• Psychedelic Medicine

Psychedelic Therapy | +80 articles

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Implications for psychedelic-assisted psychotherapy*

Carhart-Harris et al. | The British Journal of Psychiatry

Psilocybin is a classic psychedelic (‘mind-manifesting’) drug, pharmacologically related to the prototypical psychedelic, lysergic acid diethylamide. Psychedelic drugs were used extensively in psychotherapy in the 1950s to lower psychological defences and facilitate emotional insight. In cognitive terms, the ‘lowering of defences’ may be thought of as a decrease in top-down emotional control. There are several reports in this literature of spontaneous autobiographical recollections or ‘relivings’ under psychedelics – similar in some respects to the dream-like sequences seen on stimulation of the medial temporal lobes or to the flashback phenomena seen in PTSD.

The present study sought to test the hypothesis that psychedelic drugs facilitate autobiographical recollection, using psilocybin and a blocked fMRI paradigm involving personal memory cues. Spontaneous relivings under psychedelics are often explicitly linked to past traumata; however, we used only positive memory cues in order to minimise the risk of adverse reactions. We predicted that psilocybin would augment subjective and neural responses to personal memories. Based on previous studies implicating medial temporal and visual association regions in vivid autobiographical recollections, we predicted that psilocybin would increase activations in these specific regions.

Discussion

This study sought to test the hypothesis that psychedelics facilitate the neural processes underlying autobiographical recollection using fMRI and the classic psychedelic psilocybin. Robust activations to autobiographical memory cues were found after both placebo and psilocybin, but greater late phase sensory activations and more intense subjective effects were seen after psilocybin. Greater activations were observed in the bilateral auditory cortex, somatosensory cortex, superior parietal cortex, left visual association regions and the occipital pole after psilocybin, and post-hoc tests confirmed that visual and other sensory regions were uniquely activated under psilocybin. This switch in sensory function from a pattern of deactivation under placebo to activation under psilocybin is important and may explain why memories can be felt as especially vivid or ‘real’ under psychedelics.

Implications for psychedelic-assisted psychotherapy

The primary finding of this study was that psilocybin switched autobiographical memory activations in visual and other sensory regions from a pattern of deactivation to activation. Participants also reported more vivid and visual recollections under psilocybin – which is consistent with the increased sensory activations. These effects may have implications for the use of psilocybin in psychotherapy. For example, psilocybin could be combined with positive memory cues as a treatment for depression – facilitating the recall of positive life events so to reverse pessimistic mind-sets. Support for such an idea comes from findings of decreased depression scores in patients with anxiety 6 months after a single psilocybin treatment and improvements in well-being and trait openness persisting in healthy volunteers up to 2 years after a single high dose of psilocybin. Further supporting the case for psilocybin as a treatment option for depression, we recently observed marked decreases in medial prefrontal cortex activity after psilocybin. Hyperactivity in the medial prefrontal cortex in depression and its normalisation after effective treatment is a highly reliable finding.

*From the article here :
 
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Are psychedelics the new breakthrough therapy?

by Seth Lorinczi | Portland Monthly | Jan 29, 2019

LSD, MDMA, and psilocybin are the newest tools in the therapist’s kit — and Portland is embracing them.

Decades after the hallucinogenic heyday of the ’60s, psychedelics are back. But, in this case at least, they’re being ingested in a clean, bland counselor’s office in Portland’s Central Eastside. As Michael Pollan’s best seller How to Change Your Mind attests, we’re in the midst of a psychedelic groundswell, with drugs like LSD, MDMA and psilocybin mushrooms being used to treat not just depression and anxiety but also PTSD, alcoholism, and even fear of death.

Few places have embraced the underground movement with as much fervor as Oregon, which is now also among the states pushing to take the therapy aboveboard. Under an FDA fast-track rubric, Portland will soon be home to one of the nation’s first legal pilot programs to use MDMA-assisted therapy to treat patients suffering from severe PTSD. (One study found that 76 percent of PTSD patients no longer fit the definition of the condition a year after therapy.) And last fall, Oregon’s attorney general approved language for a ballot initiative to decriminalize psilocybin; the measure could go to voters in 2020.

Unlike microdosing—the productivity-boosting trend preferred by Silicon Valley tech bros—psychedelic therapy involves full-strength doses. Yes, you may be treated to eye-popping visuals, but the focus here is on the inward journey: finding fresh perspective on the ingrained patterns and stories we believe make us who we are. Renee, who’s been a licensed therapist in Portland for 20-odd years, wasn’t a newbie when it came to psychedelics. “I always had my eye on it from a clinical perspective,” she says. A patient suffering from social anxiety led her to medicine-assisted therapy in 2012. (The patient supplied the MDMA himself.) “After that,” she says, “there was no way to go back.”

Another Portlander, Paula, had allowed her therapist license to lapse. “I had cutting-edge tools, but I found it difficult to make major headway,” she says of her departure from the field. But since discovering psychedelic therapy roughly a year ago, she estimates she’s treated 90 patients using MDMA and psilocybin, for conditions ranging from PTSD to eating disorders.

Because the drugs are Schedule I controlled substances and therefore illegal under federal law—violators risk jail time and hefty fines—sessions sometimes require house calls or off-hour appointments. Therapists act as guides, supplying measured and tested doses, and then allow the process to unfold at its own pace. Some therapists join in, taking a microdose to better enter the patient’s mind-set. Locally, many therapists get their start at the Portland Psychedelic Society, a self-described “educational group” that hosts meetups and symposia.

Sessions can run upward of $500, but converts say it’s well worth it. Take Myra, a divorced mother of two teens in her early 50s. After a lifetime of chronic depression, she’d given up on traditional therapy. “I wasn’t actively seeking suicide... but wanting ... death,” she says, “just, ‘Are we done yet?’”

Myra, who had her first session in 2015, found MDMA to be almost surgical in its precision. “It homes in on very specific past traumas and wounds we subconsciously avoid,” she says. Since her initial session, Myra has gone on to do four more, roughly once a year. “I still have human struggles,” she says. “But it is like a solid footing or foundation where before there was nothing under me.”

Increasingly, the clinical mainstream is taking notice. Dr. George Keepers, chair and professor of psychiatry at OHSU School of Medicine, cites a small psilocybin trial among smokers that, after six months, boasted an abstinence rate of 80 percent. “If the trial data shows the same kind of effectiveness as these open studies, I think it’s likely these medicines will be widely adopted,” he says. “But we need good solid evidence. If something goes wrong in a session, who’s going to know? There’s no one collecting the data.”

But with numerous clinical trials under way across the US (and Europe), the landscape is shifting. Perhaps this trip has just begun.

 
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Ketamine ~ Counseling and Assisted Therapy*

According to the National Institute for Mental Health, more than 16m people suffered from a major depressive disorder in 2016, and more than 1.3m of those people attempted suicide. The last great revolution in the treatment of clinical depression was in the 1980's with the advent of SSRI's like Zoloft and Prozac.

The 1990's gave us mindfulness based cognitive therapy (MBCT), which became (and still remains) the gold standard in treating major depression and related disorders. But MBCT and SSRI's are all we've had to offer depression patients for the last twenty years, and unfortunately there are still millions of people who do not respond well to these standard interventions. These people have "treatment resistant" major depression, either from MDD or as a function of existing psychological trauma.

With the advent of ketamine, however, we have a powerful new tool that is changing the way clinical psychologists treat major depression and trauma. The Awakened Mind Institute (AMI) is among the few clinics in the country that specializes in ketamine-assisted psychotherapy.

Psychedelic assisted psychotherapy

Ketamine counseling is intensive and administered in 3-5 hour blocks, or sessions. Often only one session is needed, but just as often, one or two additional sessions will need to scheduled to achieve the patient's goals. Every session includes the patient, of course, and Dr. Wilson. Also present will be a medical professional who will be continuously "micro-dosing" the patient with ketamine. As the ketamine reaches clinical levels of effectiveness, the doctor and the patient then begin cognitive therapy.

Getting ketamine assisted psychotherapy is a process. After histories have been gathered, diagnostics established, and goals and objectives for the first session have been determined, then the session itself is scheduled in conjunction with a trusted, local ketamine clinic.

"For some patients, ketamine-assisted psychotherapy can accomplish in a few hours what months or even years of classical talk therapy and the standard medication cocktails never could. This is especially true for treatment resistant patients with trauma and dysregulated moods." - Dr. Parker Wilson

*From the article here :
 
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Why psychedelic psychotherapy works

Jerry Brown, Ph.D., and Julie Brown

Steve Jobs loved LSD. The legendary Apple co-founder said, taking LSD was one of the two or three most important things he had ever done in his life. Jobs credited the multiple use of LSD as a major reason for his success and ability to Think Different, which became Apples motto.

Jobs was not the only visionary who attributed enhanced intellectual capacity to ingesting an entheogen. Cambridge University's Francis Crick, co-discoverer of the DNA structure, was another. Crick revealed, when speaking with a close friend, that he had actually "perceived the double-helix shape while on LSD." The list of brilliant LSD users who have come out of the psychedelic closet includes physicist Richard Feynman; Microsoft founder Bill Gates; and neuroscientist John C. Lilly.

None of this should come as a surprise, given the success of an earlier study in proving that psychedelic drugs significantly enhance problem-solving abilities. In 1966, a research team, which included psychologist James Fadiman and engineer Willis Harmon, conducted a Psychedelics in Problem-Solving Experiment. The researchers administered low doses of mescaline to professional people who were highly motivated to solve a problem they had been working on for three months or more without success. Virtually all of the subjects reported making significant breakthroughs and producing solutions that were validated by independent tests and, eventually, commercial acceptance of their solutions. This promising line of inquiry was abruptly terminated by the Food and Drug Administration, which banned further research on human subjects as part of the then-growing political backlash to the 1960s psychedelic movement.

The second coming of psychedelics

Today this problem-solving research and other potential medical and scientific benefits of psychedelics are being revisited by researchers at some of the nations leading universities, such as Johns Hopkins, Harvard and the University of California. In an article titled The Second Coming of Psychedelics, journalist Don Lattin describes this renewed interest in sacred medicine. Paving the way for this resurgence of government-approved research is the Multidisciplinary Association for Psychedelic Studies (MAPS), a non-profit research and educational organization that develops medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana.

In recent years, rigorous research has been conducted on entheogens, such as ayahuasca, LSD, mescaline and psilocybin, and on the empathogen Ecstasy. The goal is to evaluate their effects on addiction, cluster headaches, depression, trauma, cancer, epilepsy, death and dying, as well as to explore their value in the study of consciousness and mystical experience. The implications of this new science of psychedelics for brain research and psychiatry, and for religion and spirituality, have been documented in numerous articles and books. A resurgence in the study of entheogens is well underway.

Lifting the taboo on psychedelic research

Harvard psychology professor Timothy Leary infamously sparked an aggressive promotion of LSD in the 1960s that would ultimately lead to the loss of his teaching position and a federal ban, the Controlled Substance Act of 1970, on all research on psychedelics.

This research blackout came to an end in 1999, when Roland Griffiths of Johns Hopkins initiated a new series of studies on psilocybin. He has since become known as the grandfather of the psychedelic renaissance and a 21st-century pioneer in the field. Unlike Leary, however, he does not aspire to be a guru or shaman. Rather, as a clinical pharmacologist and author of over 300 studies on mood-altering substances, Griffith prefers the path of scientific caution.

Griffith claims his initial curiosity about psychedelics came from his own mindfulness meditation practice. His interest was further sparked when he administered psilocybin to volunteers and found that two-thirds of the participants called their psychedelic journey among the most significant experiences of their lives.

Today, Griffiths touts the use of psychedelic-assisted psychotherapy for its ability to treat a variety of debilitating conditions, such as depression in terminally ill patients, post-traumatic stress syndrome among war vets, and alcohol and tobacco dependence.

Griffiths says:

"There is something about the core of this experience that opens people up to the great mystery of what it is that we don't know. It is not that everybody comes out of it and says, 'Oh, now I believe in life after death.' That needn't be the case at all. But the psilocybin experience enables a sense of deeper meaning, and an understanding that in the largest frame everything is fine and that there is nothing to be fearful of."

"There is a buoyancy that comes of that which is quite remarkable. To see people who are so beaten down by cancer, and they start actually providing reassurance to the people who love them most, telling them itis all okay and there is no need to worry, when a dying person can provide that type of clarity for their caretakers, even we researchers are left with a sense of wonder.
"

Why are psychedelics so effective?


Researchers know how, but they do not know why, psilocybin has worked in these settings. One theory is that psilocybin interrupts the circuitry of self-absorbed thinking that is so pronounced in depressed people, making way for a mystical experience.

Dr. Robin Carhart-Harriss group at Imperial College in London is doing neuro-imaging studies. These studies suggest that the positive effects of psychedelic-assisted psychotherapy are explained by changes in something in the brain called the default mode network.

It turns out that this network is hyperactive in depression. Interestingly, in both meditation and also with psilocybin this network becomes quiescent. This may correlate with the experience of clarity, of coming into the present moment, which is the key to getting out of self-absorbing thinking and to experiencing feelings of inter-connectedness.

Normally, information is exchanged in the brain using various circuits, or what one researcher describes as informational highways. On some highways, there's a steady stream of traffic. On others, however, there are rarely more than a few cars on the road. Psychedelics appear to drive traffic to these underused highways, opening up dozens of different routes and freeing up some space along the more heavily used ones ̶ thereby facilitating an expanded sense of awareness and access to new perspectives among participants in psychedelic therapy sessions.

Moment of absolute clarity

Our theory of why psychedelic-assisted psychotherapy works correlates closely with the findings of these brain imaging studies.

What we are seeing here are neural representations of major shifts in awareness. When you have a mind-expanding experience, you can transition from fear and anxiety to confident self-empowerment. This, in turn, provides a serene sense of well-being that is essential to both emotional and physical healing.

In this context, we can begin to understand how psychedelic-assisted psychotherapy can provide fast and effective treatment for a variety of patients suffering from addiction, depression and trauma. By fast, we are referring to positive results coming from one or two sessions, as opposed to the months and even years that traditional psychotherapy requires.

By contrast, Dr. Stephen Ross, the lead investigator and chief of addiction psychiatry at N.Y.U., points out that antidepressants can take weeks to show benefit. "Cancer patients with anxiety and depression need help immediately," he said, "especially if you consider that they are at elevated risk for completed suicide."

In a word: the moment of absolute clarity is the treasure that entheogens hold!

https://www.optimistdaily.com/2018/0...therapy-works/
 
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How MDMA and other psychedelics could change therapy
Dr. Emily Williams

Psychedelic drugs that have been considered recreational for decades—and classified as drugs of abuse by the FDA—are showing major promise as potential solutions for hard-to-treat disorders and illnesses (see this goop piece on ibogaine and addiction, as well as this one on ayahuasca). Usually associated with the street names ecstasy or molly (although it’s not actually the same), the drug MDMA is in new clinical trials to treat PTSD and anxiety; other possible therapeutic applications are being explored, too.

Emily Williams, M.D. is a resident psychiatrist at UCSF and trained MDMA-assisted psychotherapist working with MAPS, a non-profit pharmaceutical research organization leading the way on MDMA research. In Williams’ current work, she has patients take MDMA while undergoing tailored psychotherapy sessions. MDMA is thought to enhance the efficacy of psychotherapy by reducing the fear response, and strengthening the sense of the trust between patient and therapist. “MDMA seems to bring about an internal awareness that even painful feelings that arise are important to the therapeutic process,” says Williams. “Many people describe the experience of MDMA-assisted psychotherapy as ‘years of therapy in one day.’”

Below, Williams tells us how MDMA might change the future of various therapy modalities, as well as how we think about psychedelics.

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A Q&A with Dr. Emily Williams

Can you explain what MDMA is?

MDMA is not the same as ecstasy or molly, which may contain MDMA, but frequently also contain unknown and/or dangerous adulterants. (It’s important to note that in clinical research trials, the MDMA used is created in a strictly regulated lab setting and monitored by both the FDA and DEA.)

In technical terms, MDMA is a monoamine releaser and re-uptake inhibitor that affects serotonin, prolactin, and oxytocin. This means that it causes an increase in serotonin and other neurotransmitters in the body, and also allows for increased serotonin activity at certain receptors in the brain.

MDMA was first synthesized in 1912 by Merck in an effort to develop a compound to stop abnormal bleeding. It wasn’t thought to have a medical benefit until it was rediscovered by Alexander Shulgin, Ph.D. in Northern California in 1976 and spread by psychiatrists and psychologists who reported seeing benefits to its use as an adjunct to psychotherapy in individuals and couples.

What does MDMA-assisted psychotherapy entail, and who is it meant for?

Clinical trials have primarily investigated MDMA as treatment for PTSD, but there have also been studies on MDMA-assisted psychotherapy for social anxiety in autistic adults, anxiety related to life-threatening illness, as well as in couples therapy. (As mentioned above, in the late 1970’s and early 80’s, before MDMA was reclassified as a drug of abuse, it was used with anecdotal success in individual and couples therapy.)

In MAPS’ clinical research trials, a course of MDMA-assisted psychotherapy begins with a series of psychotherapy sessions, sans drugs, to establish the therapeutic relationship and safe space for processing.

This preparatory phase is followed by a series of MDMA psychotherapy sessions: Each one lasts about six to eight hours and consists of the patient orally ingesting MDMA and resting in a comfortable position with eyes closed or wearing an eye mask, while listening to music that’s initially relaxing and then emotionally evocative. Throughout these experimental MDMA sessions, periods of patient introspection alternate organically with periods of conversation with the therapists, largely determined by the desire of the patient.

The MDMA sessions are followed by integration sessions (no drugs involved) that last about 90 minutes, where the patient and therapist talk about insights gained during the experimental sessions, and how they relate to the trauma or other issues that were brought up during the preparatory phases.

Can you tell us about the results so far?

The combined results from the PTSD studies are very promising: After just two sessions of MDMA-assisted psychotherapy for PTSD, 52.7% of 74 study participants no longer met criteria for PTSD, versus 22.6% of the placebo group. Among all study participants who received active dose MDMA-assisted psychotherapy, 67.4% of 86 participants no longer met criteria for PTSD at the twelve-month follow up. This shows that not only is MDMA-assisted psychotherapy effective for treating PTSD, its benefits are long-lasting. No other psychiatric medications or therapies currently available are comparable.

What’s the treatment like for the patient?

The MDMA experience itself has been described as having an enhanced mood, heightened sense of openness, sense of closeness with others, and increased connection with one’s intuition or what we refer to as “inner healing intelligence.” A large majority of patients in the clinical trials have reported that their course of MDMA-assisted psychotherapy was profound and life-changing. Many describe it as “years of therapy in one day.

Would MDMA be effective on its own, without the therapy session, or does it work because of the interaction of the two?

MDMA’s effectiveness is reliant on the accompanying psychotherapy. It is thought that MDMA increases trust and strengthens the therapeutic alliance (the relationship between patient and therapist)—that relationship is actually the number-one factor determining the efficacy of psychotherapy. MDMA is thought to catalyze the healing process, which is further supported by highly trained MDMA therapists. MDMA seems to bring about an internal awareness that even painful feelings that arise are important to the therapeutic process. The MDMA and psychotherapy complement each other to foster a clearer perspective, helping the patient understand that the trauma is an event from the past, and to see the support and safety that exists for them in the present moment.

