Many a digital health intervention has been stymied by the same problem, one that’s familiar to anyone who’s ever tried to quit smoking or lose weight by changing their diet: the extreme difficulty of behavior change.
On the final morning of the Connected Health Conference in Boston today, two experts presented their science-based solutions to the problem of behavior change. These solutions orbit around two seemingly contradictory poles: mindfulness and mindlessness.
A fairly popular idea these days in self help and pop psychology, mindfulness is about defeating bad habits in our subconscious by exposing them to the scrutiny of the conscious mind.
“There’s a part of our brain called the orbitofrontal cortex, and this part of the brain stores and compares reward value,” Dr. Judson Brewer, director of research and innovation at the Mindfulness Center at Brown University, said.
This part of the brain stores information like “chocolate is a better reward than broccoli,” he explained. But when we fall into bad habits, he said, “we’re not paying attention. We’re not giving our orbitofrontal cortex updated and accurate information. So we asked this question: Is awareness enough to change behavior? So we developed these app-based mindfulness programs so we could teach people to pay attention to their habit behaviors.”
Brewer’s company MindSciences offers app-based interventions for smoking cessation, healthy eating and anxiety, and the technology has been shown to create demonstrative improvements in RCTs with other apps as the control.
All three apps are built around using mindfulness to drop the reward value of bad habits, opening the door for better habits to take their place.
That’s where the other piece, mindlessness, comes in, according to Dr. Kyra Bobinet, CEO of EngagedIN, who also spoke at the event.
“Mindlessness is the new mindfulness,” she said. “Now this is not a cap on mindfulness. I have been practicing mindfulness for 20 years. But, unless you make mindfulness itself mindless to do as a habit, it doesn’t do anything.”
Bobinet uses a very specific definition of a habit, namely that it has to be literally mindless, something we do automatically without using any significant mental load.
As an example, Bobinet discussed the failure of many corporate wellness programs to generate any clinically significant outcome measures. In one illustrative study, a company seemingly “threw the kitchen sink” at their employees but still came up short.
“There was nothing in that kitchen sink that had anything to do with habit formation, and all the outcome measures were about habits,” Bobinet said. “You can throw the kitchen sink at this problem, but if none of it is specifically for habit formation, you will get the same result, or lack of results, every time.
Contrary to popular belief, Bobinet said, it takes not 21 days but a full year to retrain ourselves in a habit.
Both speakers pointed out that generally speaking, people believe they can triumph in an effort to change their behavior with sheer force of will. But science and experience show that that’s a losing proposition nine times out of 10.
Instead, people should be mindful about the bad habits they’re trying to change, be iterative in their approach to changing it (trying new things when one approach isn’t working), and be patient and persistent in replacing those habits with new, healthier habits.
“As long as you don’t run the story of judgement on yourself and don’t think that you’ve failed, and you iterate on what you’re doing, you will be unstoppable,” Bobinet said.
Crucially, no amount or quality of technology will work if it doesn’t apply these evidence-backed behavior change approaches.
“We actually know a whole lot about how habits and everyday addictions form, and in fact we might be ignoring some of this critical information,” Brewer said.
Connected Health Conference
Join PCHAlliance and the Partners Connected Health Symposium in Boston Oct. 16-18.