Allison Harvey knew she’d have to study hard when she enrolled in an 11-week course on parenting techniques earlier this year.
A UC Berkeley professor of psychology who researches memory, habits and sleep, Harvey printed her notes and meticulously completed each week’s homework. She engaged with the instructors, who were also well-respected clinical psychologists. And she was far more engaged than her classmates, including her husband.
Yet, when the class ended, Harvey was confronted with a familiar reality: Despite studying hard, she’d forgotten many of the lessons she was supposed to have learned and put into practice.
Allison Harvey
“I was far short of where you’d want a patient to be at the end of 11 sessions,” she said.
Frustrating as it was, Harvey said her experience was a personal window into the shortcomings of what are called evidence-based psychological treatments. These treatments, which include various forms of counseling, trauma interventions and cognitive behavioral therapy, are rooted in science and used widely to treat an array of mental health challenges.
But as Harvey describes in a recent paper in the journal Behaviour Research and Therapy, these treatments often fall short because of humans’ flawed memories and difficulties creating new, healthier habits. Her research explores how subtle treatment changes could significantly improve patient outcomes — both mentally and physically.
Memory gaps in health care
First, change requires acknowledging the profound gap between what’s discussed in a clinical setting and what people actually remember after they leave. Doctors may have said the right thing, but there’s often a lack of follow-up to ensure the patient retains the information. People also have notoriously terrible memories, Harvey said, pointing to research showing patients only retain about 30% of information shared in a session.
“I don’t think us humans realize how fallible our memories are,” Harvey said. “We’ve got decades of psychological research showing that we fail to encode memories accurately. We fail to store them accurately. And we fail to retrieve them accurately.”
That memory gap can undermine even the best-laid treatment plans. If a patient forgets the majority of what was discussed, they’re less likely to see positive, lasting benefits.
Habits take time — and effort
Memory is only part of the puzzle. Additionally, Harvey said, we must confront how difficult it is to build new behaviors into routines — a process that social and health psychologists say can take between 18 days and 36 weeks.
There are science-backed strategies to help, like pairing new actions with existing routines or activities. But without explicit discussion in clinical settings about how to make new skills habitual, patients may struggle to maintain progress after treatment ends.
In other words, Harvey said, existing treatments too often lead patients to forget what they’re supposed to do, and those who know what they should do often fail to regularly do it.
“We’ve got a mental health crisis. We’ve got treatments that work. But those treatments need to be improved to get people much better,” she said. “That, I think, is a real scientific challenge.”
Ongoing sleep research seeking solutions
Finding ways to address the memory and habit formation elements of health interventions doesn’t need to be overly complicated. Sometimes it’s as simple as a carefully worded text message.
Harvey’s ongoing sleep research, backed by the National Institutes of Health, focuses on memory and habit change that can lead to better sleep. In one study, her team sends participants text messages with cues, reminders and follow-ups to understand what drives habit change and, ultimately, better health. “At 10 p.m. I will dim the lights and put my phone down,” said one automated message, setting the goals. A morning message asks if the goals were met. If so, participants were rewarded with a fun fact: “Did you know dolphins and whales sleep with only half of their brain at a time so they can still swim during sleep?” If not, they were encouraged to try again the next night.
Early results are encouraging, she said, adding that it would be important to also study how similar interventions could scale into mental and physical health settings.
“We can come up with augmentations that could be applied before a session, in the middle of a session or at the end of a session that are not costly,” Harvey said. “They don’t have side effects, but they’re effective at improving outcomes.”
Behind those improvements is a commitment to basic science, she said. Her work on memory is based on cognitive science and education research, and habit formation is deeply tied to social psychology. Breaking down research silos, like she’s attempting to do with sleep research, is a pathway toward improving patient outcomes more broadly.
“Unless we’re paying attention to and adhering to what’s being found in those other fields, we just won’t be effective or as effective,” she said. “It’s like a pipeline of science at every step.”
As for the parenting class she took, Harvey said there were valuable lessons. But many of them faded from memory and never became second nature.
“It’s sort of funny though, isn’t it? Despite all that studiousness, only a few months later, I’m struggling to recall. This, I guess, is the whole point.”
