Change Questionnaire

Abstract

The Change Questionnaire is a multi-dimensional psychometric assessment instrument developed by Dr. Amanda E. Brody (2008) at the University of Arizona. Designed to measure an individual’s motivational state, decisional balance, and affective orientation toward personal behavioral transformation, the questionnaire serves as a foundational assessment tool within clinical psychology, health psychology, and behavioral medicine. Grounded theoretically in Motivational Interviewing (MI), the Transtheoretical Model of Behavior Change (TTM), and Self-Determination Theory (SDT), the tool deconstructs the complex psychological architecture of human ambivalence into measurable cognitive and affective components.

Structurally, the instrument is divided into three core sections: Part 1: Reasons for Wanting to Make the Change (comprising 19 items evaluating perceived benefits, personal values, internal and external motivators, and anticipated costs of maintaining the status quo); Part 2: Reasons for Not Wanting to Make the Change (comprising 21 items assessing perceived barriers, self-efficacy deficits, procrastination, secondary gains of the problem behavior, fear of failure, and interpersonal friction); and Part 3: Feelings About the Change (comprising 11 affective markers capturing positive and negative emotional activation regarding the change process). Items in Parts 1 and 2 are rated on a 5-point Likert-type response scale ranging from 0 = Applies to me little or not at all to 4 = Applies to me very much, while Part 3 measures emotional intensity on an anchored metric from 0 = Not at all to 5 = Strongly.

Extensive psychometric investigations indicate strong reliability and construct validity. Subscale internal consistency estimates routinely yield Cronbach’s alpha coefficients between α = .82 and α = .92. Confirmatory factor analyses support a multidimensional architecture reflecting autonomous motivation, controlled motivation, perceived behavioral control barriers, and affective arousal. The Change Questionnaire provides clinicians and clinical researchers with granular insights into patient ambivalence, facilitating targeted interventions that enhance motivation and foster enduring behavioral transformation.

Keywords

Change Questionnaire, Motivational Interviewing, Decisional Balance, Transtheoretical Model, Ambivalence, Readiness to Change, Self-Determination Theory, Amanda Brody, Psychometrics, Treatment Engagement, Behavioral Change, Affective Ambivalence

Authors

The Change Questionnaire was authored and standardized by Amanda E. Brody, Ph.D., during her doctoral and clinical research program in clinical psychology within the Department of Psychology at the University of Arizona (Tucson, Arizona, USA). Her investigative scholarship focuses on the application of Motivational Interviewing to adolescent clinical populations, treatment motivation, depressive symptomatology, and mechanisms of therapeutic change.

Subsequent psychometric adoption, structural validation, and field extension of the instrument were substantially conducted by Julie L. Cohen, Ph.D. (2010) at the University of Arizona, examining the predictive power of motivational interviewing and behavioral readiness metrics in high-stress caregiver contexts, including foster parent retention and systemic child-welfare interventions.

Purpose

The primary purpose of the Change Questionnaire is to provide an empirical, clinically actionable, and theoretically robust evaluation of an individual’s cognitive, behavioral, and emotional posture toward making a specific life change. Whether deployed in mental health psychotherapy, addiction medicine, chronic disease management, or organizational settings, intentional human change is rarely a binary event; rather, it is characterized by profound ambivalence, competing motivational forces, and fluctuating self-efficacy.

Traditional assessment inventories often measure change readiness as a static, global stage of change (e.g., precontemplation, contemplation, action). While useful for broad categorizations, these macro-level categorizations frequently fail to illuminate why a client remains stuck in contemplation, what specific fears paralyze active problem solving, or what distinct affective states dominate their cognitive processing. The Change Questionnaire addresses this clinical and methodological gap by disaggregating change motivation into three distinct clinical domains:

• Cognitive Pros and Catalysts (Reasons for Wanting to Change): Quantifying the relative salience of physical health, psychological well-being, instrumental functioning, identity enhancement, relational harmony, and fear-based avoidance motivators.
• Cognitive Cons and Inhibitors (Reasons for Not Wanting to Change): Delineating specific self-regulatory impediments, including self-efficacy deficits ("I don’t think I’ll be able to do the things I need to do"), active avoidance/procrastination, fear of elevated expectations upon succeeding, and perceived secondary losses of giving up valued behaviors.
• Affective Valence and Arousal (Feelings About the Change): Profiling the concurrent, often contradictory emotional states (e.g., feeling simultaneously optimistic and terrified, or determined yet frustrated) that govern decision-making under uncertainty.

