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Why Most Mental Health Treatments Don’t Work with Dr. Dave Rabin
01:31:02
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- [00:00]
Dr. David Rabin
I start to notice that if 70 plus percent of patients in any given population are not responding to our best treatments the way that we were taught they were supposed to, then perhaps we need to go back to the drawing world and start asking some questions. Is our understanding of trauma correct in the body? Maybe what we think we're treating is not what we're actually treating, because it's not. Maybe our approach is wrong.
- [00:28]
Host (possibly Brooke Gladstone or another mental health podcast host)
Your brain is wired for deception. But here's the truth. Patterns can be broken, the code can be rewritten. Once you hear the truth, you can't go back. So the only question is, are you ready to listen? For decades, the mental health field has been stuck in a feedback loop. Diagnose, medicate, repeat. And disorders are continuing to climb. Outcomes have unfortunately plateaued. Until we meet somebody like Dr. David Rabin, who has spent years inside of that system. He was running experiments, prescribing meds, and he was watching the dogma of the industry unfold right before his eyes. Until one day he decided that a change had to be made. And he turned that change into a vagus nerve stimulating device that we now know of, called the Apollo Neuro. Dr. David Raybon is a board certified psychiatrist and neuroscientist who spent over 15 years studying chronic stress and how it rewires the body. He's the co founder of Apollo Neuro, a wearable device that stimulates the vagus nerve through vibration to help the nervous system return to balance. And the best part is that that is without medication or side effects. Dave, welcome to Decoded. We're so excited to have you here.
- [01:46]
Dr. David Rabin
I'm so glad to be here with you. Thanks so much for having me.
- [01:49]
Host (possibly Brooke Gladstone or another mental health podcast host)
So you and I had a chance to get to chat before we did this episode and I did a podcast episode with you on your show. And I know that we have quite a few things in common with how we currently at the mental health sector at large. And when you were sharing some of your background and story, I loved hearing about how you were deeply embedded in the machine, so to speak. And then you started to kind of have these realizations as you were in it, that perhaps certain things weren't working. Was there a singular moment where you were struck with the gravity of the situation that we face in the mental health field?
- [02:27]
Dr. David Rabin
Yeah, I mean, I think that there were, there was a lot of build up to that moment. For me, that moment was in 2012 when I first started working very closely with patients with severe ptsd, often chronic ptsd. Many military veterans and traumatized Women with histories of sexual abuse and, and I think that often stemming back to childhood. And I think that up until that point, I had noticed through, you know, my personal experience, training, lived experience, that there was something awry in the medical system in terms of the way that we were effectively delivering mental health care because didn't appear on the surface that we were getting the outcomes that we were taught we should be getting. But it wasn't until 2012, where I really started to work with more of these patients with severe trauma disorders firsthand and noticed that over, you know, probably 70% or more of the people that we were working with in the clinic were not getting better with the best considered gold standard, best practice treatments that we had available at that time. And then when I went back, you know, over the years and built more relationships with more psychiatry colleagues over the years, I realized that that experience I was having was not unique to me, that others, my colleagues in the space were also seeing this and many of them were writing about how they were not seeing the remission rates, the treatment outcomes that we were taught we should be seeing, and that many of our patients, sometimes 70% or more, were with PTSD were symptomatic for life. And so I think it was really around that time that I started to Notice that if 70 plus percent of our patients in any given population are not responding to our best, our best treatments the way that we were taught they were supposed to, then perhaps we need to go back to the drawing board and start asking some questions again, right? Some, some quests, like really like fundamental questions like, is our understanding of trauma correct in the modern day in psychiatry? Right. Like maybe we're what we think we're treating is not what we're actually treating because it's not getting us to the goal outcome for most people. But maybe our approach is wrong. Maybe the medicines we use do have some validity and purpose, but they're being used incorrectly. And so as I started to ask these questions and also look into other disciplines like Eastern medicine, tribal medicine, and other ways that different cultures have addressed the burden of trauma in the past and present, I started to notice that there were a lot of patterns of ways that we could do things better and including psychedelic assisted therapy. And that's what kind of led me down this path.
- [05:17]
Host (possibly Brooke Gladstone or another mental health podcast host)
What were some of the treatment mechanisms that would have been considered gold standards that you found were not actually proving to be as effective with these communities with ptsd?
- [05:28]
Dr. David Rabin
I mean, I think the, so the, I think to caveat this, what I'm going To say, I think it's important people to understand the nuance, which is that the medicines that we have available are really great for certain purposes with people with ptsd, which I, and I would call that purpose stabilization. And it's really, the medicines we have today are really important for that purpose of what I would call neurochemical stabilization in somebody with severe depression, ptsd, anxiety or one, a related disorder who's really unstable in the moment.
- [06:09]
Host (possibly Brooke Gladstone or another mental health podcast host)
And, and for a layperson, that would be just the earliest stages of trying to get them some sort of stopgap treatment to come back to center before you start to apply some other sort of treatment protocol.
- [06:19]
Dr. David Rabin
Correct, Correct. Yeah. Like somebody is really struggling, like they have had some, they're really struggling with like depression symptoms, anxiety, ptsd, we'll just stick with that for the moment. And they start to like stop taking care of themselves at home or stop functioning, stop being able to go to work and start exhibiting like real disruptive symptoms in their lives for the first time. And that's when the medications we have available are actually really effective, which would include like SSRI antidepressants, SNRI antidepressants, benzodiazepines to some extent, and there are many others, tricyclic antidepressants, MAOIs, which are actually very, very effective when used carefully. And I think that these medicines are excellent at stabilizing people. But the challenge is that the stabilization protocol does not result in long term benefits when people are continued on it indefinitely because they actually. The stabilization protocols that we use with SSRI medications, Prozac, Zoloft, Lexapro, Celexa, et cetera, and the Snris like Effexor and Cymbalta and some of these other newer ones. And benzodiazepines especially work by numbing us to our feelings so that we can cope with not feeling so terrible enough for a certain amount of time, enough to slow everything down and get back to a not so terrible baseline where you can then jump off into therapy or jump off into a more like trauma focused, trauma informed approach. But the problem is like the way we treat chronic physical pain with people getting prescribed opiates not just for six, four to six days like we're supposed to, but for forever, indefinitely, which leads to severe addiction and severe side effect profiles. We see the exact same pattern of behavior right now in the way that we treat mental illness with benzodiazepines and SSRIs, which actually do have real side effects when used long term. And they numb us to our feelings. So we become less engaged in therapy and less able to heal because healing requires coming back into touch with our feelings. And so back in the day, I think we did a lot more collaboration, collaborative work as a field with psychotherapy and medication, where medication would stabilize you and then you go right into therapy or you'd start therapy while you're on medication, getting stabilized. Now, a lot of the focus, and especially even in, in my training, even though I went to a very psychotherapy informed program, training program, we, everything was still very medication focused and they didn't even do psychotherapy with patients in the hospital. For the most part, people were discharged.
- [09:02]
Host (possibly Brooke Gladstone or another mental health podcast host)
Many of the programs when I was in the Johns Hopkins University program, many of the facilities that we toured and met with both the clients and patients and the administrators were nearly exclusively doing medication and absolutely no therapy whatsoever. No, no, no psychotherapy at any point during their stay.
- [09:22]
Dr. David Rabin
Yeah, right, exactly. And that's what, that's what we saw too. And I thought that was appalling because I'm like, if we all mutually agree that Sigmund Freud and Carl Jung and all of these forefathers of our field were right to a large extent, maybe not with everything, but right to a large extent that unprocessed, unresolved trauma is at the core of most mental illness, which by the way, is also what indigenous and Eastern traditions say, then we need to not just throw medicine at people because it's easier. We need to get people stable enough to participate in psychotherapy and then get them to start working on their inner material, processing their internal material and getting to a goal outcome that's sustainable without medicine, because long term medication results in long term side effects. Long term use of benzodiazepines increases risk of dementia. Long term risk of SSRIs increases risk of sexual dysfunction, numbness, apathy. Right. There's so many things that you and I both know about that come from long term medication, continued use when that medication is not intended to be used that way. So I think, you know, that's what's really what caused me to start asking these questions about maybe we need to do things differently. And, and I, and I think there's, you know, we're starting to see that new paradigm shift unfold in psychiatry which is really exciting for our generation.
