THE IMPORTANCE OF MAKING EXPLICIT LINKS BETWEEN THEORETICAL CONSTRUCTS AND BEHAVIOUR CHANGE TECHNIQUES

Responding to our review of behaviour change theories [1], Latkin [2]argues that current psychological theories of behaviour change are typically individualistic and emphasize decision-making and cognitive processes. Addictive behaviours, in contrast, require both physiological and social factors to be taken into account. We agree with this observation and note that there is increasing theoretical understanding of the role of associative, non-reflective processes that lead to habitual and emotionally driven behaviours. Examples of these are parallel process models [3], Bargh's concept of automaticity [4], in which the environment can prime particular responses outside conscious awareness, and West's PRIME theory which focuses upon how dispositions to experience powerful impulses develop and how these dispositions are expressed in particular situations [5]. Because our paper did not focus upon unconscious influences on behaviour (see footnote 1), a complementary review of associative and emotion-orientated theories would be welcome.

Our review used control theory (CT) as a framework for organizing theories of behaviour change. This theory has proved an influential ‘meta’-framework for understanding self-regulation [6]. CT's forebear, perceptual control theory, is also gaining support in other domains (e.g. clinical psychology [7]). Several recent reviews of behavioural interventions also suggest that manipulating key components of CT has demonstrable effects on behaviour change [8,9]

Borland [10] argues for a distinction between motivational factors and self-regulatory capacity and skills. This distinction has been adopted widely in health psychology [11–13]. For addictive behaviours, it has been used to classify behaviour change techniques (BCTs) in smoking cessation interventions, where 12 BCTs were categorized reliably as motivational and 14 as self-regulatory [14].

Borland also highlights the need to clearly conceptualize and differentiate overlapping theoretical constructs. To address this issue, a consensus study simplified and integrated 131 identified constructs from 33 theories of behaviour and behaviour change into 12 theoretical domains [15]. These have been mapped subsequently to BCTs identified from a wide literature as part of an ongoing programme of work [16].

A similar question has been addressed using factor analysis; 12 factors underlying efforts at behaviour change were identified, five of which (motivation, task focus, implementation intentions, social support and subjective norms) discriminated between people who changed and those who did not [17].

Willemsen & de Vries [18] draw attention usefully to a body of work relating intervention components to theoretical determinants of behaviour. This is highly relevant to the field of addiction, but we would argue for more rigorous linking of theoretical constructs and BCTs than has been undertaken hitherto in order to strengthen our interventions and theoretical understanding. This will require improved methods. Borland suggests that we focus upon intervention components rather than the theories from which they originate. Our view is that these are not either/or, and understanding the link between the two is key to advancing the science of behaviour change [19].

Declarations of interest

None.