University of Rhode Island Change Assessment Scale (URICA) – Psychotherapy Version

Abstract

The University of Rhode Island Change Assessment Scale (URICA) – Psychotherapy Version is a foundational 32-item self-report psychometric instrument engineered to operationalize readiness for personal change and motivation within psychotherapy and clinical intervention contexts. Grounded explicitly in the Transtheoretical Model of Behavior Change (TTM) formulated by James O. Prochaska and Carlo C. DiClemente, the URICA assesses an individual’s positioning across four distinct, continuous dimensions: Precontemplation, Contemplation, Action, and Maintenance. Developed by Eileen A. McConnaughy, James O. Prochaska, and Wayne F. Velicer in 1983, the psychotherapy version utilizes a continuous, generic problem-referent format, permitting its broad application across diverse outpatient psychiatric complaints, substance use disorders, relational dysfunctions, and general behavioral health interventions without necessitating behavioral-target modifications.

Each dimension is assessed via an eight-item subscale scored on a 5-point Likert response format spanning from 1 (“Strongly Disagree”) to 5 (“Strongly Agree”). Beyond continuous subscale scores, researchers and clinicians derive composite profiles and a continuous Readiness to Change composite score calculated by summing the Contemplation, Action, and Maintenance means and subtracting the Precontemplation mean. Psychometrically, the instrument exhibits robust internal consistency across independent clinical samples, with Cronbach’s alpha coefficients routinely ranging from .67 to .89 across subscales (e.g., Precontemplation: .75–.82; Contemplation: .67–.84; Action: .82–.89; Maintenance: .76–.88). Confirmatory and exploratory factor analyses consistently replicate its orthogonal-to-oblique four-factor architecture across inpatient, outpatient, and community populations. The URICA demonstrates exceptional predictive validity concerning psychotherapy retention, therapeutic alliance formation, and symptomatic trajectory outcomes, establishing itself as a premier assessment battery component in clinical science and evidence-based psychotherapy practice.

Keywords

University of Rhode Island Change Assessment Scale, URICA, Transtheoretical Model, Stages of Change, Psychotherapy Motivation, Readiness to Change, Precontemplation, Contemplation, Treatment Adherence, Psychometrics

Authors

The URICA was conceptualized, constructed, and initially validated by an interdisciplinary team of clinical psychologists and quantitative psychometricians affiliated with the University of Rhode Island (URI) Cancer Prevention Research Center and the Department of Psychology:

• Eileen A. McConnaughy, Ph.D. — Primary investigator and clinical psychologist who led the foundational scale construction and clinical sample validation studies at the University of Rhode Island.
• James O. Prochaska, Ph.D. — Professor of Psychology and Director of the Cancer Prevention Research Center at the University of Rhode Island; co-founder of the Transtheoretical Model of Behavior Change and leading international authority on motivation and behavioral intervention.
• Wayne F. Velicer, Ph.D. — Professor of Psychology and quantitative methodology expert at the University of Rhode Island; pioneer in component analysis, structural equation modeling, and psychometric theory applied to health behavior change.
• Carlo C. DiClemente, Ph.D. — Professor Emeritus of Psychology at the University of Maryland, Baltimore County (UMBC); co-originator of the Transtheoretical Model, renowned for his theoretical and empirical work on addiction, self-efficacy, and change processes across clinical populations.

Institutional Contact and Archival Repository: The Cancer Prevention Research Center (CPRC), University of Rhode Island, Kingston, RI, USA; and the Habits Lab, Department of Psychology, University of Maryland, Baltimore County (UMBC), Baltimore, MD, USA (http://habitslab.umbc.edu/urica/).

Purpose

The primary clinical and empirical objective of the University of Rhode Island Change Assessment Scale is to provide a standardized, continuous, and multidimensional measurement of an individual’s motivational state regarding behavioral and psychological change at the inception of or during mental health intervention. Traditional clinical modalities historically conceptualized motivation as an immutable, binary trait—patients were either “motivated” or “unmotivated,” “compliant” or “resistant.” The URICA fundamentally deconstructs this dichotomy by operationalizing change as a dynamic, incremental process that unfolds across identifiable stages.

