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mr peabody

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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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Teletherapy, popular in the pandemic, may outlast it

by Jeff Wilser | New York Times | 9 Jul 2020

Some therapists find that remote therapy is so convenient to their patients that they will continue with it.

The 10-year-old girl was afraid that her American Girl dolls — buried in the bedroom closet — would come alive and attack her. As the girl pointed her iPad at the scary closet door in a remote therapy session, her therapist, Daniela Owen, was able to coach her in real-time to conquer the fear of the dolls.

“This wouldn’t have been as effective in my office,” Dr. Owen, a psychologist based in Oakland, later explained. “Being able to do the exposure in her room was so much more powerful.”

Dr. Owen, like the overwhelming majority of therapists, switched from in-person to remote therapy during the coronavirus shutdown. According to a recent survey from the American Psychological Association, three-quarters of clinicians are doing only teletherapy, and another 16 percent are doing a combination of remote and in-person sessions.

Many therapists were initially reluctant. Tamara Greenberg, a San Francisco-based psychologist, dreaded the pivot, for example, because she worried it “wasn’t as real a form of therapy.” And now? “I would say it’s really been one of the most surprising, and in many ways pleasurable, experiences of my professional career,” she said. Interviews with more than 20 therapists reveal similarly positive experiences, even as they also acknowledged some downsides, and that they missed seeing patients in person.

As the nation gingerly begins to reopen, many providers say that remote therapy is working so well and offers such convenience to their patients that they will continue with it even after the pandemic.

Peer-reviewed studies have shown that remote therapy — or “teletherapy,” which is generally done through videoconference — can be just as effective as in-person therapy for treating post-traumatic stress disorder, depression and anxiety, according to Leslie Morland, director of the Regional TeleMental Health Program at the San Diego VA Health Care System. “There’s always a contingent who are pretty convinced that they have to have their patients in the room with them, even though that’s not supported by the data,” Dr. Morland said.

Much of the research was driven by the Department of Veterans Affairs, which sees telehealth as a way to expand access to therapy for veterans who live in tough-to-reach areas. “The research shows that clinicians can be as effective in a telehealth environment as they are in face-to-face,” said the chief executive of the American Psychological Association, Arthur C. Evans. Teletherapy could bring therapy to millions of people who need it. A 2017 study from the Substance Abuse and Mental Health Services Administration found that of the 46 million Americans with a mental health issue, only 42 percent received treatment. Dr. Morland says telehealth can help close the gap.

In addition to the obvious benefits of convenience and flexibility, video sessions can give therapists a literal window into the patient’s home. Teletherapy can offer “a much deeper level of knowing the child, and understanding what their world might really be like,” said Lisa Dion, president of the Synergetic Play Therapy Institute, based in Boulder.

Patients — who asked that their names not be published to protect their privacy — also reported benefits. “Receiving treatment is far less cumbersome, which significantly decreases your stress level, which is a huge part of why you’re in there,” said a 43-year-old female veteran, based in South Carolina, who had been seeing a Veterans Affairs therapist for treatment of depression and PTSD. Or as a 23-year-old software engineer, who sees a therapist for social anxiety and depression, discovered, when she no longer needs to deal with the commute, “there’s not as much time to hype yourself up … there’s less time to ruminate.”

Yet most therapists interviewed acknowledge that even if remote therapy is effective, it has its downsides. On top of the baseline Zoom fatigue that many of us experience, therapists must be extra-vigilant for nonverbal cues that are easier to spot in person. “In a room you have more cues, so if you relax and miss one cue, you can pick up the next,” said Dr. Dion. According to the A.P.A. survey, 76 percent of therapists said that treating patients remotely is more challenging than in-person.

Some things simply can’t be done over video. If a patient is in tears, how do you hand them a tissue? Or if a patient is really struggling with something, as Mirjam Quinn, a Chicago-based psychologist, put it, “Sometimes if there are no words, you can touch somebody’s shoulder, you can sit next to them. That’s gone. And that’s something that I really miss.”

Another drawback: It can be tough to find privacy, especially during the pandemic when everyone else is sheltering in place. Patients may retreat to a car, a closet or even the toilet seat. A 25-year-old living with his parents and brother in Modesto, Calif., who sees a therapist remotely for anxiety, depression and attention deficit hyperactivity disorder, worries that his family can hear his therapy sessions.

“It’s this weird thing when the doctor asks me, ‘Has the medication given you any sexual problems?’ And I had to answer that.”

Providers can face the same privacy challenges, as their own kids or cats or dogs could come bursting into the frame. As Dr. Greenberg described, one day her husband didn’t realize she was on a patient call, and he started pounding chicken in the kitchen. She said her patient asked, “What’s happening to you? What’s that banging?”

Therapy apps like BetterHelp and Talkspace, which allow users to text in silence, both report growth in sign-ups since the pandemic began.

Teletherapy also raises knotty questions over insurance policies (would it be covered?), HIPAA privacy regulations (is it legal and ethical to use Skype?), and state-to-state licensing requirements (could a therapist in Brooklyn see a patient who lives in Hoboken, N.J.?) In the pre-Covid era, these questions alone were enough to keep most providers from practicing teletherapy. Then Covid slashed the red tape. Medicare quickly changed its policies to cover most telehealth, many private insurance companies followed suit, and clinicians could use FaceTime or Skype without worrying that they were violating HIPAA.

Whether the regulations remain loosened after the pandemic is an open question; the A.P.A. sent letters in May to all 50 governors (as insurance regulation differs state-by-state), urging them to grant a 12-month extension of the new policy after the pandemic is over.

“If there’s a silver lining with the pandemic,” said Dr. Morland, "it may be that when the dust settles, we will be able to increase the number of people who get care.” Or as Dr. Quinn said, laughing a bit, “It’s going to be hard for all of us to go back to putting on pants on a regular basis.”

 
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mr peabody

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The power of psychedelics

by Erica Rex | Scientific American | 12 Jul 2020

They worked for my depression. Could they be the future of psychiatry?

In 2012, I had my first psychedelic experiences, as a subject in a clinical trial at Johns Hopkins University School of Medicine’s Behavioral Pharmacology Research Unit. I was given two doses of psilocybin spaced a month apart to treat my cancer-related depression.

During one session, deep within the world the drug evoked, I found myself inside a steel industrial space. Women were bent over long tables, working. I became aware of my animosity towards my two living siblings. A woman seated at the end of a table wearing a net cap and white clothes, turned and handed me a tall Dixie cup.

“You can put that in here,” she said. The cup filled itself with my bilious, sibling-directed feelings. “We’ll put it over there.” She turned and placed the cup matter-of-factly on a table at the back of the room. Then she went back to her tasks.

Whenever I speak with her, Mary Cosimano, the director of guide/facilitator services at Johns Hopkins Center for Psychedelic and Consciousness Research, mentions the women in the chamber and the cup. My experience struck a chord. For me, the women in the chamber have become a transcendent metaphor for emotional healing.

“I’ve thought about having a necklace made, with the cup, as a momento,” she said the last time I saw her at a conference. “Have you thought about it?”

Prior to their 1971 prohibition, psilocybin and LSD were administered to approximately 40,000 patients, among them people with terminal cancer, alcoholics and those suffering from depression and obsessive-compulsive disorder. The results of the early clinical studies were promising, and more recent research has been as well.

The treatment certainly helped me. Eight years after my sessions, researchers continue to prove the same point again and again in an ongoing effort to turn psychedelic drug therapy into FDA-sanctioned medical treatment. This can’t happen soon enough.

“Psychopharmacology as a field had stalled. Many patients don’t respond to conventional treatment with SSRIs,” says Charles Grob, M.D., professor of psychiatry and biobehavioral Sciences at Harbor-UCLA Medical Center, and the first modern clinical researcher to treat advanced-stage cancer patients suffering from depression and anxiety with psychedelics.

There is little hard evidence to show that long-term psychotherapy is effective in treating mental illness, depression or post-traumatic stress disorder (PTSD). And there’s the cost, which fewer and fewer insurers underwrite and ordinary people can’t afford.

The failure of the psychotherapeutic process is located at its epicenter: the power disparity in the therapeutic dyad. Merely walking through the consulting room door, the patient subordinates herself to the therapist, who, by virtue of a title, is presumed to know more about her than she does herself. Transference and countertransferance—offspring of Freudian psychoanalysis—are cogs in the same moribund engine. The field will not change until the therapeutic relationship as it has been structured since the 19th century disappears.

Psychedelic drug therapy subverts the timeworn patriarchal hierarchy by creating an atmosphere of cooperation and trust rather than competition and domination. Or, to state it more bluntly, what women do in structured settings rather than what men do; women create cooperatives, men create hierarchies.

The treatment space is furnished like a lounge, with couches, chairs and table lamps. A music track plays. Two trained guides, one male, one female, are seated close by, ready to help if the emotional path becomes difficult. Guides are not therapists; instead they serve as trusted companions along a perilous, transformative spiritual journey. The sessions are led by the subject herself, by her feelings and perceptions throughout the experience and the way she processes them afterward.

“The drug is a skeleton key which unlocks an interior door to places we don’t generally have access to,” says psychologist William Richards, one of the researchers who successfully treated patients with hallucinogens in the 1960s and early 1970s. “It’s a therapeutic accelerant.”

MDMA (3,4-methylenedioxymethamphetamine) is rapidly proving effective in treating PTSD. MDMA is an “entactogen”: it touches within in a way talking does not. Michael Mithoefer, a psychiatrist in Charleston, S.C., who has worked with military personnel and first responders, conducted a phase II clinical trial using MDMA to treat PTSD.

“Treatment is not just revisiting the traumatic experiences,” he said. “It’s a process of affirming a different experience on all levels, including in the body.”

During MDMA sessions, subjects become more emotionally flexible and able to stay the course while exploring difficult memories. Many experience an enduring change in their response to emotional triggers. Clinicians hope to see MDMA approved by the FDA for PTSD treatment as early as 2022.

Treatment with psychedelic drugs represents a paradigm shift in the approach to mental health. For me, the change in the field is embodied by the presence of the busy women along my journey. The women treated my feelings as matters of fact, not to be avoided, reviled or fled from, but so obvious and ordinary they could be poured into a Dixie cup and set aside.

The success of the cancer studies has led to investigational treatment for patients suffering from intractable depression, early-stage Alzheimer’s, anorexia nervosa and smoking addiction. Within a few years, the patriarchal therapeutic model could be a thing of the past, supplanted by short-term guided treatment with psychoactive drugs.

 

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Psychedelic-assisted psychotherapy and experiential efficacy

by David Sugarbaker, PsyD, MPH | Pyschedelic Science Review | 23 Jul 2020

With the paradigm shift created by psychedelics, a recent study suggests reconsidering the medical model of mental illness.

In a recent article in Frontiers in Pharmacology, E.E. Schenberg described a significant crisis facing psychiatry: innovation in psychiatric drug development is in decline while mental illness increasingly contributes to the global disease burden. According to Schenberg and others, the halt in psychiatric drug innovation is intertwined with a larger “paradigmatic crisis” in psychiatry, in which brain-based explanations of mental illness along with discrete categorical diagnostics no longer spur innovation in therapeutics, i.e., the development of psychiatric drugs with unique mechanisms of action.

In response to this paradigmatic crisis, Schenberg suggests that some mental health practitioners, researchers, and theoreticians have become increasingly open to new ways of conceiving of mental illness, which, in turn, inform novel diagnostic and treatment approaches. According to Schenberg, this openness may be indicative of a deeper shift in the underlying paradigm of explanation, diagnostics, and therapeutics, creating space for reconsideration of the traditional medical model of mental illness vis-à-vis alternative and novel treatment approaches.

