- Functional Medicine -

Healing by Design: Kyra Bobinet, MD, MPH

By blending compassion with neuroscience, behavior-change expert Kyra Bobinet, MD, MPH is shaping the future of health improvement.

Kyra-Bobinet

Does what I’m doing reduce suffering? And is there scientific basis for it? Everything I do is driven by these two filters — and helping people is my mission,” says Kyra Bobinet, MD, MPH.

Bobinet, who teaches health-engagement design at Stanford University’s School of Medicine’s AIM Lab, has been passionate about exploring ways to help others become more engaged in their well-being since her student days at the University of California, San Francisco School of Medicine and at Harvard School of Public Health.

Today, she and the team at her Bay Area behavior-design firm, engagedIN, use the latest neuroscience research on human behavior to help health and wellness organizations develop “sticky” wellness programs, behavior-change interventions, health websites, devices, and mobile apps.

But according to Bobinet, attitude matters more than platform or medium. In her view, the key to creating real engagement — the kind that results in healthy, sustainable change — lies in designing programs and products that are “caring, helpful, and authentic.”

Many factors — including social norms and emotions — affect behavior. But when it comes to explaining how our behavior is governed by what’s going on in our heads, the “neuroscience is solid,” says Bobinet.

“When we don’t understand how our brains work, we blame ourselves for not following through,” she says.

Traditional health messaging banks on that self-doubt, focusing on people’s embarrassment or weakness, she explains. “We tend to point out people’s flaws or disease. Instead, we need to figure out more emotionally intelligent ways to connect with people.”

Bobinet’s goal is to create products, messages, and systems that empower and support people rather than shame or discourage them. It all stems from her belief that demonstrating compassion is the most powerful behavior of all.

Experience Life |You specialize in how our brains drive behavior. What are the basics of that science?

Kyra Bobinet | We’re essentially living with two brains: a “fast brain” and a “slow brain.”

The fast brain equates to your unconscious mind and the slow brain equates to your conscious mind. Most of our behaviors originate in our unconscious minds.

We’re on autopilot because we can’t afford to concentrate on how to get our socks on our feet every single day — it’s inefficient. So our brains accommodate by laying down myelin — a fatty substance that coats and protects nerves, enabling them to conduct impulses — paving smooth roads for our frequently traveled mental routes.

We’ve all had the experience of going into a room and asking, “Why did I come in here?” That’s your fast brain — you unconsciously get to the room, but your slow brain needs a minute to remember you need to get your keys off the table.

EL | How does the gap between the “fast brain” and “slow brain” relate to health-related behavior design?

KB | Behavior design attempts to either slow down the fast brain or speed up the slow brain to close the gap so that people can follow through on their goals.

The slow brain is the one that says, “OK, future Kyra, we’re going to stop eating doughnuts.” Future Kyra says, “OK, got it.” But then tomorrow, future Kyra eats a doughnut because that’s part of the fast-brain solution to “I’m hungry or stressed.”

I’m treating myself, and then the slow brain wakes up and says, “I forgot I wasn’t going to eat doughnuts anymore!”

Therein lies the rub. It’s that time gap between the slow brain setting an intention to do things differently and the unconscious mind executing on autopilot.

Catching up to the unconscious mind and competing with that unconscious default behavior is the basis of behavior change: It’s governed by the pace and patterns of neuroplasticity between the slow brain and the fast brain.

EL | How does neuroplasticity connect to behavior design?

KB | Neuroplasticity refers to how the brain changes and evolves its neural pathways and synapses in response to shifts in behavior and environment. It’s useful in talking about behavior design because it shows how change is a process.

The slow brain works to build alternative routes, but just like real-life road construction, it takes time. It’s difficult to build a new highway or to widen a lane. There’s friction, slowdowns, and detours, and then even when the new route is established, both routes can still be taken.

The old one might be bumpier, but it’s still there. You continue to have the doughnut circuit in your brain, but it weakens over time. Instead, the leafy-greens highway gets built and becomes part of your fast brain. But when you get stressed out, or you’re around people you used to eat doughnuts with, you may unconsciously merge onto the old highway.

EL | You’ve said that most health messaging is ineffective. Why is that?

