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Digital Medicine for Distracted Minds

June 26, 2023
Adam Gazzaley


This week my guest is neuroscientist and entrepreneur, Adam Gazzaley, who co-authored the 2016 book The Distracted Mind: Ancient Brains in a High-Tech World, and whose company Akili Interactive has developed the world's first video game approved by the FDA for the medical treatment of ADHD.

Adam and I start the conversation with a robust exploration of attention from a neuroscientific perspective, investigating the modern impacts of distraction and technological stimuli. From there, we delve into how technology can also be used to improve our cognitive functioning, including through unexpected avenues like video games.

Find out more about Adam and his work at gazzaley.com or follow him at twitter.com/adamgazz


Learn more about Singularity: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠su.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Host:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Steven Parton⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ - ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠LinkedIn⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ /⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Twitter⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Music by: Amine el Filali


The following transcription was created automatically. Please be aware that there may be spelling or grammatical errors.

Adam Gazzaley [00:00:01] Everything, all technologies, everything humans engage in have, you know, two sides. You know, the sword cuts both ways. I would say anything that can do good can do harm and vice versa. And I want to ride that power and show that these tools that are ubiquitous and and getting, you know, more affordable and more accessible to people can do something really profoundly good for us as humans. 

Steven Parton [00:00:42] Hello, everyone. My name is Steven Parton and you are listening to the feedback loop by Singularity. This week. My guest is neuroscientist and entrepreneur Adam Gazzaley, who coauthored the 2016 book The Distracted Mind Ancient Brains in Our High Tech World, and whose company, Akili Interactive, has developed the world's first video game approved by the FDA for the medical treatment of ADHD. Adam and I start the conversation with a robust exploration of attention from a neuroscientific perspective, investigating many of the modern impacts of distraction and our technological stimuli. From there, we delve into how technology can also be used to improve our cognitive functioning, including through unexpected avenues like video games. Adam is full of expertise and very succinct and it was a pleasure to chat with him and I hope you enjoy the episode as much as I did. So without further ado, everyone, please welcome to the feedback loop. Adam Gazzaley. All right, Adam. Well, there are many places that I think we could start with you, given the many things that you're involved in. But because I think the best way to frame this conversation is with your book that you wrote with Larry Rosen in 2016, Distracted Minds. I'm wondering if you could kind of just lay out the motivation for that book and what problem that the two of you were noticing that led you to want to write it and share it with the public? 

Adam Gazzaley [00:02:14] Sure. So the distracted mind was really a recap in many ways of the work that I'd done for over a decade, as well as the work that Larry Rosen had done, trying to understand the sort of fragilities of the human mind when it comes to interference and distraction. And we really have very different research tools and methodologies. So that's what sort of encouraged me to write the book, writing the book fully from a neuroscience perspective, as is my take, I felt it was not wouldn't be as interesting as relevant to people. And Larry does like field psychology. He's out there in the real world trying to understand how the influence of social media and tweet tweets and texts and Facebook and all of that, how it how it interferes with performance. And so I felt like the combination really made a lot of sense. The other thing that made me excited to write that book was we really sort of zeroed in on on a premise that connected both the neuroscience work that I was doing and the real world psychology that Larry was doing, built on like an evolutionary model that our brains evolved in a certain way under a certain set of conditions to allow us to survive and thrive on a planet that was very, very different from the one we're living on now. And so the subtitle of the book, Ancient Brains in a High Tech World is what got me excited about it, because I felt there were a lot of stories about distraction already at that time when we wrote the book and people were aware that multitasking is sort of a myth and that, you know, too much fragmented attention was not good for many different things in your life. But telling the cognitive story about what what our brains are good at and what our brains are not good at, and how technology really puts a lot of pressure under on those limitations and brain function. That was exciting and that made it really fun and fresh because I had been working on it for so long. And any author will tell you writing a story about something that is so familiar to you is just not that much fun. But this was a fresh perspective on it, and it made it more enjoyable. 

Steven Parton [00:04:25] Yeah, absolutely. Well, what were some of the, I guess, key avenues in which that mal adaptation expressed itself? What were some of those differences between the modern environment and that ancient environment that where we see some of the disconnect? 

