Psychedelic Therapy | +80 articles

[mr peabody]

Psychedelic Therapy
​

by Brian Anderson | University of Pennsylvania

Psychedelic drugs are known to have profound psychological effects. Now being evaluated in clinical trials in the US as aids to psychotherapy, these substances are thought to help patients by inducing spiritual experiences that lead to improved mental health. Some people challenge the claim that authentic spiritual experiences can be induced by drugs and still others question whether spirituality and religion have any place in medicine.

A hallucinogen is "any agent that causes alterations in perception, cognition, and mood as its primary psychobiological actions in the presence of an otherwise clear sensorium." The word psychedelic, which comes from the Greek to wander in the mind, and is perhaps more accurate since hallucinogenic drugs don't produce true hallucinations, rather they engender illusions that are not normally mistaken for reality, but understood as an effect of the drug. The majority of psychedelic drugs are classified as Schedule I compounds, which means that they are considered to be substances that have no accepted medical use, and have a high abuse potential.

The assertion that psychedelics have no accepted medical use is a matter of contention that has been gaining a larger audience for the past couple decades. Since the first large push for the use of psychedelics in research and medicine in the 1950s and 1960s, psychedelics have largely been shunned from the medical community. Most recent evidence on the efficacy of using psychedelics in medicine has come from studies outside the U.S. or from reports of their underground use that necessarily surface to the public's attention as anecdotes. Now, however, the question of whether psychedelic drugs have any valid medical use is being revisited. More serious consideration is being given to psychedelic psychotherapy, which uses psychedelics as catalysts of transcendent experiences in order to break down psychological barriers to communication and recovery.

The director of the Drug Policy Program at UCLA, Mark Kleiman, said that there's obviously been a significant shift at the regulatory agencies and the Institutional Review Boards. There are studies [with psychedelic drugs] being approved that wouldn't have been approved 10 years ago. Part of the reason for this change is due to organizations like the Multidisciplinary Association for Psychedelic Studies (MAPS) and the Heffter Organization, which sponsor and promote studies of the medical applications of these drugs.

With at least four different FDA approved studies on the medical applications of psychedelic drugs currently being run in the US, it seems likely that our medical professionals and our society as a whole will soon have to face the ethical questions that accompany the practice of psychedelic psychotherapy. The paper will not discuss issues of legality, but will instead focus on psychedelics effects on people's spirituality as a possible mechanism for affecting their health, and on the question of the authenticity of a psychedelic-induced spiritual experience.

Psychological mechanisms of psychedelic therapy

When asked if he could see a future role for psychedelics in our Euro-American culture, Albert Hofmann responded "Absolutely! ... The pathway for this is through psychiatry, but not the psychoanalytic psychiatry of Freud and not the limited scope of modern biological psychiatry. Rather, it will occur through the new field of transpersonal psychiatry." He followed this by saying "What transpersonal psychiatry tries to give us is a recipe for gaining entrance into the spiritual world."

The idea of mixing spirituality with medicine is for most people in Western society a foreign concept, and while many people pray for a loved ones health to improve, there exists the distinction in our vernacular between healing, which is seen as more spiritual or holistic, and curing, which is accomplished through medicine. In order to understand the ethical issues behind psychedelic psychotherapy we need to have a better understanding of how psychedelic psychotherapy can affect people?s notions of meaning and the imperishable self as well as their ability to relate to other people.

Psychedelic-induced altered states of consciousness (ASCs) tend to include a certain list of common elements, one of which is a significant change in meaning and significance. Changes in meaning and significance can be found not only in how a patient views the world, but also in how they think of the content of their therapy. Two of the main protagonists of the field of transpersonal therapy were Stan Grof and Abraham Maslow, who both thought that a person could attain their optimal psychological health through altered states of consciousness. ASCs were thought to catalyze a therapeutic response, possibly by adding significance to therapy for the patient. In the report from a man who used ayahuasca, a hallucinogenic concoction made from a vine, to treat his colon cancer, the man talks about the thoughts that he had during his trip and says "when the vine reveals such things, the impact is far more profound."

Psychedelics seem to be able to amplify the significance and meaning of thoughts, or at least bring people closer to certain kinds of thought. Myron Stolaroff, cofounder of the International Foundation for Advanced Study in Menlo Park, California believes that the great value in these chemicals is that, in some way still not scientifically explained, they dissolve the boundaries to the unconscious mind, which allows one to then experience "the great relief of being in touch with all aspects of ones being. The joy and thrill of being totally alive comes from having complete access to all of ones feelings." The possibility of uncovering repressed thoughts and uniting a persons fragmented mind sounds appealing, but Vivian Rakoff, the emeritus professor of psychiatry at the university of Toronto cautions us that "every few years, something comes along that claims to be what Freud called the royal road to the unconscious." Transpersonal psychotherapy may be just another empty hope, but nevertheless, Rakoff says that research in psychedelic psychotherapy should be
allowed to continue.

Some of today's current medical studies with psychedelics that are seeking to re-examine psychedelic drugs therapeutic potential focus on their use in palliative care. Thousands of studies on the use of psychedelics in psychotherapy were published back in the 1950s and 60s before these drugs were scheduled. But many believe that these early studies do not, meet the standards of modern psychotherapy research, and that cautious reexamination of their [the psychedelics] therapeutic potential may be in order.

One such study is being run by Charles Grob, MD at the Harbor-UCLA Medical Center, and another is headed by John Halpern of Harvard University McLean Hospital. Both studies are looking to validate older studies that showed how the terminally ill were able to come to decrease their pain and anxiety about death through transpersonal psychotherapy. Sherwood, Stolaroff and Harmon explain how transpersonal psychotherapy might mitigate existential ills associated with the dying process with the following:

There appears to emerge a universal central perception, apparently independent of subjects previous philosophical or theological inclinations, which plays a dominant role in the healing process...

Much of the psychotherapeutic changes are seen to occur as a process of the following kind of experience:

The individuals conviction that he is, in essence, an imperishable self rather than a destructible ego, brings about the most profound reorientation at the deeper levels of personality. He perceives illimitable worth in this essential self, and it becomes easier to accept the previously known self as an imperfect reflection of this. The many conflicts which are rooted in lack of self acceptance are cut off at the source, and the associated neurotic behavior patterns die away.

This recognition of existing as an imperishable self and not the ego that is usually dissolved or partially dismantled during the psychedelic trip is what comforts the dying. It supposedly abates their fear of death by letting them believe that their entire self will not cease to exist after death, but only their physical self.

Another perspective on the use of psychedelics by the dying comes from Joanne Lynn, president of Americans for Better Care of the Dying. She says that "even in antiquity, some groups thought is was especially important to take whatever their local psychedelic was... when confronting mortality, whether to see into the hereafter, improve spiritual growth or just numb yourself to the reality." But she followed this by saying "it's sometimes poetic, sometimes majestic, but often mundane work to wrap up one's life. I think its unlikely there's a pill that will make that go away".

A psychedelic pill might not make the mundane work of reconciling with ones family go away, but it might make it easier. Elizabeth K., psychiatrist and author of over 14 books on coping with dying believed that "simply prompting patients to express their many thoughts, feelings, and concerns would be helpful to them..."

Such discussions could address concrete problems and relieve the patient of responsibilities and burdens that prevented the patient from dying in peace. Considering the report by Eric Kast, M.D. that LSD is... capable of improving the lot of dying individuals by making them more responsive to their environment and family, one can see how psychedelics might be able to facilitate this process of prompting patients to express themselves.

If the interaction between a patient and their loved ones is important for the patients well being, then it might also be pertinent to consider the well being of the loved ones as a factor in a patient's treatment. One study that measured factors affecting the global quality of life (QoL) of both cancer patients and their spouses found meaningfulness to have highest correlation with QoL in both groups. The study concluded by calling for greater attention to the existential domain in palliative care, both when measuring and when trying to improve quality of life for these patients... This call for increased attention to existential concerns was echoed in another study that found that "patients with an enhanced sense of psycho-spiritual well-being are able to cope more effectively with the process of terminal illness and find meaning in the experience."

Conclusion

Psychedelics are powerful drugs that have great potential to help as well as harm. This paper discusses the use of psychedelics in transpersonal psychotherapy and the ethical issues that accompany their employment as medicines. After examining how these drugs are thought to work in psychotherapy and their ability to cause authentically spiritual experiences, we should be better prepared to make informed decisions about the use of these drugs that not only affect ones body, but ones mind or even soul. US law says that psychedelics have no medical application, but depending on the results of a handful of current studies this may soon change. Because, compared to many other drugs, psychedelics are relatively benign physiologically, many arguments against their use are moral, not medical, objections. And as Francis, points out: We are... unwilling to take a clear stand on drugs solely on the basis that they are bad for the soul. Whether a drug is good or bad for the soul and a person's spirituality is a tough question to ask, but that does not make it impossible to answer. The soul aside, how drugs affect consciousness is a tough question in and of itself. The psychedelic mind-state is poorly understood, but its implications for human spirituality and psychiatric health nonetheless warrant a thorough investigation, which in view of their potential benefits could even be seen as unethical not to pursue.

http://www.neip.info/downloads/brian...1_anderson.pdf​

 

[mr peabody]

Ketamine and Psychotherapy*

Eli Kolp, Evgeny Krupitsky, M. Scott Young, Karl Jansen, Harris Friedman, Laurie-Ann O’Connor

A number of international psychiatric investigators have utilized treatment with ketamine to create cathartic effects in psychotherapy.

In Iran, ketamine psychotherapy was shown to be very effective in treating various psychiatric disorders. Investigators administered ketamine to 100 psychiatric patients with different mental health and psychosomatic diagnoses, including depression, anxiety, phobias, obsessive-compulsive neurosis, conversion reaction, hypochondriasis, hysteria, tension headaches, and ulcerative colitis. They reported that 91 participants were doing well after six months, and 88 remained well after one year. These investigators concluded that “ketamine’s abreactive or cathartic effect was related to its mind-expanding qualities;” however, they did not further specify their findings in clinical language.

In Argentina, Fontana used ketamine as an adjunct to antidepressive psychotherapy in order to facilitate regression to a prenatal level through a disintegration and death experience, which was followed with a progression experience that was seen as similar to a rebirth. He emphasized the advantages of ketamine, which made it possible to achieve deep levels of regression.

In Mexico, Roquet was the first clinician to employ ketamine psychedelic psychotherapy History of Ketamine in Psychotherapy in a group setting. He combined psychoanalytical techniques with the healing practices of Mexican Indian ceremonies and created a new approach to psychedelic psychotherapy that he called "psychosynthesis” (not to be confused with the same term used by Assagioli). He mainly used this procedure to treat neurotic patients, although he described some success with personality disorders and selected psychotic patients.

One of us (Krupitsky) first began using ketamine in the former Soviet Union in 1985 for treatment of alcoholism. He developed Ketamine Psychedelic Therapy (KPT) and treated more than 1,000 patients without complications. In one of his many controlled studies, nearly 70% of his ketamine-treated patients remained abstinent from alcohol during a one-year follow-up, in contrast to only 24 percent abstinence achieved in a control group treated with more traditional therapy. In a comprehensive clinical research review on this subject, Krupitsky concluded that KPT is a safe and effective treatment for alcoholism and other drug dependencies, such as heroin and ephedrine, as well as effective for treatment of post-traumatic stress disorder, reactive depression, neurotic disorders, and avoidant personality disorders, and somewhat effective for the treatment of phobic neurosis, obsessive-compulsive neurosis, and histrionic personality disorder.

Krupitsky and his colleagues recently conducted a double-blind randomized clinical trial comparing the relative effectiveness of high to low dose administrations of ketamine for the psychotherapeutic treatment of heroin addiction; two-year follow-up data indicated that high dose ketamine was more effective. The study reported that “high dose KPT produced a significantly greater rate of abstinence in heroin addicts within the first 24 months of follow-up than did low dose KPT.”

The authors also concluded that “high dose KPT brought about a greater and longer-lasting reduction in craving for heroin, as well as greater positive change in non-verbal unconscious emotional attitudes.” It appears the study’s data represent both a lower rate of recidivism and a higher degree of psychological integration.Recent changes in the regulations governing such research in Russia have now brought Krupitsky’s pioneering research efforts to a halt.

There was also an intriguing study at the University of Cambridge in the UK, in which ketamine was used to treat compulsive behavior in young women with anorexia nervosa with good results, although the publication of this study does not clearly indicate that the clinicians used a psychotherapeutic model. The study used infusions of ketamine to treat 15 patients with a long history of eating disorder, all of whom were chronic and resistant to several other forms of treatment. Nine responders showed prolonged remission when treated with ketamine infusions. There have also been various lone practitioners in other countries, usually family doctors or psychiatrists, who have used ketamine to treat psychological/psychiatric problems.

Ketamine-enhanced psychotherapy

Inspired by Krupitsky, one of us (Kolp) engaged in the clinical treatment of alcoholic clients using what he called ketamine-enhanced psychotherapy. His approach was explicitly meant to replicate Krupitsky’s pioneering work and to extend it into another cultural context, the US (note: Kolp is a bi-cultural Soviet-American psychiatrist, who was originally trained as a Soviet psychiatrist, immigrated to the United States in 1981 and was re-trained as an American psychiatrist). As with Krupitsky’s KPT technique, Kolp’s KEP treatment explicitly relied on the transpersonal effects of ketamine to facilitate psychotherapeutic change. Both researchers have recently published their combined observations on clinical and empirical research of the effectiveness of ketamine-enhanced psychotherapy for treatment of alcoholism. Once more, although most psychedelic drugs are illegal to use in the US even by physicians, ketamine is a notable exception because it is readily available to physicians as an anesthetic that can be legally used off-label for psychiatric treatment. Consequently, Kolp employed ketamine in his private psychiatric practice in the US from the fall of 1996 through the spring of 1999, administering it to more than 70 clients. Several of us also recently published Kolp’s empirical observations of the effectiveness of his KEP for treatment of alcoholism.

During this same period of time, Kolp had an opportunity to administer KEP to two patients with end-stage cancer. This paper summarizes these patients’ responses and provides Kolp’s informal retrospective observations on ketamine’s effectiveness for treatment of existential anxieties in terminally ill people. We emphasize that these clinical administrations were not conducted in a formal research context and this paper provides the informal retrospective observations on ketamine’s effectiveness for treatment of existential anxieties in terminally ill people. However, in light of the recent resurgence of psychedelic research in the US and our plans, as a research team, to now seek institutional review board approval and grant funding for formally pursuing studies on ketamine’s effectiveness in a number of clinical applications including the treatment of death anxiety, a reporting of Kolp’s clinical observations is seen as warranted.

Depression

There has been surging interest in the use of ketamine as a potential therapeutic agent for affective disorders, particularly depression. Even a single-dose of ketamine may cause rapid antidepressant effects in otherwise treatment-resistant cases of bipolar and major depression. Remarkably, this also includes the acute reduction of suicidal ideation. Recent neuroimaging studies support potential anti-anhedonic and anti-depressant effects, demonstrating its ability to alter glucose metabolism in regions implicated in mood disorders. Repeated ketamine doses may improve depressive symptoms comparable to—and perhaps even more rapidly than—electroconvulsive therapy, and it may even be successful in treating ECT-resistant depression. Despite its observed promising antidepressant effects, however, more rigorous investigation is needed to establish its clinical use as an antidepressant. The current evidence is limited by bias, small sample sizes, and limited data on important cofounding variables. In fact, a recent Cochrane Review determined that the efficacy of ketamine as an antidepressant may be limited beyond 1 week.

Post-Traumatic Stress Disorder (PTSD)

One of the newer applications of ketamine is its role as a potential treatment for Post-Traumatic Stress Disorder (PTSD), although studies examining this remain limited. For instance, Feder et al. (2014) found that ketamine may reduce symptom severity of PTSD more rapidly than midazolam; however, they did not exclude previously depressed patients, and the observed results may have been due—in part—to ketamine’s known antidepressive effects. A case reported by Donoghue et al. (2015) describing ketamine-induced remission of PTSD and disruptive symptoms in a child similarly provides inconclusive evidence for effects of ketamine specific to PTSD. While it is postulated that ketamine may be useful in preventing the development of PTSD through the induction of stress resilience, more research is clearly needed to better define ketamine’s effects on PTSD.

Models of schizophrenia

Since its discovery, ketamine has been observed to produce symptoms similar to those of schizophrenia. As a result, researchers have used these drugs extensively as models to study schizophrenia. While it now appears that overlaps in symptoms and even receptor effects are insufficient to explain the complex neuropathology of schizophrenia, ketamine has undoubtedly facilitated and stimulated research efforts into understanding schizophrenia.

*From the article here :
https://is.muni.cz/el/1423/jaro2011/PSY265/um/Ketamine-Enhanced_20Psychotherapy.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126726/​

 

[mr peabody]

Tripping might not be required for psychedelic therapy, study*

by Derek Beres | BIG THINK | 21 Apr 2021​

• A phase 2 clinical trial by Imperial College London found psilocybin to be as effective at treating depression as escitalopram, a commonly prescribed antidepressant.​
• A different study by the University of Maryland showed that blocking the hallucinogenic effects of magic mushrooms in mice did not reduce the antidepressant effect.​
• Combined, these studies could lead to new ways of applying psychedelics to patient populations that don't want to trip.​

Due to stigma, their illegal status and difficulty in finding control groups, research with psychedelics has been a challenge. But research increasingly shows that this class of drug has legitimate medicinal uses, and they may be just as good or even better than more traditional therapies.

Now, the Centre for Psychedelic Research at Imperial College London reports in the New England Journal of Medicine that when pitted against escitalopram (brand name: Lexapro), psilocybin was as effective as the popular SSRI (selective serotonin reuptake inhibitor) in treating moderate to severe depression. Perhaps most significantly, these results were obtained when comparing 6 weeks of daily doses of escitalopram to just two administrations of psilocybin.

Robin Carhart-Harris, head of the center who has published over 100 papers on psychedelics, is confident this study represents another step forward in applying psychedelics to mental health treatment protocols while also reducing fears a lot of citizens have around these substances. In a press release, he said:

"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. Psilocybin performed very favorably in this head-to-head."

As depicted above, the phase 2 clinical trial included 59 volunteers. The escitalopram (control) group received six weeks of daily escitalopram in addition to two tiny (1-mg) doses of psilocybin — a dose so low that it is unlikely to produce hallucinogenic effects. The psilocybin (experimental) group received two 25-mg doses of psilocybin three weeks apart with placebo given on all the other days.

At the end of the study, both groups saw a decrease in depressive symptoms, though the results were not statistically significant. (That isn't necessarily bad because if the two drugs have similar effects, then they would not produce statistically significant results. Still, a larger study is needed to confirm that psilocybin is "just as good as" escitalopram.)

Additionally, several other outcomes favored psilocybin over escitalopram. For instance, 57 percent in the psilocybin group saw a remission of symptoms compared to 28 percent in the escitalopram group. This result was significant.

Psychedelics without tripping

As psychedelics become decriminalized and potentially legalized for therapeutic use, however, a large population of people might desire the antidepressant effects without the hallucinations. For example, the psychedelic ibogaine may be useful for treating addiction, so the company Mindmed is developing an analog that works without producing the unwanted hallucinogenic side effects.

A new research article, published in the journal PNAS, investigated the antidepressant effects of psilocybin on a group of chronically stressed mice. (Under immense stress, mice develop something resembling human depression.) As with humans, depressed mice lose a sense of joy, which can be assessed by determining their preference for sugar water over tap water. Normal mice prefer sugar water, but depressed mice simply don't care.

Once the mice were no longer juicing up on the sweetened water, the team dosed them with psilocybin alongside a drug called ketanserin, a 5-HT2A serotonin receptor antagonist that eliminates psychedelic effects. Within 24 hours of receiving the dose, the mice were rushing back to the sugar water, indicating that tripping is not necessary for psilocybin to work as an antidepressant.

While the team is excited about these results, they realize it needs to be replicated in a different population.

"The possibility of combining psychedelic compounds and a 5-HT2AR antagonist offers a potential means to increase their acceptance and clinical utility and should be studied in human depression."

The future of psychedelic therapy

Psychedelics such as psilocybin and LSD have a long track record of efficacy in clinical trials and anecdotal experiences. Almost all volunteers of the famous Marsh Chapel experiment claimed their experience on Good Friday in 1962 was one of the most significant events of their lives — and this was a quarter-century after the fact. A more recent, controlled study found that a single dose of psilocybin showed antidepressant effects six months later.

Proponents of macrodosing and ritualistic experiences sometimes argue that the full-blown mystical trip is the therapy, though this is anecdotal, not clinical research. As the Maryland team noted, a number of people are contraindicated for psychedelics, whether through a family history of schizophrenia or current antidepressant treatments.

Senior author Scott Thompson is excited for future research on this topic. As he said of his team's findings:

"The psychedelic experience is incredibly powerful and can be life-changing, but that could be too much for some people or not appropriate… These findings show that activation of the receptor causing the psychedelic effect isn't absolutely required for the antidepressant benefits, at least in mice."

Hopefully, with more research occurring in psychedelics than even in the 1950s (when studies predominantly relied on anecdotal evidence and little government support), the longstanding stigmatization of psychedelics is beginning to recede. This could open up new possibilities for both clinical research and, for those curious about the ritual effects, a continuation of introspective experiences.

*From the article here :

Study: Tripping might not be required for psychedelic therapy

Two different studies provide further evidence of the efficacy of psychedelics in treating depression.

bigthink.com

 

[mr peabody]

Healing mind and body: A short history of psychedelic psychotherapy

by Bradley Foster

"We are not human beings having a spiritual experience. We are spiritual beings having a human experience." - Pierre Teilhard de Chardin

It’s hardly news when a therapist helps heal a client. But when a therapist has a patient use a psychedelic, the media notices. That’s because psychedelics can heal in ways that pharmaceuticals and talk therapy cannot—ways that science has not yet begun to understand.

Psychotherapy-assisted psychedelic medicine is set to leap-frog over conventional methods in the treatment of addiction, PTSD, depression, and anxiety.

It is predicted that MDMA and psilocybin will be available under controlled conditions within the next five years. At first it will only be for the terminally ill or for those with severe PTSD. Finally, the door will be open.

Psychotherapy-assisted psychedelic experiences will revolutionize how we treat mental illness. Rather than being given pills we have to take for life, we can take just one dose and be transformed. Of course, psychedelics aren’t for everyone. So there will still be a role for pharmaceuticals and conventional therapy.

Pundits are already speaking of our age as the psychedelic renaissance, a phenomenon that can be clearly witnessed within the rapidly expanding ayahuasca tourism industry as ayahuasca obtains an increasingly globalized popularity and reputation.

The techniques and philosophy of psychedelic psychotherapy have evolved over the past 50 years to work effectively with psychedelic medicine. I invite you to follow me back in time to see how psychotherapy evolved to help make the magic happen.

Psychedelic-assisted psychotherapy

Psychedelics open a door to usually hidden vistas of the psyche by putting the client into a non-ordinary state of consciousness: deviation from the normal waking mental state caused by physiological, psychological, or pharmacological agents.

