Psychedelic Therapy | +80 articles

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Dr Ben Sessa

Ketamine to treat depression and addiction at UK’s first medical psychedelic psychotherapy clinic

by Charlotte Ricca | INEWS | 25 Jan 2021

Using a class B drug to help mental health problems might not sound too sensible when it is commonly known as a horse tranquilliser and possession can carry a prison sentence of up to five years. But with excitement growing at its ability to aid depression, ketamine will be one of the first treatments offered at the UK’s first medical psychedelic psychotherapy centre when it opens in spring.

Awakn Life Sciences plans to begin welcoming patients to its clinic in Bristol in March, offering “innovative approaches”. While a key concern about psychedelics is the risk of addiction, recent trials have indicated that ketamine is proving successful in helping addicts conquer their demons.

“These drugs are banned and they are illegal, but there is strong evidence that ketamine-assisted psychotherapy is both useful and safe in a wide range of psychiatric indications,” Dr Ben Sessa, Awakn’s chief medical officer, tells i.

Sessa, a clinical psychiatrist, has set up the clinic with Awakn’s chair, Professor David Nutt, who was sacked as the government’s chief drug adviser in 2009 after saying that ecstasy and LSD were less dangerous than alcohol, a claim he stands by.

Ketamine was first developed in 1962 as an anaesthetic, but growing evidence has shown its clinical value in helping treatment-resistant depression. Awakn, which is owned by a Canadian holding company, plans to broaden its use to treat anxiety, post-traumatic stress disorder (PTSD), eating disorders and addiction.​

‘A powerful combination’​

In 2019 a government-backed study explored the combined use of psychological therapy with a low dose of ketamine, over three weeks, as a treatment for alcoholics with mild depression. The results of the Ketamine for reduction of Alcoholic Relapse (Kare) phase II trial – run by Professor Celia Morgan, a member of Awakn’s scientific advisory board – have not yet been published.

One person who took part, Grant Plant, says it “has totally reset my brain.” “I was drinking up to two bottles of wine a night, but since taking part in the trial over a year ago I have not had the urge to drink,” says Plant. “I am a complete advocate for psychedelics in the treatment of addiction.”

The ketamine-assisted programme at Awakn will follow a similar format. “There are other ketamine clinics, but they use the drug primarily for its pharmacological anti-depressant effects,” Sessa explains. “The key difference is we will augment the ketamine experience with psychotherapy. It’s a powerful combination, as psychedelic drugs provide deeper opportunities for patients to address and challenge their long standing rigid mental health problems.”

Psychedelics achieve their therapeutic effects through “dissociation”, which can induce feelings of disengagement from your surroundings and sense of self. This is what makes ketamine an effective anaesthetic, as it separates you from the pain, says Sessa. “It’s also incredibly safe and is routinely used in A&E, particularly on children, as it causes minimal damage to any organs and has no interaction with other drugs.”

Although ketamine is approved for anaesthesia, it has not been licensed as a recommended drug for psychiatric work, meaning for now it is being used “off label.” Sessa believes there is “every indication” this may soon change.

A ketamine-based nasal spray called esketamine, was licensed for psychiatric use in 2019 after a study that showed patients who used it had a 51 per cent lower risk of relapse. However, the National Institute for Health and Care Excellence has not recommended it for use on the NHS due to its high cost and “uncertainty about whether improvement in symptoms and quality of life can be sustained.”​

‘Psychedelic psychotherapy represents a new future’​

Professor Rupert McShane, a consultant psychiatrist at the University of Oxford, wrote in the British Medical Journal in 2019 that ketamine offered “new hope for the millions of patients worldwide who don’t respond to conventional drugs”, but added that more work is needed on dosing and the long-term safety of continued use.

“Yes, there is a lack of evidence, but this means we have to create evidence,” says Sessa. “There is a pioneering, experimental aspect to what we are doing. Sometimes this means you have to be brave and push forwards, but do so as safely as possible. It’s about assessing the risk-to-benefit ratio.”

Sessa hopes to expand the clinic’s treatments to include MDMA, commonly known as ecstasy, and Awakn’s research team has been involved in the first UK safety study into recovering alcoholics using MDMA-assisted drug therapy, led by Imperial College London.

The results have yet to be published, but Sessa says just 12 per cent of participants returned to pre-drinking levels within nine months. “Gold standard treatments, such as rehab and group therapy, see 80 per cent return to drinking at nine months, so this a staggering result which blows those other treatments out of the water,” he says.

Last year Professor Nutt called for restrictions on research into psychedelic drugs to be eased to help make new breakthroughs.

Sessa is also hopeful about psilocybin, the hallucinogen in magic mushrooms, but like MDMA it can only be used for research. Whether they will ever be licensed as a medicine – and how effective they could be – remains to be seen.

“There is no cure-all and no magic wand,” says Sessa. “Mental health is complex process of factors, but psychedelic psychotherapy represents a new future.”

Awakn will use a maximum dose of 100mg, which Sessa says is around a third the amount that would be given to a 10-year-old child in A&E. Therapy is carefully controlled, with a doctor in attendance and an experienced psychedelic therapist offering support.

Ketamine to treat depression and addiction at first medical psychedelic psychotherapy clinic

The class B drug is to be used by Awakn Life Sciences when its centre opens in Bristol in March, explains its chief medical officer Dr Ben Sessa

inews.co.uk

 

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How to talk to your therapist about psychedelics

by Sarah Rose Siskind | Psychology Today | 21 Oct 2020

One patient's counsel on how to counsel your counselor.

Talking with your therapist about psychedelics for the first time can be difficult. It can bring up difficult emotions for your therapist. They may be reluctant to talk about it at first. Therapists can be a cautious, sensitive bunch. So it's important to show your professionalism as a patient. Remember, your therapist has what, only 20 or 30 years of training? Don’t worry. With patience and guidance, you may just have your therapist openly discussing psychedelic therapy or even preparing to integrate your psychedelic experience.

Recently, I was seeing a therapist who was unacquainted with psychedelic research and I gently guided him towards helping me integrate my psychedelic experiences. Integration is the process of drawing insight from an often enigmatic experience. Here are some potentially helpful questions to ask your therapist.

How does that make you feel?

The first order of business is to understand how your therapist feels about psychedelics. Perhaps you might test the waters by gauging how they respond to related topics such as cannabis, Burning Man, Tim Ferriss, or the plot of the movie Inception. Next, consider their demographics. If your therapist is a Boomer, they might remember the turbulence of the 1960’s. Watch out for countercultural baggage. When the time comes to broach the topic of your desire to try psychedelic therapy, be factual but open-minded. Do not be evangelical. The hallmark of the evangelist is an inability to listen and consider alternative opinions. Make sure you hear your therapist out if they are skeptical or initially averse or simply curious.

Do you feel valued?

Some therapists may feel threatened or scared about what this means for your relationship. They might experience your stated desire to try a new type of therapy as a message that they are not good enough. Take this piece of advice from people who’ve successfully asked their spouse for an open relationship: A little praise goes a long way. Make sure your therapist knows you value them deeply and that your desire to explore does not mean you want to end the relationship.

Tell me about your mother.

OK, so maybe don’t ask your therapist about their mother. But it is helpful to understand their background. In what psychotherapeutic tradition is your therapist’s approach grounded? You can then use the language of their chosen approach to explain the benefits of psychedelic therapy.​

• Have a Gestalt therapist? You might say, “It’s one thing to role play, but what if there were a medicine that might allow me to actually talk to my late father?” ​
• Have a Psychodynamic or Psychoanalytic therapist? Try: “If dreams are the royal road to the unconscious, then psychedelics are the super highway.” Tread carefully here: Psychoanalysis and psychedelics have history, so your therapist probably has strong feelings for or against them already.​
• Have a Cognitive Behavioral Therapist? You might say, “Psychedelics have helped patients to recognize and reevaluate patterns of thinking in order to optimize their performance. Here's a worksheet." ​
• Have a Client-Centered Therapist? Just tell them you’re doing this.​

Everything you say in here is confidential.

The first concern of many therapists is legality, so it is important that you remind them that integration sessions are completely legal. There’s nothing illegal about discussing psychedelic research, answering questions, or even setting a plan. However, unless you are undergoing a psychedelic session in another country where psychedelics are legal or using them within the purview of an FDA-approved study, the ingestion of psychedelics is not legal. But your therapist is not liable for your actions. So, for better or worse, you are assuming any risk on your own.

You also might want to consider whether your therapist is stifling their own enthusiasm. Therapists, no matter how well read or optimistic about psychedelic science, cannot recommend psychedelics outside a legal context. When you talk about psychedelic therapy, do your therapist's eyes widen like a cartoon dog seeing a T-Bone steak? Do they sit on their hands so as not to involuntarily pump their fists in the air? These might be subtle signs that your therapist is secretly enthusiastic.

Could you challenge that thought?

If your therapist is skeptical of or unaware of psychedelic research, are they open to having a conversation about it? Is it possible to change their mind with evidence? Perhaps not. Remember that you’re all on the same side.

What are your goals here?

Sometimes, it can be helpful to remind your therapist of your co-constructed goals in therapy. Whether these goals are related to your anxiety, depression, addiction, trauma, sense of purpose, or other issues, psychedelic therapy has a track record of promoting neuroplasticity. This may facilitate the necessary behavior change to achieve your goals. It might be wise to remind your therapist that you’re both on the same side in trying to achieve these goals.

You are not alone.

Psychedelic psychotherapy is a relatively new (or newly returned) branch of medicine. It’s normal and healthy for your therapist to be unaware of the many advances in psychedelic therapy. Luckily, there are resources. MAPS, the Multidisciplinary Association for Psychedelic Studies, has a comprehensive bibliography of all research papers on the benefits of psychedelic therapy and a timeline of legalization. If you decide to seek out a separate integration therapist, Psychedelic Support has a list of integration practitioners. When the time comes, you or your therapist may want a more formal introduction into the world of integration. Fluence is a psychedelic integration training institution that has already trained hundreds of therapists. It is run by Drs. Ingmar Gorman and Elizabeth Nielson, two experienced practitioners who understand the trials of counseling counselors.

OK, we're out of time for today.

At a certain point you may realize that you will not be able to persuade your therapist on the matter of psychedelics. It’s important to establish boundaries and to know when to let it go. Depending on how intent you are on undergoing a psychedelic psychotherapy session, this may come at a heavy cost. It may be difficult to have a psychedelic experience and integrate with another therapist. Or it might be difficult to not bring up this experience (either the psychedelic session or the integration) with your current therapist. Ultimately, it took me a couple months, many conversations, and plenty of research to warm my therapist to the point of agreeing to help me integrate my psychedelic experiences. But like so many wins in therapy, it was worth the time.

How to Talk to Your Therapist About Psychedelics

One patient's counsel on how to counsel your counselor

www.psychologytoday.com

 

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Promise and challenges for psilocybin and MDMA use in treatment

by Dr. Peter Attia

Normal research into the therapeutic benefits of psychedelic compounds was effectively halted with the passing of the Controlled Substances Act in the 1970s. In recent decades, however, there has been a resurgence of scientific interest in the effects of these drugs on a variety of psychiatric conditions, ranging from PTSD to depression. This growing body of research on the therapeutic effects of psychedelic drugs, along with relaxing political measures for their decriminalization, have made it possible for some of these compounds to be potentially approved by the U.S. Food and Drug Administration (FDA).

There are three compounds that have regained traction over the past decade for potential mainstream use: Psilocybin—which comes from the psilocybe mushroom species—and two synthetic compounds, MDMA and LSD. All three compounds tend to be grouped together in the public discussion of psychedelic-assisted therapy, although psilocybin and LSD are considered classic psychedelics, whereas MDMA is known as an empathogen and does not produce the dissociative effects of psilocybin and LSD. Neither LSD or MDMA are naturally occurring, and therefore must be synthesized. I speak at length about the history of psychedelics and MDMA, along with how the substances work, in my discussion with Rick Doblin.

This article is a great overview of the two most promising drugs for near-term approval, psilocybin and MDMA. In its discussion of the compounds as therapeutic agents, the article canvasses the landscape of both completed and ongoing clinical trials. An Imperial College London trial evaluated the use of psilocybin in people who were classified as having treatment-resistant depression. In another study out of the Johns Hopkins University, psilocybin was administered to treat depression in patients with a terminal cancer diagnosis. More recently, the same research group studied the use of psilocybin in reducing symptoms of major depressive disorder, for which current pharmacotherapies have had limited effectiveness and adherence.

My persistent question about using psilocybin and MDMA-assisted therapy is not related to the efficacy of these drugs for treating psychiatric conditions that are otherwise difficult to address with existing pharmaceuticals. To these questions, I feel very optimistic. What gnaws at me is how we can go from approving these compounds based on their performance in very well-controlled clinical trials, to deploying and administering them at scale in a standardized way. In order for psilocybin and MDMA to fulfill their capacity as therapeutic treatments, we need a framework to move from efficacy—showing they work under perfectly controlled circumstances—to effectiveness—ensuring they work in the real world with less than perfect control.

In my view, one of the largest considerations has to do with the unique set of challenges that regulators will face with psychedelic-assisted treatments. With these therapies, the FDA will need to approve the compound in addition to the protocol for administering the drug. Unlike other prescription medications, these compounds are sensitive to an appropriate set and setting. The “set” refers to the individual’s mindset going into the session and the “setting” refers to the environment in which the treatment session occurs. The optimization of these two factors facilitates the therapeutic experience and the person’s emotional processing. Psilocybin and MDMA are powerful substances whose effects of intoxication can alter sensory perception or eliminate a person’s awareness of space, time, body, and self. In other words, these drugs will not simply be prescribed by a physician and taken autonomously the way, say, an antidepressant or an anxiolytic can be.

Thus, the FDA needs to consider the efficacy of psilocybin and MDMA for treating psychiatric conditions and set regulatory guidelines around administering the drug, along with integrating the person’s experience thereafter. There are discussions underway about whether the administering therapist needs to be trained and what that certification process would require. This certification process could mean that therapists who have long been illegally administering the drug treatment could become certified while some other experienced practitioners may resist involvement. Given the complexity of emotional experiences with psilocybin and MDMA-assisted treatment, one might also ask if the training should require that the prescribing therapist have personal experience with the compound. As important as that may be, I can’t imagine how such a stipulation could be suggested, let alone enforced.

Do we have a drug treatment model that could be applied to administering psilocybin and MDMA? Not really. The closest thing that I can think of is the pharmaceutical company Allergan, acquired by AbbVie, selling its Botox product to doctors who then administer it, rather than selling via prescription to patients who self-administer. In this example, any doctor can buy Botox and administer it to a patient. If the Botox model were applied to psilocybin and MDMA, it would also mean that there would be a spectrum of doctors with varying years of experience who administer the compounds. Obviously you would prefer to have someone qualified, but how would you know without an accreditation system? Receiving a drug like Botox also has a cost continuum related to the doctor administering it and, unfortunately, a cost that is also related to the dollars spent on the drug’s marketing. Will psilocybin and MDMA-assisted treatments have a standardized price or will there be a spectrum of practitioner fees? If there is to be high and low cost treatment, how will practitioners differentiate themselves?

