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How using MDMA during therapy helps people heal from Trauma

by Suzannah Weiss | MIC | Feb 6, 2020

CJ Hardin, a 40-year-old avionics manager and aircraft mechanic in Charleston, SC, developed PTSD after serving in the military. This qualified him to participate in a study several years ago by MAPS, which used MDMA — commonly known as molly when used as a party drug — to aid in psychotherapy sessions.

Hardin underwent three eight-hour therapy sessions, which each involved two therapists, under 125 mg of MDMA. “I was able to access my feelings without fear and convey them to people who were not in my immediate circle,” he recalls. “MDMA allowed me to talk about things that I wouldn't normally talk about, and it also allowed me to have the introspection to look back and determine the history of how I got to my condition and diagnosis. Once I was able to do that, the healing process seemed to happen without my assistance.”

Since then, he’s been able to get married and hold a full-time job that involves working with people, which he hadn’t considered possible before the treatment. “I had resigned myself to a life of numbing myself and communicating to the outside world via Facebook whenever I wasn't too anxious to open the page, which was often.”

Hardin is one of only a few people to have participated in this kind of trial, but soon, MDMA-assisted therapy will be available to more people. In January, the FDA announced that it was opening 10 sites across the country for 35 more people with treatment-resistant PTSD to receive MDMA-assisted psychotherapy through its Expanded Access program, which may grow to accommodate larger numbers of patients if the new motion yields positive results.

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Marcela Ot'alora G., MAPS’s principal investigator for MDMA-Assisted Psychotherapy Research, is leading a phase III study — the last needed before applying for FDA approval — on MDMA-assisted psychotherapy as PTSD treatment. She tells Mic the typical process includes three MDMA-assisted therapy sessions (or placebo-assisted sessions so the researchers can see which benefits are attributable to the MDMA), as Hardin experienced, and three preparatory therapy sessions before and after each.

Participants are given the option to use headphones and eyeshades to focus on their internal experiences, and music is usually played throughout sessions. Ot'alora has seen patients develop greater trust in themselves and others, healthier coping strategies, and better understanding of who they are after undergoing this process.

These benefits may stem from MDMA’s ability to down-regulate activity in the amygdala, the brain region responsible for fear, so people are able to discuss and work through things that would previously trigger them, explains Bruce Poulter, a sub-investigator on MAPS’s MDMA-assisted psychotherapy studies. As a result, they can potentially develop better relationships to these memories. MDMA may also improve therapy sessions by fostering a sense of closeness between the therapist and the client.

While it may feel cutting-edge, this type of therapy has been happening since long before researchers began formally investigating it. People received an estimated 500,000 doses of MDMA in psychotherapy sessions in North America before the US criminalized it in 1985, according to a MAPS brochure on the topic, and it continues today underground. Anthony, a 29-year-old project manager in Denver who chose not to disclose his last name to avoid legal ramifications, underwent this kind of therapy with his husband last year. They first participated in four months of non-drug-assisted therapy with a licensed psychotherapist, then the therapist came to their home and did a day-long MDMA-assisted session with them.

Both of them delved into past traumas; Anthony recalls punching a pillow while expressing pent-up anger from childhood. “I recognized that my experiences had warped my perspectives on the world, but now, that warped lens was shattered,” he recalls. “It was one of the most liberating moments of my life.” Similar to Hardin, Anthony describes MDMA as allowing him to “waltz into the bank vault of [my] mind without setting off all the internal alarm bells and protections that are usually barricading the entrance.”

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Even after the drug wore off, Anthony retained the emotional space it brought him into. “I got a very different view of my mind. In turn, I learned a very different way to interact with all the feelings and thoughts that come into it on a daily basis,” he says. “My neutral state is a lot calmer than it used to be, I interact with myself and others more mindfully, and I've started living a life more centered around my values and what is important to me instead of revolving my life and choices around the management of my own feelings.” Even though couples’ therapy wasn’t the intended purpose (sometimes it is), the session also brought Anthony closer to his husband.

Using MDMA is not without risks, recreationally or therapeutically. When patients relive painful memories under the drug, there’s a chance that they could be retraumatized, says Poulter. However, this problem is usually avoided with proper emotional support from therapists.

MDMA can also have negative physical side effects, including depression in the days following treatment due to depletion of the neurotransmitter serotonin. Telaroli describes feeling “less social and more introverted” in the weeks after his MDMA session and says 5 HTP supplements helped restabilize his mood.

Research on MDMA as therapy is still in its nascent stages but in the meantime, health experts are working to make it a reality for people who can benefit from it. MAPS has proposed that once the first 35 patients in the new program have received treatment, it will submit data to the FDA and seek approval to expand it. The organization is also wrapping up its phase III trials for MDMA-assisted psychotherapy, which could make this type of therapy a legal prescription treatment for PTSD if it yields positive results.

“I did feel a bit overwhelmed by the sheer volume of changes that started happening on their own in my life as I unpacked all that I had learned,” he says. “Continuing to go to therapy helped me stay centered and grow. I have continued to remind myself that I need to be gentle with myself and integrate changes slowly and lovingly, and so far, I’m happy to say that I’ve succeeded at doing so.”

https://www.mic.com/p/how-using-mdma-during-therapy-helps-people-heal-from-trauma-21781407
 
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Landmark study in Australia to use psilocybin for trauma

by Jesse Noakes - Jan 24, 2019

In 2015, Ian Roullier tripped on a high dose of magic mushrooms while lying in a hospital bed in London’s Imperial College. Ian had been depressed his entire adult life — as a kid, he and his sister had been repeatedly abused by their father, and the effects of that trauma left him in a hole of anxiety, self-loathing and numbness.

For years he’d tried to find catharsis through therapy and medications, but relief only came after he spent a day in that darkened room, headphones on, listening to an Eno playlist, with a pair of therapists by the bed for reassurance, while he dived inside his own mind.

The trip wasn’t easy. At one point he came face to face with his father, who he envisioned as a towering, ferocious military horse. Rather than avoiding him or running, he looked him dead in the eye and ended up laughing hysterically at the bizarre image. “I thought that if I ever engaged with those thoughts it would be the end of me but, once you actually look them in the eye, they don’t have that effect,” he told me last year.

For months after that session, Ian was finally released from his father’s grip. “I felt more comfortable being myself than ever before. I found I felt more connected to myself, other people, nature, life in general. I felt alive, rather than distant and isolated and cut off … Depression is a very narrow, restricted state, and taking psilocybin really helps you to zoom out a lot more.”

Australian patients are finally about to get the chance to experience a little of that magic over here. After years of quiet lobbying, a new study has recently been announced at St Vincent’s Hospital in Melbourne. Starting in April, 30 people will receive a dose of 25mg of psilocybin, the psychoactive extract in magic mushrooms, alongside therapeutic support before, during and after their trip.

Unlike the London study, which targeted treatment-resistant depression, the Melbourne trial will focus on people with a terminal illness. No one is claiming it’s going to cure the disease, of course; rather, it’s hoped that therapeutic tripping can help patients deal with the existential depression and anxiety that naturally accompany a pressing sense of mortality.

Martin Williams, a neuropharmacology researcher at Monash University and co-investigator on the new trial, says it’s a novel and necessary innovation. “A significant minority of patients are simply unable to face death with any degree of calmness and so their quality of remaining life diminishes dramatically. Psychedelic psychotherapy can really change people’s minds — literally — and offer them a relief from their symptoms which they’re really not achieving at the moment.”

The new approach is based on the results of earlier trials in the US, at Johns Hopkins and New York University. In 2016, the Journal of Psychopharmacology published the two institutions’ findings: 80% of the people with life-threatening illnesses they treated experienced significant reductions in anxiety and depression.

Over the past 15 years, hundreds of people have been given psilocybin in clinical studies in the US and UK — another Johns Hopkins study found 80% of smokers had quit six months after a couple of high-dose sessions. More than half of the patients who were treated alongside Ian at Imperial College found clinical remission from the symptoms of hitherto treatment-resistant depression. In the first study of the modern era, two-thirds of healthy volunteers rated their clinical trip as one of the most significant events of their life.

The results have been so striking that late last year the US Food & Drugs Administration gave psilocybin “breakthrough therapy” status, which speeds up their new drug approval process and makes it likely it will be a legal medicine within a few years. In response, there’s already a ballot measure in Oregon seeking to decriminalise and regulate the therapeutic use of magic mushrooms at the 2020 election.

Mushrooms aren’t the only psychedelic drug coming in from the cold. Trials of therapy with MDMA, primarily to treat post-traumatic stress disorder, have been ramping up over the same period. The latest round of research found that 68% of participants were still in remission a year after three all-day sessions, which run roughly the same as with psilocybin: lying down in a comfortable room, eye mask, headphones, two therapists on hand at all times, and therapy sessions before and afterwards. MDMA also has breakthrough therapy status, and is likely to be regulated even sooner than psilocybin.

For almost a decade, a small advocacy group has been trying to establish an Australian arm of psychedelic research. When I first spoke to the members of Psychedelic Research In Science and Medicine (PRISM) in 2016, they were fairly morose about their prospects, having just been rejected by a university for the second time, on the personal intervention of a deputy vice-chancellor.

Recently, though, their reception has notably improved. There is currently another proposal for a small trial of MDMA therapy working its way through the approvals process at Edith Cowan University in Perth. “Australia has a history of following the American lead in terms of any pharmaceutical and medical intervention,” Martin Williams, who is PRISM’s president, told me.

Along with Dr Marg Ross from St Vincent’s, Martin has been working for over a year to get the necessary approvals for the trial. “It’s certainly a significant step forward. I think it’s really going to break the ground for further work, and we’re already looking at other potential trials.”

A new organisation called Mind Medicines Australia has been established to train more therapists to meet the demand, and Williams reckons that psychedelics could be available as a regulated therapeutic treatment “within five to ten years”.

Nigel Strauss, a Melbourne psychiatrist who collaborated on earlier applications with PRISM, cautions that conservative Australian institutions are still resistant. “It’s to do with the belief, I guess, rightly or wrongly, that psychedelic drugs change people’s worldview … And the academic world, particularly in this country, doesn’t quite understand what that means and is a bit fearful of it. These are drugs that do help people come to terms with the meaning of their existence.”

That’s the idea behind the psilocybin study. At higher doses, it can more or less reliably induce what’s come to be known as a “classical mystical experience”, drawing on a taxonomy that goes back to William James’ classic study of religious experiences. In previous research, a more powerful sense of universal oneness and ego loss has correlated with greater therapeutic impact.

Psychiatrist Stephen Bright, vice-president of PRISM, explains what happens. “They’re able to come to terms with what’s happening for them. They end up afterwards with a sense of comfort that everything’s going to be OK. Consequently, the data shows a decrease in anxiety, depression, increased quality of life and connection with significant others.”

