Taxonomies of behavioral change

Author: Dr Simon Moss

Overview

One the main role of many psychological interventions is to change the behavior of individuals. Individuals, for example, may be encouraged to exercise more often or regulate their temper.

Researchers and practitioners have recommended hundreds of practices that can be applied to initiate and to maintain these changes. For example, individuals can be asked to imagine changing their behavior for several minutes, called imagery (see visualization). In addition, they could be asked to change their surroundings to reduce temptations and to introduce prompts, called environmental restructuring. They could also receive information on the percentage of people who engage in various behaviors, called norms.

Until recently, researchers had not developed a taxonomy or inventory of the practices, techniques, or interventions that can be utilized to facilitate change. Such a taxonomy or inventory would provide many benefits, apart from merely offering practitioners a range of alternatives they can apply to facilitate behavior change in clients.

In particular, without this inventory, researchers cannot readily describe the techniques they utilized in their studies. Several researchers, for example, may claim they utilized "motivational strategies" to encourage people to exercise. Yet, each researcher may have applied a different technique, but used the same label.

Because of these ambiguities, many questions cannot be resolved definitively (Michie, Fixen, Grimshaw, & Eccles, 2009). For example, researchers cannot readily determine which techniques or interventions are related to which determinants of behavioral change. Theory development, therefore, may be impeded (Michie, Hardeman, Fanshawe, Prevost, Taylor, & Kinmonth, 2008).

Similarly, researchers cannot ascertain which techniques or interventions are most effective in specific circumstances. If motivational strategies are more effective in studies that are conducted in hot rather than cold nations, researchers cannot determine whether temperature influences the utility of this intervention or whether the precise technique that was utilized differs across nations.

In short, these taxonomies facilitate the development and evaluation of theories and models of behavioral change (Michie, Rothman, & Sheeran, 2007). Furthermore, these taxonomies enable researchers to clarify the utility of interventions in various contexts (e.g., Michie, Jochelson, Markham, & Bridle, 2009). Several researchers have utilized these taxonomies to fulfill this purpose, especially to explore interventions that curb smoking (West, Walia, Hyder, Shahab, & Michie, 2010;; see also Michie, Hyder, Walia, & West, 2009) and encourage a healthy diet (e.g., Michie, Abraham, Wittington, McAteer, & Gupta, 2009).

Preliminary taxonomies

Michie, Johnston, Francis, Hardeman, and Eccles (2008) proposed a preliminary framework to classify the techniques or interventions that are utilized to facilitate changes in behavior. Some of these techniques or interventions were derived from two systematic reviews:

• Goal or standard: The individuals specify an outcome or target they would like to reach, such as lose 10 kg in weight
• Monitoring: The individuals record data on their behavior, such as their weight over several months
• Antecedents and consequences: The individuals reflect upon and record antecedents and consequences of both positive or negative behaviors, such as situations in which they tend to eat healthy food
• Feedback and discrepancy assessment: Individuals compare data on their behavior with goals and standards
• Comparisons: Individuals compare their behavior with some standard, such as their weight last year or the weight of someone else
• Social comparison: Individuals engage in some contest or competition to compare themselves to other people on some behavior
• Contract: Individuals sign a contract with one or more other people, agreeing they will attempt to reach some target
• Planning: Individuals identify the sequence of actions that need to be undertaken and the conditions under which these actions can be initiated (see implementation intentions)
• Coping planning: Individuals identify potential barriers as well as actions to circumvent or resolve these impediments
• Goal review: Individuals review progress after some period of time, such as weight loss after a month, as well as consider factors that have influenced success. They then adjust actions accordingly.
• Discriminative cue: Individuals include some stimulus into their environment that is associated with success on this behavior, such as tighter clothes.
• Prompt: Individuals introduce some stimulus into their environment that reminds them to engage in this behavior
• Reward: Individuals receive, or expect to receive, some valuable consequence, such as approval or money, if they execute the desired behavior
• Punishment: Individuals receive some penalty, or do not receive some reward, if they do not execute the desired behavior
• Anticipated regret: Individuals are encouraged to expect feelings of regret if they do not perform the desired behavior
• Graded tasks: Individuals perform an easier version of some activity. Each time they succeed, they increase the difficulty progressively
• Instructions: Individuals receive explicit instructions on how to execute some behavior
• Shaping: Individuals receive some reinforcement initially for behaviors that resemble the desired change. Over time, the reinforcement becomes more specific to the desired behavior
• Chaining: Individuals initially complete only the last act in a sequence and gradually add earlier acts over time
• Behavioral rehearsal: Individuals perform the desired behavior repeatedly until this act becomes entrenched
• Mental rehearsal and imagery: Individuals imagine performing the desired behavior repeatedly
• Behavioral rehearsal: Individuals perform the desired behavior repeatedly in a specific context, to ensure the context itself is sufficient to prime this act
• Role play: Individuals perform the desired behavior in a simulated setting
• Behavioral experiments: Individuals perform the behavior in different settings to identify the consequences of variants or adjustments to this act
• Modeling and vicarious reinforcement: Individuals observe someone else perform a behavior as well as watch the rewards this person receives.
• Self talk: Individuals articulate, either aloud or silently to themselves, the behaviors they will implement
• Cognitive restructuring: Individuals refine their beliefs about the causes and consequences of the desired behavior

Four health and clinical psychologists then undertook a brainstorming exercise to expand this list. This procedure uncovered some other techniques, including:

• Relapse prevention: Individuals identify reasons why they may relapse and introduce measures to prevent these setbacks
• Personalized messages: Individuals receive messages or are encouraged to apply techniques that accommodate their preferences, capabilities, or environment
• Persuasive communication: Individuals receive evidence that vindicates the benefits of this behavior
• Social support: Friends or colleagues of individuals complete other tasks that enable individuals to complete the behavior& they may cook suitable meals or offer childcare while the individuals exercise, for example
• Coping, stress management, and relaxation: Individuals introduce measures that prevent or resolve sources of stress or other emotional impediments

Finally, two of the researchers extracted additional techniques from textbooks that promote change in behavior. Examples include:

• Systematic desensitization: Individuals expose themselves to settings that become increasing stressful over time. They learn to associate this stress with relaxation techniques
• Time management: While individuals develop plans, they reflect upon and accommodate time constraints (see also managing time effectively)
• Motivational interviewing: Individuals uncover motivating statements to overcome resistance to change
• Environment change: Change the environment to facilitate the behavior, such as remove unhealthy food

Many other techniques, usually embedded within specific therapeutic paradigms, have been suggested as well including biofeedback, flooding, stress inoculation, group rewards or punishments, counter conditioning, fading, covert conditioning, deflection techniques, positive scanning, paradoxical intentions, and turtle techniques.

Four researchers also considered which of these techniques enhance 11 key determinants of behavioral change: social or role identity, knowledge, skills, beliefs about capabilities, beliefs about consequences, motivation and goals, memory, attention, and decision processes, environmental context and resources, social influence, emotion, and action planning. The following list specifies the techniques that most likely facilitate each of these determinants:

• Social or role identity: Social support
• Knowledge: Instruction
• Skills: Goals, standards, and monitoring
• Beliefs about capabilities: Graded tasks, rehearsal, modeling, monitoring, self task. motivational interviewing
• Beliefs about consequences : Persuasion
• Motivation and goals: Goals, rewards, punishments, graded tasks, persuasion, personalized messages, motivational interviewing
• Memory, attention, and decision processes: Planning, cues, and prompts
• Environmental context and resources: Environmental changes
• Social influence: Social support and modeling
• Emotion: Coping, stress management, and relaxation
• Action planning: Goals, contracts, planning, and prompts

The CALO-RE taxonomy

Michie, Ashford, Sniehotta, Dombrowski, Bishop, and French (2011) revised previous taxonomies, such as the items reported by Abraham and Michie (2008), to develop the CALO-RE or Coventry, Aberdeen and London Refined taxonomy. This updated taxonomy overcame many of the limitations and ambiguities of previous attempts.

