Episode 145: Upgrading Humanity's Cognition with Subconscious Learning Moments - Adam Gazzaley

Dr. Adam Gazzaley obtained an M.D. and Ph.D. in Neuroscience at the Mount Sinai School of Medicine in New York, completed Neurology residency at the University of Pennsylvania, and postdoctoral training at University of California, Berkeley. He is currently the David Dolby Distinguished Professor of Neurology, Physiology and Psychiatry at University of California, San Francisco and the Founder & Executive Director of Neuroscape at UCSF, a translational neuroscience center engaged in technology creation and scientific research.

At Neuroscape, he leads the design and development of novel brain assessment and cognitive optimization technologies. Neuroscape’s novel approach involves the development of custom-designed, closed-loop video games integrated with the latest advancements in software and hardware (virtual/augmented reality, motion capture, mobile physiological recording devices, transcranial electrical brain stimulation). These technologies are then advanced to rigorous research studies that evaluate their impact on cognition, as well as neural mechanisms using a combination of functional magnetic resonance imaging (fMRI), electroencephalography (EEG) and transcranial magnetic stimulation (TMS).

Dr. Gazzaley is co-founder and Chief Science Advisor of Akili Interactive, a company developing therapeutic video games, Sensync, a company creating the first Sensory Immersion Vessel, and JAZZ Venture Partners, a venture capital firm investing in experiential technologies. He has been a scientific advisor for over a dozen companies including Apple, GE, Deloitte, Magic Leap, and the VOID. He was a Science Board member of the President's Council on Fitness, Sports & Nutrition, and is currently a Board of Trustee and Science Council member of the California Academy of Sciences.

Dr. Gazzaley has filed multiple patents for his inventions, authored over 140 scientific articles, and delivered over 675 invited presentations around the world. His research and perspectives have been consistently profiled in high-impact media, such as The New York Times, New York Times Magazine, New Yorker, Wall Street Journal, TIME, Discover, Wired, PBS, NPR, CNN and NBC Nightly News. He wrote and hosted the nationally-televised PBS special “The Distracted Mind with Dr. Adam Gazzaley”, and co-authored the 2016 MIT Press book “The Distracted Mind: Ancient Brains in a High-Tech World”, winner of the 2017 PROSE Award in the category of Biomedicine and Neuroscience. Dr. Gazzaley has received many awards and honors, including the 2015 Society for Neuroscience Science Educator Award.

Audio Title: Ep145 - Adam Gazzaley
Audio Duration: 01:03:43
Number of Speakers: 2

[00:00:00] Intro: Welcome to the Heroes of Reality Podcast, a podcast about the game of life and the hero's journey we all experience. Let's jump in with our host, Dylan Watkins, as he introduces today's guest.

[00:00:17] Dylan Watkins: Can video games be medicine? Can we combine the values of the entertainment, the gaming space, along with neurology and psychology? Well, in this podcast today, I have Adam Gazzaley. He has obtained an MD and a PhD in neuroscience at the Mount Sinai School of Medicine in New York, completed a neurology residency at the University of Pennsylvania and postdoctoral training at the University of California, Berkeley.

He is currently the David Dolby Distinguished Professor of Neurology and Psychology – Psychiatry, at the University of California, San Francisco, and the Founder and Executive Director of Neuroscape at UCSF, a translational neuroscience center engage in the technology creation and scientific research. Without any further delay, I'd like to welcome, Adam.

[00:01:04] Adam Gazzaley: Hey Dylan. Thanks for having me here.

[00:01:06] Dylan Watkins: Hey, I am super duper excited to talk to you about the intersection of gaming and transformative design. I see you sitting there a lot with basically the combination of, you know, living our lives as if we were in video games. And I'm very excited to talk to you about these things. But first, love to learn just a little bit about your journey that brought you to this really unique intersection of, you know, neuropsychology and gaming.

[00:01:40] Adam Gazzaley: Yeah, that's a long story. You know, I would say to summarize it briefly, I've always had an interest in having my research as a neuroscientist impact people's lives in a positive way. So not just compile information about how the brain works, write papers, get grants, the standard academic circle of life that we all engage in. But rather to do things that became products and actually touched people's lives directly, improved the quality of it and the function of their brains.

And I didn't really work on that for most of my career. I was a neurologist for many years, seeing patients largely with dementia and Alzheimer's disease. I've been a neuroscientist, doing neuroscience now for 30 years and using a whole array of tools to understand the brain from microscopy to functional MRI and EEG and transcranial brain stimulation and trying to understand how neural networks lead to higher order behaviors. And that research had been going great. I've been successful with it and built a nice research lab that's now a center at UCSF.

But around 12 years ago, I just got frustrated with that and realized that if I didn't do something out of the box I was going to just get caught in that same loop of get a grant, write a paper and not really make a true impact in helping people directly. And so I was searching for a way of integrating my expertise in neuroscience and the methodology we use and my understanding of the brains and needs of people, in general, but specifically focused on attention.

And the question that I asked myself was how do we use what I just described to you to create something to help improve people's attention? And the idea that I had was an interactive experience, one that was fun, so we call that a video game that challenged people and rewarded them at a high level in a very personalized way. And essentially harnessed the ability of our brains to change itself and modify itself in response to experience what we call neuroplasticity.

And so that's the story. I essentially combined the work that I was doing in my research labs with a real interest of mine in gaming, and worked with a pretty diverse team of people, a lot of them at LucasArts in my lab at the time and built our first video game to see if it can improve attention abilities. And, you know, there's been another decade on top of that story, but that's sort of the beginning of it.

[00:04:20] Dylan Watkins: That's awesome. And yeah, there's a couple of pieces, I mean, one is escape in the lab. There's a lot of this science that just gets left on the lab cutting floor and that's just where it lives. And there's a big chasm from being able to pull something from the areas of, in the library from a science to applied science.

And one of the greatest challenge is I think personally is trying to take education or transformation and try to make it entertaining. Right there at that intersection is incredibly challenging to try to make that, especially changing one's patterns and behaviors and psychology, narrative patterns. There's a lot of things that are going on. So can you talk to me about some challenges or lessons learned that you've had trying to hit that intersection of transformation and education?

[00:05:09] Adam Gazzaley: Yeah, it is a big challenge and it's coupled with another challenge of trying to do really rigorous research on it as well. So, you know, I think it would be – it's a high bar already to create transformational tools that are also fun and engaging and immersive and have all the value that entertainment has. When it doesn't try to actually improve your cognition or your emotional capacities now, try to build that in such a way that lends itself to do phase three trials and clinical research and validate and understand the mechanism of action of those tools, such that you can position it for regulatory approval, like FDA approval, which we've done with one of our games so far.

And so, you know, I just bring that in because it's part of the mix in what goes into our development and that when we're creating a video game and we've built a dozen of them over the years at Neuroscape and some have left Neuroscape like, the one that we call now EndeavorRx, which was developed by Akili, a company that I co-founded out of NeuroRacer, which was our first game. But most of the games are still at Neuroscape, which is a research center at UCSF.

And I would say that when we sit down to build a game, we have all those components in mind. What are the interactive aspects? What is the closed-loop feedback systems and the mechanics of the game play that's going to challenge the brain in such a way to lead to an optimization of its function. So, there's that question.

