About Our Guest- Dan Engle – Integrative Psychedelics
Dr. David Rabin, MD, PhD, a board-certified psychiatrist and neuroscientist, is the co-founder & chief innovation officer at Apollo Neuroscience, the first scientifically-validated wearable system to improve heart rate variability, focus, relaxation, and access to meditative states by delivering gentle layered vibrations to the skin. In addition to his clinical psychiatry practice, Dr. Rabin is also the co-founder & executive director of The Board of Medicine, and a psychedelic clinical researcher currently evaluating the mechanism of psychedelic-assisted psychotherapy in treatment-resistant mental illness.
Full Podcast Transcription
Dr. David Rabin 00:00
There is there’s no risk to using Apollo as often as you like people, usually when they first get it, they use it multiple times a day every day and wear it all day. And then over time, somewhere between three and six months, we start to see people really taper off their usage to use the device more intentionally. So instead of using it all day, they’ll use it a couple times a day specifically to wake up and to fall asleep or specifically to fall asleep and to focus. And that has been really interesting because people were seeing or not becoming dependent on it. They’re using the tool to teach them how to do this on their own. I think that’s really the goal of all this is to empower people to understand that we have the ability to change the way we feel.
Diva Nagula 00:41
Hello and welcome to another episode of From Doctor to Patient. Today I’m pleased to have Dr. David Rabin. He is a board certified psychiatrist and neuroscientist is the cofounder and chief innovation officer at Apollo Neuroscience, the first scientifically validated wearable system to improve heart rate variability, focus, relaxation, and access to meditative states by delivering gentle layered vibrations to the skin. In addition to his clinical psychiatry practice, Dr. Rabin is also the cofounder and executive director of the board of medicine, and a psychedelic clinical researcher currently evaluating the mechanism of psychedelic-assisted psychotherapy in treatment resistant mental illness. Dr. Dave, thank you so much for being on the show this afternoon. How are you?
Dr. David Rabin 00:41
Good. Thanks. Thanks so much for having me. Dr. Diva, it’s a pleasure to be here with you.
Diva Nagula 00:41
You know, I really have been looking forward to this conversation because you’re like my hero, because you’ve accomplished so many things, you know, in the field of medicine, and on the cutting edge of psychedelic-assisted therapies in regards to research, and also you’re an adventurer, so how do you balance all these things? I mean, what does your day look like?
Dr. David Rabin 00:41
That’s very kind of you. First off, I really appreciate that. And, but I think, you know, I, I’m in relatively early stages of all of this, you know, I, by no means, you know, at the end of my career, so I’m, I’m really, you know, I’m working with a lot of people who are like minded to start a lot of important Well, we all agree to be, you know, and the we the greater we as you know, the teams that I work with in these different organizations like the board of medicine, and Apollo neuroscience and my clinical team and my clinical practice, and, and we all see eye to eye on the way we believe health should be delivered, and that we all need to focus on, for instance, the least harmful treatments. First, the most safe treatments first as the first line, which is, you know, typically tends to include a lot of natural interventions, a lot of mindfulness interventions, psychotherapy and things of that nature. And then, you know, stemming out into more gentle medicine approaches, rather than going directly into something that could actually cause a significant amount of suffering. effects for someone or make their symptoms worse. And so I think that core principle, being something that we all are passionate about, because we’ve all been touched, to some extent by the opioid crisis by the PTSD crisis by COVID, right, there’s nobody who hasn’t been affected by this kind of stuff that’s going on. And these are public health issues that actually have solutions. But it’s hard to see the solutions when you’re stuck, just looking at it from one perspective. So we, you know, starting out in 2014, I think when we really started doing a lot of this work, it was about surrounding ourselves, believe it or not, with as many people from different disciplines who are not artists, upland, as well as people in our discipline, who are experts, but people from lots of different disciplines, people from, you know, psychiatry, but also the business of medicine, right, the business of in health insurance, business, in general financial financing, and marketing engineers, as software, hardware engineers, people that we normally wouldn’t interact with, who all have their own perspective on the way to do things. And then we take the best of those ideas and bring them together. And everyone, once every, you know, you come to consensus, and everyone agrees, you end up having a much more powerful thing that you’re all striving for, and you’re much more likely to get there.
Diva Nagula 06:15
Exactly. And it’s great thing to be around people who are like minded because it makes things so much easier, and it flows so much better. And as I’ve been doing this work in, you know, spiritual growth, and development for last two and a half plus years, it feels like the people that I used to surround myself with, I don’t really connect with anymore, and whether it’s because I’m vibrating on a higher level, or whether it’s because I’m just more in tune with people who are like minded, and it’s just easier to connect with those type of people. Now, I like to think it’s a combination of the two, but it really does make a difference on who you surround yourself with. I mean, if you surround yourself with people who are negative and bring it down, that’s going to be likely your mindset. And that’s what’s going to happen. And so, I’ve always preached with my previous podcast guests, it’s like, you really need to surround yourself with the best of the best to enable you and to elevate you. So in that sense, you know, with all what you’ve accumulated in terms of your knowledge and expertise in healing people, I really want to understand your hierarchy or algorithm in treating a patient with depression. So like, as a psychiatrist, espoused in Western philosophy, and Western medicine, and then also with a mind that is also surrounded himself with spirituality with Eastern, so I’m that way too, and I understand where I want to tackle a patient that’s fighting mental illness, I like to just take a little deep dive and understand what your approaches are.