Specifically, two groups of researchers, from Coventry and Aberdeen, applied the manual developed by Abraham and Michie (2008) to various interventions. They uncovered items that were ambiguous or unhelpful. Some items, for example, were difficult to distinguish. That is, they could not decide which of two of more techniques best describes a particular intervention. They also uncovered instances in which the label did seem to describe a specific intervention appropriately.

The teams then collaborated to refine the taxonomy and overcome these limitations. The ensuing taxonomy is presented below and comprises 40 items:

• Information about general consequences: Individuals receive information about the consequences of this behavior for people in general, usually derived from epidemiological or scientific information.
• Information about specific consequences: Individuals receive information about the consequences of this behavior for people with similar characteristics to themselves. This information, thus, is more tailored to individuals.
• Information about injunctive norms: Individuals receive information about the degree to which the desired behavior is approved by other relevant people, such as members of the same demographic (see theory of planned behavior)
• Information about descriptive norms: Individuals receive information about the extent to which other relevant people undertake this behavior
• Process goals: Individuals set goals about the behaviors they plan to implement, such as the hours of exercise they plan to undertake (see goal orientation)
• Outcome goals: Individuals set goals about the outcomes that individuals would like to achieve, such as the target weight
• Implementation intentions: Individuals plan the precise actions that would like to undertake in specific contexts or settings rather than merely specify the behaviors they would like to undertake in general.
• Problem solving: Individuals identify and resolve problems and barriers that could preclude changes in their behavior, such as conflicting goals.
• Review of process goals: Individuals review the extent to which previous goals to undertake specific behaviors have been fulfilled. Goals may be revised if necessary
• Review of outcome goals: Individuals review the degree to which previous goals to fulfill specific consequences have been fulfilled. Goals may be revised if necessary
• Rewards dependent on effort or progress: Individuals receive rewards if they dedicate enough effort or progress sufficiently on their goals. Individuals may offer these rewards to themselves
• Rewards dependent on success: Individuals receive rewards, such as praise or money, if they achieve the desired consequence.
• Shaping: Individuals receive some reinforcement initially for behaviors that resemble the desired change. Over time, the reinforcement becomes more specific to the desired behavior
• Generalizing changes: After implementing a behavior in one instance, the individuals are then encouraged to undertake this behavior in other settings as well
• Self monitoring of behavior: Individuals maintain a record or diary of relevant behaviors, such as all activities that relate to their weight
• Self monitoring of outcomes: Individuals maintain a record or diary of relevant outcomes of these behaviors, such as their weight
• Reflection on past success: Individuals reflect upon, and sometimes record, past achievements and successes that relate to this behavior
• Present feedback about performance: Individuals receive feedback about whether their behavior aligns with their goals or plans or compares favorably to the actions of other people
• Present information on opportunities: Individuals receive information about opportunities or resources that could be utilized by individuals to change their behavior, such as exercise classes
• Present instructive information: Individuals receive information about how to perform the behaviors most effectively, such as how to use a gym
• Modeling: Some person or people demonstrate or model the behavior to individuals
• Utilization of prompts: Individuals are taught to utilize prompts or cues in the environment to remind them to perform a desired behavior
• Environmental restructuring: The environment is changed to encourage people to enact the desired behavior. Temptations may be removed, for example, and helpful prompts may be introduced instead
• Contract: Individuals write an agreement that explicitly states the behaviors they will undertake, witnessed and thus encouraged by someone else
• Rehearsal and practice: Individuals repeat the behavior or related acts many times
• Follow up prompts: The intervention of other people, such as psychologists, is gradually withdrawn. For example, face to face counseling is supplanted with occasional telephone calls instead
• Social comparison: Individuals are encouraged to compare their progress to the performance of other people
• Galvanize social support: Individuals are shown how to garner the social support that is needed to facilitate their change in behavior, such as a buddy system
• Adopt the perspective of a model: Individuals are encouraged to recognize their behavior may shape the choices of other people, such as their children, and they should thus behave as a suitable role model
• Highlight the potential of regret: Individuals are encouraged to expect feelings of regret if they do not perform the desired behavior
• Evoke fear: Individuals receive information about the risks and costs they may incur if they do not change their behavior
• Self talk: Individuals are encouraged to articulate, either aloud or silently to themselves, the behaviors that will implement
• Use of imagery: Individuals are encouraged to imagine completing some or all the actions of some behavior
• Relapse prevention: Individuals formulate plans on how to sustain changes in the behavior and avoid problems that provoke relapse
• Training in emotional regulation: Individuals develop capabilities they can apply to regulate stress and other negative states, ultimately facilitating the receptivity of individuals to change
• Motivational interviewing: Individuals are encouraged to engage in self talk that overrides their doubts or resistance to change
• Time management: : While individuals develop plans, they reflect upon and accommodate time constraints
• Training in communication skills: Individuals undertake role plays or other activities to improve listening skills, assertiveness, or other capabilities that relate to communication. These communication skills may be relevant to many changes in behavior, such as overcoming peer pressure
• Stimulate anticipation of future rewards: Individuals are encouraged to imagine the rewards they will receive if they change their behavior