This process also relies on concepts of “set” and “setting”: Set is the intention of the patient, the preparations they have made, as well as their mental and physical characteristics. The setting is the physical/interpersonal environment that can contribute to a person’s altered state of consciousness. The psychotherapeutic frame of MDMA-assisted therapy is so important; the preparatory process works towards establishing an optimal set and setting for the MDMA experience.

It is also important to stress that there are medical risks associated with MDMA use, including hyperthermia, cardiac complications, as well as a potentially fatal complication called Serotonin Syndrome, so close supervision by a physician is critical.

How is MDMA/psychotherapy treatment thought to decrease the fear response in patients?

MDMA can reduce a patient’s perceived threat to their emotional integrity; it can also decrease defensiveness without blocking access to memories, or preventing a deep and genuine experience of emotion. Eliminating your conditioned fear responses can lead to more open, comfortable communication about past traumatic events and give you greater access to information about those events. Some studies show a decrease in communication between the amygdala (the fear-processing area of the brain) and hippocampus (memory storage) with MDMA compared to a placebo, however the actual mechanism of action remains unknown, which is why further research is crucial in this growing field.

Could MDMA be used for other applications/to treat other conditions?

MDMA-psychotherapy has the potential to be used to supplement more traditional therapy modalities, such as psychodynamic or cognitive behavioral therapies, as a way to explore personal growth and overall wellbeing.

Besides MDMA, which psychedelic drugs do you think are most promising in terms of potential therapeutic applications?

There are a number of different psychedelics being studied currently for a variety of disorders, ranging from depression to addiction and tobacco cessation. At this moment, I would say that psilocybin (the active compound in psychedelic “magic” mushrooms) is also very promising in terms of becoming legalized for clinical use. The Amazonian brew, ayahuasca is also showing benefit in some recent research studies for a variety of disorders, including trauma and depression.

MAPS’ work is all privately funded; do you see federal funding (or FDA approval) on the horizon?

The Multidisciplinary Association for Psychedelic Studies (MAPS) is undertaking a roughly $25-million effort to make MDMA into an FDA-approved prescription medication by 2021; it’s currently the only organization in the world that’s funding clinical trials on MDMA-assisted psychotherapy. We’re closer than ever before to seeing federal research funding awards to projects focusing on MDMA-assisted psychotherapy. We are experiencing a societal, cultural shift in how psychedelics are perceived and I hope that as more people express interest, the funding will follow.

How did MAPS get started, and how did you become involved with the organization?

MAPS is a non-profit organization focused on pharmaceutical research. It was founded in 1986 by Rick Doblin, Ph.D. in an effort to preserve the therapeutic use of MDMA after it was identified by the US DEA as a drug of abuse. Doblin realized that to legitimize psychedelic-assisted psychotherapy, we’d have to prove its efficacy via clinical trials. Nearly a decade later the first FDA-approved, double-blind, placebo-controlled US Phase I dose-response safety study of MDMA was published; it was sponsored by MAPS. MAPS is now beginning the first Phase 3 multi-site clinical trial of MDMA-assisted psychotherapy for the treatment of PTSD, one of the last steps towards MDMA becoming an FDA-approved medication.

I first became connected with MAPS when I was in medical school in Charleston, South Carolina, which also happened to be the site of one of the original MDMA-assisted psychotherapy studies in the US. Over the last several years, I have trained as an MDMA-assisted psychotherapist with MAPS in parallel with my psychiatry residency, and I will be a therapist and team co-leader on our clinical PTSD trial. I’m also working on an MDMA psychotherapy study for anxiety related to life-threatening illness.

Emily Williams, M.D., is a resident psychiatrist at UCSF where she is conducting an analysis of the effects of MDMA on therapeutic alliance, as well as serving as co-investigator on a clinical trial for MDMA-assisted psychotherapy. She is a mentor for the Center for Psychedelic Therapies and Research at the California Institute of Integral Studies, and works as the independent clinical rater for a MAPS-funded study on MDMA for end-of-life anxiety. In addition to her clinical and research work, she serves as a supervisor for the Zendo Project, which provides psychedelic harm reduction for events and festivals.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.

 
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Building the infrastructure for legal psychedelic therapy

by Wesley Thoricatha | Psychedelic Times | Oct 18 2019

Veterans in Canada’s cannabis industry have teamed up to start Field Trip Psychedelics, a for-profit company focused on healing the sick and bettering the well through therapeutic psychedelics. Their ambitious goals include building brick-and-mortar clinics for legal psychedelic therapy, starting a psychedelic research lab in Jamaica, and developing novel drugs from alkaloids and tryptamines derived from psychedelic substances. We recently spoke with Ronan Levy, one of the founders of Field Trip, about their plans to build the infrastructure of legal psychedelic therapy in Canada and beyond.

Thanks for speaking with us, Ronan. Give us an overview of how Field Trip Psychedelics came about and what you’re hoping to accomplish in the psychedelic space.

The team at Field Trip came from the Canadian cannabis industry. We were very early participators in that field and we created two sister companies, one called Canadian Cannabis Clinics and one called CanvasRx. The latter we sole to Aurora Cannabis which is one of the largest legal producers of cannabis worldwide. After we sold Cannabis RX we came across psychedelics as an opportunity, and like most people who think about starting a business in this space, we came up against the wall of them being almost entirely illegal. So we thought, “How do we do something interesting in psychedelics?”

We spent a long time trying to craft a strategy that made sense. As part of that exercise, we realized that psychedelics will almost certainly become legal in some form, whether it be through a ballot initiative or a clinical trial approval, or through constitutional challenge like how cannabis came about in Canada. The infrastructure needed to support the coming wave of using psychedelics to treat mental health is needed. Field Trip is designed to build what we think is the necessary infrastructure to support the reemergence of psychedelics.

The first pillar of what we’re doing is opening psychedelic-focused medical clinics. The Canadian medical cannabis clinics we started have grown to become a network of 30 clinics across Canada, and it was necessary because the infrastructure didn’t exist before then to support access to medical cannabis. When we looked at psychedelics, we realized the same issue would occur. To go through a therapeutic psychedelic experience is quite a long process, and you can’t really expect to go to your GP’s office to have that kind of treatment for MDMA or psilocybin. While psychiatrists are generally well equipped to facilitate these sessions, they are often owner, operator, and sole proprietor, and that doesn’t lend itself to scale. So we realized that a whole new clinic model is needed to support the coming wave of psychedelics. So we are in the process of setting up what will be five flagship clinics focused on psychedelic medicine, starting with ketamine-assisted psychedelic therapy, and then moving into classic psychedelic therapies as they become legal and approved. These locations will be Toronto, New York, LA, Portland, London, and Jamaica.

The second pillar we announced a few weeks ago, and it is the world’s first legal cultivation and research institution for psilocybin producing fungi, which will be in Jamaica. Ultimately we’d like to expand to all plant-based psychedelics, but we’re starting with psilocybin. Looking at all the work that’s been done with cannabis over the last 15 years or so, a lot has advanced in terms of understanding the plant from genetics to strains to cultivation to bioprospecting and novel molecule identification. We expect much like we found in cannabis well over 100 cannabinoids, we’ll find lots of interesting tryptamines and alkaloids in mushrooms other than psilocybin and psilocin.

The third piece is traditional drug development. If we see something interesting or novel in the mushrooms, or other molecules that engage serotonin receptors and offer psychedelic effects, we’ll look to explore clinical trials around them. So essentially we are a vertically integrated business focused on the emerging use of psychedelics to treat mental health conditions.

In addition to building brick and mortar clinics, will you also be training therapists?

Certainly that will be part of it. It’s essential that you have qualified people and medical professionals to facilitate these experiences. Right now, the training around psychedelic-assisted psychotherapy is a bit challenging because many of the current protocols were developed in the 60s and 70s and are quite labor intensive in terms of psychotherapist time. The MAPS clinical trial right now includes something like 84 hours of psychotherapist time for a single patient for a single session. We are exploring ways to offer training on a more efficient and therefore more affordable basis, but that work hasn’t been done yet. We want to optimize this training to enable the most people to access it.

So yes, we plan to do training for sure, but establishing the protocols that can form the foundations of the therapist training still needs to be done. We hope to work with practitioners who are already participating in the clinical trials right now, and underground practitioners who have experience and wisdom in this field as well, and develop a rigorous training program around that.

Many people believe that direct experience with these substances is the most important factor in becoming a good facilitator. Will your training include access to a guided psychedelic-assisted psychotherapy session for the facilitators?

One of our core principles is that we are only doing things that are consistent with law and regulation. If there’s a legal way to provide that opportunity, then certainly. I know MAPS has the expanded access program; to the extent that we can enroll our therapists in that program or other programs that open up, yes. But we are also cautious to make sure we don’t encourage people to engage in illegal behavior, so it’s finding the right balance. It’s certainly beneficial and empathy is so important to understand what people are going through, yet we don’t want to encourage going against existing laws, as misguided as they might be.

Are you looking to develop your own GMP psilocybin [GMP stands for Good Manufacturing Process, which is the quality needed for clinical trials] or sourcing it from somewhere?

We’re not producing any synthetic psilocybin right now. Our focus is on researching the mushrooms, and we may look to do some cultivation at the Jamaican facility to support the local market and community, but we’re taking it one step at a time. The government of Jamaica has been really supportive so far. I think they have some hesitation about this becoming a “Wild West” and it moving too fast, so we want to do it thoughtfully and show that we are good actors.

Ultimately we do want our Jamaican facility to be GMP-compliant so we can be producing psilocybin-containing mushrooms and extracts that are qualified for GMP with a view to supporting clinical trials, and also if there becomes a legal market in Jamaica or beyond, that the quality of the product we produce is safe and fit for people to use. Right now we are not sourcing any GMP psilocybin; we are just sourcing spores to build our genetic library in Jamaica and that’s it.

We recently ran a thought piece on the Medicinal Mushroom Dispensary in Canada which is selling psilocybin mushrooms online. Any thoughts on that?

My perspective is that it’s similar to that of the decriminalization efforts in Denver and Oakland and beyond. I think it’s positive in terms of advancing the dialogue and in terms of helping people access medicine and improve their quality of life. These are laudable ambitions and should be supported in that regard. I can’t help but assume some part of their motivation is to engage the constitutional conversation in Canada in terms of access to these mushrooms. To the extent that it advances the conversation, that’s great, but we don’t know who the suppliers are, and we don’t know what kind of cultivation they have. I’m confident that the product is safe and consistent, but this is the challenge with a grey market or mostly black market—uncertainty, which creates unnecessary risks.

You mentioned that your Jamaicain facility would ultimately be interested in all plant-based psychedelics. Have you looked at ayahuasca at all? As an admixture brew it is notoriously challenging to fit into the scientific research and clinical trial model.

It’s on our radar but that’s about the extent of it; we have not actively thought about how to work with it yet. For now, we’re focused just on psilocybin-producing fungi. So yes, we’ve thought about it, but that would be down the road for us.

I’m sure you have your hands full right now. Take us into an ideal future for psychedelics and Field Trip. How does this all happen in the best way possible?

An ideal future looks a lot like what you see in Canada around cannabis. There’s a medical program that’s highly supervised with licensed administration overseen by a psychiatrist, and then there’s a wellness program that doesn’t require people to be in a disease state. That’s one of the challenges with modern medicine: it requires you to have a clinically diagnosed condition. It would be unfortunate if only people with diagnosed states like PTSD, depression, OCD, and so on could access psychedelic treatments. They have profound potential to “better the well” and expand creativity and understanding and caring for the environment. If you keep it as a solely medicalized program, then all the people who don’t meet the clinical definition of having some kind of disease will be excluded from it. So a future with a plethora of modalities, whether it’s medical, wellness—with a range of different options, synthetic pharmaceutical ones and organic fungal mushrooms products—that’s the ideal future. There’s acceptance and regulation and respect, and strong education so people understand what they are getting into and what to expect. By and large that’s what you see in Canadian cannabis with a robust medical program and an adult usage market. For psychedelics, the adult usage would have to be perhaps a bit more carefully done than cannabis, but I think it’s a good model to look at.

 
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Psychedelic therapy in the fight against depression

by Wesley Thoricatha

“It was a whole personality shift for me. I wasn’t any longer attached to my performance and trying to control things. I could see that the really good things in life will happen if you just show up and share your natural enthusiasms with people. You have a feeling of attunement with other people.” – Dr. Clark Martin reporting on his experience with psilocybin to treat depression

When depression hits, people become a shadow of their highest potential, and when depression becomes chronic, people often turn to destructive coping behaviors and prescription drugs of dubious effectiveness that have dangers all their own. Thankfully, new research is showing that psychedelic therapy using substances like LSD and psilocybin mushrooms can be enormously helpful to people with mood disorders like depression, with many patients reporting lifelong positive changes to their outlook on life.

Good news for a seriously bad illness

Depression is rightfully considered a serious illness, but our traditional treatment methods with antidepressant drugs have a spotty track record in combatting it. A recent National Institute of Mental Health study illustrated that less than half of people on antidepressants claimed that their symptoms were cured, and that even among those who do respond well to medication, people often slip back into depression despite continued use of antidepressant drugs.

Keep in mind that reliance on powerful antidepressant drugs is a serious matter. The Center for Disease Control and Prevention reports that prescription drug overdoses account for more deaths than overdoses on street drugs like heroin, cocaine, and meth combined. So while the established medical system sees psychedelic treatment as somewhat radical, it’s important to understand that substances like LSD and psilocybin mushrooms are dramatically safer and often much more effective than prescription antidepressants when used properly. This is great news for those that suffer from depression and are not interested in turning to or continuing on prescription drugs.

The power of psychedelic therapy

The core of depression is being out of alignment with our true nature, not following our calling, making too many compromises, and feeling trapped in our current life situation. Antidepressant drugs only temporarily numb this pain, and do nothing to address the heart of depression. Psychedelic treatment, on the other hand, has some big advantages over traditional treatment methods. The vast majority of the time, psychedelic therapy is done with just 1 or 2 doses of the substance, rather than a regiment of continued use. Psychedelic journeys are so powerful that people report lifelong positive effects from just a single experience, with lasting benefits to their mood and sense of wellbeing. Scientists are still trying to define exactly how psychedelics are able to accomplish this, but the immediacy and uniqueness of a psychedelic experience is hard to quantify. What they do know from decades of research and clinical trials is that they do work, even if we don’t know exactly how.

Where prescription antidepressants and traditional treatment methods for depression often only focus on subduing the symptoms of depression, psychedelics have a remarkable and unparalleled ability to holistically transform a person. A Johns Hopkins University study that looked into the effectiveness of psilocybin mushrooms found that even 14 months after the treatment, 94% of the 18 adults that took mushrooms in the trial claimed that their trips were among the top 5 most meaningful experiences of their lives, with 39% saying it was the single most important experience. Friends, coworkers, and family members of the subjects also reported that after treatment, they noticed they were calmer, happier, and kinder. Compare those benefits with the side effects of traditional antidepressants like Zoloft and Prozac and you can see why more research and adoption of psychedelic therapy is an exciting and hopeful prospect for depression sufferers. Psychedelic therapy for depression is faster, safer, longer lasting, and more holistically effective.

 
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Why MDMA and other psychedelic therapies may NOT work for you

by Saj Razvi, LPC | Mental Health | Nov 19 2019

Let me be clear, we strongly support the current revolution in mental health that is psychedelic psychotherapy. We have been involved in MDMA research, we provide psychedelic therapy at our clinics in the US as well as in Amsterdam, and we know what it means to work with these medicines in mental health compared to how long, difficult, and at times impossible healing can be without them. This does not, however, mean a positive outcome is guaranteed. One of the most significant and yet invisible factors in a person’s psychedelic therapy session is their capacity for dissociation.

What is dissociation?

Dissociation is a biological reaction we all have to overwhelming threat. It is an involuntary emotional and physical numbing response that is caused by the release of natural, endogenous opioids within the brain and nervous system. In a landmark paper on the topic, PTSD researcher Dr. Bessel van der Kolk notes:

“…two decades after the original trauma, opioid-mediated analgesia developed in subjects with PTSD in response to a stimulus resembling the traumatic stressor, which we correlated with a secretion of endogenous opioids equivalent to 8 mg of morphine.”

Van der Kolk is referring to Vietnam veterans who 20 years after their trauma were re-exposed to some echo of the war (sounds, images, smells). These vets had the same numbing response that can be produced with an injection of 8 mg of morphine. Lesser doses of opioids are used in hospitals to treat severe breakthrough pain. This means that our internal pharmacy is secreting powerful opioids to physically, emotionally and psychologically numb us out even decades after a trauma has taken place. This is true for war veterans; this is true for adults who grow up in stressful, neglectful, chaotic or abusive families as children. Dissociation is not mild, it’s not invented, it’s not a placebo. It is a very real neuro-chemical shift in the brain that can be measured.

To comprehend the central role of dissociation in mental health, we turn back to van der Kolk who notes:

“…A vast literature on combat trauma, crimes, rape, kidnapping, natural disasters, accidents, and imprisonment has shown that the trauma response is bimodal:…hyper-reactivity to stimuli, and traumatic re-experiencing coexist with psychic numbing, avoidance, amnesia, and anhedonia. These responses to extreme experiences are so consistent across the different forms of traumatic stimuli that this bimodal reaction appears to be the normative response to any overwhelming and uncontrollable experience.”

Van der Kolk is saying that this combination of sympathetic nervous system fear, stress, anxiety, and panic mixed with an opioid-based, parasympathetic, dissociative numbing response is utterly common. We see it in research, and we see it every day in the trenches of mental health work.

These two sides are the hallmark of trauma, but the surprising fact is that there are no widely practiced modalities that effectively treat dissociation. You can see and feel stress; it is much more challenging to see and feel blankness. Neither your own mind nor your therapist is trained to notice, much less successfully engage dissociation.

Trauma-focused therapies and dissociation

The EMDR protocol, for example, advises the clinician to back away from the processing phase and return to resourcing if the client begins to dissociate. Arguably one of the most well-known modalities for treating trauma was never designed to treat dissociation. Consider that any self-report measure of distress such as the ‘how bad do you feel on a scale of 0 to 10’ on the Subject Units of Distress (SUDs) assessment will completely miss and underrate significant trauma events involving dissociation versus much less severe stress events involving no dissociation, which will rate higher.

Common talk therapy or CBT is very limited in what it can do with symptoms emanating from dissociated material. This is because we talk about what the mind can see. We talk about what is upsetting and can be felt. We don’t talk about or even look for what should be there but is oddly missing, especially if the numbing blankness has been in a person’s life since childhood and is the water they swim in. Dissociation is the central dilemma at the heart of mental health. We don’t have good metrics for even noticing it, engaging with it and in our opinion, it is the central cause behind depression and treatment resistance.

Most people have some level of dissociation. This is almost certainly true of people considering psychedelic therapy to resolve their more treatment-resistant symptoms. It’s more a question of how much and how deep the dissociation runs.

Is the client coming in for a single event trauma, like an assault or a car accident, where they dissociated during just that one event or is there prolonged, repeated, childhood neglect or abuse that happened in their family of origin? Both will create dissociation, but the latter person will likely have lived significant parts of their childhood in a dissociative state. They will typically not remember their childhood with actual specific concrete events but will have vague, abstract, generalized recollections of a ‘fine, happy’ childhood. This person will encounter much more profound dissociation during their psychedelic therapy session.