Adam Gazzaley [00:04:38] Yeah, I mean, two notable areas and these are long, long discussions that we probably don't have time to go super deep in, but just to give you the high level. One of them is about attention, and that's my area of research focus. And there's, you know, like half an hour lecture on attention. It's one of those things that seems so obvious, but it's so complicated and detailed in so many different types of attention. And there are two prominent ways of classifying attention. One is top down attention, which is what your listeners and you and me are doing right now, where we're choosing to pay attention. We have a goal. You made a decision with directing what we're hearing, what we're seeing, and that's a very human type of attention, a very evolved system of attention that allows us to direct our limited resources where we want them to be. The other type of attention, sort of reflexive without control, it's where stimuli in the in the environment demand your attention based upon our nervous systems sort of programing. So things that are very salient are very novel command attention, right, lights, sounds, your name gets programed over time to be a very salient stimuli. And this is the more ancient type of attention. It's the attention that allowed, you know, animals to avoid predators and to find food. And we still have it deeply in us. How that intersects with the modern world is that technology has whether it was wittingly, you know, sort of directed or not, have taken advantage of that bottom up stimuli. And so our technology devices are really designed to pull bottom up attention away from a goal that you might have. So it may be a vibration of a phone, a message or a message or alert or, you know, having another tab sitting. There are a link. You know, there are all these bright, shiny things that technology has placed in our paths to keep us, keep us moving, keep our attention where they want our attention to be. And so that's one really prominent area of sort of the ancient brain and our sensitivity to this type of input and its ability to disrupt us from our goals has really. Collided with the tech world. That's one example. 

Steven Parton [00:06:47] Yeah. Well, beyond the goals, obviously, that's a huge thing, right? We want to complete our goals, but maybe more clinically. When you have something like that constant bottom up stimuli, when you're constantly being forced into that kind of survival unconscious distraction mode. What are some of the consequences that occur when you're just constantly deprived of access to that, like top down go directive type of behavior? 

Adam Gazzaley [00:07:15] They are broad and there's tons of research in from different fields that have sort of tagged this. So that was another fun part of the book is to reach out of our own research domains and to others. So my work has really focused on the impact of interference. This is a type of interference, distraction. Multitasking is is a related but different type, but they form the same domain of interference, goal interference. And I've looked at how they interfere with memory, short term memory, long term memory, recalling memory. And that that's sort of my area of interest is how does how does a tension underlie memory function? We reached a little beyond that to perceptual and decision making. So you could see it on a cognitive perspective that how we engage in a task that's potentially demanding is degraded when there is interference. And that degradation pretty much occurs across the full range of things you're doing. And so that's what you do in a laboratory. We put someone in an MRI scanner, you look at their brain, you challenge it and you see all these sensitivities to interference. But the consequences are also evident in the real world, right? So there's the obvious ones head. Now everyone else, like the safety ones, like if you text and drive, you're basically might as well be drinking and driving. It's really bad. You know it's bad. You feel that it's bad. So that's not so complicated, but other things that it impacts people's relationships and the depth of connection they get of the degree of empathy that they might feel for someone that they're interacting with. It impacts sleep when engaging in interference in your goal, to go to sleep in your garden, in your bed at night with your phone, in your hand, or your kids put it under their pillows if they're allowed to, so that they can get the vibration if someone texts them or messages them or think that, you know, whatever, whatever way we have of letting someone know that something's coming in for them and and, you know, and that it's part of them, that it affects work and has impacts on mood and stress and anxiety. So it's sort of everything like if we can't hold a steady attention, especially where we want it, if we're constantly fragmented and pulled in all sorts of directions that are outside of our control, it just degrades everything that makes us human in a way. 

Steven Parton [00:09:32] Yeah. What are the impacts, I guess, in terms of more clinical or more tangible consequences? For instance, you know, we all talk about the fact like, yeah, I'm addicted quote unquote to my phone or, you know, we have everybody says they have ADHD now because we live in this ADHD like world. But are they really tangible consequences, like in terms of how our brains are being physiologically impacted from this interaction? 

Adam Gazzaley [00:10:04] I would say yes, because everything affects your brain. That's this wonderful feature of our brain is that it has plasticity and changes all the time and that's how we learn. And it goes in both directions. So negatively, adaptive behaviors change your brain as well. And whether it's classically meeting signatures of addiction, which were really defined based upon a lot of the physiological changes that occur with drugs. So but behavioral addiction, is that the same as a different There's a lot of debate about that. But putting aside that which is somewhat semantic, it can become such an obsession if you don't want it, if you're not comfortable with it, addiction it becomes becomes so absorbing to your life that it displaces other things that are super important, like going outside, like talking with other people, like having physical fitness. So yeah, it could be incredibly disruptive to life. Whether or not you give it like that classic addiction signature or not. And likewise whether or not your attentional deficits reach the level of being labeled ADHD, they could still be incredibly impactful, negatively impactful in your life. So, you know, a lot of these clinical definitions, especially in the psychiatric domain, are based upon symptoms that we really classify and reframe all the time. And so we don't have a true biomarker necessarily, like when we're saying, okay, this is high cholesterol, this is high blood pressure, this is ADHD, that one moves a lot. And so, you know, it's really framed at that negative functional impact on your life. And when it hits so many categories that it reaches that level of. Teria. But, you know, without getting too caught up in the categorization and the psychiatric and the clinical care category position, which has a lot of limitations and problems as we've come to realize, what's most important is to think about how is this impacting my life? Is it really making me better? Is it neutral or is it actually degrading my life in some ways? Is it is it impacting my work, my my social relationships, my sleep, my mood, my stress? And, you know, if you are able to get introspective enough to do that or have someone that could help guide you through thinking about that, then you wind up with the conclusion that it is having a negative impact. Then, regardless of whether or not it gets a clinical label, it should be improved. You know, it's true of all types of behaviors, not just technology. You know, how you eat, how you you know, how you engage physically. Are you are you physically active enough to keep yourself healthy and you know how you consume information. It's just another type of consumption similar to food consumption in a lot of ways, that has to be done thoughtfully with intentions and not just done reflexively. 

