Our brains evolved for a simpler life, and today they struggle to cope with a deluge of distraction from technology.
Dr. Adam Gazzaley, professor of neurology at the University of California San Francisco, reveals why the brain loves multi-tasking even though it’s so bad for productivity; why “single-tasking” is so hard to relearn; and why 60-year-olds can’t filter out irrelevant information.
Plus… a prescription video game that can help kids with ADHD and others change their brains to find better focus.
Phil Stieg: Hello, I’d like to welcome Dr. Adam Gazzaley, the distinguished professor of neurology, physiology and psychiatry at the University of California, San Francisco. He is also the founder and Executive Director of Neuroscape, where he leads the design and development of new cutting edge technologies and techniques in neuroscience to advance education, wellness, and medicine.
Recently, he has been involved with the first FDA approved prescription video game, which has been shown to help people with ADHD. Today, we are here to discuss his book, “The Distracted Mind: Ancient Brains in a High-Tech World”. Let’s learn how we can find a signal amidst all the noise of our high-tech world.
Adam, thank you so much for being with us today.
Adam Gazzaley: Thanks for having me.
Phil Stieg: So I found your book fascinating, and I have to admit it is one of my pet issues, the sensory overload that everybody’s experiencing with all the social media. But we’re not going to get away from it, and I’m glad to see that you’ve provided some hope. So let’s get to your book, “The Distracted Mind: Ancient Brains in a High-tech World”. Tell us what you mean by that.
Adam Gazzaley: Yeah, so the idea is that our brains, as amazing as they are — clearly look at what is around us, like, we’ve created these societies and languages and art and technology. So the brain is amazing. But —
Phil Stieg: The big but … [laugh]
Adam Gazzaley: The big but is that there are fundamental limitations that go back evolutionarily that are just part of who we are as animals. Like it’s so easy to forget that we are also animals and that we evolved in an environment that was dramatically different from the one we are in today.
And so we’re not necessarily evolved for this world of high speed communication around the world in one instant, with everyone you could ever imagine or every piece of information right in your pocket, accessible with the push of a button. It’s just not how we evolved. The deeper dive is, what’s going on? What happens when you take that ancient brain and bring it into this modern world?
Phil Stieg: So assuming that the brain, evolutionarily, is there to preserve energy and maximize the amount of energy that it has to do its function, why do you think it has developed such sensitivity to distractions and interferences? How is that evolutionarily advantageous?
Adam Gazzaley: So there are several reasons. One is that there are two types of attention. This is the easiest way to break it down for me. Top-down attention and bottom-up attention. Top-down attention is the most evolved type of attention. It’s what your listeners are doing right now. They’re choosing, they’re making decisions to direct their attention at what we’re talking about, to listen to it. Its goal-directed attention. It’s not that my voice or your voice is the most salient thing even in their environment right now. So it is selective attention driven by goals. That’s what top-down attention is.
Bottom-up attention is the more ancient attention; that is attention not driven by goals, driven by the external stimuli themselves, the salience of them, the relevance of them, the power of them. And this type of attention was pivotal for survival. And so if there is a flash of light, a scent, a vibration, it could trigger a threat that you need to be aware of or a source of food that you need to be aware of. So it is fundamental to the survival of every creature to have bottom-up attention. And that’s what allows you to survive in the wild that we evolved in.
And so these bottom-up attention signals are reflexive. So you get the signal and it produces a response. It’s called the perception action cycle. And you see this in the nervous system of every animal. Even those that don’t have, like insects, that don’t have higher level cognition, they still have this reflexive response to these bottom-up environmental signals.
We have them, too. They are not gone. They’re part of our ancient brains, and they’re also important for our survival. If you’re crossing the street and you’re deep in thought with your top-down human brain and a car beeps its horn because you didn’t notice that you’re walking the street, you will stop, you will hear it, you will respond, and it will drive you.
So this is one example of a type of feature function of our brain, bottom-up attention, that is ancient and preserved and creates distraction because technology cleverly uses bottom-up signals, whether or not the developers were aware of it, because we still have this fundamental attraction to them. So the vibration of your cell phone, the flash of light that you have a message coming in, the sound of an alert, these are the things that are embedded in our technology to take advantage of this bottom up sensitivity.