Albert Garcia-Romeu, currently leading a psilocybin study at Johns Hopkins, calls it “inverse PTSD”.

“When people have these very profoundly moving experiences with psilocybin it causes brain changes and personality changes that are long-lasting, similar to the way that a serious trauma can have the same kinds of negative effects,” Garcia-Romeu said.

In London, neuroimaging by the Imperial College researchers has shown that psychedelic drugs seriously inhibit the activity of a brain network called the default mode network, which is associated with self-reference, rumination and acts as a sort of executive director of higher level cognitive processes. At a high dose of psilocybin, it shuts down — in its stead, a stack of new neural connections and networks form.

The same pattern has been shown in long-term meditators — it’s a bit like psychedelics can offer the royal road to the subconscious and ego loss, at least for a few hours. The new scans vindicate Aldous Huxley’s old line about the brain operating as a reducing valve on consciousness — knock it out temporarily and watch those doors expand.

Of course, we’ve been here before. Through the ’50s and ’60s, many thousands of patients were given therapy with psychedelics by enthusiastic doctors. The results were good, if a little amateur. Then came the counterculture, the backlash, Nixon, the war on drugs, etc. The true believers never lost their faith, though — a small community of therapists and researchers, based mainly in the US, kept working away underground. Now they’re going mainstream again.

Robin Carhart-Harris, the head of the Imperial College team that gave Ian Roullier his therapeutic trip, is presenting the team’s findings at Davos this week. A Peter Thiel-funded start-up has swept in recently and rushed through much larger trials of psilocybin for depression in the UK. Michael Pollan’s book about his own experiences with therapy with mushrooms and other drugs was an Amazon bestseller, and he's discussed it on Colbert and the morning shows.

Williams has noted a big shift recently. “There’s been a broad shift in the public discourse which we were always trying to contribute to quietly, but it’s really gathered a lot of momentum.” Since 2016, when the US and UK research groups all published their major findings, media attention has been lavish.

“The more people are familiar and comfortable with the concepts, the easier it becomes to broach the subject.” Just last week, even the FT in London was running an enthusiastic feature about non-clinical psilocybin “group therapy” — in response, a retiree from Cornwall wrote in to detail her own recent psilocybin experience, crediting Pollan’s book with including people like her in the “mushrooming mental health zeitgeist.”

About a decade late as usual, it looks like Australia is finally starting to get with the times.

https://www.crikey.com.au/2019/01/24/magic-mushroom-study-australia/
 
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MDMA therapy achieves an astounding 76% success rate for treating PTSD

by Rich Haridy | NEW ATLAS | 1 Nov 2018

Newly published results from a Phase 2 clinical trial into the efficacy of MDMA-assisted psychotherapy in treating post-traumatic stress disorder (PTSD) have revealed striking success, with 76 percent of subjects not meeting the standard clinical criteria for PTSD 12 months after receiving the treatment.

This latest study is one of six key Phase 2 clinical trials that were used to last year convince the FDA to grant the landmark MDMA-assisted treatment a Breakthrough Therapy Designation. This particular trial, sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS), was conducted in Boulder, Colorado and led by psychotherapist Marcela Ot'alora.

The trial comprised 28 subjects, all with clinically diagnosed PTSD that had persisted for an average of almost 30 years, despite attempts with other conventional treatments, including drugs and psychotherapy. The structure of the treatment resembled the model established by MAPS in other trials: two day-long MDMA treatment sessions followed by integrative therapy sessions. A third MDMA session was also offered to evaluate whether that improved long-term responses compared to two sessions.

Responses to the treatment were evaluated using the Clinician Administered PTSD Scale (CAPS-IV), the current best standard for PTSD assessment. Here the results were nothing less than spectacular. On enrolment the average CAPS-IV score of each participant was 92, and at a follow-up 12 months after the final MDMA session, the average CAPS-IV score was just 31. A remarkable 76 percent of participants, after 12 months, did not meet the clinical diagnostic criteria for PTSD.

These impressive results bode well for the long-term staying power of the treatment, with the average CAPS-IV score dropping an additional 9.6 points from the point the treatment finished to the 12-month follow-up.

The final stage before MDMA for PTSD can become an FDA-approved treatment is expansive Phase 3 trials. These trials kicked off in September 2018, after a slight delay in producing and encapsulating the MDMA needed to conduct the experiments. Encompassing between 200 and 300 subjects across 16 different sites in the US, Canada and Israel, it should take up to two years to complete this final stage, with ultimate FDA approval on track for sometime in 2021 if all goes well.

https://newatlas.com/mdma-ptsd-successful-trial-results/57074/
 
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How psychedelics saved my life: My experience with anxiety and PTSD

I was drawn to journalism at a young age by the desire to provide a voice for the ‘little guy’. For nearly a decade working as a CNN investigative correspondent and independent journalist, I became a mouthpiece for the oppressed, the victimized, the marginalized. My path of submersion journalism brought me closest to the plight of my sources, by re-living the story to get a true understanding of what was happening.

After several years of reporting, I realized an unfortunate consequence of my style - I had immersed myself too deeply in the trauma and suffering of the people I’d interviewed. I began to have trouble sleeping as their faces appeared in my darkest dreams. I spent too long absorbed in a world of despair and my inability to deflect it allowed the trauma of others to settle inside my mind and being. Combine that with several violent experiences while working in the field and I was at my worst. A life spent reporting on the edge had led me to the brink of my own sanity.

Because I could not find a way to process my anguish, it grew into a monster, manifesting itself in a constant state of anxiety, short-term memory loss and sleeplessness. Heart palpitations made me feel like I was knocking on death’s door.

Why I chose psychedelic medicines

Prescription medications and antidepressants serve a purpose, but I knew they weren't for me. I first heard of the healing powers of psychedelics as a guest on the Joe Rogan Experience podcast. Joe told me that psychedelic mushrooms transformed his life and had the potential to change the course of humanity for the better. My initial reaction was one of amusement and somewhat disbelief, but the seed was planted.

Psychedelics were an odd choice for someone like me. I grew up in the Midwest and was fed 30 years of propaganda about how bad these substances were. You can imagine my surprise when, after the Rogan podcast, I found so many articles and studies on the prodigious medicinal effects of these substances… and the examples of how we’ve been misled by authorities who classify psychedelics as Schedule 1 narcotics with ‘no medicinal value’ despite dozens of scientific studies proving otherwise.

Tripping around the world

Having only ever smoked the odd marijuana joint in college, in March 2013 I found myself boarding a plane to Iquitos, Peru to try one of the most powerful psychedelics on earth. I ditched my car at the airport, packed my belongings in a backpack and headed down to the Amazon jungle placing my blind faith in a substance that a week earlier I could hardly pronounce: Ayahuasca.

Ayahuasca is a medicinal tea that contains the psychedelic compound dimethyltryptamine, or DMT. The brew is rapidly spreading around the world after numerous anecdotes have shown the brew has the power to cure anxiety, PTSD,depression, unexplained pain, and numerous physical and mental health ailments. Studies of long-term ayahuasca drinkers show they are less likely to face addictions and have elevated levels of serotonin, the neurotransmitter responsible for happiness.

If I had any reservations, doubts, or disbeliefs, they were quickly expelled shortly after my first ayahuasca experience. The foul-tasting tea vibrated through my veins and into my brain as the medicine scanned my body. My field of vision became engulfed with colors and geometric patterns. Then I saw a vision of a brick wall. The word ‘anxiety’ was spray painted in large letters on the wall. “You must heal your anxiety,” the medicine whispered. I entered a dream-like state where traumatic memories were finally dislodged from my subconscious.

It was as if I was viewing a film of my entire life, not as the emotional me, but as an objective observer. The vividly introspective movie played in my mind as I relived my most painful scenes - my parents divorce when I was just 4 years-old, past relationships, being shot at by police while photographing a protest in Anaheim, and crushed underneath a crowd while photographing a protest in Chicago. Ayahuasca enabled me to reprocess these events, detaching the fear and emotion from the memories. The experience was akin to ten years of therapy in one eight-hour ayahuasca session.

But the experience was terrifying at times. Ayahuasca is not for everyone - you have to be willing to revisit some very dark places and surrender to the uncontrollable, fierce flow of the medicine. Ayahuasca also causes violent vomiting and diarrhea, which shamans call “getting well” because you are purging trauma from your body.

After seven ayahuasca sessions in the jungles of Peru, the fog that engulfed my mind lifted. I was able to sleep again and noticed improvements in my memory and less anxiety. I yearned to absorb as much knowledge as possible about these medicines and spent the next year traveling the world in search of more healers, teachers and experiences through submersion journalism.

I was drawn to try psilocybin mushrooms after reading how they reduced anxiety in terminal cancer patients. The ayahuasca showed me my main ailment was anxiety, and I knew I still had work to do to fix it. Psilocybin mushrooms are not neurotoxic, nonaddictive, and studies show they reduce anxiety, depression, and even lead to neurogenesis, or the regrowth of brain cells. Why would governments worldwide keep such a profound fungi out of the reach of their people?

After Peru, I visited curanderas, or healers, in Oaxaca, Mexico. The Mazatecs have used psilocybin mushrooms as a sacrament and medicinally for hundreds of years. Curandera Dona Augustine served me a leaf full of mushrooms during a beautiful ceremony before a Catholic alter. As she sang thousand year-old songs, I watched the sunset over the mountainous landscape in Oaxaca and a deep sense of connectivity washed over my whole being. The innate beauty had me at a loss for words; a sudden outpouring of emotion had me in tears. I cried through the night and with each tear a small part of my trauma trickled down my cheek and dissolved onto the forest floor, freeing me from its toxic energy.

Perhaps most astounding, the mushrooms silenced the self-critical part of my mind long enough for me to reprocess memories without fear or emotion. The mushrooms enabled me to remember one of the most terrifying moments of my career: when I was detained at gunpoint in Bahrain while filming a documentary for CNN. I had lost any detailed recollection of the day when masked men pointed guns at our heads and forced my crew and I onto the ground. For a good half an hour, I did not know whether we were going to survive.

I spent many sleepless nights desperately searching for memories of that day, but they were locked in my subconscious. I knew the memories still haunted me because anytime I would see PTSD ‘triggers’, such as loud noises, helicopters, soldiers, or guns, a rush of anxiety and panic would flood my body.

