Powers of Attention 

By  Dr. Mike Hansen

Powers of Attention: The Challenges of Maintaining the Brain’s Ability to Focus, and How to Meet Them

If you are reading this, most likely you are sitting at a computer. You’ve got some other browsers open, including your email, which you probably can’t help but check from time to time.  Maybe your phone sits nearby on your desk, or it’s pinging in your pocket, heralding the arrival of a tweet or a text message. Ah, but that’s the least of it, isn’t it? “What’s for dinner?” you wonder, as your belly rumbles. How about that game last night? What a shot! Who is playing tonight? Wow, you wonder, what’s going to happen on your favorite show? That much anticipated final episode is coming up this weekend. What’s the president done now? Oh, shoot, your significant other wanted you to pick something up at the store —  what was that again? Is your credit card due today? What’s your password for that site? When is the deadline for your big work project, again? Why won’t the pain in your neck go away?

Of course, it’s equally likely some long and winding train of thought is happening as you drive down the freeway. According to the National Safety Council, one in four accidents in the United States —  1.6 million car wrecks —  is caused by texting and driving. But in a larger sense, none of this is about your computer or your phone.

If you sit down to do your bills one morning, you very well know the task at hand is something that can be done in a couple of hours, but you also very well know your mind might go wandering down any number of alleyways. It’s boring, you don’t really want to do it —  maybe just take a break and look at the news? —  and next thing you know the morning is gone and the task remains undone.  The screens always at your beck and call only aid and abet the runaway train of your attention. What this is about is not the tools of distraction at your disposal so much as it is the tool you use for everything: your mind, and its ability to concentrate attention.

The details of our daily distractions differ, but such meanderings are something we are all subject to, particularly in the impulse-rich environments we live in as part of modern society. We all have times we need to truly concentrate and direct our attention on a single task or goal; the degree to which we are successful will determine much in our life. Yet the runaway train is hard to get back on the tracks. 

Lack of focus has significant consequences not just in the most dangerous activity most of us engage in, driving, but throughout our lives. It’s when mistakes happen, whether you are a surgeon or a data entry clerk or a center fielder. Problems with attention can slow learning, as crucial pieces of information simply don’t make it to your memory. A chronic inability to focus can upend your daily routine, your sleep, and even your ability to pursue long-range hopes and dreams. And if you do lose sleep due to that runaway train of your thoughts, things can spiral quickly: it becomes a negative feedback loop, further deteriorating your physical ability to train your attention on any task.

A lot has been reported regarding the age of attention deficits we now live in, but other than pharmaceutical approaches, very little information comes our way regarding the things we can do to address such problems. It’s an odd state of affairs: we tend to our vehicles with regular maintenance, we might even tend to the rest of our physical fitness with regular exercise, but typically very little care is given to maintaining and strengthening our cognitive health. A lot of variables are at play: your overall physical health, environment, age, and emotional stability. Today we are going to take a look at how such factors affect your brain and its ability to give focused attention. Most crucially, we are going to look at a few evidence-based approaches regarding how you can maintain or improve your powers of focus and attention.

Under the Hood: the Brain

Attention at its core is a mental process. It underlies all cognition — our reasoning, perception, and problem solving — and thus are central to human behavior. The famed twin verses written by Buddha, who aside from any religious status was among the first to truly study the processes of cognition, recognized this: “All that we are is a result of what we have thought. We are formed and molded by our thoughts.” That is, what we give our attention to determines who we are and how we are able to navigate the world.

So in order to improve our powers of attention and overall cognitive health, it’s helpful to first understand how attention works, physically. Let’s take a look at one of the great wonders of the world, the human brain, and the vast array of neural networks that work together like a microscopic symphony to allow us to bring our attention to anything at all.

Attention is biological. It is so fundamental that it doesn’t have to be learned. A newborn baby’s first action, after breathing and maybe screaming, is one of attention to matters at hand —  the need to eat, stay warm, and close to its mother. This most simple power of attention is something we retain the rest of our lives. It’s called passive attention, and it’s at play every time you instinctively jump, flinch, or twitch when you hear a shout, a car horn honking, or a door slamming. These are not instances of actively paying attention, but result from passive attention and can be triggered not just by noises but other sense perception, such as glimpsing a spider crawling up your arm or feeling an unexpected tap on your shoulder. 

