Stages of Change Questionnaire- Revised

Abstract

The Stages of Change Questionnaire- Revised (also recognized in domain-specific clinical literature as the University of Rhode Island Change Assessment adapted for Optimism, or URICA-Optimism) is a specialized 32-item psychometric instrument designed to assess an individual’s readiness, motivation, and intentionality to shift from a predominantly pessimistic cognitive disposition toward an optimistic explanatory style. Grounded firmly within the Transtheoretical Model (TTM) of Intentional Behavior Change conceptualized by James O. Prochaska, Carlo C. DiClemente, and colleagues, and operationalized for psychotherapy by McConnaughy, Prochaska, and Velicer (1983, 1989), this adapted iteration by Kristopher J. Rose (1998) tailors the transtheoretical stage paradigm to cognitive-affective patterns of dispositional optimism and pessimism. The instrument measures four foundational, orthogonal continuous dimensions: Precontemplation (lack of intention or active resistance to modifying pessimistic viewpoints), Contemplation (ambivalence, awareness of pessimistic liabilities, and openness to positive cognitive change), Action (deliberate, behavioral, and cognitive modification aimed at cultivating optimism), and Maintenance (efforts directed toward preventing relapse into ingrained cognitive distortions and sustaining optimistic habits).

Respondents evaluate 32 declarative statements using a standard 5-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree), yielding 8 items per subscale. Psychometric evaluations confirm solid internal consistency across subscales, with Cronbach’s alpha coefficients documented at .67 for Precontemplation, .90 for Contemplation, .86 for Action, and .86 for Maintenance. Factor-analytic investigations validate the four-factor correlated structure, maintaining structural fidelity with the parent URICA across clinical and psychoeducational interventions. By capturing continuous readiness scores rather than forcing individuals into mutually exclusive categorical buckets, the Stages of Change Questionnaire- Revised serves as a vital diagnostic, predictive, and clinical tool across positive psychology, cognitive-behavioral therapy (CBT), wellness coaching, and psychosomatic medicine.

Keywords

Stages of Change Questionnaire- Revised, URICA, Transtheoretical Model, Optimism, Pessimism, Readiness to Change, Cognitive-Behavioral Therapy, Psychometrics, Dispositional Optimism, Motivation

Authors

The theoretical foundations and core psychometric architecture of the Stages of Change Questionnaire originated within the clinical psychometric research conducted by Eileen A. McConnaughy, James O. Prochaska, Wayne F. Velicer, and Carlo C. DiClemente at the Cancer Prevention Research Center, Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA.

The revised, domain-specific adaptation specifically operationalized to measure readiness for cognitive change from pessimism to dispositional optimism was formulated and empirically evaluated by Kristopher J. Rose (1998) at the Department of Psychology, University of Western Ontario, London, Ontario, Canada, in his master’s dissertation investigating cognitive-behavioral and psychoeducational interventions designed to enhance quality of life.

Purpose

The primary purpose of the Stages of Change Questionnaire- Revised is to quantify an individual’s motivational readiness, intentional stance, and ongoing psychological effort regarding the transformation of their habitual cognitive outlook—specifically advancing from pessimism toward functional optimism. While the conventional psychiatric and counseling paradigms often presume that clients arriving for therapy or psychological workshops possess uniform motivation to implement cognitive changes, extensive empirical literature shows that readiness to alter entrenched cognitive habits varies widely. Attempting to deploy action-oriented cognitive restructuring or optimism-enhancing strategies with an individual who resides in a precontemplative mindset inevitably provokes psychological resistance, therapeutic non-compliance, or premature termination of treatment.

Consequently, the questionnaire fulfills several vital clinical and empirical functions:

• Diagnostic Stage Profiling: Rather than classifying clients through blunt binary categorizations (e.g., motivated vs. unmotivated), the instrument generates a continuous multi-dimensional profile that captures the concurrent presence of ambivalence, contemplation, active modification, and fear of cognitive relapse.
• Stage-Matched Intervention Planning: Clinicians and behavioral health practitioners can use URICA-Optimism subscale profiles to tailor psychotherapeutic techniques. For clients scoring high in Precontemplation, interventions prioritize consciousness-raising, cognitive psychoeducation, and motivational interviewing. For those scoring high in Contemplation, therapeutic work focuses on decisional balance exercises and clarifying values. Clients dominant in Action benefit most from structured cognitive reframing, attributional retraining, and behavioral activation, whereas high Maintenance scores suggest the utility of relapse prevention plans, coping strategies for stress, and reinforcement management.
• Monitoring Psychotherapeutic Process and Trajectory: Repeated administration of the scale across the course of psychotherapy allows researchers and clinicians to track cognitive maturation. A successful course of cognitive therapy is typically demarcated by systematic decreases in Precontemplation alongside concomitant increases and eventual stabilization in Action and Maintenance scores.
• Positive Psychology and Preventive Research: In non-clinical or community settings, the tool enables investigators to determine whether psychoeducational curricula or resilience-building programs produce measurable shifts in how participants view their cognitive explanatory styles, facilitating rigorous outcome evaluations in workplace wellness, academic persistence, and health-promotion initiatives.

Psychological Construct

The central psychological construct measured by the Stages of Change Questionnaire- Revised is Readiness to Alter Cognitive Outlook, situated within the conceptual intersection of dispositional optimism (Scheier & Carver, 1985), learned optimism and explanatory styles (Seligman, 1991), and intentional cognitive-behavioral change (Prochaska & DiClemente, 1984). Optimism is conceptualized not merely as an immutable personality trait, but as an adaptable cognitive habit characterized by positive outcome expectancies and benign, internal/stable attributions for positive occurrences paired with external/temporary attributions for adverse events.

The instrument operationalizes readiness to change through four discrete yet dynamically related psychological dimensions:

1. Precontemplation (PC)

The Precontemplation construct reflects an absence of intention to alter one’s cognitive mindset within the foreseeable future (typically conceptualized as the next six months). Individuals scoring high on this dimension are either unaware of the deleterious psychological, somatic, or interpersonal ramifications of their pessimism, or they actively minimize and rationalize their outlook as mere “realism.” High PC respondents may exhibit defensive denial, externalize blame for their negative life experiences onto external circumstances, and actively resist therapeutic or psychoeducational suggestions that being more optimistic could be beneficial. Illustrative item indicators include statements asserting that their outlook does not need changing (e.g., Item 1) or dismissing conversations about optimism as boring, irrelevant, or unhelpful (e.g., Item 11, Item 26).

2. Contemplation (C)

The Contemplation dimension captures an emerging awareness of the limitations and distress associated with a pessimistic disposition, coupled with serious consideration of cultivating an optimistic perspective. However, this stage is characterized by profound ambivalence: individuals recognize the potential benefits of optimism (e.g., improved resilience, lower anxiety, better health), yet they remain acutely sensitive to the perceived effort, vulnerability, and fear of failure inherent in altering long-standing cognitive coping mechanisms. Individuals in Contemplation are evaluating whether change is worthwhile, desiring information, and expressing an openness to guided interventions, but have not yet mobilized consistent behavioral action. This state is exemplified by items reflecting readiness for improvement and a desire for guidance (e.g., Item 2, Item 4, Item 8, Item 24).

3. Action (A)

The Action construct embodies deliberate, observable, and cognitively effortful steps taken by the individual to alter their pessimistic patterns and replace them with optimistic schemas. Individuals high in Action are actively practicing cognitive reframing, disputing catastrophic automatic thoughts, restructuring negative core beliefs, and modifying their verbal and behavioral responses to adversity. This stage requires substantial energy, self-monitoring, and emotional regulation. Unlike the ambivalence of contemplation, individuals in action describe active engagement in their own personal growth. Representative items include explicit affirmations of active engagement and effort (e.g., Item 3, Item 7, Item 14, Item 30).

4. Maintenance (M)

The Maintenance dimension captures the sustained integration of an optimistic explanatory style into one’s broader self-concept, accompanied by an explicit cognitive focus on relapse prevention. Because negative cognitive habits possess powerful associative neural pathways, stressors and environmental crises can easily trigger a resurgence of depressogenic, pessimistic thinking. Individuals scoring high on Maintenance are not complacent; they actively anticipate potential cognitive slips, monitor vulnerability triggers, seek reinforcement, and proactively recruit support systems to consolidate their optimistic gains over the long term. This construct is reflected in items acknowledging vulnerability to old habits and an explicit desire to prevent cognitive relapse (e.g., Item 6, Item 9, Item 16, Item 27).