When given appropriate support and framework, deeply entrenched personal problems can be safely worked out. It’s the therapist’s job to stay out of the way and to gently encourage self-healing of the body and mind. The patient’s inner work, enhanced by psychedelics, goes much deeper and is more rapid than it would be through talk therapy alone.

Survivors of trauma tend to be well defended or in denial about the dark places inside of them. Psychedelics help them access and come to terms with their demons or darkness. Once these previously hidden traumas are resolved, the problems they cause disappear.

In a psychedelic session, only the client uses the psychedelic. The therapist sits quietly with the client to help with any arising difficulties and to ensure a safe experience. The therapist must be open to whatever may come up for the client during the trip, gently encouraging them to confront any fears that appear.

The psychotherapist’s job is to encourage self-direction and to trust that the client can find a path to healing. The notion that each person has an inner healer who, when encouraged by a therapist, can help them overcome trauma, is unconventional in the world of psychotherapy and psychiatry, where the therapist is seen as more of an expert or a guide.

There are several classes of psychedelics that work in different ways. For instance, LSD reduces the subject’s ego and quiets the Default Mode Network, and at the same time facilitates signaling throughout the brain. MDMA appears to reduce signals from the amygdala , which allows a client to go deeper into frightening memories or trauma with less fear.

A bit of history

The last few hundred years represent the only time in human history that psychedelics have been repressed throughout most of the world.

It is thought that humans have used psychedelics since the first conscious being ingested (likely) magic mushrooms. Almost every culture in every part of the world used some form of psychedelic plant for ritual or healing throughout history. In the age of colonialism, conquistadors and the church took a dim view of natives with their psychedelics. The prohibition of psychedelics spread to most modern nation states, with little regard or respect for their efficacy and healing potential.

Few psychologists recognized the significance of non-ordinary states of consciousness until LSD was discovered. Patients of mainstream psychiatrists who presented with religious experiences, different states of consciousness, or who were undergoing a spiritual crisis were likely to be diagnosed as having had a psychotic experience, mania, delirium, or delusions.

After its discovery during World War II, LSD was sent to psychologists and researchers who were told that it mimicked psychosis. A great deal of experimentation took place, much of it misguided and immoral due to misunderstanding how the drug worked.

The U.S. Army launched MKUltra, which studied the feasibility of using LSD as a weapon to disorient enemy soldiers. The CIA hired noted psychiatrist Dr. Ewen Cameron of McGill University to conduct experiments in mind control.

LSD therapy at that time often involved no informed consent, unwilling victims strapped to a stretcher for hours at a time, being interrogated and studied like rats. The results ranged from sad to hilarious, as in the case of a British army platoon on LSD, and fortunately didn’t prompt follow-up studies.

Several research projects used psychedelics as a psychotherapeutic tool, but personal growth is difficult to quantify. Early researchers quickly realized that LSD was an amazing tool for probing the psyche and studying consciousness. But they had a lot to learn before they knew how to control its effects and use it properly.

By the mid-1950s psychoanalysts started using LSD with their clients in a more humane manner. They discovered that set and setting were crucially important in treating clients successfully. Set and setting means creating a safe, comfortable environment, preparing their clients for what to expect, and encouraging them to reflect on their intention before the trip.

The client lay down on a couch in a living room, wore eye shades, and had headphones that played gentle instrumental music. Typically, two therapists sat with them to observe and ensure a safe and consistent experience. This is when therapists sitting with their clients became known as sitters because they limited their intervention during the trip and just sat with the client.

Much of the research published in the 1950s and 60s showed promise for treatment, particularly when psychotherapy was used as an adjunct with a psychedelic. During this period, LSD was taken by researchers themselves, who, far from finding schizophrenia-like psychosis, discovered astonishingly kaleidoscopic paths to self-enlightenment and heightened states of consciousness. In a letter to Zip Reilley in 1957, Psychoanalyst Betty Eisner famously quipped that "taking LSD was like going through four years of analysis in six hours."

By 1960, the pace of innovation increased as journal articles were published and conferences on psychedelic psychotherapy were held. Researchers met and exchanged information in a rapidly growing field.

Psychedelic research clearly demonstrated LSD’s promise in helping people with addiction and many trauma-related illnesses. But it was a difficult drug to work with, and many of its properties were unknown. Some people had adverse reactions, from psychosis to difficult and frightening experiences.

Many alcoholics treated with a dose of LSD stayed sober for up to six months but many relapsed. In other cases, psychedelics produced profound effects but dissipated over time. Clinical research is hampered because it is impossible to have a control group when it is very clear which participants are on psychedelics. It was also difficult to replicate results of previous experiments because the studies were not up to modern standards. Much of the research at the time was being conducted in an informal manner with little state or corporate sponsorship.

Walter Pahnke, a researcher at Harvard University, conducted the Good Friday Experiment in 1962. Twenty divinity students were given either a dose of psilocybin or niacin (which mimics some symptoms of psilocybin) to see if psilocybin would react reliably in a group of religious scholars. The participants then spent Good Friday in contemplation in a chapel. Pahnke discovered that psilocybin had a profound effect on the students, most of them had a life-changing religious experience.

Rick Doblin’s follow-up study 30 years later demonstrated that its effects can still be as profound. The study also showed that it was equally important to prepare the participants as well as help them integrate their experiences. Pahnke’s study made it generally accepted that psychotherapy was the key to helping people integrate and find meaning in their experiences. Having a religious experience on a psychedelic is often an overwhelming experience that needs to be processed and integrated to have meaning in our more ordinary state of consciousness. This work is continuing at Johns Hopkins, studying the effects of psilocybin on religious leaders and their practices.

At the time, the most popular psychotherapeutic modalities were derivatives of Freudian analysis. Carl Jung’s ideas of the collective unconscious were more compatible with psychedelic therapy than many of Freud’s concepts. In England, the most popular use of psychotherapy and LSD involved using a psycholytic, or a low dose, whereby participants took a dose a few times a week and participated in group therapy. In North America, less frequent but larger psychedelic doses were used. Both methods were effective in different ways.

Psycholytic has become popularized these days as microdosing, which helps people on a daily basis. A psychedelic dose tends to be a much more powerful tool for interrupting old patterns and requires much more intervention from professionals.

Some psychedelic therapists realized that working with clients in different states of consciousness opened up new ways of working with the psyche. Bill Richards and Walter Pahnke were the first therapists to understand that:

“Each person’s psyche is infinitely wiser than the egos of the patient and the therapist (or traveler and guide), and, if trusted, will manifest the experimental sequences or imagery, memories, emotions, revelations and insights needed to facilitate conflict-resolution, and communication with the sacred realms of the Self, and healing.”

Think of an elevator where you can press a button to access the floor where traumatic events are stored or where your self-healer lives. Psychedelics offer a simple and effective method of getting clients into a state where they get into their psychic vaults without the ego and its defenses getting in the way.

Stanislav Grof

Research into psychedelic psychotherapy began in earnest at the Spring Grove State Hospital (1960-1965) and continued at the Maryland Psychiatric Research Center (1965-76). Much of the credit for advancements in understanding the use of psychotherapy with psychedelics is due to pioneers like Walter Pahnke, Bill Richards, and Stan Grof. Building on research during the previous decade, they developed new techniques that transformed psychedelic psychotherapy for the treatment of psychological and spiritual distress.

It’s significant that Pahnke and Richards were students of theology, not just psychology. They understood that psychedelic trips were manifestations of spirituality. They also made the connection between the spiritual and the inner healer, which is what makes it therapeutic.

Traditional psychoanalysis and newer modalities arising from the “human potential movement” wanted little to do with anything that had the taint of religion. They were striving to be “scientific.” Religious leaders wanted even less to do with a drug that could induce religious experiences. Therapists working with psychedelics in the mid-1960s were often working without much support from the medical, religious, or psychiatric establishments.

Researchers at Maryland developed key guidelines for “travelers” or clients embarking in different states of consciousness:

1. It is important to trust the therapist so you will be capable of expressing honesty, courage, and curiosity.

2. The paradox of ego strength and ego transcendence means that one must have a reasonably strong ego, a developed sense of self, before you begin your journey. Experiencing a higher state of consciousness means the traveler must trust himself on the threshold of ego transcendence.

3. Being must be accepted and experienced without judgment no matter what state you’re in.

4. Whether embedded trauma emerges from the depths, or one has a transcendent experience, it must be simply accepted.

5. Through the magic of therapists staying out of the traveler’s way, and through the transcendence of self-acceptance, the client learns how to heal herself.

In 1971, U.S. President Richard Nixon declared drug abuse to be public enemy number one. Psychedelics were placed on Schedule One of the Controlled Substances Act, which included a set of policies that forbade their consumption, manufacture, and distribution, effectively shutting down all clinical research.

Just when the wheels of research were beginning to spin with new and effective psychedelic treatments for alcoholism, anxiety, and depression, they were forced to stop immediately. It is a cruel irony that scheduling was intended to keep psychedelics out of the hands of youthful experimenters, but its main effect kept psychedelics out of the hands of researchers, not teenagers. It’s tragic that so many people could have been healed during this time, and we could be in an era of psychedelic medicine were it not for the intrusion of politics.

In Part 2, we’ll take you through the long, dark years between 1972 and 1993, explore why and how psychedelic research came to a standstill during that period, and then bring you up to date with the psychedelic renaissance.

Part 2

We knew we couldn’t make it illegal to be either against the war or blacks, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.” – John Erlichmann, aide to Richard Nixon, 1994

In part one we took a journey through the milestones of psychedelic research up to the point where all studies were shut down.

Now let’s go forward in time through the government’s ban on psychedelics, the cauterizing effect of prohibition on psychedelic research, and into its tentative re-ignition, exploring how this has blossomed into the psychedelic renaissance.

The curtain comes down

Until the mid-1960s, modern psychedelic interest was confined to the lab or the psychotherapist’s couch. Timothy Leary, a psychiatrist at Harvard, along with Richard Alpert took them mainstream. Suddenly hippies were everywhere, throwing a spanner into the works of U.S. postwar conformity.

The mayhem at the 1968 Democratic convention, the burning cities, and Vietnam War protests prompted Nixon to criminalize all psychedelics by placing them on Schedule One of the Controlled Substances Act, which is reserved for drugs with a high likelihood for abuse and which have no medical value. Psychedelic research screeched to a halt, and for decades it became impossible to get access to psychedelic drugs for clinical study, and it was illegal to make, buy, sell, or use. Research into different states of consciousness was set back 30 years.

One of the few bright spots in the years of prohibition was Stan Grof’s work with holotropic breathwork. When Stan was prevented from having access to LSD and the Maryland clinic closed down, he moved to California where he pioneered the use of rapid, deep breathing, which can make the breather experience a different state of consciousness. While not as intense as many types of psychedelic experiences, holotropic breathing was much safer and could be used on many clients where psychedelics were inappropriate or hazardous, such as on pregnant women or children. Stan also pioneered new techniques of integration, including the concept of prenatal trauma, which are finally being recognized by a wider community of therapists.

Alexander Shulgin

Psychedelic chemist Alexander Shulgin introduced Leo Zeff, a Jungian psychotherapist, to MDMA, which he dubbed “Adam” because he believed it returned those who took it to a primordial state of innocence. Zeff was another pioneer who incorporated LSD in his practice in the early 1960s. Shulgin felt that MDMA was the perfect drug to use with psychotherapy. Zeff was so excited by it, he shelved his retirement plans and became known as “the Johnny Appleseed” of MDMA as he traveled around the country, turning over 4,000 psychotherapists onto MDMA couples counseling.

An opening

Beginning in the 1990s, there was a small blip in research as the gatekeepers loosened control of psychedelics, allowing clinical studies access to MDMA and psilocybin. More studies were spawned, with interesting results. Modern protocols, careful screening, and the addition of psychotherapy to the use of psychedelic medicine resolved many of the old problems, produced more reliable results, and increased the effectiveness of the medicine.

Psychedelic therapists are trained to deal with people who experience different states of consciousness, not only those produced by taking drugs. Psychedelic therapists play an important role helping clients work through transpersonal states such as loss or change of faith, existential and/or spiritual crisis, experience of consciousness or different states, psychic openings, spiritual emergence, possession, grieving, near-death experience, kundalini awakening, shamanic journey, and difficulties with a meditation practice.

Unfortunately, many otherwise well-trained psychiatrists and psychotherapists may not be able to make sense of these states and may do more harm than good, for instance by diagnosing the person experiencing them as having a mental illness and medicating it.

Pahnke noted, “Without competent psychiatric supervision, such experiences may, at best, remain frightening memories and, at worst, cause a person to decompensate under the stress.”

It’s become a rite of passage for many youth to attend outdoor concerts while high on assorted substances. In 2006, MAPS spawned the Zendo Project as a harm reduction strategy at Burning Man to help people having difficult trips. Zendo was also a unique opportunity for training psychedelic psychotherapists. At any given festival there are dozens of participants who are freaking out. Zendo provides care for people having difficult experiences. They have developed effective strategies for psychedelic harm reduction to help festival-goers. Many other organizations such as Kosmicare, EnergyControl, The Loop, DanceSafe, TripProject and drugsand.me also practice psychedelic harm reduction within their communities.

Richard Yensen

Inside the Zendo tent, sitters provide a safe container for people going through difficult psychedelic experiences. The sitter provides a compassionate, calm, grounded presence. In order to do this, the sitter has to start with a beginner’s mind and be curious. There is no analyzing, leading, or agenda, just safety and support. Richard Yensen, one of the psychologists at the Maryland Research Center, likens the psychedelic therapist to a stained-glass window. The power is in the light that shines through each pane of glass onto the client.

- Zendo’s Rules for Psychedelic Harm Reduction
- Safely sitting through difficulty
- Creating a safe space
- Sitting, not guiding
- Talking through, not down
- Difficult is not the same as bad

The integration of the experience of different states of consciousness is vital. There is little therapeutic value gained unless it can be transformed into meaning in our everyday lives. Some feel strongly that recreational users who experience these states don’t get the benefit from them due to a lack of integration. Experiencing something as vast as the universe, or feeling God-like while on a psychedelic does not lend itself well to day-to-day reality. We all might need a little help unpacking it. A psychedelic therapist helps make sense of these experiences which can be so profound that old habits and addictions can easily be broken.

Because psychedelic medicine is currently illegal in most Western countries, therapy occurs only in clinical trials, in retreats in countries where say, ayahuasca or iboga is legal, or through underground therapists. Integration therapists or integration circles create a safe space for users of psychedelics to tell their stories after the fact.

Once a client has had a different state of consciousness, the most important role for the therapist is to help their client integrate their experiences. Integration involves understanding the meaning and bringing it into their daily life. Therapists who offer integration services have backgrounds in many modalities, though most tend to have a psychodynamic orientation. Psychotherapists with training in transpersonal or shamanic modalities are becoming increasingly common among practitioners.

Amanda Feilding

Psychedelic therapy remains a work in progress. When psychedelics are approved for use, psychiatry will have access to medication that promotes healing, rather than simply treating symptoms. And we will need a lot more psychedelic therapists. As research moves forward, it appears likely that psychedelics will revolutionize our understanding of the mind for decades to come. Nearly all psychedelic studies are small scale and sponsored by foundations like MAPS, the Beckley Foundation, and university departments. Even so, psychedelic research is expanding rapidly despite being hobbled by having no corporate money behind it. Researchers are suggesting many more uses for psychedelics, so we can expect to hear about the results of new studies far into the future.

A small group of therapists working within the limits of clinical protocols are pulling off amazing results. Psychedelics offer tremendous insights into understanding and healing the causes of a wide range of mental health issues. Just imagine the flood of findings and discoveries that could be unleashed if public money was invested in more research. As it is, we are barely scratching the surface.

An accumulating body of clinical research finds psychedelic-assisted therapy highly effective in healing PTSD, trauma, anxiety, depression, existential anxiety, addiction, eating disorders, and even cluster headaches. Crucially, for those with these conditions, present-day psychiatry treatments provide very modest improvements.

There are many hurdles psychedelic research has to jump over before treatments become mainstream. We may see MDMA-assisted psychotherapy treatment for PTSD within a few years. Treatment of death anxiety for cancer patients may be permitted on compassionate grounds in some more progressive countries in the near future. As each day passes, more evidence supports the assertion that psychedelics are a miracle cure for people who suffer from a wide variety of mental distress.

Psychedelic therapy will revolutionize psychiatry and psychotherapy for years to come. Patients who suffer from a wide range of debilitating mental health conditions will be healed through novel treatments that we are beginning to discover. One day, many years from now, the psychedelic renaissance may become known as the psychedelic revolution.

http://s588276343.onlinehome.us/wp-...ort-History-of-Psychedelic-Psychotherapy1.pdf​

 

[mr peabody]

Treating mental disorders with psychedelic psychotherapy

Every day in Australia, more than eight people die by suicide. Millions more suffer mental health issues. We have treatments available, but we are missing out on therapies that are showing great promise in other parts of the world. Why? Because they use psychedelic drugs.

Psychedelic drugs and mental health issues may sound like a terrible combination—and can be in the wrong setting. But increasing evidence suggests that using controlled portions of these drugs with trained psychotherapists could help people overcome several mental health disorders. Even healthy people might be able to benefit in the future.

Dr Stephen Bright is Senior Lecturer of Addiction at Edith Cowan University (ECU) and Vice President of Psychedelic Research in Science and Medicine (PRISM). He’s hoping to bust the myths about psychedelic drugs and push through the politics so that Australians may one day benefit from these potentially life-saving therapies.

What is psychedelic psychotherapy?

Psychedelic psychotherapy involves using small amounts of psychedelic drugs in a controlled, clinical setting. Psychotherapies aim to help patients overcome problems—usually by facing them head on. For example, someone with PTSD may avoid thinking about the bad experience they had. In psychotherapy, the therapist will actually direct them towards facing that bad experience to help them to work through it.

Adding psychedelic drugs to the mix generally helps patients get there faster. The therapists ‘hold the space’, allowing the patient to mostly guide the session. The therapists will usually only need to intervene if the patient is avoiding facing their issues or bad feelings.

“It never fails to amaze me how much spontaneous insight people gain in the MDMA sessions. It would take 10+ weeks of normal psychotherapy to guide a person to the insights that the patients spontaneously come up with while on MDMA,” Stephen said. Stephen explains that this is a technique he often used while ‘trip sitting’ at festivals.

“The further they push against bad feelings, the worse their experience becomes. So we try to talk to them about what they’re experiencing and allow them to approach it and work through it rather than avoid it, and doing so seems to have a therapeutic response.”

But patients aren’t thrown in the deep end like someone having a difficult trip at a festival. Psychedelic therapy involves planning and preparation. The preparatory sessions are thorough, so the patient knows exactly what they need to do, and therapists know how to best support them.

“The person is fully prepared beforehand for what they’re going to experience, and they have some coping strategies.”

A mystical experience

So what is it about psychedelic drugs that patients find therapeutic? Neurologically, we’re not sure. But Stephen said the secret often lies in the mystical experience you can have on psychedelic drugs. It’s difficult to explain, but it’s a spiritual sense of oneness. Kind of like having an epiphany. The mystical experience usually happens with the more psychedelic drugs like psilocybin, rather than MDMA. A study at NYU found that patients with life-threatening cancer who had a mystical experience from psilocybin psychotherapy had improved quality of life and decreased depression and anxiety. This has huge implications for palliative care.

“That spiritual experience seems to be the catalyst in allowing them to come to terms with their situation,” Stephen explains. But this isn’t exactly a new discovery. The co-founder of Alcoholics Anonymous, Bill Wilson, said the spiritual awakening he experienced on LSD is what started his own sobriety. “The problem is spiritual experiences are hard to create but we know, with psychedelics, we can induce these mystical experiences in a clinical setting in the right context with the right trained therapists involved,” said Stephen.

This is why research has also looked into psychedelic psychotherapy as a treatment for addictions like smoking. One study found that psilocybin psychotherapy helped people quit smoking, with 60% still smoking-abstinent after 12 months.

“That’s remarkable when you consider Champix—which is the leading pharmacotherapy for nicotine cessation—that has a success rate of 21% at 12 months,” said Stephen. “The subjects in this study reported that this mystical experience that’s induced by the psilocybin is ranked as one of the top five most significant experiences of their life.”

Your brain on psychedelics

Not only has this therapy shown good results in PTSD, palliative care and addiction, it’s also being looked at as a treatment for depression because of the effect it has on the brain.

“Another area that’s in its infancy is psilocybin and depression. There’s been an open label study published by Imperial College in London among people who hadn’t responded to other treatments for depression. They found a number gained significant benefits from psilocybin-assisted psychotherapy.”

In this study, they also took a look at what was going on in the brain of patients with neuroimaging. Using this, they found a change in the brain was linked to a reduction of depressive symptoms. It turns out psilocybin can temporarily switch off a part of the brain called the Default Mode Network, which correlated with patients having that mystical experience.

“The Default Mode Network is a series of interconnected neural pathways. It is activated all the time when we are in a waking state. It allows us to have this conversation because we can concentrate on what we’re doing,” said Stephen. “If we turn off the default mode network, we end up with a lot of cross-talk happening in the brain. In the context of depression, perhaps having all those different interconnected pathways allows the person to see the world, themselves and others in a completely different perspective.”

He likens the default mode network to a conductor in the brain. Turning off the Default Mode Network with psychedelics is like putting the conductor on “paid service leave for 6 to 12 hours”. Without the conductor, the orchestra starts playing all kinds of things.

“In that cacophony of noise comes epiphanies.”

Inducing everyday epiphanies

If you’re like me, by now you’re probably thinking you could use an epiphany too. Surely this can’t only be useful for mental health disorders? I asked Stephen to play the hypothetical game of looking into the future and letting me know if there will ever be a day this could be accessed by anyone needing to make a big life decision.

“People can go when they want to engage in some sort of spiritual contemplation or they’re not sure about something in their life, and they can utilise the psychedelic experience to help them with that.”

But before we get there, we have some serious catching up to do.

What’s stopping us?

You may have noticed that all the studies referenced in this article have been from the US and the UK. That’s because Australia lags way behind in psychedelic research. Stephen says there are a few reasons for this, namely “academic conservatism”, which is why I swell with pride when Stephen tells me that ECU has thrown their support behind psychedelic science.

“We’ve been banging our heads against the wall for about 8 or 9 years now, and things are now really starting to look quite positive. I don’t want to get too optimistic, but things are starting to look really positive,” he said. “The fact that ECU is supportive of it is fantastic.”

Stephen’s worked in both the policy and scientific spheres to try and get Australia to embrace and get involved in psychedelic research. In particular, he’s been leading the charge for MDMA-assisted psychotherapy. Right now, the Multidisciplinary Association for Psychedelic Studies (MAPS) is in the process of phase 3 trials for MDMA-assisted psychotherapy for PTSD, after phase 2 yielded promising results.

“What we’re hoping in Australia, and what ECU’s supporting, is that Perth will be a site for a phase 3 trial,” said Stephen. “If we can demonstrate we have the people and infrastructure to do MDMA-assisted psychotherapy, then we can come on board as a phase 3 site, and so all we need to do to demonstrate that is just run a very small pilot feasibility study. And so that’s what we’re working on at the moment.”

Getting Australia on board means we will be able to access psychedelic psychotherapies and won’t be left behind.

