In last month’s edition (August 2023), I discussed how “smart” devices and products can serve as a fundamental tool in behavior change. In a similar vein, I had the unique opportunity to interview behavioral science expert, Cary Sears, on his experiences in the field. This month’s Behavior Bytes newsletter will give you insight into his thoughts on breaking into the field, the proudest moment of his career, and his views on artificial intelligence (AI).

Why you should read this interview

You’ll be interested in reading this interview if you have a non-traditional background and want to break into behavioral science. You’ll also learn what drives behavioral scientists working in a demanding, uncharted field of digital health, and how such researchers conceptualize artificial intelligence. 

Background

Cary Sears, MS, MA, NBC-HWC is a thought leader in the behavioral science and digital health fields and has studied and influenced individual behavior for over a decade. He has worked in diverse settings including academic research, major medical centers, community agencies, and digital health companies. He has combined expertise in experimental psychology, user experience design, and health behavior change to help develop interventions that merge high-tech with high-touch in the digital health space.

His talents and experience were quickly recognized by Noom, a leading digital health company whose mission is to help as many people as possible live healthier lives through behavior change. Noom helped to pioneer digital health coaching. After serving as a coach himself, he was promoted several times, eventually working as a Senior Coach Manager where he used his exceptional leadership and communication skills to supervise 100+ Health Coaches at the company to promote behavior change across a multitude of users. He also helped implement user experiments at Noom by piloting experimental coaching protocols. 

After nearly 4 years at Noom, he now acts as Head of Care Coaching at Neura Health. As one of the founding team members of the company, he helps individuals manage chronic neurological conditions virtually. Neura Health is an all-in-one benefits solution to virtually manage neurological conditions, which affect approximately 130 million Americans. Unlike the traditional care model - which is often expensive and confusing for patients - users can meet with board-certified neurologists within days, access their care team via chat anytime, obtain a personalized treatment plan, and receive access to coaching services to provide support and guidance for making lifestyle changes related to stress, sleep, nutrition, and movement. Cary helped develop Neura Health’s coaching program from the ground up, and is transforming how patients with chronic neurological disorders treat their health concerns.

Cary Sears earned a bachelor’s degree in psychology and master’s degrees in experimental psychology and user experience design. He is a National Board Certified Health and Wellness Coach and also holds a certificate in behavioral economics.

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1. Please tell us about yourself, your background and how you became interested in behavioral science.

Cary: I would love to be able to say that my current position was all part of my master plan but really I just followed a meandering path paved by my interests. I have always been fascinated by human behavior. This led me to earn a Master’s degree in experimental psychology. My initial intention was to go on for a doctorate and become an academic doing research and teaching. During graduate school, I worked as a research assistant in a cardiovascular psychophysiology lab and completed my thesis research on biofeedback at a major academic medical center, where I ended up working full-time conducting neuropsychological testing.

My career path was not well defined and I was trying to weave together several threads of interests into a coherent whole. These included wanting to transition into industry, having an interest in technology and how people interact with technology, as well as an interest in psychological aspects of physical health and illness.

My background being in academic psychology, at that point I was unaware of the whole field of behavioral science that combines insights from psychology, behavioral economics, and other disciplines to design effective behavioral interventions. My gateway drug into this world was user experience design (UX). I started to read a lot about UX and human computer interaction and ended up doing a second graduate degree in UX. I also started working for Noom (before many people really knew their name) as a behavioral health coach and learned about designing digital health behavior change interventions at scale. This encapsulated all of my interests. I worked my way up to leading a team of health coach managers that collectively managed a team of over 100 health coaches.

Currently, I am founding head of care coaching for Neura Health, a digital neurology clinic that is an all-in-one benefits solution to virtually manage chronic neurological conditions, which affect 130 million Americans. We are building a novel solution to chronic condition management.

2. How have you applied behavioral science principles in your work, in terms of product design, coaching or other services?

Cary: Behavioral science informs just about everything I do at Neura Health. Our whole coaching program including the care plans that patients see in our app is based on evidence based interventions.