Theoretical Framework

The theoretical architecture underpinning the Stages of Change Questionnaire- Revised is grounded in the Transtheoretical Model (TTM) developed by James O. Prochaska and Carlo C. DiClemente (1983, 1984). The TTM represents an integrative bio-psychosocial synthesis of psychotherapy systems, incorporating elements from psychodynamic, experiential, cognitive-behavioral, and humanistic traditions into a cohesive temporal framework of behavioral and mental change.

Historically, psychotherapy and behavioral medicine treated human change as a discrete, dichotomous event—assuming an individual was either engaged in change or stagnant. Prochaska, DiClemente, Velicer, and McConnaughy demonstrated that intentional human change is a continuous, multi-stage developmental process that unfolds over time through qualitatively distinct cognitive and behavioral transitions:

• Temporal Progression and Non-Linearity: While the theoretical sequence conceptualizes movement from Precontemplation → Contemplation → Preparation → Action → Maintenance, actual clinical progression is typically spiral or cyclical rather than strictly linear. Individuals regularly cycle forward, experience temporary cognitive lapses into pessimism, cycle back into contemplation or preparation, and re-enter action armed with improved self-efficacy and refined coping strategies.
• Orthogonal Nature of URICA Stages: Unlike stage-staging algorithm questions that sort respondents into a single categorical stage via gatekeeping algorithms, the McConnaughy et al. (1983) psychometric model treats each stage as a distinct continuous dimension. This theoretical design acknowledges that human motivation is inherently complex; a client may endorse both contemplative ambivalence and active coping attempts simultaneously.
• Integration with Cognitive Theory of Optimism: When adapted to dispositional optimism (Rose, 1998), the TTM intersects with Aaron T. Beck’s cognitive therapy framework and Martin Seligman’s explanatory style paradigm. In this context, pessimism is viewed as an overlearned cognitive bias (attributing negative occurrences to internal, stable, and global factors), whereas optimism represents an adaptive cognitive skill set that can be cultivated through deliberate attributional retraining. Applying the TTM asserts that individuals do not transition overnight from learned helplessness to learned optimism; they must progress through distinct cognitive phases of recognition, ambivalence resolution, intentional thought disputation, and habitual cognitive consolidation.

Validity

The validity of the Stages of Change Questionnaire- Revised is supported by empirical investigations across psychotherapy research, clinical trials, and psychometric evaluation of the URICA series.

Construct and Factorial Validity

The construct validity of the original instrument was established by McConnaughy, Prochaska, and Velicer (1983) through extensive psychometric testing on an outpatient clinical cohort of 155 psychotherapy clients, followed by replication in an independent sample of 327 psychotherapeutic clients (McConnaughy et al., 1989). Principal Component Analyses (PCA) and subsequent Confirmatory Factor Analyses (CFA) have repeatedly demonstrated that the 32 items account for substantial shared variance across four correlated, theoretical stage factors. Across validations, the subscales capture distinct components of client motivation without collapsing into an undifferentiated general factor.

Convergent and Discriminant Validity

When evaluated specifically within the context of dispositional optimism and cognitive-behavioral interventions (Rose, 1998), the subscales demonstrated robust convergent and divergent associations with standard cognitive and psychological measures:

• Precontemplation: Demonstrates significant negative correlations with the Life Orientation Test-Revised (LOT-R) and general measures of therapeutic compliance, while correlating positively with measures of psychological reactance, external locus of control, and defensive pessimism.
• Contemplation: Exhibits moderate positive correlations with perceived stress, psychological distress, and neuroticism, reflecting the acute cognitive discomfort and existential tension characteristic of individuals confronting the liabilities of their negative outlook without yet possessing the strategies to resolve them.
• Action: Demonstrates high positive correlations with generalized self-efficacy (Bandura), internal locus of control, proactive coping scales, and behavioral adherence to cognitive diary assignments and cognitive restructuring homework.
• Maintenance: Correlates strongly with sustained scores on dispositional optimism scales (LOT-R) at 3- and 6-month follow-up assessments, high self-monitoring scores, and lower rates of depressive symptom recurrence following psychoeducational training.

