The Stages and Processes of Change: The Effects of Initiation of Psychotrophic Medication

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

William J. Lyddon

Advisor Department



The hypothesized relations among the stages of change, the processes of change, and psychological distress (i.e., anxiety and depression) in a clinical population were investigated in this study. More specifically, the purpose of this study was to examine whether different processes of change may be employed at different stages of change in relieving psychological distress, and if these processes of change, especially the initiation of a psychotropic medication, may be related to movement through the stages of change over a four- to six-week period. The potential differences in the level of psychological distress experienced in relation to movement in the stages of change over a four- to six-week period were also investigated in this study. Results of a multivariate analysis of variance (MANOVA) and Tukey comparisons indicated no significant differences of process utilization at initiation of a psychotropic, nor did the utilization frequency of the processes of change significantly differentiate among those who had maintained, progressed, or regressed in their stage of change over a four- to six-week period. Also, there were no significant changes in individuals' levels of psychological distress over the four- to six-week period. However, at the four- to six-week follow-up, persons in the Action and Maintenance stages of change used contingency management processes significantly more than persons in the Contemplation stage of change. In addition, persons in the Maintenance stage used stimulus control processes significantly more than those in the Contemplation stage. An informal analysis of participants' stage of change profile (i.e., a description of participants' mean scores on all four stages of change) showed that participants in this sample could be characterized as "Preparticipators." This provided some explanation for this sample's relatively low levels of progress in making changes. Another informal analysis of the usage of the processes of change indicated that the participants in this study did utilize more cognitively based processes, as opposed to the more action-oriented, behavioral processes. This finding is also consistent with participants' relatively low level of commitment to or involvement in any one stage of change. The significance and implications of these findings for psychotherapy practice and future research are discussed.