Then there is, how does that intersect with art, music, story, reward, different types of interactive features that you might consider? Is it in VR? Is it motion capture? What are the elements that make it fun and engaging that make you want to dive in deeply and make you want to do it for a long period of time?

And then the third part is how does this get studied? How do we – because we're a lab when it comes right down to it. And then that's really our day job, right? We work with lots of professionals that help us, you know, I would say I take the first design pass at all of our games, but then we work with tons of video game professionals that help us with putting it together and actually creating it. But what we are, you know, where our background is actually doing the research studies.

How do we record brain activity and other physiological measures and performance measures and design a well-controlled, blinded study that allows us to make strong conclusions and interpretations from this tool? And if we can't do that, then we're sort of left with this big question mark of what does it really do? And so when you're designing an intervention to have impact on, let's say attention, to be fun and also to then be a research tool. There's just a lot of considerations and it usually takes us a couple years to build each game that we create.

[00:08:22] Dylan Watkins: So you're saying you, don't only – it's not only a two-fold problem with the entertainment and transformation combining together. And then the other, but it's actually a threefold problem of actually how you actually make this a provable repeatable model that's results driven. It's not just, "Oh, we totally did it." but actually have a way to be able to show that scientifically and therapeutically And that's – yeah.

[00:08:45] Adam Gazzaley: Yeah. Undoubtedly. And it's, I would say it's one of our strengths that we pair those together, those three components early on. Because I feel like a lot of groups will build out with two of those things in mind. And then be like, how do we study this? And then you realize that it wasn't perfectly designed to be studied in a rigorous way. And so, yeah, I think that they're all part of the puzzle.

And it's why our teams are so multidisciplinary and people always like, "Well, what's your most valuable IP or patent? Or, you know, to me, the most valuable thing that I've ever created or been a part of is bringing together multidisciplinary experts that learn how to listen to each other and really work together because this is, you know, an impossible task for any single individual, even single field. This is definitely a merger of a lot of different minds at the table.

[00:09:42] Dylan Watkins: Yeah. I mean, it's very much, much like the human condition. The transformation, the growth comes from their time under tension. And sometimes in social dynamics, the time under tension is having two opposing forces and trying to hold them together in one creative session. So...

[00:09:56] Adam Gazzaley: Undoubtedly. I've witnessed a lot of that over the years. And you know, I've also been in a lot of meetings where it fails, where you have creatives and scientists and technologists and all types of engineers sitting there, all believing strongly that they know what's right. And that they are the smartest person at the table and not really listening to each other. And the product that's created is just never very good. But when you have a group of people that actually respect each other and listen to each other, if you could set that type of dynamics, then you could create things that no one else ever has.

[00:10:35] Dylan Watkins: Yeah. Yeah. There's a couple of things with that. One of them being is a quote we try to often use is the – you're sitting at this peak of being passionate about the experience, but being indifferent with how to get there and being able to actually understand that no matter what idea you have, it's not as important as you think it is while you're having it. Why you're thinking about it, it's not nearly, you know, that hook is you can just get away from it. It seems to be, but there's that attachment to the idea. And it's a challenge.

[00:11:13] Adam Gazzaley: Yeah. There's a lot of that which occurs in our development process where people get attached to something that doesn't work. And often it's not that it's not a good idea. It's just that when you're building the type of things that we are, the skills that you had in the past and the tricks and the paths that you took to success may not work anymore. And so, for the right type of person, it's like an amazing challenge. For the wrong type of person, it's frustrating and not fun at all. For example, I'll give you an example to make it less abstract.

[00:11:50] Dylan Watkins: Yeah. Thank you.

[00:11:54] Adam Gazzaley: So when we build a game, we have the need to have our reward systems drive the engagement and the pressure on a certain operation or task that we're trying to reinforce, that we want to adapt and constantly put pressure on. So what that means is you can't just enter the room with an idea of a good reward mechanic that you have used in the past successfully. Because it may take away, you may not be able to direct it where we want it to, because of its very nature, the time scale that it's being delivered at or some other aspect of it.

And so it winds up pulling the player, even though it works from an entertainment point of view, as it has for that person before. In this situation, it actually pulls them away from where we want their attention, and sometimes you just have to let those go. Or, it's a challenge of like, "Okay, yes, that, that makes a lot of sense. Now, let's try to repurpose it for this, which is going to take reinventing it in many ways." So that's an example of something that I saw a lot of in the early days, not so much with working with like game professionals.

[00:13:05] Dylan Watkins: So that's trying to use a hammer to build a sand castle.

[00:13:09] Adam Gazzaley: Yeah, that's true.

[00:13:10] Dylan Watkins: Yeah. So then how do you – if you see that and you recognize it, so part of that is that recognization of the situation, you know, what are the techniques or things, what are the things that you seem to be able to do to get people to expand what's possible and detach from those ideas? Have you been able to see anything for that more cohesive environment for creativity?

[00:13:28] Adam Gazzaley: Yeah. For me, it really comes down to a mutual respect that people around the table have for each other. If that's not there, it doesn't matter what type of mechanism and process you put in place for development, as far as I'm concerned. So for me, it was really fortunate that a lot of the original game professionals like super high end storytellers, engineers, artists, the whole works were friends of mine.

And so, we already like liked each other, loved each other and respected each other immensely. And we almost like, I can't believe I'm working with you on a project on both sides. So we entered it with, "Oh, that doesn't work. Okay. I see that now." You know, it wasn't like you were fighting for your ideas. You were like, "Tell me why that doesn't work. I'm so curious because it works all the time." "Oh, I see it doesn't work here."

And we were like that on both sides of the table. And what I think happened was that other people would enter this that didn't know us as well. And they would see this and they would just fall into this sort of mutual admiration society and just allow the other person to speak and hear what they have to say and be willing to let go of something that you think should work based upon your previous experiences.

[00:14:48] Dylan Watkins: Oh, that's awesome. I mean, it's setting a strong – that mutual respect and appreciation for working with people, I mean, you set a very good cultural tone in the beginning that then was just the medic as you move through the process, which is beautiful.

Do you – like, so, I mean, I do want to look at the thing that you mentioned earlier, I want to kind of dive into a little bit. You said that there's – transformation is one of the challenges. Entertainment is another, but the third bucket is the measurement, right? And a measurement can only really be a couple of aspects. It can be self-reported, other-reported or biofeedback.

Is there a crawl, walk, run method for measurements for bringing a game to fruition or bringing what you're talking about this kind of therapy gaming, or this digital teleme– digital medicine gaming? Is there in terms of measurement features?

[00:15:35] Adam Gazzaley: We measure in pretty much every way that you can. And there's just so many different approaches you can use. So there's the pre-post measure, right? That's like the standard of a clinical trial, of any research trial where there's an intervention, is that you have – you're recording things beforehand and you are recording them again later and you want to see if they change.

You have another group that's involved in either placebo or some type of other intervention or just seeing what the practice effects are. So pre-post measures are, you know, that's the industry standard. That's what you're looking to see makes a statistically significant change versus whatever control group you have.

And then there's lots of other – and those could be completely varied from your neuroimaging methods to behavioral recordings, to surveys, to real world metrics of change, physiological or otherwise. And then there are some recordings that you do during the actual treatment itself. It may be game play metrics or other aspects of physiology and even neural activity and certainly performance that you're recording during the training. So, you know, right across the whole experience of going from before, during and after we have recording approaches.