Dr. David Rabin 07:49
Sure, yeah, I’m happy to, I think, you know, speaking of depression is one example. Because it’s probably the most common mental illness that, you know, we’re facing in our society to date. And, and there’s about, you know, probably 30 to 50% of people who receive the gold standard of Western medical treatment for depression are not achieving sustained symptom remission. Right. So we’re, we’re seeing I think, interestingly, the same for PTSD, the same for a lot of anxiety disorders, we’re seeing that a very substantial percentage of people who meet the diagnostic criteria, by the book, the DSM, are not achieving symptom remission, they’re not recovering significantly, with the treatments that we have available today. Right, that are that are in the western on the western side. So that automatically presents to us an issue that needs to be tackled, right. And so I think, from my standpoint, I think the, you know, having been in the western paradigm and trained in the western paradigm, seeing it from the inside, I think one of the biggest problems with it that I recognized is that when we focus on the way we talk about Western psychiatric medicine approaches to a patient, I think it’s very disempowering for the patient. And what I mean by that is that the patient often feels that, that they have to continue to take something like a medicine, or they have to go to therapy, they have to continue to engage in treatment, that requires things from outside of themselves to get better. And all the therapists that I talked to, that I know that I work with, or that I’ve known, and all the doctors all agree pretty much that it’s always up to the individual, that to be the deciding factor in the healing process. And we all as individuals have to do our own work. That being said, the system itself is teaching people with giving them a diagnosis that is something that they you know, then apply to their identity, going back in time and forward in time, seeing the statistics about how people with depression almost never fully recover. Seeing that if you take an SSRI, you have to keep taking it every day for the rest of your life or You are likely to relapse right? That is not a promising none of those statistics are promising to present to patients. They are real statistics. But they are also skewed, based on the fact that they are pulled from a paradigm that is administering medicines in a way that makes people feel like they are, they require the medicine to get better, and that they have an illness that is biological in nature, it’s more than it is environmental in nature, which is a fundamental flaw in terms of flawed assumption about depression, depression. There’s no evidence today that any mental illness, but particularly depression, is related to any biological, genetic hereditary imbalance that is, like inborn into our bodies or our brains, that is causing our depression. There is all the evidence to say that environmental stress and stress from trauma, past trauma and then stress that we’ve been imposed on ourselves because of unprocessed past trauma is much more likely to be resulting in the ultimate diagnosis of depression or PTSD, or whatever the the symptoms describe. But the diagnosis is just a pattern that we use as doctors to communicate symptoms to each other, and understanding of treatment paradigms, but it’s not for the, it’s not for the client, it’s not actually for the patient to use that word is not the diagnosis is never useful to them, because it creates an illness identity disorder that, you know, doesn’t necessarily manifest as a disorder. But the illness identity, this association of I’ve, I have depression, meaning I’m a depressed person, and I always will be, is fundamentally counter to the nature of I have an inner healer in myself, which is the eastern tribal approach and the psychedelic medicine approach, I have an inner healer inside myself, that is always able to heal me, whether it’s physically or mentally or emotionally, as long as I nurture it, and I allow it to heal me. And, and those practices of things like gratitude, forgiveness, compassion, self love, are some examples of things that can help nurture that inner healer that then allows us to recover more effectively on our own doesn’t mean these tools of medicines and strategies are not helpful assistance, they just need to be used properly.
Diva Nagula 12:17
Yeah, I think that’s a huge realization is that these labels of disease, actually, it doesn’t empower the person to look into themselves inward and utilize their internal healer, right, it’s just a label that replacing on an individual, and we’re feeding into the disease process, oh, something is wrong with you, here is a pill to make you feel better. So as you were alluding to, they’re looking at an external means to improve their outcome. And that’s so counterintuitive to how healing has traditionally taken place, you know, through the millennia, and I, it’s all about our wording and how we we phrase things, and you beautifully said it’s like, that’s, that’s a fundamental thing that we need to start doing as a society, not even in the medical society, but as from peer to peers, and as some relationships, but absolutely in the field of medicine, and we need to stop using these labels. It’s just devastating to people, oh, you have chronic pain syndrome, you know, or you have, you know, chronic fatigue syndrome, you know, something, we just don’t want to use those words to place labels on people, it just marries them to a specific illness, that’s not necessarily our product of who they are.
Dr. David Rabin 13:35
Right? Right. And it’s, it’s not an accurate representation of who they are. Right? It’s not like even just the word chronic saying that you have a chronic illness or a doctor telling you that you have a treatment resistant illness, I mean, there’s fewer things as doctors that we can do in one visit that is more destructive than telling someone that, you know, it’s really just extinguishes hope. So then how do we, how do we work together as a team with the client to to invigorates hope, right, rather than to extinguish it, I think, is the challenge. And that’s, and a lot of the answers to that question come from the studies of tribal medicine, Eastern medicine, and actually be ancient Western medicine, the origins of Western medicine, which comes from Hippocrates, and my mommies, who used all of these techniques of what they call the art of medicine, right, which is building a relationship and a foundation of trust with your patient that facilitates the healing experience based on a fundamental belief, which hopefully is becomes more than a belief that becomes like a knowing that we all have the ability to heal, we all can heal. And that hailing starts with as the pocket he said, I think he said, Let food and nourishment or something be thy medicine. I’m terrible with quotes, but that was the gist. Right? And so we we have access to all of these different tools around us. But the but it’s up to us to, to nourish those healing parts of ourselves that allow us to recover on a continuous and sustained basis, right, not just having a short term like, Oh, I, you know, I feel numb to my anxiety right now. So I feel better. That’s not a long term solution, there are actually very potent and powerful 1000s of year old long term solutions that I found are very helpful when I use them as first line treatments for people with any mental illness. And I never give a diagnosis to any of my patients, by the way, and my patients will tell you that, because again, I feel that it doesn’t serve them. Do I talk about what diagnosis I think they have with my, with my colleagues that are working on the case together, of course. But that’s, that’s companies, right, or the insurance companies. But it’s not, it’s not something that’s useful to the client. So it’s not something that we focus on and in any way. Yeah, exactly. And it really, and they, and they appreciate that actually.