The psilocybin was the key to unlock the trauma, enabling me to relive the detainment moment to moment, from outside of my body, as an emotionless, objective observer. I peered into the CNN van and saw my former self sitting in the backseat, loud helicopters overhead. My producer Taryn was sitting to the right of me frantically trying to close the van door as we tried to make an escape. I heard Taryn scream “guns!” as armed masked men jumped out of security vehicles surrounding the van. I frantically dug through a backpack on the floor, grabbing my CNN ID card and jumping out of the van. I saw myself land on the ground in child’s pose, and I watched as I threw my hand with the CNN badge in the air above my head yelling “CNN, CNN, don’t shoot!!”

I saw the pain in my face as security forces threw human rights activist and dear friend Nabeel Rajab against a security car and began to harass him. I saw the terror in my face as I glanced down at my shirt, arms in the air, praying the video cards concealed on my body wouldn’t fall onto the ground.

As I relived each moment of the detainment, I re-processed each memory, moving it from the “fear” folder to its new permanent home, the “safe” folder in my brain’s hard drive. Five ceremonies with psilocybin mushrooms cured me of my anxiety and PTSD symptoms. The butterflies that had a constant home in my stomach have flown away.

Psychedelics are not the be-all and end-all. For me, they were the key that opened the door to healing. I still have to work to maintain the healing with the use of floatation tanks, meditation, and yoga. For psychedelics to be effective, it’s essential they are taken with the right mindset in a quiet, relaxed setting conducive to healing, and that all potential prescription drug interactions are carefully researched. Ayahuasca can be fatal if mixed with prescription antidepressants.

I am blessed with an inquisitive nature and a stubbornness to always question authority. Had I opted for the doctor’s script and resigned myself in the hope that things would just get better, I never would have discovered the outer reaches of my mind and heart, and I might still be in the midst of my battle with PTSD.

https://www.sociedelic.com/how-psych...saved-my-life/
 
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Psychedelics help heal childhood trauma, study
by Evan Lewis-Healey | PSYCHEDELIC SPOTLIGHT | 25 Oct 2021

Researchers find that there were significantly lower levels of complex trauma symptoms and feelings of internalized shame in study participants that had used psychedelics therapeutically.

Psychedelics are leading a paradigm shift in the fight against poor mental health. To add to the long list of disorders that these powerful compounds have the potential to treat, a recent study has shown that psychedelics may alleviate symptoms of childhood trauma and shame spurred by abuse and neglect.

Childhood abuse and neglect is extremely common worldwide, leading to a battery of psychological issues in later life. Common treatments of the consequences of childhood abuse, such as antidepressants, are, however, unlikely to address the trauma itself. The research at hand may represent how psychedelics can fill the gap, and address the root causes of childhood abuse.

How psychedelics treat trauma

The article, published in Chronic Stress, surveyed 166 participants who had suffered from child maltreatment. The participants were asked to detail the extent of the abuse they had suffered as a child, and to document their current symptoms of trauma. Many of the participants had serious symptoms of trauma, with 61% meeting the criteria for PTSD.

Participants were also asked, “Have you ever used a psychedelic/entheogenic/hallucinogenic substance…with the intention of healing or processing childhood trauma?” Out of the 166 participants, around a third of them had used psychedelics in a therapeutic context in an effort to heal childhood trauma.

The researchers found that there were significantly lower levels of complex trauma symptoms and feelings of internalized shame in the participants that had used psychedelics therapeutically. That is, participants that had used LSD, psilocybin, or MDMA to self-medicate were less likely to experience severe symptoms of PTSD like feelings of deep shame and guilt, or suicidal thoughts.

Remarkably, and importantly, this was found despite the two different groups (psychedelic users and non-psychedelic users) undergoing similar levels of childhood abuse and neglect.

Treatment at the root

Trauma is increasingly becoming embedded in our dialogue around mental illness. Esteemed physician, Dr. Gabor Maté, highlights this negative impact of trauma on development: “The greatest damage done by neglect, trauma or emotional loss is not the immediate pain they inflict but the long-term distortions they induce in the way a developing child will continue to interpret the world and her situation in it. All too often these ill-conditioned implicit beliefs become self-fulfilling prophecies in our lives.”

These long term distortions found are often experienced as feelings of deep shame—a negative view of yourself can lead to an inability to accept yourself for who you are. This can then have a knock on effect, and foster patterns of addiction, depression, or other mental health issues.

But why could psychedelics so successfully treat these symptoms of trauma?

Well, the researchers argue that these substances may be a catalyst for change in the way we view ourselves; high doses of psychedelics can induce ego dissolution—the realization that there is no continuous self.

This experience of ego dissolution, that psychedelics can induce, may be a force for change; realizing that you are not a continuous fixed self provides the insight that you can become different, and no longer suffer.

Many participants from this study highlighted how their trip helped them move towards a healthier and happier version of themselves. One participant confessed, “It [therapeutic psychedelic use] has freed me from the ego that I’ve spent my whole life creating.”

While this study is promising, it simply represents a first step in the use of psychedelics to treat trauma at the root cause. The nature of the study (through uncontrolled online samples) means that we can not be fully sure whether psychedelics will be effective for the general population.

To be more sure, there needs to be more research investigating the potentially powerful trauma combatting effects that these plant medicines can have.​

 
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Psychedelics helped me heal from sexual trauma*

by Kiki Dyon | PSYCHEDELIC SPOTLIGHT | 22 Sep 2021

Reprocessing sexual trauma is a difficult task, but psychedelics are presenting themselves as a powerful tool to help survivors.​

After I was sexually assaulted at 14, I spent the next half of my life trying to forgive myself for that sexual trauma.

The decade after was overwritten by flashbacks, unfurling frustrations, and failed attempts to cement my sexuality. I was either all orgies or all abstinence, vacillating between extremes in every aspect of my life. I was never fine; I was only singing-in-the-street happy or banging-my-head-against-a-California-redwood enraged.

I drove my truck in circles laboring under the delusion that if I could articulate the event perfectly, rendering it with great tact, the memory would lose power. I would be healed and reborn, on top of being re-hymened. I absolutely consecrated myself to the notion that if I wrote something capable of making people laugh, cry and cringe in one tight paragraph, my fingers would ascend from the keyboard, and I would evaporate into a reality where I don’t go home and cry every time the subject of virginity loss is broached over hors d’oeuvres.

When I began to accept that I would never be able to write it perfectly and the concept of catharsis through composition was a little faulty anyhow, I turned toward some more colorful alternatives.

Though I never went into any of my psychedelic experiences with the expectation that they would heal me, I was optimistic that they would allow me to see myself more empathetically. After researching, I understood that psychedelics work on the part of the brain known as the parahippocampal retrosplenial cortical network, which is thought to have a hand in dictating our sense of self –– something that I desperately needed to restructure.

So, I began.​

Clinical use of psychedelics may heal sexual trauma

I’ll be honest: my psychedelic-assisted therapy was self-administered. However, while I did have to skulk in dark Scottish alleyways to get the goods, I was obsessive about dosing and “doing it right.” From a consciousness-shifting K-hole in the Whistlebinkies bathroom to shrooms at sunset on Lake Ontario, I found a new sense of softness and empathy for myself with each trip.

When it comes to psychedelics helping sexual assault survivors, my experience is far from singular.

According to Roland Griffiths, a seasoned psychedelic researcher, and professor at Johns Hopkins University School of Medicine, over 70% of people who took magic mushrooms to treat mental illness, anxiety about impending death or PTSD cited their psychedelic experience as being one of the most important events in their entire lives. Research also suggests that psilocybin, the active ingredient in magic mushrooms, often induces emotional breakthroughs and profound shifts in perspective for those who ingest it.

A chorus of experts echoes these epiphanies.

My experiece that psychedelics (used safely) are an unrivaled tool to help people access greater embodiment and encouragement to reprocess their trauma and, in the words of sex therapist and psychedelic integration therapist Dee Dee Goldpaugh, “experience a compassionate recasting of ourselves in the story.”

Activist Leia Friedman, host of The Psychologist: Consciousness Positive Radio, gives a glowing review of MDMA: “MDMA is probably the most commonly used medicine for treating sexual trauma, [but] I have heard from different people that ayahuasca, psilocybin, ketamine, LSD, and mescaline-containing cacti were all helpful, as well.”

Similarly, psychologist and sexologist Dr. Denise Renye adds, “Using the psychedelic psilocybin and the empathogen MDMA can both create psychic spaces within individuals to gain a deeper sense of self.” She continues, “MDMA can help an individual recollect a sexual assault without the PTSD symptoms of freeze, fight or flight. MDMA can also allow for the survivor to have a sense of empathy for their self that went through the assault, thus alleviating some of the self-judgement that sometimes accompanies it.”

The evidence isn’t purely anecdotal either; there is a wealth of studies touting the benefits of MDMA for those suffering from PTSD. According to one such study, “after three doses of MDMA administered under a psychiatrist’s guidance, PTSD patients reported a 56 percent decrease in the severity of symptoms on average. By the end of the study, two-thirds no longer met the criteria for having PTSD. Follow-up examinations found that improvements lasted more than a year after therapy.”

Looking forward

It’s not just me. Experts agree psychedelics are an untapped resource in the barbed pursuit of healing from sexual trauma. With the help of shrooms, MDMA, and a sprinkle of ketamine, I became able to see my assault the same way I’d view it if it happened to a friend: with empathy instead of self-loathing.

The future looks hopeful with cities such as Denver and Oakland decriminalizing psilocybin and conducting trials on MDMA and ketamine for PTSD treatment. However, for now, if you’re a survivor considering psychedelics, remember how crucial setting and dosage are. If you’re not in a location where psychedelics are decriminalized, test your substances and ensure that you have a trusted friend with you while you trip –– and I wish you the same success that I’ve had.

All my experiences with psychedelics, from the meticulously planned to the spontaneous and ill-advised, have helped me reframe my assault. Able to separate the event from the body of hurt it left behind and the unruly actions it inspired, I could forgive myself. Better yet, I could begin to accept the obvious: it wasn’t my fault.

*From the article here :
 
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New survey suggests psychedelics could help heal the Complex Trauma of Child Abuse*

by Jon Kelvey | LUCID | 17 Nov 2021

Widespread, serious study of psychedelics for the treatment of mental health conditions is relatively new in the 21st century, and many conditions, substances and practices remain understudied in Western medicine, leaving low hanging fruit.

Take the potential use of psychedelics to treat complex childhood trauma. Clinical trials with MDMA have explored the drug’s potential for treating Post Traumatic Stress Disorder (PTSD) for instance, but such trials haven’t distinguished between types of trauma or studied if other drugs such as psilocybin could help such patients. The studies have also been conducted in controlled, clinical settings, and may not address whether MDMA or other substances effectively treat trauma when people take them on their own outside of the clinic — known as “naturalistic” use.

