RHR: Tools and Technology for Better Mental Health, with Dr. Dave Rabin

In this episode, we discuss:

• The importance of touch
• The evolution of our stress response
• Exploring the Apollo device- functionality and research
• Applications of Apollo in sleep, stress, and social settings
• Psychedelic therapy integrating Apollo

Show notes:

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Hey everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. I have a real treat for you today. I’m talking with Dr. Dave Rabin, a medical doctor, PhD, neuroscientist, board certified psychiatrist, health tech entrepreneur, and inventor who has been studying the impact of chronic stress in humans for more than a decade. He’s also the co-founder and CMO at Apollo Neuroscience, which has developed one of the best wearables in the space that improves energy, focus, and relaxation, [in addition to having a] significant impact on sleep, stress management, resilience, and even feelings of relaxation in common social situations. I’ve been using [Apollo Neuro] myself for several years and have recommended it to lots of patients with great results.

I had a conversation with Dave about the roots of touch therapy, which of course starts from the very moment that we’re born and have skin-to-skin contact between the mother and child. [We also spoke about] the role of the vagus nerve and stimulating the parasympathetic nervous system response, which is the opposite of fight-or-flight, and the rest-and-digest response, and techniques that we can use to stimulate the vagus nerve and put ourselves in that more relaxed state. And then [we also discuss] how the Apollo device contributes to that sense of relaxation and rest and helps to rewire our nervous system in ways that make us more resilient in the face of chronic stress that we all experience in our day to day lives.

Dr. Rabin also is active in the field of using psychedelic interventions for PTSD and chronic pain, so we talked about how psychedelic therapy overlaps with touch and sensory methods and the Apollo device. He’s doing a study right now on ketamine and the Apollo wearable, which just is fascinating to me because of the incredible results that ketamine-assisted therapy has shown with depression and other conditions. It’s a really fascinating conversation. I hope you enjoy it as much as I did. Let’s dive in.

Chris Kresser:  Dr. Dave Rabin, pleasure to have you on the show. Welcome.

Dave Rabin:  Thanks so much for having me. It’s a pleasure to be here.

The Importance of Touch

Chris Kresser:  I want to begin by talking a little bit about the origins of sensory or touch therapy. And this is not new, of course. Touch therapy goes way back. But at least some of the newer applications that have come [along] like the Apollo device are relatively new. But they have deep roots in human physiology and connection. Can you talk a little bit about that?

Dave Rabin:  Sure. It’s one of my favorite topics. I think the best way to understand the meaningfulness of touch is to look beyond humans. Let’s look back into the old world mammals and the mammals who have been on the earth a lot longer than we have. And every single mammal, every single great ape, and every single ape ever has nursed their young and coddled their young when they were born.  This is the very first [experience] after birth from the womb, which is, in and of itself, a physically traumatic, harrowing experience for the newborn. [It] then gets its immediate first safety signals from mom– or parents, but usually mom– and that is nonverbal communication through sense of touch. Because the newborn can’t understand words or verbalization at that point, so touch is the most instant way that we have evolved to send safety signals to each other, safety being the signal that amplifies vagus nerve activity, or parasympathetic nervous system activity, which is responsible for all of our recovery systems and functions in the body like sleep, digestion, immunity, reproduction, [and] empathy.

So this is universally important to the way that we recover and the way we heal and the way we stay healthy and fight off illness. That’s kind of the ancient origins. There’s lots of other places it comes from too, but that’s where it starts.

Chris Kresser:  So this is the antidote. This is the rest-and-digest system we’re talking about, parasympathetic, which is the flip side of the fight-or-flight sympathetic nervous system arousal that is perhaps the defining feature of Western civilization in many ways. It’s set up to chronically activate that system. We’re talking about this touch that infants experience. That first safety signal is not just nice to have, right? I seem to [recall] reading research or some kind of editorial that, in some cases, if an infant is deprived of touch it can even be fatal, or at least some very serious problems can develop. It’s not a luxury, it’s actually something that’s deeply hardwired and necessary for normal development.

Dave Rabin:  Yeah, that’s absolutely true in the case of it being necessary for normal development. That’s why some of the original, or maybe not original but the oldest use of vibration technology has been in incubators of premature babies when they have to be on some sort of life support so they can’t be around mom or anybody else who’s touching them. We have the doctors and the nurses come in, and we lovingly touch the baby, but we’re also examining the baby. It’s not exactly the same as a mother’s unconditional love, especially your mother’s. So it’s one of the tools that has been used to try to replicate at least some of that physical sensation of touch. It’s not the whole thing, but it’s at least some percentage of it. By using gentle vibrations that get delivered through the bed, [it helps] these premature infants have better survival rates, which is really incredible.