Phil Stieg: So, from a human standpoint, with bottom-up, you’re talking about the limbic system, I’m presuming, and with the top-down, you’re talking about, which is particularly human, the cognitive portions of our brain. And I guess you just made me think about this. When the light flashes on my phone that it’s going off, it’s kind of a fear response. “OOH, a light went off!” And so that’s really hitting my primitive part of my brain, but then it sucks me into paying attention to it in my cognitive brain.
Adam Gazzaley: That’s exactly it. And it’s even more primitive than that. So prick your finger with a pin, and you will withdraw it. That is a reflex that’s bottom-up that doesn’t even involve your brain. That reflex takes place in your spinal cord. And reflexes are all over us. Your pupillary response. We’re full of these reflexive bottom-up responses that are not in our consciousness.
What happens is that because we have such a very dominant top-down attentional system, more so than any other animal, this is what allows us to create society and art and music, that we have this top-down power. But the bottom-up is the trigger, and then the top-down takes over, and next thing you know, you’re lost.
Phil Stieg: So is that your end game or your long term plan is to get us as humans to better understand that top-down control so that we can limit the distractions and thereby improve our memory and other functions?
Adam Gazzaley: One of my main messages is, it’s time to take control. And the idea is, based on this it’s that the first stage is to recognize that you have this top-down brain that still is susceptible to bottom up interference. And to realize that it is taking control away from you, that you are allowing yourself to be led by your technology because of these features that harness this bottom-up, and you are just being led. You’re being led through your email, you’re being led through your multiple screens that are open, or your multiple tabs, or your phone in your pocket.
And it’s time to take control, to be able to have your top-down system override those, or to build your environment in such a way that you’re going to be less influenced by them. Once you allow yourself to be swept away in the stream of technological bottom up influences, it’s just hard to break out of that. It’s very habit forming. So you have to form new habits.
Phil Stieg: So what do you say to a person like me, I’m fighting what you’re talking about, the distraction. I don’t want it. I want to get back to the day where I could walk in the woods and not be distracted by something. But because of that, I’m being marginalized — you are a luddite. We have nothing in common. What do we do about that?
Adam Gazzaley: Well, I think that it’s about — I’m a dad now, so I have a young daughter, so I’m already starting to talk like a parent a bit. So I think it’s about moderation. I remember being told that throughout my life —
Phil Stieg: — never believed it.
Adam Gazzaley: But no, but it’s like a fundamental thing that applies to almost everything. Sure, I use a lot of technology, but I also consciously set aside time every day, especially now. I will not bring technology into my daughter’s room because I will use it. Plain and simple. I am weak. If I am sitting in her room — she’s only two — I’m sitting in her room with her and I have my phone in my pocket, and she goes off and starts playing with something, I will pull it out reflexively. I’ll be like, I wonder if I have any email. It’s not like I have to do something. I just will. So I just don’t bring it in the room. So you have to be conscious about it or you will use it all the time.
Phil Stieg: So tell me about people that are particularly susceptible to the distractions. Children, like you said, teens, and for that matter, older adults.
Adam Gazzaley: Yes.
Phil Stieg: What’s not happening? So they get distracted.
Adam Gazzaley: Well, yeah. So the top-down attention that we’ve been talking about is felt to be mediated by networks in the brain. We talked a little about networks. Those networks always involve the prefrontal cortex, which is the most evolved part of the human brain and also the last part to develop and one of the most sensitive parts to aging. So you have like a small window around like 24 years old where you’re sort of at the pinnacle of prefrontal cortical function. So if any listeners are in that age range, enjoy it. This is a very small window.
Phil Stieg: Same for boys and girls?
Adam Gazzaley: Similar. It’s similar, yeah. And so what happens is that the prefrontal cortex comes online and that gives you some degree of power of control over this. And children and I see it every day are notoriously bottom up, right? They might have a goal. They might have a goal, a rudimentary goal of like they want to do something and then something else presents itself. A new goal. Right? That’s a classic example. Their prefrontal cortex is not strong enough to maintain them on that goal if a bottom-up signal comes in and that’s just nothing you can really do about it. It’s just going to take time for that system to come online. And every parent knows this, right?
