Ep. 365 Healing Power of Touch: Exploring Sensory Methods for Health with Dr. Dave Rabin
- May 29, 2024
- No Responses
I am delighted to reconnect with Dr. Dave Rabin today. He last joined me for Episode 91 in April of 2020.
Dr. Rabin is a board-certified psychiatrist and neuroscientist. He is the Co-founder and CMO at Apollo Neuroscience, the first scientifically validated wearable system to improve heart rate variability, focus, and relaxation, and helps attain meditative states. He is also Co-founder and Executive Director of the Board of Medicine and a psychedelic clinical researcher, currently evaluating the mechanism of psychedelic-assisted psychotherapy and treatment-resistant illness.
Today, we examine the value of touch and sensory techniques, discussing the distinctions between sympathetic and parasympathetic vagal tone in the autonomic nervous system, changes in sex hormones during perimenopause and menopause, and how that impacts sympathetic dominance, the development of stress responses, and the concept of stress leading to personal growth. We explore the influence of the vagus nerve on systemic health, explaining what HRV is and how it can demonstrate bodily coherence, and we also dive into wearable technologies like Apollo, the disruption of psychedelic interventions, and the impact of trauma on physical and mental well-being.
I am confident that you will find today’s engaging discussion with Dr. Dave Rabin eye-opening and enlightening.
“Menopause is probably one of the more intense experiences for women.”
– Dr. Dave Rabin
IN THIS EPISODE YOU WILL LEARN:
- How touch helps us connect, bond, and support our autonomic nervous system
- How finding balance between the parasympathetic and sympathetic nervous systems can help us manage stress and anxiety
- Techniques for quickly restoring balance to the nervous system
- Why women experience more anxiety, depression, and heart arrhythmias during perimenopause
- How breathing techniques can improve heart rate variability
- The significance of HRV metrics for understanding physical and mental health
- How the Apollo device activates a healing response within the body
- The potential of MDMA and other psychedelics hold for trauma healing
Connect with Cynthia Thurlow
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- Check out Cynthia’s website
- Submit your questions to support@cynthiathurlow.com
Connect with Dr. Dave Rabin
Previous Episode MentionedEp. 91 – How To Listen To Your Body and DE-STRESS During COVID-19 – with Dr. David Rabin
Transcript
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I’m your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of reconnecting with Dr. Dave Rabin. He last joined me on Episode 91 in April of 2020. He is a board-certified psychiatrist and neuroscientist, is the co-founder and CMO at Apollo Neuroscience, which is the first scientifically validated wearable system to improve heart rate variability, focus, relaxation, and access to meditative states.
[00:00:56] In addition to his clinical psychiatry practice, he is also Co-Founder and Executive Director of the Board of Medicine and a Psychedelic Clinical Researcher currently evaluating the mechanism of psychedelic-assisted psychotherapy and treatment resistant mental illness. Today, we dove deep into the value of touch and sensory methods, differences between the autonomic nervous system, sympathetic and parasympathetic, vagal tone, the impact of changes in sex hormones, in perimenopause and menopause, and how this impacts sympathetic dominance, the evolution of the stress response, how stress equals growth, the impact of the vagus nerve on systemic health, what is HRV? and how it can demonstrate coherence and harmony within the body, wearable technologies including Apollo, the disruption of psychedelic interventions, and how trauma impacts our physical and mental well-being. I know you will enjoy this conversation as much as I did recording it.
Dr. Rabin, such an honor to reconnect with you. I know we were talking before we started recording. It’s really nice to have you back on the podcast.
Dr. Dave Rabin: Likewise. It’s great to be here. Cynthia.
Cynthia Thurlow: [00:02:13] Yeah. I would love to start the conversation today speaking to the value of touch and how that is instrumental in connection and bonding and supporting our autonomic nervous system.
Dr. Dave Rabin: [00:02:28] Yeah, I think that’s a great place to start. So, touch is really interesting because if you look back throughout evolutionary time, back to the first mammals, whether you believe that they’re related to us or not, if you go back to the earliest mammals that all nurse their young, the very first experience of safety after leaving the womb for a newborn baby was to be held by its mother in some fashion, or to be nearby mom. And at that time of life, that interaction between mother and baby is absolutely critical to convey to the baby that just left the ultimate safety, the womb, where every single thing is provided for it to coming out and taking its first breath and starting to have to completely survive on its own having its own all organ systems online, everything running right, and also not to have any constant surrounding warmth unborn baby has when in the womb.
[00:03:32] So, all of a sudden, baby exits, can’t speak. Doesn’t have any understanding of words, so you can’t communicate safety verbally to the newborn like you could an older child or an adult. So, the only communication and primary communication opportunity is through touch. And that touch is the very first and arguably the single most important way that we communicate safety to each other as human beings and as mammals in general.
