Creating a Desire for Change: Part 4: Action | Medical Institute for Sexual Health

Creating a Desire for Change: Part 4: Action

MI science staff, June 2016

The fourth stage in the Transtheoretical Model of change is action. In this stage an individual has made specific, observable changes in their lifestyle within the past 6 months in moving toward behavioral change. A teen who has made a firm decision to “take a break” from all sexual activity has made changes in their behavior and in their surroundings in preparation for returning to a sexually abstinent lifestyle.  They are expending a lot of time and energy to make these changes and their message to others is “Here I go.”

There are four important processes for successful change to occur in the action stage. They are:

  1. Contingency Management – Increasing the rewards for the positive behavioral change and decreasing the rewards of the unhealthy behavior.
  2. Helping Relationship – Seeking and using social support for the healthy behavioral change
  3. Counterconditioning – Substituting healthier alternative behaviors and cognitions for the unhealthy behaviors.
  4. Stimulus Control – Removing reminders or cues to engage in the unhealthy behavior and adding cues or reminders to engage in the healthy behaviors.

Now that all the wordy terms and definitions are listed, let’s step back and review where we are with the teen who has committed to change and is now ready to follow up on that commitment.  If the individual has not yet done so, they should write down their commitment. The actual commitment statement needs to come from the teen and not from other advisors. For example, the teen’s commitment may only be to stop having sex until he/she turns 17 years old or until they are “in love” or even until they and their potential partner are tested and declared disease free.  One of these stated goals would be a very good first page for a journal, if the teen is willing to keep one.

In addition, it would be very helpful to write down the “reasons” they have decided to stop engaging in sexual activity. For example, if a young man has been motivated to stop sexual activity because he had a very painful break-out of herpes, he may list that he does not want to transmit herpes to anyone; or he may want to write down that he does not want to get another sexually transmitted infection.  Or a young lady may want to avoid the emotional pain of becoming attached to a sexual partner and then breaking up. When it becomes difficult to keep the commitment, it is very helpful to remind the teen of his/her goal and his/her own reasons for setting that goal.  The written statements become a part of contingency management; reminding the teen of the rewards for stopping sexual activity (ie. not getting another sexually transmitted infection).  These written statements can also be a positive stimulus control, a reminder of why the individual decided to stop the risky behaviors.

Helping relationships are very important for changing risky teen sexual behavior.  Adult helpers and peer helpers are both important.  We know from many surveys that teens are strongly influenced by their parent’s values.  Parents can be helpful by stating and re-stating their values and the reasons that they hold those values. They can also be helpful by allowing themselves to be the “scapegoat” or the one the teen can blame if he/she needs an excuse to get out of a compromising situation. Parents can also help the teen by setting healthy boundaries, such as not allowing teens to be alone in their home, or not allowing their boyfriend/girlfriend to be in their bedroom.

If the teen is open to counseling and it can be afforded, the counselor could be a helper.  Perhaps a youth worker at church or a scout leader could be called upon to help, but only if the teen has a trusting relationship with them and is willing to share information about their romantic relationships.

Peer helpers are great as long as they share the same values as the teen seeking to make the change. Teens who are interested in having fun without sexual engagement need to be sought out to help with counterconditioning, as well.  Church youth groups or community youth groups may provide healthy activities that are designed to keep young people active and away from risky behaviors.  Some teens will easily make new friends and participate, but others may find it very difficult to change their peer group.

Stimulus control becomes very important if the young person decides to engage in dating relationships during this period of abstinence. Once a young person has engaged in sexual behaviors, they may find that their boundaries of physical contact need to change in order for them to remain abstinent.  For instance, kissing might have been a safe boundary prior to engaging in oral sex, but once the boundary has moved, the individual may need to set a new boundary of hugging or holding hands, since kissing has now become a stimulus for oral sex.

Each organization or agency needs to decide how far into the change process to go with their client. For example, a health care worker may only be able to monitor a patient through the preparation stage and then advise and assist the young person to find a mentor or a counselor to guide them through the action stage and arrange a follow-up meeting in 6 months to a year. A youth worker from a big brother/sister organization, however, may have the resources to remain with the client through the action stage. Each agency should pre-determine what referrals and helps they will have in place, so the young person will have as much opportunity for success as possible.