Sustaining Behavior Change Through Disgust

Behavioral interventions and lifestyle modifications have been used for decades to treat medical conditions ranging from incontinence and other symptoms of overactive bladder to cardiovascular and metabolic diseases.

The effectiveness of these behavioral modifications can vary quite extensively, but the evidence from observational trials suggests that when combined with drug interventions they have additive effects resulting in better outcomes.  In the real world, virtually all of the programs created for patients to easily change behavior suffer the problem of sustainability.  According to a survey of 1250 patients across 7 therapeutic areas, 67% of patients fail to remain engaged in a program by day 26.  

Research has shown that poor emotional engagement plagues much of the content within these types of programs.  Research with healthcare practitioners and patients established that the content in most programs are both clear and provides educational value – so what causes the engagement problem?
In most cases, the problem is that the educational content engages the wrong emotion of the patient and provider.  Unfortunately, the educational value that the patients receive is not enough to sustain an actual lifestyle modification for the longer term.

Evidence has shown us that disgust is a much stronger emotion than happiness. Researchers and marketers often attempt to engage happiness through promises of reduced symptoms or improved quality of life, but what makes us happy when first implementing lifestyle changes after a while loses its ability to bring overt joy.  Disgust, however, such as the sensation of eating food that has gone bad, stays with us for quite a while. What disgusts us now--for instance, sitting on a bus next to a person who hasn't bathed in weeks--will most likely produce equal disgust should it happen in the future.

There are solid evolutionary reasons for this. The things that would disgust primitive man--tainted food, unsanitary conditions--are directly related to his survival. If it took many learning trials to become averse to such situations, humans might not have survived their learning curves. By hard-wiring disgust, learning, and motivation, nature provided the opportunity for one-trial learning: the briefest of all therapies.

When we examine many of the most dramatic examples of sustainable change, we find disgust as a common element. What gets a person to finally talk with a healthcare provider is reaching the point of disgust with his or her appearance, energy level, etc. Similarly, smokers and alcoholics reach the point where the consequences of their behaviors disgust them, whether those consequences are smelling bad, becoming short of breath, or losing jobs or driver's licenses. "I can't stand living this way," is a frequent refrain among patients who are ready for change.

Define the right emotion to engage and amplify your patients’ results.