Cynthia Thurlow: [00:04:01] And is this primarily an interrelationship between the hormone oxytocin reducing cortisol? Because I think for so many people understanding that this is this fundamental hormonal regulation that goes on in the body. And I think about, I was very fortunate, I was able to breastfeed both of my children for a little over a year each. And I can honestly say that it was one of the most amazing things for me as a woman to be able to feel so connected to my children. And I understand physiologically what’s happening in our brains while that’s occurring, but just such a bonding and important moment in terms of their development, my development as a parent, understanding how important that is. But does it come down to that physiologic interrelationship and interplay between those hormones?
Dr. Dave Rabin: [00:04:54] Yeah, absolutely and it’s not just those hormones. It’s a whole cadre of tons of hormones and neurochemicals in the body that happen anytime we experience any sensation, really. So, whether it’s sound, music, light, taste, smell, all of those are frequency and chemical interactions that result in an immediate emotional state change. And oftentimes an energy state change and a thinking state change and that feeling, which was like the term we used to describe, that whole experience has a ton of downstream effects that cause and the feeling itself results from rapid change in the neurochemical environment of the body and the hormones of the body.
[00:05:44] And so oxytocin and cortisol are very important hormones and neurotransmitters to consider, because oxytocin being the primary bonding hormone or bonding chemical that is responsible for release when we have intimate and authentic human interactions, anything from snuggling pet or another human being to making eye to eye contact with somebody, etc., and even sexual intimacy, all of these things introduce a ton of oxytocin into the body, and oxytocin amongst other things that happen in what we call the HPA axis, which is in neuroscience, this is like the hypothalamic-pituitary axis. So, it’s this network of the pituitary gland, the hypothalamus, which is the brain part that regulates the entire stress response in the body and regulates the vagus nerve to some extent.
[00:06:38] And this regulates our adrenals and how we release adrenaline and things that result in us responding to stress. Cortisol is a stress response hormone and so when we have stress at certain ways, in certain times, much of that time, cortisol is increased, and cortisol has a side effect while being anti-inflammatory to the body, because we don’t want our immune system to be taking a lot of resources when we’re running from a lion. So, cortisol suppresses immune activity, which is helpful in certain ways, but it also increases the speed of our thoughts and some of our energy and restlessness and anxiety, and that feels like anxiety.
[00:07:15] So, having too much cortisol, too much of the time is likely also impacting the way we’re feeling and thinking on a stress anxiety level and how able we are at any moment to feel in control of ourselves and what’s going on. And then there’s also lots of other hormones that are really interesting and chemicals like endorphins, dopamine, and serotonin neurotransmitters, dopamine is the major reward signaling and memory signaling molecules. Serotonin is responsible for a lot of mood regulation and also meaning, it seems, making meaning from things, which is really interesting, and then other things like endocannabinoids, which are the cannabinoids that our bodies make themselves that are extremely important for emotions and emotional health and inflammation.
[00:08:04] And then also endogenous opioids, so our own pain molecules. And most people don’t realize that our bodies make our own pain-relieving molecules, and they’re opioid molecules, but they’re natural that we make, and we can train our bodies to make more of them when we want them to on purpose. And it just requires, a little bit of practice. But that mind body connection truly goes from the feeling to the molecules, which is so cool.
Cynthia Thurlow: [00:08:29] It is so cool. And I guess for the benefit of listeners, speaking to this autonomic nervous system, where we have the parasympathetic and the sympathetic nervous systems. And I think, when we spoke four years ago, whether we realized it or not it, it was just the crux of the start of the pandemic. And so now we’re four years out. But a lot of the behaviors that I saw, especially in the very beginning were fear driven, sympathetic dominance driven. And certainly, in your work, working with individuals that have experienced a trauma and have significant posttraumatic stress disorder, help listeners have a high-level understanding of how these systems interact with one another and why it’s so important to find some degree, I hate the word balance, but find some degree of balance between the parasympathetic versus the sympathetic so that we can navigate our day to day lives and do so effectively.
Dr. Dave Rabin: [00:09:27] Yeah, that’s a great question, and I don’t think balance is such a bad word. [Cynthia laughs] I think it actually describes it pretty well because it really is like a seesaw that is balancing back and forth and as activity in one. Basically, when the activity in the sympathetic fight or flight survival system and the parasympathetic vagal rest and digest and recovery system are balanced or close to balanced, that’s when we start to basically be in flow. And that’s really interesting. And so, there are ways that we are just starting to scratch the surface on how the understanding of the balance, the dynamic balance, because it’s constantly moving up and down. So, it’s not a balance like these are all even all the time. They’re always going up and down.
[00:10:15] Every breath, every stressful thought, every time you wake up in the middle of the night, every time something just catches your attention, your balance is getting shifted towards sympathetic, towards fight or flight just a little bit. And then we have to breathe or hug ourselves or play soothing music [Cynthia laughs] or do things that kind of bring the balance back. And then they start to reset. And then something catches our attention again and our sympathetic goes up. And ideally, we learn enough of the parasympathetic vagal nerve-based training techniques. The vagus nerve is the primary nerve that governs the parasympathetic nervous system. And the primary techniques are these deep breathing, yoga, regular exercise, resilience building techniques, mindfulness, and meditation.
