1 Transtheoretical Model: Readiness to Change in Psychiatric Patients with Substance Abuse The transtheoretical (TTM) model is a change model developed by Prochaska and DiClemente to guide behavioral changes in individuals. Behavioral change is a process that takes time through which an individual goes through stages of change (Prochaska & Velicer, 1997). Therefore, the theory can be applied as a change model among psychiatric patients with substance abuse because they are expected to undergo behavioral lifestyle changes that can influence their lives (Callaghan, Taylor, & Cunningham, 2007). In this paper, the description of the model will be discussed based on its purpose, origin, major concepts, propositions, assumptions and the context of use. In addition, this paper will explain how the theory can be utilized in influencing change in psychiatric patients with substance abuse. Description of the Transtheoretical Model Purpose of the Model The change model was developed to help influence positive behavioral changes in individuals who are willing to undergo change. It assesses the willingness of a person to adopt a healthier behavior and provides a guide to the processes or stages that the person is expected to undergo. Therefore, the main purpose of the transtheoretical model is to guide the change process of an individual. This model focuses on the decision-making of an individual other than the influences of the behavior (Dugdale, Elison, Davies, Ward, & Dalton, 2016). By utilizing the model, individuals are able to know the expected changes they are to undergo. This is provided through the description of the expected stages of change. The change has to be intended by the individual as the model only provides a guide to change. Resultantly, the theory is widely used in encouraging behavioral changes in patients who are willing to go through a change (Callaghan et al., 2007).
2 Scope or Level of the Theory The transtheoretical model is a middle range theory. This means that the theory is based on specific aspects of human behavior, making it a sociological theory (Prochaska & Velicer, 1997). A middle range theory focuses on explaining a social phenomenon in a population through the exploitation of their causes. Unlike the grand theory or other types of theories, they are more descriptive, explanatory or predictive (Dugdale et al., 2016). Just like other middle range theories, the transtheoretical model is applicable to most sociological research. They are useful in coming up with interventions or answers to specific problems, topics and situations. Middle range theories also do not focus on a specific topic rather; they tend to focus on specific human behavior. For instance, the transtheoretical model does not focus on a single behavior change like smoking (Nidecker, DiClemente, Bennett, & Bellack, 2008). Instead, it is applicable to a wide range of behaviors. Origin of the Model Prochaska and DiClemente developed the theory in the 1970’s. The theory was coined after studying behaviors of people who were quitting smoking. Smokers who were quitting on their own were examined and their experiences documented. The studies also tried to establish why some people were able to quit independently while others required medication (Prochaska & Velicer, 1997). Through these studies, it was established that individuals could change their behaviors independently if they are willing to change. Hence, the theory was developed as a model of purposeful change (Dugdale et al., 2016). Major Concepts of Transtheoretical Model The model provides a description of how people can undergo behavioral change and adopt new positive habits. The model identifies that behavioral change is a process that takes
3 place continuously over different stages or cycles (Prochaska & Velicer, 1997). Therefore, it is structured as steps or stages of intentional change. The trantheoretical model theorizes that a person goes through six stages of change: “precontemplation, contemplation, preparation, action, maintenance, and termination”. Each stage takes undetermined period; therefore, different intervention strategies could be utilized to help move a person to the next stage (Callaghan et al., 2007). However, the whole process is based on the individual decisions of a person. In the end, a person is able to adopt a new, desirable behavior. Major Theoretical Propositions The model proposes that behavioral change takes place in six different stages. These include precontemplation, contemplation, preparation, action, maintenance, and termination. For the change process to be initiated, the person has to realize the harm caused by a behavior and to intentionally decide on changing (Nidecker et al., 2008). Therefore, personal decision making on the pros and cons to change, as well as self-efficacy largely influences the change process. In addition, the model proposes ten cognitive, behavioral and evaluative processes of change that facilitate change as well help a person to maintain change. They include consciousness raising, dramatic relief, environmental reevaluation, self-reevaluation, social liberation, self-liberation, counter conditioning, helping relationships, reinforcement management, and stimulus control (Dugdale et al., 2016). Major Assumptions The major assumption of the model is that individuals make intelligible and logical decisions. However, the decisions made by an individual can be influenced by several factors including the social set up and the environment they are in. Furthermore, not all individuals can make rational decisions. Also, the model assumes that the context in which the change takes
