Conquering bad habits in the age of digital health
The popularity of digital health apps and gadgets that monitor our weight, activity, sleep, mood and other variables can be attributed to one thing: they help us change our behaviour. The mechanism that facilitates these changes, however, has been in use long before the quantified self and digital health era.
For decades the core component of behavioural approaches to weight loss and diabetes management, for example, has been self-monitoring – a fancy word for setting a goal (e.g. losing weight) and tracking progress via regular measurements (e.g. weighing ourselves weekly). When we measure, we manage and self-monitoring highlights the effect of our behaviour on our goal. When we progress, the changes we made are rewarded; when we regress, that sinking feeling steels us to resist the bowl of candy and to walk the extra mile.
The control that self-monitoring instils helps many people make significant changes to their health. For instance, a common characteristic of people who lose weight and keep it off is regular weigh-ins. Self-monitoring and activity trackers, however, aren’t a panacea. Bad habits formed over many years can be difficult to break (see image below) and traditional behavioural interventions also focus on understanding people’s habits as well as encouraging self-monitoring.
While there are some excellent digital services for creating new, healthy habits, when it comes to dealing with bad habits, digital health offers few solutions. Fortunately, the technology that drives digital health can easily be put to use to conquer these habits. But before I tell you how, I need to explain why you should care about habits.
What are habits?
A habit is a sequence of behaviours (getting in thecar, driving to McDonalds , ordering, and eating) that have previously been reinforced by their positive consequences (the rush of brain chemicals after you eat a burger, for example). Habits are repeated frequently, triggered by a specific context and are automatic and difficult to control. They are very real things that are wired into our brains. Once habits form they are difficult to eliminate, they over-ride our goals and they make us impervious to new information – even information that tells us our habits are causing us harm. The key point is that even if we want to change our behaviour (e.g. to stop eating burgers), if we have a strong habit, often the habit will win out.
How Can Digital Health Help?
Although there are many ways to change bad habits, one approach that is particularly suited to digital health technologies involves understanding what triggers a habit and having a detailed action plan to counter the habit. A smartphone app could easily provide this service. Let me explain how.
The Discovery Phase
Habits are triggered by context, the most common contexts being time (e.g. mid-afternoon), location (e.g. the office), objects (e.g. a candy wrapper), specific people (e.g. our drinking buddies), mood (e.g. depressed or bored) and/or a physiological state (e.g. being hungry or tired). The discovery phase of our fictional app involves measuring context whenever our habit is triggered. This involves answering questions about who we’re with, our mood and our physiological state. When we submit our answers, a time and location stamp would also be added, thus capturing all the important contextual information quickly. After a week of discovery, analysis can identify what context, or combination of contexts (e.g. a time and location, or time and mood), is triggering our habit.
Once the contextual trigger(s) for our habit has been identified, the app helps develop action plans via a planning template that we can populate with specific details. For example, “if X situation occurs, then I will do Y” would become “if I have an urge to buy a burger for lunch, I will eat the meal I prepared earlier”. The app also has the option of listing all the preparation required (e.g. buying produce and cooking our meal at home) to help this plan come to life. These simple plans have been shown to be highly effective when changing behaviour.
An Early Warning System
Once we’ve identified our contextual triggers and formed action plans, the app now has the information to warn us when our habit is likely to be triggered and to make our action plan top of mind. Because our phones know where we are and what the time is, the app can easily warn us of habits that are triggered by a time or a place. Likewise, with habits triggered by another person our app could pair with the phones, or social media accounts, of these people, sending us a warning and associated action plan whenever they are close by. Early warnings for habits triggered by mood or physiology may prove trickier, but with longer discovery periods and smart analytics these could also be achieved. A variety of warnings could also be provided, ranging from a simple vibration to a flashing red screen on our smartphone or smart watch.
Habits have a huge impact on the quality and quantity of our life. If we establish positive habits, eating right and working out become seamless; if we build bad habits, it can be a constant struggle to do the right thing. The techniques that underpin habit change are not well known; digital health, however, has the opportunity and technology to take habit change mainstream.