Best Tools for Focus & ADHD | Dr. John Kruse & Dr. Andrew Huberman

00:00:00.560 | - I wanted to ask about behavioral tools for ADHD.

00:00:05.560 | I've seen some of the literature claiming

00:00:09.680 | that certain video games might actually be useful

00:00:12.880 | for training focus.

00:00:14.280 | I've managed to find a few papers

00:00:17.520 | that talk about focus and meditation tasks

00:00:21.560 | that kids in particular,

00:00:23.840 | but adults may be able to get better at.

00:00:26.400 | I mean, are any of these brain training games

00:00:28.840 | to get people better at focusing?

00:00:30.360 | Are any of them known to be worthwhile

00:00:32.520 | according to like real data or clinical observation?

00:00:36.600 | - So I'll start by stepping back a little bit

00:00:39.600 | and broadening it, I'll get to the video game things.

00:00:43.320 | But one of the effective approaches

00:00:45.960 | that helps with symptomatic reduction with ADHD

00:00:49.000 | is cognitive behavioral therapy.

00:00:51.040 | So that's a form of talking therapy.

00:00:53.240 | And my quick overview of it

00:00:55.400 | is that it focuses on actions, thoughts, and feelings

00:01:00.920 | and that humans can have direct control

00:01:02.760 | of their actions and thoughts,

00:01:03.880 | not too much over their feelings,

00:01:05.240 | but all three are affecting each other.

00:01:07.360 | And the traditional CBT was developed by Aaron Beck

00:01:12.080 | to treat depression, probably 50 years ago.

00:01:16.280 | maybe longer 60s, I think, late 60s.

00:01:19.960 | Anyway, on the surface, it's a horrible match for ADHD

00:01:24.920 | because we know it requires lots of repetitive, boring homework,

00:01:28.760 | doing the same thing.

00:01:29.800 | It involves introspection of being aware of what you're doing already,

00:01:34.360 | looking at those patterns, looking at what the triggers,

00:01:37.160 | you know, to see if you can see triggers for them.

00:01:39.160 | And then doing lots and lots of repetitive homework,

00:01:43.000 | which, and when it's successful for depression or PTSD or other venues,

00:01:48.840 | we know it actually changes brain wiring and brain chemistry.

00:01:53.080 | So lots of people still think talking therapies are sort of up here doing something

00:01:57.640 | and chemicals and medications are really changing the brain.

00:02:00.840 | If your thoughts are changing, if your behavior is changing,

00:02:05.080 | your brain has changed.

00:02:06.440 | That's the only place that thoughts and behaviors come from.

00:02:09.480 | But there have been at least two groups, Mary Salanto's in New York

00:02:13.560 | and a Harvard group by, I'm blanking on his first,

00:02:18.920 | Safran and some other, Ramsey at Pennsylvania,

00:02:22.760 | developed approaches using CBT techniques

00:02:25.880 | specifically designed for people with ADHD to help overcome some of those hurdles

00:02:31.240 | and barriers.

00:02:31.880 | And both of them encourage actually the use of medications in combination with it.

00:02:37.400 | Because many people with ADHD are too unfocused,

00:02:41.240 | too unable to sit down and do it.

00:02:43.640 | But these are approaches and both approaches are amazingly similar,

00:02:48.200 | although devised completely independently.

00:02:51.080 | At the core of both of those approaches is having a system of scheduling each day.

00:02:55.720 | That doesn't mean micromanaging each minute, but it's having the essentials in place,

00:03:00.440 | having blocks of time that you know what you're going to do.

00:03:03.640 | And having a task list in combination with that.

00:03:08.440 | And ways of learning to prioritize and move things up or down.

00:03:13.480 | And again, with ADHD being interest-driven rather than importance-driven, you may have a task.

00:03:19.160 | I mean, you probably have 17 task lists.

00:03:21.000 | One's New York coffee.

00:03:22.040 | One's at the grocery store.

00:03:23.720 | One, it's having one consolidated list, because if it's everywhere, then it's nowhere.

00:03:30.600 | And two is the simplest triaging or organizing approach is having the things that are both

00:03:39.640 | urgent and important.

00:03:42.280 | So that happens to happen today, those get in the A category.

00:03:46.760 | The things that are important but aren't as urgent are the B category.

00:03:50.760 | And all the other things are the C.

00:03:52.920 | And one of the temptations that people with ADHD have is, oh, I need to be productive.

00:03:57.720 | You know, it's fun to go buy shoelaces, and that's on my list.

00:04:02.680 | So I'll go to buy shoelaces, because then I can cross something off my list.

00:04:06.040 | But I didn't move the car.

00:04:07.720 | I didn't do my taxes.

00:04:08.920 | I haven't done my homework.

00:04:10.440 | And all the important things remain undone.

00:04:12.520 | So it's a system for getting done what's really needed to be done.

00:04:17.000 | And eventually, if your shoes don't work, the shoelaces will move up to that.

00:04:22.680 | A category.

00:04:23.560 | But for most people, they're not really there.

00:04:25.880 | And it's not a good use of your time to do them first.

00:04:28.440 | So that-- and there's much more to it.

00:04:32.200 | So the CBT approach can work with decreasing procrastination.

