My Plastic Brain Page 5
Other tests, though, seem less difficult. In one, I have to click only on the pictures of whole apples and ignore pictures of apples with a bite taken out of them. Then I have to click on a dot as it jumps over the screen in an iPad version of whack-a-mole. Just as I’m thinking that this is too easy, Joe says something mysterious about working out which side of my brain I tend to use more to pay attention. I can’t help wondering if the reason why it seemed easy was because I’d missed something really important. They’re tricky, these cognitive psychologists.
Then comes the final test: this time of my visual attention skills. This test is designed to measure how easily I am distracted by something in my peripheral vision, like an email notification on the screen or a bird flying past the window. I think I do okay on this one, but by now I am starting to flag, and I am sitting at the desk with my head in my hands. It's late in the afternoon, and lying down for half an hour for a brain scan—even in a noisy MRI (magnetic resonance imaging) scanner—seems like a lovely idea.
We head downstairs to a white room where the MRI scanner is kept. The receptionist passes me a form that probably only exists in military hospitals; I sign to confirm that there is no shrapnel in my body or metal in my eyes. “Oh, and you’ll have to change into paper pants for the scan,” Mike adds, by way of an aside. “I hope you don’t mind?” It finally clicks that he's not talking about my underwear when, ten minutes later, the technician hands me an enormous paper trouser suit. Phew. With that, they pack me into the scanner with earplugs and a foam neck brace, and I promptly start to doze.
The point of the scan is not to track my brain's activity but to get a 3-D picture of my brain; this is then used to pinpoint the areas involved in focusing attention that they want to target with TMS. Their main area of interest is called the dorsal attention network, which links thinking areas toward the front of the brain to the parietal cortex, which lies above and slightly behind the ears and acts as a kind of switchboard for the senses.
Both sides of the brain have a version of this network, but real-time imaging studies suggest that most of the work is done by the right side. People who struggle to sustain attention, though, often have more activity in the less efficient left side.
Mike and Joe later tell me that part of their plan is to use the TMS machine to temporarily turn down activity in the left side of the attention network, which will force me to start using the right. It's sort of a brain equivalent of strapping down my dominant arm to force me to strengthen the weaker one. And since the brain will always route messages through the easiest path, once that more efficient system is working properly, it will hopefully be there whenever I need it.
The other part of the plan is the training itself—Joe's area of expertise. I am going to do three lots of twelve-minute training, twice every day for a week, with extra sessions on two of the days following the brain stimulation. I start that evening, and Joe promises to email me three sessions that I can do when I get back to the hotel.
To be honest, while potentially useful, the training is pretty boring. Much like the Betty test, there is a target image on the screen that you don’t press the button for—say a white cup on a brown table—but that you do press for any other cup-table combination. On my first attempt, I get only 11 percent of the “don’t touches” correct. I don’t have anything to compare it with, but it seems a fairly terrible score. Later, I’m told that, for the training to work, they need to adjust it to a point where I get 50 percent correct. Only then can they start to improve my skills. There's certainly a lot of work to do, and there are now only four days to turn things around before I fly home to the United Kingdom. But right now, all I can do is sleep.
Next morning it's zapping day, and I wake up excited about seeing my brain for the first time. I’m more than a little nervous about the actual process, but there are some benefits to being easily distracted: I forget all about my nerves when I arrive at the VA hospital and find a sing-along in full swing in the lobby. A youngish guy with long curly hair is strumming his acoustic guitar, asking the assembled veterans for song requests. Suddenly, an old veteran, dressed from head to toe in red, white, and blue, jumps up and requests “Stand by Me.” Then he bursts into song at the top of his lungs, while the guy on the guitar tries to keep up. At one point, the older man even adds a solo played on the comb-and-paper. I’m disappointed when Joe and Mike appear, looking amused to find me singing along, and drag me away to begin work on my brain.
We head up to the room with the big chair in it—and there it is, large as life, on an enormous screen. My brain. I’m not sure what I was expecting, but it all looks fairly normal, lumps in all the right places and no obvious holes that shouldn’t be there. Mike has overlaid the position of the dorsal attention network with the image of my brain and has marked a target over an area of the network called the “frontal eye field”—which is where he is going to target the stimulation.
Figure 1.1. X marks the spot: my brain, with the brain stimulation target in the crosshairs. (With permission from Mike Esterman and Joe DeGutis)
I had assumed that the plan would be to jolt my brain into working better, but it turns out to be the opposite. The plan is actually to knock out activity in part of the left side of the attention network, using targeted magnetic pulses, to force me to use the right—which is the one I should be using anyway. The effect of the pulse wears off after a few minutes, so I’ll do my first bout of training straight after being zapped. Then we’ll repeat the process another two times. The idea is that the right side should eventually become strong enough to take over from the left in everyday life, in a self-perpetuating cycle.