The behavioral change wheel

The behavioral change wheel, proposed by Michie, van Stralen, and West (2011), represents another attempt to classify the interventions that can be utilized to promote behavior change. Unlike the CALO-RE taxonomy, the behavioral change wheel utilizes broader categories: all techniques are divided into 9 overarching items. Furthermore, the behavioral change wheel not only classifies the techniques but also classifies the avenues or domains that can be utilized to apply these interventions, such as taxation, legislation, training, and so forth. Finally, the behavioral change wheel specifies the interventions that practitioners can apply instead of the techniques that individuals can utilize themselves.

This taxonomy offers several benefits. When broad categories are utilized, researchers can develop a more parsimonious model to characterize the association between specific interventions and the mechanisms that underpin change in behavior. Indeed, the behavioral change wheel represents an initial attempt to delineate these associations.

In particular, the behavioral wheel can be represented as three concentric circles. The outermost circle represents nine main interventions:

• Education: Impart knowledge and develop understanding in people
• Persuasion: Communication that is intended to evoke positive or negative feelings towards various alternatives
• Incentives: Offering the prospect of rewards, such as lotteries to win a prize if individuals enact the desired behavior
• Coercion: Highlighting the possibility of punishment or cost if individuals do not change
• Training: Facilitating the development of skills rather than merely imparting knowledge
• Restriction: Introducing measures that prohibit or limit undesirable behaviors
• Environmental restructuring: Changing either the physical environmental or social context to encourage or deter some behavior
• Modeling: Demonstrating the desirable behavior to participants
• Enablement: Providing the means or circumventing barriers to facilitate changes in behavior

The middle circle represents seven policies. Specifically, to implement each of these interventions, individuals can invoke a variety of avenues, called policies. Seven policies have been differentiated: marketing, guidelines, fiscal or taxation, regulations, legislation, environmental planning, and service provision.

The inner circle represents six mechanisms that underpin behavior change. These six mechanisms or determinants are called physical capability, psychological capability, reflective or conscious motivation, automatic or unconscious motivation, available physical resources, and available social support.