- [10:46]
Host (possibly Brooke Gladstone or another mental health podcast host)
And do you think that large numbers of psychiatrists today are starting to ask more of those questions? Because it would seem you've been trained enough to understand the long term consequences of remaining on medication without ever titrating off of it, and yet it does seem that that seems to be the status quo right now is that people just keep prescribing and keep people on things. So how, if you had to give proportionality, what proportion of the psychiatric field right now is becoming aware that perhaps they're participating in something that is not in humanity's best interest? If they don't start to ask some better questions, you know, it's a good.
- [11:22]
Dr. David Rabin
Question and I, I can't say I have the, you know, it's, it's just really like a speculative answer. Yeah, I think, I think a lot of the younger generation is very, of psychiatrists is very much aware of this and I think a lot of the psychologists have been aware of it for a long time. Because psychologists don't prescribe medicine. They focus entirely on psychotherapy interventions. So I think that many of the younger generation of psychiatrists is aware of this now. However, it's the older generation that mentors them that is not particularly aware of it completely to the point of taking the evidence and putting it into action to change practice. And there's a couple reasons for that. One, I would say the two major reasons are that there's not enough hours in the day for psychiatrists to get reimbursed fairly to do psychotherapy, which is a problem. So basically our time as like the care, the chief care providers and care planners of the mental. Someone's mental health treatment program ends up getting relegated to, you know, 15 to 30 minute med check visits because we're the only ones who can really do that in somebody's mental health treatment program. We're the only ones that are fully trained to do med check med revision type evaluations quickly and we can pass psychotherapy off to somebody else like a social worker or psychologist. And so oftentimes there's just not enough time in a 15 to 30 minute session when you can only see like 12 people, 15 people in a day. And you got to make a living. Right. There's just not enough time for us to do therapy. I'm probably one of the few psychiatrists nationwide that does therapy as a primary part of their practice. But I can't take insurance to do that because insurance doesn't reimburse me fairly to do it. So for all of the psychotherapists out there, there's a financial disincentive to provide the kind of treatment we're talking about. So that's a huge part of the problem. Right. Like, think about that. At the core of what we do, we are financially disincentivized if we take insurance, which most psychiatrists do nationwide, to provide psychotherapy as part of our clinical treatment, because it doesn't reimburse the way that medication med check, medication prescriptions do. So that's number one, and number two is that the medical boards that govern our licensure and best practices have not updated to the point with all of this information. They haven't updated their best practice recommendations to say, well, the evidence says we need to focus on getting people into psychotherapy first and, you know, focusing on healing unresolved trauma. And like all the things that we're talking about, they're a little bit behind. And so they're also now political organizations more than their medical boards protecting doctors and patients. So I think there are some very significant barriers in the way, but I think the awareness is spreading. And that's good news.
- [14:17]
Host (possibly Brooke Gladstone or another mental health podcast host)
It's great news. And for those of you that are listening or watching, we've covered some of these gatekeeping, red tape, bureaucratic intermediaries in the episode Big Academia, and in that episode, I do dissect what I think is the source of the problem, and I think you hit it on the head is there's a lot of fractures, and then there are different people that are in charge of kind of regulating or making rules, and then they're not all communicating with each other. So I think that is partially why on this podcast I aim to.
- [14:51]
Dr. David Rabin
They're generally not even doctors. They're not even psychiatrists or doctors.
- [14:55]
Host (possibly Brooke Gladstone or another mental health podcast host)
Oh, yeah. I mean, of course, I feel like that's. It seems like that's typically the case. Those who are regulating typically have actually no idea what they're actually responsible for regulating. They're not actually experts in the said field that they're currently making decisions. I think that's, you know, that's about how things go. Both government, politics, religion, there's all this fracturing, compartmentalization. But I think that's why on this podcast I try to aim to speak to and wake up medical professionals that I know may have been either indoctrinated so much that they're having trouble even thinking of what questions to ask, or they're afraid to ask questions because they're afraid to lose their job, which I've met with many of these medical professionals throughout my career. And it's. It's a real fear. You're not making that up. There is a sort of climate of ostracizing people or demonizing them publicly if they're asking what you deem to be the wrong questions. So it's one of the reasons that I really enjoyed one of our initial talks. Cause I think you are asking the right questions. And I've always thought that it's interesting that often when people start to ask the right questions, one of their first steps tends to be, what if we go all the way back to the most traditional indigenous forms of. Of medicine? How is it that we knew more then, to some extent than we know now? And I think this is where I think the conversation perhaps takes a bit more of a spiritual or multidimensional turn. What role should spirituality, or something that is more multidimensional play specifically in helping people sort through mental illness, as it pertains to both your research and what you've dug into with Eastern traditional.
- [16:42]
Dr. David Rabin
Well, so I think it goes without saying that spirituality is a fundamental. Maybe it doesn't go without saying for everyone, but I think it goes without saying, as somebody trained even in Western medicine, that spirituality is a fundamentally important part of human existence and experience. And that's been taught in Western medicine even for thousands of years, like since Hippocrates and Maimonides, the first, some of the first physicians ever taught that spirituality was fundamental to healing and the human experience. And that includes belief, it includes faith, it includes prayer, it includes connecting to what people might call source of the universe or God or higher power or whatever. It is something connecting to something greater than us, outside of us, and that is inclusive of us. And we can't deny that which is spiritual and still be good at our jobs, because most of our patients, not all, but most of our patients have some degree of spiritual upbringing. And, you know, people will maybe upset at me for saying this, but. But atheism myself is at some point in my life, having, you know, trans, you know, or I should say traveled through atheist thinking is really like spiritual trauma. You know, it's like almost a result of. Of feeling so disconnected that we'd rather it's easier just to believe that there is no God. And I think that a big part of our healing process has to be spiritual. It has. It's about trust. And if you're trust, if you're learning trauma. In Gavarmate, one of my favorite colleagues talks about this a lot as the core of trauma. The core damage that trauma does to us, other than teaching us learned fear in the body, is that it causes a fracture of self trust, which prevents us from trusting ourselves. And when we don't trust ourselves, we can't trust our intuition and we can't trust ourselves to keep us safe. And so learning to trust our intuition again is also the process of learning to trust what our intuition is, which is our inner source of connection to the divine. It's like our intuition is like our inner source of spiritual connection. And as we learn to nurture it and listen to it, like all the Western, Eastern and tribal traditions say, we awaken this inner healing, you know, what Maps describes is like this in the modern language, this inner healing intelligence that knows what to do to take care of us. It knows what to do to heal us. It knows what to do to recover. And that's really the goal is to. Is for us as clinicians in the modern sense, is to help people look at a holistic psychiatry, not like just medication or just therapy, but like a holistic mind, body, spiritual, physical, embodiment of psychiatry that is inclusive of the. Inclusive of spirituality. And I think that's more important now than ever.
- [19:52]
Host (possibly Brooke Gladstone or another mental health podcast host)
One of the things that I've seen quite a bit in particular with clients of mine who struggle with suicidal ideation, depression, anxiety, some ocd, is there tends to be a moment where they arrive at a sense of futility. And I'm a firm believer that the only real solution for that experience of futility is to connect with something higher than yourself and that restoration of faith and an understanding that perhaps the moments of pain that we experience in life are actually equipping and preparing us for something, rather than just completely random and some big cosmic joke. So I love that you said that, because I have found repeatedly that when you can restore somebody's faith, that sense of futility goes away relatively quickly, even if it had been in existence for, you know, 10, 15 years before they even came through your doors of your practice.
- [20:49]
Dr. David Rabin
Yeah.
- [20:49]
Host (possibly Brooke Gladstone or another mental health podcast host)
And I think that a lot of. I know that you mentioned that spirituality is supposed to be a part of Western medicine, you know, essentially since the foundation of Hippocrates. But I don't think it really is like most of the, you know, man or woman in white lab coat, they don't typically include that. And I think as we've gotten ourselves more into a climate of political correctness, that's also coincided with the rise in atheism or secularism. So now it's, you know, something taboo. You're not actually supposed to talk about spirituality. You're not really supposed to talk about things like faith because you don't want to be offensive, because you don't necessarily know what somebody's spiritual belief systems are. And I do think that you can see a negative outcome correlated with this where people instead maybe just start to believe in whatever the bad news is, and they don't know how to hold out hope or faith for something miraculous or something to maybe happen in their favor rather than to their detriment. So I love that you reminded us that that's supposed to be at the core because I think a lot of people that have had experiences with Western medicine have not unfortunately had that experience. But it is my hope that we are moving toward a place right now where people are becoming more spiritually attuned, maybe more open again. I think we tend to move through these pendulum swings as a country where we kind of go overly progressive and then overly fundamental, traditional, and we kind of like keep doing these wild swings. But it is my hope that people will start to find a more well calibrated center point. Because there is a way to have spiritual conversations without being offensive. And that doesn't mean we have to kind of go all the way, you know, Handmaid's Tale or all the way to let's just not ever mention God. And any mention of God is now considered politically incorrect. So I think we're. I think we're getting there. Do you feel like you're seeing evidence that humanity and maybe the United States as a whole is starting to potentially recalibrate back to center?
