 First, I just want to thank you all for being here. It's been a long year for me, for us. It's Friday night. I'm tired. Yeah, I'll have more of you. It is Friday night, right? I was just so impressed to see you all here and paying such attention to this. I know these are important areas, but you're giving your time, and it's valuable, and I appreciate it. So thank you for sitting here and listening to everything. I appreciate that. Thank you. Hey there. Time's up. Music composer turned game designer turned product manager now working in mobile games. I got into mobile for this. I mean, what you're talking about, games is a very powerful tool for change, right? Specifically from mobile, a lot of what you've been talking about is like VR, AR type stuff, and it's a lot of like lab setting stuff, right? Yeah. I kind of like ditched console games to get specifically right into mobile. Most of what we do is mobile. It is, OK. Yes, I didn't make that clear, because it's fun to talk about the VR stuff that we're doing now, but mobile, its accessibility, most of what we do is mobile. Nice. OK, cool. I wanted to ask, so a perspective here is people use the adage, if you can measure it, you can manage it, right? I've always felt like if you can measure it, you can gamify it, and I think I'm very excited about what kind of info is coming into phones and what kind of info is becoming available to mobile apps, mobile games, right? I'm very curious what info we don't have yet or that isn't consistent enough yet that is going to be pivotal and really changing the kind of impact useful, serious games can have through mobile devices, just whatever tech's coming there for mobile stuff. Yeah, it's a great question. You know, we have the most accessible things to us are the concrete performance metrics, right? The behaviors that you do. When you tap on something, when you shake something, you know, that's obviously what most of us latch on to because it's quantifiable, it's discreet, it's usually time-locked. By that we mean it occurs in the context of another event that it can be related to, so it's powerful. I mean, it's what every tech company uses in some way or another, it's what we use in most of our work. What's elusive but so valuable is a lot of what's going on under the hood. And it's not trivial in its potential because although the outcomes might be the same, that speed of response, even the response that you make, given the factors that influence it or that limit it, we could really create the type of experiences, whether it be entertainment or communication or enhancement tools that are much more powerful and much more appropriate for the person. We just often just don't know what's under the hood, where their attention really lies, what their emotional setting is while they're engaging. We just don't really know. And I am really excited by the new sensor data, but as we know, most of it just is completely unactionable. It's frustration for me as a medical professional in a lot of the data just not being validated and not knowing clearly how reliable, how sensitive, how consistent it is. So we need to up our game in terms of sensor data, even in the consumer space. So that when we're just today, as in the gym and I was on the elliptical and- Adam works out every day, is it in the morning? I mean, five days minimum, but- He boosts his cognition. Seven if possible, but exercises the most clear thing for cognition benefits. But I had my hands on the elliptical and I guess I was touching the sensors. I don't really use it as a sensor tool, but it is recording it. And there's a message like this information may, this wasn't there like a month ago, because I would have noticed it. This information may not be accurate as for reference purposes only. I was like, what the hell good is it then, right? And that's like part of the problem. It's like the ideas are there, but they are covering themselves because if someone goes on there and then that heart rate is not really reflective, then there's liability issues, but we see this. But to me it was just a reminder. I was like, well, I'm glad I'm not recording and paying attention to this data because I've been on this thing for like the whole year and only now is it telling me that basically saving this data is not reliable. So there is a lot of amazing physiological recording that is possible. And some of it is only capable in very controlled settings like we do in the laboratory with very expensive equipment. Bridging that divide is like the next big frontier, but that data telling your emotional, your attentional context, your memories will be valuable and dangerous. So with all great value comes danger, right? There's always two sides to this sword and it's really, really evident to me when you think about reading out someone's memory, attentional and emotional context in the moment. I mean, think about the good that could be done with that but think about the dangers. So. Hi, so my name is Avia. Thank you so much for being here tonight. So I'm a college student in my last year of school and I was just wondering what kind of projects in AR or maybe even VR do you see kind of up and coming? Whether or not they're related to the work you do that you think could be super impactful and if so, like how would you suggest someone get involved or even just learn more like me? Cool, great question. We're just starting to experiment with AR. I've advised