And there’s also, this system declines with age. It is what leads to that senior moment is that decreased ability to hold attention at the same level, creating a susceptibility to interference, and it could manifest as problems with memory that are really attention problems.
I’m not talking about dementia, I’m talking about 60 year olds that are working full time, like really engaged. They’re doing fine, but they complain that “oh, I went to the refrigerator the other day and when I got there I was like I had no idea why I was there. I opened it up and I was like I must be here for a reason, but I cannot remember.” That’s called a working memory interference. And really, these are attentional problems caused by prefrontal cortical networks that are not as robust as they were. So those populations, which is a lot of people, are even more susceptible to bottom up interference and distraction.
Phil Stieg: So I can concentrate for 4 hours during a neurosurgical procedure, but I can’t concentrate for a split second during a golf swing. [laugh] It’s a top-down problem, huh?
Adam Gazzaley: It is, and you know there’s nuance and complexity everywhere. So an extreme example of a population that is susceptible to distraction is ADHD. I mean, it’s in the name of the condition. But even that population, under certain circumstances, many children with ADHD can focus seemingly just fine. I have parents tell me like, oh, my kid has an ADHD diagnosis and I get it. I mean, he has trouble focusing, but I watch him play a video game for 3 hours without any sign of fluctuation and decrease of his attention. So, explain that to me.
Attention is very context dependent. You gave an example of context-dependent attention where you’ve been training your whole life as a surgeon. It is an environment and a context that you are incredibly well trained and disciplined in. And it is not hard for you to maintain your attention. Well, you move to another environment and you feel that vulnerability.
A child that’s in a very stimulating environment that drives them, that has novelty and high reward. And that might be enough of a contextual force that it gives them the opportunity to bring their attention online, put them in an environment that is not stimulating. Even if they’re trying, they may fail, which is what happens in class. So yes, it’s important to know that attention is context dependent.
Phil Stieg: So tell us. Technically, how do you go about studying this? What scientific methods are you using to look at concentration, focus, and that?
Adam Gazzaley: Yeah, so there’s a lot of different approaches. My co-author Larry Rosen studies it in the real world. So he will have students in a classroom all get a text at the same time and see how this impairs them or determines how much social media are they using in the evening. Some of it could be extra experimental, where you do an intervention. He has studies where you take people’s phones away and watch their anxiety levels increase when they’re denied it. Some could be observational where you just see two children that use social media in the evening do more poorly at school. So these are real world ways, and there’s many examples of them to study how attention is really performing in the real world.
I don’t do that type of research. I do research on the opposite end of the spectrum in as unreal as possible because I want to see under the most controlled circumstances how vulnerable attention is. So, for example, we’ll have people inside an MRI scanner where we can record both the structure of the brain but also the function of the brain by looking at how blood flow changes over time.
And we have a goal for them. We want you to remember these pictures of faces. You see pictures flash up every couple of seconds, and then we insert other pictures that we tell them, if you see anything that’s not a face, it’s irrelevant, ignore it. And those might be pictures of nature scenes. And what we could do is take a look at their brains and see how the visual part of their brain activates when they’re looking at a face, which is relevant, versus when they’re looking at a scene, which was irrelevant.
And we also have people just look at faces and scenes with no goal at all to get a sort of baseline. And what that baseline showed us is that what we might call focus is how much more activation there is when you’re looking at something relevant like a face versus baseline. And ignoring is how much less activity there is when you should be ignoring something like the scene versus baseline.
So now we have a measure of focus and a measure of ignoring from brain activity, right? An objective measure of how well you’re doing it. And what we learned is that focus and ignoring are not two sides of the same coin. In other words, you could be focusing just fine and failing to ignore. They have different networks, and they move differently. They’re not attached to each other.
There was a thought that if you’re paying better attention, you’re also ignoring better. That is not true. And what we found was that older adults focused just like the 20 year olds. There was no difference in the signal. Where the big difference was they were not ignoring the irrelevant information. Those older adults that were ignoring more poorly were not remembering the faces as well.
So what we showed here was that the memory of the faces was not about focusing on the faces. Everyone was doing that the same. It was about how effectively you were ignoring the irrelevant information. The more effectively you filtered it out, the better you remember the faces. And so it showed two things, the interface between attention and memory, but also that older adults had a selective deficit in suppression and not focus.