[00:11:01] All of these kinds of things help to train the autonomic nervous system to have more ability to quickly restore balance when it gets disrupted. That’s what health really is in a spiritual, ancient yogic sense, and also in a Hippocratic sense. It’s really about resilience training, adaptation training. Because adaptation is one of our most important skills as human beings. It’s why we’ve survived so long as a species and understanding how to leverage that and train it to be able to restore the balance as quickly as possible, as often as possible, because there’s always going to be stuff that upsets the balance, right?
Cynthia Thurlow: [00:11:38] Oh, for sure. In fact, we’re talking about this right before we started recording that we have a project going on at the house, and it’s like inevitable. You have people at your house, there’s always a hiccup. And just trying to take a deep breath and realize, okay, everything is figureoutable. Now, the one thing that was interesting, I just interviewed Dr. Felice Gersh for the fourth time on the podcast. And she and I were talking about the dynamics of perimenopause and menopause as an example of why women at that stage of life seem to experience more anxiety, more depression, more sympathetic dominance.
[00:12:10] And what I found was really interesting in our conversation is that the loss of estradiol, so this predominant form of estrogen prior to going into menopause, that in and of itself impacts our sympathetic regulation quite significantly. So, this is when women and I’m sure you probably have seen this with your own patients, more palpitations, more atrial fibrillation, which is a heart arrhythmia, more issues with anxiety and depression, just as a byproduct of that one shift in very likely not just estradiol, but also progesterone. But those hormonal shifts can make it more challenging for us to find that degree of balance between these two sides of the autonomic nervous system. Has that been your clinical experience when you’re looking at your patient population as well?
Dr. Dave Rabin: [00:12:55] Yeah, I would say, generally speaking, that’s consistent. I think in those particular cases, shifts in those particular hormones are really significant. They are not small changes, and they impact so many things in the body when they’ve been around at a certain rate over time. And now all of a sudden, their rates and amount of aroundness are totally different. The body has to bounce back from that. And that’s a stress, there’s no doubt about it. And basically, all transitions are stress. Anytime, we have to change our energy level or mood or we’re struggling with something feeling different or changing that’s unpleasant, we have to cope with it. All of those are like micro stresses, and some of them are more intense, and some of them are less intense and argue that menopause is probably one of the more intense experiences for women.
Cynthia Thurlow: [00:13:45] Yeah, and it’s interesting, because I feel as if, within the medical community, there seems to be a shift and a greater awareness of this transitional period for women, which I think is so important. Now, when we talk about stress, not all stress is bad. There’s distress versus hormetic stress or eustress. And so perhaps defining, where is that fine line? is it all necessarily relative to the individual? Because I think there are some people who seem to be more stress resilient than others, and that can be a byproduct of many factors. But I think it’s important at least to have that discussion, because I have, for the course of 25 years of working in healthcare, I can definitely identify people who seem to be just much more stress resilient than others, family members, friends, patients. I think there’s many things that are at play there, but let’s differentiate these two different types of stress, beneficial versus nonbeneficial.
Dr. Dave Rabin: [00:14:42] Yeah, I think. Yeah, it’s interesting, right? All stress is commonly misunderstood, but stress is not inherently bad. As you said, all stress can be beneficial in certain ways, because stress and the process of figuring out how to overcome whatever’s causing it or solve the problem is teaching us stuff about ourselves, about the world, etc. And ideally, we’re learning everything we’re supposed to learn from those experiences so we don’t fall into the same ones again as often. And so, a lot of the way, there’s basically two major factors in what eustress, which is effectively or hormetic stress, stress in the context of safety that facilitates growth. And the growth part is really about perspective and the way we look at challenge and stress.
[00:15:33] So, there’s two major ways that people look at stress, the common one which is, why me? Why did this happen to me? What’s wrong with me that this happened to me today, right now, etc., etc. All the different kinds of thoughts that can come from that. And that’s really like resisting the situation that we’re in and asking the question of, which implies that there’s something wrong with us that this happened, which is an assumption that is incorrect. There’s nothing wrong with us that stress happens. You’ve seen the shit happens sure, right?
Cynthia Thurlow: [00:16:07] Yes. [laughs]
Dr. Dave Rabin: [00:16:07] Yeah. So, it’s like every religion and culture has their saying for what to say when shit happens. It just happens. And so, when you think about that, the safety piece is critical piece number one. But the second piece is feeling safe enough to look at stress as an opportunity for personal growth. And then every time, like one of the ancient Buddhist meditators whose name, I’m not able to recall right now, has said that walk people through an exercise, and the exercise was close your eyes and imagine your most challenging person that you have to deal with in your life. Just think about the person who gives you the most pain, the most suffering, the most intensely unpleasant feelings to have to interact with, and then know that person is your greatest teacher.
