Why Mindset Matters in Clinical Research

Brian S. McGowan, PhD, FACEHP, Chief Learning Officer and Co-Founder, ArcheMedX, Inc.

Clinical trials professionals face a host of challenges: for some, it’s the complexity in protocol design, for many it’s lagging enrollment rates, and for others it’s the site burden that’s inherent to change management. As I’ve argued in previous columns, these issues are deeply rooted in human behavior and decision-making; and understanding how individuals think, learn, and act can introduce solutions that improve trial outcomes, enhance participant engagement, and streamline operations.

In my final column of 2024, I’d like to introduce two books that serve as marvelous primers for exploring the sciences of thinking, learning, and doing: Drunk Tank Pink: And Other Unexpected Forces That Shape How We Think, Feel, and Behave by Adam Alter and The Expectation Effect: How Your Mindset Can Change Your World by David Robson. These books are not just intellectually enriching but also practical guides for understanding the human factors critical to clinical research success.

Original artwork co-created with ChatGPT

Drunk Tank Pink explores the subtle and surprising environmental cues that influence human behavior. From the colors we see to the names we are given, Alter unpacks how these factors impact decision-making, productivity, and emotion. Meanwhile, The Expectation Effect focuses on the transformative power of belief and mindset. Through an engaging synthesis of psychological research, Robson demonstrates how expectations shape health, performance, and outcomes in profound ways.

Both books are accessible yet thought-provoking. They introduce clinical researchers to critical insights from behavioral and cognitive science, offering a lens through which to reframe contemporary challenges in clinical trials.

The following are just a few of the most memorable studies presented within the books that have direct relevance to practices and approaches in clinical research.

1. The “Drunk Tank Pink” phenomenon (Drunk Tank Pink)

• In the 1970s, researchers discovered that painting prison cells a specific shade of pink—now famously known as “Drunk Tank Pink”—reduced aggression among inmates. This study highlights the profound, often subconscious effects of environmental factors on behavior (Schauss, 1979).
• Relevance to clinical trials: Small changes in the clinical environment, such as the color of materials or patient-facing spaces, will influence participant mood, engagement, and compliance.

2. Placebo effects of expectations (The Expectation Effect)

• A seminal study revealed that patients given a placebo they believed to be a high-cost medication experienced greater pain relief than those who believed it was a low-cost drug (Waber et al., 2008). The price tag influenced their expectations, which directly affected outcomes.
• Relevance to clinical trials: Managing participant and clinician expectations can significantly shape trial outcomes, emphasizing the need for transparent yet mindful framing of interventions.

3. The Pygmalion effect in performance (The Expectation Effect)

• In a classic educational study, teachers who were told certain students were “high performers” saw those students achieve more, even though the label was randomly assigned (Rosenthal & Jacobson, 1968).
• Relevance to clinical trials: Trial staff expectations can subtly influence participant adherence and outcomes. Training teams to foster positive expectations might enhance trial performance.

4. The impact of names on behavior (Drunk Tank Pink)

• Studies have shown that the names we are given influence not only how others perceive us but also our own behavior. For example, people with easier-to-pronounce names are often judged more positively (Alter et al., 2010).
• Relevance to clinical trials: Thoughtful naming conventions for trials, interventions, and patient groups can influence perceptions and potentially engagement.

5. Mindsets & aging (The Expectation Effect)

• A study found that older adults exposed to positive messaging about aging showed improved physical and cognitive performance compared to those exposed to negative stereotypes (Levy et al., 2002).
• Relevance to clinical trials: Participant recruitment materials and communications that emphasize positive narratives could improve enrollment and retention, particularly in older populations.

Food for thought

Clinical research professionals must embrace the practical lessons offered by cognitive and behavioral sciences. Understanding the human factors that drive decision-making, motivation, and engagement is no longer optional in a field as people-centric as ours.

Drunk Tank Pink and The Expectation Effect provide a simple and engaging introduction to these sciences and are sure to inspire new strategies for overcoming the challenges of contemporary clinical trials.

Plus, with the holiday season approaching, consider gifting these books to colleagues. Not only are they fascinating reads, but they also make excellent stocking stuffers or Hanukkah gifts—a fun way to spark meaningful conversations around science and innovation and the interplay of unique behavioral approaches—past and present. 

Brian S. McGowan, PhD, FACEHP, is Chief Learning Officer and Co-Founder, ArcheMedX, Inc.