Is “brain hacking” right for behavioral medicine?

By Jason Fanning a health psychologist and programmer

It’s an attractive possibility: A health app so engaging the user does not want to put it down. All the better if they feel compelled to move a bit more or eat a bit less to get that next reward! This is certainly the model for many of the most popular social media applications, and the term “brain hacking” – or the attempt to purposefully trigger the brain’s reward circuit to prompt the user to come back time and time again – has recently entered the popular lexicon and received coverage from several major news outlets. Successes in the health arena are often held up with excitement: behavioral researchers looked on as millions suddenly took to the streets to catch as many Pokemon as their feeble batteries would allow. Or as others strapped various wearables to their wrists and started competing against friends for the highest daily step count. This ability to move so many users around the globe is clearly valuable for promoting behavior change, especially in the short term.

But it is worth stopping to discuss the role of these techniques in our digital behavior-change endeavors. There are some concerns that are ethical in nature – for example, building the need to continually return to one’s smartphone may stoke the release of stress hormones between exposures. Some concerns are philosophical – is it in our interest as health providers to attempt to change our participants’ behavior through covert means? And others are pragmatic – developing an awareness of one’s behaviors is an important step in promoting long-term behavior change; making the person an agent of their own behavior change, perhaps by setting goals or tracking food, is a key component in successful interventions. If the behavior is secondary to some reward, like walking as a happy consequence of catching Pokemon, when the incentive loses its value, is the person any closer to making a meaningful change? The evidence generally suggests not, especially when these apps and/or devices are used on their own.

Naturally there is not likely to be a specific set of rules to follow as we build the best of these features into our thoughtful, engaging, and effective mHealth tools, but remembering to place a premium on beneficence is a useful first step. Our primary goal is to improve the health and well-being of those who receive our interventions, which may stand at odds with commercial application developers focused on advertising revenue or in-app purchases. With beneficence in mind, the researcher might weigh some of the exciting advantages provided by a reward center-triggering feature – perhaps higher engagement – against the feature’s disadvantages – maybe higher daily stress or distraction from social relationships. As we continue to gain access to richer streams of moment-by-moment data, there are bound to be many further ethical questions to consider. What do you feel are issues the research should consider when leveraging these data? If they are ultimately used to change an unhealthy behavior, do you see potential harms in “brain hacking” for health?

BIO: Jason Fanning is a health psychologist and programmer with an interest in building health tools to support behavior change across the day. He is currently a postdoctoral researcher in the Department of Gerontology at Wake Forest School of Medicine.

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