[00:16:58] Dylan Watkins: Are there any... Yeah.

[00:16:59] Adam Gazzaley: Do you have...

[00:17:00] Dylan Watkins: I can hear you.

[00:17:00] Adam Gazzaley: Is my video working? And the video's working. Okay.

[0:17:03] Dylan Watkins: Yeah, everything is working. We're good.

[00:17:04] Adam Gazzaley: Sorry. It's frozen on this side. So I'm just making sure it's working.

[00:17:06] Dylan Watkins: Oh really? You're looking good on this side. I'm not seeing any issues.

[00:17:09] Adam Gazzaley: I moved though. Okay, it's fine.

[0:17:10] Dylan Watkins: Okay, you're good.

[00:17:12] Adam Gazzaley: I don't need to see myself moving. It's actually peaceful that I'm frozen, just...

[00:17:17] Dylan Watkins: I'll wave my arms back and forth and start screaming if you go out, okay?

[00:17:21] Adam Gazzaley: That's good. Yeah. I'm just like, you're moving and I'm just like, err, as long as I'm moving to you.

[00:17:27] Dylan Watkins: From my perspective everything is great. Isn't it, by the way, isn't it so funny? It's the same thing is true in neurobiology and psychology, how I live in my own narrative world, right? And maybe you say something or do something that doesn't register to me. And you know, you throw me a volleyball and I catch an apple. You know what I'm saying? And I'm like, why is this? And then we have this internal landscapes that we're trying to cross this chasm together. Right? So...

[00:17:50] Adam Gazzaley: Exactly.

[00:17:52] Dylan Watkins: So, but looking at it from that perspective, I mean, what a great, you know, in the moment thing to look at it. Is there ways that you actually help people gain awareness of their own internal landscape and bring it to the forefront that help them understand it, that lets them shift, and actually have those transformative effects? Have you seen ways to do that within this interactive landscape that aids itself to that?

[00:18:12] Adam Gazzaley: Sometimes we do that and sometimes we don't. So, a lot of our treatments are really – especially, you know, we do a lot of treatments on people that have neurological and psychiatric conditions and others on children, even children that are fairly young. And so most of our interventions in our games, whether we think of them as clinical tools or as educational tools, or as wellness tools, we're sort of agnostic to that. And we could come back to that.

But they're sort of designed to work without your ability to realize why they're working. And so there's not a lot of necessary awareness that's part of them in order to get the benefits, which is an asset or not, depending on how you look at it. Certainly for younger children, the fact that, or people with early dementia, the fact that they don't need to be like, "Oh, I just had an epiphany or breakthrough in understanding"  is an asset for us, right?

So it's like, do your work, have fun, it's a game, enjoy it. Don't overthink it. And at the end of this, you're going to come out with better attention abilities. That's sort of what we're  – in most of our interventions, what we're doing, and matter of fact, like our – we have an ADHD treatment that was just FDA approved and out on the market so we're starting to see a lot of feedback from kids. And, you know, most of them are just, it's a game.

And you know, they get that, they're taking it as a medicine, but the reality is that they're not like being taught something about how they should be behaving different or paying attention different. It's just making their brain stronger.

[00:19:49] Dylan Watkins: Man, you want to talk about taking the medicine and putting a candy wrapper around the thing to have somebody enjoy it. And just the thought of saying the, just the sense of you putting, I made this video game that's technically medicine is every kid, I could picture them running to their parents, "Let me have my medicine, give it to me." There's some magic in that.

[00:20:12] Adam Gazzaley: It's magic. I mean, it is technically medicine. It's a Class II medical device approved by the FDA. It is available only by a doctor's prescription. It's medicine and it's really exciting. It took over a decade to turn an idea into medicine, through a video game but we got there.

[00:20:30] Dylan Watkins: Yeah. I think some people that hear, oh, I have this FDA thing that became a medicine. It's like, "Oh, it must have been just so easy. Just applied, turn it in, and it was done. It was just bada bing, bada boom, how easy for him? I've got my demo. I've put – I've worked on this for a weekend. Why can't mine be a digital drug? I don't understand." Can you please talk to me about what I call this as the hero's journey...

[00:20:51] Adam Gazzaley: Yeah.

[00:20:52] Dylan Watkins: ...some of your threshold guardians that you did battle with in order to have a prescribed video game as a medicine?

[00:21:03] Adam Gazzaley: Yeah. It was a long journey and I always joke, and some of my co-founders and I joke, it's like to everyone that hears about it for the first time, they're like, "Wow! That's like an overnight success story." It's always an overnight success story to people that don't know about it. It's never an overnight success story for the people that's spend a decade working on it. But I get it. I see why it feels that way to other people, but we...

You know, so, it was an idea of mine in 2008 to this video game, this particular video game, there were very certain from something that I actually woke up from a dream with the design details of the game, which is weird, but true. That happens. I have like three or four of those in my life of waking up from sleep, grabbing a pen and writing down or drawing something that becomes a big part of my life. This was probably the biggest.

And then working with LucasArts and my friends over there to develop Neuroracer, spending years doing research on it. One of the massive battles was the publication or that paper in Nature, which is like the premier scientific journal and became the cover of the journal. This is in 2013, 5 years after we started.

And, you know, putting even before the paper, actually I should mention trying to get scientific funding for a video game project in a research lab was an incredible challenge. We were able to finally, after multiple grant applications that were rejected, get funding from the Robert Wood Johnson Foundation that had this really innovative program to support things that were sort of crazy ideas. But other than that, we were not getting funded. People were not digging this as an idea at the NIH, let's just say. Things have changed, but not back in 2009 when we're applying for funding.

[00:22:54] Dylan Watkins: There's a – so always great ideas always go through this transition. There's like a – this transition from crazy idea to prolific, to common sense, right? That's the transitionary steps that these things move through, right? Can you talk to me about the luminary periods, the transitional periods in between, you know, A to B, B to C? What do you think made those changes? What made it go from crazy town to prolific and prolific from probably still there to going into the mainstream, which will be at some point? Can you tell me about that?

[00:23:23] Adam Gazzaley: Yeah, of course. It was definitely crazy town in 2008. There weren't a lot of examples of anything in the entertainment space, having such traction scientifically. There was the beginning of some work, like my colleague Daphne Bavelier was publishing papers and Shawn Green showing that entertainment video games had some improvement abilities on cognition and kids that were playing games. And that was published in Nature, in one of those papers.

So there was a little bit of it out there, but not so much in terms of "I'm going to just start from scratch and build a game in a laboratory at a university as a therapeutic to improve attention." That was just not really a thing that people were writing grants on, or writing papers on. And if they did exist, they were on things that were barely games, I would say.

I would say they were called games, but if you played it, you'd be like, "This is not a game." so they're like gamified tasks. And my vision was very different. My vision was like a video game. Now, granted, it's not going to be an amazing video game with the budget we had and our agenda wasn't to create a product, we were building a prototype to see if there was a signal there. Now, it's a video game years later.

So, I'd say at the very beginning days of trying to get grants and trying to tell my colleagues, what I was working on, it was definitely thought to be a little strange, a little farfetched of an idea. But that's okay. I'm not afraid of that. And it was fun. We were building a video game. It was great. And it was great to work with video game professionals. And it was just amazing to like, have artists like take an idea and turn into something beautiful. It's an incredible time, even though it was crazy tad. It didn't matter. It was really exciting and I love those days.

