This episode is sponsored by a company who has
truly found a solution to an age -old problem,
and that is Karna Bunker Gear. One of the most
prevalent conversations in the fire service is
should we or should we not train in our bunker
gear? Now the answer to both is yes. As most
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and training that does not require puncture or
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in gear myself throughout my career, I wish this
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class a few weeks ago and can testify that it
not only simulates the heat retention of frontline
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fire ground. Now some additional benefits include
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Think of the number of times that we allow, for
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it's infused with all these carcinogens. So there
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you want to hear the whole story behind this,
listen to my conversation with Ryan Conley on
episode 1175 of the Behind the Shield podcast,
or go to karnabunkergear .com. Welcome to the
Behind the Shield podcast. As always, my name
is James Geering, and this week it is my absolute
honor to welcome on the show neuroscientist,
board -certified psychiatrist, and the inventor
of Apollo Neuro, Dr. Dave Rabin. Now, in this
conversation, we discuss a host of topics, from
the relationship between sleep deprivation and
mental ill health, the neuroscience behind suicide
ideation, an incredible insight into the application
of pharmaceuticals and where they're being abused,
the healing power of psychedelic medicines, the
incredible non -invasive technology he's developed
to help with mental health and PTSD, and so much
more. And before we get to this amazing conversation,
as I say every week, please just take a moment.
Go to whichever app you listen to this on. Subscribe
to the show. Leave feedback and leave a rating.
Every single five -star rating truly does elevate
this podcast, therefore making it easier for
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is that you help share these incredible men and
women's stories so I can get them to every single
person on planet Earth who needs to hear them.
So with that being said... I introduce to you
Dr. Dave Rabin. Enjoy. Well, Dave, I want to
start by saying two things. Thank you to everyone
at IHMC for making this initial connection, and
we'll get to that organization in a little bit.
And secondly, I want to welcome you onto the
Behind the Shield podcast today. Thanks so much
for having me. It's a pleasure to be here with
you. So where on planet Earth are we finding
you this afternoon? I'm in Monterey, California
right now. Beautiful. I normally take a deeper
dive into someone's life, but I know we've got
a shorter amount of time, but I think there's
a lot of value in even understanding how you
got to where we are today. So let's start at
the very beginning. Tell me where you were born
and tell me a little bit about your family dynamic,
what your parents did, how many siblings. Sure.
So I was born in Mill Valley, California, just
north of San Francisco. And my parents, I have
two younger brothers, one who is now in law school
and the other who is a physician. And we grew
up in a family where, generally speaking, curiosity
was highly encouraged. Asking questions was highly
encouraged, which was really nice. And I don't
think I fully appreciated how nice that was at
the time, because how could you as a kid? But
as I got older, I started to realize how... much
that impacted my way of thinking and my drive
to learn about the world and helped me really
understand from a young age that learning was
something that took place all the time not just
when you're in school like school is just the
school stuff but then there's everything else
that you learn all the rest of the time of your
life and learning just doesn't doesn't just stop
at school if school makes you hate learning then
it's really done a terrible job of what it's
supposed to be doing right so i think um so that
was really helpful and helped me get through
the, the, my like academic school years, because
school was actually quite challenging for me.
And, um, I always found myself like very distracted,
very much like wanting to like socialize and
also be like learning the next thing before it
was being taught. And so that was, um, that was
school was, was tough, but, uh, again, I think
thanks to my parents and, um, who are both also
physicians and researchers, they really helped
to cultivate a, um, a really nice like learning
environment for us growing up. One thing that's
really kind of been glaring recently in these
conversations is what seems to be the enemy of
critical thinking would be all things that challenge
mental health. So stress, sleep deprivation,
et cetera, et cetera. And I think there's this
on here several times. I think that COVID and
how that was perceived and received by the masses
was a great multimillion. participant study on
what happens to an overstressed population when
asked to just simply stand in the middle and
critically think. So with that being said, what
are, through your eyes, what are the challenges
of the resistance to critical thinking, the resistance
to, like you said, the being the journeyman learner
rather than staying in the parameters of an academic
space or maybe a corporate or profession space?
I mean, There's so many endless challenges to
critical thinking. It's a, it's a funny question.
I'm actually writing a book about this and because
it's such a multifaceted area, you know, part
of which is that if I was to kind of summarize
it succinctly, it is that we have on one hand,
we have a few core drives of being a human. And
they are like, we need sleep, we need food, we
need water, we need air, we need shelter from
predators and from the environment. And then
connection. Those six things are basically the
six core things that we absolutely require to
live as sane, functional, happy, healthy human
beings on this earth. And we have a survival
system in our nervous system called the sympathetic
fight or flight response that is designed over
hundreds of millions of years and evolved over
hundreds of millions of years. But interestingly
enough, it's still quite similar now as it was
hundreds of millions of years ago in the ancient
sea snails and reptiles, which turns on automatically
in response to potentially threatening or threatening
things. And we have done this incredible job
in our environment, in our drive for convenience,
to eliminate potential actual threat. We don't
have lions and tigers chasing us very often.
We rarely have predators chasing us. We rarely
have to worry about having enough shelter from
a storm or from the environment. We generally
have enough people around us in terms of human
connection. We have smartphones with social media
that allow us to actually expand our human connection
if we choose to use it for that. We are the most
connected, convenient generation of human beings
ever to exist on this earth. And you can experience
that by reaching out to somebody immediately
with your phone and getting together or, you
know, ordering something on some website and
having it delivered to you from anywhere in the
world in two days, right? Like, we've never had
that before. And yet, we are about to screw it
all up. All that goodness that we have, we are
about to screw it all up because we are so caught
up in the, like, dopamine -driven attention.
economy of the of social media and smartphones
technology and all the things it's used for to
sell us stuff or to capture our attention as
a product that they we that they that is commoditized
that we have become addicted to technology and
addicted to smartphone technology in particular
which is around us all the time but screens as
a whole and when our attention gets sucked away
into anything like that that's on a regular basis,
it's not present. We are literally giving up
our, especially when it's unintentional, we're
doing, you know, it's just doom scrolling or,
or endless, you know, meaningless shopping or
like whatever it is to distract yourself from
not feeling good using your phone or your whatever
device you're out giving away your power by handing
your attention over to someone else to decide
what it gets to focus on. And then whatever it
focuses on in those moments is what comes into
our consciousness becomes part of us. And so
Again, it's hard to explain in short form, but
ultimately I think it's like our drive for convenience
and comfort and avoidance of discomfort has slipped
a little bit down this slippery slope of what
happens when we start to become too reliant on
technology for those things. And are we losing
the ability to cope ourselves? Are we losing
the ability to learn new things ourselves or
to do hard things? Because we're so focused on
being able to feel good instantly with our phones
and distract ourselves from hard things that
maybe we don't need to do hard things anymore.