Active or directed attention, on the other hand, is purposeful. It’s what you pay attention to, the beam of your mind flashing on what it wishes to perceive. There are four kinds of active attention: selective, divided, alternating, and sustained.

Selective attention is the ability to focus or concentrate on a single thing, such as when you are in a noisy, crowded restaurant but are able to discern your friend’s voice amid all the clamor as she tells you the story of her day. Divided attention is more commonly known as the ability to multitask, like when you talk on the phone while folding your laundry. Alternating attention is the ability to switch back and forth between tasks, like answering phone calls while writing an email, or looking up the ingredients to a recipe in your favorite cookbook while putting it all together in the frying pan and setting the table for dinner. Sustained attention, also known as vigilance, is extending your focus over time in order to concentrate on a task at hand, such as listening to a lecture, reading a book, or — if you are an air traffic controller or an ocean lifeguard, jobs for which this type of attention is highly developed —  closely monitoring at all the comings and goings of airplanes or swimmers over the course of hours. 

Alright, so, how exactly does this all work? It’s all at the very front of your brain, an area known as the prefrontal cortex, where the magic of what is called cognitive control takes place.

Cognitive control, also known as executive function, is your ability to coordinate the myriad processes of your brain and direct them towards action. It’s the maestro at the front of the symphony, which is all tuned up and ready to play. And it’s you at your desk, ignoring the fascinating saga unfolding at Fenway Park on one browser window, the emails accumulating in another, your growing hunger for a snack, and the kid bouncing a ball off a wall next door in order to focus on doing your taxes.

Cognitive control, ideally, isn’t a maniacal dictator. You need the flexibility to be able to switch from task to task —  the baby crying in the bedroom, the phone call from your mother —  while more generally staying on task. That’s what executive function is all about, prioritizing the many processes happening in your brain at any given time to get something specific done. 

The prefrontal cortex, or PFC, is just behind your forehead. It connects with the regions of your brain that receive sensory input and initiate muscle movement but is also tapped into parts of the brain that store memory and govern emotion. All of these functions of the brain must be coordinated, which is why the PFC is so crucial for attention and concentration.

The PFC is home to executive function and does its job largely in the processing of the different types of information coming from these various areas of the brain. This happens in two ways. Bottom-up processing is how your brain receives real-time information — sensory input, perception, rudimentary cognition. Top-down processing is where things become intentional. It is how the brain does its sorting among various sense-inputs, thoughts, and emotions, prioritizing which has immediate relevance. This is the process of concentrating attention. 

Neurons are the foot soldiers of attention. Billions of neurons race across the PFC, briefly storing bits of sense-input information, a short-term memory process akin to the RAM memory of a computer associated with its processing power. For example, when you read that your recipe calls for two teaspoons of sugar, you hold that information until you scoop the sugar, and then you move on to the next ingredient (and thoughts of sugar are suddenly gone). This is the PFC at work, prioritizing sense-input and memory and moving towards the larger task.

Such working memory has limits. As a matter of prioritization, it discards information constantly. You won’t remember that recipe by the time dinner is on the table, for example; but if you make the recipe repeatedly, eventually you won’t need the cookbook. Your executive function will have moved information into long-term storage, enabling you to focus on other things. This is how we learn just about anything, from guitar scales to typing the keys on your keyboard or thumbing out text messages.

More than 120 billion neurons exist in the human brain. Each neuron is connected with other neurons, sometimes thousands of others, and extend by nerve fiber all the way down the spinal cord to form what is often described as the body’s information superhighway. Every action you take in the world, from a glance at a stranger to blowing your nose, results in millions of movements up and down this superhighway. 

The PFC oversees all the traffic. The superhighway maintenance crews are hard at work, constantly building new connections between nerve cells, and clearing away unused connections. This is a key process called neuroplasticity. When you’ve learned that recipe or guitar scale by heart, a new road has been established, and every time you go down this road again it becomes more deeply entrenched. If you never cook the recipe again, it’s like tire tracks in the sand on a beach wiped away by the incoming tide.