Steven Parton [00:12:55] Yeah, And you're speaking there about, you know, information, the information landscape and the stimuli landscape as well. And it makes me wonder, even if we are talking subclinical, I'm sure you're familiar with the idea of directed attention, fatigue, and this idea that we're constantly having to block out stimuli and that there's cognitive effort that that takes. So I mean, I suspect and maybe you can expand on this, that just by virtue of being in an environment that is constantly bringing us so many stimuli, we are kind of exhausting the part of our brain that helps us marshal or control our attentional resources 100%. 

Adam Gazzaley [00:13:34] I actually write about that a lot in the book. It's a particular interest of mine, this concept of cognitive fatigue. Everyone knows muscular fatigue, right? And physical fatigue. Anyone that's ever done any exercise have played any sport or dance or anything that that they exert themselves just understands what that is. Your brain does it, too. And we often consider it or have consider. I think that's shifting like a sign of weakness, like work through it 8 hours straight, you know, keep going. Like unlike physical fatigue, where even like the world's best athletes, you know, Olympic athletes, professional sports players know very well that they have to be sensitive to fatigue because their gains in their training will diminish if they don't recover. And so recovery is like a part of training in the athletic world, and it has not been embraced, unfortunately, in the cognitive domain that it is a natural and healthy part of of human cognition, that there is a fatigue and recovery cycle and restoration required. It's the top down attention that we've talked about already. So that's that's a helpful term that I could return to that fatigues, this system that requires so much effort. I'm going to segway here because it's just so relevant. And what I would talk, I think probably where I went with this in the book is that the other type of attention, the bottom up attention that I presented in its negative aspects just a little bit ago, in that it's how technology usurps our attention from our goals can also be framed as as a healing component or, you know, a tool, an asset that can be that can be leveraged. So, for example, when top down attention that you might be doing all day long and even it, you know, top down attention is not just you working on an assignment or interacting with your boss or writing an article. Top down attention is responding to social media, putting a TAC out. You know, like anything that is goal directed is top down attention. And so one of the things that I'm really interested in how do you recover from fatigue, cognitive fatigue, What is the best way of restoring? And some people say, oh, I'll take a break, and then they go on social media or then they check their email, right? That's not a break. So what is a break? Well, one way of looking at a break is that we want to give top down attention, a break. But sometimes it's really hard to do nothing like nothing is actually a pretty good break if you can do it right. If you can like. Close your eyes, center yourself. Really allow yourself to relax. I would say that is restorative, but I think it is very hard for people to do that. I think it takes practice to pause in that way. And so one interesting way that people are exploring is to take a break by moving from top down attention to a bottom up attention that doesn't require goals but is still attentional, demanding. It's different than just pausing and closing eyes and doing nothing. And one of a really positive experience that drives bottom up attention, this nature. And so there's all this emerging scientific literature that exposure to nature going outside in nature, walking in a park, being around trees, even looking at pictures of nature as the sounds of nature is, it pulls your attention, but not through goals. It pulls your attention through the stimuli evolutionarily program, because we grew up in nature that allows you to offload the top down for a bit and really restore. And that's why I think people would respond favorably or like, you know, get that advice because they've walked, they've taken a hike, the like. Yeah, I feel great afterwards. You know, there's even a practice in Japan known as forest bathing that is sort of become essentially prescribed around the world as a way to help with stress and mood. Anxiety and fatigue is just get out in nature and allow your mind to wander and not be so called directed. So that's just a little example of how important it is to restore cognitive fatigue and a really great way to do it. 

Steven Parton [00:17:46] This is my own little nerdy curiosity, I guess, but as is the attention restoration theory stuff that you're alluding to here, does that bring into play the default mode network at all? Is that is that something that comes online more when we're losing goal directed attention? 

