Weight Control: Processes of Change

The following experiences can affect the weight of some people. Think of any similar experiences you may have in trying to lose weight or keep from gaining weight. Please rate how FREQUENTLY you use(d) each of these during the past month. There are FIVE possible responses to each of the questionnaire items. Please circle the number that best describes your experience.

1 = Never
2 = Seldom
3 = Occasionally
4 = Often
5 = Repeatedly (always)

1.	I read about people who have successfully lost weight
2.	Instead of eating I engage in some physical activity.
3.	Warnings about the health hazards of being overweight move me emotionally.
4.	I consider the belief that people who lose weight will help to improve the world.
5.	I can be open with at least one special person about my experience with overeating behavior.
6.	I leave places where people are eating a lot.
7.	I am rewarded by others when I lost weight.
8.	I tell myself I can choose to over-eat or not.
9.	My dependency on food makes me feel disappointed in myself.
10.	I am the object of discrimination because of my being overweight.
11.	I remove things from my place of work that remind me of eating.
12.	I take some type of medication to help me control my weight.
13.	I think about information from articles or ads concerning the benefits of losing weight.
14.	I find that doing other things with my hands is a good substitute for eating.
15.	Dramatic portrayals of the problems of overweight people affect me emotionally.
16.	I stop to think that overeating is taking more than my share of the world’s food supply.
17.	I have someone who listens when I need to talk about my losing weight.
18.	I change personal relationships which contribute to my overeating.
19.	I expect to be rewarded by others when I don’t overeat.
20.	I tell myself that I am able to lose weight if I want to.
21.	I get upset when I think about my overeating.
22.	I notice that overweight people have a hard time buying attractive clothes.
23.	I keep things around my place of work that remind me not to eat.
24.	I use diet aids to help me lose weight.
25.	I think about information from articles and advertisements on how to lose weight.
26.	When I am tempted to eat, I think about something else.
27.	I react emotionally to warnings about gaining too much weight.
28.	I consider the view that overeating can be harmful to the environment.
29.	I have someone whom I can count on when I am having problems with overeating.
30.	I relate less often to people who contribute to my overeating.
31.	I reward myself when I do not overeat.
32.	I tell myself that if I try hard enough I can keep from overeating.
33.	I reasses the fact that being content with myself includes changing my overeating.
34.	I find society more supportive of thin people.
35.	I put things around my home that remind me not to overeat.
36.	I take drugs to helpl me control my weight.
37.	I recall information people have personally given me on how to lose weight.
38.	I do something else instead of eating when I need to relax or deal with tension.
39.	Remembering studies about illnesses caused by being overweight upsets me.
40.	I consider the idea that overeating could be harmful to world food supplies.
41.	I have someone who understands my problems with eating.
42.	I ask people not to overeat in my presence.
43.	Other people in my daily life try to make me feel good when I do not overeat.
44.	I make commitments to lose weight.
45.	I struggle to alter my view of myself as an overweight person.
46.	I notice the world’s poor are asserting their rights to a greater share of the food supplies.
47.	I remove things from my home that remind me of eating.
48.	I take diet pills to help me lose weight.

Scoring

Consciousness Raising	1, 13, 25, 37
Countercoditioning	2, 14, 26, 38
Dramatic Relief	3, 15, 27, 39
Environmental Reevaluation	4, 16, 28, 40
Helping Relationships	5, 17, 29, 41
Interpersonal Systems Control	6, 18, 30, 42
Reinforcement Management	7, 19, 31, 43
Self Liberation	8, 20, 32, 44
Self Reevaluation	9, 21, 33, 45
Social Liberation	10, 22, 34, 46
Stimulus Control	11, 23, 35, 47
Substance Use	12, 24, 36, 48