But touch is absolutely essential, and I think that many of us did have more touch, loving touch– hugs, things like that– as kids than we do [as] adults. But part of the problem is that, as adults, we’re still kind of big babies in some ways. We really do still need certain things that we needed as kids, like soothing touch and hugs and affection and intimacy. Those are all critical parts of feeling safe and connected. And for some reason as we get older, we start to deprioritize those things. But they are critically important for our mental health and emotional health and well-being and survival.

Chris Kresser:  Right. I know I’ve seen research suggesting that people who are married or in a committed relationship often live longer than people who are not. And I imagine that plays some role, that intimacy and affection and touch and warmth that is so core and essential to who we are as human beings. And the lack of that may be having such a big impact that it can shorten our lifespan. Of course that’s not always in our control whether we have a partner or not into our old age, but it definitely drives home the importance of this and how it affects not just our mental health, but also our physical health. I’d love to chat about that a little bit because we know now that chronic activation of the sympathetic nervous system, being in a perpetual fight-or-flight response, has broad and diverse effects. It contributes to virtually every chronic disease that we know about, from cardiovascular disease to GI conditions to dementia and Alzheimer’s [disease].

The Evolution of Our Stress Response

Chris Kresser: Can you talk a little bit about the way that our stress system evolved initially, and maybe [about] what the conditions were for most of our hominid evolutionary history? And then how that’s changed in modern Western civilization [and] what the impacts of that are for us.

Dave Rabin:  Yeah, it’s really interesting. Eric Kandel won the Nobel Prize for discovering this in part, with respect to the way we learn and remember safety and fear responses and store that memory in our brains, which is something that he was originally studying in ancient sea snails from 300 million years ago. Try to close your eyes and put your mind into the body of an ancient sea snail with a little shell and you’re just kind of snailing around and looking for food, and all of a sudden you see or smell or your antennae sense a predator or something around you that can eat you. Something sets you off. You’re like, “Okay, I have to go hide.” Or, “I have to go do something to get to safety.” Forget about food, forget about everything else. And so, evolutionarily, over the course of hundreds of millions of years, we evolved to [where] our nervous systems are doing basically the same thing in response to fear and threat. And when that threat is gone, that snail goes, “Oh okay. Threat’s gone. I can go back and search for food again.”

And of course it’s not just food in many cases. It’s food, and reproductive opportunities, right? Very similar to humans. What do we care about? We care about food, we care about reproductive opportunities, we care about shelter [and] comfort. We’re not that different. So Eric Kandel won the Nobel Prize for that work around memory and showing [that] the high similarities between these different species over hundreds of millions of years is conserved. And what that teaches us is a couple of things. Practice makes mastery, because the more we’re doing anything, the better we get at it. That results in learned behavior which is how we learn. You do something, you repeat it, you repeat it [and] you repeat it until you don’t have to think about it anymore. We’ve all done things like that. Driving is a very common one. Putting on our clothes in the morning, different things. The feeling of our clothes on our bodies. You just do it, and then you forget about it.

So stress evolved in the way that we originally evolved that system to deal with the immediate threats like predators, lack of air, lack of water, lack of food. Those are the things that evolved that parasympathetic, rest-and-digest, [and] sympathetic, fight-or-flight system. The fight-or-flight system is dealing with that survival stuff. Once we get into safety mode, we can go back to thinking about food and reproduction and comforts and being empathetic with each other. But when we’re in survival mode, we evolved to not do or prioritize any of those things. And what that means in our bodies is that there’s a redistribution of resources, because there’s only so much blood to go around to feed any part of our bodies at any given time. So the body, in times of stress, constricts blood flow to all of our parts of our bodies that are not critical for survival, and then dilates blood vessels to our heart, our lungs, our motor cortex of our brain, our skeletal muscles, which take a ton of blood, our fear center of our brains, and all the parts that are critically important for getting out of a survival situation like predators, lack of food, lack of water, lack of air. Real survival situations. That’s what our body knows. And our body can’t tell the difference between perceived threat and actual threat. Our mind can, if we train it, but our bodies can’t. Our bodies just know threat or safety.

Chris Kresser:  Right. So your stock portfolio crashing is triggering the same set of limbic system and nervous system responses as a lion stalking you. Until you’re able to cognitively work out that [it’s] a different threat, your body responds in that same way, or a similar way at least. It seems to me that’s the crux of the issue. Because in the modern world, we have a capacity through our frontal cortex and the way that we’re living to be constantly thinking about perceived threats or experiencing perceived threats. [For example], getting cut off in traffic. I mean, that could be a real threat in that case.

Dave Rabin:  That’s a really good one. Or cutting someone else off.

Chris Kresser:  Yeah, getting cut off in traffic. Something happened financially. There’s any number of things that are almost this constant stream of threats that we deal with on a day-to-day basis. And what you’re saying is [that] our biological, relatively binary stress response system was not set up to deal with that, originally.