Adam Gazzaley [00:18:03] Yeah, it's a good question We don't I haven't seen a study we're actually doing a big nature study now. We'll be looking at the interplay between the attention network and the default network. But in general, the default network, which is these medial structures in the brain as opposed to the lateral structures of the structures down the middle are engaged during periods of introspection, mind wandering, thinking about the future in the past. So it's not that as opposed to the lateral areas like the prefrontal cortex in the parietal cortex, which are engaged when you're focusing your attention externally. So it's almost more like an internal attention versus an external attention compared to bottom up and top down attention. So it can be quite exhausting also to engage internally and quite distracting as well. So it's not necessarily like that is the solution to restoration, which is really interesting. We're actually going to go pretty deep in parsing that out and some work at nerve skip it in my my center at UCSF. But it's a great question. But it's again, this lots of different types of attention and the default never handles it's not no attention. It's really just more internally focused attention. 

Steven Parton [00:19:18] Yeah, well, have you done any work with the flow state and that idea, you know, that we're fully engaged with our intention on one thing and that kind of makes everything else disappear around us? 

Adam Gazzaley [00:19:28] Yeah, I haven't done much work with it, although we do touch on a lot in the in the research that we do because we do a lot of video game designs and a lot of those interactive experiences create flow states where you lose, you know, perception of time and, and you know, you just go into a very focused, usually exhilarating, highly positive state. It's it's been hard to study because. Getting inflows. They could be hard to induce. It could be transient, but it's an area that we're going more deeply into. So our research has become more more interested across. Our research is on the breadth of experience that we can have as humans, including these bottom up nature driven experiences, flow states and psychedelic experiences, even sleep experiences. So we're moving out of the range of experience that we had focused on, which were largely the tension demanding activities into these other areas. 

Steven Parton [00:20:36] Yeah, I guess one reason I was thinking about that specifically is stuff like the switch cast effect and the constant movement between stimuli, and maybe you could just speak to that. Like what? What are some of the maybe downfalls or consequences of, of constantly trying to move kind of in a multitask session between stimuli? 

Adam Gazzaley [00:20:55] Yeah, it's a great question. So sometimes you'll hear scientists I have started to say that multitasking is a myth. And what is meant by that? It's complicated because if you it depends how you describe multitasking. So if you say multitasking is a behavior where you just do lots of things in the same period of time, of course we multitask, multitask all the time. But what that what, why, why people refer to multitasking as a myth is because if you define multitasking as parallel processing, multiple streams of information, multiple activities such that you're engaging in all of them equally simultaneously, which is sometimes what people think multitasking is, then we don't multitask. So we multitask as a behavior. But mechanistically, from a neural processing point of view, we don't really multitask. Things that demand multiple things that demand attention. So things don't demand attention like chewing gum and and having a walking, let's say, two very reflexive activities. You do them simultaneously and you probably don't experience much degradation if you didn't do one compared to if you did both. But if it demands attention, like having a phone call and responding to emails, there's no way you can do those both without some degradation. And so what's happening when you have attention demanding activities and we've done neural research on this with Meri and and G is that neural networks are engaged for one task, let's say paying attention to what someone saying to you in a conversation and then you switch to the other task, your email. Even if you feel like you're multitasking, then you're really switching. And that's the term that you use as a switch cost. Because with each switch there is a loss. There's there's a loss of time, there's a loss of the high fidelity information that was in the focus that is no longer in the focus. And so with each switch, you have a bit of a degradation. This can be measured in the laboratory very precisely, including the timing aspects of it and the delays that are induced. And so, yeah, that's that's what happens either with your awareness or without it. If you pay attention to it, you can feel that cost a bit. And the more intentionally demanding both both of those activities are, the more they collide and the greater the cost of switching between them. 

Steven Parton [00:23:23] So so given these mini consequences that we've kind of danced around here, do you feel that it is hyperbolic to say that technology is genuinely degrading our additional resources like our art? Are we seeing a tangible generational impact here where something is happening to the average person's ability to navigate the world Because of this relationship with technology? 