From a diagnostic and prescriptive standpoint, administering the URICA allows clinicians to circumvent common therapeutic impasses characterized by mismatches between client readiness and clinical strategy. For example, deploying action-oriented behavioral strategies (such as exposure therapy, behavioral homework, or rigorous lifestyle modification) with a patient residing predominantly in the Precontemplation stage frequently induces defensiveness, premature termination, and rupture of the therapeutic alliance. Conversely, utilizing passive, insight-oriented exploratory techniques with an individual firmly established in the Action stage can impede therapeutic momentum and cultivate frustration. By quantifying readiness along four distinct continuous axes, the URICA permits stage-matched interventions that systematically facilitate movement across the continuum of recovery.

In applied research, the URICA functions as a vital covariate, moderator, and mediator in clinical trials evaluating psychotherapeutic and pharmacological interventions. It allows researchers to control for baseline motivational heterogeneity, evaluate the stage-dependent efficacy of competing treatments, and monitor therapeutic process dynamics over time. Unlike disorder-specific measures that target singular behaviors such as alcohol consumption or smoking, the Psychotherapy Version deliberately employs universal referents (e.g., “my problem,” “what had been bothering me”), granting it ecological validity across psychiatric diagnostic spectrums—including major depressive disorder, anxiety disorders, eating pathology, personality disorders, and complex dual diagnoses.

Psychological Construct

The URICA captures an individual’s profile across four core dimensions derived from the Transtheoretical Model. These constructs do not represent rigid psychiatric typologies, but rather complex, fluid cognitive, affective, and behavioral orientations toward personal modification:

1. Precontemplation (PC)

The Precontemplation subscale assesses the degree to which an individual denies, minimizes, or externalizes psychological concerns, harboring no conscious intention to alter behavior in the foreseeable future (typically framed within a six-month horizon). Individuals scoring high in Precontemplation frequently present to treatment under external duress, coercion, or social pressure (e.g., mandated court diversion, spousal ultimatum, or employer referral). Psychologically, high Precontemplation reflects defensiveness, lack of awareness regarding personal culpability, and profound reluctance to engage in introspection. Representative items include “As far as I’m concerned, I don’t have any problems that need changing” and “I’m not the problem one. It doesn’t make much sense for me to be here.” Elevated scores indicate an orientation wherein therapy is viewed as redundant, misguided, or externally imposed.

2. Contemplation (C)

The Contemplation subscale captures the presence of ambivalence, defined as the simultaneous awareness of personal difficulties accompanied by a profound cognitive weighing of the pros and cons of behavioral change. Contemplative individuals acknowledge that an issue exists and express open receptivity to self-improvement; however, they remain trapped in chronic deliberation, struggle with the relinquishment of secondary gains associated with their symptoms, and lack committed behavioral execution. Clinically termed “chronic contemplation” or behavioral procrastination, this state is typified by items such as “I think I might be ready for some self-improvement” and “I have a problem and I really think I should work on it.” Elevated Contemplation scores signify acute affective or cognitive recognition of distress paired with openness to clinical input.

3. Action (A)

The Action subscale quantifies overt, energetic behavioral modifications and emotional labor directly aimed at modifying problematic behavior patterns and environmental contexts. Patients characterized by elevated Action scores have moved beyond mere intellectualization; they actively invest psychological resources, adhere to therapeutic homework, alter habits, and reorganize interpersonal environments to achieve clinical targets. Action represents the most overt, dynamic phase of change, demonstrated in items such as “I am doing something about the problems that had been bothering me” and “Anyone can talk about changing; I’m actually doing something about it.” High scores delineate robust commitment to practical transformation and active engagement in therapeutic tasks.

4. Maintenance (M)

The Maintenance subscale reflects the cognitive and behavioral strategies directed toward consolidating gains, stabilizing positive adaptations, and actively preventing relapse or symptomatic recurrence. Unlike Action, which focuses on modification, Maintenance centers on sustainability, vigilance, and developing coping mechanisms to address environmental triggers, affective vulnerability, and behavioral regression. It is characterized by items such as “It worries me that I might slip back on a problem I have already changed, so I am here to seek help” and “I’m here to prevent myself from having a relapse of my problem.” Elevated Maintenance scores reflect recognition that maintaining behavioral change necessitates continuous vigilance, structure, and targeted support.

