Updated: Feb 2
The global pandemic and our national crisis is changing us. COVID-19 will continue to change us. Will you be better for it or not? Here is a roadmap to the better. Better health and longer life.
In 1994 I read the book, Changing for Good, and my reading of the book changed for good the manner in which I aided my patients and their families in the process of recovery from destructive behavior of all types.
The book impressed me with its groundbreaking conceptualization of the recovery process. I wanted to learn more.
I next read another book by the same authors entitled The Transtheoretical Model, written for professionals. The book focused on understanding the curative ways or processes leading to significant life change and the evolution of the processes over months, years, even decades.
To further my learning and share with other professionals in 1996 I organized a two day workshop entitled "The Wisconsin Lifestyle: Can Clinicians Foster Healthy Change?" As the course director, I introduced to the professional community of Milwaukee two of the authors of Changing for Good, James O. Prochaska, Ph.D. and Carlo C. DiClemente, Ph.D.
The Stages of Change
The Stages of Change are six. Recovering individuals can move straight through the stages, but more often than not, recovering individuals will progress and regress and again progress. In other words, two steps forward, one step back, two steps forward.
Precontemplation. "People at this stage usually have no intention of changing their behavior and typically deny having a problem." A person could spend a lifetime in precontemplation. Often life is shorter than average because of the addictive behavior.
Contemplation. "In the contemplation stage people acknowledge that they have a problem and begin to think seriously about solving it." However "contemplators may be far from actually making commitment to action." Like precontemplation, contemplation may extend over a lifetime.
Preparation. "Most people in the preparation stage are planning to take action within the very next month..." or within several months. In preparation one gathers the resources for change. "An important step is to make public your intended change."
Action. "The action stage is the one in which people must overtly modify their behavior and their surroundings...Action is the most obviously busy period and the one that requires the greatest commitment of time and energy." This stage may be as short as three months or as long as years. In the Alcoholics Anonymous culture there is a saying, "ninety meetings in ninety days." In other words, attending at least one AA meeting each day for ninety days.
Neuroimaging shows the addicted brain to require at least ninety days to change substantially.
Maintenance. "...during maintenance you must work to consolidate the gains attained during the action stage and other stages and struggle to prevent lapses and relapse..." A lapse can be a one time event in regression into the old behavior. A relapse occurs after multiple lapses and leads to a person giving up the effort to change, at least temporarily.
Termination. "The termination stage is the ultimate goal for all changers." However wisely many successful individuals view themselves as permanently in maintenance. In Alcoholics Anonymous, individuals who have been sober for years or decades refer to themselves as "recovering alcoholics". The effort of recovery never stops!
The Processes of Change
Dr. Prochaska and Dr. Diclemente describe "can be simply: any activity that you initiate to help modify your thinking, feeling or behavior is a change process." Further, "You will apply different processes to your problems at different stages of change." In order to successfully change one does not need to engage in all of the processes, only those most helpful.
Consciousness Raising. It is "the most widely used change process...any increased knowledge about yourself or the nature of your problem, regardless of the source, raises consciousness." COVID-19 gives us reason and time to self reflect and learn.
Social Liberation. "This process involves any new alternatives that the external environment can give you to begin or continue change efforts." Social liberation may include changing one's personal environment, for instance ending relationships with unhealthy friends and beginning healthy friendships.
Emotional Arousal. "It works on a deeper feeling level and equally important in the early stages of change...emotional arousal is a significant, often sudden emotional experience related to the problem at hand." For instance, a threat of a spouse to end a marriage may move someone to begin recovery. A DUI or DWI might do the same. Or COVID-19.
Self Reevaluation. "This process requires you to give a thoughtful and emotional reappraisal of your problem..." Going to ninety meetings in ninety days, that is at least one meeting per day for ninety days as recommended in Alcoholics Anonymous, allows self reevaluation every day.
Commitment. "The first step of commitment is private, telling yourself you are choosing to change. The second step involves going public and announcing to others that you have made a firm decision to change."
Countering. "The technical term for substituting healthy responses for unhealthy ones is countering...Almost any healthy activity can be an effective countering technique...There are many different good countering activities - the trick lies in finding the ones that will work for you."
Environmental Control. "Like countering, environmental control is action oriented. In this instance, however, you do not seek to control internal reactions but to restructure your environment so the probability of problem causing events is reduced. "Often environmental control involves putting a distance between the recovering person and the agents of addiction.
Rewards. In Alcoholics Anonymous even early in the process of recovery, tokens are given for sobriety... a month, a year, five years. When a recovering person shares her sobriety date, one says, "Congratulations!" Buying a new wardrobe after weight loss is a common example.
Helping Relationships. "While we cannot control how our friends and family members act toward us, we can certainly request their support..." Alcoholics Anonymous gives us a wonderful example in sponsorship. A sponsor is an individual who worked all twelve steps, completing the steps with his own sponsor. He, in turn, is generous with his time in being a sponsor.
I recommend reading Changing for Good. It offers direction, not only for changing within drug addictions, behavioral addictions, and eating disorders, but also in changing any unhealthy behaviors and replacing them with healthy ones. Please note the link to the *website of Dr. Prochaska.
COVID-19 is a national calamity and a personal challenge to each of us. We have changed. We will change. You can change for the better. You can change for good.