Diva Nagula 15:57
I think that’s part of their healing by not hearing what’s wrong with them. And it’s just enabling them, and giving them positive feedback, and telling them that they have the power to heal themselves. And, you know, and that’s interesting, I wanted to find out like, so do you still use conventional medicines and pharmaceuticals, for your patients? You know, and I’m assuming this is in short term, while you are able to employ different tactics and strategies to help that person, you know, heal themselves? Right?
Dr. David Rabin 16:21
Absolutely. So I do use traditional Western medicines, I also use a lot of natural, you know, tried and true safe supplements. I think that the the difference between the way that I use medicines now, and the way I use them in my training, or the way we were taught to use them is that when I give a medicine to a patient now, whether it’s this antidepressant, anti psychotic, or, you know, you name it, prescription that they need, we’ve already tried a whole bunch of other stuff, right, we’ve tried a whole lot of other stuff, they’re still struggling. And I explain the medicine differently. Now. Now that I’ve had more learnings in the Eastern and tribal approaches, and the psychedelic approaches, I explained the medicine, similar to the way that I would explain to somebody about how ketamine works. So I would describe it as you know, the medicine is a powerful tool that has the ability to show us a way that we can feel right away that we are a new state of being for a certain window of time. And it does so through a biochemical process. Similarly, you can induce a different state of being with a musical process or a vibrational process. In the case of Apollo, right, there’s lots with touch, there’s so many different ways that we can do it. In the case of medicine, it’s biochemical. And so that state change is, is a state in which we have the opportunity to feel to know that we have the ability to feel different, right? We have the ability to feel focused, in the case of amphetamines, we have the ability to feel not sad all the time. In the case of SSRIs, we have the ability to feel a little bit less anxious. In the case of some times when other people use us Arise for OCD and severe anxiety disorder, we have the case that the experience of knowing that we don’t have to hear voices in the case of antipsychotics, right? Because people can be plagued by these symptoms like plate like 24, seven non stop brain just doing crazy things that they don’t feel they have control over. So you show them for a brief amount of time, that hey, when you take this medicine, this medicine is going to show you what it feels like to be in control of this experience. And then, as they’re taking the medicine during the the course of the medicine, which is not forever, it’s like, you know, we aim for six to 12 months at most, that there is a very specific set of skills that they practice to reinforce what they’re doing, what the medicine is doing for them so that they end as we do a taper off of the medicine so that they understand how to use their skills that we’re working on to enter the states on their own. And that’s ultimately the goal is the medicine is a teacher. And the experience is teacher and every every experience in every medicine is is it a tool that helps us understand how to overcome challenge better in our lives.
Diva Nagula 18:59
And at what point would you start considering the tools of psychedelics?
Dr. David Rabin 19:48
That’s a that’s a good question. So, you know, I think that we’re at a really interesting
time. As you know, in medicine, as we were talking about earlier, where we have access and evidence now for the use of many psychedelic medicines that show that when used properly, according to protocol, they are actually a lot safer in terms of side effect profile than many Western medicines. And ketamine is a perfect example, it’s legal, it’s an anesthetic that’s been safely used since the 19 6050 6070s. And it is extremely safe. And at the doses we use in mental health, it’s extremely safe, and people almost never have any side effects from it. And it’s a very, you know, we do a short course of, you know, anywhere from nine to 12 sessions and, or six to 12 sessions in over a three to six week time period. And, and different people do it different ways. That’s one of the way that we do it with, you know, with the cap protocol with Dr. Phil Wilson and, and the medicine is incredibly powerful. And the experiences that people have in a six to 12 week, I can tell you in a six to 12 week time period, sorry, in a three to six week time period with six to 12 doses of ketamine. I have seen transformations and people that it takes years to achieve with SSRIs and psychotherapy, amazing. Yeah, it’s, it’s incredible, I’ve actually been able to witness some of those things with patients who have been suffering from treatment resistant depression, which is the indication of ketamine assisted therapy. And in these cases, these are patients who are on you know, are polypharmacy, you know, multiple medications to treat their depression, and helping them with sleep. And, and and a lot of these people have, you can just look at them, you know, they’re they’re obese, because of the side effects from the antidepressants there, just continuously have in display this, this depressive effect. And I have seen and I’m curious about your protocol, because I wasn’t aware of Wolfson’s was protocol, I’ve been doing four sessions of escalating doses of ketamine over a period of two weeks. And I’ve used an integrative approach where I also combine that with diet modifications, so we can stimulate the gut to produce more serotonin. I’m sure that you’re doing that on your own as well. And and some other modifications, that’s more of an integrative approach. But yeah, and usually after one to two sessions, you can just see the light in their eyes. And it’s, it’s fabulous. And then it’s, it’s rewarding, because then they empower themselves, and they can feel that they have control over their emotions or their feelings, and then you start to taper off there to no depressants, you know, and then it’s a little tricky sometimes. But yeah, then they feel even better. They’re not dependent on those medications. So for my own knowledge, are you doing escalating doses when you’re doing these six to 12 sessions of ketamine? Or is it literally the same, you know, dosing structure? It’s actually it’s a case by case basis, I think it just depends on the patient. But but more often than not, they actually stay at a steady dose all the time. And occasionally, they will go up. But we do I do a lot of oral lozenges. So the dosing is, we jump up by 25 milligrams each time. So in terms of how much is absorbed, so you don’t we don’t have lots of just for every guest, so we do 25 5075 and 100, most