Trans-Theoretical Model: A Behaviour Alteration Therapy For Addiction

The Trans-Theoretical Model for Psychotherapy

Question:

Discuss about the Trans-Theoretical Model.

Trans-theoretical model is a form of behaviour alteration therapy, which helps individuals, alters a certain behaviour for the personal growth and overall improvement. Behaviour therapy is a part of psychotherapy, which deals with integrative therapy (Prochaska, 2013). In this technique integrates the complete personality of the patient and assessing the “affective, cognitive, behavioural and physiological systems within a person”. The case study provided is about a 35-year0old male who wants to change his habit of smoking a full packet of cigarette everyday for the past ten years. Ying is worried that might develop severe health issues and now wants to seek professional help to alter his behaviour pattern and treat his addiction (Miller & Heather, 2013). The paper will discuss the application of using the trans-theoretical model treatment in this case study and identify the components of motivational interviewing that can be used to assist with the therapy in altering the current behaviour.

The trans-theoretical model for approach for psychotherapy, is based on the concept that the patient is ready to make the required change for alter his or her behaviour and thus, either seeks professional help or takes the actions for initiative to make the change (Prochaska, 2013). The model comprises of different components, like “stages of change”, “processes of change”, “levels of change”, “self-efficacy” and “decisional balance”. The trans-theoretical model is also called the “Stages of Change Cycle”, as the patient or an individual is seen to undergo through a level of changes starting from realization of the behavioural problem to maintaining the process of behaviour change (Transtheoretical Model (or Stages of Change) - Health Behavior Change, 2018). A brief description of the components of trans-theoretical model is described below concerning the given case study.

Fig 1: Stages of Change Cycle

Source: www.health.gov.au

• Precontemplation: This stage of the cycle describes the phase where the individual or the patient has not yet had the realisation about his or her behaviour issue. The individual or patient thinks that regardless of the disadvantages of the behaviour, the cognition for the habit is more important (Prochaska, 2013). It can be contemplated that the patient Ying had already gone through this phase before seeking professional help.
• Contemplation: this stage of the change cycle describes the moment where the patient of individual realizes the ill effects of his or her behaviour, like the repercussions of alcohol or other drugs. The individual in this stage is at constant ambivalent state or dilemma regarding the behaviour and is analysing the options (Prochaska, 2013). Ying, in this case must have weighed his situation based on pros and cons of smoking before deciding that he wants to quit.
• Preparation: In this phase of the change cycle, the individuals have analysed the situation and decided to either take up the initiative by themself or seek professional help to undergo therapy for behaviour alteration (Prochaska, 2013). The case provided starts from this phase of the change cycle, where, the patient Ying has decided to seek help from a therapist and wants to change his smoking habits for the prevention of future health issues.
• Action: In this step, the individual takes necessary changes required to alter or modify the habit and decides to follow the advice provided by the therapist. Ying must follow the instructions from the therapist and start taking necessary changes, like initially cutting down his smoking from a packet to two or three sticks and then cut down to none within a given time (Transtheoretical Model (or Stages of Change) - Health Behavior Change, 2018).
• Maintenance: In this stage of the change cycle, the individual takes necessary measures to stop the urge to revert to the old habits. The patient or individual is able to successfully handle and stay away from temptations and employ coping mechanisms (DeAngelis, 2014). Ying should try to maintain the success of his progress and learn to control his temptations.
• Relapse: This stage of the change cycle describes the tendency of the individuals to given in to temptations of the old habits. This phase can occur in any stage of the cycle, for multiple times, which will make it difficult for the individual to overcome the habit or in this case nicotine addiction (DeAngelis, 2014). Relapse challenges the individual’s will power and occasionally demotivate them, which is a major setback. Relapse helps the individual realize personal strengths and weaknesses that they can improve and restart the change cycle by improving their behaviour (Lindson?Hawley, Thompson & Begh, 2015). Ying should be made aware that relapse in the change cycle is a very common thing and that he should not feel demotivated and start over, if he fails.