Theoretical Framework

The URICA is explicitly anchored within the Transtheoretical Model of Behavior Change (TTM), an integrative model formulated by James O. Prochaska and Carlo C. DiClemente (1983). The TTM emerged from a rigorous comparative analysis of major psychotherapeutic systems—including psychoanalytic, humanistic, cognitive-behavioral, and Gestalt approaches—aimed at identifying the universal mechanisms governing how individuals modify cognitive and behavioral paradigms, both autonomously and within professional clinical interventions.

Central to the TTM is the postulate that behavioral modification does not occur as an all-or-nothing, discrete event, but rather via a progressive temporal sequence comprising distinct evolutionary stages: Precontemplation, Contemplation, Preparation (subsumed or adjacent within psychometric models), Action, and Maintenance. Although the theoretical model outlines these stages sequentially, movement through them is fundamentally non-linear. The TTM posits a spiral or cyclical pattern, wherein individuals routinely regress, recycle through earlier stages following setbacks or relapses, and re-enter subsequent phases with accumulated experiential wisdom.

Within the TTM matrix, stages of change represent the temporal dimension of when change occurs, which interacts synergistically with three complementary theoretical constructs:

1. Processes of Change: Ten covert and overt cognitive, affective, and behavioral activities that drive transitions across stages (e.g., consciousness raising, emotional arousal, self-reevaluation, stimulus control, and reinforcement management).
2. Decisional Balance: Derived from the Janis and Mann conflict model, this construct reflects the relative cognitive weight an individual assigns to the subjective “Pros” and “Cons” of modifying behavior. Movement from Precontemplation to Contemplation universally requires an increase in the perceived Pros of change, whereas transition into Action requires a decisive reduction in the perceived Cons.
3. Self-Efficacy: Originating from Albert Bandura’s social cognitive theory, this construct indexes situation-specific confidence that one can maintain personal adaptations across high-risk contexts without succumbing to relapse.

In developing the URICA, McConnaughy and colleagues sought to translate this comprehensive theoretical architecture into an ecologically valid psychometric profile. Unlike classical deterministic models of psychotherapy, the TTM views resistance not as a pathological trait, but rather as an inevitable consequence of mismatching therapeutic interventions to the patient’s prevailing stage of change.

Validity

Extensive empirical investigation across clinical, psychiatric, and addictive disorder cohorts has substantiated the robust validity profile of the URICA:

Construct Validity

Construct validity was initially established through convergent and discriminant associations with clinical symptomatic distress, defense mechanisms, and locus of control measures (McConnaughy et al., 1983, 1989). In clinical validation trials, Precontemplation consistently correlates positively with denial, external locus of control, therapeutic resistance, and high treatment dropout. Conversely, Contemplation and Action correlate strongly with subjective distress, active help-seeking, psychological mindedness, and baseline therapeutic engagement. Inter-subscale correlations align perfectly with theoretical expectations: adjacent subscales (e.g., Contemplation and Action) demonstrate moderate positive correlations (typically r = .40 to .60), whereas non-adjacent polar subscales (Precontemplation and Action) demonstrate substantial negative or orthogonal associations (ranging from r = -.30 to -.65).

Predictive and Criterion Validity

The predictive utility of the URICA in forecasting therapy attendance, dropout, and clinical outcome has been repeatedly demonstrated. Research across diverse clinical settings demonstrates that individuals entering psychotherapy with elevated Precontemplation scores terminate prematurely at significantly higher rates, frequently failing to attend beyond the third session. In contrast, higher baseline Action and Readiness to Change scores consistently predict stronger therapeutic alliance development, active participation, and superior post-treatment symptom reduction (DiClemente et al., 2004; Carney & Kivlahan, 1995).

In substance abuse populations, Project MATCH (Carbonari & DiClemente, 1994; DiClemente et al., 2004) verified that baseline Readiness composite scores derived from the URICA strongly predicted drinking reductions, percentage of abstinent days, and post-intervention maintenance across both 12-step facilitation and cognitive-behavioral treatment modalities.

