The Transtheoretical Model (TTM)

Consider the journey involved in adopting a regular exercise routine. Initially, you might reflect on how exercising could improve your well-being. You then take practical steps, perhaps signing up for a gym membership and buying some new workout clothes. Eventually, you head to the gym and keep it up for several weeks. 

As life gets busy, you worry about maintaining this new behavior and decide to recruit a gym buddy for some additional motivation. In the process of picking up a regular exercise behavior, you’ve moved through several stages of change—from contemplation and preparation to action and maintenance.

The TTM, also called the stages of change model, illustrates how people move through different levels of motivation, commitment, and action when attempting to alter or adopt a behavior.¹ The model was originally developed to understand why some people could manage behavior change more easily than others, suggesting that people have to be ready in order to enact change.

The TTM is often used in the context of lifestyle behaviors like nutrition, exercise, substance use, and stress management. People don’t change these behaviors overnight—rather, change is a lengthy, ongoing process that involves several distinct stages.

The TTM outlines six main stages of change that describe an individual’s preparedness for change.1,2 These are:

1. Precontemplation: People in this stage have no intention of making a change in the foreseeable future (within the next six months). They do not see a problem and lack awareness of the negative consequences of their behavior.
2. Contemplation: Individuals in this stage are aware that a problem exists and have started thinking about making a change in the near future (within the next six months). They recognize that their behavior is problematic, but have not yet made a commitment to take action.
3. Preparation: This stage is where intention and action come together. People in the preparation stage are aware that their behavior is problematic and that change would be beneficial. They start taking small steps to prepare for change and intend to take action immenently (within the next 30 days).
4. Action: This is the stage where change finally happens. Individuals in this stage modify their behavior or environment to overcome problems and intend to keep moving forward with the change.
5. Maintenance: People reach this stage once they have maintained the behavior for at least six months. They work to prevent relapse and consolidate gains to focus on the progress they have made. This stage has no limit—many people remain in the maintenance stage indefinitely.
6. Termination: The stage in which people have no desire to return to previous behavior and experience zero temptation for relapse. Most people never reach this stage, so it’s often excluded in health promotion programs.

Importantly, this is not a linear path, but cyclical. People can revert to earlier stages from any stage. For instance, someone who has been steadily going to the gym for several months might miss a few workouts and eventually stop exercising altogether, returning to the contemplation stage before moving forward again.

The primary goal of the TTM is to facilitate behavior change by identifying an individual’s readiness to change and providing tailored interventions that support their progression through the stages.