Meditative Model: Understanding The Process Of Change

The process of change in the meditative model is a gradual progression through several stages, with relapses being an inevitable part of the journey. The first stage is precontemplation, where individuals are unaware of their problematic behaviour or deny its existence. This is followed by contemplation, where they acknowledge the issue but are uncertain about taking action. In the preparation stage, people commit to change and gather information, before moving to the action stage, where they actively work towards their goal. The final stage is maintenance, where they sustain their new behaviour and prevent relapse.

Precontemplation: Denial of a problem or lack of awareness of it

Precontemplation is the first stage of the Transtheoretical Model (TTM) of behaviour change, which is a widely used model that describes the stages of change that individuals go through as they work to modify their behaviour or attitudes. During this stage, individuals are often in denial about their problem and are not considering making a change. They may be unaware of the negative consequences of their actions or may not believe that change is possible. This stage is characterised by an individual's lack of awareness of the need to change or their resistance to change.

In the precontemplation stage, individuals are not aware that their behaviour is unhealthy or problematic. They may underestimate the benefits of changing their behaviour and focus on the potential drawbacks. They often present as resistant, unmotivated, and unwilling to change. They may also obsess about the negative aspects of change rather than recognising the potential gains. For example, an individual struggling with alcohol addiction may not be considering seeking help or making changes to their drinking habits because they are not aware of the negative consequences of their drinking or do not believe they have a problem that requires treatment.

People in the precontemplation stage often end up in therapy due to pressure from others in their lives. They may exhibit elements of change as long as this external pressure remains constant. However, if the pressure is removed, they will quickly return to their old habits. Consciousness-raising therapy and significant life changes may help individuals in this stage progress to the next stage of change.

During precontemplation, individuals have no intention of making a change in the next six months and often make comments like, "I don't see a problem with what I'm doing, so there's no reason to change anything." They may feel resigned to their current state or believe they have no control over their behaviour. It is important for individuals in this stage to start by asking themselves some reflective questions, such as whether they have tried to change their behaviour in the past and what would need to happen for them to consider their behaviour a problem.

Therapists play a crucial role in the precontemplation stage. They must adopt the role of a nurturing parent, showing empathy, using active listening, and working with the client's resistance rather than against it. It is essential to create a safe and supportive environment, gain the client's trust, and respect their autonomy. Motivational strategies, such as asking for permission to address the topic of changing substance use behaviours, can help establish rapport and build trust.

Contemplation: Acknowledging the problem but feeling ambivalent about change

The second stage of the meditative model is contemplation, where individuals acknowledge the problem but feel ambivalent about making a change. This stage is marked by an awareness and acknowledgment of the problematic behaviour, but the individual is uncertain if the problem is worth correcting. This internal conflict results in no commitment to taking the necessary steps towards change.

During this stage, people become more aware of the benefits of making a change, but the costs stand out even more. This creates a strong sense of ambivalence about changing. Because of this uncertainty, the contemplation stage can last months or even years. Many people never make it past this phase.

If you are contemplating a behaviour change, it is important to ask yourself some questions: Why do you want to change? Is there anything preventing you from changing? What are some things that could help you make this change?

People in the contemplation stage are more open to receiving information about their behaviours and finding solutions to correct them. They may make comments such as, "I know I have a problem, and I think I should do something about it." This stage is also known as chronic contemplation or behavioural procrastination.

The contemplation stage is a critical period where individuals weigh the pros and cons of making a change. They may feel resigned to their current state or believe they have no control over their behaviour. They may also be unsure about their readiness and ability to change. It is important to identify the barriers to change and promote new, positive outcome expectations.

The contemplation stage is a crucial step in the process of change, where individuals acknowledge the problem but struggle with ambivalence about taking action. It is a period of reflection and consideration, where people become more aware of the potential benefits of change but also focus on the costs and challenges. This stage can last for varying lengths of time, and it is important to address any feelings of ambivalence and promote a sense of readiness for change.

Preparation: Committing to change and gathering information

Preparation is the third stage in the process of change in the meditative model. This stage involves a commitment to change and gathering information.

During this stage, individuals acknowledge that their behaviour is problematic and make a commitment to correcting it. They recognise that the benefits of changing their behaviour outweigh the drawbacks. They may make comments such as, "I've got to do something about this — this is serious. Something has to change. What can I do?"

People begin gathering information from various sources, such as self-help books, counselling, and change-oriented programs, as they develop a plan of action. This information-gathering stage is crucial, as bypassing it can lead to insufficient planning and stumbling when challenges arise. Relapse is also more likely if this stage is skipped.

People at this stage may also take direct action towards their goal, such as consulting a therapist, joining a health club, or reading self-help books. They may also start making small changes in preparation for a larger life change. For example, switching to lower-fat foods if their goal is weight loss, or reducing the number of cigarettes smoked per day if their goal is to quit smoking.

To improve the chances of successfully making a lasting life change, individuals in the preparation stage can take the following steps:

• Gather as much information as possible about ways to change their behaviour.
• Prepare a list of motivating statements.
• Write down their goals.
• Find resources such as support groups, counsellors, or friends who can offer advice and encouragement.
• Reward their successes.
• Seek out social support.

Action: Taking steps towards change and seeking support

The fourth stage of the Transtheoretical Model (TTM) is the Action stage, where individuals take steps towards their goal. This stage is reached after the precontemplation, contemplation, and preparation stages.

During the Action stage, individuals have recently changed their behaviour and intend to keep moving forward with that behaviour change. They may exhibit this by modifying their problem behaviour or acquiring new healthy behaviours. For example, if an individual's goal is to quit smoking, they might switch brands or smoke less each day.

People in the Action stage are motivated to change their behaviour and are actively involved in taking steps to change their bad behaviour by using a variety of different techniques. They are making overt efforts to change their behaviour and are at great risk for relapse. They may use short-term rewards to sustain their motivation and analyse their behaviour change efforts in a way that enhances their self-confidence.

People in this stage are also open to receiving help and are likely to seek support from others. This is a very important element of the Action stage.

Maintenance: Sustaining new behaviours and preventing relapse

Maintenance is the fifth stage of the Transtheoretical Model (TTM) of behaviour change. During this stage, people have sustained their behaviour change for a while (more than six months) and intend to maintain the new behaviour going forward.

People in the maintenance stage work to prevent a relapse to earlier behaviours. They remind themselves of how much progress they have made and remain aware that what they are striving for is personally worthwhile and meaningful. They are patient with themselves and recognise that it takes time to let go of old behaviour patterns and practice new ones. They may have thoughts of returning to their old habits but resist the temptation and stay on track.

People in the maintenance stage are able to anticipate the situations in which a relapse could occur and prepare coping strategies in advance. They are skilled at identifying triggers that may result in a relapse and have constructed ways to deal with these situations.

A longitudinal study from the 1990 Surgeon General's Report showed that after 12 months of abstinence, 43% of people returned to their previous habits. However, it was not until the five-year mark of abstinence that the risk for relapse dropped to 7%. Individuals in this stage require support as they re-evaluate their reasons for change, acknowledge their success so far, consider the potential triggers for relapse, and create contingency plans to try and avoid relapse.

The TTM acknowledges that relapse is a common factor in behaviour change and should be discussed and normalised. Change behaviour will often take a spiral or recycling of stages rather than a linear progression. For example, smokers can take an average of three to four action attempts before achieving long-term maintenance. Relapse should not be viewed as a failure but as an opportunity to re-evaluate triggers, reassess motivation for change, and plan stronger contingency plans.

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