“Hundreds of thousands of Australians will no longer needlessly suffer from depression. We'll see less suicides occurring among war veterans,” said Stephen. “Australians won’t need to travel overseas to access these treatments because we will have clinics and trained therapists available in Australia who can provide these therapies.”

So it’s probably time that Australia had an epiphany and took psychedelic science a little more seriously.

https://particle.scitech.org.au/peop...psychotherapy/​

 

[mr peabody]

Eduado Schenberg

Psychedelic-Assisted Psychotherapy: A paradigm shift in psychiatric R&D

by Eduardo Schenberg | 5 Jul 2018

Mental disorders are rising while development of novel psychiatric medications is declining. This stall in innovation has also been linked with intense debates on the current diagnostics and explanations for mental disorders, together constituting a paradigmatic crisis. A radical innovation is psychedelic-assisted psychotherapy (PAP): professionally supervised use of ketamine, MDMA, psilocybin, LSD and ibogaine as part of elaborated psychotherapy programs. Clinical results so far have shown safety and efficacy, even for “treatment resistant” conditions, and thus deserve increasing attention from medical, psychological and psychiatric professionals. But more than novel treatments, the PAP model also has important consequences for the diagnostics and explanation axis of the psychiatric crisis, challenging the discrete nosological entities and advancing novel explanations for mental disorders and their treatment, in a model considerate of social and cultural factors, including adversities, trauma, and the therapeutic potential of some non-ordinary states of consciousness.

The current psychiatric crisis

Mental disorders increasingly contribute to the global burden of disease, with huge socio-economic costs. However, research and development in psychopharmacology—psychiatry's primary mode of intervention—came to a halt in 2010. Approval of new molecular entities for psychiatric conditions by the US Food and Drug Administration (FDA) fell from 13 in 1996 to one in 2016, with 49 approved between 1996 and 2006 and 22 from 2007 to 20161 In pharmacology conferences in the period, just about 5% of presentations were dedicated to human studies involving drugs with novel mechanisms of action. These occurrences are part of a complex picture clearly dissected as a triple crisis in psychiatry: of therapeutics, diagnostics and explanation.

Problems surrounding psychiatric diagnosis also surfaced in 2010, when the UK Medical Research Council published a strategy for mental health and wellbeing and the US National Institute for Mental Health (NIMH) launched its Research Domain Criterion (RDoC). It proposed five domains based on specific neural systems that can be impaired in mental illness, a radical departure from the hundreds of discrete conceptual disorders of the much older Diagnostic and Statistical Manual (DSM). Thus, the RDoC advanced a multidimensional approach to diagnosing mental disorders in a continuous spectra. At around the same time, a network psychopathology perspective was conceptualized and empirically assessed with statistical models for psychometrics based on thousands of patient reports' and hundreds of symptoms.

The treatment and diagnostic axes of the crisis are connected by the explanatory domain: despite huge investment in neuroscience as the ultimate source for understanding mental illness, both classification and diagnosis as well as knowledge about pathogenesis and etiology still faces many challenges. The explanatory debate about mental disorders is summarized by the contrasting declarations that “mental disorders are brain disorders,” or that psychiatry runs the risk of “losing the psyche.”

Clinical developments with psychedelics

Synthetic substances like LSD, MDMA, Ketamine, and naturally occurring alkaloids including Psilocybin, and Ibogaine have been used in a series of studies as well as Phase 2 clinical trials (Table 1). These substances are orally active but have different mechanisms of action. LSD and psilocybin effects' critically depend on 5-HT2A agonism, MDMA inhibits monoamine transporters, especially for serotonin, while ketamine is an NMDA antagonist and ibogaine non-specifically binds to many receptors.

The most studied is ketamine, which in higher doses is an anesthetic in use for decades. In lower dosages it temporarily modify consciousness including changes in mood and cognition. It is the experimental intervention in almost 70 Phase 2 trials for psychiatric disorders and two Phase 3 trials for depression. Protocols involve single or repeated administrations in different doses, routes of delivery and research designs. Most are for depressive disorders, but is also studied for Obsessive-Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), suicide, alcohol, and cocaine use disorders. Nine meta-analysis from depression trials show low frequency of serious adverse events in the short term, with short-term positive outcomes for a significant proportion of patients.

MDMA is investigated in 17 Phase 2 trials and was designated a breakthrough therapy for PTSD by the FDA, a status that can expedite approval. Also studied for social anxiety in autistic adults, existential anxiety and alcohol use disorder, MDMA is commonly confused with the street drug “ecstasy.” However, these illegal products frequently do not contain MDMA, only adulterants. This loose terminology creates unfortunate confusion about MDMA's safety. In research with healthy volunteers, occurrences of hypertension, tachycardia and hyperthermia are below 1/3 of cases, not leading to serious adverse events. In clinical populations, serious adverse events were very rare, with only one brief and self-limiting case of increased ventricular extrasystoles in more than 1,260 sessions. Therapeutic results obtained with severe, treatment-resistant PTSD patients in Phase 2 studies were considered “spectacular,” with approximately 70% or more of participants no longer qualifying for the diagnosis after 12 months, while the remainder third had less intense symptoms. Furthermore, the improvements lasted up to 4 years, mostly without additional treatments and without inducing drug abuse or dependence. An independent preliminary meta-analysis found MDMA-assisted psychotherapy was superior to prolonged exposure when evaluated by clinician-observed outcomes, by patient self-report outcomes and also by drop-outs.

Psilocybin is the third most studied psychedelic substance for clinical applications. It has a very high safety ratio and very low risk profile even in unsupervised settings. It is orally administered in eight trials for major depression, cigarettes, alcohol, and cocaine use disorders and existential anxiety in life-threatening diseases, mostly cancer. Despite moderately increasing blood pressure and inducing transient headaches, it has been safely administered to more than a 100 volunteers in neuroscientific research and another 100 in clinical studies with notable results.

LSD, the most potent psychedelic currently administered in clinical trials, has very slow dissociation kinetics at the human 5-HT2A receptor and thus long lasting effects. It has a very high safety ratio, and is not associated with major health impairments after unsupervised use. It is the active substance in just two recent Phase 2 trials for existential anxiety in the terminally ill. This paucity is perhaps due to stigma surrounding large-scale recreational use since the 1960's, with considerable political implications. However, before political turmoil, more than a 1,000 studies including 40,000 patients were done, mostly showing positive potentials. LSD was thus the prototypical substance in the development of radically new forms of psychotherapy, including psychedelic-assisted psychotherapy, and another approach based on repeated low doses (10 to 50 μg) to potentiate psychoanalysis, known as psycholytic psychoherapy. Despite the paucity of recent trials, a recent meta-analysis with rigorous research from 60 years ago confirmed LSD also has important potential for alcohol use disorders.

Finally, ibogaine is the less advanced psychedelic in the development pipeline, with no interventional clinical trials executed or registered since the National Institute on Drug Abuse (NIDA) cancelled efforts to develop this compound to treat opioid addiction in the 1990's. And indeed there are important safety concerns, given ibogaine can prolong QT interval, potentially evolving to fatal cardiac arrhythmias. This critically differentiates ibogaine's safety profile from other psychedelics. However, given the seriousness of drug addiction and the difficulty to treat these patients, observational and retrospective studies for opioid and psychostimulant addiction reporting considerable success suggests Phase 2 trials focusing on cardiac safety should be performed. Given ibogaine is unscheduled in many countries and currently used as an alternative treatment with an unfortunate series of fatalities, financial support is needed.

Psychedelic-assisted psychotherapy (PAP)

Safeguarded important differences regarding safety and mechanisms of action, the grouping of these substances in a prototypical PAP model has important practical and theoretical implications. The main feature is the therapeutic use of a potent psychoactive substance (currently most are scheduled compounds) in very few sessions. These are generally accompanied by drug-free sessions before and/or after drug sessions, usually called preparatory and integrative psychotherapy, respectively. With ketamine positive results were obtained with one to 12 administrations, with MDMA just three and with psilocybin and LSD only two, while ibogaine may be effective after a single administration. During drug effects, patients are continuously monitored and supported by trained mental health professionals following available guidelines. Generally patients listen to instrumental evocative music, and are encouraged to stay introspective and open to feelings, attentive to thoughts and memories, being free to engage in psychotherapy at any time. Frequency and type of psychotherapeutic interventions varied from a minimum in ketamine studies, sometimes including only music during drug effects, to a more intensive protocol with MDMA including 12 non-drug sessions, which follow a detailed manual based on non-directive transpersonal psychology. Between these two ends of the spectrum are psilocybin, LSD and ibogaine studies, which used a variety of interventions. Psilocybin studies used psychological support comprised of non-directive preparation, support and integration in few non-drug sessions. LSD included three post-drug integrative sessions. Ibogaine, used in different clinics for drug dependence, included a series of more or less standardized psychotherapies for addiction, pre- and post-drug, like 12-steps, individual and group counseling, among others. Increasing focus on types and frequency of psychotherapeutic interventions can arguably help improve outcomes, as exemplified by older ketamine studies with existentially oriented psychotherapy for drug addiction, and as recently tested with cognitive behavioral therapy for relapse prevention after ketamine for depression. As results from most trials reliably show, PAP can be more effective and faster than current treatments, even for patients considered “treatment resistant.” And these outcomes were not only statistically significant but had large effect sizes, which is encouraging for Phase 3 trials.

Beyond potential novel treatments, PAP has important practical and theoretical consequences for the three axes of the crisis. The combination of psychotherapy with psychedelics can be conceptualized as the induction of an experience with positive long-term mental health consequences, rather than daily neurochemical corrections in brain dysfunctions. Thus, a comprehensive understanding of PAP suggests a conceptual expansion of “drug efficacy” to “experience efficacy4” Instead of conceiving the drug as correcting functional imbalances in the brain through a specific receptor, PAP is a treatment modality in which specific pharmacological actions temporally induce modifications in brain functioning and conscious experience. When appropriately mediated, these can be deeply meaningful experiences that elicit the emotional, cognitive and behavioral changes reported. Attempts to develop ketamine and ibogaine analogs devoid of the subjective “psychedelic” effects, e.g., lanicemine and 18-MC, will further illuminate this question. However, available therapeutic results for depression with ketamine analogs with less dissociative effects were only modest, while ketamine administration without preparatory psychotherapy and music support recently resulted in an interrupted trial. Furthermore, positive correlations between subjective features like ketamine's dissociative effects or psilocybin peak-experience with positive treatment outcomes in depression corroborates the notion that the meanings of the psychedelic experience plays an important role in therapeutic outcomes.

It is thus very hard to strictly reduce PAP to neuropharmacology. In this sense, PAP can benefit from potentially rich interactions with other fields like psychodynamic psychotherapy. Furthermore, PAP can help solve many pressing safety concerns in current psychopharmacological treatments by bridging a current gap in knowledge between research and clinical practice. This gap is created because psychiatric clinical trials rarely last longer than 6 months, while the products approved based on these trials are later prescribed for chronic daily use for years, sometimes decades. Many current adverse consequences from the use of psychiatric prescription medications arise from this gap, including decreasing drug adherence over time, toxicity from increasing polypharmacy, addiction to prescribed medications causing severe withdrawal symptoms, and a plethora of side effects arising after prolonged daily drug use, e.g., weight changes, stomach pains, constipation, mood swings, confusion, abnormal thoughts, delusions, memory loss, restlessness, akathisia, tardive dyskinesia, sexual dysfunction, anxiety, dizziness, sleep problems, and even suicidal ideas. By administering medications only under supervision, PAP can reduce or even eliminate drug adherence problems and polypharmacy. By administering psychoactive drugs just a few times, PAP can prevent addiction and the development of side effects after chronic use of medications. And by exclusively licensing psychedelics for especially licensed therapists and physicians, rather than prescription and dispensation to patients, PAP can reduce risks of diversion and abuse. Considered together, these PAP features can arguably help reduce psychiatry's alarmingly high-rate of post-market safety events, reported at more than 60% after 10 years.

Besides critical consequences for the therapeutic axis, PAP is also relevant for diagnostic concerns. The fact that ketamine and psilocybin, substances with radically different pharmacological mechanisms of action, can induce positive outcomes in a single disorder, like depression; or that a single substance like psilocybin can be used to treat different disorders, like depression or drug dependence, challenges nosologies which discriminate disorders in mutually-exclusive categories. Thus, PAP supports a multidimensional spectra. However, proposals such as the RDoC were criticized by its biomedical reductionism, while psychedelic research recognize the concept of set and setting as crucial for the results obtained with these treatments. Set includes circumstances and factors other than drug and pharmacological targets, including people's beliefs, attitudes, preferences, choices and motivations. Setting refers to environment, context, therapists, supporting team etc. Thus, PAP supports other conceptually richer diagnostic approaches considerate of biopsychosocial factors.

This does not imply that neuroscience is not fundamental to understanding PAP and its consequences for psychiatric research and development. On the contrary. Current limitations of neuroimaging in psychiatry include long-term confounders like smoking, weight and metabolic variations, and low prognostic accuracy and predictive validity. By developing faster treatments and bridging the gap between research and clinical practice, PAP can allow the use of within-subject designs in shorter time spans, reducing the impact of confounders and improving reliability of neuroimaging data. Thus, confidence in translating results from acute psychedelic neuroimaging to clinical applications which will more closely resemble research designs is increased.

Finally, detailed study of the subjective aspects of PAP has enormous consequences for the explanatory axis. Recent qualitative and phenomenological research shows that psychedelic experiences involve meaningful autobiographical and social psychological concerns. Therefore, PAP can deepen understanding of which psychological contents of the therapeutic experience are most relevant for treatment outcomes. This can not only foster improvements in PAP but corroborates the importance of biopsychosocial aspects in psychiatric explanations. A rich methodological integration can help develop theoretical constructs that are not excessively reductionistic. Thus, PAP can conceptually enrich psychiatric explanations for mental disorders and their treatment. If neglect, trauma, childhood adversities, poverty, abuse, and deprivation—i.e., mental injuries—can have lasting negative consequences for mental health, it is also logically plausible that positive, cathartic experiences, sometimes of the mystical type, reliably achieved in PAP, can induce long lasting positive mental health outcomes. Indeed, in the 1950's and 60's, before drug scheduling and cessation of clinical studies with psychedelics, and before neuroscience took central stage in psychiatric understanding of mental disorders, pioneer psychiatrists like Stanislav Grof and Sidney Cohen already questioned the fundamental theoretical grounds of mental disorders. Based on theirs' and others' experiences in non-ordinary states of consciousness with positive therapeutic outcomes (termed “holotropic” and “unsane,” respectively), they made radical theoretical proposals that can still be relevant to psychiatry, as it was for psychology. It is thus possible that instead of brain dysfunctions causing discrete disorders treated with specific drugs, psychiatry can conceptualize mental injuries causing suffering that can be optimally treated with holistic approaches, including those which modulate the state of consciousness. This can greatly contribute to the understanding of how social circumstances and adverse life experiences shape mental health and brain activity, and how meaningful treatment experiences foster resilience.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041963/​

 

[mr peabody]

Trials of Psychedelic Therapy

by Matthew Oram | Johns Hopkins | 4 Oct 2018

When I began exploring the history of LSD psychotherapy research in 2008, I had little idea that the momentum was in fact building on a new era of psychedelic research. In the 1950s and 60s, researchers reported impressive results using LSD in conjunction with psychotherapy to treat a range of psychiatric conditions, and an astounding 50% success rate treating chronic, treatment-resistant alcoholics. From my initial research, two narratives quickly emerged explaining the drug’s medical downfall: either LSD’s significant therapeutic potential fell victim the moral panic and government crackdown following its rising recreational use in the 1960s, or, by contrast, that the research had had little scientific rigor, had since been largely debunked, and had been spearheaded by enthusiasts such as Timothy Leary whose objectivity was significantly skewed by their own use of the drug.

The new era of research, underway at prominent institutions including Johns Hopkins University, New York University, and the University of New Mexico, has largely picked up from where the previous era left off, exploring the effectiveness of the same treatment methods developed in the 1950s and 1960s. This research has therefore naturally been in close conversation with the past, as researchers attempt to avoid the pitfalls of the previous era. The primary focus has been on addressing the perceived lack of scientific rigor in past studies, which stemmed from studies being cut short by LSD’s prohibition before they reached scientific maturity. Now that the dust of the 1960s has settled, promising treatment approaches can be revisited, and given a more sober, rigorous evaluation through the modern controlled clinical trial methods required by the Food and Drug Administration.

In this way, the common historical narratives of LSD psychotherapy’s decline provides a clear path for modern scientists. Yet as I explored more deeply the regulation of LSD research in the 1960s and the fate of the studies of that era, elements of the common narrative began to come apart. Although I initially approached the topic convinced that government interference had terminated research, I struggled to find evidence that any legislation prohibiting the non-medical use of psychedelics significantly restricted medical research. Instead, I found that government agencies had actively supported research for much longer than had been recognized: to my great surprise, in FDA files I discovered that in 1966, when LSD’s manufacturer, Sandoz Pharmaceuticals, withdrew its sponsorship of research in response to the increasing controversy surrounding the drug—which had already lead to its partial criminalization—the FDA, National Institute of Mental Health, and Veterans Administration had stepped to in ensure legitimate research continued. At this point, had these agencies not acted, all LSD research would have ended. Instead, although it declined over the 1960s, limited but significant studies continued into the mid-1970s.

Secondly, looking more closely at the later clinical research with LSD showed that research methods evolved considerably over the 1950s-70s and largely reflected the evolving state-of-the-art. As well as a period of social and cultural upheaval, the 1960s saw a significant transformation of pharmaceutical research and development, with the passage of legislation that introduced FDA oversight of clinical research and the need to provide proof of drug effectiveness for FDA approval. While small uncontrolled studies had indeed characterized the LSD research of the 1950s, this was common for drug research in this era. In the 1960s researchers attempted to follow-up these studies with larger, and often sophisticated, controlled clinical trials. So neither prohibition nor a lack of scientific rigor seemed to explain the disappearance of LSD psychotherapy from psychiatry.

However, comparing the research and treatment techniques employed in the later studies revealed the challenges of demonstrating the effectiveness of LSD psychotherapy through the controlled trial methods required by the FDA: blind administration could not effectively be maintained, and the incorporation of significant psychotherapy was unconventional for drug treatments and complicated efforts to establish objectively comparable control conditions. As researchers attempted to overcome these hurdles, some altered the treatment techniques of those earlier researchers who had claimed remarkable results in order to establish a more standardized and easily testable treatment. This influenced often negative or lackluster results. Ultimately, I found that LSD psychotherapy’s decline was due less to prohibition than to the growing disinterest of the psychiatric community in a drug that had apparently failed to live up to the hype.

The history of LSD psychotherapy I discovered was therefore ultimately one of an unconventional but highly promising treatment that did not fit within an increasingly rigid model of pharmaceutical research and development. Rather than dominated by controversial figures such as Leary, little-known researchers such as Charles Savage and Albert Kurland persevered through the 1960s and 70s at a far remove from the counterculture and continued to publish their studies in leading psychiatric journals. Yet they struggled to design studies that would allow them to uphold both the integrity of their treatment and the scientific standards expected by the FDA and wider scientific community. From this perspective, the lessons that can be gleaned from the history of LSD psychotherapy become more complex, revealing scientific and regulatory challenges that remain for contemporary researchers and that have wide implications for American medicine and psychiatry.

https://www.press.jhu.edu/news/blog/trials-psychedelic-therapy​

 

[mr peabody]

Set and setting in psychedelic-assisted psychotherapy

Chacruna | 13 Dec 2018

If someone had told us a few years ago we would be legally using MDMA and ketamine in psychotherapy, we’d have laughed at the notion as impossible. However, while highly implausible to imagine it only a few years back, this is where our professional development has taken us. We are currently working as psychedelic therapists in the roles of facilitators, caretakers, midwives, and witnesses, helping individuals to reconnect with, process, and resolve past traumas and alleviate symptoms of severe anxiety and depression. It seems we are indeed successfully treating their otherwise intractable treatment-resistant symptoms with the aid of psychedelic catalysts.

To the extent that we, as therapists, have explored our own inner terrain, we also act as ambassadors to these same, hitherto neglected or forgotten inner realms within our patients. It is a common view in the psychoanalytic community that “the symptom” is an expression of threatening or unmanageable psychic material that has been pushed into the unconscious, so that it is unprocessed, un-metabolized, even unknown. What if our responsibility as therapists to facilitate access to these uncharted subterranean catacombs can be catalyzed, indeed expedited, by psychedelic medicines to more efficiently bring repressed material into the light of conscious awareness? If that is the case, then not using these tools, at least in some cases, would be a disservice to our patients and to the search for truth.

Set – short for “mindset”

The patients’ set involves their current state of mind, mood, attitude, interpersonal or professional concerns, beliefs about psychedelic medicines, and expectations about the specific therapeutic session. As therapists, we also must consider our own set, and its influence on the patient and treatment. Our set involves our own current frame of mind, mood, outside concerns, and hopes for the session and the treatment as a whole.

The broader socio-cultural values and perceptions need to be also carefully considered as influences on the patient’s set: their “social set.” What are the collective social beliefs, cultural values, and stigmas regarding psychedelic use? How do their friends, family, and loved ones perceive the use of psychedelics in general and in treatment? We recognize that these collective perceptions, expectations, judgments, and fears play an important role in how the patient anticipates and interprets the work.

We strive to be mindful that every phone contact, email, and in-person meeting will naturally influence our patient’s perception (i.e., his or her set) far in advance of a session with the medicine. The essential foundation of the patient’s set is their well-informed understanding of all aspects of the treatment. Following the intake, they should have a good sense of the specific rationale for the chosen treatment protocol, dosage strategies, common physiological and psychological effects and duration of the medicine(s), the typical stages and progression of a psychedelic journey, and all known risks and benefits of the treatment. Patients are informed about their right to discontinue treatment at any time for any reason. Side effects, possible use of emergency and support medicines, if needed, and alternative treatment options are also discussed. In preparation for a psychedelic session, we try to cultivate a trust in the process, understanding that it may not be linear or predictable and may come with unexpected twists and turns.

In these preparatory sessions, the intentions and motivations of the seeker are explored and openly examined. What multiple factors have brought them to the point of consider taking a mind-altering substance in treatment? What are they hoping to get out of the treatment? Where are they in their process of psychospiritual development? Sincere and uninhibited self-inquiry is encouraged to identify patterns of thinking, feelings and behaviors that are reinforcing their dis-ease. We endeavor to support and facilitate the freedom of the “traveler” to go wherever he or she wishes and make meaning of and understand their symptoms, with the ultimate goal of liberating themselves from the shackles of old, rigid, fear-based beliefs and dictates.

Trusting the patient’s inner healing intelligence

Perhaps the most important core principle in the work is encouraging patients to trust the medicine and their own inner healing intelligence. This concept and its implications are elucidated in the MDMA study treatment manual: “It is essential to encourage the participant to trust their inner healing intelligence, which is a person’s innate capacity to heal the wounds of trauma. It is important to highlight the fact that the participant is the source of their own healing. The [medicine] and the therapists are likely to facilitate access to a deep healing process, but they are not the source of this healing process.” We trust that our patients’ natural ability to heal, along with a sincere desire for healing, will guide them to the material that needs attention, processing, and integration.

