Podcast Summary: Extend with Darshan Shah, MD

Episode 145: Dr. Dave Rabin: HRV, Vagal Tone, and the Science of Safety for Performance and Mental Health
Date: March 10, 2026
Host: Dr. Darshan Shah
Guest: Dr. Dave Rabin, MD, PhD

Episode Overview

In this episode, Dr. Darshan Shah interviews Dr. Dave Rabin, a board-certified psychiatrist, neuroscientist, and creator of the Apollo wearable. They delve into the science of stress, heart rate variability (HRV), vagal tone, and the nervous system’s role in resilience, mental health, and peak performance. The conversation covers practical, science-backed approaches to optimize recovery, create a sense of safety, and extend healthspan—culminating with an exploration of psychedelic therapies and the future of psychiatry.

Key Discussion Points & Insights

1. Redefining Stress: Eustress vs. Distress

• Eustress (Good Stress): Drives growth, personal development, and adaptive resilience (11:43-13:56)
  • “EU means good. EU stress is good stress…it facilitates growth and personal development.”—Dr. Rabin [12:00]
  • Examples include exercise, learning, healthy risk taking.
• Distress (Bad Stress): Overwhelms, triggers survival threats, and leads to disease when unchecked.
  • “Distress is stress that is overwhelming…It causes disease.”—Dr. Rabin [13:00]
• Most people ignore early signs of distress—irritability, poor sleep, fatigue, brain fog, loss of empathy—leading to burnout (13:56-15:07).

2. Evolution, Overstimulation, and Survival Mode

• The human nervous system evolved for bursts of stress, not constant input (08:40-11:18).
  • “Our system is still designed to tackle those issues…What happens instead is overstimulation—phones, screens, too many responsibilities—and your system thinks it’s under survival threat when it’s not.”—Dr. Rabin [10:00]
• Loneliness as a modern “survival threat”—lack of community now triggers the stress response ([10:42]).

3. Recovery Is as Important as Performance

• High performers today risk burnout by neglecting recovery.
• “We’re not taught to adequately prioritize peak recovery as much as we prioritize peak performance.”—Dr. Rabin [05:53]
• Build recovery (rest, connection, play, downtime) into your schedule as non-negotiable (06:12-07:05).

4. Perception and Expansion of Time

• The experience of “time” can be contracted by “rush” or expanded by mindfulness and presence.
  • “If you’re constantly running, a year goes by in a flash. If you spend more time being mindful, that year can last a very, very long time.”—Dr. Shah [15:07]
• Techniques like slow breathing, touch, and gratitude expand time and presence (16:08-17:49).

5. Modern Metrics: Heart Rate Variability (HRV)

• HRV: A measure of adaptability and resilience, reflecting vagus nerve activity (23:04-26:36).
  • “HRV is the rate of change of the heartbeat over time…It predicts longevity, physical and cognitive performance, and recovery.”—Dr. Rabin [25:15]
  • Low HRV signals under-recovery, stress, or unresolved trauma.
• Tracking HRV:
  • Establish your monthly baseline, especially during sleep, then notice and respond to significant drops (30:16-31:39).
  • “If your HRV is low, you’re going to perform less well. Don’t push your limits that day.”—Dr. Rabin [31:48]
  • HRV is highly individual—no need to compare your number to others (32:21-33:45).
• Good News: HRV is fully trainable and has no known upper limit (38:08-39:39).

6. Vagus Nerve, Breath, and Creating Safety

• The vagus nerve is the body’s main “brake pedal”—regulates return to safety and recovery (39:47-44:45).
  • Activities that boost vagal tone: deep breathing, soothing touch, music, gratitude, physical environment (light, sound, reducing clutter).
• Breath as Control:
  • “When you choose to breathe, your prefrontal cortex is telling your amygdala—I’m in control. That creates a feeling of safety and immediately improves HRV.”—Dr. Rabin [46:10-47:48]
  • Most people breathe too quickly (12-24 breaths/minute), perpetuating stress; aim for 5-7 breaths/minute at rest.
• Don’t Over-Complicate Breathwork:
  • “Just take the work out of breathwork. Just remember to breathe. Micro-moments throughout your day are more important than doing it perfectly or for 45 minutes.”—Dr. Rabin [50:54-53:00]

7. Recovery Protocols and Environmental Design

• Curate calming physical spaces—light, sound, declutter, ambiance—all impact vagal tone (39:47-41:36).
• Recovery can be trained: Spreading “micro-moments of wellness” across your day is more valuable than marathon sessions (52:04-53:07).