And then we had our Nature paper and that was ground shifting. I mean, it changed everything because the journal is, you know, a world premier journal. There's like Science and Nature. Those are the two journals. And, getting a publication in there in your career is a big deal, getting the cover of the journal is like, it's like a Grammy in our world. It's just –there's nothing really bigger besides, you know, like giant prizes, like Nobel prizes and things like that. But just for a publication, it's an incredible amount of visibility. It still is.

And it wasn't enough to turn it into, you know, maybe we didn't, you know, leave crazy town right away, but it wasn't enough to raise a lot of eyebrows. And, you know, the paper wasn't like, this is like the answer to everything. It was a well done paper that had all its normal set of limitations in it. But you know, it did some important things.

We were able to show meaningful change in attention and a type of memory called working memory in older adults. That was very, very different from game play. We had two control groups, including one slightly different version of the game that didn't show those changes. So we showed mechanism of action. We recorded brain activity during game play before and after to show what was changing in the brain that led to those improvements. We showed that there was some improvement on aspects of game play and multitasking in the game, six months later.

So to be able to show transfer of benefits, mechanism of action and sustainability of effects was I think really important and opened up the path for my lab to become Neuroscape and then to do this again and again. Now, we have many papers on many different types of games and to launch a company, Akili, to take this prototype and the signal. I always say it was like the paper wasn't enough for me to say, "Hey, everyone, go out and play the Scape." It was a signal that there was something meaningful here that needed more work.

And then now there's been 30 studies done, many of which I'm not even an author on, including the phase three, the pivotal trial on ADHD, which was a double blind placebo controlled multi-site trial on a video game with children with ADHD that eventually went on to FDA approval.

So I'd say with every passing study, showing similar benefits, not just in older adults, like we showed in our Nature paper, but in children with sensory processing disorder and older adults with depression, and then a group of people with multiple sclerosis and then all the studies on ADHD. Now we're like, "Oh, this is not just like a random finding. This is highly replicated across multiple populations with different researchers."

So it wasn't like it happened like that, but slowly over the course of the last decade as this data piled on. And then of course the FDA's recognition of it as a medical device after two years at the FDA, you know, was I think a crowning achievement in terms of advancing this to the next step.

[00:28:22] Dylan Watkins: Yeah. I mean, that journey 10 years plus the – it sounds like the switching areas, right? The crazy town to prolific was publication. And then from prolific to good idea is FDA approval. Those luminary periods that happen long. And, you know, it's a series of grades as you go through that process.

[00:28:42] Adam Gazzaley:  Yeah.

[00:28:43] Dylan Watkins: But looking at those moments and looking at like how you actually had to do that in that time horizon, it sounds like you have different business structures to kind of shift your product from ideation to – in the lab, in the lab to kind of half experimental to then full on out the door.

[00:29:02] Adam Gazzaley: Yes.

[00:29:02] Dylan Watkins: Is that why you have those different structures in place?

[00:29:04] Adam Gazzaley: Yes.

[00:29:05] Dylan Watkins: Is it a vertical integration of innovation? Is that what we're talking about?

[00:29:08] Adam Gazzaley: Yeah. You know, I have this really unique opportunity to live both in academics and industry, which has been incredible, because I get to see the strengths and weaknesses of those different institutions.

So academics is great for having a crazy idea, being okay in crazy town and, you know, having a philanthropist or a funding agency say, "Yeah, we get it. It's crazy, but that's okay. That's what academics is for. Like, you have a good hypothesis. You have a good team. You have a good track record of success. We're going to fund you, go for it. If it doesn't work, it doesn't work. We get that. That's what science is all about." And you could do that in a lab.

But you're not really building anything that's scalable or tested with enough replication to lead to regulatory approval to do all the things to turn an idea into a final product that doesn't really happen in an academic institution. So that's where I had to learn how to bridge from the lab into a company, into a structure that allowed for the [A] the high level game development, which had like, you know, a 40-person game team.

So, you know, NeuroRacer, which was the predecessor game to Endeavor was, you know, sort of like in an, you know, '80s Nintendo game, right? It's like, "Sure, it's fun and almost in a retro way. And it had game mechanics in it and rewards and colors and a 3D environment. But it wasn't really a sustainable, fun, engaging, you know, experience."

And going from the lab to a company allowed us to do two things. One, it allowed us to build a way better game, which is far from trivial and all game developers know that. I bow deeply to what occurs during the true, you know, game making process. It's unbelievably hard and takes years of incredibly talented people doing that. And I respect that and I knew that we couldn't do that at UCSF. And so, that's one of the things that occurred.

And then the other is just tons of research, multiple trials across different universities, not all with me as an author. That's what you want. You want to diversify the teams that are applying their expertise to it, and that needed the company. And then the whole process of going through the FDA approval process is really just not fit well-suited for a lab. So, they work great together. They have very complementary strengths.

[00:31:45] Dylan Watkins: Yeah. I mean, that's what it sounds like. I mean, you're looking at those three elements that trifecta of, you know, transformative gaming in terms of the results driven, you know, measurement entertainment piece and why you need different facilities that focus on those pieces, right? Which is, which is really cool. I have a couple of questions. One, just NeuroRacer, was Noah Falstein on that one?

[00:32:08] Adam Gazzaley: Yeah, Noah was on that one.

[00:32:10] Dylan Watkins: Oh, cool.

[00:32:11] Adam Gazzaley: Yeah. So Noah and my buddy, Matt Omernick, who was at LucasArts. And Eric Johnson, who was our head programmer, and Dmitri Ellingson was also on that project. But Noah was introduced to me from the Lucas' guys and he was there on day one. Yeah. So he's been on this entire journey with us.

[00:32:31] Dylan Watkins: Have him on the podcast a while ago.

[00:32:33] Adam Gazzaley: Oh, he's great.

[00:32:34] Dylan Watkins: Yeah. He's awesome. And it's – I remember hearing the name. I was like, "That sounds like Noah's." I was like, "Oh". And I made the connect the dots. So small, small world.

[00:32:42] Adam Gazzaley: Yeah. I was introduced to Noah back in 2008 when we started this. I mean, he's obviously beyond the moon, excited with where this all has went now. And not that we don't have a lot of challenges, but like you said, we passed a lot of important milestones.

[00:32:57] Dylan Watkins: And along there's things, so there's the – not only there's the FDA approval and that kind of approval. You have to have – you have to satisfy so many different groups of people or needs and urges the entertainment, the transformation, the measurements.

Can you talk to me a little bit about, did you have to build a community around this type of application? You know, because generally when you have a game that you're launching, you're putting something out there. People build, you know, discord channels and slack channels and, and then you have to find the first one, then 10, then a 100 and go on from there.

How did you build the community engaged support in this type of environment? Because I – those are different worlds. I imagine the way you build in an academic world is not the same as you build a game community. So, can you talk to me about that?

[00:33:41] Adam Gazzaley: Yeah. So, let me just make sure I understand. You mean to build the community of people using the game or people that were helping to create the game? You mean...

[00:33:47] Dylan Watkins: Using the game. Yeah. Users of the game. Yeah.

