My guest this week is Dr. David Rabin.
In this episode, Dr. David and I discuss innovative ways to support stress reduction and mental health for children and adults. Chronic high levels of stress is an issue for so many children and teens, especially those diagnosed with any type of neurodevelopmental or mental health condition. As parents and professionals, we are also facing unprecedented levels of stress in our personal lives, parenting, and professional lives. Dr. Rabin shares his novel research and approach to one of the lesser known ways we can reduce and manage stress. What is that? Touch! We talk about new innovations to mimic the same positive neurological response, as well as providing ways that support symptom reduction in the moment and build regulation capabilities over the longer term. To me as a pediatric practitioner, Dr. David’s team has developed one of the most exciting wearable devices because it opens up a whole new avenue of supporting our brains and nervous systems in ways that had been difficult to access previously, especially for kids with more severe challenges. Let’s dive in and explore how we can leverage supportive, productive tools and strategies to improve mental health for all of us!
Dr. David Rabin is a 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 the cofounder and Chief Innovation Officer at Apollo Neuroscience, which has developed the first scientifically validated wearable technology that actively improves energy, focus and relaxation using a novel touch therapy that signals safety to the brain. Dr. David is the cofounder and executive director of the Board of Medicine, a nonprofit organization of physicians and scientists establishing the first peer-reviewed, evidence-based clinical guidelines for the production and safe use of currently unregulated alternative medicines. In addition to his clinical psychiatry practice, Dr. David is conducting research on the epigenetic regulation of trauma responses to determine the mechanisms of psychedelic-assisted psychotherapy, and the neurobiology of belief.
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Episode Intro … 00:00:30
Introduction to Dr. David Rabin & Research … 00:01:33
Unaddressed Trauma–Most Pressing Mental Health Issue … 00:10:46
Root Level Trauma in Pediatric Population … 00:16:27
Environmental Stress & Oversaturation of Information …00:24:05
Attention System, Touch and Brain-Body Connection … 00:30:51
Neurobiology & How Apollo Works … 00:38:23
Building the Attention Muscle with Wearable Tech … 00:43:54
How to Use Apollo … 00:49:00
How Dr. Nicole Uses the Apollo … 00:57:50
Resources to Learn More About Apollo … 00:59:55
Episode Wrap Up … 01:01:10
Dr. Nicole Beurkens
Hi everyone, welcome to the show. I’m Dr. Nicole, and today we’re talking about innovative ways of supporting stress reduction for children and adults. Chronic high levels of stress are an issue for so many children and teens, especially those diagnosed with any type of neurodevelopmental or mental health condition. As parents and professionals, we’re also facing unprecedented levels of stress in our personal lives, in our parenting, in our professional lives. One of the lesser known ways we can reduce and manage stress, and just support brain function in general is through touch, and new innovations and technology are providing options for this in ways that support symptom reduction in the moment and build regulation capabilities over the longer term. To explore this topic with us today I’ve invited one of my favorite psychiatry colleagues, Dr. David Rabin on the show. I want to tell you a little bit about him.
He’s a 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 the cofounder and Chief Innovation Officer at Apollo Neuroscience, which has developed the first scientifically validated wearable technology that actively improves energy, focus and relaxation using a novel touch therapy that signals safety to the brain. Dr. David is the cofounder and executive director of the Board of Medicine, a nonprofit organization of physicians and scientists establishing the first peer-reviewed, evidence-based clinical guidelines for the production and safe use of currently unregulated alternative medicines. In addition to his clinical psychiatry practice, Dr. David is conducting research on the epigenetic regulation of trauma responses to determine the mechanisms of psychedelic-assisted psychotherapy, and the neurobiology of belief. All really cutting edge stuff. As you can already tell from his bio, Dr. David is not your typical mainstream psychiatrist, and also happens to be a great guy. David, thank you for being here. Welcome to the show.
Dr. David Rabin
Thanks so much for having Nicole, it’s a pleasure.
Dr. Nicole Beurkens
So I want to start with your story because you are somewhat unusual, or very unusual in the field of psychiatry, in terms of not only how you practice, but also all of the innovative things you’re working on, the research that you’re doing. So I’d love to have you share a little bit of your story of what led you to medicine and psychiatry specifically in the first place, and then sort of how your journey took you to practicing and doing the things that you’re doing today.
