Creating a Desire for Change: Part 2

MI Science Staff: April 2016

In March, our science article introduced the Transtheoretical Model for Behavioral Change as a viable model for changing risky sexual behavior. Only the first of six stages of “readiness for change” was visited in the March article. In this second article, the contemplative stage of readiness for change will be presented.

In the second stage, or contemplative stage, an individual is seriously considering making a behavior change in the next 6 months. In this stage of readiness, a person recognizes that their behavior is putting them at risk. An adolescent might only be concerned about the risk of parents finding out about their sexual activity. If the teen is having vaginal intercourse, their foremost fear is of getting pregnant or of causing a pregnancy. A young person may even be realizing that sexually transmitted infections are a very real and likely consequence of their sexual activity. The contemplative stage indicates that the individual realizes that if change does not take place, consequences are likely to occur.

A person in the contemplative stage has thoughts about changing, but is not committed to change. Often a young person is weighing the pros (the benefits of sexual activity) and cons (the risks of sexual activity), but the balance between the two has made him/her ambivalent. In regard to sexual behavior, there are many factors that complicate the risk vs benefit scenario, often leaving a person “stuck” in this stage for an extended period of time. The person in this stage of readiness is saying, “I want to stop feeling so stuck.”

The process that is most helpful in moving people through the contemplative stage is self-reevaluation. The process of self-reevaluation occurs when one realizes that the behavior change is an important part of one’s identity as a person. This means that the individual comes to “own” the behavior, along with its consequences. It is important to recognize that the change the teen is considering may just be to obtain a method of birth control or to start using condoms. The reevaluation of their identity may be that they are a person who has “responsible sex.” The goal, however, is to move them towards risk avoidance.

In a sexual health education class, a teen who asks a lot of questions, or who comes up after class to ask a question, may well be in the contemplative stage. Sexually transmitted infections and teen pregnancy have now become more personal than informational. The educator has an opportunity to tilt the balance toward the cons, rather than the pros of sexual activity with factual, non-judgmental information. If the student is asking questions about contraception, it would be useful to remind them that contraception is not 100% effective and that it does not protect against sexually transmitted infections.

An update of an intriguing book by Dr. Jill Grimes, Seductive Delusions, has recently been released; and in it Dr. Grimes presents true stories of adolescents and the consequences they experience as a result of their sexual behaviors. Young people can identify with the stories of other people their own age and a book like this could help move someone toward self-reevaluation. It is available on amazon.com.

Health professionals are in a unique position to evaluate each young patient as to their sexual behavior and their readiness towards change. Asking about a young person’s sexual activity not only informs the clinician of the risks that need to be addressed, but it also helps the young person to “own” the behavior and engage in self-reevaluation. MI’s Clinical Intervention program encourages professionals to Ask about sexual activity at every visit, as well as to Assess, Advise, and Assist their patients toward change. After discussing the risks associated with the patient’s sexual activity, the clinician might advise the patient regarding sexual risk reduction, as well as introduce the idea of risk avoidance by asking if the individual has considered “taking a break from sexual activity”. MI’s brochure, “Moving Forward”, would provide appropriate information for someone in the contemplative stage. A follow-up appointment should also be scheduled according to the patient’s risk assessment.

Medical Institute will continue this series of articles on the Transtheoretical Model of Behavioral Change. All related articles will appear on our “blog”, which is available for viewing by the general public. Articles will also be posted as “featured articles” in the Membership area of the website. Please remember that Membership to our website is now FREE. Go to www.medinstitute.org and sign up today.

4 Responses to “Creating a Desire for Change: Part 2”

  1. barbara beavers

    Can you give a further definition or example of dramatic relief that can be used in the precontemplative stage of behavior change?

    • mhenderson

      Thank you for your question regarding “dramatic relief”. I want to refer you to an article that emphasizes the importance of dramatic relief in moving a person from pre-contemplative to contemplative stage. This was a study done regarding drug treatment, yet, it can easily be applied to risky sexual behavior, as well. Here is a quote from the article, “Dramatic Relief is a trigger that prompts people to acknowledge, at an emotional level, their problem behavior and its impact on those around them. Fear, inspiration, guilt, and hope are some of the emotions that can promote dramatic relief and move people from Precontemplation to Contemplation. Motivational interviewing, psychodrama, role playing, grieving, and personal testimonies are examples of techniques used to create such movement.”
      Have you seen our video, “Sex is not a Game”? Both the original version and the newly updated version depict high school students whose lives have been impacted by sexually transmitted infections. When the video is shown to adolescents who are not the least bit interested in changing their sexual behavior, a student might be emotionally impacted and have an internal response that says, “that could be me.” and even further, “I don’t want that to happen to me”.
      I hope this example and further explanation are what you are looking for. Here is the article reference: Conner, BT, Longshore D, and Angin, MD, “Modeling Attitude towards Drug Treatment: The Role of Internal Motivation, External Pressure, and Dramatic Relief,” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693046/

    • mhenderson

      Great! I’m so glad that you are finding these articles helpful.