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22 T M C » P U L S E | J U LY 2 0 1 8 Changing Behavior: Challenging, But Possible Two TMCx digital health startups and a UH researcher offer solutions H umans are creatures of habit, which makes change difficult. Starting an exercise program, beginning a medication regimen or adhering to a new schedule can be challenging, even for the most determined people. But two startup companies that recently completed the Texas Medical Center Innovation Institute (TMCx) digital health accelerator program, along with a University of Houston researcher, are offering creative solutions to help individuals change their ways. Gain Life Behavioral change has two necessary compo- nents, according to Sean Eldridge, co-founder and CEO of Gain Life, a technology company focused on behavior design. One part is executive function—conversation, planning, goal-setting and creating routines. The other part is "centered identity," which involves clarifying one's purpose and values. Eldridge created the digital application Gain Life with his co-founders to help individuals change their behaviors. The team was inspired by psychologist Daniel Kahneman, Ph.D., winner of the Nobel Prize in economics and author of Thinking, Fast and Slow. Kahneman's work is based on a model he calls System 1 and System 2 thinking. System 1 is unconscious or "fast" thinking, while System 2 is conscious or "slow" thinking. Eldridge's real-life example of System 1 think- ing is buying fast food on the way home, while System 2 thinking would be buying ingredients to make a healthy meal. "How you want to change behavior is to take a person from unhealthy System 1 thinking to System 2—taking control of decisions to be healthy or managing your diabetes—and then back to System 1 making those subconscious healthy decisions," Eldridge said. "When you are lost in the jungle with a machete, you can carve a path, but you don't know which way to go. If you have that North Star, you have a path and can see where you're going. That is where Gain Life comes in." Klikkit Klikkit is a Danish company that uses sound alerts and visual signals from smart buttons to reinforce good habits. The buttons—which can be placed on almost anything, from a jar of vitamins to a vegetable—work with an app that can be downloaded onto a smartphone. When a person clicks one of the buttons, the app makes a record and monitors progress. If the button isn't pressed, the user will receive a notifi- cation while the Klikkit beeps and flashes. This process is based on the "habit loop," a neurological cycle discovered by Massachusetts Institute of Technology researchers that governs habits and consists of a cue, a routine and a reward. "You have the visual cue, and even more pow- erful—a light flash and sound," said Aleksander Eiken, M.D., a Klikkit medical advisor. "The more senses stimulated, the more powerful the reminder." Clicking the button develops a "routine" and delivers a "reward." The user feels accomplish- ment as the body releases a small amount of dopamine, which is what keeps people addicted to reward-motivating behavior, Eiken said. B y C h r i s t i n e H a l l Top: Sean Eldridge, co-founder and CEO of Gain Life, pitches his digital health solution at the TMC Expert Forum in March. Bottom: Aleksander Eiken, M.D., medical associate at Klikkit, explains the Klikkit smart button to a TMC Expert Forum attendee.