Dr. David Rabin
That’s a great place to start. So I guess it originally started when I was a kid. I was very, very young, and I used to have extremely vivid dreams, going back as far as I can remember. And they weren’t always bad or good, necessarily, but they were so vivid and real to me when I was maybe as young as 3, 4 or 5, 6 years old, that I would reference them in real life, thinking that they had actually happened and those events that transpired, and then the people who I was interacting with were like, “What are you talking about?” And I was like, “Oh, that was in a dream.” My parents are both western-trained physicians. My dad’s an ophthalmologist and an engineer, my mom’s a neurologist. And so of course, I asked them what they thought about all this, and they said, “Oh, don’t worry about it, dreams aren’t real.” And I think that’s the explanation most kids get at that age, but that just didn’t really sit with me. It felt so real that it made me question what does real even mean if this feels real and waking life feels real. Then what is real? Maybe there’s something else going on here. And so that just kind of sparked my earliest memories of being interested in consciousness and exploring reality, and at some point, I shadowed some researchers in the lab and some doctors in the clinic, and realized that studying the human condition and what it means to be well, and also to be sick and how to treat illness, was something was very interesting to me. I really always wanted to study consciousness and how we think and feel and make meaning from the world, but many of the people who advised me when I was young said, “That’s a very, very challenging area to research, and you probably want to go on to something that will actually pay you to do work and to have a decent life, and then you can do that stuff on the side.” And so I took their advice and I went down the traditional medical path, and I think I became really, really fascinated by resilience and chronic stress and just seeing these people who are some of my role models in the world, people like Michael Jordan, people like famous authors, famous figures that really inspired me growing up, these people, some of them had overcome such tremendous adversity and had such incredible challenges in their lives, and rose above them to become these incredible idols of human society and role models for so many of us. And then I noticed that there were a lot of other people who were facing challenges that were not as easy to overcome, that were actually holding them back and preventing them from achieving their full potential. And so it really made me interested in resilience, which is sort of how we bounce back from stress, how we adapt to stress and overcome it, and become ideally stronger after we’ve experienced something stressful or challenging, rather than having it set us back, and what is involved in that whole process. And I started researching that on stem cells and human cells in the lab, which is what I did my PhD on in New York, and then realized after working in the lab for about seven years on human cells, that I really liked the lab work, but I just couldn’t look at cells for my entire life. I really enjoyed working with people, the whole person, and really working with people in a way where even if I treated their eyes, or I treated their brain, or I treated some other organ system with their body, that there were still other things going on under the surface that were often psychologically related that weren’t being addressed. And so it really drove me. I had a great psychiatry rotation in medical school and a lot of really encouraging mentors there. Having good mentors is so important. They kind of nudged me in that direction. And as I thought more about what I wanted my life to look like in the future, one of my friends introduced me to some manuscripts, some articles on the latest stuff going on in the field of psychiatry around technology and how technology was being used to treat and address and track mental illness outcomes, about psychedelic-assisted psychotherapy and things like MDMA and psilocybin that were at that time in phase one, phase two trials for depression and PTSD, that were showing groundbreaking results. And what we were seeing from all this work collectively was that we were able to finally, for the first time in modern medicine, explore consciousness as research. And I went from shifting my focus at that point to cell biology and mostly physical medicine focused predominantly on the eye and the brain as the physical organs to psychiatry, where I really wanted to study the whole person, and really help people on a more holistic scale, and so that is ultimately how I got into the field. And then from there, I just realized, of course, like many of us, with all the problems that we that we face as a field in the in psychiatry and how hard it is to actually treat these mental health conditions with the tools that are available to us, and realizing that we just frankly need more tools. We desperately need more tools, we need more skills to use those tools and to figure out how to help people differently, and that forced me to question if maybe we have the idea of trauma not quite right. Maybe mental illness is a lot more than what we think it is, and maybe we’re not addressing it properly. And that led to the development of Apollo and everything else. So there you go.
Dr. Nicole Beurkens
It’s amazing, sort of the full circle nature of that, even from an early age, being interested in consciousness, and then this educational and professional journey that took you to a point of actually now being able to weave that in and explore that as part of your clinical and research work. Wow, those seeds that were planted early on, you were like an existentially-minded toddler, who now is like doing this for a living. I love it. I think it’s amazing and unique too, your research background, the PhD, the research background, and then bringing that into your work in the field of medicine. I think that informs that in a way that’s different as well. I couldn’t agree with you more about the need for more tools. I think all of us in mental health recognize that we need more tools. Whenever we think about the mainstream approaches and the tools that we have available, whether people think those are good, bad or otherwise, the fact is we just need more of them. We have too many people who are not getting better in the way that we would hope that they do.
So I want to just touch on that for a minute because I’m curious, from your perspective, both in your clinical practice, as well as what you’re seeing in the data with the children and adults that you’re doing studies on: What do you feel like are some of the most pressing mental health issues that we’re seeing right now? In pediatric populations and adult populations, maybe it’s the same across the board, but what do you feel like are the biggest things happening that we need to address for people?
Dr. David Rabin
That’s a good question. I’ll try to see if I can figure out how to break this down into one thing. If I had to say one thing that is the biggest issue that we are not addressing adequately, it is unaddressed trauma. So trauma psychiatry is kind of my specialty focus, even though I became very interested in it because what I realized from reading a lot of publications and seeing a lot of patients over the years was that every single person I saw had, no matter what their DSM diagnosis was, they all had some kind of trauma history, which wasn’t necessarily what some people call “The big T trauma”, it was an experience that they had that was personally relevant to them, that was very personally meaningful to them, that was, from what they could tell negative in that it was unpleasant in some or many ways, and they were not supported after the experience sufficiently, which often leads an individual to feel like it’s their fault that this thing happened to them. And then what happens after that could potentially be called depression or anxiety, or PTSD, or ADHD, or whatever. But I think that denying the origin of what ultimately starts most of what we eventually call mental illness, is the biggest problem that we face in the field because it ignores the root cause of all the illness in the first place. What we’re seeing when we look at people with mental illness, taking a step back and looking at how mental illness affects the physical body, we can measure that now. Biofeedback actually was a big part of pioneering the way that we understand what