necessary ^[54]
• The model makes predictions that are "incorrect or worse than competing theories."^[53]
• The model "assumes that individuals typically make coherent and stable plans," when in fact they do not.^[53]
• The algorithms and questionnaires that researchers have used to assign people to stages of change have not been standardized, compared empirically, or validated.^[55][56]
• The designs of many studies supporting the model have been cross-sectional, but longitudinal study data would allow for stronger causal inferences.^[55]
• In a 2002 review, the model's stages were characterized as "not mutually exclusive"; furthermore, there was "scant evidence of sequential movement through discrete stages."^[57] While research suggests that movement through the stages of change is not always linear, a study conducted in 1996 demonstrated that the probability of forward stage movement is greater than the probability of backward stage movement.^[58]

See also

• Change management
• Decision cycle

Notes

The following notes summarize major differences between the well-known 1983,^[59] 1992,^[60] and 1997^[13] versions of the model. Other published versions may contain other differences. For example, Prochaska, Prochaska, and Levesque (2001)^[18] do not mention the Termination stage, Self-efficacy, or Temptation.

1. In the 1983 version of the model, the Preparation stage is absent.
2. In the 1983 version of the model, the Termination stage is absent. In the 1992 version of the model, Prochaska et al. showed Termination as the end of their "Spiral Model of the Stages of Change," not as a separate stage.
3. In the 1983 version of the model, Relapse is considered one of the five stages of change.
4. In the 1983 version of the model, the processes of change were said to be emphasized in only the Contemplation, Action, and Maintenance stages.
5. In the 1983 version of the model, "decisional balance" is absent. In the 1992 version of the model, Prochaska et al. mention "decisional balance" but in only one sentence under the "key transtheoretical concept" of "processes of change."
6. In the 1983 version of the model, "self-efficacy" is absent. In the 1992 version of the model, Prochaska et al. mention "self-efficacy" but in only one sentence under the "key transtheoretical concept" of "stages of change."

Prochaska, J. O., & Norcross, J. C. (2002). Stages of change. In J. C. Norcross (Ed.), Psychotherapy relationships that work (303-313). New York: Oxford University Press.

References

1. Prochaska, JO; Butterworth, S; Redding, CA; Burden, V; Perrin, N; Leo, M; Flaherty-Robb, M; Prochaska, JM. Initial efficacy of MI, TTM tailoring and HRI's with multiple behaviors for employee health promotion. Prev Med 2008 Mar;46(3):226–31. Accessed 2009 Mar 21.
2. Greene, GW; Rossi, SR; Rossi, JS; Velicer, WF; Fava, JL; Prochaska, JO. Dietary applications of the stages of change model. J Am Diet Assoc 1999 Jun;99(6):673–8. Accessed 2009 Mar 21.
3. Pro-Change Behavior Systems. About us. Transtheoretical model. 2008 Mar. Accessed 2009 Mar 21.
4. Prochaska, JO; Norcross, JC; DiClemente, CC. Changing for good: the revolutionary program that explains the six stages of change and teaches you how to free yourself from bad habits. New York: W. Morrow; 1994. ISBN 0-688-11263-3.
5. Goleman, Daniel. New addiction approach gets results. New York Times 1993 Sep 1. Accessed 2009 Mar 19.
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Further reading

• Patterson, D. A. & Nochajski, T.H. (2010) Using the Stages of change model to help clients through the 12-steps of Alcoholics Anonymous. Journal of Social Work Practice in the Addictions, 10(2), 224-227.
• Patterson, D. A., & Buckingham, S. L. (2010) Does motivational interviewing stages of change increase treatment retention among persons who are alcohol and other drug dependant and HIV-infected? Journal of HIV/AIDS and Social Services, 9(1), 45-57.
• Prochaska, J.O., Wright, J. A., & Velicer, W.F. (2008). Evaluating Theories of Health Behavior Change: A hierarchy of Criteria Applied to the Transtheoretical Model. Applied Psychology, 57(4), 561-588. doi:10.1111/j.1464-0597.2008.00345.x
• Prochaska, JO; DiClemente, CC. The transtheoretical approach: crossing traditional boundaries of therapy. Homewood, IL: Dow Jones-Irwin; 1984. ISBN 0-87094-438-X.
• Miller, WR; Heather, N. (eds.). Treating addictive behaviors. 2nd ed. New York: Plenum Press; 1998. ISBN 0-306-45852-7.
• Connors, GJ; Donovan, DM; DiClemente, CC. Substance abuse treatment and the stages of change: selecting and planning interventions. New York: Guilford Press; 2001. ISBN 1-57230-657-2.
• Velasquez, MM. Group treatment for substance abuse: a stages-of-change therapy manual. New York: Guilford Press; 2001. ISBN 1-57230-625-4.
• Burbank, PM; Riebe, D. Promoting exercise and behavior change in older adults: interventions with the transtheoretical model. New York: Springer; 2002. ISBN 0-8261-1502-0.
• DiClemente, CC. Addiction and change: how addictions develop and addicted people recover. New York: Guilford Press; 2003. ISBN 1-57230-057-4.
• Prochaska, JO; Norcross, JC. Systems of psychotherapy: a transtheoretical analysis. 6th ed. Australia: Thomson/Brooks/Cole; 2007. ISBN 978-0-495-00777-7.
• Glanz, K; Rimer, BK; Viswanath, K. (eds.) Health behavior and health education: theory, research, and practice, 4th ed. San Francisco, CA: Jossey-Bass; 2008. ISBN 978-0-7879-9614-7.

External links

Wikimedia Commons has media related to Transtheoretical model.

Wikiversity has learning materials about Public health

• Cancer Prevention Research Center, University of Rhode Island. Summary overview of the transtheoretical model.
• HABITS [Health and Addictive Behaviors: Investigating Transtheoretical Solutions] Lab, Psychology Department, University of Maryland Baltimore County. The transtheoretical model of behavior change.
• Lenio, James A. Analysis of the transtheoretical model of behavior change. University of Wisconsin–Stout, Journal of Student Research, Fifth Edition, 2006.
• Pro-Change Behavior Systems, Inc. Company founded by James O. Prochaska. Mission is to enhance the well-being of individuals and organizations through the scientific development and dissemination of Transtheoretical Model-based change management programs.
• Zimmerman, GL; Olsen, CG; Bosworth, MF. A 'stages of change' approach to helping patients change behavior. Am Fam Physician 2000 Mar 1;61(5):1409–16.

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