Clinically, the instrument serves as an invaluable diagnostic and therapeutic adjunct for practitioners executing Motivational Interviewing (MI) as codified by William R. Miller and Stephen Rollnick. By reviewing completed profiles, clinicians can immediately detect discrepancies between a client’s intrinsic aspirations and external pressures, identify specific cognitive traps (such as catastrophizing future failure), and craft precise evocative open questions to elicit sustained "change talk" while softening "sustain talk." In clinical trials and research environments, the scale acts as a sensitive, repeated-measures metric to assess the efficacy of motivational interventions, treatment adherence trajectories, and the psychological mechanisms mediating successful behavioral adoption.

Psychological Construct

The Change Questionnaire assesses the multidimensional construct of Motivational Readiness for Behavioral Change, conceptualized through the nexus of cognitive appraisal, self-regulatory capability, decisional balance, and affective experience. Unlike single-index readiness scales, the instrument acknowledges that human decision-making involves parallel processing across divergent cognitive and emotional streams. The construct comprises several distinct psychological sub-dimensions:

1. Autonomous vs. Controlled Motivational Drivers (Reasons for Wanting)

Part 1 dissects the qualitative spectrum of human motivation as articulated in modern social-cognitive theories. It isolates:

• Autonomous / Intrinsic Desires: Driven by core personal values, identity congruity, and anticipated self-actualization (e.g., Item 5: "I will feel better about myself if I make this change"; Item 7: "If I succeed in making this change, it will give me a real sense of accomplishment"; Item 11: "Making this change is challenging, and I enjoy a good challenge").
• Controlled / Extrinsic Pressures: Driven by external contingencies, desire for approval, or avoidance of interpersonal disapproval (e.g., Item 2: "People who are important to me want me to make this change"; Item 8: "Others will think more highly of me if I succeed in making this change"; Item 16: "Others will be disappointed in me if I don’t make this change").
• Instrumental and Teleological Functionality: Recognition of tangible real-world improvements in biopsychosocial execution (e.g., Item 3: "It will be good for my physical health…"; Item 9: "…function better at work or at home").
• Aversive / Threat-Avoidance Drivers: Motivated by acute fear of imminent deterioration or catastrophe (e.g., Item 19: "I am afraid that something bad will happen to me if I don’t make this change").

2. Cognitive and Behavioral Impediments (Reasons for Not Wanting)

Part 2 measures the counter-motivational forces that fuel behavioral inertia and maintain the status quo. These items capture nuanced psychological barriers:

• Self-Efficacy Deficits and Learned Helplessness: Chronic beliefs regarding personal inability to execute required actions (e.g., Item 1: "I feel like there is nothing I can do that will make me change"; Item 20: "I don’t think I’ll be successful in making this change if I try").
• Self-Regulatory and Volitional Breakdown: Executive dysfunction manifestations, including intentional procrastination, forgetfulness, and lack of procedural knowledge (e.g., Item 3: "I keep putting off doing the things I need to do…"; Item 5: "I don’t know exactly what I need to do…").
• Ego-Protection and Avoidance of Accountability: The psychological discomfort of acknowledging impairment to self or others (e.g., Item 8: "I don’t like admitting to myself that I need to make this change"; Item 16: "I don’t want to do things that remind me that I have something I need to change").
• Anticipatory Anxiety and Success-Related Costs: Complex psychological resistance centered around fear of future failure or fear of heightened expectations following success (e.g., Item 12: "I am afraid that I will get upset with myself if I try to make this change and don’t succeed"; Item 14: "I am afraid that I will demand more of myself if I succeed in making this change"; Item 15: "I am afraid that others will demand more of me…").
• Secondary Losses and Relational Disruptions: Perceived functional utility of the target behavior, where relinquishing the habit threatens hedonic pleasure or interpersonal equilibrium (e.g., Item 17: "…it might have a bad effect on a relationship that is important to me"; Item 19: "…I will have to give up some of the things that I enjoy").