MDMA and other psychedelics do not, by their own nature, crack dissociation.

Most clients in the first scenario, people with a relatively stable childhood who experienced a traumatic event later in life, are typically not driven by suffering from treatment resistant symptoms. These are clients for whom talk therapy, EMDR or standard treatment has worked or who may not have even needed to enter into therapy in the first place.

At least for now, the psychedelic therapy client is more likely to be the complex PTSD, early childhood, developmental trauma patient with a significant amount of dissociation in their system. First, when used skillfully they can lead to peak or mystical experiences in which the boundaries of the individual ego dissolve and one knows that they are intimately connected through love to everything and everyone else on the planet. After having had such an experience most people find that it is much more difficult do things that are harmful to anything or anyone. This is one of the more generic outcomes of mental health research on psychedelics that shows they may be very therapeutic in treating depression, anxiety, addictions, and a variety of other mental health conditions.

MDMA and other psychedelics do not, by their own nature, crack dissociation. They can significantly accelerate the clearing of it, but the process needs to be focused, to be guided, in order to go beyond this dissociative defense structure. Consider this scenario: you will be taking a powerful psychedelic medicine to address the pain in your life, and at the same time, your neurobiology is going to release a large dose of numbing heroine-like opioids specifically to protect you from your traumatic memory. Your system has been doing this for years (perhaps even as far back as infancy), it’s good at it, and it’s not going to stop today. Consider what might happen when a psychedelic response runs straight into an opioid response. This is where we get some variation in people’s experience.

Here is what we have seen specifically with MDMA, but these observations apply to other psychedelics as well (which we focus on in part 2 of this article below): clients frequently feel completely sober even at the high point of a session. People will think that they received a placebo, or it’s just not working for whatever reason. They will feel like nothing is going on. They’ll feel bored and that they can get up and go about their day. They will simply feel unaltered.

Another possibility is that they may just become sleepy. If a therapist was not in the room, they might well fall asleep for a few hours on MDMA which may be hard to fathom if you are familiar with this drug in a recreational setting. In a therapy session, however, where dissociation is given room to emerge because we are focusing on traumatic memory, sleepiness is common. Just like antipsychotic medication will prevent a psychedelic response, our endogenous opioids also have the power to shut things down.

Psychedelic therapy and the body

The conscious, storytelling, meaning-making mind being what it is, we will often ascribe meaning to this experience such as ‘I knew nothing would ever work for me’ or ‘The medicine is telling me…’. There are all sorts of conceptual stories we can generate on top of what is happening, but the core experience is one of ‘nothing much is going on’.

The trick to working with dissociation is not to ignore the gold that is boredom in favor of other juicy bits that are more interesting to the mind. The client and the therapist will have an impulse to provide something evocative to get the session going, but the trick is to bring the nothingness, the blank, flat, sobriety, or sleepiness into focus. Have the client notice all the details of boredom. Doing so will take a lot of trust; just know the blankness is incredibly valuable.

The seeming non-response is the access point to go deeper. One of the gifts of many psychedelics, and certainly of both cannabis and MDMA, is that they generate a profoundly embodied, visceral, ‘here and now’ experiences. In this case, the very real ‘here and now’ reality that the medicine is bringing up is dissociation; it is a blanked out, unfeeling state. Our recommendation is to stay with that experience even though it does not fit the client’s idea of how the session should be. Again, easier said than done when the psychedelic therapy client has so much hope and expectation that this treatment will work and be the one thing that helps.

The seeming non-response is the access point to go deeper.

Eventually, the blank boredom will crack. It might take staying with it for 30 minutes, it might take 2 hours, or the entire session, but it will crack. When it does, there is an entire universe underneath that was being hidden from awareness by the dissociation. This is the material that can now be engaged with since it has become visible. Remember, the reason why the dissociation became active in the first place was that overwhelming experiences were taking place. These overwhelming and impossible experiences are what the client fully believes they couldn’t survive when they were happening. Certainly, they were not digestible, integratable experiences at the time and were partitioned off.

Your mind is very well organized not to see dissociation. You will have developed all sorts of interesting, often repeating distractions that will keep looping you around in the session(s). These can be an even a more exaggerated form of the defensive looping that we see in non-psychedelic therapy. There is a lot of other material and channels to focus on that will seem interesting to you, but these are mostly just a distracting puppet show put on by your mind to keep the dissociation in place.

The other possibility is that dissociation doesn’t appear because most people who have traumatic events residing in dissociation also have many other more surface events that are appropriately available to be worked with. Events that were not so overwhelming that they generate an opioid response but instead, these events were milder and thus create disturbing anxiety and fear responses that are visible to awareness.

Essentially, many clients are in a target-rich environment for both dissociation as well as garden-variety stress events. Ketamine, MDMA, and cannabis are very effective at clearing out these more available-to-consciousness surface experiences. PTSD scores generally will go down, and clients will feel a lot better for some significant period of months or years. However, the work and, unfortunately, the symptoms are typically not done yet. There is a lot of short-term benefit, but the material that was hanging out in dissociation will begin to bubble to the surface because you are ultimately more healthy, resourced, and trusting of the process.

In this condition, where your entire system is less compromised and more trusting, it may be weeks or months later but at some point, previously dissociated material will begin to emerge. It is not a sign that your previous psychedelic sessions failed. Quite the opposite, it is a sign of a person’s innate health that their system wants to keep excavating and processing until they are actually done.

In part 2 of this article below, we’ll talk about how dissociation interacts with psilocybin (psychedelic mushrooms) assisted therapy. We reference our experience in our Amsterdam program as well as interviews with clinicians who are part of the Psychedelic Society of the Netherlands who regularly use psilocybin in their therapy practice.

 
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MDMA-assisted therapy*

by Marlene Rupp | Sapiensoup | Mar 16 2018

Every day, 120 Americans commit suicide; 20 of them are war veterans. “I know without a doubt: MDMA saved my life.” said one war veteran who was suffering from post-traumatic stress disorder (PTSD), a mental condition which is hard to cure and may lead to further disorders such as anxiety, depression and addiction.

More than 868,000 US war veterans suffer from PTSD and their families suffer with them.3 Living with a partner or parent with PTSD means living with their elevated levels of anger or irritability which are often paired with feelings of hopelessness, guilt or depression and all too frequently accompanied with substance abuse. At best, this poses a challenging family life, at worst it can lead to suicide. As dark as this situation may be, a new ray of hope is emerging from—of all things—MDMA: a substance currently deemed an illegal party drug. MDMA-assisted therapy has proven to be far more effective than any other PTSD treatment available today. The Food and Drug Administration (FDA) has approved a roadmap to legalize the substance for medical use by 2021.

MDMA is currently being researched for its efficacy in social anxiety, end-of-life distress, couples therapy and most pressingly: PTSD. Consider that more US troops die from suicide than in combat. Besides the emotional costs of such a condition, an estimated $17 billion are spent on disability compensation for veterans suffering from PTSD each year.

Unlike common psychiatric medicine, that has to be taken on a daily basis and potentially for the rest of one’s life, MDMA is only administered a few times. According to the latest study by MAPS, after only three sessions of MDMA-assisted therapy, 61% of patients no longer suffered from PTSD.4 The effects are immediate and long-lasting; an earlier study showed that even after four years later the patients did not tend to relapse.

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What these numbers don’t reflect are the dramatic stories of the war veterans, rape survivors and victims of childhood abuse behind these statistics. For years, they had lived with chronic anxiety, depression and panic attacks until they finally underwent MDMA-assisted therapy. Scott, who served in Afghanistan and Iraq and had seen three of his comrades commit suicide, said “I know without a doubt: MDMA saved my life.” Watch some of the study participants tell their story in their own words. You might want to keep a tissue handy.



What is trauma?

“Trauma is not a divorce, your mother’s depression, your father’s alcoholism or physical abuse.” explains Dr. Gabor Maté, psychiatrist and expert in trauma, addiction and ADD. While such experiences may be traumatic, they’re not the trauma itself. He emphasizes that “Trauma is not what happens to you, trauma is what happens inside you.” And what may happen inside of you as a result of a traumatic event is that you get disconnected from your emotions and your body. This in turn makes it increasingly difficult for you to be present in the moment. You develop a negative view of the world, of yourself and you develop a defensive attitude towards other people.

And indeed, people suffering from PTSD often find it difficult to regulate their emotions and navigate relationships. The typical clinical symptoms of PTSD are insomnia, anxiety, nightmares, emotional distress or panic attacks.

Post-traumatic stress disorder in the brain

How does PTSD manifest in the brain? People who suffer from PTSD show a decreased activity in the hippocampus and the prefrontal cortex—areas associated with learning, rational thinking and decision making. At the same time, a brain area called the amygdala—responsible for emotions, fear conditioning and fight-or-flight responses— shows increased activity levels. The amygdala is the commander-in-chief of your survival instincts. When she speaks, everybody listens.

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Now, when a PTSD patient is reminded of a traumatic experience—through subtle cues like sounds, smells or fabrics—their amygdala takes over and shuts down the higher order functions of their brain, like the prefrontal cortex. The individual is left with a seemingly irrational fear response that can manifest as stress, panic or aggression. People who suffer from PTSD have the hardest time processing their trauma rationally, because whenever they’re confronted with their traumatic experience, the rational areas of their brains are simply not accessible.

MDMA helps navigating trauma

MDMA can help patients with PTSD to revisit their traumatic experiences without being overwhelmed by negative emotions. MDMA decreases activity in the amygdala and leaves the prefrontal cortex online, enabling patients to analyze and reflect on their experiences, which in turn gives them the chance to integrate these experiences into their lives.

A rape survivor described it as “It was like I got to do brain surgery on myself. I could go into my mind and see the thought patterns and the belief systems that had calcified in there and rewire them.”

The right dose of MDMA puts patients in a so-called optimal arousal zone. That’s a state in which the patient is positive and calm while at the same time being motivated to engage in a therapeutic process and open to connect. Usually, patients suffering from PTSD struggle to be any of the above. They tend instead to be hypervigilant, closed up and reluctant to talk about their experience. For all these reasons, MDMA-assisted therapy is beginning to look like a fast lane to healing trauma.

Integration, integration, integration

MDMA alone doesn’t cure patients of their PTSD, it’s the combination of the substance and psychotherapy. The leading research organization in this field, MAPS (Multidisciplinary Association for Psychedelic Studies), uses a 12-week treatment protocol that distinguishes between three kinds of sessions: (1) preparation sessions, (2) dosing sessions and (3) integrative psychotherapy sessions.

It’s of the utmost importance that patients feel safe and at home with their therapist. Not having a trusted ‘sitter’ was found to be one of the strongest predictors of a so-called bad trip. During preparation sessions, patient and therapist get to know one another and get comfortable with the setting. The dosing sessions usually include two therapists: ideally one male and one female. The star therapist-team in the MAPS studies were psychiatrist Michael Mithoefer and psychiatric nurse Ann Mithoefer, who is Michael’s wife. They are professionals with years of experience and training in special techniques such as Holotropic Breathwork, which Stanislav Grof developed based on decades of learnings from LSD-assisted therapy.

During an MDMA dosing session, people are capable of accessing subconscious content that would usually be filtered or blocked out by their normal waking state of consciousness. When this door opens, patients can go through intense outbursts of emotions like sadness, desire or fear and often have meaningful insights. After the acute effects of the substance have tapered off, the therapist helps the patient to integrate their experience. This means helping the patient to acknowledge and allow their feelings, and as a next step, reflect on them in a self-compassionate way. If, as Dr. Gabor Maté proposes, trauma is the disconnection from one’s body and emotions, then integration is one’s re-connection to them.

Treatment rooms have a cosy, living-room style atmosphere

It’s of the utmost importance that patients feel safe and at home with their therapist. Not having a trusted ‘sitter’ was found to be one of the strongest predictors of a so-called bad trip.10 During preparation sessions, patient and therapist get to know one another and get comfortable with the setting. The dosing sessions usually include two therapists: ideally one male and one female. The star therapist-team in the MAPS studies were psychiatrist Michael Mithoefer and psychiatric nurse Ann Mithoefer, who is Michael’s wife. They are professionals with years of experience and training in special techniques such as Holotropic Breathwork, which Stanislav Grof developed based on decades of learnings from LSD-assisted therapy.

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Michael and Annie Mithoefer, therapists

During an MDMA dosing session, people are capable of accessing subconscious content that would usually be filtered or blocked out by their normal waking state of consciousness. When this door opens, patients can go through intense outbursts of emotions like sadness, desire or fear and often have meaningful insights. After the acute effects of the substance have tapered off, the therapist helps the patient to integrate their experience. This means helping the patient to acknowledge and allow their feelings, and as a next step, reflect on them in a self-compassionate way. If, as Dr. Gabor Maté proposes, trauma is the disconnection from one’s body and emotions, then integration is one’s re-connection to them.

*From the article here :
 
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Mindbloom opens first psychedelic therapy center in NYC

by Javier Hasse | Forbes | 10 Mar 2020

Mindbloom has opened their first psychedelic therapy center on 5th Avenue in New York City. The new center offers science-backed, clinician-prescribed, guided ketamine therapy in a spa-like setting, for $150 to $250 per session.

After conducting a few hundred private sessions over the past couple of months, Mindbloom is now making its clinical protocols (designed by well-known psychedelics researcher and psychiatric practitioner Dr. Casey Paleos) available to the public. The company will seek to address common conditions like anxiety and depression at first.

Mindbloom also offers technology-enabled, remote therapy options. “We’re essentially One Medical meets Headspace, but for psychedelic therapy,” says CEO Dylan Beynon, when asked to briefly explain what his company does.

How it works

As per Mindbloom’s protocol, all patients need to undergo a “rigorous initial screening,” including a clinician-led psychiatric evaluation, before receiving the green light to receive ketamine therapy.

The program then consists of four one-hour sessions where FDA-approved ketamine is administered via sublingual tablets or an intramuscular injection in a spa-like setting.

“Friendly, expert guides” accompany the patients throughout their experiences. Each session is followed by some introspection time.

Dr. Paleos, Mindbloom’s medical director and a board-certified psychiatrist, has spent more than a decade researching psychedelics such as ketamine, MDMA and psilocybin (a psychedelic prodrug compound found in “magic mushrooms”) in both academic and clinical settings. After such a long time working with these remedies, he feels it’s a “privilege to help bring these cutting edge medicines to the people who need it most."

“Mindbloom’s therapeutic protocols are science-backed, medically supervised and expertly designed to help clients achieve optimal wellness and mental health,”
he explains.

Beynon has also experienced “profound healing and personal growth with ketamine therapy.” This is why he decided to found Mindbloom: “to bring psychedelic medicine out of the shadows and make it an approachable, accessible option for people battling anxiety and depression."

“Every detail of our first psychedelic therapy center in New York City has been thoughtfully designed to deliver a comfortable, elevated and inspired client experience,”
he assures.

Other centers planned

Mindbloom is the first fully legal psychedelics clinic in the U.S., and the second one in all of North America. Only last week, Field Trip Health, a wholly owned subsidiary of psychedelic-enhanced psychotherapy company Field Trip Psychedelics, opened a clinic in Toronto.

The Field Trip clinic is also administering ketamine, using its own protocol.

Field Trip says it will open additional centers in New York and Los Angeles over the course of 2020. Similarly, Mindbloom has planned openings in Los Angeles, San Diego, San Francisco and Austin.​
 
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Psychedelic therapy for depression, PTSD*

by Bethany Ao | Medical Xpress | 19 Feb 2020

When Marc Morgan tried LSD for the first time as a teenager, he noticed that he could emotionally disconnect from traumatic memories of the sexual abuse he had suffered as a child.

"It allowed me to dissociate from the sharp pain that a lot of these memories can bring up, which caused me to shy away from processing them," said Morgan, who PTSD as a result of the abuse. "I was able to confront the topic in a more analytical way that felt healthier."

Years later, Morgan learned about microdosing—taking tiny portions of psychedelic substances, as little as a twentieth of a recreational dose, to get positive effects, like more focus and emotional balance, without negatives like hallucinations and disorientation. He realized that taking small doses allowed him to process his emotions without the stronger, visual effects and looping thoughts.

"It's basically like taking a cup of coffee," said Morgan, now 30. He said that he takes a full dose once or twice a year, and microdoses about four times a year. "You're just able to be a little more free and a little more honest with your emotions without breaking down. There's more of a mental clarity."

Morgan, who has lived in Philadelphia for the past decade, is part of a group of people who use both full doses and microdoses of psychedelic substances to process trauma, and better deal with depression. For some, it's because conventional antidepressants haven't worked for them. Others choose psychedelics because it's a more affordable option than therapy or medication.

However, medical experts don't recommend self-medicating.

"For people interested in a treatment who can't get into a trial, this is not the only thing out there," said Matthew Johnson, an associate professor of psychiatry and behavioral sciences at Johns Hopkins University who has studied psychedelics for over 15 years. "It's one promising thing, and it's important for people to stay in treatment."

In recent months, the use of psychedelics for treatment-resistant depression, anxiety and PTSD—meaning patients do not respond to medication or therapy—has become a hot topic in the mental health field. The FDA approved a nasal spray for treatment-resistant depression (TRD) last March, which uses a derivative of the psychedelic ketamine called esketamine. It is the first new antidepressant in decades. (It's currently offered at a handful of clinics in the Philadelphia area.)

In November, the FDA gave psilocybin, a psychedelic compound found in magic mushrooms, its second "breakthrough therapy" designation in just over a year. The designation fast-tracks the development and review of drugs.

In a 2017 study of psilocybin and depression, researchers at Imperial College London gave psilocybin therapy to 20 patients with treatment-resistant depression, who reported benefits as long as five weeks after treatment. The study found that psilocybin decreased activity in the amygdala, which processes emotions like fear and anxiety.

"We know that when someone is on a therapeutic dose of a psychedelic, there's a dramatic increase in communication across brain areas," Johnson said. "My theory is that what we're seeing with psychedelic therapy is more like what we normally associate with talk therapy. Psychedelic therapy prompts a therapeutic process, and people learn something by transcending their sense of self and getting out of their own way."

Much less is known about the science behind microdosing psychedelic substances, but a 2019 study by researchers at the University of California-Davis found that the practice can provide relief for symptoms of depression and anxiety in rats.

Additionally, a 2019 survey of more than 1,000 people from across the world who microdosed on LSD found that repeated microdoses were followed by improvements in negative moods, especially depression as well as increased positive moods and energy levels.

"There really hasn't been substantiation of the claimed benefits of so-called microdoses," Johnson said. "That's not to say the claimed benefits aren't possible."

The benefits people feel from microdosing might be from a combination of a strong placebo effect and some possible benefit from "tinkering with the serotonin system," Johnson said. But he's open to the potential benefits of microdosing, particularly for depression.

As a result of their research on how psychedelics can be used to help smokers and cancer patients, Johnson and others at Johns Hopkins have suggested that psilocybin's FDA classification should be changed from Schedule I, which means that it has no known medical benefit, to Schedule IV, similar to prescription drugs.

Victor Pablo Acero, a 24-year-old bioengineering doctoral candidate and executive director of the Penn Society for Psychedelic Science, said that accepting both full doses and microdoses as mental health treatments is an important step in destigmatizing the substances.

"Having a mystical experience is correlated with actually getting more clinical effects," Acero said. "Microdosing doesn't recapitulate the mystical experience or ego death. Also psychedelic use ... does not magically heal you, you have to put in work and effort to integrate your experience."