Description

Meta-analyses of models of how people change have identified a common set of processes underlying the modification of problem behaviors (Prochaska, 1979; Prochaska & DiClemente, 1982, 1983, 1985, 1986, 1992; Rossi, 1992). These processes of change are overt and covert change strategies and techniques that can be employed by professionals, such as therapists or physicians, or by people changing on their own or with the aid of self-help programs. Ten to twelve processes have been consistently replicated across time, problem behaviors, sex, age, geographical region, and response formats (Prochasks & DiClemente, 1985; Prochaska, Velicer, DiClemente, & Fava, 1988; Rossi, 1992; Rossi & Bellis, 1993). For weight control, 12 processes of change have been identified: consciousness raising, counterconditioning, dramatic relief, environmental reevaluation, helping relationships, interpersonal systems control, reinforcement management (sometimes termed contingency management), self liberation, self reevaluation, social liberation, stimulus control, and substance use (sometimes called medication).

Brief definitions of the processes can be found linked to the CPRC Transtheoretical Modelpage. Brief definitions of the processes are given in Table 1. Structural analyses indicate that the processes are organized into two general second order (hierarchical) constructs, reflecting the tendency of individuals to use more than one process of change at a time (Prochaska et al., 1988; Rossi, 1992). This model has been replicated across nine different problem behaviors, including smoking cessation, alcohol use, cocaine use, exercise adoption, dietary fat reduction, HIV risk reduction, psychological distress, weight control, and heroin use (Marcus, Rossi et al., 1992; Prochaska et al., 1988; Redding & Rossi, 1993a; Rossi, 1992; Rossi et al., 1993a; Rossi, Rossi et al., in press; Snow, Prochaska, & Rossi, in press). The two higher order factors are the experimental and the behavioral processes of change. In general, the experimental processes may be characterized as incorporating the cognitive, evaluative, and affective aspects of change whereas the behavioral processes include more specific, observable change strategies. However, these distinctions are not absolutely clear-cut. Across nine different problem behaviors, the correlation between the experimential and behavioral factors ranged from .51 to .91 (median = .77), indicating a general tendency to use (or not use) all of the processes of change (Rossi, 1992).

The processes of change and the stage of change are integrally related. Transitions between stages are mediated by the use of distinct subsets of change processes (DiClemente et al., 1991; Prochaska & DiClemente, 1983; Prochaska, DiClemente, Velicer, Ginpil, & Norcross, 1985; Prochaska, Velicer et al., 1991). For example, consciousness raising is an experiential process reflecting an individual’s attempt to seek out information concerning their problem behavior. Employment of this process predicts successful movement from the precontemplation stage to the contemplation stage. The process of self reevaluation is characteristic of the change from contemplation to action, whereas stimulus contol is most frequently employed by individuals progressing from action to maintenance. In general, use of the experiential processes of change tends to peak in the contemplation or preparation stages, whereas use of the behavioral processes tends to peak in the action or maintenance stages. Precontemplators use the processes least of all. Longitudinal data suggest that when individuals (or treatment programs) mismatch processes to stages, action attempts are likely to fail (Fitzgerald & Prochaska, 1990; Gritz, Berman, Bastani, & Wu, 1992; Ockene et al., 1992; Prochaska et al., 1985). These results suggest that stage-specific interventions may accelerate progress through the stages of change. Interventions tailored to participant’s stage of change have been developed for smoking cessation (Prochaska, DiClemente, Velicer, & Rossi, in press), exercise adoption (Marcus, Banspach, Lefebvre, Rossi, & Carleton, 1992), and sun exposure (Rossi, Blais, & Weinstock, in press) and have proved successful. Consideration of the processes of change and their relationship to the stages of change is thus important from the standpoint of providing guidance for the development of successul intervention programs applicable not only for individuals who are ready to change a problem behavior but for the vast majority of people who are neither prepared nor motivated to change.

Stages of Change in which the Processes of Change of Weight Control are most emphasized

Processes of Change	Stage of Change
Consciousness Raising	Precontemplation-Contemplation
Dramatic Relief	Precontemplation-Contemplation
Helping Relationships	Contemplation-Action
Social Liberation	Contemplation-Action
Self-Liberation	Action
Self-Reevaluation	Action
Stimulus Control	Action
Substance Use	Action
Counterconditioning	Action-Maintenance
Reinforcement Management	Action-Maintenance