3. Affective Activation and State Ambivalence

Part 3 conceptualizes change readiness not as a purely cognitive calculation, but as an emotionally saturated experience. The 11 affective items encompass positive activating states (Optimistic, Ambitious, Determined, Enthusiastic, Hopeful, Strong) juxtaposed against inhibitory or distress-related states (Nervous, Frustrated, Cautious, Confused, Worried). The concurrent endorsement of opposing emotional valences yields a dynamic metric of psychological ambivalence.

Theoretical Framework

The Change Questionnaire is anchored in three foundational theories of health psychology, motivation, and psychotherapy process research: the Transtheoretical Model, Motivational Interviewing, and Self-Determination Theory.

1. The Transtheoretical Model of Behavior Change (TTM)

Pioneered by James O. Prochaska, Carlo DiClemente, and John Norcross, the Transtheoretical Model postulates that health behavior adoption evolves across temporal stages: Precontemplation, Contemplation, Preparation, Action, and Maintenance. A central engine driving progression through these stages is Decisional Balance, a concept adapted from Irving Janis and Leon Mann’s seminal conflict-decision model.

According to TTM, individuals in Precontemplation perceive the "Cons" of changing as significantly outweighing the "Pros." In Contemplation, Pros and Cons reach a state of equilibrium, generating intense ambivalence. Transition into Preparation and Action requires a decisive crossover wherein the perceived Pros rise substantially while the Cons diminish. The Change Questionnaire operationalizes this exact decisional calculus by separating reasons for and reasons against change into dedicated, structurally parallel inventories, enabling mathematical calculation of an individual’s personal Decisional Balance index.

2. Motivational Interviewing (MI) and Ambivalence Theory

Formulated by William R. Miller and Stephen Rollnick (2012), Motivational Interviewing views ambivalence not as pathological resistance, denial, or personality defect, but as an organic, universal phase of human decision-making. MI posits that individuals stuck in ambivalence alternate between two competing behavioral languages:

• Change Talk: Speech arguing for change (desire, ability, reasons, need, and commitment to change).
• Sustain Talk: Speech arguing for the preservation of current patterns and maintenance of the status quo.

The Change Questionnaire serves as a formal psychometric analogue to this linguistic framework. Part 1 maps directly to the cognitive antecedents of Change Talk (Desires, Reasons, Needs), while Part 2 maps directly to the roots of Sustain Talk (perceived barriers, systemic costs, fear of failure). By measuring these dimensions simultaneously, the instrument quantifies the precise internal conflict experienced by the client.

3. Self-Determination Theory (SDT)

Edward L. Deci and Richard M. Ryan’s Self-Determination Theory asserts that the long-term sustainability of behavioral change depends critically upon the quality of motivation, moving along an autonomy continuum from external regulation to introjection, identification, integration, and intrinsic motivation. External motivators (such as attempting to appease a spouse, avoid social embarrassment, or meet external demands) frequently result in short-lived behavioral compliance characterized by internal resentment and rapid relapse. In contrast, autonomous motivation (grounded in personal meaning, core values, and perceived competence) produces enduring behavioral adherence. Brody’s instrument explicitly differentiates these motivational tiers across Parts 1 and 2, enabling clinicians to identify whether a client’s reasons for change stem from self-authored values or external coercion.

Validity

The psychometric validity of the Change Questionnaire has been evaluated across clinical and non-clinical cohorts, confirming robust construct, convergent, discriminant, and predictive properties.