Clearly there needs to be a standardized drug administration protocol for FDA approval. But let’s pretend for a moment that psilocybin and MDMA receive approval as therapeutic treatments. Who will produce these compounds? When pharmaceutical companies develop drug treatments, they consider the associated economic incentives. To this point, I discuss healthcare costs, and specifically drug pricing, in my conversation with Marty Makary. In the Botox example, Allergan trademarked the drug, giving the company financial incentive to produce it. By contrast, both psilocybin and MDMA, not to mention LSD, are in the public domain and therefore cannot be trademarked or patented. It also means that for-profit pharmaceutical companies are likely not going to be interested in developing the compounds for prescription use. One way big pharma has gotten around this problem in the past has been to slightly change the compound formula so that it can be patented for profit. This is what Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson, did with ketamine—a drug that produces a spectrum of anesthetic effects and has been used in the treatment of severe depression and pain management. Janssen patented a different FDA approved formulation of the generic ketamine formula so that it could make a profit.

The process for a standardized administration model and the large-scale production of the therapeutic compounds are both still riddled with questions that need to be answered before either psilocybin or MDMA can be put into practice. My hope is that the process can be addressed so that treatment intervention with either of the compounds can proceed. I do have concerns that, once these drugs are approved, a few therapists—who are at worst incompetent and at best overzealous—will create more harm than good. They could potentially set back a field that has spent decades earning the right to finally help people, legally, with some of the most powerful healing molecules available. I hope I’m wrong.

Promise and challenges for psilocybin and MDMA use in treatment - Peter Attia

What lies ahead before FDA approval

peterattiamd.com

 

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Predicting who may do best with psychedelic-assisted therapy

by Emily Caldwell, Cayla Mitzkovitz, Emily Bloesch and Christopher Davoli | Ohio State News | 22 Mar 2021

Being open to new experiences associated with positive effects.

As psychedelics gain ground as a potential therapy for mental health disorders, there remains a pressing concern that patients in clinical trials may have adverse effects to the drugs.

New research identifies personality traits that have been associated with positive and negative experiences on psychedelics in previous studies, information that could help predict how future clinical trial participants will respond to the drugs.

The findings suggest that people more open to new experiences and willing to surrender to the unknown may be best positioned to have a positive experience on psychedelics, and individuals who tend to be preoccupied or apprehensive could be more likely to have a negative, or challenging, experience.

These predictions could be used by scientists to help hesitant clinical trial patients feel more open to the potential therapy, possibly by offering lower doses as a starting point, researchers say – though such a concept remains speculative.

“The findings point to interesting testable things we can look at in future research,” said Alan Davis, assistant professor of social work at The Ohio State University and senior author of the review. “It might be plausible to use threshold doses that are smaller than those used in a trial as a first exposure so people have less anxiety, experience the benefit and, from that, go into a higher dose later.”

The study is published online in the journal ACS Pharmacology & Translational Science.

To arrive at these predictions, the researchers reviewed 14 published clinical trials and other types of studies conducted in recent years that documented participants’ personality traits or states of mind and their associations with a positive or negative experience on psychedelics.

“It’s been an open question so far in psychedelic science: How can we predict how people will react? We thought this review would be a good opportunity to develop a narrative of what the consensus is so far,” said study first author Jacob Aday, a PhD candidate in psychology at Central Michigan University who collaborates with Davis.

Preliminary evidence has suggested that psychedelics may be effective in treating mood, anxiety, trauma-based and substance use disorders.

“Psychedelics might broadly apply to a whole range of different psychiatric problems, and in part that might be because they’re directly affecting neurotransmission and the brain’s ability to communicate in new ways that involve different parts of the brain,” Davis said. “But there is still a lot to unpack about exactly how this all works and why it may be effective.”

Of the studies reviewed, 10 tested psilocybin (commonly known as magic mushrooms) as a therapy, two involved LSD, one used a hallucinogenic brew called ayahuasca and one examined psychedelic use in general.

Experiences on psychedelics vary in intensity and tend to comprise three categories: a mystical, insightful or challenging experience. A mystical experience can feel like a spiritual connection to the divine, an insightful experience increases people’s awareness and understanding about themselves, and a challenging experience relates to emotional and physical reactions such as anxiety or increased arousal.

The review suggests that people who are high in the traits of openness, acceptance and absorption – the tendency to immerse oneself into imaginative experiences – and in a psychological state of surrendering to whatever may transpire are more likely to have positive psychedelic experiences.

A state of surrender, in particular, stood out for its association with a lower chance for acute dread and a higher likelihood of a mystical experience and what is known as “ego dissolution,” when one’s sense of self gives way to a closer connection to other people and the broader world.

In contrast, people who are low in those traits or who are in preoccupied, apprehensive or confused states are considered more likely to experience adverse reactions.

“There was also tentative evidence that increased experience with psychedelics and increased age were associated with slightly less intense effects with the drugs,” Aday said. “And there weren’t any differences according to sex. Men and women responded similarly.”

"Three studies had identified potential neurological markers that could help predict research participant reactions to psychedelics, but the cost of collecting brain scans to screen trial candidates made them less practical predictors than psychological traits," Aday said.

Davis has already considered potential reactions to psychedelics for a psilocybin trial he is planning for veterans who have post-traumatic stress disorder.

“People who have experienced trauma are not very high in surrender, because they are anxious all the time about their past traumatic experiences,” he said. “A possibility to explore is starting with a low or moderate dose prior to giving the full therapeutic dose, which might help them increase in surrender. We’ve designed the study this way, thinking that might be helpful.”

Predicting who may do best with psychedelic-assisted therapy

As psychedelics gain ground as a potential therapy for mental health disorders, there remains a pressing concern that patients in clinical trials may have adverse effects to the drugs.New research identifies personality traits that have been associated with positive and negative experiences on...

news.osu.edu

 

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Comparing Psychedelic and Psycholytic Therapy

by Tanya Ielyseieva | Truffle Report | 29 Mar 2021

Mental health disorders are skyrocketing while the development of novel medications and psychiatric approaches has remained stagnant for decades. As researchers continue clinical trials on psychedelics’ abilities to treat depression, anxiety, PTSD, and addiction, it’s becoming apparent that therapeutic psychedelic use can be a powerful tool for people suffering from mental health issues. After the discovery of LSD in 1943, research into the use of psychedelic drugs in psychotherapy took place all over the world. There are two general approaches to use psychedelics for psychotherapeutic purposes, the full-blown psychedelic and the more subtle “psycholytic” models.

Psycholytic Therapy

Psycholytic therapy evolved primarily in Europe. The therapeutic model for psycholytic therapy was established by Hanscarl Leuner in Germany. In 1960 Leuner established the First European Symposium on Psychotherapy where Ronald Sandison, a therapist from England, suggested the name “psycholysis” or “psycholytic therapy” for the method. In 1964, Leuner founded the European Medical Society of Psycholytic Therapy (EPT). In 1985, Swiss researchers founded The Swiss Medical Society for Psycholytic Therapy with a goal of promoting psycholytic psychotherapy and providing training for qualified therapists.

Psycholytic (“soul- or mind-loosening”) therapy uses low to moderate doses of a psychedelic drug at a higher number of sessions combined with talk therapy. This method is focused on greater access to the unconscious and sees psychedelics as a way for a patient to unlock deeper insights while remaining present and partially in control of the process. Lower doses of psychedelics allow patients to have a dialogue with the therapist or clinician during the trip, with the drug playing only a supporting role.

Most psycholytic therapists reported long-term improvement in two-thirds of their difficult and chronically neurotic patients. However, these studies were performed at the clinical and ethical standards of psychotherapy of that time and might be subject to major errors.

Psychedelic Therapy

The psychedelic therapy method was initially developed by Abram Hoffer and Humphry Osmond. In 1950, they discovered that many patients with alcohol dependency went into remission after experiencing delirium tremens, the most severe form of alcohol withdrawal. Based on their admittedly flawed initial understanding, they decided to induce a similar state in patients by using high doses of LSD. Those patients who had positive religious, spiritual, or mystical experiences had longer-lasting therapeutic effects.

Psychedelic (“mind-manifesting”) psychotherapy was designed to use relatively high doses of the hallucinogenic drug over several treatment sessions. The aim of this version of psychedelic therapy is ego-dissolution, allowing patients to leave their bodies and undergo a highly intense mystical experience. This method requires the preparation of the patient in specific safe, comfortable surroundings with the aid of music while therapists allow the drug to work on the patients. After the psychedelic session, a patient undergoes integration support where the psychedelic experience is processed.

Historically, the psychedelic method was usually used without long-term psychotherapy and as a result, the initially drastic improvements of patients were not long-lasting in most cases.

Modern approach

Modern approaches to psychedelic therapy are attempting to incorporate the most effective aspects of both models. However, most psychedelic research involves the psychedelic therapy approach. Since psycholytic therapy usually requires a longer overall duration and can be composed of between 10 and 50 sessions, psychedelic therapy seems more approachable in terms of scientific research, with only one to three experiences being typical for a course of treatment.

Psycholytic therapy can be more effective for patients who are afraid to be overwhelmed by the trauma and experience a “bad trip”, since the dose is very low. This method also allows patients to be guided more easily by a therapist, which can be preferable when treating some mental health disorders.

Therapists and prospective patients should not consider the use of psychedelics in either form as a panacea for any mental health condition, and instead focus on the patient’s specific needs, as well as their medical and mental health histories.

Comparing Psychedelic and Psycholytic Therapy - Truffle Report %

Comparing Psychedelic and Psycholytic Therapy - Truffle Report

www.truffle.report

 

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Music a ‘hidden therapist’ in psilocybin therapy

by Joshua Falcon, MA | Psychedelic Science Review | 8 Apr 2021

A look back at the therapeutic role of music in psilocybin therapy.

The incorporation of music into psychedelic therapy initially emerged as a means of providing nonverbal support to patients during their psychedelic experiences. Music is often considered an integral component across most psychedelic psychotherapy treatment models; however, limited empirical research has examined the nature and magnitude of its therapeutic effects.

A 2018 study by Kaelen et al. was the first of its kind to explore how music is experienced from the patients’ perspective during psilocybin therapy. The researchers set out to understand what variables most positively contribute to music’s therapeutic outcomes.

Study design and methods

To begin the study, 19 patients were recruited from an existing study on treatment-resistant depression (as determined by the Hamilton Depression Rating Scale, aka HAM-D). Individuals with a history of psychotic disorders in their family, suicide attempts, and drug or alcohol dependence were excluded from the study sample.

Patients received a 10-mg oral dose of psilocybin during their first session, followed by a 25-mg dose during the second. The sessions were conducted in a therapy room that was specifically designed and housed within Imperial College London’s Clinical Research Facility. Unnecessary medical apparatuses were either hidden or removed, and the therapy room was decorated with plants, paintings, artifacts, cushions, and custom lighting.

After consuming psilocybin, therapists suggested to patients that they relax on bed cushions and wear eye-shades. Participants also had the option of listening to music either through in-ear headphones or a standing stereo speaker.

Researchers used a standardized music playlist for all patients but adapted to the needs of each unique participant by modifying songs accordingly if requested. To minimize prior experiential or religious associations made with certain songs, therapists designed a playlist that predominantly contained contemporary music ranging from traditional/ethnic and ambient musical styles to contemporary classical and neo-classical genres.

Following the pioneering work of Walter Pahnke, Stanislav Grof, and William Richards, researchers designed the playlist to meet the psychological needs associated with different phases of the psychedelic psychotherapy experience. One week after both psilocybin sessions, patients participated in a semi-structured interview that centered on their music experience. An interpretative phenomenological analysis (IPA) was used to analyze participants’ interviews to examine the meanings that patients attributed to particular aspects of their experience.

Study findings

Three variables (liking, resonance, and openness) emerged through data analysis which was hypothesized as being predictive of therapeutic responses to the music. These three variables were correlated with the five principal components drawn from the 11 Dimension Altered States of Consciousness.

Upon analysis of all 19 participant interview transcriptions, researchers identified four separate groupings, each of which contained several related themes and clusters:

1) welcome influences;
2) unwelcome influences;
3) appreciated playlist design and music styles;
4) unappreciated playlist design and music styles. In response to the music, researchers found that:​

• 79% of study participants reported music as a source of guidance.​
• 73% of those that reported music as a source of guidance found the music to be psychologically supportive.​
• 95% of patients reported welcome or appreciated influences of the music.​
• 89% of participants stated that the music intensified their subjective experience​
• 82% within this subgroup described the music as emotionally intensifying their experience.​
• 53% of study participants reported calming effects induced by the music.​
• 53% reported unwanted, unappreciated, and unwelcome influences.​
• 50% of the patients that reported unwelcoming experiences claimed that the music intensified unwanted feelings such as sadness or fear.​
• 32% of the total study participants reported incongruencies and misguidance being provoked by the music.​
• 42% of patients had positive reactions towards African, Indian, and Spanish music styles, while 37% reported appreciation for neo-classical music and vocal music.​

Although 32% reported that the music playlist contained elements that were not appreciated, 89% of patients claimed to appreciate the playlist design.

Researchers found that they could significantly predict decreases in depression scores 1 week after the psilocybin session in those patients who reported resonance, openness, and liking of the music. These variables were found to positively predict mystical experiences as well. In general, it was found that unpleasant feelings and disliking of the music were correlated with either a feeling of resistance or a diminishment of the subjective effects of psilocybin.

Limitations

The study is first and foremost limited by having obtained data without a placebo condition. Additionally, the only data gathered and analyzed was qualitative in nature, preventing researchers from examining the degrees to which the observed themes were experienced by participants.

Discussion

This was the first study to show that mystical experience occurrences are related to the music played during psilocybin psychotherapy sessions. It further suggests that it is not the intensity of psilocybin’s effects alone that correlate with reductions in depression. The positive therapeutic effects of psilocybin therapy are thought to result from the interaction between music and psilocybin on patients’ subjective experiences.

Kaelen et al. suggest that therapists have a responsibility to properly design playlists by thoughtfully selecting music styles that can provoke resonance and liking from patients undergoing psychedelic psychotherapy with psilocybin. They also propose that baseline measures should be established by future researchers so that individual experiences with music during psilocybin therapy sessions can be more reliably predicted.

Music is a ‘Hidden Therapist’ in Psilocybin Therapy

A look back at the therapeutic role of music in psilocybin therapy.

psychedelicreview.com

 

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First head-to-head trial pits psychedelic therapy against common antidepressant

by Rich Haridy | NEW ATLAS | 14 Apr 2021

A first-of-its-kind clinical trial has pitted a common antidepressant against psilocybin, the main psychedelic compound found in magic mushrooms. The results, recently published in the New England Journal of Medicine, are decidedly mixed with the primary depression measure revealing no significant difference between the two treatments, but a number of secondary measures notably favoring psilocybin.

As research into psychedelic psychotherapy accelerates around the world it seems as though we may be just a few years away from these paradigm-shifting treatments becoming clinically accessible. The US Food and Drug Administration (FDA) has even granted Breakthrough status to psilocybin therapy for both major depressive disorder and treatment-resistant depression, helping speed up ongoing Phase 2 trials.

Although early signs suggest psilocybin psychotherapy may be effective in treating depression, until now there has not been any robust research directly comparing this new treatment to common antidepressant treatments. To fill this gap in the science a team of researchers from Imperial College London’s Centre for Psychedelic Research conducted a phase 2, double-blind, randomized, controlled trial.