Because the inner healing intelligence goes to where it is needed, the healing process not only involves letting go, on both the part of the client and the therapist, but also trusting that any challenging material that arises is “coming up for healing.” There is a well-known maxim in our field: There are no bad trips, only challenging ones. The healing process is not about avoiding challenges but rather engaging with them in new ways, and discovering a more expansive, harmonious, accepting, empathic, and loving way of relating to them. In fact, Myron Stolaroff, an influential pioneer of psychedelic psychology, felt the most significant transformational healing and growth resulted from encountering dark thoughts and emotions, and unresolved fears and trauma during a psychedelic session. Challenging experiences can be incredibly valuable and important, sometimes even essential, to the journey towards wholeness.

Setting in psychedelic-assisted psychotherapy

The setting, at its most concrete, is the physical space where the experiential session takes place. At our ketamine psychotherapy clinic, Polaris Insight Center, we do our best to make the setting cozy and comfortable and to minimize outside distractions and disruptions. The room’s decorations are carefully chosen to create a welcoming ambiance that is aesthetically appealing, simply adorned, and not overwhelming in any manner. We try to avoid using trappings of a traditional institutional, medical, or clinical environment. Instead, we strive to curate a familiar, living-room-like setting conducive to relaxation and surrender. These conditions create an optimal space for the patient to let go and for the journey to unfold and flow of its own accord.

More subtly, considerations of setting include various environmental influences on the patient and the process. For example, the setting of a therapy suite in San Francisco will have a different impact on the experience than that of a therapy center in the mountains of Colorado. A psychedelic psychotherapist must keep in mind how the larger socio-cultural context might impact the psychedelic experience.

Music as part of setting

Music plays an important role in our work. It provides a container for the patient’s emotional processing while guiding the forward movement of the journey. Stanislav Grof describes the role of music as creating “…a continuous carrier wave that helps patients to overcome difficult parts of the sessions and move through impasses”. Furthermore, the practice of listening to music puts the listener into a more receptive, meditative state, which, in turn, facilitates the process of letting go; an important component of the psychedelic experience.

Thoughtful care is put into curating specialized playlists with the intention of taking the listener on an ultimately uplifting and healing journey. Playlists are arranged to mirror the drug effects. In our work with MDMA, atmospheric ambient tracks are used for the come-up period, faster and more emotionally evocative tracks are played during the peak, and tender heart-opening pieces are selected for the come-down period. In ketamine sessions, more spacious, textured ambient electronic tracks are used. As the participant’s journey unfolds, the music fosters emotional openness for connecting or reconnecting with old memories and deep emotions of sadness, grief, surrender, joy, and love. Some samples of playlists curated specifically for psychedelic journeys can be found at Chacruna’s Psychedelic Therapy Music Forum.

Planning for integration as a part of set and setting

The integration process in the days and weeks following the psychedelic experience is important to consolidate the insights gained during the journey and implement changes in one’s life. During this period, we help patients find words for their experiences, unpack insights, and develop new personal narratives. We further discuss strategies and practices to retain and actualize this new knowledge. These sessions tend to involve a more directive approach where we suggest specific techniques (e.g., journaling, drawing, listening to music, dancing, meditation, connection with nature). The questions we pose to the patient during this period support these efforts: In what ways, if any, have your psychedelic sessions shifted how you see and understand yourself now? How has it informed your view of reality, your role in it and your understanding of your life’s journey? Has it changed your relationships, motivations, self-criticisms, and criticisms of others?

Training and approach of psychedelic psychotherapists

To be effective in the role of psychedelic psychotherapist, we believe well-trained therapists should have some familiarity with, and experience navigating, non-ordinary states of consciousness (NOSC). This preparation may involve therapists having their own personal experiences with psychedelic-assisted therapy, or alternatively, having non-drug NOSC experiences such as with floatation tanks, immersive meditation retreats, or holotropic breathwork. However, we feel strongly that, without direct experience of the psychedelic-assisted therapy, the therapist will be less prepared to navigate the terrain of NOSC in psychotherapy. One of our colleagues captured this idea in a colorful metaphor: If you’re climbing Mount Everest, you would want to know that your sherpas have climbed it before, are familiar with characteristic challenges of the terrain, and are acquainted with the particularly scenic routes and viewpoints along the way.

In training psychedelic therapists, we want to cultivate a professional ethic of mindfulness and patience, as we carefully tend and till the soil of patients’ psyches in preparation for the harvest. This approach inevitably involves a good amount of waiting and not-doing. The apprentice gardener may earnestly believe that more directive interventions will lead to more growth. However, each patient’s path is unique, and the healing process is best served when the therapist is able to trust the process and put aside their own plans, expectations, and judgments.

Recommendations for further education and training

Dr. Janis Phelps, Director of the Center for Psychedelic Therapies and Research at the California Institute of Integral Studies, has developed a set of best practices to achieve optimal outcomes in psychedelic therapy.4 Among the core competencies of psychedelic therapists are empathetic abiding presence, trust enhancement, knowledge of the physical and psychological effects of psychedelics, and therapist self-awareness and ethical integrity. Her recently published article in the Journal for Humanistic Psychology is highly recommended for further reading on this subject.

Furthermore, for those interested in more formal training in psychedelic-assisted psychotherapy, we recommend the following programs:​

• MAPS: MDMA-Assisted Psychotherapy Training Program​
• CIIS: Certificate in Psychedelic-Assisted Therapies​
• The Center for Transformational Psychotherapy: Phil Wolfson, MD and Julane Andries, LMFT​
• Kriya Institute: Raquel Bennett, PsyD​
• Grof Transpersonal Training​
• ZENDO Project​

https://chacruna.net/ambassadors-to...etting-in-psychedelic-assisted-psychotherapy/​

 

[mr peabody]

Everything you need to know about psychedelic-assisted therapy

by Donovan Alexander | Interesting Engineering | Sep 13 2019

Psychedelic-assisted therapy is currently getting more and more attention from the scientific community.

The world of psychedelics is exciting, to say the least. As we mentioned in our previous article, newly rekindled scientific research in the world of psychedelics have brought them to the forefront of cultural discussion and debate.

Even just recently, John Hopkins Medicine received $17 million from donors to open a new center purely devoted to psychedelic research.

So, you are probably wondering why there is all this interest in these mind-bending drugs? More and more researchers are pointing to the potential therapeutic benefits of psychedelics.

Even more so, some of these psychedelics potentially hold the promise of treating psychiatric disorders ranging from PTSD to depression. However, there are still a lot of questions to be answered.

The recent scientific interest in these drugs coincides with the underlying interest in mental health. However, it is good to mention that a lot of commonly used psychedelics were once used for treating mental illnesses decades prior to them becoming illegal.

We are going to break down everything you need to know about psychedelics and therapy, and the coming age of psychedelic science.

Introducing psychedelic-assisted therapy

Before we go on our “trip,” it is good to mention that psychedelic-assisted therapy is not where you scarf down a whole bunch of magic mushrooms and hope for the best.

Psychedelics are dangerous, as you can never truly predict how you or your mind may react to the experience, with some experiences exacerbating any existing mental health problems.

Psychedelic-assisted therapy does refer to therapeutic practices that involve the ingestion of a psychedelic drug. However, this is usually in a controlled and safe environment with a therapist present.



In clinical trials, psychedelic therapy is often broken down into 2-3 sessions, with each session lasting around eight hours. However, these sessions are not done back to back, as most researchers or therapists like to space out each session, keeping them about a month apart.

Trials begin with participants talking and building trust with their therapists before taking any drugs. Preparation may also include taking a complete medical history questionnaire and providing information about the study drug. Once the patient has taken a controlled dose of the drug, the process is relatively simple. Participants might be given an eye-shade or headphones while they are “tripping” and talk to their therapists about how they feel.

What psychedelics are used?

Many of the most common psychedelics have attracted the interests of scientists to treat a wide array of mental health issues. Psilocybin has taken center stage, along with other well-known psychedelics like MDMA and or LSD.

A lesser-known substance, ayahuasca, is also becoming more popular in the west. This is a traditional Native American drink made from the Banisteriopsis caapi plant, along with other plants. The drink has been used in indigenous cultures for thousands of years and has more recently become a tool for treating people in psychotherapy centers in Latin America.

What mental illnesses are being treated with psychedelics?

In short, in a controlled and safe environment, psychedelic treatments have been shown sometimes to produce a positive and even lasting behavioral change.

Psychedelic treatments have been shown to have an effect in combating addiction, anxiety related to terminal illness, chronic PTSD, depression, obsessive-compulsive disorder, and social anxiety.



Let’s dive a little deeper.

In a study on using psilocybin to treat anxiety-related to terminal illness, published in the Journal of Psychopharmacology in 2016, researchers stated: “High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism.”

“At 6-month follow-up, these changes were sustained, with about 80% of participants continuing to show clinically significant decreases in depressed mood and anxiety.”

Another study, published in the Journal of Psychopharmacology in 2012, highlighted how LSD and psilocybin could potentially be used to treat alcohol dependence. Psychedelic therapy has also been linked to the treatment of other mental health issues, including social media addiction.

Other studies have highlighted how MDMA-assisted psychotherapy could be used to help people suffering from various forms of PTSD.

Finally, researchers are excited about psilocybin, as it has consistently shown the potential to help treat people with depression.

What is microdosing?

Now, when discussing psychedelics, you have probably heard the term micro-dosing thrown around. It has actually become a major trend among Silicon Valley tech workers searching for ways to improve their productivity.

Micro-dosing refers to the ingestion of very small doses of certain psychoactive drugs, most often LSD, psilocybin, or cannabis. Micro-doses are known as 'sub-perceptual' and are usually around one-tenth of a normal dose. Such a tiny amount is taken that users often do not feel any of the traditional psychedelic effects at all.

In short, the aim of micro-dosing is to trigger a drug’s therapeutic benefits, such as increased creativity or improved mood, without the potentially disruptive effects seen at higher doses, such as hallucinations or dissociation. There are already countless anecdotal testaments to people becoming more productive and changing their lives for the better.



Nevertheless, there is not much science on micro-dosing at the moment. More controlled trials are needed. Some animal studies have also identified potentially negative effects with micro-dosing, such as metabolism that slowed after use, which needs more investigation.

Where can I go for psychedelic-assisted therapy?

Unfortunately, you can not just walk down the street and look for a psychedelic-assisted therapy center. Nevertheless, some of the psychedelics on this list are on the path to being decriminalized, at least for medical uses, around the world.

Because research is highlighting that they do more good than harm, we may see therapies brought into the mainstream. There are places in Jamaica, the Netherlands, and in Latin America that offer psychedelic-assisted therapy. The other way to try out psychedelic-assisted therapy is through becoming part of a clinical trial at a place like the new Johns Hopkins center.

Everything You Need to Know about Psychedelic-Assisted Therapy

Psychedelic-assisted therapy is currently getting more and more attention from the scientific community.

interestingengineering.com

 

[mr peabody]

Treating mental disorders with psychedelic psychotherapy

by Cahli Samata | Medical Xpress | 10 Oct 2018

Millions of Australians suffer from a myriad of mental health issues. Depression, PTSD and addiction to name a few. But what if we could help them by trying something a little trippy?

Every day in Australia, more than eight people die by suicide. Millions more suffer mental health issues. We have treatments available, but in Australia, we're missing out on therapies that are showing great promise in other parts of the world.

Why? Because they use psychedelic drugs.

Psychedelic drugs and mental health issues may sound like a terrible combination—and it can be in the wrong setting.

But increasing evidence suggests that using controlled portions of these drugs with trained psychotherapists could help people overcome several mental health disorders.

Even healthy people might be able to benefit in the future.

Dr. Stephen Bright is Senior Lecturer of Addiction at Edith Cowan University (ECU) and Vice President of Psychedelic Research in Science and Medicine (PRISM). He's hoping to bust the myths about psychedelic drugs and push through the politics so that Australians may one day benefit from these potentially life-saving therapies.

What is psychedelic psychotherapy?

First, let's cover the basics.

Psychedelic psychotherapy involves using small amounts of psychedelic drugs in a controlled, clinical setting with trained psychotherapists. There are different drugs used for different purposes, but some of the main ones are psilocybin (magic mushrooms), LSD and MDMA (also called ecstasy). The drugs used in this type of therapy aren't like ones you'll find on the street. They are pharmaceutical grade, meaning you know the exact dose and what's in it.

All psychotherapies aim to help patients overcome a problem or make a positive change to their life—usually by facing it head on.

Take post-traumatic stress disorder for example. Someone with PTSD may avoid thinking about the bad experience they had. In psychotherapy, the therapist will actually direct them towards facing that bad experience to help them to work through it.

Adding psychedelic drugs to the mix generally helps patients get there faster. The therapists 'hold the space', allowing the patient to mostly guide the session. The therapists will usually only need to intervene if the patient is avoiding facing their issues or bad feelings.

"It neverfails to amaze me how much spontaneous insight people gain in the MDMA sessions. It would take 10+ weeks of normal psychotherapy to guide a person to the insights that the patient spontaneously come up with while on MDMA," Stephen said.

Stephen explains that this is a technique he often used while 'trip sitting' at festivals.

"The further they push against [the bad feelings], the worse their experience becomes. So we try to talk to them about what they're experiencing and allow them to approach it and work through it rather than avoid it, and doing so seems to have a therapeutic response."

But patients aren't thrown in the deep end like someone having a difficult trip at a festival. Psychedelic therapy involves planning and preparation.

The preparatory sessions are thorough, so the patient knows exactly what they need to do and therapists know how best to support them.

"The person is fully prepared beforehand for what they're going to experience, and they have some coping strategies."

A mystical experience

So what is it about psychedelic drugs that patients find therapeutic?

Neurologically, we're not sure. But Stephen said the secret often lies in the mystical experience you can have on psychedelic drugs. It's difficult to explain, but it's a spiritual sense of oneness. Kind of like having an epiphany. The mystical experience usually happens with the more psychedelic drugs like psilocybin, rather than MDMA.

A study at New York University found that patients with life-threatening cancer who had this mystical experience from psilocybin psychotherapy had improved quality of life and decreased depression and anxiety. This has huge implications for palliative care.

"That spiritual experience seems to be the catalyst in allowing them to come to terms with their situation," Stephen explains.

But this isn't exactly a new discovery. The co-founder of Alcoholics Anonymous, Bill Wilson, said the spiritual awakening he experienced on LSD is what started his own sobriety.

"The problem is spiritual experiences are hard to create but we know, with psychedelics, we can induce these mystical experiences in a clinical setting in the right context with the right trained therapists involved," said Stephen.

This is why research has also looked into psychedelic psychotherapy as a treatment for addictions like smoking. One study found that psilocybin psychotherapy helped people quit smoking, with 60% still smoking-abstinent after 12 months.

"That's remarkable when you consider Champix—which is the leading pharmacotherapy for nicotine cessation—that has a success rate of 21% at 12 months," said Stephen.

"Subjects in this study reported that this mystical experience that's induced by the psilocybin is ranked as one of the top five most significant experiences of their life."

Your brain on psychedelics

Not only has this therapy shown good results in PTSD, palliative care and addiction, it's also being looked at as a treatment for depression because of the effect it has on the brain.

"Another area that's in its infancy is psilocybin and depression. There's been an open label study published by Imperial College in London among people who hadn't responded to other treatments for depression. They found a number gained significant benefits from psilocybin-assisted psychotherapy".

In this study, they also took a look at what was going on in the brain of patients with neuroimaging. Using this, they found a change in the brain was linked to a reduction of depressive symptoms.

It turns out psilocybin can temporarily switch off a part of the brain called the default mode network, which correlated with patients having that mystical experience.

"The Default Mode Network is a series of interconnected neural pathways. It's activated all the time when we're in a waking state. It allows you and me to have this conversation at the moment because we can concentrate on what we're doing," said Stephen.

"If we turn off the default mode network, we end up with a lot of cross-talk happening within the brain."

"In the context of depression, perhaps having all those different interconnected pathways allows the person to see the world, themselves and others in a completely different perspective."

He likens the default mode network to a conductor in the brain. Turning off the default mode network with psychedelics is like putting the conductor on "paid service leave for 6 to 12 hours". Without the conductor, the orchestra starts playing all kinds of things.

"In that cacophony of noise comes epiphanies."

Inducing everyday epiphanies

If you're like me, by now you're probably thinking you could use an epiphany too. Surely this can't only be useful for mental health disorders?

I asked Stephen to play the hypothetical game of looking into the future and letting me know if there will ever be a day this could be accessed by anyone needing to make a big life decision.

"People can go when they want to engage in some sort of spiritual contemplation or they're not sure about something in their life and they can utilise the psychedelic experience to help them with that."

But before we get there, we have some serious catching up to do.

What's stopping us?

You may have noticed that all the studies referenced in this article have been from the US and the UK. That's because Australia has been seriously lagging behind in psychedelic research.

Stephen said there are a few reasons for this, namely "academic conservatism", which is why I swell with uni pride when Stephen tells me my old stomping ground ECU has thrown their support behind psychedelic science.

"We've been banging our heads against the wall for about 8 or 9 years now, and things are really starting to look quite positive. I don't want to get too optimistic, but things are starting to look really positive," he said.

"The fact that ECU is supportive of it is fantastic."

Stephen's worked in both the policy and scientific spheres to try and get Australia to embrace and get involved in psychedelic research. In particular, he's been leading the charge for MDMA-assisted psychotherapy.

Right now, MAPS is in the process of phase 3 trials for MDMA-assisted psychotherapy for PTSD, after phase 2 yielded promising results.

"What we're hoping in Australia, and what ECU's supporting, is that Perth will be a site for a phase 3 trial," said Stephen.

"If we can demonstrate we have the people and infrastructure to do MDMA-assisted psychotherapy, then we can come on board as a phase 3 site, and so all we need to do to demonstrate that is just run a very small pilot feasibility study. And so that's what we're working on at the moment."

Getting Australia on board means we will be able to access psychedelic psychotherapies and won't be left behind.

"Hundreds of thousands of Australians will no longer needlessly suffer from depression, post-traumatic stress disorder and anxiety associated with dying … we will see less suicides occurring among war veterans," said Stephen.

"Australians won't need to travel overseas to access these treatments because we will have clinics and trained therapists available in Australia who can provide these therapies."

So it's probably time that Australia had an epiphany and took psychedelic science a little more seriously.

https://medicalxpress.com/news/2018-10-mental-disorders-psychedelic-psychotherapy.html​

 

[mr peabody]

How to find psychedelic treatment for your psychological disorder

by Wesley Thoricatha | Psychedelic Times | 28 Apr 2017

Mental health disorders are the elephant in the room of modern day society. An estimated 8.3 million Americans suffer from chronic stress, anxiety, depression, PTSD, and related psychological conditions, and those numbers are on the rise. In addition to that, nearly 24 million Americans are addicted to alcohol or drugs, and even with the best of intentions they face a long struggle and steep odds to get clean and address the underlying issues at the heart of their destructive patterns. The good news is that thanks to a resurgence in the study of psychedelic-assisted therapy, we are on the verge of adopting a whole new set of incredibly powerful medicines that seem to be tailor-made to deal with this epidemic of mental illness and addiction. Psychedelic treatment and psychedelic-assisted therapy are proving to be some of the most potent and successful treatments for addiction and psychological distress that we have ever seen.

How to find treatment

Psychedelic therapy is still illegal in the US, but thanks to the efforts of organizations like the Multidisciplinary Association for Psychedelic Studies (MAPS), psychedelics like MDMA are on track to become a FDA-approved prescription medicine within a few years, and others such as psilocybin may not be far behind. There are some psychedelic-assisted clinical trials happening at prominent hospitals and universities, but the number of participants admitted to these studies are quite low.

Generally speaking, if you want to find psychedelic treatment in the the near future, you will have to travel outside of the US to places like Mexico, Brazil, and Costa Rica. A simple Google search will uncover dozens of psychedelic healing centers around the world, but we strongly recommend speaking with the facilitators and people who have been there to properly investigate and “gut-check” any center. Almost everyone in this field will recommend that you use a combination of due diligence investigation and your intuition when choosing a location. We have featured a few of these retreat centers in previous articles, which you can find here:

The Tradition of Ayahuasca in the Amazon: Creating the Temple of the Way of Light
At the Crossroads of Ibogaine and 5-MeO-DMT: An Interview with Dr. Martin Polanco
Shamanic Iboga Treatment in Costa Rica: Interview with Gary Cook of Iboga Wellness Center

It’s also important to know that not all psychological disorders lend themselves well to psychedelic treatment. While there is no scientific basis for the propaganda that psychedelics can “make you crazy,” it has been suggested that those with latent schizophrenia could have their condition triggered early by a strong psychedelic experience. Keep in mind this is still a new frontier of research, and people with certain medical conditions or on certain medications should absolutely not take certain psychedelics. Any properly run treatment clinic will have a full physical and mental health screening before treatment, and walk you through any contraindications that may be revealed. We do not endorse any illegal behavior, but from a harm reduction perspective, anyone who chooses underground treatment should exercise extreme levels of research, discernment, and safety precautions throughout the process.

Finding Integration Support

Beyond the psychedelic journey itself, integration of the experience after the fact plays a critical role in ensuring that the insights, progress, inspiration gained are translated into daily life in a sustainable way. Whether you are fresh out of an underground ayahuasca ceremony that helped you deal with childhood trauma, or a recent outpatient of an iboga center that helped you detox from an opiate addiction; a few weeks or months of integration support from someone who understands psychedelic treatment is immensely beneficial in securing your new goals, perspectives and commitments. While this is still a budding field in the US, we have featured three of these such programs: Holistic House Vegas– a brick and mortar healing center which specializes in addiction rehab after ibogaine treatment, Being True to You– a service that offers premium remote coaching and support all over the US and even certification programs in integration coaching, and Innerspace Integration– an integration program closely aligned with the Aware Project.

Releasing the Stigma

One of the most insidious aspects of mental illnesses is the stigma that surrounds them. Despite the statistics that show how common these disorders are, our culture still often adopts a “toughen up and go it alone” approach, leading many to isolate themselves and be fearful of speaking up about their condition, much less seek help. Psychotherapy, prescription medications, and conventional rehab centers do help many people stabilize their lives, but sometimes these routes are not enough to fully eradicate the pain, trauma, and stress that lay at the core of the disorder, leading people to simply numb their symptoms without seeking true healing.

Radical shifts in behavior, self-image, and wellbeing are something that psychedelics excel at when used appropriately, but not everyone is able to travel abroad for psychedelic treatment or willing to find underground options. The single most important thing that anyone suffering from an addiction or mental disorder can do is to speak up about it to their loved ones and seek help. Shame and stigma surrounding these issues should be forever discarded, as these conditions are an integral part of the human condition, and everyone faces stress, challenges, and addictive habits in their own way. This point was beautifully summarized in a recent conversation we had with comedian and podcaster Duncan Trussell:

“In the field of mental health, I think we would see a kind of renaissance… and perhaps we would see some reduction in certain types of mental illness. Not just because psychedelics are great for treating depression, but also because another thing that’s great for treating depression is not hiding the fact that you’re depressed. If we we’re not afraid to go outside to the park with big, beautiful, black dilated eyes and stare up into the sky holding hands with strangers and laughing for a few hours, then maybe we won’t be afraid to tell people that we love that we’re not feeling okay, that something seems to be different. From the moment you start announcing you’re in a bad place, you are on the pathway to healing.” -Duncan Trussell

https://psychedelictimes.com/2017/04...ical-disorder/​

 

[mr peabody]

How psychedelic therapy could change your practice

by Rich Simon | Psychotherapy Networker | 29 Oct 2019

Author Michael Pollan on the promises and challenges of a growing movement.