But a new study by the Wendy D’Andrea lab at the New School in New York suggests new approaches researchers might pursue regarding childhood trauma and the potential for studies of naturalistic psychedelic use to guide clinical investigations. Published July 11 in the journal Chronic Stress, the paper surveyed people with histories of childhood mistreatment and resulting trauma and found some people who reported using psychedelics also reported fewer complex trauma symptoms than those who did not use psychedelics.

More specifically, the study found that people who had experienced childhood abuse, and also reported using psychedelics with “therapeutic intent,” reported fewer symptoms of complex trauma and less internalized shame than people with similar backgrounds who hadn’t used psychedelics in this manner.

“There were participants who endorsed a history of having used psychedelics,” said C.J. Healy, a clinical psychology Ph.D. student in the D’Andrea lab and first author of the paper, “but did not endorse a history of having used them with the intention of healing and processing childhood trauma.”

Importantly, Healy adds, while around one third of participants reported using psychedelics with therapeutic intent, “It was a kind of subgroup of people who had used [psychedelics] more than five times that was driving that result,” they said.

The study was conducted via an online survey, which 166 people completed. Of those, 52 people reported using psychedelics with therapeutic intent, and of those people, 21 reported having done so five or more times. Of the substances participants reported using, psilocybin mushrooms, LSD and MDMA were the most common, but some reported using ketamine, DMT, ayahuasca, mescaline or peyote, and 2C-B as well.

Participants were also assessed for symptoms of internalized shame, a common symptom in survivors of childhood mistreatment, and for the self-reported severity of their traumatic childhood experiences. Participants were given the International Trauma Questionnaire, a 12 item measure that distinguishes between PTSD and complex PTSD.

“Complex PTSD is not recognized in the DSM, the Diagnostic and Statistical Manual, which is the most commonly used diagnostic manual in the U.S.,” Healy said, adding that "the International Classification of Diseases 11th Revision, the newest diagnostic manual of the World Health Organization, does include complex PTSD.”

While PTSD is typically associated with single incident traumas, like a car accident, complex PTSD stems from ongoing traumatic experiences, like those of a prisoner of war or a child in an abusive environment. "PTSD symptoms tend to involve intrusive memories, flashbacks, or nightmares, while complex PTSD symptoms involve distortions of self concept,” Healy said, "with people having negative views of themselves and difficulty relating to others."

The D’Andrea lab is largely focused on distinguishing the psychological and physiological profiles of these different types of trauma. Considering recent and historical evidence that psychedelics could be helpful in treating trauma, Healy designed the study to gauge the effectiveness of these substances in treating complex trauma.

Healy’s hypothesis was that there’s something about the psychedelic experience that is inherently helpful for people seeking to heal from childhood trauma. "The strength of results among participants who used psychedelics five or more times suggest that repeated uses of psychedelics are more efficacious than just a handful,” Healy said.

But it’s also possible that participants willing to take psychedelics five or more times with the expressed intent of healing past traumas had other life factors that contributed to their reduction in symptoms. “Maybe in general, these are people who are just more motivated to heal, and maybe they’re engaging in other healing modalities,” Healy said. “It might not be the psychedelic experiences alone, and might not even be the psychedelic experiences at all.”

"It’s a preliminary survey study,"
Healy added, "so it’s not definitive, but hopefully it will point the way towards future research.”

That research will, they hope, focus on learning more about the potential benefits of naturalistic use of psychedelics, as well as their clinical use in treating complex trauma. But Healy added, "such a statement almost sounds a little ridiculous, because there are people around the world who have known that for thousands of years, and it’s just a given. There’s a certain, I think, epistemic arrogance to say that we can’t yet say conclusively that using psychedelics, outside of formal clinical settings has therapeutic benefit.”

*From the article here :
 
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Can MDMA help heal grief?

by Charley Wininger | LUCID | 3 Mar 2022

It was a serene day by our secluded spot by the lake in Brooklyn’s Prospect Park, but my wife Shelley was sobbing uncontrollably. Clutching the framed picture of her handsome, smiling son (my stepson), she knew he was finally free.

It was a moment none of the forty of us in the midst of an MDMA experience would ever forget.

MDMA, commonly known as Ecstasy or Molly, is the still-illegal drug that recently demonstrated significant results in Phase 3 clinical trials providing profound and apparently lasting relief for sufferers of intractable cases of PTSD.

Shelley and I hoped that this medicine (we prefer the term to “drug”) would help us heal our grief. Now in our early seventies, we’ve taken it together four or five times a year ever since we met over twenty years ago. Each experience has been either healing, bonding for us as a couple, or simply joyous.

Certainly this is in part due to our caution. We know at our age that if we did a powerful substance like MDMA irresponsibly, it would knock us on our butts. And Shelley, a retired nurse, is conscientious about our health. So we always test it for purity; weigh the powder to the milligram; stay adequately hydrated the entire time; and replenish our bodies with plenty of sleep, 5-HTP, and healthy food for days afterwards.

For us, the scientific revelations of this “party drug” as a therapeutic medicine have simply confirmed our lived experience. So much so, we long ago decided to start hosting annual group gatherings for our friends (who bring their own medicine), and these have become increasingly popular.

Nine days before that occasion, I awoke to the sound of blood-curdling screams coming from our living room. I bolted in to find Shelley, her phone flung across the room, pounding the couch and bursting with horror as if she were witnessing her heart being ripped from her chest.

“It’s Scott.”

Shelley’s son Scott had just moved into a house with his new girlfriend, his two cats and her little dog. Earlier that morning, his girlfriend had found him dead and slumped over on their couch. He was 39. (We are still awaiting the autopsy results.)

We both knew that our grieving process, especially Shelley’s, would take a long time. Not being religious, she wasn’t exactly sure where to begin. She did know that nine days later we were scheduled to participate in the group experience. Though devastated, neither of us doubted for a moment that we’d be attending.

So on that day in Prospect Park, we gathered with our friends – of all ages, from all walks of life, and from all over the country. Earlier in the week, while sharing the news of her loss with those who would be coming, Shelley had requested a healing circle at some point during the day, for herself and anyone else who needed it. We were therefore expecting a healing experience of some sort. But what happened that day startled the both of us.

It turned out that many of us in this time of pandemic, fear and isolation had something to grieve. One, a fellow boomer, spoke of losing his mom in just the past week. He said he felt like he needed to scream in anguish. To be honest, at that moment I thought, Oh my God, please don’t scream here in the park!

Shelley, however, threw him a cushion and told him to just do it. (I thought, “I’m a psychotherapist. Why didn’t I think of that?”) Three times he let loose into the cushion, to his great relief, and to ours on his behalf.

After everyone who wished to had spoken, Shelley unwrapped a photo of Scott that a friend had enlarged and framed, and which she couldn’t look at until that moment. She showed it to the group and started to weep. She spoke of how her son had been in pain all his life – great mental anguish, and, the past few years, great physical pain as well, due to a back injury.

At this point, I needed to speak up. “What I haven’t shared with you until now, Shelley, is that the day Scott died, I felt his presence there in our living room. He was sending us his love, and seemed to want to reassure us."

“He was smiling. ‘I’m free,’ he said.”


It was then that Shelley burst like a dam, erupting into deep, cathartic sobs. And all at once, everyone seemed moved to huddle all around her, with those closest placing their hands gently on her head, legs, and arms. The rest of us reached out to touch someone touching her, until it felt as if we’d become one organism sending healing energy to the part of us that needed it.

When Shelley lifted her head and opened her eyes, she felt this swelling human wave of love washing over her, flooding her with the healing intention of forty friends. It was a communal heart-tipped arrow that seemed to pierce her agony. Her crying seemed to shift from pure pain to a kind of surrender, acceptance, and peace.

Several days later, a participant wrote to us, “I never want to go to a traditional wake or funeral again, now that I’ve seen this alternative!”

Now, nine months later, Shelley still speaks of how that day profoundly alleviated her grief. And watching this happen for her helped heal me as well.

Our healing process is going to take some time, of course. But while Shelley will always start to weep whenever the subject comes up, she seems neither broken nor debilitated by this great loss.

Grief is an eccentric companion, peculiar to each individual. For us, MDMA helped. Due to its ability to increase empathy in those under the influence, our tragic loss will forever be associated with an unabashed outpouring of love, caring and connection that reverberates to this day. And due to the MDMA-spurred release of serotonin, which enhances feelings of wellbeing, Shelley felt safe enough to lower her defenses, bare her soul, and allow that turbo-charged gush of love to enter and serve as a balm to her raw and wounded heart.

That day made us wonder what it would be like to live in a world where people would gather when tragedy strikes, use MDMA to connect with those most bereft, and directly participate in their healing. Indeed, it was the combination of community and this remarkable medicine that was so consoling. Together they seemed to work with tragedy and loss like light works with shadow.

Who can imagine the applications for this uncanny compound still to be discovered? We recognize that our experience is purely anecdotal. We look forward to solid research involving MDMA and grief.

 
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Psychedelics help heal childhood trauma, study
by Evan Lewis-Healey | PSYCHEDELIC SPOTLIGHT | 25 Oct 2021

Researchers find that there were significantly lower levels of complex trauma symptoms and feelings of internalized shame in study participants that had used psychedelics therapeutically.

Psychedelics are leading a paradigm shift in the fight against poor mental health. To add to the long list of disorders that these powerful compounds have the potential to treat, a recent study has shown that psychedelics may alleviate symptoms of childhood trauma and shame spurred by abuse and neglect.

Childhood abuse and neglect is extremely common worldwide, leading to a battery of psychological issues in later life. Common treatments of the consequences of childhood abuse, such as antidepressants, are, however, unlikely to address the trauma itself. The research at hand may represent how psychedelics can fill the gap, and address the root causes of childhood abuse.

How psychedelics treat trauma

The article, published in Chronic Stress, surveyed 166 participants who had suffered from child maltreatment. The participants were asked to detail the extent of the abuse they had suffered as a child, and to document their current symptoms of trauma. Many of the participants had serious symptoms of trauma, with 61% meeting the criteria for PTSD.

Participants were also asked, “Have you ever used a psychedelic/entheogenic/hallucinogenic substance…with the intention of healing or processing childhood trauma?” Out of the 166 participants, around a third of them had used psychedelics in a therapeutic context in an effort to heal childhood trauma.

The researchers found that there were significantly lower levels of complex trauma symptoms and feelings of internalized shame in the participants that had used psychedelics therapeutically. That is, participants that had used LSD, psilocybin, or MDMA to self-medicate were less likely to experience severe symptoms of PTSD like feelings of deep shame and guilt, or suicidal thoughts.

Remarkably, and importantly, this was found despite the two different groups (psychedelic users and non-psychedelic users) undergoing similar levels of childhood abuse and neglect.