changes happen in the physical body when we are sick mentally or emotionally. And so when we are traumatized, a traumatic event, effectively, is a very intense and meaningful, stressful event that we don’t have support to cope with afterwards, and we probably don’t have the adequate preparation to deal with in advance. And so that triggers our stress response system, that sympathetic fight or flight or freeze response system to take our limited resources that we have available and shuttle them over to our skeletal muscles, our motor cortex of our brain, our heart and our lungs and all the parts of our brain and body that are required to get us out of an actual survival threatening situation, the same exact systems, the research shows it now, as when we encountered a lion in the jungle in the ancient days, right? But most of the stress that we face nowadays is not lion in the jungle stress. It’s very, very different. And so that system can get turned on in times, often when it’s not actually indicated. And so the problem is: Where do the resources come from that turn that system on? Well, they come from all the other systems that need to be running to help us feel good, like our reproductive system, and our digestive system, and our immune system, and our rest and recovery system that helps make sure we can wind down sufficiently to go to sleep. And what we call the parasympathetic nervous system, that basically responds to safety to trigger the recovery of our bodies to turn on. So if we’re safe enough to not have to be in a threat state, or we can remind ourselves that we’re safe enough to not be in a threat state, threat being evolutionarily specifically defined as survival threats, which include predators, lack of food, lack of water, lack of air, or lack of acceptance by our community in a real way, like being thrown out of your community, in situations where those things don’t exist, we should not be taking resources from our precious recovery system and diverting them to our stress response system. But ultimately, that’s what traumatic events do. And when you look at people with depression or anxiety or PTSD, or any number of other mental illnesses like ADHD as well, we see that these people’s bodies are showing us that the sympathetic nervous system is overactive, and their bodies have responded to these stressful events and have not been able to sufficiently recover. And that over time correlates with worse responses to treatment, it correlates highly with worse performance cognitively and physically, more rates of injury because you’re distracted by stress, and worse sleep, and more likelihood of infection, and all the things that we don’t want to happen, that come from unresolved trauma. And this is the physiology, this is what the physiology is saying. This is what the actual physical measurements of the body are telling us. So that is objective data. And if we, as a field in mental health, psychiatry and psychology, fail to understand that, which unfortunately it hasn’t been fully integrated into our training yet, then we’re missing a big part of the picture of what mental illness really is, which is unresolved, unprocessed trauma. And that’s what we really need to focus on as a field, rather than just trying to deal with it with numbing things or distracting things that can be useful for a short period of time, but they are not the solution to the problem. They are great for stabilizing people. They’re great for getting people to a state where they can make the big change, but they’re not the answer to the trauma problem.
Dr. Nicole Beurkens
I completely agree. I’m so glad that’s how you decided to answer that question because I think it’s so true. And I think there’s something fundamentally important and empowering about using that trauma framework with patients, because so much of the messaging in psychiatry and psychology has been “You’re broken, there’s something intrinsically wrong with you.” And this understanding of root level trauma really reframes that as “There’s nothing fundamentally wrong or broken about you, this is about a response to what’s happened to you.” And I find that to be such a powerful reframe and way of helping people to understand what’s going on for them. I want to touch on this piece with kids, because I think there can be a defensiveness on the part of parents, professionals, adults in general, when we start to talk about these things having a root of some type of trauma. Nobody has a parent or a teacher or a therapist or whatever wants to think about “I’ve done something” or “Something has happened to this child under my care.” So I think it’s just understanding that we all have these experiences; it’s our perception of them. We don’t mean for our kids to experience these things, just like our parents didn’t mean for that to happen. It’s sort of a part of being human, and so this isn’t blaming if you have a child who’s struggling with these things. It’s not that you are a bad parent or did something to traumatize your child, although certainly I mean, in cases of abuse, neglect, whatever, that’s an obvious thing. But I think it’s this understanding that we need to, as parents and as adults working with kids, understand that this is relevant to symptoms that kids have. And then specifically within that, for kids who have brains that we might say are on the neurodivergent spectrum, whatever the diagnosis was, or not-diagnosis might be, that these kids inherently experience higher levels of stress, and have more experience of trauma just because of the disconnect between how their brain is functioning and the way the world works. And so I am interested in your thoughts on those, as it relates to the pediatric population.
Dr. David Rabin
Yeah, I mean, I think you’re absolutely right. Folks, children, especially with neurodiverse backgrounds, I think the biggest challenge to help them adjust to the society that we’re in that doesn’t necessarily facilitate or cater to their needs or the way their brains work, is the anxiety associated with being second class citizens. The idea that your brain works differently than most people’s brains, and so therefore, because you do not necessarily have as much ease at doing the kinds of things that the rest of us have to do, that you’re not as good, you’re not as valuable, right? And that often gets passed on at a very, very young age, that sentiment, even from well-meaning families and caregivers. And it’s not on purpose. It’s just something that is unfortunately a part of our society right now. And then the child has this challenge of not only trying to cope with the way that their brains they’re different and the way that society does not really support or cater to their different needs, which is challenging enough as it is, but then they have to cope with also the anxiety that we all have, a feeling like we’re not good enough, but extra, because they are actually born with a different way that their brain works. And so, yeah, it’s a real problem. And I think the best thing that we could do for these kids is really exactly what you said, is to destigmatize all of this for them by explaining to them that it’s not their fault, and that their brains do work differently, and that’s okay. And the challenge for them that they need to focus on more than anything else is: How do I figure out how to learn, how to adapt basically, to a society with a different kind of starting point, right? Like I started with what I started with, you started with what you started with, we’re all going to have different journeys, some of us are going to be more similar than others. But for the kids who are really different, for those kids, let’s try to eliminate as much anxiety as possible and really just focus on giving them the tools that they need to learn effectively, and to know that their challenges are really around learning to adapt, not learning to adapt and cope with anxiety of being lesser than. And at that point, when we do that, what we often see with these kids, which is just incredible, is that they blossom into some of the most incredibly talented individuals we’ve ever encountered, right? Like we were talking about Temple Grandin earlier, she’s a perfect example of this. And there are so many other people who have been, for example, on the autism spectrum, that are absolutely some of the brightest minds we’ve ever encountered in the history of humankind. And the reason for that is because they have been given the resources and support they need to learn to adapt to the different ways their brains work.
