145. Dr. Dave Rabin: HRV, Vagal Tone, and the Science of Safety for Performance and Mental Health

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Mar 10, 2026

Dr. Dave Rabin, a psychiatrist and neuroscientist who co-founded Apollo Neuro, explains why recovery matters more than nonstop productivity. He breaks down vagal tone and HRV as markers of resilience. Short practical topics include breathwork, environment design, wearables, cold exposure, and how psychedelic-assisted therapies and safety-based approaches support trauma healing.

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ADVICE

Calibrate HRV With A Monthly Baseline

Track HRV baseline for 2–4 weeks (ideally during sleep) before acting on daily fluctuations.
Use baseline shifts to guide decisions: if HRV is ~20% lower than baseline, favor recovery over high-demand tasks that day.

INSIGHT

HRV Is A Window Into Vagal Brake And Resilience

HRV is a practical proxy for vagus nerve function and resilience, predicting longevity, recovery, and performance.
Rabin frames the vagus as the brake to the amygdala's gas; higher HRV reflects stronger parasympathetic braking.

INSIGHT

Vagal Tone Is Trainable Through Repeated Safe Stress

Vagal tone is highly trainable and largely learned, not fixed by genetics.
Practices like exercise, breath, sauna/cold exposure, meditation and gentle hormesis strengthen vagal activity and raise HRV over months.

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Chronic stress is quietly reshaping how we think, perform, sleep, and recover. In a world optimized for productivity, we rarely prioritize the one variable that determines long term resilience: recovery.

In this episode of Extend, we sit down with Dr. Dave Rabin, neuroscientist, psychiatrist, and co founder of Apollo Neuro, to unpack the science of vagal tone, heart rate variability, and how safety signals in the body drive peak performance and mental health. We break down the difference between eustress and distress, how unresolved trauma suppresses recovery, why HRV may be the most powerful biomarker of resilience, and how tools like breath, environment design, and wearable neurotechnology can retrain the nervous system in real time.

We also explore how psychedelic assisted therapies such as ketamine and MDMA are reshaping psychiatry, why safety is the foundation of trauma healing, and how small daily practices can restore autonomic balance and unlock human potential.

Dr. Dave Rabin, MD, PhD, is Executive Director of The Board of Medicine and a psychiatrist and neuroscientist specializing in chronic stress and treatment resistant illness. He has spent 15 years researching non invasive therapies including MDMA assisted treatment for severe PTSD, and is the author of the upcoming book A Simple Guide to Being Alive, a science backed framework for navigating burnout and reclaiming mental clarity in the modern world.

Pre-order Dr. Rabin's book "A Simple Guide to Being Alive" here: http://www.simpleguide.life

What We Discuss:

(00:00) Performance Culture vs Recovery Deficit
(05:05) Evolutionary Stress and the Modern Nervous System
(09:30) Eustress vs Distress and Early Warning Signs
(20:35) HRV as a Biomarker of Vagal Tone and Resilience
(27:24) Baseline Tracking and Using Wearables Intelligently
(37:34) Environment, Ambience, and Nervous System Regulation
(41:37) Breath as a Choice and Reclaiming Autonomic Control
(49:23) Micro Moments of Recovery Throughout the Day
(54:12) Apollo Neuro and Vagus Nerve Modulation
(1:04:22) Trauma, Safety, and Healing the Stress Imprint
(1:09:16) Ketamine and the Future of Psychedelic Assisted Therapy
(1:15:01) MDMA, Meaning Making, and the Possibility of Cure

Thank You to Our Sponsors:

Function Health: Learn more and join using my link. Visit www.functionhealth.com/drshah and use gift code DRSHAH25 for a $25 credit toward your membership.

Learn more about Dr. Shah:

Website: https://www.drshah.com/

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Learn more about Dr. Dave Rabin

Dr. Dave's Website: https://www.drdave.io/

Instagram: https://www.instagram.com/drdavidrabin/?hl=en

The Board of Medicine: https://www.boardofmedicine.org/

The Psychedelic Report: https://podcasts.apple.com/us/podcast/the-psychedelic-report/id1670195179