The Cycle of Change

What is the Cycle of Change?

The Cycle of Change aims to describe how people change, with or without therapy, and maintains that responsibility for this change lies with the individual. People often go round the cycle more than once before making a final exit. Some believe that it is common for people to go round the cycle from 3 to 7 times. People are thought to move from one stage to the next around the cycle, either clockwise (good), or anticlockwise (bad).

What are the stages of the Cycle of Change?

There are 6 stages in the Cycle of Change:

1. Precontemplation: In this stage, people do not intend to take action in the foreseeable future (usually defined as within the next 6 months). People in this stage do not think that they have a problem. They could typically be referred via the legal system or be attending due to pressure from family or friends.

2. Contemplation: People in this stage may be planning to change within the next 6 months, or at least recognise there may be a problem, but are unsure what, if anything, to do about it.

3. Preparation (Decision): In this stage, people have decided to change but not sure how to go about it. This is a decision-making stage when change is planned within the next 30 days.

4. Action: In this stage, people have decided how to change, now they are trying to do it. This is the first 6 months of change.

5. Maintenance: In this stage, people have sustained their behaviour change for a while usually defined as more than 6 months and intend to maintain the behaviour change going forward. People in this stage work to prevent relapse to earlier stages.

6. Lapse/Relapse: Returned to previous behaviour despite efforts to change. Lapses can occur at any stage and are a temporary return to substance use. Relapse is a full return to using behaviour. Both are normal in the cycle of change.

Can the Cycle of Change predict treatment outcomes?

The Cycle of Change does not attempt to provide a theory about human functioning, or to identify possible bio psychosocial 'reasons' for substance misuse/addiction. The key point about the Cycle of Change is the idea that different therapies are appropriate for patients in different stages. Unsuccessful treatment outcomes are related to the use of therapeutic techniques that belong to a different stage from the patient. It is thought that the key to successfully helping patients through a period of change is to correctly identify the stage they are in and apply therapeutic techniques suited to this stage.

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