people fall into the 75 category. Occasionally very sensitive people fall into the 50 category or the 25 category. But I didn’t answer your question earlier, actually about protocol because I didn’t, I did. You know, I think that is an interesting thing to talk about. And the way that I usually work with my clients when they come in, actually always is we start with a overview of what their what their life is like, right? And, and you know, what is your What are you struggling with? What is your lifeline and just, you know, gather as you as you do, and as most doctors and therapists do gather a very thorough history, understanding, you know, what are your stressors, what are you struggling with? And then also, what are you eating? Right? What are you putting into your body? How much movement are you getting? What what drugs are you using? What substances you put your body, what pharmaceuticals what prescriptions Do you have, what supplements Do you take a lot of people don’t think about supplements, but supplements can actually cause harm to us if we misuse them and many people most many of my patients actually overuse several Which is very, very common. And it’s not it’s not a, you don’t have to be, you know, a rocket scientist to, you know, navigate it. But it’s confusing, it’s legitimately confusing the way that supplements are sold. And the way that they’re told to us, many of them are, are they’re, you know, they want to sell more pills are more products that they recommend higher doses to people and, and that, you know, people don’t really think about that. They’re like, Oh, somebody’s telling me to take it at this dose. That’s what I’m gonna take. So, so a supplement review and a medicine medication review is one of the first things that we do. And then we recommend scheduling, lifestyle changes, supplements and medication modifications that are the basic things that we can do nutrition, recommendations, and behavioral stuff to start. Then, in terms of real interventions, sometimes we add a couple of supplements on usually, you know, some non psychoactive cannabinoids, Phyto cannabinoids, like CBD CBN, these things can be really helpful for people for lots of different inflammatory issues and mood issues. And then Apollo, of course, which is extremely helpful for just helping retrain the body to be in an autonomically balanced state, and it has no side effects. And we’ve tested it on lots of people, a lot of the work at the University of Pittsburgh, and now in the real world with 10s of 1000s of users. So it’s been really exciting to see that that’s been extremely helpful. And it’s very empowering for people because it’s not drunk, right, so you can just you can just press a button on your body. And, you know, the gentle vibrations remind us that we’re safe in the moment, and that we can enter a state of calm or enter a state of focus or meditation or relaxation, when we want and without without so much resistance and pushback. And then from there, actually, I go into more intensive psychotherapy, usually, you know, psychotherapy and talk therapy is a component of all of this, which is a combined approach of lots of different psychotherapy disciplines. But we so we customize it really to each person. And then I actually go into psychedelic medicine with ketamine, which would be ketamine assisted psychotherapy sessions. And then if people if people do not achieve, what their hope, what they hope to achieve from the ketamine-assisted psychotherapy sessions, which is very unusual, and we would then move on to thinking about prescription medicines. And this is specifically for depression, that be a punishment. And would you consider? I mean, I know, I know, it’s at this time, it’s in clinical trials. And I’d like to hear more about your experience as maps trained therapists. But at what point would you find it useful or appropriate to introduce a patient who’s to consider MDMA assisted psychotherapy? So I mean, you name the challenge, right? So the challenges is the legality and access. So there are lots of people out there, you know, the, this the results from the FDA phase two trials, and the update from the phase three trials, I mean, the results are outstanding, and they’re better than any results we’ve ever seen with any medicine for mental health disorder ever. And, and they really reinforced this understanding of this in nurturing this inner healer. Because there’s more people who are better at one and five years out than there were right after the treatment protocol, the 12 week treatment protocol ended. And there were no additional treatments administered, right, more people are better. After years later, that never happens. So that is something really fascinating in terms of a paradigm shift, which is three doses of MDMA, for PTSD, that is really incredible. And so but this medicine won’t be available to us legally, likely out of outside of a clinical trial, until 2022 2023. And that’s, and that’s unfortunate, because, you know, we wish we could have it sooner and cross our fingers, maybe something will happen, but that’s what it looks like right now. And so the problem is that if you if you’re a licensed physician, who’s board certified, you can suffer consequences legally. If you administer these medicines, underground, or however and, and for many of us, it’s just not worth the risks. So, you know, ketamine is legal. And that’s what we focus on predominantly, because when ketamine is administered properly, the ketamine assisted psychotherapy protocol that Phil Wilson developed is actually very, very similar to the MDMA protocol, but it’s condensed into one three hour session instead of an eight hour session where you sleep over afterwards. So it takes a little longer, you know, it’s still within the 12 weeks framework. It’s just more doses of ketamine than of MDMA. So there I think I would love to use MDMA as a medicine. I think we’re so close to getting there and to be able to do that more effectively. And I would love to be able to refer people to that. Unfortunately, I don’t often because you know, we have a very limited way for people to access these treatments. I have sent To the clinical trials, and you could check email@example.com. And look into the MDMA trials, which are recruiting subjects currently, for with with PTSD, and there’s also the Hopkins study, which is a great place that is doing psilocybin administration for depression. And I believe for terminal illness as well like cancer, and things of that nature. People can go to Hopkins, and it’s an open label trial. So So anyone who meets their their study criteria, these these studies are currently recruiting and you can participate In going back to MAP – so the phase two and three trials, they’re specifically for patients with PTSD, correct? Or is it other mental health disorders? Specifically PTSD, right.