Cynthia Thurlow: [00:16:57] Yes, I think that that goes without saying whether we find the reframe of understanding that our challenges really become our greatest opportunities to learn, evolve, shift, and grow. And I 100% agree with that statement because I do think that even as a parent, and I was having a conversation with someone recently talking about, I have two children, they’re both the same gender. One child has been fairly easy to raise. He’s a rule follower. He doesn’t like to argue. We talk openly about things. He’s just an easygoing child now, now young adult. And my second born child is completely the opposite. He’s not easygoing. His world is very black and white and he pushes back.
[00:17:42] And I was saying to a friend, I have learned far more about myself as an adult, parenting number two child, because I’ve had to completely parent entirely differently. And it’s amazing how as adults you can get so triggered by your children. So right now, I would say the person in my life that’s teaching me the most is my 16-year-old. And finding ways to count to 10 before I speak. Because sometimes when we speak out of anger, we don’t say things that we want to say. And so, learning to shut my mouth and think before I speak, but also understanding that I’m giving him opportunities to navigate being this very strong, independent young person.
[00:18:23] So, I agree with that statement about, there are people that are our greatest teachers and he’s showing me my blind spots, certainly the things I need to be working on. Now for those that are listening, that are trying to understand some of this physiology. So, autonomic nervous system, parasympathetic nervous system, the vagus nerve, the wanderer, the longest nerve in the body, what are some of the things that are impacted by the vagus nerve that maybe will allow this to be a little bit more solidified in individual’s brain so they understand that this nerve impacts every single system of the body.
Dr. Dave Rabin: [00:18:57] Yeah. So, remember the balance we were talking about earlier. If you think about the seesaw and that the reason why these systems have to balance on a seesaw and why they’re constantly in balance is because they compete for resources. Because both systems innervate the sympathetic fight or flight survival system and the parasympathetic rest and digest recovery system. Both of these systems innervate basically the entire body and control blood flow to the entire body. And the body requires blood to do stuff, none of our organs function without blood, because blood brings all the nutrients and all the fresh oxygen to feed the cells so they can work, and it carries away waste. Cells make waste, just like everything else. So, something has to carry that away and then clean it and flush it out of the body.
[00:19:50] So, the way that the body controls what is active at any moment and what is inactive at any moment is by tightening or opening blood vessels, capillaries that go to those organ systems, like our skin, when it’s hot, your blood vessels dilate and your skin becomes more red, and you release heat to cool the body. And the opposite happens when it’s cold, to conserve heat, to protect the body, and keep it warm. So, there’s all these different things that are happening at all times that are all blood flow regulated.
[00:20:21] And the vagus nerve which is the primary nerve of the parasympathetic rest and digestive recovery system, is governing particularly what happens when we’re safe. Safety in general is a major trigger for the vagus nerve. You can also notice the vagus nerve if you rub your finger on the inside of your ear or take a few deep breaths, not the inside, but the outside of the inside. And then you can also take a few deep breaths. If you breathe in for five seconds and out for five seconds, for three minutes, you will also very strongly activate your vagus nerve. There are lots of ways to do it, but this nerve naturally is the nerve of that parasympathetic recovery nervous system.
[00:21:03] And so, when it gets activated, it tells the body to dilate blood vessels to all the systems that are important for recovery. So, sleep and energy recovery, immunity, digestion, reproduction, and then other things like empathy and emotional connectivity, relational connectivity, because you don’t want that to be getting resources when you’re running from a lion [Cynthia laughs] that would be really bad. So, those systems are in balance to regulate blood flow to those organ systems. And so, when we’re safe we can send all the blood to digestion, recovery, immunity, and the like, and empathy. And when we’re not safe, we want to take all available blood flow and send it to heart, lungs, skeletal muscles, motor cortex of the brain, [unintelligible 00:21:48] center of the brain, all the parts that get us out of a threatening situation or potentially threatening situation to safety.
[00:21:57] So, if that system’s active all the time, because we’re always perceiving that we’re afraid or under threat, which is what trauma is. Trauma is trained threat and trained fear. And that trained fear in the body literally is composed of neural networks in the body that are surrounding this increased activity in the amygdala, the fear center that regulates blood flow. And so all the blood, most of the time, if you’re constantly afraid, if you’re somebody who has PTSD and actual diagnosed PTSD and you’re hypervigilant where you’re always looking over your shoulder for threat, your body is actually taking all the blood flow and diverting it over to skeletal muscles, motor cortex, heart, lungs, all the stuff, and taking it away from digestion, reproduction, empathy, and all the good stuff that you want, sleep.
[00:22:41] That’s why sleep is one of the first things to go when people get experienced a traumatic or extremely challenging unsafe event. So, the good news is we can fix it with a lot of tools that we have. We can help people remember and retrain their nervous system to function and restore balance, but that it just takes a little bit of time and energy, and that’s what Apollo can help with too.