for a company called Magic Leap. You probably know about them. We have the device where we're figuring our way through the world of AR. I think there's great potential there. I'm excited about it but I haven't come up with anything really clear that we're investing our time in. VR on the other hand, the opportunity to create fully controlled environments that are immersive and engaging across all your senses is just infinitely exciting to me. So two of the VR projects that we're doing. So we're trying to do things that we're not just doing in VR because they're cool to do in VR, because VR is cool, but things that we just can't do outside of VR. So that's like always my charge to our group. It's like, does this have to be in VR? If you could do this on a tablet, why would we do it in VR? Tablets are just so much more accessible. Do it on a phone. What do we have to do in VR? Like where is the true utility of this technology? So the two things that we're doing is a game called Labyrinth and a game called Coherence. Labyrinth is we take our participants soon to be patients and we put them in a 3D cityscape that they have to learn and navigate by literally moving their legs and walking through it. It's on an omnidirectional treadmill. Yeah, omnidirectional treadmill. It's on an omnidirectional treadmill, although the trackers with the Vive are really effective without the treadmill. So this technology is just coming out. So we're constantly trying to be flexible, but the idea is like the one thing that's here does really well is give you space, which you just can't get in the 2D format. So our memory systems, the hippocampus, really evolve for spatial navigation. Like we still are full of these place cells and it's just part again of our ancient brains. The hypothesis that I have is that if we could challenge your spatial memory at a high enough level and a real world enough level, we will improve your memory performance outside of that domain. Now that's a crazy hypothesis. If that's true, it'll be massive because we have like no tools that really actually improve memory. We have memory like sort of orthotics that like give you tricks to do memory but not really improve memory function itself. And we're looking at that in very early Alzheimer's disease, early dementia. The other game we created is a game called Coherence and this was inspired by my friendship with Mickey Hart from the Grateful Dead and he has since we've been friends has been talking about rhythm and music as treatments, as medicine. And again, another ancient experiential treatment that hasn't really had the type of research data that's fully convincing to regulatory agencies and professionals that it's become medicine. Just hasn't happened yet. And a lot of it is I think because we haven't put it into these algorithms where we could deliver them reproducibly. And so what we created was a closed loop system where you're challenged rhythmically in a three dimensional space across visual, auditory and soon vibrationally where you respond to rhythms with your entire body and as you show competency and mastery in terms of your accuracy and your consistency, the rhythms become more complicated in many ways. The hypothesis is that because rhythm involves anticipation and timing, which are abilities that our brain uses for essentially everything, it would be like fine tuning this machine and we'll see benefits across the whole scope of cognitive abilities, hypothesis. So those are two VR projects that we're interested in. There's so many different touch points for the work we do. Our center has people with pretty much every type of background you can imagine. So it depends what your interests are. We do all of our programming in Unity, which as you know is available for anyone. It's really democratized game development and we often work with a team of two people, even one person. So learning tools like that and understanding its potential to help activate different cognitive systems I think would be a really exciting thing to do. I am, thank you for coming here today. It's been fantastic. I'm really interested in this topic that you touched on a few times in the idea of the distracted mind, the sort of world of like Facebook and other companies whose stock prices are largely correlated to their ability to get people stuck in a sort of a do loop. And so on one hand, I'm very nervous that social media, addictive social media and other forms of internet attention grabbing mechanisms are in some ways sort of an existential threat to mindfulness. That's very interesting to me. And you're working on a lot of things that it seems to me might be the next wave of vaccinations. So I'm very interested in this, not just in the treatment side, but on the using digital medicine as a vaccine. And so if that's the case, here's so, I'm so sorry, this might take a second and I apologize to everybody. This is a question I promise. But if you can treat, I don't have the right terminology for this, but if you can treat people's intentions throughout their lives as a weighted function. So each intention has a weight and they build up over time. Some intentions are more permanent than others. Some are more recent than others. There's some kind of curve that can map all that out. And you also treat like future desires like what you would want on your death bed, like spending more time with friends and family. Like there's some kind of weighted future