00:04:36.760 | It can help with structuring your own workspace, given that you probably have much more trouble

00:04:43.080 | doing that and not doing it spontaneously.

00:04:45.880 | It's how to eliminate distractions and modules on even extending your

00:04:52.280 | concentration time.

00:04:53.160 | So the answer with the video games, there is one product that's actually been FDA approved for

00:04:59.560 | use in ADHD.

00:05:01.320 | And the really important thing to remember there is the FDA's system for addressing medications

00:05:08.200 | is much more rigorous, much more thorough.

00:05:12.040 | You have to demonstrate it really works and does something.

00:05:15.400 | When the FDA approves devices, basically, they're saying it's not going to kill anyone.

00:05:21.960 | It might help.

00:05:24.120 | I mean, it might help tremendously.

00:05:25.560 | But having the FDA imprimatur for that doesn't guarantee that or mean that at all.

00:05:30.600 | Do you recall if the study of that device or the study of that video game has a conflict of

00:05:35.800 | interest?

00:05:36.120 | Was it run by the company?

00:05:37.000 | Yeah, so almost all of them have been run by the company.

00:05:41.240 | I mean, it's good people at UCSF who are at least partly involved in it.

00:05:46.520 | Oh, is this Adam Gazzelli's group?

00:05:47.880 | I think so.

00:05:49.320 | Yeah, I should just say that I've followed his work for some years.

00:05:53.720 | He's a neuroscientist.

00:05:55.080 | I know people who have been in his lab.

00:05:56.360 | He's known for doing very, very high quality and stringent work.

00:06:00.920 | Their product and some of the others can clearly show you get better at their product

00:06:05.080 | and you get better at tests that look exactly like their product.

00:06:10.360 | But in terms of real world, how much is this really helping ADHD symptoms on a day-to-day basis?

00:06:17.560 | Not a lot of data at all.

00:06:19.240 | So again, that doesn't mean it doesn't work.

00:06:22.040 | And I'm going to go sideways and talking about neurofeedback because there's

00:06:26.120 | lots and lots of neurofeedback companies across the country that are making lots and lots of money.

00:06:32.360 | And there was an article in the American Journal of Psychiatry in the last year.

00:06:38.280 | I'm not remembering which group did it.

00:06:41.720 | And it was another failure to find a significant impact from neurofeedback.

00:06:49.080 | And again, I'm not saying it doesn't have an effect, but I've had lots of people saying,

00:06:53.640 | writing me, should I keep spending hundreds of dollars each week because my insurance isn't

00:06:59.320 | covering this and the doctor is saying, oh, maybe 20 more episodes will retrain your brain.

00:07:05.800 | And so this gets back to a topic you brought up earlier.

00:07:10.600 | How much are we retraining our brains with immersion in social media?

00:07:15.800 | And the evidence is we are rewiring our brains.

00:07:18.840 | So maybe anything pushing in an opposite direction or maybe this is reinforcing some

00:07:23.720 | of the bad things we don't want.

00:07:25.480 | it's we're in a messy world without clear answers yet.

00:07:31.320 | I've made it a point to put social media on an old phone.

00:07:35.320 | So those apps are only on that phone.

00:07:40.040 | I don't even know the number to that phone.

00:07:41.560 | If I need to post something, I airdrop it onto that phone.

00:07:43.960 | And this has helped tremendously in segregating that activity and limiting it.

00:07:48.920 | It also means that people send me something which would otherwise direct me to social media.

00:07:54.840 | It's much more difficult for me to go look it up.

00:07:57.560 | It's helped tremendously.

00:07:58.520 | I just pass it on because it's one of the things that's really allowed me to

00:08:01.480 | restrict my social media time.

00:08:03.000 | And yet still be, you know, in keeping with the fact that I think social media has its uses.

00:08:08.120 | I post there, et cetera.

00:08:09.320 | Yes.

00:08:10.680 | Getting back to the scheduling.

00:08:12.360 | I mean, what I recommend to people and one of my week, I don't know the specific apps,

00:08:17.080 | but there are apps that will help shut you out of Facebook or discord or

00:08:21.800 | TikTok or whatever it is.

00:08:23.080 | If you can't exert your own willpower, which again is harder to do if you have ADHD.

00:08:28.120 | And if the app approach doesn't work, the next level up is there are all sorts of companies

00:08:35.640 | making lock boxes and physical devices where you can lock yourself out to your device for certain

00:08:41.240 | hours of the day.

00:08:42.760 | And I think that's a good idea for lots of people.

00:08:46.040 | I do too.

00:08:47.320 | And I think it also helps, at least in my experience, to do things that are very different than social

00:08:53.160 | media as well, but still consuming content.

00:08:56.040 | So I make it a point to read from an actual physical book a bit each day or night.

00:09:00.840 | Also because I was raised doing that and writing by hand is just sort of in keeping with the way

00:09:05.800 | that my brain was wired, so maybe that's more specific to me and my generation.

00:09:11.480 | But I find that when I'm doing those other activities, when I go onto social media,

00:09:18.440 | it feels more like a departure from the rest of life as opposed to the other way around.

00:09:23.400 | That's a good sign for preserving.

Best Tools for Focus & ADHD | Dr. John Kruse & Dr. Andrew Huberman

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