See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/16334721 Stages and Processes of Self- Change of Smoking - Toward An Integrative Model of Change Article in Journal of Consulting and Clinical Psychology · July 1983 Impact Factor: 4.85 · DOI: 10.1037//0022-006X.51.3.390 · Source: PubMed CITATIONS READS 4,676 12,520 2 authors, including: Carlo Diclemente University of Maryland, Baltim… 212 PUBLICATIONS 27,919 CITATIONS SEE PROFILE Available from: Carlo Diclemente Retrieved on: 30 May 2016 Journal of Consulting and Clinical Psychology Copyright 1983 by the 1983, Vol. 51, No. 3, 390-395 American Psychological Association, Inc. Stages and Processes of Self-Change of Smoking: Toward An Integrative Model of Change James Q Prochaska Carlo C. DiClemente University of Rhode Island Texas Research Institute of Mental Sciences An integrative model of change was applied to the study of 872 subjects changing their smoking habits on their own. The subjects represented the following five stages of change: precontemplation, contemplation, action, maintenance, and relapse. Ten processes of change were expected to receive differential emphases during particular stages of change. Results indicate that self-changers: (a) use the fewest processes of change during precontemplation; (b) emphasize consciousness raising during the contemplation stage; (c) emphasize self-reevaluation in both contemplation and action stages; (d) emphasize self-liberation, a helping rela- tionship, and reinforcement management during the action stage; and (e) use counterconditioning and stimulus control the most in both action and mainte- nance stages. Relapsers were found to respond like a combination of contempla- ters and people in action. Results are discussed in terms of developing a model of self-change of smoking and enhancing a more integrative general model of change. Formalized treatment programs for smok- including history of previous attempts to quit ing fail with a majority of smokers (Hunt, smoking. DiClemente and Prochaska (1982) Barnett, & Branch, 1971). Nevertheless, 30 found that self-changers did differ from ther- million Americans quit smoking in the past apy changers in terms of the processes of decade, with 70% to 80% quitting on their change that were emphasized in recent at- own (Adult Use of Tobacco, 1975). Further- tempts to quit smoking. More importantly, more, 70% of smokers surveyed indicated both self-changers and therapy changers re- that if they were to quit, they would not at- ported retrospectively that they had used af- tend a formal treatment program (McAlister, fective and cognitive processes more during 1975). In spite of the preponderance of and early stages of change and emphasized be- preference for self-change approaches, re- havioral processes during later stages. search on smoking cessation has focused pri- Perri, Richards, and Schulteis (1977) com- marily on formalized treatments. The pres- pleted retrospective interviews with 24 suc- ent study reports on the change processes that cessful and 24 unsuccessful college students were emphasized by 872 self-changers rep- who had made attempts to quit smoking on resenting five different stages of quitting their own. The successful self-changers re- smoking. ported using self-reinforcement procedures In one of the few studies on self-change, significantly more than the relapsers. Al- self-changers did not differ from individuals though encouraging, this study was limited in formalized treatments on smoking habits, by focusing on just two stages and four pro- locus of control, and measures of the Jackson cesses of change. Baer, Foreyt, and Wright Personality Inventory (Pederson & Lefcoe, (1977) analyzed letters describing the quitting 1976). DiClemente and Prochaska (1982) experiences of 51 self-changers who had also found that self-changers did not differ maintained nonsmoking for at least 2 years. from subjects in two types of therapy pro- While most of the self changers used multiple grams in terms of smoking history variables, techniques, the investigators were not able to discover any systematic clustering of their quitting methods. This work was supported by Grant CA 27821 from Research to date on self-change ap- the National Cancer Institute. Requests for reprints should be sent to James O. Pro- proaches to smoking cessation has been lim- chaska, Department of Psychology, University of Rhode ited by inadequate models of change and ret- Island, Kingston, Rhode Island 02881. rospective methodologies. The present re- 390 SELF-CHANGE OF SMOKING 391 search applied the transtheoretical model were assigned to one of the following five groups, de- that has been developed both from the ther- pending on the stage of change they currently were in: Long-term quitters (LTQs). These 247 subjects rep- apy literature (Prochaska, 1979; Prochaska resented the maintenance stage, since they had main- & DiClemente, 1982) and from data on self- tained their nonsmoking for at