Dr. Nicole Beurkens
It’s so true. And I think as you’re talking about this, what’s coming to me is this convergence that we’ve had, especially over the last handful of years, of root trauma, we recognize now has historically always been an issue, whether we’ve understood it or not. We know now that that’s a piece of it. But we’ve had additionally, in the last handful of years, especially, this layer of profound and chronic high stress from the environment, from the world that we live in, layered on top of that. And I feel like that’s such a big part of why we’re seeing these escalating rates of adults and kids endorsing that they’ve got really significant mental health symptoms now, or are really struggling. And to me, the headlines around that get framed, as “Well, now 75% of the US population is mentally ill.” And it’s like, well actually what’s going on is we’ve got a population of people who now have been under an incredible amount of stress that well exceeds our capacity to manage. And so of course, we’re going to have symptoms of anxiety, of depression, of even psychosis, of suicidality and these things. And so I think that we have to also address or recognize the piece of environmental stress, that in at least US culture, Western culture, the expectations for children and adults, we have kids now telling us in survey studies that they are experiencing levels of chronic stress that are equal to or greater than what middle aged adults were saying they had 20 and 30 years ago. So I think the stress piece is such a big piece because it just exacerbates everything else that’s going on with us.
Dr. David Rabin
Absolutely. And the fact that we also, as you said, have so much input coming in, we have so much incoming information, more than ever now because of cell phones and screens everywhere and all these things and all the responsibilities that we have and the internet itself, everything everywhere all the time. It is very real, and just that simple oversaturation of incoming information is overstimulating to us. And if we haven’t learned one of the most important skills that we have as human beings, which is — I know this is going to sound like an oversimplification, but it’s how to control our attention, which is the gateway to information coming into our consciousness and becoming effectively then part of us. If we have not been taught how to do that, then, when all of that overwhelming information comes in, we don’t know how to process it and we don’t know how to sift through what’s important to us right now and what’s not important to us right now or what’s not important to us ever. And how to remind ourselves that we’re in control of that most valuable resource that we have, which is what every single advertising company is focused on capturing, which is our attention, right? Because when you capture attention, you can feed information into somebody’s consciousness, which can even become part of our identity. So it’s really this imbalance that we have between not having the tools — or having the tools, because we are all born with the ability to control our attention, we just don’t know how to use it because we were never taught effectively, and that, combined with being overstimulated all the time is basically a recipe for chronic stress. And there’s no way around it, no shortcuts, really, except for surrounding ourselves with the tools that remind us how to control our attention again. Breathwork is a perfect example, right? Breathwork is the training of attention control that we all can do anytime, anywhere, wherever we are, it’s totally free, right? It’s the best. Soothing touch is the thing that we can deliver to ourselves or to others. Soothing music, exercise and engaging in intentional movement or stretching on a regular basis. Mindfulness techniques, meditation. So all of these things are the tools that we can use that help support that process of training that one critical resource we have of attention control. But if we don’t understand that, and that is really, in a lot of ways, our antidote to this problem, then we’re just going to be sitting in the cage spinning the wheels and we’re not really going to get out of it.
Dr. Nicole Beurkens
So well put, and I think it applies to all of us as adults in today’s world, whether we have a diagnosis of ADHD or anxiety or not. This is a rampant problem. But I especially want to hone in on that for kids. This is such a missing piece, when we think about therapeutically how we approach kids who are having even clear attention problems, kids who get diagnosed with ADHD or autism spectrum disorder or something like that, clearly have symptoms that show they’re not able to properly regulate their attention. Kids with anxiety, those types of things. If we’re not addressing that head on in our therapeutic approaches, we’re not getting very far, we have to teach these kids how to do that gatekeeping process, how to leverage that. And some of them are going to struggle much more with that than others. Some of them, if they don’t have a neurodivergent brain, that is going to come easier to them and they’re going to be able to do that more quickly and effectively than kids who do have some of those conditions. But they all need support around that if we’re going to get to the root of helping them with their symptoms. And that’s really what excites me about the technology that you’re coming out with. I want to shift gears a little bit and focus on something that you said a moment ago, which is that touch, therapeutic touch is a way of accessing this attention system of helping us to regulate our attention, to regulate our nervous system function. So let’s talk about touch specifically, and why that’s so important for our brain and our body.