Road Barriers

Your brain’s byways have been well established the longer you live. The prefrontal cortex has done its job, and thus your brain is better able to discriminate between what is important and what is not. This is why, in part, a child is more likely to be scared by something that isn’t a real threat than an adult. It is also why your ability to concentrate and focus should grow stronger with time.

But it doesn’t always work that way. Traffic problems will continue to occur. The key to navigating the obstacles that arise is first to see them. This means recognizing the physical and emotional factors that often interfere with focus and attention. A key component of this is understanding that the brain, like every other part of your body, is subject to the wear and tear of life. Therefore if you want to improve your powers of attention, it’s essential to take a look at how you live. The following are a few key areas to examine:

Sleep. It’s almost impossible to overstate the importance of sleep. It applies to every aspect of our health. Poor quality sleep negatively affects our metabolism, immune system, our cardiovascular system, emotional stability, our ability to encode new memories and hence learn, and of course our ability to focus attention.

A poor night’s sleep makes it difficult for the PFC to do its job. It becomes less efficient at sorting information and thus is less able to prioritize input that is important from that which is not. Hence the door left wide open for distraction. Studies indicate that less than five hours of sleep is disruptive to overall brain operations, diminishing neural connections, and your ability to absorb new information. So you may be able to perform well in areas you are well-practiced, where the roadways are deeply established, but new tasks —  those requiring selective attention —  can be all but impossible.

Digital distractions. Distractions have always been a bane to focused attention —  maybe the caveman’s mind was so occupied by thoughts of grilled mutton that he missed the onrush of the saber-toothed tiger —  but never has distraction been so abundantly pervasive as today. It’s important to realize that not only does our world of screens provide the nearly constant buzz of distraction, but it also conditions our brain to attune itself to an arrhythmic and unnatural state of being. We form habits of inattention. According to a 2018 survey by the technology company Asurion, we crave our phones daily more than we do food and water. Americans check their cell phones an average of 80 times a day; some check their phones as many as 300 times every day. Research has also shown that social media sites such as Facebook deeply trigger our brain chemistry, releasing surges in dopamine, the neurotransmitter with pleasure and reward. It’s one of many ways electronic life makes the PFC’s job so much harder: how to discern between the pleasure of a Facebook “like” and the more enduring happiness but less-dopamine producing activity of learning is a unique challenge of modern life. And then, to top it all off, the blue light emitted by our screens negatively impacts our ability to sleep deeply, creating yet another negative feedback loop: we spend hours on our cell phone, distracted, then sleep poorly, thereby falling into a cycle in which we couldn’t pay attention if we wanted to.

Alcohol and drug use. Alcohol has been legal and so socially acceptable for so long that it’s easy to forget what a powerful drug it is. The ethyl alcohol present in beer, wine, and hard liquor depresses the central nervous system, which causes physical sluggishness, impairs judgment, and worsens sleep quality. Naturally, it also makes it much more difficult to concentrate. These short-term impacts over time, with ongoing usage, become long term impacts. Heavy drinkers change their brain chemistry, often developing deficiencies in nutrients necessary for cognitive health, such as thiamine.

Many illegal drugs also have long term negative impacts on our ability to focus. Heroin, cocaine, and amphetamines trigger dopamine releases in the brain, and in so doing defeat the PFC’s executive function. The pleasure-response impulse overrides the brain’s ability to exercise cognitive control, leading to addiction and the obliteration of anything resembling the power of attention. Like alcohol but even more so, these kinds of drugs can permanently rewire the brain, creating altogether less organized, more haphazard roadways centered solely in the pursuit of immediate pleasure, also known as addiction.

Stress. The PFC is particularly vulnerable to the effects of stress. The PFC normally can regulate the level of stress hormones to support cognitive control but chronic stress undermines its ability to do so. What happens is the amygdala, the part of the brain that regulates emotion, becomes dominant under stress. You breathe faster and your heart rate increases and the PFC’s ability to intercede is diminished, thus damaging your ability to utilize both working memory and active attention. Over time with chronic stress, the PFC actually shrinks, further damaging your ability to focus attention. 

Aging. A hard fact of life is that as you age, cognitive function across the board tends to decline. This varies greatly from person to person and depends greatly on genetics, environment, and nutrition. But in general, the ability to concentrate declines with age, often exacerbated by a corresponding tendency to sleep less.