Diva Nagula 28:21
And then the studies? I mean, from my understanding, it’s, you know, after it, I can’t remember if it’s after the 12 weeks of the three MDMA sessions along with psychotherapy, it’s like, Is it a 60%? Not only improvement, but….
Dr. David Rabin 28:34
It was like 52%. improvement right after.
Diva Nagula 28:37
Where they no longer meet the criteria of the definition of PTSD. Right?
Dr. David Rabin 28:41
Right. They no longer meet diagnostic criteria after being treatment-resistant for an average of 17.6 years.
Diva Nagula 28:48
That’s incredible. And then it actually, the percentage improves after more time has elapsed.
Dr. David Rabin 28:55
Right. So at one year, and I believe at five years, that percentage increases to 67% of people no longer meeting diagnostic criteria. I mean, what could be better evidence? I mean, I I personally, spent a lot of time thinking about this, and I can’t think of any other explanation for what’s happening. Yeah, can you?
Diva Nagula 31:41
Yeah, yeah, exactly. It’s a wonderful to be a part of this process at this time of our lives, and to see that there is potentially a cure for, you know, mental health illness, and which is well needed, especially during the times that we’re living right now with COVID, and lot of people are suffering from depression and anxiety – I really hope that the legalization will occur sooner than later. But out of curiosity, what are you anticipating? When they do approve of this for depression or PTSD? Is it going to be something that’s offered by physicians across the board psychiatrists? Or, you know, what do you think is how it’s going to be delivered to patients,
Dr. David Rabin 32:21
I believe that you don’t have to necessarily be a be an MD to be one of the therapists. But there has to be an MD, who has a license to use the medicine, right? To write the prescription. So as long as you have an MD present to write the prescription, then I think you can have a PhD level or Psy D level psychologist, therapist, as well as a non, a non graduate level therapist can sit together. And if a doctor is present, that’s great, but doesn’t have to be an MD doctor, and the two therapists will administer the treatments, and everyone would have everyone who’s administering the treatments, those eight hour therapy sessions, and the integration and preparatory work over the 12 week period, would have to be trained by somebody that maps and the FDA approval because the FDA has basically from my understanding is they’ve approved maps, the multidisciplinary Association for psychedelic studies, as their protocol is the protocol. And so you have to be trained by them or someone that they have approved to be able to legally administer MDMA, and I assume there’ll be a trade, there’ll be more training, there are training programs now. And I assume there’ll be a lot more will be popping up the board of medicine, actually, we are working on our own training programs, and also helping to helping people distinguish what are the best training programs from better the gold standard from those that are less than such by offering a peer reviewed evidence based certification for those training, so that I think that, you know, it’s worth collaborating in this way. You know, again, across disciplines, I think it’s really important to make sure that, you know, we maximize the information and educational opportunities available to clinicians so that they can deliver better public health. And that’s how the transition, that’s how we evolve healthcare. Right. So start with that start with the doctors.
Diva Nagula 34:17
Exactly. No, it’s it’s well, point. It’s great point. And I look forward to you know, when these programs come out, you know, I definitely have partaken in some underground programs where I was administered MDMA and and it’s been life changing for me in terms of the use of psychedelics. And, yeah, I’m really looking forward to when this can be legally given to people above ground in a more controlled way where the treatments and and the patient’s healing is more optimized. We’ve been talking a lot about pharmaceuticals and medications to help with this process. And obviously, you know, you were talking previously about Apollo, but Asides from Apollo, which we’ll get to in just a moment. What other modalities Do you employ nonpharmaceutical for your patients in the treatment of mental health disorders.