Cynthia Thurlow: [00:23:04] Yeah, and I can’t wait to talk about it. I think for anyone that’s listening, the concept of trauma, we’ve spoken about this several times on the podcast, adverse childhood events. There are a lot of people that have high ACE scores, are dealing with sympathetic dominance, autoimmunity, etc., and just did a great podcast with Dr. Sara Gottfried talking about some of the research surrounding this. So, I want to redirect people’s interest back to that podcast. Now, I want to talk about heart rate variability before we talk about solutions, because I think this is an important concept to understand. I think I see an Oura Ring on your finger. I’ve got one on. Let’s talk about what it represents, exactly what it represents, why variability is so important, and some of the metrics that you, as a scientist look out for when you’re working with your patients, things that identify that someone does not have good balance between their autonomic nervous systems.
Dr. Dave Rabin: [00:24:01] Yeah. So, heart rate variability is an interesting, biometric is the rate of change or heart rate over time. So, the variability of the heart rate. And traditionally, on a scientific basis, it has to be measured in the lab in a quiet environment, sound and electromagnetically shielded room with EKG leads on the skin and measuring somebody at rest for three minutes and that’s how you typically get an HRV measurement. And HRV has now become to be understood through mostly the biofeedback literature, which is the science of breathing effectively. And it’s one of the coolest research fields, actually, of the last hundred years, and now has spun out into lots of other interesting things like neurofeedback as well. But they all started about 70 years ago studying breath with EKG and respiratory monitors and things like that.
[00:24:52] And so the way that the body regulates in large part is through these different breathing techniques that biofeedback has shown that when you enter into a five to seven breaths per minute breathing rhythm, that within about 90 seconds, 95% of healthy people enter into what’s called a coherence state or a cardiorespiratory resonance state, where your heart and lungs are actually working at optimal efficiency. Together, they’re in resonance harmony, rather than dissonance, where they’re working like against each other or not in time. Now they’re pumping oxygenated blood much more efficiently throughout the body with less work. And that five to seven breaths per minute rate is where heart rate variability starts to go up. And that’s also where vagal tone activity in the parasympathetic nervous system starts to go up and heart rate starts to come down.
[00:25:43] And as the heart beats slower, there’s more time between each beat, which is more opportunity for variability, which is why HRV goes up. And so, if you breathe fast and then get into a stressful situation, then the opposite happens, your heart rate goes up. There’s less time between each beat, because now you’re beating like 120 beats per minute instead of 60. So, it’s half as much time between each beat, and then there’s less opportunity for variability. So, each beat is closer to exactly half second apart, rather than sometimes a little more and sometimes a little less.
[00:26:13] So, that’s how measure HRV now through wearable technology, because almost every modern wearable tracking device like Oura Ring, Apple Watch, newer Fitbits, WHOOP, and other devices, Garmin, they all measure heart rate variability, because the elite military and athletic world have now published and shown that much farther ahead of western medicine actually, in this respect, that heart rate variability is one of the best predictors of which, again, heart rate variability as a measure of vagal nerve activity.
[00:26:45] How much vagal nerve activity you have is one of the most reliable predictors, if not the most reliable predictor of recovery. And just how recovered you are, how resilient and adaptable you are, how likely you are to resist illness, how likely you are to live healthy, long life. How likely you are to recover from an illness if you have one across the board. The most reliable biometric we have, you can measure through the skin, can predict all of that stuff. Thats really, really cool because we, and it also happens to also have some predictive capacity in mental health disorders. And we haven’t had objective biomarkers for mental health disorders.
[00:27:22] So, when you think about– we’re just doing surveys for 100 years in mental health either interview surveys or written surveys or what have you to try to track outcomes, but it’s all subjective. Now, we have heart rate variability, so that in people with PTSD and actually many other mental illnesses that are severe, their heart rate variability is very low. So that means they’re in fight or flight mode all the time. And that’s exactly what we were talking about earlier, is really not a conducive state for the body to heal in. It’s a threatened fear state in the body.
[00:27:56] So, seeing that started to lead me to think about in my research what maybe stuff that improves heart rate variability would have an impact on people with PTSD, particularly veterans who don’t really have a lot of options. And so, we started to study soothing touch, and going back to the beginning of the conversation and soothing music and soothing sensations in general really rose to the top of the list. In addition to vagal nerve activation and biofeedback and all of these kinds of things, all of these activities and soothing sensations really reached the top of the list in terms of ability to increase calm and relaxed states in the body and increased vagus nerve activity, recovery, nervous system activity. And we thought HRV, but it hadn’t been studied that much.