Dr. David Rabin
So this is one of my favorite topics. So touch is interesting, because of what we were talking about earlier with respect to the stress response. So if we think about our bodies and our brains together as one person, and one living thing, and that living thing is this giant sensory organ, so we are sensing information coming from the outside and coming from the inside, all the time. We’re not always aware of everything. Usually, our awareness is like the tip of the iceberg sticking out of the water. And then there’s all this other 10,000 times more stuff going on under the surface, under the water, and we call that our subconscious or beneath awareness. The tip of the iceberg is what we call our awareness or the conscious. Then if we start to expand how many things are coming in, then that triggers our brains to say, “Hey, wait a minute, there’s a lot going on here.” It’s like listening to music that’s too loud and too fast, right? It’s hard to keep up with. It sends our heart rate up, it sends our blood pressure up, and it sends our breath rate up. And it effectively triggers our bodies into a stress state. And that can come from, again, too much, too fast things, or it can come from too intense, too negative things, or too foreign, too new things, right? Those are the kinds of categories that in general will trigger our stress response to turn on. But too much too fast is probably the most common one that we all face on a daily basis without even realizing it. And so when we think about touch, what touch is really doing is it’s creating noise canceling for our brain by targeting the body with something that’s extra soothing, closer than all of that stuff that’s coming in from the outside too much, too fast. And so if you think about the way that the body works, the body is a sensory organ that’s in taking lots of information, and we’re perceiving, because there’s too much too fast, too many emails, too many kids screaming, too much construction, too much traffic, etc., we’re interpreting that as a threat and we feel ourselves getting tense and our heart rates going up, and we’re feeling ourselves sweat and feeling restless and uncomfortable. Those are signs that our body is reacting to those inputs as a stress response. Our bodies are perceiving it as a threat, a survival threat. But there’s not actually a survival threat from traffic, or from our emails, or from kids screaming or construction. It’s just annoying. And so when you apply soothing touch to yourself by touching your chest or rubbing the side of your neck or having someone else touch you, like holding your hand or giving you a hug, or wearing Apollo, which is a touch therapy device that we developed to give people some of these benefits without having another person around, it sends a signal to the brain in two ways, one of which is the emotional signal, which goes to what we call the insular cortex, which is near the center of the limbic system, which is our emotional cortex of our brain. That sends a very powerful signal that says, “If I’m safe enough right now, to feel and pay attention to the soothing feeling of this touch on my body, then I can’t possibly be running from a lion right now. There can’t possibly be a lion around, because if there was a lion around,” my nervous system — This is a subconscious thought for most people, most people don’t recognize this. They’re not aware of it consciously, but our subconscious brains are recognizing through this connection between the touch receptors, the emotional cortex and the amygdala which is our fear center, that says when your fear center is blasting off with too many emails or too much traffic, that emotional cortex, through touch, says to that “Hey, bud, you’re safe enough to pay attention to this nice feeling on your skin right now. So you can’t possibly be running from a lion.” Because if you were running from a lion, there’d be more signals from the amygdala, the fear center going to the insula saying, “Shut up, we have to run.” And so that’s effectively how touch works in the short term. And in the longer term, there are certain soothing touches. For example, when it’s somebody that we like, where there’s a very clear emotional context that there’s certain rhythms of touch, whether it’s one we like, or whether it’s a technology that’s delivering touch, or what have you, that sends rhythms to the body that are also detected by the brain that tell the brain that these rhythms are comfortable or soothing, like soothing music, or like a cat purring on us. And so those two together combine to basically dramatically amplify our feelings of safety physically in the body, which reminds us that we’re actually safe, and then allows us, basically, from those emotions, starting with the emotional cortex of the brain, start to gently redirect resources back to that parasympathetic recovery part of our bodies, like the digestion, the reproduction, the immunity, the rest and digest, and sleep, and all of that stuff that actually makes us feel good, and away from the survival response system.
Dr. Nicole Beurkens
That’s such a great explanation of that neurobiology and how all that works. I’m thinking, if we think about young children, or even elementary age kids, inherently we use a lot of touch with them to soothe them, to regulate their nervous systems. What are toddlers and preschoolers and young kids always wanting when they’re starting to flare and get distressed? They want to sit on our lap, we soothe them, we rock them, we stroke them, we give them a massage, we hug them. And we experience that even as adults in our lives, and in relationships as well, the soothing nature of that. And I’m thinking about when we do different kinds of therapies with kids who maybe have a history of significant trauma and are very dysregulated, or kids who are autistic, or have ADHD, we use tools around touch. I’m thinking about things like a weighted blanket, things like brushing therapy, things like compression, and that really is the same process that you’re talking about of sending these signals to the brain, “Okay, we’re safe. We can relax now”, building in some of that regulation, because the lived experience of so many of these kids is that the world is just totally overwhelming. their brain and their nervous system is bombarded constantly. And of course they can’t feel safe, and of course they can’t regulate and they can’t settle down, and so touch is such a powerful mechanism with that. So I think that was just a brilliant explanation of it. And I want you to talk about how you have harnessed that in Apollo, because you’ve created this amazing wearable. For those of you who are watching the video, I’ll hold it up here. You’ve created this wearable device that harnesses all the things we’ve been talking about so far in this episode, harnesses the theories and the research behind that to be able to apply this in a wearable device. And so I’d love to have you talk about what Apollo is and how it works.