Dr. David Rabin 35:05
So I think the major, the major modalities that I work with are, I think, as, as a psychiatrist and a therapist, a lot of them are thought tools. And cognitive practices that are a combination of Eastern and Western practices, as many of them are, that I didn’t come up with. I didn’t, I didn’t make these up. But they’re things that have existed for a very long time that I have personally found very efficacious, that I know have worked for many, many other people. And there’s lots of there’s lots of things to talk about. But I think that these really formed the foundation of the work that I do with people, which are, as I mentioned before, the four pillars which come from South American tribal medicine, and there’s four pillars like this and other traditions like Buddhism, and traditional Hindu medicine, and Ayurvedic medicine. But the four pillars that we focus on are self gratitude, self forgiveness, self compassion, and self love. And these pillars are called the four pillars, because they formed the foundation of trust in ourselves. And by practicing them to nurture them is skills, like the way we would go and work out our muscles in the gym, we are rewiring our brain to take in a gratitude focused approach, rather than a self deprecating or self critical approach first, as our first go to, right. And so that that retraining of of ourselves by just practicing a new pattern, a new way of thinking first about something with gratitude, rather than fear, for instance, is an approach that is very easy to do and takes very little extra time out of your day, because you can take it with you. And so we really spend a lot of time working on education about these skills and why they’re important. And then also just how to practice them throughout your day. And one of the ways is breathwork. Right. So so being grateful, when you’re stressed out when you’re anxious, worried, being grateful for the opportunity to just take a breath in that moment, allows us to center ourselves and bring our focus of control back to something that we have control over. Right. So we don’t necessarily talk about this enough. I don’t think we’ve talked about it enough at all. But the source of our anxiety, for the most part in our day to day lives, is that we only have so much attention, we only have so much time to attend to things in our day, and bring them into our awareness, right? If we are devoting a significant amount of that attention to things we don’t have control over, we will feel out of control. And that will make us feel anxious, worried, restless, etc. However, taking the opportunity to express gratitude for anything, but particularly for our breath. And in the in this moment, being able to feel the air coming in and smell the air and feel our lungs filling with air and then out instantly sends a signal to our brain says if I have the time to pay attention to this feeling of air coming into my lungs right now in my windpipe in my in my chest, I can’t possibly be running from a lion in the smoke. And the same thing happens with soothing touch. And the same thing happens with soothing music. And this creates a subconscious loop that helps to remind us that we’re safe. And then we can approach our decisions or situation in our experience, whatever that is, from a position of safety of control of agency, rather than a position of weakness, fear and austerity. So those little mindset shifts combined with the practices like breathwork, which is one of the most I can’t emphasize enough, the most important and free practices that we can have, that we can have access to, is so critical. And then adding other things like basic stretching with the breathing, a little bit of yoga, gentle yin yoga with breathing is so amazing. calms people down so much soothing self touch pressing on your chest, pressing on the inside of the outside of our ear has a vagus nerve terminal, the chip pressing on the chest activates the Vegas nerve, gently rubbing the side of our neck will activate the vagus nerve pressing on the back of our heads below the neck line, the nuchal line of our skull, the base of the skull can activate the vagus nerve. So there’s all these different things that we can do, that are available to us in any moment. And some of them are easier to do than others. But tapping right is an interesting one too. So. So that’s that’s sort of what I predominantly focus on.
Diva Nagula 39:30
And yeah, you’ve brought up a lot of tools. I mean, these are incredible tools, you know, with breathing it’s is it’s obviously available to us at any time. And it’s the one action that we can perform both consciously and subconsciously. So it’s very unique in how we can regulate our nervous system, and using them in conjunction with all the things that you’ve mentioned. I mean, I can only imagine, you know, the benefits the escalating benefit with the stacking of these modalities that people can get. And yeah, I had an episode that I did with someone who was versed on on the EFT practices, which is a tapping that you mentioned, and it’s wonderful to see how that can be employed. And just by applying some pressure to various meridian points of the body, and how that can eliminate the potential of any emotions from actually sinking into our bodies and helping it to release. So it’s very valuable. And then, of course, you know, which I’d like to talk to you about for a few minutes is the you can also use the Apollo. And this is a wonderful device. And as a pain management physician, it was making me think how this works, right? Because, you know, when we’re talking about pain, you know, we can actually block specific receptors, by applying pressure and vibration to a large nerve bundle, that actually closes the sensation of pain that’s going into the body, it’s almost like when you’re you rub your elbow against a doorknob, and you feel that discomfort, and then the immediate thing you do is, subconsciously, you put your other hand and you start rubbing it, and that eliminates that, that pain sensation, you know, because you’re stimulating the nerve fibers. So tell us the technology about Apollo and and how it actually works.
Dr. David Rabin 41:08
So this technology is a wearable, it’s about the size of an old Fitbit. And it’s the first first version, and it can be worn on the ankle or the wrist. And we developed out of research at the University of Pittsburgh on treatment resistant PTSD and treatment resistant depression, and trying to help people, because because what we found was that the body was showing signs in people who had these disorders, was showing signs. And people were saying that they were not feeling safe, they were feeling afraid all the time. And fearful all the time. And their bodies were showing it they had a high resting heart rate, much of the time, low heart rate variability, which is a sign of resilience and balance of the nervous systems, the autonomic nervous system. And we see lots of these signs over and over and over again, that have been published literature showing this, this imbalance and and with these disorders that we said, okay, well, if people are not feeling safe, what helps them feel better. And the natural techniques that help them are the same ones, we’ve been talking about soothing touch, soothing music, you know, deep breathing and mindfulness exercises, but those techniques either are difficult to use in real time, or they require 1000s of hours of practice to get really good enough at them to use them in real time under stress or under perceived threat, like to get out of a flashback if you have severe PTSD, for instance, right? So what we were trying to do, the challenge was at the university, and this was starting in about 2014 was how do we cope with the technology that people can take out of the office, because we can help people feel safe in the office, that’s what we’re good at. But when they leave, they oftentimes feel terrible again, and we don’t have
anything to give them other than medicine. So and these techniques that require tons of practice. So could we make something that taps into the evolutionary pathway of safety, the most, most evolutionarily conserved safety pathway, which is Touch, touch has been the best way to deliver safety signals to the brain going back 10s of millions of years to ancient mammals. And, and so it’s, it’s highly conserved in us. And that means that the pathways of soothing touch on our skin to the safety part of our brain that were the fear Center, the amygdala is very strong, very, very, very strong, and very fast in terms of of a pathway. So he said, can we figure out the right signal to send to the skin to induce these states of safety that people can achieve with deep breathing or meditation or yoga or stretching or any other thing. So we just started diving into the literature reviewing everything that anybody had done on any kind of stimulation to the to the body,
electrical sound, vibrational, whatever, massage, and then try acupuncture, try to understand what worked the best what didn’t work for people. And then in the lab, doing experimentation with ourselves and with other people at first, and just trying to figure out what patterns worked. And then one day, we finally found a pattern that is actually the clearing focus setting, which was the first pattern that we discovered and we put it on, and it was the first time that we put it on and we instantly felt so nice. And and it just just amazing. It was and it felt it felt nice, but but not sedated, right. It was like it was like flow, it was like clear and focused flow. And then we call the the freshness and we put it into a wearable prototype that my wife raised funding to build who’s the CEO of Apollo neuro, and the business brains of the operation and then she and then we tested it on 1000s of people in the real world and in some clinical trials. And we showed there was repeatability of the findings. And we show that not only could we repeat that, that one clear and focused experience, we also created an algorithm That helped us to understand from our clinical trials, that slight changes to these patterns could produce relatively reliable outcomes and people in terms of shifting of, of wakefulness up or down, or, or energy up or down or mood, and up or down. And, and some other things too, like pain, modulation creativity. And it’s all by changing the signals that we’re sending to the touch receptors in the skin, which change the way that our brains perceive how safe we are. And the more safe we are, the more we are able to really dive into our experience without fear.