Psychedelic-assisted psychotherapy as a novel treatment approach and beyond

Psychedelic-assisted Psychotherapy (PAP) is a novel treatment for mental illness that involves the therapeutic and supervised use of psychoactive substances, such as ketamine, MDMA, LSD, and psilocybin, among others, in the course of psychotherapy. Rather than a prolonged course of psychotropic medication, the PAP therapeutic course includes the therapeutic use of the potent psychoactive substance in a limited number of sessions. The three stages of PAP include: Preparation, Psychedelic Session, and Integration. Preparatory sessions set the stage for the administration of the psychedelic substance, and follow-up sessions are aimed at integrating the therapeutic benefit of the psychedelic sessions while shoring up treatment gains.

Beyond its potential as a novel, safe, and efficacious treatment for mental illness, Schenberg suggests that PAP has implications for shifting the collective attitude toward the widely accepted medical model, including its reliance on brain-based explanations for mental illness and use of discrete diagnostic categories with specific symptoms constellations targeted by longer-term psychiatric drug treatments.

The medical model vis-à-vis PAP: Explanation, diagnostics, and therapeutics

Conceptual models of mental illness differ in terms of explanation, i.e., how the mental disorder is etiologically explained, diagnostics, i.e., how it is identified and labeled, and therapeutics, i.e., how the illness is treated.

The medical model typically explains mental illness as arising from various organic brain dysfunctions, which are identified and categorized by characteristic symptom constellations and treated with specific drugs, taken over a long period. These drugs are thought to target the underlying brain dysfunction, most commonly a neurochemical imbalance, which is then adjusted, ideally, to asymptomatic levels through prolonged use of the drug.

This traditional medical approach is brought into question by PAP, as Schenberg points out, which conceptualizes mental illness along the axis of explanation, diagnostics, and therapeutics in a broader, more inclusive fashion. As compared to the medical model, the PAP model advances an explanation of mental illness more inclusive of psychological, social, and cultural variables, as well as adverse life events and trauma, broadly defined as mental injury. Furthermore, in terms of diagnostics, the PAP model presents symptoms on multidimensional spectra as compared to grouping symptoms within discrete diagnostic categories.

Indeed, mental injuries have been shown to correlate with a broad range of negative and trans-diagnostic mental health outcomes, and the PAP model implicitly hypothesizes that broad-based holistic treatments, such as PAP, can bring about experiences that have positive mental health outcomes, spanning diagnostic categories, such as promoting increased “acceptance” and “connectedness” or producing “emotional breakthroughs.” As such, rather than considering the efficacy of the drug, the PAP model attends to the efficacy of the experience.

Experiential efficacy and the therapeutic value of PAP

When PAP practitioners and researchers use the term “experiential efficacy,” a term Schenberg attributes to Leor Roseman, they are describing the experiential and phenomenological states that serve as the therapeutic mechanisms of action of PAP. Instead of conceiving of the drug as correcting functional neurochemical imbalances, the PAP model suggests that through mediation and processing of the psychedelic experience via psychotherapy, a patient may experience deeply meaningful and profound insights that bring about emotional, cognitive and behavioral changes across diagnoses and even in “treatment-resistant” cases.

While the therapeutic mechanism of action is not entirely understood, theoreticians are attempting to understand the experiential efficacy of PAP via neuroscience research as well as by drawing parallels to the identified mechanisms of action of various psychotherapy modalities, including Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and psychodynamic psychotherapy.

The potential of PAP

PAP has the potential for shifting the current paradigm in psychiatry via the notion of “experiential efficacy,” which brings into focus and the forefront the subjectivity of the patient experiencing the illness. While not ignorant of the therapeutic neurochemical changes that may attend the course of PAP, the primary concern of PAP practitioners is the phenomenology of the treatment experience and its therapeutic value across a broad range of diagnoses, for example, patient reports of cathartic emotional breakthroughs.

Thus, PAP may offer a way for psychiatry to minimize its risk of “losing the psyche” while also overcoming its current paradigmatic crisis by adopting a broader, more inclusive approach to mental illness explanation, diagnostics, and therapeutics.

 
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mr peabody

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Ketamine-assisted psychotherapy – Online?

Veronika Gold, LMFT and Eric Sienknecht, PsyD | Psychedelic.Support | 19 Jun 2020

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

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

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

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

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

Consider these three dimensions of virtual ketamine-assisted psychotherapy:

Accessibility

Upsides

Virtual KAP is more affordable compared to in-office treatment.

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

Virtual KAP is more accessible compared to coming in person to the clinic.

People who live in remote areas and places where there are no Ketamine-Assisted Psychotherapy clinics can now have access to this treatment.

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

The home setting can be more convenient for supporting the inner process and reducing side effects.

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

Downsides

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

Safety

Upsides

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

Downsides

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

Support System

Upsides

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

Downsides

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

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

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

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

 
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mr peabody

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Dr. Jessica Hollingsworth and Dr. Jake Hollingsworth


Psychiatry clinics gear up for new psychedelic treatments

by Jake Hollingsworth, DO. | Psilocybin Alpha | 24 jul 2020

Psilocybin may be safe for treating depression, but research is stymied by government controls.

We spoke to Jake Hollingsworth, DO, owner and operator of Pacific Psych Centers, a medical clinic that offers—among other treatments—IV ketamine infusions and Spravato (esketamine) for depression. We were particularly interested in how the Center’s clients have received these existing ketamine-based therapies, and how Jake is preparing to offer additional psychedelic medicines as soon as they become available.

Thanks for taking the time to talk to us. Could you tell us a little about your clinic, especially the ketamine therapies you offer?

My wife, who is a board-certified anesthesiologist, and I (I’m a board-certified psychiatrist) run an outpatient psychiatric clinic in Del Mar, California where we offer several treatment modalities including psychiatric medication management and psychotherapy, as well as providing IV ketamine infusions, intranasal esketamine (Spravato), Transcranial Magnetic Stimulation (TMS), men’s hormone replacement therapy, and injectable nutrients. We primarily treat anxiety and mood disorders, and we accept insurance directly for most of our services, with the exception of IV ketamine which is a self-pay treatment. We officially started our practice in late 2015, and it has evolved into what it is today. In the future we hope to bring in psychedelics as treatments, specifically MDMA and psilocybin assuming they eventually obtain FDA approval.

What level of demand have you experienced for IV ketamine and Spravato/S-ketamine?

Demand for both has been high and continues to grow. Spravato, being newer and with a much heavier marketing presence from the pharmaceutical industry, is growing at a much faster rate. The demand for ketamine is still growing, but not at the exponential rate that Spravato’s demand is growing. Most cities are somewhat saturated with “ketamine clinics,” so the demand has dropped nationwide.

And, what’s the general consensus from your clients on those treatments?

More success than not. Treatment-resistant depression, by definition, is tough to treat, so when we have a 50-60% success rate in that population of patients with either ketamine or esketamine: I would say that’s good. The intensity of the effect of IV ketamine infusions is much stronger and more altering than intranasal Spravato, but the outcomes regarding depression treatment are very similar between the two treatments. Both are generally well-tolerated and very safe from what I have observed. Our clinic has much more experience with IV ketamine infusions (around 5,000 treatments today) compared with Spravato treatments, which we have done around 300 over the past year.

Have clients enquired about other psychedelic medicines?

There is a lot of “buzz” around the potential for the FDA approval of MDMA and psilocybin, and I hear of some patients that are pursuing it on their own. Some are learning how to procure mushrooms via YouTube, some are travelling to South America for ayhuasca retreats, etc.

How do you think the emergence of psychedelic medicines like MDMA and psilocybin will be different to that of medical marijuana?

The biggest difference between MDMA and psilocybin will be the FDA-approval aspect. Cannabis is not FDA-approved for any medical indications. The other issue is that the evidence and efficacy of MDMA and psilocybin for psychiatric indication is substantial, almost hard to believe actually. If the studies continue to show off-the-charts efficacy and safety, these substances are going to blow cannabis out of the water. The only two FDA-approved medications for PTSD are Paxil and Zoloft, and as a psychiatrist I can say that the efficacy is very limited and even when these two medications are effective, they usually come at the cost of significant advese effects like weight gain, sexual side effects, daytime sedation, etc.

What work are you carrying out to prepare to administer MDMA and psilocybin?

We are looking into the MAPS protocols for use and we plan to attend the MAPS training. We plan to build out an MDMA and/or psilocybin treatment room(s) at our clinic. I am going through all the literature and evidence so that we can utilize these medications as soon as it’s legal to do so. We are in the process of creating content for our website regarding these potential treatments for patient education.

What use cases will MDMA and psilocybin cover that IV ketamine and S-ketamine cannot?

MDMA will likely be FDA-approved for PTSD, IV ketamine is only FDA-approved for use as an anaesthetic (and not for any psychiatric purpose), and S-ketamine is only FDA-approved for Major Depressive Disorder (MDD). Those are very important facts because FDA approval as a medication (regardless of the indication) makes it legal for doctors to prescribe it. What it’s FDA-approved for is important because it affects what the insurance companies will pay for. When patients pay out of pocket (i.e., don’t use insurance to pay for treatment), the indications for prescribing are up to the doctor and patient. For example, IV ketamine is not FDA-approved for any psychiatric indications. Doctors can prescribe it for depression as an “off-label” treatment, but the insurance companies won’t cover it. But there will be a lot of overlap in patients across diagnoses, and some will need to wait until insurance companies roll out protocols and policies to pay for them. In the beginning, the patients who are willing to pay out-of-pocket will be the first to have these treatments (psychedelics). We are still slowly rolling out Spravato treatments for patients (despite the demand) more than a year after FDA-approval because the insurance companies have hardly reimbursed our clinics for the treatments we have done to date. Very frustrating for the clinic and for the patients!

Also, for MDMA and psilocybin to be used, patients must be off most psychiatric medications due to the drug-drug interactions. Some patients won’t be able or willing to do this for various reasons. Ketamine has almost zero significant drug-drug interactions so patients don’t need to change their medication regimens. This is an important issue.

In terms of timelines, when do you envisage being able to administer these medicines and therapies in your clinic?

As soon as possible! Assuming they are FDA-approved and we are able to prescribe them using safe and effective protocols we will start utilizing them as soon as they are available. MDMA may be available in 2021/22 and psilocybin will likely be a few years behind MDMA.

 
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How I fell in love with online therapy

by André Wheeler | The Guardian | 7 Aug 2020


Therapy is the pinnacle of awkward. You spend an hour talking about the deepest parts of yourself, to a person you barely know, and then you pay them and carry on with your day. I always leave with the same guilt and self-consciousness that comes with an accidental overshare. Did I talk too much about my childhood? Does she view me as overdramatic? What does she think of my new haircut? I couldn’t imagine undergoing the same process virtually.

Therapy under lockdown: 'I’m just as terrified as my patients are'

Then the pandemic hit. Trapped inside my Oakland studio apartment, I was trying to survive a shelter-in-place order with no clear end date. Devastating news reports, combined with personal pressures, caused a thick fog to enter my head. I was not depressed, per se, but I was closer to an episode than I was far. I knew I needed help, but I had doubts about unpacking my sadness while sitting inside the same four walls that housed it.

Then I decided to give virtual therapy a try.

Exactly one week into the pandemic, I sat in the “kitchen” of my studio apartment, wiping my clammy hands on my jeans and waiting for the therapist to enter the Zoom room. My therapist entered, an older, stern white woman, with her hair pulled back tightly, wearing a sensible floral top – and I wondered whether she and I, a queer, ostentatiously dressed black man in my 20s would get on.

We made small talk at first.

She told me about her own attempts to cope with quarantine by purchasing workout equipment and exercising at home. I showed off the French bulldog I had gotten a few weeks before lockdown.

Then, step by step, she chipped away at the looming problems in my life. The process was so subtle and masterly, that before I knew it intimacy and trust developed between us. I felt she was in the room with me, performing the act of kindness I so desperately needed: listening.