Adam Gazzaley [00:23:47] It seems that way that that fits a little bit more into Larry's work, where like, you know, my work is like, okay, what happens in the brain? Like, can we multitask? No, we can't. Does it get worse when we get older? Yes, it does. Like what are, you know, like, that's that's where I have spent a lot of my time. And then there's the real world impact of that. And that's why, Larry, because that's what he studies, the same field, but really different view. And it it's hard to it's hard to sometimes get really definitive answers on that because the developing minus is changing. So a lot of these questions are about children. Technology's always changing. It's hard to randomized studies of kids in real life, but I would say the convergence of evidence just that it is having a negative impact not just on performance, but on mood. And, you know, then it gets complicated. There are other aspects besides the multitasking. There's the very rapid rewards cycles that lead to short and maybe shallow interactions with whatever you're engaging in before you move again. And that that's another prominent feature. And then there's just the amount. Of information that we're exposed to that might not be relevant. Right. Like, I'm glad that when I was 12 years old, I didn't know what every other kid was doing when I was doing that. I'm so thankful for that. But so there's a lot of pieces here that could lead to depression, anxiety and other types of cognitive disruptions in people when they engage in technology. So I would have to say a definitive yes. Technology challenges our brains in some fundamental ways across multiple domains and multiple populations. And if you have a clinical diagnosis, pretty much any in psychiatry or neurology, whether you have a massive depression or autism, schizophrenia, early Alzheimer's disease, on and on and on, you have an increased vulnerability to interference and distraction. So these things are even more negatively impacting those populations. I would say there is reason to to be concerned about how technology has influenced us, and that was really what inspired me to write that book in the first place, just to increase awareness that, yeah, it's it's fun. It's fun to use technology in this way, just to let you know, it's like surfing. Just let it like, you know, write it right or whatever it, it, it gives to you. You take and you go and then go with the next one. And that novelty load. Our brain loves that, but it is not the healthiest way to interact. 

Steven Parton [00:26:28] Right. Well, and having said that, though, one of the things that is very interesting, obviously, about you and your work is that you created Endeavor Hour X, which was, I think, the world's first and still maybe only FDA approved video game treatment. Right. So technology is able to and you were able to make technology a benefit for 8 to 12 year olds. And I think just this past week that became something that adults can engage with without a prescription. Could you tell us more about kind of this whole process of how this digital medicine is working and and just really what's coming to a head now with these FDA approvals? 

Adam Gazzaley [00:27:07] Yeah, this is a great Segway. This is why I don't give five minute interviews, because it's really confusing to write a book called The Distracted Mind and then make video games. So it takes some some time to really break it down. To me, it makes total sense and it feels so coherent because, you know, so the switching point in this conversation and then I could go deep into Endeavor X and all the stuff we're doing it neuro scape and ADHD treatments using video games. But the switching point is that everything, all technologies, everything humans engage in have, you know, two sides. You know, the shortcuts both ways. I would say anything that can do good can do harm and vice versa. And you know, it's true of like our most ancient technologies, like fire, right? It can cook your food. It could burn your house down. Right. Physical fitness, like it's great for your heart, but, you know, run a marathon, you blow at your knees, right? I mean, and food, right? You know, some foods are good foods as bad food, drugs saved your life or kill you, Poison kills you. Right? It always cuts both ways. Technology is the same, right? It can be used, you know, without intentions, thoughtlessly as we've been discussing. And it could usurp your your intentionality and your goals and your how you interact with your family and how you perform at work, as we've been talking about. But I would say, just like all the other things that can be abused and not treated in a in a thoughtful manner, a technology can also do good. And that is what really excites me because it is amazing, right? It's so accessible. Like there's few things in the world. It's accessible as technology right now. It's growing all the time. It's affordable. There's, you know, so many different versions of it. It's completely global and and it's just getting better and better. It's fueled by like very rich industries, like the movie industry, music, entertainment in general. So our tech companies are the richest companies in the world. So I want to ride that power and show that these tools that are ubiquitous and and getting, you know, more affordable, more accessible to people can do something really profoundly good for us as humans. And that became my goal, I guess, around ten or 15 years ago, sort of when I was transitioning over myself from doing research on distraction to saying how do we help the distracted mind? And so that's the transition point. That's why you can talk about both the negative impacts of distraction and the positive impacts of of technology and the same podcast, because there are two sides of the same sort, essentially. And so I became very motivated actually 15 years ago on how do we create interactive experiences. I thought it would be. To deliver them through video game mechanics because fun immersion engagement is a is a very important part of changing a system like your brain. Our brain has plasticity. It responds to experiences. I thought that these type of experiences, especially personalized experiences, which is something that you could do with a game called the closed loop experience. This is the type of game. So we create games that challenge and reward you in a appropriate manner based upon how you're performing. So really targeting you right in the sweet spot like a personal trainer in the gym analogy might be like, You're ready for a new weight. Let's go up. Okay, back down a little bit. You're having a bad day. That's okay. Don't hurt yourself. That's what we can use. Technology and a video game can be a really powerful digital tool that you can have in your home that can help improve cognition. So that's like the big picture of what I have called digital medicine in the past. Now I actually call experiential medicine. I think it actually fits into the same category as something like mindfulness meditation, which has been a medicine that humans have used for thousands of years. Here's another type of experiential medicine just happens to be digital and happens to be a video game. I think like the video game and the digital is more like a pill or a syringe or a sublingual. It's it's the way that we deliver the experience to you. But the medicines, the experience, that's what we know from neuroscience. That's what changes the brain. And so that's sort of the high level story about what I've been working on both at UCSF and a company I co-founded called Akili, and how do we take the technology that we all have, most of us on our on our person at any time, and use that to deliver these personalized experiences that can improve brain function. And then let's figure out if it does or not, right? Because I don't want to create snake oil. There's enough of that out there that if it doesn't work, let's say it doesn't work. And so we spent the last decade doing dozens and dozens of research studies like randomized controlled trials, the same studies that you would imagine that you imagine being done for drugs. We've done for video games and showed many, many of them that we could see improvements in attention and memory and perceptual processing. And we're expanding that beyond beyond that to emotional regulation. Even empathy and compassion are areas of focus for us. 