Dave Rabin:  Yeah, and not just that, but you add on the news, right? The news, just that in and of itself. Add on work responsibility, social media.

Chris Kresser:  Social media, technology, phones in your pocket always beeping and flashing and constantly sucking our attention.

Dave Rabin:  Right. Responsibilities to your family, your kids. All of it. And all of that is just incredibly overstimulating for us. Studies estimated that we’re consuming as much information [with]in the first 30 minutes of being awake now than, I think this is two years ago, but because of smartphone technology, we’re consuming as much information in 30 minutes as we did in a week in the 1950s.

Chris Kresser:  Wow. Which is a huge evolutionary mismatch as well, because we evolved in these close knit, tribal, social groups of maybe 100 to 150 people and not in a situation where we’re constantly aware of what’s happening thousands or tens of thousands of miles away on the planet at all times. I mean, this is something with patients that I always have discussed, because I think it’s often the elephant in the room in health conversations, where somebody could be eating pretty well, doing a pretty good job with exercise and other stuff. But if there’s not really an active effort to mitigate the impacts of this chronic hyper-stimulation of the fight-or-flight response, or the sympathetic nervous system, all of those efforts, they’re not going to be in vain, because they certainly will help, but they’re going to be diminished in their impact because [the] hyper activation of this system affects everything, including how we digest that healthy food we’re eating– because of what you just said. If your body perceives that your survival is threatened, it doesn’t really care about digesting the meal you just ate. It’s prioritizing other things. And it certainly doesn’t care about your fertility or longer term hormonal regulation or things like that. It’s going to prioritize everything needed for that immediate term survival.

So given that this is the situation we are all in, let’s talk about some of the ways we know to activate the parasympathetic response, maybe starting with the vagus nerve and its importance in the parasympathetic system. Then we can talk about vagus nerve stimulation exercises and the Apollo device and how that fits in to give people some idea about how to mitigate some of this stress that, honestly, most of us at this point can’t avoid. We can make choices to minimize it, but I think it’s impossible for most people at this stage, if they’re living in the 21st century modern Western world, to eliminate it entirely. And [it’s] probably not even desirable. It’s a feature of life to some extent.

Dave Rabin:  Yeah, absolutely. So it starts with understanding the good news and the bad news. The bad news is that stress is inevitable, as you just said. It’s not ever going completely away. There’s always going to be something that is stressful that we need to deal with or adapt to. What does change, however, is our perception of stress as an opportunity for growth. Because if we weren’t stressed or challenged, we wouldn’t be able to grow and develop as human beings. That’s how we grow. That’s how we learn new stuff– we have to do stuff that’s hard and that we don’t understand. That’s how it works, right? That’s how it’s always worked for learning, for all animals, but especially for us. So that’s the bad news. But the good news is that there’s hope. We understand how the brain works now much better than we did even 20 [or] 30 years ago, to the point where we understand that it’s possible to retrain our brains to perform at a higher level, to do what we were taught they were supposed to be doing with our emotions, our thoughts, and our memories, and the way we regulate ourselves– how much energy we have, and how easy it is to fall asleep at night. All of that is trainable through practice. [Also] regulating anxiety and mood, all of this can be trained through practice.

And the core of it, despite all the other things we might be doing, number one [is] to just constantly remind ourselves that we’re safe. That we’re actually not under survival threat right now. And that’s something important that we can remind ourselves [of] in our bodies by breathing, by giving yourself a hug, by doing what we call somatic techniques– techniques that bring our minds back into our bodies. These techniques are also called vagal techniques. I think we talked briefly about the vagus nerve earlier, which is getting a lot of popularity right now, because people are finally starting to understand what we’ve known for quite a long time– that the vagus nerve is the most critical nerve innervating almost all of our organs in our entire body, and almost our entire body that communicates, not in all cases, but in most cases, the signal of calming down and recovery. Recovery meaning digestion, reproduction, immunity, metabolism, creative thinking, empathy, all of it. Sleep, all of it, the whole thing. Emotion regulation. That feeling of flow. All of it is encompassed in this recovery nervous system that we call the vagus nervous system or the parasympathetic nervous system. And this system is opposing the sympathetic system, the fight-or-flight system we talked about earlier. They’re fighting for resources.

If we think we’re afraid, sympathetic fight-or-flight gets more resources [and] the rest of our system [gets] depleted. Our recovery system. As we remind ourselves that we’re safe, we restore the balance of resources and allow the body to understand through training that we’re actually not under survival threat right now at this moment. Because if we were, we wouldn’t be able to take the time to think about it or to take a deep breath or to give ourselves a hug or do any of these things, right? There’s a positive feedback loop of training that occurs [when] we remind ourselves that we’re safe in situations that used to feel threatening. This is an old technique in psychology. Talking about it now is really funny, because it still hasn’t been fully adopted and accepted, despite how true it is and how well it’s been practiced. But what we’re talking about became the field of cognitive behavioral therapy with prolonged exposure, which is the leading psychotherapy treatment for [post-traumatic stress disorder] currently available.