Phil Stieg: So I want you to give up a little bit of the secret sauce in your book. You cite a number of ways to do this, but how can the listeners become less distracted and how can they focus better?
Adam Gazzaley: So one thing I like to say is that I am not a self-help guru. And I like to frame that the advice that I give on what you can do is advice that I give myself, right? And these are tools that I found by thinking about this deeply and having researched it for so long, that take advantage of the strengths of our brain to make us navigate the distracted mind better.
I really put approaches to helping in two categories. One would be behavioral, changing your behavior, and the other is changing your brain, actually improving the strength of your brain to make it less distracted.
The first thing you could do is help yourself out as best you can by organizing your environment in such a way to minimize distraction and your chances of multitasking, since we now know that both distraction and multitasking, which are two forms of interference that are not exactly the same, but they’re both interference, since they degrade performance. And not just performance, they degrade your safety if it occurs while you’re driving. They could degrade your interactions with your loved one if it occurs while you’re sitting at the dinner table. The consequences are broad for being distracted.
So how do you do that? Well, make your environment as clean as possible. Minimize the things around you that might pull your attention away.
The other is, minimize your opportunity to multitask. So having multiple screens, having multiple tabs open is going to be a challenge for a lot of people. Having your phone always out, having it open on Facebook while you’re doing your email — this is just setting yourself up for trouble.
So minimize your environment, understand your own vulnerabilities — that’s always the first and most important thing. Your brain is very vulnerable to interference and that technology is your friend sometimes, but it’s also very distracting.
The next big thing I would say is practice “single tasking”. So once you get used to multitasking all the time, it gets really hard to actually do one thing at a time. Why is that? Well, multitasking is fun. And from a neuroscience perspective, multitasking has a high novelty load. When you are constantly switching, which is really what you’re doing, you just keep refreshing with a new thing. It feels good. Our brain seeks novelty. Again, a part of the ancient brain. So multitasking feels good. It feels better than single tasking.
You know, if you challenge yourself and say, okay, I am going to do something for 1 hour and not do anything else, you will find it really hard. You’ll find that you get really bored, that you might even get anxious, like, oh, I haven’t checked in. Even though there’s nothing you really need to check in on. You feel the pull and the draw for these sources that you’ve now become accustomed to and you have a habit.
Technology is not bad. Distraction is not bad. Distraction actually could promote creativity. It’s just about making choices. So I make choices. I say for 1 hour here in the middle of this day, I’m going to multitask away. I’m just going to do low level things. I can’t really get in trouble if I mess up. But, in this hour, I’m not doing that. This hour I’m locking it down and I’m going to write this paper that is due next week and that is all I’m going to do.
Now, I would like to say that the first time you try this, it will be near impossible to give an hour to a single task. What I suggest is that you do it for 15 minutes, take a break, do it for 15 minutes, take a break and soon you might find that you can do it for longer without taking a break.
And the last thing I’ll say is that those breaks that you take are really important because if the break that you take during your single tasking hour period is email or social media, you’re in trouble. Because you will get caught in this iterative cycle of being pulled down, that bottom up influence is strong. And you’ll find that your two minute break is not two minutes anymore. So the breaks that are best are just closing your eyes, doing some meditating, looking at nature, taking a short walk where you’re not exposed to lots of people and then re-engage.
And lastly, I’d say just like running, which is really painful when you start and all of a sudden feels good. Single tasking feels good After you get over the hump. It has its own level of reward if you unlock it.
Phil Stieg: So is this where as founder and Executive Director of Neuroscape, you’re going to provide an answer to this process? What’s the focus of Neuroscape?
Adam Gazzaley: Yeah. Okay, so what Neuroscape does, which is our center at UCSF, is tries to flip this story around. How can we use technology as a tool to improve the function of our brains, notably, attention? Notably our ability to resist distraction, to have top-down, goal-oriented attention, through technology?
Video games, while they could be completely absorbing and even addicting because of the very, very intentionally well designed reward cycles in them, could potentially be used for good as well. Pills are a perfect example, right? Pills are really complicated because we know that molecules can save someone’s life but also be poison and kill people. Like, extreme examples of cutting both ways.