[00:28:39] So, we started to explore that and found that soothing touch was actually extremely effective at increasing HRV and vagal tone within seconds to minutes. But in just minutes, you could have a significant increase in your vagus nerve activity without doing anything. You don’t have to breathe with it, you don’t have to move with it, you don’t have to follow any instructions. You can literally just put this gentle, soothing vibration, soothing touch on the body and it increases heart rate variability. And then as a result of that, it seems when people are calmer, they perform better under stress, physically and mentally. And one of those studies was published I think last year or two years ago. So, yeah, so it’s really, really interesting because we’ve never had technology that can do stuff like that before and it’s through touch.
Cynthia Thurlow: [00:29:26] Well, and I think it’s so important because it also gives people some insights into their own behaviors. I think about the things that impact my HRV most significantly, unfortunately travel, travel altitude, sleep quality, food timing, I no longer eat.
Dr. Dave Rabin: [00:29:42] Alcohol.
Cynthia Thurlow: [00:29:42] Alcohol is a huge one. And so, it’s interesting that people have the ability to monitor this metric on their own. And nothing tanks my HRV more than altitude. That’s been a pretty consistent, I think the last time I was in Denver I was amazed. I think my HRV was in the 20s and I’m a middle-aged woman, it’s normally 40s, 50s. If it’s in the 60s, I’m doing great. That’s a great place for me to be. But I think for a lot of people listening understand those lifestyle pieces have quite a bit of significance. Now, I think in another podcast that I listened to you were talking about, when you see an HRV less than 30 or a pulse rate greater than 70, that in and of itself can be a sign of some degree of lack of variability, more sympathetic dominance. Are those the qualifiers that you like to use when you’re looking at your participants and your studies and also your patients?
Dr. Dave Rabin: [00:30:35] Yeah, I think right now HRV is more of just an assistant to what we’re already doing. Because I went to school for 12 years to learn how to [Cynthia laughs] interview somebody and figure out what’s going on with authentic, genuine human connection. So, I feel like HRV is just further confirmation of the state of their body. But there are really interesting occasions where people don’t tell the whole truth. You see patients, people sometimes just aren’t feeling in the mood to talk about what’s actually going on and so you don’t really know and then you check their HRV from their Oura Ring or from one their wearable Apple Health, whatever and you realize that it’s really low.
[00:31:21] I think what matters more is not the exact specific number, it’s more about the percentage increase or decrease at any given time. So, if your HRV is normally 50 and it’s 20 today, and your baseline is 50 most of the time, like at rest, and the Oura Ring is probably the most accurate wearable HRV tracker because it measures mostly at rest and has a really great algorithm for predicting HRV. So, if you look at your baseline and your baseline, as usual, is in the 50s, and then all of a sudden today you’re in the 20s, that is a great indicator that there’s something going on where you either didn’t sleep last night at all, or you went on a bender, [Cynthia laughs] or you’ve just been having a lot of stress lately.
[00:32:08] And that is a really great indicator for us, because then even if you don’t have the opportunity to communicate with somebody and in person download, you can look at somebody’s heart rate variability and understand. Similar to sleep data, sleep data also helps, but you can understand with HRV, this person needs to take some time to just chill and recover, and then there are different things that we can give them to do that.
Cynthia Thurlow: [00:32:32] And I love when Oura essentially tells you you’re getting sick, would you like me to go into rest mode? And the answer is always yes, because it gives you that opportunity without having to look at all the data. Let’s talk about Apollo, how it works. And this is, again, facilitating some of the conversation we’ve already had the value of touch, but how does Apollo work? And I know that this was initially designed to utilize with, I believe, veterans who have PTSD and now is applicable to the general public. Talk to us about this device, because I think that this is something for many people, it’s a really gentle way to help support your body.
[00:33:11] My kids laugh because I’ll wear it on my ankle and then they tell me, please take it off before you leave the house, because [laughs] it could potentially look like I have a home monitoring device, [laughs] but I always remind them, no one thinks the Apollo looks like ankle bracelet.
Dr. Dave Rabin: [00:33:25] Yeah. I actually have had some great random conversations with people that became friends as a result of them making a joke about me, which was hilarious, because obviously it’s not, but it’s funny. And the nice thing about Apollo is that you can wear it anywhere. So, I’m wearing it on my chest right now. Most people who wear it on their ankle actually just wear it to bed on their ankle. I really like how it feels in the ankles, so I alternate between ankle and chest during the day. But it’s unlike other wearables, you can literally put it anywhere on your body, and it will work as long as you can feel it. And it is what we were talking about earlier about how touch is extremely powerful way 100 million years ago, activating the vagus nerve and the safety response system in the body that activates healing and recovery, because it allows resources like blood to go to the healing and recovery systems. That is something that soothing sensations do, like touch.
[00:34:22] And so we thought, working with these, our veteran patients with PTSD, who are really struggling with this obviously low HRV, overactive, sympathetic fight or flight response all the time, when we mapped out, there was enough evidence to justify effectively looking at noninvasive ways, using technology to deliver that vagal safety response to people on the go that they could take out of the office with them and maybe even use instead of medication, because the medications were not fixing their issue and often had a lot of side effects.