Acero said that he became interested in psychedelics once he began reading research papers about how the substances can be used in clinical settings. But he said that research in this area is still lacking.

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"Funding is nonexistent," Acero said. "Scientists are having to argue that they need funding to study the medical purposes of a substance that's classified as having no medical purpose."

Most people suffering from treatment-resistant depression, anxiety or PTSD won't be able to access the new treatments for at least a few years, as research groups run clinical trials. The trials have a limited number of spaces. The Usona Institute, a nonprofit medical research group, recruited just 80 participants for a study that's part of their Phase 2 clinical trial for psilocybin. Similarly, LSD is being evaluated in a Phase 2 clinical trial as a treatment for depression in Switzerland. MDMA, better known as ecstasy or molly, is currently in a Phase 3 large-scale clinical trial for PTSD. Upon FDA approval, the SoundMind Center will open in Cedar Park, offering MDMA-assisted psychotherapy to populations with higher rates of PTSD.

While patients wait, self-medication without the aid of a therapist or medical professional is much more common, although it is not recommended. Johnson said that there are risks to psychedelic therapy for people with existing psychotic disorders, like schizophrenia.

"Even if this stuff is approved, it's not going to work for everyone," Johnson said.

Aysha Ali, who struggles with depression and anxiety, began using full doses and microdoses of magic mushrooms about two years ago. Ali, 21, said antidepressants caused side effects like appetite loss, decreased libido and nausea. She also found that mushrooms are more accessible and cheaper for her.

"It's definitely easier to go to bed at night," said Ali, who lives in Wilmington, Del. and works in King of Prussia. "I'm a little more focused, and I feel like I can smile and giggle in the moment. I can feel myself going through my day a little bit better, and the days after feel so much better."

She said that it refreshes her brain and allows her to wake up with a positive attitude.

"It helps me see that I'm not going to be stuck where I am," Ali said. "It's not a cure for everything, but the scientific information we're getting now is helping people get out of this mindset of, 'This is bad.'"

Mike Allebach, a photographer who lives in Montgomery County, first learned about magic mushrooms for mental health through a New York Times article last year.

"It didn't really quite match up with my understanding of mushrooms," said Allebach, 37.

Allebach, who was struggling with depression when he read the article, said that he later tried magic mushrooms in California, where psilocybin mushrooms are decriminalized in Oakland and Santa Cruz. The trip brought him out of his depression. Since coming home, Allebach uses breath work and meditation to maintain his mental health.

"As a society, we're in a place where 'the new rich' is feeling calm and having peace. And if antidepressants don't work for someone, this could be great for someone who wants to be happy again and work on themselves," he said.

*From the article here :
 
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What evidence do we have that psychotherapy and psychedelics can be combined?*

by Dr. Ben Sessa | Psychedelic Press | 22 Nov 2017

The historical human use of psychedelic plants and fungi is diverse and varied throughout the world. Some researchers even credit psychedelics as the catalysts that fuelled the development of humans from non-sentient primates to spiritually aware beings. Today there are few cultures that have no historical use of such substances and many modern religions can trace their origins back to the influence of these drugs.

Some cultures in the developing world still perform psychotherapeutic ceremonies involving the use of these ‘sacred plants’. Examples include the Native American Indian use of the peyote cactus (containing mescaline), the Mexican Indian use of magic mushrooms (containing psilocybin), the Amazonian use of Ayahuasca (containing DMT), the West African use of the root Iboga (containing Ibogaine), and the use of cannabis for religious purposes in India, the West Indies and East Africa.

These cultures use the drugs in varied ways, but common to all of them is the concept of healing–for both physical and mental health issues–and is often called Shamanism. The drug is usually taken in a group, lead by a highly respected member of the community, the Shaman, who acts as both a doctor and a spiritual guide. Through the use of the drug and also incense, tobacco, chanting and dancing–all aimed at altering the level of consciousness–the guide helps the patient to explore, confront and overcome their personal issues.

For these fragile societies, these ceremonies are important traditions that have enormous cohesive purpose. They are not linked to an increase in recreational drug use - indeed, in some of these cultures (for example the Native American Indian use of peyote and the West Africa use of Iboga) this shamistic use of psychedelics is heralded as a major factor in reducing alcoholism, and empowering the community to resist other harmful, mono-cultural influences of the West.

Rediscovery of drug-assisted psychotherapy

The Swiss chemist, Dr Albert Hofmann first discovered the psychoactive effect of LSD in the 1940s whilst working for the pharmaceutical company Sandoz. LSD was disseminated to psychiatrists throughout the world in the 1950s. Initially thought to be useful as a psychotomimetic (for therapists to take themselves to help them understand the experience of psychosis) it was later used extensively to assist in psychotherapy.

Britain has a rich history of LSD-assisted psychotherapy from this time. Dr Ronald Sandison at Powick Hospital, Gloucestershire, pioneered the use of ‘psycholytic’ (mind-loosening) psychotherapy when he combined low doses of LSD with ongoing psychotherapy and found the drug to be useful in helping patients to progress who had previously become ‘stuck’ in the traditional psychoanalytical therapy. Between 1950 and 1965 LSD was used safely and with good success by psychiatrists throughout the world. Some 40,000 patients were treated with LSD and over 1,000 papers were written on the subject. Even though the drug was often being used on only the most resistant and chronic patients, the results were overwhelmingly beneficial.

Many case studies were examined with meta-analyses. The number of adverse incidents was low and doctors were developing an increasingly sophisticated method for achieving the most comfortable and productive psychedelic sessions–which were often informed by Eastern tradition–with elements of meditation, chanted verses and a relaxing environment.

But psychedelics leaked from the scientific community to a wider audience. By 1966 LSD misuse had become a major social problem and its possession was made illegal. Despite the promising results of the preceding research, the scientific community was forced to distance itself from interest in the drug. Governments clamped down on research licenses and increasing reports of adverse drug reactions to psychedelics taken recreationally, as opposed to in controlled, scientific circumstances (which remained safe), appeared in the publications. As a result, research use ceased while illicit use remained, fueled by a growing criminal distribution system.

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Modern objections to psychedelic drugs

Since the rise, and subsequent collapse of psychedelic psychotherapy, the legacy of the dangers of illicit, non-medical abuse of these drugs has remained with us. Successive governments since the 1960s have adopted the strict War on Drugs policy, which includes demonising the psychedelic drugs alongside harmful and addictive drugs such as heroin and cocaine. It is noted, however, that unlike the psychedelics, both heroin and cocaine (in their various forms) have managed to retain their roles in medicine as essential parts of any hospital’s formulary. Nevertheless, psychedelics have disappeared from view - with even their place in psychiatric history erased from the curricula of medical student’s teachings.

Concerns surrounding the contentious history of clinical LSD research

There is no doubt that these drugs have a history littered with abuse and danger. And not only from the unsolicited use by the poets and pop-stars of the 1960s - there was also misuse from within the medical profession. By the late 1950s many lay-therapists began offering expensive, private treatments. Some of these had little regard for the safety considerations involved in such therapy, and even began to mix research with recreational use, holding parties at their homes in which they shared LSD with their friends.

The psychiatrist Sidney Cohen was initially a firm advocate of the new LSD research at the beginning of the 1950s, but as the decade wore on he could not ignore the improper use of the drug by some professionals. An editorial accompanying one of his articles criticised LSD investigators who ‘Administered the drug to themselves… became enamoured of the mystical hallucinatory state’ and were thus ‘disqualified as competent investigators’, whose research was corrupted ‘due to unjustified claims, indiscriminate and premature publicity and lack of proper professional controls’.

The most famous clinician of the 1960s to abuse LSD was Timothy Leary, the Harvard psychologist whose research began legitimately with clinical experiments using psilocybin-assisted psychotherapy. Leary’s massive personal use of psychedelics was followed by unsolicitered distribution to Harvard undergraduate students, and he was expelled from the university. His subsequent rise into notoriety as a self-appointed leader of the growing drug culture in the United States is well documented. For those genuine psychedelic therapists working at the time, Leary’s damaging public profile was extremely frustrating - and it certainly played a part in the subsequent severe restrictions on further medical research with psychedelics.

Concerns surrounding addiction and dependence

There is no evidence to suggest psychedelic drugs are addictive. Whilst tolerance develops quickly (after four days of continuous use, LSD becomes ineffective, even at high doses) no recognised physical withdrawal syndrome occurs. In animal models of drug abuse, reliable self-administration does not occur. In fact, because of the intense nature of the psychedelic drug experience, most recreational users have had only very few experiences with the hallucinogenic drugs, and their use tends to decrease or stop spontaneously over time. As recently demonstrated clinically, although the majority of users found the psychedelic experience to be intensely profound and valuable, very few had aspirations to repeat the experience again.

Concerns surrounding the lack of robust clinical research

Despite the sheer number of patients treated with LSD, and the generally positive results obtained, the studies quoted from the 1950s and 60s hold little more than anecdotal value compared to the rigorous standards expected by modern research trials. They were subject to a selection bias, usually lacked control groups and had little or no long-term follow-up. But then this goes for just about any psychiatric research that is now 50 years old… and some would argue is still true for psychotherapy today.

Concerns surrounding toxicity

The ‘classical’ psychedelics such as LSD and psilocybin are remarkable safe. During the early stages of the intoxication there are mild and transient autonomic effects, but no severe physiological reactions have been demonstrated (from many thousands of monitored clinical trials) and no deaths solely from LSD have ever been recorded. The largest known overdose with LSD was 40mg (400x greater than the average clinical dose) and the subject survived.

There have been several recent physiological studies with psilocybin, in which subjects under the influence of the drug, and in follow-up, had repeated measurements of physical parameters such as heart rate, respiratory rate, blood pressure, blood hormone, electrolyte, liver function and glucose analysis. No significant differences from controls were observed and no subjects reported any adverse drug reactions.

However, the physiological toxicity concerns surrounding the drug MDMA are more significant. Some users most likely have a genetic predisposition to the potential harmful physical and psychological effects of MDMA, which then interact with certain environmental factors.

There are two major ways in which recreational ecstasy users (e.g. at a rave) can suffer acute toxicity: The first is through hyperthermia secondary to not consuming enough water. The sequalae include liver and kidney failure, cerebral oedema, rhabdomyolysis and disseminated intravascular coagulation. High temperature has also been demonstrated to further exacerbate the risk of longer-term neurotoxicity.

The second cause of acute toxicity is hyponatreamia. In vulnerable individuals with a genetic predisposition for the condition, MDMA can cause an impairment of the kidney’s normal water homeostasis mechanism via an increase in arginine vasopressin (ADH) that can lead to excess water retention. When this is combined with excessive water consumption (as has sometimes occurred because users have been over-vigilant about the risks associated with dehydration) there can be associated decreased serum sodium, which in turn leads to nausea, weakness, fatigue, confusion, seizures and coma.

So in summary, when ecstasy is taken in uncontrolled circumstances, in extreme heat and with vigorous exercise, there may be problems associated with either drinking too much or too little water. Despite these very real physiological risk factors associated with recreational consumption of MDMA in a non-clinical setting, it is important to stress that these problems due to temperature and water consumption can easily be controlled in a clinical setting. This has been demonstrated by the Phase One trials for the contemporary MDMA psychotherapy studies. They did not record any significant changes in temperature and no associated abnormal water homeostasis reactions occurred - suggesting that severe toxicity reactions associated with uncontrolled recreational ecstasy use do not analogise accurately to proposed clinical applications with MDMA.

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Objections to the theoretical value of psychedelic psychotherapy

Many psychotherapists oppose the proposition that the psychedelic experience can be of any use in psychotherapy. Notable in his rejection of the psychedelic drugs, was Carl Jung in a letter to Victor White (Jung, 1954):

The LSD-drug, mescaline: It has indeed very curious effects – vide Aldous Huxley! – of which I know far too little. I don't know either what its psychotherapeutic value with neurotic or psychotic patients is. I only know there is no point in wishing to know more of the collective unconscious than one gets through dreams and intuition. The more you know of it, the greater and heavier becomes your moral burden, because the unconscious contents transform themselves into your individual tasks and duties as soon as they become conscious. Do you want to increase loneliness and misunderstanding? Do you want to find more and more complications and increasing responsibilities?

Other commentators have been sceptical of the claims that the psychedelic experience is similar to the religious experience. The philosopher RC Zaehner, who wrote extensively on religion and mysticism, was opposed from a Christian point of view to the idea that drugs could offer a ‘quick ticket to God’. He was also rejecting of the LSD-culture’s interest in describing the psychedelic experience as something akin to the Eastern religion’s appreciation of God - refuting the idea that it shared similarities with the Buddhist or Hindu state of enlightenment.

Since the 1960s, psychedelics have continued to be embraced by the New Age culture, where there remains a lot of unempirical crossover between science and mysticism. It remains difficult, therefore, for a clinician to find dispassionate, evidence-based information on the medical potential of psychedelic drugs, as the subject is so often littered with unhelpful references to individuals’ anecdotal hedonistic experiences. This undoubtedly scares off genuine interest from enquiring doctors.

Nevertheless, if the natures of these substances are to be explored and understood by doctors, then doctors must develop a meaningful language with which to describe these unusual mental states. Words like “Bliss”, “Enlightenment” and “Cosmic-oneness” have so far been very much the dispensation of the religions. They tend to make many scientists feel uncomfortable. But whether God can be found in a bottle or not (and certainly the Bwiti tribes of West Africa and the Mazatec Indians in Mexico believe it to be so), the psychedelic experience at least feels similar to a mystical or religious one - and this warrants closer examination by scientists interested in the psychological capabilities of our brains in their entirety.

The new renaissance in psychedelic research

After a hiatus of almost 40 years, there are now multiple new psychedelic drug research projects occurring. The ethical considerations associated with this kind of research are immense. These projects have taken decades of planning, and authorities are rightly cautious about enquiries involving drugs that have a history of abuse. However, medical research methods have changed a lot in the 50 years since these compounds were first used on patients. Modern day studies are subject to strict and rigorous ethical conditions that ensure patients are fully informed and consenting to these trials.

How best to re-introduce psychedelic therapy to sceptics

As far as discredited treatments go, the psychedelic drugs, particularly LSD, suffer with perhaps the greatest image problem of all past medical research. Indeed, perhaps LSD itself is beyond retrieval. Those very letters puts fear into the minds of physicians, politicians and parents alike. The future for these substances therefore requires some serious re-branding. The word psychedelic itself, coined by Dr Humphrey Osmond in communication with Aldous Huxley in the 1950s, might best be superseded by an alternative. Sandison’s suggestion of a better word, ‘psycholytic’, might not only be more acceptable to the public, but also be a more accurate description of the drug’s properties.

LSD may best be superseded by newer drugs such as MDMA or less publicised drugs such as psilocybin - both of which are shorter acting and more clinically manageable than LSD. Of course MDMA has a significantly different psychotropic effect to both LSD and psilocybin, being less classically ‘psychedelic’. Some would argue that this further makes MDMA more clinically useful.

In order for sceptics to embrace a fresh look at these drugs it is important to stress the risk-benefit argument. All medical treatments (especially those involving drugs) carry risks - but this must be balanced against potential benefits. If risks can be reduced to a minimum through careful, controlled applications in a facilitative environment, and benefits can be as great as offering a breakthrough for patients with previously unremitting mental illnesses, then this equation can be justified. After all, medicine is littered with examples of invasive treatments that are justified in terms of the outcome gains they give, e.g. chemotherapy for cancer treatments. And of course, there is no suggestion that psychedelic therapy is by any means as risky or noxious as chemotherapy. In fact, perhaps the greatest problem is that of the public perception and stigma associated with these drugs.

A way forward for this therapy is through encouraging the public to vote with their feet. The current environment of ‘user-driven practice’ favours patients who make choices. The drive for alternative treatments can motivate legislators to re-open access for research into the psychedelic compounds.

It is essential in developing psychedelic therapy to ensure any research proposals are rigidly scientific and avoid cliches. Only by adopting a clear, dispassionate and ‘non-Leary-esque’ stance can we best convince legislators of the possibility of re-visiting this research.

An important factor in the history of psychedelic-drug assisted psychotherapy, and of vital importance for selling this kind of research to people in the future, is that despite the tendency to concentrate on the drugs themselves, this subject is principally one of psychotherapy - and not psychopharmacology. All of the current projects underway involve just a few sessions with a drug, alongside non-drug psychotherapy, followed by the prospect that the patient can thereafter make real progress and then not have to continue on the daily, lengthy treatment with drugs such as the SSRIs. For this reason, it seems unlikely that the massive pharmaceutical companies—in their present form—are willing to show enthusiasm for such treatments. After all, why would they wish to sponsor research that offers a patient the chance to resolve their problems without the long-term use of drugs?

Conclusion

The many opinions about the relative usefulness or contrasting worthlessness of psychedelic drugs appear to be as numerous and varied as the effects of the drugs themselves. Examining only the negative points of view about psychedelic drugs, the politicians, physicians and journalists of the future are bound to be sceptical of these substances. But by exploring more widely and objectively they can make new conclusions based on a broader body of evidence.

The persisting split between mind and body, maintained by the continued insistence on the long-term pharmacological treatments, is selling both the patients and the psychiatric profession short. Now is the time, therefore, to examine new possibilities and novel treatments. But new researchers in this field must be careful to stay true to the concept of evidence-based medicine, keep in mind the risk-benefit argument and steer well clear of the quackery that invades this subject at all levels.

Psychiatry and psychotherapy have always been uncomfortable bed-partners. Perhaps through the development of targeted, safe, clean and efficient drug-assisted psychotherapy we will remember the 21st century as the point at which there was a true integration of these theoretical models.

*From the article here: https://psychedelicpress.co.uk/blogs/psychedelic-press-blog/tpsychotherapy-pharmacology-psychedelic-therapy-sessa
 
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Psychedelic therapies for Brain Injury, PTSD*

by Gail Dutton | BioSpace | 22 April 2020

PSYC, a new company formed by the holding company Global Trac Solutions Inc., is one of a handful of young companies and respected universities and research centers that are exploring the therapeutic potential of psychedelic drugs.

On Tuesday, PSYC announced its intent to develop a company focused on psychedelic medicine. The launch is intended for May 2020.

The interest in psychedelic medicine – particularly psilocybin, a pro-drug derived from some 200 varieties of the so-called magic mushrooms – stems from multiple factors. Notably, decades of research into psilocybin by reputable universities suggests it may offer therapeutic benefits for patients diagnosed with traumatic brain injury, depression, anxiety, PTSD and similar conditions.

For example, in 2019, the Johns Hopkins School of Medicine opened the Center for Psychedelic and Consciousness Research in Baltimore. It is studying psilocybin as a treatment for Alzheimer’s disease, PTSD, smoking, anorexia and depression. Studies also are planned for opioid addiction and post-treatment of Lyme disease.

“Our scientists have shown that psychedelics have real potential as medicine, and this new center will help us explore that potential,” Paul B. Rothman, M.D., dean of the Johns Hopkins University School of Medicine and CEO of Johns Hopkins Medicine, said on the Center’s website.

With $17 million in funding from private donors, the Center is the first research center of its kind in the U.S., and the largest such center in the world. It is headed by Roland R. Griffiths, Ph.D.