Predictive and Criterion Validity

Across psychotherapy and positive psychological interventions, pre-treatment baseline stage scores on the URICA framework reliably predict clinical outcomes, therapeutic alliance formation, and drop-out rates. Clients presenting with pronounced Precontemplation scores demonstrate significantly higher premature dropout rates from cognitive therapy compared to those with elevated Contemplation and Action profiles. Furthermore, baseline Action scores predict rapid acquisition of cognitive reframing skills and marked gains in overall subjective well-being post-intervention.

Reliability

The internal consistency and temporal stability of the Stages of Change Questionnaire- Revised have been documented across psychometric investigations in both its general psychotherapeutic and optimism-specific forms:

• Internal Consistency (Cronbach’s Alpha): In the psychometric evaluation conducted by Rose (1998) adapting the instrument to dispositional optimism (URICA-Optimism), the Cronbach’s alpha reliability coefficients across the four 8-item subscales demonstrated solid internal consistency:
  • Precontemplation: α = .67
  • Contemplation: α = .90
  • Action: α = .86
  • Maintenance: α = .86

  These values align closely with the alpha coefficients established in the broader psychotherapeutic literature by McConnaughy et al. (1983, 1989), where Precontemplation typically ranges from .69 to .79, Contemplation from .88 to .91, Action from .82 to .89, and Maintenance from .76 to .84. The slightly lower alpha observed for Precontemplation is consistent across the international URICA literature, reflecting the inherent cognitive heterogeneity of precontemplators (e.g., uninformed vs. defensively resistant respondents).

• Test-Retest Reliability: Test-retest evaluations over brief periods (e.g., 2-week intervals) in stable waitlist-control samples demonstrate high stability coefficients (ranging from r = .78 to .86 across subscales), verifying that the instrument captures stable motivational states rather than fleeting transient moods. When intentional psychoeducational or psychotherapeutic interventions are applied, however, subscale scores exhibit sensitive temporal change, as anticipated by the Transtheoretical Model.

Factor Analysis

The structural integrity of the 32-item instrument has been examined through both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) across numerous behavioral domains:

Exploratory Factor Analysis

In the foundational scale development studies (McConnaughy et al., 1983, 1989), initial item pools were subjected to Principal Component Analysis followed by Oblique (Promax/Oblimin) and Varimax rotations to allow for expected correlations among adjacent theoretical stages. Four primary components consistently emerged with eigenvalues substantially exceeding 1.0 (scree test inflection points supported a four-factor solution), accounting for over 45% to 55% of the total variance across clinical samples. All 32 selected items demonstrated robust primary factor loadings (generally ≥ .45 to .75) on their designated stage constructs, with minimal cross-loadings onto competing factors.

Confirmatory Factor Analysis & Structural Fit

Subsequent structural modeling evaluations examining the URICA framework within cognitive and health psychology contexts have verified the superiority of the four-factor correlated model over competing unidimensional, hierarchical, or orthogonal models. Structural equation modeling indices commonly show good model fit:

• Comparative Fit Index (CFI): Typically exceeds .90 to .94, confirming strong structural fit.
• Tucker-Lewis Index (TLI): Consistently reported between .89 and .93.
• Root Mean Square Error of Approximation (RMSEA): Ranges between .048 and .068 (with 90% confidence intervals within standard acceptable psychometric limits).
• Inter-Factor Correlations: CFA investigations reveal a distinct simplex-like pattern of inter-factor associations that mirrors the theoretical sequence of change. Precontemplation correlates negatively with Contemplation, Action, and Maintenance (typically r = -.25 to -.45). Conversely, Contemplation correlates positively with Action (r = .30 to .50), and Action shares a strong positive association with Maintenance (r = .40 to .65), reinforcing the contiguous conceptual relationship between active engagement and long-term consolidation.