The trial recruited 59 adults with moderate to severe depression. Thirty subjects were assigned to the psilocybin arm receiving two active psychedelic therapy sessions three weeks apart. They also received daily placebo pills for the six-week duration of the trial. The antidepressant group received daily doses of escitalopram (commonly known as Lexapro) for six weeks, while also completing two "placebo" psychedelic therapy sessions with an inactive microdose of psilocybin.

The primary outcome measure in the trial was a change in baseline scores on a widely used scale for measuring depression called the Quick Inventory of Depressive Symptomatology–Self-Report (QIDS-SR). At the end of the six-week trial improvements were seen in both the psilocybin and escitalopram groups’ QIDS-SR scores, however, no statistically significant differences were found. Basically, according to the QIDS-SR scores, psilocybin therapy was virtually as effective as the common antidepressant after six weeks of treatment.

In and of itself this somewhat neutral finding has value. Escitalopram is a well studied antidepressant drug that has shown in prior clinical trials to be efficacious compared to a placebo in treating serious clinical depression. So demonstrating psilocybin therapy is as at least efficacious as escitalopram is promising despite potentially underwhelming more ardent psychedelic science advocates.

However, as with most things, the devil is in the detail. And Robin Carhart-Harris, lead researcher on the project, has suggested a number of secondary outcomes point to the psilocybin treatment demonstrating significantly greater efficacy than escitalopram. In fact, out of the 11 outcomes measured in the study, the QIDS-SR score showed the smallest difference between the two groups.

Carhart-Harris has expressed regret in locking the QIDS-SR measure as the trial’s primary outcome, and in an expansive Twitter thread he suggests the more “conservative” framing of the results in the published study were a result of the journal’s editing procedure.

“I strongly encourage readers to check out the supplementary appendix,” he notes. “This contains some figures and tables we would have preferred to have been made available to readers within the main paper but the journal moved them to the appendix. Some of the framing of the results are not our words but rather those of the paper's handling editor.”

Kevin McConway, an Emeritus Professor of Applied Statistics at the Open University, suggests what Carhart-Harris calls “conservative” are actually established scientific conventions that prevent research data from being skewed by scientists. McConway argues Carhart-Harris is being somewhat “misleading” by presenting values in an appendix and claiming those results are “free of any narrative.”

“The values are numbers that emerged from particular choices, made by him and the other researchers on this trial, on how to design and register a clinical trial, and on further choices about how to analyse the data,” says McConway, who did not work on this new research. “Looking at the numbers in isolation as if the numbers can stand for themselves is seriously misleading.”

The research team are very open and frank about the limitations of their trial. There was no placebo group serving as control, and it is virtually impossible to effectively blind a trial involving psychedelics. The six-week duration of the trial was also noted as potentially too short to best evaluate the efficacy of escitalopram, a drug with a known delayed therapeutic action.

Despite these mixed results and comprehensively self-reported caveats, some experts not affiliated with the trial see the findings as encouraging. Paul Keedwell, from Cardiff University, calls the secondary outcome results “tantalizing” and points out the new data will inform the design of future, larger trials.

“Bigger and longer studies are needed to test the potential of this exciting psychedelic, which is thought to produce 'emotional breakthroughs' in depression sufferers,” says Keedwell. “An 'active placebo' will be essential, because individuals know when they have been given the psychedelic.”

In general this novel study is a potent reminder of the work that still needs to be done before psilocybin psychotherapy for depression is broadly approved for clinical uses. Unlike MDMA for PTSD, a psychedelic medicine currently in late-stage Phase 3 trials and nearing market approval, psilocybin for depression is still only in Phase 2 testing.

This newly published research is a valuable building block for researchers moving forward, offering insights into Phase 3 trial design while delivering potent indications psilocybin may very well be a valuable therapeutic compound. So despite the inconclusive nature of the data presented, a finding that suggests psilocybin is at least as efficacious as a common antidepressant it still is of great value.

“One of the most important aspects of this work is that people can clearly see the promise of properly delivered psilocybin therapy by viewing it compared with a more familiar, established treatment in the same study," says Carhart-Harris. "Psilocybin performed very favorably in this head-to-head.”

The new study was published in the New England Journal of Medicine.

First head-to-head trial pits psychedelic therapy against antidepressant

A first-of-its-kind clinical trial has pitted a common antidepressant against psilocybin, the main psychedelic compound found in magic mushrooms. The results, recently published in the New England Journal of Medicine, are decidedly mixed with the primary depression measure revealing no significant…

newatlas.com

 

[mr peabody]

Psychedelic-assisted therapy could change your life

by Victor Fiorillo | 26 Aug 2021

Hannah McLane just opened the region’s first-ever psychedelic-assisted mental health clinic. She’s already treating patients with ketamine and says MDMA and magic mushrooms are coming soon.

Medical marijuana is so 2019. At the just-opened SoundMind Center in West Philadelphia, physician and psychotherapist Hannah McLane is treating patients with ketamine and plans to incorporate MDMA and psilocybin, a.k.a. magic mushrooms, once she can legally do so. We called the Temple (speech pathology), Brown (med school), Harvard (masters of public health) and Penn (neurology and preventive medicine) alum to learn more about this fascinating area of medicine.

What mental illnesses can be treated with psychedelics?
This answer is a bit more complicated than listing out a bunch of indications. I see the world primarily through the lens of trauma. And I understand trauma in a broader sense compared to the way psychiatry defines it. We all have trauma. For some people, it is “big T trauma” like a military trauma or childhood sexual trauma. But for others, it is a form that is more chronic and everyday, like, say, racism or other microaggressions. Some of us have memories from childhood we can’t shake or a nasty divorce that still haunts us. These are all real and affect the way we are in our everyday life.

Where do psychedelics come into play?
Sometimes, someone is referred to ketamine-assisted therapy because they qualify for a PTSD diagnosis, sometimes because of anxiety or depression, but regardless of the diagnosis that qualifies a person for treatment, I still see the way psychedelics work as primarily addressing traumatic experiences and memories. This holds true for ketamine, MDMA, and psilocybin. Because they are used as catalysts to enhance our abilities to process difficult experiences in therapy, at their root they are helping to address those initial traumas that led to psychological problems downstream.

I’m guessing, though, that you’re not recommending that a person who is depressed suddenly starts eating magic mushrooms every day.
We are talking about psychedelics in the context of co-occurring therapy here. Not just psychedelics on their own. There are some psychedelic substances that may have therapeutic properties without co-occurring therapy. But in the research we base our work on and the way we practice at SoundMind, therapy is required during the psychedelic journey. It is primarily an enhancement of the therapeutic process. It’s not just about treating a brain chemical. In this way, we are again redefining how we think of brain health and disease. It’s about the whole picture: your environment as well as physiologic properties of your physical brain, and everything in between. It’s redefining the root of the problem. And we need these therapies and this perspective now more than ever. There is so much healing we need to do.

When did you decide that opening Philly’s first psychedelic-assisted therapy clinic was what you wanted to do with your life?
At a conference in 2018. I saw a video of MDMA-assisted psychotherapy for PTSD. I saw people being healed. Quickly. I had never seen anything like that before. I’ve seen it happen slowly in psychotherapy. But with the MDMA-assisted psychotherapy for PTSD, two thirds of the people were healed after just three months. Two thirds of the people no longer met the criteria for PTSD, and some of these people had 18 years of symptoms. The numbers were astounding. And I decided I wanted to open a clinic.

Tell me more about SoundMind, the organization.
We are a nonprofit aimed at addressing mental health and neurological disorders through integrative medicine and psychedelics. We have a team of 10 clinicians in training to be able to administer MDMA for PTSD once approved. And we’re currently providing ketamine-assisted psychotherapy for depression, anxiety and PTSD. SoundMind is a diverse group of clinicians, interested in creating top-notch psychedelic care to the Philadelphia population and beyond, as well as a particular focus on inclusion of marginalized populations in clinical care and training to become psychedelic therapists — especially BIPOC, LGBTQIA+ and neurodiverse individuals. We are a training, treating and research center that is really the first of its kind on the eastern seaboard.

You are only doing ketamine-assisted therapy at SoundMind, because you can’t legally use MDMA yet, right?
Yes. MDMA only became illegal in the 1980s. It was actually used as a therapeutic medicine after it was discovered in 1912. Then in the ’80s, the government freaked out because people started using it as a recreational drug. So they made it a scheduled substance, and there’s been a push to get it approved by the FDA ever since. MDMA is now in phase three clinical trials, and we’re expecting to be able to incorporate that into our practice soon with psilocybin to follow.

All I know of ketamine is what I learned from Law & Order: SVU. It’s a horse tranquilizer that, like GHB, is sometimes used to drug people. How does it work in therapy?
With ketamine, you dissociate. It’s the opposite of MDMA, which makes you extremely grounded. There was a Harvard study that looked at transcripts of MDMA-assisted therapy trials, and it was predicative of success if the patient asked the therapist, “How are you doing?” So it’s weird, because ketamine is a dissociative, so how would it enhance therapy? Well, if you wanna understand Earth, you can shoot yourself into space and look back at it and see this orb with its oceans and continents or you can dig a hole in the Earth and put yourself in it. In both cases, you are learning about the Earth through different experiences. Ketamine is the one where you are shooting yourself into space. People report that they can gain perspective of their life. It can be uncomfortable. You must have a good guide. You need a therapist to sit with you.

Psilocybin is now legal in Oregon for supervised use, right?
They basically voted to legalize it. It’s been decriminalized in some other places, which essentially makes it so people won’t go to jail. But in Oregon, they’ve now allowed an entire infrastructure in psilocybin to be built. Psychiatrists and facilitators are doing a 10- to 12-month training program. And it looks like that training program will then be able to go elsewhere. Pennsylvania is actually very interested in this. There’s a heavy burden of mental health in the state, a heavy burden of PTSD. John Fetterman has shown support for mushrooms. And we have Kennett Square — the “mushroom capital of the world” — right here.

Are you suggesting that the tiny borough of Kennett Square could become the epicenter of psilocybin cultivation and production in the United States?
[Laughs] I’d love that. The infrastructure would be the same. You need the same climate, the same skills, the same sterile environments. But of ketamine and psilocybin and MDMA, I see MDMA as maybe the most important. It really goes deep into trauma and hardships. It’s very predictable and grounding.

What’s the future of all of this?
We’re in phase two trials with psilocybin for treatment-resistant depression. And once it’s approved for that, it can be approved for other indications pretty easily, and then there’s more flexibility around the off-label use. PTSD. Palliative care. Anxiety related to cancer care and dying. MDMA is also being studied for anxiety related to autism, and it’s showing positive results. In Canada, they are studying MDMA for eating disorders. As more research comes out, we’ll understand that this person has this form of PTSD so we’ll start them with MDMA and then maybe psilocybin. Maybe prepare them for that with ketamine. We’re way out from mixing them together, but a lot of researchers are saying you could mix to have different psychedelic experiences. Find the right combo. The research has been shut down for decades, so we’re picking up where we left off in the ’70s.

So you’re using ketamine at SoundMind and plan to use mushrooms and MDMA in the near future. What about LSD?
I think LSD is fascinating, and it probably does have a lot of therapeutic possibilities. It’s being studied for ADHD and dementia. There hasn’t been a lot of research because of the stigma. When you’re going to spend millions of dollars on trials, you’re going to do it for something that doesn’t have much of a stigma barrier to get through.

I’ve heard a lot in recent years about the rise of microdosing LSD and other psychedelics.
Microdosing is interesting. But to me, the innovative part of psychedelics is that you are getting people off of psychiatric meds and ideally not putting them on something else on a daily basis. You can actually heal people with psychedelic-assisted therapy. A deep psychological trip is a lot of work and can be frightening. Microdosing can be a way for certain people — for it to be less scary. But you’re going to run into the same problems again, eventually.

And we’ve somehow gone through this entire interview without talking about the one drug that we smell every day. Where does marijuana fit into all of this, if it does?
I do prescribe medical marijuana, mostly for anxiety and helping someone sleep. But it’s not the same as a psychedelic. There are some clinics out west where you take the cannabis and do therapy. It can loosen up defenses. But I don’t have any experience of using it in therapy. But I’ve heard that people can benefit.

One last thing: Are there implications for psychedelics beyond just mental health?
Psychedelics are not only going to revolutionize mental health. They have the ability to revolutionize all of healthcare. Changing the way we think about the relationship between mind and body. And health and disease. It’s relevant to all of it — not just the things we call “mental health disorders.” People talk about psychedelics creating a mental health revolution, but the way I see it, the effects will reach far beyond mental health. I believe if we do this right — train facilitators properly, always have an eye for safety — these medicines will change the way medicine is practiced.

West Philly Doctor Opens Psychedelic-Assisted Therapy Clinic

She's treating patients with ketamine now and says MDMA and magic mushrooms aren't far behind.

www.phillymag.com

 

[mr peabody]

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Opinion: Current Psychedelic Therapies use flawed models of the mind – It’s time for Relational Therapy*

by James Barnes MSc., MA | Healing Maps | 14 Mar 2022

The rebirth of psychedelic-assisted therapy (PAP) has been garnering a great deal of attention lately. Not only in medicine and academia but in the media and the public consciousness at large. Many herald this renaissance after decades of legal embargo, but some have expressed a good deal of skepticism and caution. Is it time to move to a relational therapy approach?

A key concern around current PAP is that the field is being dominated by medical and research institutions. On the one hand, this is to be expected and accepted to the extent that organized, well-funded empirical work is necessary. On the other hand, it creates an approach organized around the shared commitments and ideologies of the medico-scientific establishment.

The result is that almost all of the current research into and discourse around PAP is cast in terms of individualistic, cognition-centric theory. I will call it the “IC-C framework.”

This isn’t just a problem because it is biased toward one particular way of viewing PAP. Much more importantly, it is a problem because such a view, as I will attempt to show, is based on weak, outmoded and problematic foundations.

The Current Model of Mind: The Dominance of the ICC framework

The lion’s share of PAP research is based on the assumptions and language of cognitive psychology and neuroscience. From this standpoint, mental phenomena are best explained in terms of internal cognitive processing and the neurological systems correlated with such processing.

Following this, the literature is almost exclusively focused on cognitive phenomena. And how beliefs, perceptions and thinking patterns etc — may have become problematic and how psychedelics may change those things. One of the leaders of the field, Carharrt-Harris, suggests that PAP is principally concerned with the “de-weighting of a plethora of maladaptive cognitive/ perceptual schemas or ‘sets’ about self, others and the world."

Social and interpersonal levels of experience and functioning are largely ignored and our embodied-affective involvement in the world and with others is neglected by design.

In line with this, we find cliche mind-as-computer metaphors widely employed, i.e., ‘rebooting’ or ‘resetting’ ‘malfunctioning’ or ‘distorted’ thinking. It is not at all incidental that computers are devoid of social and interpersonal experience and context.

What we are talking about, then, is clearly cognition-centric and thoroughly individualistic. The focus is on the individual and their thinking abstracted from context.

Unsurprisingly the kinds of psychotherapy currently used in PAP are ones that share consonant assumptions and biases. Namely, the Cognitive-Behavioral group of therapies.