The increasing success of FDA-approved cannabinoid therapeutics helps drive the interest in psychedelics. ClinicalTrials.gov lists more than 400 trials involving cannabinoids. As its effectiveness is shown, the compound gains traction within the pharmaceutical industry as a possible active ingredient in a variety of therapeutics.

“We were fortunate to watch the cannabis industry grow into a sustainable marketplace for both medicinal and recreational use,” said Vanessa Luna, CEO of PSYC. “Part of that journey surrounded research and development including working alongside industry experts to gain the knowledge and understanding needed to service that industry."

“We will be embarking on the same path for psychedelic medicine by engaging with industry experts, which will likely expand to a new advisory board and a more defined approach,”
she continued. “That, in turn, likely will result in a unique plan to engage this market.”

She did not elaborate.

Realizing the potential this relatively new therapeutic area holds, PSYC is establishing strategic partnerships with key individuals and companies with the goal of establishing collaborations.

PSYC joins a growing number of companies exploring this controversial field of therapeutics with the goal of FDA approval.

For example, CB Therapeutics is collaborating with the Cleveland Clinic, manufacturing psilocybin and other tryptamine-based therapeutic compounds for clinical trials to treat depression, addiction and PTSD.

The FDA already has granted psilocybin-assisted psychotherapy a Breakthrough Therapy Designation for major depressive disorder as well as treatment-resistant depression.

“Psychedelic compounds have the potential to bring significant improvement to the lives of many individuals suffering from mental illness,” Brian Barnett, M.D., Center for Behavioral Health, the Cleveland Clinic, said in a statement.

Tassili Life Sciences is working with Michael Hoffer, M.D., professor of otolaryngology and neurological surgery at University of Miami’s Miller School of Medicine, to develop psilocybin-based therapeutics to treat mild traumatic brain injuries and PTSD. Preclinical studies are underway, with results expected in 2021.

So far, Tassili has filed four provisional patents. Three are for controlled release, and the remaining one is to treat mild traumatic brain injury and PTSD.

Ultimately, Tassili hopes to combine psilocybin and CBD in a certified drug that is approved by the FDA and other regulatory agencies. As Tassili Chairman George Scorsis said in a statement, “Working with the University of Miami, we aim to shift the mainstream perceptions about psychedelics by establishing the scientific underpinnings of the two compounds’ medical benefits and then developing a prescription-based therapeutic medicine for this combined disorder and a number of other disorders on the horizon, such as obsessive-compulsive disorder (OCD).”

That company recently signed an agreement to be acquired by Vancouver-based Champignon, which formulates medicinal mushrooms into novel delivery platforms for the pharmaceutical and nutraceutical industries.

Another company, Mind Medicine, is exploring LSD and other psychedelics. On Tuesday it announced what could become an “off” switch, allowing clinicians to halt hallucinogenic trips and control the dosing of LSD during therapy. Earlier, the company signed a collaborative research agreement with the lab of Matthias Liechti, a global leader in psychedelics pharmacology and clinical research at Switzerland’s University Hospital Basel.

Seelos Therapeutics last month announced interim data from a Phase I study of intranasal racemic ketamine and completed a Type C meeting with the FDA to design a study for suicide intervention in depression.

Compass Pathway is studying psilocybin as a therapy for treatment-resistant depression. Its Phase II trial is scheduled to complete later this year.

These are just a few of the organizations developing psychedelic therapeutics. The Psychedelic Opportunity Summit will explore the current and evolving state of regulatory, scientific, investment and legal aspects of psychedelic innovations in mental health care. It will be held, virtually, June 17th and 18th this year, and is hosted by Momentum, Green Market Report, and Green/Entrepreneur.

*From the article here :
 
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Utah clinician exemplifies innovation in Ketamine Therapy

by Aaron Genuth | Lucid.news | 22 April 2020

A ketamine clinician in Utah is using a method of intramuscular injections which he says provides longer lasting benefits than more common protocols. The promising success rates claimed for patients receiving this therapy, who suffer from Treatment Resistant Depression (TRD), Post Traumatic Stress Disorder (PTSD), and suicidality, reflect continuing innovation in what a growing consensus of prominent mental health professionals say is the breakthrough potential of ketamine treatment for mental health conditions.

This therapy protocol was adapted by Dr. Robert Hiemstra, who worked as an emergency room doctor for more than three decades before founding the Ketamine SLC clinic in Salt Lake City. Patients at the clinic are administered increasingly higher dose intramuscular injections of ketamine, spread over two hours. This approach differs from the well-established “Yale Standard,” which was developed in 2000 by researchers at the Yale School of Medicine. "That approach calls for intravenous injections at a lower dose of 0.5 milligrams of ketamine per kilogram of body weight, administered over the course of six treatments in two weeks. Ketamine SLC increases the dosage and compresses the course of therapy from two weeks to a single day, which" Hiemstra says "extends the benefits of the treatment, often by many months."

Hiemstra’s treatment typically includes two intramuscular injections of about 1 milligram per kilogram of body weight, or twice the dosage of the Yale Standard, though the dosage can vary based on his assessment of the patient’s reaction. The doses can then further escalate in ‘steps,’ if more treatments are needed. The primary benefit of this method, says Hiemstra, is that patients receive and metabolize twice as much ketamine as they would get from an intravenous dose, and build twice as many neural pathways in the brain. Hiemstra’s clinic is also offering a treatment regime at what they say is a lower price for patients.

Once a patient has established their specific course of treatment, which costs up to $300 per session, Ketamine SLC offers a six-treatment regime for $1,500, which does not include integration therapy or aftercare costs. The Ketamine SLC website claims that other ketamine therapy providers typically charge up to $1,000 per treatment and often continue patients on a six-treatment regime that can cost more than $1,500 per month. Hiemstra asserts that his clinic can provide treatments as infrequently as every three months for the same price. Ketamine SLC is also partnering with The Ketamine Fund to offer free treatment to veterans.

Hiemstra says he’s planning to patent his ketamine therapy method, though he’s been delayed by the challenges of providing care during the Covid-19 pandemic and is presently redirecting his focus toward maintaining his clinic with a significant reduction in clientele. According to Hiemstra, he is pursuing a patent to prevent other private practitioners from claiming ownership of his therapy thereby possibly preventing him and others from using the method he created, or charging them to use it. If granted the patent, he says he intends to license the therapy to other ketamine doctors and clinics at no cost, provided they commit to the treatment protocol he is codifying. Hiemstra says he intends to publish his protocol standards and treatment methods in a book later this year.

Ketamine SLC has treated over 8,000 patients with this innovative protocol, and has received no reports of major adverse effects, according to Hiemstra. “Forty percent of patients receive three months of relief after the first treatment,” he says. “The rest fall into a different range, which is where I apply the step system which allows me to increase the dose sequentially and get them to that ‘Holy Grail’ of three months in between symptoms returning.” Ketamine SLC has compiled their patient treatment data, and Hiemstra says he welcomes the ability to publicize his results and methods for peer and public review. He intends to include these data, along with his assessment and critiques of other methods, in his upcoming book.

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Examining patient outcomes

Hiemstra pursued his treatment protocols in part by using the Patient Healthcare Questionnaire, PHQ-9, a nine question system for measuring the severity of depression. According to the PHQ-9 instruction manual, the system, which was established at Columbia University in the late 1990s, recognizes that “a particularly important use of a measure is its responsiveness to changes of condition severity over time.” The PHQ-9 is used to assess the level of depression severity, establish initial treatment decisions, and as an outcome tool to determine treatment response. The scale ranges from zero to 27, with a zero score indicating no depression, and a range from moderate (five) to severe (20+).

Patricia Johnson, a clinical statistician contracted by Ketamine SLC to process and present the treatment data, sees evidence of the success of Hiemstra’s method after evaluating the outcomes of 200 patients who have received therapy at the clinic. “The sample data proves that with a step-up ketamine intramuscular approach, there is a consistent reduction in PHQ-9 scores,” showing that “as the milligram strength of ketamine goes up, the depression goes down,” says Johnson. She notes that multiple patients’ PHQ-9 numbers dropped ten points or more, and that a clear correlation to Hiemstra’s method will be shown in a full data release. “There appears to be an overwhelming success rate with this approach,” says Johnson.

While Hiemstra and his method represent a less common approach in the growing exploration of ketamine treatment methods, diverging from the Yale Standard and institutional models does not make him an outlier in the field.

Dr. Cole Marta is a psychiatrist and researcher who has studied ketamine since 2015 and co-authored a study that looked at different routes of therapeutic administration. He is the co-founder of the California Center for Psychedelic Therapy and a Clinical Investigator for the Phase 3 clinical trial conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS) for MDMA-assisted psychotherapy. “Over the last 15 to 20 years, more studies have been done to build on the initial [Yale] study, because of all of these game changing qualities of ketamine for depression,” explains Marta. “It works rapidly, it works for people with treatment resistant depression, it seems to work even for bipolar depression in many cases.”

Marta notes that while the Yale Standard and IV treatment remain the most common forms of administration, ketamine therapy can be administered in a wide variety of ways, including intramuscular, oral, internasal, and intravenous delivery. ”In the years since it was first shown to be effective for TRD, there have been a lot of different studies looking at how we can extend the benefits" he says. “For example, is twice a week better than three times? Is one really big dose preferable?”

Marta further details how ketamine’s legal status lends itself to an exploratory clinical approach that is often more open to developing new methods in the field than other psychedelic therapies. Unlike other psychedelics, ketamine has been legal since 1970 and is widely used as an anesthetic. Doctors have the option to prescribe it for other conditions ‘off-label’ as Hiemstra does because of its relatively lenient DEA scheduling. Psilocybin, MDMA, and LSD, for example, are Schedule 1, a federal designation that indicates these substances have “no currently accepted medical use and a high potential for abuse,” which makes them almost impossible to legally prescribe or access. Ketamine is classified as Schedule 3, meaning “a moderate to low potential for physical and psychological dependence.”

“Because ketamine didn’t go through the formal FDA process [for use in therapy] that, for example, MDMA is going through, and psilocybin is trying to go through, and eventually these other [Schedule 1] psychedelics will probably go through, we have off-label use,”
explains Marta. Prescribing drugs off-label is a common practice. For example, when the depression drug Prozac is prescribed for anxiety, its use is off-label.

“The only on-label use for ketamine is as an anesthetic,” says Marta. He notes, however, that "there’s so much evidence for its usefulness for treatment resistant depression, that at this point, it would be considered common practice to try this if you’ve tried other front line antidepressants and haven’t seen benefit from it.”

Hiemstra believes his compressed one-day therapy, and higher dose intramuscular injections in general, create an opportunity for the longer term extended benefits and relief that Marta describes.

“The major way that I’m pursuing success rates is with the measure of the interval,” Hiemstra says. “Ketamine offers a unique type of stability. And that requires a certain amount of dosage. If you don’t get the appropriate dosage up there, you aren’t going to get that ‘Holy Grail.’”

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Growth in demand for ketamine therapy

The expansion of ketamine clinics reflect the growing demand for innovative mental health treatments in the US, where mental health disorders are among the leading causes of disability. Rates of depression and suicide continue to escalate, particularly among young people and veterans. In 2019, the American Psychological Association reported “…a steady rise in mood disorder and suicide-related outcomes” among people born in the 1980’s and 1990’s.” The Veterans Administration reports that an average of 20 or more veterans die by suicide each day. The impact of Covid-19 is expected to increase the global need for effective mental health treatments.

Dr. Erica Zelfand is a family physician who consults for health care providers and patients on ketamine treatment options and methods. She is not surprised by the growth of interest in ketamine, and like Marta, encourages the discovery and development of new treatment methods. “The variety of administrative methods and protocols surrounding ketamine is a testament to the fact that using it in this context is fairly new, and there’s no agreed upon gold standard,” says Zelfand. “It’s a beautifully versatile molecule that works in a variety of contexts for a variety of different cases.”

The growth in ketamine clinics has also been driven by technological advances. At Ketamine SLC, Hiemstra and his staff employ CareTaker, a technology to wirelessly monitor the vital signs of patients with a noninvasive finger cuff that sends data to a monitor. This setup allows the clinic to treat multiple patients simultaneously and increase their revenue. The availability of diagnosis and treatment through telemedicine, as well as ketamine lozenges and nasal spray, make ketamine treatment accessible to people suffering from symptoms of depression who are reluctant to leave their home, or who have difficulty accessing a clinic due to geographic barriers. As Covid-19 social distancing measures sweep the country and in-person consultations become more challenging, these technological options become more critical to patients in need.

Ketamine SLC doesn’t offer traditional integration therapy as part of their package. Rather, they use a combination of set and setting applied to the experience, including using binaural beats to get patients into a quick theta state, and PHQ9 assessments before and after treatment to evaluate the patient. Hiemstra also applies his clinical expertise to determine the level of treatment and aftercare that is needed or appropriate for the individual. Patients in many areas of the US don’t have access to therapists who are experienced with psychedelic medicines, or if they do, the cost can be prohibitive. For those without access to trained therapists, Zelfand points to the online Psychedelic Support directory, which provides integration and other counseling from licensed practitioners remotely and by video. Zelfand herself is a member of the Psychedelic Support network.

“Ketamine synergizes incredibly with counseling,” Zelfand says. “If we are going to use this molecule to its fullest potential, we should optimally pair it with some kind of therapy, before and after.” With therapeutic doses, particularly the more intense intramuscular regimen offered by Ketamine SLC, patients aren’t able to engage in therapy during treatment due to the dissociative effect. "Over the following days when they can, they should seek this care if possible," says Zelfand.

“Unpacking and making sense of what happened during the journey they had, and how those visions and that experience fits into their life or not moving forward, is very powerful, as it is with any psychedelic or mystical experience,” says Zelfand.

At Ketamine SLC, the staff are now adjusting to the Covid-19 pandemic and preparing for the impending mental health crisis that Hiemstra expects will follow. The need for treatment will likely be compounded by triggering media reports, personal experiences of death and illness, and extended social isolation.

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A clinic staffed by veterans

Ketamine SLC is largely staffed by veterans who received treatment from Hiemstra, many of whom say they found new meaning and purpose in helping their fellow vets and others to heal.

Auric Avila came to Ketamine SLC in 2019 seeking relief from PTSD and other symptoms stemming from his 8 and a half years as a Marine, including service in Iraq. After his second successful treatment he committed his life to introducing ketamine to suffering veterans and others in need.

“I was a patient going through the treatment and had a very profound message that I need to take charge of this experience and make it known to people,” Avila says. He is now the director of the clinic, and overseeing increasing success in outreach to his fellow veterans. “The biggest challenge in treating veterans is not that they don’t need help. It’s getting them to admit they need help and submit to the treatment,” says Avila. “As more veterans get treated, the word travels and more are open to admitting they need treatment and reaching out for it.”

Prior to the upheaval caused by Covid-19, Ketamine SLC had been treating about 30 new veterans weekly, a significant percentage of their overall patient load. The clinic has expanded their work with veterans thanks to a $60,000 financial commitment from The Ketamine Fund. The nonprofit is sponsoring 400 free treatments for veterans at the clinic, of which half have been administered to date.

The Ketamine Fund was co-founded by philanthropists and psychedelic activists Warren Gumpel and Mike “Zappy” Zapolin. According to the group’s website, the nonprofit is “dedicated to providing free treatments to veterans and those who need help now” via a network of over 25 clinics across the country. In addition to funding treatment for veterans, Zapolin and Gumpel have supported Hiemstra’s work by advising Ketamine SLC on set and setting, based on the feedback they say they’ve gathered from the diverse group of patients and practitioners they work with.

“The PTSD that people are getting from this pandemic is real,” says Zapolin. “Coming out of this, all the ketamine doctors and operators are prepping for a tsunami of people wanting and needing to try it, having got more in touch with themselves and their mental health while isolated.”

In addition to The Ketamine Fund, Zapolin, an entrepreneur who is considered a pioneer in the domain name industry, is the director of a documentary about his experience with ayahuasca, The Reality of Truth. His upcoming film, “Lamar Odom: Reborn,” follows the former NBA All-Star’s successful recovery from well-documented and high profile struggles with addiction through therapy with ketamine and ibogaine. Zapolin believes that with the proper funding, treatment methods, and access, ketamine can significantly reduce suicidality and depression in the US, both of which will be compounded by the Covid-19 crisis.

As an advocate for the health benefits of a variety of psychedelic medicines, Zapolin has concluded that ketamine is the safest FDA approved therapy currently available for many mental health conditions. “We need to lead people to ketamine as a light at the end of the tunnel,” says Zapolin, “and as advocates we can hold it up as the triage we need as a society.”

 
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Lasting change in Psychedelic Therapy*

by Sean Lawlor | Psychedelics Today | 6 Oct 2020

The role of therapy in psychedelic therapy has been underexplored in mainstream articles that focus more on neuropharmacology and the psychedelic medicine experience. Without therapy, however, results from clinical trials would be no more significant than if the substance was studied in a recreational setting, and the fact that there is such a difference is central to the growing appeal.

As our companion article on psychedelic therapy explained, numerous therapeutic approaches used in psychedelic therapy converge on an inner-directed, relational approach. In psychedelic sessions themselves, therapists take more of a back-seat role, encouraging clients to focus inward and engage in an authentic process facilitated by their “inner healer” and refraining from interpretation. Still, complications can arise in psychedelic sessions, such as an upsurge of trauma, and if therapists lack the skills to respond, they risk leaving clients stuck and unresolved, potentially re-traumatized from improper care in a vulnerable state.

While therapeutic training is essential in case overwhelming content arises, the bulk of therapy work occurs during preparation and integration sessions. Across numerous clinical trials and clinics offering ketamine and cannabis-assisted psychotherapy, psychedelic therapists are using many therapeutic approaches to help their clients heal. Here are some of the most common.


Internal Family Systems

One of the most consistently referenced models used in psychedelic therapy is internal family systems (IFS). Developed by Richard Schwartz in the 1980s, IFS views the psyche as an amalgamation of interrelated personalities, or “parts” that often conflict with one another. IFS brings clients’ attention toward three main parts of the psyche: Exiles, Managers, and Firefighters. When these parts are in conflict, they prevent people from grounding in their core Self.

Exiles are related to psychological trauma, often from early childhood. They are the parts that have been cast away- buried beneath shame, fear, or pain that has not been expressed or accepted. In psychoanalytic terminology, they have been “repressed.” Managers keep the Exiles in control, relegating them to their shadowy domain so they do not disrupt overall function. Still, Exiles sometimes break through Managers’ control, at which point Firefighters take over, putting the system on high alert and inciting reactive behaviors to avoid encountering the Exiles. All of these parts create the “internal family,” and IFS helps clients center in the Self, which transcends all the parts, to create a loving inner container for intrapsychic balance and communication.

“The goal of IFS is to first acknowledge these protected and wounded parts within a person, and then to foster this reconnection with the higher Self,” explained Jason Sienknecht, who practices ketamine-assisted psychotherapy in Fort Collins, CO. “Ultimately, the Self is put into a position of a manager so the other parts can fall in line behind the Self’s guidance, instead of monopolizing a person’s consciousness. We want the Self to monopolize the person’s consciousness.”

Sienknecht is a MAPS-trained MDMA-assisted psychotherapist and a lead trainer for ketamine-assisted psychotherapy through the Psychedelic Research and Training Institute (PRATI). In his psychedelic therapy work, Sienknecht regularly uses IFS. “The reason I gravitate toward IFS is because ketamine aligns the client with their higher Self, or inner healer, very naturally,” Sienknecht said. “The Self doesn’t need development- it’s the root of love and wisdom within each of us. Some people have lost sight of the Self through years of identifying with the protected or wounded parts of themselves.”