Steven Parton [00:32:19] What are some of the ways in which you bring those benefits to the table? I mean, I looked at some of the numbers for your latest announcement, and I mean, we're talking more than 80% improvements in focus, more than 70% improvements in quality of life facets. And I'm just wondering, like, what is it that really, I guess, is happening inside these experiences that allow them to provide this benefit that we may not be seeing in other forms of digital experiences or engagements? 

Adam Gazzaley [00:32:49] Yeah, great questions. And I'm smiling because, you know, those research results are super thrilling. I'm not even a researcher on those studies. And to see that data, you know, come out and it will be come out in a paper soon. And that's what led to our over-the-counter version of Endeavor X, which up until now has been prescription only for children through the FDA medical device pathway. And as you said, the first video game approved. And we're seeing incredible results now in adolescence, three times the benefits we saw in children. Adults should seven times the benefits likely due to deeper engagement in the treatment itself. And so what's happening here is that we have spent, you know, a decade meticulously and iteratively designing and redesigning these games to put pressure on those neural networks and those cognitive systems that we want to optimize and then have done a lot of research to determine what's happening, both in terms of outcomes and real life behaviors, also have been shown to be impacted like over 73, almost three quarters of the adults reporting improvements in quality of life. And that's my blowing to me and so excited to see that, that they're seeing that they're better able to focus and engage in the tasks that they're doing in real life, because obviously we want the benefit to leave, you know, even the cognitive domain. We already show that type of transfer, but this is even even more exciting. And so the deep engagement in a interactive experience that's been designed to do that, plus the closed loop system. So you got to design the game based on an understanding of how the brain works and understanding of the systems that you want to improve. But then the engineering component of it, the act of adaptively changing rewards and the challenges like in real time, sometimes multiple times a second based upon data that is also a critical part of having this game push performance and push these outcomes. And remember, it doesn't happen in the deck. I mean, this study has done over six weeks playing five times a week, 25 minutes. Today. So it's work. This is not a magic trick. And it's not even it's not a holy grail. It doesn't work in everyone the same way. But if you put in the work, then then these are the benefits that we're seeing and that's super exciting. And then the last piece that I will say is that we work with like a large team of video game professionals. There's like art music story in there, you know, avatar optimization for kids, which they love. And it's important, you know, I wouldn't say it's like our our core engine of our active ingredient, but that type of delivery system really helps because, a, if you can engage deeply in the moment, you're not going to lead to change like on to the German, just like moving weights around like this. And so we think that's why adults are showing and this is a hypothesis that we want to understand more are showing bigger effects than children is because they're engaging deeper. And then you have to keep coming back and doing it. Some people are self-motivated enough. They're like, I really want it to my attention. Like, it doesn't matter how this if this is fun or not, but other people like having it a bit fun and having an avatar that they're up to it and gives them that little bit more that that brings them back again. So those are a bit of the other things that we pay a lot of attention to. 

Steven Parton [00:36:10] I imagine the more developed frontal cortex probably plays a role as well, right? Like because that's what we were talking about before that. Exactly. The part of the brain that kind of block out the stimuli are more developed in adults. 

Adam Gazzaley [00:36:22] Exactly. You know, and this this new set of data takes the same game, sort of the same experiment, saying, you know, we saw the improvement in 8 to 12 year olds that led to FDA approval. Then we basically did the same study on adolescents and found three times the improvement in the attention outcomes, then the same study in adults at seven time. And it's like, Oh, that's really interesting, was the same, same game. And so it's likely the prefrontal cortical development, which we know matures even into adulthood that allows that deeper attentional focus and thus allows the, the experience in the closed loop system to do its job more effectively. 

Steven Parton [00:37:02] Yeah. So is the experience one that would be more akin to kind of like a brain training exercise where you're very aware that you're kind of playing a puzzle in a way, or is it something that's much more like this feels like a regular adventure game and I'm just going through the world playing a game. It but it happens to also have these benefits. 

