Placing more value in your future is healthy

An app being developed locally by MUSC and Qonceptual for tobacco cessation will tap into the concept of delay discounting.

In 1970, Stanford researchers Walter Mischel and Ebbe B. Ebbesen conducted the first “Marshmallow Test,” perhaps one of the cutest tests in the history of research, to see if the ability to delay gratification existed in nursery school children.

The children were lead into an empty room where a treat of their choice, a marshmallow, Oreo cookie or pretzel, was placed on a table. They were told they could eat the treat, but if they waited 15 minutes, they would get two.

Some would give in and eat the treat. Most of the 600 children waited, though often tortured, covering their eyes, turning away from the treat or even stroking the marshmallow like stuffed animal.

In follow-up studies, Mischel found unexpected correlations between the results of the marshmallow test and the success of the children many years later.

Those able to delay gratification were described by parents as more competent, had higher SAT scores, performed better in brain imaging tests on controlling responses to temptations.

Fast forward to now and subsequent generation of researchers and studies have taken that basic Marshmallow Test concept to the proverbial next level and are on the verge of making it a valuable tool in helping people lead healthier lives.

The notion of instant gratification has been broadened to a concept called “delay discounting,” or the decline the present value of a reward with a delay to receiving it.

Dr. Warren K. Bickel, director of Virginia Tech’s Addiction Recovery Research Center, has been among the top researchers on the delay discounting for the last two decades and says everybody discounts the future to some degree.

“I’m confident that if I asked you if you wanted a $1,000 right this minute or $1,000 a year from now, you’d probably pick a $1,000 now,” says Bickel. “But what if I offered you $950 now or $1,000 a month from now? Or how about $900 now or $1,000 a month from now?”

At some point, obviously, many of us would chose a greater reward at a later date, depending on the reward and the date.

Bickel started his research in the mid-1990s when he found that heroin addicts discount the future excessively. Since then, he and peers in the field have found the trait among obese people, smokers, gambling addicts and people who engage in risky behavior.

“Excessive discounting of the future seems to be a process that operates in multiple challenging and unhealthy behavior,” says Bickel, noting that it is present in every form of addiction with the exception of possibly marijuana.

Additionally, Bickel says those who discount the future a lot you tend not to do routine physical examinations, such as get blood pressure and cholesterol checks, cholesterol testing, don’t get dental exams, eat breakfast or exercise. They don’t follow physician advice, get flu shots, mammograms, pap smears, prostate exams and don’t wear a seat belt.

Most recently, he points to studies showing that those who text while driving and eat at fast food restaurants more frequently also discount the future more.

“It (delay discounting) is a broad phenomenon that seems to be tied up with health. Fundamentally, health might be considered things we do today to be healthy tomorrow, but if you don’t care about tomorrow, you’re not going to do things that are healthy today.”

But the cool thing now is this.

Bickel says researchers can now quantify a person’s tendency to “discount the future” and they can do so with a series of questions that takes less than a minute to answer. By doing this, researchers are finding ways to help people embrace the future, and therefore their health.

Using the assessment will be a key to personalizing medicine.

“I think there are a couple of ways we can use discounting to ease problems,” says Bickel.

First, he says that when used when people start addiction treatment programs, the test will be predictive of those who will likely be more successful with standard treatments. Those who discount the future excessively made need something more than those treatments.

Another is what Bickel is doing research on now, “episodic future thinking.”

He describes it as getting people to think about concrete events in the future, including who will be at the event, what will happen, what they will see, feel and hear. It helps them value the future more.

“When they are under the influence of those things, we are able to shift those valuations of the future so that they value the future more than if they didn’t do that,” says Bickel.

Among those who have been influenced by Bickel’s research is Dr. Bryan Heckman, an assistant addiction sciences professor at the Medical University of South Carolina and associate researcher at MUSC’s Hollings Cancer.

Heckman is applying the concept of delay discounting in his research on tobacco cessation with the ultimate goal to cut preventable cancer rates.

“Knowing someone’s delay discounting is one factor in the equation in providing treatments that relative to that individual,” says Heckman.

To that end, he has been working with Charleston-based software company Qonceptual on two cell phone apps that can predict when a person will have a craving to smoke and warn he or she to take a nicotine replacement therapy, such as a gum, or undertake another diversion.

The app does it by using GPS to detect environmental cues, such as gas stations with cigarette advertising, and factoring in other elements before sending a warning.

“Quitting is difficult, but that doesn’t mean it can’t be fun,” says Heckman, of the app, which is expected to be available next year, pending grant approvals.

Meanwhile, Bickel also is working with Dr. William Epstein of the University of Buffalo on a study, which just received funding from the National Institutes of Health, on whether episodic future thinking will help keep people considered “pre-diabetic” from transitioning into Type II diabetes.

“We’re going to get in there and see if we can get them to value the future more and make better choices about food and exercise, but also see if they will be more medically compliant,” says Bickel.

Reach David Quick at 937-5516.