Chris Kresser:  It’s also the leading intervention for insomnia, I believe, as well. Or one of the first lines of treatments for insomnia at this point.

Dave Rabin:  Yeah, [cognitive behavioral therapy for insomnia] (CBTI).

Chris Kresser:  Yeah, CBTI.

Dave Rabin:  But that’s different.

Chris Kresser:  Yeah.

Dave Rabin:  Yeah, so that’s a different approach. But the exposure approach is really interesting, because the whole idea of cognitive behavioral therapy with exposure is you’re exposing the person who’s afraid of X thing or situation or person to thoughts, images, people who look like or things that look like that, and then the actual thing in the context of a safe environment. And we’re with the therapist present to hold that safe space and make sure that person remembers that they’re safe. Then that person learns safety again in situations that feel threatening. It’s a beautiful technique and it works really well. But it requires a silly amount of work for both [the] therapist and patient. It’s a little costly, and it’s very time consuming.

So when we were doing this work at the University of Pittsburgh, we realized that if the CG pathway was as critical as all the evidence seems to be pointing to, then perhaps by activating and creating technology to activate the soothing touch mechanisms in our nervous system and our skin and our bones, the same things [that] get activated when you get a hug or you hold a purring cat, we could start to give you that feeling of that therapist being by your side, or that person that you trust and feel safe around being by your side anywhere you go. We started testing that [by] using electricity and vibration, sound waves that are low frequency [and] that are oscillating at certain different breath rhythms. And we found that specific rhythms that were crafted in a very specific way could very rapidly, like two to three minutes in a highly controlled setting in the lab at the university, actually increase heart rate variability under stress, decrease heart rate, and improve cognitive performance proportionate to the amount that the body was improving its functioning. So it allowed us to understand how vibration affects the body when you don’t even hear it. It’s just felt through your skin, through your chest, through your wrist, and that can actually have cardiorespiratory effects in a very short time, and [also] significant cognitive effects. This was a double blind, randomized, placebo controlled crossover study. So we were pretty blown away. And then from there, we continued to develop the technology. My wife started the company and then hired me in 2018, and we commercialized the technology as Apollo Neuroscience in 2020.

Exploring the Apollo Device: Functionality and Research

Chris Kresser:  Great. Let’s talk a little bit more about Apollo and some of the research behind it. First of all, maybe you can just explain what the device is, what it looks like, how it’s worn, and some of the basics for people who are not familiar with it. Then we can talk a little bit about the use cases. I know you’ve done studies on sleep that showed, if I recall, a 30-minute increase in sleep, including improvements in deep sleep. And then you’ve done studies on stress that indicate an increase in heart rate variability and improved cognitive performance. So I would  love to start with an overview of the device and how people are wearing it and using it throughout the week, and then talk a little bit about the research behind it.

Dave Rabin:  Sure. This is what it looks like. Apollo is a wearable device that is a pod you can wear anywhere on your body with a clip. During the day I often wear it with a clip in between my buttons on my chest, and at night I wear it on my ankle. I think the ankle is actually the most popular spot because of how good it feels and how nicely it works down there.

Chris Kresser:  Yeah, that’s my preference as well.

Dave Rabin:  Yeah, yeah. It’s the best, especially for sleep. So the feeling of Apollo, if anybody’s listening and has an iPhone, by the way, you can go to the app store and download the Apollo Neuro app and actually feel the Apollo experience as a demo so that you can understand what we’re talking about. But basically, if you’ve ever held a purring cat, or you’ve ever [gotten] a hug from a friend and you feel this gentle wave of warm fuzzies, that feeling is a feeling that we can access with breathing states. Just by breathing at a certain rate, you can naturally bring yourself into that state. And one version of that we’ve probably all heard of is ohm meditation, right? You’re making a sound and breathing at a certain rate that creates these resonance patterns in the body to help get us into a certain state of feeling and consciousness and experience. So people use Apollo to improve their ability to change states and to regulate their circadian cycles, because the gentle vibrations calm the body and bring the body into a slightly more vagal state, or a slightly more focused state, or a slightly more wakeful, creative, social, relaxed, recovered [state]. And then there’s unwind and sleep. You can manually activate these as you wish on the app. We recommend that people go in and schedule them, and we customize a schedule to your personal lifestyle and chronotype. Because we know chronotype science is starting to show some promise. This is the understanding that we all have a certain time. We all have a diurnal cycle, which is a day and night cycle, and we all have certain times where we are better at focusing and better having energy and better being physical and better at sleeping and getting that deep, restorative restful sleep. And they might be different for you and me, slightly.