Sienknecht added that clients’ subpersonalities also naturally arise under the influence of ketamine, and IFS helps them make sense of the confusing content. As such, it is more a framework of integration than an intervention used in psychedelic sessions. “When you’re engaged in dialogue in a medicine session, you don’t want to give your client linear, logical reflections that their left brain can attach to,” Sienknecht said. “You want to encourage their non-linear state of consciousness to continue, rather than connecting them back to their thinking mind. I generally don’t bring my understanding of IFS into the dialogue of a medicine session.”

As a tool for psychedelic integration, IFS provides a powerful means to restructure one’s relationship to one’s inner reality for lasting healing to occur.


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Gestalt Therapy

Gestalt therapy preceded internal family systems as a predominant modality focused on internal parts. Created and developed by Fritz and Laura Perls in the 1940s and 1950s, Gestalt therapy helps clients enhance their present moment awareness through acute sensitivity to internal responses to stimuli. “Gestalt is a way to identify inner polarities within a person, or inner parts, and encourage dialogue between those opposing parts or beliefs,” explained Sienknecht.

Those dialogues can take the form of the “empty chair technique,” in which clients converse with a part of themselves as if that part is sitting in the empty chair beside them. Clients are encouraged to feel and express the emotions that arise. Through the process, therapists help them expand their self-awareness and take more responsibility over their way of being in the world.

Sienknecht recently facilitated ketamine therapy for a man suffering from alcoholism. A part of this man wanted to stay in a comfort zone and keep emotional pain at bay, which he did through binge drinking, while another part wanted to free himself from that addiction. Sienknecht helped him become aware of the polarity between these opposing parts, and from that awareness, the client could move toward resolving the conflict.

Psychedelics can enhance clients’ awareness of the relationships and dichotomies between internal parts of themselves. Therapists have found that models based on accepting and balancing those parts can significantly enhance the healing potential from that newfound awareness.


Somatic Therapy

Somatic therapy refers to body-focused psychotherapy. Somatic therapy is a relatively recent development without much research on its efficacy, yet it has still recently come to be regarded as one of the most effective approaches for healing trauma. Its foundational premise is that trauma is stored in the nervous system, and listening to the body’s messages is the ideal inlet to healing trauma’s lasting effects.

The two most prevalent somatic methods are sensorimotor psychotherapy and somatic experiencing. Rafael Lancelotta, a psychedelic therapist and researcher practicing in Denver, CO, helped elucidate the differences. “Somatic experiencing is highly relational and has a ton of emphasis on resourcing,” he said. “Sensorimotor is more based on movement. It’s a little less relational; more let’s go into your body and see where these incomplete movements are. It’s more physical in nature.”

The somatic style used by Innate Path, a psychedelic therapy clinic where Lancelotta worked for two years, is called trauma dynamics. Trauma dynamics uses elements of both approaches but focuses more on challenging clients outside of their window of tolerance. Lancelotta explained that while challenging clients can be effective, sometimes it can be too challenging and push clients too far outside their comfort zone. “I’ve found it most helpful to use pieces of all of these to find something that can be more fluid from one person to the next,” he explained.

Since somatic therapy involves focusing on the body, it can be a helpful intervention in psychedelic sessions themselves. If therapists notice that clients appear stuck in their processing, they can invite the client to focus on their body and notice what arises. From there, new content can become conscious, allowing the client to move toward the point of stuckness and continue processing through it.


Cognitive-Behavioral Therapy

Many psychedelic therapists reject the efficacy of cognitive-behavioral therapy (CBT) and claim it does not lend itself well to psychedelic work. Nevertheless, one of Johns Hopkins University’s most significant psilocybin studies to date uses a framework of CBT- a study using psilocybin-assisted psychotherapy for smoking cessation.

Dr. Matthew Johnson is the study’s principal investigator. While he explained that the psilocybin sessions themselves (which typically involve the synthetic equivalent of a Terence McKenna “heroic dose”) proceed with a non-directive, supportive approach, the many weeks of preparation and integration are CBT-focused.

“In terms of the CBT, my thinking is that any number of empirically validated forms of therapy can be brought to bear here,” Johnson said. “If a tool tends to work for the disorder of focus, my bet is we can combine it with psychedelics and make it work. When you’re talking about smoking cessation, most of the programs and a lot of empirical support are based in CBT.”

CBT is among the most widely practiced therapies; used for depression, anxiety, PTSD, and addiction. Therapists help clients identify distorted thought patterns and then replace these cognitive distortions with new, healthier thought patterns, which correspond to better emotional regulation and healthier behavioral patterns. CBT has no interest in psychoanalysis and the unconscious mind. It is an action-oriented, solution-focused approach, and Johnson has found it particularly effective during the “afterglow” of a psychedelic experience.

“We have a lot to figure out [about] what that afterglow is, but there’s probably some neuroplasticity lingering- this window of increased agency,” Johnson said. “If we then establish a new normal with boring, bread-and-butter techniques like CBT, it’s probably going to help.”

In the study’s ongoing second iteration, 59% of participants who received psilocybin were confirmed as abstinent from smoking in the one-year follow-up, as compared with 27% who received a nicotine patch. Such powerful results suggest that even modalities unconcerned with psychological depth can enhance psychedelics’ healing properties.


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Mindfulness-Based Approaches

Mindfulness involves directing one’s open attention to present moment awareness. While this may seem like a given in therapy, many therapeutic approaches encourage interpretation and recounting of past experiences, both of which can impede awareness of the present. Mindfulness-based approaches to therapy, such as mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction, foster present-moment awareness as a path to healing.

Sienknecht has found that mindfulness-based approaches align well with ketamine-assisted psychotherapy. “Ketamine quickly and effectively helps someone transition from the thinking self to the observing self,” he explained. “It just so happens that meditation does the exact same thing. Meditation mimics the activity of the higher Self, which some people refer to as the eternal witness. You’re not walking down the street, you’re 'aware' of yourself walking down the street. It’s one step back from the ego. Mindfulness-based psychotherapy can help teach the skills needed to move more fully into this observing self.”

In order for people to move more fully into the witnessing Self, both inside and outside the psychedelic session, it is important they develop a daily mindfulness practice. “I find that people who practice daily throughout the course of a two-month ketamine treatment program are more able to move in the natural direction of the medicine as it moves you away from your thoughts and into an observing self,” Sienknecht explained.

A daily mindfulness practice does not have to be seated meditation. The practice can involve journaling, painting, exercising, or simply walking through the woods, as long as it is intentional time taken to practice awareness and receptivity to what arises within and without.


The Hakomi Method

The Hakomi Method is a mindfulness-based somatic approach that is often discussed alongside psychedelic therapy. Developed by Ron Kurtz in the 1970s, Hakomi focuses clients on their present-moment experience and understands that the body is the harbinger of messages from one’s inner workings. Hakomi clients are encouraged to focus on mental content that arises alongside embodied sensations, such as images and memories.

Hakomi therapists use “probes” to gather information on a client’s internal process. These probes often aim at clients’ core beliefs that structure their relationships to their self and their world. For instance, a hakomi therapist might encourage a client to close their eyes, focus on their breath, and notice what arises as they say, “You are lovable exactly as you are.” It does not matter whether a client experiences elation and lightness, or bitter, self-defeating thoughts and constriction of the stomach- what matters is that the client notices what happens, because the response contains all the information needed to then work with the core content.

Psychedelic sessions can cast new light on core stories while also showing clients that other stories are possible. Skilled Hakomi therapists help clients restructure and heal those stories’ ongoing impact on their present moment experience.


Experiential Therapy

Another present-focused approach is experiential therapy. Sara Reed spoke to the approach’s efficacy in her work with ketamine-assisted psychotherapy at the Behavioral Wellness Clinic in Connecticut, as well as her work in MAPS’ Phase II trials for MDMA-assisted psychotherapy for PTSD. “What that therapy is about is really focusing on what’s happening in the here and now,” Reed explained. “Often clients come in flooded with a lot of different things, and experiential therapy can help clients slow down and be present with what’s happening in the here and now.”

Experiential therapy can take many forms; those forms are united in that therapists involve clients in real, present-focused processes to gain insight into their thoughts, feelings, and emotional responses. Examples include art therapy, animal-assisted therapy, adventure therapy, and psychodrama.

Michelle Hobart, a specialist in psychedelic integration, uses psychodrama with her clients. She described psychodrama as “an embodied enactment of certain scenes from life,” thereby allowing clients to engage creatively with their experience. “Creativity is a really important way of working with the material that arises,” Hobart explained. She often helps clients work with their psychedelic experiences as if they were dreams, focusing less on analytical processing than on “embodiment and active imagination.” This approach becomes especially important when psychedelic experiences cannot be rationalized or interpreted at all.


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Transpersonal Psychology and Spiritual Emergence

While transpersonal (meaning “beyond the personal”) psychology is not a modality, it is a broad wave of western psychology that embraces the validity of non-ordinary states of consciousness and understands humans as inherently spiritual. Academic programs in transpersonal psychology, such as those offered at Naropa University and Sofia University, are among the most popular programs for students interested in working with psychedelics. Understanding the expansive frameworks through which it views people can help therapists support clients through their most challenging internal experiences.

An important topic within transpersonal psychology is “spiritual emergence.” Developed by Stan and Christina Grof, spiritual emergence refers to experiences in which individuals suddenly expand far beyond their established understandings of themselves into a broader perspective on the universe. When this process becomes too overwhelming, it can incite a “spiritual emergency,” which the western diagnostic model can misinterpret as psychosis.

“Spiritual emergency is when something comes up that’s so expansive that it’s not able to be metabolized or integrated,” explained Hobart, who specializes in spiritual emergence in her integration work with clients. “Sometimes that opening is very ecstatic and blissful, and sometimes it’s terrifying and devastating. If we don’t have a framework for how to work with and hold spiritual emergence and emergency, then when that process happens; whether it’s catalyzed by medicines or happens spontaneously as through kundalini awakening or near-death experience, people may think it’s a mental illness or psychosis. Then people get sent into hospitalization, thrown into the pathology paradigm and forcibly medicated, and it’s not understood as what is actually happening.”

In honoring clients’ overwhelming experiences, Hobart helps clients integrate those experiences and adjust into a society that does not understand or appreciate their profound transpersonal expansion. “I hold it in terms of awakening to spiritual gifts,” she explained.

Hobart also suggested that the potential for spiritual emergency in a psychedelic session heightens the need for therapists to be highly skilled and trauma-informed. “Some people who have been activated into these states have not been held properly in medicine spaces,” she said. “To be able to hold spiritual emergence and emergency, and for that matter, entheogenic work, people need to have attunement and the capacity to hold emotional and energetic space. And they need to be trauma-informed. That’s a huge piece.”


Conclusion

If anyone told you that being a psychedelic therapist is easy, that person lied to you. While specific regulations and training requirements are sometimes hazy and differ between medicines, psychedelic therapy calls for both responsibility and a diverse skill set for therapists to bring out optimal healing potential for their clients.

These therapeutic approaches and frameworks do not comprise a complete picture of the approaches currently being practiced in psychedelic therapy. As Johnson suggested, it is possible, if not likely, that psychedelics can enhance any therapeutic specialty. Regardless, a robust therapeutic tool kit will help any psychedelic therapist meet clients’ specific needs. There is always more to learn, and psychedelic work has never been about staying within an established pattern or comfort zone.

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Sean Lawlor is a writer, certified personal trainer, and Masters student in transpersonal counseling at Naropa University, in pursuit of a career in psychedelic journalism, research, and therapy. His interest in consciousness and non-ordinary states owes a great debt to Aldous Huxley, Ken Kesey, and Hunter S. Thompson, and his passion for film, literature, and dreaming draws endless inspiration from Carl Jung, David Lynch, and J.K. Rowling. For more information or to get in touch, head to seanplawlor.com, or connect on Instagram @seanplawlor.

 
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Psychedelic-assisted psychotherapy

by Jerry B. Brown and Julie M. Brown | Psychedelics Today |

“There is something about the core of this experience that opens people up to the great mystery of what it is that we don’t know.” - Roland Griffiths

It is well-established that mystical experiences have historically played a pivotal role in indigenous shamanism and world religions (the miracles surrounding Moses’ burning bush and Jesus’ baptism). What is less well-known and quite unexpected is the discovery that mystical experiences are the catalyst for healing in contemporary psychedelic research.

Both the Johns Hopkins and NYU studies of the impact of psilocybin on cancer patients found that “In both trials, the intensity of the mystical experience described by patients correlated with the degree to which their depression and anxiety decreased.”

In other words, research scientists have consistently occasioned mystical experiences or “flights of the soul” traditionally thought to be beyond the scope of empirical science ̶ in clinical settings by administering high-dose synthetic psilocybin. Furthermore, it turns out that these experiences hold the key to positive patient outcomes in psychedelic-assisted psychotherapy. Let this enigma sink in for a moment.

Three seminal studies

In the 1960s urban legends began circulating, claiming that psychedelics could allow intrepid trippers to meet spirit guides, to travel to other dimensions, and even to know God. In fact, the new science of psychedelics was in part inspired by the mystical experiences of early psychonauts: Grof’s cosmic consciousness revelations on LSD in Prague; Harner’s near-death journey on ayahuasca in the Amazon; and Leary’s mind-expanding awakening on psilocybin mushrooms in Cuernavaca, Mexico, to name but a few. Over time, the ability of psychedelics to generate authentic mystical experiences was confirmed in three seminal studies.

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Dr Stanislav Grof

The first, the Miracle of Marsh Chapel (also called the “Good Friday Experiment”), was a psychedelic research experiment carried out by Walter N. Pahnke under the auspices of Leary’s Harvard Psilocybin Project. On Good Friday 1962, Pahnke randomly divided twenty volunteer Protestant divinity students into two groups assembled in a small room in the basement of Marsh Chapel. In this controlled double-blind study, half the students received capsules containing thirty milligrams of psilocybin and the other half received a large dose of niacin (vitamin B3) as a placebo. The results were compelling. Almost all members of the group receiving psilocybin reported profound mystical experiences.

As Pahnke reports, “the persons who received psilocybin experienced to a greater extent than did the controls the phenomena described by our typology of mysticism.” He built a follow-up survey into the research design, which found that six months after the experiment the psilocybin subjects reported persistent positive, and virtually no negative, changes in their attitude and behavior.

The second study showed that the Good Friday Experiment would withstand the test of time and scrutiny by independent reviewers. A 25-year follow-up investigation conducted in 1987 by then-graduate student Rick Doblin, founder of MAPS, documented that “all seven psilocybin subjects participating in the long-term follow-up, but none of the controls, still considered their original experience to have had genuinely mystical elements and to have made a valuable contribution to their personal lives.” Doblin concluded that Pahnke’s research on synthetic psilocybin “cast considerable doubt on the assertion that mystical experiences catalyzed by drugs are in any way inferior to nondrug mystical experiences.”

In assessing Pahnke’s research, Walter Clark, recipient of the American Psychological Association’s Award for contributions to the psychology of religion, writes “There are no experiments known to me in the history of the scientific study of religion better designed or clearer in their conclusion than this one.”

A third round of studies initiated more than 40 years after the Good Friday Experiment was conducted at Johns Hopkins School of Medicine under the direction of psychopharmacologist Roland R. Griffiths. In two papers, published in 2006 and 2008, Griffiths empirically demonstrated that psilocybin could regularly result in mystical experiences with lasting benefits for participants. These double-blind studies found that: psilocybin was safe in structured, clinical settings; generated one of the five most meaningful experiences for most participants; and produced improvements in mood and quality of life that lasted up to 14 months after the sessions.

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Roland Griffiths

Mystical Experience Questionnaire

Our understanding of the common elements in mystical experience is largely based on the insights of William James (The Varieties of Religious Experience, 1902) and Walter T. Stace (Mysticism and Philosophy, 1960). These elements were refined, validated, and incorporated into a 30-question operational definition of mysticism, the Mystical Experience Questionnaire (MEQ30) utilized in the Johns Hopkins psilocybin studies.

The five common elements of mystical experience are:

- Unity/sacredness – deep sense of unity with all of existence; knowledge that “all is one”; profound sense of reverence.
- Positive mood/ecstasy – deeply felt sense of well-being; experience of ultimate peace and tranquility; irrepressible feelings of joy and amazement.
- Transcendence of time and space/eternity – loss of usual sense of time and space; existing beyond past, present and future; entering in a liminal, mythical dimension.
- Authoritative/true self – ability to know reality beyond the illusion of the senses; encounter with all-knowing divine presence; understanding one’s authentic or true self
- Ineffable/indescribable – difficulty describing the experience in words; impossibility of adequately communicating it to others.

Psychedelic-assisted psychotherapy

Since 2006, Johns Hopkins School of Medicine has been conducting the first research since the 1970s administering psilocybin to human subjects, including studies of personality changes and of psychedelic therapy for treating tobacco/nicotine addiction and cancer-related distress.

In 2016, Johns Hopkins undertook the largest ever study of psilocybin in treating chronic depression and anxiety among patients with life-threatening cancer. In this randomized, double-blind, cross-over trial, 51 patients were given a low placebo-like dose (1-3 mg/70 kg weight) vs. a high dose (22 or 30 mg/kg) in two sessions with a six-month follow-up.

In a Journal of Psychopharmacology article, Roland R. Griffiths, Matthew W. Johnson, and colleagues report that “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, and decreases in death anxiety.” A six-month follow-up study showed that these results were sustained in most of the participants.

Some 70% of the cancer patients rated the high-dose psilocybin sessions as among the top five “most meaningful” and “spiritually significant” life experiences. In addition, their post-session mystical experience scores served as statistically significant predictors of therapeutic efficiency in reducing anxiety and depression.

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Psilocybin in the treatment of cancer-associated
depression and anxiety.


The daughter of one study participant noted that “This opportunity allowed my dad to have vigor in his last couple of weeks of life ̶ vigor that one would think a dying man could not possibly demonstrate. His experience gave my father peace. His peace gives me strength.” These outcomes prompted Griffiths to observe that “It’s very common for people who have profound mystical-type experiences to report very positive changes in attitudes about themselves, their lives, and their relationships with others.” And to exclaim that “As a scientific phenomena, if you can create a condition in which 70 percent of the subjects achieve positive, lasting results…in one or two sessions!”

Guided imagery-assisted psychotherapy

Julie M. Brown, coauthor of this article, is a psychotherapist who for thirty years worked with women’s issues and cancer patients. In her private practice, she utilized a variety of therapeutic modalities, including guided imagery which she studied under her mentor in psychosynthesis.

Guided imagery, also known as visualization, is a technique in which psychotherapists help clients focus on mental images in order to facilitate relaxation, healing, and resolution of life issues. In guided imagery-assisted psychotherapy, a person can call on mental images to improve both emotional and physical health.

Typically, Brown’s cancer patients turned to psychotherapy after conventional treatments (chemotherapy, radiation, pharmaceuticals) failed to reduce or eliminate tumors. By combining guided imagery with a complementary cancer approach, Brown found clients could enter states of mystical experience that empowered both emotional (anxiety, depression) and physical (cancer) self-healing. The profiles and outcomes for three clients are summarized in this table.