Dr. David Rabin
Happy to. So Apollo is a wearable, like Nicole just showed you. It’s about the size of an Apple Watch or a Fitbit, and it can be worn anywhere on the body, but most people wear it on their wrist, ankle or arm. And we developed it out of my research at the University of Pittsburgh, basically, we were trying to come up with new non-drug ways to help people cope with these feelings of not being safe, who had severe mental illnesses like PTSD. And it was very clear to us that these people’s bodies, from the literature and from our own studies, were showing that they did not feel safe. They were saying “We don’t feel safe.” So we knew that touch worked, we knew that music worked so effectively. We were all musicians and neuroscience folks, so we thought: What if we take the feeling that you get from when you have a horrible day, and you get into your car, and you turn it on, and your favorite song is on the radio, and you’re like, “Wow, this is awesome. I’m grooving out to my song!”, and you totally forget that you were having a crappy day. Or you go you go home to your partner, and you had a tough time, and your partner gives you a hug, or your friend gives you a hug, and all sudden you feel so much better, and you’re not really thinking about all the challenges you had earlier, at least for a certain amount of time. And this feeling is very well known in the literature. It’s very well known throughout thousands of years of human experience, and yet we haven’t really thought of other ways to bring it on, other than music. There just haven’t been that many other tools. And so we thought, “Well, is it possible with technology we have today, knowing what we know about the touch receptor system, knowing what we know about how soothing touch engages in this emotional brain reaction that can facilitate safety very, very quickly, that, again, has been observed, not just unique to humans, this has been for all of mammalian history, all mammals who cuddle each other for comfort, who breastfeed their young, are all animals that have this extremely highly developed touch receptor system. So we’re talking hundreds of millions of years old here, or at least tens of millions of years old. And when we think about that, what we thought of was, well, maybe there’s technology out there today that can simulate, maybe not all of the benefits of soothing touch, but at least some of them, that could give you the safety response by activating the touch receptors in a way that reminds us of being touched by a loved one. And so we went and studied everything that we could find about touch and what had been published before, and did a bunch of research between 2014 and 2018 in the lab. And eventually when we figured out that there were certain very specific patterns that the body responded to, in our lab assessments, to look the way that it looked when people experience soothing touch from a loved one or deep breathing or meditation, we were basically able to induce these same states. And when we induced those states with these very gentle vibrations from the Apollo, we were seeing that people’s cognitive performance got better. Why? Because stress makes it hard to focus. So if you’re overwhelmed from stress because you’re thinking about how you left your keys in your car or you forgot to lock your car, or you might have accidentally left the stove on, or you forgot to call somebody back or whatever, and you’re trying to do a math test in school as a kid or you’re trying to focus at work in the meeting as an adult, there’s only so much focus to go around, so you’re going to be sending resources out to things that are not on task, which makes your performance drop dramatically.
So what we saw was, in our first double blind, randomized, placebo-controlled clinical trials at the university, was that it was very, very clear that simply by calming the body with these vibration patterns that simulate the benefits of soothing touch very gently, you can give people up to as much cognitive benefit improvement in terms of focus that people get with amphetamines within three minutes time under stress. So if you think about how interesting that is, that is really, really interesting, right? Because that means that yeah, amphetamines are great and they can solve a lot of problems for a lot of people. They’re generally not good long-term solutions, but they are great for teaching people how to focus and showing them the ability to focus for sustained amounts of time, but they do have side effects. And so for people who want to learn to focus on their own and train attention on their own, using calming techniques like touch, like Apollo, and like breathwork, and like these other tools that basically boost parasympathetic tone and vagal tone, the recovery system activity in the body, by calming our stress response down, we can improve our cognitive performance by ourselves almost as much as amphetamines can do. So it’s all within us. It’s just reaffirming this ancient knowledge and wisdom that’s been passed down for thousands of years from the Buddhist to the yogis to the Ayurvedic practitioners, to the tribal practitioners, that all the healing power is right here. We have it all. It’s just about reminding ourselves how to use it and how to bring it into practice, and training ourselves to do it. And then we can do it.
Dr. Nicole Beurkens
It’s the building of that muscle. It’s the becoming aware, first of all, that we can even do that, and then the building of that muscle, so to speak, that practicing of it. And the thing that’s exciting about this is this works for kids and adults. One of the challenges for children, historically, around teaching these kinds of tools, especially if they really struggle to focus or if they really struggle with awareness, it can be a challenge to have them get really proficient with things like breathwork and meditation and those things. But what’s so cool about this technology is we can help them build these skills, build this attention muscle, through the wearable, through the app, without them having to consciously do something to work at it. And to me as a pediatric practitioner, that’s one of the most exciting things because it opens up this whole new avenue of supporting these kids’ brains and nervous systems in ways that had been difficult to access, especially for kids with more severe challenges.
Dr. David Rabin
Absolutely. I mean, we joke around a lot, Catherine and I. Catherine’s my wife and the CEO of Apollo. We joke around a lot, because asking somebody who already has PTSD or ADHD to learn how to focus enough to meditate is like a cruel joke. I mean, there are, of course, some people who can do it, but you’re talking to somebody who has these very direct and acknowledged challenges around focusing for sustained periods of time, then you’re saying, “Practice this technique that requires you to focus to even learn it.” Right? How challenging are we trying to make it for people?
Dr. Nicole Beurkens
Right, just say to a parent, “Your kid who’s constantly bouncing off the walls, who you can barely get to focus on finishing their meal, guess what? Now, therapeutically, you need to practice that”, and they just go, “Why do you hate me? Why are you trying to get me to do something with my kid that clearly, I’m not going to be able to do?”