- [22:53]
Dr. David Rabin
Yeah, little by little in different, different ways. I mean, I. I think. I think what's interesting about. What's interesting about the times that we're alive in right now that makes this more exciting, I would say, than almost any time in the history of humanity is that we science has finally caught up and is continuing to catch up rapidly with spirituality and traditions of the past. And up until recently, like, maybe even as much as like 10 years ago or less, many science leaders in the scientific community, and still many to this day in different areas are. We're denying, systematically denying the validity of indigenous and Eastern medicine practices and what we now know and denying the existence of God or a higher power. And what we now know is that science has proven that most of the most common indigenous and Eastern medicine practices, number one, work and have scientific evidence, number two, and number three, that God is in fact real and that God exists. We can't deny it, or whatever you want to call God, like source of whatever, all creation or whatever. Right. It doesn't have to be like the religious, Western rel. Organized religion, stigma of God label, but.
- [24:14]
Host (possibly Brooke Gladstone or another mental health podcast host)
There is a creator that created something. How? However you want to define.
- [24:19]
Dr. David Rabin
Yeah, there's like a source of energy that, that brought Forth all of our existence that we are also part of. It's not outside of us, which I think is what Western religion often gets misinterpreted to, to lead to the belief of. But it's really that we are, it's inclusive of us. And I think that's critically important for us to understand. Like you write about self deception and I talk about how one of the core first self deceptions that we make is believing that we are separate from Source, that we are separate from everything else around us. We are and we are first together and then we have, we're differentiated, right? And the differentiation is enriching and, and a beautiful expression of our, for of our diversity and variety. But we're not separate. Separation is an illusion and we know that now. And so I think like that is really exciting like, like to double click on like science proving the existing, the existence of God and having that like actually be societally accepted. Like that need that needs to happen. Like people need to understand like the impact of that. You don't need to worry, question your belief anymore or doubt that God exists. Like prayer improves your functioning of your biology. Expression of gratitude, forgiveness, compassion, self love, love of others improves the function of your biology, right? Like we know belief in and of itself and practicing belief in something greater than us improves the functioning of our biology and physiology. This is not up for debate anymore, right? So for those things to be scientifically proven is in and of itself proof of the existence of God. I think, and I think a lot of my colleagues agree and the fact that I think we talk a lot about like awe inspiring experiences that help us remember faith and hope and that's the antidote to futility, right? Like when you think about what's the antidote to futility and hopelessness, it's awe. And where do we get awe more than any other time? It's from nature. It's from like one on like interactions with nature. Looking at a beautiful sunrise and a quiet morning, or a beautiful sunset on a quiet evening, or over a tremendous vista from a hill you hiked up, right? Like all of those kinds of things are awe inspiring experiences. Lightning, like giant lightning thunderstorms, like those kinds of things are, are like taking those in those sensory experiences and just paying attention to them in and of itself is connecting us with spirituality, with nature, with divinity, with source, you know, with everything that is both outside of us and inclusive of us. And I think that that is when we stop, when we stop spending time and I should say really wasting time trying to justify the denial of the existence of God and just focus and source and just focus our energy on trying to nurture that relationship. Think about how much more time we have each day to train our ability to trust and feel good and be connected to each other in the world and all that. Right. It's like a, it's like a real paradigm shift for people though. But I think that's, it's really important for people to understand. Like there's no scientific justification to rationalize the denial anymore. Like we're, we're in a new era and that people need to take that in.
- [27:35]
Host (possibly Brooke Gladstone or another mental health podcast host)
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- [31:04]
Dr. David Rabin
Probably not.
- [31:04]
Host (possibly Brooke Gladstone or another mental health podcast host)
Who should or shouldn't use it? And what is that line of potentially overuse to a place where it's not even medicinal anymore?
- [31:13]
Dr. David Rabin
Yeah, those are all good questions. And I think your comment about awe and how it works in the psychedelic experience, I think this is why psychedelic experiences are so fascinating. Because when they're delivered therapeutically, properly, according to best practices, which if anybody's curious, you can check out our paper in Journal of affective disorders from 2023 where we document best practices to date. So there's not really a debate on that either anymore, I think that we see that people reliably have safe access to awe inspiring experiences. And even if parts of those experiences are terrifying, they still come out feeling better because they know they're safe and guided and held within that experience of terror that despite the feeling of terror, they're still safe to feel. And the feeling can be awe inspiring in and of itself for people and very healing. And so I think that awe is a really critical word that we need to. Because we need to continue to bring up in conversation as therapeutic because it's also like what kids do, right? It's like childlike awe is what we seem to have forgotten quite a bit as adults as we go through the challenges of the world through our own maturation process. So I think that, so that's, that's really critical and I think you air quoted maturation.
- [32:45]
Host (possibly Brooke Gladstone or another mental health podcast host)
That's something that I often do in my show. I'm like social emotional maturity is a paradox. It's not real, you actually devolve.
- [32:52]
Dr. David Rabin
Rather it feels like regression. When you look at it from a Freudian perspective, I feel like. But yeah, no, I mean, yeah. So I think, but to, to answer your question about, you know, who's a good fit? I think generally speaking people who have the. The simple answer is adults who over 18 who have PTSD, depression, anxiety or a related or even in some cases adhd who have. And whoever. Just those conditions without any other conditions that I'll describe in a second are tend to be great candidates for psychedelic assisted therapy with the caveat that folks with primary anxiety as their chief illness like, like anxiety, like they have depression and they have trauma, but anxiety is like the number one symptom they have. Those people have control, a different level of control attachment that makes psychedelic therapy more challenging and so they can benefit from it. But it requires a tremendous amount of upfront preparatory work to get them into a place where they're receptive to allow and surrender to the psychedelic experience. You can't just with somebody with depression and ptsd you can with a couple, one or two preparatory sessions. Generally speaking, you can get people right into psychedelic treatment. But with anxiety patients who have primary anxiety, we have to usually take I would say between 5 and 10x the amount of prep to get them receptive to letting go of control to allow the psychedelic experience to really unfold in a positive and therapeutic way. If they're white knuckling it the whole time, they're not going to have a good experience. It's basically a recipe for disaster. And if they don't come back then, then you know, we haven't really done a good job. The folks who are really bad candidates for psychedelics, generally speaking, are folks with psychotic disorders. Delusional disorders, Bipolar, bipolar one disorder in particular. Delusional disorder is a broad category that I think is really important to consider because it includes personality disorders. Access to personality disorders. Yeah. Which is something a lot of people don't think about. But narcissism in particular, antisocial personality disorder. You know, these, these tend to, if not managed extremely carefully by somebody who's very, very highly trained in transference and transference based therapies and other techniques, these patients can very quickly get out of hand and be, have their, their illness worsened by psychedelic use, especially when it's unreguided psychedelic use. But even guided psychedelic use can result in worsening of personality disorder symptoms because personality disorder is technically a delusional disorder. So I think that's really important to understand. And, and I think the last group of people, the two last groups of people that are not good candidates for psychedelic medicine in particular are children. Because children under 18, while they could benefit from ketamine therapy for instance, if they've tried everything else, their brains are in a much more neuroplastic state. They're better at learning when they're that young. And so we have, they typically when good, their psychotherapy treatment is delivered to kids and technology based solutions and non medication based solutions, kids respond really, really if the therapy is delivered properly. And so we tend to hold off on using psychedelic medicines in kids until we know they've tried especially except for ketamine, but until we know they've tried everything else, that with the right kind of therapy being delivered and that they've really put in a, put in a good effort because we, when again kids respond very well to therapy when they're working with people they trust. And the last group is people taking serotonergic antidepressant medication. So anyone who this is really not talked about enough, but anybody who's taking an ssri, an SNRI medication or an MAOI or in some cases a tricyclic antidepressant can be at risk for serotonin syndrome, which is deadly if they take a serotonergic psychedelic, which includes things like tryptamines, inclusive of dmt, Ayahuasca, psilocybin and also MDMA family phenethylamines, all put patients at risk of serotonin syndrome if those other medicines are on board. And so we do, and the only exception to that rule is with ketamine and cannabis, which can be used with those medicines on board but other psychedelic medicines cannot because they are all acting on the same serotonin Same part of the serotonin system. So that's a major category because that's like 40% of Americans are prescribed one of these drugs or something like that. It's like a huge number. Yeah.