[00:33:49] Adam Gazzaley: Well that is a great area of discussion. So that's where we're up to now. So remember I said, like, there's still a lot of big challenges in front of us? So, having built the game, a great game that had all the scientific elements we wanted, but also the fun elements and that was quite usable and people really could do for a long period of time, had long, long reward cycles, big challenge. Having all those clinical trials occur and positive outcome, big challenge. Going through the FDA-regulated process and getting approval as a Class II medical device, massive challenge. Check, check, check.

Now, we have to get the game into people's hands, right? That is where we're at now. And it is – you already talked about how, you know, challenging it is  to get any game. There's a lot of noise out. There's lot of games. There's a lot of sources, a lot of different platforms you could play it on from mobile to consoles, VR platforms.

So we also have this really unique opportunity and challenge in that our game is available only via prescription. And how do you work with the medical system to now take something that has lived in the entertainment world, bring it into the medical world and have it compete in many ways, head to head with a pharmaceutical. It doesn't mean that people have to come off a drug. And matter of fact, they're not recommended to necessarily come off a drug if they're being treated on it. But it is another available treatment in a field that may or may not be coupled depending on a physician's preference.

And so, how do we get this into people's hands, the children that need this as a treatment? How do we work through the path to make it reimbursed by insurance? Which is something that you need to occur with any medical device or drug. And that's something that we're working actively on.

So, we're doing that now. And we have some of the same tools that we can use that any medical, new medical treatment would that has been built up from the pharmaceutical medical device industry. But we also have a digital medicine. We have something that is obtainable on a digital pharmacy that you don't have to physically walk into CVS to obtain. And you don't physically pop it in your mouth, like a pill.

So there's so many differences that we also have to be innovative, not just in the tool that we created, the treatment we created, but in terms of how we get it to people. And that's something that we're working actively on now.

[00:36:23] Dylan Watkins: Building communities around any game is a challenge. I know that – I've had games, built them, getting the community to get engaged, finding your first raving fan, the other 10 behind that, being able to get them to rally to get there. Because there's a lot – I mean there's so much drop off because bringing it back to one of the cornerstones of what you do attention, we live on an attention economy. And right now, if you look at the advancements of social media, right, you look at things like why is everybody going to TikTok?

Everyone is going to TikTok because it's the shorter attention to span economy. The eyeballs like, right now a podcast is an hour long, hour and a half. People don't want – if you have five podcasters that you like, you listen to, that is five hours of content, or five people's things. If you have one person on TikTok, five hours on TikTok is like 400 creators, right?

[00:37:13] Adam Gazzaley: Right.

[00:37:13] Dylan Watkins: So the value of the eyeball gets spent a lot better. Right? The tariffs and the trades across the land, it's a lot more economical. So, can you talk to me about how you keep attention in this attentiony driven economy, we're constantly, we're getting shorter, faster, and that the challenges that you face with that.

[00:37:33] Adam Gazzaley: Right. Well, you know, I pointed out that we have some real challenges and that we are a prescription medicine obtained by a doctor to treat a condition. But it's also an asset in that sense, because if you are prescribed this, you have a need. And if what we do really works, which we think it really does work, we think – our data suggests that it really does improve attention abilities, then there will be a return to the individual beyond the entertainment value. And that's what makes it different.

So that is the opportunity and that's, you know, that's the business opportunity really of why we would hope to be successful, because just going out there with a game that you're going to compete with the other great games on the market is nothing that we were pitching to investors, let's just say that, right?

So yes, we want to have a fun game and a good experience, something that people value and enjoy and come back to. But at the end of the day, we're medicine that should be leading to demonstrable improvement in people's lives and in terms of their cognition. And hopefully they're coming back to it because they see that value and they want more of it.

[00:38:45] Dylan Watkins: Yeah. It almost reminds me of if you're in the food court, right? You're in the virtual food court for people, right? There's your place, which is a plant-based all natural, health store right next to a Krispy Kreme. And they're like, "What would you like to eat right now?" They're like, "I'll take the quick junk food, please." You know? And that's hard because those are the different fuel sources, right? Your fuel source, much like keto or anything else, it's a longer lasting, more holistic revitalizing system. All the other one is quick to burst, more intense, but ultimately leads you depleted over time.

[00:39:15] Adam Gazzaley: Yes. That's a good analogy. And you know, we try to put some of that tastiness of the fast food in there. There's, you know, avatars that are optimizable and is, you know, it's a beautiful, beautiful environment when you play Endeavor. So it's not deplete of all of that yumminess completely. But it's certainly not like we're directly trying to compete with that.

[00:39:41] Dylan Watkins: Yeah. No, it's a different crowd and I imagine they have a different identity and there's a different need that they have there. You know, I mean, looking at the measurement piece, can you talk to me about, like, how do you measure, like, how do you tell – not how do you measure. Like, can you talk about some of the results with Endeavor and the systems and say, "Okay, we get these kinds of results. These are the kinds of things people expect, which is really the heart of why this is so different than any other fast food dinner of entertainment."

[00:40:08] Adam Gazzaley: Yeah. Yeah. There's a lot of papers out there and lots of different results and improvements based upon the population and what the target was. Like, most recent studies showed improvement in behavioral measures that are seen with ADHD, reports of parents, you know, things that are really amazing. And I mean, I wouldn't say unexpected, but pretty high bar to have a video game lead to improvements and parent reports of ADHD behaviors.

But, you know, there are many other populations where we're not measuring that. So I would say the most consistent finding largely because it's the most consistently used outcome measure and it does change consistently is improvements in sustained attention. And that was a primary outcome measure on our big phase three trial for ADHD. And it was really the primary outcome that we were targeting in our paper that wound up in Nature on older adults. So totally different populations.

Kids with ADHD, older adults, healthy high performing older adults, both show the exact same improvement in their ability to sustain their attention on a really boring task called a sustained attention task. It's designed to be boring. Like, the purpose of this task is to bore you, to see how long you could keep your attention focused despite the fact that you are bored. That's the goal of the task.

It sounds like so counterintuitive that someone would design something boring, but this is actually designed to do that. And everyone suffers with it. It is really horrendous. I mean, it is black and white. There's no feedback. There's no reward. It doesn't change. It's relatively easy, but hard to hold your focus to it.

And if you. Have ADHD or if you're an older adult, you're going to even do worse on it. And what we show is that despite the fact that this is an incredibly different way of deploying attention compared to our game, you get better at it. You get better at holding your attention even though you're bored to tears, because you have this ability to focus your attention based upon your goal to do so, not just that you're pulled in because it's amazingly fun. That is the most consistent finding.

[00:42:29] Dylan Watkins: And it sounds amazing and awful, all at the same time. I cannot tell you to – as a game designer, builder dude, and it's like, you basically made a paint drying feature that says, "Okay, sit there and go stare at the paint dry." And I'm like, I'm not going to give you any rewards, no benefits, no juice, no polish, no nothing. On your sheer willpower, go!" And you're like, "You can't give me a bone? Come on, I want to see a short level up. Give me a little hoop to jump through, a little countdown to that."

[00:42:56] Adam Gazzaley: No, nothing.

[00:42:56] Dylan Watkins: No, nothing?

[00:42:57] Adam Gazzaley: No.

[00:42:58] Dylan Watkins: Uh-oh, man.

[00:42:59] Adam Gazzaley: That's, yeah. So that's the outcome measure that we use in like all of these studies.

[00:43:03] Dylan Watkins:  That's wonderful.