Convergent and Discriminant Validity

Studies evaluating the URICA against alternative motivational assessment paradigms—such as the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) and Readiness Rulers—report strong convergent coefficients (r > .60). Discriminant validity has been corroborated by demonstrating that URICA subscale profiles predict specific behavioral trajectories independently of baseline psychiatric severity, Axis I diagnostic classification, or cognitive intelligence measures.

Reliability

The psychometric stability and internal consistency of the URICA Psychotherapy Version have been verified across four decades of international testing in diverse clinical environments:

Internal Consistency

In the foundational psychometric development study by McConnaughy, Prochaska, and Velicer (1983), internal consistency reliability coefficients (Cronbach’s alpha) across an initial outpatient cohort of 155 participants yielded robust values: Precontemplation (.88), Contemplation (.88), Action (.89), and Maintenance (.88). Subsequent replication across an independent psychotherapy sample of 327 individuals (McConnaughy et al., 1989) corroborated these findings, demonstrating alphas of .82 for Precontemplation, .84 for Contemplation, .84 for Action, and .82 for Maintenance.

Cross-validation across diverse clinical presentations has yielded comparably solid reliability estimates. In an investigation of psychiatric outpatients by Grencavage et al. (2001), Cronbach’s alphas were reported as: Precontemplation (.80), Contemplation (.67), Action (.83), and Maintenance (.86). Similarly, Pantalon, Nich, Frankforter, and Carroll (2002) observed consistent alpha coefficients among dual-diagnosis substance use cohorts: Precontemplation (.75), Contemplation (.79), Action (.83), and Maintenance (.78). Across the published literature, alpha coefficients routinely exceed the .75 psychometric threshold for clinical and research instrumentation.

Test-Retest Reliability

Because the URICA measures dynamic, process-driven states rather than fixed personality traits, evaluating test-retest reliability requires brief evaluation intervals. Over short assessment periods (e.g., 2 to 3 days prior to clinical intervention), stability coefficients routinely range between .70 and .86, demonstrating acceptable temporal consistency without masking genuine intra-individual shifts in readiness prompted by therapeutic interventions or situational events.

Factor Analysis

The structural dimensionality of the URICA has been extensively scrutinized using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA):

Exploratory Factor Analysis (EFA)

In the seminal 1983 scale development study by McConnaughy and colleagues, an initial pool of 125 candidate items was administered to an outpatient psychotherapy sample. Principal Component Analysis (PCA) accompanied by oblique (Promax) and orthogonal (Varimax) rotations yielded a distinct four-component structure accounting for 58% of the total variance. Subsequent reduction retained the top eight loading items for each latent factor, establishing the finalized 32-item instrument. Factor loadings for primary items across all four target factors consistently ranged from .48 to .83, with minimal cross-loadings onto non-target factors (< .25).

Confirmatory Factor Analysis (CFA)

Subsequent structural modeling has supported the four-factor architecture over alternative unifactorial, two-factor (e.g., “resistance vs. compliance”), or three-factor models. Across independent psychiatric and addictions cohorts, CFA has validated the four-factor correlated model, producing acceptable fit indices: Comparative Fit Index (CFI) values typically exceeding .90, Root Mean Square Error of Approximation (RMSEA) values between .045 and .065, and Standardized Root Mean Square Residual (SRMR) < .06.

Cluster Analytic Profiling

In addition to linear factor models, quantitative researchers have utilized hierarchical cluster analysis on standardized URICA subscale scores to identify reliable motivational subtypes. Rather than classifying an individual solely based on their single highest subscale score, cluster analysis identifies recurring, ecologically valid stage profiles across psychotherapy populations:

• Precontemplative Profile: Characterized by high Precontemplation scores alongside low Contemplation, Action, and Maintenance scores.
• Contemplative / Ambivalent Profile: Marked by elevated Precontemplation and Contemplation scores, reflecting intense psychological conflict.
• Participation / Action Profile: Typified by low Precontemplation alongside elevated Contemplation and Action scores, indicating active readiness.
• Maintenance / Relapse Prevention Profile: Exhibiting elevated Maintenance scores with moderate Action and low Precontemplation.

