Five Questions With: James O. Prochaska

James O. Prochaska, a professor of psychology and director of the Cancer Prevention Research Center at the University of Rhode Island, will speak at URI’s first well-being conference on population health Sept. 14.

Prochaska, best known as the developer of the transtheoretical model of behavior change, is a founder of and consultant to Pro-Change Behavior Systems, an internationally recognized behavior-change company in Rhode Island that partners with wellness companies. At the conference, he’ll present examples of how the Cancer Prevention Research Center’s interventions and interactions have led to improved health and well-being of individuals and populations.

PBN: Please briefly describe the transtheoretical model of behavior change.

PROCHASKA: The transtheoretical model defines behavior change as involving progress through a series of six states. At each stage, different processes of change from different theories need to be applied to progress to the next stage, hence the name transtheoretical.  In the precontemplation stage, for example, individuals are not aware of the multitude of pros, or benefits, of changing.  So, TTM helps them to apply consciousness-raising processes based on [Sigmund] Freud’s theory. In the action stage, individuals have changed risk behaviors in the past six months (e.g., quitting smoking) and need to apply reinforcement processes to prevent relapse.

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PBN: How does the Cancer Prevention Research Center incorporate these principles?

PROCHASKA: The Cancer Prevention Research Center has incorporated these change principles in computer tailored interventions. The CTIs are tailored to each individual’s stage and provide feedback on whether the individual is underutilizing, overutilizing or utilizing processes effectively that will help them progress to the next stage.

Individuals can receive feedback that is reinforcing, like “Congratulations, you have progressed two stages since we last interacted. This means you have tripled your chances that you will take effective action in the next few months. These CTIs enable us to deliver high-impact and low-cost individualized and interactive digital health interventions to entire populations, e.g., employees in companies and students in schools.

PBN: What element of this model can lay people use to improve their own health, or that of a family member or friend?

PROCHASKA: The most important element of TTM that lay people can use is a new mental model of behavior change. Most lay people, and too many health professionals, still rely on an action model that gives them only two choices: take action or do nothing. For the vast majority of at-risk populations who are not in the preparation stage, pressuring themselves or others to take action only produces defensiveness and demoralization as they fail fast because they took action without being adequately prepared.

One of the best ways that lay people, and professionals, can learn how to assess each stage of change and simple techniques to apply appropriate processes of change is via our new book, “Changing to Thrive,” that my wife, Janice, and I recently published. This book and other works recently won us a Career Excellence Award from the Harvard-affiliated Institute of Coaching.

PBN: You’ve noted CPRC programs have been as effective when simultaneously treating three risk behaviors compared to two risks and just a single behavior. Can you explain why CPRC is so successful?

PROCHASKA: There are a number of reasons why CPRC programs have been as effective when simultaneously treating three risk behaviors compared to two risks and just a single behavior. First, the same principles of change are applied across very different risk behaviors, so what individuals are learning to do can be transferred from one behavior to another behavior. An analysis of 125 studies from 10 countries found that the decision-making principles of the pros and cons of changing across the stages of change for 48 health risk behaviors were almost exactly as predicted by TTM.

So, with TTM-based simultaneous multiple health behavior changes [or MHBC], individuals are guided by some of the best evidence that the science of behavior change has to offer. Another big factor is that individuals are not taking action on each behavior at the same time. That would be overwhelming. As they take action on one behavior, they can be progressing to the next stage with other behaviors.

PBN: What surprising thing about your work do you think people would find most useful?

PROCHASKA: One of the most surprising things about our work that people can find particularly useful is our recent discovery of synergy when changing multiple behaviors. In our TTM programs, when individuals take effective action on one behavior, they significantly increase the odds that they will be successful in changing a second behavior.  We call this coaction. Across risk behaviors and populations, we find that TTM-guided individuals are typically 1.5 to 3.5 times more likely to change a second behavior compared to individuals who did not take action on the first behavior.

But, coaction rarely occurs in control groups, where individuals take action on one behavior but do not increase their odds of changing a second behavior. For example, we found that high school students receiving TTM-guided programs were about three times more likely to take action on exercise when they took action on health eating. But, their peers in the control condition were 50 percent less likely to change the second behavior, even though they were successful on the first behavior.

There has been no data reported yet that coaction occurs in MHBC programs based on other models of change. The surprise for lay people, and professionals, is that rather than being hindered by MHBC, they may benefit from the synergy of increasing their abilities to change a second behavior when they are effective in changing an initial behavior.

Rob Borkowski is a PBN staff writer. Email him at