Diva Nagula 45:37
You have various modes in your app, and like the Clarion focus to sleep, and then there’s awake, I’m probably not saying the words correctly, but how are these signals different from one selection to the other? And do they pretty much have different oscillations in vibration frequencies that manipulate and change our our brain chemistry or firing patterns?
Dr. David Rabin 46:02
Yeah, so we’ve done some EMG studies, I can’t tell you for sure that we’re changing, which specific firing patterns we’re changing at this point. But behaviorally, we see that the patterns reliably change behavior, they change the way people feel. And they change biometrics, like heart rate, like heart rate variability, and like sleep metrics, and when we track it over time with like ordering, for instance, in the real world, so and so to answer your first question, all the waveforms are different, they’re seven modes, and the patterns are gentle vibrations that feel they’re supposed to be barely noticeable, you can adjust the intensity level up and down in the app to make it more noticeable or less noticeable. But the goal is for it to be just barely noticeable when you use it. And then at that threshold of sensitivity is where the frequency patterns of vibrations, they tend to augment presence. And that’s really what we’re focusing on is augmenting presence, not creating something that’s like a distracting escape, because it doesn’t serve us in the long run. So the so the patterns all regardless of which one you use, they all help augment prejudice toward a specific goal. And that goal could be waking up or energy at that at the highest most stimulating level. And then going down to the into the slightly less stimulating
modes that are more calming the social and open is like social flow, creative flow. They’re all really designed to sort of help people enter these present flow states, clearer focus is like deep workflow deep, sustained focus, kind of like taking an amphetamine, but it’s non chemical, and increases like sustained attention for a long period of time on one thing. And again, these were all waveforms that we tested in part in our original clinical trials at University of Pittsburgh, and then there’s rebuilding recover, which helps people wind down that’s the most balanced mode that’s roughly equal sympathetic and parasympathetic tone. And that’s for really helping the body wind down quickly after exercise or any intense mental physical, emotional stress or after travel. And then we get into the very calming mode. So that’s meditation, mindfulness, which augments meditative states. And people have told us is great for pain, nerve pain, and chronic pain, fibromyalgia, things like that, then going down from there is relaxing on wine, which is like deep relaxation before bed. And that’s one of the most deeply calming modes that many people have compared to sort of like a cannabis indika effect, but without the without the right to psychedelic aspects of the THC. And then, and then the last one is sleep, which is self explanatory.
Diva Nagula 48:29
And with these frequencies that are utilized, is there any side effects from these from using it during the duration? When is on or are you able to use it multiple times during the day? And does it last even when the actual frequencies are turned off?
Dr. David Rabin 48:50
Yes, this is a good question. So there’s no side effects. The vibration patterns that we use are all sound waves. So they’re the same frequency patterns that would come out of a speaker or subwoofer in the on the low end of a song. So they’re, they’re, you know, universally found to be safe, especially at the levels, we’re delivering them to the body, the decibel levels are extremely low. And they’re basically sub Audible, you can’t hear them. So there’s no risk to using Apollo as often as you like people use it all the time. Usually, when they first get it, they use it multiple times a day, every day, and wear it all day. And then they’ll find modes that they like and then just activate it with the buttons to turn it on when they want to boost. And then over time, what happens what we see in the usage patterns is after about somewhere between three and six months, we start to see people really taper off their usage, not completely but to use the device more intentionally. So instead of using it all day, they’ll use it a couple times a day specifically to wake up and to fall asleep or specifically to fall asleep into focus. And that has been really interesting because people were seeing or not becoming dependent on it. They’re using it as a tool to teach them which is again, the goal of the healing process with medicine on any techniques that we use, they’re using the tool to teach them how to do this on their own. And that’s been really exciting. So I think that’s really the goal of all of this is to empower people to understand that we have the ability to change the way we feel part of it is our intention, right, and where we direct our attention. And the other part of it is the tools or the people that as you said earlier, our friends that we surround ourselves by, and the better the tools we have available to us, the better the better, we are using those tools. And the better the foundation we have in terms of the skill sets that we that we need to nurture ourselves and the better chances we have at at feeling good and in performing very well on a consistent basis. And
Diva Nagula 50:47
What I’m also curious about is, were you able to measure the time period that elapse before one actually sees improved HRV improve sleep? Is it immediate? Or is it something that has to be used over? I don’t know, two to four weeks?