[00:43:04] Adam Gazzaley: It is because it's like the idea behind it is that the people who are suffering in attention are, you know, kids at school that aren't being engaged. It's not nearly as boring as this, but to them it's pretty boring. And it's certainly, you know, some of those, some classes they're in a way more boring than what they get to do after school and even playing a video game.

And so that's why it is a cool outcome measure, because it's like the ultimate challenge of attentional stability. And so, if you can show that you can maintain attention on this and kids improve a lot on it. But they don't improve on like our control games. It's not like any game improves disability. And so that is some – that is a finding that I'm really proud of because we've replicated it so many times.

And what it means is that they're not just better at deploying their attention on the game, right? Something changed in their brain that now when they go to this boring paint drying task, they're better able to hold their attention there. That's so fascinating from a mechanistic point of view that this led to that. And that's really the most exciting outcome.

[00:44:15] Dylan Watkins: I mean, yeah. I mean, you're looking at – when you look at transformation in people, right? There's a reason why we love the montage. Why do we love the Rocky Balboa of montage? So, the four of us that are old enough to appreciate that, if not, kids, Google it, you know. But the Rocky montage because humans love to see progression, right? And if we can see six months of progression in seven seconds of me punching a punching bag and all of a sudden I get better, it feels like we're just like, we get this maximum benefit.

But really sustained transformation comes through a couple of these key traits, abilities and mindsets. One being the ability to do boring things repeatedly and sustain it over a long period of time. The ability for delayed gratification. The ability for emotional and mental resilience, right? These are some different pieces that if you gave people the ability to delay gratification, have resilience and to do the mundane task, but do it like they love it. Those are some keys for success.

Are there elements that you're looking to teach? Is this the one vector being the attention economy? Is there another vectors or other ones that you're looking at to also help level up people's abilities or skillsets and mindsets?

[00:45:25] Adam Gazzaley: Yeah. So sustained attention is core to a lot of what we do. You know, the ability to delay gratification to regulate emotions is all part of the general system that we work on. It's actually very similar overlapping networks that allow you to control yourself, essentially. They all have that in common, right? They're all making you not slaves to your environment, such that you're pulled and pushed based upon what we call bottom up information, right? Just having stimuli, pull you over here or there, this is top down control.

It's your ability to have your goals dictate how you interact with the world around you. And that may be to sustain your attention on something that's boring, even in the moment or over a long period of time. It may be the control to be able to not have an automatic negative or aggressive reaction to something that is occurring. It may be a decision to lay, receiving a reward now for reward in the future. So, all those things you mentioned are part of the same system of cognitive control that most of our games are working to improve.

[00:46:42] Dylan Watkins: That very much makes sense to – if I could simply put a simple quote in one of my favorite book, Victor Frankl's Man Search for Meaning. And inside there, he talks about the ability to respond. Your power in life comes to your ability to respond, not react to life's stimuli. And so that is like the key of what we're talking about. It's being able to choose.

And when you're talking about bottom up versus top down, what I'm taking that is, you're talking about your mammalian response, which is really the, you know, the base level Maslow hierarchies of base need, base urges versus top down, which is prefrontal cortex, higher level thinking where you're able to actually take cognitive control and say, "I'm going to actively choose this path not because it's the most sensational, but because my higher values dictate that. And that's the – are there any tips or -  

[00:47:26] Adam Gazzaley: You said it perfectly. That is everything we work on. And I wrote a book on this topic called The Distracted Mind: Ancient Brains in a High-Tech World where I spent, you know, the first, this is with a co-author at Larry Rosen, but spent the first like three chapters just breaking down exactly what we were just talking about top down versus bottom up.

We have this phenomena in our brain. It's basically a fundamental principle of our brain called the perception action cycle. We perceive information and we act. And most of what our brain does is still that, it still perceive and acts. And much of it is reflexive in animals, an incredible – other animals, an incredible amount more is reflexive than in us. But there's still many reflexive aspects to our behavior, but that ability to put a pause in between the perceive and the act so that it's not reflexive, so that you could bring on your perceptual abilities and your decision making and reach a different decision than you may be reflexively drawn to. And then act upon that in a goal-directed way.

That is the core of what I think is being challenged right now with modern technology, which is sort of one of the points of that book, The Distracted Mind. And one of the features of our functions of our brain that we most need to improve, if we're going to have a better life on this planet.

[00:48:50] Dylan Watkins: Yeah. And that respond versus reacting is, if you could say, how do you – if you want to turn life into a video game and you want to – and it's, I always say it's very difficult to be the first – it's very hard to be the first player and the dungeon master in the game of life. And being able to switch between those two perspectives from being the character running through the game, and then taking that step out to look back and go, "Here's what I need to do now and then actively steal your player" is so critically difficult.

And it's something that I don't think most people don't always view themselves in that way. They feel like they they're often powerless. They get that victim feeling mindset where they have no control over their baseline needs and responses. And so, you know, I'm super curious on how – is there any advice that you would give to people on how to actually do that in real life? Is there any ways, like knowing all your neurological background, things like that, how do you actually switch from those lower base needs to higher base, if you recognize you're in it? Do you have any advice around that?

[00:49:51] Adam Gazzaley: Yeah. Yeah, for sure. You know, so, I think about this in two ways. One is the way we've just been talking about. How do you improve the pure processing capability and function and optimize the ability of your brain to allow you to do that, what we just said?

And that's what we do at Neuroscape and Akili. We build games that challenge your cognitive control abilities so that you have more capability of controlling them when you make that decision to. That's why it helps a kid with ADHD. Based upon our work is that now you have more control. It doesn't actually mean you're going to do it. First of all, that's an important distinction. It's not changing your personality, such that now you just constantly have, you know, act in that way. But you have a stronger machine between your ears to enact that.

So part of it is just having a stronger brain and a better functioning brain to be able to have higher levels of cognitive control. But then there's the part that we're just talking about the other piece of this is behavior, right? So I distinguish between cognition and behavior. Cognition is like the machinery. What's there, if tested in a laboratory to the highest level. And then behavior's a real world phenomena. It has tons of different influences upon it upon how you actually take that Ferrari that we just put in your head on the road. Are you actually a good driver? Do you drive it at all? So that's how I distinguish between the cognition and behavior.

Behavior is, you know, a tricky business. And it's not really my expertise in terms of behavioral improvement and modification. But I did a lot of research during the time of when I was writing The Distracted Mind with Larry. And one of the takeaways that I came away with in terms of the behavioral part of this was really on – based upon exploring my own behaviors and how I manage losing control to technology like we all do at times and to taking back control.

And so for me, my approach is one that starts with awareness. Right? Now, awareness doesn't lead to behavioral change automatically. You might know smoking is really bad for you and certain types of food and sun exposure, but it doesn't lead to change, but it's an important first step, right? So, recognize the fact that your brain has a lot of difficulty multitasking and a lot of challenge with distraction. Realize and pay attention to your bottom up influences and how hard it is sometimes to control your behaviors based on your goal.

So being aware of it is a great first start, and that could start with just basically introspection, sort of a meta awareness of how you interact in the world. And then the second part, which is the harder part is sort of relearning habits and ways of interacting that give you the opportunity for control. And it might take breaking some of the habits of the ways that you might reflexively reach for your phone, the first thing you do when you wake up in the morning, or even when you're at a red light, even though, you know, you only have like 15 seconds left. These are habits, right? And breaking them and allowing yourself to like take ownership of how you are acting is really important and it takes practice like everything else.