How to Protect Your Powers of Attention

After all the aforementioned challenges, we have some good news to report. Maintaining your ability to focus attention isn’t complicated. It’s really the same advice our wise elders have given through the ages: get a good night’s sleep, eat well, exercise your body and your brain, and make an effort to control what you can control and not stress overly much about the rest. Here are a few tips for how to implement good practices in your life that will allow you to strengthen your powers of attention.

Regular sleep. You do it for work, why not for sleep? Try to give yourself a schedule. Block off certain hours for sleep and don’t let anything interfere with those precious hours. Studies show that humans sleep deepest between the hours of 8 p.m. and midnight; in fact, a UC Berkeley study indicates that every hour of sleep before midnight is worth two after. This is another hard truth, but just try it out. You’ll be surprised by the immediate difference it makes. 

Also take care to set up a peaceful, clutter-free, and ideally electronics-free sleep environment. Distractions are so pervasive we need to build this pocket of serenity in our lives, a place of genuine rest. Also, try not to eat two to three hours before bedtime, so your body can focus on restoration, not digestion, and stay away from bright lights in the hours before bed whenever possible.

Exercise. You know this already: your body is meant to be used. The average American sits nearly seven hours a day, and this sedentary lifestyle has wrought both an obesity epidemic and an anxiety epidemic. What it has not done is helped us to develop better powers of attention. One study has shown that just moderate exercise three days a week actually grows the hippocampus, the area of the brain involved in memory and learning, and likewise offsets age-related brain deterioration. 

Mindfulness practice. Here we come back to the Buddha, but it’s not really about Buddhism, but rather taking an active role in the quality of your thoughts and frequency of your thinking. Of late, science has caught up with ancient practices of meditation, which are now thought of more broadly (and secularly) as mindfulness practices. Two groundbreaking studies at Harvard last year indicated that mindfulness practices, which include meditation but touch on everything from eating more slowly to walking more consciously, have measurably positive impacts across many areas of physical and mental health, including irritable bowel syndrome, fibromyalgia, psoriasis, anxiety, depression, chronic pain, and post-traumatic stress disorder. A UCLA study found that long-term meditators had better-preserved brains than non-meditators as they age. A Yale study showed that mindfulness practices decrease activity in the brain’s so-called “default mode network” (DMN), the area responsible for mind-wandering and self-referential thoughts (also known as “monkey mind”).

The bottom line is mindfulness is about attention control, which is essential to everything we’ve been talking about. The more you practice attention control, the more your brain adopts those habits, and the stronger your powers of attention become. 

Eat whole, eat well. Thousands of books are being published every year on this topic,  but suffice to say that your grandmother was right if she gave you advice in line with food writer and UC Berkeley professor Michael Pollan’s distillation: “Eat food. Not too much. Mostly plants.” The Mediterranean diet is the most commonly recommended for both body and brain health; it is rich in fruits, vegetables, whole grains, beans, nuts, seeds, and olive oil. It’s not vegetarian, but protein serving sizes are limited. Several studies have shown the broad outlines of this diet lowers the risk of developing mild cognitive impairment and slows the progression to dementia in people who have that condition.

Phone use/cognitive training. Oh yeah, that. Take a look around you, right now. Where is your phone? Now take that thought and throw it away, with great regularity. A cell phone is a great tool — for productivity, for human connection, for communication —  but like all tools, you need to set it down often. Phones are rewiring us for less long term attention replaced by that small pinging sense of attention. Humans existed for eons without cell phones, and our bodies and brains are still not used to the constant attention they seem to require. Don’t let the phone become a part of you. Practice other forms of attention, like reading a book, or engaging in long, electronics-free conversations. From time to time, log out.

Voluminous scientific evidence demonstrates that the more you stimulate and challenge your brain, the more you promote neuroplasticity, i.e. the ability of your brain to change as you learn. This also protects your brain against changes that come with aging and encourages neurogenesis —  the birth of new neurons, and greater connectivity throughout your brain and particularly in our old friend, the PFC. These new connections bolster the brain’s processing speed and ability to regard distractions for what they are —  inessential, attention-sapping dead-ends.

It’s a simple lesson, really. Your attention is your responsibility, and a precious one. Mind it.   

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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