Beware the Voice of the Customer

Applied neuroscience techniques that go beyond what customers say to help you understand what really drives purchase decisions.


Two identical groups of doctors.  Same demographics, same firmographics, same time in practice, etc. Yet one group was high prescribers of one respiratory drug, and the other group was high prescribers of a competing drug.

This is not an unusual situation for a pharmaceutical company. So when one of the world’s top drug makers found themselves in this situation, they did what most companies would: conducted qualitative research to ask doctors what was going on. The company was surprised by the answer: the doctors had no idea.

In fact, doctors not only didn’t know why they prescribed one drug more than another, they denied it was the case. The typical refrain, heard again and again, was “There is little difference between the two drugs. I just start a patient on whatever I have a sample for.” Yet, the pharma company knew that both sets of doctors received the exact same number of samples, and that prescribing was very different between the two groups.

What was going on?

The problem here was confabulation. That sounds like a made up word from an episode of the Simpsons. But it’s a real word in the scientific literature that refers to when people create fabrications to fill in gaps in their own memory.  Not only do people make up facts — they actually believe them.

The reason for confabulation is because human memory is imperfect. We forget things. We confuse one experience with another. We’re susceptible to suggestions that influence our memories. But when someone asks us to remember what happened, our brains work to put together a coherent story—generally based on other experiences, beliefs and hopes. We usually don’t even realize we’re doing it.

Examples of confabulation are ubiquitous. Eyewitnesses to crimes are notoriously unreliable and easily influenced by cues from law enforcement officials. In psychology, people can’t remember what makes them happy and usually overestimate the impact of money and possessions, despite an overwhelming research that shows relationships and experiences are stronger determinants of happiness. The field of behavioral economics is rife with examples of people not remembering or recognizing the things that drive their own behavior.

In market research, confabulation is a pervasive and little-recognized problem.  It helps explain why what consumers say in qualitative research is all too often contradicted by quantitative research or in-market behavior.  It has a major impact on habits and practices research, perceptual measures, or anytime you ask someone why they did something.  

When it comes to memory, you just never know when something is accurate or subject to an unintentional fabrication (i.e. confabulation).

The advent of "neuro-marketing," and the related neuro-research field, has blossomed in the past decade to try to address flaws in cognitive thinking and memory recall issues like confabulation.  The technology can be staggering — top research firms are using EEGs, MRIs, biometrics, eye tracking and other technology to scan people’s brains, measure their emotional responses and try to predict their intentions. The challenge is what do you do with this information?  Most of this sort of research is expensive, academic and difficult to apply.  So you know your ad stimulates the consumer’s amygdala (fear area of the brain).  Now, what do you do?

Fortunately, there are much simpler techniques, well grounded in the science of human memory, that can directly lead to marketing decisions—decisions based on a true understanding of how your customers make decisions. We call this "Applied Neuroscience," vs. the more theoretical, expensive and difficult to apply neuro-research. Here are a few Applied Neuroscience techniques that are field tested and proven to deliver business results:

  • The Cognitive Interview - As mentioned, eyewitnesses are notoriously unreliable. Different witnesses remember things differently, and their stories change over time. But there is a proven way around this: the cognitive interview. The cognitive interview combines several “context restoration” techniques to help eyewitnesses more completely and accurately recall the events they witnessed. What were you doing just before you witnessed the event/made this decision? What was the time of day? Who was with you? The idea is that memories are stored in neural networks, and the more completely you can restore the neural network, the more complete and accurate the memory recall will be. The results are impressive. In literally dozens of published academic studies (including several meta-analyses), the cognitive interview has been shown to dramatically improve not just the accuracy, but also the completeness of eyewitness recall of a crime.  

The application to market research is obvious: use the same context restoration techniques to more accurately and completely reconstruct consumer memories of purchase decisions, product experiences, or whatever else you’re researching. At The Seidewitz Group, we’ve developed a storytelling technique based on the cognitive interview, and have used it to uncover deep-seated memories and motivations where other research techniques could not (continue reading to see how we used it with the pharmaceutical company trying to figure out its low prescribers).

  • Stimulate Multiple Brain Systems - The old idea of long-term memories being stored in a specific region of the brain (the hippocampus) has been debunked. Every part of your brain is plastic (i.e. can change and reform itself), and every part of your brain stores memories. Simple memories, like senses, or emotions, or simple facts, tend to be stored in local brain systems (e.g. sense memories are stored in sensory brain systems and emotions are stored in emotional brain systems). But complex memories of experiences we’ve had or decisions we’ve made are stored in neural networks that cross many brain systems. Every time we recall these complex memories, the neural network needs to be reconstructed—and again, the more completely it’s reconstructed, the more complete and accurate the memory recall will be.  

One approach to more completely restore the neural network is to stimulate multiple brain systems. The more systems you can engage in a research participant’s brain, the more likely they are to recall the many aspects of a given experience or decision. We use a technique called Visual Laddering™, which combines collaging, individual and team exercises, verbal explanation and emotional laddering (among other things).  When we use this technique, we find consumers not only more completely remember what motivates purchase decisions, but often recall “implicit” memories (difficult to remember factors they might not have even been aware of).  Participants will say things like “I hadn’t thought of this before, but…” The specific combination of research techniques is less important than finding creative ways to stimulate multiple brain systems at once—and see the magic happen.

  • Stimulate Emotional Responses in the Moment - Another way around imperfections in memory recall is to not wait until after the fact to do your research.  Ethnography, or observational research, is a bit of a fad right now, and it has its merits. The use of observation is great for documenting what actually happens; however, it misses the most important research objective: explaining why something happened. Usually, "the why" is explored later, with traditional research techniques subject to the same problems of confabulation we’ve been discussing. Fortunately, there is a way around this: interject emotionally laden questions immediately after the experience or decision. Emotions are motivational systems, designed to incite action. When emotional systems are aroused, they tend to get people more focused, animated and in touch with their motivations. We like to inject emotional laddering into observational studies and usually find consumers are able to articulate with great detail the rational and emotional factors that went into their purchase decision. It does intrude on the pure observational nature of traditional ethnography, but the payoff in terms of insights is well worth it.

So did these techniques help with that pharmaceutical company who wanted to know why some doctors prescribed their drug at such a low rate? You betchya.

We used our Context Storytelling technique, based on the cognitive interview, to help reconstruct the memory context of both the high- and low-prescribers. And something fascinating emerged. We found that superior efficacy claims made almost eight years ago by the competitive drug continued to drive prescribing behavior with the low-prescribing doctors. This was despite the fact that our client had since published parity efficacy data, and doctors perceived the two drugs as equivalent.  We heard comments like “I guess I got into the habit of using the other drug with more severe patients and never stopped. I didn’t even realize it.”

The findings were immediately actionable for the pharmaceutical company.  They developed a new marketing campaign, targeted to low-volume doctors, promoting their drug’s efficacy with severe patients.  Within six months, our client gained a half share point in a $6 billion category—topline growth of $30 million.  All from one research project!  That’s the power of applied neuro-research.