least 6 months. The mean changers (DiClemente and Prochaska, 1982; duration of maintenance was 5.9 years. The mean age Prochaska, DiClemente, Velicer, & Zwick, was 44 years, and there were 133 females and 114 males. They had begun smoking^at a mean age of 17.2 years. Note 1). The present research applied the Recent quitters (RQs). These 134 subjects represented model in a cross-sectional design to study the action stage, since they had quit smoking on their self-changers who were in one of the following own within 6 months of entering the study. The mean five stages of change: precontemplation, con- duration of time since they had quit was 2.2 months. templation, action, maintenance, and re- The mean age of these subjects was 35 years, and there were 80 females and 54 males. They had begun smoking lapse. at a mean age of 16.6 years. The transtheoretical model involves 10 Contemplators (Cs). These 187 subjects represented processes of change receiving differential ap- the contemplation stage, since they were smoking reg- plication during the five stages of change ularly for the past year but reported that they were se- riously thinking about quitting smoking in the next year. (Prochaska & DiClemente, 1982). The 10 The mean age of these subjects was 40 years, and there processes of change are as follows: conscious- were 113 females and 74 males, They had begun smoking ness raising, self-liberation, social liberation, at a mean age of 17.4 years. self-reevaluation, environmental reevalua- Immotives (I's). These 108 smokers represented the tion, counterconditioning, stimulus control, precontemplation stage, since they reported that they had no intention of quitting smoking in the next year. reinforcement management, dramatic relief, The mean age of this group was 38 years, and there were and helping relationships. 74 females and 34 males. Their mean age of beginning Based on the transtheoretical model (Pro- smoking was 16.3 years. chaska & DiClemente, 1982) and previous Relapsers (RLs). An exploratory group of 196 relap- sers was included to investigate how individuals u s e par- research (DiClemente & Prochaska, 1982), ticular change processes after having failed within the the following p r e d i c t i o n s were made. Because past year in their attempt to quit smoking. The mean precontemplators tend to be defensive and age of this group was 36 years, and there were 129 fe- avoid changing their thinking and behavior, males and 67 males. Their mean age of beginning smok- they would use the change processes signifi- ing was 17.3 years. Basic demographic data on the subjects indicated that cantly less than subjects in other stages. Be- they were middle-age and middle-class adults who began cause contemplators are seriously thinking smoking as teenagers (M = 17 years). The mean age was about changing their smoking behavior, they 40 and the median 37 years. Of the total sample 62% would use consciousness raising the most to were married, 27% single, 16.5% divorced, and 5.8% sep- arated or widowed. O f the total sample, 19.3% completed gather further information about their smok- high school or less, 41.7% had attended some college ing. Because self-reevaluation appears to be classes, 17.8% had bachelor degrees, and 19.3% had some a process that bridges contemplation and ac- postgraduate education or a graduate degree. Approxi- tion, self-reevaluation would be used most in mately one half of the subjects had incomes of less than the contemplation and action stages. Because $15,000, and 8% had incomes of more than $30,000. subjects in the action stage are most com- mitted to making behavioral changes, they Measures would use self-liberation, counter-condition- The processes of change test. This test is a 40-item ing, stimulus control, and reinforcement questionnaire that measures 10 processes of change in management the most. No clear predictions a statistically well-defined and highly reliable manner had emerged from previous research on (Prochaska et al., Note 1).' Table 1 presents a sample which processes would be emphasized during item and the alpha coefficient for each process. There the maintenance and relapse stages. are four items representing each of the 10 processes. Subjects were asked to rate on a 5-point Likert scale how frequently they employed each item in the past month Method (1 = not at all; 5 = repeatedly). Smoking-status measures. Saliva samples were taken Subjects from each subject to increase validity of self-reports via the bogus pipeline phenomenon (Jones & Sigall, 1971). There were 872 subjects from Rhode Island and Hous- ton, Texas who volunteered to participate in the study in response to newspaper articles and ads. All subjects ' Copies of the test are available from the authors. 392 JAMES O. PROCHASKA AND CARLO C. DiCLEMENTE Table 1 Sample Items and Alpha Coefficients for the 10 Processes of Change Processes Alpha Sample item Consciousness raising .88 I look for information related to smoking.