Category: Child / Adolescent - Depression
DiClemente and Prochaska (1982) developed the construct of readiness to change, which has been identified as a mediator of treatment outcomes. In their model, readiness to change drives behavior change, and is thought of as dynamic, fluctuating between four stages: precontemplation, contemplation, action, and maintenance. Currently, there is a lack of research evaluating the fluctuation between different stages over the course of treatment, with the exception of behavioral health research (e.g., smoking). The present study aimed to address this gap in the literature within a randomized controlled trial, the Treatment for Adolescents with Depression Study (March et al., 2004). Specifically, two aims were articulated: (1) explore the prevalence of stage memberships and transitions over time, (2) evaluate predictors of stage membership and stage transitions. Participants were 418 adolescents (aged 12-17) that had a primary diagnosis of Major Depressive Disorder. In order to measure readiness to change, The Stages of Change Questionnaire (SOCQ) was used. The SOCQ is an 18-item self-report scale that was administered at baseline and week 6 of treatment. Latent transition analysis was used to examine movement between stages of change from baseline to week six of treatment and to evaluate predictors of stage membership and stage transitions. Stage membership was classified by accounting for their highest subscale score. Results revealed that, overall, adolescents can regress, stay, or progress stages from baseline to week 6 of treatment. Specifically, the majority of adolescents stayed in precontemplation (59.1%) and contemplation (40.7%). However, those who started in action (17.2%) and maintenance (17.2%) stages tended to mostly regress in the first six weeks of treatment. A small amount progressed from precontemplation to contemplation (22.8%), from contemplation to action (11.7%), and from precontemplation to maintenance (10.4%). More intriguing, a large majority regressed from action to contemplation (45.1%), from action to precontemplation (41.5%), from maintenance to precontemplation (41.0%), from maintenance to contemplation (35.2%), and from action to contemplation (30.2%). All other transitions were below 10%. Hopelessness emerged as a predictor of stage membership, as well as a predictor of stage transitions. Number of comorbidities was also a predictor of stage transitions. This study demonstrated that stages of change in adolescents is a dynamic construct that can shift within a few weeks. Additionally, this study underscored that readiness to change is not linear. Given that previous studies have linked the action stage to positive treatment outcomes and the precontemplation stage to treatment dropout (Callaghan et al., 2005; Lewis et al., 2009; May et al., 2007), therapists might need to pay close attention to regressions that might occur within the first few weeks of treatment, particularly with clients with high levels of hopelessness and comorbidity. Aim of our future work will be to evaluate the link between stage transitions and treatment outcome.