Evoking Emotion to Set the Stage for Behavior Change

Table of Contents

• Introduction: Our Passion to Understand Customer Emotions
• A Personal Anecdote on the Power of Emotion
• Ways We Leverage Emotions
• Healthcare Disrupts the Emotion Cascade
• Taking Our Emotional Targets “Upstream”
• Take-Home Points

Introduction: Our Passion to Understand Customer Emotions

Emotions might be credibly described as an obsession among life science marketers and insights professionals.  We talk about “unlocking customer emotions,” “creating deep empathy” and “finding moments of meaning” in customers’ lives.  We conduct emotional journey studies and emotional driver studies.  We try to measure emotions as a way of assessing the quality of marketing collateral.  Overall, I can’t think of a type of primary insights work that evokes more passionate engagement with marketing colleagues than those focusing on customer emotions.

And there’s good reason for this focus.  Emotions are powerful.  They are our built-in “pattern interrupt” system that makes us snap to attention when important things change in our environment (Yiend, 2010).  They help us make sense of the world and help us make different decisions in the future.  But most of all, we all understand that they are powerful mediators of behavior change (Angie et al, 2011).  As one team of emotion scholars noted, emotion and decision-making go hand in hand (Lerner et al, 2015) – an assessment that is born out in extensive experimental work and academic meta-analysis.  But, as we will explain, it is possible to misconstrue the ways in which emotion operates in the context of life science decision-making, which as we know, is a very different kind of animal than other domains of marketing.  This post presents what we hope will be a highly useful and productive view of how to conceptualize the power that we can leverage by evoking emotions through our promotions. 

A Personal Anecdote on the Power of Emotion

Some time ago I had a memorable buying experience that might be helpful in setting up this discussion.  One evening, while exercising, an advertisement came onto my YouTube feed that immediately caught my attention. It was for a very specific item that related to my favorite hobby (recording music).  As I watched it, my workout was forgotten, and I felt an unusual surge of excitement.  If I were to put it into words, it would go something like “Oh my gosh! This is what I’ve wished someone would make.” Before the ad was over, I was on the company website ordering the item. The experience was surreal – partly because I like to think of myself as a person with reasonable impulse control.  So, what happened?  There were a few psychological keys to this behavioral cascade. 

• Goal-Relevant Salience:  The item was salient to me because it was directly linked to a goal that I have in my life.  Salience is one of the giant levers to communication effectiveness.¹
• Evaluation:  I quickly appraised that this item afforded me the opportunity to address a nagging problem with my recording.
• Intense Emotion:  I was literally excited because the nagging problem had been a frustration.  Interestingly, I had the sensation that the excitement was essentially simultaneous with the evaluation – both felt instantaneous. 
• Barriers:  I could afford it and I had sole discretion on whether to buy it. 
• Outcome:  Purchase and eagerly await delivery.

Had any one of these factors been removed, I suspect the ad would have gone unnoticed.

What’s the point of this anecdote?  I submit that this kind of process is something like what marketers usually have in mind when they talk about finding emotional drivers.  We hope to trigger that specific feeling that will produce this kind of behavior cascade, or at least something approximately like it.

¹Readers interested in learning more about the role and power of Salience in messaging and marketing communication are invited to read our post entitled, “Content Salience Drives Communication Effectiveness“. 

Ways We Leverage Emotions

The question of how emotions influence downstream outcomes is important and very much worth understanding for marketers and insights professionals.  Based on our consulting work, we have seen a range of pathways for leveraging emotions. This is not an exhaustive list, but in our experience, the bulk of emotional explorations in life science live in one of these categories.

1. Showing Alignment with Customers’ Emotional Experience:  If we identify precise and important aspects of customers’ emotional experiences, we may be able to use this information to demonstrate earnest empathy with our advertising.  By showing the depth of our understanding, we may create positive associations with our brand, which in turn may translate to brand preference.
2. Sharpening Salience & Shifting Attention:  Emotional events capture our attention and have the ability to make something personally salient when it may not have been otherwise.  If our ads can engender even a facsimile of a real-life emotional reaction, we may strengthen the call-to-action for a particular change in thinking or behavior.  For example, highlighting a rarely considered aspect of patient suffering may invoke a slight guilt response, which in turn translates to greater attentiveness to that issue in the future.
3. When Logic Goes Against Your Brand:  Finally, I have been involved with cases where a brand team is working with a product that is systematically less good on at least one key product feature compared with a competitor.  In such cases, marketers may want to use emotional priming as a way to tilt the comparative evaluation of products in their favor. In this context, the emotional association (or attitude) would act almost like a distinct product feature – something that can tip preference in the direction of your brand. 

Underneath each of these approaches (or any variations around them) is a belief that emotions work through a pathway that looks something like the following diagram. At a basic level, the marketing stimulus is presented, some kind of emotional response is evoked and, ultimately, some kind of behavior change ensues.  The Optional Step in this diagram can be a reasonable stand-in for processes like attitude formation or some kind of mental elaboration, and we include it because I suspect most marketers would acknowledge that there might be mediating processes. Let’s call this deliberately simplistic model the stimulus-emotion-behavior cascade. 