function there as well. And then we have the present moment, right? Where we have all the power. So present us has a disproportionate amount of power relative to past us or future us. Cause we get to make the decision right here in the moment. And so, and you described it as a pause, right? Between the reaction and action. So my question to you is, can we use digital medicine to increase agency in that moment and by both vaccinating ourselves against invasive memes or what have you? And can we also treat the loss of agency in the present moment with digital medicine? Do you think we can get it on both sides? That's sort of what I'm asking. Yeah, it's a great question and really eloquently stated. I mean, it's sort of what we do. You know, we want to get out in front of things. As you know, healthcare is really sick care, right? That's a misnomer. We don't take care of healthy people. We take care of sick people. Had you see a staff at every medical center, it's a major problem, right? Talk about the economy of technology being misdirected. You know, I'm just saying we have a challenge as a hospital in that our entire economy is built on you being sick, right? You being well is not actually very financially beneficial to us. And you know, it's just another economic model challenge that we face because what we want to do is keep you healthy, right? Ideally, right? That's the mission. So I think that there's a ton to do in terms of preventative tools that can detect the most subtle changes and it relates to your future plans, how you view your past that affect you in a way that may be below your awareness level that could just help you maintain a healthy mind for your life. So that's really what our highest level goals are to do. It's very hard to fix people when they're broken in some ways. It's much, much more ideal to keep people functioning well. I mean, think about like your car, which is a way simpler system, right? I mean, that's why you get tune ups, right? You prevent that breakdown that's more expensive and more time consuming and you could lose your car but if you keep it at a high level and I think we need a little bit more of these mental tune ups. And so I don't know if that particularly answers your question but that's sort of the dream goal is to have such a sophisticated system. I mean, it's so much more nuanced when you're looking for changes in people that are healthy that are early but that's where we hope to go. Even right now, like our ADHD study, people like some people don't respond to that equally well, right? Even though they may have troubles with stimulants being the only treatment they're still like, oh, but video games, you know, they still like have this weight of like, I hate that too, I hear it all. And you know, the thing that I always tell them is that these games that we're creating as treatments are not meant to make your child do a certain thing or act a certain way, they're meant to give them control. That is the goal and that's what our data suggests. It's not like they're now like attention focused machines. That's not what we're trying to do. We're trying to make them have the machinery to pay attention when they want to. We're not even telling them when to pay attention. That could be an asset or a deficit depending on how you look at it. But we're giving them the machinery that when they decide I should be paying attention, they can. So it's really actually giving agency in a way, in a way that the drugs don't actually do very well. They don't really give the agency. They change the state in a way that is comforting to some people and discomforting to others as opposed to giving the choice, I think. That's how I view it. We had an amazing talk, amazing technology and thank you for talking to us about this. My name is Aaron, I told you earlier that I have a background in molecular neurobiology. So I'm very interested in neuroplasticity and really how that works on a molecular level. But I completely agree that in terms of the input, just bombarding the brain with small molecules with drugs is not the way to really change the brain. And so it's amazing that you're approaching this from a more gestalt kind of holistic. Although I started, my PhD was on NMDA receptors on the hippocampus, which are glutamate receptors involved in the molecular mechanisms of plasticity. I mean, that's where I came from. Absolutely, that's how I got my start in neurobiology too. But so you're trying to, but ultimately, the brain is changed by changes in biology, changes in gene expression, changes in molecular dynamics. And so if you guys are moving through clinical trials, your end point really is going to be a change in plasticity, correct, and plasticity at some sort of functional level. So have you guys identified any biomarkers or any real molecular changes that can be seen by putting people into these closed looped systems? Yeah, it's such a great question. You know, we don't really have access to the molecular chemistry of people really. In a very crude way with PET scans, most of our biological metrics are related to functional imaging, either fMRI, given its advantages and limitations, which I'm sure you're aware of, and a lot of what we do is with EEG. So in our nature paper, and we have a paper in review right now, we have a meditation training game. We didn't get to talk about that in review right now. We're very excited about it. Closed loop