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What more can we learn from early learning theory? The contemporary relevance for behaviour change interventions.

Much of the current approach to behaviour change derives from early research in learning theory, i.e., the investigations and theories of classical conditioning and instrumental or operant conditioning. For example, more than 25 of the 93 behaviour change techniques (BCTs) in BCTTv1 (Michie et al., 2013) are directly related to learning theory. This is hardly surprising given that learning theory is about changing behaviour. To quote Landrine and Klonoff (2004, p. 545), ‘learning theory, the best theory of behavior and behavior change’ or Skinner (1950), ‘Those who are interested in a science of behavior will insist that learning is a change in behaviour’. Central goals of health psychology include the explanation of behaviour using theories of health behaviour change and the design of interventions to change behaviours such as smoking, attendance at screening, adherence to medication, or delivery of evidence-based health care. These goals are quite similar to those of early learning theorists although the latter tend to express it slightly differently, for example Watson (1913) wrote that Psychology’s ‘theoretical goal is the prediction and control of behavior’, while Skinner wrote: ‘Ifwehave achieved true scientific understandingofmanweshouldbe able toprove this in the actual prediction and control of his behaviour’ (Skinner, 1972, p. 259). ‘Whenwe have achievedapractical control over theorganism, theories of behavior lose theirpoint. . .. When behaviour shows order and consistency, we are much less likely to be concerned with physiological or mentalistic causes.’ (Skinner, 1956, p. 231). Skinner demonstrated unprecedented success in designing successful behaviour change interventions, for example in training two pigeons to play ping-pong (https://www.youtube.com/watch? v=vGazyH6fQQ4). Skinner described behaviour change as ABC, (A = antecedents, B = behaviour and C = consequences) with A?B?C. He proposed that behaviour was changed by altering antecedents and consequences and made considerable progress in establishing how A and C needed to change to achieve behaviour change. Historically, learning theory became important as a basis for health-related interventions in the 1960s and 1970s. These interventions focussed on behaviour while still allowing that cognitive processes might have a causal role (Bandura, 1969). However, following success in dealing with anxiety disorders, the main intervention developments were in cognitive theory and methods. More recently, there has been increasing focus on behaviour as a cause of ill health and, consequently, on behaviour change as an opportunity for prevention and intervention usingmethods developed from those used in clinical and social psychology. The aim of this article is to revisit learning theory to