But it's important to learn hard things to grow
and become a person, right? Like you have to
be an effective person. We have to do hard things.
It's not a question. It's known fact, scientific
fact, right? So I think that's kind of like the
real conundrum that we're facing as a society
right now. You touched on sleep. So I'll just
walk through that though. Now, this is obviously
a dead horse that's being flogged for nine years.
You and I first met in IHMC when we did a blue
sky for Marion County fire rescue, which is the
county that protects my family. And when we were
in that presentation, you know, the thing that
I brought to the room was the impact of the way
that we work our firefighters, the 56 -hour work
weeks, then the mandatory overtime that ends
up being 80, et cetera. Without taking too deep
dive into that whole conversation, talk to me
about the correlation between sleep deprivation,
especially chronic, and all things mental ill
health. Well, so stress on the whole, you're
talking about burnout for one, like burnout is...
the culmination of tremendous overwhelming amounts
of stress over time and we call that like like
allostatic load like how much how much force
is being put on the body uh over time and when
that level of like stress itself impairs sleep
and we are designed evolutionarily to not be
able to sleep and particularly to not enter deep
and and rem sleep states the most restorative
sleep states when we are under threat when our
body perceives threat And our amygdala, the fear
center in the brain, doesn't know the difference
between being, you know, call shifts or maybe
being called for a shift or, you know, all the
different things that could happen when you're
on call at the fire department and an actual
immediate survival threat. Because a lot of the
times, a lot of the stuff that comes in in the
fire department is an actual survival situation.
And so in those particular situations, particularly
specifically with like first responders. doctors,
military, police, firefighters, EMTs, we get
extra conditioned to respond with, to basically
not be able to settle down and to stay in a heightened
state so that we can tackle an emergency that
could come in at any moment. But there isn't
an emergency every moment. And so The stress
of that memory of this could be an emergency
right now or at any time, which is future thinking,
sets our body's sympathetic nervous system into
a fight or flight response as if there were a
predator around the corner at all times. And
so our bodies say, nope, we're not allowing you
to get deep restful sleep. That's where sleep
paralysis happens. That's where you're so out
of it, you lose control of your body. You can't
possibly be in a situation where you could lose
control of your body. when or you're paralyzed
when there could be a threat around right even
if it's just a possibility of a threat the body
shuts that down and that's one of the biggest
reasons why people have look poor deep in REM
sleep is because their stress response systems
over activated and so people who have been work
especially first responders been working on in
these jobs that have an extremely high uh stress
level in terms of the day -to -day work and they're
working crazy hours and um Then they also don't
have enough really great recovery time and or
practices. A lot of people just go to their phones
and start scrolling as soon as they get a break.
That is not calming the body. That's adding additional
allostatic load to the body. It's additionally
stimulating. So it makes it even harder to sleep
when you finally get that chance to go and lie
in bed. Your brain is still hyperactivated and
spinning. So does that kind of answer your question?
It does. Well, I think one of the biggest myths
in the fire service from the outside looking
in is, oh, you get to sleep at work. And I've
always used the analogy, when you sleep at a
fire station, it's like the guy in the orchestra
that has the big cymbals and he's whispered in
your ear, I'm going to smash these in your ear,
but I'm not going to tell you when. How well
would you sleep? And that's it. Yes, they might
be unconscious for periods of time between calls.
But you are not getting the deep restorative
sleep that's going to process the learning. It's
going to heal all the training that you've done
to make your ligaments, tendons, and muscles
stronger. And it's not going to process all the
thoughts that you've been through, including
the traumatic thoughts. So every third day, you
are degrading, basically. Yeah, exactly. Yeah,
that's the gist. And I think that's one of the
things I talk about a lot is we need that deep
restorative sleep. It's not optional. If we are
putting ourselves in work or lifestyle situations
that have dramatically impacted our sleep, and
our sleep is under six hours a night, especially
as a major sign regularly, and we're getting
low amounts of deep and REM sleep, then that
is a recipe for burnout over time. Because we
need, sleep is like our number, we're supposed
to spend a third of our, a third of our entire
lives on earth asleep, right? Like we are not
even close to that. And that is like our body's
deepest, safest, restorative state. And when
we have to get into that state, that's like going
to the gas station for your car, right? Like
it's the best gas we've got is sleep. Food is
like, you know, obviously, or maybe food is the
first best gas, sleep is second. most important,
but close second. So we really need to make sure
that we're refilling the tank. Absolutely. Well,
just going back to your journey then, you have
physician parents. What was it that sent you
into the world of neuroscience and psychiatry?
Well, it was kind of a funny story. So when I
was a kid and very, very young, probably between
the ages of maybe five and nine, I started to
have these really vivid dreams. And I didn't
really understand much about what dreams were
other than the fact that I know I would like
wake up like surprised or shocked of like what
I had just experienced. And as I started to go
to school and they were really vivid dreams,
like they were so vivid that I would have a dream
that I was like hanging out with my brother doing
something. And then I would be hanging out with
my brother the next day and I would mention,
hey, do you remember that thing that we did?
And he'd be like, what are you talking about?