"While everyone was using webcams to pretend we were fine, here I could be real."

Good therapy means having your problems met with seriousness and compassion, no matter how big or small, mature or petty. My therapist did not berate me for feeling a lack of motivation, or for viewing the pandemic solely through how it was inconveniencing my life. She took notes as I vented, like a student preparing for a test.

“We are going to come up with a plan to get you back to where you need to be,” she said, at the end of our first session. After weeks of flux and uncertainty that was exactly what I needed. A plan.

I left those first sessions buoyed, as if I had gone for a run or danced to my favorite pop song. I was surprised. In my life, everyone was using webcams to pretend we were fine – here I could be real.

I could tell my therapist about how the deaths of George Floyd and Breonna Taylor left me feeling untethered. I don’t know whether she could identify with my anxieties, but she could recommend small adjustments to help me cope.

We discussed healthy hobbies to develop during lockdown: establishing a better sleep schedule, and breathing exercises to practice in the morning. Slowly but surely, the fog began clearing from my head.

Text therapy: once my therapist sent me an emoji, I knew it was game over

Two weeks ago, I met with my therapist again. I took stock of how comfortable I had grown logging on, angling my webcam just right and diving into our conversation with ease. I praised the fitness app she recommended last session; she asked how my puppy was doing. As the session came to a close, my therapist beamed. “You just have such a glow now!” She examined my image on her computer screen and nodded once. “I think we got you back where you need to be.”

 
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The hidden world of underground psychedelic psychotherapy in Australia

By Jenny Valentish | ABC News

John puts The Passion of the Christ soundtrack on the stereo and lies on the single bed in this Melbourne house. He's a 37-year-old engineer working in the renewable energy sector, and not at all savvy about street deals, so he bought his dose of cactus, which contains mescaline, on the dark web. He takes it without ceremony, then talks to his therapist about how he's been feeling. When he starts to feel a vague effect of the drug in his thighs, John puts on his eye shades and waits for the first wave to hit.

This is underground psychedelic psychotherapy, using illegal substances and facilitated by therapists known only through cautious word of mouth. While most people are unaware it exists, it's been going on globally since the 1950s. That's when clinical trials into the possible uses of psychedelics began, before being curtailed by LSD being made illegal.

Now trials are underway again, in the US and UK in particular, including using MDMA (not strictly a psychedelic) for PTSD, LSD for anxiety, psilocybin for depression — and advocates believe it could transform mental health care. The most optimistic researchers hope that regulated psychedelic-assisted therapy will start rolling out slowly in 2021 with approval from bodies such as the FDA.

But not everyone wants to wait, or to be dictated to by government bodies and pharmaceutical companies.

What happens in an underground session?

John is in his 11th year of treatment, which has included holotropic breathwork and regular psychoanalysis.

"When I started I was on the brink of suicide," he says. "It stems from sexual, physical and emotional abuse when I was two to three years old." A hypnotherapist referred him to a therapist known for treating trauma. John had no idea that his new therapist facilitated psychedelic sessions. "He uses whatever works for the individual," John explains. "It might be talking therapy, meditation or relaxation techniques. Given I'd had recreational experience with psychedelics, it's something he put forward."

With the aid of psychedelics, John says he can access memories quicker than with regular therapy. A $150 session last anywhere between 30 minutes for DMT, to five hours for MDMA and 14 hours for mescaline. The hard work comes in the ensuing sessions, when he and the therapist integrate what he experienced during the trip. As John points out, it's far from fun. He's concerned that news stories about trials make out psychedelic psychotherapy to be a quick fix. On a TV show The Doctors, for instance, a woman who took part in a clinical trial of MDMA-assisted therapy claims her PTSD was "cured" in three sessions.


Dr Prashanth Puspanathan

Quality control could fall by the wayside

Dr Prash is a medical doctor and neuropsychiatry fellow at The Alfred Hospital, Melbourne. Four years ago he gave his first talk to the Alfred's psychiatry department about advances in psychedelic-assisted psychotherapy, and he's impatiently awaiting regulation. "I don't plan on being in conventional psychiatry for the rest of my life," he says. "The psychedelic sphere is where I see promise for the future." Dr Prash can understand the rise in underground practice. "The more that the Australian population reads stories about trials in other parts of the world, the more they'll get frustrated at the lack of access," he says. His concern is that anything forced underground becomes adulterated.

"We saw that with prohibition in the 1920s and the war on drugs in the current day," he says. "In the case of medical cannabis, regulation took ages, and by that point people thought, 'I'll just give my child cannabis.' But you're not necessarily going to choose the right compound for the right problem."

Legal consequences of underground sessions not clear

Facilitating underground sessions is risky for therapists, particularly if they're registered with the Australian Health Practitioner Regulation Agency (AHPRA).

Technically they're not breaking the law because they're not supplying the substance, but if something went wrong it's not clear what the legal consequence would be.

Ethically, it could be argued that they're not acting in the best interest of their profession just by being there.

"If you were called up to the medical board or the health practitioners board of AHPRA then you would be judged by your peers about what is considered to be a good standard of care," Dr Prash explains.

A spokeswoman for the Psychology Board of Australia, which operates through AHPRA, says: "If a practitioner is placing the public at risk, National Boards and AHPRA would want that concern raised with us."

"Psychologists must only provide psychological services within the boundaries of their professional competence."

"This includes working within the limits of their education, training, supervised experience and appropriate professional experience; basing their service on the established knowledge of the discipline and profession of psychology, and complying with the law of the jurisdiction in which they provide psychological services."


It's risky for patients too, who place a lot of trust in their therapist. In California, six women accused the founder of the Interchange Counseling Institute of sexual assault after taking hallucinogens.

Patients with a family disposition towards psychosis would likely be discounted from regulated psychedelic psychotherapy, but these precautions are not guaranteed with underground sessions.

Similarly, some medical conditions are prohibitive: in 2014, West Australian man Brodie Smith died in a Thai rehab centre when having his methamphetamine dependence treated with ibogaine.

Then there's the issue of — in psychedelic circles — seasoned "trip sitters" upgrading themselves to therapists and tackling a friend's trauma.

"That's one of the biggest problems," Dr Prash says.

"They might measure the dose by what they've read around clinical trials, but the purity of street MDMA could be 20 per cent. Other adulterants potentially include meth."

Dr Prash thinks that even if the TGA approves psychedelic psychotherapy in Australia, the earliest clients are likely to be from the severe end of the spectrum, such as end-of-life patients who might be treated by psilocybin.

"That's the first area that stigma recedes from," he explains.

"There's an 'ah, why not?' attitude from the public, which influences policy makers."


Dr Nigel Strauss

The efforts to get trials approved in Australia

Some medical professionals and researchers worry that unsanctioned practice will jeopardise regulation later on.

As psychiatrist Nigel Strauss points out: "If there's some terrible outcome where someone dies or develops psychosis, that's bad news for the rest of us trying to initiate scientific studies."

Dr Strauss has a long interest in PTSD, having worked with the survivors and families of the Port Arthur massacre and the Black Saturday bushfires.

"I'd always thought that the available treatments were not really adequate," he says, "so I had a look at the evidence that was coming out of MAPS and was impressed by the early results."

He now advocates for clinical trials to be held in Australia.

He and Dr Martin Williams of Psychedelic Research in Science and Medicine put in a submission to Deakin University in December 2015 for a PTSD study using MDMA.

It was blocked at the last moment by a professor who worried that the research would attract adverse media coverage.

"These drugs are stigmatised and there are frequent headlines about young people overdosing in clubs on ecstasy," Dr Strauss says.

"Universities are fragile places: they're financially dependent and under pressure."

"It's a generational thing as well — I think if the people making the decisions were 30 years younger, we might have more hope."



Evolving a new system

Dr Strauss thinks trials will begin in Australia in the next five years, but acknowledges the difficulty of trying to shoehorn the countercultural phenomenon of psychedelic use into the paradigm of science.

"It's up to scientists and psychiatrists who have an understanding of consciousness to find a way," he says.

"I'm interested in evolving a system where there could be more synergy between the two."


Dr. Ben Sessa

Ben Sessa is a Bristol-based medical doctor already carrying out MDMA trials to treat alcohol dependence.

In a past life he was a raver and a club DJ, so he's fairly sympathetic to underground psychotherapy.

"There's a massive amount of knowledge within it so it's not to be sniffed at," he says, "because anecdotally the experiences can direct researchers to new avenues. But it's not going to help getting new drugs licensed. That has to be done in the way that the regulatory authorities want you to do it, based on studies."

Dr Prash has a similar view.

"If it's underground then it doesn't have the kind of vigour that the mainstream scientific model requires, and then it's not going to get much purchase anywhere," he explains.

"It would be no more useful than the anecdotal evidence that we're all already aware of. It can't be peer reviewed and the validity of your results cannot be assessed."

In decades to come, perhaps we will see the MAPS vision of psychedelic centres that aren't restricted to people tackling mental health issues. But in the near future, progress will be slow.

John is concerned that certain drugs will be mandated for certain conditions, as if one size fits all. He also wonders how client-practitioner boundaries will be flexible enough.

This isn't an hour-long session where the therapist says, 'Time's up.'

"Sometimes afterwards I won't feel good so I'll hang about until I feel safe."


Dr Sessa acknowledges: "Quite a lot of people say to me, 'Why do you bother trying to license these drugs? There are plenty of good underground therapists' — and that's true."

"But there are 70,000 untreated cases of PTSD in the UK, and the majority of those people don't want to break the law."

"They're the population that I'm interested in increasing access for, so you have to beat the man at his own game."


http://www.abc.net.au/news/2018-08-30/underground-psychedelic-psychotherapy-mdma-lsd/10134044
 
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What is psychedelic therapy? Common trends, practices, and foundations in the field

by Sean Lawlor | Psychedelics Today | 11 Aug 2020


Now that millions of dollars are being invested in psychedelics and news platforms are reporting positively on them, it’s safe to say that psychedelic therapy has entered the mainstream. But mainstream news tends to highlight catchy elements while glossing over other details, often resulting in an unbalanced portrait of the whole. For psychedelic therapy, you’re way more likely to hear about the “psychedelic” than the “therapy.”

No surprise there. Reports on people healing complex PTSD by taking the “party drug ecstasy” while wearing eyeshades and listening to music in a cozy office are more gripping than reports on the months of talk therapy that follow (ecstacy is not always MDMA, it sometimes contains other dangerous compounds). So, perhaps this article on the therapy side will not be as gripping as an Anderson Cooper 60 Minutes special, but I hope it will prove informative for anyone who desires to learn more about how psychedelic therapy is currently being practiced, and the complex elements beyond the administration of a substance that go into achieving the astounding improvements in depression, addiction, and PTSD that have now been so broadly reported.

The importance of staying humble

I’ll kick this off by recognizing it is not possible to “capture” psychedelic therapy in any sentence or article or doctoral thesis. There are as many approaches and strategies as there are practitioners, and eliminating the potential for exploration and breakthrough through a prescriptive definition would be an insult to psychedelics themselves, which have exploded understandings of phenomena for centuries.

“There’s a lot of impression about what psychedelics are, how they should be treated, and what the optimal therapy is,” explains Dr. Matthew Johnson, Associate Director of the Center for Psychedelic & Consciousness Research at Johns Hopkins University. “We need to keep humble in terms of how much we don’t know, rather than fooling ourselves into thinking something is cemented in.”

While the future is ripe for exploration, there are several trends in approaching psychedelic therapy. So, this article is simply a glimpse into these trends, rather than a concrete definition of the whole.