Adam Gazzaley [00:37:20] That that's, that's, that's the latter is true. So it is a game that feels like a video game like you would you would probably be surprised if someone said this game has clinical data and is FDA approved if you just played it, you know, and there's nothing about it that feels like a brain training game. Whatever people imagine when they see that, which I guess is like a cognitive task with game features on it, that this is not that this does not feel like that at all. It feels like a video game does feel a little different than a video game. In some ways. It's really hard. It's designed to be hard. Like it has to push the system. It's not so hard. We hope it's not so hard that you give up, and most people do not. But I would say most entertainment video games just back it up a little bit compared to where we go because we have like an outcome that we want in addition to fight, we want to make your attention better and its work, you know, just like making your your, your aerobic endurance better, are your muscles stronger? Like it can be fun, but it's going to be it's going to take some effort. And so that I think if someone played this game without knowing that it was a you know, an FDA approved attention treatment for ADHD, they'd be like, this is a video game. It's fun. It's hard and weirdly hard. So that's what I would say. 

Steven Parton [00:38:42] So are other games capable of providing a similar benefit that may not be as directed, but I mean, is it just the is it the process of really engaging in what I would call it sounds like a flow state mentality where you're really just kind of in the flow channel of engagement. Is that is that benefit there with other games to a lesser degree or similar degree? 

Adam Gazzaley [00:39:04] It is. There's a lot of data out there and papers on consumer video games that show cognitive improvements, even though they weren't intentionally designed for that. It matters on it matters what type of game games are a massive genre. It's almost like saying food or sports or drugs. I mean, there are games that are incredibly slow paced that you play with dozens of people over months that probably do not have these benefits. They might have different benefits. And then the games that we're talking about are very rapid games that update your that they cause you to update your attentional focus all times. Like first person shooter games, for example, for good or bad, given some of the, you know, violent elements of that. Putting all that aside, that discussion has shown data improving attention and distraction, resistance and other aspects of working memory. Those games are more. Similar to our game in terms of how it's designed. We don't have really violent aspects in our game. We took that out because we didn't think that it was required and it's less complicated in lots of ways to not have that. But I would say that that's what our game does. It's it gives you a focus of attention. It presents distractions that you have to ignore and it makes you move your focus rapidly. And that act of managing all that interference leads you to have better attention, even in boring environments. That's our main test. That's like the coolest aspect of all of this. This from scientifically from this story is that you can engage your attention in this game like environment which is so rich of stimuli and rich of reward and tons of multitasking. And then we test your attention in the most boring environment with no rewards, no color, one task, and it gets better. That's like our main outcome measure That transfer of benefits of how you can deploy your attention in different environments is is what we're so excited about because that's where people are actually suffering on their attention. Not a video games, they're suffering on their attention in class and other environments that are not that motivating. And so we get that benefit out of the game into those environments. That's why we moved it through the FDA successfully. 

Steven Parton [00:41:16] Is this is this may maybe specifically addressing something like sustained attention I'm thinking is the art task sustaining attention response task. 

Adam Gazzaley [00:41:26] That's exactly what we use as our competitors. These are sustained attention tasks called the turnover attached to variable attention. It's actually FDA approved as a diagnostic tool for ADHD. We have no attachment with the turnover in any other way. Besides that, it is a very effective outcome measure of sustained attention that has shown improvements across over a dozen studies that we've done with even with different types of games. But that is the benefit the we engage you in this rich multitasking, highly stimulating visually and reward environment, and we see an improvement, sustained attention and vigilance in very boring and stimulating and rewarding environments. That's exactly. 

Steven Parton [00:42:08] Wonderful. And where do you think this is going? Because right now it's a bit of a bit of a segue way. But, you know, A.I. is the talk of the town right now. And when we're talking video games or automated experiences, especially when we're talking about scaling up the the flow channel to make sure you have that closed loop feedback, A.I. is phenomenal for that. Yep. So where do you see that going? Do you see that's something that you can integrate into this kind of medicine, this experience and where we're going in general? 

Adam Gazzaley [00:42:40] Yeah, I mean there there's a lot that I am excited about in terms of the most recent technology offerings and how they can make this medicine reach the next level. A.I. being one of them, and not just the air that everyone's thinking about when we say that the general today I the chat you beauty, the middle journey, the creation layer, but also what I call like interpreted the AI algorithms that let our game and our system, our process to understand you in the moment better. And that includes how do we get that information. And so bias biosensor technologies, higher level e.g. eye movement capture, which for you know, in other devices now electro dermal activity, heart rate, respiratory recording, facial expression, tracking, all that data is multi-dimensional, it's complex, it changes over time, it's dynamic, it needs to be interpreted. That's an that's an AI machine learning task in itself. And then it could be used to generate environments, maybe even more adaptively and more personalized in a way that we have accomplished. So I think A.I. is is a part of this. I think advances in signal processing and engineering and understanding all these these different physiological markers of of our state, of our attention, of our level of arousal, our mood, our awareness. All of this is a part of our development that we're really excited about. And then immersive environments, right? I mean, Apple just announced an incredible device, super expensive, but super incredible that will have the potential to even create more powerful experiences. So how do we leverage that? Part of technology that exists now is only going up to. Enrich the depth of the experience that a person has in a digitally delivered medical treatment. So that's another big part of our development. So there is a lot to be excited about. There's a lot of challenges. We're talking about an entirely new type of medicine that doctors are not familiar with, right? They give, you know, prescriptions for Adderall for kids with ADHD. Now we're like, no, no, no. You can also consider a video game. That's a that's a big shift. How do how do you know payers wrap their heads around insurance reimbursement for this? This is there's a lot of work to do to deliver the version we have now, which is on a mobile device without brain recordings, without high levels of AI, without virtual reality. We have a lot of work we need to do right now to introduce this and make the world the world, because it's it's really global challenge that we're trying to address. Comfortable with a completely new type of medicine for the mind. And at the same time, we need to be doing the work now to come out with the next generation of this as that as that phase happens. 