And I would instantly remember that that was
a dream that he wasn't. actually physically there
so these were really vivid uh for me and as i
got older i started to notice that especially
as i you know started talking to you know seeing
patients many people have extremely vivid dreams
as a kid you don't know anything about it and
so i didn't think much about it it's just interesting
and then um when i started to go to school in
kindergarten first grade second grade i started
to have more like darker dreams more nightmares
still vivid um and those became pretty scary
and so i started to ask my parents because i
wasn't feeling that great about and that excited
about sleep you know like what are dreams what
are nightmares you know why do we have them etc
and um you know i think to calm my my mind and
ease my thoughts around sleep they said something
that most parents say which is like uh don't
worry dreams aren't real they can't hurt you
and i that was innocuous enough at the time but
you know i kept having occasional extremely vivid
dreams and they feel real, right? Like it felt
as real as waking reality for me as an experience.
And I think that was really fascinating and made
me start to question from a very early age, if
this feels real, as real as waking life, what
maybe the adults don't understand what the word
real really means, right? Maybe we need to put
a little more like inquiry into that word. Um,
because of the describing experience, this feels
real. you know so what is it what is real so
that was so that's kind of like where it started
for me was very young and then i started to just
kind of percolate on that thought and uh and
then i started reading a lot of science fiction
as i got into high school and um started to become
really interested in studying dreams scientifically
and started to find like some carl jung and some
psychology stuff and i my dad took me on a walk
one day uh i was probably in like 10th or 11th
grade And I had really admired my parents' passion
for medicine because they did some research and
they spent time doing research in their careers.
They also saw patients and they primarily saw
patients and they saw a lot of patients who couldn't
afford care for free and provide a lot of charitable
medical care to the community, particularly like
the poor immigrant community in San Francisco.
And they were so happy about providing that service.
they i always saw like how great they felt when
a patient who couldn't afford like we were eating
like a a rum cake that a patient italian patient
could who couldn't afford care like bought him
to as a gift for saving her vision you know and
allowing her to see again and it was just like
it was just like a silly rum cake but he was
like he really felt so good about having been
able to help this woman even though she couldn't
pay for for what you know the service that was
actually quite expensive that he was providing
and that left uh seeing the patients and how
happy they were you know when they could all
of a sudden see again i never thought that was
possible really left a mark on me and so i always
had that mind but never was sure that i wanted
to go to medical school or be a doctor in my
early years started doing some research in high
school um in the lab and started to see that
doing research was really cool sort of you know
going to work and see patients with doctors shadowing.
I thought that was interesting. And then my dad
takes me on this walk in like 10th or 11th grade.
I think it was 11th grade. And he was like, what
do you want to do, son? What do you want to do
with your life? And I originally wanted to be
a professional baseball player, but those dreams
had kind of faded. And I was thinking, I really
want to study dreams. So I told him. And he's
like, well, that sounds interesting, but you're
never going to be able to make a living doing
that. And if you want to do it and you want to
do it. like to the best of your abilities, be
much better off going to medical school and becoming
a doctor so you can see patients and then actually
work with them with their material, their subconscious
material and their dreams. And then you can always
do research on the side as much as you want.
But if for some reason your research doesn't
work out, you can always go see patients and
make a living. And I was like, this is practical
advice. So I thought about it and I applied to
a medical school, a medical school in, and then
during medical school in college i was continuing
to do research and found that my um that my my
mentor dr sally temple who had just won a macarthur
award macarthur prize for her groundbreaking
research in stem cells and she offered me the
opportunity to leave medical school take a leave
of absence for a couple years and do a phd with
her and continue my research in a more dedicated
fashion and when that opportunity came up it
was hard to say no so i um I took a leave of
absence for a few years between, it was like
four years, between third year and fourth year
of medical school, and then did my PhD in neuroscience
and stem cell and aging, and then came back,
finished medical school, and then realized in
that last couple of years of training that one
of my colleagues, I was actually still thinking
up until the last two years of my training, I
was still going to be an eye doctor because I
spent most of my time doing aging eye research.
And then one of my good friends, I had had a
great psychiatry rotation. One of my good friends
in medical school, who we spent a lot of time
together talking about consciousness, said, you
know, Dave, you really need to consider being
a psychiatrist. You'd be a great psychiatrist.
And I was like, honestly, I've never really considered
that before. Because at that time, psychiatry
was quite a stigmatized field in medicine. A
lot of people didn't respect psychiatry, even
back in that 2028, 2010 time. It's not that long
ago. So I never really honestly considered it.
And then she sent me 10 of the top papers that
had come out in psychedelic medicine research,
basically with psychiatrists and neuroscientists
studying psychedelic drug -induced waking dream
states and consciousness. And I was like, holy
crap, this is 10 papers in top -tier publications.
This is 2012. And overnight, I was like, this
is it. This is my field. I'm going to become
a psychiatrist and do this work. Before you jump
into psychedelics, because we're about to, stem
cells, I've heard kind of conflicting areas as
far as what they can do currently, what we're
hoping they can do, and then some of the mythology
around them. As we sit here now in 2026, where
are we as far as the exciting potential of stem
cell therapy? I think there is and has always
been an incredible amount of exciting potential
with stem cells. you know, theoretically infinite
potential because they're stem cells. But I think
the idea, the idea being that, you know, we really
are just scratching the surface. And I think
part of the challenge has been. in the way that
the therapies are administered and the rules
governing the regulation, the regulations around
the quality of the therapies. And a lot of people
are still getting their stem cells from Mexico
and from like other international sources. And
the quality is not guaranteed in any way or,
or preserved in any way. And then there are other,
other companies that are doing stem cell work,
autologous stem cell work, like from your own
body. And they're, you know, turning those stem
cells either sometimes in some cases umbilical
or in other cases, like peripheral stem cells
and turning them back into totipotent, you know,
induced pluripotent stem cells, which is really
incredible. And then delivering those back to
the body and seeing great results. And so I think
a lot of it, a lot of the, there's a ton of,
I think in short, there's a ton of exciting stuff
that's already happening with stem cells legitimately
in the regenerative medicine field, especially
orthopedics. There's incredible work and incredible
data on orthopedic use of stem cells to repair
injury faster. And most professional athletes
who make their living doing as professional athletes
today, when they get a severe orthopedic injury
that could benefit from stem cell repair, stem
cell facilitated repair, they get it. And it
helps accelerate recovery. So that's really cool.