- [37:44]
Host (possibly Brooke Gladstone or another mental health podcast host)
You don't ever hear that talked about. I always suspected as much, but I've never actually heard somebody outright just say that they are not candidates for psychedelic assisted therapy.
- [37:54]
Dr. David Rabin
I mean, it's just you should probably.
- [37:55]
Host (possibly Brooke Gladstone or another mental health podcast host)
Sound the alarm on that because I'm fairly certain there are quite a few people doing medicine that fall into these categories.
- [38:02]
Dr. David Rabin
Yeah, for sure. I, I'm working, we're working on that with our, with our medical board where we, the board of medicine where we offer like as a nonprofit, we offer trainings in these, in these areas. We are working on really sounding the alarm because we see people who have. Even in my seminars that I do regularly, I'll ask if anybody has ever experienced serotonin syndrome from this issue or known somebody who has. And almost every single session I do, at least one person raises their hand. And these are sessions of 20 to 30 people, which is astounding. Right. That somebody would have to go to the ER under the influence of mushrooms or MDMA because they didn't realize they were not supposed to be taking it with their SSRI on board. What? It doesn't mean they can't get access to or they can't use those medicines, the psychedelic medicines. It just means that they should go through a taper protocol first or start with ketamine first before they introduce and start mixing medicine. Because it's the mixing that's really the problem. And so it's very doable to taper off of one of like your SSRI and then start your psychedelic treatment or to use ketamine first and then another psychedelic later if needed. But people just aren't educated about this that much. So we're really trying to make sure the word gets out there so people don't get hurt.
- [39:19]
Host (possibly Brooke Gladstone or another mental health podcast host)
Well, hopefully people that are listening to this that work in the industry, both medical and non medical, because I know that we have people that follow the show that are doing it your way and then those who are doing it perhaps more the indigenous, traditional way. I personally have, I have some concerns that I know you and I have talked about and I'm glad that you brought up the personality disorders because from doing the data research that we have through break method for the last 12 years, one of the things that I've certainly had to face is that there are a lot more people running around with Personality disorders than know they have personality disorders. The amount of people that know that they do and have it diagnosed is, is very statistically low compared to what's actually out there. So that's kind of my primary concern is that I see so many people who, from just looking at their brain pattern mapping data, they'll be like, well, do you think I should do this or this? You know, this therapist was thinking this and from my perspective, I'm like, you know, I, I have kind of these zones on the brain pattern spectrum where to me these would be the red zones, where it's like, these are absolutely not good candidates. And you effectively labeled all of them as matched with how we would organize the data and brain pattern mapping. So I do hope that people heed this warning and understand that personality disorders are much more prevalent than we're led to believe that they are. And I have found in particular with break method, people are able to pretty rapidly actually move through some of this sort of delusional behavior that they didn't, maybe they weren't aware of until they had to face it and break. And then they realized, oh my God, if I fit these puzzle pieces and then all of these other things make sense and they might not have ever had to confront it before. And maybe they had just enough coping mechanisms and masks to kind of navigate through the world unchecked. But for you that are listening, that might fall into some of those categories which those of you that understand break, these are predominantly the rejection based patterns. You should think twice and maybe do a little bit more structured, data driven work on yourself before you go dip your toe off in the waters of going to XYZ Medicine Retreat in Austin, Texas, or work with somebody like Dr. Rabin, who's going to go about it in a way that has a more clinical approach where he would flag some of these things before you potentially put yourself at risk.
- [41:50]
Dr. David Rabin
So let's take a turn. Oh, I was gonna say I could just close the loop on that because I think you're absolutely right. Like it. And I think it is possible for people with personality disorder to be able to have these experiences. They just need to be aware of what they're coming in with. Because especially with people with narcissistic tendencies, borderline tendencies, or antisocial tendencies in particular, psychedelic medicine has a way of amplifying narcissistic delusions which are at the core of those three key and most destructive personality disorders. And part of the major characteristic of personality disorders is that there's poor insight, right? So people don't and poor insight, meaning like people don't realize they have them or they just live a life of denial that they have them because it is. These disorders were developed because of a coping response to past trauma. But it's too painful for them to admit or go back and review the past trauma. For instance, with narcissistic and borderline in particular, it's very, very common. These people were neglected or not shown appreciation or love in the way they needed to from their parents growing up. It's very, very common.
- [43:08]
Host (possibly Brooke Gladstone or another mental health podcast host)
One thing that I want to just jump in here and say, I understand that that is maybe the, the establishment perspective from doing the digging on this for the last 12 years. I think the last part of what you were saying is absolutely true. And the data supports that more often than not, these people tend actually to have childhoods that are not riddled with very explicit, obvious traumas. But the perception of favoritism or lack of attention is actually the core wound. So, for example, just because I know that real neglect, where your parents have actually left you alone in the home to fend for yourself and to figure out a way to maybe care for your younger siblings because nobody's around and you have to scrounge for food, I have found those inputs never correlate to personality disorders. The personality disorders tend more to be more of a medium grade where the parents are around. But maybe you feel like your younger sibling was born and they're now getting more attention, they've stolen attention from you. So I just want to throw that out there because we have talked about this fairly extensively on the show and I don't, I don't know what the data that you're looking at talks about regarding this issue, but I've seen that statistically every single time. It's never the really severe neglect, which tends to push people to the left side of the brain pattern spectrum. It tends to be more of the what's called gray or subjective neglect that may not actually match the objective record.
- [44:42]
Dr. David Rabin
Yeah, I would agree. And I would say generally speaking, that's the case. And also it's that plus poor, poor behavior and poor or manipulative coping strategies are modeled for those people. And when they're being modeled, they see the people engaging in those poor or destructive coping strategies or manipulative coping strategies getting what they want. And if you have that combination of kind of that medium grade, medium grade trauma, you're not getting medium grade. Right. But it's still, it's still perceived by them as a very unpleasant, absolutely Right. And I think when you, when you couple that with seeing people feel better by lying or controlling a situation despite all odds or et cetera, et cetera, manipulating situation, what they want or their needs met, then that seems like a viable option. And then that kind of develops into what manifests as a personality disorder over time. But a big part of that again, is not having insight or denying at the core that you had anything bad happen to you because it's too unpleasant to go back and even feel and be present with that lack of appreciation or attention, even though it might not have been to the degree that we often see with many of our more severe cases, it's still painful for them. And so that's important because that's part of the lack of insight denial piece. And so it's up to us. And this is why these patients need to be, this needs, this awareness needs to be spread about this. Because when we're screening, patient screening and patient selection for psychedelic therapy, as you can tell from how this conversation has progressed, is critical, right? It's like fundamental to achieving the desired goal outcomes and not having poor outcomes or accidentally worsening somebody's condition, which is not anybody's goal. And so patient selection, client selection is critically important. And by having somebody like me or somebody who's well trained and aware of symptoms of personality disorder be able to identify that somebody is on that personality disorder spectrum in advance of a session, we can start to build insight and do activities with them that are, that are insight building activities. They don't always work and if they don't work, they're not a good candidate for psychedelics. But when they start to work, then that opens up a window of healing and access to a willingness to access vulnerability, which is really the source, and unveil vulnerability, which is really a source of healing. And so I think there's a, you know, there's a way to do it, but it just needs to be handled very, very carefully and very delicately.
- [47:25]
Host (possibly Brooke Gladstone or another mental health podcast host)
The one last thing that I want to say regarding the personality disorder piece from the early childhood perspective, another likely scenario is that one or both of the parents placated the child's delusional behavior or manipulation because they felt it was easier to just let it go, to just keep things moving in the right direction. So it's not always modeled by a parent. Sometimes it's actually just enabled by the parent. And then because it's enabled by the parent in those early childhood ages, the ruts become deeper and they don't outgrow it because it is actually to them, proven to be an effective strategy.