Classic CBT is what we might call the master psychotherapeutic theory of a group of therapies that come under the title of CBT (usually expressed in terms of ‘waves’). The core premise of classic CBT is that emotional and psychological suffering principally follows from irrational or erroneous beliefs, attitudes, or other cognitive structures that the person holds.

For CBT, the broad goal of psychotherapy is to effectively correct the errors in such thinking. The therapist’s role is to challenge underlying beliefs and attitudes and/or use behavioral ‘experiments,’ which seek to interrupt the cycles between thinking, feeling and behavior that are believed to cause the emotional suffering involved.

Acceptance and Commitment Therapy (ACT), part of the so-called “third wave” of Cognitive Behavioral Therapies, currently holds sway at the key institutions. While ACT and related mindfulness based ‘third-wave’ models do offer a more nuanced and sophisticated set of assumptions about the individual and what effects psychotherapeutic change, the essential problems of the ICC framework nevertheless remain the same.

In all cases, the issue is understood in or with the individual. The solution is deemed to be found in the corrective power of an otherwise un-implicated therapist. The importance of which will become clear below.

Now, while this may sound like just what therapy is, or is supposed to be, this has much more to do with the power and resources behind these kinds of approaches than anything necessary about their assumptions.

Why the individualistic, cognition-centric framework is flawed

These models are speaking the same language because they assume the same philosophical framework. This framework, however, is not something that is scientifically evidenced. In fact, it is not even something founded upon a well-accepted philosophy. On the contrary, it is essentially based on a set of outmoded enlightenment era assumptions, which have not borne out the test of time.

The largely foreign idea that ‘mind’ is separate from others and the world and the exclusive seat of experience and identity principally arose through the philosophy of Descartes and the British empiricists in the 17th & 18th centuries.

While this fundamental philosophy has been largely abandoned outside of psychology and psychiatry, it has persevered in the psy-disciplines. This is mainly due to it being highly convenient for doing the kinds of quantitative, empirical research that gains the acceptance and prestige associated with the ‘hard sciences.’ The psy-disciplines have historically been very insecure in this regard, and as a result, all the more ardent in their identifications with such philosophies.

For our purposes here, there is one key, well-established reason that poses irresolvable problems for this framework. This comes from developmental research.

In its psychological incarnation, the ICC framework has been predicated on the assumption that we come into this world as experientially private, internal subjects with little correspondence to the ‘outside world’ and its key others. This model principally derived from Freud and Piaget, both of whom assumed the same 19th century philosophical background.

The notion of psychological development that arose from this starting point was one concerned with connecting internal experience and otherwise unknowable things outside via internal representations, which had to be centralized to explain the linkage. The whole of western academic psychology and psychiatry more or less followed this.

Consequently, psychology became focused on the individual and their internal constructions, rather than what is going on in their world and with others.

Infant research over the past several decades, however, has conclusively shown these assumptions to be false. In fact, it shows the complete opposite of the assumptions of the ICC model to be the case.

We now know that come into this world aware of, and psychologically attuned to, primary others from the very beginning. Infants and caregivers are shown to engage in intimate intersubjective exchange from the very beginning. And it is this, not internal cognitive processes, that form the basis of psychological development.

We are not the isolated subjects we were assumed to be, but social, experientially open beings that are inextricably bound up with the world and primary others from birth.

The implications of this cannot be overestimated. As prominent infant researcher, Trevarthen, wrote in 2010, “the story of human infancy told by philosophers and medical and psychological sciences has been rewritten.”

One might legitimately point out that PAP is not doing research or psychotherapy with babies. However, one’s stance on our basic psychological nature is not just about development. It tells us something vital about our core psychological and experiential selves and represents the core of the subsequent psychology, which all further ideas and theory are built around.

In the present context what this means amounts to the following: if we are not first and foremost private individuals but inherently intersubjectively related beings, then psychological and emotional suffering and what ameliorates it is something that happens between people — not inside the brain or individual mind.

This has obvious implications for PAP and, indeed, all psychotherapy.

The shift to relational therapy

You wouldn’t know it based on the PAP literature, but there has been an explosion of ‘relational’ and ‘intersubjective’ theory and practice in psychotherapy and related disciplines over the past few decades. We see it in the resurgence of psychoanalysis in its relational and intersubjective forms. We see it in the focus in existential, humanistic therapies. As well as the feminist and social justice-oriented therapies on the ‘here and now’ of the relationship. And we see it more generally in the central role that attachment research is enjoying across all (non-CBT) psychotherapeutic theory and practice.

Much of this is based in, or informed by, the developmental shift described above. It is also centrally linked to the repeated finding that the ‘therapeutic alliance’ between therapist and client is the best predictor of therapeutic outcome.

Outside of institutional psychology and psychiatry there has been a decisive shift away from the internal functioning of the mind/brain and toward a focus on interpersonal processes and dynamics.

The sort of disengaged scientist-at-a-distance focus on internal constructions and use of specific techniques (i.e., challenging thinking patterns, behavioral experiments, interpretations etc.) has been supplanted. It is now the ongoing therapeutic relationship that is understood as the key agent of change. Again, you would have no idea about this based on reading the PAP literature.

It is not what the therapist can do for the client in terms of specific interventions. It is ‘who’ they can be for them in the therapeutic relationship that is. The goal is to develop a particular kind of secure, interpersonally rich and authentic experience. It is the therapist’s ongoing capacity for empathic reflection/exploration, interpersonal regulation of affect and emotion, and deliberate, authentic communication that performs the most important role.

Crucially, these are not actions that one does or takes, so much as ways of being with another. And here we meet the key difference: relational therapy is about facilitating a relationship over time. Something that is in stark contrast to the few sessions of cognitive ‘integration’ that current PAP employs based on the ICC model.

Time for Relational PAP?

Interestingly there is reference to related themes in the PAP literature itself. Watts, who uses a form of ACT, for example, reports, “Feedback so far suggests that the aspect of therapy most appreciated by patients is having been sensitively supported by fully present and respectful caregivers. Themes relating to an absence of accurate empathy in early life emerge for many of our patients.”

These are interpersonal, relational concerns. We have to ask ourselves why the models employed in PAP are individualistic, cognition-centric ones that downplay and neglect these factors? We also have to ask, how does or even can only a few sessions of ‘integration’ (the norm in these approaches) come close to responding to these issues?

In short, they can’t.

It is also not at all surprising that the ameliorative effects of using current PAP models have been found to be time limited, to around 6 months. From a relational perspective, when one returns to habitual relational dynamics, situations and other people with vested interests in things staying the same, a shift in one’s view of oneself is likely to dissolve in the tide. Indeed, we hear anecdotal reports of exactly this.

An individualistic model used over a very short period is simply not suited for sustained change. We need a relational framework.

Something very different is needed, which goes beyond cognitive or behavioral change. To understand what PAP would be within a relational framework, we need to leave behind the idea that it is one’s cognitions that need to change. We also need to leave behind the idea that people are in need of an external source to provide some sort of solution. Along with this — and here’s the catch — we need to leave behind the idea that meaningful, sustained change should occur quickly.

A relational therapy approach would be using the psychedelic experience to facilitate a different, conceivably deeper, kind of relational experience within an already established therapeutic relationship.

It would have to be this way because there is no ‘quick-fix’ from a relational perspective. Indeed, the search for quick solutions is in some important sense exactly what has already not worked for the person.

If we are principally relational beings and what we are trying to address is primarily at the interpersonal, relational level, then the response needs to be in kind. This cannot be contrived into a discrete experience to be ‘integrated,’ no matter how convenient this may be for research purposes, funding or political expediency. Relational speaking, change only happens incrementally, over time.

If psychedelics could increase ‘relational depth,’ then there is reason to think that employing a relationally framed PAP may indeed provide a much more real, sustained improvement than current PAP seems unable to.

Relational Therapy – In Conclusion

Let’s return to the question of why the ICC dominates. It is important to know that ‘relational models’ have in fact been around since the very inception of psychology and psychotherapy.

There has in fact been a consistent strand of this thinking going back to the Freudian era. And through the work of Ferenczi, Sullivan, and Winnicott — to name but the most influential. What’s more, interpersonal models of mind have also been around in philosophy since early and mid-20th century phenomenology.

The brute fact is that all of this has been ignored, denied even, by academic and institutional psychology and psychiatry over the decades simply because of the vested ideological interests in cognitive and biomedical thinking that have dominated.

I will close by pointing out that this isn’t just an academic or practical issue. It is in fact a serious ethical one. If what I have said above is true, then the current set-up in PAP not only fails to get to the roots of the matter but actually serves to further distance people from what is actually helpful.

If now is not the time to enforce a change, then when is?

*From the article (including references) here :

Opinion: Current Psychedelic Therapies Use Flawed Models of the Mind - It's Time for Relational Therapy

Psychedelic-assisted therapy has changed the way we look at mental health. This expert suggests a relational therapy approach.

healingmaps.com

 

[mr peabody]

Psychedelic-assisted psychotherapy: Reshaping perspectives and guiding transformation*

by Olivia Horge | Psychedelic Times | 20 May 2021

Enthusiastic research into the use of psychedelics in therapy began in the 1940s. Triggered by Albert Hoffman’s discovery of LSD and its mind altering properties, research began to explore if psychiatry could make use of the substance in treating mental illness. Over the centuries, humans have used a multitude of entheogens, such as ayahuasca and peyote, to induce periods of altered state of consciousness for sacred ceremonies and spiritual growth. As research into these psychoactive substances began, the field of psychedelic-assisted psychotherapy developed. In the 1950s, Humphry Osmond and Aldous Huxley conducted experiments that blended science and humanism which ultimately shifted approaches to defining and treating mental illnesses. Together, they discovered that the “psychedelic reaction created a period of reflection, or insight, which allowed one to gain perspective on one’s self.” The motivation behind the creation of this approach was to use psychedelic drugs as catalysts deepening one’s understanding of themselves and their struggles by opening the doors into the unconscious.

Currently, research is still taking place to explore how psychedelic-assisted therapy can be used to help individuals improve their lives. The results have been promising so far. MDMA has been used to aid in the recovery of those suffering from post-traumatic stress disorder. LSD and psilocybin can be used in the treatment of substance addictions, major depressive disorders and end-of-life distress.

Major assumptions

When considering the nature of change, psychedelics have the potential to catalyze transformative paradigm shifts for the individual. The psychedelic substance aids in expanding one’s perception of the world and their place within it. The mind-altering trip brings unconscious material to the surface. Addiction therapy breakthroughs consider the recovery to be due to individuals gaining a broader collective mindset, to “see beyond themselves,” which aids them in altering their unhealthy patterns of behaviour that affect themselves and their close relationships. Clients were able to look at themselves in a new light which also gave them a different lens in which to consider their actions. It induces an empathetic, reflective and open state of mind that is sustained for long periods of time after the experience. The majority of participants in MDMA research view the experience of one of the most profound, personally meaningful and healing experiences of their lives.

Psychedelic experiences also altered the relationship between therapist and client. As therapists usually undergo the psychedelic experience prior to guiding their clients through it, it enhances their ability to empathize and support the client. With a knowledgeable and skilled counselor, the therapy is more likely to be a successful process.

Role of the counselor

During the sessions involving the use of psychedelic substances, the role of the therapist is three-fold. When facilitating the psychedelic experience, the counselor is continuously playing the role of sitter, guide and therapist. As a sitter, the counselor must have a broad understanding of how the drug could affect the client and be able to help the client through any potential feelings of anxiety or paranoia. As a guide, the counselor uses their skills to help the client navigate the experience and inform them about the direction of the trip. As therapist, the role is to show empathy and use techniques that help the client reach insights on themselves and their lived reality. Six competencies have been outlined by Phelps as necessary for success in this approach; “empathetic abiding presence, trust enhancement, spiritual intelligence, knowledge of the physical and psychological effect of psychedelics, therapist self-awareness and ethical integrity, and proficiency in complementary techniques.” While the psychedelic substance facilitates the process of uncovering one’s truth, the therapeutic relationship is the supporting factor that takes this approach effective.

Major techniques

There are three phases of therapy in this approach. First, the counselor must prepare the client for the psychedelic-assisted session which, in this context, is often referred to as “set and setting.” Set involves outlining the client’s expectations, motivations and intentions, the therapist’s techniques and understanding of the psychedelic experience, and the mutually agreed-upon goals. Setting refers to the environment in which the sessions take place and the interpersonal relationship between the counselor and client. A trusting relationship needs to be established between the individuals with a mutual understanding of goals. Once the client is ready, the psychedelic experience takes place. Lastly, the counselor aids the client in integrating their revealed insights during subsequent therapy sessions. Further exploration is often needed to uncover the full effect of the trip. The counselor’s approach and relationship with the client are crucial as they navigate this new ground and reach for desired outcomes.

Psychedelic experiences are complex phenomenons. The manner in which it is taken as well as set and setting greatly influence whether the experience will be life-enhancing, damaging or ineffective. By exploring their lives in a mind-altering state, individuals can encounter their consciousness in new ways. With the help of a counselor in the therapy sessions, this approach has the potential for enormous breakthroughs in treating mental illness as well as opening anyone’s mind to reshaping their perspectives on life and their interpersonal connections.

*From the article here :

Psychedelic-Assisted Psychotherapy: Reshaping Perspectives and Guiding Transformation - Psychedelic Times

The remerging world of psychedelic-assisted psychotherapy is poised to revolutionize the field of mental health treatment.

psychedelictimes.com

 

[mr peabody]

Dr David Spektor will participate as a clinical psychologist in a research trial involving MDMA with PTSD sufferers and their therapy.

The psychologists signing up for psychedelic therapy training: ‘Amazing things can happen’

The global renaissance of psychedelic drugs in the treatment of mental health gains further legitimacy in Australia as psychologists sign up for clinical trials.

by Jenny Valentish | The Guardian | 29 May 2021

When growing up in Yea, in rural Victoria, Campbell Townsend took a dim view of drugs.

“My parents were born in the shadow of Nixon’s war on drugs, and I was a very simple country boy,” the psychologist says, sitting in his cottage outside Castlemaine. “I grew up with stories from my parents about friends of theirs at university going crazy just from one choof of a bong.”

Townsend’s fears persisted until he read journalist Michael Pollan’s 2018 book, How to Change Your Mind: The New Science of Psychedelics. The book found favour in the most mainstream of media, from Time magazine to The Late Show with Stephen Colbert, and became a New York Times No 1 best-seller as the so-called renaissance in psychedelic research took hold around the world.

“I just got stuck into this research vortex,” Townsend says. “As a clinical psychologist who believes in evidence-based practice, I couldn’t ignore the research that began 50 years ago and the resurgence in the last decade. I thought: ‘I need to be on that train. I need to have access to this so I can give it to my clients.’ ”

Townsend is part of a wave of mental health professionals training in psychedelic-assisted psychotherapy. While Australian universities have generally been conservative in their interest, the field gained legitimacy with the announcement in March that the federal government intends to back psychedelic clinical trials with $15m.

Campbell Townsend has signed up to a Monash University research trial which coaches
the people involved in using psychedelics as part of their therapy.