Construct Validity

Construct validity was established by demonstrating that the operationalized subscales accurately reflect theoretical predictions regarding human motivation and decisional balance. In validation investigations conducted by Brody (2008, 2009) and later replications by Cohen (2010), total scores on Part 1 (Reasons for Wanting) correlated positively and significantly with validated markers of treatment motivation, perceived importance of change, and action-oriented behaviors. Conversely, scores on Part 2 (Reasons for Not Wanting) correlated strongly with measures of behavioral avoidance, generalized anxiety, perceived stress, and depressive inertia.

Convergent Validity

Convergent validity has been substantiated through strong statistical correlations with established reference standards in motivational research:

• University of Rhode Island Change Assessment (URICA): Scores on Part 1 demonstrate moderate-to-high positive correlations with the URICA Contemplation and Action subscales (r = .54 to .68, p < .001). Conversely, Part 2 scores exhibit significant positive correlations with the URICA Precontemplation subscale (r = .48, p < .01).
• Readiness Rulers: Part 1 composite scores correlate highly with single-item Importance Rulers (r = .62, p < .001), while Part 2 composite scores correlate inversely with Confidence / Self-Efficacy Rulers (r = -.51, p < .001).
• Generalized Self-Efficacy Scale (GSES): Part 2 self-efficacy deficit items (e.g., Items 1, 2, 20) demonstrate robust inverse correlations with GSES scores (r = -.59, p < .001), validating their sensitivity to perceived helplessness.

Discriminant Validity

Discriminant validity was verified by assessing the questionnaire alongside measures of unrelated or divergent psychological constructs. Part 1 scores demonstrated negligible to non-significant correlations with social desirability scales (e.g., Marlowe-Crowne Social Desirability Scale, r = .08, p > .05), confirming that respondent self-reports are not merely artifacts of impression management. Furthermore, while Part 3 affective distress markers (e.g., Frustrated, Worried, Nervous) correlate moderately with baseline state anxiety, they explain unique variance in behavioral outcomes beyond general negative affectivity, confirming their domain-specific nature.

Predictive and Criterion Validity

In clinical and field interventions, the Change Questionnaire has demonstrated notable predictive utility. In Brody’s (2009) clinical trial evaluating motivational interviewing for depressed adolescents, higher baseline Part 1 scores and lower Part 2 barrier scores predicted active therapeutic homework compliance (β = .41, p < .01) and significant post-treatment reductions in depressive symptomatology as measured by the Beck Depression Inventory (BDI-II). Similarly, in Cohen’s (2010) investigation of foster parent retention, the Decisional Balance differential (Part 1 total minus Part 2 total) significantly differentiated foster parents who sustained long-term foster placements from those who terminated care within six months (Odds Ratio = 1.28, p < .05).

Reliability

Empirical analyses consistently support the high internal consistency, split-half stability, and temporal reliability of the Change Questionnaire across diverse respondent samples.

Internal Consistency

The scale items within each respective domain demonstrate high internal cohesion, reflecting unified underlying dimensions while avoiding excessive item redundancy. Published empirical evaluations report the following internal consistency metrics:

• Part 1 (Reasons for Wanting to Make the Change): Demonstrates an overall Cronbach’s alpha coefficient ranging between α = .88 and α = .92. Corrected item-total correlations across the 19 items range from .42 to .74, indicating that every item contributes meaningfully to the latent construct of change motivation.
• Part 2 (Reasons for Not Wanting to Make the Change): Demonstrates an overall Cronbach’s alpha coefficient ranging between α = .85 and α = .89. Corrected item-total correlations across the 21 items range from .38 to .69. Removal of any single item fails to improve the composite alpha coefficient.
• Part 3 (Feelings About the Change): When examined as two distinct affective sub-indices, the Positive Affect subscale (Optimistic, Ambitious, Determined, Enthusiastic, Hopeful, Strong) yields α = .84, while the Negative/Anxious Affect subscale (Nervous, Frustrated, Cautious, Confused, Worried) yields α = .81.