- [48:03]
Dr. David Rabin
Right. They're getting what they want.
- [48:06]
Host (possibly Brooke Gladstone or another mental health podcast host)
Yeah. Somehow they're getting what they want, and nobody's. Nobody's giving them the external feedback for them to build insight. So typically, that's something that has to be created from childhood, is your parents are willing to maybe say the hard thing or say the hard thing in a way that you can actually receive rather than put up your defenses and then actually become retaliatory. So there is a secret sauce, so to speak, here of how a parent has to provide the right sort of feedback with the right sort of modeling so that the child can receive it, thus building insight. And as you can imagine, that doesn't happen. That doesn't happen as often as it should, which is why in break method, we do focus so much on helping people understand the importance of parenting inputs and the output of brain pattern, emotional response and behavior. So let's turn it over to understanding a bit more about Apollo Neuro, because I really want our audience to understand what led you to create the device, how it works, who it's for. So when did you initially have the idea for what the Apollo Neuro device would be? And where did that specific idea come from?
- [49:17]
Dr. David Rabin
I would say that idea came from it's probably around, like, 2016, 2017, when I was working in the department of psychiatry at the University of Pittsburgh Medical center, and we were working with even more people with severe trauma disorders, lots of veterans, and we were trying to figure out how to. Because we basically had. And I had an understanding from my work with, in my research into and training in MDMA assisted therapy in 2016, and also my experience in. I think at that point I had been trained in like six different psychotherapy, six to eight different psychotherapy techniques, traditional psychotherapy techniques that I was continuously engaging in with my patients, my PTSD patients. And I realized that it was very, very clear how critical safety learning was in these people to get the desire, achieve the desired outcomes in healing. And that no matter how many stabilization medications that we threw at somebody, even though the book said to throw them at people, we would still see them ill if they did not feel safe in their bodies. And so as I started to notice that and noticed that we were being taught in our traditional psychotherapy trainings that establishing a trusting relationship with the patient and establish making sure the patient feels safe and not judged in our presence, et cetera, was at the foundation of all psychotherapy in Western model. And it was a foundation of MDMA assisted therapy in The MDMA model, I realized very quickly how important safety was from a practice perspective, because if what we were talking about earlier, like if, if Gabor Mate says, and I think this is fairly agreed upon in general now, that's that one of the core effects of trauma on our bodies is fractured self trust, then how and learn fear, then how do we, how do we, you know, rebuild trust is we have to feel it by building trust and experiencing what trust feels like and how good it feels to feel trust, trusted, trusting and safe with another human being and that other human being, in this case the therapist, models that role, models that trusting relationship and that feeling of trust for us so that we can then go back in and learn to trust ourselves again and feel safe within our own skin. And, and so I started to go back and look at the neuroscience of trust and safety. And when I started to look at that, which there had been quite a bit published Back in 2016, I noticed that everything pointed at the vagus nerve, everything pointed at this cranial nerve 10 that comes down from our brainstem, that gets activated by everything that makes us feel safe, like soothing smells, soothing touches, like hugs, snuggling pets, soothing music, deep, slow, deep breathing, slow, soothing movements. All of these things increase ocean waves crashing gently, right? All of these things increase vagus nerve activity. And many of my patients were doing these activities already. They should understand how to communicate what it was doing for them other than that it made them feel calmer. But they were already doing these things. They already had service animals, they were already listening to music all the time. That calmed them down, right? They were doing these techniques. And so I thought, well, if. But they were having trouble keeping up with them on a regular basis and integrating them into their day to day lives. And so I thought, well, if the vagus nerve is the key nerve that responds to safety and slows the body down, slows the heart, slows the lungs, decreases inflammation, slows our thoughts, the speed of our thoughts helps us feel safe enough to cope with stress better and adapt to stress better, then perhaps we should be focusing on developing technology that passively augments or modulates vagus nerve activity on the go. Something that people could wear anywhere, anytime, like a clip on your chest or on your ankle or on your wrist, arm, whatever that sends the right signal to the body that gets detected as something that boosts or modulates vagus nerve activity that we can just take with us everywhere we are. Because triggers happen all the time. You can't predict when a trigger is going to Happen, right? You can't predict when somebody's going to drop something behind you at the supermarket, when you were in a blast overseas, in wartime, and then all of a sudden you're back there because somebody drops a bottle of milk behind you. You can't predict that. But what can we do is we can use technology to tune the body into a state where when those unpredictable triggers happen, the body is in a state that is more likely, less likely to be triggered and more likely to react with poise and calm from a safe perspective through sensory stimulation. And so from that work, we, and the study of MDMA in particular, and how that therapy works, we developed Apollo to replicate some of the benefits of mdma. Therapy focused on safety and replicating the safety benefits through soothing touch using sound waves that you can feel through your body. And anybody who's listening to this can download the app and try it for free as we're talking so you get a feel for it on the Apple App Store.
- [54:36]
Host (possibly Brooke Gladstone or another mental health podcast host)
Let's take a quick pause to welcome a brand new sponsor to the show, Manukura Honey. This is Manuka Honey from New Zealand. They approached me a few weeks ago and I got to try some of their products and I am absolutely in love. But the best part is, aside from honey obviously tasting good, we all love the taste of honey. The health benefits are out of this world. I honestly didn't really know that much about the benefits of honey until I started to dig into it and all the literature that they provided to me. And there are different quality ratings of honey. One of the ratings that you can use is called an MGO rating. And as you can imagine, the higher up you go, the better the quality of honey. And the honey that I was sent was over 800 milligrams. When we're talking about Manuka Honey, we're talking about anti inflammatory benefits, immune system benefits, GI tract benefits, and just from my past life in traditional Chinese medicine. It also can be used topically for different sorts of rashes and skin conditions. Aside from obviously tasting out of this world, this product is great to add into your daily regimen. I've been having my kids take it every single morning. And literally every morning now, Harley wakes up and says, mama, where's my honey spoon. So we're having a special offer for you guys today using the code BG Heal. This honey is incredible. I hope that you give it a try. And thank you so much, Manukura. We can't wait to keep promoting your products. When we think about the Apollo Neuro Device. Is this a two way conversation? Is it scanning your biometric data and determining when you've been triggered so that it knows what input to give you back. Is that how the device works?
- [56:15]
Dr. David Rabin
Yeah. So there's different forms of trigger, right? So there's triggers when we're awake and then there's triggers when we're asleep because we're diurnal creatures, so we have asleep part of our day. Like a third of our lives we're supposed to be asleep and getting really good deep restful sleep. And two thirds of our lives are supposed to be awake. And the kinds of triggers and what triggers mean, and the reaction of the body to those triggers in those different states is slightly different. And so Apollo has an advanced AI system that we spent years researching over thousands of people in lab studies, but over a hundred thousand people in the real world who we've collected data on. And then train an AI system to do what you described, which is detect when the body is entering or looking like it's entering into a triggered state at night that looks like physical restlessness. It looks like you're starting to wake up or you're actually awake. And then Apollo turns on automatically in advance to help you help prevent a wake up you don't want to, or to help you fall back asleep faster if you've woken up. And during the day we take in your biometrics from devices like your OURA ring, like this little guy, which is one of the most advanced biometric trackers. And we pull that data in and then we customize vibration patterns for the body that keep the body in a maximally resilient state that is measured by high vagal tone, high heart rate variability, lower resting heart rate, and higher readiness scores and things like that, so that when stress comes, we are more likely to respond to it and adapt to it quickly and effectively and get back to safety. So we bounce back quicker and we respond more thoughtfully and effectively. And it trains us over time to do that, which is really nice. So I think, yes, to answer your question, it is a two way street. Apollo is the first wearable, that technology that is representative of that, what's called a closed loop system, where we are learning about your body, in taking information about the body and about our behavior patterns and then customizing an experience that's personalized to the individual to help their body feel safe and help their mind feel safe in their body.
- [58:35]
Host (possibly Brooke Gladstone or another mental health podcast host)
And is this something that a person would use all the time rather than they wouldn't reach for this device if they were having a panic attack. There's a more long term commitment to something like this. Is that right?