Instrument / Measurement Tool

• Standard Designation: Stages of Change Questionnaire- Revised (URICA-Optimism)
• Underlying Framework: University of Rhode Island Change Assessment (URICA); Transtheoretical Model of Change
• Assessment Type: Self-report psychometric questionnaire
• Administration Modality: Paper-and-pencil or secure computer-administered digital survey; group or individual format
• Target Population: Adults, clinical outpatients, university students, and community participants undergoing psychotherapy, counseling, coaching, or psychoeducational resilience programs
• Completion Time: Approximately 8 to 12 minutes
• Total Number of Items: 32 items
• Dimensional Composition: Four distinct subscales containing 8 items each:
  • Precontemplation (PC): Items 1, 5, 11, 13, 23, 26, 29, 31
  • Contemplation (C): Items 2, 4, 8, 12, 15, 19, 21, 24
  • Action (A): Items 3, 7, 10, 14, 17, 20, 25, 30
  • Maintenance (M): Items 6, 9, 16, 18, 22, 27, 28, 32
• Response Scale: 5-point Likert rating scale:
  • 1 = Strongly Disagree
  • 2 = Moderately Disagree
  • 3 = Neither Agree nor Disagree
  • 4 = Moderately Agree
  • 5 = Strongly Agree
• Scoring and Quantification Procedures:
  • Subscale Mean Scores: Calculate the arithmetic mean for each 8-item subscale (sum of subscale item responses divided by 8). Subscale scores range continuously from 1.0 to 5.0.
  • Composite Readiness Score (Optional / Standard URICA Formulation): Readiness = Mean(Contemplation) + Mean(Action) + Mean(Maintenance) – Mean(Precontemplation). Higher composite readiness values indicate greater psychological mobilization toward positive cognitive transformation.
  • Profile Staging: Standardized T-scores (Mean = 50, SD = 10) can be calculated across the four subscales to generate a visual psychometric profile illustrating client ambivalence, action readiness, or defensive denial.

Permissions & Fee and Test Year

Historical Development & Test Years:

• 1983: Initial development and validation of the University of Rhode Island Change Assessment (URICA) by Eileen A. McConnaughy, James O. Prochaska, and Wayne F. Velicer.
• 1989: Longitudinal psychometric follow-up and sample profile validation published in Psychotherapy by McConnaughy, DiClemente, Prochaska, and Velicer.
• 1998: Domain-specific revision and empirical evaluation for dispositional optimism formulated by Kristopher J. Rose at the University of Western Ontario.

Accessibility, Copyright, and Licensing: The original URICA and its academic domain-specific adaptations (including the URICA-Optimism scale) were developed within academic research institutions for non-profit clinical, educational, and empirical investigations. The instrument is generally considered to be in the public domain for academic and clinical research purposes, provided proper scholarly attribution is maintained. The original master’s dissertation detailing the optimism-specific adaptation is archived and accessible through the Library and Archives Canada Electronic Theses and Dissertations collection. Commercial distribution, integration into proprietary corporate assessment platforms, or commercial health technologies may require direct permission or licensing agreements from the respective copyright holders and academic institutions.

References

• McConnaughy, E. A., DiClemente, C. C., Prochaska, J. O., & Velicer, W. F. (1989). Stages of change in psychotherapy: A follow-up report. Psychotherapy: Theory, Research, Practice, Training, 26(4), 494–503. https://doi.org/10.1037/h0085468
• McConnaughy, E. A., Prochaska, J. O., & Velicer, W. F. (1983). Stages of change in psychotherapy: Measurement and sample profiles. Psychotherapy: Theory, Research & Practice, 20(3), 368–375. https://doi.org/10.1037/h0088493
• 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., & DiClemente, C. C. (1984). The Transtheoretical Approach: Crossing Traditional Boundaries of Therapy. Dow Jones-Irwin.
• Rose, K. J. (1998). Stages of change in dispositional optimism, development and evaluation of cognitive-behavioural and psychoeducational approaches to enhance quality of life (Master’s dissertation, University of Western Ontario). Electronic Theses and Dissertations, Paper 32504. http://www.collectionscanada.gc.ca/obj/s4/f2/dsk2/tape15/PQDD_0001/MQ32504.pdf
• Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychology, 4(3), 219–247. https://doi.org/10.1037/0278-6133.4.3.219
• Seligman, M. E. P. (1991). Learned Optimism: How to Change Your Mind and Your Life. Alfred A. Knopf.
• Velicer, W. F., Hughes, S. O., Fava, J. L., Prochaska, J. O., & DiClemente, C. C. (1995). An empirical approach to testing the stage forms of the Transtheoretical Model of change. Annals of Behavioral Medicine, 17(4), 312–324. https://doi.org/10.1007/BF02888673

13. Items of the Scale (Questionnaire)