Chris Kresser:  And different for different ages, right? Teenagers. My daughter is 12, almost 13, and she used to be an early riser. Now she’s sleeping like a teenager, staying up late at night and sleeping in. If only schools were more aware of this and it was easier to shift school schedules along with chronotype. I think that would be a big improvement. But I digress. So, it sounds really cool. That’s one of the things I like about Apollo most is the ability to customize the various routines throughout the day, because my schedule will sometimes shift and I’ll have different use cases. And you can override and do it manually as well, if you want a particular mode at a specific point in time. So that’s super helpful.

Dave Rabin:  Yeah, absolutely. And I think there’s one other thing that I want to tell you about. I don’t know if we [gave] you SmartVibes yet? Have you been using it?

Chris Kresser:  No. I don’t have the latest version and I lost [mine], unfortunately, in my recent move. It was in a box and that box disappeared along with some other cool stuff that I haven’t been able to find.  I don’t have [SmartVibes] yet.

Dive into the future of mental health with Chris Kresser & Dr. Dave Rabin on our latest podcast. Explore how the Apollo device is revolutionizing stress management & well-being through the science of touch. #MentalHealthInnovation #ApolloNeuroscience #chriskresser

Applications of Apollo in Sleep, Stress, and Social Settings

Dave Rabin:  Well, let me tell you about SmartVibes, because you’re going to love [it]. We’ve been working on this feature for five years. We figured out when we did this Oura ring study, this gets into the sleep story. You’ve seen Oura ring, right? You’ve seen Apple Watch. This is an amazing product. Like our product, they work really well. It’s really great at tracking. But it’s just tracking you. So when you use it, or you use your Apple Watch, or your Whoop, or your Fitbit, or your Garmin, it tells you information about your sleep or about your stress or about your activity or any number of things. You’re adding more information to your life and not really knowing what to do about it. And it’s actually changing the way people feel. [In] some survey studies, up to 50 percent of people are just shelving wearables in general that are fitness trackers because they get data fatigue. So we thought, “Okay, we’re working with Oura ring, we’re doing research with them,” and we started a 1300-person sleep study that we crowdsourced, because COVID shut down every sleep lab in the country indefinitely. All of our sleep studies in early 2020 that were set to start got canceled indefinitely. So we were like, “Who can we do the study with?” And Oura ring was really research friendly. So we went over and started asking our users to donate their data. And they did. We tracked 1300 people over three years to the tune of over 100 million data points of their Oura ring data and their Apollo data– usage data from just buying it and using it out of the box, no instructions. And this study is what will be published in the next three to six months or so. It’s one of the biggest sleep studies, probably that’s ever been done of an actual observational sleep study of its kind, which is really interesting. And we showed that just adding Apollo to your life, regardless of how you use it, is significantly improving your sleep. It’s a small amount so that, across all variables like drinking alcohol and using drugs and wearing the devices improperly and staying up too late and everything else that people do, just adding Apollo statistically significantly improved sleep.

So then we said, “Okay well, how do we figure out who’s getting the biggest benefits and having the best results with this tool?” We started to look at the patterns of usage and we found that people using it for three or more hours a day, five days a week, and ideally seven, if you’re using it that much and there’s a little bit of daytime use and a lot of nighttime use, then people will have a 95 percent chance of having statistically significant improvement to their sleep at 21 days. Over three months that’s up to 30 minutes more sleep with concentrated deep and [rapid eye movement] (REM) sleep. So give me your impression of what that means. Ambien, which is one of our best pharmaceutical sleep aids, gives 22 minutes of sleep that doesn’t make deep or REM sleep better. If anything, it sometimes makes it worse.

Chris Kresser:  Worse, yeah.

Dave Rabin:  Right? Because it’s a sedative, hypnotic, benzo[diazepine] family drug and that’s the side effect of those drugs. Apollo is getting you up to 30 minutes with concentrated deep and REM [sleep] because it’s just naturally augmenting [the] vagal tone slightly to help us transition more smoothly into sleep. And that has cardiovascular implications, which we’re publishing in a follow-up study. So in short, that was the work. Seeing the impact on sleep that was so dramatic for people, we took that data and we trained Apollo to track sleep and to intake data from the Oura ring so that whenever people sync it up, we can understand when you’re in a state that is a stress state or a state [where] you’re not feeling quite yourself or quite your best, and we can send you Apollo vibes to help you feel more like your best [self] because we know what works for you by training predictive and generative [artificial intelligence] (AI) to work in the background. Think about, when you apply AI to a wearable health product, the kinds of things that you can do. We figured out how to solve unwanted middle of the night wake ups.

Chris Kresser:  Wow, that’s huge. Sleep maintenance, insomnia, especially as people age, is so common.

Dave Rabin:  Did you know there’s not a single product that is not medication, and we don’t recommend people take medications when they wake up in the middle of the night because [it makes] them groggy later in the day. But there’s not a single product that solves this problem to date. In the history of insomnia, nobody has been able to solve this problem.