- [58:48]
Dr. David Rabin
I mean it's both. I, I would say like definitive like you can, you can absolutely use Apollo as point of use for a panic attack. We have tons like thousands of people who use Apollo to abort panic attacks before they settle in. But it actually works. It's very exciting that being or PTSD flashbacks which is like a kind of anxiety response similar to a panic attack. That being said, while it is effective at doing that and that's why the part of why the iPhone version exists, it's called Apollo Sessions that is free to try and free to use that version is point of use. You just like I don't have a wearable, I don't like wearables or what have you. And I'm feeling like really stressed out right now or I have to give a big talk and I need to calm down. So I'm gonna hold my phone to my chest or hold it in my hands and feel the therapeutic vibrations in the moment and get that in the moment benefit. That being said, that benefit does not extend outside of the moment much more than like you know, 30 to 60 minutes outside of the moment unless you use Apollo regularly, like three to five hours a day. And we've seen from our clinical trials that people wearing the wearable three to five hours a day have tremendous clinical benefit. So we're starting to see improvements in a number of mental health disorders, autoimmune disorders, cancer, pain disorders, but then everything from focus to fatigue to quality of life. General overall quality of life to 60 minutes more sleep a night from wearing this regularly to 10 to 20% increases in heart rate variability, which has never been seen with a wearable technology before that you can just get that boost in heart rate variability just by wearing something. You don't have to do anything. You just strap it on and it does the thing for you. So you just have to feel it. And it's all about Apollo's about feeling. So I think that's the and, and really feeling safe enough to connect with our feelings again. So I think that's, that's big part of, of how it works and why people use it. So the long term health benefits really come from around, you know, wearing it three to five hours a day or around the clock. Many of our PTSD patients wear it around the clock like all day and all night and only take it off to charge it or shower. But most of the people are wearing it about three to five hours A day.
- [60:57]
Host (possibly Brooke Gladstone or another mental health podcast host)
Can you explain to our listeners a bit more about direct versus indirect vagus nerve stimulation? Because I know there are so many devices out there and yours is an indirect. And I think it'd be helpful for people to wrap their heads around how it would be stimulating the vagus nerve without that direct contact.
- [61:13]
Dr. David Rabin
Sure, yeah. And there's another piece to that, which is. Which is vagus nerve stimulator versus vagus nerve modulator. So this is also something that's not well explained in the field. So, Apollo, vagus nerve stimulators that use electricity to directly activate the vagus nerve in the neck or in the chest or as an implant or in the ear, they use electricity, electrical shocks usually sent directly through the skin, that activate a direct terminal of the vagus nerve. So it's actually stimulating what's called the afferent or receiving end of the vagus nerve nerve that is just stimulating the vagus nerve, which means it's increasing vagus nerve activity only doesn't decrease it. It just. Or change it. It just increases it. It's very predictable. And these have been around for 100 years. There's. They're not really. There's not really much new innovation in the vagus nerve stimulator world other than ear stimulators, which are probably the newest version. But it's the same. Same thing. And they have. And vagus nerve stimulators have side effects because they're just boosting vagus nerve activity and they're using electrical shocks to do so. So they don't feel particularly good on the skin. They can induce skin burns. And, and you can only use them for about 20 minutes a day, or 20 and 20 minutes a session. And you can't use them when you're doing other things. So you wouldn't use a vagus nerve stimulator when you're going to the store or driving a car or doing any other activity. You'd be taking 20 minutes out of your day to go use your vagus nerve stimulator, and then you go back and take it off and go do the rest of your day. And so that's that historical category of products that's been around again for about 100 years and is very, very useful and was hugely impactful in our research to make better vagus nerve products. So what we found was, though, that those limitations I just described, you can't use it when you're doing other things. It has electrical shock side effects like skin burns. It takes time out of your day to use and, you know, all decrease compliance to. With patients. People stop using them because of those things, and they don't use them enough. And so what we thought was, well, how do we tackle those things? Well, what if we. And. And also the fact that you can't turn vagus nerve activity down, you can only turn it up. So patients with fatigue often need their vagus nerve activity turned down sometimes, not just turned up all the time. You can get, you know, low blood pressure episodes, passing out, fainting with too much vagus nerve stimulation, another side effect I didn't mention earlier. And so we thought, well, okay, how do we fix all of that? Well, let's use sound waves instead of electricity, because we know music boosts vagus nerve activity up or turns it down. If you're listening to fast, loud music, it turns vagus nerve activity down. If you're listening to slow, calming, soothing music, it turns vagus nerve activity up. So let's take sound waves and apply them to the skin of these different varieties. Fast and loud, slow and soothing, and everything in between. And let's measure the body with brainwave analysis and EKG analysis and respiratory analysis and physical restlessness analysis and cognitive physical performance analysis, recovery, et cetera. And let's see what happens. And ultimately, what we found out was that you can, through the skin, using sound waves, you can turn the vagus nerve activity up or down dynamically in the moment. Which is why music works to make us feel good instantly. It's why everybody's had this experience. You've had it right where you're having, like, kind of a crappy day, and then all of a sudden you walk into a room or you get into a car and one of your favorite songs comes on the radio by random chance or on the speakers, and you almost instantly feel better, Right?
- [64:55]
Host (possibly Brooke Gladstone or another mental health podcast host)
Yeah.
- [64:56]
Dr. David Rabin
So that is like an undeniable. Or you get a hug and you almost. From somebody you like, and you almost undeniable, like, instantly feel better. And it's an undeniable, universal human experience. The reason why is because that favorite song or that hug instantly increases vagus nerve activity. And so Apollo does that by activating the touch receptor system just like a hug. So the same reason why somebody holding your hand who you like increases vagus nerve activity, just like somebody giving you a hug, but they're touching different parts of your body, or somebody rubbing, like gently stroking your back, they all increase vagus nerve activity, but not through activating the vagus nerve input terminal directly. It's through the touch receptor system that signals safety to the vagus nerve through the emotional cortex. And so it's basically it's getting to the same part of the brain via an indirect pathway, which is called the somatosensory pathway. So it's the same pathway that eating some delicious food or smelling some delicious anything, or getting a hug, or snuggling a pet, or holding someone, holding your hand, or any of these soothing sensations, listening to your favorite song, they're all sensory information coming in. But the fact that it's soothing activates the emotional cortex first, which then tells our amygdala, hey, you don't need to be firing off right now. We're good. We can have a moment to experience this soothing sensation. And that boosts vagus nerve activity through the roof proof. And so that's how Apollo works. And it uses sound waves to do so through the touch receptor system, because the touch receptor system feels more soothing with sound wave vibrations and with electricity. And it's a modulator. So it turns vagus nerve activity up and down. So Apollo is unique in that it's the first indirect transcutaneous through the skin, anywhere on the skin, Indirect vagus nerve modulator. And we will see a lot more products like this coming out in the future. But at this point, Apollo is the first.
- [67:04]
Host (possibly Brooke Gladstone or another mental health podcast host)
Where would you wear a device like this.
- [67:10]
Dr. David Rabin
During the day? I wear it where you see me wearing it now on my chest. It just feels really, really nice. I mean ultimately Apollo works by sending. If you're feeling it through your phone as you're listening to this, you'll notice it's very, very gentle, low frequency sound waves that move at kind of feel like an ocean wave or a cat purring on your chest and that or in your hands. And that feeling is very low frequency bass vibration. So it's like the vibrations that would come out of a stand up bass or like a double bass or a subwoofer. And so those vibrations are felt through the body and through bone better than through like subcutaneous fatty tissue, for instance. And so you want to wear, to get the best benefits from Apollo, you want to wear it somewhere near a bony area of the body. But other than that, it doesn't really matter where. The most convenient areas to wear it are like chest, on a shirt, on a bra, on a belt, on your pants, like on your hip bone. Or for me, my personal favorite spot, particularly, especially at night, is the ankle. I wear on the inside of my ankle right next to my ankle bone. And it feels very soothing and grounding and just travels Straight up my body and, you know, puts me to sleep very quickly and keeps me asleep all night. And that's probably one of the most popular spots to wear it during the night.
- [68:34]
Host (possibly Brooke Gladstone or another mental health podcast host)
And does it give you some sort of visual representation of what's going on in your body during the hours that you've been wearing it in the app?