Treatment at the root

Trauma is increasingly becoming embedded in our dialogue around mental illness. Esteemed physician, Dr. Gabor Maté, highlights this negative impact of trauma on development: “The greatest damage done by neglect, trauma or emotional loss is not the immediate pain they inflict but the long-term distortions they induce in the way a developing child will continue to interpret the world and her situation in it. All too often these ill-conditioned implicit beliefs become self-fulfilling prophecies in our lives.”

These long term distortions found are often experienced as feelings of deep shame—a negative view of yourself can lead to an inability to accept yourself for who you are. This can then have a knock on effect, and foster patterns of addiction, depression, or other mental health issues.

But why could psychedelics so successfully treat these symptoms of trauma?

Well, the researchers argue that these substances may be a catalyst for change in the way we view ourselves; high doses of psychedelics can induce ego dissolution—the realization that there is no continuous self.

This experience of ego dissolution, that psychedelics can induce, may be a force for change; realizing that you are not a continuous fixed self provides the insight that you can become different, and no longer suffer.

Many participants from this study highlighted how their trip helped them move towards a healthier and happier version of themselves. One participant confessed, “It [therapeutic psychedelic use] has freed me from the ego that I’ve spent my whole life creating.”

While this study is promising, it simply represents a first step in the use of psychedelics to treat trauma at the root cause. The nature of the study (through uncontrolled online samples) means that we can not be fully sure whether psychedelics will be effective for the general population.

To be more sure, there needs to be more research investigating the potentially powerful trauma combatting effects that these plant medicines can have.​

 
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Cambridge
Why psychedelics are a more ‘compassionate’ way to treat trauma

A therapist explains what it’s like to give psychedelic-assisted therapy.

by Sarah Sloat | INVERSE | 14 Feb 2021

The past decade has been witness to a renaissance in psychedelics research. Studies suggest some of these drugs can safely benefit people with psychological problems when paired with therapy.

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Dr. Elizabeth Nielson is a psychologist and psychedelics researcher. She’s a therapist on FDA-approved clinical trials of psilocybin-assisted treatments of alcohol use disorder, treatment-resistant depression, and MDMA-assisted treatment of PTSD. She’s also the co-founder of Fluence, an independent training institute for the integration of psychedelic experiences in clinical settings.

Inverse recently spoke with Nielson about what it’s like to be involved in this type of work, the future of psychedelic-assisted therapy, and the hurdles ahead.

How and why did you become involved in the world of psychedelic-assisted therapy?

I was really interested in finding and developing better, more humane, and more compassionate ways of helping people who were struggling with both addictions and trauma. Psychedelics offered a really good way to work toward these goals. I got involved just as I was finishing my doctoral degrees.

I had looked at several kinds of empirically supported treatments, like harm reduction and mindfulness-based interventions. Psychedelic-assisted therapy really offered a next step toward potential improvement of what the clinical therapy could offer.

What has it been like to see a change in opinion on the therapeutic use of psilocybin since 2014 when you started your research?

I think there has been growing acceptance of the possibility over the course of these years. When I first became involved, it just seemed like something that people were less familiar with. And, to his credit, the author Michal Pollan’s book, How to Change Your Mind, really put this on the map for a lot of people.

There’s overall been growing familiarity with the whole idea of psychedelic-assisted therapy and the potential of psychedelics to effectively work this way.

How has your confidence in psychedelics' potential to aid changed over time, especially now that there’s supporting clinical research?

When I came into this, I was already very familiar with the history of psychedelics in terms of how they had been used in both indigenous settings and shamanic practices, as well as in medical settings in the United States and Europe, especially in the 1950s and ‘60s.

So I guess you could say I’m not surprised. What’s more surprising to me is to see the adoption of what sometimes we refer to as the “mainstreaming” of psychedelics: the bringing of them into our existing institutions, clinical research worlds, and potentially into our clinics in ways they may be available to the public. That process has really been interesting to watch.

There’s a lot of focus on the psilocybin part of psilocybin-assisted therapy. Can you please expand on the role of the therapist? What is their primary role?

Therapists have a primary role in establishing the physical and psychological safety of the participants and getting them through their session experience. In psychedelic-assisted therapies in general, the subjective experience is a critical part of the way that we think these therapies may work. The role of the therapist is really helping to create the relational and emotional environment in which the experience takes place.

In general, during psychedelic-assisted therapy — it’s important to note specific trials are all a bit different and have their own procedures and protocols — a participant is seen through that experience by, usually, a co-therapist pair. They are asked to spend the bulk of their time focusing on what their internal subjective experience is. Whether or not there are conversations about specific things or a specific manner depends on the protocol, the treatment diagnosis, and the therapeutic approach, because all the studies have different therapeutic approaches.

Why are there two therapists?

There are a couple of reasons for the two therapists model. One is the safety of the participants should one therapist be needed to attend to the participant. Another, for instance, is if one needed to attend to some other aspect of the environment or interact with the rest of the team in some way. The other reason is the sessions are often quite long, so it’s somewhat easier from the therapist's standpoint if one needs to briefly exit the session at some point.

That seems practical. How long are the sessions?

Pretty much across the board in psychedelic therapy sessions in the United States, they are eight hours long.

Something your new paper really digs into is the need for specially trained therapists who can provide high-quality care to participants in clinical studies. But if regulatory approval is on the horizon, is there also a need for therapists who are ready to go once this type of therapy is actually legal?

Yes, definitely. We, as a field, don’t know what the regulatory requirements will be for becoming a provider of any of these therapies if they are approved. That is something that is unknown at this time.

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What I can say is that from the perspective of a researcher who is providing this therapy, the need for specialized and specific training is essential to being able to provide this therapy in a way that is ethical, safe, and has the potential to demonstrate the kind of results the studies may show. And I’m using “may” specifically because we don’t have those results yet.

But if we do have positive results from the studies and we want to be able to generalize those in non-research settings, we really need to address the training piece.

Something I’ve been generally curious about is whether or not there were already plans to create some sort of infrastructure that would support this therapy if it is approved — so that’s really interesting to know.

Interestingly, Fluence was started in order to build that infrastructure now, because, as research therapists and clinicians, my co-founder and I could see that this could potentially be a major rate-limiting factor: the training of therapists.

When we were going through our own training, we were both incredibly impressed with the complexity and the need for real attention to the specifics of doing this kind of work. We were also simply appalled by the thought of how on Earth will our field meet the challenge of training the number of therapists that would actually be needed to provide this to the public? We started this project in order to build the infrastructure to help meet that need.

What has it been like for you, personally, to work in this space?

It’s different every day. What I really like about working in this space is that it is challenging; it requires creativity. It requires a lot of problem-solving, and it requires building programs and solutions from the ground up. You have to figure out how to do things that are not necessarily clear from the outset.

I think for myself and probably a lot of people in my cohort of trainees and clinical researchers, it’s been about learning how to be very flexible, adaptable, and being able to respond enthusiastically to challenges. When I say cohort, I mean people who came to it around the same time and from the same level of training.

To start in 2014 as a trainee therapist on a research trial to now, in 2021, being the co-principal for the MAPS New York City private practice research site is really seeing the result of a lot of sticking with it.

Looking to the immediate future — let’s say one to five years from now — what are you most eager to see happen?

I’m really excited about therapist training. Part of the reason I’m excited about it is because I think therapists in general are just a wonderfully compassionate group of people. They have amazing skill sets they can bring to this work. I meet so many that are really passionate and motivated to get involved.

I’m really looking forward to more research and more development of therapist training programs in this field. It’s going to be a field of its own, and to some extent, it is already.

Psychedelic therapies, in general, have the potential to address some of the existing disparities that we see in healthcare, especially in mental healthcare. Therapist training programs are the optimal place to bring education to bear on that process.

 
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Cambridge

How MDMA helps patients with trauma

by Janna Lawrence | 15 OCT 2018

When combined with intensive psychotherapy sessions, MDMA — commonly known as ecstasy — has elicited impressive results in phase II trials and a global phase III study is just beginning.

On 4 July 2014, the people of South Carolina were celebrating Independence Day. But Jonathan Lubecky, a veteran of the Iraq War, was unable to join in with his neighbours because he was suffering from severe post-traumatic stress disorder (PTSD). “Where I live, they love fireworks, so my whole neighbourhood turns into Baghdad,” he says. That particular night, his now wife walked into the closet in their bedroom to find Lubecky wearing his body armour, with his service dog, having flashbacks.

In the eight years since returning from Iraq, Lubecky had tried to commit suicide five times and was taking 42 pills per day to control his depression, suicidal ideation and symptoms of PTSD. But by the following year’s Independence Day, despite the booming of fireworks, Lubecky was out on his porch. This time, he was “annoyed and … a little bit triggered” but more angry, rather than in the non-functional state he had been in the year before.

The “miracle” that changed his life is MDMA. Lubecky participated in a study using MDMA-assisted psychotherapy sessions to treat PTSD. After the trial his suicidal ideation was “eliminated,” his depression subsided by 40% and is now 70% gone, and his PTSD symptoms were reduced by 50%.

Lubecky is one of 26 veterans, police officers and firefighters who received MDMA for their moderate-to-severe PTSD in a 2018 study run by Michael Mithoefer, a psychotherapist and clinical researcher at the Medical University of South Carolina, and his wife Ann, a nurse. One month after the final MDMA session, 68% of the patients who received an active dose no longer met the criteria for PTSD.

This was the second trial conducted by the Mithoefers and overall the sixth phase II trial to use MDMA to treat PTSD — the others being conducted in the United States, Canada, Israel and Switzerland. After the success of the Mithoefers’s second trial, the US Food and Drug Administration (FDA) gave the drug breakthrough status and a phase III trial has just started. “The phase II trials have been very encouraging,” says Michael Mithoefer. This has buoyed other psychiatrists too, who are now investigating MDMA-assisted psychotherapy to treat different illnesses, such as alcohol addiction and social anxiety in adults with autism. Alicia Danforth, a clinical psychologist at the University of California, San Francisco, says “knowing what we know about MDMA, there could be tremendous implications for psychotherapy.”

Early research

MDMA was first synthesised in 1912 by a German chemist working for the pharmaceutical company Merck. The company patented it in 1914 but never investigated the compound. Decades later, psychologists and therapists began to take an interest in MDMA for its ‘feeling enhancing and non-hallucinatory properties’ and, between 1977 and 1985, several case studies were published using the drug to facilitate psychotherapy sessions.