That announcement followed a growing worldwide interest and positive research developments: at the forefront is the US-based MAPS, which has been conducting trials for MDMA-assisted psychotherapy for PTSD since 2011. In April 2021, the results of its first phase 3 trial were released: more than two-thirds of participants who took a dose of MDMA no longer qualified for a diagnosis of PTSD two months later. Participants with more treatment-resistant forms of PTSD had their depressive symptoms significantly mitigated.

Australia’s part in the psychedelic movement has been observed by Dr Martin Williams, executive director of Psychedelic Research in Science and Medicine Incorporated (Prism) Ltd, who identified the pivot point of professional interest as coming two years ago. That’s when Melbourne’s St Vincent’s hospital announced that its clinical psychologist, Dr Margaret Ross, would oversee Australia’s first psychedelic trial, using psilocybin – the psychoactive ingredient in magic mushrooms – to treat people in palliative care.

“Until that time, people had been concerned for their professional standing, but suddenly it had become legitimised and destigmatised,” Williams says.
‘
Interested healthcare professionals tended to fall into two categories: those sympathetic to psychedelic psychotherapy and have been waiting for legislation to catch up, and those medical “elders”, such as psychiatrists, who have become recently convinced.

“There’s a cohort of psychiatrists and psychologists who have been frustrated by the demonstrable lack of positive outcomes for a certain proportion of the patients,” he says. “They’ve come to the conclusion that the current drugs – antidepressants and mood stabilisers and so forth – just don’t work for everybody.”

So far, all Australia’s psychedelic trials involve psilocybin or MDMA, but the training needs for each are very different. With a “classic psychedelic” such as psilocybin – which lends itself to the treatment of addiction, depression and anxiety and mood disorders – the participant has a very internal experience, so the therapist may provide minimal intervention, leaving the main work to follow-up sessions. Psilocybin has been researched in the treatment of palliative care patients suffering existential distress – its properties have been known to produce profound alterations in thought and perception and, in some cases, “ego dissolution and mystical-type experiences.

A dose of MDMA – regarded as more useful in the treatment of PTSD – tends to enhance trust and increase communication, so a therapist can explore traumatic memories with the participant while they are in their altered state.

The MDMA trial that Townsend has been recruited for – along with 24 other Melbourne-based practitioners – is overseen by principal investigator Dr Paul Liknaitzky, who heads up the the clinical psychedelic research lab at Monash University.

Sarah Pant is a psychologist who has signed up to a Monash University research trial which
coaches the people involved in using psychedelics as part of their therapy.

In Liknaitzky’s estimation, the government’s $15m is enough to fund about six clinical trials. He hope the money is used in “rigorous research that is neither biased toward panacea thinking, nor ignorant of the best-practice track record and literature to date.”

The trial will happen in the second half of this year, pending ethics approval, with the sessions held in the meditation room at Monash’s neuroscience research clinic, BrainPark. Though the protocol hasn’t been finalised, one therapist will accompany a participant throughout their treatment, which is likely to involve lying down with eyeshades and headphones after taking the dose.

Some aspects of being a psychedelic clinician will require less rigidity than in standard practice, such as being able to comfort a participant with a touch of the hand or even a hug. Such arrangements would also have to be approved by a trial’s ethics committee, as well as by the participant beforehand. As the Maps code of ethics states: “We obtain informed consent for any physical touch by describing the type of therapeutic touch.”

Often during training programs there will be role play in which the therapists take turns playing the participant. Townsend experienced this when training for a psilocybin trial earlier this year.

He lay down with eyeshades on and listened to a playlist as another therapist sat with him. Townsend says that even without the substance – which is still not a legal option in Australia – the experience was moving: “There were all these psychiatrists and psychologists in tears, having deep perceptual shifts while listening to the music, having images, memories, profound things happening. What it demonstrates is if you put enough ritual and intention into something, amazing things can happen.”

Another of Liknaitzky’s recruits is Sarah Pant. Before training in psychotherapy, Pant worked in theatre, something she thinks puts her in good stead for immersing herself in people’s alternative realities. Now she has her own private psychotherapy practice, but it’s her time spent as a wilderness therapist, taking young people struggling with substance use on a journey through nature, that she feels will be closest to working as a psychedelic psychotherapist.

“It’s the having a journey of some kind and then lots of integration work,” she says. “So much of my work was just getting out of the way, witnessing and being there to understand more about the experience that the client was having, and then integrating it.”

Integration refers to the extensive psychotherapy sessions held after dosing: “I always liken that work to when you hear people going off for a great holiday, and they come back and say, ‘It changed my life!’ I always think, ‘Did it? How? What are you doing differently now?’ How do we take that learning and be sure that it feeds into your everyday life? Otherwise there’s a risk of it just being a great experience you had once.”

David Spektor, another recruit, has been a clinical psychologist for 17 years. He may have a more traditional background than Pant and Townsend – he’s never held retreats or sustained sessions – but as someone trained in intensive short-term dynamic psychotherapy focused on helping people build their capacity to tolerate their emotions, he’s curious about the way in which MDMA is thought to open up emotional processing.

Dr David Spektor takes part in the research trial.

“I’m a bit sceptical of it being that simple, but what better way to learn firsthand than to be part of this training?” he says. “I’m not a typically spiritual person, but it’s undeniable that people experience things that are very interesting. I’ve never had the experience myself, but the anecdotal evidence has always fascinated me.”

Spektor had been approached by Liknaitzky and was immediately interested, despite not being sure if and when he’ll wind up integrating psychedelic-assisted psychotherapy into his practice.

“MAPS is the most famous and reputable training, from what I can tell, so to be part of a program that is helping research in places like China, Israel, Canada, American and now Australia, is an incredible opportunity,” he says.

Spektor, Pant and Townsend express concern that this sphere can attract evangelists pushing to move ahead faster than the research will safely allow, or who are unwilling to concede that psychedelic psychotherapy is not a panacea.

“This field has suffered from people being a little bit too careless,” says Spektor. “It needs to be appropriately researched and treated in a very serious manner in order to gain the reputation it deserves and help as many people as possible.”

There’s no confirmed timeline for when psychedelic psychotherapy will become a reality in Australia. Pant isn’t sure where the training will take her yet, though she’d like to work with a team, such as through a retreat. Even if that winds up being only once a year, she thinks the training will benefit her professional development more widely. “People experience altered states in many different ways – often mental health symptoms can take people into altered states to varying degrees,” she says, “so I think any framework and skill development in this area will be advantageous.”

For Townsend, the potential of this work dovetails nicely with what he does in his private practice and makes him the ideal candidate for overseeing eight-hour MDMA dosing sessions. He specialises in deep trauma work, but also “marathon therapy.”

“I see couples for seven-hour intensive sessions,” he says. “It really does mirror the psychedelic journey.”

https://www.theguardian.com/society/2021/may/30/the-psychologists-signing-up-for-psychedelic-

 

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​

Clinics seek to widen access to psychedelic therapy for marginalized communities*

by Justin Hampton | LUCID | 13 Jun 2021

"I learned growing up that magic mushrooms was drugs, and McDonald’s was food,” says Deran Young. Born to a crack-cocaine addicted mother and raised by her grandmother at times when her mother couldn’t, Young undertook a vast journey through 37 countries in the US Armed Forces, and an education in psychology and social work, to make sense of the racial trauma that shaped not just her, but her community as well. Along the way, she learned about the Internal Family Systems therapeutic model, which she credits for helping contextualize residual pain from her childhood. In addition, during three formative stays in Ghana between 2009 and 2011, she observed a community-based approach to mental healing, including group therapy sessions, which she applies to this day in her work as a therapist and president/CEO of Black Therapists Rock.

Her insights regarding psilocybin evolved after a grassroots session she did with her significant other. Prior to this experiment, Young “was pretty programmed and conditioned to believe that you have to stay on the straight and narrow. ‘If you ever even think about going down that path, it’s going to be bad.’ There’s lots of people in my family that are examples of that.” However, far from enticing her towards addiction, her experience unearthed repressed memories of battling pneumonia as a three month old in a Neonatal ICU.

“When I was able to acknowledge it with psychedelics, I could see that I wasn’t alone, that there was something there keeping me alive,” Deran recalls. “Some presence that cared for me and loved me enough to help me survive, and that that presence is always with me. Always.”

Those developing the field of psychedelic-assisted therapy are encouraged that breakthroughs like Deran’s could transform the lives of many individuals with mental disorders brought about by institutionalized bigotry. The challenge is getting it to them. For instance, research indicates that BIPOC are less likely than white people to have access to, or seek out, these services, and to receive quality care.

Grassroots psychedelic clinics aiming to address the difficulties they and other marginalized communities may face in accessing these kinds of therapies are emerging across the country. Offices such as SoundMind Center in Philadelphia, and Sage Institute in Berkeley, California currently provide ketamine-assisted therapeutic services which focus on serving BIPOC, LGBTQ+, neurodiverse and disabled populations, while projects such as Sana Healing Collective in Chicago and Nautilus Sanctuary in New York are announcing their intent to enter this space in the near future.

“I see [the SoundMind Center] as a community space that people can collaborate in,” says SoundMind founder Dr. Hannah McLane, or “Dr. Hannah” to her patients. A combination neuroscientist, physician and psychotherapist, she has poured her life savings into the West Philadelphia office space that opens on August 1st. “It’s about really creating strong connections and having a model that makes other people want to be part of that model more than a corporate model.”

These clinics are united by an ethical mission as political as it is therapeutic. McLane often refers to the 1985 MOVE bombing, in which the Philadelphia Police Department bombed a residential home occupied by a Black liberation group, as an example of the sort of enduring pain she wants SoundMind to address.

Vilmarie Fraguada Narloch, co-founder of Sana Healing, touts her staff’s work in community activism and organization alongside their mental health credentials. Similarly, Genesee Herzberg, Executive Director and Co-Founder of Sage Institute, lists a commitment to social justice, as well as lived backgrounds within the racial and sexual demographics the Institute supports, as important qualifications for her therapists.

According to Herzberg, "even in deeply transpersonal moments of ego dissolution, archetypal symbols and images come through that are particular to [a patient’s] cultural background… it’s a delicate process of helping to hold the value and the meaning of these experiences, even as people enter back into their regular state of consciousness, especially with ketamine, because it’s a shorter-acting experience.”

For now, the currently-open clinics are being financed through a combination of donations and grants, ongoing teacher training seminars, and a sliding scale for patients. McLane emphasizes the online training courses for clinicians and facilitators she promotes in part through her 2500-member Psychedelic Therapists club on Clubhouse, as well as more community-oriented educational materials her organization creates, as central to SoundMind’s mission.

In addition, Sage Institute’s sister organization, Sage Integrative Health, has just been designated an MDMA Expanded Access site. These sites will provide MDMA treatment for seriously ill patients who do not otherwise qualify for the stage III clinical trials currently being conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS) for MDMA therapy. According to McLane, the treatment will cost $20,000, and it won’t be covered by clinical trial finances or insurance. "The MAPS MDMA-assisted therapy protocol will hopefully be integrated into Sage’s upcoming certificate/psychedelic-assisted therapy training course," said Herzberg.

Even at this early stage, the work of these clinics hasn’t gone unnoticed. In early June, McLane conducted a presentation on psychedelic-assisted therapies for the Pennsylvania State Office of Advocacy and Reform alongside MAPS’s Rick Doblin, Joseph McCowan and Bessel van der Kolk. Sage Institute was singled out in a Dr. Bronner’s blog post on ethics within the psychedelic industry for their sliding-scale model and willingness to share data with similarly-minded organizations. "The Institute will also be collaborating with psychedelic healthcare strategists Forth Road Health on a pilot study to perfect their model in preparation for a potential national rollout," says Herzberg.

Some well-capitalized clinical networks that offer psychedelic-assisted therapy, including Field Trip and Mindbloom, have also expressed an interest in serving marginalized communities. Mindbloom’s medical director, Dr. Leonardo Vando, says, “Our approach is to radically increase access to ketamine therapy by reducing costs for anyone who is a medical fit while simultaneously improving mental healthcare outcomes. Mindbloom works with costs for individual clients who may be facing financial difficulties, no matter their race, sexual orientation, or status.” However, Mindbloom would not provide demographic information about their clientele for this article.

McLane is critical of the venture-backed clinics’ expansion strategies, and believes the slow and steady development of SoundMind’s therapeutic model is a better approach. “I think there will be, unfortunately, some harm caused in rollouts that are too fast. Then it’ll be like a pulling back and a reconsideration of what other people are doing that are thinking more slowly about what these clinics should look like.”

Clinics like Sage and SoundMind target an audience that is generally unfamiliar with psychedelics, or may even think of them negatively. However, none of the clinicians spoken to for this piece have had difficulty finding clients.

McLane notes that “there’s often a high burden of trauma for marginalized communities.” These traumas sometimes stem from proximity to drug abuse, so the introduction of previously stigmatized substances into their healing can scare some potential clients away. As a therapist and psychedelic educator in the Black community, Young advocates for the communal model she was introduced to in Ghana.

Along with cutting costs, Young finds that with the group therapy model, “the healing [in these sessions] is deeper; the healing is more sustainable. Because not only are you giving [your patients] a medicine; you’re giving them people that they can walk this journey with.”

Whether or not the inclusive clinics are ultimately sustainable will depend on several factors, from insurance reimbursement to buy-in from the communities they serve. For McLane, the goal is to develop a successful, innovative model.

“That’s the major benefit of staying independent, because we can create structures that end up leading the way for others,” says McLane. “Rather than franchising out before we know exactly what these things should look like, it’s a collaborative model where people from different backgrounds are coming together and saying, ‘What should this look like?’ And doing it together.”

*From the article here :

Clinics Seek to Widen Access to Psychedelic Therapy for BIPOC and Other Marginalized Communities - Lucid News

Grassroots clinics across the U.S. aim to address the difficulties BIPOC face in accessing quality, psychedelic therapy.

www.lucid.news

 

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What it’s like to do Ketamine-assisted psychotherapy

by Suzannah Weiss | DoubleBlind | 8 Jan 2021

Suzannah Weiss was hoping to use ketamine in order to reduce anxiety and symptoms of Lyme disease, including fatigue, irritability, and insomnia—here's how it went.

"The cat is chasing the mouse in the shed outside the house,” I mutter. These nonsensical phrases seem inexplicably significant as I recline in a massage chair, my eyes covered in eyeshades.

“Come back to your original intention—body image. Is there anything coming to you about that?” the therapist asks.

“That if I picture all my positive traits times ten, and all my negative ones divided by ten, that’s what other people see when they look at me.”

I’m at the psychedelic therapy center Field Trip Los Angeles and I’m on ketamine, an anesthetic traditionally used for surgeries, which also happens to have psychedelic properties and has recently gained attention as a mental health treatment. Research has suggested that ketamine can provide lasting relief for depression and anxiety and even other issues like chronic pain.

Field Trip isn’t the first place where I’ve done ketamine. Last year, I began my journey with the dissociative psychedelic at the Ketamine Healing Clinic of Los Angeles, hoping to reduce anxiety and lingering symptoms of chronic Lyme disease, including fatigue, irritability, and insomnia.

Back then, at Ketamine Healing Clinic, I did two ketamine sessions a week for three weeks, tapered down to once a week for a month, then came in on an as-needed basis. During each appointment, the doctor or nurse would give me the ketamine through an IV, leave me alone for an hour and a half (periodically checking in just to make sure I was okay), then come back for a brief, perhaps five-minute, chat about what happened.

