The headline of this article may be reminiscent of alphabet soup. Health psychologists and behavioral scientists can be quick to toss out abbreviations that appear to be endless streams of letters linked together in seemingly random, confusing patterns including BCTs (behavior change techniques), MI (motivational interviewing), and CBT (cognitive behavioral therapy). Unless you’ve read up on the topics, you may find yourself wondering what it all means, and…why you should care.
Just like the ABCs are the foundation of reading, writing, and communication, BCTs can be seen to be the building blocks for successful patient self-management and optimal treatment adherence. Similar to the way in which letters are combined to create a variety of words, phrases, and sentences, BCTs can be combined in a variety of ways to create endless options of interventions that can be used in patient support programs.
A behavior change technique has been formally described as an observable and replicable component of an intervention designed to change behavior. In layman’s terms, BCTs are methods of altering beliefs, attitudes, and other determinants of behavior. They can enable people to:
- Think and feel differently about the behavior
- Learn new skills to help perform the behavior, and
- Restructure the environment to help support the behavior.
Common BCTs you may have encountered include:
- “goal setting”
- “pros and cons”
- “problem solving”
- “self-monitoring of behavior”
- “habit formation”
BCTs derive from multiple models and theories of behavior change. For example, some BCTs are grounded in behavioral psychology and relate to managing triggers and responses of behavior. Other BCTs are more cognitive in orientation and focus on changing beliefs in order to change behavior. Regardless of the foundational theory, the overarching grounding in behavioral science validates the techniques and lends support for their application in the real world. Indeed, it may be helpful to think about BCTs as the actionable application of a psychological theory.
There are dozens of BCTs—and it can be hard to make sense of them all to understand how to combine them and to recognize what techniques work best in what situations. Behavior change researchers have published a number of taxonomies, or classifications, to help organize and categorize these techniques, but it is still complicated. One taxonomy, for example, groups BCTs by how they attempt to bring about change—i.e., via goals and planning, via feedback and monitoring, via social support. Other classifications simply present BCTs in the form of an unstructured list. In addition to these taxonomies, there are also overarching approaches such as motivational intervention (MI), cognitive behavioral therapy (CBT), and acceptance and commitment therapy (ACT) that use standardized combinations of techniques to bring about change.
Application in the Real World
To leverage BCTs in patient support programs, it’s essential to involve experts with formal health psychology training and credentials. While these taxonomies are important starting points, the effective use of BCTs demands more than just knowing the name and definition of a technique. The key is understanding the conditions under which each technique works, and how to successfully combine techniques as part of a comprehensive intervention.
Determining which BCTs should be used in which circumstance requires skill. Some techniques work better for addressing certain types of beliefs. For example, “action planning” may help someone who is having practical trouble developing or adhering to a treatment schedule, while debating “pros and cons” may help a person think through belief barriers to a new type of treatment. Another factor that impacts the choice of BCTs is the communication channels through which they are being accessed. Some BCTs are best delivered via human interactions—either face-to-face or over the telephone—while others can be more flexibly applied through digital and print channels.
The health condition may also impact the type of techniques selected. As in the planning of any successful self-management or adherence program, it is important to consider the needs of the individual and what we know about the broader population. Therefore, it is critical that any intervention and program begins with a body of research to understand the population and the barriers to disease self-management and adherence.
Regardless of the health condition and the interventions selected, individualization is key. That isn’t to say that each person will receive different messages, different BCTs, or different channels, but rather it recognizes that people learn and process differently. Using a variety of channels affords people the opportunity to get multiple BCTs in different ways. Some channels may be better suited to certain BCTs and some individuals may have a preference to channel type. Mapping research insights with individualization, BCTs, interventions, and channels allow for a comprehensive approach to behavior change. It is also imperative to remember that BCTs must be part of interactions between people and their healthcare teams. Utilizing behavior change techniques in clinician/patient relationships can strengthen the relationship, improve understanding, and promote better self-management and adherence.
But…Why Use BCTs?
This question takes us back to the beginning of this column. Behavior change techniques are truly the building blocks of behavior change. Education and information are important elements of changing behavior, but they cannot stand alone. Behavior change techniques help to augment education and information by trying to engage the patient to think differently, to learn new skills, or restructure their environment so that behavior change is more likely not only to be initiated, but also to be sustained over the long term.