On the Health Record - Interview with Rohan Dixit of Lief Therapeutics

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A neuroscientist’s journey takes him from conducting research at Stanford to working with monks in the Himalayas. Read about how Rohan Dixit, founder and CEO of Lief Therapeutics, has turned his passion for studying the brain into a way for others to manage stress and anxiety. You can also listen to the full podcast episode here.

What initially attracted you to studying the brain?

I had been interested in the brain since I was a teenager. It always fascinated me that the seat of all of our emotions and thought and really who we think of ourselves is all mediated through the brain.

So when I was growing up and the reason I got interested in neuroscience in part was because I’d found a book about mindfulness and meditation. I think a lot of us probably go through periods of self-doubt and anxiety as a teenager, as an adult or growing up in a lot of ways, but I found that learning about meditation and practicing some of those skills actually really helped me self-regulate and feel more relaxed and calm. So what I ended up studying both in college and then afterwards at Stanford in the Martinos Center was different states of consciousness- people who are in a coma, people under anesthesia, the deep sleep state, as well as people who have done 10,000 hours of meditation training. What do their brains look like? What changes when you do those kinds of intentional practices, and what is driving a lot of the physical benefits and mental health benefits we’ve seen over the last decade?

When did you get interested in wearables?

That was maybe a decade ago. I was getting excited about taking some of the research we were doing in the lab. I personally gained a lot of benefit from mindfulness practices and attentional practices and things like that, and I genuinely wanted to get it out to more people. So research was one way to do that, and say, “Hey, look, there’s some science here that that kind of practice may actually help you, both your physical health and your mental health.”

And when sensors first started - they got kind of cheaper around 2010 - that’s when I started to think that maybe we could take this out of the lab and actually create some device that could go around with you and help you to learn some of these skills, like self-regulation mindfulness, biofeedback, and that was kind of the beginning.

In 2011, you founded a company called BrainBot. Can you tell me more about that?

Before I had taken the plunge into entrepreneurship and working on medical device products, I just had this really frustrating sense when we would be looking at and measuring people who had all this meditation experience and they were so calm. It almost started to piss me off a little bit because I was like, “I don’t feel that way”. Just studying something isn’t really making a big difference to me in my personal life, and I find that a lot when I’m talking to people about meditation- it’s something that a lot of people think that they’d like to try, but they don’t ever get started.

It’s hard to know what to do, and that practice is tough. So I found myself in that same place, and I thought, well, why don’t I try something different? I’ll learn these practices myself, and through that process, maybe I’ll figure out a way to create a wearable device to help with this. So I quit my job at the lab and bought a one-way ticket to the Himalayan mountains, and I went out to live with monks for almost a year with brainwave equipment and sensors in my backpack. That was the beginning of BrainBot, which is the first kind of product that we ended up releasing, which was a brainwave headset, and we ended up licensing that product to another healthcare company that uses that technology for people that have really bad chronic pain.

There’s a ton of research out there that shows that if you use mindfulness techniques to help patients who have really persistent pain, that isn’t modulated by pharmaceutical drugs, you can actually use techniques like mindfulness to decrease how much pain somebody reports feeling on a day-to-day basis. So that was BrainBot. That was the first step in the direction of using mindfulness techniques that are also based heavily in science.

I’m curious about how that worked out. How did the Himalayan monks receive your backpack full of neurological measuring devices?

I was surprised actually, because you’d expect that it would be a pretty weird proposition for people, but it turns out that the Dalai Lama coincidentally has had this thing going on for the last decade or more now, where he works with neuroscientists, and they study monks a lot of the time. So a lot of the folks where I started initially in Dharamshala - which is where the Tibetan government in exile is - a lot of them are already familiar with the Dalai Lama’s efforts and bridging neuroscience and meditation together. So it wasn’t as crazy as you might think, and as I started to talk to more monks, some of them even thought that technologies like this could be used to train monks to see which of their students are really doing the meditations or not. So I think it’s an interesting East-meets-West, nature-meets-modern phenomenon. I think there’s a lot to learn looking at things from another perspective.

You were involved with BrainBot from about 2011 to 2015, but in 2015, you went to start another company, Lief Therapeutics. Can you tell me what inspired you to start another company?