Psychedelic-assisted psychotherapy

“Psychedelic therapy” is more accurately termed “psychedelic-assisted psychotherapy.” This distinction is critical, because the psychedelic is an adjunct to the therapeutic process, rather than a replacement for the process itself. So, when I refer to “psychedelic therapy,” I am simply abbreviating “psychedelic-assisted psychotherapy.” And there are far fewer psychedelics being used in therapy than there are psychedelics in general.

Psilocybin and MDMA are the two predominant substances currently being researched in psychedelic therapy, and each has been granted “Breakthrough Status” by the FDA in separate clinical trials, which basically means even the government recognizes how promising they are in therapy. Other substances used in psychedelic therapy are ketamine, a legal medicine throughout the U.S., and cannabis, which is still fully illegal in only eight states.

Interestingly enough, only one of these substances—psilocybin—is a classic psychedelic. The other three are all noted as having psychedelic properties, but ketamine is a dissociative anesthetic, MDMA is an entactogen, and no one can seem to agree on what cannabis is.

Other psychedelics, such as LSD, ibogaine, ayahuasca, and 5-MeO-DMT, are being researched, yet none appear close to becoming legal. However, research into LSD-assisted psychotherapy in the ‘50s and ‘60s, especially as spearheaded by Dr. Stanislav Grof, provided foundational elements for common frameworks implemented with other substances today. But LSD’s stigmatization remains heavy, and its unpredictable effects are particularly long-lasting, so it has not re-emerged to the forefront of psychedelic therapy. So, the “psychedelics” of psychedelic-assisted psychotherapy of interest in this article will be psilocybin, MDMA, ketamine, and cannabis.

A framework of preparation and integration

Psychedelic therapy is not as simple as administering a substance and Voila! Depression defeated! The psychedelic sessions—interchangeably referred to as “medicine” or “dosing” sessions—take place in a broader framework of preparation and integration therapy, neither of which involves the administration of a substance.

The ratios of preparation/integration sessions to medicine sessions vary widely and depend on many factors, such as dose size and financial limitations. The most widely-documented framework currently being practiced comes from MAPS, the organization behind the FDA-approved trials for MDMA-assisted psychotherapy for the treatment of PTSD. MAPS’ MDMA therapy involves three 90-minute preparatory sessions, a first MDMA session, three integration sessions, a second MDMA session, three more integration sessions, a third MDMA session, and three final integration sessions. In total, that’s three medicine sessions, and twelve preparation/integration sessions, a cycle that lasts about five months.

That’s five times as many non-medicine sessions as medicine sessions. MAPS’ significant results—i.e. one year after their Phase 2 trials, 68% of participants no longer qualified for PTSD—cannot be separated from this full process. Sara Reed, who worked on MAPS’ Phase 2 trials and is now the Director of Psychedelic Services at the Behavioral Wellness Clinic in Connecticut explains, “The integration sessions are just as important as the dosing sessions, if not even more important.”



Johns Hopkins University’s research in psilocybin therapy also involves far more preparation and integration therapy than psychedelic sessions. Among the many focuses of their Center for Psychedelic & Consciousness Research, Johns Hopkins is researching psilocybin therapy for smoking cessation.

Johnson is the study’s Principal Investigator. Results from the study’s pilot phase, published in 2014, found that after 6 months, 80% of participants had remained abstinent from smoking, compared to the 30-35% success rate of predominant treatment models. In the study’s second iteration, which is ongoing at the time of this writing, Dr. Johnson reports that at the one-year follow-up, 59% of the psilocybin group were biologically confirmed as abstinent, compared to 27% of the group who used a nicotine patch.

While the pilot study involved three medicine sessions, the current study involves only one. Everything else is preparation and integration.

“Right now, they have integration sessions for ten weeks after the psilocybin session,” Johnson explains. “These are hour-long, weekly check-ins. With preparation, we have about eight hours across four different sessions.”

Given that ketamine therapy is being widely practiced, and numerous other psychedelic therapy trials are underway, it would take many articles to detail all the protocols being used. The trend to note is that sober preparation and integration sessions are essential to psychedelic therapy, and even tend to involve far more time than the medicine sessions.

A relational approach to therapy

I’m tempted to write a section on what preparation and integration therapy looks like, but this would be impossible. These terms are vague; there is no set way to do them, no script to follow. Yet amidst common components such as intention setting, dose determination, and discussions of the particular psychedelic’s effects, the glue that connects these sessions across countless frameworks is the essentiality of establishing a strong and trusting therapeutic relationship.

“More important than the therapist’s psychological orientation is the rapport with the participant,” Johnson explains. “If you actually care for this human being you’re dealing with, and you’re making a sincere effort, and they get that—that overrides whatever descriptors you use.”

A client-centered, relationship-based approach to therapy arose in the mid-20th century in response to the dominant paradigms of psychoanalysis and behaviorism. Back then, therapists were viewed as the “expert” in the room, interpreting and diagnosing clients while remaining emotionally detached. Carl Rogers then theorized that interpretation and theoretical expertise were not essential, or even necessarily helpful; the central element to a client’s healing was the quality of the therapeutic relationship, cultivated in a climate of genuineness, accurate empathy, and unconditional positive regard. This client-centered approach laid the foundation for humanistic psychology.

Whether or not one aligns entirely with Rogers’ framework and disposition, it is widely accepted in psychedelic therapy that the therapeutic relationship is paramount.

“When you’re getting into psychedelic work, there can be a subconscious pull toward skipping aspects of relationship building,” explains Rafael Lancelotta, who practices cannabis and ketamine therapy at Innate Path in Denver, CO. “That can really negatively affect the process. If you’re going to vulnerable places with someone you don’t trust, your system’s defenses are going to come up and prevent you from moving through a healing process.”

Therapy is already vulnerable; that vulnerability amplifies exponentially when a substance is involved. Imbibing a psychedelic, a client sacrifices control, accepting the heightened uncertainty of where the session may lead. If they do not trust the therapist, the lack of trust will likely manifest in the medicine session and impede the work.



An important element to a relational approach is respecting and understanding the identities clients hold. Sara Reed is part of several committees devoted to increasing access to psychedelic medicines for underserved populations, and she brings specific attention to the complexities of clients’ social identities.

“I approach ketamine therapy through an intersectional lens,” Reed explains. “I take into account a person’s age, race, sexual orientation, gender, geography, socioeconomic status, education, and what they’ve been exposed to in the world. I’m sensitive to the way they language their experience and the way they experience the world. From that lens, we create treatment plans specific to their symptom presentation and symptom severity to give them a tailored psychedelic psychotherapy experience.”

Reed does not position herself as the expert; she positions herself humbly in relation to the client’s experience, listening to their unique background and needs in order to develop a course of action. This humility, and the trust-building that comes through it, is the essence of a relational approach.

Given that psychedelics often attract people with spiritual and esoteric worldviews, therapists must be prepared and willing to enter and understand a client’s way of seeing. Michelle Anne Hobart specializes in preparation and integration therapy—which, by the way, is a legal therapeutic modality, so long as illegal medicines are not administered. Hobart is a specialist in “spiritual emergence,” which she describes as “a space of people expanding beyond the separate sense of self into a larger understanding of interconnection between other beings and the planet.” This inner awakening can occur through psychedelic experiences and potentially be destabilizing, and Hobart’s speciality allows her to meet her clients in their expansive worldviews.

“It can be helpful to check the astrology transits in preparation for journeys,” Hobart explains, referencing the Archetypal Astrology work of Stan Grof and Richard Tarnas. “It’s making correlations between the type of medicine experience that someone might be having with the overlay of archetypal dynamics at that time. It can be really empowering to know that certain tones might show up in the medicine journey.”

If an astrologically-minded seeker comes to a material scientist whose preparation cannot extend beyond images of entropic brain states and explanations of oxytocin, the amygdala, and the hippocampus, it probably will not be a good fit. A relational approach hinges on meeting clients where they are, and many psychonauts do not view the world through a strictly scientific lens.

Therapists cannot simply assume trust due to the position they hold. They have to earn it, and that process takes time and patience. If that process is not honored, numerous problems can result, including the potential for re-traumatization in the medicine session due to an unsafe container—an issue that Hobart rightly describes as a “shadow” of psychedelic therapy. Like therapy itself, preparation and integration are most effective when relational, adaptable, and responsive to clients’ individual needs. With a trusting relationship established, an “inner-directed” process can unfold.



Inner-directed therapy

Psychedelic therapists often maintain that the medicine helps incite an “inner-directed” healing process, where a client’s “innate healing intelligence” or “inner healer” can emerge from its walled-off container and catalyze the necessary internal movement.

“As a therapist, your therapeutic stance is to trust the process and not get ahead of the medicine, to follow the participant in their journey,” Reed explains. “In essence, you’re just really present with the medicine, the material, the client, and yourself, navigating that liminal space where transformation can happen.”

Again, the client is the expert, and the therapist skillfully cultivates space for a process to organically unfold. Stan Grof created the term “holotropic” for this process, which translates to “moving toward wholeness.” The therapeutic approaches then used in integration can come out of the client’s authentic holotropic experience, allowing for the integration to meet emergent needs rather than place an established framework onto a process.

Psychedelic therapists create trusting, comfortable conditions that allow the client’s inner healer to guide the medicine sessions, and all ensuing sessions by extension. What that clients’ inner healer brings forth depends on other measurable factors as well, such as the size of dose administered.

Psychedelic vs. psycholytic therapy

When folks are talking about psychedelic therapy, they are sometimes in fact talking about psycholytic therapy. “Psychedelic” therapy involves high-dose medicine sessions, in which the client may lose contact with the therapist, if not the physical world. “Psycholytic” therapy involves low-dose medicine sessions, in which perceptual doors are opened, but not obliterated completely.

Jason Sienknecht trains ketamine therapists through the Psychedelic Research and Training Institute (PRATI), an organization he helped found. In his therapeutic practice at the Wholeness Center in Fort Collins, CO, he facilitates both psychedelic and psycholytic ketamine therapy.

“In the psychedelic session, we use high-dose ketamine to induce a fully-dissociated psychedelic state,” Sienknecht explains. “They go in very deeply, and the ketamine and music helps them move toward insights about their life and give them clarity and perspective about their struggles.”

This high-dose, non-dialogue approach is used by Johns Hopkins with psilocybin in the smoking cessation study. “We use a high dose of 30 milligrams per 70 kilograms of body weight,” Johnson says. “That generally equates to about 5 dried grams of psilocybe cubensis. So, it’s the classic Terence McKenna ‘heroic dose.’”

In psychedelic sessions, dialogue with the therapist is kept to a minimum—sometimes by necessity, when clients temporarily lose the ability to speak. In psycholytic sessions, on the other hand, clients enter a “low-dose trance state” and stay engaged with the therapist.

“With psycholytic therapy, you don’t dissociate so much that you lose your capacity to sustain dialogue with a therapist,” Sienknecht explains. “You stay in contact the entire time. Some clients I work with really like that, as opposed to me saying, ‘Goodbye, I’ll see you on the other side,’ as we do with psychedelic sessions.”



Each approach has its uses. Some clinicians believe psychedelic sessions are necessary for clients to transgress their self-imposed limitations and open to a more expansive kind of healing. Psychedelic sessions can also be helpful for crisis situations. For example, some clinicians use high doses of ketamine for suicidal clients, as an ego-dissolving experience may be necessary to help the client “break out” of their all-consuming mentality.

Psycholytic sessions allow for conscious processing of emerging material through direct, intentional work with what arises. Further, these low-dose sessions allow clients to work directly with relational wounds by remaining in contact with the therapist through the non-ordinary state. Again, the significance of this relational element cannot be understated, especially as relationship-building extends beyond the need for trust in the session.

“I find it difficult to think of any form of mental illness that isn’t highly relational,” explains Lancelotta. “I think this work is for healing those core relational wounds.”

In this understanding, the relationship with the therapist is the relationship through which deep relational wounds can be healed. These “core relational wounds” affect people far more than they often realize, playing into numerous mental conditions and existential struggles that cannot be healed in isolation.