4 place in is favorable for an individual. As a result, it overlooks the social and economic factors that could influence change. Context for Use The model is applied to various kinds of problematic behaviors in an effort to influence change. There is no specific behavior pointed out for its particular use. The model has been utilized in several behavioral problems, including smoking cessation, exercise, low-fat diet, alcohol abuse, weight control, use of sunscreens to prevent skin cancer, drug abuse, and stress management, among others (Dugdale et al., 2016). Readiness to Change in Psychiatric Patients with Substance Abuse Most psychiatric patients have co-occurring mental health or behavioral problems and substance use disorders. This results in negative outcomes on their health. Furthermore, substance use affects their use and response to psychiatric medications, making it an issue that has to be addressed among this group of patients. To achieve this, the transtheoretical change model can be utilized to help these patients quit substance use (De Biaze, Jungerman, Laranjeira, & Callaghan, 2009). The behavioral change model will provide guidelines for coming up with interventions, assessing patients and monitoring the change process. The transtheoretical model is particularly appropriate for addressing substance abuse in patients. First, the model is based on behavior change from a problematic behavior to more desirable behavior. Substance abuse is a behavioral problem that a person develops and has a negative impact on their health. Second, using the model provides a stepwise intervention stage that are useful in monitoring and influencing change. Also, most psychiatric patients who are on medication are in a position to understand the negative impact of substance use on their health (De Biaze et al., 2009). All these make the model a great choice for effecting change.
5 Furthermore, the model can be used to meet the specific needs and pace of a patient. It recognizes that habit and behavioral change is a process that takes time and effort to be realized. The model will require that the patients undergo an intentional change in their behavior. Therefore, the interventions that will be compulsory include creating awareness of the problem to the patient and encouraging behavioral transformation once the patients are aware of their behavior and the need to change ((Nidecker et al., 2008). The steps of the model, as well as the processes of change, will be employed in monitoring the patients and guiding change (Callaghan et al., 2007). Also, a conducive and supportive environment has to be provided to the patients. In nursing practice, the change model will be in a capacity to be utilized in evidencebased practice and patient centered care, thereby widening its application to other patients with different behavioral conditions. Through this, the quality of lives, as well as patient outcomes will be improved (Dugdale et al., 2016). Patients will also have the capacity to take part in their care through decision making and contributing to their plan of care. Furthermore, the setbacks to medication adherence, self-care and health complications related to substance abuse will be addressed. Utilizing the transtheoretical model is helpful in improving my nursing practice. To begin with, the theory requires that a care provider works in close contact with the patient to access and identify the stages of change. This gives an opportunity to advance how I relate and care for patients. Moreover, it provides an opportunity to create awareness and address the issue of substance abuse. Throughout the change process, I will be able to promote the health of psychiatric patients and be of benefit to their lives.
6 References Callaghan, R. C., Taylor, L., & Cunningham, J. A. (2007). Does progressive stage transition mean getting better? A test of the Transtheoretical Model in alcoholism recovery. Addiction, 102(10), 1588-1596. doi:10.1111/j.1360-0443.2007.01934.x De Biaze, V. F. A., Jungerman, F. S., Laranjeira, R., & Callaghan, R. (2009). The transtheoretical model and substance dependence: theoretical and practical aspects. Revista Brasileira De Psiquiatria, 31(4), 362-368. Dugdale, S., Elison, S., Davies, G., Ward, J., & Dalton, M. (2016). Using the transtheoretical model to explore the impact of peer mentoring on peer mentors' own recovery from substance misuse. Journal of Groups in Addiction & Recovery, 11(3), 166-181. doi:10.1080/1556035X.2016.1177769 Nidecker, M., DiClemente, C. C., Bennett, M. E., & Bellack, A. S. (2008). Application of the Transtheoretical Model of change: Psychometric properties of leading measures in patients with co-occurring drug abuse and severe mental illness. Addictive Behaviors, 33(8), 1021-1030. doi:10.1016/j.addbeh.2008.03.012 Prochaska, J. O., & Velicer, W. F. (1997). The transtheoritical model of health behavior change. American Journal of Health Promotion, 12(1), 38-48.