This form of trans-theoretical model for change is associated with motivational interviewing which helps the individual overcome doubt, resolve ambivalent feelings and most importantly help the patient make a life changing decision (Barkway, 2013).

Motivational interviewing or MI is a form of counselling technique that is used to helps individuals overcome ambivalent feelings and gather the confidence to take life changing decision or personal growth and benefit (Lundahl et al., 2013). People who seek professional help for behaviour alteration therapy often times find it difficult to retreat from alcohol and other drug addiction issues (Connors, DiClemente, Velasquez & Donovan, 2013). This form of therapy is based on patient-centric approach where the therapist provides the patient advices based on empathy, practicality and consideration with respect to the patient’s condition.

It is generally implemented to treat addiction issues, like in case of the given case study. Other situations where the therapy can be implemented are management of conditions harming physical health like diabetes, heart disease as well as asthma (Lakerveld et al., 2013). This a form of intervention to motivate the patient to maintain the better choice option for health. This approach has been proven to improve the condition of the patient and motivated them show less resistance and to the behaviour alteration therapy (Brand, Bray, MacNeill, Catley & Williams, 2013).

Components of Trans-Theoretical Model for Change

In Ying’s case, he can be motivated to reduce his smoking and maintain that behaviour in order to prevent future chronic diseases related to health. The therapist can advice Ying to take up healthier alternative to quit smoking. The therapist needs to make sure that Ying does not feel reluctant to share his personal details and thoughts about the care plan. This can be ensured by asking Ying open-ended questions and leave the patient room for their input (Stein-Parbury, 2013). Taking into consideration the choice of therapy or approach for the patient is very important in motivational interviewing. The therapist should make sure that Ying is given opportunity to make decisions for his own life. The therapist needs to suggest Ying with alternatives to quit his smoking to prevent relapse (Lindson?Hawley, Thompson & Begh, 2015). The therapist can also motivate Ying by providing a positive feedback, including and clarifying the care goals and actively helping him throughout the therapeutic journey.

The motivational therapy sessions can be improved if the therapist provides the conditions, which will motivate Ying to overcome his nicotine addiction. This can be ensured if the therapist expresses their empathic thoughts towards Ying and consider a more focussed patient-centric care (Neuner-Jehle, Schmid, & Grüninger, 2013). The therapist will have to overcome their own ambivalent thoughts about the patient’s condition and practise reflective listening skills. The therapist should leave Ying the room for putting his own thought and encourage discrepancy but avoid argumentation. The resistant attitude of the patient need to be handled professionally and controlled rationally without creating a difficult environment. The self-initiatives should be encouraged by the therapist when the patient shows signs of improvement. This will motivate them and work harder to achieve the set health outcome.

Resistance is common for behaviour therapy; in case of motivation, interviewing the patient may express resistance towards the therapy at later stages. The resistance can be of verbal or non-verbal forms of resisatnce, which the therapist will have t handle without getting into any argument with the patient (Harakas, 2013). The resistance from the patient can develop when the patient feels that the therapy is not achieving the desired outcome. It can also occur when the patient is feeling demotivated to progress with the next steps of the therapy. The therapist will have handle the situation considering the patient’s situation and provide motivation based on the current situation and make the patient understand his or her best interest of physical and mental health.

Conclusion:

Addiction for alcohol, cigarette or other such substances can affect the mental as well as physical health of an individual. This form of condition is effectively treated with behaviour modification techniques like motivational interviewing. The stages of the psychotherapeutic model can be assessed using the trans-theoretical model of change that the patient undergoes and decides to seek professional help or self-initiate the actions.