meditation, basically, using digital technology, but... In the name of the game? Say again? The name of the game? Metatrain. Metatrain is the name of that game. We developed it with Jack Cornfield, a friend and real leader in the mindfulness and meditation world. And there, just like our nature paper EEG is an outcome measure, and so the main thing that we look for are changes in coherence. You know, what we all learn when you, if you had any neuroscience training, is that neurons communicate with each other by these electrochemical signals that go down the axons, and then through a synapse on a dendrite or another neuron cell body, send that signal to the next neuron on and on and on. That's true. But what we have come to realize is that another phenomena involved in the transmission of neural, of data across the brain is related to rhythm. That neural, if you look, if you take a step back from the neuron, that you have these what we call ensembles of neurons that have these on and off activations and inactivations that lead to oscillations of activity, rhythms. Just like everything in nature has these rhythms and you could record these. That's what EEG records, is these oscillations of electrical activity in the cortex of the brain. One thing that we've come to realize, and I think it's largely agreed upon, at least the neuroscientists I know, and we certainly use this state a lot, is that when you have rhythms in two different brain areas that become synchronized, coherent rhythms, phase locked, right? Like try to talk to someone when you're not in the same phase. It's really difficult. Same way with brain areas. If they communicate with each other out of phase, the transmission of data is less effective. And so one of the things that we look for in a lot of our data is coherence in rhythms across brain regions at different frequencies. So these type of metrics that are more sophisticated ways and getting more sophisticated all the time of using neural data in humans become essentially our functional biomarkers. And we could see them change with different conditions. The brain basically becomes dysrhythmic in many types of conditions. And that's sort of a lot of the inspiration around some of the rhythm work we're doing is to see if that helps create greater coherence across the brain, thus the name of that game. But that's what we've been using. But I have colleagues that work on animal models of a lot of these things where you do have much easier access to the chemistry of the brain. And so we do have collaborations with other groups trying to find some of the molecular underpinnings of the types of changes that we're seeing. I don't know how large your sample size is, but I mean, you've been together. Yeah. It's one of the things we haven't done yet. We've done a lot of things, but I am interested in it. We actually collect blood samples from almost everyone in our studies now. In the future design, once we know exactly the type of genetic markers that we'd be looking for, so we're preparing for it, but we haven't done it yet. But it's a great thought. Yeah, I'd love to. That'd be great. Great. First of all, great talk. And I feel kind of privileged to live in a time where it's possible to discuss all these things and to think outside of the box. I'm a post, my name is Larissa. I'm a postdoc at UCSF at the Department of Psychiatry. And currently I'm thinking about putting in a grant to actually look at increasing treatment for substance use disorder and mental health using VR. And for that, I just wanted to ask you, substance use is kind of something you left out in your experiences. And I wanted to ask whether you have experiences and what your recommendations would be when addressing these kinds of problems. And I'm coming from Switzerland, so I'm coming from an environment where harm reduction is actually implemented in drug policy. And this is what I wanna see around the world is how we actually meet the people where they're at. And I believe that VR can have a huge possibility or it's a great opportunity to actually bring people closer to the treatment where we wanna have them. Yeah, it's great. We should definitely talk. Shout out to MAPS. Yeah, out of this context I'd love to talk to you. We get a lot, we've just recently started getting a lot of interest from addiction researchers. So one thing I wanna make clear, like all those conditions I listed, the reason we focus on them is because someone that knows those populations really well that gets what we do, that sees the connection reaches out to us. We really don't start collaborations because A, we have a lot of incoming and we find the best collaborations are when we have a motivated partner and there's so much to do. So we're really just waiting for the right addiction researcher to start these collaborations. So it makes sense. I have tons of ideas related to addiction. We have a new game called Engage, which is, I won't go into detail now, but basically it starts with the normal, super rich video game environment and then rewards you by switching to a much more impoverished, slower, less frequent reward environment. Basically we make 10 year olds meditate despite the fact that they're not aware that they are. It's really awesome to watch. And so we think that there could be a lot of benefits in addiction research because of this, the shifting of the reward systems that we think that we're accomplishing. So that's one game