In addition to translating findings from behavioral science into our programs, I see behavioral science as a process. It is a process or experimentation and iteration. It informs the way we engage patients and learn from them in a never ending cycle.

Kiran: A process-focused approach to research and behavioral science is so important. It also essentially acknowledges that there is always an opportunity to learn, improve and innovate. This all translates to opportunities to engage with patients and users to help serve them better. I think this philosophy also lends itself well to applying artificial intelligence (AI) in behavioral science.

3. Why do you think this field (behavioral science) is important?

Cary: Behavioral science is important because it brings together the best learnings and processes from different disciplines to bear on essential human challenges.  Behavioral science is being used in everything from public policy to health communication. If we want to positively influence people’s behavior, it is important for us to understand the most effective ways in which to accomplish that.

4. What are some of the challenges that organizations face in applying these strategies in their products and services? Why do you think more companies are focusing on this field now?

Cary: I have seen some companies try to jump on the “nudge” bandwagon and implement very cookie-cutter behavioral science learnings without taking into consideration how their customers, company and other situational variables make for a very different context than the original research they are often citing second hand.

The challenge is in building a behavioral science culture and process rather than just trying to apply random learnings out of context. To really take an experimental approach to understanding your particular customers and context.

I think the reason more companies are trying to focus on this field is because behavioral science - when done well - is very powerful. As complicated as technology can be, human beings are infinitely more complicated. More companies are understanding that the human element, how they interact with their customers, prospective customers, and employees is critical to their success and probably best not left to chance.

5. What technologies or techniques would you be interested in exploring through product development? How do you apply this in your coaching work?

Cary: I think AI actually holds a lot of promise for health coaching. I am not talking about AI health coaches but rather using technologies such as machine learning to develop real time individualized interventions. In digital health, the product is the human coaching relationship combined with the in app curriculum / care plan. Machine learning models can be used to better understand each individual user based on their engagement with the app, the actions that they are taking, feedback given, information gained through APIs, biometrics, etc. This information could be used to tailor the intervention in real time -  both constantly crafting what the patient sees in the app as well as helping inform the human coaching process.

Kiran: I agree and I like that the product is a combination of the human relationship and the app. This follows up quite nicely to a topic I discussed in last month’s edition (IoTs). The data - biometrics, engagement with the app - can be scrutinized with exceptional detail and fed into models to support the learning of new information and the prediction of specific outcomes. The human coaching element is novel and can perhaps further improve the accuracy of outcomes.

One exciting venture that is possible thanks to AI is enhancing inclusion and accessibility for individuals who have a disability or who may otherwise not have access to features or services due to their physical, economic, geographic, etc. limitations. Involving a diverse sample of users (and the diverse perspectives and experiences that come with that) reduces the risk of developing applications that can feed into an echo chamber or that can magnify biased or detrimental attitudes and behaviors, factors that adversely affect machine learning predictions.

6. What does a typical day or a typical week look like for you?

Cary: There is a lot of variety in my job. One of the things I love about working for a startup is the “all hands on deck” mentality. It is impossible to list all of the different things I get involved with. Some of the typical things though are that I spend a few days a week coaching patients via video and the rest of my week is focused more on program development. My job has included everything from coach hiring, training, ongoing mentorship and supervision to helping design and implement our care plans. I have done user research and run behavioral design experiments. I spend a lot of time on care plan development for both our general curriculum and individual care plans for particular conditions such as vestibular migraine. This has entailed user and desk research, working with subject matter experts, creating specs, writing content, hiring and managing a multidisciplinary team of professionals including UX writer, visual designer, animator, and videographer. We recently launched a care plan utilizing cognitive behavioral therapy for insomnia where I took the lead on both curriculum design and developing coaching protocols. 