Steven Parton [00:45:36] Well, aside from our cheeky recommendation for people to play video games as a form of medicine, what would you what would you suggest for the average person right now who is maybe feeling intentionally drained or feeling at odds with their environment of stimulation and the things that you would point people towards? 

Adam Gazzaley [00:45:55] Yeah, no, it's great to talk about that. I always try to, you know, you know, in addition to the fact that I have a conflict of interest of being the founder of a company that sells a video game that's now available over the counter, I'd love for you to try it out. I feel like I have to say that not just because it's it's a it's a company that I co-founded, but because we've been working on this for 15 years. And only last week did it become available to people. You know, I have hundreds of emails over a decade of people saying, Hey, I want to play this game. Like, sorry, it's not available. It's still in the lap. And then when it became available, it was only for kids with prescriptions. So here it is. I'm super excited about that. I hope people try it. I hope people love it, but it is not the only thing that we should be doing. A matter of fact, you can't even play it for more than 25 minutes a day. We don't want people to overdose on our medicine. It's meant to be time limited. Play it for a month, get the benefits if you need more. It's it's really meant to be a limited exposure to change your brain and hopefully give it an adjustment and help your attention. But there's so many things that we should be doing and many of them don't cost anything at all. So going out in nature, which I've already talked about, something I do all the time is critically important, and then the things that we've learned that are healthy for our bodies are healthy for our brains, how we sleep, how we eat, how we how we engage in physical fitness and exercise, all those things. So that's the stuff that's accessible to most people and is really good for your brain. I think will show over the years. Works really nice in compliment with a digital treatment. But those things are, you know, just as important to do. 

Steven Parton [00:47:38] And regarding the games accessibility, is that something that we can share to our audience as of now? 

Adam Gazzaley [00:47:44] Yeah, and Denver Etsy.com is the website. It has a link to the App Store and it's it's available, it's on. And I'd love to hear from anyone about their experiences. It's it's work in progress or it's the first version of this week expected. We have many milestones this year of improving it, but we are really delighted to finally get it to people at scale, which has been a long term mission of ours. And it's, you know, we wanted to make sure we did the research to really feel comfortable with that. And and we're at that stage now. 

Steven Parton [00:48:13] Well, congratulations, man. And in honor of your time as well here, I want to give you a chance to give us any last closing thoughts before we let you get get on with your day. 

Adam Gazzaley [00:48:22] Yeah, I mean, I think we we we hit on some of the things I'm most excited about in the last 10 minutes or so and that the future of this field is really exciting. It's all the, you know, the latest and greatest from the technology world. Like I immersive sensory experiences, advances in biometrics, both recordings and signal processing. We want to bring all of this into our medicine. And you know, I'd say at the highest level, my biggest message is that we've worked diligently on trying to change medicine, right? We've taken a video game through the FDA and we're really proud of that. We want parents to have options that are not drugs to treat children with ADHD and for adults to have that option to now. But that's not the ultimate goal. The ultimate goal is to make tools like this accessible to anyone, whether or not you have a diagnosis. And you know what? What what I feel is that, you know, sure, that there is a very serious, important global mental health crisis that we could talk about for an hour. And that's real and it's painful and it's getting worse. But. I would say we have a bigger problem. I sort of frame this as a cognition crisis and even outside of the clinical impairment are limitations in how we make decisions in long term thinking. And our empathic concern for each other is really pretty tragic. I would say in general, and I feel like we're suffering as a species, not just clinically but across the board. Just reading the news every day is enough to give you the evidence that that we're having troubles with our minds. And so the bigger the bigger story that I hope to reveal itself over the next decade is technology. And the tools that we're creating and validating can help everyone across multiple domains. That's the that's the bigger mission. Sure, we have our medicine focus. There's a lot to do to help medicine, but it's bigger than that. So that that's what really gets me up in the morning. 

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