MDMA is loosely categorised as a psychedelic, although many of its features are unique. Chemically, it has structural similarities to both the psychedelic mescaline and the stimulant amphetamine. Charles Grob, a psychiatrist at Harbor-UCLA Medical Centre in Los Angeles, California, who has completed two studies with MDMA, became acquainted with psychedelic research in the 1970s and says it persuaded him that this class of drug should be of great interest to mental health professionals.But MDMA was banned in the UK in 1977 and in 1985 in the United States. It was given Schedule 1 status in both countries, meaning that it is classified as a drug of abuse with no medical applications, which made researching it difficult and costly. “Because of the political and cultural turmoil … for a couple of decades all research into psychedelics was halted." As the years went by, Grob, along with Mithoefer, saw an opening in the regulatory landscape and started to apply for permission to work with MDMA. It seemed like an ideal candidate to use for psychotherapy, “particularly this notion that patients remain alert, oriented, tapped into their feelings and able to articulate and achieve insight,” says Grob. In 1998, he published the first phase I study administering MDMA to healthy volunteers, which established “good safety parameters.”

Shortly after, in 2001, Mithoefer applied for permission to use MDMA for the first time to treat PTSD caused by sexual assault, abuse or violence in a phase II trial. He had spent many years treating patients with PTSD and recognised that there was a “large percentage of people we just couldn’t help with existing therapies.”

Current treatment for PTSD entails psychotherapy alongside taking an antidepressant — commonly a selective serotonin reuptake inhibitor, an anxiolytic and a sedative. Mithoefer explains: “We realised a long time ago that although some medications could be useful for treating PTSD symptoms, the definitive treatment is psychotherapy. This treatment path is recommended in international guidelines, including those from the National Institute for Health and Clinical Excellence. But even with gold-standard treatment, between 25% and 50% of people do not respond was shut down,” says Grob.

For these people, it seems that psychotherapy does not work because they are too traumatised to fully participate. “As soon as they’re asked to reflect on the traumatic memory, they are so overwhelmed with negative affect that they dissociate and they can’t do the trauma process work,” explains Ben Sessa, a psychiatrist working in Bristol, UK. Lubecky, who had psychotherapy for eight years before taking part in the MDMA trial, says that “when I was doing regular therapy I wouldn’t talk about the trauma because … I felt like I was back there again, my body would react like it did when the trauma first occurred.”

Mithoefer explains the theory was that MDMA would stop people from being overwhelmed and help “overcome the obstacles to successful therapy.” But there was a delay in beginning this first phase II trial, which was only published in 2010, because of what turned out to be false claims about MDMA’s toxicity in primates.

Phase II trials

When the results from the study were eventually published, they showed that, of the 12 people given MDMA, 10 no longer met the criteria for PTSD at the end of the study compared with 2 out of 8 patients in the placebo group. As an additional benefit, all three subjects who were unable to work on account of PTSD returned to employment.

Mithoefer says that, since these data have been published, there has been a “very striking change” in attitude towards MDMA and the public seem to be more educated now. It was the strength of the first phase II results that prompted the other five studies, including the 2018 one, which have all returned “strong results”, says Mithoefer. While his first trial involved survivors of sexual assault and violence, research suggested war-related PTSD is harder to treat and so his 2018 study recruited veterans and emergency workers, including Lubecky.

Patients came to the trial through word of mouth or referral from a mental health professional. Lubecky says that he only found out about it when his psychiatrist’s intern told him to google “MDMA PTSD”. At this point he had tried to commit suicide so many times that he says he had nothing to lose, so he called the Mithoefers. Like all participants he was required to undergo a physical examination and baseline assessment before enrolling in the study. This is primarily to exclude patients with prior cardiovascular disease because MDMA can elevate blood pressure, explains Mithoefer. Participants are also required to taper off their normal medicines owing to concerns about drug interactions.

Each participant is carefully prepared for the trial with three psychotherapy sessions, each 90 minutes long, before they take any MDMA. On the day that patients take the drug, they attend the Mithoefers’ medical practice, which is in a converted house. Despite being hooked up to a blood pressure and temperature monitor, Lubecky says the environment is “comfortable”, with a real bed to relax on.

Mithoefer stresses that “we don’t believe [MDMA is] something you should be able to pick up at the pharmacy and take home,” it should only be given through licensed clinics. The study also confirmed that the potential for abuse of MDMA following clinical use is low. Of 26 participants, 6 had previously taken MDMA between two and five times. In the 12 months following treatment, two participants who had previously taken MDMA took it again, but none of those who were new to the drug did so.

He says he was “in such a safe place with the MDMA. I was able to just talk about things I had never talked about before without having a physical response to it,” he adds. He refers to the experience as “doing therapy and feeling like you’re being hugged by everyone on the planet who loves you, and a load of puppies are licking your face.”

Pharmacology

Lubecky is describing the myriad effects that MDMA has on the brain caused by its action at multiple receptor sites. It exerts an effect through the 5HT1A and 1B receptors, therefore stimulating the release of serotonin, which reduces anxiety and depression and causes mood-elevating effects. In addition, it has a mild psychedelic effect; nothing like as intense as classical hallucinogens, such as LSD, says Sessa, but enough to provide for an “extra level of creativity so that you can see things in a new light."

Crucially, it also dampens the activity of the almond-size region of the brain called the amygdala which, says Sessa, “selectively impairs the fear response which allows the patient to work in that mental state where they can safely recall and reflect upon painful trauma." Hormones such as oxytocin, the bonding chemical, are also released, as well as dopamine, which can help people to focus.

While this is happening in the brain, the participants in the PTSD trial complete an eight-hour psychotherapy session. This is repeated one month later.

Going into the study, all participants had moderate-to-severe PTSD. One month after the second blinded dose of MDMA, 6 out of 7 patients in the 75mg group and 7 out of 12 patients in the 125mg group no longer met the criteria for PTSD, compared with only 2 out of 7 patients in the active placebo group. Symptoms of depression, global psychological function and sleep quality also significantly improved in the active treatment groups compared with the 30mg placebo group. A third, open-label MDMA dose was given to all patients after this point and the active placebo group were given the option of having two or three full-dose sessions. Following these sessions, PTSD symptoms dropped by at least a further 30% for four out of six placebo patients.

For the active-dose groups there was a continued trend towards improvement in symptoms, but a third MDMA session did not have a significant benefit. However, the improvements that patients did experience were sustained. A year later, 67% of the 24 patients who completed follow-up no longer met the criteria for PTSD and, on average, symptoms of depression had reduced from severe to minimal.

However, MDMA is not without side effects. There were 85 adverse events reported during the trial. Four occurred before drug administration and another four were serious. Of the four serious events, only one of these was deemed to be related to MDMA; a patient who had premature ventricular contraction at baseline developed an acute increase during the third session, but later fully recovered. The most frequent adverse reactions were anxiety, headache, fatigue, muscle tension and insomnia, occurring in the seven days following administration, but these symptoms did not last. Mithoefer says that the risk benefit ratio of taking MDMA in a clinical setting, where the patient is screened and monitored, is very different to the risk profile of recreational use when patients can overheat, dehydrate or take too much.

The reported side effects have not been enough to dissuade researchers. Sessa calls MDMA a “remarkable compound” with its use signifying “a paradigm shift in how we can deal with chronic mental health conditions.” He has just embarked on a phase II trial using MDMA to treat alcohol addiction, in collaboration with Imperial College London and based in Bristol, UK.

Since the end of the 2018 PTSD study, Mithoefer has been supervising preparations for the much larger phase III trial, which began officially in September 2018. Fifteen locations in the United States, Canada and Israel are participating and he has reviewed how all of the researchers administer MDMA to ensure “consistency across sites”. The EU is not currently involved but Mithoefer says that the research team is talking to the European Medicines Agency to try and understand the needs of the regulatory agency. “It’s likely to be second or third line in Europe but we don’t want this to be a requirement … we think the clinician should decide,” he says. This is partly because he hopes that when veterans come back from war they could potentially have the treatment very early, before PTSD becomes chronic.

Concerns

But widespread use in countries with government-funded healthcare could be hindered because of the amount of psychotherapy needed. The PTSD and social anxiety trials follow the same therapy protocol — after the first three preparatory sessions and the first dose of MDMA, there are a series of integration sessions to help people “identify those insights … and remember that state of mind”, says Danforth. This process is repeated after each MDMA session. But this amount of therapy raises some concerns with Alain Brunet, a clinical psychologist at McGill University, Montreal, Canada, who is not involved in MDMA research. He says that he is “pretty impressed with the results” because the treatment effect size is large and the participants had failed previous treatments, but that the method is labour intensive and hard to teach.

In total, the psychotherapists spend 16–24 hours during the two or three MDMA sessions and roughly another 10 hours in the additional therapy. “As a therapist, if you’re ready to invest 30 plus hours of treatment with a patient, you’re likely to get good results,” he says. His concern is that “from a service provision point of view you’re always looking for the smallest dose of treatment that will deliver the largest bang for the buck.”

Mithoefer says that the time involved is a “valid concern” and is going to be a challenge. But he points out that although patients improved with psychotherapy alone, it was not nearly as much as with MDMA. He adds that the researchers are already thinking about ways to reduce costs, such as through group therapy sessions. He argues, however, that despite the high upfront cost of therapy, in the long run it may save money if patients who were previously untreatable are able to come off medication and even return to work.

To illustrate this point, in the 2018 PTSD trial, 86% of patients were taking an anxiolytic and an antidepressant and 71% were taking an antipsychotic, such as quetiapine, which Mithoefer points out comes with a host of costly side effects. Lubecky’s pill count has gone from 42 down to 2; he now only takes Concerta for the traumatic brain injury he sustained in Iraq and occasionally Ambien to help him sleep.

The changes in Lubecky’s personal life have been even more profound. He says he is now a better father to his stepson and a better husband to his wife. He has also been able to go back to work doing something he loves, as the veterans and governmental affairs liaison at the Multidisciplinary Association for Psychedelic Studies (MAPS), which has funded the MDMA research into PTSD and social anxiety in adults with autism. This was something he could not do before because it involved being around crowds. His goal is that “everyone with PTSD knows that this treatment is coming and has hope and does not get to the point that I got to and want to take their life."

https://www.pharmaceutical-journal....-with-trauma/20205586.article?firstPass=false
 
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MDMA could revolutionize care for trauma, a social worker’s perspective

by Courtney Hutchison | Feb 19, 2019

In my role as a social worker and psychotherapist, I see so many clients suffering from the repercussions of trauma—experiences of abuse, neglect, and discrimination—that have left them struggling to feel safe on a fundamental level.

Healing from these traumas invariably focuses on helping these clients overcome feelings of disempowerment and disconnection, rebuilding interpersonal trust and intimacy in the context of the therapeutic relationship.

