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. 2023 Feb 8;13(6):406–417. doi: 10.1093/tbm/ibad003
BCT Definition Coded excerpt example Frequency (number of instances) Frequency (%)
1. Information about health consequences “Provide information (e.g., written, verbal, visual) about health consequences of performing the behaviour” “Anorexia can cause severe physical problems because of the effects of starvation on the body. It can lead to loss of muscle strength and reduced bone strength” 27 22.5%
2. Social support (unspecified) “Advise on, arrange or provide” social support (e.g., from friends, relatives, colleagues,’ buddies’ or staff) or noncontingent praise or reward for performance of the behaviour. It includes encouragement and counselling” “Get counselling … in particular, look into cognitive behavioural therapy (CBT) … a CB therapist will help to break the patterns of disordered eating through the use of food monitoring, thought monitoring and meal regularity and nutritional monitoring” 24 20.0%
3. Information about antecedents “Provide information about antecedents (e.g., social and environmental situations and events, emotions, cognitions) that reliably predict performance of the behaviour” “Predicting factors of anorexia include social pressure to be thin, difficulty expressing feelings, a lack of social or family support…” 23 19.2%
4. Instruction on how to perform the behavior “Advise or agree on how to perform the behaviour (includes ‘Skills training’)” “Advise on eating a small or medium serving of a nutrient-dense food provides needed calories and nutrition” 13 10.8%
5. Social support (practical) “Advise on, arrange, or provide practical help (e.g., from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour” “A physician should be supervising the recovery process and meeting with you in a medical office on a regular basis … weekly weigh-ins, vital signs measurement, and periodic laboratory testing including CBC, serum electrolytes and serum amylase levels” 5 4.2%
6. Information about social and environmental consequences “Provide information (e.g., written, verbal, visual) about social and environmental consequences of performing the behaviour” “The illness can affect people’s relationship with family and friends, causing them to withdraw” 3 2.5%
7. Pharmacological support “Provide, or encourage the use of or adherence to, drugs to facilitate behaviour change” “Advise to be on life-long calcium, have normal levels of vitamin D (or take supplements to achieve normal levels)” 3 2.5%
8. Salience of consequence “Use methods specifically designed to emphasise the consequences of performing the behaviour with the aim of making them more memorable (goes beyond informing about consequences)” “Complications of anorexia includes dehydration and can lead to highly concentrated urine and more urine production (image provided to emphasise the consequence)” 3 2.5%
9. Social comparison “Draw attention to others’ performance to allow comparison with the person’s own performance” “Learn from others, seek out success stories from other people recovering from anorexia … figure out what they did to change their relationship with food and eating for the better” 3 2.5%
10. Action planning “Prompt detailed planning of performance of the behaviour (must include at least one of context, frequency, duration and intensity)” “Eat throughout the day … eat regular meals, spaced about three to four hours apart” 2 1.7%
11. Habit formation “Prompt rehearsal and repetition of the behaviour in the same context repeatedly so that the context elicits the behaviour” “Snack more frequently. Reminding yourself to eat more often, to snack between meal and to eat whenever you feel hungry … get into the habit of snacking throughout the day on small healthy foods” 2 1.7%
12. Self-monitoring of behaviour “Establish a method for the person to monitor and record their behaviour(s) as part of a behaviour change strategy” “Keep a food journal. Keeping track of food intake can lead to healthier eating habits” 2 1.7%
13. Adding objects to the environment “Add objects to the environment in order to facilitate performance of the behaviour” “Keep a small scale and measuring cups on hand when preparing meals” 1 0.8%
14. Conserving mental resources “Advise on ways of minimising demands on mental resources to facilitate behaviour change” “Advise to measure and weigh your food, humans are not a good judge of size, so keep a small scale and measuring cups on hand when preparing meals” 1 0.8%
15. Credible Source “Present verbal or visual communication from a credible source in favour of or against the behaviour” “I suffered from the age of 12 until I finally sought help at the age of 24 … I thought that change would never be possible and therapy was such hard work. It took a long time but I eventually entered recovery and have never looked back. My life now is wonderful!” 1 0.8%
16. Distraction “Advise or arrange to use an alternative focus for attention to avoid triggers for unwanted behaviour” “Distract yourself with these unique and incredible images (series of photos were provided)” 1 0.8%
17. Feedback on behaviour “Monitor and provide informative or evaluative feedback on performance of the behaviour (e.g., form, frequency,
duration, intensity)”
“Time you have saved so far # Days, # Hours # Minutes” (a time that clocks the period you refrain from engaging in anorexic behaviour) 1 0.8%
18. Information about emotional consequences “Provide information (e.g., written, verbal, visual) about emotional consequences of performing the behaviour” “What it is like to have anorexia … As I lost weight I began to feel tired and this made me more depressed, I couldn’t think straight or concentrate in school … I realise now I was suffering from the effects of starvation” 1 0.8%
19. Monitoring emotional consequences “Prompt assessment of feelings after attempts at performing the behaviour” “Track how you’re feeling before and after you eat, and what kind of thoughts you’re having that may affect eating habits and lead to unnecessary food restriction” 1 0.8%
20. Non specific reward “Arrange delivery of a reward if and only if there has been effort and/or progress in performing the behaviour (includes ‘Positive reinforcement’)” “Trophies are locked until your progress passes each phase. You are then awarded trophies to help you stay motivated and tract your progress” 1 0.8%
21. Re-attribution “Elicit perceived causes of behaviour and suggest alternative explanations (e.g., external or internal and stable or unstable)” “Though the restrictive eating patterns that characterise this anorexic eating disorder are similar to dieting behaviours, there are stark differences … while someone may diet in an attempt to control weight, anorexia nervosa is often an attempt to gain control over one’s life and emotions” 1 0.8%
22. Social support (emotional) “Advise on, arrange, or provide emotional social support (e.g., from friends, relatives, colleagues, ‘buddies’ or staff) for performance of the behaviour” “Advise on setting goals with your doctor, mental health professional and registered dietitian [and set] goals in the area of learning emotional self-care and developing trust in people who are trying to help you” 1 0.8%
Total 120 100.0%