Habit Lens
Market Research

"Behavioral Beliefs": A Critical Link in Customer Habit Formation

By Noah Pines

SSRIs and Stadium Lights

A brilliant colleague once shared a story with me about a psychiatrist who used a fascinating metaphor to describe the onset of effect of selective serotonin reuptake inhibitors (SSRIs) to his patients. "Think of it like a football stadium," the psychiatrist would say. "You flip the switch, and the lights don't come on immediately. One by one, the banks of lights flicker to life until the entire field is lit."

This simple analogy—a concept we call a 'behavioral belief'—has helped countless patients stick with a treatment that offers no immediate reward and often comes with side effects before benefits. Without it, many might have abandoned their antidepressant medicines too soon. With it, they had a rationale (and a mental construct) to stay the course.

This story, while seemingly trivial, captures an underleveraged tool in pharmaceutical marketing: the power of behavioral beliefs to help form and reinforce customer habits.

Habits in Healthcare Marketing: More Complex Than We Admit

In neuroscience, we understand habits as the result of deeply ingrained neural loops involving the basal ganglia, dopamine-mediated reinforcement, and cortical cues. These biological mechanisms align surprisingly well with the habit models made popular by Charles Duhigg's "cue-routine-reward" loop and Nir Eyal's "trigger-action-reward" model. These models work beautifully in consumer tech, fast food, fitness, and even finance. But in healthcare—and pharma in particular—this loop often breaks down.

Why?

Because in pharma, the "reward" is often delayed, invisible, or even negative. A patient taking a statin doesn’t feel anything—unless it’s muscle pain. A psoriasis treatment might cause flares before clearing. An oncologist might prescribe an immunotherapy knowing that scans could show pseudo-progression before improvement. These are not intuitive feedback loops. They don’t reinforce habits. They challenge them.

Contrast this with the user experience of modern consumer electronics. Select an app on your smartphone, and you get what you want instantly: the news, weather, directions, entertainment. It's an immediate on switch that gives us a sense of reward. A smartwatch taps your wrist the moment you close your activity ring. These technologies essentially train users to expect immediate, frictionless feedback—a dynamic pharma products rarely provide.

Case in Point: The DORA Dilemma

Consider the recent market challenges surrounding dual orexin receptor antagonists (DORAs) in treating insomnia. Compared to "z-drugs," sedative hypnotics like Ambien, which create an immediate knock-out effect, DORAs work gradually by modulating wakefulness. They require consistent nightly use and time to achieve efficacy.

For patients conditioned to expect an immediate impact, the feedback from DORAs felt like failure. Physicians began reporting skepticism from patients who didn't "feel" the drug working the way Ambien did. In this case, a lack of immediate, visceral feedback created a belief gap.

By leveraging the right behavioral belief—such as, "This medicine helps your brain find its natural rhythm again over time" or "The absence of a knockout effect means you're regaining real sleep, not sedation"—the interpretive frame could shift from doubt to understanding. Belief can define the success or failure of an experience.

Behavioral Beliefs: The Cognitive Bridge Over Negative Feedback

From a neuroscientific standpoint, belief formation is a process of neural encoding in the prefrontal cortex that helps us anticipate outcomes and assign meaning. In complex medical treatments, where feedback is inconsistent or ambiguous, beliefs serve as the scaffolding for behavioral persistence.

We at ThinkGen call these constructs behavioral beliefs—cognitively constructed explanations that help individuals interpret their experience and assign value to it. They transform counterintuitive or negative feedback into evidence of progress. Outside healthcare, the belief "No pain, no gain" accomplishes exactly this. Muscle soreness after a workout is recast as a positive sign of effort and growth.

In pharma, behavioral beliefs function similarly. They help physicians explain, for example, why a migraine preventive needs to be taken daily even if the patient doesn’t experience daily migraines. Or why flu-like symptoms after vaccination are not side effects to fear, but signs of immune engagement. Or why an Alzheimer's treatment isn't going to help the patient's symptoms to improve, but rather to slow their decline.

Why Behavioral Beliefs Matter

Behavioral beliefs are essential to the healthcare journey today for several reasons:

  1. Biological Complexity: Our products increasingly modulate subtle and non-obvious pathways—immunologic, neurologic, genomic. The experience of these therapies often confounds intuition.
  2. Temporal Delay: The most meaningful benefits in chronic disease and prevention are realized long after the initiation of treatment. This time gap must be cognitively bridged.
  3. Cognitive Load and Misinformation: Patients and even HCPs are overwhelmed by information. Beliefs cut through complexity with narrative and purpose.

From Education to Belief Engineering

More often than not, pharma marketing defaults to rational education—data, mechanisms of action, comparative tables. But neuroscience tells us that belief change occurs through emotional salience, storytelling, and repetition—not through bullet points.

Belief engineering is the discipline of shaping the mental models that drive adherence, prescribing, and usage. Ask:

  • What is the expected feedback a user will experience?
  • Will that feedback confuse or reassure?
  • What belief will help them reframe it constructively?

It’s not enough to disseminate facts. We must design beliefs that make behavior sustainable.

Behavioral Beliefs in Action: A Few Examples

  1. Cancer Immunotherapies: Pseudo-progression once triggered discontinuation. Now, oncologists who hold the belief "a flare may precede a win" are more likely to maintain treatment.
  2. Acne Therapies: Dryness and irritation can be reframed as "purging"—a sign that clogged pores are clearing.
  3. Insomnia and DORAs: Repositioning these therapies not as sedatives but as agents of circadian realignment shifts expectations from knockout to restoration.

Each of these beliefs changes the internal narrative from threat to reassurance—from doubt to trust.

Behavioral Beliefs and the Habit Lens

At ThinkGen, our Habit Lens approach integrates behavioral science and neuroscience to diagnose where the habit loop breaks down and what beliefs are needed to complete it. In pharma, the loop is often incomplete because of challenges in feedback interpretation.

We help clients uncover habit-critical beliefs:

  • What does an HCP need to believe about this product to recommend it long-term?
  • What does the patient need to believe to accept and continue treatment?

These aren’t just insights. They’re strategic imperatives.

The Strategic Implications for Marketers

Pharma marketers must embrace belief engineering as a foundational strategy:

  • Messaging: Move from explanation to interpretation.
  • Training: Arm reps with metaphor, analogy, and narrative—not just objection handling.
  • Support: Build digital tools and PSPs that reinforce key beliefs over time.
  • Research: Go beyond awareness to uncover the beliefs driving sustained use.

This approach aligns closely with the evolving field of neuromarketing—the application of neuroscience principles to influence behavior. Though regulatory caution has made adoption slow in pharma, the discipline offers tremendous value when applied responsibly: to inform, not manipulate.

Because if we fail to close the belief gap, even the most effective therapies may fail in the marketplace—not for lack of science, but for lack of meaning.

Final Thoughts: Design for the Mind, Not Just the Market

In a world of complex biology, delayed outcomes, and uncertain feedback, we must shift from behavioral tactics to belief strategy. That means designing for cognition, not just compliance.

When we help customers build explanatory beliefs, we give them the psychological structure to persist, adapt, and succeed. That’s not just good marketing—it’s good medicine.

Let’s shape belief, not just behavior.