So the focus of Neuroscape is to understand how we can use this amazing technology that we’ve created. How can we use this to improve our focus and help our attention and expand our cognition?
Phil Stieg: So give me the example. You got a person with ADHD. You want to apply your video game to treat that. Just briefly go through the process and kind of what’s going on in the video game that makes their ADHD better.
Adam Gazzaley: Yeah. So I will give a quick fly through of 15 years. So in 2008, I had this idea of a video game as a tool to improve attention. In — no surprise now to your listeners — older adults, because that’s the same population that I found had that distraction deficit that I described to you.
So we built this video game narration. I’m going to describe it to you in a little bit of detail, and then published a paper in 2013. What we showed there is that in older adults that played this video game, we didn’t just improve their ability to play the game, but we improved their attention using tests before and after, very, very different than the gameplay. And we even improved their working memory for faces. And we recorded brain activity during gameplay, before and after, to show that it was those networks, the prefrontal cortical networks, that were strengthened to the level of 20 year olds that led to this improvement.
So that led to a game that was created by a company that I spun out of my laboratory called AKIKI. And that company has now built a much better game called Endeavor RX. That game uses the exact same mechanics as NeuroRacer, but has way higher levels of art, music, story engagement, better usability, now using an iPad as opposed to a laptop. And so on the technology side, the game is a lot better, but the same underlying mechanics. And over 30 research studies have now been done to validate that game as a tool to improve attention.
And then during COVID in 2021 this game was approved by the FDA as a medical device, a treatment for children with ADHD, making this the first ever video game approved by the FDA for any medical condition. So that game is now prescribable. It is prescribed in all 50 states already to children eight to twelve years old, is the indication on the label of our medicine, only by prescription to treat ADHD and improve attention.
Phil Stieg: So tell me for the parent that doesn’t want their child to be on Ritalin for a long time, what website, where do they go to find out about video games and how to maybe approach this?
Adam Gazzaley: Yeah, so this particular video game is called Endeavor Rx. Endeavorrx.com is a way that you could find it. AKILI is the name of the company. You could find more there and it describes the data behind it and it also has pathways for your doctor to learn about it and to prescribe it. There will be listeners that are going to ask themselves a question of I’m not eight to twelve years old and my attention is not great. I’m just going to pre address that question that I know I’m going to get from your listeners. And I could tell you that this particular game is prescribed the label and the indication is for that age range. Of course, off-label prescriptions happen all the time. I can’t really push that because that’s what the label is.
But I do want to share that there are top line results. They’re not yet peer reviewed, published, but that’s in the process that were presented this year, showing that in a study of adolescents, 12 to 18 year olds, the effects were twice as strong, and in studies of adults, the effects were seven times stronger. And also almost 50% of adults reporting literally a subjective improvement in the quality of life, which is just mind boggling to me. So we are working to expand our indication and our access across the entire lifespan of ADHD and to other clinical conditions.
Phil Stieg: So, last question. Where is Neuroscape going next?
Adam Gazzaley: We have been doing a lot of things to take this idea of what I describe as experiential medicine and take it to the future. So at Neuroscape, we have a dozen games, all with many, many different mechanics. Games that take place in virtual reality where you navigate environments to improve your memory. We have rhythm games that use motion capture, we have a lot of tools of that nature. We also have a research focus that now has shown in almost a dozen papers that we can stimulate your brain electrically while you play a game. You can’t even feel it. It’s like a very low level. And this actually accelerates Neuroplasticity, and you’re learning on the game. Now we’re looking to see if that leads to better benefits.
We have research now with sensory immersion rooms and nature exposure. So using technology to improve mood. And even a new area of research is looking at things like psychedelics, which are showing benefits in clinical populations like depression and PTSD. How that can be integrated with these type of digital technologies.
So there’s a lot there. We now have ten faculty at Neuroscape, so there’s a lot going on, but that’s where we’re heading. What’s the future of what we presented with Endeavor RX? Where do we wind up in ten years? And that’s what we’re working on.
Phil Stieg: Adam, thank you so much for being with us today, showing us how we can any distractions so that we will be able to find that important signal amidst all the noise that is around us.
Thank you so much for being with us.
Adam Gazzaley: My pleasure. I had a great time talking with you.