Chris Kresser:  Yeah, that’s definitely the hardest one, as a clinician, that I deal with.

Dave Rabin:  Right, and same. So we were just like, “Well, AI can run in the background, what if we train the AI on the Apollo itself to sense your motion position, which is the most reliable way to assess sleep states, train that against other wearables, and then make it really accurate?” So now it’s tracking when you’re asleep and when you’re awake as well as any of the other wearables, and when you’re about to be awake after having been asleep. And if we can understand when you’re about to be awake after having been asleep, we can understand when to turn Apollo on to prevent you from waking up, and then we can tell whether it worked or not because we’re sensing the motion, and we can train it to work better for you over time based on your personal sleep patterns.

So we’re seeing people using this. We’ve now tracked 7000 people over eight months, and we’ve seen people who wake up in the middle of the night. People who fall into this category, [for whom] that’s a problem, that they wake up and they can’t get back to sleep, we see some of these people getting 60 minutes more sleep a night. 60 minutes.

Chris Kresser:  Wow, that’s incredible.

Dave Rabin:  Just through anticipatory technology. That’s what you have to look forward to when you get your new Apollo.

Chris Kresser:  I’m excited. Tell me about the difference between SmartVibes just with the Apollo and then SmartVibes with Oura. Because I know that, from the little I read about it, you can integrate Apollo with Oura and that will add some additional data. What’s the difference there? What do you get when you add the Oura versus just the Apollo alone?

Dave Rabin:  So this is a really cool feature that we just released as well. What we figured out was [that] Apollo can do the nighttime stuff by itself. It can detect in real time when you’re about to wake up and prevent you from waking up. But having more data from other devices that measure your heart rate and your heart rate variability and your activity more accurately, and other things that we don’t do as well, we can pull that data in from them and then use that data to actually customize a solution. So if Oura tells you that you didn’t sleep well last night and you’re tired or you might be tired today, we can give you vibes that keep you up and give you energy. We use generative AI to then compose rhythms of vibration patterns for you that are scientifically validated, that just gently nudge your energy up and down to where it needs to be throughout the day, which is especially impactful when you’ve had a rough night last night or a rough week at work. Because I can tell you, running a startup is hard, and this thing really helps.

Chris Kresser:  Absolutely. We talked a little bit about sleep, but there’s also kind of obviously a stress management application, and even a social application. I think people are probably least familiar with the social applications. Can you talk a little bit about that?

Dave Rabin:  Yeah. The social application of this is really along the lines of, remember when the COVID quarantines were all kind of wrapping up and they told us we could take our masks off, and everybody was starting to hang out again for the first time in a really long time? You remember that, right?

Chris Kresser:  Absolutely.

Dave Rabin:  Yeah, you remember some people or yourself being a little bit uncomfortable being back in that environment?

Chris Kresser:  Yep.

Dave Rabin:  So that phenomenon is just like a distance, or it creates an unfamiliarity, and in that context we often think, what is it, “time makes the heart grow fonder,” or whatever.

Chris Kresser:  Distance or time. Both.

Dave Rabin:  Distance or time. Time apart makes the heart grow fonder. But I think in this case, we were taught to be afraid of each other. We were taught to worry that the person we’re interacting with again is sick. We might not be able to know, and we could get our whole family sick, right? And you could die. This was like a big communications nightmare. This triggers our fear response, even subconsciously. Even if we’re like, “Oh, no, I don’t care about any of that anymore,” there’s still a part of us that has been trained over three years to think when you meet somebody new without a mask on that this person could get me and my whole family ill, and somebody could die. That has now been ingrained in all of us. And we’re gradually training it out so it’s not a thought anymore. But ultimately, that is something, and there’s still lots of people who are stuck in that mode, like my parents. They’re very, very protective about this kind of stuff. And there’s, in some cases, good reason. But in some cases, it goes too far.

So when that trains your fear response to kick up, that makes social engagement and interaction with other people immediately [set] off the threat response from the offset. And for people who have social anxiety, or people who have just not had a lot of good practice at being comfortable and safe in social situations, or they were picked on a lot as kids, it can take a really long time for those people to feel safe and comfortable in social situations regardless of COVID. COVID just made it way worse for those people. Apollo works really well for this, because we figured out certain vibration patterns that are so common but slightly higher energy, [which] seem to be really helpful with creativity and social anxiety and calming people down in social situations. It’s called the Social Vibe on the app [and] it’s one of my favorites. People describe it [as] feeling like a bubbly glass of champagne with your friends, or like hanging out outside in the sun, or something kind of like that. Just a generally relaxing but not sleepy experience.

Chris Kresser:  And no hangover, no downsides.

