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# The stages of change (transtheoretical model)

- Theory

Changing a habit happens in stages; each stage needs different help, and relapse is part of the path.

Updated Nov 5, 2026

## Key points

- Precontemplation: no intention to change in the next 6 months.
- Contemplation: intends to change in the next 6 months; marked ambivalence.
- Preparation: plans to change in the next 30 days and has taken some step.
- Action: changed less than 6 months ago; maintenance: more than 6 months.
- Relapse is expected and is not failure: the person returns to an earlier stage and recycles.
- Match the intervention to the stage: inform and motivate early; plan, reinforce and prevent relapse later.

## What it is

Prochaska and DiClemente's transtheoretical model grew out of studies of smokers who quit on their own or with help. It holds that change is a process, not an event, with five stages: precontemplation, contemplation, preparation, action and maintenance. People can enter at any stage, slip back and go round the cycle again, which is why it is drawn as a circle or spiral. Knowing the stage lets you choose the intervention and set realistic goals.

## Key facts

- Decisional balance: in early stages the cons of changing weigh more; as people move on, the pros outweigh the cons.
- Self-efficacy rises and temptation falls as the stages advance.
- Processes of change: experiential ones (consciousness raising, emotional relief, self-reevaluation) dominate early; behavioural ones (stimulus control, counterconditioning, reinforcement, seeking support) dominate later.
- Some versions add a termination stage, with no temptation and full confidence, which few reach.

## Stages of change and the matching intervention (example: tobacco)

| Stage | How to recognize it | What the patient says | Intervention |
| --- | --- | --- | --- |
| Precontemplation | No intention to change within 6 months | ‘Smoking does not hurt me’ | Personalized information on risks, without confrontation; leave the door open |
| Contemplation | Considering it within the next 6 months | ‘I know I should, but it relaxes me’ | Motivational interviewing: explore pros and cons, develop discrepancy |
| Preparation | Plans within 30 days and has taken a step | ‘I have set a date’ | Concrete plan: date, support, treatment options, graded goals |
| Action | Changed less than 6 months ago | ‘I have been smoke-free for two months’ | Feedback, problem solving, social support, reinforcement |
| Maintenance | Has kept the change more than 6 months | ‘I do not think about it much anymore’ | Relapse prevention: spot triggers, alternatives, reminders |
| Relapse | Returns to the old behaviour | ‘I smoked again at the party’ | Normalize, review what happened and plan again without blame |

## Clinical notes

- Criticisms: the time cut-offs are arbitrary, and trials do not consistently show that stage-matched interventions beat unmatched ones.
- Even so, asking about the stage avoids handing an action plan to someone who has not yet decided to change.

## Memory aid

‘Not thinking, thinking, getting ready, doing, keeping it up’; and if I fall, I get back on the wheel.

## Test yourself

Think of the answer, then tap the question to see it.

## A patient says they will quit alcohol some day, but not now. Which stage are they in?

Contemplation if they are considering it within the next 6 months; if they have no intention within that time, precontemplation.

## What separates preparation from contemplation?

In preparation the person plans to change within the next 30 days and has already taken a concrete step.

## What intervention best fits precontemplation?

Personalized information on risks and benefits without confrontation, leaving the conversation open for the future.

## How is relapse understood in this model?

As an expected part of the cycle: the person returns to an earlier stage and can recycle with what they learned.

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## Elsewhere in DurgiPedia

- [Medicines, allergies and habits: tobacco, alcohol and other substances](https://durgical.com/en/clinical-exam/medicines-allergies-and-habits-tobacco-alcohol-and-other-substances/)

## Connections

## Related 6

- [Motivational interviewing](https://durgical.com/en/behavioral-science/motivational-interviewing/)
- [Screening and brief intervention (SBIRT) and harm reduction](https://durgical.com/en/behavioral-science/screening-and-brief-intervention-and-harm-reduction/)
- [Cues, craving and relapse](https://durgical.com/en/behavioral-science/cues-craving-and-relapse/)
- [The health belief model](https://durgical.com/en/behavioral-science/the-health-belief-model/)
- [Self-efficacy, locus of control and planned behavior](https://durgical.com/en/behavioral-science/self-efficacy-locus-of-control-and-planned-behavior/)
- [Addiction concepts: reward, tolerance, dependence and withdrawal](https://durgical.com/en/behavioral-science/addiction-concepts-reward-tolerance-dependence-and-withdrawal/)

## Related conditions 3

- [Tobacco use disorder](https://durgical.com/en/conditions/tobacco-use-disorder/)
- [Alcohol use disorder](https://durgical.com/en/conditions/alcohol-use-disorder/)
- [Obesity](https://durgical.com/en/conditions/obesity/)

[← All of behavioral science](https://durgical.com/en/behavioral-science/)

Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: [Theory at a Glance: A Guide For Health Promotion Practice (Second Edition)](https://cancercontrol.cancer.gov/sites/default/files/2020-06/theory.pdf) (National Cancer Institute, National Institutes of Health (US), 2005); [A Research Agenda to Examine the Efficacy and Relevance of the Transtheoretical Model for Physical Activity Behavior](https://pmc.ncbi.nlm.nih.gov/articles/PMC2990961/) (Psychology of Sport and Exercise (PubMed Central), 2011).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/the-stages-of-change/