that we have that I would love to do addiction work on. We haven't done it yet. We do have a lot of collaborators, including in Switzerland and Lausanne. I don't know if you're from Lausanne, but the Schuve is a hospital that we work very closely with. We actually have two collaborations with that group. But yeah, I'm happy to talk to you offline about it. Hi, my name is Ashley. I was curious to hearing how your experience-driven cognitive drug would impact the therapeutic industry, therapy, essentially whether it be working in tandem with your product or how? With like cognitive behavioral therapy like therapy. Yeah, yeah. Yeah, we don't know. We also don't know how it's gonna impact the pharmaceutical industry. So I told you what I know. I have a really long list of things I don't know that I'm happy to share with you. We don't know how our treatment will interact with synergistically or antagonistically with pharmaceuticals, with other forms of therapy. We don't know the minimal viable dose of our treatment. Don't know. We don't know how often we have to reduce people. There's a lot of things we don't know. We have a lot of work to do. This is first step one, is that we've shown a benefit with a certain modality. All of the children with ADHD that were in that trial was not on any treatment at all. It's actually very easy to find children like that. We have six million children diagnosed with ADHD in our country alone. Two million of them are taking no treatment and never have. Two million had, but they withdrew from it for all sorts of reasons, then two million are on a treatment. And so treatment being stimulants, really, when it comes down to it for this description. So I think that in the setting of what I described to you that our goal is to make this machine stronger, behavioral treatments, whether they're human interaction or digital behavior is gonna be really important. I think it's an important piece of this that we haven't done a ton of work on, but I think that bridge. So in other words, sometimes I always make this analogy like we're giving this kid a Ferrari. We're like, here's your new brain. We just tuned it up. Now you could get that car and leave it in the garage. You could get it and drive it like shit and crash it on your first day. Like I think we need a bridge between this more fine-tuned machine that they have and their ability to use it in the real world. And that's where I think some type of behavioral intervention whether it's digital or not is gonna be critical to get the maximal utility out of what we're giving them. Yes, I'm wondering if you have any experience to share with us and people doing active research for decades on this. Pam Omidyar, for example, on Hope Lab, on children that are challenged with cancers and stuff. And so it's a virtual reality, trying to give them help. Hopeful and tuning them into responding to different drugs and medication. The other is like DARPA that's been working for many years on high-performance teams, like the Blue Angel fighter pilots and the virtual realities and how a team can be very effective. So it's not just the cognitive of an individual, but it's the team. And the third area is someone like Mary Lou Jepsen now that it's looking for a major breakthrough and that's a million times higher resolution than functional MRI through optics, near infrared optics. And she believes that if she can do this and that they'll be able to read and write thoughts in the human brain, open up a pathway of telemetry between people, the bandwidth, you'll be able to share, communicate through holograms, what your dreams are, what your thoughts are. And are you involved or? So I know all of those groups and all of those people and I can answer quite simply by saying, I love it all. I think it's great that we have innovation across so many different domains. I mean, basically I told you my story here and the work that we're doing, but we're part of a way bigger ecosystem that I really haven't talked about in great detail, but I'm largely agnostic with a lot of the tools we use. Someone comes out like Mary Lou with a better, non-invasive brain recording device. I'll be using it tomorrow. So we're really flexible on the things we use. I've known Hope Labs from the beginning. We don't pretend that we're the only game in town or that we're gonna answer all the questions and we're always looking for partners, whether it's at Neuroscape or Akili or Jazz Door Investments. So where you really got my story here, but extrapolate out all of these innovative companies and individuals like I'm so happy they exist. I wish there were a thousand more of them, but it takes an army to do this. Like one company, one lab, one person, not gonna change the world, we need more and that's a lot of why I do travel around the world is to find those groups and form, we have this group called the Neuroscape Alliance where we create like this international consortium of groups, that's our Luzon connection, to like all of us raise the tide and then all the ships are at a higher level. So that's really the goal. So yeah, I know all those groups and I think they're doing great work. Love it. That was, that's our wrap to the Q and A segment. You guys know, we talked a lot about top down processing, goal setting and execution, stay focused, build the future. I love you all, thank you for coming. Much love. Thank you. Thanks Adam. Thanks. Come on. Come on. Come on.