- [68:44]
Dr. David Rabin
So Apollo is designed not to have a screen because it's meant to be not distracting to us and not overstimulating. So it has buttons that allow you to control it on the device and turn it up and down and start, stop, and then in the app we track your usage data and Apollo tracks your sleep data and sleep to some extent your sleep architecture on a basic level and so enough to show you when you're asleep, when you're sleeping is your sleep is disturbed or restless. And then when you're awake and when Apollo turns on to prevent wake ups. So you can actually see when your wakeups are not prevented, when it's not working, which because it doesn't work all the time, and when it is working to actually prevent your wakeups. And then we measure by tracking your sleep, when Apollo's working versus not working, on versus off, we understand how much sleep you're actually getting back each night. And so we present back to everyone, in addition to all the usage data that people like, we present back through the app, how many minutes of sleep people get back every night from using it, which is really nice. So you get your sleep tracking and you get the amount of extra sleep you just got back from using this intervention.
- [69:56]
Host (possibly Brooke Gladstone or another mental health podcast host)
We are going to be putting my code in the show notes and I always use the same code for everything. So if you're listening or watching, the code is going to be bgheal H E A L and it's going to give you $90 off the device. So we'll put all the information in the show notes. I have had many of my employees use this device and I've been recommending it to clients who have all given it rave reviews. So we're really excited to be partnering with Apollo neuro and with Dr. Rabin. So before we close this episode, I wanted to find out from your eyes and your perspective what you think the future of mental health will look like. And if you could potentially paint a picture for us over the next five years, what sorts of either gadgets or disruptive modalities do you think are going to emerge and where do you think we're going?
- [70:51]
Dr. David Rabin
I mean, I think the where we're going is we're going to start curing mental illness if we focus on this correctly. And I think that it goes without saying, if you look at the data objectively, which I don't think that many people have, and I mean all the data like I've reviewed in our medical board, part of the reason why we created our own medical board was so that we could provide objective reviews of thousands of publications that a lot of other folks just don't have the time to review because there's so much material out there. And if you really look at the evidence for psychedelic medicines used properly, plant medicines used properly, technology used properly, properly, and what they're teaching us about this new paradigm of healing mental illness through a trauma first, trauma informed approach, if we focus on that and just updating the field on that piece, understanding that the evidence is there that trauma is reversible, that the effects of trauma on the body, I should say, are reversible, repairable, definitively, the evidence is there if we do the right stuff. Which is another paper that we published in Frontiers in psychiatry looking at MDMA's effect on trauma healing and on epigenic code in 2022 that folks can feel free to check out on our website, theboardofmedicine.org what we're really looking at is curing mental illness. Going from a treatment for life approach, symptom management approach, which used to be the way we treated infection, by the way, prior to antibiotics 100 years ago, to a curative approach to mental illness, particularly affective disorders, which I think will be cured first, which is ptsd, depression, anxiety. And the tools that are really paving the way to understand that that's possible is really the research that has been conducted by, and led in large part by MAPS and the md controlled, rigorous, controlled, double blind, randomized, placebo controlled trials of MDMA assisted therapy. Because they've shown that with just three doses of MDMA and 12 weeks of psychotherapy, which is 42 hours of psychotherapy over 12 weeks, and then that's it, that's all the treatment is. Three doses of medicine, 12 weeks of therapy at one year out, more people are better than they were after the treatment concluded without any additional treatment provided by the study providers, the researchers, that is pretty incredible. We have never seen data like that in the history of the field of psychiatry.
- [73:32]
Host (possibly Brooke Gladstone or another mental health podcast host)
What were their incoming symptoms or diagnoses for that study?
- [73:36]
Dr. David Rabin
So that study was the phase two study of ptsd, which were mostly veterans, not all. And they had an average of 17.56 years of completely treatment refractory treatment resistant PTSD. So these are people who've tried everything under the sun and never had achieved relief that lasted any amount of, reasonable amount of time. Nothing that looked like remission, ever. And after the treatment ended, after the 12 week treatment ended, I think something like 55% of them were considered to have entered remission and remission from PTSD and without any additional treatment. At one year out, that number increased to 67% without any additional treatment.
- [74:19]
Host (possibly Brooke Gladstone or another mental health podcast host)
That's amazing.
- [74:20]
Dr. David Rabin
It's incredible. And that kind of effect is only a level of effect that we've seen with things like antibiotic treatment for infection, right? Like prior to, we have to remember our history and how much resistance these other, what are now considered to be the greatest discoveries in the history of medicine have faced to get implemented at mass scale. Like prior to germ theory, prior to the development of antibiotics, we did not know that you could treat things like syphilis with antibiotics. Right? It just was not known. And people were diagnosed with syphilis and then they were, you know, eventually institutionalized with neurosyphilis and they lost their minds and they died in institutions, many of them, or in hospitals and you know, the invention of penicillin, or discovery of penicillin as a, a bread mold, it can be encapsulated and provided as a treatment, cured these people within like less than 12 weeks. Right? They went from terminal illness. We can't do anything for you. Sorry. Like you're just in, in this now for life, rest of your life, whatever that, however long that is, to similar to the what we talk tell people about PTSD, right, and depression now to within 12 weeks you are fully cured and you are unlikely to have a relapse. Right. Like that is where we're going with, with mental health. And I think we really just need to keep our eye on the prize because that's never been possible before and now the evidence shows that it's possible. So we just need to focus and not get distracted or, or divided by all the other bullshit that's going on around us. We just need to focus on like that goal. And if we can really zoom in and focus on that goal, we could actually be curing mental illness in the next five years. I am confident in that.
- [76:04]
Host (possibly Brooke Gladstone or another mental health podcast host)
It sounds like in a much more foundational way, people in the mental health field need to actually believe that curing mental illness is possible because I don't actually think most people in the mental health field today believe that curing mental illness is possible on the scale that we need it to be cured. And I wonder, where do you think that comes from? We've talked about it quite a bit on the podcast. How people that enter healing profession would eventually land in a place where everything becomes more about coping, mitigating, adapting, than actually believing that full healing is possible.
- [76:41]
Dr. David Rabin
I mean, a lot of it, it's not exactly anybody's fault. A lot of it is just like the historical precedent of the way we have understood mental illness. And the medication, the biological, the biologic medication revolution into mental illness in the 70s through 90s really set us back in terms of our chemical imbalance.
- [77:07]
Host (possibly Brooke Gladstone or another mental health podcast host)
Everything's.
- [77:08]
Dr. David Rabin
Yeah, the chemical imbalance theory, right. Like, all of that really, like, set us back in our understanding of how. Of whether or not a curative approach to mental illness is possible. But again, it taught us a lot about stabilization techniques that work, and it taught us about the serotonin system and how modulating it in different ways can get desirable and undesirable effects for different illnesses. You know, then fast forward to psychedelic assisted therapy research, and that's teaching us something different, right? Like, like we talked about a second ago, like the research in psychedelic assisted therapy, if people actually go back and look at the data, which is really what we're encouraging people to do. And if you don't have time to do that, like, just go check out our nonprofit medical board. We summarize it all for you there, boardofmedicine.org, so you don't have to go read everything from scratch. Try to make it really, really easy. And we have training courses available. And I think if people actually go back and look at the data, it becomes undeniable that what we're learning from psychedelic assisted therapy is that a curative paradigm is possible. And, and that is what needs to be re educated, because we just haven't. We've all been indoctrinated, myself included in my training. We were all indoctrinated to not even use the C word. Cure. Yeah, right. Just don't use it. Don't talk about it. It's a sore subject. And that is a paradigm that we have to be willing to step out of. But I think when people realize that it is possible, which is probably many people hearing this for the first time, realizing for the first time this is actually possible, and we start educating ourselves on it, we realize that's actually what we've always wanted. Right? Like we've always, all of us, whether you're a patient struggling with mental illness or you're somebody who is not yet A patient who's struggling with mental illness symptoms or you're a clinical mental health provider. All of us share the common goal of wanting to be able to cure these illnesses. So it's just that we have to know and believe and understand that the evidence is now saying, hey, we, we've updated this. It's possible to do this. This paradigm is within reach. And when we start to have these conversations, we are starting to make that change.