8. Wearables and Technology (Apollo Neuro)

• The Apollo wearable provides gentle vibrations that “feel like a hug” to the body, stimulating the vagus nerve and improving HRV, stress resilience, sleep, and recovery (55:37-63:55).
  • “The Apollo was built for people who didn’t respond to anything else. It works by delivering music-like, low-frequency vibrations through the skin to boost vagal activity.”—Dr. Rabin [61:27]
• Pairing Apollo with devices like OURA ring allows personalized feedback and further optimization.

9. Trauma, Safety, and Healing

• Unresolved trauma is common and lowers baseline HRV and resilience.
• Recovery requires accepting our own history and building safe environments/relationships for healing (65:26-70:08).
  • “First step is accept we’ve all had trauma. Second step is start doing things that help the body feel safe enough to heal from it.”—Dr. Rabin [70:08]

10. Psychedelic Therapies: The Future of Psychiatry

• MDMA, psilocybin, ketamine, ayahuasca, and ibogaine are showing promise in treating PTSD, depression, and trauma—by amplifying feelings of safety and allowing people to “remake meaning” of their experiences (71:29-78:26).
  • “With psychedelics plus therapy, 67% of patients had a complete remission of PTSD—unlike anything in psychiatry’s history.”—Dr. Rabin [58:54]
  • Real healing comes when medicine is used with therapy, not alone; context and integration are essential.
• Psychiatry is moving towards holistic, root-cause healing (nervous system medicine) and even potential cures for mental illness (81:08-83:14).

Notable Quotes & Memorable Moments

• On Recovery and Performance:
  “We’re not taught to adequately prioritize peak recovery as much as we prioritize peak performance…if we keep performing without refueling…it’s inevitable we’ll burn out.” —Dr. Rabin [05:53]

• On Presence and Time:
  “You can expand and contract time depending on what you’re doing. If you’re constantly running, a year can go by in a flash. If you spend more time being mindful…that year can last a very long time.” —Dr. Shah [15:07]

• On Breath and Safety:
  “When I choose to take a breath, my prefrontal cortex tells my amygdala, ‘I’m in control.’ Now, I have reinstated safety in my body and increased vagus nerve tone and HRV—immediately.” —Dr. Rabin [46:10]

• On HRV’s Limitlessness:
  “There’s no upper limit on HRV…which means human potential is far beyond what we know it to be. We haven’t even begun to push the limits.” —Dr. Rabin [38:39]

• On Trauma’s Subtle Forms:
  “Even just having a loving parent yell at you to be quiet can lead to a lifetime of holding back your voice. That’s trauma. And it controls your entire life.” —Dr. Rabin [68:02]

• On Wearables and the Nervous System:
  “We composed music for the touch receptors…delivered as vibration, to activate the insula-amygdala-prefrontal loop. It worked. Vagus nerve activity goes up, performance goes up, sleep goes up.” —Dr. Rabin [61:27]

• On the Future of Psychiatry:
  “We are starting to see evidence that we can cure mental illness like PTSD. We’ve never, ever been able to do that before.” —Dr. Rabin [81:08]

Timestamps for Key Segments

• The Differences Between Eustress and Distress: 11:43–13:56
• Evolution and Modern Overstimulation: 08:40–11:18
• Building Recovery Into Performance Schedules: 06:12-07:05
• HRV Metrics and Practical Tracking: 23:04–34:25
• Vagus Nerve, Breathwork, and Safety: 39:47–53:07
• Apollo Neuro and Wearable Technology for Recovery: 55:37–63:55
• Psychedelic Therapy Breakthroughs: 70:38–83:14

Actionable Protocols & Takeaways

• Listen to Subtle Signs: Don’t wait for major symptoms. Early signals (irritability, poor sleep, brain fog) mean you need more recovery.
• Track Your HRV: Establish a sleep-based baseline; pay attention to drops and prioritize downtime when needed.
• Train Recovery:
  • Micro-moments matter—pause regularly to breathe, play, or connect.
  • Curate your environment for soothing sensory input.
  • Try tools like the Apollo wearable for nervous system support.
• Breathe Intentionally:
  • Aim for 5–7 deep breaths per minute when at rest.
  • Simple, conscious breathing is enough to reset your nervous system.
• Acknowledge and Heal Trauma: Everyone experiences some trauma. Healing begins with acceptance and creating safety.
• Explore New Therapies: The future holds promise in integrating wearables, vagus nerve–targeted interventions, and guided psychedelic therapy—not just conventional medication.

For more, follow Dr. Dave Rabin on socials (@drdavidrabin), or explore his book “A Simple Guide to Being Alive” for a deeper dive into these practical, paradigm-shifting approaches to mental and physical wellbeing.