KB | Health messaging that works resonates with our self-image, which is a private conversation we have with ourselves: Who am I? We’ve defined that unconsciously, and products, messages, and people run across our purview and either resonate with us or not.

People buy products or respond to things either as their real selves (the one who’s honest about who and where I am) or their idealized selves (who I want to be). The actual self drives more engagement and action than the idealized self, who purchases things like treadmills that sit in the den and collect laundry.

So, successful health messaging has to be grounded in reality while resonating with what people envision for their lives without being too fabulous — because if it’s too fabulous, then it’s not authentic. If there’s too much space between reality and aspirations in health messaging, people lose interest and steam.

Health messaging needs to strengthen rather than weaken people, because people are attracted to things that support them in feeling strong, smart, and fabulous.

EL | How did the mind–body stress-reduction program you developed while working at Aetna come about?

KB | The idea for that program came from a personal experience. I got into meditation in 1999 when I was stressed and depressed. I had decided to take a work-productivity meditation course, which revealed so much about what was going on with me that I’d never noticed before. I realized then that I wasn’t alone in experiencing all the noise and random thoughts; so many others were dealing with it, too.

As the medical director of health and wellness innovation, I pitched teaching mindfulness to our employees and it grew from there. It’s important because our thoughts cause us to suffer — the neuroscience supports this, especially Dr. Richard Davidson’s work on how we’re happier and more productive when we’re able to focus and have sustained attention.

Giving people the gift of sustainable attention at work is essential because everything about how we work shatters our attention and stimulates our emotions. How can we resist the vending machine of junk food when our attention span is in pieces from all of our email alerts and texts throughout the day? Mindfulness empowers the slow brain so that people have more control over their real choices.

EL | What can we do to design effective behavior change for ourselves?

KB | The critical step is adopting the mindset of an experimenter and a designer. Search out resources that match — and support — your slow-brain intention. The first five might not work, but the sixth one will because it keeps your attention.

What works is unique to each person. And you’ll eventually need new tools because you’ll make progress. You’ll say, “I’ve done that meditation, journaling, or gratitude app; now I’m bored.” So you’ve got to move on to the next thing. This needs to be done consciously and deliberately, always with an eye toward designing, tinkering, and optimizing what works for you.

EL | The digitization of healthcare promises to be transformative for insurance providers, medical practitioners, and patients, but so far it hasn’t been. What needs to happen to get there?

KB | So far we’ve simply made things a bit more convenient by making them electronic. We go to a website to do things rather than mailing, faxing, or copying, but a lot of those old forms of communication still exists. Translating things into digital form has sped things up, but it hasn’t changed what happens.

If we fully digitize healthcare, other issues crop up. For example, there’s a whole revolution about seeing your physician online when it’s appropriate along with self-diagnosing, and even replacing visits as the centerpiece of healthcare.

EL | What are the potential pitfalls of full digitization?

KB | There will always be risks due to bad actors in the field and even hackers. We need to put in safety nets — like supports and advocates — for vulnerable populations that may not be able to navigate the new world because of factors such as mental health issues, educational barriers, technological disparities, and generational norms.

Look at what happened when technology made retirement savings more self-driven. There was concern that if people started using the tools on their own they’d destroy themselves with it, but the majority of the population survives the transition and figures out the new behavioral norms.

EL | What’s the key to building successful technology for engagement?

KB | As humans, we can tell when things are about us and when they’re about somebody else. We have mirror neurons that act like little compasses inside our brain and detect whether we are dealing with a narcissist or whether we are dealing with somebody who is there to serve our needs. I think a lot of health technology fails when it becomes the equivalent of talking to a narcissist at a cocktail party. It’s all about them. It’s all about them getting my data — it feels creepy and people naturally disengage.

Technology has to play by the same rules as people do. It has to be a good citizen. It has to be helpful. It has to be a humble servant. It has to be truly authentic. And that’s why I believe in people’s ability to discern whether technology has met this test — they vote with their engagement. I trust that if something is useful to people at large, it will be used, and when the balance is tipped toward narcissism, it won’t. So we hold all technology to the same social rules we would a person because we don’t have any other way of understanding technology except to, in our brains, anthropomorphize it and make it a person with certain characteristics, intentions, and personalities.

 

Follow Bobinet’s work at www.drkyrabobinet.com.

Heidi Wachter is a staff writer with Experience Life.

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