When Time magazine named Michael Pollan one of the most influential people of 2010, the author who profiled him describes being “Pollanized” by reading one of his books about the food industry. She’s referring to Pollan’s distinctive influence and authority as a voice in the culture, a widely respected writer whose thoroughness and integrity often profoundly challenges the worldview of his readers. The bestselling author of several nonfiction books, including The Omnivore’s Dilemma, often cited as a pivotal work in changing our modern culture’s relationship with food, Pollan has now turned his attention to the mental health field with his most recent big-splash publication, How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence.

That the book has had an impact and a reach beyond what anyone might have expected is both an indication of an evolving cultural receptivity to psychedelic experience and to Pollan’s ability to offer a compellingly comprehensive portrait of a growing movement that many believe could reshape the mental health field. In the Q&A below, he talks about the surprising impact his book has had, as well as the many challenges therapists face in integrating the lessons of psychedelic therapy into their work.

Psychotherapy Networker: "How do you explain the level of attention your latest book has received?"

Michael Pollan: When I started the book I wasn’t aware of the degree of dysfunction in the mental health system. But when I began talking to therapists about psychedelic therapy, I found far more receptivity than I expected to, even from establishment figures like Tom Insel, former head of NIMH, and Paul Summergrad, former head of the American Psychiatric Association. They emphasized not only the limited effectiveness of the pharmacological tools in psychiatry, but also that mental health care is reaching only about half the people who need it. And even for those it reaches, the results aren’t great. If you compare mental health treatment to fields like cardiology or oncology or infectious disease treatment, you just don’t see the same advances in its efficacy and capacity to alleviate human suffering.

PN: "What are the challenges therapists face in adopting psychedelics into their work?"

Pollan: There are a number of them. How do you incorporate this work into the therapist’s lifestyle and work day? What’s the business model if clients aren’t coming back every week for years? Similarly, Big Pharma hasn’t figured out how to make money on a treatment that only requires a few pills, but they’re keeping an eye on the small companies getting into this space. As soon as one of them figures out a way to make money offering psychedelic therapy, it seems likely they’ll snatch them up.

Their “product” probably won’t be just selling pills, but a package—the medicine plus therapeutic support—sold to hospitals and clinics or national health services. Another problem for the pharmaceutical companies is that psilocybin comes from a wild mushroom that can’t be patented, and LSD and MDMA are both off patent. So there are all sorts of interesting economic challenges. I don’t doubt that they’ll be sorted out, but it just doesn’t fit the model of psychotherapy or psychopharmacology as we now understand it.

PN: "For whom do you think psychedelics might have the most impact?"

Pollan: One of the most promising indications is treating people who are facing a terminal diagnosis, right now primarily cancer patients, but it may work for other people facing an ALS diagnosis or Parkinson’s, or things like that. But that hasn’t been tested. Some oncologists are even thinking about creating a room in their offices where patients who need it can have psychedelic therapy with guides or trained therapists. That might happen soon as an adjunct to conventional medical practice. With addictions, you’re likely to see psychedelic therapy in the various places where people go for rehab.

PN: "How is being a psychedelic therapist any different from ordinary practice?"

Pollan: Let’s say you’re doing MDMA therapy. The drug itself establishes the therapeutic bond very, very quickly. And so instead of having weeks or months of getting acquainted and earning trust, an intense engagement happens right out of the box. But an interesting mix of skills is needed here, because for part of the time during the drug journey, therapists have to be very laid back and noninterventionist; whereas after the session, they need to become far more active and help the client draw lessons and make sense of this elaborate, extended trip that they’ve been through.

Doing psychedelic-assisted therapy requires many of the things therapists are good at, such as listening, interpreting, and bonding, but in slightly different proportions than in more traditional therapy. Overall, there’s a real issue of how much specific training you need to do this kind of work.

I think MDMA therapy takes more skill than the others, because during the journey, you need to help the person bring out the painful memories and process them. Something very important happens during the session between the therapist and the client. Whereas in psilocybin therapy, people kind of go off on their own and have their experience without much intervention at all from the therapist.

With MDMA, there can be hours where nothing happens at all, and then suddenly, either upon a prompt from a therapist or on their own, the patient takes off their eye mask and starts telling a story. With the help of the drug, the memory of the trauma can be examined in a very calm way without exciting the disturbing emotions that would otherwise normally accompany it.

PN: "In all your reporting for your book, what was, to you, the most striking evidence of psychedelics’ therapeutic potential?"

Pollan: Two experiences stand out. One involved talking to the cancer patients from the NYU and Hopkins psilocybin studies. Before the treatment, many of them had never used psychedelics and were paralyzed by their anxiety and fear at the prospect of death. Seeing how they’d achieved an equanimity after a single psychedelic session was remarkable to behold. That one experience with the drug completely reset their understanding of death.

One woman I interviewed, despite being in remission for ovarian cancer, was crippled by fear of the cancer coming back: she couldn’t function. During her psychedelic session she had the experience, as many of the cancer patients do, of imaginatively traveling inside her body. She encountered this black mass under her rib cage. It wasn’t her cancer—it wasn’t in the right place. She realized the mass was her fear. So she screamed at it, “Get the f*** out of my body!” And it vanished. Later, in talking to her therapists, she said that the experience made her realize that while she couldn’t control her cancer, she could control her fear.

The other group that impressed me were the addicts. I talked to cocaine, alcohol, and cigarette addicts, all of whom were being treated with psilocybin. And in the case of the smokers, there was a pilot study in which they achieved very high rates of abstinence after a year: 67 percent, which is remarkable for smoking. (Right now, the best available treatment only has a 20 percent success rate.) These people weren’t facing death, but they had these experiences that often involved moments of sublimity.

https://www.psychotherapynetworker....sychedelic-therapy-could-change-your-practice​

 

[mr peabody]

Psilocybin mushroom therapy: Clinical observations from Amsterdam
​

How to get the most out of psilocybin mushroom therapy, including set, setting, therapeutic relationship, and addressing disassociation.

by Saj Razvi, LPC | Psychedelic.Support | 20 Mar 2021

The first thing to say here is that psilocybin is an incredible medicine. What it asks of the person using it and what it provides is beyond anything I’ve experienced in the MDMA, cannabis, and ketamine therapy world. That being said, it is absolutely an advanced medicine that will not reveal its true potential unless external and internal conditions allow for it. In other words, there are factors that will cause psilocybin to express its profound healing capacity or have very little effect regardless of dose.

The observations I’m about to make are from our experience in our Amsterdam psilocybin therapy program and from interviews with clinicians at the Psychedelic Society of the Netherlands who use this medicine in therapy on a regular basis. What seems to be the case based on observations is that there are two major factors that determine the depth and usefulness of a psilocybin mushroom therapy session.

To be clear, this article is for the mental health audience. It is for the person seeking to address their symptoms through psychedelic means. It is less applicable to the Michael Pollans of the world or the ‘betterment of the well’ seekers.

Set and setting

With that caveat in mind, the first major factor is the appropriateness of your environment: what is commonly known as set and setting. Taking psilocybin in a recreational setting versus a spiritual ceremony versus in a group versus individual therapy will all yield different results. If your intention is mental health related and you want to use the session to go deep into your psyche, symptoms, history and structure, you will absolutely want to work in an individual therapy setting and you would ideally have a two person female and male therapist team. We ordinarily dislike being so prescriptive since there are so many different paths healing can take.

However, we reliably see that the container, processing, and individual focus required for deep personal healing is simply not available in a group setting (and obviously not available recreationally). Your system will naturally censor the depth and intensity of your process if you know you are in a group of people all needing time and attention from the facilitators. This is an appropriate evaluation of your environment and what it can hold.

Wonderful things certainly do happen in a group or especially a ceremonial setting. People can have profound experiences although these are frequently transpersonal in nature. It’s awe and reconnection to the world, and not the realm of psychotherapy and your individual mental health. If you are there for your personal mental health reasons, it is helpful for the container and focus to be more oriented to you and not a general group environment.

Internal readiness

The second major factor determining the outcome of your mushroom session is your internal readiness for it. Consider it an advanced treatment to be engaged when people have moved through their foundational level healing with something like MDMA, cannabis or ketamine assisted psychotherapy.

Here is what we mean by this distinction between initial and advanced levels of psychedelic work: MDMA and cannabis focus on the events in your life, even very early, preverbal events that you had no recollection of. Psilocybin is an advanced medicine insofar as it addresses the very ‘you’, the identity and sense of reality that got constructed from these events. Psilocybin challenges the very fabric of reality that was put together quite early in life. This is significant insofar as your very sense of self and reality are a much deeper layer of programming. It is a layer of learning that is thought to be unchangeable.

It was a well-established belief in the MDMA clinical trials that MDMA does not affect personality level shifts, but rather is focused on traumatic events. These starter psychedelic medicines are so effective for mental health because their scope and depth are limited to events. They are not asking anything more from the user, whereas psilocybin does.

So, what happens in this initial level of work such that it is a necessary condition for psilocybin to do its magic? We speculate that a foundational level of ego and nervous system integrity is needed before psilocybin can do anything with a person’s system. The type of work we do with clients at Innate Path focuses on autonomic nervous system responses to events, establishing somatic pathways for processing very intense emotional charge, and perhaps most importantly, dissolving through dissociation.

As we noted in part 1 of this article, dissociation is a big factor in mental health in general, it’s a big factor with psychedelic therapy, and it’s a big factor with psilocybin. We recommend reading part 1 before going on but to briefly summarize, all mammals including humans involuntarily generate and release natural opioids that not only numb us out during a highly stressful or overwhelming event but this dissociative, numbing response is active decades after these events have taken place. Essentially, a protective depressive, numbing reaction is present that can block awareness, therapy and even psychedelic responses from taking place.

If you have dissociation as part of your structure, and many people whose symptoms are not easily resolvable do, psychedelic mushroom therapy is likely not going to be that useful for you…. Whether it is the medicine making this choice or it is your own protective psychological mechanisms blocking it, the psilocybin will mostly pass you by with only mild psychedelic distortions.

If you have dissociation as part of your structure, and many people whose symptoms are not easily resolvable do, psychedelic mushroom therapy is likely not going to be that useful for you. We find that people who have trauma in their life, particularly in childhood, and have never done therapy before or the type of work they’ve done has been limited to conventional forms of talk therapy typically do retain their dissociation. Yes, those years of expensive talk therapy, while interesting and helpful in some ways to your conscious mind, will not have done much to crack through your system’s protective layers to get to the core of your symptoms, at least not in the manner that psychedelic therapy is able to accomplish.

If this is you and you engage in a psilocybin mushroom therapy session, it is likely going to be a fairly mild experience regardless of how much medicine you ingest. You will likely have peaceful prosaic images of nature, water, the dance of light, flowers, colors and psychedelic distortions but none of these images will connect to your interior world and they will not engage you in a transformative process. Psilocybin is not the ideal medicine to crack dissociation: what it asks of you is too big for what your system is ready for if you are still inside of or just emerging from psychological numbing.

Whether it is the medicine making this choice or it is your own protective psychological mechanisms blocking it, the psilocybin will mostly pass you by with only mild psychedelic distortions. This is why the government of the Netherlands is comfortable allowing packets of psychedelic mushroom truffles to be legally sold to roving bands of recreational spring breakers. Neither the set and setting nor the person’s psyche are ready for a big process and so it does not happen. It ends up being a relatively safe, visually interesting trip with laughter.

We find this to be the case with our Amsterdam clients regardless of the dosage. This was confirmed in the interviews with the therapists at the Psychedelic Society of the Netherlands where it is infrequent that clients are ready for the big sessions they expect. The protocol we’ve adopted in response to this is to begin with psilocybin therapy, but if the session is primarily dissociative in nature with the mild responses mentioned above, we’ll inform them about cannabis-assisted psychotherapy and what we typically see with that medicine.

We will often get a puzzled look since the cannabis work is available in the US and these people have gone through the trouble of flying to Europe for psilocybin therapy. More often than not, these clients end up choosing to continue with the cannabis work instead of jumping back into another mushroom session right away. This is because cannabis and MDMA are more appropriate to the stage of work these clients are at. The cannabis process is able to grip into and crack the dissociative numbing in a way psilocybin does not. What ends up happening is that a client will engage in three or four cannabis therapy sessions on consecutive days and then move back to a second psilocybin session after their dissociation has shifted. We find that the second psilocybin session is quite different compared to the first one.

At this point, the mushroom medicine can stretch its wings and begin to express its potential in your system. It is just too big of an experience to do this with someone still at the very beginning of their work.

At this point, the mushroom medicine can stretch its wings and begin to express its potential in your system. It is just too big of an experience to do this with someone still at the very beginning of their work. Once you have cracked your dissociative structure and you are not having a massive opioid dump in response to the events in your life, the psilocybin can get traction in your system. You have moved through enough of your trauma with cannabis or MDMA and now your body is available to help you handle the much fuller contact with being that psilocybin beckons.

Let me note another caveat here, your body is very important in this process. In contrast to your tip-of-the-iceberg cognitive capacity, which was not built to process big emotions, you will go much further in a psilocybin session if your body is available to conduct the powerful charge that comes with psilocybin’s revelations.

You feel engaged by the mushroom therapy down to your DNA. You can finally feel the mountain of frozen grief in your chest at not being loved or welcomed as a child and the layers of aggression, callousness and depression operating on top of this core experience. You can also feel the deliciousness of touching anything alive: a hand, a face, your own soft body, leaves. It will lovingly challenge your inability to love. The session can take you to your own birth, your infancy and the utter freshness of the world as experienced through a child’s mind/body.

I hesitate to say this because of possible unintended consequences but we have seen it heal what are known as Axis 2 personality disorders. These are diagnosis like narcissistic or borderline personality disorder that the world of conventional treatment has very little to offer. As we mentioned before, personality is considered stable and unchanging trait and even MDMA does not touch personality disorder. My hesitation in mentioning it is because it will take a lot to support this type of client to move through the first level of work, not to mention the profound reactivity that will be unleashed with psilocybin. I mention it only to say the mushroom work is big enough that it can alter what was previously thought unalterable.

The big takeaway here is that therapeutic set, setting and relationship is essential, the medicine is essential and the readiness of your psyche is essential. These medicines can effect amazing healing but we have to be ready for them. In other words, take your time and approach this endeavor with an understanding that there are no magic pills, you are part of an amazing process that still adheres to natural principles in how it moves and unfolds. An integrated, associated, healthy ego structure is a good foundation to have before diving into the deep end.

Psilocybin Mushroom Therapy: Clinical Observations from Amsterdam

How to get the most out of psilocybin mushroom therapy, including set, setting, therapeutic relationship, and addressing disassociation.

psychedelic.support

 

[mr peabody]

Falling apart, merging together: Psychedelic Psychotherapy

by Jennifer Levin | May 12, 2017

A terminal cancer diagnosis can inspire fierce bravery in some patients. Though there is no way to fight the disease, they accept their fate and embrace their final days with gusto or spiritual peace. They may be sad, but they are not clinically depressed. Others, however, sink into themselves. They cannot see a point to the time they have left.

"They struggle for months with their worries, disabled by their fear of death," said George Greer, a psychiatrist and the medical director of the Heffter Research Institute. Heffter, with headquarters in Santa Fe, supports research into psychotherapy for terminal cancer patients that utilizes the drug psilocybin. Greer and his colleagues are also involved in psilocybin therapy research for alcohol, nicotine, and drug addiction. Psilocybin is a psychedelic substance that, when properly synthesized, dosed, and taken in a controlled setting, shows great success in treating a range of psychological problems.

Greer's work and the Heffter Research Institute are included in Changing Our Minds: Psychedelic Sacraments and the New Psychotherapy, by Don Lattin, recently published by Santa Fe's Synergetic Press. Changing Our Minds is part journalistic memoir and part advocacy expose that weaves together the many threads of the psychedelic therapy movement, which has its origins in the 1950s, when some doctors began using LSD, or "acid," in psychoanalysis. Research in those days also showed LSD's promise in the treatment of alcoholism. Lattin tells the stories of numerous scientists, psychiatrists, therapists and counselors, arranging history in a somewhat nonlinear fashion. The book touches here and there on Albert Hoffman's invention of LSD in the 1940s, Timothy Leary and Richard Alpert's Harvard Psilocybin Project in the early 60s, and many other non-household but nevertheless important names in the field.

Psychedelics made the leap from the lab to the street in the early 1960s, and by mid-decade in California, "a promising novelist named Ken Kesey gathered a Dionysian troupe of Merry Pranksters and put on a series of parties called "Acid Tests," where revelers dosed themselves and danced to a new band called the Grateful Dead," Lattin writes. The backlash against what was perceived by many as a hallmark of the hedonistic hippie drug culture came first in the form of government regulations over academic and medical research and eventually as an outright ban on possession by the public. By 1970, "a new federal law ignored the findings of research scientists and declared LSD and psilocybin medically useless and easy to abuse." MDMA emerged later, but it faced a similar fate - its recreational use characterized by the government and media as a social ill while its positive therapeutic uses were ignored or denied.

Greer moved to Santa Fe from San Francisco in the 1980s with his wife, a psychiatric nurse. They were already involved in psychedelic psychotherapy, and began meeting others in town who were also waiting for the dark ages imposed upon their work to end. In the early 1990s, the FDA quietly changed its mind about its Nixon-era attitude towards psychedelic drug research, and studies were allowed to resume, albeit with no government funding. All money for psychedelic studies still must come from private sources, according to Greer. Heffter, founded in 1993, and the Multidisciplinary Association for Psychedelic Studies (MAPS), founded in 1986, fill this niche by reviewing research proposals and then raising money for the studies they want to support. MAPS also performs educational outreach, harm reduction at music festivals, and advocacy for the legal use of recreational psychedelics. Heffter, founded by doctors and scientists, is a pure research organization. In addition to medical uses for psilocybin, Heffter has also been involved in studying the psychological and spiritual effects of psilocybin on healthy people who meditate as well as on members of clergy.

When used in the treatment of alcohol and addiction, Greer and other medical professionals claim, psychedelics hasten the process of a drinker or addict "hitting bottom," which is the term often used for when an addict finally admits he or she has a problem and wants to get sober. Psychedelics open the door to a mystical, bird's-eye view of one's own life, in which emotional problems are transcended, replaced by a greater understanding of one's self and one's place in the connected whole of the universe. After a psychedelic therapy session or two, patients crave the addictive substance less and its importance in their lives declines. The effects of such sessions on the terminally ill are similar - psychedelic therapy alleviates their existential suffering. "They experience a shift in outlook about who they are, and about the meaning of life and death," Greer said.

Post-traumatic stress disorder (PTSD) patients in studies funded by MAPS report a reduction in nightmares, flashbacks, and intrusive thoughts after taking MDMA in guided therapy sessions. Changing Our Minds describes such a session from beginning to end with an Iraq war veteran named Nigel McCourry, led by researchers Michael and Annie Mithoefer. The rare glimpse inside an experience that is usually private is an unusual therapy session, to be sure, but there are no wild hallucinations or giggle fits. Contrary to MDMA's reputation as a party drug and the behavior it stimulates, McCourry does not become helplessly sexual or need to dance. He closes his eyes, listens to New Age music over headphones, and lets his mind drift. He discusses what comes up with his doctors.

The Mithoefers had "already completed an initial study of MDMA-assisted psychotherapy with 20 volunteers suffering from PTSD, most of them victims of child sexual abuse, adult rape and assault," Lattin writes. "Eighty percent of the twenty patients in that pilot study had no PTSD symptoms two months following the completion of the treatment, compared to 25 percent who got a placebo pill." McCourry was part of a second study, this one of veterans, that also showed positive results. "People with PTSD have increased activity in the amygdala, the fear center in the brain," Michael Mithoefer says in the book. "They have a lot of trouble trusting and developing a therapeutic alliance. They can be suspicious and expect people to betray them. They might read expressions on a therapist's face as not being safe. Something like MDMA can turn down that distortion and make them less likely to reject therapy."

Current studies on psychedelic psychotherapy are approved by the FDA and are considered as "Phase 2" of a three-phase testing process. Phase 1 tests, performed decades ago, established that these drugs do no lasting harm to humans. Phase 2 uses a limited number of participants to prove that a drug has the efficacy to treat a specific problem. Phase 3 allows researchers to broaden their sample sizes and test hundreds of subjects for better data. Greer said FDA approval for Phase 3 testing of MDMA and psilocybin therapy is likely only a couple of years away, and when it comes, psychedelic psychotherapy will have a home in Santa Fe, where a number of therapists are already interested in trying it with their patients.

Changing Our Minds includes chapters on other kinds of psychedelic therapy, including ayahuasca and ibogaine. Ibogaine, a root from West Africa, has a long-acting psychedelic effect similar to LSD. Because it also blocks opiate withdrawal, in countries where it is legal, like Mexico, it is used to help heroin addicts get clean. "Research has shown some danger of neuro- and cardio toxicity with ibogaine," Greer said, and there have been some deaths among addicts who are in ill health, but scientists are working on a safer, non-psychedelic version. Ayahuasca, used in religious ceremonies, is a brewed mixture of Amazonian jungle plants, mainly the vine Banisteriopsis caapi, and either chacruna or chagropanga, both of which contain the psychedelic substance DMT. "Though DMT is chemically similar to psilocybin," Greer said, "because it is a plant rather than a "pure drug," it is difficult to study." Ayahuasca tea is legal for ingestion in the United States only by members of the Uniao do Vegetal (UDV) church, but an ayahuasca tourism economy has sprung up in South America to capitalize on American and European interest in having profound mystical experiences. Many of the experts cited in the book warn against traveling to a foreign country and putting your physical and psychological safety in the hands of strangers trying to make a buck, or even those who are well-intentioned healers but who know nothing about you.

Lattin is careful not to come across as evangelizing the unconstrained recreational use of any of the drugs he writes about. He covers opposing points of view among researchers, psychiatrists, and other practitioners and proponents of psychedelic psychotherapy. Some want it strictly monitored in medical and scientific settings, while others believe enough is already known about the drugs' effects to render spending years giving control groups placebos a waste of time and money. Lattin also discusses the potential downsides of psychedelic psychotherapy, as in when a therapist abuses his power over a patient who is in a suggestive state, or when people with delusions of grandeur use the drugs to manipulate others, such as in "cultic" environments.