Afterward, on the Uber ride back, I’d text my acupuncturist (who I was close with) all the thoughts that had come out of the journey. I don’t think she even usually responded; it was more for me to have that record of my experience and solidify it in my own mind. Often, I’d head straight to a session with her or a bodyworker afterward to talk about the journey and reinforce any physical healing it had accomplished.

Most ketamine treatment clinics are like this. You have the support of a doctor and/or nurse, but most of the integration of the experience happens on your own.

Field Trip, however, takes a different approach. They have psychotherapists on staff, who are with you while you receive the ketamine and talk to you about the experience in separate sessions. After I signed up for the program, hoping to address COVID-related anxiety and depression, I had an introductory session with the therapist assigned to me, which didn’t involve ketamine. The next week, I had a ketamine-assisted therapy session and a regular therapy session, and that same structure repeated the following week. While some patients, such as those with severe trauma, continue to go for six weeks, the team decided my treatment was complete after two weeks.

During the ketamine-assisted sessions, I’d narrate my trips, and the therapist would occasionally interject to nudge me in a useful direction—so that I, for instance, addressed the body image issues that had been plaguing me, rather than lingering on abstract images of animals and the like.

That’s the thing about ketamine—it’s really weird and abstract. A lot of the things that came up, I was never able to make sense of in therapy. But we focused on what seemed to have the most direct connection to my life. For instance, one issue that kept coming up was my difficulty distinguishing between all the competing voices in my head when I try to make decisions, so we talked about how to figure out which part of myself to listen to.

I expected that combining ketamine with psychotherapy would be the clear, more impactful way to do it, but I actually saw the pros and cons to both approaches I experienced. The pro to Field Trip’s approach was that I had a professional to help me process the ketamine in a meaningful way while I was on it. People sometimes say the best way to use psychedelics is to just surrender, but I often get more out of a trip if I can direct it a little, and that’s easier to do with the help of someone who’s not intoxicated.

Field Trip also gave me the chance to explore the trip in-depth from a psychological perspective, but I found the truncation of the therapy a bit jarring; the treatment ended just as I was starting to get to know the therapist and scratching the surface of deep-rooted issues.

I found the truncation of the therapy a bit jarring; the treatment ended just as I was starting to get to know the therapist and scratching the surface of deep-rooted issues.

At Ketamine Healing Clinic, with the simpler model, I received less attention but more freedom. Getting started was less of a process, and I was allowed to continue going for as long as I wanted and had some say in the frequency. I also developed an ongoing relationship with the doctor, though our conversations were minimal. And because I was processing my journeys with people I was already working with, like my acupuncturist, from the beginning, I had continuous support from the same people both during and after my course of treatment.

These experiences combined taught me that integration can look a lot of different ways. Psychotherapy is just one way to do it. At times, for me, integration has looked like sending love interests bold texts because of the increased confidence I was experiencing, exploring new aspects of my sexuality that came up in journeys, and writing about ideas that came to me in a book. It has not always been about looking into my psyche; sometimes it’s been about looking outward and moving forward.

My advice to others looking into different kinds of psychedelic therapy is that ultimately, no matter what format you choose, you’re the captain of your healing journey, and it’s your job to curate the integration modalities that work for you. Even if the center you’re going to provides therapy, you’ll need to think about what you’ll do afterward.

In neither course of treatment did ketamine offer me permanent changes in mood or physical health, but what it did do was give me a new, more positive perspective from which to make new choices. And it’s ultimately those choices we make after a psychedelic experience that determine how lasting and impactful it is for our lives.

What It’s Like to Do Ketamine-Assisted Psychotherapy

“The cat is chasing the mouse in the shed outside the house,” I mutter. These nonsensical phrases seem inexplicably significant as I recline in a massage

doubleblindmag.com

 

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Preventing Sexual Abuse in Psychedelic Therapy

by Evan Lewis-Healey | Psyhchedelic Spotlight | 15 Oct 2021

Recent study interviews 23 underground psychedelic therapy practitioners about the biggest ethical issues and boundary challenges they face while sharing such an intimate space with clients. ​

Clinical trials of psychedelic therapy are hugely promisingin the battle against mental health issues. However, recent research has highlighted that there are a myriad of ethical issues associated with the therapeutic use of psychedelics.

One of the most focal, and potentially rife, issues identified in a study published in the Journal of Humanistic Psychology involves sexual abuse between psychedelic therapists and clients. The researchers of this paper hope to illuminate ways in which these cases can be prevented as psychedelic therapy moves into the mainstream.​

Vulnerability and power​

Psychedelic therapy itself, whether that be MDMA-assisted or psilocybin-assisted, leads us into sketchy ethical territory. There is a huge imbalance of power between therapist and client during psychedelic sessions; patients already have existing mental health issues, which is coupled with the often incapacitating effects of a high dose of a psychedelic.

This has led to some psychedelic therapists exploiting their patients’ vulnerability. There have been reports of sexual abuse in psychedelic therapy as recently as 2018, in an FDA phase III trial of MDMA for PTSD.

These issues are not isolated to psychedelic therapy. Sexual abuse cases are shockingly high in traditional talk therapies. But this begs the question: If cases are this high in traditional therapies, how high could it be if and when psychedelic therapies move to the mainstream? And how can these sexual abuse cases be prevented?​

Underground Interviews​

This is the question on the lips of the authors of the current paper. To try and answer this question, the researchers interviewed 23 underground psychedelic therapists. The authors and therapists explored how ethical issues may arise in psychedelic therapy, and ways in which they can be prevented.

When interviewed, some therapists highlighted that the lengthy sessions, coupled with the therapeutic use of touch can lead to a level of intimacy not seen in classic talk therapy. The authors write, “Many [therapists] felt that this intimacy is part of what is therapeutic about psychedelic work. However, they noted that it has also led to ethical boundary challenges, often by inadvertently encouraging romantic feelings in the client.”

This may also be doubly challenging during MDMA-assisted therapy. The effects of MDMA can include heightened empathy, sexual arousal, and increased intimacy, which may further blur the boundaries for a patient during the session. Again, this highlights the patient’s extreme vulnerability, which always needs to be at the forefront of a therapist’s mind.

One of the main preventative issues around psychedelic therapy was to do with consent. One of the therapists discussed their two-stage process of consent surrounding touch, “Ahead of time, before we even get into the experiential session, I ask, ‘Is it OK if I work with your body or touch you.’ If not, then I will not touch them. Even if they said yes, in the journey itself, I’ll ask them first, ‘Can I put my hand on your shoulder, your chest, your belly?’”

Other therapists highlighted the need to be supervised when conducting psychedelic therapy. Having two therapists present, one man and one woman, should form a gold standard practice in psychedelic therapy, and hopefully prevent as many sexual transgressions from occurring.

Psychedelic Therapy moving forward

The emerging profession is, undoubtedly, a minefield.

The power imbalance between therapist and patient is already huge, and only gets bigger when psychedelic substances become involved. The authors of the paper highlight this by saying that psychedelic therapy is “rife with unique ethical challenges that require self-awareness and practical approaches that go beyond the training of a conventional psychologist.”

However, this research represents a step in the right direction. Hopefully organizations pick this research up, and form more stringent guidelines for psychedelic practitioners.

Preventing Sexual Abuse in Psychedelic Therapy | Psychedelic Spotlight

23 underground psychedelic therapy practitioners reveal ethical and boundary challenges they face while sharing intimate space with clients.

psychedelicspotlight.com

 

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60 Therapy Training participants from 14 countries gathered in Landgraaf, Netherlands from September 26 – October 3, 2018, to attend Part B of the MDMA Therapy Training Program: learning about “inner healing intelligence” and how the concept translates internationally.

Cultivating Inner Growth | The Inner Healing Intelligence in MDMA-Assisted Psychotherapy

by Shannon Clare, M.A. | Psychedelic Frontier

Just as a seed has within it the knowledge to grow, humans have an innate capacity to heal, when given the right environment to do so. When help is needed to create that environment, psychotherapy, like a greenhouse, can provide a container conducive to healing.

The term “inner healing intelligence” refers to the knowledge and power within oneself to move towards wholeness and wellbeing. There are many terms that could be used here; various paradigms of thought would articulate these concepts in different ways; some might reference Spirit, truth, unity, and there are many other terms that can and do carry similar meaning. I once heard a participant call it the “inner champion,” as she encountered what she experienced as its destructive counterpart, the inner critic. In this writing, I adopt the phrase “inner healing intelligence” and similar terms such as inner healer, deep knowing, innate wisdom. If you connect with the concept of an intrinsic ability to heal and grow oneself, I encourage you to consider any other name you like, and to think of that name as you read.

We can learn to hear our own voice of wisdom amidst the crowded room of the psyche. Cultivating the inner healer is part of cultivating deep relationship with oneself.

A seed has within it the intelligence to grow into a vibrant and blossoming plant. Given a nourishing environment, rich soil, water, air, and light, a seed will naturally develop into a mature and thriving plant. It will develop roots, establishing the ability to take in nutrients and water from the soil and stay grounded in the midst of erosion. Leaves develop to absorb energy from sunlight and carbon dioxide from air, so the plant can initiate photosynthesis and transform these ingredients into food. So long as the environment continues to provide what it needs, the plant will grow to full capacity, expressing its intrinsic qualities.

When the outside environment can’t provide what is necessary, a plant demonstrates signs of poor health: wilting leaves, pale color, blossom rot. If the conditions aren’t adjusted, the plant’s health will continue to deteriorate as it strives to survive. When the outside environment doesn’t have what the plant needs, a greenhouse can offer shelter, respite from extreme temperatures, and protection from the elements. The conditions inside the greenhouse are set specifically for the plant it intends to serve.

Like plants, our consciousness naturally flourishes when given a safe and supportive environment and encouragement. Accessing this inner healing intelligence is a process of honoring and expressing strength from within, coming from a place beyond mental chatter and negative self-talk, from alignment and clarity, even when our current experience may be of fragmentation and confusion. We can learn to hear our own voice of wisdom amidst the crowded room of the psyche. Cultivating the inner healer is part of cultivating deep relationship with oneself.

Unfortunately, many people are not in a place of encouragement and support. Like a plant in a time of flooding, or being perpetually whipped by harsh winds, being in an unsafe or unsupportive environment, whether for a short or long period of time, is a common characteristic of trauma. A traumatic event is one that causes (or threatens to cause) death, serious injury, or sexual and/or other kinds violence, which a person may experience directly or indirectly. During a traumatic event, instinct kicks in and the body’s resources are allocated to respond to the trauma—survival is the primary concern. The body’s trauma response is adaptive: in the face of threat, it is intended to save one’s life.

What happens, though, when the threat is no longer present? This was the focus of Peter Levine’s observation of animals in the wild when under attack by a predator: after surviving an assault, an attacked animal’s body may shake and tremor, a natural release of energy. Within a few minutes, animals returned to their resting state and resumed normal activity. What do humans need to do in order to “shake off” trauma? What do we need in order to heal?

Doing difficult trauma processing requires a degree of safety. This is challenging for people with PTSD, since symptoms such as flashbacks and hypervigilance make it difficult to differentiate between past and present threat. It’s especially challenging for people to find respite if they continue to be exposed to threats of injury. It’s important to acknowledge that many people are living continuously at risk of harm, and for future research and clinical practice to inform how best to deliver MDMA-assisted psychotherapy to actively threatened populations.

Inner healing intelligence blossoms in a context of safety. Like the protection a greenhouse offers, effective trauma therapy fosters a safe and supportive environment for people who are processing traumatic events and their impact. MDMA-assisted psychotherapy is designed with the intention to create a space for a person to come back to recognizing their own power, their own capacity to heal, to love, and to live a full life. In a safe setting, supported by two clinicians, and with ample time, participants are offered the chance to address the core issues of their trauma.

Therapists who help their clients establish a deep connection with their inner guide give a tremendous gift, one that can last as the client applies their own wisdom to a myriad of life’s challenges.

Providing this context of safety and support is a primary task of MDMA-assisted psychotherapy. In addition to essential safety procedures, such as monitoring vital signs, the therapy team must work with each study participant to determine what conditions they require in their metaphorical greenhouse. In setting the specific conditions, it’s important to consider medical and psychiatric history as well as culture, needs, beliefs, and identity. The participant plays a crucial role in designing and contributing to the container of safety. The power of inner healing intelligence is honored from the first study session, when a participant is greeted with interest and care, and their ability to make decisions about their treatment is valued, starting with obtaining their informed consent to be in the study. The participant is treated as an expert of their own experience and as having the capacity to access the knowledge they need to heal, whether it’s through the cognitive mind, the body, emotions, or spiritual experiences. When a person who has been burdened with trauma has an internal experience of safety, they gain what they didn’t have before: a reference point for healing. If they can find this mental and physical state of refuge—their greenhouse—they will have found a place to do healing work.

Just like the therapy team helps create a safe environment in preparation for, during, and after the MDMA therapy sessions, the MDMA itself simultaneously contributes to that sense of safety during the processing of trauma. From my experience with participants in recent trials, MDMA seems to reduce hypervigilance (always being on alert) and allow them the ability to face traumatic memories while remaining connected with the present reality, in which they know they are safe. With the assistance of MDMA, participants are better able to tolerate the process of trauma therapy.

The protocol for MDMA-assisted psychotherapy affords substantial time for participants to work through trauma. Study sessions, eight hours in total, are designed with enough time for the effect of MDMA to come on and, eventually, subside. The eight-hour therapy sessions allow the participant to go through their process without pressure to rush; it takes time to do deep healing work. It can be powerful when the therapists communicate, “There’s time for you, there’s time now for your healing process.”

All therapy visits are conducted by a co-therapy pair. With two therapists, the amount of care, attention, and interaction takes on a greater depth than is usually possible with just one. Each has a different perspective and contributes unique strengths. The participant will have a different response to each of the therapists, which adds richness to the therapeutic relationship. Both therapists are in service to the participant and their inner healing intelligence, and support each other in providing and improving this act of service. In addition to the benefit of relational support, two therapists are needed in order to sufficiently attend to the necessary protocols, such as taking vitals, monitoring hydration, administering psychological assessments, adjusting music, walking the participant to the bathroom, completing progress notes or source records, and conducting psychotherapy for the long eight-hour sessions, in which the participant is never left alone.

In some cases, the care from two therapists serves as a corrective experience to the abusive or neglectful ways the participant was treated in the past. For many people with traumas of abuse, attention from others was dangerous. The therapists act with integrity and take responsibility for upholding professional boundaries. By receiving ethical care, the participant gets an opportunity to experience nurturing and trustworthy relationships and to tend to their inner healing.

The results of the Multidisciplinary Association for Psychedelic Studies (MAPS)’ first completed study of MDMA-assisted psychotherapy for chronic, treatment-resistant PTSD (Mithoefer et al., 2011) highlight the impact of the therapy alone. After two eight-hour experimental sessions, 25% (2/8) of participants who received placebo had a greater than 30% drop in their PTSD symptoms (measured by the Clinician Administered PTSD Scale [CAPS-4]) and no longer met the diagnostic criteria for PTSD. While the sample size was small, this is a considerable change in response to the therapy modality without MDMA. By comparison, the MDMA experimental group had a much higher response: 83.3% (10/12) of participants who received MDMA had a greater than 30% drop in CAPS, and 10 no longer met diagnostic criteria for PTSD.