The time comes to be strapped into that chair. I look ridiculous, wearing a tight headband with what looks like a coat hook on the top. This, apparently, is a bit of kit that allows them to link the brain image on their screen to my actual brain in real life, to ensure that they zap the right spot. Their research assistant, Hide Okabi, tells me it's basically an expensive version of a Nintendo Wii, linking your movements in real life to what is happening on the screen version of you. So when Mike moves the magnet over my head, he will be able to see on the screen where in my brain he is aiming.
First, he does the finger-twitching trick on me. It takes him a while to find the right spot on the top of my head—apparently everyone is slightly different—but eventually he gets it. It feels seriously weird; my hand clenches in front of my eyes as if someone is pulling it with strings. It doesn’t hurt, but the hit of electromagnetic energy feels a lot like someone flicking me pretty hard on the head once a second, in time with a loud click. At first, it's just a light tap, but five minutes later it has become very, very annoying, and I’m starting to feel a bit lopsided. I’m supposed to have three eight-minute sessions of stimulation, but when I admit to feeling a bit dizzy, they decide that two is probably enough.
After the zapping, I do another session of Joe's training and it soon transpires that, with or without brain stimulation, the training is just as frustrating after a good night's sleep. I can see my hand moving toward the space bar in slow motion, but I’m still unable to stop it.
After my first bout of stimulation, I do even worse at the tests, and I can tell that Mike is a bit perturbed. He's not saying much, but it seems that he expected me to do better after a short, sharp zap. But then Joe says that it could mean that I usually lean on the left side so heavily that without it I can’t do the task at all. If that's the case, then I should start to improve with training.
Except that doesn’t happen. By day three, I am getting no better, and I am so frustrated I feel like yelling every time I hit the space bar in error. I feel so stupid—I have no trouble spotting the target; in fact, I see it straightaway. But it feels as though a gun to my head couldn’t stop me from pressing the space bar. Mike and Joe are looking even more frustrated than I am—and a bit worried too. Joe later confesses that he was scared I’d go home and write about how his training program is “the dumbest th
ing ever.”
But then, out of the blue, on day three, sometime between morning and evening training, something clicks. My score jumps from between 11 and 30 percent correct “don’t touches” to 50–70 percent. What's more amazing is that I’m starting to enjoy it. And when I accidentally make a mistake, I have a strange understanding of where my mind went. I realize, for example, that I got one wrong because I was wondering what my son was up to back home. And should I have wine after training, or beer? By the next day, I am doing it one-handed, while casually grabbing for my cup of tea with the other hand. Crucially, where before there had been white noise and no way of getting my mind to behave, I now feel only a Zen-like calm with just a few ripples of distraction.
Joe seems excited by this—and tells me it could be an important development. Being aware of what you are thinking is known in psychology as “meta-awareness,” and it's essential if you are trying to spot mind-wandering before it takes you too far away. “Everyone that the training has helped finds that they get to the stage where they are a little more meta-aware. They are doing the task and they see themselves thinking about other things,” he says.
And it might be my imagination, but I feel a lot calmer, too. Normally I procrastinate when I should be working, and, as a result, I end up working—and stressing—in what is supposed to be relaxation time. But this week I’m a journalistic ninja: I do all of my work in the allotted time slot, then have a great time catching up with friends in Boston, enjoying being back in one of my favorite cities, with no guilt or stress about work not being done. It might not sound like much, but it's a revelation to me. Maybe life doesn’t have to be so stressful after all.
I’ve also noticed a few more subtle changes outside work. On day two in Boston, I moved out of the hotel and went to stay with friends for the rest of the week. This would usually have caused me to get in a right old state—even with good friends and close family, I am an anxious house guest. I can’t relax because of the nagging feeling that I’m in the way, that I should be doing more to help with the cooking and cleaning, or that I should be making better conversation—and then I’ll worry that my worrying is stressing everyone out. But not this week. This week it's all good.
I haven’t mentioned this to Mike and Joe—I have the feeling they think I’m a bit unusual—but I’m intrigued to know what has changed. But aside from confirming that there is room for improvement, and that I probably don’t have ADHD, they’re saying nothing until I re-sit the “Betty” test on Friday. They’re not just being mysterious. Keeping experimental subjects in the dark is part of how science works: the more I know, the more likely my expectations will skew the results. All I know is that training has now become easy and that the butterfly feels under control for the first time in a long, long time.
Almost thirty years, in fact. Now I’m thinking about it, I came up with a few strategies to get the “butterfly brain” through school. I’d forgotten about these strategies until I recently found that psychologists and neuroscientists were suggesting similar things, although this time based on proper studies of the attention span. The fact that the attention span is limited might seem obvious enough, but psychologists have spent decades arguing in long-winded journal articles about precisely why. When we were about eleven, my friend Anna and I came up with a system that helped us get through math class. We would do twenty minutes of work, then break for a five-minute chat. It worked great, and we would always manage to stick to the schedule well enough to finish our work before the end of the lesson.