- [79:31]
Host (possibly Brooke Gladstone or another mental health podcast host)
One of the things that I think is important for everyone to wrap their head around, which is why even for a moment, brought up the chemical imbalance narrative. I think when people are trying to expand a paradigm or ask some more challenging questions, you're often met in the moment with, but the evidence says this, but this is the standard approach. And I just want to empower people. Sometimes you have to say yes and keep asking the questions anyways, because I think we're now at a phase where I fear genetics is going to become the same chemical imbalance, issue it. To me, they're two sides of the same coin. Everything's a chemical imbalance. Everything's actually genetic. When I think you and I both agree that you cannot discount the role that early childhood inputs plays and that of course the early childhood inputs will change the biochemical soup that exists in our body. Our early childhood inputs will turn on and off our genetics. We can't get distracted. You guys, just hear me when I say this. Do not fall in the trap of everything is genetics. That's going to take us down the same damn road that the chemical imbalance narrative went down. And maybe Dr. Rabin and I can do a whole other episode on that. Do you, do you feel the same way about genetics now being kind of the new chemical imbalance?
- [80:54]
Dr. David Rabin
Well, so they're. They're actually one in the same. It's the.
- [80:57]
Host (possibly Brooke Gladstone or another mental health podcast host)
I agree.
- [80:58]
Dr. David Rabin
Yeah, yeah. Like the genetic theory that we are born with a chemical imbalance already encoded in our DNA at birth is the chemical imbalance theory. Manif is. Is the way it was attempted to be explained. And now I think we can say that probably at least a few hundred million dollars of research later. There is no consistent evidence that that is the case across any number of mental illnesses. The gross majority of mental illnesses do not fit into that paradigm. There are very, very few genetic mental illnesses. Like maybe 1% of all mental illness falls into that category of being a genetic predisposition that caused it. So that's a big deal. Right. And I think that combined with the data that came out of the massive Umbrella study that from, I think it was University College of London a few years ago, showing that when they did a meta analysis of all the meta analyses of every single study looking at neurochemical imbalance assessments and depression, they found that in fact there is no consistent evidence that depression is caused by neurochemical imbalance. And they found that the most common linkage between people who have depression that would predict you having depression is not, in fact, again, a chemical imbalance. It's trauma. Unreprocessed, unresolved traumatic events. And the thing that has the, the treatment that has the most likely, the intervention that has the most greatest likelihood of resulting in improvement for people is not SSRI antidepressants. In fact, it is exercise, regular, healthy amounts of movement. Right.
- [82:44]
Host (possibly Brooke Gladstone or another mental health podcast host)
See, when you get back to basics, you guys, we've spent so many millions of dollars trying to do things that really a lot of it was just right there. If we go back 6,000 years ago, Ayurveda, TCM, different indigenous cultures, they seem to have it right. And the one thing that I'll leave us on that I think is important, and I know that Dr. Rabin and I both agree on this, I think the term trauma has been intentionally weaponized over the last, in particular 10 years in both positive and negative ways. I firmly believe from the data that we have gone through over the last 12 years in break Method, every single one of us has our own unique matrix of traumatic input and those inputs are going to be unique to us. And Dr. Dave mentioned it a little while ago, when we come into this world, we're not yet patterned with anything else. So whatever we experience will be traumatic to us. Even if when you measure it against somebody else, maybe you could say, oh, that's medium grade, that's a high grade, that's a low grade. It's irrelevant because we come into this world innocent, curious, and just wanting to give and receive love in return. And often what we get are the opportunities to do none of those three things. So what ends up happening as a result? We experience trauma. So I think it's important for any of us that are here listening or wanting to engage with Dr. Rabin's work, with my work, and even a lot of what I think we're going to start to move into is pairing the Apollo Neuro with people that are doing the Break Method program. Everyone has trauma. And the key is understanding the very specific inputs of your trauma and how they are correlated to the outputs in your behavior, your distorted perception of reality, your patterns of self deception, because when you can crack the code on those three things, I have seen people absolutely unequivocally be cured. And Dr. Ruben, I don't think you know this yet, cause this hadn't happened time that we spoke, but we officially got our study accepted by JMIR and it shows that break method was 87% effective with OCD and suicidal ideation, which is very exciting. And there statistical correlations of, of, of efficacy with anxiety and depression as well. But the standouts were suicidal ideation and ocd. So I think when it comes to the work that, that you're doing, that we're doing with break method, everyone is out here trying to ask the hard questions, trying to roll up sleeves. And I think those of you that are listening to this podcast, those of you that are out in the field bringing different methodologies or tech gadgets into the field, it is so essential to set your sights on believing that cures are possible. Because without that belief, we're never going to get there. And I think that's something that Dr. Rabin highlighted earlier on in the episode, that belief is so important to everything that follows after that. So if there's one thing you take from this episode, it is believing that we have a future where people are able to overcome mental illness. And if you don't believe that, it's just going to delay us all. So Dr. Rabin, where can everybody find you following your work? And we will put in the show notes, notes, the Link and the BG Heal code for $90 off the Apollo Neuro.
- [86:10]
Dr. David Rabin
Oh, sounds good. And, and just before I, I just wanted, before I go there to where people could find me, I just wanted to echo what you said, which I think is really, you know, really on point. And, and the idea that, you know, we, we have the ability to, to heal ourselves and to be able to. And belief in that is where it starts. And believing is a skill, right? Like believing is a skill. Like learning how to ride a bike and pumping iron at the gym is a skill. And you're not going to be good at it the first time you start trying. So it might be even hard or uncomfortable when you start. But as we practice believing, we start to get really, really good at it. And the outcome of it is manifestation of our beliefs, of our goals, of our wildest dreams. And that is where being human gets really, really exciting. So I think that thinking about, about belief as a skill in that way is, is really important. It's not just a, it's not just a whatever woo woo like thing it is not scientifically backed. It is functionally a skill just like anything else that we train ourselves to do and should be treated as such.
- [87:31]
Host (possibly Brooke Gladstone or another mental health podcast host)
And I think it predicts outcomes much more than actual skill.
- [87:36]
Dr. David Rabin
Right. Well, like others. Yeah, certain other skills.
- [87:38]
Host (possibly Brooke Gladstone or another mental health podcast host)
Right.
- [87:38]
Dr. David Rabin
It definitely does. And, and I think the, you know, the, and I think the, the last piece is that, you know, by practicing these kinds of emotional, I would, I call them like emotional bodybuilding skills. Beliefs, gratitude for self. Gratitude, self forgiveness, self compassion, self love. Just by doing these simple practices, we can rewire our brains and rewrite our own story the way we now know ourselves to be, rather than the way we were taught, which is not necessarily the way we actually are reflective of who we actually are and what we're capable of. And that's what all of this work is really, really culminating in. And again, it couldn't be more exciting time in the history of psychiatry to be alive. So, again, thank you so much for having me. I really appreciate you having me join you and really looking forward to more conversations. And if anybody wants to find me, you can find me at my clinical website is Apollo Clinic or Drdave IO. You can find the Apollo Wearable in the App store under Apollo Neuro. Or you can go to ApolloNeuro.com a p o l l o n e u r-o.com if that's too hard to remember, you can go to wearablehugs.com it'll take you to the same place. And if you want to find my work on the research that we were talking about here, the nonprofit medical board work, the medicine trainings and all of this, go to theboardofmedicine.org it's theboardofmedicine.org or boardofmedicine.org and if you would like to learn more about my work in the psychedelic space and some of my neuroscience research, I have two shows, one called the Psychedelic Report, which you will hear busy on with me shortly, and another called your Brain Explained, both of which are available on Spotify and Apple podcasts.
- [89:50]
Host (possibly Brooke Gladstone or another mental health podcast host)
Awesome. Thank you so much for joining us. And we will surely have Dr. Rabin back on. And be sure to check out my episode also on the Psychedelic Report. I know we're planning to time these similarly so you can have a little back to back if you have any questions on the device or anything that we've talked about today. You know I'm an open book. You can hit me in the DMs anytime. And I will make sure that all of the links links are on the show Notes. Thank you so much Dr. Reben. We will see you soon. And I will see you all next week. Your brain isn't broken, it's running. An old code break method is a system that maps your neurological patterns, decodes your emotional distortions and rewires your behavior fast. No talk therapy spiral. No getting stuck in your feelings, just logic based rewiring. In 20 weeks or less. Head to breakmethod.com and see what your brain is really up to. Your brain is wired for deception. But here's the truth. Patterns can be broken. The code can be rewritten. Once you hear the truth, you can't go back. So the only question is, are you ready to listen?