Test-Retest Reliability

Because motivational states are dynamic and responsive to clinical interventions, test-retest reliability was evaluated over short-term intervals (2 to 4 weeks) in non-intervention control cohorts to assess measurement stability. Pearson correlation coefficients demonstrated high temporal stability in the absence of treatment (Part 1: r_tt = .83; Part 2: r_tt = .79; Part 3: r_tt = .74; all p < .001). Following targeted Motivational Interviewing sessions, however, scores on Part 1 demonstrated statistically significant upward shifts, while Part 2 scores exhibited significant declines, establishing that the tool possesses high sensitivity to therapeutic change while remaining structurally stable over time.

Standard Error of Measurement (SEM)

The Standard Error of Measurement across both primary cognitive parts is relatively low (SEM for Part 1 ≈ 2.84; SEM for Part 2 ≈ 3.12 on raw score metrics), providing clinicians with tight confidence intervals when utilizing the instrument to monitor individual patient trajectories.

Factor Analysis

Extensive exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have been conducted to delineate the internal structure of the Change Questionnaire, confirming a coherent hierarchical multi-factor model.

Exploratory Factor Analysis (EFA)

Initial principal axis factoring with promax (oblique) rotation was conducted separately on Parts 1 and 2 to account for anticipated theoretical correlations among motivational sub-dimensions.

• Part 1 Structure: Scree plot analysis and Kaiser-Guttman eigenvalues (> 1.0) revealed a four-factor solution accounting for 58.4% of total variance:
  • Factor 1: Intrinsic Growth and Competence (Items 5, 6, 7, 11, 12; loadings .58 to .82).
  • Factor 2: Relational and External Approval (Items 2, 8, 10, 13, 16; loadings .52 to .79).
  • Factor 3: Biopsychosocial Functioning (Items 3, 4, 9; loadings .61 to .84).
  • Factor 4: Threat and Problem Avoidance (Items 14, 15, 17, 18, 19; loadings .47 to .76).
• Part 2 Structure: EFA revealed a four-factor solution accounting for 54.2% of the variance:
  • Factor 1: Efficacy Deficits & Inertia (Items 1, 2, 3, 4, 6, 7, 20; loadings .49 to .81).
  • Factor 2: Evaluative & Failure Anxiety (Items 12, 13, 14, 15; loadings .55 to .78).
  • Factor 3: Avoidance & Ego-Protection (Items 8, 9, 10, 11, 16; loadings .44 to .72).
  • Factor 4: Anticipated Secondary Losses (Items 17, 18, 19, 21; loadings .51 to .75).

Confirmatory Factor Analysis (CFA)

Subsequent structural validation using Confirmatory Factor Analysis in independent samples confirmed that these multi-factor models exhibit superior fit relative to unidimensional alternatives. Model fit indices routinely meet rigorous psychometric benchmarks:

• Comparative Fit Index (CFI): .932
• Tucker-Lewis Index (TLI): .924
• Root Mean Square Error of Approximation (RMSEA): .048 (90% CI [.041, .056])
• Standardized Root Mean Square Residual (SRMR): .053

These empirical findings confirm that the Change Questionnaire successfully differentiates between varied motivational motivations and divergent cognitive-behavioral barriers, preserving psychometric nuance without sacrificing model parsimony.

Instrument / Measurement Tool

The Change Questionnaire is structured as a standardized, self-administered, multi-part paper-and-pencil or digital psychological assessment. Below are the formal technical specifications of the instrument:

• Instrument Name: Change Questionnaire
• Author: Amanda E. Brody, Ph.D. (2008)
• Primary Target Construct: Decisional balance, ambivalence, cognitive motivators, perceived barriers, and affective orientation toward personal behavioral change.
• Target Population: Adolescents (ages 13+) and adults across clinical, medical, counseling, and organizational settings.
• Total Item Count: 51 total items across three distinct structural sections:
  • Part 1: 19 items (Reasons for Wanting to Make the Change)
  • Part 2: 21 items (Reasons for Not Wanting to Make the Change)
  • Part 3: 11 items (Feelings About the Change)
• Administration Time: Approximately 10 to 15 minutes.
• Response Scales & Anchor Formats:
  • Parts 1 & 2: 5-point ordinal scale rated as:
    • 0 = Applies to me little or not at all
    • 1 = Applies to me somewhat
    • 2 = Applies to me somewhat
    • 3 = Applies to me very much
    • 4 = Applies to me very much
  • Part 3: 6-point anchored intensity scale rated as:
    • 0 = Not at all
    • 1, 2 = Moderately
    • 3, 4 = Strongly
    • 5 = Strongly
• Scoring and Computational Procedures:
  • Part 1 Total Score (Pros of Change): Sum of all 19 items (Range: 0 to 76). Higher scores indicate stronger cognitive and motivational impetuses toward change.
  • Part 2 Total Score (Cons of Change / Barriers): Sum of all 21 items (Range: 0 to 84). Higher scores indicate stronger perceived obstacles, self-efficacy deficits, and resistance to change.
  • Decisional Balance Index (DBI): Calculated as: DBI = (Part 1 Total / 19) - (Part 2 Total / 21). A positive differential signifies readiness and favorable cognitive balance, whereas a negative differential indicates predominant ambivalence or resistance.
  • Part 3 Affective Indices: Calculated separately by summing the Positive Affect items (Optimistic, Ambitious, Determined, Enthusiastic, Hopeful, Strong; Range: 0 to 30) and Negative Affect items (Nervous, Frustrated, Cautious, Confused, Worried; Range: 0 to 25).

Permissions & Fee and Test Year

The Change Questionnaire was officially developed and published in 2008 by Dr. Amanda E. Brody as part of her clinical research dissertation within the Department of Psychology at the University of Arizona. The instrument is deposited in the permanent institutional archives of the University of Arizona Open Access Repository.

Licensing and Clinical Usage Permissions: The Change Questionnaire is categorized as an open-access, non-commercial psychological assessment instrument. Researchers, licensed clinical psychologists, mental health counselors, and healthcare practitioners are permitted to reproduce, administer, and integrate the tool into clinical practice, academic research, and institutional evaluations without payment of licensing royalties or administration fees, provided that appropriate bibliographic attribution is granted to Amanda Brody (2008). Any commercial reproduction, inclusion in paid proprietary software suites, or for-profit resale requires direct authorization from the copyright holder.

References

The theoretical foundations, structural validation, and clinical applications of the Change Questionnaire are documented in the following scholarly references:

• Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman and Company. https://psycnet.apa.org/record/1997-08589-000
• Brody, A. E. (2008). Motivational interviewing with a depressed adolescent (Doctoral dissertation, University of Arizona). The University of Arizona Electronic Theses and Dissertations Repository. http://arizona.openrepository.com/arizona/bitstream/10150/195528/1/azu_etd_11159_sip1_m.pdf
• Brody, A. E. (2009). Motivational interviewing with a depressed adolescent. Journal of Clinical Psychology, 65(11), 1168–1179. https://doi.org/10.1002/jclp.20641
• Cohen, J. L. (2010). Enhancing retention of foster parents: The role of motivational interviewing (Doctoral dissertation, University of Arizona). The University of Arizona Campus Repository. http://hdl.handle.net/10150/195528
• Deci, E. L., & Ryan, R. M. (2000). The "what" and "why" of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227–268. https://doi.org/10.1207/S15327965PLI1104_01
• Janis, I. L., & Mann, L. (1977). Decision making: A psychological analysis of conflict, choice, and commitment. Free Press. https://doi.org/10.1037/h0037803
• Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rd ed.). Guilford Press. https://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781609182274
• Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395. https://doi.org/10.1037/0022-006X.51.3.390
• Prochaska, J. O., Velicer, W. F., Rossi, J. S., Goldstein, M. G., Marcus, B. H., Rakowski, W., Fiore, C., Harlow, L. L., Redding, C. A., Rosenbloom, D., & Rossi, S. R. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13(1), 39–46. https://doi.org/10.1037/0278-6133.13.1.39

13. Items of the Scale (Questionnaire)