Dr. David Rabin 51:04
Oh, yeah. And yeah, before I get to that your other so the HRV. And the biometric changes are more complicated to explain, explain in a second, because they’re difficult to measure based on the measurement tools available to us, not to us, but to the world right now. The effects of Apollo do tend to last after the vibrate, the vibration has stopped, which is the last thing I’ve read to say. Usually, it’s about the duration, we found as how long 15 minutes of soothing touch last typically 30 minutes to two hours afterwards. So we seen roughly the same thing, which is about 15, similar to touch 15 to 30 minutes of use of Apollo will ask people an additional 30 minutes to two hours afterwards, which is great. And and the more people use it, the more sensitive they become to it. So the quicker they notice the effects, and the longer the effects last afterwards. So there’s a there’s a learning effect that we see, which is you know, as you and I both know, conditioning is one of the most important ways that we learn by training or retraining our brains. In this case, it’s from the body first bottom up, rather than telling the brain to do something, and then having the body have to act on it, we’re acting on the body first. And then the brain falls and falls in line. So the so the changes can be measured on different timescales like like HRV changes, the heart rate changes, but it just depends on how clean the measurement vironment is. So the gold standard for measuring heart rate and HRV heart rate variability is an EKG machine, which should be measuring somebody in a relatively quiet area with the person not moving. And there should be, you know, some some protection from noise, like audible noise and also electromagnetic noise. So there’s no interference in the measurements, because these are electrical measurements. This is not typically the way that people measure HRV in the real world, because most people don’t have access to these lab grade systems and spaces. So when we did our first trial with Apollo, we actually demonstrated that in one of these clinical grade laboratories at the University of Pittsburgh, that we see HRV improve under stress significantly within minutes. And we see, and this improvement in HRV, with Apollo directly correlates to the amount of performance improvement, up to 25%. improvement on accuracy, cognitive accuracy. So you think about that’s like, that’s like getting 25% better on a test. Just because you’re more calm and present in the experience, and not less, you’re not thinking about, you’re not thinking about the last question you might have gotten wrong, you’re just in the moment, focused on what you’re doing 100% or as much of as much of that you as you can. And that, that is what I think is really fascinating is, in terms of what we’re showing is, the more you balance the nervous system, the better performance we feel, and the better we perform. And the better we recover, right? It’s it’s a, it’s a whole ecosystem of improvement. And we can do this on our own. But Apollo is just one more tool for those of us who have never learned how to do this, and really is an incredible help.
Diva Nagula 54:10
And the hope is that with all these tools that we’ve talked about in the last hour, it’s allowing the person to give them the tools to have more autonomy on their overall health. And give them a sense of control that they can balance, you know, their nervous system on their own, without having to use conventional pharmaceuticals or having extrinsic types of tools that are able to modulate the system. We want them to be able to do it internally on their own. And these are the tools that we’re able to provide them to help use those skills.
Dr. David Rabin 54:44
That’s exactly right. And it’s important, you know, to really know how to use the tools for instance, just based you know, going back to what we were just talking about, home consumer wearables like that. I love many of them Apple watch or ring whoop, Garmin devices fitbits these tools are really fun. But they are not clinical grade tools. They are not laboratory grade tools, and they’re not being used in a controlled environment. So it’s really, really important to understand that that data is extreme variability in that data. And so it’s it’s not useful most of the time to look at it on a on a data point, data point basis, we have to use it to trend trends are useful. And we want to trend or HRV up, we want to trend our sleep metrics up, we want to trend our resting heart rate down. That’s the stuff that matters the day to day stuff. But it’s not not as important unless you’re really trying to figure out, you know, that you shouldn’t drink as much alcohol. Right? I mean, other than that, it’s not, you know, it’s not really that useful to look at the day to day. But but that’s really critical, because a lot of people expect that they’re going to make a behavior change, like starting to exercise a little more every 30 minutes a day. And they’re going to see a significant boost in HRV. Right away, that’s not going to happen. You know, it’s not going to see it right. When you start meditating, you’re going to see that happen over the course of weeks to month couldn’t agree more.
Diva Nagula 56:08
Well, Dr. Dave, thank you so much for being on the show today. There’s so many tools that we’ve talked about, and so much great information for people, I really appreciate the opportunity to have a chat with you. If people want to find out more about you Apollo, and any information that you might have on the net, what’s the best way for them to search for you.
Dr. David Rabin 56:29
So if you want to find out about Apollo, you can go to apolloneuro.com. Or apolloneuroscience.com will also work. And you can also follow us – we ‘re also on socials. You could follow me on socials and reach out to me – that’s a great way to get in touch. It’s always great to hear from you. My Twitter is @DaveRabin, and my Instagram is @DrDavidRabin. And if you would like to check out my clinical practice website, it’s drdave.io. And the board of medicine is theboardofmedicine.org. use those skills.
Diva Nagula 57:06
Thanks again, Dave. I appreciate it.
Dr. David Rabin 57:09
Thanks so much for having me. It’s a pleasure.