A lot of other things. It's kind of overstated
for at this point, but there's more evidence
coming out. And I think, you know, there's a
lot of opportunity there. I just think we need
to standardize more so that we know we're working
with the same material at baseline and then do
more studies of that baseline material that's
pure. Absolutely. It's exciting because I'm missing
cartilage on both knees. My meniscus said Joe
handled tears bilaterally. And one day I'm hoping
that they'll be able to get those to grow back.
So that's why I'm asking. All right. Well, then
talking about psychedelics. That would be amazing.
I mean, that's that's the minute thing. Obviously,
the brain would be phenomenal on the spine and
other one. So before we even enter the world
of psychedelics, the traditional route, I say
traditional, the modern medicine route when it
comes to psychiatry. Talk to me about what you
were taught on that track. And then let's talk
about the pros and cons of what we know as pharmaceutical
antidepressants, et cetera, that are available
at the moment. I mean, I can answer those questions
together, which is that the core of psychiatry,
biological psychiatry, which is what we call
it over the last 50 years or so since we started
releasing and using SSRI antidepressants in treatment,
which really ushered in the kind of current era
of psychiatry, is really focused on stabilization.
So stabilization is important. But it's just
one phase of the entire treatment course or illness
course for an individual. And when we think about
stabilization for a physical injury, we think
about, oh, you just got into a car accident.
You're bleeding out from your legs. We need to
get you into the hospital and we need to get
you into the ER and we need to stop the bleeding
and we need to get you biologically, you know.
physiologically stable so that then you can heal,
right? And we do that so quickly because not
only can you die, but we can see the injury.
We can see you bleeding out and we can see the
injury needs to be fixed. In mental illness,
you can't really see the injury, which is a bit
of a problem for Western medicine in terms of
how we approach it because it has the same risks
that physical injury has, it can still kill you,
right? It just won't necessarily kill you right
away. But mental emotional injury that we don't
stabilize properly can stick around if we don't
do anything about it, and it can still kill you.
But you can't see the injury. And so what often
happens is we ignore it. uh or we're just told
it's our fault deal with it right don't let it
happen again like any of or anything in between
and so this compounds the injury inside and then
that injury just like a physical injury when
not treated effectively can become infected uh
you know gangrenous festering gangrenous like
it can you and eventually like We amputate parts
of our emotional selves from access because they're
so painful that we don't want to access them
anymore, right? We don't want to go back and
think about it anymore. So SSRIs are really great,
and many of the other medications we use today
are great at stabilizing people in mental health
crisis. And mental health crisis being you're
about to harm yourself or somebody else, or you're
in a really, really bad way and are just about
to get to the point of harming yourself or somebody
else. medications or the medications we have
are are often very effective when used properly
at stabilizing people in that state and getting
them back to a near baseline state to how they
felt before they had this episode a near baseline
not usually back to baseline quite back to uh
baseline being like you know how they were before
they started feeling really bad um that's important
however what we do in in mental health because
we can't see the wound is we just We continue,
and we have for the last 50 years, and I would
argue this is one of the biggest challenges that
we have that is part of the reason why we're
in the mental health crisis we're in right now
is because we don't have a next step after we
stabilize you in terms of what medicines you're
going to take next or what therapy you're going
to do next. We have suggestions for therapy.
We don't require anybody to go to it. And so
what we end up telling people is you have to
take these medicines for life. There's no cure
for your illness. We can treat it and do our
best to keep it in remission, but you could have
attacks at any time, right? You could enter remission
at any time. And especially if you stop taking
your medicine, the evidence shows that you're
much more likely to have an attack again. So
effectively, you're putting the stabilizer on,
you're putting the brakes on, the emotions, emotional
window of awareness, you just put the brakes
on there, and then you're just keeping them there
for years. And what happens is, number one, people
become tolerant to the brakes that are on or
the sedatives. So they need to add more, add
more distraction, add more numbing, add more
stabilizer. And then people start to get a lot
of side effects from those additional dosing
of those medicines because they're not risk -free.
And then people also start to have withdrawal
effects when they stop taking them. And so what
we're really moving, so that's kind of how the
system is set up today. We don't really have
a continuation after stabilization, which is
a huge issue. I had a Swedish psychiatrist on
probably about a year ago now, and he was saying
in Sweden, I think they were only allowed to
prescribe for about six months and it underlines
what you're talking about. And in my world, it
would be parallel to having a femoral bleed,
me putting a tourniquet on and then being all
right, just don't take it off. like you're not
fixing anything down the road so it's fascinating
the way that you frame that because it really
does illustrate the issue and i would argue you
know to remove mental health for a second it's
the same with you know hypertension and hyper
cholesterol and um you know the the the uh oh
my god what am i trying to say now that the diabetic
symptoms is Yes, some of these pills can stabilize,
but where is the exit strategy? Where is the
conversation of, okay, we're going to get your
blood pressure where you don't have a stroke,
but now let's talk about meditation and exercise
and healthy eating so that your body itself can
get back to where it can maintain homeostasis
when it comes to its blood pressure. So I've
always said this, that they seem like they're
a great tool, but just like you said, they're
a bridge to whatever is next. And if there is
nothing next. then as you as you alluded to then
you're walking around with a tourniquet now exactly
and and so that's where i think you know we're
coming back full circle from this last half century
of biological psychiatry to where we've marginalized
psychotherapy to one in which psychotherapy is
becoming realized as essential to give people
the skills they need to achieve the longstanding
benefit of the healing experience from mental
illness, whatever illness they have, by practicing
techniques to help them cope with discomfort
more effectively. And what we're finding is that
if you just use the stabilizers, SSRIs, SNRIs,
benzodiazepines, et cetera, to numb people to
discomfort without giving them the coping skills
and allowing them opportunities to practice those
coping skills. to manage and adapt to discomfort
on their own they never learn how to do it and
so then you take the medicine away and they're
flooded with feelings again they're like i don't
have what am i supposed to do with all these
feelings this is a lot right it's just overwhelming
for people and i think that is in large in large
part one of the major reasons for such uh significant
withdrawal effects from ssris and snri antidepressants
is just that feeling of being completely overwhelmed
with sensation again and feelings when your emotional
window has been narrowed and shrunk for. often
many years. But in the past, yes, we would prescribe
for six to 12 months. Many places in Europe do
this. And then you would give somebody the skill
sets they need in that six to 12 months to be
able to successfully taper off of the medicine
and not have to take it anymore. And so that's
the work we do in our clinic. That's the work
that many advanced clinics in America are now
doing and going back to. Then we're starting
to teach more in institutions of higher learning.