Dave Rabin:  Right, no hangover, yeah. You can turn it off when you want. On a personal note that I don’t talk about all that often, when we first discovered this Vibe, I don’t think any of us realized how useful it was. The Social Vibe, in particular. We made like 3000 prototypes and sent them out and had lots of people testing them and giving us feedback. And people were telling me that this was the best thing that’s ever helped their social anxiety and that they were able to speak publicly with confidence. They’ve never been able to do that before in their lives. And I was like, “This is interesting. I can try that for myself,” because I had a little bit of public speaking anxiety at the time. Enough that I noticed it and it bothered me. So I started to use it every time I would go on stage and talk, which started to become relatively frequent. And it was like a light bulb went off, like in the cartoons, one day. It was probably the first or second time that I was using it on stage, and this light bulb went off. Right before I was about to start talking, there were a few minutes [when] people were still gathering and I was asking myself a question, just involuntarily. I was like, “Have you ever thought about how much time you’re spending thinking about what other people are thinking about you right now?” I just started to notice how much I was thinking about what everyone was thinking about me right then. Because when I go to talks, I mean we’re kind of thinking about the person, but not really. We’re just getting seated and doing our thing and getting ready for the person to speak. And we want them to do a good job, because if they do a good job then we’re entertained. And then it was worth the half hour, hour, or whatever.

So I started to have this realization in my head that people were there to hear me speak and do a good job. And for me to do a good job, I have to put all of my attention on doing the thing that I’m here to do, giving the talk. If 50 percent of my brain is thinking about what everyone’s thinking about me while I’m trying to give a talk, that only leaves 50 percent of my brain left over for the talk, right? It was like a math equation that just clicked in my brain, and I was like, “Oh wow, that actually makes a lot of sense.” Then I just started not thinking about that anymore and training myself to focus on the vibration when I got distracted, and then to bring myself back to the center, bring myself back to doing what I was here to do and give the talk. And [the] quality of my speaking went way up very quickly. I would say within four to six months I wasn’t even wearing it on most of my talks and I was doing great. And now I speak several times a week.

Chris Kresser:  That’s interesting that it seems to have a persistent effect even after you stopped wearing it. I imagine because of the neuroplasticity that maybe happens there, in a similar fashion to cognitive behavioral exposure therapy, where your neurons that fire together wire together. So you get in that situation, you have an experience where you feel safe and comfortable speaking publicly, those neurons get triggered over and over, and then eventually, you don’t need the device to reinforce that anymore. Which is a pretty amazing kind of cognitive learning, restructuring of the brain type of experience.

Dave Rabin:  Yeah.

Psychedelic Therapy Integrating Apollo

Chris Kresser:  While we’re on that note, I want to briefly ask you about your interest in psychedelic therapy, because that’s something we share an interest in. I’ve had several people on the show, including Michael Mithoefer and Rick Doblin and others who I’m sure you’re connected with to discuss this. And we’re running out of time, so we won’t go too far into this. Maybe we can have you back and talk about it further. But I’m especially interested in the intersection for you of everything we’ve been talking about today– activation of parasympathetic response, neuroplasticity, the ways in which we can mitigate the harmful impacts of stress, especially in severe cases like PTSD and soldiers coming back from war, which I know [The Multidisciplinary Association for Psychedelic Studies] (MAPS) and a lot of [3,4-Methyl​enedioxy​methamphetamine] (MDMA) studies have focused on. What are the parallels for you, since you work actively in both of these fields, between sensory therapies like Apollo and psychedelic assisted therapy?

Dave Rabin:  I’ll answer this with another personal story, and I think you and your audience [will appreciate this] because you mentioned Michael and Rick, who are wonderful people. I [first] became interested in psychedelic assisted therapy in 2012 because I was trying to figure out exactly what I wanted to specialize in, personally, in medicine as my career.  I started to have a lot of friends who said, “Dave, you should really become a psychiatrist.” And I wasn’t really certain about that. So one of my friends who was avidly interested in modern psychiatry sent me 10 or 12 papers on the leading psychedelic research that was being published at that time in 2012. I stayed up all night reading these papers because they were fascinating and I’d always been interested in studies of consciousness. And it made me realize that in psychiatry, I could actually do what I had always wanted to do, which is study consciousness and how the brain works and how we think and feel and experience all of this stuff that we call life.