Psychedelic psychotherapy is not recommended for everybody. "It is not an easy experience and requires a patient's willingness to "surrender, to let themselves merge or fall apart," Greer said. Screening processes help researchers make sure they are not treating anyone with a personal or family history of schizophrenia or manic episodes, as there is some evidence that the drugs can trigger such an episode in someone who is predisposed to them. Other conditions that might disqualify someone from a study are high blood pressure and brain tumors that impair cognitive function. Greer said that "not every terminal cancer patient is a candidate for this kind of therapy. Though both psychedelics and terminal cancer diagnoses are known to bring on sudden spiritual transformation in people suddenly acutely aware of their mortality, Heffter and MAPS studies are for patients who are not able to get to such a place on their own and are experiencing significant anxiety over their prognosis."

For those who are skeptical that a "drug trip" can have lasting psychological healing power, Greer explained that psychedelics open up additional areas of consciousness while preventing other parts of the brain from engaging in their usual running commentary on day-to-day life. While under the influence of psychedelics, people have what researchers refer to as a mystical or peak experience, which Greer described using such terms as ineffability, positive mood, and feelings of unity.

"Psychedelics change the pattern that your brain is in when you're in your normal personality," he said. "The mind gets quiet and lots of other things can happen. We have the brain wiring to do this - otherwise it wouldn't be possible at all. People who have these peak experiences are statistically more likely to have this transformational outlook on themselves and on life and death. There was one woman who was a lifelong atheist and she said that during her session she experienced God, though she was still an atheist. She said it wasn't something she could put into words, that it was beyond language."

http://www.santafenewmexican.com/pa...cle_3253b357-2037-5f5e-8f9a-2512ac645f82.html​

 

[mr peabody]

Psychedelic therapy is coming

by Moises Velasquez-Manoff | Nautilus | 21 Mar 2019

How psilocybin can spring people from fears and destructive habits.

Three years later Daniel Kreitman still chokes up when he talks about what he saw, and how it changed him. Kreitman, an upholsterer by trade, had taken psilocybin in a trial at Johns Hopkins University School of Medicine for nicotine addiction. He was 52, and he’d smoked between one and two packs a day for nearly 40 years. After his first psilocybin session, his urge to smoke was gone. During his third and final session, he had the vision that helped him quit for good.

He saw lakes, roads, and mountains, and a broad-shouldered man at the helm of a ship, lassoing birds. Was it his dead father? He wasn’t sure. But he remembers giggling and feeling good. Music was playing in his headphones. During Aaron Copland’s Appalachian Spring he had the sensation of physically touching the music, which was smooth and bright yellow in his mind’s eye. As the music progressed, he traveled, flowing outward toward an immense space that never ended. He may have wept for joy - he’s not sure - but the beauty of the vision overwhelmed him. “I was seeing forever,” he told me.

Kreitman was brought up Jewish, but doesn’t consider himself to be particularly religious. Yet he falls back on religious language to explain the experience. “I think I saw God at one point,” he said, his voice cracking with emotion. The day after the session, in his journal, he wrote: “The question is, if I saw God and infinity, what’s next? How does that change me and my life?”

When I spoke with him this August, Kreitman had an answer: He hadn’t had a cigarette for three years. He’d previously tried nicotine gum and patches, to no avail. He always returned to the habit, falling into the easy rhythms of smoking on the way to work and on the way home. It was taking a toll on his health, though. He was chronically short of breath and although they didn’t nag, his wife and children were concerned for his health. Since that session three years ago, however, cravings have barely registered. “It’s kind of crazy,” he told me. “I don’t feel like I’m fighting this addiction. It’s like it’s not even me.”

The trial was small, just 15 people, but it’s on the vanguard of resurgent research into the therapeutic potential of psychedelics - a “psychedelic renaissance,” as one researcher described it. Work from the mid-20th century suggested that psychedelics held therapeutic promise. But those studies didn’t generally hew to modern scientific design.

Now, after decades of neglect, scientists are beginning to rigorously test psychedelics as medicine. They’re trying to treat some of our most vexing afflictions, including addiction, depression, and the existential anxiety of having a terminal disease. The small studies so far conducted have yielded striking results. In one 10-person pilot study on alcoholics, participants more than halved their alcohol intake six months after taking psilocybin. In Kreitman’s study, 60 percent of smokers who took psilocybin hadn’t smoked two-and-a-half years later.

If psychedelics prove effective in treating substance abuse, they would address a massive unmet need. They’d also possibly force a change in how we think about the dysfunction that underlies these conditions.

In the past, addiction was cast as a moral failing. Today it’s variously seen as a psychiatric condition, a learning disorder, or a disorder of the brain. Given that dependency on one’s drug of choice eventually emerges, a common treatment approach is to wean addicts off their drugs by, in the case of smoking, giving ever smaller quantities of nicotine in patches or gum.

Psychedelic therapy dispenses with this gradualist approach, instead seeking a more sudden transformation. That’s in part because many studies, including the Johns Hopkins trial Kreitman participated in, suggest those who have mystical experiences while on psilocybin have the best outcome. This kind of sudden, divine-seeming insight, what William James termed a “conversion,” is central to many religious and meditative traditions. It can also occur in more prosaic contexts - a phenomenon one psychologist has dubbed “quantum change.” People can quickly and inexplicably, often after a profound epiphany, change.

The question of how, precisely, psychedelics trigger these transformations has sent neuroscientists down an intriguing rabbit hole. They have observed similarities between what happens in meditators’ brains and people on hallucinogens. Neural networks that serve as control centers—the neural correlates of the old Freudian ego - may loosen their grip, freeing other regions of the brain.

Researchers often use an unusual language to talk about this transformation, one that emphasizes meaning and subjective experience over molecular pathways and neurotransmitters. Psychedelic therapy seems to recast addiction not only as a disorder of the brain, but as a disorder of meaning - of framing and how we see ourselves.

Ultimately, psychedelic researchers are addressing a mystery that’s central to psychology and psychiatry, not to mention the self-help section of the bookstore: the question of how people change, of how they escape limiting and often self-destructive behavioral patterns. Their early research suggests that psychedelic therapy offers a radically new perspective on the self, showing people that they’re not slaves to their compulsions or fears, and providing them with a sense of connection to something ineffable, something greater than themselves.

The psilocybin studies at Johns Hopkins University School of Medicine have been guided in part by Roland R. Griffiths, Ph.D., a professor in the departments of psychiatry and neuroscience at the university. About 15 years ago, Griffiths began meditating. He started with a Hindu mantra-based practice, and moved to Buddhism. As a scientist, he studied drugs of abuse - how they hooked people and why. But he’d always been curious about the nature of consciousness itself - why we’re aware at all - which is in many ways the fundamental enigma of human existence. He thought that meditation was one method, albeit a subjective one, for exploring this mystery.

As his meditation practice deepened, he began to have interesting and unusual experiences. They opened “a spiritual window,” he told me. “With meditation, one really begins to see how the mind works, how ideas come up.”

Seeking to better understand these experiences, Griffiths dove into the literature on comparative religion. There, he discovered claims that psychedelics could induce experiences like those he had while meditating.

William James offered a compelling perspective on alternative consciousness in the early 20th century. “Looking back on my own experiences” with nitrous oxide, he wrote, “they all converge towards a kind of insight to which I cannot help ascribing some metaphysical significance. The keynote of it is invariably a reconciliation. It is as if the opposites of the world, whose contradictoriness and conflict make all our difficulties and troubles, were melted into unity.”

In the 1950s, scientists began exploring psychedelics therapeutically. Humphry Osmond, a British-born psychiatrist working in Canada, conducted some particularly interesting work. Osmond, who coined the term “psychedelic” - “mind manifesting,” in his words - wanted to help alcoholics quit drinking. When longtime drinkers stop, they can suffer from a severe and occasionally deadly form of withdrawal called delirium tremens, which can include psychotic episodes. Delirium tremens also sometimes served as a turning point toward recovery in alcoholics’ lives. Only after they “hit bottom,” the thinking went, could they get better. Osmond and his colleagues reasoned that an LSD session, which also induces a psychosis-like state, might accelerate this naturally occurring process. He and his colleagues hatched a plan to treat alcoholics by inducing with megadoses of LSD the very psychosis they might experience down the road.

And it worked, sort of. Of his first two patients, one remained sober six months later. Over the years, Osmond and his colleagues treated perhaps 2,000 more drinkers with LSD, including many who hadn’t responded to other therapies, and achieved impressive results. Between 40 and 45 percent of his patients continued to abstain a year after treatment. It wasn’t that they were scared straight by their LSD episodes. Rather, over and over, these patients reported insightful and often mystical experiences—a feeling of being at one with the universe, and of seeing oneself and one’s internal conflicts clearly and objectively. Those experiences were central to their subsequent abstinence.

As it happens, Albert Hofmann, the Swiss scientist who first synthesized LSD, and who himself had an intense mystical experience while on the drug, had always hoped that his creation would be studied scientifically, its therapeutic potential rigorously tested. He once described LSD as “medicine for the soul” - as “a tool to turn us into what we are supposed to be.”

But by the late 1960s, research on hallucinogens mostly ground to a halt. The burgeoning counterculture got a hold of psychedelics - “altered consciousness” was a central aspiration of the movement - and a kind of anti-psychedelic hysteria took hold among the establishment. Psychedelics were linked to anti-war demonstrations and student riots. Newspaper articles began appearing claiming that LSD caused psychotic episodes, fetal abnormalities, and crime. The emerging evidence of therapeutic potential was dismissed as flawed, and the drugs were made illegal.

In the nearly 40 years since, establishment attitudes toward hallucinogens began to shift. Scientific curiosity began to displace hysteria. And in the early aughts, Griffiths decided to test the idea that hallucinogens could reliably provoke mystical experiences. He recruited 36 volunteers for a double blind study. No one knew exactly what drug conditions would be administered, and the stimulant Ritalin was given as a placebo.

He published his first results in 2006. Many participants reported having mystical-type experiences that, two months later, they rated as among the most meaningful of their lives. Nearly two-thirds of the participants said the experiences had increased their well-being - something that Griffiths and his colleagues confirmed with family and friends. Maybe most surprising, the subjects reported lasting change after the psilocybin sessions.

Psychologists often rate personalities in broad domain categories like neuroticism, extroversion, and agreeableness. After the age of 30, it’s thought that one’s personality is more or less set. But in Griffiths’ study, one domain in particular improved among the psilocybin-takers more than a year after the sessions: openness. They reported more imagination, creativity, and aesthetic appreciation.

Others call these studies groundbreaking. They’re the first studies on psychedelics in the U.S. in decades, and among the only rigorous studies ever. They suggest that mystical experiences are reliably inducible. And for Griffiths, they indicate that the human brain is wired to have these kinds of experiences. You don’t have to be a saint or a master meditator; you don’t have to be born lucky, or suffer from an unusual mental glitch. Perhaps because we’re extremely social animals, the ability to feel a deep sense of oneness with existence, which seems so therapeutic, is latent in us. “The results suggest that almost everyone is capable,” he told me.

It also makes psychedelics easier to study, and easier to administer as therapy. That’s not to say that everyone who takes hallucinogens will feel at one with the universe, or see their version of God. The lead-up to the sessions is, Griffiths believes, important to the outcome. He and his colleagues put a lot of thought into creating a setting that they think increases the odds of a positive session. Kreitman began preparing for about two months before his psilocybin sessions. He learned to meditate, talked with a psychologist regularly, and developed a mantra - “For myself and my family, I quit for life” - meant to crystallize his intent to stop smoking.

On the day of his first session, after crushing and throwing away his last pack of cigarettes, he lay back on a comfortable couch in a warmly lit room decorated with Buddha statues, pulled a blinder over his eyes, and listened to pleasant, occasionally Indian-sounding music on earphones. Doctors monitored him, periodically asking how he was doing and taking his blood pressure. “It was comforting to know they were watching me,” Kreitman said.

Post-psilocybin, Kreitman describes himself as the same, but also “deeper.” And this newfound depth occasionally manifests in the strangest way: a tendency to spontaneously weep, not with sadness, but with joy. “It’s great,” he told me. “But my kids think I’m losing it.”

When you imbibe psilocybin, your body metabolizes it into psilocin, the active compound in the psychedelic. Psilocin and LSD both stimulate serotonin receptors on neurons, exciting those cells and prompting a cascade of secondary activity. Serotonin is often described as a mood regulator, important to one’s happiness and sense of well-being. Many antidepressant drugs also boost serotonin levels in the brain. Yet this biochemical understanding doesn’t quite explain the subjective experience of “the trip,” or the effects that continue long after hallucinogens have left the body.

It’s from neuroscience that the most alluring and potentially informative portrait of what happens to the brain on psychedelics has begun to emerge. Scientists at the University of Zurich have found that activity in the amygdala, the fear center of the brain, declines on psilocybin, making people less reactive to negative stimuli, which might explain how it could help with depression.

A series of studies by scientists at Imperial College London indicate that while people are on psychedelics, connectivity within neural networks responsible for weaving information into a coherent whole declines; but connectivity between networks usually specialized in different tasks increases. What that implies is both a kind of disorder—the kaleidoscopic colors and sensation of dreaming while awake - and a kind of freedom, which the researchers call “ego dissolution.”

“Under the influence of psilocybin, there’s more crosstalk across networks. Brain activity is less tightly organized,” Michael Bogenschutz, a scientist at New York University who’s conducting a study on alcoholics, told me. “It’s consistent with people’s subjective reports of synesthesia” - smelling colors, seeing flavors, and a general sensory confusion - “and perceiving connections between things that don’t ordinarily appear to be related.”

One of the networks where activity declines is the “default mode network.” It’s important for internally directed activity like rumination and daydreaming, and includes neural hub areas like the parahippocampus (involved in spatial recognition), the posterior cingulate cortex and precuneus (imagining oneself in the future or the past), and the medial prefrontal cortex (autobiographical memories).

The default mode network usually operates in opposition to another network associated with externally oriented tasks, like playing soccer or hunting deer, called the “task positive network.” These two separate neuronal webs tend to operate like a seesaw: When one is activated, the other is muted, and vice versa.

But when volunteers took psilocybin, the Imperial College scientists found, both networks activated simultaneously—a pattern also observed in experienced meditators. Brain scans of people on hallucinogens, as with meditators, have revealed that the concurrent activation of these networks predicts a loss of one’s sense of separateness—the ego—and the emergence of a feeling of profound interconnectedness.

LSD also causes the default mode network to fragment slightly, while boosting activity between other usually segregated areas. The parahippocampus and another region called the dorsomedial prefrontal cortex, important in that sense of “me-ness,” begin talking more, even as the posterior cingulate cortex and the parahippocampus - two hubs of the default mode network - talk less.

The Imperial College scientists interpret these findings as evidence that regions of the brain charged with executive control and top-down maintenance of order - the “rich club,” they call it—relax their grip. The usual separation of brain regions and their functions collapses, and a kind of neural cosmopolitanism emerges. It’s tempting to imagine that, with the proverbial parents out of town, the brain throws a wild, teenage party - that what happens during an LSD trip is a bottom-up explosion of usually repressed exuberance.

This explanation gets at one of the more fascinating models of brain function. Making sense of the world may require the brain to restrain itself - to limit how and what it perceives. In a Darwinian sense, it’s obvious why that imposition of order might be necessary. If you constantly experienced the world as an LSD trip, unable to distinguish your imagined dragons from that very real tiger waiting to pounce, you probably wouldn’t last long. But it’s also possible that the imposition of order can, when it becomes too iron-fisted, imprison us psychologically. So by taking those punctilious, literal-minded “hubs” offline, hallucinogens may free up other brain regions and their associated talents, enabling “a state of unconstrained cognition,” as the scientists put it, and ultimately liberating us from ourselves.

In the neuroscience literature, case reports on stroke, trauma, and even dementia victims suggest that damaging one part of the brain can indeed lead to dramatic enhancements in creativity and well-being, likely by freeing other regions of the brain and their creative energies. Hallucinogens may do something similar, not by destroying those parts of the brain, but by momentarily weakening their hold over other areas.

Still, that doesn’t explain how psychedelics, which are taken for just a few sessions, can induce lasting changes - like Kreitman’s three-year abstinence from cigarettes. Most psychotropic drugs, such as SSRIs, must be taken chronically to work. The medication needs to be in your system to have its effect. By contrast, the effect of hallucinogens seems to continue long after they’ve left your body.

Bogenschutz hypothesizes that psychedelics open a window of enhanced neural plasticity, the brain’s inherent ability to change. Networks of neurons, connected by branch-like filaments, underlie everything you think and feel. Rather like heat makes metal malleable, psychedelics might enable and accelerate the formation of new connections between neurons, allowing you to alter the prison of your bad habits, fears, and compulsions. And if the mystical experience is important in this plasticity - Bogenschutz says “more work will be necessary to determine if that is indeed the case” - the implication is that the drug alone isn’t what’s important, but rather the subjective experience while on the drug.

As evidence that such a thing is even possible—that intense experience can rewire connections in the brain - Bogenschutz points to post-traumatic stress disorder. There are measurable differences in brain and immune function in people suffering from the condition, changes prompted by trauma that’s not necessarily physical, but experiential.

“In PTSD, it’s the intense emotional response generated by what you perceive is happening” that induces these changes, Bogenschutz says. “It’s mediated not just by the experience itself, but by the meaning attached to that.” Why, then, couldn’t an extraordinary experience of great significance push you in a more positive direction—toward, say, an epiphany that helps you stop smoking?

For his part, Griffiths sees psychedelics as a crash course in the nature of mind, “which may be relevant to what meditation and religious traditions have explored,” he said. Many forms of meditation exercise the ability to observe the mind without becoming trapped in what’s happening. With time, strengthening this skill may result in a lightness to one’s day-to-day activity, a non-attachment that practitioners often describe as liberating. Perhaps by loosening the grip of the inner tyrant, psychedelics impart a similar “lightness of being,” as Griffiths calls it. That kind of “efficacy” - the ability to avoid becoming entangled in your own fickle desires - is probably essential to abstinence, he says. Post-psilocybin, patients “are not so worried about their addiction of cravings,” Griffiths told me. “They know that it will pass.”

Nearly a century ago, an alcoholic named Bill Wilson was lying in bed, in a hospital, struggling mightily with his lifelong depression. At wits’ end, he reportedly cried out, “I’ll do anything! Anything at all! If there be a God, let Him show Himself!” at which moment, he saw a bright light - he’d later call it a “hot flash” - was overcome by a feeling of ecstasy, and a great sense of peace.

He never drank again.

Wilson went on to found Alcoholics Anonymous, the well known recovery and abstinence program. At some point, Wilson became interested in LSD as a way to help alcoholics quit drinking. He tried it himself, and, like Osmond, thought it might induce in others the experience that had helped him. What Wilson’s story makes clear, however, is that people can naturally and spontaneously have epiphanic experiences that help them quit drinking.

Will Miller, an emeritus psychologist at the University of New Mexico in Albuquerque, has dubbed these sudden psychic shifts “quantum changes.” He began studying them after his own troubled daughter had an epiphany, and transformed into a caring, responsible woman seemingly overnight. These stories present certain commonalities, he says: an intense sense of interconnectedness; the sudden awareness that one’s sense of isolation is an illusion; the realization that others’ shortcomings should be met with compassion, not judgment and punishment. People find sudden release from addictions and dependencies. They repair broken relationships. “I think of it as an evolution in consciousness,” Miller told me. He added, “dramatic change is possible. We’re not stuck in yesterday.”

But these sudden transformations were completely unpredictable. Miller couldn’t pinpoint any characteristics that foretold who might experience them, or when. The psychedelic research needs replication precisely for this reason. If you could induce “quantum change” reliably, you can study it. And imagine the potential benefit not just for addicts, but for everyone.

Assuming that addiction research continues to show promise, Griffiths foresees psychedelics used in clinical settings that, like his own studies, offer extensive pre- and post-treatment support. Griffiths doubts that psychedelic therapy will spread anytime soon, however, not because it’s a bad idea, but because we have a strong cultural bias against performance-enhancing drugs. “Right now, the idea of giving drugs to improve the betterment of all people would strike at least some people as repugnant,” he told me.

But in 20 years, who knows? By then, we may have more precise approaches to induce the same shifts, such as transcranial magnetic stimulation or even precision brain surgery. For Griffiths, psychedelics' primary contribution may be as a teaching tool, a way to learn how human transformation works so we can encourage it by other methods with fewer potential side effects. The lesson for now, he said, is simply that profound metamorphosis is possible. “We do appear to be biologically predisposed to have experiences that can be the pivot point for enduring radical behavioral change in personality, attitudes, and behavior.”

http://nautil.us/issue/70/variables/hallucinogen-therapy-is-coming-rp​

 

[mr peabody]

Treating mental disorders with psychedelic psychotherapy

by Cahli Samata | PARTICLE | 10 Oct 2018

Every day in Australia, more than eight people die by suicide. Millions more suffer mental health issues. We have treatments available, but in Australia, we’re missing out on therapies that are showing great promise in other parts of the world.

Why? Because they use psychedelic drugs.

Psychedelic drugs and mental health issues may sound like a terrible combination—and it can be in the wrong setting.

But increasing evidence suggests that using controlled portions of these drugs with trained psychotherapists could help people overcome several mental health disorders.

Even healthy people might be able to benefit in the future.

Dr Stephen Bright is Senior Lecturer of Addiction at Edith Cowan University (ECU) and Vice President of Psychedelic Research in Science and Medicine (PRISM). He’s hoping to bust the myths about psychedelic drugs and push through the politics so that Australians may one day benefit from these potentially life-saving therapies.
What is psychedelic psychotherapy?

First, let’s cover the basics.

Psychedelic psychotherapy involves using small amounts of psychedelic drugs in a controlled, clinical setting with trained psychotherapists. There are different drugs used for different purposes, but some of the main ones are psilocybin (magic mushrooms), LSD and MDMA (also called ecstasy). The drugs used in this type of therapy aren’t like ones you’ll find on the street. They are pharmaceutical grade, meaning you know the exact dose and what’s in it.

All psychotherapies aim to help patients overcome a problem or make a positive change to their life—usually by facing it head on.

Take post-traumatic stress disorder for example. Someone with PTSD may avoid thinking about the bad experience they had. In psychotherapy, the therapist will actually direct them towards facing that bad experience to help them to work through it.

Adding psychedelic drugs to the mix generally helps patients get there faster. The therapists ‘hold the space’, allowing the patient to mostly guide the session. The therapists will usually only need to intervene if the patient is avoiding facing their issues or bad feelings.

“It never fails to amaze me how much spontaneous insight people gain in the MDMA sessions. It would take 10+ weeks of normal psychotherapy to guide a person to the insights that the patients spontaneously come up with while on MDMA,” Stephen said.

Stephen explains that this is a technique he often used while ‘trip sitting’ at festivals.

“The further they push against bad feelings, the worse their experience becomes. So we try to talk to them about what they’re experiencing and allow them to approach it and work through it rather than avoid it, and doing so seems to have a therapeutic response.”

But patients aren’t thrown in the deep end like someone having a difficult trip at a festival. Psychedelic therapy involves planning and preparation.

The preparatory sessions are thorough, so the patient knows exactly what they need to do and therapists know how best to support them.

“The person is fully prepared beforehand for what they’re going to experience, and they have some coping strategies.”

A mystical experience

So what is it about psychedelic drugs that patients find therapeutic?