And that's really, I think, what in large part
psychedelic medicine has to offer because psychedelic
medicine shows us that when you combine the neuroplasticity
increasing, learning increasing, perspective
shifting, biochemical experience that comes from
taking a psychedelic with psychotherapy and the
right kind of psychotherapy, you get these profound...
long -lasting changes that only require a few
doses of medicine compared to everyday dosing.
And so you can achieve better long -term benefits
with a lower side effect profile with certain
psychedelic medicines used properly, like ketamine
in therapy, which we can't currently see with
existing antidepressant medications, which is
very exciting. Before we kind of take a deeper
dive into that, one of the startling commonalities
with Pretty much every single person who's come
on the show who's either been right at that point
of taking their own life or in some cases even
gone through with it and survived their attempt.
When we were young, a lot of the conversation
with suicide was it's cowardly, it's selfish.
How could you think of your family? And, you
know, that's what I believed as well. And then
you start listening to these people that were
there. And there seems to be this common denominator
that through the perfect storm of all things,
all the factors that break down our mental health,
unaddressed childhood trauma, sleep deprivation,
organizational betrayal, side effects of alcohol,
psych meds, etc, etc, etc. There seems to be
a miswiring of the brain. to where their actual
reality becomes distorted. And they believe that
they are the reason for the pain of their loved
ones. And if they just remove themselves, which
in that period of psychosis, I would argue is
courageous and selfless, even though it's a distorted
way of thinking, that if they just do that, everyone
else will be happier. Now the healthy mind knows
that pain is passed on to the people that are
left. And that's a whole different conversation.
But that feeling of burdensome, that voice saying,
you are the reason for everyone's suffering.
I don't feel like that's discussed enough in
front and center mental health conversations.
And I feel like it should be one of the biggest
red flags that if you're starting to hear that
self -talk or you're hearing your friend speaking
in that way, that that's a good precursor to
getting someone maybe before it's too late. Yeah,
yeah, absolutely. And that is exactly what comes
up in the trauma therapy we do with people. And
it's also why like four of the most powerful
words that you can say to somebody is it's not
your fault you know like i think like people
everybody blames themselves for more than they
need to blame themselves for but people who are
really in that sort of penultimate moment of
despair um have this do have this often overwhelming
burden that is I think you used the right word.
I mean, it is delusional thinking that, that
I am the reason what for everyone's suffering.
And if I was just gone, this would, everyone
else would live a better life, you know? And
I think that's never true. Generally speaking
across the board, like that's never true. Um,
there, there's always more we can do together
alive to remedy a situation than when somebody
is gone. And so, um, so yes. And I think like
when somebody can, and when somebody can be to
be reasoned with right then you can start to
convey to somebody hey you know it's not your
fault and you know like you know there's a there's
a lot that can be done here to help you um but
when it enters a stage of delusional thinking
reason kind of goes out the window and i think
that's why that wording that you use is actually
really important because that's when we start
to think well like okay this person like really
needs a higher level of support and care um because
we're talking about someone who is has really
been over rotating on these on these thought
loops these just what we call like distorted
thought loops that you take over your mind right
and then you eventually like lose perspective
that it could be any other way you get so certain
on it. So I think like that's when we start to
see those, you know, that it's good that you
brought it up. That's a really important thing
to notice and, and really, you know, help people
as an early sign, get into, get into care earlier,
talk to somebody early so that you can start
to, you know, somebody who can challenge those
thoughts, right? The whole point of therapy is
that you have somebody who's not part of your
day -to -day life, who, when you say stuff like
that, like, what if it's my, like, what if it's
my fault that everybody else is suffering around
me? And they're like, well, let's talk about
that. Is that actually possible? Let's talk about
your mom. And then you start to talk through.
And they come to their own realization that,
of course, it's impossible for that to be the
case. But without having a person to talk to
about that kind of stuff, it's really sensitive.
It's hard to process. What about the prevalence
of childhood trauma? When we had, again, IHMC,
we're talking about, you know, psychiatric screens
at the beginning of a profession it's again been
incredible how many people i know that had multiple
tours that had super traumatic um careers in
the first responder professions and yet when
they have either maybe it's traditional counseling
more often not in these conversations it is more
of the psychedelic journeys that they've done
that it was actually the formative years that
really were the fractures in their foundation
But when you see the conversations in my profession,
usually it's, oh, well, James had that decapitated
three -year -old. That's why he's struggling.
Not that when he was four years old, he was trapped
in a house fire and almost died. Let's talk about
that as well. So what about that? A lot of the
people listening that are wearing a uniform,
you know, talk to me about the prevalence of
actually the early years being a big factor of
their mental health struggles. I think it's extremely
prevalent. I mean, as a trauma psychiatrist,
I would argue that it's much more prevalent than
we talk about. And I think it's probably, you
know, from what we know, I think it's not a question
about whether or not there's a high likelihood
of someone in one of these careers having childhood
trauma. It's how bad was it? How severely impacted
are they from that traumatic childhood experience?
I would argue that pretty much everyone on the
face of the earth has overcome some kind of,
assuming that you survived childhood, some kind
of severe childhood challenges that could be
classified as traumatic. I don't know a single
person who doesn't have something like that.
But I think the degree of severity increases.
pretty substantially. And the commonality of
that severity starts to increase pretty substantially
when you start to get into the military and veteran
populations and also first responders. And in
a lot of cases, even physicians. And I think
there's a lot of people who go into the caregiver
role in a field because of something that happened
to them as a kid, where giving care... Maybe
they had to start caring for their parents early
in life or taking on additional responsibility
that was not typical for a child. But yeah, I
mean, I think that there's certainly a lot to
that. Supposedly. Military first responders have
an ACE score of 6 out of 10, and supposedly the
average incarcerated person has the same. So
that then gives you that metaphorical crossroads.