During preparatory sessions, the therapists discuss the structure of the sessions and outline specific ways in which they will be attentive to the participant. Directly stating the intention to support a participant provides a powerful experience for the participant, as the therapists set the tone for deep healing work. This affirms the container of safety, defining the growing conditions of the greenhouse. Below is an example of how the therapists might articulate some of the ways they will be supportive and ensure the participant’s safety. This example does not include all of the required elements to be discussed during preparation, but it touches on many, and would be part of a longer conversation about safety, support, and what to expect during an experimental session.

We are here to support you and your process; this day is for you. We will be here with you. We encourage you to ask for what you need and will also do our best to anticipate your needs. There are no silly questions. We invite you to express yourself in any way that feels right, whether that’s using your voice or moving your body, this can actually help the process unfold as things come up during the session. We are here to ensure your safety, we will be monitoring your vital signs and hydration. When you stand up or move we will protect you from falling or hurting yourself, such as helping you walk to the bathroom, or using a pillow to keep you from hitting the wall or the floor if you are moving your body. In the rare case of immediate medical concern, we will consult a physician. We already discussed with you some of the boundaries that protect you in this work, to reaffirm one of them, sexual contact isn’t part of this work and we won’t engage in that way. If you experience sexual energy you are welcome to talk about it and feel through it, if that seems helpful to your process, but not to act on those feelings during the session. We want you to know that we take your health and safety very seriously. Do you have any questions about what I’ve said so far?

We want to do whatever we can to make this the most helpful to you, please let us know if there is ever anything we can do more or less of, you won’t hurt our feelings. You don’t have to take care of us. Each of us will take a short break for lunch, one of us will always be with you. We want to know about your experience and encourage you to share your internal process by talking with us when it feels right; but not to feel any pressure to talk to us before the time is right for you; we will also check in with you regularly during the session to see what’s happening so that we can best support you. If at any point you feel stuck, overwhelmed, or confused, let us know, we will help, that is what we are here to do. As you work through aspects of trauma, difficult, scary, or seemingly overwhelming thoughts, feelings, or images may come up: we will be with you to support you in staying with them as much as you can in order to process and move through them. We are honored to be a part of your process.

Notice that the communication about safety emphasizes the ways the therapists will actively attend to the participant, and even intervene when necessary to prevent bodily harm. It’s important for the participants to know that the therapists are not passive. The therapists are attentive and responsive, responsible for ensuring safety throughout the session so that the participant can allocate their resources towards healing instead of defense.

Once the parameters of safety are established, the therapists discuss with the participant the concept of the inner healing intelligence. The therapists encourage the participant to consider, in a way that makes sense to them, that they have strengths and resources that are valuable assets in this healing journey. Throughout the treatment the therapists prompt the participant to reach for their internal resources, validating the participant’s strengths and capability while reinforcing that the therapists are presently supporting the process.

MDMA-assisted psychotherapy is inner-directed, meaning the therapeutic content and the direction of the session is informed primarily by the participant and their inner healing intelligence. The participant’s relationship with their internal source of power will outlast the course of treatment and their relationship with the therapists. When a participant is (re)acquainted with the confidence that they can lead a healthful life, they get to reap the rewards of their hard work and know it was them who made it happen. In the same way, at some point a well-cared-for plant will outgrow its greenhouse shelter, and go out into the world with the health and strength to protect itself and sustain its own life.

MDMA-assisted psychotherapy is designed with the intention to create a space for a person to come back to recognizing their own power, their own capacity to heal, to love, and to live a full life.

MDMA-assisted psychotherapy is designed with the intention to create a space for a person to come back to recognizing their own power, their own capacity to heal, to love, and to live a full life.

The complement to inner-directed therapy, guided by the participant’s internal wisdom, is non-directive therapy, which means that the therapists are not guiding the session in a particular direction or holding an agenda. This is counterbalanced with the active support the therapists give in ensuring the participant’s safety and wellbeing. It can be challenging for a therapist to be non-directive. Typically, we want to “do” something to help, especially when it is our job to help. An overly active therapist could inadvertently bypass or overpower the person’s own inner healing intelligence, robbing them of the experience to connect to their self-power. Therapists who help their clients establish a deep connection with their inner guide give a tremendous gift, one that can last as the client applies their own wisdom to a myriad of life’s challenges.

In communicating about the inner healing intelligence, the therapists may say something like:

We are here to support you and step in to offer help when needed. You are resilient, motivated, and wise. We want to endorse your strengths. We trust your process and ask you to try to do the same. If you come to a place of confusion or overwhelm, please let us know, we are here with you. At that point, we encourage you to take a few breaths, slow down if possible, and see if you can get in touch with the part of you that is connected to insight and clarity. In this work, you may find that, more often than not, deep down and with a bit of support and patience, it will become clear what to do, or to allow to happen, and you will find many of the answers you seek. A large part of this work is connecting to that place of inner knowing, it’s not easy and there’s no one right way to do it. We are here to help you navigate that process.

A greenhouse doesn’t intervene in the growth of a seed—it doesn’t tell a seed what it should or shouldn’t do. In fact, the greenhouse doesn’t even know how a seed grows to a plant. It just provides the right circumstances. In a very similar way, MDMA-assisted psychotherapy creates a container for safety and support, so that the participant can connect with their innate ability to heal and grow, through developing a relationship with their inner healing intelligence and, from there, working through trauma.

It takes courage and resilience for a person to pursue trauma therapy. I am hopeful that there are increasingly more effective treatment options to make this difficult journey worth the effort. My hope in this modality is that people can get their lives back, enjoy satisfying relationships and work and a positive sense of self, and that they will always know their intrinsic wisdom and ability to heal.

Cultivating Inner Growth - Psychedelic Frontier

Just as a seed has within it the knowledge to grow, humans have an innate capacity to heal. MDMA can help us connect to that inner healer.

psychedelicfrontier.com

 

[mr peabody]

Training Therapists to Integrate Psychedelics

by Beverly Stills | LUCID News | 16 Aug 2021

ive years ago, clinicians at Oregon-based Portland Psychotherapy didn’t hear much about the use of psychedelics among its patient population. In the past year or so, however, client use and interest has skyrocketed, says psychologist Brian Pilecki, PhD. As such, the team there decided it was important to support clients in a trained, research-based fashion.

While the clinic is also a psychedelic research center, Pilecki says the Portland team sought out specific training from Fluence, a New York-based program designed to assist clinicians in psychedelic integration. “We see a growing number of clients who seek out psychedelics on their own,” says Pilecki. “We want to support that population as best we can.”

Pilecki attended a Fluence training session in 2018 prior to joining the practice in Portland. He left armed with the tools he needed to assist patients curious about, or using, psychedelics. As the use of psychedelics grew and exploded, he suggested the Portland team participate in the training as well. “The two-day training provides the background and research-based results to create a community of therapists interested in integration work,” Pilecki says. “Fluence approaches the topic with scientific rigor, caution, and humility.”

Psychedelic Integration Training

Up to 10 percent of the U.S. population has tried psychedelics at one time or another, according to Ingmar Gorman, psychologist and co-founder of Fluence. “With trends to decriminalize the drugs in some states, and widespread media coverage, we’re witnessing a big uptick in interest about their therapeutic applications.”

While this demand for psychedelic treatment is growing, the clinical world largely lags behind. “When you go through medical school, there’s very little time dedicated to learning about psychedelics and their applications,” explains Gorman. “We want to help clinicians get up to speed so that they can responsibly handle this clientele.”

Fluence focuses on psychedelic integration training for clinicians as a way to guide their clients through the experience. This does not mean administering the drugs, nor does it mean accompanying patients while they trip, or encouraging seeking them out at retreats and other settings.

Instead, psychedelic integration aims to help clients understand and process their trips. “These are complex experiences and it’s key that therapists have an understanding of that in order to best serve their patients,” added Gorman.

Key to this is assisting patients in harm reduction, a core component of the Fluence training. Harm reduction includes a spectrum of interventions aimed at reducing the negative effects of health behaviors without necessarily seeking to eradicate them. So, while the use of psychedelics may be helpful to some patients in working through depression, anxiety or PTSD, it may bring with it a host of negative impacts. Harm reduction therapy works to minimize those impacts.

“Using psychedelics outside of a clinical setting can be unpredictable,” explains Elizabeth Nielson, psychologist and Gorman’s co-founder. “We train therapists to respond to these situations.”

In the case of Portland Psychotherapy, for instance, Pilecki learned to take the stance of not encouraging clients to do anything illegal, while understanding they may do just that. “My role is to provide clients with an understanding of the full risks and benefits and empower them to make the right decisions for their particular situation,” he says.

Psychedelic experiences might include an exacerbation of symptoms, such as heightened anxiety or depression, for instance, or a negative trip that returns a patient to an intensely traumatic event. When therapists are trained to expect and respond to this, they can greatly improve a patient’s outcome.

Logistics

Fluence training sessions vary in topic and duration, but their introductory program includes an overview and history of psychedelic drugs, current research findings on the topic, integration and harm reduction therapy training. Nielson points out the importance of the historical aspect. “There was a good deal of valuable research with psychedelics in the ‘60s,” she says. “It’s important to visit that body of work and learn from it.”

At Pilecki’s suggestion Portland Psychotherapy hosted Fluence for an introductory training, attended by around 50 staff and local clinicians. “There are other training groups popping up these days, but we went with Fluence because it offers continuing education credits, which further validates this area of treatment,” Pilecki explains. The training doubled as a fundraiser for Portland Psychotherapy’s MDMA-assisted therapy research study.

The two day live-online program included didactic training, role playing, Q & A sessions and more. “We set up groups of three so that each member can have a chance role playing as patient, as therapist, and as observer,” explains Nielson. “We also teach therapists to identify potential contraindications, and patients at higher risk for negative consequences.”

In addition to online workshops and in-person retreats, Fluence offers 12-week online classes broken into hour-and-a-half long sessions. These cover topics like psychological approaches to psychedelics therapy, integration essentials, and psychedelics and social justice.

To date, nearly 700 clinicians have taken part in Fluence training, and in the current environment, that’s probably the tip of the iceberg. "That’s a good thing," says Pilecki. “In Oregon, the law change to decriminalize psychedelics will certainly increase its usage,” he says. “That won’t change how I operate as a therapist, however, and my primary focus will continue to be harm reduction.”

Pilecki likes the fact that following the training, he and his fellow therapists became part of a list-serve made up of fellow Fluence attendees. “This has been very useful,” he says. “I go in regularly to bring up questions that arise as I treat different clients. Given the fact that this is a newer clinical application, we’re always running into new areas where we can use consultation with other therapists.”

As soon as next year, the FDA may begin to approve therapeutic uses for a variety of psychedelics. The role of clinicians trained in psychedelic integration therapy will become more critical than ever, as will the need for formal training in psychedelic-assisted therapy. Fluence is ready to meet that call.

Training Therapists to Integrate Psychedelics - Lucid News

Clinicians are playing catch up when it comes to understanding psychedelics. This training program aims to fix that.

www.lucid.news

 

[mr peabody]

Are Psychedelics the Future of Therapy?*

Presented by Rachel Humphreys, with Robin Carhart-Harris and Rachel Yehuda | The Guardian | 13 Sep 2021

Scientists treating depression and a range of other mental illnesses have been running controlled trials using MDMA and psychedelic drugs such as LSD and the results have been encouraging.

Aside from the profound immediate health challenges of the global pandemic, many countries in recent years have had huge increases in numbers of people presenting with depression and other mental illnesses. In the UK, prescriptions for antidepressants has more than doubled in the past decade.

This huge demand has meant opportunities for research into all sorts of possible treatments for mental illnesses and for Robin Carhart-Harris that has meant groundbreaking investigations into the possible therapeutic uses of psychedelics and other controlled substances. The mind-altering properties of drugs such as ecstasy, LSD and magic mushrooms are well known, but their usefulness to medicine has until now not been the subject of rigorous medical trials. The early results are encouraging. Robin tells Rachel Humphreys how he has been leading work showing how psilocybin ( or magic mushrooms) can be used to assist psychotherapy for difficult-to-treat depression, making a significant difference where conventional antidepressants and talking therapy have not.

In the US, Oregon became the first state to legalise psilocybin for medical use last November. Dr Rachel Yehuda is director of the Center for Psychedelic Psychotherapy and Trauma Research, at Mount Sinai school of medicine in New York. She has been researching PTSD since the late 80s, and recently got FDA approval to run stage 3 trials using MDMA as a treatment. She tells Rachel that if the results of the her trials continue to go well, we could see treatments hitting the market in the coming years.

*From the article here :

Ecstasy, LSD and magic mushrooms: are these drugs the future of therapy?

Scientists treating depression and a range of other mental illnesses have been running controlled trials using MDMA and psychedelic drugs such as LSD and the results have been encouraging

www.theguardian.com

 

[mr peabody]

Ketamine-assisted Psychotherapy – Online?

by Veronika Gold, LMFT and Eric Sienknecht, PsyD | PSYCHEDELIC SUPPORT | 30 Nov 2020

Is the COVID pandemic presenting us with a new opportunity in the field of psychedelic-assisted psychotherapy? Can we collaborate with patients to offer virtual sessions safely and effectively? If so, what are the implications of this new way of providing treatment? Here we join Dr. Eric Sienknecht, PsyD and Veronika Gold, LMFT in an exploration of offering ketamine-assisted psychotherapy during social distancing.

In mid-March 2020, as the Shelter-In-Place order was put into effect in San Francisco, nearly all businesses and services ground to a halt. We stayed home, canceled all plans and appointments, foraged for the meager supplies remaining in stores, and waited. Our ketamine-assisted psychotherapy clinic, Polaris Insight Center, was closed for business, indefinitely. As fears of infection spread, along with the virus, we worried about our many patients, some of whom were suffering from Treatment-Resistant Depression and Anxiety while others reported newly emergent symptoms, exacerbated by the stress of the pandemic.

The question on hand became: How could we best respond to this potential healthcare crisis?

After several meetings, and as Telemedicine and HIPAA regulations were relaxed, we decided to begin offering virtual ketamine-assisted psychotherapy (KAP) sessions. Although our physicians regularly provide suitable patients with prescriptions for ketamine lozenges for at-home use during maintenance phases of treatments, we typically require in-office medical and psychological evaluations and several in-office KAP sessions before transitioning to at-home regimens. In this new COVID era, we would now be conducting evaluations, determining treatment plans, and facilitating the self-administration of ketamine lozenges at home via Zoom, all without ever meeting the patient in person.

Readers with an understanding of the powerful, often transformative, effects of psychedelic medicine may be skeptical and may wonder, “How is this possible?” and “Is this safe?” We also had similar questions, which informed the development of a new protocol for virtual services that included additional requirements to maximize safety and support.

Consider these three dimensions of virtual ketamine-assisted psychotherapy:

1. Accessibility

Upsides

Virtual KAP is more affordable compared to in-office treatment: Standard KAP treatment is a significant time investment. Typical treatments will include, at minimum, 1/2 hour with the physician, 1-hour intake with the therapist, 1 – 3 hours of preparation, several 2- to 3-hour experiential sessions, and 1 or more 1-hour integration therapy sessions. Because off-label use of ketamine is not usually reimbursed by insurance companies, the 10 – 20 hours or more of treatment are typically paid out of pocket. Virtual sessions allow for savings on rent in clinics and allow clinicians to see more patients, as there is less time spent between sessions (in the waiting room, in transition between session and transportation, changing sheets, and resetting the room).