7. What are some of the challenges that you face in your work and how do you resolve them?

Cary: One of the challenges is that we are cutting edge. We are at the forefront of developing digital interventions for neurological conditions. Care coaching within the context of a medical clinic is a pretty new concept. So we don’t really have a playbook to follow. We have to take an evidence-based approach and also listen to and learn from our patients. We tackle this challenge by adopting an innovative and iterative approach. We have to always be learning, growing, and improving what we are delivering to our patients.

8. Do you ever face any ethical problems? If so, how do you navigate them?

Cary: I don’t have any drastic dilemmas to discuss. There are always ethical concerns within healthcare and unique ones within digital heath. For example, in working with patients with chronic conditions accessibility is important as is inclusive language. We also have an ethical obligation to combat stigma.

As a health coach, I also need to be very aware of issues around scope of practice. For example, we are not licensed mental health professionals. While we provide support, we cannot diagnose or treat mental health conditions. We need to make this clear so there are no misperceptions or misunderstandings.

Health coaches have expertise in helping people with health behavior change but we have to be careful not to be too prescriptive. For example, while we might help someone adopt healthier eating habits, we are not registered dietitians, and so we cannot provide nutritional counseling.

9. How prevalent is “compassion fatigue” and what steps do you take to “fill your own cup”?

Cary: Compassion fatigue is pretty prevalent, particularly within the medical field. We work with patients with serious medical conditions. For me the work itself is often energizing because it is an opportunity to really have a positive impact and help people. Nothing is more satisfying. By the same token, when you really care about the people you serve it can be draining sometimes to see them suffering. People in the caring professions can have a tendency to put others first. This can be detrimental when you are not taking care of yourself. 

Several of us at Neura Health, including myself, also have chronic illnesses. This gives us great empathy but we really have to be mindful of caring for ourselves while caring for others. I am also cognizant of modeling self-care for both patients and other coaches. For me, this means intelligent energy management. I engage in mindfulness and relaxation practices in short increments throughout my day. This can be as simple as 5 minutes of meditation between patients so that when the appointment starts I can be more fully present for patients.

I am also practicing being better at the fundamentals such as regular hydration, nutrition and sleep. Physical activity is also important. I recently started practicing martial arts several days a week. This has been a great way for me to blow off steam and engage in a mind/body practice. Finally, spending time with my wife, family, and friends helps me focus on what is important and is renewing.

10. What are you most proud of in your work?

Cary: Our average coaching satisfaction score is 4.9 out of 5. This makes me really proud!  As a team, we are positively impacting people’s lives every single day. The numbers represent real people. We regularly receive testimonials from patients that literally bring me to tears. I hear from patients all the time that what we do matters. The team I work with is the best in the business. I am proud to be a part of it and truly grateful every day for this opportunity to make a difference.

11. What recommendations do you have for people who want to follow a similar career path?

Cary: Become good at asking good questions. Get curious about why people do what they do. Come up with hypotheses and learn how to test them. Reach out to people who are doing interesting work. The community on LinkedIn is incredibly engaged and helpful. Try to figure out what value you can provide for other people that you are interested in building relationships with. Sincere interest in people’s work goes a long way as well. Read articles that they have written and engage with their ideas. Try implementing something you learned from them perhaps in a novel way or with a different population or setting.

Kiran: I completely agree. LinkedIn has revolutionized how professionals interact with one another, and I recommend professionals take full advantage of the platform.

12. Any final words for readers who are curious about people, psychology, behavioral science, and artificial intelligence?

Cary: There is a lot of negative hype and fear mongering around AI. I don’t think that technological growth and innovation should be feared. In fact, AI is going to help solve a lot of difficult problems. I do think though that we need to be careful to design and implement solutions that are user-centered and serve humanity. The behavioral sciences and disciplines like UX play an extremely important role in humanizing technology.

Kiran: I appreciate your conscientiousness regarding the use of technologies, like AI, to ensure it is used in a way to improve the human experience. Thank you for sharing your thoughts in this interview!

This interview has been edited for length and clarity. Want to know more about Neura Health? You can visit their website here, and you can also connect with Cary via LinkedIn.