Did you have a positive mentor or a negative
mentor in your life, but the same kind of trauma?
Where I think there's an interesting conversation
to be had is having gone through numerous psych...
You know, evals, I had to do the MMPI numerous
times, which I learned down the road was never
meant to be a standalone test to see if someone's
worthy of being a first responder or not. But
what I realized is if there's an acknowledgement
that if you are towing the line as a soldier
or a firefighter or a cop, that there's a good
chance that you've had some struggles up to this
point. And if addressed, I truly believe that
becomes resilience and fosters empathy. If left
unaddressed, I feel like it's the fracture of
the foundation. Yeah, it's the blind spot. Absolutely.
So reframing rather than checking a box and saying
we tested to see if they were batshit crazy,
they passed, so therefore we're good. I'm washing
my hands of any responsibility. What about having
the conversation of the same way that we do PT?
that you literally normalize therapy sessions
as you go through your formative year, your first
probationary year, and then obviously checking
in ever since so that you can start working through
whatever it is and view it with a lens of performance.
Look, you will operate at a higher level in a
gunfight searching for a child in a fire if we
can get your mind working clearly. So rather
than this, you got over that hurdle, you're good
for the next 25 years. having this conversation
at the front door so you've normalized it. There's
no barrier to entry when you do have something
bad. And then down the road, you always know,
well, I'm going to go speak to Dr. Dave because
it's been a rough shift. So it's as ingrained
into our culture then as pushups and pulling
fire hose. Yeah, it's mental, emotional bodybuilding.
Right. It's the same. It's of equal, if not more
importance. And I think that when you are, you
said it really, really well, which is that when
we do this work, when we process our traumas,
when we accept that what's going on and we work
on it and we grow, we grow into highly resilient
human beings. And you can measure that because
When we feel like we've processed, when we get
to a state in our lives, when we've processed
a lot of the things and dealt with a lot of the
things that have happened to us, and we're not
constantly thinking about them or worrying about
them or ruminating on them, we feel safer in
our own bodies every moment. And our HRV, our
heart rate variability goes up. So you can actually
measure a biomarker, which is the rate of change
of your heartbeat over time, which is a proxy
for vagus nerve activity of the parasympathetic
recovery nervous system. And as you... feel as
you process trauma and feel safer in your body
and do other things to feel safe in your body
regardless of whether you have a diagnosis or
not you can increase your vagal tone and increase
your heart rate variability which is the best
biomarker we have of consistent peak performance
consistent injury prevention resisting illness
uh like overall mental and physical fitness and
accuracy and now longevity right longevity and
health span it's the best biomarker so this is
like a really important biometric that we you
know now have that we can track against which
is really exciting but also i think it's more
what's more important is that it's it's like
any of us can make a decision to just start doing
this work for ourselves right now by just prioritizing
it um like prioritizing um you know like you
said having somebody to talk to is really important.
But even just like having quiet time without
your phone, going on like doing things that are
like nice for yourself and treating yourself
well and thinking about yourself well and with
gratitude and forgiveness and compassion. And
there are lots of these techniques that really
help. But again, there's no doubt about it. This
is not easy work when you get started, which
is why having somebody as a guide along the path
can be really helpful. And that really gets to
why we developed Apollo, because what we realized,
as you said, is that when you've processed this
stuff or you feel a little safer in your body,
you get more resilient. And so we thought that,
well, if we increase vagus nerve activity, then
perhaps we can help. people feel safer, safe
enough to feel their own feelings again. And
if they can feel their own feelings, they can
process them and then feel better on the other
side faster. And that's actually now what we've
seen using this technology. And I'm just wearing
one on my chest right now, but you can wear it
anywhere. And it uses sound wave vibrations to
help us get into the same state of healing and
recovery that we're talking about that results
in those performance boosts later and consistently
down the road. Well, let's expand on that. You
brought Apollo to not only IHMC when we did the
Blue Sky, but also you did a talk here in Ocala
a few weeks ago, and I got to use it again for
a moment. What even sent you down the road of
the science behind that? And then talk to me
about the product and let's elaborate on the
applications for the people listening. Sure.
Well, it's very relevant because as a psychiatrist
and researcher, I was working with patients who
were primarily PTSD survivors. and most of them
were traumatized military veterans or women with
sexual trauma or burnt out first responders and
people of that nature. And we were throwing from
the Western psychiatry approach, we were throwing
the kitchen sink at these people. Like we were
doing everything we could. They'd done multiple
medication trials, multiple therapy trials. Most
of these people were not getting better. Like
they were still heavily symptomatic long -term.
And some of them, when they, by the time I saw
them, which was like, several doctors down the
road have been taking like five to 15 different
medications and still not experiencing any consistent
relief. And that was just really surprising to
me that we were seeing so much of that. And as
I started to see more of it in my clinic, I started
talking to my colleagues and they were seeing
the same thing. And then I started looking at
the research and other doctors were publishing
that PTSD especially PTSD with adverse childhood
events, is much harder to treat, tends to be
much more resistant to treatment than other forms
of mental illness, and that most people who ever
get treated with all the treatments don't get
better. So I thought, well, this is a ripe area
for discovery. If only 30 % of people are getting
better and 70 % are still sick after being diagnosed
with PTSD, like we have a huge amount of improvement
we can make in this area so started with my patients
and the patients just didn't respond to treatment
and then as i started to learn more from these
people by talking to them you know we're talking
like hundreds, thousands of people over the years
just continually asking about their feelings
and what they're going through and what they're
struggling with and how they're coping with it
and what's working and what's not working and
what makes it worse and et cetera, all the things
that we ask about in a mental health interview,
you start to get really well acquainted with
a traumatized consciousness and you really start
to see not only the similarities between people,
but also the similarities between these people
who I'm working with as my patients and myself
and how I deal with trauma and stress myself.
I started to realize that PTSD is a learned fear
response, right? Like we don't talk about it.
We talk about it like that, but not quite all
the way like that. But it's like BF Skinner,
right? It's like learned fear with rats in the
cage with the button. And you can train a rat
to fear food if you associate it with something
that makes food unpleasant, right? And then it
will die of starvation. Like that's really interesting.