Neurologically, we’re not sure. But Stephen said the secret often lies in the mystical experience you can have on psychedelic drugs. It’s difficult to explain, but it’s a spiritual sense of oneness. Kind of like having an epiphany. The mystical experience usually happens with the more psychedelic drugs like psilocybin, rather than MDMA.

A study at New York University found that patients with life-threatening cancer who had this mystical experience from psilocybin psychotherapy had improved quality of life and decreased depression and anxiety. This has huge implications for palliative care.

“That spiritual experience seems to be the catalyst in allowing them to come to terms with their situation,” Stephen explains.

But this isn’t exactly a new discovery. The co-founder of Alcoholics Anonymous, Bill Wilson, said the spiritual awakening he experienced on LSD is what started his own sobriety.

“The problem is spiritual experiences are hard to create but we know, with psychedelics, we can induce these mystical experiences in a clinical setting in the right context with the right trained therapists involved,” said Stephen.

This is why research has also looked into psychedelic psychotherapy as a treatment for addictions like smoking. One study found that psilocybin psychotherapy helped people quit smoking, with 60% still smoking-abstinent after 12 months.

“That’s remarkable when you consider Champix—which is the leading pharmacotherapy for nicotine cessation—that has a success rate of 21% at 12 months,” said Stephen.

“Subjects in this study reported that this mystical experience that’s induced by the psilocybin is ranked as one of the top five most significant experiences of their life.”

Your brain on psychedelics

Not only has this therapy shown good results in PTSD, palliative care and addiction, it’s also being looked at as a treatment for depression because of the effect it has on the brain.

“Another area that’s in its infancy is psilocybin and depression. There’s been an open label study published by Imperial College in London among people who hadn’t responded to other treatments for depression. They found a number gained significant benefits from psilocybin-assisted psychotherapy.”

In this study, they also took a look at what was going on in the brain of patients with neuroimaging. Using this, they found a change in the brain was linked to a reduction of depressive symptoms.

It turns out psilocybin can temporarily switch off a part of the brain called the default mode network, which correlated with patients having that mystical experience.

“The default mode network is a series of interconnected neural pathways. It’s activated all the time when we’re in a waking state. It allows you and me to have this conversation at the moment because we can concentrate on what we’re doing,” said Stephen.

“If we turn off the default mode network, we end up with a lot of cross-talk happening within the brain,”

“In the context of depression, perhaps having all those different interconnected pathways allows the person to see the world, themselves and others in a completely different perspective.”

He likens the default mode network to a conductor in the brain. Turning off the default mode network with psychedelics is like putting the conductor on “paid service leave for 6 to 12 hours”. Without the conductor, the orchestra starts playing all kinds of things.

“In that cacophony of noise comes epiphanies.”

Inducing everyday epiphanies

If you’re like me, by now you’re probably thinking you could use an epiphany too. Surely this can’t only be useful for mental health disorders?

I asked Stephen to play the hypothetical game of looking into the future and letting me know if there will ever be a day this could be accessed by anyone needing to make a big life decision.

“People can go when they want to engage in some sort of spiritual contemplation or they’re not sure about something in their life and they can utilise the psychedelic experience to help them with that.”

But before we get there, we have some serious catching up to do.

What’s stopping us?

You may have noticed that all the studies referenced in this article have been from the US and the UK. That’s because Australia is seriously lagging behind in psychedelic research.

Stephen said there are a few reasons for this, namely “academic conservatism”, which is why I swell with uni pride when Stephen tells me my old stomping ground ECU has thrown their support behind psychedelic science.

“We’ve been banging our heads against the wall for about 8 or 9 years now, and things are really starting to look quite positive. I don’t want to get too optimistic, but things are starting to look really positive,” he said.

“The fact that ECU is supportive of it is fantastic.”

Stephen’s worked in both the policy and scientific spheres to try and get Australia to embrace and get involved in psychedelic research. In particular, he’s been leading the charge for MDMA-assisted psychotherapy.

Right now, MAPS is in the process of phase 3 trials for MDMA-assisted psychotherapy for PTSD, after phase 2 yielded promising results.

“What we’re hoping in Australia, and what ECU’s supporting, is that Perth will be a site for a phase 3 trial,” said Stephen.

“If we can demonstrate we have the people and infrastructure to do MDMA-assisted psychotherapy, then we can come on board as a phase 3 site, and so all we need to do to demonstrate that is just run a very small pilot feasibility study. And so that’s what we’re working on at the moment.”

Getting Australia on board means we will be able to access psychedelic psychotherapies and won’t be left behind.

“Hundreds of thousands of Australians will no longer needlessly suffer from depression, post-traumatic stress disorder and anxiety associated with dying … we will see less suicides occurring among war veterans,” said Stephen.

“Australians won’t need to travel overseas to access these treatments because we will have clinics and trained therapists available in Australia who can provide these therapies.”

So it’s probably time that Australia had an epiphany and took psychedelic science a little more seriously.

https://particle.scitech.org.au/people/treating-mental-disorders-with-psychedelic-psychotherapy/​

 

[mr peabody]

Psychedelic therapy for depression

by Guthrie Dyce | The Naked Scientists | 3 Apr 2019

The academic interest in psychedelic drugs, in particular psilocybin has markedly increased over the last decade...

The increase has been fueled by the publication of a number of small studies investigating the therapeutic potential of psychedelic drugs, and the FDA has granted Compass Pathways, a company conducting research into the clinical potential of Psilocybin Therapy for Treatment Resistant Depression, ‘breakthrough therapy’ designation. This means the FDA believes psilocybin therapy may be substantially better than other available therapies for treatment-resistant depression, and will try to help expedite clinical research with psilocybin.

Two of the more rigorously-controlled clinical trials supporting this designation examined the effect of supervised psilocybin experiences on individuals with depression and anxiety secondary to life-threatening cancer diagnoses. Headed by Roland Griffiths at Johns Hopkins University, and Stephen Ross at New York University, these studies report rapid and sustained reductions in depression and anxiety. The subjects enrolled were randomly assigned to different conditions: psilocybin or placebo. Placebo conditions consisted of a low dose of psilocybin or niacin, which produces flushing. Both studies blinded the supervisors and the subjects: neither were sure what dose of psilocybin had been given, if any. Both groups found that for 60-80% of subjects, six months after a high dose experience, there had been a 50% or greater reduction in symptoms. Over 60% of these individuals met criteria for the remission of their depression.

Nevertheless, we have a poor understanding of what psilocybin, and psychedelics more generally, do to the brain to produce these effects. The word psychedelic is derived from the ancient Greek words psyche (meaning mind or soul) and dêlos (to reveal or make manifest), but the same drugs are also referred to as psychotomimetics (mimicking psychosis) and hallucinogens (generating hallucinations). These terms reflect different truths about this class of chemicals, which this year has been described in yet another way: as ‘psychoplastogens’ (making the mind malleable).

Psychedelics promote the growth of neural connections

This new term was introduced by Calvin Ly and David Olson at the Centre for Neuroscience at the University of California, Davis (UCSD), and it heralds a step forward in our understanding of the effect of drugs like psilocybin on the brain. These scientists bathed cultured rat neurons in a range of psychedelic chemicals including one called dimethyltryptamine (or DMT). This molecule is structurally similar to psilocybin, and is itself the psychedelic ingredient in the Amazonian brew ayahuasca, a word meaning ‘vine of the soul’ or ‘vine of the dead’. Both psilocybin and DMT are serotonergic psychedelics, which (like lysergic acid diethylamide, or LSD) exert their psychological effects through the serotonin 2A receptor.

After being bathed in DMT, the cultured cells in the experiment showed an increase in the number of nerve cell branches (dendrites), and connections (synapses) with other cells. The same was observed in neurons in the prefrontal cortex (PFC) of rats given either DMT or the anaesthetic ketamine. Lower numbers of dendrites and synapses in the prefrontal cortex are a hallmark of depression. Low doses of ketamine have also recently been shown to rapidly alleviate severe depression for up to two weeks. In fact, the authors were able to show that both drugs exert their effects through similar cellular signalling pathways. The effect of either drug on cell growth could be eliminated by blocking the action of brain-derived neurotrophic factor (BDNF), or another signalling protein called mTOR which is part of the same pathway but downstream of BDNF. Together these results suggest that the psychedelic drugs exert their these effects by upregulating BDNF signals in relevant parts of the brain.

While this sounds promising, the authors do caution that there are drawbacks to the clinical use of both ketamine and psilocybin. Ketamine is known to be addictive, and while this cannot be said of serotonergic psychedelics, their psychological effects are confronting and sometimes disturbing. For example, Christopher Timmermann, Robin Carhart-Harris and their colleagues at Imperial College in London found that intense psychedelic experiences bear striking resemblance to 'near-death experiences'. People reporting the former score highly on the same questionnaire used to measure the latter. The scientists at UCSD suggest that safer, structurally similar chemicals, with the same long-lasting antidepressant effects, might be developed in future.

Clinical effects of the psychedelic experience

Curiously, the psilocybin-assisted psychotherapy conducted with cancer-patients, along with open-label clinical research into its application for treatment-resistant depression and smoking cessation, seems to have cast doubt on this hope. These studies all report clinical effects that are dependent on the nature of the psychedelic experience reported. High doses have been shown to reliably produce ‘mystical-type experiences’ in a controlled environment. This is quantified using the reports of participants in a questionnaire that is based on historically recurring themes in such experiences. These themes are feelings of unity with the universe, a sense of sacredness and positive mood, a sense of transcending time and space, a sense of encountering fundamental reality and a feeling that the experience cannot be expressed in words (ineffability).

On the other hand, Roland Griffiths and his colleagues found that, five weeks after receiving a high dose of psilocybin, participants scoring higher on this questionnaire also scored lower on the hospital anxiety and depression scale (HADS), regardless of the self-rated intensity of the experience (responses on the hallucinogen rating scale, or HRS). The same pattern was found in the cancer study at NYU using both the HADS, and other measures of depression and anxiety. These findings are also consistent with two other small ‘open-label’ trials; those in which the participants know when they are to be given the psilocybin. A first trial into the effectiveness of this therapy for treatment-resistant depression found that participants describing their experiences more in terms of ‘Oceanic Boundlessness’ had greater symptom reductions five weeks later. In another trial for smoking-cessation, smokers scoring highly on the mystical experience questionnaire were more likely to remain abstinent six months after a high dose session, with abstinence being verified biologically.

The importance of a cultural container

These preliminary studies are small, they involve self-selected and highly-screened participants, they are conducted by only a few research groups and those with an open-label design cannot rigorously distinguish between the effect of psilocybin and participant expectation. In spite of its limitations, the research so far suggests the psychedelic experience may not be separable from its clinical effects. If this is the case, it highlights the care with which any effort to integrate it into society must proceed. The psychedelic experience is still considered a model for psychosis, and not without reason. The networks of cells in the brain supporting internally and externally directed attention tend not to operate simultaneously. In people under the influence of psilocybin or suffering from psychosis, these networks operate more synchronously. This would seem to parallel the subjective reports in the clinical trials of feeling unity with the universe. Indeed, “altered ego boundaries” are a common feature of early psychosis. Additionally, the intense psychedelic experiences reported in the scientific literature are sometimes described in terms of 'ego dissolution' instead of mystical language. For fear of provoking psychosis in those predisposed to it, current clinical research screens out at-risk populations: people with schizophrenia and bipolar disorder, and their first-degree relatives, for instance. This elimination of ego boundaries also appears to produce personality change in adults lasting at least a year. Specifically, it appears to increase subjects’ scores on the personality trait of ‘openness to experience’. An epidemiological analysis of 654 Australian secondary school students found that this trait is associated with persecutory ideas (i.e. paranoia) and magical thinking. Having said that, it is also associated with aesthetic appreciation, imagination and creativity. In short, psychedelic drugs appear to open the mind to good and bad ideas.

Conclusion

According to the World Health Organisation there are over 300 million people with depression globally. If the clinical effects of psilocybin therapy are replicated in larger clinical trials, meeting the increased demand responsibly may be a challenge. For instance, psychedelic use in supervised groups the way ayahuasca is used in Colombia and Peru may be more practical than providing individual therapy sessions. However, this would necessarily reduce the amount of attention paid and care provided to each person. The ayahuasca tourism industry specifically highlights the dangers posed by insufficient regulation. For example, without proper screening and supervision, psychedelic experiences can precipitate psychotic episodes with tragic consequences. Unais Gomes allegedly became homicidal after drinking ayahuasca and was killed by his friend Joshua Stevens in self-defence at a retreat in Peru in 2015.

Psychedelic drugs also make people suggestible and vulnerable to abuse. While researching shamanism in the Amazon, Harvard Divinity School student Lily Ross was repeatedly raped by a shaman who kept her under the influence of containing scopolamine. If the psychedelic experience becomes part of the psychiatric toolkit, the right kind of screening, supervision, support and guidance will be necessary in order to maximise the benefits of their administration and minimise the risks. Clinical research involving psilocybin has so far involved monitors (often clinical psychologists) being present while subjects are under the influence of psilocybin to provide support. These monitors are also usually present before and after the experience to prepare subjects and then help them make sense of it. The care demonstrated in this research is reassuring. However, larger rigorous clinical trials into the safety and efficacy of psychedelic therapy are needed to clarify under what circumstances, if any, it is an appropriate intervention.

In summary, it appears that serotonergic psychedelics could help people overcome end-of-life anxiety, depression and addictions. The blurring of conceptual boundaries, particularly between self and other, may be an important factor predicting positive clinical outcomes. That said, we owe our sanity, morality and humanity to conceptual boundaries as well. It seems prudent to begin thinking about how the promising field of psychedelic medicine might ultimately be integrated into modern secular societies. I for one will continue to watch this space with interest and apprehension...

Psychedelic therapy for depression

Psychedelic therapy may be our best treatment for depression. So must we lose our minds to come to our senses?

www.thenakedscientists.com

 

[mr peabody]

The rise of psychedelic psychotherapy*

by Daniel Oberhaus | Dec 4, 2018

Following Albert Hoffmann’s accidental discovery of lysergic acid diethylamide in 1943, the drug was quickly adopted by clinicians for a variety of therapeutic uses. In fact, the Harvard psychiatrist Lester Grinspoon estimates that between 1950 and 1965, more than 1,000 papers were published on psychedelic therapy that involved the treatment of more than 40,000 patients. Of particular interest to many researchers was the drug’s efficacy in treating alcoholism, a disease that was just beginning to be recognized in the early '50s.

At the center of the movement to treat alcoholism with LSD was Humphry Osmond, an English psychiatrist whose interest in psychedelic therapy began with his investigations into the psychoactive properties of mescaline derived from peyote cacti. In 1951, Osmond took a job as the lead psychiatrist at the Canadian Mental Hospital in Weyburn, Saskatchewan, a small city in central Canada. After his move across the Atlantic, Osmond continued to research psychedelics and was introduced to LSD by the young Canadian doctor Abram Hoffer. In 1953, Hoffer and Osmond began treating diagnosed alcoholics with acid, a research program that laid the foundation for the medicalization of psychedelics.

According to Erika Dyck, a researcher at the University of Saskatchewan and an expert on the history of psychedelic psychiatry, Hoffer and Osmond hit upon the idea of using LSD to treat alcoholism during a sleepless night ahead of a conference they were supposed to give a presentation at the following day. In the course of their conversation, Hoffer and Osmond remarked that LSD experiences were strangely similar to delirium tremens, the intense confusion and hallucinations experienced by alcoholics during a sudden withdrawal.

As Hoffer later recounted the conversation, the comparison of LSD and delirium tremens “seemed so bizarre that we laughed uproariously. But when our laughter subsided, the question seemed less comical and we formed our hypothesis… would a controlled LSD-produced delirium help alcoholics stay sober?”

When they returned to the Canadian Mental Hospital after the conference, Hoffer and Osmond put their hypothesis to work on two test subjects—one male and one female—who had been diagnosed as alcoholics. After giving their two subjects 200 micrograms of LSD, the male subject quit drinking and abstained for six months, but the female subject did not. This suggested that LSD could have a 50 percent chance of success in treating chronic alcoholism. Over the course of the next 10 years, Hoffer and Osmond would administer LSD to more than 700 alcoholics with similar results.

In 1961, Hoffer and Osmond were concluding their pioneering LSD trials in Canada, and psychedelic therapy came into its own in the United States. This was the year that Myron Stolaroff, an electrical engineer who quit his job after a particularly profound LSD experience, founded the International Foundation for Advanced Study in California. IFAS quickly became the American center for medical research on psychedelics.

During its first five years, the institute conducted a number of clinical trials on the therapeutic effects of LSD and mescaline that resulted in six published scientific papers. In total, Stolaroff and his colleagues treated 350 patients with psychedelics. As recounted in the Albert Hoffman biography Mystic Chemist, an initial LSD study on 153 patients found that “83 percent of subjects found the psychedelic experience to positively influence their personal development” and the “improved capacity to love and be loved was noted by 78 percent, and 69 percent experienced more profound communication with others.”

Although some research on psychedelics occurred in the '90s, most notably Rick Strassman’s studies on DMT at the University of New Mexico, it wasn’t until the mid-2000s that psychedelic psychotherapy was considered a serious research paradigm once again. Over the last decade, the new wave of research on psychedelic therapy has largely focused on psilocybin and MDMA, but ayahuasca, LSD and even ketamine are increasingly commanding the attention of psychiatric professionals.

A substantial portion of the psychedelic renaissance has occurred due to the efforts of two institutions: the Multidisciplinary Association for Psychedelic Studies (MAPS) and Johns Hopkins University.

MAPS was founded in 1986 by Rick Doblin, who was also involved with MDMA researchers affiliated with groups like ARUPA and EMDL. In 2008, MAPS made history by completing the first FDA-approved pilot study on the use of MDMA to treat patients suffering from PTSD. This initial study involved 20 individuals whose PTSD was caused by experiences such as military service, violent crime and sexual abuse. Today, MAPS is conducting a final phase 3 FDA trial for MDMA as a treatment for PTSD and expects MDMA to become a legal form of therapy for those with PTSD by 2020.

Meanwhile, at Johns Hopkins University, psychiatrists have spent the last decade investigating the role of psilocybin, the psychoactive compound in magic mushrooms, in treating depression and anxiety in patients with terminal diseases. In 2016, researchers at Johns Hopkins enrolled 51 terminally-ill patients in a pilot study that involved dosing the patients with psilocybin in the clinic. The results were unambiguous: 80 percent of participants showed “significant” decreases in depression and anxiety related to dying, and a similar number reported an increase in well-being and life satisfaction.

“The most interesting and remarkable finding is that a single dose of psilocybin, which lasts four to six hours, produced enduring decreases in depression and anxiety symptoms, and this may represent a fascinating new model for treating some psychiatric conditions,” Roland Griffith, a Johns Hopkins psychiatrist, said of the study. “I could imagine that cancer patients would receive psilocybin, look into the existential void and come out even more fearful. However, the positive changes in attitudes, moods and behavior that we documented in healthy volunteers were replicated in cancer patients.”

MAPS conducted a similar study on the use of LSD in patients with life-threatening illnesses in Switzerland in 2014. Like the Hopkins psilocybin study, the use of LSD resulted in a remarkable improvement in the attitudes and moods of the patients.

These positive results in modern psychedelic psychotherapy are not just limited to the the terminally ill. Johns Hopkins researchers also showed that psilocybin can be used to help smokers kick their habit, researchers in Brazil concluded the first randomized, placebo-controlled study on ayahuasca (a psychoactive brew made in the Amazon) last year and found it significantly reduced depression symptoms, and the University of New Mexico did a pilot study that suggested psilocybin can successfully treat alcoholism and is currently designing a similar study for LSD.

Unfortunately, the federal prohibition on psychedelic substances has made it exceedingly difficult for researchers in the United States and many countries around the world to study the therapeutic potential of psychedelics in a clinical setting. Although researchers at Johns Hopkins and elsewhere have called upon the DEA to loosen restrictions on psychedelic substances, there are few signs that this will change any time in the near future. In the meantime, many psychiatrists continue to practice psychedelic therapy underground. Yet according to the journalist Michael Pollan, who recently wrote a book on psychedelic therapy called How to Change Your Mind, even those researchers who are conducting clinical research on psychedelics at institutions are ultimately indebted to the underground clinicians that came before them.

In his book, Pollan details his experiences with “Mary,” an underground psychedelic therapist. Mary was the first person to introduce Pollan to psilocybin and had been practicing psychedelic therapy for decades. As he listened to a cello concerto by Bach, Pollan experienced synesthesia, ego-disillusion and a number of other profound psychological experiences. Through it all, Mary was there to guide him. Although Mary was practicing her therapy outside the confines of institutions like Johns Hopkins, Pollan said this didn’t detract from the profundity of the experience—if anything he had gone straight to the source of psychedelic psychotherapy.

“Though the university researchers seldom talk about it, much of the collective wisdom regarding how best to guide a psychedelic session resides in the heads of underground guides like Mary,” Pollan wrote in an adaptation of his book for the New York Times.

This is, in a way, reassuring. Even if the federal government persists in its moratorium on psychedelic research, history has shown that there will always be an underground network of dedicated therapists who understand the potential of psychedelic therapy. Perhaps one day our elected officials will.

*From the article here :

PRØHBTD

PRØHBTD is a cannabis-centric lifestyle brand for the conscious mind and cultured palate that rebels against prohibition past, present and future through art, street style, travel, cuisine, and entertainment.

prohbtd.com

 

[mr peabody]

Set and setting in psychedelic-assisted psychotherapy

Veronika Gold, Eric Sienknecht | Dec 13, 2018

If someone had told us a few years ago we would be legally using MDMA and ketamine in psychotherapy, we’d have laughed at the notion as impossible. However, while highly implausible to imagine it only a few years back, this is where our professional development has taken us. We are currently working as psychedelic therapists in the roles of facilitators, caretakers, midwives, and witnesses, helping individuals to reconnect with, process, and resolve past traumas and alleviate symptoms of severe anxiety and depression. It seems we are indeed successfully treating their otherwise intractable treatment-resistant symptoms with the aid of psychedelic catalysts.

To the extent that we, as therapists, have explored our own inner terrain, we also act as ambassadors to these same, hitherto neglected or forgotten inner realms within our patients. It is a common view in the psychoanalytic community that “the symptom” is an expression of threatening or unmanageable psychic material that has been pushed into the unconscious, so that it is unprocessed, unmetabolized, even unknown. What if our responsibility as therapists to facilitate access to these uncharted subterranean catacombs can be catalyzed, indeed expedited, by psychedelic medicines to more efficiently bring repressed material into the light of conscious awareness? If that is the case, then not using these tools, at least in some cases, would be a disservice to our patients and to the search for truth.

Set – short for “mindset” – in psychedelic-assisted psychotherapy

The patients’ set involves their current state of mind, mood, attitude, interpersonal or professional concerns, beliefs about psychedelic medicines, and expectations about the specific therapeutic session. As therapists, we also must consider our own set, and its influence on the patient and treatment. Our set involves our own current frame of mind, mood, outside concerns, and hopes for the session and the treatment as a whole.

The broader socio-cultural values and perceptions need to be also carefully considered as influences on the patient’s set: their “social set.” What are the collective social beliefs, cultural values, and stigmas regarding psychedelic use? How do their friends, family, and loved ones perceive the use of psychedelics in general and in treatment? We recognize that these collective perceptions, expectations, judgments, and fears play an important role in how the patient anticipates and interprets the work.