Whether a client’s healing will come best through psychedelic or psycholytic therapy—or a hybridization of the two, as Lancelotta envisions—depends on numerous factors, to which therapists must remain sensitive and attuned. A “more-medicine-is-better” mentality can be highly problematic and potentially destabilizing for an already unstable client. Regardless, medicine sessions cannot exist in a vacuum. Without preparation and integration to support the psychedelic experience, psychedelic therapy is no different than peer support, and while this can still be hugely impactful, it will undoubtedly diminish the potential for lasting transformation.

Bringing it home

Psychedelic-assisted psychotherapy is an umbrella term that is far more complex than someone taking a drug in a calm and comfortable room. It is an extensive framework involving a significant amount of “regular” therapy that adapts to clients’ unique struggles and needs. As much as mainstream news may want to convince you otherwise, psychedelics are not the “magic pill” panacea that will quickly and easily make all your problems go away. Yet psychedelic experiences can bring profound insight and meaning, and a growing body of psychedelic therapists use tried and tested methods to enhance these substances’ transformative potential, so that a revelatory trip can truly change a person’s life.

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 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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Mystical experience critical for the therapeutic effects of psilocybin

by Alex Criddle, MA | Psychedelic Science Review | 14 Aug 2020

Two studies indicate that higher doses of psilocybin are necessary for sustained reductions in depression and anxiety.

Research indicates that a mystical experience is a mediator between the therapeutic effects of psilocybin and the patient. Two studies conducted in 2016 found that in end-of-life cancer patients, those who reported having a mystical experience were more likely to have decreased depression and anxiety in addition to an increased sense of well-being.

What is a mystical experience?

A mystical experience is an altered state of consciousness t
hat exhibits a few key features. These features can include a sense of internal or external unity, a transcendence of time and space, feelings of ineffability and paradoxicality, a sense of awe or sacredness, a noetic quality of direct knowledge of an ultimate or higher reality, and a deeply felt positive mood.1 The exact characterization of the experience varies from person to person, but these features are common among most mystical experiences.

Griffiths, et al., 2016

The first study was a randomized, double-blind, cross-over trial conducted by Roland Griffiths and colleagues. 51 patients were given low (placebo-like) doses of 1 or 3 mg/70kg or a high dose o
f 22 or 30 mg/70kg of psilocybin in conjunction with psychotherapy.2 The doses were in a counterbalanced sequence with 5 weeks between sessions with a 6-month follow-up afterward.

Prior to each session participants scored their depression, anxiety, and other negative emotions on clinical questionnaires. After each session, participants were given a series of questionnaires to assess the experience and outcomes. These included the 5-Dimension Altered States of Consciousness (5D-ASC), Hallucinogen Rating Scale (HRS), and the Mystical Experience Questionnaire (MEQ30).

What Griffiths et al. found was that high doses of psilocybin produced significant decreases in self- and clinician-rated scores of depression and anxiety. This was in addition to an increased rating of their quality of life, sense of meaning, and optimism, despite being end-of-life cancer patients immediately after the high-dose psilocybin sessions. This result was largely dependent on a high mystical experience score (rated on the MEQ30). These positive outcomes were sustained at the 6-month follow up, with 80% of participants showing clinically significant benefits.

Both clinicians and participants associated the benefits with the high-dose psilocybin sessions that contained a mystical experience rather than the low-dose, non-mystical experience sessions or the psychotherapy itself. This suggests that the mystical experience is key in mediating the positive outcomes.

This study’s limitations include pharmacological effects from the placebo dose (the authors suggest 0.01 mg/70 kg should be used instead), the nature of a crossover trial which inhibits the accuracy of interpretations of clinical benefits after the crossover has occurred, and the difficulty in using stringent exclusion criteria for these end-of-life cancer trials.

Ross et al., 2016

A second study, a double-blind, placebo-controlled, cross-over trial conducted by Stephen Ross and his colleagues, corroborated these findings.3 In this study, 29 patients were given either psilocybi
n or niacin (placebo) at a dose of 21 mg/70 kg in conjunction with psychotherapy. There were 7 weeks between sessions with a 6.5-month follow-up to assess continued outcomes.

The data indicated that psilocybin, but not niacin, produced immediate, clinically-significant reductions in depression and anxiety levels, even prior to the crossover. At the 6.5-month follow-up exam, patients who had had higher scores on the MEQ30 during their psilocybin session had higher sustained reductions in depression and anxiety levels long-term in addition to decreases in cancer-related demoralization and hopelessness. Patients experienced improved spiritual wellbeing, quality of life, and attitudes towards death. The researchers concluded that

"...the psilocybin-induced mystical experience mediated the therapeutic effect of psilocybin on anxiety and depression."

There are, however, a few limitations to this study. This trial included a small sample size (29 patients), the majority of whom were white women. This crossover style of trials limits the accuracy of the interpretation of clinical benefits after the crossover has occurred.

Summary

Both Griffiths and Ross’s studies suggest that psilocybin produces sustained reductions in depression and anxiety levels in end-of-life cancer patients over at least 6 months. It does appear from these studies that the strength of the mystical experience, provided by a dose of psilocybin around 21 to 30 mg/70kg, is attributed to the sustained reductions in depression and anxiety providing direct and/or indirect benefits to the therapeutic potential of psilocybin.

It is important to note that these studies used pure psilocybin, not psilocybin-containing mushrooms (aka magic mushrooms). The dose required for a mystical experience using magic mushrooms may be very different from using pure psilocybin. The features of the two mystical experiences may differ as well. These differences may be due to the entourage effect that occurs with the compounds in cannabis and is hypothesized to occur with the compounds in magic mushrooms.


 
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Teaming psilocybin with Mindfulness Meditation*

by Emma F. Stone, MA, PhD | Psychedelic Science Review | 6 Aug 2020

A double-blind study reveals that mindfulness meditation practice may amplify the positive effects of psilocybin while reducing the likelihood of a bad trip.

Set and setting are both acknowledged to shape one’s experience of psychedelic medicine profoundly. Set refers to an individual’s expectation of the experience, their personality, and current mood. Setting, on the other hand, speaks to the physical and social environment in which the experience takes place.

Armed with this knowledge, a team of researchers recently set out to explore the effects of a 5-day mindfulness meditation retreat combined with a psychedelic experience. The double-blinded placebo-controlled study, which was published in the October 2019 issue of Nature Scientific Reports, revealed some fascinating findings.

Meditation and
psilocybin: Parallel pathways to self-dissolution?

Throughout history, both meditation and psilocybin have offered gateways to self-transcendence, non-dual awareness, mystical awareness, and personal change. Both meditation and psychedelic experiences offer the potential for beneficial therapeutic outcomes, such as prosocial behavior and the alleviation of depression, stress, and anxiety. Despite the similarities that both meditation and psychedelics may induce in one’s sense of self, these two experiences have never been systematically investigated.

While psychedelic experiences that induce self-dissolution occur at relatively high rates (up to 60 percent), profound states of selflessness occur more infrequently during meditation and are usually confined to long-term meditators. However, the self-dissolution induced by psychedelic experience can also be accompanied by severe anxiety and a groundswell of emotion. Smigielski et al. hypothesized that a mindfulness meditation practice teamed with psychedelic experience could lead to greater changes than mindfulness meditation alone and reduce the likelihood of ‘a bad trip.’

Mindfulness meditation represents a specific type of meditation. Simply put, it is “nonjudgemental attention to present-moment experiences.” Smigielski et al. describe it as “a temporary state of intentional self-regulation of attention to foster greater awareness of one’s sensations, emotions, and thoughts with a non-judgmental attitude.”

The study

Thirty-nine expert Buddhist meditation practitioners were recruited for a five-day mindfulness meditation retreat. Two-thirds of the participants had never experienced psychedelics before, and one-third had experienced limited previous exposure. On the fourth day of the retreat, 19 participants received a placebo capsule, and 20 received a psilocybin capsule in a double-blind manner. The psilocybin dose within the capsule was calculated based on the individual’s weight and contained 315 micrograms of psilocybin per kilogram of body weight.

The researchers evaluated the spectrum and extent of change in consciousness, the loss of cognitive control and anxiety, and the level of mystical-type experience using a range of tools. These tools included the Freiburg Mindfulness Inventory, the Meditation Depth Questionnaire, the Toronto Mindfulness Scale, the 5-Dimensional Altered States of Consciousness rating scale (5D-ASC) which is designed to quantify both positive and negative forms of ego dissolution, and the M-scale which assesses external and internal aspects of mystical experience.

After four months had elapsed, participants completed the Life Changes Inventory, Revised (LCI-R) questionnaire, which evaluates changes in attitudes and behaviors. Each participant additionally designated a closely-related person to complete a third-person LCI-R questionnaire concerning the participant. Finally, the researchers asked the participants how personally meaningful the experience was, and whether they had perceived any enduring changes in their behavior or attitudes in themselves.

The findings

The outcome of the research offers some compelling findings. The combination of psilocybin and mindfulness meditation produced markedly more pronounced alterations of consciousness than mindfulness meditation alone. The alterations that were more profoundly experienced included a sense of unity, spiritual experience, blissfulness, insightfulness, disembodiment, complex imagery, audiovisual synesthesia, and changed meanings of precepts.

Those who received the psilocybin capsule also noted a deeper sense of self-dissolution than those who received the placebo. Nineteen out of the 20 participants who received psilocybin met the criteria for having had an intense mystical experience, compared with 3 out of 10 participants in the placebo group. While the depth of mindfulness meditation increased throughout the retreat, the participants who received psilocybin were able to deepen their mindfulness meditation practice significantly. Ultimately, the evidence suggests that incorporating mindfulness meditation into psychedelic experiences may positively shape the experience.

Critically, the study also demonstrated that mindfulness meditation teamed with psilocybin bolstered the non-judgmental acceptance of thoughts and emotions and emotional regulation. Participants experienced virtually no loss of cognitive control or anxiety, despite the relatively high dose of psilocybin used, and also reported a positive self-dissolution experience. These findings support the hypothesis that mindfulness meditation may buffer psilocybin-induced anxiety and vigilance deficits. In other words, the addition of mindfulness meditation appeared to reduce the likelihood of having a ‘bad trip.’

What were the lasting effects of the experience?

Four months after the retreat, researchers followed up with the participants to evaluate whether the experience had imprinted lasting behavioral or attitudinal changes. Those who had received the psilocybin scored significantly higher on a scale of appreciation for life, self-acceptance, quest for meaning, sense of purpose, and appreciation of death. The individuals who had received psilocybin also scored higher on scales for concern for others and spirituality but scored lower with respect to concern about worldly achievements.

The psilocybin group additionally ascribed significant personal meaning to the experience four months later. Thirty-seven percent considered it one of the five most meaningful experiences in their lives, while 47 percent considered it in their top ten. Other literature has indicated that enduring positive changes in attitude and behavior following one or two doses of psilocybin have been reported to persist for 14 months or longer. It’s also noteworthy that although the group had expressed high life satisfaction before the study, they still notably benefited from the experience.

The bottom line

Going forward, this study by Smigielski et al. suggests that mindfulness meditation could potentially be integrated into psychedelic experiences as a powerful tool for transformation. Mindfulness meditation has already been linked to a range of formative health and well-being markers.

The authors indicate that a combination of mindfulness meditation with psychedelic-assisted intervention could be used to improve well-being in both therapeutic and non-therapeutic settings. Most critically, the synergy of mindfulness meditation practice with psychedelic-assisted intervention may provide a more therapeutically beneficial experience than psychedelics alone.

*From the article here:

 
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Mechanisms of change in psychedelic-assisted psychotherapy

by David Sugarbaker, PsyD, MPH | Psychedelic Science Review | 28 Aug 2020

A new study sheds light on cognitive behavioral change mechanisms underlying psychedelic-assisted psychotherapy.