So we actually do that same fear learning. to
ourselves and we have that experience in the
world and uh if and that's what results in eventually
for many people a diagnosis of mental illness
i think the real question is well then if we
need to rethink this uh disorder of ptsd to start
as fear learning then how do you fix fear learning
in animals you relearn safety and it works and
you extinguish the fear Like, well, isn't that
what it says about humans? Of course, it does
say that about humans, that you just have to
relearn safety. And that's how our psychotherapies
work. So as I'm starting to see this, I thought,
well, okay, there is an opportunity here to look
at, well, what are the biological correlates
of fear and safety in the body? The neurobiological
correlates are the fight or flight sympathetic
nervous system responds to fear and puts us in
a survival state when we're afraid, when we could
die. And then the parasympathetic. rest and digest
nervous system in response to safety and they're
separate and they split resources between fear
response and safety response safety's recovery
digestion immunity uh reproduction metabolism
sleep all the good stuff we want to happen most
of the time fear the you know sympathetic and
the fear response is what we want to happen when
we're running from an immediate threat so that
seeing those patterns i started to realize well
what if we just gave the, if you do safety practices,
does that help with PTSD symptoms? If you do
the deep breathing, the meditation, yoga, mindfulness,
massage, service animals, yes, in fact, it all
does. How does it work? And MDMA therapy too.
And I looked at all these techniques. I mapped
out the nervous system pathway to get from the
technique to the brain and i found that they
all activate the emotional cortex in the brain
that is response to safety so how do we send
more safety to the body like can we use technology
for people who don't have service animals and
don't have other people around to help and don't
know these techniques can we make a technology
for our traumatized veterans and first responders
that can actually Give them more of that safety
input on the go. Will that accelerate recovery
from PTSD symptoms and also just performance
in general life and day -to -day life and sleep?
And it turned out that it did. And so that technology
became Apollo. And we discovered it between 2014
and 2016 at the University of Pittsburgh Medical
Center. And it just sends soothing vibrations,
like gentle sound wave vibrations that you can
feel noticeably that feel kind of like an ocean
wave kind of. crashing up and down very slowly
or like a cat purring on your chest and um you
can wear it anywhere on your body and it sends
these vibrations to the body that in that uh
turn the vagus nerve activity up or down depending
on how fatigued or or stressed or um what state
you're in and what state you want to go to and
you can use it all the time as much as you want
and and it really actually is helping people
with ptsd which is really exciting So what are
you seeing then as far as the efficacy from its
inception to what you're witnessing now, 10 plus
years later? So we have, since that time, we've
completed 17 clinical studies across over 2000
subjects, most of which have been completed at
independent universities. we just send them product
and technology and they test it in their patient
populations or their healthy populations or first
responders and i think the most interesting consistent
things we see are that using apollo within minutes
as little as two to three minutes has a noticeable
change on the body and that's really interesting
because like the body and by mean body i mean
like your heart rate your heart rate variability
and your breath rate and your blood pressure
you can notice a change in as little as two to
three minutes of just feeling the apollo vibration
on your body and that's really interesting because
that's how long it takes deep breathing to work
and that's how long it takes soothing touch to
work and apollo is a combination of deep breathing
and soothing touch so it's working in the same
time scale as measured in a double blind randomized
placebo controlled trial in a very very rigorous
university lab that this is working in the same
time scale two to three minutes as deep breathing
in and soothing touch which are its origins scientifically
so that's really interesting from there we started
to do trials in regular populations of people
and and ill populations of people and we saw
i think consistently what's most interesting
across the board whether you're looking at folks
with ptsd whether we're looking at folks with
depression symptoms with anxiety with uh metastatic
breast cancer or terminal cancer diagnoses or
people with severe terminal autoimmune diseases
is that There's an improvement in a core set
of symptoms and metrics that are all autonomic
-related components. And so these are sleep improves
statistically and clinically significantly between,
depending on who you are, like 30 to 45 minutes
a night. We see deep and REM sleep improve. We
see heart rate and resting heart rate go down.
Blood pressure goes down. HRV, heart rate variability,
the sign that the vagus nerve is being activated,
goes up. And fatigue, which can be a measure
of lots of different things that happen in the
body when you're overly stressed out, fatigue
goes way down across all of these populations.
The PTSD groups, the autoimmune groups, the cancer
pain groups, pain perception is altered. people
are still experiencing pain, but they're not
experiencing quite as much pain. And the more
they use Apollo, the less pain that they experience.
And we are seeing borderline statistical significance
there. All the other metrics I just mentioned
are profoundly statistically significant. Like
P is less than 0 .001. So that's really exciting.
So that means that there's like no chance that
this data happened by chance, particularly now
that it's been replicated across multiple different
study sites. So that's kind of the gamut of the
kinds of improvements we're seeing. But I think
the three things that are the most relevant to
first responders are, number one, the benefits
of this happen in as little as one night. That
is amazing. There is so little that we have that
doesn't have side effects that works that quickly.
So you can see benefits from Apollo, especially
if you have a first responder. what we'll call
a irregular sleep schedule, you could see benefits
in as little as one night. And I think that that
is something that makes this very accessible
and interesting to people as a way to just be
able to gain control over your sleep rhythms
and your day -to -day recovery, which is really,
as you've been alluding to, centered around sleep.
Absolutely. Yeah. Your technology and New Calm
is another one I think is phenomenal. When we
get these work weeks to where they're healthy
and then we teach people all these tools to get
the most out of their rest days as well. I mean,
you know, we would revolutionize health in my
profession. There's no question. One more area
because I know we've only got a few minutes left.
I've had Jonathan Edwards on talking about ketamine
and Catherine Walker as well. Dr. Ben Sess has
been on a couple of times talking about MDMA
and psychotherapy with that. I've talked about
Ibogaine, Ayahuasca, all these different ones.
Which is some of the psychedelic side that's
exciting you the most? I mean, I think it's like
the whole thing, right? I think one of the things
that I teach about that a lot of other people
don't teach about for whatever reason is what
what what is the common mechanism of how psychedelic
medicines when combined with therapy facilitate
healing and access to transformation right what
is the common ground regardless of whether it's
ketamine or mdma or ayahuasca or psilocybin or
lsd what do they have in common and What's interesting
is they actually have, when we think about it
from that perspective, quite a lot in common.