At the same time, there is growing recognition in the mental health field that we must address trauma across multiple levels: not only interpersonally or psychologically, but physiologically. We must also heal the way trauma inscribes itself on the brain and body, leaving survivors hijacked by nervous systems that vault into fight, flight, or freeze at a moment’s notice.

That is why it is imperative that social workers, and all mental health professionals, take notice when a new promising treatment comes along that seems to treat trauma across these multiple levels: the limited, adjunctive use of MDMA (3,4-methylenedioxymethamphetamine) in psychotherapeutic treatment for posttraumatic stress disorder (PTSD) presents just such a treatment.

MDMA-assisted therapy as a breakthrough treatment

Research on MDMA-assisted psychotherapy for PTSD has been growing over the past 15 years, showing remarkable success in clinical trials. The FDA granted it “breakthrough therapy” status in 2017 based on these strong results.

For example, a 2011 study found that 83% of those receiving a combination of supportive psychotherapy and two MDMA-assisted psychotherapy sessions no longer met criteria for a PTSD diagnosis after treatment, compared to only 25% of those who received the same supportive psychotherapy and a placebo.

Moreover, these studies were working with the hardest-to-treat cases—clients whose PTSD had failed to respond to other treatments, such as prolonged exposure therapy, other cognitive behavioral therapies, or pharmaceutical medications. Follow-up studies have shown that the majority of those helped are still PTSD-free nearly four years later.

These striking findings led me and my colleague, Dr. Sara Bressi, to explore the potential of this treatment, especially given the stigma often attached to MDMA as being the primary ingredient in the recreational drug “molly” or “ecstasy” (though substances found in recreational settings are rarely observed to be pure MDMA).

This article is a summary of the findings from our recent paper on this topic, including: why mental health professionals are in dire need of better treatment for PTSD, how MDMA-assisted psychotherapy works, and how important a treatment like this could be for addressing the immense burden of trauma in vulnerable communities, especially communities of color and low-income communities.

Treating PTSD is an uphill battle

For those with PTSD, past traumatic events intrude upon their daily life through flashbacks, nightmares, and pervasive anxiety and hyper-vigilance that makes it difficult for them to engage in day-to-day life, and can make it especially difficulty to talk about or reflect on their traumatic experiences.

In an attempt to minimize their symptoms, individuals with PTSD often avoid anything that could trigger them, and begin to isolate themselves from the world and others—consequences that tragically cut them off from the potentially healing effects of relationships, both within their personal lives and within the context of therapy.

Existing PTSD treatments try to reduce these symptoms in a few different ways: psychiatric medications try to change brain chemistry to reduce anxiety; exposure therapies try to de-link trauma triggers from the strong fear response; skills-focused therapies target areas such as emotional coping and interpersonal skills; other trauma-informed approaches try to create a sense of safety in session that rebuilds trust over time and extends outside of the therapy room.

Unfortunately, these treatments often have mixed results and do not meet the needs of all people with PTSD: studies in veterans, for example, show that more than 70% of those engaging in PTSD treatment do not see significant improvement.

How does MDMA-assisted psychotherapy work?

In MDMA-assisted psychotherapy, the MDMA acts as a catalyst for the therapeutic process, working synergistically with regular psychotherapy sessions. Biochemically, MDMA releases chemicals that increase a sense of well-being, enhance empathy and feelings of closeness to others, and dramatically reduce fear and anxiety.

A potentially key ingredient in this process is oxytocin, sometimes called the “love hormone” because we release it when we bond socially, when we are with people we care about, and even when we cuddle with our pets.

In a course of MDMA-assisted psychotherapy, traditional talk therapy is interspersed with two or three medicated sessions. These medicated sessions occur over 6-8 hours (the drug’s duration plus a few hours), under medical supervision, and consist of periods of quiet introspection and client-led discussion of traumatic material, facilitated by two therapists.

Non-drug psychotherapy sessions then help process and understand what came up for client while on the drug. After treatment, which generally occurs over 8-15 weeks, the majority of participants are not only PTSD-free, they report an “increased self-awareness,” “increased ability to feel emotions,” and “improved relationships in general.”

Though research on why MDMA is such a powerful catalyst is still new, in our paper we hypothesize that MDMA’s fear-reducing and pro-social affects work together to help clients tap into their capacity to heal, allowing them to engage in therapy faster and more profoundly than they could otherwise.

The fear-reducing effects help clients think and talk about their trauma without being as hijacked by flashbacks or panic symptoms, allowing them to gain perspective on what happened to them and integrate it into a larger narrative of their lives.

The pro-social effects help clients trust and bond with their therapists and “take in” the support and empathic attunement they provide—a task that is especially difficult for those who have had their trust violated through interpersonal trauma and abuse.

Moving forward: How this treatment could be a game-changer

That MDMA-assisted psychotherapy has worked so rapidly, and so effectively, in many people who have not responded to existing treatments is a powerful testament to its potential—especially for low-income communities and communities of color who disproportionately experience trauma.

At the same time, it is unclear what access to this treatment will be like for these populations. Given that people of color and low-income individuals already face the dual hurdle of being more likely to experience trauma, and less likely to have reliable access to health care, it will be essential that social workers be attuned to these potential barriers and be fierce advocates for access to this breakthrough treatment.

First and foremost, trauma survivors have experienced ruptures in trust—trust in others, in the safety of the world, and in their own inherent value. Too often, these ruptures are then tragically re-experienced in relationships with loved ones, clinicians, and institutions.

If MDMA-assisted psychotherapy, in helping clients move toward spaces of empathy and trust, can facilitate and accelerate repair of these ruptures, its use will have repercussions far beyond the treatment of PTSD symptoms.

It could enable clinicians to more readily, more consistently, and more profoundly tap into what psychotherapy at its best offers: a pathway toward more fully, authentically, and lovingly engaging with themselves and their lives.

https://psychedelic.support/resources/mdma-assisted-psychotherapy-trauma/
 
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Magic mushrooms could help ex-soldiers to overcome trauma

by Jamie Doward | The Guardian | 4 Jul 2020

As more troops self-medicate with psychedelic drugs to help with PTSD, a group of experts lobby for proper clinical trials.

A growing number of soldiers suffering from post-traumatic stress disorder are turning to “magic mushrooms” and LSD to treat their condition. But drug laws make it almost impossible to establish whether they work.

Now a new body, the Medical Psychedelics Working Group, a consortium of experts, academics, researchers, policy specialists and industry partners, is to begin lobbying for a change in the law so that scientists can conduct clinical trials.

“This is something that’s been developed by veterans,” said Professor David Nutt from Drug Science, an independent scientific body which calls for an evidence-based approach to the legislation and is part of the group.

“Three years ago if I was asked the question would psilocybin work for veterans, I would have said it would be quite dangerous to relive the trauma when tripping. But so many vets are doing it now that I’m convinced it can work.”

It is estimated that 17% of people who have seen active military service report symptoms such as flashbacks, nightmares, anxiety, depression, grief and anger.

Earlier this year a team at the Medical University of South Carolina reported on clinical trials which found that PTSD sufferers who used magic mushrooms as part of their therapy showed greater levels of improvement compared with patients who did not receive the drug.

But such clinical trials are difficult in the UK because LSD and magic mushrooms, which were legal until 2005, are classed as Schedule 1 drugs.

The classification means it costs around £3,500 for a licence from the Home Office to conduct tests using the drugs, and the application process can take a year. Scientists face prison sentences if the drugs fall into the wrong hands.

“But when ex-servicemen and women in the UK are reporting how their own use of psychedelics is having a marked effect on PTSD symptoms, we need to restart our studies,” Nutt said. “It could be that these substances can improve the lives of countless people who are suffering with debilitating and life-diminishing mental health conditions.”

Guy Murray, an infantryman with the 4th Battalion The Rifles, served on a long tour of Helmand Province, Afghanistan where his best friend and many other colleagues were killed by the Taliban. He was diagnosed with PTSD in 2017, after suffering from suicidal thoughts, anxiety and severe depression for several years.

After watching a Ted Talk about psilocybin and depression, he began experimenting with magic mushrooms, and then, under specialist supervision, was given LSD.

“It allowed me to address things which I was not open to addressing and it has honestly changed my life,” Murray said. “I believe I left my PTSD behind in those sessions. I am no longer destructive or closed off. I have my life back.”

Crispin Blunt, Conservative MP for Reigate, who served with the 13th/18th Royal Hussars, said that Murray’s experiences were common among the armed forces.

“About a third of veterans with PTSD from recent conflicts, estimated by some to be 2,400 individuals, have the condition so seriously as to be beyond recovery from current treatment practice,” Blunt said.

“We need to provide a safe, professional and lawful route of access to novel treatments such as psilocybin, collecting evidence and calling for our drug laws to be evidence based so our servicemen and women are not forced to travel to other countries, go underground or break the law to obtain treatment that works.”

 
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Psychedelic drugs greatly reduce psychiatric symptoms among special forces veterans

by Beth Ellwood | PsyPost | 27 Jul 2020

A recent study published in Chronic Stress found support for a psychedelic treatment not yet approved in the United States. US Special Operations Forces (SOF) Veterans treated with ibogaine and 5-Methoxy-N,N-Dimethyltryptamine (5-MeO-DMT) showed large reductions in symptoms of PTSD, depression, and anxiety.

Special Operations Forces (SOF) are members of the military who have been singled out for their superior “physical and psychological resilience.” Still, they are typically exposed to more extreme conditions and show psychiatric impairment similar to that of conventional forces veterans.

“Although SOF Veterans exhibit PTSD symptoms at rates comparable to conventional forces Veterans,” study authors Alan K. Davis and associates say, “they may be more reluctant to seek mental health treatment. There is growing concern of a mental health crisis and an alarming increase in the incidence of suicides in SOF members highlighting limited effective treatment methods for this unique population.”

Davis and his team conducted a study among 51 US SOF veterans who received psychedelic treatment at a clinical program in Mexico between 2017 and 2019. Over the 3-day treatment, participants were given three to five doses of 5-MeO-DMT (a psychedelic tryptamine) and a single dose of Ibogaine (a psychoactive indole alkaloid).

In 2019, the 51 veterans completed a retrospective survey that asked them to rate various aspects of their mental health one month before the treatment and one month after. The assessments included symptoms of Post-Traumatic Stress Disorder (PTSD), anxiety, depression, and suicidal tendencies. The surveys also assessed cognitive functioning, by asking subjects to report times they had felt “confused or had difficulties with reaction time, reasoning, memory, attention and concentration.”

The results overwhelmingly supported the treatment, uncovering strong decreases in reported symptoms of PTSD, depression, and anxiety following the program. There was also a substantial drop in reports of suicidal ideation and cognitive impairment, and an increase in reported psychological flexibility. In fact, participant reports of post-treatment symptoms no longer met the cut-offs for clinical diagnoses.

