Dijkstra Arie
Department of Social and Organizational Psychology, University of Groningen, Groningen, The Netherlands.
Clin J Pain. 2005 Jan-Feb;21(1):27-37; discussion 69-72. doi: 10.1097/00002508-200501000-00004.
In attempts to decrease chronic pain and the negative impact of chronic pain on broader functioning, patients can be stimulated to adopt self-management skills. However, not all patients are motivated to do so. Insight into the causes of motivation and the process of behavior change could increase the practitioners' effectiveness in stimulating patients to use self-management skills. The stages of change construct is a psychologic construct that maps the process of behavior change. Patients in the Precontemplation stage are not motivated to adopt self-management skills, patients in the Contemplation stage think about it, patients in the Preparation stage are planning to change and are already trying some (parts) of the skills, patients in the Action stage are actively learning to engage in self-management, whereas patients in the Maintenance stage keep on working to stabilize the new behavior pattern. Although the stages of change model is intuitively plausible and has the potential to increase effectiveness of the practitioners' counseling, its validity should be proven before it is applied clinically. The present article reviews the 8 available publications in which the stages of change construct is studied in patients with chronic pain. The results show that the theory of the stages of change needs more articulation, that the operationalization should be more directly derived from the theory, and that the results from more appropriate tests of the theory should be used to change the theory when necessary to develop it. Recommendations are made with regard to the theory, the operationalizations, and the tests to be conducted to develop the theory and assess its validity.
为了减轻慢性疼痛以及慢性疼痛对更广泛功能的负面影响，可以促使患者采用自我管理技能。然而，并非所有患者都有这样做的动机。深入了解动机的成因和行为改变的过程，可能会提高从业者在促使患者使用自我管理技能方面的效果。改变阶段构想是一种描绘行为改变过程的心理构想。处于前思考阶段的患者没有采用自我管理技能的动机，处于思考阶段的患者会考虑此事，处于准备阶段的患者正在计划改变并且已经在尝试一些（部分）技能，处于行动阶段的患者正在积极学习进行自我管理，而处于维持阶段的患者则继续努力稳定新的行为模式。尽管改变阶段模型直观上看似合理，并且有可能提高从业者咨询的效果，但在临床应用之前，其有效性需要得到证实。本文回顾了8篇现有出版物，这些出版物对慢性疼痛患者的改变阶段构想进行了研究。结果表明，改变阶段理论需要更清晰的阐述，操作化应该更直接地从理论中推导出来，并且在必要时应该使用对该理论更恰当测试的结果来改变理论以发展它。针对该理论、操作化以及为发展该理论和评估其有效性而要进行的测试提出了建议。