And then when we separate them all by molecular
structure and try to focus on how are these molecularly
working and try to ground up, understand the
mechanism, it's not as interesting as understanding
phenomenologically what happens when you take
these different medicines. Starting out with
the fact that ayahuasca, one of the oldest known
psychedelic brews that's still used by indigenous
cultures. was originally, when we asked, we went
down to Peru to talk to one of the oldest Shipibo
tribes and talk to the shamans and understand
from them what they were using ayahuasca for
and how they used it in their own language. And
the single word answer when I asked him, what
are you using this for? What do you use ayahuasca
for? Single word answer, trauma. To them, trauma
means the energetic blockages that prevent our
energy from flowing freely, from our human essence,
from being free. As they see it, they're using
and working with that medicine, and there's a
whole lot more to it than this, but in the medicinal
sense, it's to help process trauma. help the
individual process their trauma and resolve it
to grow into a more resilient, higher version
of themselves. Fast forward to today with MDMA
and ketamine therapy and psilocybin therapy,
we are using the same techniques with a modern
Western adaptation to treat trauma. It's not
with a shaman. It's with a doctor or somebody
like me, with therapist, colleague, and we create
a foundation of trust. to guide you into your
subconscious, unconscious material in a setting
where you feel safe enough to allow whatever
comes up, come up and work with it. And as people
start to notice that they start to become more
accepting of what happened and release fault
and let go of past regrets and all that kind
of thing, they feel more free to be themselves.
They feel more free in general. Right. So like
we're doing the same stuff. And what's even more
interesting to me is that the effect of psychedelic
medicines, when you look at the is like what
what do these represent in the path of the evolution
of modern medicine? Right. Because we've been
treating, as I mentioned, the beginning of this
interview, we've been treating mental illness.
the same way for the last 50 years and before
that it was just psychotherapy basically no drugs
then it was just drugs and basically no psychotherapy
for the next 50 years now we have a combination
of all this stuff happening and we have psychedelic
medicine entering the scene and psychedelic medicines
unlike our traditional western pharmaceuticals
for mental health you don't take every day you
take to read anywhere from one to six or one
to 12 doses a year, depending on the drug, with
intensive psychotherapy accompanying it and in
between, and you get to long -term remission.
And in the MDMA trials with severe PTSD, you
get to long -term remission from just three doses
and 42 hours of therapy that gets even better
when you're out without additional treatment.
So I think that is nothing to scoff at. We don't
see that kind of improvement in mental illness
with any modern treatment or any past treatment
ever. The only way to go find something as a
medication or treatment that works in that way
where you treat somebody over one to 12 weeks
and then they get better and then they get after
and then they get even better one year later.
The only kinds of things that are drugs that
work like that are antibiotics. right? Antifungals,
things of that nature. And similarly, you also
have to use those for one to 12 weeks, depending
on how bad your infection is, right? And you
also have to do aftercare, and you also have
to protect the wound or wherever the infection
is, right? You have to take care of yourself
or the infection won't go away. And the antibiotics
work by helping weaken the bacteria so that your
body is more able to easily fight it and kill
it. They don't actually kill the bacteria for
us. They just weaken it so that our body can
kill it. What do psychedelics do? They weaken
the meaning around trauma, traumatic events,
right? They loosen the association of there must
be something wrong with me because this happened.
It weakens the power that we've given to that
past traumatic event that's happening. The past
traumatic event is still what happened. It's
still the same. What's different is that now
we're able to process it and digest it more easily
and break it down and then spit it out the other
side because it doesn't seem so scary. Does that
make sense? No, it does completely. I think this
is the creation of this podcast initially is
there are so many solutions now. There just are.
There's a lot of stigma around some of them.
There's just misinformation. You know, smacks
against what we thought was illegal or immoral
in the past. But now it's just the storytelling,
getting people to understand that, you know,
how important sleep is and the rest and recovery
between shift work, if that's what you do. And
then using psychedelics if you're not able to
access trauma and finding forgiveness. And then,
you know, CBD and it just the list goes on and
on and on. And then obviously the technology,
you know, Apollo Neuro and New Calm and some
of these other incredible technologies that we're
using modern, you know. modern tech now to address
age -old solutions as well so i know we've come
at the end of the hour for people listening then
where can they find apollo and then where are
other places they can learn more about you and
reach out thank you again for having me and i
think just to put the closure on this any between
to answer your question in full between technology
and psychedelics i would say in the next five
to ten years we will if we focus on what i was
just talking about we will start to see actual
cures for mental illness emerge in the next five
to 10 years. We're that close, but we have to
focus on developing and studying effectively
and disseminating the technology and the psychedelic
medicine approaches thoughtfully, respectfully,
properly. It can't just spread it all out there
with no regulation, no guidance. It has to be
delivered correctly to get the outcome. It has
to be used correctly to get the outcome that
we're talking about. But I think that's the exciting
light at the end of the tunnel. That's the shining
star, right? Is getting to a time where we can
actually start curing mental illnesses like PTSD,
depression, anxiety, and maybe many others. And
we're not that far away. Again, thank you so
much for having me. This is such an exciting
topic to talk about. If anybody wants to come
find me, you can find Apollo at apolloneuro .com.
That's A -P -O -L -L -O -N -E -U -R -O .com.
If you can't remember that, you can go to wearablehugs
.com, which is what the kids call it. And if
you have an iPhone and you want to try Apollo
for free, you can just download the Apollo Neuro
app to your iPhone. Apollo Wearable works with
all platforms, but... We have a free version
that you can try on iPhone now. So if you have
an iPhone, try it out. Just download the Apollo
Neuro app from the App Store. And then if you
want to come find me, I am at drdave .io. And
you can find my clinic and all of the work that
I do and my podcasts that I work on, which are
The Psychedelic Report, which comes out every
couple weeks on Spotify and Apple, and also Your
Brain Explained, which is a consciousness show.
about how your brain works, which also comes
out about quarterly on Apple and Spotify.