And the last thing I'd say, and I won't belabor this too much because I have put a ton of thought into it is, how do you go about like working for an hour without being derailed by social media, whatever else pulls you away from your goal? Just an hour. I'm not saying eight hours, I'm just saying one hour. And it's harder than it seems. Maybe it's not, maybe everyone is like, "An hour?" But, you know, I think it's reasonable to be able to work continuously on something for an hour. And – but it may not be really accessible to a lot of people if you've become, if you've trained yourself to be fragmented in your attention and just essentially break every three to five minutes, which is what many people do.

And so if you want to try to push an hour, it's sort of like training for a marathon, do it in pieces, right? Take a period of focus time that's not an hour. That's maybe like 10 minutes, 15 minutes, 20 minutes. Put a break in there and then go again and just build up the skills like you would if you were running or doing something in physical fitness to increase your endurance of being able to do something like that.

[00:54:24] Dylan Watkins: All right. So then you, you break it down to more manageable chunks and then you kind of say, "Okay, I can bite that off." And you take that off and that's the smaller step. And if you can't do that, cut it down. Okay. Can you go for one minute? Can give me one minute of paint drying entertainment? Can we get that?

[00:54:38] Adam Gazzaley: Exactly, exactly. Yeah, I say, but it's also really important to not take a break that is going to derail you. Right? So that's why I often say like a great break might not be Facebook or TikTok or Instagram, or even email, because those are like these iterative sinkholes , right? You get in there and you, before, you know, it you're like just gone. And so, you know, a break of maybe eyes close, like whether or not you meditate, just a period of pause or look at nature or do some pushups. Don't take something that in itself is going to become like a whole new distraction.

[00:55:21] Dylan Watkins: Yeah. No, I can see that it's your – you're talking about is what are you doing with your nervous system? Is it going sympathetic, parasympathetic, where you're involving more of your time? And so being able to switch, you know, from the sympathetic to the parasympathetic nervous system, through meditation versus throttling the gear in the other direction where you get highly entertained. And then you're just trying to settle back down. It seems like it's...

[00:55:44] Adam Gazzaley: Yeah. And it's not a break. It's also a very top down heavy thing. So you're supposed to give your top down a break. That's the goal. And that can be done through some bottom up. That's why nature exposure is really powerful for that type of cognitive fatigue restoration.

[00:56:00] Dylan Watkins: Well, what about nature and virtual reality? Does that count? Is that a...

[00:56:05] Adam Gazzaley: We're trying to figure that out right now actually. Yeah, and people are always like, "Why would you put nature virtual reality?" It's like nature is already outside. It's like, "Yes, that's true. I'm not going to argue that. I love going out to nature. I'm in national parks once a month. Like, I love it."

But [A] nature's not accessible to everyone. So there are many, many people around the world in urban environments or other accessibility restrictions, whether it's financial or physical, that just can't get into nature. So that is one reason why it's interesting to explore nature in virtual environments. The other is that you get to control the nature in a way that could be quite powerful and even quite magical to create nature that's not even accessible in the real world, different versions of nature that could open up new gateways of perception. I'm really very interested in nature and virtual environments.

[00:57:01] Dylan Watkins: I can have another conversation about that because there's things that we're also exploring. It's an interesting – it's an interesting topics, why I brought it up. Are you going to be at GDC this year? Are you going?

[00:57:13] Adam Gazzaley: I don't know. My conference calendar is still a little open this year. Normally, I'm at all of them, but I recently started decreasing them, not just because of COVID. I have a little daughter at home, so I'm doing a little less conferencing, but I may.

[00:57:27] Dylan Watkins: I understand. Yeah. Yeah. You got to nurture your actual baby, not your business baby.

[00:57:31] Adam Gazzaley: Exactly. Yeah. Shifted priorities a little bit.

[00:57:34] Dylan Watkins: That's cool. Congrats.

[00:57:36] Adam Gazzaley: Thank you.

[00:57:37] Dylan Watkins: One thing we're looking at here is, I mean, this is the lowering of dopamine, but I do want to talk about another thing. We're talking about – I read an article a while back. I don't know where, when and whatever, but it was on the fact that we are predictive machine. We're constantly predicting what's going to happen next, right?

And then our ability to shift our predictions are based upon three realities we live in. Our internal, our internal landscape, right? What we – the stories we tell yourself, thinking, feeling all that fun stuff. Our external landscape, which is our environment, or our virtual environment, wherever you find yourself in. And the social reality that we construct together. Can you talk to me about the humans as prediction machines and how do you try to rewrite better predictions?

[00:58:20] Adam Gazzaley: Our brains are essentially always living a little bit in the future. Almost everything that we do is a prediction, whether it's our motor actions or even our perception is based upon predictions of how things should be based upon how they were in the past, based on your priors, you build a reality that then you fit together. And when there's a discordance between them and a conflict, it creates all sorts of confusion.

So we, it's just – it's core to brain function is that we are constantly creating these predictions. And they're not necessarily like predictions like people might be thinking of that word, how it's used in common language. These could be happening on, you know, the level of hundreds of milliseconds. But setting up models that we then fill in. And this is all about efficiency and speed by which we're able to, you know, navigate the world. That's really, you know, it's back to that perception action cycle. That's what animals do in the world they perceive. And then they move through it. And your ability to be able to have models that you then fit allow that whole process to be more effective.

[00:59:38] Dylan Watkins: Yeah. I never thought about that. It's almost like our short-term memory is almost like a short-term imagination, short-term prediction. So we're literally constantly a couple steps ahead of reality. And like, like walking, every walk is actually a fall. You just put your leg in front of you. And though you're just predicting that your foot is going to hit something solid every step you take without – and so we kind of need that in order to function in reality. But part of that is we're like, we're mostly right about everything that we do. But...

[01:00:07] Adam Gazzaley: Yeah. Yeah. And when this mismatch it's quite obvious to you. Another, just because you've talked about walking, so just to mention, that's another area where we also rely on reflexes. So there's a ton of reflexes. Like, you know, the patella reflex, if you hit like under your knee and your foot goes up. That is just a very obvious way of eliciting that reflex, but that reflex occurs every time you take a step that allows those muscles, you don't have to think about all those muscles that are involved in the coordination of a step or maintaining stability.

And so we rely on prediction and we also rely on a lot of reflexes as well, which is sort of invisible to us. Both of those things are essentially invisible to us most of the time. But, you know, so you have like this very tip, literally the tip of the iceberg, which is sort of your conscious mind that's allowing you to make decisions to some degree and to control how you interact. But it's based sitting on top of this incredible prediction and reflexive engine that we are.

[01:01:10] Dylan Watkins: It's so amazing. I'm picturing like a, you know, one of those like Japanese race cars with poor steering. You know, it's just spinning all over the place and you're trying to steer it the best you can. But it's just wobbling all over the place and there's not a lot of control you've got in the system.

[01:01:26] Adam Gazzaley: Yeah. You just like, describe me watching my daughter try to walk across the room. It's really amazing for me, you know, I've been doing neuroscience 30 years. I'm 53 years old and now I have a baby daughter, you know, so I'm watching developmental neurobiology happen in front of me after studying it for so long. And just watching the process of a child of a baby going from not walking to walking. It's just, it tells you everything about correction and you know, like she falls all the time. I mean, it's not a big deal. She's so close to the ground. She's made out of rubber basically.