[00:34:58] So, this was the challenge that we set out to do. And then through a ton of research at the University of Pittsburgh Medical Center in the Department of Psychiatry from 2014 to 2018, we figured out how to compose these gentle, soothing vibrations that you can actually experience on your iPhone. If you’re listening and you have an iPhone, go to the App Store and download the Apollo Neuro app, and you can hit feel Apollo when you open it. And you can feel vibrations unlike anything you’ve ever felt come out of your cell phone before that have this slow up and down soothing rhythm starting at about five to seven breaths per minute. And this specific rhythm is what allows the body to enter these parasympathetic states very quickly.
[00:35:41] And then it has this nice additional effect of feeling that trains our body to breathe at that rate on its own, which is the rate we’re supposed to breathe at most of the time. That’s one third of our normal breath rate, which is usually 12 to 24 breaths per minute, which is very fast, stress breathing. So, Apollo was technology we developed for veterans to treat PTSD, which it is actually helping with, it seems, from our pilots and early trials, and then we started using it ourselves because we needed to prototype it and test it and see before we made a product and that we commercialize how would people use this in the wild? and would it have the same effects in the real world as it did in the clinical studies, and we released hundreds of devices to over 3000 people in the real world between 2018 and 2020.
[00:36:29] And we saw that people were using it for sleep more than anything else, and that it was reliably helping us and other people manage stress better during the day and our energy and our mood. And that was really interesting, but especially that sleep was the most popular use for it. So, because of that and because it felt so nice to use, we released it as a consumer product in 2020 for everyone, so that anybody could get access to it without a prescription. And now it’s been on the market for about four years with great results, and it’s just changed our lives, which is awesome.
Cynthia Thurlow: [00:37:05] And so there’s differing settings based on what people need. Can we run through that? Because I think this in particular is very interesting.
Dr. Dave Rabin: [00:37:12] Yeah. So, Apollo is, again, music for your body. It’s sound waves that are based and developed on the neuroscience of sound and music and how touch and vibration affect the body. And so, it’s basically the same kind of sound that comes out of your subwoofer. So, if you think about your big bass speaker. So, if you think about what sound does to the body, high energy fast music gives us energy and low energy soothing music calms us down. So, that is actually no different for any of our senses. Intense big flavors wake us up. Big smells wake us up. Lots of fast-moving visual things wake us up. Same with music, same with touch. That is the nature of the way we detect and respond to sensation with our bodies in all the physical senses.
[00:38:06] So, when we started to experiment with this, we tested a whole bunch of different frequencies of vibration that were studied a little bit in the literature. There was some stuff that had come out showing different effects with some different vibration, a lot of studies with electricity, and then a decent amount of studies with sound. And so, we pulled from all of that and were able to figure out what was likely to work. And then we tested it on a whole bunch of people in double-blind, randomized, placebo-controlled crossover studies, where everybody was blinded and nobody knew what they were getting or what any of the vibrations or the placebo or null vibrations were supposed to do. And we saw that certain vibrations can reliably give you energy, which then became like the energy vibe, which is the top in the app.
[00:38:49] And then we had other ones that increased creativity and feelings of calm around other people that became social. Then we had ones that improved focus and cognitive performance under stress, that became focus. Then we had vibes that increased HRV rapidly and recovery after exercise in particular, that became recover. Then we had vibes that increased access to meditative states, and that became calm, which used to be called meditation, but calm also improves access to meditative states. And then we saw vibes that deeply relaxed people and helped them feel sleepy very quickly, and that became unwind and sleep. So, those are all the seven vibes that anybody can choose from on the app. And then we have some really awesome AI features too that can turn Apollo on automatically to help prevent middle of the night wake ups, for instance, using predictive AI. So, there’s lots of exciting stuff that you can get access to.
Cynthia Thurlow: [00:39:42] Yeah, I think for people that are listening, understanding throughout the course of our day. And now my Oura Ring, as an example, will start tracking. I was relaxed, I was stressed, and it intuitively is picking up on that data, and it sounds like the Apollo can do that as well, which I think is really exciting. Now, there’s a topic of conversation that I’ve gotten lots of questions about that I know is an area of your interest as well when we’re talking about psychedelic intervention. So, research that’s ongoing, utilizing psychedelic therapy to help with individuals, as an example, that have a history of trauma. Where are you in terms of your research talking about MDNA or other types of psychedelics and how that can be incredibly impactful for individuals that are trying to heal or process their traumas on their health and wellness journey?
Dr. Dave Rabin: [00:40:36] Yeah, that’s a great question. So, I think backing up for everybody who are unfamiliar with this topic, the word psychedelic means, psyche means mind. delos means to show or to reveal. So, we’re talking about states of mind where parts of ourselves that we were unaware of, we are now aware of, parts of our, what Freud called and Carl Jung called the subconscious, which is what’s beneath our awareness and our consciousness that becomes available to us, and we become aware of different parts of it. It’s a huge amount of material. It’s like 100 million times more down there than what we’re aware of up here. But we start to become aware of parts of it when we experience psychedelic states. And psychedelic states do not require drugs.