So BrainBot had worked with brainwave sensors, where you’re putting something on your head, whether that’s a bunch of sensors that a technician might help you put on, or a more simple kind of wearable headset. So the interesting thing about that technology is that you’re looking at the brain, and you’re able to see what’s happening in real time to some degree, and you can use that to drive the feedback loop. But the problem was that when you’re measuring brainwaves, the signal strength when you’re measuring someone’s electrical activity for their brain is actually really low. Looking at brainwave activity is not really good for helping somebody figure out what’s happening in their mind and doing something useful with it if you’re not sitting down totally still with your eyes closed. So I found myself having dealt with anxiety in the past and wanting tools that would go with me throughout the day. When I talked to my friends who meditate a lot, I’d sometimes say that when you’re on the meditation cushion, things are relatively easy to deal with, but life gets you when you’re out and about.

You need a wearable device that can go with you throughout the day, right? So I started experimenting with friends, looking at all kinds of different places where the body can measure signals that correlate with mindfulness, from your ears to the soles of your feet, and eventually we came up with a signal that’s actually called heart rate variability. Basically heart rate variability is kind of like the millisecond timing differences, one heartbeat to the next, but what was interesting as a neuroscientist looking at that was that it’s actually really tied to your brain. Your heart and your brain are actually in this bidirectional feedback loop where you can measure a lot of what’s happening to your mental state by looking at your heart.

That was kind of like a mind blowing moment for me, because as a neuroscientist, you have this myopia where you’re just constantly thinking everything interesting must be happening between your ears, and you never really looked at the rest of the body, but that was a big moment for us because we realized that we had a window into mental state through measuring this biomarker at the heart, and that biomarker is way easier to measure, so the signal strength of it is such that you can actually get a good signal while somebody’s moving around throughout their day. And then you can fill feedback from that and create this ideal system that I’d been dreaming about as a teenager, so that’s how we stumbled into heart rate variability.

So when someone does feel stress, what kind of biofeedback can you do? And how would I even start to think about slowing down my heart rate?

We train people through our Lief products to be able to tell you when you’re starting to get anxious right at the beginning before it’s out of control in that early phase where you can actually make a difference. That’s a key part of it.

But the second part is basically just a training where you use our device. The device has this built-in vibration interface, as well as an app and training system that goes along with it. Basically over time, in clinical trials - we’ve looked at eight weeks as a training period for people with anxiety - and in that time, you can learn how to control your heart rate through breathing by using the feedback that the device gives you. Within a couple months, people’s self-reports of their anxiety state actually goes down. In our data from last year, we looked at people that started at very high levels of anxiety on standard assessment and went down to subclinical, meaning they didn’t even really warrant a diagnosis of anxiety anymore.

What’s cool about the training is that because you’re learning the skill of self-regulation, it’s almost like training wheels on a bike where once you know how to ride a bike, you can take the wheels off. You’ve internalized the skill of riding your bicycle. A Lief device is really similar to that. It’s something I really love about our product. It’s giving people a tool that they can use throughout the rest of their life, even without necessarily needing the device, and it’s giving people those skills that I think have been shown to be so helpful in dealing with situations in one’s life. That’s where our technology builds on where biofeedback was in the seventies and tries to apply it to some of the modern problems that we’re facing today.

You’ve been in wearables for almost 10 years now, and you’re doing great work, but I think you might agree that wearables haven’t blown up like people thought they might. For example, the Apple watch is pretty cool, but it’s more an extension of your phone than it’s own kind of thing. If you could go back 10 years and give yourself some advice before you got into this industry, what would you tell yourself?

I would tell myself to be patient. I think a lot of times with new technologies, like wearable devices or biometric sensors or AI, people enter into the industry at the beginning of a hype phase where there are a ton of possibilities, and you’re operating more on a sense of hope than on actually providing value. It’s a natural process, and it happens with everything really. So if I could go back 10 years, I would tell myself to be patient. I think we’re just now entering a phase with wearable devices where the devices are becoming accurate enough, and the use cases are becoming meaningful enough that there is actually going to be real value that is created and delivered into people’s lives. So I’m really excited about wearable devices, because I think that as we enter that phase of integrating into people’s lives and teaching them new things about themselves, that is going to be the point at which the promise of wearable devices actually becomes real and starts to really help us live healthier and more happy lives in a way that isn’t a gimmick and is very concrete and super helpful.

Listen to the full podcast episode here.