In a recent article in Frontiers in Psychiatry, Wolff and colleagues proposed a cognitive-behavioral model of how psychedelic-assisted psychotherapy (PAP) promotes acceptance. To understand the full scope of their work, one must start by understanding experiential avoidance and its import across a wide range of psychopathologies.

Experiential avoidance plays a central role in the onset and maintenance of various psychopathologies. It can be broadly conceptualized as an unwillingness to encounter inner distress—emotions, thoughts, memories and body sensations—coupled with attempts to control or evade the distress in whatever form despite long-term and negative symptomatic outcomes.

Recent work on psychedelic-assisted psychotherapy (PAP)—a novel treatment for mental illness that involves the therapeutic and supervised use of psychedelic substances in the course of psychotherapy—suggests that one of its key therapeutic mechanisms of action may be lessening experiential avoidance coupled with cultivation of an acceptance toward inner experience.

Acceptance, in contrast to experiential avoidance, is an adaptive attitude towards inner experience, however distressing that inner experience may be. It involves allowing emotions, thoughts, memories, and body sensations to occur and evolve without attempting to control or escape them. Many contemporary cognitive-behavioral psychotherapies, including mindfulness-based therapies, dialectical behavior therapy, and acceptance and commitment therapy, consider the patient’s acquisition of acceptance as pivotal in promoting lasting behavior change. Whether the acquisition of acceptance also underlies the efficacy of PAP has been a topic of research as of late.

What the research says: PAP, experiential avoidance and acceptance

In 2017, Watts and colleagues explored whether the promotion of acceptance and minimization of experiential avoidance underpins therapeutic changes in patients treated with PAP. At a 6 month follow-up they conducted a qualitative thematic analysis of semi-structured interviews. Watts and colleagues discovered that in addition to a movement from disconnection to connection, patients also transitioned from an avoiding attitude toward inner experience to an accepting one.

More specifically, the researchers found that in patients who were experiencing inner distress, an avoiding attitude coupled with attempts to evade and exert control over the distress did not bring relief. Rather, the patients reported that when adopting an attitude of acceptance toward the distressing inner experience, the experience changed qualitatively toward one of a more positive nature. This ended up yielding therapeutic insights and emotional breakthroughs. In short, the researchers found that a patient’s attitudes toward inner experience qualitatively changed the experience itself.

At the conclusion of Watts and colleagues’ work, the question remained, just how does PAP facilitate a change from experiential avoidance to acceptance? To answer this question, Wolff and colleagues recently conducted a thorough exploration of Watt and colleagues’ qualitative findings through the lens of the cognitive-behavioral theory in order to formulate a model of how PAP promotes acceptance.

PAP through the cognitive behavioral lens

Wolff and colleagues’ primary research question was as follows: How does PAP help patients adopt an accepting rather than avoiding stance toward inner distress? To answer this they explored the qualitative patient reports synthesized within a framework of cognitive-behavioral theory and the theory of belief relaxation. Wolff and colleagues proposed that PAP may facilitate the change from avoidance to acceptance through three primary mechanisms which operate synergistically: 1) Operant conditioning of acceptance; 2) Elicitation and excitation of private events, and 3) Relaxation of avoidance related beliefs.

Operant conditioning of acceptance

As a typical feature of numerous psychopathologies, avoidance is perpetuated by negative reinforcement. For example, avoidance of a distressing internal image may be perpetuated because the distress associated with the image is removed when avoidance strategies are employed. According to Wolff and colleagues, however, PAP has the unique quality of promoting acceptance rather than avoidance of distressing private inner experiences, which then become conditioned through the very same mechanism of negative reinforcement.

For example, in PAP, patients often report a curious phenomenon of being drawn to encounter rather than avoid a distressing inner experience, be it a thought, emotion, an image, or bodily sensation. Being drawn to the encounter changes the quality of the private event to a more positive valence, e.g. a patient moves towards rather than away from a distressing inner image. The change in quality then elicits a positive emotional response, and acceptance rather than avoidance becomes negatively reinforced.

Elicitation and excitation of private events

In addition to operant conditioning of acceptance, Wolff and colleagues also proposed that elicitation and excitation of private events facilitate change. The mechanism does this by calling forth the very inner experiences that a person typically avoids in daily life during the PAP therapy session. These typically warded-off inner experiences then become amenable to alteration not only through operant conditioning of acceptance as mentioned above but also through relaxation of avoidance related beliefs.

Relaxation of avoidance-related beliefs

Facilitated by elicitation and excitation of private events in the context of a PAP session, Wolff and colleagues hypothesized that acceptance becomes conditioned through negative reinforcement. Concurrently, beliefs about avoidance become amenable to change. This ability to change is due to negative expectancies are proven false by new experiences with the context of encountering distressing inner experiences during PAP.

Previously, Carhart-Harris and Friston put forth belief relaxation as central to the efficacy of PAP. There exist stable and often unconscious beliefs which are hidden from awareness during normal states of consciousness, yet made accessible through the psychedelic experience. According to Wolff and colleagues, PAP may not only lead to this sort of relaxation of avoidance related beliefs but could, under the right conditions, even promote acceptance beliefs.

Conclusion

The cognitive-behavioral framework may help researchers further understand the mechanisms of change underlying PAP. Using the cognitive-behavioral model, Wolff and colleagues formulated a model that sheds light on potential mechanisms of change involved in PAP, including the synergistic interaction between operant conditioning of acceptance, elicitation, and excitation of private events and relaxation of avoidance related beliefs.

This proposed model appears to provide a starting point for further research on cognitive-behavioral change mechanisms. The model also calls to the fore a need for the development of specific measurement instruments and techniques to facilitate further understanding of these change mechanisms. Illumination of change mechanism underlying PAP will likely produce greater acceptance of PAP among mainstream researchers and clinicians, especially when underscored by empirical support.

 
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The meaning-enhancing properties of psychedelics and their role in psychedelic therapy*

by Ido Hartogsohn | Harvard University | 6 Mar 2018

Past research has demonstrated to the ability of psychedelics to enhance suggestibility, and pointed to their ability to amplify perception of meaning. This paper examines the existing evidence for the meaning-enhancing properties of psychedelics, and argues that the tendency of these agents to enhance the perception of significance offers valuable clues to explaining their reported ability to stimulate a variety of therapeutic processes, enhance creativity, and instigate mystical-type experiences. Building upon previous research, which suggested the potential role of psychedelic meaning-enhancement in enhancing placebo response, the paper explores the mechanisms by which the meaning-amplifying properties of psychedelics might also play a role in enhancing creativity, as well as in effecting mystical-type experiences. The wider social and public-health implications of this hypothesis are discussed, and suggestions are made as to the various ways in which scientific understanding of the meaning-enhancing properties of psychedelics might be advanced and utilized.

How do psychedelics induce their dramatic and variegated effects which include, among other phenomena, psychotherapeutic insights, creative breakthroughs, and mystical-type experiences? The recent literature on psychedelics showcases a growing preoccupation with the underlying mechanisms responsible for the panoply of extraordinary effects instigated by these agents. Some recent papers have sought to offer a grand unifying theory of psychedelic action by pointing to neuropharmacological mechanisms that underlie psychedelic action. Others have focused their attention on the role of psychological mediating factors in determining reactions to psychedelics. The most commonly mentioned of these mediators of psychedelic response are unquestionably spiritually meaningful experiences and experiences of ego dissolution, whose occurrence is often correlated with the success of therapy, but researchers have also suggested a numbers of other mediators including relational embeddness, embodiment, “the difficult struggle,” affect and catharsis, visions, and recovered sense of appropriate priorities. In this paper I wish to argue for the importance of another often overlooked mediator of psychedelic action, which is fundamental to understanding the effects of psychedelics in therapy, creativity, and spirituality. I am referring to the remarkable tendency of these agents to enhance the perception of meaning, or, in other words, to cause things to appear dramatically more meaningful than they would otherwise seem to be.

Extraordinarily, though the ability of psychedelics to enhance perception of meaning is supported by the literature, it has so far not been the focus of any deliberate and sustained line of inquiry. Nevertheless, hints and traces of this idea and its significant implications permeate both popular and clinical psychedelic literature. In Huxley's Doors of Perception, the classic text that brought psychedelics to popular attention in the West, the author noted that under the effects of the drugs objects were “all but quivering under the pressure of significance by which they were charged,” and made enlightening observations about psychedelic aesthetics and its crucial relation to radical alterations in the perception of meaning. Clinical research has also provided data to support the claim that psychedelics enhance the perception of meaning. Remarkably, one of the most striking qualities of psychedelics, which was noted on by both 1960s as well as by contemporary psychedelic researchers, is their ability to induce experiences which people regard as extremely meaningful. Between two thirds to 86% of those who have psychedelic experiences in a supportive therapeutic setting consider them to be either one of the five most meaningful and spiritually significant experiences of their lives, or the single most meaningful experience. Proving the clinical efficacy of psychedelics has posed considerable challenges for psychedelic researchers for decades, yet the ability of these agents to reliably elicit subjectively-perceived highly meaningful experiences is beyond doubt.

While this in itself constitutes no proof, it is telling that the very word “psychedelic” seems to quite straightforwardly convey the idea that psychedelics enhance the perception of meaning. The widely accepted designation of these substances as “mind-manifesting” or “mind-revealing” speaks to their ability to enhance and accentuate whatever objects exist in the mind. Psychedelics have commonly been described as magnifiers, amplifiers, and augmenters of consciousness. What these overlapping, perhaps even coterminous, terms seem to share is the recognition that psychedelics intensify mental phenomena and cause them and their significance to appear bigger, vaster, and more dramatic than otherwise.

Additional evidence of the widespread recognition that a key aspect of psychedelic efficacy relates to the agents' ability to enhance the perception of meaning can be found in the growing discourse contrasting the dissimilar modes in which psychedelics and SSRI-anti depressants treat depression. Several recent papers present SSRI medication as agents that diminish the intensity of experience, thereby allowing individuals who are otherwise overwhelmed by feelings to adequately cope and function. In these and similar accounts, SSRI's are regarded as commensurate with a less dramatic, more flattened experience of the world. Psychedelics, by contrast, are regularly described in these and other accounts as doing the exact opposite: as drugs which amplify consciousness, and augment the intensity of perception, emotional reactions, and neurological indicators such as amygdala response. Without engaging the validity of such ideas, this discourse, which brings psychedelics in conjunction with another, allegedly diametrically opposed family of psychoactives, provides further evidence of the widely held view that psychedelics enhance perception of meaning. SSRI therapy, it argues, functions by diminishing emotional volume, thereby making experiences more bearable, while psychedelic therapy functions by amplifying emotional volume and demanding that patients “face the demon.”

Examining psychedelics through the prism of their ability to enhance perception of meaning provides valuable insights into their remarkable effects by allowing a keener appreciation of the different ways in which amplification of experience shapes key aspects and characteristics of psychedelic action. More specifically, the meaning-enhancing effects of psychedelics seems to play a key role in the fields of therapy, spirituality, and creativity enhancement.

Coming first to the issue of therapy. In a recent paper I have argued that a substantial part of the therapeutic effects of psychedelics might be explained by bringing psychedelic theory into contact with the growing field of placebo research. This relation becomes evident when one considers the fact that placebo researchers have proposed the concept of “meaning response” as a more accurate term to replace the arguably problematic term “placebo." The concept of “meaning response” advances the idea that subjective experiences of knowledge, symbol, and meaning can have pronounced biological, and medically therapeutic effects of the type commonly described as “placebo." The amplification of meaning by psychedelics therefore automatically entails amplification of placebo, and can offer help in explaining psychedelics' extraordinarily versatile uses and applicability in a wide variety of medical conditions. Understanding psychedelics as enhancers of meaning-response also explains why the concept of Set and Setting—a doctrine for the beneficial management of meaning response—has emerged within psychedelic research. The psychological context (set) and sociocultural context (setting) of a psychedelic experience are considered crucial because their meaning is significantly multiplied by the effects of the drugs, rendering each and any factor of extreme importance. The relevance of set and setting, and the validity of the psychedelics-as-placebo-enhancers approach can be clinically tested by controlling for variables such as expectation, intention, and doctor-patient relationship.