Figure 1.  “Strawman” Model of the Implied Role of Emotions in Marketing

One immediate question we might ask is, is there any reason to believe that this conceptual model is valid?  Interestingly, the answer is a qualified yes.  In another post called, “Limitations of Self-Reported Emotion”, we shared some robust evidence for the kinds of downstream changes that different kinds of emotions reliably produce.  The strongest correlates of laboratory-invoked emotions turn out to be behavior-change endpoints (Lench et al, 2011) and decision-making endpoints (Angie et al, 2011). Those conclusions are based on experiments that produce relatively muted versions of real-life emotions that are produced via lab manipulations.  These kinds of emotion manipulations are good proxies for the scope and intensity of emotions that we can expect to generate with our marketing collateral.  This mounting body of evidence also aligns to a range of scientific hypotheses about both the origins and the mechanisms of emotion functioning, which are based on the idea that emotions operate as something of a behavioral override system. We experience emotional episodes when our goal-related behavior is disrupted in some way.  This happens so that we change our behavior – hopefully in ways that are more goal-relevant.  For example, a wave of disgust gets you to spit out a potentially dangerous piece of food.  Anger makes you shut down someone who disagrees with you about a policy you are trying to advance.  In both cases, the emotion is a pattern interrupter in your behavior.  On balance, both the systematic study of emotion and prevailing theories of emotion seem to offer some support for the stimulus-emotion-behavior cascade.

However, if you are sensing a “but” coming, your intuition is serving you well.

Healthcare Disrupts the Emotion Cascade

Despite everything we’ve said to this point, there is reason to be skeptical about the stimulus-emotion-behavior cascade as it applies to healthcare.  In healthcare, we are not operating in a normal human social environment. If we think back to my personal anecdote about emotion-mediated buying, it takes just a second’s reflection to see that this scenario (or anything like it) could almost never play out in the world of professional healthcare.  I invite readers to participate in a simple thought exercise.  Think of three prescription medicines that are approved for any type of treatment.  From among these three, try to imagine a scenario where a patient could have an experience of rapidly accessing the product upon learning about it for the first time?  My guess is that you will struggle to think of an example. 

A friend of mine once quipped (I’m paraphrasing this from memory): “Everything is backward in healthcare.  The person (i.e., patient) who gets the product doesn’t get to choose it. The person making the product choice (i.e., physician) isn’t the one taking the product.  And the person who pays for it (i.e., payors) doesn’t do either.”   While you can quibble about this synthesis at the margins, it’s tough to argue that my friend was wrong.  And the dynamics implied by his synthesis create problems for how we think about the role of emotions in marketing.  To be slightly more systematic, I would break it down this way. 

• Time Lag:  There will almost always be a major time lag between the point of experienced emotion and the point where the patient or physician can exert her will on the process of accessing a drug. 
• Proxies:  Much of our focus in healthcare promotions is on physicians, people who are trained to be more objective and more reliant on data and statistical information, and for whom the consequences of decision-making are mostly conceptual (since they are not taking the drugs themselves).  Decision-making on the part of proxies is simply different than decisions made by the person who will experience the results of her/his own decisions directly. 
• Second & Third Parties Stage-Gates:  Even if that surge of emotion were translating to an immediate behavioral intention, the path from emotion to outcome goes through the evaluative filters of other people – and sometimes multiple people. 

Taken together, these very familiar dynamics make it difficult for the classic stimulus-emotion-behavior cascade to play out.  And the point is that, if emotions are going to be relevant to our work as marketers, we have to orient to them in a way that fits with the realities of how healthcare is administered and structured in the real world.

Taking Our Emotional Targets “Upstream”

None of this is bad news to us because emotionally evocative content can be useful to us in many ways.  In our prior summaries looking at the science of persuasive communication, one of our key learnings had to do with the fact that our communications can powerfully influence a range of customer endpoints from beliefs about how the world works, to attitudes toward products or therapeutic approaches, to intentions about how they will evolve behavior in the future.  And each of these cognitive endpoints has been shown to change (often meaningfully) under the influence of evoked emotions.² So, even if you cannot immediately influence outward behavior, you can absolutely use emotion to set the table for those behaviors in the future.

Our view is that most decision-making and product selection behavior in healthcare emerges through a more extended process that is mediated by a variety of cognitive overlays.  In the context of healthcare, the sorts of cognitive endpoints we are now focusing on can be seen as preconditions to behavior change.  Many models for healthcare behavior change exist, but they tend to have some commonalities, which go something like this.