Regular breaks are often touted as a way to help focus. But why should they work? Some put it all down to regular “alertness cycles” in the brain, which supposedly give us about ninety minutes of alertness before zoning out for a while to reset. This idea has been knocking around since the 1970s—and since then, studies of productive people have backed it up, showing that they often naturally choose to work intensely for ninety minutes, three times during the morning, with a fifteen-minute break in between. It sounds good, but when I tried it, I found that it was not the easiest thing to fit into a working day. It was also hard to work out when my most alert time was; on some days, the alert part of the cycle stubbornly refused to show up. However, the basic take-home message is that we need to take breaks—preferably five or six a day, according to the ninety-minute rule.
Other psychologists argue that it is more likely that our limited span comes down to simply running out of steam. By this reckoning, we pay attention quite literally using a reserve of mental energy, eventually running out of funds. In this view, the break doesn’t have to be fifteen minutes. The catch is that it has to be a total distraction, like trying to do a difficult bit of mental arithmetic. Chatting to your neighbors in the office probably won’t work unless their conversation is truly engaging. I can’t remember what Anna's conversation was like at school, but I’m fairly sure it involved boys.
Taking breaks isn’t the only strategy I stumbled upon at school that has since been backed up by proper science. Through school and university, whenever I needed to remember facts, I’d write and rewrite my notes, over and over, using different colors on each line. Or I’d change my style of handwriting for each section, or even do some bits in mirror writing. I didn’t think much about it at the time, but what I was doing was finding ways to hold my attention for long enough to get the stuff to stick.
Then, a few years ago, Nilli Lavie, a cognitive neuroscientist at University College London, came up with the “load theory” of attention, which suggests that we should deal with our limited attention not by reducing what the brain is processing at any one time but by giving it more to do.3 This has since been borne out by experiments that measured how much an on-screen distraction slows people's performance while they are doing a mental puzzle. Lavie and her team have shown that the busier the screen is during the task, the easier people find it to ignore the distraction. It sounds counterintuitive, but the idea is that if our senses and perception are full of things that we should be thinking about, we will have no room for any mind-wandering. It seems to work with all senses, too, Lavie says; so making what you are doing more mentally demanding, either by deliberately working in a noisier environment or by coloring in revision notes like I did, might be worth a try.
The only problem with making this work in the real world, however, is ensuring that all the slots are taken up with something useful and not with distractions that take your attention even further away. If coloring your notes becomes too elaborate, as I have often found it does, they can easily turn into a work of art rather than an aide-mémoire. And mirror writing tends to make note-taking and reading slower, which probably defeats the purpose. Even achieving the right level of background noise while working in a public place is never easy.
The final explanation for why attention is limited, though, is the one that makes the most sense to the adult me. Mindlessness theory says that loss of attention happens when the brain gets so used to the task that it shifts into automatic mode, essentially taking focused, effortful attention elsewhere. Allan Cheyne, a psychologist at the University of Waterloo, in Canada, is a proponent of this theory, and he suggests that some kind of alert system—maybe something as simple as an alarm every twenty minutes—could help to drag you out of dreamland and back to the task at hand.4
For me, the trouble with all of these solutions is that they require not only a certain amount of mental control but a lot of organization, and that's not always easy when you’re already battling a limited attention system. And even when working at home at your own pace, these kinds of rigid schedules aren’t always workable. Plus, what I’m trying to do in Boston is to make such strategies redundant by fundamentally changing the way my brain uses its attention resources. If I can do that, then I won’t need to color my notes in anymore because my brain will be much better at slipping into the “zone” and staying there.
So did all that training and zapping really do anything to my brain? Well, the short answer se
ems to be yes. My score on the Betty test showed a huge jump, going from 53 percent incorrect before training (worse than any other healthy person they had tested, and in the region of a brain-injury patient) to 9.6 percent afterward (almost as good as the best healthy person in the same study).
Figure 1.2. Percentage errors in the “Don’t Touch Betty” test.
Joe was as amazed as I was. “We were like, ‘What? Did we run the same version of the test? That's remarkable,’” he said. And in fact, I asked them the same question straight after doing the test because the experience of doing it was so totally different. This time, it felt as if I had all the time in the world to spot Betty—and when she came on the screen she didn’t smirk before disappearing; instead, she gave me a friendly smile as if to say “Hi,” before slowly fading away. A few times, I even smiled back. Everything felt as if it were happening in slow motion. But they checked, and it was indeed exactly the same test, and strangely the time it took me to press the button was exactly the same before and after the training. Real time hadn’t changed, just my perception of it.
But might I have simply become better at controlling my hand to stop myself from pressing the button? The training is similar to the Betty test, after all. I put this to Joe—but he tells me that, on the basis of their other studies using this training, they would expect up to a 4 percent improvement from practice alone; I improved by more than ten times that. Moreover, my accuracy on the blink test—measuring how soon the brain can refocus after a distraction—showed similar improvements, scoring 46 percent before training and 87 percent afterward. “That's a huge improvement,” says Joe, and the blink test not only doesn’t involve pressing buttons at all but has even less of a practice effect than the Betty test.
Okay, so if the results are real, what have they done to me? Have I really changed my brain in just one week, after only four hours of, boring but fairly easy, brain training and a side order of stimulation?