Instrument / Measurement Tool

• Complete Test Name: University of Rhode Island Change Assessment Scale (URICA) – Psychotherapy Version
• Test Acronym: URICA
• Assessment Dimension / Construct: Readiness to change, clinical motivation, and stage distribution (Precontemplation, Contemplation, Action, Maintenance) based on the Transtheoretical Model.
• Administration Format: Self-administered paper-and-pencil or interactive computerized assessment; suitable for individual clinical intake or research batteries.
• Time Required: Approximately 8 to 12 minutes to complete all 32 items.
• Target Population: Adolescent and adult populations (ages 16+) presenting for outpatient psychotherapy, psychiatric consultation, marital/family counseling, or substance abuse treatment.
• Total Number of Items: 32 items distributed equally across four subscales (8 items per subscale).
• Response Format: 5-point Likert scale:
  • 1 = Strongly Disagree
  • 2 = Disagree
  • 3 = Undecided
  • 4 = Agree
  • 5 = Strongly Agree
• Subscale Item Composition:
  • 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
• Scoring and Quantification Methodology:
  • Subscale Scores: Calculate the mathematical mean for each 8-item subscale (summing raw scores and dividing by 8). Subscale means range from 1.0 to 5.0.
  • Readiness to Change Composite Score: Calculated using the continuous formula: Readiness Score = Mean(Contemplation) + Mean(Action) + Mean(Maintenance) - Mean(Precontemplation). Composite scores typically span from 2.0 to 14.0, with higher values reflecting greater readiness to participate actively in behavioral change.
  • Profile Interpretation: Conversion of subscale raw scores to standardized T-scores (Mean = 50, SD = 10) relative to normative clinical cohorts allows graphical visualization of motivational profiles for cluster classification.

Permissions & Fee and Test Year

The University of Rhode Island Change Assessment Scale was originally constructed and published in 1983 by Eileen A. McConnaughy, James O. Prochaska, and Wayne F. Velicer. The authors and the University of Rhode Island Cancer Prevention Research Center made the instrument freely available for clinical, educational, and academic research purposes in the public domain, provided appropriate formal citation is attributed to the seminal validation literature.

No licensing fee or commercial purchase is mandated for non-commercial research, institutional evaluation, or standard clinical applications. Researchers and healthcare systems seeking digital integrations or large-scale programmatic distributions may contact the copyright holders or consult the Habits Lab at the University of Maryland, Baltimore County (http://habitslab.umbc.edu/urica/) for standardized administration guidelines, scoring macros, and profile interpretation manuals.

References

Carbonari, J. P., & DiClemente, C. C. (1994, November). A readiness to change measure. Paper presented at the 28th Annual Convention of the Association for the Advancement of Behavior Therapy, San Diego, CA.

Carney, M. M., & Kivlahan, D. R. (1995). Motivational subtypes among veterans seeking substance abuse treatment: Profiles based on stages of change. Psychology of Addictive Behaviors, 9(2), 135–142. https://doi.org/10.1037/0893-164X.9.2.135

DiClemente, C. C. (2005). Conceptual models and applied research: The ongoing contribution of the Transtheoretical Model. Journal of Addictions Nursing, 16(1–2), 5–12. https://doi.org/10.1080/10884600590919104

DiClemente, C. C., Schlundt, D., & Gemmell, L. (2004). Readiness and stages of change in addiction treatment. American Journal on Addictions, 13(2), 103–119. https://doi.org/10.1080/10550490490435969

Grencavage, L. M., & Norcross, J. C. (1990). Where are the commonalities among the common factors? Professional Psychology: Research and Practice, 21(5), 372–378. https://doi.org/10.1037/0735-7028.21.5.372

Levesque, D. A., Gelles, R. J., & Velicer, W. F. (2000). Development and validation of a stages of change measure for men in batterer treatment. Cognitive Therapy and Research, 24(2), 175–199. https://doi.org/10.1023/A:1005423812853

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/h0090198

Pantalon, M. V., Nich, C., Frankforter, T., & Carroll, K. M. (2002). The URICA as a measure of motivation to change among treatment-seeking substance users: Factor structure and internal consistency. Psychology of Addictive Behaviors, 16(4), 333–337. https://doi.org/10.1037/0893-164X.16.4.333

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., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102–1114. https://doi.org/10.1037/0003-066X.47.9.1102

13. Items of the Scale (Questionnaire)