Dr. David Rabin
Right. And it’s unfortunate, because those techniques really do work. But there has to be a foundation there that we build on for them to stick and to really set people up for success. And so this really comes down to the foundation of learning that attention control again, which we kind of alluded to earlier. But it’s really understanding, and this is something we should teach everyone, adults and kids included, which is all the things I mentioned here I think are fun, because they’re all things that I learned late in life that I wish I had known earlier also, and it’s the idea that there are two fundamental different kinds of learning. There’s top-down learning, which is the kind of learning that we’re talking about, where I give you the instructions of how to meditate or how to deep breathe. And then it’s up to you to understand those instructions, and then focus enough on those instructions on a consistent basis to actually teach yourself how to do it. That’s the way all of us have learned in school and in our whole lives predominantly. It is a kind of learning that requires dedicated and sustained attention, which again, for those of us who are challenged by that, myself included as a young child, really are not set up for success. And so it requires so much more effort to be able to succeed in those environments. And so what Apollo is, as with therapeutic touch, is it’s bottom-up learning, right? So bottom-up means body first, then brain, which is also referred to as experiential learning. So it’s being able to experience a feeling, feel the feeling, feel what it feels like to actually be able to feel calm and focus on something that might have otherwise been very challenging for you in the past, then you do it. And then you’re like, “Oh, this is what it feels like to do that. This is what it feels like to do my homework and actually not get distracted. This is what it feels like to meditate for the first time. This is what it feels like!” And once we can understand what it feels like, all of a sudden, we have a goal. We have that pie in the sky concept, that we know what we’re striving for. And once we know what we’re striving for, maybe not the first time or the second time, but after enough times of feeling that feeling and knowing that we can get there relatively naturally or with a little bit of assistance, it becomes that much easier for the top down stuff to really take root. It’s like if you imagine the brain and our bodies are like a garden, trying to teach people how to learn meditation or breathwork without the foundation of the experience of what it feels like, it’s like trying to plant seeds in a garden with no soil. We have to put the soil down and the fertilizer, and all the food that nourishes the learning, to allow the seed of what we’re trying to teach people to actually grow and sprout and become the plant. If we don’t do that, anything else that we layer on will just kind of wash away in the rain.
Dr. Nicole Beurkens
Totally. And that’s what I think is so important about using this as a foundational tool. Okay, so we put this on our restaurant ankle, or our child. And just for people to know, the band is very soft, it’s comfortable. For the kids that we’ve used it with in the clinic, it’s very well tolerated. It’s well designed. If you have a kid with maybe some tactile sensitivity issues, you can find a spot to put this that’s comfortable. It’s not intrusive to their movements or anything like that. But David, talk about how this works on a practical level, because parents might be thinking, “Oh, this sounds awesome. I really want to try this for myself or my child.” So we put on the band, we put the device on, and then the app connected to it. Just talk briefly about how that works. Then I also want to make sure that you touch on what I think for kids is one of the coolest things, which is that parents or other adults can create settings and schedules to run the device without even needing to be near the kid or have the device. We can preset things to support our kids in different environments.
Dr. David Rabin
Yeah, absolutely. That’s my favorite feature too. And what was your first question? Again, I apologize.
Dr. Nicole Beurkens
So there’s an app connected to it. For people wondering like, “How do I make it work? How does it operate?”
Dr. David Rabin
Right. Thank you. So the device works independently of the app. You have to connect it to the app at first when you set it up so that your phone can be the control for the app and allow you to access all the features. But the device, we purposely designed it to be able to work independently of the phone, because we really don’t need more screen time. And screen time is another overstimulation thing that is bombarding us. So if we can use the technology that’s helping us feel calm, centered and clear, without having to rely on our screen, for example, by using the buttons on the device instead, or scheduling it to automatically turn on, which you could do as well, then it allows people to feel more independent and separate from requiring the phone to be part of it. And a lot of kids don’t have cell phones anyway. So that was a big focus for us. And so the app has seven modes. Those modes range from what we identified as the seven most common needs that most people have from a couple years of market research of prototypes in the wild. And those are going from most energizing to least energizing: Energy and wake up, which kind of feels like a shot of espresso, or a jolt of wakefulness. Then down from there is Social and Open, which is sort of a creative social flow that most people use for socializing when they’re tired or giving presentations or doing creative work. And that’s the favorite for people with social anxiety without a doubt. Down from there is Clear and Focused, which is the mode that we developed to feel most like amphetamines. That was the mode that we tested in a clinical trial I described earlier as the main focus of that trial, to show that we improve cognitive performance under stress. And that is for the deep, sustained focus that most kids benefit from in school, during class and homework and things like that. That’s my most used mode, hands down, because I’m also a little bit distractible and I like to do lots of things. And then down from there, there’s Rebuild and Recover, which is the most even, balanced mode. This is one of the more popular modes as well, that just kind of brings people back down to a sort of feeling like evenness. Not wakeful, not sleepy, just balanced. And that’s great after any stressful event, physical, mental, emotional, etc., and just helping wind down quickly. We have lots of athletes who use that mode after workouts after performance activities so they can fall asleep at night and things like that. And then down from there, we start to get to the very recovery focus modes that are much more calming. So the Meditation and Mindfulness mode is great for meditation and mindfulness. It’s also great for aches and pains, it’s great for just generally feeling calm, chill, winding down, starting to wind down, then the Relax and Unwind is what adults kind of describe as feeling a little bit like a shot of whiskey, but it’s really just a deep relaxation that most people use in that half an hour to an hour right before bed to make sure that they are ready to conk out when they get into bed. And then the most relaxing mode is the Sleep and Renew, which people use when they get into bed and you can schedule these throughout your day to turn on automatically, as you alluded to earlier. The scheduling is amazing because it makes sure that I get the sweet spot, which seems to be from our studies in a couple thousand people. It seems to be the sweet spot of use is having the device on you vibrating about three and a half hours a day, at least five days a week. So I schedule it to wake me up in the morning, I schedule it to keep me focused in the morning, late morning during my afternoon slump, and social in the evening after work, so I’m not all amped up after spending my whole day in meetings and work etc., and I can transition into hanging out with my partner, and my friends, and not be irritable. And then I have it wind me down at night before bed with Relax and Unwind and Sleep, and it just does it for me which is great.