The interventions, policies, and determinants are arranged to represent possible associations. For example, education may enhance psychological capability and reflective motivation. Therefore, these labels appear in the same sector of the wheel. Specifically, according to Michie, van Stralen, and West (2011):

• Education enhances psychological capability and reflective motivation
• Persuasion enhances both reflective and automatic motivation
• Incentives enhances both reflective and automatic motivation as well
• Coercion also enhances both reflective and automatic motivation
• Training enhances physical and psychological capability
• Restriction diminishes physical and social opportunities to engage in undesirable behavior
• Environmental restructuring affects automatic motivation as well as physical and social opportunities to engage in undesirable behavior
• Modeling enhances automatic motivation
• Enablement enhances all determinants, perhaps apart from reflective motivation

Related taxonomies

Mindspace

Mindspace is an acronym that represents nine avenues that can be utilized to influence people, and to initiate changes in behavior, without explicit prompts or instructions. That is, mindspace emphasizes the importance of strategies that affect individuals implicitly or unconsciously (for a review and discussion, see Dolan, Hallsworth, Halpern, King, Metcalfe, & Vlaev, 2012). The nine strategies include:

• Messenger: Subtle features of the messengers, such as their height, voice, and popularity, affect the likelihood that people will respond to recommendations.
• Incentives: Because of various biases, not all incentives affect behavior as expected. For example, potential losses are more salient than prospective gains.
• Norms: Our inclinations depend significantly on the behavior of people who are similar to ourselves
• Defaults: Our behaviors are biased towards entrenched tendencies and the status quo
• Salience: Our attention is attracted to events that are novel and relevant to our goals, which in the turn governs our choices and behaviors
• Priming: Unconscious cues can activate specific goals or increase the salience of particular events
• Affect: Generally, we are more likely to choose courses of action that we associate with positive emotions rather than negative emotions
• Commitments: We are more likely to enact behaviors that are consistent with past promises or reciprocate the favors of other people
• Ego: We tend to implement acts that inflate our attitudes towards ourselves

References

Abraham, C., & Michie, S. (2008). A taxonomy of behaviour change techniques used in interventions. Health Psychology, 27, 379-387.

Dolan, P., Hallsworth, M., Halpern, D., King, D., Metcalfe, R., & Vlaev, I. (2012). In?uencing behaviour: The mindspace way. Journal of Economic Psychology, 33, 264-277. doi: 10.1016/j.joep.2011.10.009

Gardner, B., Whittington, C., McAteer, J., Eccles, M., & Michie, S. (2010). Using theory to synthesise evidence from behaviour change interventions: The example of audit and feedback. Social Science and Medicine, 70, 1618-1625.

Michie, S. (2008). What works and how? Design more effective interventions need answers to both questions. Addiction, 103, 886-887.

Michie, S., Abraham, C., Wittington, C., McAteer, J., & Gupta, S. (2009). Effective techniques in healthy eating and physical activity interventions: A meta-regression. Health Psychology, 28, 690-701.

Michie, S., Ashford, S., Sniehotta, F. F., Dombrowski, S. U., Bishop, A., & French, D. P. (2011). A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy, Psychology and Health, 1-20.

Michie, S., Fixen, D., Grimshaw, J.M., & Eccles, M. (2009). Specifying and reporting complex behaviour change interventions: The need for a scientific method. Implementation. Science, 4, 40.

Michie, S., Hardeman, W., Fanshawe, T., Prevost, A.T., Taylor, L., & Kinmonth, A.L. (2008). Investigating theoretical explanations for behaviour change: The case study of ProActive. Psychology and Health, 23, 25-39.

Michie, S., Hyder, N., Walia, A., & West, R. (2009). Smoking cessation services Understanding their content and impact. Psychology and Health, 24, S1.

Michie, S., Jochelson, K., Markham, W.A., & Bridle, C. (2009). Low-income groups and behaviour change interventions: A review of intervention content, effectiveness and theoretical frameworks. Journal of Epidemiology and Community Health, 63, 610-622.

Michie, S., Johnston, M., Francis, J., Hardeman, W., & Eccles, M. (2008). From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques. Applied Psychology: An International Review, 57, 660-680.

Michie, S., Rothman, A. J., & Sheeran, P. (2007). Advancing the science of behaviour change. Psychology and Health, 22, 249-253.

Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42-52.

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