References:

Barkway, P. (2013). Psychology for health professionals. Elsevier Health Sciences. Retrieved from:https://books.google.co.in/books?hl=en&lr=&id=yuXQAgAAQBAJ&oi=fnd&pg=PP1&dq=Barkway,+P.+(2013).+Psychology+for+health+professionals.+Elsevier+Health+Sciences.&ots=Ttk4uFLZku&sig=Fkqf7e6tA82jg6jWvt0Lv4hO3q0#v=onepage&q=Barkway%2C%20P.%20(2013).%20Psychology%20for%20health%20professionals.%20Elsevier%20Health%20Sciences.&f=false

Brand, V. S., Bray, K. K., MacNeill, S., Catley, D., & Williams, K. (2013). Impact of single?session motivational interviewing on clinical outcomes following periodontal maintenance therapy. International journal of dental hygiene, 11(2), 134-141. https://doi.org/10.1111/idh.12012

Connors, G. J., DiClemente, C. C., Velasquez, M. M., & Donovan, D. M. (2013). Substance abuse treatment and the stages of change: Selecting and planning interventions. Guilford Press. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=spvR78osXbgC&oi=fnd&pg=PP1&dq=Connors,+G.+J.,+DiClemente,+C.+C.,+Velasquez,+M.+M.,+%26+Donovan,+D.+M.+(2013).+Substance+abuse+treatment+and+the+stages+of+change:+Selecting+and+planning+interventions.+Guilford+Press.&ots=BrnB3Gls_7&sig=xMAk4jWdZjkBiYXyYrl-7nc2nuM#v=onepage&q&f=false

DeAngelis, T. (2014). Thank you for not smoking. https://www.apa.org. Retrieved 18 April 2018, from https://www.apa.org/monitor/2014/03/cover-smoking.aspx

Harakas, P. (2013). Resistance, motivational interviewing, and executive coaching. Consulting Psychology Journal: Practice and Research, 65(2), 108. https://dx.doi.org/10.1037/a0033196

Lakerveld, J., Bot, S. D., Chinapaw, M. J., van Tulder, M. W., Kostense, P. J., Dekker, J. M., & Nijpels, G. (2013). Motivational interviewing and problem solving treatment to reduce type 2 diabetes and cardiovascular disease risk in real life: a randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity, 10(1), 47. https://doi.org/10.1186/1479-5868-10-47

Lindson?Hawley, N., Thompson, T. P., & Begh, R. (2015). Motivational interviewing for smoking cessation. The Cochrane Library. DOI: 10.1002/14651858.CD006936.pub3

Lundahl, B., Moleni, T., Burke, B. L., Butters, R., Tollefson, D., Butler, C., & Rollnick, S. (2013). Motivational interviewing in medical care settings: a systematic review and meta-analysis of randomized controlled trials. Patient education and counseling, 93(2), 157-168. https://doi.org/10.1016/j.pec.2013.07.012

Miller, W. R., & Heather, N. (Eds.). (2013). Treating addictive behaviors: Processes of change (Vol. 13). Springer Science & Business Media. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=5j2DBwAAQBAJ&oi=fnd&pg=PA3&dq=Treating+addictive+behaviors:+Processes+of+change+(Vol.+13).+Springer+Science+%26+Business+Media.&ots=cOMiiQp3PA&sig=Jy3bZ2MAaAp8xg_htKPqBVV1Fpo#v=onepage&q=Treating%20addictive%20behaviors%3A%20Processes%20of%20change%20(Vol.%2013).%20Springer%20Science%20%26%20Business%20Media.&f=false

Neuner-Jehle, S., Schmid, M., & Grüninger, U. (2013). The “Health Coaching” programme: a new patient-centred and visually supported approach for health behaviour change in primary care. BMC family practice, 14(1), 100. https://doi.org/10.1186/1471-2296-14-100

Prochaska, J. O. (2013). Transtheoretical model of behavior change. In Encyclopedia of behavioral medicine (pp. 1997-2000). Springer New York. . https://doi.org/10.1007/978-1-4419-1005-9_70

Stein-Parbury, J. (2013). Patient and person: Interpersonal skills in nursing. Elsevier Health Sciences.

Transtheoretical Model (or Stages of Change) - Health Behavior Change. (2018). prochange.com. Retrieved 18 April 2018, from https://www.prochange.com/transtheoretical-model-of-behavior-change