[00:41:24] Number one most important thing to understand about psychedelics. Psychedelic states can be accessed with many different kinds of experiences. So, for instance, flow states are considered to be effectively psychedelic states because they change our perception and our sense of presentness and improve our cognition and lots of other things. Dreams are the most common psychedelic state that any of us experience in our lives from early childhood, because dreams are when our ego, our protector survival mind starts to feel safe enough to take a backseat for a minute and allow us to just experience our subconscious material during our dreams. And that is effectively a psychedelic state. Meditation, certain meditation states, yogic states, breath work states like holotropic breath work. There are all these different ways to get there without drugs.
[00:42:17] Psychedelic drugs and medicines are interesting, in particular for lots of reasons, but in large part in the western medical model, they’re interesting because they completely disrupt the current paradigm of the way we think about mental illness to the level of what I would say is the discovery of antibiotics for infection in 1908. It’s that level of paradigm shifting discovery in terms of what psychedelics can do for mental health. And to give you an idea of what that means, prior to 1908, we didn’t really have a good understanding of germ theory that was widely accepted as germs being the cause of illness and infection, which we now know to be true.
[00:42:58] And with that, in 1908, came the discovery of antibiotics, the first one being penicillin, that basically turned infection, which was something that, up until that point, could not be cured at all or easily, and was a major leading cause of death terminal illness, or having to have an amputation as a result of getting a wound, a physical wound. It turned all of that into many years of extended life. An infection is something that could be rapidly cured in most cases. Change the world forever, the entire world was one of the greatest discoveries of all time, is considered to be taking something that was a terminal illness of humanity, infection, and transferring that into something that we can now use the cure word for.
[00:43:47] So, that is where we are at currently with psychedelic medicines and mental health, where we are still in a paradigm, hopefully coming to the end, where we are prescribing stabilizing medications for life, which really should be taken in the short term, like SSRIs and things like that help stabilize somebody at a time of great distress, but are not necessarily great long term unless somebody’s doing the work and doing the therapy and the self-healing work. Because the healing has to come from in here. It doesn’t come from the SSRI. And even with the antibiotics, the antibiotic doesn’t kill the bug, weakens the bug so that we can kill it. We are the ones that heal ourselves. And even all the medicine traditions of the past all describe this.
[00:44:37] So, I think in the next 5 to 10 years, we could be using the cure word for mental illness because of what we’re learning from how psychedelic medicines work and how to use them with psychotherapy, with intensive therapy, it’s not just taking a psychedelic drug, but using them together has these tremendous effects that are actually long lasting a year or more out, people are getting better with treatment-resistant PTSD with just three doses of MDMA over 12 weeks with 42 hours of therapy. So, that’s a pretty astounding figure. And it really is incredible for our field.
Cynthia Thurlow: [00:45:15] Yeah, it’s exciting for me just haphazardly probably a month ago, admittedly, I was on Netflix and there’s a documentary by Michael Pollan talking about psychedelic therapies and did it in a very objective, nicely formulated, integrating the history, the scientists who were at the forefront. And for me it was really interesting as someone who– I was an ER nurse before I was a nurse practitioner and at the time that I was a nurse, worked across from one of the biggest psych hospitals on the east coast. And so, for me, we did a lot of intake and what really left me with an indelible impression taking care of so many patients was that we really didn’t at that time, and this is the 1990s, early 2000s, we just didn’t have enough options for people to be able to help support them. So, I love that this disruptive state has come and is challenging people’s belief systems about how to address the significance of trauma.
[00:46:14] Well, Dr. Rabin, I always love our conversations. I would love for you to share with listeners how to connect with you on social media, learn more about your work, get connected if they would like to learn more about the Apollo or more about some of the topics we discussed today.
Dr. Dave Rabin: [00:46:30] Yeah, absolutely. Thank you so much for having me. I always really enjoy our conversations. This is really fun. People can reach me at my website, drdave.io or apollo.clinic and you can find me on socials. I always love to hear from you. If you have questions or you’d like to learn more, please reach out. And I’m @drdavidrabin on Instagram and Twitter. You can find Apollo wearable at apolloneuro.com or wearablehugs.com, which is what the kids call it. And you could find me on Apple Podcasts and Spotify at The Psychedelic Report and Your Brain Explained, which are two shows on the latest psychedelic news and consciousness respectively, and translating some of this modern neuroscience stuff into language that everybody can understand, which is really fun. So, I hope you reach out.
Cynthia Thurlow: [00:47:26] Thanks so much. I enjoy your work.
Dr. Dave Rabin: [00:47:28] Thanks so much, Cynthia.
Cynthia Thurlow: [00:47:32] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.