But I get it, like every one of those falls is like a subconscious learning moment of, "Oh, you can't lean that far." you know? And it's really an incredible process to watch this machine, you know, develop, the brain develop. And just, it's all about that. This is building all those systems so that, you know, you could just walk effortlessly and, you know, without any conscious intention once you're an adult.

[01:02:27] Dylan Watkins: That's so much of the learning process. And what we're talking about, you know, I'm feeling that pattern of behavior is there's – people feel that a lot of learning is you like forcing that thing to happen. You, being critical, "You, big dummy. I can't believe you can't do this right. I'm going to..." and you're trying to grind your way through education versus so much more of it is actually more of this being aware, but being in flow and paying attention, but like without judgment, because as you said so much of that behavior, that kind of throttles into it. You're going to say something?

[01:03:00] Adam Gazzaley: Yeah, I was going to say like, you just basically described how our games work. You know, going back to that, going back to that point before, right? You've gone full circle. The games aren't there to make you learn this, learn this, learn this particular thing. You just go and flow, have a good time, work hard. But your brain will learn. It'll figure it out and it will be stronger after this process.

So yeah, it's sort of like our whole design thesis is exactly, basically what you said is to build tools that allow your brain to become stronger without just teaching you didactically how to do it, just teach you through process.

[01:03:37] Dylan Watkins: Yeah, I love that. And what's your holy grail? What's your flag in the stand for this game, for this company, for all the things that you're doing, what is that?

[01:03:46] Adam Gazzaley: Yeah, I guess there's a couple. One is that we desperately need better tools to help people who are suffering around the world with mental health challenges, and of all sorts, whether it's neurological psychiatric conditions. And then everyone in general wants to level up a bit and be a little bit more compassionate, a little more thoughtful and a little more attentive in how they engage in the world and with themselves and with their families. And we've, you know, done a tremendously poor job of advancing our minds as a species, is really what I believe.

I wrote a piece not so long ago called The Cognition Crisis, sort of an update after My Distracted Mind, where I really dive in on this rather depressing reality that I think we're in a crisis moment. And every day I pick up, you know, I don't pick up the news, but every day I look at the news on a device. I see evidence of cognition crisis. I mean, you know what it is this week.

And so we have to really up level our brains. I really do believe that, and it's not going to happen through just like traditional didactic education where we just shove information and content into you. We need process building. We need better sustained attention, higher level decision making, delayed gratification, more empathy, and compassion. And if we could use technology to accomplish that in a way that can scale at the level that we needed to, which is full global, that would be an amazing future. And that's one of my, you know, my main goals is helping us to get to that future.

[01:05:29] Dylan Watkins: I love that. I mean, you're, I mean, it's almost like you're upgrading humanity's cognition ability, you know.

[01:05:34] Adam Gazzaley: That is my goal.

[01:05:35] Dylan Watkins: And it's awesome. If that's the goal, then what's the holy grail. Like, what's your big challenge? What's the big thing that you don't know if you can actually defeat and you might need to upgrade who you are in order to get this done?

[01:05:47] Adam Gazzaley: Well, I think the big challenge is that the systems that sort of deliver medicine and education today have the flexibility and the capacity to change as much as I think they need to change. You know, we've already taken some steps. We've gotten the FDA to prove of video game, that was sort of a step in the right direction, but there's a lot more steps. You know, insurance companies, how they view this type of treatment, how school systems view giving games to kids to play as homework. I don't know how flexible these systems will be in terms of adapting such new approaches to improving how we function.

[1:06:40] Dylan Watkins: Yeah. And that is the thing is like, can you reinsert a new paradigm in an old system? Right? Like, can you...

[01:06:46] Adam Gazzaley: It – you know, that – it's so funny. I was supposed to give a Ted talk a couple years ago, main stage on, right, during at the – when the pandemic started and that disappeared. And I was working on my slides and I wanted my – basically what I wanted to say is that we need a paradigm shift. And that term is so overused. I really struggled with using it in that talk, which I never gave, hopefully someday.

But I actually do believe that that is the appropriate term and you used it right there is that it's a different paradigm. A different paradigm of medicine for the mind is not to think that there's a magic brain pill that we're going to pop and we're better, and autism is gone and Alzheimer's is gone. I mean, we hope that's the case, but we've been trying for like 50, 60 years to accomplish it through a molecule and we failed.

So the idea that an interactive experiencing, harnessing our brain's plasticity can have a meaningful enough effect to lead to changes across all these conditions. That's a paradigm shift. And paradigm shifts are really, really hard and I've read a lot about them, and how they're accomplished. And, you know, pulling that off is going to be a tough one. I really am optimistic about it, but a lot of things have to come together over the next couple decades.

[01:08:06] Dylan Watkins: Yeah. No, absolutely. I mean, yeah, I mean, one of the biggest ways those too is they said, I think that Buckminster Fuller put it, he's like, "You don't change someone's behavior. If you want to change someone's behavior, give them a new tool. A new tool lead to a new way of thinking that will lead to a new behavior." which is ultimately what you're trying to do is give somebody a new tool so that they can change, you know, their cognitions and their abilities over time.

[01:08:30] Adam Gazzaley: Exactly.

[01:08:31] Dylan Watkins: I can see as the sun dial gets closer and closer to your eyes, I believe we're wrapping out on time here. I want to be respectful of the time and say, I really appreciate you coming on here. This has been a fantastic conversation. Is there anything else you'd like to let people know about before you tell them how to get ahold of you and  find out more about your work?

[01:08:49] Adam Gazzaley: Well, I would just leave, you know, a little glimpse of optimism since a lot of what's going on right now is so distressful, a war is happening, we're sort of still in a pandemic and we've been talking about cognition crisis and distracted mind, but there is so much to be optimistic about. I really do believe that.

And you know, I think core to this podcast is the hope that technology can play a role in that. And I really do believe it can. I've seen lots of examples of that. So, for all of your listeners and all the varied skillsets and interests that they may have, there's a role for them to play in helping to create this future.

[01:09:36] Dylan Watkins: Absolutely. Yeah. The future is not written. It is built by us. So we got to actively go out and shape it. Yeah. Beautiful. And if people want to find out more about your work, how do they find out?

[01:09:47] Adam Gazzaley: Well, there's a whole bunch of websites I'm associated with, obviously with Neuroscape and Akili, but I also have Gazzaley.com, which is like, sort of my aggregate site, where I bring all the things that I'm working on into one place.

[01:10:00] Dylan Watkins: Oh, beautiful. Adam, thank you so much for your time. It's been an honor and a pleasure and I look forward to speaking with you again. Have a blessed and beautiful day and I'll see you on the other side.

[01:10:10] Adam Gazzaley: Thanks so much for having me.

[1:10:11] Dylan Watkins: Thank you. Bye now.

[01:10:15] Outro: Thank you for listening to the Heroes of Reality Podcast. Check out HeroesofReality.com for more episodes. While you're there, you can also take the Hero's quiz to find out what kind of hero you are, or if you have a great story and want to be on the podcast, tell us why your hero's journey will inspire others. Thank you for listening. See you on the other side.