• Customer becomes aware of an option (e.g., a therapy)
• Customer evaluates benefits/drawbacks of a therapy
• Customer develops some evaluative feeling (i.e., attitude) about the therapy
• Customer establishes some kind of formal or informal intention about the therapy
• And if the customer has agency and power to act, he/she can ultimately act on that intention

Again, there are numerous variations in models of healthcare decision-making and behavior change, but they all assume an extensive degree of cognition prior to the actual behavioral outcome. 

In turn, cognitive scientists who study emotion have repeatedly demonstrated that emotions can systematically alter a range of cognitive processes that are salient to healthcare decision-making and behavior change.³  In a subsequent post, we’ll be getting into more of the specific relationships between types of emotions and their effects on cognition.  But for the moment, it is probably most helpful to understand that, generically, emotions have moderate to substantial influence on:

• What we pay attention to
• Our durable attitudes
• Our evaluations/appraisals of things
• Our judgments and perceptions of likelihood
• Our preferences, intentions and decisions

As Blanchette and Richards (2010) note in their excellent review of the literature on the interplay between emotion and various aspects of cognition, emotions are intimately intertwined with mental processes and it makes little sense to examine one without examining the other.   

In light of both the available evidence from emotion science and the realties of healthcare decision-making, we think that a better way of conceptualizing the role and value of emotions in our promotional work is captured in our proposed model below.  Instead of the stimulus-emotion-behavior cascade, we prefer to think of the emotion-cognition-intention cascade.  The basic elements of the model are shown in Figure 2 below. 

Figure 2.  Emotion-Cognition-Intention Model

Not only do we consider this a more realistic view of how our content influences customers in this market, but it gives us a range of ways to have an impact.  The reason we end this cascade with a “?” has to do with the nature of time lags and external controls on behavior that predominate in healthcare. There are plenty of cases where a customers’ judgments, attitudes and product preference are simply overridden by external forces.  Even if the marketer does everything correctly, the desired behavioral outcome is still uncertain. 

There are two major points here for people working in marketing-related roles:

1. First, it is not only appropriate but desirable for you to be thinking about orienting the effects of your emotion-centric communications toward these upstream effects.  After all, they respond to emotional content, and they are critical to eventual behavior change. 
2. Second, for insights professionals, this gives us a more accurate and expanded set of dependent variables to think about and measure as we are evaluating the quality and potency of communication content. 

By taking a step back and thinking about the dynamic interplay between emotion and cognition, we allow ourselves to be more scientific and evidence-based in our thinking, and more effective in planning for realistic results for our communication campaigns. 

² Several relevant meta-analyses deal with the non-behavioral or “upstream” outcome signatures that are associated with discrete emotional states.  From our reference list, readers may be most interested in those by Bartholomeyczik et al (2022), Angie et al (2011) and Lench et al (2011). 

³ For excellent reviews of how distinct types of evoked emotions influence cognitive outcomes such as judgment, reasoning and preference see Blanchette & Richards (2010) or Chapter 14 of Fiske & Taylor’s book, Social Cognition.

Take-Home Points 

When you are planning to explore customer emotions or planning to incorporate emotionally salient content into your marketing, please consider the following take-home points.

• POINT #1:  In Healthcare, Emotions Often Cannot Lead to Near-Term Behavior Change
  • In many human settings, emotions link fairly directly to near-term behavior change.  But in healthcare, that linkage is disrupted by time lags, external influencers and process stage-gates.
• POINT #2:  But, Emotional Communications Still Have Real Value in Shaping Upstream Changes 
  • Nevertheless, emotionally evocative communications can still have tremendous value because they can be used to shape “upstream” endpoints that serve as pre-conditions to behavior change. 
  • Extensive evidence indicates that these upstream endpoints are also powerfully mediated by emotions. 
• POINT #3:  So, When We Establish Goals for Our Marketing Based on Emotional Elicitation, We Should be Planning For Cognitive Outcomes, Not Just Behavior Outcomes
  • Expanding our outcome focus to include the influence of emotions on various cognitive processes allows us to more accurately understand the real impact that our marketing collateral is having on customers.
• POINT #4:  A Complete Assessment of the Impact of Marketing Materials in Research Should Include Measures of Cognition
  • Because cognition is likely to be the first thing that changes in response to emotionally evocative materials, planning to assess those upstream endpoints will help you provide your marketing stakeholders with a more complete view of what they are accomplishing.

If You Enjoyed These Points, You Might Also Like:  Can marketing materials really influence customer emotions in a way that has any relevance to real life?  And if so, how can we know what kind of real subjective emotional experience is being produced by the materials?  These questions have surprisingly rigorous answers from the last few decades of emotion science.  Those answers are exciting and have a range of implications for both insights professionals and marketers.  Learn about it in our post entitled, “Accepting the Limitations of Self-Report in the Measurement of Emotions”.     

To learn more, contact us at info@euplexus.com.

About euPlexus  

We are a team of life science insights veterans dedicated to amplifying life science marketing through evidence-based tools.  One of our core values is to bring integrated, up-to-date perspectives on marketing-relevant science to our clients and the broader industry.