So I ended up starting to study that, and then mostly just catch up and become familiar with the literature and what was going on. Then I learned that I had to meet Rick Doblin. We met virtually, and then we met in person for the first time in 2016. I had like 20 minutes with Rick, [who] is the executive director of MAPS for those who don’t know, and he’s moving MDMA through [The United States Food and Drug Administration] (FDA) trials with great success, in terms of their results as some of the most successful results for PTSD that we’ve seen with any treatment ever. And it’s around the corner from FDA clearance. So I went after Rick and I said, “Rick, I’m a psychiatrist and I’m seeing these people with PTSD. I’m studying how these medicines work. We need to figure out how MDMA is working. Because if we can understand how MDMA is working to get these dramatic healing effects in these severely afflicted veterans with PTSD, then we can start to replicate that effect with other tools and other techniques that are more accessible than MDMA.” And he actually found that really interesting. So he allowed me and three of my psychiatrist colleagues to get trained in MDMA-assisted psychotherapy with MAPS by Mike and Annie Mithoefer in upstate New York, and that was in, I think, 2016. Then we kicked off from the understanding of how MDMA worked in that clinical setting, and then in combination with the scientific research that had been done in the lab [on] animals at that time showing that MDMA helps reinforce safety learning circuitry in the brain, that there was this core thread of safety that was coming out through all of this work. The MDMA seemed to be working by molecularly amplifying safety circuitry in our emotional brains that help us to amplify the safety of the therapeutic container, which is that space of trust and non-judgement and acceptance between the therapists and the patient that [is] built with multiple sessions before receiving any medicine. And the medicine’s working by amplifying that safety. At least that was our leading theory at the time. Again, all the studies are still in the works. But this was the leading theory at the time.

So we went back to the lab and we said, “Okay, well, how do we make people feel safe?” Soothing touch is probably the fastest way there. So we started doing these experiments and constructing these different sound wave vibrations that feel like soothing touch, [which] through much study eventually became Apollo.

Chris Kresser:  Wow, that’s such a cool story. I look forward to a future study that integrates psychedelic assisted therapy and something like Apollo over a period time, [to] see what the synergistic effects of that might be.

Dave Rabin:  Yeah, they’re coming. We’re doing studies with ketamine and Apollo currently, so keep a lookout for those. But because Apollo is a consumer product, it’s a wellness product. It’s not a medical device. We have over a thousand patients who have been treated over the last three years by ketamine providers using Apollo with their patients because it improves their experiences and it improves their long-term results. [It’s] been really exciting to see that people are using it in the wild with their clients. Doctors are using it with their clients and their patients. That’s really, really exciting. So there’s a lot of promise there. We’re also doing a study in collaboration with MAPS where we’re looking at integration– that therapy period where you continue to unpack and integrate what you’ve learned from your MDMA experiences, with MAPS in this case, [which] continues long after the medicine sessions have ended. So we ended up at Rick’s. It was really Rick’s idea to get a study approved to look at what happens when you give Apollo to everyone who’s been through the MAPS MDMA trials one year out, and then we track their long-term outcomes and see if it sustains remission more over time by giving them a tool that helps the same pathways that MDMA is working on in a gentle way.

Chris Kresser:  Amazing. I imagine that it will have a significant effect, just because in that parasympathetic state, we’re so much more receptive. I think the neuroplasticity circuits are probably more likely to fire and rewire in ways that have a long-term beneficial effect if we’re in that place of being more resourced and settled. But it’ll be interesting to see what happens. I can’t wait.

Well, this has been fascinating Dr. Rabin. I really appreciate the conversation. Where can people learn more about the Apollo device and pick one up if they’re interested?

Dave Rabin:  You can learn more about Apollo at ApolloNeuro.com or WearableHugs.com, which is what the kids call it, if that’s easier. If you have an iPhone, I strongly encourage you to have the Apollo experience, which is a really awesome experience as a cell phone user, [whereas] we’re used to our phones mostly annoying us. This actually upgrades your phone to make you feel good, which is really, really fun. So download the Apollo app in the App Store. That’s definitely worth doing. And come find me at DrDave.io and on socials @DrDavidRabin.

Chris Kresser:  Great. And one thing I’ll say from having used this device for a while is, although many people, including me, can notice the difference right away, the studies suggest there’s a cumulative effect. It’s not like drinking a glass of wine in the sense that you have this kind of immediate impact and it’s not going to change over time. It’s really [an] intervention where the benefits accumulate over time, as the sleep study you mentioned indicates. So it’s important to give it enough time to actually have its effect. I used to tell patients that all the time, because often people are expecting [it to be like] pharmaceutical interventions. Like Ambien, for example– you take it and it affects you the way it’s going to affect you that same night. It doesn’t necessarily change over time. But this is not like that. The effect definitely improves and increases over time. So just keep that in mind if you’re going to use it.

Dr. Rabin, thanks again. I’d love to have you back to discuss the results of these future studies at some point and thanks for doing this important work. It’s been a game changer for me and for many of my patients. So I really appreciate it.

Dave Rabin:  I’m so glad to hear that. That warms my heart. We created this to help our patients and so I’m so happy to hear that. And I really enjoyed chatting with you. Thanks again for having me.

Chris Kresser:  Great. Thanks everyone for listening. Send your questions to ChrisKresser.com/PodcastQuestion. We’ll see you next time.

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