Virtual KAP is more accessible compared to coming in person to the clinic: People who live in remote areas and places where there are no Ketamine-Assisted Psychotherapy clinics can now have access to this treatment.

KAP is most often used to target Treatment-Resistant Depression. One of the common challenges with depression for people is finding the motivation to engage in treatment, i.e. planning for sessions, leaving the house, and driving to and from appointments. With virtual sessions, these roadblocks are removed, facilitating access to, engagement in, and delivery of treatment.

The home setting can be more convenient for supporting the inner process and reducing side effects: Patients can stay with their process without interruption beyond the time of the session. Ketamine can elicit non-ordinary states of consciousness and, even when patients return to their normal state of consciousness, the physical effects of the medicine can continue beyond the time of the session. For this reason, many clinics, like ours, have “recovery areas” where patients wait, and patients are required to have arranged a ride home. When treatment is done at home, the patient can stay in their bed or on their sofa for as long as they need, and there is no pressing need to shift the state and commute home. One of the most common side effects of ketamine therapy is nausea, which is exacerbated by movement, and so this is greatly decreased during at home sessions where the patient can stay in a comfortable position as long as they need.

Downsides

Due to limitations of the online format, there is a greater need to communicate instructions clearly. During in-office sessions, the therapist/physician team are responsible for creating the setting and co-creating the set of the sessions. During online sessions, the patient has to prepare the set and setting themselves. As such, additional communication around details of preparation – from interacting with the compounding pharmacy, to learning how to use the lozenges, to setting up the music, to navigating online platforms – are needed. Instructions need to be explicitly spelled out and often repeated. In short, more energy and effort are required by the provider on the front end to facilitate a smooth, safe, and supportive experience.

2. Safety

Upsides

Virtual sessions in the familiarity of the home environment are experienced as safer for some patients, allowing for the possibility of greater vulnerability and increased capacity to fully let go into the therapeutic process. As human beings, we are wired for relationships and in healthy individuals, personal contact and connection facilitates relaxation, feelings of joy, and openness. However, for many people who suffer with depression, anxiety, and PTSD, personal contact and/or being in clinical settings can increase their discomfort, thereby creating an obstacle to depth exploration.

Downsides

Safety concerns for our patients and legal concerns for our clinic required us to spend more time and energy upfront anticipating risks and creating contingency plans. We developed new informed consents, including a telehealth consent and an at-home lozenge-use consent, describing in detail set and setting requirements, safety plans, and the importance of support systems. Additionally, since we would be expanding our services to people outside the Bay Area, we created new contact lists for local emergency services for various areas in California.

3. Support System

Upsides

Particularly since the pandemic, there has been a greater need for connection with others and as well with those who are familiar with KAP. . We have found ourselves sharing more community online resources with our patients and discussing the importance of Ketamine Integration groups. We have seen much more interest in virtual support groups such as the weekly Psychedelic Integration Circles with Tam Integration and Polaris Insight Center and the weekly Ketamine Integration Circles with Sage Integrative Health.

Downsides

The patient’s support system is even more important if they are engaging in virtual sessions. Time and energy are needed to communicate with the patient’s support system. In cases involving extreme social isolation, inability to communicate with others and/or absence of a support system could be a major obstacle to this kind of treatment.

Compared to in-person sessions where the therapist/physician is physically present and can provide verbal and physical support, patients can sometimes find it harder to take in the support in a virtual session. As such, having a sitter present during the session, in the same or separate room, or at least someone who is aware that the patient is taking a journey and who can be on-call if needed, should be arranged.

---

The favorable outcomes we have witnessed thus far with this new method of collaboration between providers and patients have broader implications for our healthcare system. Patients treated at home might be less dependent on the system for their healthcare needs, resulting in greater self-empowerment and agency, and less strain on the healthcare system. Furthermore, with at-home sessions being significantly less expensive than in-office treatments, access to care would widen.

As at-home sessions are being provided by more clinics, it will be important to track safety and efficacy in an ongoing way, and protocols will need to be revised accordingly. Nevertheless, after successfully facilitating many at-home treatments, it is our belief that virtual KAP sessions can be provided safely and effectively when paired with sufficient screening, preparation, and support.

Ketamine-Assisted Psychotherapy - Online? - Psychedelic.Support

Is the COVID pandemic presenting us with a new opportunity in the field of ketamine-assisted psychotherapy? Join us as we explore remote medicine.

psychedelic.support

 

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Australian therapists to be given psilocybin to better understand their patients

For the first time, researchers have been given ethics approval to study whether the psychedelic can be used to treat a primary anxiety disorder.
​

by Gavin Butler | VICE | 8 Nov 2021

It’s been more than 10 years since researchers noticed that the active ingredient in magic mushrooms could help terminally ill people come to terms with their deaths. During a study at California’s Harbor-U.C.L.A. Medical Center, psychiatrist Charles Grob found that administering a dose of psilocybin to end-stage cancer patients noticeably reduced their end-of-life anxiety.

Five years later, two more studies – one out of New York University and the other out of Johns Hopkins University – similarly investigated the potential of the powerful psychedelic in palliative care, and yielded similar results. After receiving a dose of the drug in the company of psychotherapists, subjects showed a significant and enduring reduction in anxiety, depression and existential distress.

These trials represented major stepping stones in what has come to be known as the “psychedelic renaissance” – a recent, booming interest in the therapeutic potential of otherwise illicit drugs – and their findings have been instrumental in highlighting psilocybin as one of the movement’s more promising candidates. But experts believe that the potential of psilocybin in treating mental health issues, and anxiety in particular, is yet to be properly investigated. To date, there has never been a clinical trial studying the efficacy of psilocybin in treating a primary anxiety disorder.

A team of researchers at Melbourne, Australia’s Monash University is hoping to change that.

Last month, they became the first in the world to gain ethics approval for the clinical study of psilocybin as a treatment for Generalised Anxiety Disorder (GAD): a severe, chronic type of anxiety that can manifest as worry or panic on an ongoing, day-to-day basis.

“Previously we’ve seen psilocybin used with good outcomes in the treatment of anxiety symptoms associated with a terminal diagnosis... but this is the first trial where we're looking at this treatment for quite a different kind of anxiety – one that is chronic, entrenched and generalised,” Paul Liknaitzky, head of clinical psychedelic research at Monash, tells VICE.

The trial is set to take place at Monash’s “Brain Park” facility, a world-first neuroscience research clinic that comes fitted with a meditation room and consultation suites. Patients will be administered a high dose of psilocybin over the course of two sessions – starting with 25 milligrams in the first, and an even higher quantity in the second – and each dosing session will be preceded and followed by at least three psychotherapy sessions with two qualified therapists.

“The treatment duration is only seven weeks,” Liknaitzky explains, “but participants’ involvement in the trial is about six months, with assessments before, during and after the treatment phase.”

The intended function of the specialised form of psychotherapy is to help participants prepare for the often intense psychedelic experiences, support them during the all-day dosing sessions, and then process these experiences afterwards – a crucial part of the process that Liknaitzky compares to “preparing the launchpad for a profound cosmological journey, and then providing the support needed for a safe and fruitful mission.”

Mentally preparing anxiety sufferers for an experience as potentially anxiety-inducing as a psychedelic trip is a delicate process. According to Liknaitzky, trust between the patient and their therapists is key. For this reason, the trial has sought and secured world-first approval of another kind.

“We’re also providing psilocybin as an option to our therapists as part of their training,” says Liknaitzky. “While this was commonplace for psychedelic therapists using LSD during the first wave of psychedelic research in the 50s and 60s, this is the first trial ever to offer psilocybin as a training tool for therapists, and the first to offer a classical psychedelic for this purpose since 1974.”

A therapist’s own, personal experience with psychedelic substances appears to play an important role in facilitating therapeutic benefits for patients. Liknaitzky points out that during an overseas trial into MDMA-assisted psychotherapy as a treatment for PTSD, almost all patients asked their therapist whether they’d experienced the drug before.

“When you’re dealing with the crucial element of trust in this treatment approach, an affirmative response from your clinical support team – ‘yes, I’ve been there before, it was challenging but I survived and benefitted, and I can help you’ – that helps an enormous amount with the participants’ trust,” says Liknaitzky.

“Crucially, the psychedelic experience is impossible to describe, and the ability to support people in these very profound states of altered consciousness may depend in part on the therapist’s own experience in that environment.”

By way of explanation, he offers a metaphor: "If you’re about to be rocketed to a new planet with an alien landscape that is completely different to anything you’ve ever encountered before, and it’s likely to be challenging, you’ll probably want the safety and confidence of someone who’s been there before,” he says. “Or at least someone who’s been somewhere similar.”

Getting approval for this particular arm of the study, he adds, is a major breakthrough.

“This is a real step forward for the field. Our trial, which is the biggest trial in Australia with 72 participants, is the first primary anxiety trial with psilocybin ever. In addition, a notable achievement for this trial is that we're able to offer psilocybin to our therapists as an optional part of their training.”

It was the ethics approval for the trial overall, though, that was the major hurdle. Now that it’s been given, the researchers are securing all the required state and federal permits and licences to import psilocybin into Australia, and hope to start recruiting patients to participate in the study in the first quarter of 2022.

So how long until psilocybin-assisted therapy for GAD will be available to the general population? It’s still early days.

Liknaitzky suggests that the first psychedelic-assisted treatment to become a regulated legal option – ”psychedelic” having become an umbrella term in the clinical context – will likely be MDMA-assisted therapy for PTSD. MAPS is currently running those trials overseas – and they’re showing such strong promise that it’s believed the Food and Drugs Administration (FDA) may green-light MDMA for the therapeutic treatment of PTSD within the next few years. Liknaitzky suggests that psilocybin-assisted therapy for the treatment of GAD could follow shortly thereafter.

“MAPS look very likely to get approval in the U.S., and probably at a similar time in Australia, in late 2023 or early 2024,” he says. “Which is pretty soon; it’s a lot sooner than a lot of people might imagine, given the field spent the better part of four decades in a deep freeze. And psilocybin-assisted therapy is likely to be two or three years behind that.”

It is also just one part of an emergent local industry, though.

Liknaitzky has established Australia’s first clinical psychedelic lab at Monash, has obtained the first industry funding for psychedelic research in Australia and is coordinating the country’s first applied psychedelic therapist training programs, as well as a number of research programs within the space of psychedelic medicines. He is, currently, the only full-time psychedelic researcher in the country. But in the next few months, that’s likely to change.

Earlier this year, the Australian government pledged $15 million of competitive grants to “kick start Australian clinical trials exploring the use of potential breakthrough combination therapies for the treatment of debilitating mental illnesses” – pointing to the growing body of evidence showing that drugs like psilocybin, ketamine and MDMA can be used to effectively treat conditions like PTSD, depression and addiction.

“That'll fund a number of large trials,” Liknaitzky predicts, “and there’ll be a number of new groups kicking off.”

He has concerns, however, about the level of hype that’s building within the field of psychedelic medicine – a space that has spent decades getting to where it is today. Liknaitzky is worried that the sudden surge of interest may be exploited by some commercial and advocacy groups who are attempting to rush through the research and development process prematurely, potentially risking patient safety and setting the field back again.

“While the results from these trials have been incredibly promising,” he says, “the field is young, the body of data is still small, and no psychedelic treatment has satisfied all the standard tests applied to any new medicine yet.”

Australian Therapists to Be Given Psilocybin to Better Understand Their Patients

For the first time, researchers have been given ethics approval to study whether the psychedelic can be used to treat a primary anxiety disorder.

www.vice.com

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[mr peabody]

Health Canada grants Special Access to restricted drugs for Psychedelic Therapy

by Greg Gilmanon | Psychedelic Spotlight | 4 Jan 2022​

New amendment reverses a 2013 Health Canada policy that prevented "a letter of authorization for a new drug that is or that contains a restricted drug."
2021 was a milestone year for psychedelic therapy, and 2022 promises to be even more progressive in North America, with Canada kicking off the new year on a high note.

Starting tomorrow, Health Canada’s Special Access Programme (SAP) will allow physicians to request patient access to illegal psychoactive substances, like MDMA and psilocybin, for psychedelic-assisted therapy. Decisions will remain on a case-by-case basis, and will be reserved for serious treatment-resistant or life-threatening conditions, in instances where other therapies have failed, are unsuitable or are not available in Canada.

In short, only a select few interested in psychedelic therapy will benefit from this amendment, but it’s a signal nonetheless that the Canadian government is taking the potential of psychedelics to treat a range of mental health issues more seriously.

Payton Nyquvest, founder and CEO of psychedelic-focused mental healthcare company Numinus Wellness, commended Health Canada’s decision for “righting a historical wrong based on stigma,” and believes this is just a first step for broader drug reform.

“While we believe this is only the beginning of greater change to come, it signifies an important step towards creating expanded safe access to treatment and care in the mental health sector through psychedelic medicine,” Nyquvest said in a press release before the holidays last month. “I am proud of our team who have had a longstanding role in advocating for this reform.”

Health Canada, however, clarified last July, when the amendment was just a proposal, that “the proposed regulatory amendments do not signal any intent towards the decriminalization or legalization of restricted drugs, and they are not intended to create large-scale access to restricted drugs.”

“Health care professionals wishing to access psychedelic drugs for professional training purposes are not eligible for the SAP,” the regulatory body declared, and added, “Clinical trials remain the best option to request access to restricted drugs and to generate scientific evidence.”

“It is important to note that the proposed amendments would not guarantee that restricted drugs would be approved through the SAP,” Health Canada clarified last year. “The proposed amendments would simply treat restricted drugs like all other drugs for the purposes of the SAP. The SAP is a science-based program that only grants access to an unapproved drug where scientific evidence is available to support the potential effective and safe use of the drug for the treatment of the underlying medical condition.”

The SAP allows doctors to gain access to non-marketed drugs that have not yet been approved for sale in Canada. The program authorizes a manufacturer to sell a drug that cannot otherwise be sold or distributed in Canada. Drugs considered for release by the SAP include pharmaceutical, biologic, and radio-pharmaceutical products not approved for sale in Canada.

This amendment is a reversal of a 2013 Health Canada policy that prevented “a letter of authorization for a new drug that is or that contains a restricted drug.” Psychedelic medicines are classified as restricted despite Indigenous populations in the area using them for centuries.

Dr. Lindsay Farrell, Vice President of Indigenous Initiatives and Reconciliation at Numinus, called this amendment a “critical first step” while acknowledging the urgent need for more “equitable access to psychedelic-assisted therapies for racialized, marginalized, underserved populations and Indigenous Peoples.”

“We encourage the federal government to create regulations that acknowledge and honor the traditional use of certain sacred plants and create pathways for safe and equitable access,” Dr. Farrell added.

How Psychedelic Treatment Through Health Canada’s SAP Works

One surprising oversight: Health Canada's Special Access Program doesn't require a psychedelic drug be consumed in a therapeutic setting.

psychedelicspotlight.com