Client profiles and guided imagery therapy outcomes

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Unlike the controlled Johns Hopkins study involving 51 participants, these three case studies were not validated by independent observers nor subjected to methodological controls. Nevertheless, the seminal role of mystical experience in both psychedelic-assisted psychotherapy and guided imagery psychotherapy raises important questions.

Comparative questions for future research

In the case of Brown’s guided imagery outcomes with cancer patients, significant questions are:

Can success in healing cancer via guided imagery be validated? Beyond Brown’s anecdotal cancer outcomes have other therapists been able to reduce or eliminate tumors utilizing guided imagery? Could healing have taken place in this context without a strict sugar-free diet, or was it the combination of diet and guided imagery that facilitated remission?

Can psychedelic therapy protocols be integrated into guided imagery therapy? As an experienced psychonaut, Brown recognizes that the ability to administer psilocybin to clients could have significantly shortened the therapeutic healing process, possibly from years to months. Given that clinical trials on psilocybin for treating depression have been given “breakthrough therapy” status by the U.S. Food and Drug Administration, what changes in state and federal policies and professional regulations would have to take place so that psychiatrists and psychotherapists could legally integrate psychedelics into more conventional treatment modalities?

In the case of Johns Hopkins psychedelic therapy outcomes with cancer patients, significant questions are:

Can psychedelic-assisted therapy be used to alleviate psychological anxiety and depression in terminal cancer patients, to facilitate physiological healing in cancer patients?

Given the pivotal role of mystical experience in both short-term psychedelic-assisted psychotherapy and long-term guided imagery psychotherapy, could psychedelic therapy combined with guided imagery possibly reduce or eliminate tumors in cancer patients, if integrated into a mid-term treatment protocol?

Will long-term, costly psychotherapy eventually be replaced by short-term, more affordable psychedelic psychotherapy? Since short-term psychedelic therapy has achieved positive and sustained outcomes in 70% of the participants, based on one or two high-dose psilocybin sessions administered over several weeks, will it eventually replace long-term psychiatric and psychotherapeutic modalities which require years of treatment and cost thousands of dollars?

How does mystical experience facilitate healing?

These rigorous psychedelic therapy studies of psychological stress reduction and anecdotal guided imagery therapy cases of physiological cancer remission suggest that mystical experience can facilitate both mental and physical healing. “How” this healing takes place is the theoretical Holy Grail of the new science of psychedelics.

Our quest to unravel this mystery begins with the insights of four mind explorers: Roland Griffiths, grandfather of the psychedelic renaissance; Robin Carhart-Harris, pioneer of psychedelic brain imaging; Stanislav Grof, founder of LSD psychotherapy; and Carl Jung, who with Sigmund Freud laid the foundations of modern psychotherapy.

In essence, Griffiths concludes that “the psilocybin experience enables a sense of deeper meaning and an understanding that in the largest frame everything is fine and that there is nothing to be fearful of.” How the brain expands from normal consciousness to encompass this “largest frame” is visually revealed in Carhart-Harris’s magnetic resonance imaging (MRI) of the brain’s neural pathways before and after ingesting psilocybin mushrooms. Psychedelics allow us to leave the “brain’s default-mode network,” the brain’s everyday information highways, and travel into areas of the mind only available in expanded states of consciousness, clearing the way for mystical experience.

The brain’s neural pathways before and after magic mushrooms

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Homological scaffolds of brain functional networks.

What is the source of this expanded consciousness? Based on guiding thousands of psychedelic sessions, in The Holotropic Mind, Grof reaches this paradigm-shifting conclusion: “I see consciousness and the human psyche as expressions and reflections of a cosmic intelligence that permeates the entire universe and all of existence. We are not just highly evolved animals with biological computers embedded inside our skulls; we are also fields of consciousness without limits transcending time, space, matter, and linear causality.”

Jung’s concept of the “spiritual self” (also called “spiritual consciousness”) embodies knowledge that emerges from these transcendent “fields of consciousness.” Beyond Freud’s three-fold model of the self, comprised of the body, emotions, and intellect, Jung proposes the existence of a “spiritual self.” Through dreams, messages from the spiritual self are brought into awareness. This paper shows that, in addition to appearing in dreams, the authentic spiritual self may emerge through mystical experiences occasioned by psychedelic-assisted psychotherapy and guided imagery.

Mystical experiences arise when the doors of perception are flung wide open so that the spiritual self can emerge from the depths of the psyche, empowering us to heal and understand that in the cosmic scheme of things “all is well.”

Grof suggests that “the potential significance of LSD and other psychedelics for psychiatry and psychology was comparable to the value the microscope has for biology or the telescope has for astronomy.” We propose that, just as in astrophysics “dark matter” cannot be directly “detected” but only “implied” by gravitational effects, so in psychology, mystical experience cannot be easily “accessed” but can be regularly “occasioned” through psychedelics. Hidden from ordinary consciousness, mystical experience manifests from the dark matter of the mind.

Hopefully, these reflections on the role of mystical experience in psychotherapy will inspire further exploration of this unique phenomena that holds a key to health and well-being.

About the authors

Jerry B. Brown, Ph.D., is an anthropologist and Julie M. Brown, M.A., LMHC, is a psychotherapist. They are coauthors of The Psychedelic Gospels: The Secret History of Hallucinogens in Christianity, 2016.

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Jerry B. Brown, Ph.D.

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Julie M. Brown, M.A., LMHC

 
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Musings around Psychedelic Integration Therapy

by Debbie Kadagian | Psychedelics Today | 26 May 2020

Throughout my twenties, I spent a lot of time wondering what the meaning of my life was. I was reading Hermann Hesse, Viktor Frankl, and other similar authors, but I couldn’t quite connect those books to my own life. I wanted to know what it was like to experientially engage in a vocation. Reminiscing on this struggle, I was motivated to write an article on my experiences thus far with psychedelic integration, share what has been helpful to me, and provide insight to those either wondering about this practice, studying it, or actually beginning it.

My path towards becoming a licensed psychotherapist was not direct, as I did not receive my clinical license until my late 50s! I can now see, with that lovely 20/20 hindsight, that everything I did led me here, with valuable insight that I would not have had if my path had been more direct. I studied food, nutrition, and painting, had children, taught yoga, and became a certified Ayurvedic counselor before landing on my current path.

My Ayurvedic practice began to really crystalize my direction. Ayurveda is a science of life and embodies the mind, body, and spirit to integrate a lifestyle most suited for each individual. Much of my Ayurvedic practice had to do with clients’ emotional states. As such, I became more focused on the mind. This led me to a conversation with the dean of a nearby university, and shortly after, I enrolled in a Master’s program that had not even been an idea in my conscious awareness the year before.

Plant medicine was not on my radar at the time of my schooling. This path evolved through witnessing the healing that close friends and family experienced. Having had my fair share of psychedelic experiences as a young adult living through the ‘70s, I was always comfortable with the experience but did not yet see it as a healing therapy. After going directly to the source again and having my own experience with this new idea in mind, I now KNEW this was an unprecedented healing modality. I have since expanded my mindset to welcome plant medicines/psychedelic experiences as one of the most effective healing therapies that exists.

For thousands of years, people have been using psychedelic substances to further their understanding of themselves and the universe. Sadly, most of these medicines have been labeled as Schedule 1 drugs in the USA, though this is changing with several FDA clinical trials currently taking place. These research trials are studying the efficacy of using psilocybin as a treatment for depression, and MDMA as a treatment for PTSD. The trials for MDMA are in Phase 3, and the hope is to have this as a valid form of therapy by 2021. In the meantime, outside the US, there are countries where plant medicine is legal now.

Psychedelic Integration is designed to assist those seeking support in connection with psychedelic experiences. Individuals who have had difficult experiences can benefit from a better understanding of the often-challenging feelings stirred up by psychedelics; while those who have found the use of psychedelics to be a positive method of gaining insight can use supportive therapy to bolster and integrate that knowledge into their daily lives (http://www.ingmargorman.com/psychedelic-therapy). This part of the process, before and after the experience itself, is such an integral component of the whole journey. Working together, the therapist helps the client to understand what may happen, guiding them toward the safest set and setting (this phrase describes the physical, mental, social and environmental context that an individual brings into a psychedelic experience), and then fully integrates the experience afterward, perhaps even for months or years to come. We all have the capacity to understand our own selves, but having a guide makes sense of a plant medicine journey or psychedelic experience leads to deeper healing and a deeper understanding of self. I like to think of it like this: if plant medicine is a teacher, then an integrative therapist is a tutor, helping the traveler understand the teachings.

There are 3 categories in which I have been offering integration to clients, not one necessarily more prevalent than any of the others.

Category One: “My husband is freaking out! He did Bufo 3 days ago and he is sitting on the floor of the shower, shaking and crying… he can’t seem to come out of it.”

Category Two: “I found your name on an integration list and I need to talk to someone about an experience I had…”

Category Three: “I’ve been thinking a lot about going to do ayahuasca (or psilocybin, etc). I’ve read so much about it but I feel scared. I’ve never done anything like this before.”

All names and details are changed to protect privacy as I proceed to describe a sample of each category:

Category One:

I received a call from Ron, who was clearly in distress, evidenced by the urgency and desperation in his voice. He was begging me to see him (he lived 2 hours away). He had experienced a powerful bufo journey (the strongest known natural psychedelic on planet earth, tryptamine 5-MeO-DMT, produced by Bufo Alvarius, a toad of the Sonoran Desert). I found out that he was not an inexperienced partaker in psychedelics, as he had gone on an ayahuasca retreat for a week the year before. Regardless, the bufo experience floored him. Until I was able to get him in to see me, I instructed him to go to the beach, assisted by his friend, and sit on the sand, feeling the sand under his hands and legs, and breathe in the healing salty air, using a mantra of “I am safe, I am right here” repetitively. This mantra was to ground him to the here and now. I also had him eat grounding (comforting) foods, which his friend was able to provide (warm stew, butternut squash, soup, etc.).

He arrived the next morning to my office wrapped in a blanket with sand on his feet, as he was coming straight from his second day of sitting on the beach. He was trembling and he didn’t understand what had happened to him. Having been further informed by his friend, and thankfully, with the knowledge of Dr. Stanislav Grof’s work with “spiritual emergency,” I was able to normalize this intensity for him. He was experiencing past trauma (that he re-lived during his ayahuasca ceremonies the year before), but now he was somatically experiencing it, coming up and out of his body, resulting in uncontrollable shaking. Through his tears, he described his trauma as his body continued to tremble. As a child, Ron had been repeatedly molested by his older brother, and when he went to his mother, she told him he was lying. Confused and traumatized, he left home at 11 years old to stay with a friend, and his mother never came to collect him. I encouraged him to just keep on letting his body tremble- that this was a necessary part of releasing the traumatic experience. I found myself moving closer to him and making sure he felt safe. After giving him the encouragement that this was exactly what needed to happen, and with the support of his loving friends and family, he was eventually able to go home, instead of what normally would have resulted in an ER visit (I have to admit, when he first arrived, I thought I would have to refer him to the ER, but am very thankful that this didn’t happen). His trusted friend kept very close by, physically assuring him that he wasn’t alone and he was safe.

Two of his friends brought him back the next morning. Ron already looked better and was able to articulate more about his experience. He went on to meet with me several more times and has been able to process these very difficult events to the point where they are no longer stuck in his body. He has since described a sense of calm that he couldn’t ever remember feeling.

Because of the knowledge of what each of the particular plant medicines can do and how the body processes trauma, we were able to prevent what could’ve been a very detrimental stay in a psychiatric hospital. This is a very clear example of why integration is so important, and particularly with a trained therapist, with prior experience working in an acute care unit of a psychiatric hospital.

People who reach out for integration are looking to understand their experience and process it through their own history and trauma. They’ve turned to plant medicines or psychedelics because what they have been doing hasn’t been working and they’re not happy with how they’ve been living. They have not been able to get through the walls they built to keep them safe growing up (but no longer serve them as an adult).

In a therapeutic environment, there are no “bad trips.” The experience referenced above may appear to be frightening, but as we can see, it was very intense, and yet, very healing.

Category Two:

As for Category Two, I’ll share an example I had with Paul. He called to tell me that he wanted an appointment because he had a psilocybin experience that left him feeling happy for the first time since he could remember. He had been on the verge of suicide many times for the 3 years prior, seeking different forms of therapy and medication to no avail. He could not get out of a deep sadness and numbness that he felt, no matter what he tried. Plant medicine was a last resort, and in his words, if it didn’t work, he was done.

He tentatively arrived in my office and described this feeling of peace and love that he was somewhat desperate to hold on to. This integrative therapy evolved in a way that I didn’t expect, because over the course of a year of our work together, Paul went through some physical symptoms that derailed him for quite some time, but was so closely connected to the fear that kept him from experiencing any joy in his life. As he came to realize that these symptoms were connected to past trauma, and as he realized that he was, indeed, a very sensitive person (this was met with almost disdain when it was suggested in the early stages of therapy), he truly began to heal and come alive. This is an example of what the “spectrum of trauma” means. Paul’s repressed grief had a lot to do with his intense emotions around the death of a beloved pet when he was 11 years old. He was shamed for his grief by family members and peers. By pushing down these feelings of grief, coupled with this new shame, his capacity to feel was also pushed down, and depression became his norm. While this trauma may not appear to be nearly as intense as Ron’s trauma, it affected Paul to the point where he had disconnected from himself, and ultimately, didn’t think life was worth living, although he had no understood connection to the repressed grief at the time.

The psilocybin journey showed him what was possible, but it did not enable him to live a happy life until he got underneath his “firewall” (described below) and worked at it. There was a lot of grief for him to process, and tears came along with shame until it moved its way out. Today, I can happily say that smiling is the norm for him, and spontaneity is part of his daily life. He embraces his sensitivity and sees how it has become a gift to him. He worked hard to get there.

We all have unresolved trauma. Trauma is the response to a deeply distressing or disturbing event that overwhelms an individual’s ability to cope, causes feelings of helplessness, diminishes their sense of self and their ability to feel the full range of emotions and experiences. Some of us have experienced more intense trauma than others, but some of us are more sensitive than others as well. If a disturbing experience led you to disconnect from your true self because what you were feeling was too much, that is the internal impact of trauma. We create a “part” that protects us from this overwhelming emotional pain, assuring us that we will not feel it again. Most of the time, we are completely unaware that we have done this.

These traumas become more clear during integration therapy, as the plant medicine helps to reveal that which we have buried deep in our subconscious. I truly believe that psychedelics/ plant medicine, when used properly, are here to bring us back to our whole self- to show us our own “operating system” that we have created as a result of our experiences, and how there may be some “firewalls” up that are protecting us from pain and keeping us from our true nature. Why would we want to pull down this firewall that has protected us for so long? Because that pain we are protecting is where we are going to find ourselves the most alive. We need to sit with it, feel it, allow it, and finally, let it move its way through us and out. What is depression, but a condition where we feel disconnected from self and others, where nothing will make us feel better because we have lost our way? What is anxiety, but an unprocessed fear that we are not going to be ok? We may have felt like we couldn’t survive this emotional pain as a child (emotional pain can be very intense and confusing for a child, and none of us are exempt from this), but we need to know that we will survive it now. This is also what integration therapy is about- having a safe place to be reminded that you will be okay now. You are safe. You can learn to witness and feel at the same time, thus allowing the firewalls to gently move out of the way.

Category Three:

Finally, I’ll touch on Category Three. Terry called to tell me that she wanted to take psilocybin but was very scared to. Her husband and brother had both taken it and assured her that they would be there for her. Her motivation for wanting to do this was to help understand and heal her Misophonia, a condition meaning “hatred of sound,” which manifested in her becoming highly irritated at many sounds, with the sound of someone chewing or sniffing causing her the most distress. She loved her husband and children, but these sounds, even coming from them, created anger inside of her, which in turn, stressed her out even more.

We talked about some of her history and when the Misophonia began. She described overhearing a conversation between her parents that involved her father being unfaithful with a man. Terry loved her dad, and I believe she did not know what to do with any feelings of anger towards him, and she remembers being really angry at him chewing his food. This wasn’t the first time she thought there was a connection, but she didn’t know how to remove the root of it. We talked about what the set and setting would be like for her journey: music, a mantra she could use as she began preparing for the day, and what her husband could do as her “sitter.”

When we met after her journey, she described feeling so much love and no fear at all. She shared that she had a sure feeling that whatever was going on, there was something inside of her that was going to know how to handle it and know what to do. This was the plant medicine reminding her who she really was. Our subsequent sessions were about connecting with the anger that she was sidestepping and sitting with feeling uncomfortable around that, as she was able to understand that while it wasn’t safe for her at the time to feel anger towards her father, she transferred it to something that did feel safe. Obviously, this was no longer serving her and it was hurting her and her family members. Because of the inner knowing that she received from her experience with psilocybin, she was more easily able to access the anger in our integration sessions afterward, without feeling like she couldn’t handle it. She worked hard through these sessions and in-between, and while the Misophonia isn’t completely gone, she feels it very rarely now, and she is able to easily ride through the irritation.

As a therapist, it is a very rewarding experience to see the recognition in someone’s eyes that “yes, I can handle this and I will be ok.” This concept, called “therapeutic alliance,” allows a client to let go- to begin to trust. Many clients aren’t aware that they don’t trust because they’ve never experienced trust in the first place. They don’t know what it feels like to let go and still feel safe. Somewhere along their road of life, usually in early childhood, the world became an unsafe place to be. This is often due to parents or caregivers unable to see their child’s pain, or not knowing what to do with it, likely due to their own unrealized traumas. The child then learns to do whatever is necessary to survive because their world depends on them burying their intense emotions and “pushing through.” Intense emotions can make someone feel as if they are going to die. The emotion is too big for the child to bear, and often, there are no words to communicate this. If they are not seen by someone who cares, then the child has to figure it out for themself. This is where plant medicine can reveal deep traumas, underneath all of their survival mechanisms, beyond the “firewall.” Of course, there are other methods, but here, we focus on plant medicine.

It takes a great deal of courage (doing something in spite of fear) to put yourself in the hands of a shaman or sitter and enter the unknown. Most clients will say that they were scared but did it anyway.

Another final case I’d like to share: Brian had been addicted to heroin on and off for about 7 years. Many rehabs and detoxes did not accomplish what a 10-day stay at an ibogaine clinic did.

Brian had been on and off with me for about 3 years. We were working on a harm reduction approach away from opiates. This approach involved cannabis and kratom (an extract from a tropical evergreen tree from Southeast Asia, often used to help wean someone off opiates). Brian had already been through Buprenorphine and Methadone enough times to realize they weren’t going to keep him from relapsing back to opiates. The cannabis and kratom approach was up and down, and he still felt desperate. After much talk about ibogaine (ibogaine is a plant-based substance extracted from the iboga shrub, which originates in Africa), he went to a clinic out of the country and was administered ibogaine from a medical doctor. I believe that it is an immense disservice to addicts that ibogaine has not yet been legalized in this country for opiate addiction, although that is a subject for another article (stay tuned!). Two weeks later, he was back in session with me describing his experience, and it was clear that something had truly changed. He was able to see different paths that he took in his life, and how he always had other options. These paths were shown to him in a way that he reports “almost felt like it had rewired my brain. My interest in opiates is just not there.” A year and a half later, still clean from opiates, Brian has been working on creating that trusting relationship with his own self, developing confidence that he can withstand uncomfortable and painful emotions. Without integration, the uncovering of painful emotions could have led back to a relapse.