And I think the thing with kids that I want to mention that’s really, really important in particular, and should not be neglected, is that one of the biggest sources of anxiety for all of us whether you’re a child or you’re an adult, that we also should have been taught when we were kids, is — because we only have so much time to do anything each day, spending time thinking about things that are outside of our control. We only have so much time to think about things each day. So if we spend 60% or 70% of that time thinking about things we can’t control, like what other people think about us, or the future or the past or things like that, then we feel out of control 60 or 70% of the time. If we, on the other side, spend that time thinking about things we can control, like our breath, like our movement, like our attention, and then practicing controlling those things, our expression of gratitude to ourselves and others around us, as an example, we practice doing those things, we strengthen those muscles, and then we feel more in control more of the time, which then causes our anxiety to drop dramatically, which causes our feelings of calm and certainty to increase dramatically, right? And so with kids, especially in our society right now, one of the biggest reasons that kids have anxiety is because they don’t feel in control of anything. They don’t even feel in control of how they feel, and they don’t know why. They don’t understand their feelings. And mainly because we’re just terrible at teaching them. Not us as parents, but us as a society. We are not even barely understanding them, ourselves. I always assumed that, right? But they can figure it out. Kids are extremely smart and extremely what we call neuroplastic and creative and thoughtful. And if they are given the opportunity to recognize, that despite all the chaos going on around the world, that they have the ability by pressing two buttons on this device that they’re wearing on the wrist of their ankle, to give them control over how they feel in that moment or how much they’re focusing are able to focus in that moment, that is so empowering to a child, that it can help them to start to understand their own emotions on their own by training self-awareness. And so that was actually something we did not necessarily know would happen when we built the technology, but after many, many, many cases, hundreds of cases with kids working in trials and in clinics, we realized that kids were actually getting this benefit, and that just the simple act of empowering them to control the device themselves to understand the device themselves, whether they have a phone or not, doesn’t matter, just saying “Here are the buttons. Here’s how you turn it up, here’s how you turn it down, here’s how you turn it on. And this is the schedule that you have for the day”, that is so helpful to them, that they start to take responsibility and ownership over their own sort of growth and healing journey themselves. And it’s so, so exceptional to see that happen. And if we were teaching kids from a young age breathwork, from the age of two or whatever, they would also have disability, but we don’t. So this is a tool that we can now use to help facilitate the self-awareness training, which is also emotional awareness training, and it builds our emotional intelligence and makes us highly functional human beings.
Dr. Nicole Beurkens
I love it, the empowerment of that is so good. And with your the younger child or a child who maybe has more cognitive or developmental limitations, you can, as the adults set the schedule based on what you’re observing in them, what their day is, but what I love is as they start to get older, we can involve them in the process of thinking about building that awareness. Where do you see yourself struggling—what parts of your day? Let’s think that through. And start to, as they get older, to hand that over to them to create their schedule in the app, to be able to use that tool in a way that best supports them. And that’s profoundly important for them, not only throughout their childhood, but then as they become adults. So many amazing things with this. I love the Clear and Focused when I’ve got, focus work I have to do, I’ve got to get this writing project on or whatever, that is like magic. And then I also love the Relax and Unwind in the evening. To me, how I describe it is sort of like my experience of when I take melatonin and after a little while you’re just sort of like “I think I could go to sleep now.” It’s not knocking you out, but it just relaxes you and you’re like, “Oh I think I could wind down and sleep”, and that’s the feeling that I get from that Relax and Unwind. So those are my two favorites. I think it’s an amazing tool for us as adults, as well as for kids. I’m such a fan. And David, the amount of past research but also the ongoing research that you have with this is amazing. Far beyond other types of wearables and things. I get introduced to a lot of devices, a lot of things, very few of which I take much interest in, let alone promote to other people, and I just think that what you’ve done here is so amazing and so needed. I really appreciate your work around it, and sharing it with us today. I know that so many of the listeners are going to want to get one, so let’s share with them where they can get more information about Apollo Neuro and where they can get their own device.
Dr. David Rabin
Happy to, and first off, it’s my pleasure. I didn’t do this alone. We have a wonderful team of extremely hardworking people, my wife, Catherine included, who have devoted our lives to, as difficult as it is, to start your own company to really develop technology that finally helps us rather than just trying to sell us stuff with our attention. And so we’re so glad and so grateful to hear that you’ve been enjoying it, and I hope that all of your listeners do as well. And if you would like to find out more, you can check out the technology and all our research. We also have opportunities to participate in research for anybody who’s interested at apolloneuro.com or apolloneuroscience.com. And for short, you can also go to wearablehugs.com, which will take you to the same place. And if you’d like to stay in touch with me, I’m always happy to hear from you. You can check me out and my personal website, www.drdavid.io, or my clinic website, www.apollo.clinic. And you can also find me on socials, Instagram at @DrDavidRabin, and on Twitter @DrDavidRabin. And I hope to hear from you.
Dr. Nicole Beurkens
So many great resources available. And I just want to let you all know, when you go to apolloneuro.com, if you decide to purchase a device, they have been gracious enough to give listeners of this show a special code. So if you put in the code, drnicole10, you’ll get 10% off, which is very gracious of them. I hope that many of you will take advantage of that. Even if for your family, you just want to start with one device, try it out for yourself, your partner, try it out on your kids, but I have a feeling you will soon get to the point where you realize that everybody benefits from having their wearable throughout the day. So try it out. Let David know what you think, let me know what you think. I think this is just a great example of leveraging technology in a really supportive, productive way that improves mental health for all of us. So thank you again, David, for being here today and sharing your time with us. And thanks as always, to all of you for being here and for listening. We’ll catch you back here next time.
Dr. David Rabin
My pleasure, thanks Dr. Nicole. Thank you everyone.