We strive to be mindful that every phone contact, email, and in-person meeting will naturally influence our patient’s perception (i.e., his or her set) far in advance of a session with the medicine. The essential foundation of the patient’s set is their well-informed understanding of all aspects of the treatment. Following the intake, they should have a good sense of the specific rationale for the chosen treatment protocol, dosage strategies, common physiological and psychological effects and duration of the medicine(s), the typical stages and progression of a psychedelic journey, and all known risks and benefits of the treatment. Patients are informed about their right to discontinue treatment at any time for any reason. Side effects, possible use of emergency and support medicines, if needed, and alternative treatment options are also discussed. In preparation for a psychedelic session, we try to cultivate a trust in the process, understanding that it may not be linear or predictable and may come with unexpected twists and turns.

In these preparatory sessions, the intentions and motivations of the seeker are explored and openly examined. What multiple factors have brought them to the point of consider taking a mind-altering substance in treatment? What are they hoping to get out of the treatment? Where are they in their process of psychospiritual development? Sincere and uninhibited self-inquiry is encouraged to identify patterns of thinking, feelings and behaviors that are reinforcing their dis-ease. We endeavor to support and facilitate the freedom of the “traveler” to go wherever he or she wishes and make meaning of and understand their symptoms, with the ultimate goal of liberating themselves from the shackles of old, rigid, fear-based beliefs and dictates.

Trusting the patient’s inner healing intelligence

Perhaps the most important core principle in the work is encouraging patients to trust the medicine and their own inner healing intelligence. This concept and its implications are elucidated in the MDMA study treatment manual: “It is essential to encourage the participant to trust their inner healing intelligence, which is a person’s innate capacity to heal the wounds of trauma. It is important to highlight the fact that the participant is the source of their own healing. The [medicine] and the therapists are likely to facilitate access to a deep healing process, but they are not the source of this healing process.” We trust that our patients’ natural ability to heal, along with a sincere desire for healing, will guide them to the material that needs attention, processing, and integration.

Because the inner healing intelligence goes to where it is needed, the healing process not only involves letting go, on both the part of the client and the therapist, but also trusting that any challenging material that arises is “coming up for healing.” There is a well-known maxim in our field: There are no bad trips, only challenging ones. The healing process is not about avoiding challenges but rather engaging with them in new ways, and discovering a more expansive, harmonious, accepting, empathic, and loving way of relating to them. In fact, Myron Stolaroff, an influential pioneer of psychedelic psychology, felt the most significant transformational healing and growth resulted from encountering dark thoughts and emotions, and unresolved fears and trauma during a psychedelic session. Challenging experiences can be incredibly valuable and important, sometimes even essential, to the journey towards wholeness.

Setting in psychedelic-assisted psychotherapy

The setting, at its most concrete, is the physical space where the experiential session takes place. At our ketamine psychotherapy clinic, Polaris Insight Center, we do our best to make the setting cozy and comfortable and to minimize outside distractions and disruptions. The room’s decorations are carefully chosen to create a welcoming ambiance that is aesthetically appealing, simply adorned, and not overwhelming in any manner. We try to avoid using trappings of a traditional institutional, medical, or clinical environment. Instead, we strive to curate a familiar, living-room-like setting conducive to relaxation and surrender. These conditions create an optimal space for the patient to let go and for the journey to unfold and flow of its own accord.

More subtly, considerations of setting include various environmental influences on the patient and the process. For example, the setting of a therapy suite in San Francisco will have a different impact on the experience than that of a therapy center in the mountains of Colorado. A psychedelic psychotherapist must keep in mind how the larger socio-cultural context might impact the psychedelic experience.

Music as part of setting in psychedelic-assisted psychotherapy

Music plays an important role in our work. It provides a container for the patient’s emotional processing while guiding the forward movement of the journey. Stanislav Grof describes the role of music as creating “…a continuous carrier wave that helps patients to overcome difficult parts of the sessions and move through impasses.” Furthermore, the practice of listening to music puts the listener into a more receptive, meditative state, which, in turn, facilitates the process of letting go; an important component of the psychedelic experience.

Thoughtful care is put into curating specialized playlists with the intention of taking the listener on an ultimately uplifting and healing journey.Playlists are arranged to mirror the drug effects. In our work with MDMA, atmospheric ambient tracks are used for the come-up period, faster and more emotionally evocative tracks are played during the peak, and tender heart-opening pieces are selected for the come-down period. In ketamine sessions, more spacious, textured ambient electronic tracks are used. As the participant’s journey unfolds, the music fosters emotional openness for connecting or reconnecting with old memories and deep emotions of sadness, grief, surrender, joy, and love. Some samples of playlists curated specifically for psychedelic journeys can be found at Chacruna’s Psychedelic Therapy Music Forum.

Planning for Integration as a part of set and setting in psychedelic-assisted psychotherapy

The integration process in the days and weeks following the psychedelic experience is important to consolidate the insights gained during the journey and implement changes in one’s life. During this period, we help patients find words for their experiences, unpack insights, and develop new personal narratives. We further discuss strategies and practices to retain and actualize this new knowledge. These sessions tend to involve a more directive approach where we suggest specific techniques (e.g., journaling, drawing, listening to music, dancing, meditation, connection with nature). The questions we pose to the patient during this period support these efforts: In what ways, if any, have your psychedelic sessions shifted how you see and understand yourself now? How has it informed your view of reality, your role in it and your understanding of your life’s journey? Has it changed your relationships, motivations, self-criticisms, and criticisms of others?

Training and approach of psychedelic psychotherapists as a part of set and setting

To be effective in the role of psychedelic psychotherapist, we believe well-trained therapists should have some familiarity with, and experience navigating, non-ordinary states of consciousness (NOSC). This preparation may involve therapists having their own personal experiences with psychedelic-assisted therapy, or alternatively, having non-drug NOSC experiences such as with floatation tanks, immersive meditation retreats, or holotropic breathwork. However, we feel strongly that, without direct experience of the psychedelic-assisted therapy, the therapist will be less prepared to navigate the terrain of NOSC in psychotherapy. One of our colleagues captured this idea in a colorful metaphor: If you’re climbing Mount Everest, you would want to know that your sherpas have climbed it before, are familiar with characteristic challenges of the terrain, and are acquainted with the particularly scenic routes and viewpoints along the way.

In training psychedelic therapists, we want to cultivate a professional ethic of mindfulness and patience, as we carefully tend and till the soil of patients’ psyches in preparation for the harvest. This approach inevitably involves a good amount of waiting and not-doing. The apprentice gardener may earnestly believe that more directive interventions will lead to more growth. However, each patient’s path is unique, and the healing process is best served when the therapist is able to trust the process and put aside their own plans, expectations, and judgments.

Recommendations for further education and training

Dr. Janis Phelps, Director of the Center for Psychedelic Therapies and Research at the California Institute of Integral Studies, has developed a set of best practices to achieve optimal outcomes in psychedelic therapy.4 Among the core competencies of psychedelic therapists are empathetic abiding presence, trust enhancement, knowledge of the physical and psychological effects of psychedelics, and therapist self-awareness and ethical integrity. Her recently published article in the Journal for Humanistic Psychology is highly recommended for further reading on this subject.

Ambassadors to Hidden Territories: Set and Setting in Psychedelic-Assisted Psychotherapy

If someone had told us a few years ago we would be legally using MDMA and ketamine in psychotherapy, we’d have laughed at the notion as impossible. However, while highly implausible to imagine it only a few years back, this is where our professional development has taken us. We are currently...

chacruna.net

 

[mr peabody]

Ketamine’s breakout in psychedelic therapy

by Dan Bernitt | Psychedelic Support | Apr 30, 2019

Psychedelic therapy holds a lot of promise, which medicine is right for you? Dr. Raquel Bennett describes her journey to find ketamine assisted psychotherapy and launch the first ketamine specific conference. She talks about different methods and approaches used in ketamine therapy.

After struggling for over a decade with severe depression, Raquel Bennett turned to psychedelics after no available treatment made substantial improvement. Working with a psychiatrist and an underground psychedelic shaman over a two-year period, her psychotherapy was facilitated first with MDMA, then psilocybin, then LSD.

As therapeutic tools, these psychedelics provided little relief; two of them made her worse.

“I felt I failed at psychedelic therapy.”

“It was catastrophic,” she said. “At that point, I was really discouraged and I felt that I had failed conventional treatments and that I had essentially failed psychedelic treatment, and I was ready to kill myself. I was really at the edge of that rope there.”

What Bennett didn’t know at the time was that she had an misdiagnosed mood disorder. For people with serotonergic disorders, including major depressive disorder, bipolar disorder, schizophrenia, and other mood disorders, some psychedelics can have a dangerous impact. Too much serotonin can be destabilizing. “Any of the medicines that are active in the serotonin pathway will really screw somebody up if they have an organic problem with serotonin regulation.”

“It’s very common actually that people with organic mood disorders do very poorly with MDMA,” Bennett said. She notes that "people on the bipolar spectrum can have manic episodes during the MDMA experience, followed by an extremely severe depression." For the same group, psilocybin can induce a psychiatric emergency or persistent psychosis that requires hospitalization. “There’s been a terrible job of adequately educating people that you cannot give serotonergic agents to people who might be on the bipolar spectrum because you could hurt them.”

A spiritual exploration

Bennett’s shamanic teachers continued working with her in an ongoing psychotherapeutic and spiritual context. Two years into psychedelic work, her teachers suggested using ketamine to aid a spiritual exploration. The intention for the experience was to explore her intense suffering: why was it in her life, and what was its purpose or value?

“It was life-saving,” Bennett said. Under the drug’s influence, the visions began. “My experience was that God came, and God put a giant golden key into my right ear and turned the key and turned my brain on. It was like the whole system got rebooted. I realized that I was awake and that I was alive and that my brain actually did know how to work. It had just been asleep for a long time. I was very excited.” Paralyzed in that moment by the medicine, she wasn’t able to express her immediate excitement to her teachers, and then she continued on a psychedelic journey that, nearly twenty years later, still resonates for her with profound beauty and expansiveness.

Poetic and symbolic, a common thread throughout her experience is moving from isolation to a deep connection. After feeling God’s key turn on her brain, she found herself on an orange surfboard on the edge of the outer Universe. Next, she identified herself as a single raindrop, her own autonomous being. Then her drop reunited with other drops into a river she knew innately as a “river of love.” Her psychedelic ketamine experience helped her to recognize her inherent worth and sense of wellness, she said. “At the core of who I think I am, I am not defective or broken. I was ill, I needed treatment, and there was enough reason to stay alive to pursue more treatment.”

For weeks following, Bennett’s depression remained lifted. This came as a complete surprise to her teacher, her psychiatrist, and other mental health providers she spoke to. No one believed an immediate antidepressant could ever exist.

Awe creates curiosity

The effect of Bennett’s ketamine experience, as well as the experience itself, captured her attention: how does this work? Is it reliable and repeatable, or was it a fluke? She sees the medicine impacting her in two ways: chemically and spiritually. While the chemical effect relieved her depression for months, the visions she experienced were the most striking.

“There’s too much emphasis on it as a pharmaceutical agent and not enough attention being paid to its very prominent visionary properties,” she said. “Nothing is more profound for somebody who wants to die or who hates themselves so much that they want to kill themselves than to find themselves being cradled in the arms of God, realizing that everything is connected, that their life is meaningful, that they’re an essential piece of the puzzle for what’s supposed to be happening right now on the planet.”

How does it happen in evolution that you come to have a lock in your brain with no key? - Dr. Raquel Bennett

First synthesized in the 1960s, ketamine has commonly been used as a surgical anesthetic and recreationally as a psychedelic. Unlike other psychoactive medicines, ketamine has no natural analogue. For example, the synthetic psychedelic LSD has an analogue to ergine, which exists in morning glory and Hawaiian baby woodrose seeds. Ingesting these seeds triggers receptors in the brain that LSD also triggers. What strikes Bennett deeply is that nothing in the natural world has been found that hits the same pore on the same receptor that ketamine hits, a receptor that controls the perceptions of pain and separateness.

“How is it that you have a receptor that’s activated by this molecule, but for more than 10,000 years there’s been nothing that’s been hitting that receptor?” She asked. “How does it happen in evolution that you come to have a lock in your brain with no key?”

While the neuroscience is interesting to her, it’s not her primary focus. If ketamine allowed her to lose the sense of pain, to see walls between herself and others dissolve, and to gain deep feelings of connection, could that be healing for others? Could it be reliable and repeatable? Her curiosity drove her to pursue graduate study in clinical psychology where she met new walls: discussing ketamine and other psychedelics was forbidden.

“It was professional suicide.”

When Bennett began graduate study in clinical psychology a few years later, she planned to devote her career to helping people living with mood disorders, including severe and refractory depression, bipolar disorder, and active suicidal ideation. At the end of her seven years of psychoanalytic study and training, the people referred to her were very depressed and suicidal.

“I was totally frustrated by the treatment options that were available for them because they’re too slow,” she said. Talk therapy can take several months for noticeable effects. Psychiatric medicine is another option, but it takes several weeks to reach their optimal levels in the body. Additional variables of dosage and finding the most suitable medication can add more time before noticeable improvements. “It’s not that they don’t work. They do work. They’re just too slow for when people want to kill themselves.”

A decade had passed from her first ketamine experience to the end of her clinical training. She couldn’t forget how impactful the experience was. “I had mentioned to a couple of people during my graduate training that I had had this amazing experience,” she said. “They forbade me from ever mentioning it or openly expressing my interest.” Discussing psychedelics was considered “professional suicide.”

Despite the warnings, in 2012, Bennett began battling with her school to write her dissertation on ketamine. At first, they forbade her from using the word “psychedelic.” She said, “I fought with them for a whole year about this, because they thought that was an inappropriate topic for academic study.”

She prevailed and sought anybody and everybody who would discuss ketamine use outside of the context of anesthesia. In 2013 and 2014, after extensive calls and emails, after thorough Internet research, she interviewed everyone who would talk. How many would speak? “Five. Five clinicians. Five providers on the planet. Not kidding.”

Explosion after silence

When publishing her dissertation in spring 2014, people regarded ketamine in widely divergent ways. Most known ketamine use was in high doses for psychedelic or transpersonal exploration. Ketamine-facilitated therapy was still unknown.

“The National Institute of Mental Health had conducted a couple of studies using low-dose ketamine with modest results, so they were advocating for the low-dose infusion. But everybody that I knew was doing high-dose injection,” Dr. Bennett said. After her dissertation publication, Bennett found herself fielding people’s questions about ketamine and being a middleman for relaying various perspectives.

In 2015, Dr. Bennett decided to create a gathering where people working with ketamine could share information: dosing strategies, routes of administration, preparation and integration. She organized a lunch to gather these voices and ideas in one place. But people were anxious about attending: their reputations were on the line, and associating with psychedelics, no matter how legal, still seemed like a very bad idea.

“Everybody wanted a confidentiality agreement to make sure that nobody found out that they attended,” Bennett said. “Then, at the last minute, everybody wanted to bring a friend. The reality is that a lot more people were using ketamine for psychedelic exploration than they wanted to admit to.”

The number of people now wanting to attend surpassed what the restaurant could handle for a group lunch. Bennett rented a library space to accommodate the event, which began to snowball from the original handful of invitees. Realizing the potential historic nature of the event—a conversation taking place that may have never occurred before—Bennett hired a videographer to document it.

Dr. Raquel Bennett

The video, Bennett says, shows 28 people perspiring heavily from anxiety. But the space had been created. “As soon as there was a gathering where it was okay to talk about this, I think people wanted to find other people with similar interests, in particular people whose interest overlapped with psychiatry, psychotherapy, and psychedelics,” she said. The KRIYA Conference was born. The gathering in 2016, the following year, hosted 53 attendees from around the world. “For 2017 they all wanted to come again, and they all wanted to bring a colleague.” Over 100 people attended the 2017 KRIYA Conference.

Whiplash

2017 was a landmark year for psychedelics. Both the National Institute of Mental Health and the American Psychiatric Association acknowledged the benefits of using low-dose ketamine to treat depression. In August, Time Magazine’s cover story was about ketamine as “the new anti-antidepressant.” Relatedly, that same month, the Food and Drug Administration granted breakthrough therapy designation status to MDMA for the treatment of post-traumatic stress disorder, marking it the first time psychedelic-assisted psychotherapy would be evaluated in Phase 3 trials for possible prescription use.

The following summer Michael Pollan’s book on psychedelic research, How To Change Your Mind, became a #1 New York Times bestseller. In California, a 2018 initiative to decriminalize psilocybin mushrooms failed. Similar ballot initiatives are currently underway in Denver and Oregon.

Also in 2018, over 1,000 people applied to attend KRIYA Conference. Four years earlier, 28 people had been cautious about associating.

“We have intellectual whiplash, because the information is changing so fast. We haven’t had time to adjust to the very rapid change in this field,” Bennett said. She added that, despite all the whiplash, the major institutions remain consistent in their view of the psychedelic side effect of these substances: “They call it psychotomimetic, meaning creating or mimicking psychosis. From their perspective, the psychedelic effect, the visionary and hallucinogenic properties, is to be avoided. You either have to dose under it or you have to medicate it out.”

Pandora’s toolbox

In a short period of time, ketamine has become a widely accepted therapeutic tool. The adoption is not without its risks. While the medicine’s possibilities are known, the range of its potential remains to be explored. What all can it do, and how can we know?

Major institutions recommend low-dose ketamine infusions. With Bennett having seen the therapeutic value of higher-dose treatments, what remains to be explored is the optimal dose. She asked, “What’s a good starting place? How high can you go? Is more better? Is there ever too much? We’re trying to work that out.”

If an optimal dose is found, then other questions emerge. With various methods of administration available and their differing bioavailability, which is best? Then questions of frequency emerge. Bennett asked, “How often should you do this? What does maintenance dosing look like? Is it okay to do this long-term? We don’t know. We don’t have enough long-term patients to be able to answer that question.”

Bennett is quick to clarify that working with ketamine in the psychedelic dose range is not safe or appropriate for many people. For a patient to have a medically and psychologically safe psychedelic experience, careful selection and adequate preparation is crucial. “I don’t think we should be doing this broadly.” Bennett said.

“This is not a try-this-at-home situation.”

As with other psychedelics, ketamine must be used with the deepest respect. “If you use it with respect, then it can be very beautiful and generous. But if you use it without respect, it can be very fickle. I get a call every day of the week from somebody who had a bad experience because they didn’t respect the medicine,” Bennett said.

Due to the nature of the medicine and its risks, Dr. Bennett declined to provide guidelines on dosage and preparation, because she says it requires a nuanced understanding of diagnosis and integrative treatment. Doing so would be incomplete and, if acted upon, could be damaging. Some common side effects are not life-threatening, like hypertension, nausea, headaches, tremors, and an emergence reaction, a fear caused by anesthesia. Other side effects can be deadly: seizures, respiratory distress, paralysis. “When those things come up, people go south really quickly and need immediate medical intervention. You really just don’t have time to call 911 and wait for an ambulance to come,” Bennett said, having witnessed two medical emergencies in her career and had a emergency medical team ready to intervene.

Much risk comes from how ketamine is administered. The methods with the highest bioavailability are through intravenous or intramuscular injection. With oral ingestion of other psychedelics like psilocybin or MDMA, the body can protect itself by rejecting what it doesn’t want. Needles bypass the body’s defenses.

“As the provider or as the sitter, you really are holding that person’s life in your hands for that period of time. As the provider, you need to be equipped for that level of responsibility, psychologically and medically,” Bennett said.

Where MDMA and LSD enjoyed experimentation by underground lay therapists and patients doing the work on their own, ketamine’s risks don’t allow for the same exploration. This limitation requires collaboration by a range of medical professionals in order to see the medicine’s potential.



The three paradigms

For researchers and clinicians working with ketamine, Bennett sees them functioning from one of three paradigms: biological, psychological, or psychedelic.

In the biological paradigm, the focus is the biochemical effect. The patient shows up for treatment, receives the medicine, and the medicine does its work. Bennett believes it’s a useful paradigm for much of medicine, but making the patient passive is “a terrible idea.” She also notes that much of the current research operates from this paradigm.

“Where you’re emphasizing the biochemical properties and its effect on receptors, you may not be paying enough attention to people’s mental experience,” Bennett said.

With the psychological paradigm, the emphasis rests on ongoing psychotherapy. Ketamine is introduced as an assistant in the process, allowing the patient to access and process difficult material. This is the same principle in most psychedelic-assisted therapy research, where a psychotherapeutic dialogue causes the patient’s improvement.

“What’s interesting about this is that, in both of these paradigms, getting psychedelic is problematic. They’re trying to dose under or avoid psychedelic experience because you don’t want the patient too far out,” Bennett said.

In the psychedelic paradigm, the visionary, mystical experience is what’s valued. “The visions are basically perceived as a gift from God, and you have heavy preparation to help the patient to offer up their own body as a vessel to receive the visions,” Bennett said. Meaning is extracted or constructed from the visions and experience and turned into actions after the session. Essentially, visions instruct the patient how to move themselves toward wellness.

While these three paradigms can overlap, not all clinicians recognize or understand the value of operating in other paradigms. In addition, therapeutic ketamine has become lucrative, which is privileging each paradigm independently. This may stunt the advanced exploration of the medicine’s potential.

“A whole bunch of anesthesiologists have opened clinics on the side that provide intravenous ketamine infusion to depressed people. They’ve been arguing that the only safe way to use ketamine is intravenous. In other words, at their clinics,” Bennett said. “There’s a turf war currently between the anesthesiologists and the psychiatrists over this question about route. Economics are a huge factor.”

Matching patients with the right therapy

Despite the conflicts, the main question remains that Bennett knew innately from her first experience in the early 2000s: match the therapy to the patient. “I’m totally opposed to a one-size-fits-all approach to ketamine treatment. That’s a terrible idea, Different people benefit from different things.” she said.

Any psychedelic therapy must begin with a differential diagnosis. An experienced mental health professional needs to thoroughly evaluate the patient and understand what causes the person to suffer. A treatment plan appropriate to the diagnosis comes next.

There are concerns about the broad use or legalization of psychedelics. “They’re great tools, and I’m totally in support of them being more available,” Bennett said. “But, if you are not an experienced mental health professional, how are you going to know if the patient is presenting with unipolar depression or bipolar depression or a substance use disorder or severe trauma?”

In developing any treatment plan, a crucial question to ask is what will help the patient the most? “What I’m trying to do is educate patients that they have a variety of options, that there’s a whole spectrum of ketamine services that are available. And I’m trying to educate clinicians on how to know the difference about when to do what. That in fact is the purpose of KRIYA Conference is for us to compare notes about this as we try to sort this out. That’s my job: to figure out in greater detail.”

With the recent explosion of interest and therapeutic research, it’s important to note there is no panacea—only a range of tools available we must try to understand.

Visions to Heed: Ketamine’s Breakout In Psychedelic Therapy

Ketamine therapy is used for mental health disorders. Dr. Raquel Bennet talks about her healing journey with ketamine and the need for different approaches.

psychedelic.support