Thus, integration involves creating that relationship with yourself, dialoguing with that younger version of yourself, and helping your inner child to heal- integrating your OWN self. The word integration is so perfect, because as we are integrating the plant medicine experience, what we are really doing is integrating our true self, beyond all of our ego’s constructions of what was necessary at the time, but no longer serves us in being whole.

What has been most helpful to me as an integrative therapist was my own experiences with plant medicine, particularly ayahuasca. It’s not always easy to “hold space” for some of the pain that is releasing from clients, as the energy can be intense. One of the most important visions I had during an ayahuasca journey in Peru was the night I had a matrix in front of me of all happenings between humans for a long timespan. Certain squares of the matrix would become the focus as I observed specific human mental suffering, abuse, some more benign scenes… some family members and friends I knew… I could move the scene out of the way if it wasn’t something I felt I needed, and focus closer on scenes that were meaningful to me in some ways. I witnessed a scene between a relative and her father that was devastating, as well as several others like this. The reason this was the most important vision for me was I was a silent observer. I was aware of the pain and tragedy, but I wasn’t in pain myself. This is not usually true for me in my daily life, as I feel pain in my own body when someone else is experiencing pain. It has, at times, made it difficult for me as a therapist to hold back tears when a client is in tears, and I have had to momentarily think of something funny to pull me out of this empathic experience. Being able to be aware of the pain in this matrix experience, but not be in pain myself, has helped me tremendously in my practice, as well as with friends and family. I feel less responsible to “fix” it, in a way, because I clearly realize the pain is not mine. This has not made me less empathetic in any way, but it has enabled me to have more clarity. Therapy isn’t about fixing, but helping people to uncover their own guide within; their own inner wisdom. This has become my purpose, to just be a guide in the storm of someone’s life and allow them to see that they’ve known all along who they are, they just need to move their “firewalls” out of the way.

If you are reading this and have been wondering what it might be like to work with people in this capacity, I hope this has been helpful. As Terence McKenna once said, “It’s all about love… making someone else’s existence just a little easier… nothing else matters. I know this now.”

About the Author

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Debbie Kadagian became certified as a Holistic Health Practitioner in 2007, specializing in Ayurvedic Health Counseling. She traveled to India to study at the Jiva Institute with Dr. Partap Chauhan. She received her Masters in Social Work from Fordham University and became a licensed clinical social worker. She has worked at inpatient psychiatric hospitals and outpatient treatment centers prior to setting up her private practice. Debbie is also a certified yoga teacher since 2001. Debbie has a true desire to assist people in finding meaning in their lives in order to transcend suffering, addiction, and trauma.

Debbie is the producer of the film, “Healing the Mind: The Synthesis of Ayurveda and Western Psychiatry,” available to view at Gaia.com.

“If plant medicine is a teacher, then an integrative therapist is a tutor, helping the traveler understand the teachings.”

 
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Veteran Navy SEAL advocates for Psychedelic Assisted Therapy

by Wesley Thoricatha | Psychedelic Times | 22 Jan 2020

Marcus Capone is a former Navy SEAL who, like many of his teammates completed multiple combat deployments overseas. After returning home and retiring from service, Marcus and his wife Amber faced an escalating crisis of depression, anxiety and suicidality that was underpinned by Marcus’ post transition struggles and years of head trauma from football and military service. After exhausting every conventional treatment option imaginable, they eventually turned to ibogaine and 5-MeO-DMT treatment outside the US, and only then found a medicine that truly worked.

Since then, Marcus and Amber have gone on to found Veterans Exploring Treatment Solutions (VETS), a nonprofit that is partnered with MAPS and provides resources for combat veterans seeking psychedelic treatment for TBI and PTSD. In this interview, Marcus and Amber share their harrowing journey through desperation and redemption, and why they are stepping up to help other veterans overcome depression, suicide, and broken family lives.

First and foremost, thank you both for doing this. I heard you share your story at the recent MAPS conference in Austin, but can you share your incredible journey for our readers?

Amber: This is actually the first interview we’ve done. We’ve been holding this very tightly and we’ve turned down a lot of requests, so we’re honored to share this today after over two years of silence.

Marcus: I’ve had a history of contact sports since I was seven years old. I played tackle football all the way through my senior year of college, and from there I entered the military. I spent 13 years attached to the SEAL Teams, and part of being a SEAL is that you spend a large portion of your time around gunfire and explosives. I was a breacher, which means I was one of the explosives experts of the team who either detonated or was near a lot of different detonations. So I had years of contact sports, fighting, and proximity to explosions.

What the experts are telling us is that all these sub-concussive and concussive blows to the head are causing a major impact on our brain. After transitioning out of the military and trying to find purpose and direction, I fell into a black hole of depression and anxiety, mixed with mild traumatic brain injury, and it was a recipe for disaster.

Amber: When Marcus got out of the military, we thought we would be riding our bikes down the road, skipping and holding hands, [laughter]. We were adjusted to the war deployments; they were just a reality. I wasn’t at all prepared for the fact that the next war would be in our home… fighting to save Marcus and our family.

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At first, his only diagnosis was PTSD, but that never really resonated with me. Trauma definitely existed, but he was not hypervigilant and wasn’t checking the doors five times or petrified of fireworks. It was more like he forgot to check the locks and was too depressed to go watch fireworks, so it felt different. I didn’t ever buy into the PTSD-only diagnosis. Then one of his buddies committed suicide and they performed an autopsy and found a serious brain disease. That got me really worried because all the symptoms fit. This was more than PTSD, so I got him to all the top brain clinics, 5 in total. It entailed weeks and weeks away from home.

Marcus: I went to five different clinics, and took eight different SSRI’s, SNRI’s, sleeping pills and pills to allow me to focus and stay awake. My SPECT scans were not good: they showed mild traumatic brain injury, PTSD markers, depression, and stuff that I never had in the past, like ADD and ADHD, and mood disorder.

Amber: When he first got out of the military, we thought he just needed a break from deploying to transition out. But each year he was getting worse and worse. There was no relief, and it was just continuing to escalate. All these brain clinics didn’t really make a difference, and we were really coming to the end. I started to become afraid of him, and our kids were living a hellish existence… we all were.

I knew that if I left him it would be a real recipe for a disaster, but I was out of hope. I went to visit him at one of these clinics and he was worse than ever. I came home and told my parents that I had to leave him, and for me that was a huge step. It’s something I thought I’d never do. But then I remembered that there was this one other treatment that a SEAL had done. I reached out to him to get Marcus to go and try it too. I didn’t know if it would make any difference; I thought it would be just like all the other clinics… but it worked.

Marcus: Some individuals say the medicine finds you. We were made aware through family friends that an individual had been helped in a clinic outside the US by taking part in a psychedelic assisted therapy session with a medicine called Ibogaine, synthesized from the Iboga root. I thought it was ridiculous that you can take a pill (because I had already been handed bags of pills), and along with psychotherapy, 24 hours later be healed and reborn like you never thought possible. I had zero experience with psychedelics or cannabis, so for me this was very different. But I trusted the individuals that were getting me to commit to the treatment, and the risks were outweighed by everything else.

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Marcus and Amber at the 2019 Psychedelic Science Summit in Austin, TX

I was treated with a flood dose of Ibogaine, an alkaloid found in the root bark of the African plant Tabernanthe Iboga. After a 12-hour very intense trip to hell and back, (literally one of the scariest experiences of my life), I had a 24-hour recovery, and then I was treated with 5-MeO-DMT, a psychedelic of the Tryptamine class, extracted from the venom of the Colorado River Toad (no shit!). These are two of the world’s most powerful psychedelics, and they radically changed my life.

I initially thought this may have been just subjective and too good to be true. But the impact this has had, and continues to have on myself and others is lasting and powerful.

That’s incredible. How did you go from your treatment experience to starting your nonprofit VETS?

Marcus: The first thing I did was turn to Amber and ask, “How do we help everybody else who is struggling the same way I was?” The only way to do this was to raise money and build a nonprofit so we could fund others to receive the same type of experience that I had. So that’s what we did—we kind of got after it with glue and tape. We worked with a few individuals, an amazing doctor and provider of the medicine, the best therapists and coaches, hooked up with some advisors, and here we are today. We want this to flourish because of all the mental health issues happening in our country, including those involving the veteran community, and we feel that psychedelics are going to play an integral part in healing our soldiers, and perhaps a larger component of society as a whole. We are focusing on SEALs and their families first, then eventually all Special Operations veterans, and can only work with those who are retired and no longer serving.

Some veterans separate from service and have amazing, successful lives, but many of them are suffering just like I was. Some are isolating themselves for weeks or months, divorcing their spouses, losing their families… it’s terrible. You serve for 20 or 30 years and you expect to retire and have this wonderful life (as they should) in the private sector, but sometimes it actually gets worse.

Amber: Marcus came through treatment and within 24 hours he was saying that we have to help more people, because the veteran community is in absolute crisis, and it is experiencing many suicides. I was sitting at a funeral of a dear friend and I thought, “I don’t ever want to be in this chapel again! We have to do something.”

Marcus: And it’s not just the SEAL community—the greater special operations community is having a real hard time. We’re being told the SF [Special Forces] operators in Australia, New Zealand and the UK are really struggling, and we’d love to eventually help them if/where we can.

Amber: We have a great burden on our shoulders, but it’s an honor to carry forward this message of hope.

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Marcus: Some days I wonder, “Why the fuck are we doing this?” because it can be frustrating and full of headaches due to the sensitive nature of the treatments. We’re dealing with individuals who are really struggling. It’s challenging, but when I get a text message from someone who just got out of treatment that says “Hey man, you saved my life and kept my family together, I can’t thank you enough,” it’s all I need to hear to keep going.

Let’s say I’m a veteran having a tough time. I’ve seen Soldiers of the Vine and From Shock to Awe where veterans are using ayahuasca to heal. I read this and hear that ibogaine and 5-MeO-DMT is a great way to heal. I come across MAPS and their research saying that MDMA-assisted therapy is the way to overcome PTSD. I’m hopeless and I’m not sure where to go. What would you say to that person?

Amber: The goal of the nonprofit is to provide funding for those seeking psychedelic assisted therapy on their own. We have multiple treatment options that we can help fund. So if they choose ibogaine and 5-MeO, or ketamine, or MDMA-assisted psychotherapy or psilocybin, we want to be able to provide them with what they need to seek the treatment they choose.

So when a veteran comes to us, we educate them on the risks and benefits associated with all of them, but they do their own homework and present a plan. We’ll assist with some due diligence on different clinics, but we won’t ever direct or suggest any specific clinic or modality. About half of those coming to us are having suicidal ideation, and we want to help them discover and pursue treatment before it’s too late. We also provide preparation and integration coaching as well, because that’s such a huge component of the overall process.

Marcus: It’s not my job to steer people to ibogaine. We can’t prescribe or diagnose individuals because we are not doctors. But we can make sure they know about the research, and all the options that are out there, and where people can go to legally pursue these alternative treatments.

That’s really great. How can people donate to VETS or contact you for help?

Marcus: Our website is vetsolutions.org. We have a partnership with MAPS, and so all donations to us are tax deductible, and very soon we will have our own 501(c)(3) designation, as well. In 2020, we’d like to be able to support 200 soldiers, but as you know that’s a hefty price tag and so we’ll definitely need the donor support. If someone would like to donate they can go to our website’s donation page.

 
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Canada’s first psychedelic-enhanced psychotherapy centre is changing how we treat depression

by Mike Drolet | Global News | 14 Jun 2020

What’s been billed as the “first psychedelic-enhanced psychotherapy centre in Canada” opened the week before most of the country went into COVID-19 isolation. So before it could open any minds to its potential, its doors were closed.

Three months later, it’s finally open to the public.

“The need exists because there are so many people struggling with depression and anxiety and other mental health conditions,” says Field Trip Executive Director Ronan Levy.

The company’s first location is based in downtown Toronto. Two new locations in Los Angeles and New York will open later this summer. The office looks more like an upscale yoga studio than a doctor’s office. Spacious rooms and comfortable chairs are meant to put patients at ease as they undergo a treatment that mixes a microdose of ketamine with psychotherapy.

"The idea is to get away from our reliance on anti-depressants," says Field Trip medical director Dr. Michael Verbora,

“Traditional medicine is passive,” he says. “’You take this pill, this pill is going to fix you.’ This is ‘we’re gonna give you a drug and we’re gonna help open up an opportunity for you to be your own healer,’ and we’re gonna be here for whatever you may need.”

A typical session that includes ketamine and therapy lasts around two hours. The patient would receive a microdose of ketamine through a needle in the arm or leg before relaxing in a reclining armchair with noise-cancelling headphones. After about 45 minutes the drug wears off and the therapy starts. Each session costs between $200 and $400.

Canadians are among the highest consumers of anti-depressants in the world (86 dosages per 1,000 people), trailing only the US (110 dosages), Iceland (106) and Australia (89) according to the OECD.

Most psychedelics are banned in Canada, including psilocybin and MDMA which are more commonly known as magic mushrooms and ecstasy. The drug used at Field Trip, ketamine, is legal for medical use and most commonly used as an anesthetic during surgeries. Its street name is Special K.

In the 1950s Canadian researchers in Saskatchewan were considered world leaders in the research of psychedelics to treat a variety of diseases, including depression and alcoholism. But LSD pioneer Timothy Leary helped usher in the counter culture movement of the ’60s, and psychedelics became synonymous with hippies. As a result, the U.S. and Canada banned them in the 1970s, essentially putting an end to any research projects.

In recent years scientists have begun looking for alternatives to anti-depressants, which a study from McMaster University suggests are hard to kick because of extreme withdrawal symptoms. Just last year, researchers at the University of Toronto launched the Centre of Psychedelic Studies where they’re looking at the effects of psilocybin. And researchers at the University of British Columbia Okanagan are well into a study looking at the impact of MDMA on patients with PTSD.

And while promising, U of T psychology professor Dr. Norman Farb cautions it’s still early days.

“We have almost no long term research,” he says. “So just because you feel incredible — right after a trip or even a week after a trip — doesn’t tell us anything about what’s going to happen to you in six months, a year or longer.”

Ketamine became known as a “club drug” in the 1990s. According to CAMH, when taken in high doses users report an out-of-body or near-death experience. It can also become addictive because higher doses are needed to counter increased tolerance. Smaller microdoses can give users a sense of floating, dissociation and numbness in the body.

During the worst days of the pandemic Field Trip offered virtual sessions to its clients, which have to be referred by a family doctor. The clinic has also provided free, remote therapy services to first responders and health-care workers. They’re now open for patients to visit them in the clinic.

 
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Therapeutic effects from a single dose of psilocybin persist for years

New York University | 27 Jan 2020

Antianxiety and antidepressant effects from a single dose of psilocybin persist years later in cancer patients.

Following up on their landmark 2016 study, researchers at NYU Grossman School of Medicine found that a one-time, single-dose treatment of psilocybin, a compound found in psychedelic mushrooms, combined with psychotherapy appears to be associated with significant improvements in emotional and existential distress in cancer patients. These effects persisted nearly five years after the drug was administered.

In the original study, published in the Journal of Psychopharmacology, psilocybin produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual well-being, and increased quality of life. At the final 6.5-month follow-up assessment, psilocybin was associated with enduring anti-anxiety and antidepressant effects. Approximately 60 percent to 80 percent of participants continued with clinically significant reductions in depression or anxiety, sustained benefits in existential distress and quality of life, as well as improved attitudes toward death.

The present study is a long-term follow-up (with assessments at about 3 years and 4.5 years following single-dose psilocybin administration) of a subset of participants from the original trial. The study reports on sustained reductions in anxiety, depression, hopelessness, demoralization, and death anxiety at both follow-up points.

Approximately 60 percent to 80 percent of participants met the criteria for clinically significant antidepressant or anxiolytic responses at the 4.5-year follow-up. Participants overwhelmingly (71 to 100 percent) attributed positive life changes to the psilocybin-assisted therapy experience and rated it among the most personally meaningful and spiritually significant experiences of their lives.

“Adding to evidence dating back as early as the 1950s, our findings strongly suggest that psilocybin therapy is a promising means of improving the emotional, psychological, and spiritual well-being of patients with life-threatening cancer,” says the 2016 parent study’s lead investigator, Stephen Ross, MD, an associate professor of psychiatry in the Department of Psychiatry at NYU Langone Health. “This approach has the potential to produce a paradigm shift in the psychological and existential care of patients with cancer, especially those with terminal illness.”

An alternative means of treating cancer-related anxiety and depression is urgently needed, says Ross. According to statistics from several sources, close to 40 percent of the global population will be diagnosed with cancer in their lifetime, with a third of those individuals developing anxiety, depression, and other forms of distress as a result. These conditions, experts say, are associated with poorer quality of life, increased rates of suicide, and lowered survival rate. Unfortunately, conventional pharmacologic treatment methods like antidepressants work for less than half of cancer patients and tend to not work any better than placebos. In addition, they have no effect whatsoever on existential distress and death anxiety, which commonly accompany a cancer diagnosis and are linked to a hastened desire for death and increased suicidality, says Ross.

The researchers say psilocybin may provide a useful tool for enhancing the effectiveness of psychotherapy and ultimately relieving these symptoms. Although the precise mechanisms are not fully understood, experts believe that the drug can make the brain more flexible and receptive to new ideas and thought patterns. In addition, previous research indicates that the drug targets a network of the brain, the default mode network, which becomes activated when we engage in self-reflection and mind wandering, and which helps to create our sense of self and sense of coherent narrative identity. In patients with anxiety and depression, this network becomes hyperactive and is associated with rumination, worry, and rigid thinking. Psilocybin appears to acutely shift activity in this network and helps people to take a more broadened perspective on their behaviors and lives.

How the original research and follow-up were conducted

For the original study, the NYU Langone team provided 29 cancer patients with nine psychotherapy sessions, as well a single dose of either psilocybin or an active placebo, niacin, which can produce a physical flush sensation that mimics a psychedelic drug experience. After seven weeks, all participants swapped treatments and were monitored with clinical outcome measures for anxiety, depression, and existential distress, among other factors.

Although researchers found that the treatment’s antianxiety and antidepressant qualities persisted 6.5 months after the intervention, little was known of the drug’s effectiveness in the long term. The new follow-up study is the longest-spanning exploration of psilocybin’s effects on cancer-related psychiatric distress to date, the study authors say.

“These results may shed light on how the positive effects of a single dose of psilocybin persist for so long,” says Gabby Agin-Liebes, Ph.D. candidate, lead investigator and lead author of the long-term follow-up study, and co-author of the 2016 parent study. “The drug seems to facilitate a deep, meaningful experience that stays with a person and can fundamentally change his or her mindset and outlook,” she says.

Agin-Liebes, who is pursuing her Ph.D. in clinical psychology at Palo Alto University in California, cautions that "psilocybin does not inherently lead to positive therapeutic effects when used in isolation, and in uncontrolled, recreational settings, and should be taken in a controlled and psychologically safe setting, preferably in conjunction with counseling from trained mental health practitioners or facilitators.”

Next, the researchers plan to expand this research with larger trials in patients from diverse socioeconomic and ethnic groups who have advanced cancer-related psychiatric and existential distress.

“This could profoundly transform the psycho-oncologic care of patients with cancer, and importantly could be used in hospice settings to help terminally ill cancer patients approach death with improved emotional and spiritual well-being,” says Ross.

 
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