Mystical-type experiences are also enhanced by the meaning-enhancing properties of psychedelics. Evidence of the ability of psychedelics to induce spiritually significant experiences were provided in Pahnke's 1962 Good Friday Experiment, whose results were later corroborated by recent studies into the mysticomimetic qualities of psychedelics. Crucially, one of the four principal features of such mystical-type experiences, as defined by James, is their noetic quality, i.e., the experience of gaining access to a profounder, more significant plane of existence imbued with paramount authority and significance which transcend ordinary reality. It is highly conceivable that such noetic qualities would be strengthened by meaning-enhancement. Similarly, conversion experiences are often triggered by a sense of encounter with a formidable, awesome, “greater-than-human” presence that radiates immense significance and meaning—an encounter with an hyperreal dimension of overblown metaphysical proportions, which some religious scholars classically referred to as the numinous or mysterium tremendum. This experience of confronting an overwhelming, ineffable, and even unfathomable quality of the world is arguably facilitated by the tendency of psychedelics to imbue the mind and the external world with vibrant significance, as noted by Huxley. By causing mental and external phenomena to appear immensely more significant, psychedelics facilitate magical thinking and a re-enchanted experience of the world. Crucially, the perception of the significance of psychedelically induced mystical-type experiences is magnified as well. In other words, mystical-type experiences and insights obtained on psychedelics subjectively appear more significant than comparable non-psychedelically induced experiences and insights by virtue of the meaning-enhancing action of these drugs.

Meaning-enhancement arguably plays an additional role in psychedelically induced enhancement of creativity and problem-solving capabilities. While research on psychedelic enhancement of creativity is scant, largely dated, and often inconclusive some evidence does point to the creativity enhancing properties of psychedelics. Beyond popular lore which credits psychedelics for the performance of great creative feats, several clinical studies have indicated creativity improvements following psychedelic use, while others have called for the renewal of research into the creative benefits of psychedelic use. Here as well, meaning enhancement might play a key role. By magnifying the perceived significance of creative challenges and insights psychedelics provide users with the impetus to pursue new, less obvious lines of ideation that they might otherwise have ignored; and with enhanced motivation to explore new creative directions to their fullest ramifications. Some investigators have noted the potential role of meaning finding in enhancing creativity, while others have pointed to the importance of other mediators that could arguably be correlated with enhanced perception of meaning such as reduced inhibition or heightened empathy. By imbuing possible solutions with a magnified sense of meaning and plausibility, psychedelics might assist in reducing inhibitions, self-criticism, and kindle greater concentration and enthusiasm for creative exploration. Crucially, here as well, psychedelics might also enhance the perceived significance of such creative breakthroughs. As with spiritual experiences, this is not to say that creative-breakthroughs with psychedelics are invalid, but that one should be aware of the tendency to overstate the importance of such breakthroughs, particularly during, or shortly after psychedelic experience.

Finally, it should be noted that the meaning-intensifying properties of psychedelics also play a key role in precipitating what has been described as their psychotomimetic or psychosis inducing properties. The increased intensity that psychedelics bring to experience, and the increased significance with which they imbue mental objects can manifest itself equally in spiritual epiphanies as well as in paranoid thought patterns, intensified anxieties, amplified fantasies, and other pathological thought patterns.

Discussion

How does the recognition of the meaning-enhancing role of psychedelics alter our perception of these agents and their utility? One implication is to allow us a clearer understanding of their mode of action, of the potential outcomes of psychedelic experiences, as well as of the ways in which deliberate use of such meaning-enhancing qualities might assist therapy, enhance religious life, and facilitate creative activity.

From a wider theoretical perspective, psychedelics' function as enhancers of meaning can be seen in the broader cultural context of late modernity's struggle to make sense and meaning of life in increasingly atomized, individualized, and stress-ridden societies; a difficulty compounded by the disappearing role of religion and the implosion of linear narratives of progress. Philosophers and sociologists have long warned that life in industrialized, technological societies is undergoing a process of impoverishment of meaning. Such tendencies might be brought in conjunction with growing empirical data on the rising prevalence of depression, suicidality, and other psychopathologies in modern societies. Several studies have demonstrated correlations between feelings of meaning in life and increased psychological well-being, increased longevity, as well as reduced risk of suicidality and depression. Perhaps, says Michael Steger, who studies the psychology of meaning, “meaning is a matter of life and death.” Could psychedelics help fight rising rates of psychopathologies by bolstering individual and social sense of meaning and purpose? We are unquestionably still far from answering such questions, but evidence does point to potentially significant implications which the psychedelic meaning-enhancement model might have for fortifying society's resistance to mental pathology.

Finally, considering the utility of psychedelics for the enhancement of sense meaning, certain metaphysical questions might enter the discussion. Namely, is it ethically acceptable to artificially bolster the meaning of experiences and relationships? Some might argue that the ability of psychedelics to amplify meaning beyond its normal dimensions turns them into nothing else than mental illusogens that create only illusions of profoundness. When drugs cause their users to find more meaning in their experiences and relationships than ordinary circumstances allow, might this represent an insidious form of self-deception?

The argument seems compelling at first, yet it is arguably flawed. It relies on the assumption that there exists one “correct” mental framework from which to approach the world and that any psychochemically induced digression from that norm is inherently wrong. In practice, human ability to meaningfully relate and to authentically appreciate experiences is contingent on myriad factors of everyday life, and arguably strongly disrupted by the circumstances of life within atomized, competitive, high-stress, bureaucratized societies. The psychedelic perspective could thus be viewed along a two-poled spectrum which runs the gamut from utter depletion of meaning to overwhelming abundance of meaning.

The question, then, is whether there is anything inherently wrong in using a chemical to find more meaning in one's life or in a close human relationship even when such artificially-stimulated insights of newly found intimacy and authenticity continue to prove themselves meaningful and helpful in the long run, as demonstrated by studies? This is an intriguing and arguably normative issue which should not be left for medicine to decide, and it is rendered moot in cases where pathology and deep suffering is involved, as can be seen by the ample use of psychotropic medicine in contemporary psychiatry.

Conclusion

The meaning-enhancement property of psychedelics is a hypothesis supported by classic accounts of the psychedelic experience as well as by clinical research, but it has not yet received the attention it deserves. This path of investigation can be opened up by employing various psychometric tools to help assess the degree to which psychedelics enhance meaning and potential correlations with therapeutic, spiritual, or creative benefits. Recent, initial and still unpublished results have found significant increase in meaning in life following administration of psilocybin, as measured by the Meaning in Life Questionnaire. Future research might develop and employ similar questionnaires to study the degree to which psychedelics might amplify the perceived meaning of objects, activities, emotions, thoughts, and beliefs. Demonstrating the meaning-enhancing effect of psychedelics can advance our understanding of psychedelic effects and offer new paths for investigation and use in the fields of therapy, religion, and creativity.

*From the article here:

 
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Aquilino Cancer Center in Rockville, Maryland


Could group therapy make psychedelic drug treatments more accessible?

by Abbie Rosner | Forbes | 16 Sep 2020

Psychedelic drug therapy can be life-changing – but the expense of having two therapists attending to a single patient over a many-hours-long therapy session is one factor that could prevent widespread adoption of this powerful modality. Now, a newly launched clinical trial is investigating the feasibility of using group therapy with psilocybin for treating depression in cancer patients.

The study is taking place at Aquilino Cancer Center in Rockville, Maryland, in partnership with mental health company, Compass Pathways. In 2018, Compass received FDA breakthrough therapy designation for psilocybin therapy for treatment-resistant depression, and is currently conducting clinical studies in 20 sites in Europe and North America, according to the company’s website.

Dr. Manish Agrawal, an oncologist at Aquilino Cancer Center and the lead investigator for the study, explains that the novelty of the current study is that it combines simultaneous administration of psilocybin with one-on-one support.

Thirty patients with a cancer diagnosis will be recruited to the study and assigned to cohorts of four patients each. All participants will receive a combination of individual and group therapies with their cohort during all three stages of the treatment protocol: preparation, drug administration and integration.

During the drug administration stage, each of the four patients will receive the drug simultaneously. They will then undergo the therapy session in separate rooms, each monitored one-on-one by a single therapist, while the study’s lead therapist will oversee all four from an observation room created for this purpose.

The study coincides with, and was made possible by, the opening of a new, purpose-built Healing Center specifically designed to support this type of group therapy. Dr. Agrawal describes the new 2700 square foot facility, designed by Gensler, and the message it relays to patients:

“ …it's really, as far as I know, the first purpose-built space for psilocybin-assisted therapy…There’s an area at the entrance where people can do group meditation or yoga and then there's a middle area that looks like a living room where you would do group therapy and then in the back there's four rooms for psilocybin therapy, and an observation area for the lead therapist…

Aquilino is a beautiful building and there's an amazing lobby and chemotherapy suites. We have radiation and a place for PET scans. But we also wanted to send a message that this is a dedicated space for patients to deal with their emotional suffering, and not just sort of an afterthought...”


Dr. Agrawal emphasizes that, in addition to the savings in therapist hours, group therapy offers important benefits to patients as well. As he explains, patients with cancer who receive treatments together frequently develop a sense of community and mutual support that can enhance their recovery and overall well-being.

“… patients with cancer and their family members suffer tremendously with emotional issues around meaning and distress that we don't adequately address. This space for psilocybin and psychedelic therapy is to see if these therapies can provide that.”

Ultimately, Dr. Agrawal takes a pragmatic approach to this research:

“Our goal is to do a rigorous study that helps move the ball forward… that matters to regulators and will contribute to the field…”

If a protocol for group therapy is indeed approved by regulators, it could exponentially expand access to this powerful treatment.
 
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Why psychedelic therapy is (so) effective at combating addiction

by San Woolfe | 24 Sep 2020

Addiction is a growing worldwide problem – and this applies to all kinds of addictions: behavioural (e.g. sex, gambling, and internet use), illegal drugs (e.g. heroin and cocaine), and legal substances (e.g. alcohol and prescription drugs). Traditional treatment for these addictions includes full-time rehab and further plans like staying at sober houses that focus on staying sober. However, even though these committed and long-term recovery plans help many people, others still find themselves relapsing. And given the scale of the addiction problem at hand, we need to find alternative solutions. One such solution that is receiving increased interest from people with addiction, therapists, and addiction specialists is psychedelic therapy.

This form of therapy involves an individual with a particular condition taking a high dose of a psychedelic while being supervised by one or more therapists. As part of the current ‘psychedelic renaissance’ we are living in, this period of increased scientific interest in psychedelics, researchers are discovering that psychedelic therapy is effective in the treatment of many different disorders, including addiction. Psychedelic therapy appears to help combat addiction for several important reasons.

Overcoming trauma in psychedelic therapy

According to addiction specialist Gabor Maté, past trauma is the common root of many addictions. Whatever the addictive substance or behaviour may be, it helps in alleviating the emotional pain associated with the trauma, and so it is understandable that what might begin as occasional use would later turn into a hard-to-escape addiction. The addiction becomes an easy and reliable coping mechanism, but of course, it is maladaptive in the long run.

While many forms of therapy can help individuals confront the trauma that has led to their addiction, many patients find this process to be slow, drawn-out, expensive, or simply ineffective. Because there are many psychological barriers that prevent individuals from revisiting their trauma and working with it, it may take a long time before noticeable (if any) progress is made in overcoming that trauma.

In a psychedelic therapy session, on the other hand, these barriers and defences are more easily broken down, so an individual is often forced to confront his or her trauma, which can be frightening, but it ultimately turns out to be a positive, healing experience. Due to the emotionally turbulent nature of such an experience, it is ideal for the psychedelic experience to be coupled with psychological support from a therapist, as this allows the individual to know they can safely explore his or her trauma and receive emotional support or guidance if needed.

The mystical experience

Researchers have generally found that it is the mystical experience that reliably predicts an individual’s effective recovery from his or her condition. One study, for example, underscored this was the case for tobacco addiction. Patients who scored higher on measures of the mystical experience (such as a sense of unity, transcendence of time and space, ineffability, and sacredness) were more likely to quit smoking.

It seems that the mystical experience leads to significant improvements in personal meaning and well-being following the experience and this can be why addiction is less likely to be continued; after all, for many people, it is underlying discontent and lack of meaning that fuelled addiction in the first place. If a psychedelic-induced mystical experience can ignite positive feelings in you, for the long-term, then you won’t need drugs or alcohol to provide such feelings (which are never equal or sustainable replacements for inner-driven joy and contentment).

The role of the therapist in psychedelic therapy

Many people struggling with addiction can successfully kick their habit and avoid relapse by taking psychedelics on their own or during a retreat (in which a guide is present, but not a professionally trained therapist). Nonetheless, the purpose of the therapist in psychedelic-assisted therapy is to help prepare the patient for the experience and help them to integrate it. A guide or facilitator will also aim to do this during a psychedelic retreat, say, with ayahuasca or mushrooms, but having the knowledge and experience of a trained professional may prove more effective. The therapist can be better equipped to deal with a patient’s problems before they dive into the experience and after, which is when the patient can openly discuss the quality of the experience and the psychological material it brought up.

While studies on psychedelic therapy don’t tend to involve too many sessions with a therapist after the psychedelic experience, it is believed that continued sessions with a therapist can help an individual properly integrate their experience. This will help to create greater and longer-lasting effects on personal meaning and well-being, which is a crucial aspect of addiction recovery.

 

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Psychedelic-assisted therapy in the post-pandemic era

by Heather Mayfield, MS | Psychedelic Science Review | 28 Sep 2020

In the wake of Covid-19, psychedelic-assisted therapy is gaining attention.

Mental health issues have been on the rise globally for many years. There is no universally accepted strategy to combat the increasing depression, anxiety, and psychological trauma; in many cases stigma, shame, fear, and access remain the major hurdles faced by many. Treatment options remain few – with varying success – and broad-scale investments in novel treatments are lacking.

The consequences of keeping the status quo

Under this current climate of inadequate treatments, an era of unprecedented mental health crisis will unfold globally as the current Covid-19 pandemic sweeps across countries. Sharp increases in depression and anxiety have already been documented, and as the pandemic progresses and moves into recovery, the mental health toll will continue to increase in severity and size. This pandemic may present itself as a turning point in the current mental health strategies and treatment options. According to the World Health Organization, more investment needs to be placed into expanding access to current treatment options and strategies while also investing in novel and alternative treatment options.

Psychedelics and psychedelic-assisted psychotherapy research not only offer a new path for treating and managing treatment-resistant depression, anxiety, and complex PTSD, but may also provide treatment options for the long-lasting mental toll stemming directly from social isolation, grief, and fear.

The current mental health treatment situation

As of 2017, over 792 million people suffered from at least one mental health disorder, including substance/alcohol abuse. Disparity in the available treatment access across the globe presents the first problem to overcome. Expanding access globally provides a vital helpline in areas where it may be needed most; but as access increases, the efficacy of treatments comes under the lens of scrutiny.

Medications to treat both depression and anxiety are prescribed at alarming rates, often as long term treatments with little significant improvement in patient health overall. With high rates of non-responders to classical treatments and little treatment efficacy in the long term, researchers have recently begun to question the current models of strategy and treatment. Not only do these statistics paint a bleak picture of what the outlook for mental health was prior to the current pandemic, but they also provide insight as to why new treatment strategies and management is vital.

As the current Covid-19 pandemic unfolds, all signs point to an upcoming crisis in mental health globally. This crisis will have long-lasting effects compounded not only by the direct effects on mental health by the pandemic but also by the indirect creeping effects of economic downturn and despair. The road to recovery presents a choice to either continue with the status-quo or embark on a new path which may revolutionize mental health treatment strategies.




Studies are showing the effectiveness of psychedelics

Psychedelics and psychedelic-assisted therapy have recently re-entered the realm of research in novel treatment options for a variety of mental health issues. Since a pivotal clinical study in 2016 – which saw dramatic effects of a psychedelic in reducing the symptoms of PTSD – the research world and the FDA (US Food and Drug Administration) have begun rethinking psychedelics as a legitimate form of treatment.

From depression to PTSD, alcoholism, and end of life anxiety, pilot and small scale clinical trials have investigated the effectiveness of psychedelic substances in treating and managing the symptoms of these disorders. The safety and tolerability of these substances have been established in these studies, and promising results in the effectiveness in treating and lowering rates of remission have been reported.

Psychedelics and psychedelic-assisted therapy present the opportunity to provide relief to individuals who respond poorly to classical treatments and may be able to replace long-term pharmaceutical interventions that have not shown significant symptom relief for patients. As of 2020, over eighty new clinical trials investigating the efficacy of multiple psychedelics and psychedelic-assisted therapies on treating various mental health disorders are now recruiting patients, showing a continued and sustained interest in the field.

Avoiding a bigger crisis

This current pandemic can serve as the impetus of change. If the status quo in mental health strategies is maintained, the world will face an unprecedented crisis with long-lasting repercussions, according to experts. By proactively integrating new and novel psychedelic-assisted therapies and treatments, the challenges faced in the future may be mitigated.

 

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Harnessing the synergy between Acceptance & Commitment Therapy, and Psilocybin-Assisted Psychotherapy*

by David Sugarbaker, PsyD, MPH | Psychedelic Science Review | 10 Oct 2020

Psilocybin-Assisted Psychotherapy (PcbAP) has attracted attention from researchers and clinicians as a potential breakthrough treatment for depression. In light of its clinical promise, efforts are underway at leading academic institutions to employ existing evidence-based therapies, such as Acceptance and Commitment Therapy (ACT), as theoretical and methodological frameworks for understanding PcbAP, and perhaps augmenting its clinical application through the creation of manualized treatment protocols.

Researchers at Yale University recently published the first edition of The Yale Manual for Psilocybin-Assisted Therapy of Depression (The Yale Manual). The manual was created for use in controlled clinical trials of PcbAP and provides a method for integrating the principles of ACT into PcbAP. Manualized treatment protocols are crucial for establishing the evidence-base for nascent therapeutic modalities because they permit the treatment to be studied via controlled clinical trials. The Yale Manual may help establish the evidence base needed for the widespread adoption of PcbAP as a treatment for depression.

As noted in The Yale Manual, ACT and PcbAP appear to have a natural synergy resulting from overlap in theoretical foundation and therapeutic technique. This two-part series will explore the theoretical and technical synergy between ACT and PcbAP as described in The Yale Manual, beginning with an investigation of their theoretical intersection.

The theoretical underpinnings of Acceptance and Commitment Therapy

ACT was developed as a trans-diagnostic psychotherapy for psychological distress.3 Central to the therapeutic efficacy of ACT is its theoretical tenet that psychological distress is rooted in the innate tendency of human beings to enact experiential avoidance as opposed to acceptance.

Experiential avoidance
is defined as an unwillingness to encounter inner distress—emotions, thoughts, memories, and body sensations—coupled with attempts to control or evade distress in whatever form despite long-term negative symptomatic outcomes. In contrast, acceptance is an adaptive attitude towards inner experience; emotions, thoughts, memories, and body sensations are allowed to occur and evolve without attempting to control or escape them.

Theoretically, ACT owes a portion of its therapeutic efficacy to decreasing avoidance and increasing acceptance, thereby promoting psychological flexibility, its stated principal aim. To accomplish this end, ACT has several key targets of treatment which are captured in the acronym FEAR:

  1. Diminishing cognitive Fusion or over-identification with cognitions, narratives, and beliefs;
  2. Curbing the tendency to Evaluate or judge inner experience as wanted or unwanted;
  3. Decreasing Avoidance of inner experience; and
  4. Lessening habitual Reason-giving, or rationalizing experiential avoidance, after the fact.
In targeting FEAR, ACT has its theoretical foundation in six core therapeutic processes:
  1. Increasing the client’s experiential contact with the present moment;
  2. Promoting his or her stance of acceptance toward inner experience;
  3. Enhancing defusion, or the process whereby a client can de-identify with thoughts;
  4. Nurturing the experience of self-as-context, or a client’s capacity to occupy an observing or transcendent state of mind;
  5. Helping a client to clarify values to provide guidance for his or her behavior; and
  6. Bolstering committed action, or a client’s ability to behave in accordance with identified values.
These theoretical underpinnings of ACT are represented in the Hexaflex (Figure 1) and synergistically align with certain aspects of the theoretical foundation of PcbAP.


Figure 1: Hexaflex diagram illustrating the theoretical underpinnings of Acceptance and
Commitment Therapy (ACT).


The theoretical basis of psychedelic-assisted psychotherapy: Where does ACT fit?

When considering the theoretical basis of PcbAP from the psychological perspective, PcbAP clinicians and researchers consider the phenomenological aspects of the psychedelic experience which are therapeutic mechanisms of action, i.e. the efficacy of the experience. Certain core processes of ACT appear to enhance the experiential efficacy of PcbAP.

As the psychedelic experience unfolds in a PcbAP session, a characteristic occurrence is that the PcbAP participant comes into direct contact with present inner experience, which may be quite distressing. The therapeutic efficacy of the psychedelic experience depends in large part on the patient’s willingness to adopt a stance of openness to the experience, and tolerate it, as it evolves.

As noted in The Yale Manual, PcbAP participants are guided to surrender to their experience during PcbAP sessions, as this attitude of openness and acceptance appears to yield positive outcomes in treatment. This, of course, harkens backs the ACT notion of promoting acceptance, one of its central theoretical tenets. The Yale Manual notes several other synergistic alignments between ACT and PcbAP.

The unfolding psychedelic experience in PcbAP has been shown to have profound effects on self-perception. PcbAP participants often report experiences of unity, connectedness, transcendence, and even ego dissolution. In the case of depression, experiential contact with a transcendent self often dislodges the patient from fusion with depressogenic cognitions and ruminative narratives. The theoretical synergy between this PcbAP phenomenon and ACT’s core processes of self-as-context and defusion is readily made. Yet still, other areas of overlap between ACT and PcbAP are noted in The Yale Manual.

Research on the psychedelic experience in PcbAP has shown common occurrences of illumination of and clarification around personal values, and insight into behaviors out of alignment with those values. As such, the possibility exists that this naturally occurring characteristic of the psychedelic experience would lend itself well to the core ACT core processes of values clarification and committed action.

Conclusion: The natural synergism between ACT and PcbAP

The Yale Manual for Psilocybin-Assisted Psychotherapy demonstrates the existence of synergies between the six core processes of ACT and naturally occurring phenomena of the psychedelic experience in PcbAP. It appears, at first glance, that ACT may provide an established theoretical framework from which to understand the efficacy of PcbAP, and perhaps augment its clinical application.

The decision to create a manualized ACT protocol that provides an ACT-based theoretical frame for naturally occurring phenomena in the psychedelic experience appears to have strong theoretical support. In the next installment of this two-part series on the synergism of ACT and PcbAP, attention will shift to the exploration of synergies in therapeutic technique.

*From the article here:

 
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