Moreover, when asked to evaluate the program, the vast majority (80 percent) of participants were “either very (28 percent) or completely (53 percent) satisfied with the program.” The majority even reported that the program was “one of the top five most personally meaningful (84 percent), spiritually significant (88 percent), psychologically insightful (86 percent), and psychologically challenging (69 percent) experiences of their entire lives.”

Davis and his team explain how the two psychedelic drugs may have alleviated veterans’ psychiatric symptoms. 5-MeO-DMT, they say, “demonstrates neuroprotective, regenerative, and anti-inflammatory properties” which may be effective in treating the causes of cognitive impairment and PTSD. Ibogaine may also alleviate symptoms of PTSD, by facilitating “the evocation and reprocessing of traumatic memories and occasions therapeutic and meaningful visions of spiritual and autobiographical content.”

The study has significant limitations including recall bias, lack of clinical assessments, and an uncontrolled design which did not allow for a placebo. However, the compelling results lead researchers to call for future controlled studies to verify the effectiveness of ibogaine and 5-MeO-DMT in treating veterans with psychological difficulties.

The study, Psychedelic Treatment for Trauma-Related Psychological and Cognitive Impairment Among US Special Operations Forces Veterans, was authored by Alan K. Davis, Lynnette A. Averill, Nathan D. Sepeda, Joseph P. Barsuglia, and Timothy Amoroso.

 
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Cultivating Inner Growth - The inner healing intelligence in MDMA-assisted psychotherapy

by Psychedelic Frontier | 11 Jan 2019

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

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

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

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

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

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

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

The results of MAPS’ first completed study of MDMA-assisted psychotherapy for chronic, treatment-resistant PTSD highlight the impact of the therapy alone. After two eight-hour experimental sessions, 25% of participants who received placebo had a greater than 30% drop in their PTSD symptoms (measured by the Clinician Administered PTSD Scale [CAPS-4]) and no longer met the diagnostic criteria for PTSD. While the sample size was small, this is a considerable change in response to the therapy modality without MDMA. By comparison, the MDMA experimental group had a much higher response: 83% of participants who received MDMA had a greater than 30% drop in CAPS, and 10 no longer met diagnostic criteria for PTSD.

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

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

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

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

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

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

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

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

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

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

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

Shannon Clare Carlin, M.A., received her Master’s Degree in Integral Counseling Psychology from the California Institute of Integral Studies in 2014, including a practicum working with youth on moderation management for drug and alcohol use. At MPBC Shannon serves as Associate Director of the Training & Supervision Department, overseeing administration and program development to educate professionals and researchers to provide MDMA-assisted psychotherapy for PTSD in approved settings. Shannon is also committed to psychedelic harm reduction, and continues to provide integration services through the Zendo Project. Shannon served as co-therapist on the MAPS-sponsored Phase 2 trial researching MDMA-assisted psychotherapy for anxiety associated with life-threatening illness, and will be a co-therapist at the Phase 3 site in Los Angeles, researching MDMA-assisted psychotherapy for severe PTSD. She can be reached at [email protected].

*From the article here :
 
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Positive effects of medical cannabis on trauma reported*

by Zachy Hennessey | The Jerusalem Post | 16 Feb 2022

Next to therapy, medical cannabis may be the best thing for post-traumatic stress disorder (PTSD), according to a recent clinical trial conducted by Soroka University Medical Center and Israeli medical cannabis company Cannbit-Tikun Olam. The study was conducted over several years with the goal of evaluating the safety and efficacy of treatment using medical cannabis.

The results of the trial were considerably positive. Notably, a number of cannabis-medicated patients stopped or reduced their dosages of opioids (by 52 percent), anti-psychotics (by 37 percent), anti-epileptics (by 36 percent) and hypnotics and sedatives (by 35 percent). Overall, over two thirds of patients reported at least moderate improvement with no serious side effects, with 90.8% of treated PTSD patients being classified as therapeutic successes after six months.

Other benefits included a huge decrease in rage attacks, restlessness, nausea and sleep disturbances. Nearly half of the patients reported that their quality of life had improved during the time of treatment.

Of course, as anyone who’s spent a smoky night wondering if they were being watched should suspect, there were reports of side effects such as dizziness, the munchies, sleepiness and feeling high (which medical cannabis isn’t meant to cause) – though each of these side effects were only experienced by a single-digit percentage of users.

The study focused on 8,500 male and female Israelis, averaging 54.6 years old, using cannabis strains developed by Cannbit-Tikun Olam.

“In the past, we already demonstrated that treatment with medical cannabis products relieves symptoms and improves quality of life for patients,” said the company’s head of R&D, Lihi Bar-Lev Schleider. “This is the first time that in-depth, organized and systematic analysis of a large amount of data on a very large group of patients was performed, and in which, without bias, the effect of the treatment for various indications was examined.”

In December last year, an exclusive and mutual collaboration agreement was signed by Cannbit-Tikun Olam and Teva Israel, wherein the former’s products will be distributed by the latter throughout Israel and the Palestinian Authority.

Teva Israel CEO Yossi Ofek said, “The medical cannabis arena is developing and being professionalized at a dizzying pace in Israel, and there is more openness to it in Israel and worldwide."

“Today, it is clear to many in the pharmaceutical industry and in the medical community that the use of oils produced from specific cannabis strains may provide additional treatment options and respond to unmet medical needs of patients. I have no doubt that the medical cannabis oils Cannbit-Tikun Olam produces – according to Teva’s high quality and safety standards – will help us realize our goal of improving the lives of patients.”


*From the article here :
 
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Tim-Ferriss-Healing.jpg



My Healing Journey after Childhood Abuse, part 1

by Tim Ferris

Tim Ferriss: For me personally, this is the most important podcast episode I’ve ever published.

It’ll describe the most life-shaping, most difficult, and most transformative journey of my 43 years on this planet. This is a journey I’ve certainly never shared publicly before. To give you an idea, most of my family and closest friends know nothing about it.

I believe this episode is relevant to almost everyone. If you haven’t experienced trauma, you will meet people who have, and you may already know people who have (including friends or family members who simply haven’t told you).

Please do note, however that this episode is not suitable for children.

All that having been said, my dance partner and safety net in this conversation is my friend Debbie Millman. Here’s her formal bio:

Debbie (@debbiemillman) has been named “one of the most creative people in business” by Fast Company and is the host of Design Matters, one of the world’s longest-running podcasts. She is also Chair of the Masters in Branding Program at the School of Visual Arts, Editorial Director of Print magazine and has worked on design strategy for some of the world’s largest brands.

But all that’s not why I asked her if she’d join me. I asked Debbie because she’s a dear friend, we have a lot of shared experiences, she’s an excellent interviewer, and she’s been an incredible support for the last few years, including some late-night emergency phone calls.

Last but not least, she and I have experienced similar trauma but have taken two very different paths to healing using very different sets of tools, so you get a two-for-one deal.

This conversation was fucking hard for me. And I could have deleted some of the stammering and struggling— but I chose not to. Because that would have been fakery, and I wanted to share the emotional struggle in its rawness. This stuff isn’t always easy, and it can be messy, but it is possible to get to the other side.

Please listen to the whole thing, as the lessons, tools, and resources that have helped us are scattered throughout, including an especially dense last 30 minutes.

Just a few more notes and then we’ll get into it:

First, to those who know me and who might reach out, please note that I expect to be overwhelmed — emotionally and otherwise — when this is published, and I sincerely ask for your understanding if I’m not able to reply to any outreach. It’ll be a very challenging week for me, and probably a very challenging month. Thank you for understanding.

Second, this is — and we are — a work in progress. Debbie and I both reserve the right to change our minds about how we think and feel about everything.

Third, and a very important disclaimer: We are not therapists, we are not doctors, so this is not intended in any way as professional or medical advice. This is for informational purposes only. It’s just two people sharing their personal stories and perspectives.

As Debbie put it in this episode:

“I think it’s really important for people to understand that their path to healing is very much their own path to healing, in the same way that everybody has their own path to love, or success, or family.”

And everything mentioned in this episode, and many more things that might help, are available in one place at: tim.blog/trauma


OK, here we go…


***

Tim Ferriss:
So Debbie, first of all, you are the sweetest of sweethearts. Thank you for doing this with me. I know that you’ve been a trusted companion for quite a long time, with respect to many of the things that we’ll be talking about. And it really means the world to me. So thank you.

Debbie Millman: My honor, Tim, truly, truly.

Tim Ferriss: So I don’t think I’m going to bury the lede, as they say, in journalism with this conversation. I’ll start with the statement and then we can work around that. So the statement is and the opening is that I was routinely sexually abused from ages two to four—that seems to be accurate based on conversations with my mom about the timeline—by the son of a babysitter.

So if you imagine sort of the most disgusting, repulsive activities that you might envision with that statement, that is what happened. And I don’t know if it was on a weekly basis. I don’t know if it was multiple times a week, but it was frequent over a period of two years. And I want to speak to why I’m recording this podcast and discussing this with you now. So I’ll tackle the why with you first. And that is because you really inspired me when, seemingly, 100 years ago on my podcast, after I noted before our conversation that you seldom spoke about your childhood, you opened up and spoke about your own abuse that you suffered through. And it was such a courageous act and helped so many people. And my intention has always been to talk about this chapter, I’d say, over the last five or six years, at least. That’s been my intention and I’ve wanted to put it into a book that tracks my healing journey effectively. And had a conversation with my girlfriend, perhaps six months ago.

And this was just as COVID was beginning to set in. This was probably early February, mid-February as global news. And I had fears around my mortality due to respiratory issues, comorbidities. And I’d also done work in therapy that involved asking the question prior to that: If you were to say you are going to die tomorrow, what would you regret having not said or not done? Alternatively, if you knew you had a year left in perfect health and then you would die a year from now exactly, what would you do in that year? And at the very top of the list was talking about the sexual abuse. And my girlfriend made an observation as we were talking about plans for the book, which was, if the book takes three years, there may be people who are no longer around in three years through suicide or natural causes who could benefit, who might benefit from speaking about this openly.

So that is why I decided to record this. And as we’re recording this, I don’t know if I’m going to release it or when I will release it, but to at least have a record. God forbid something were to happen to me, I would really regret not having spoken about this. And the intention is hopefully to show that it is possible to find some light, actually incredible amounts of light in the darkness and that there are tools available that really do work and help. And Debbie, it’s been a rollercoaster in the last, say 36 hours as I’ve been appreciating the realness of having this conversation with you because old coping mechanisms have started to crop up. Like even last night, I was talking to my girlfriend about this and I started to dissociate. My mind started to separate itself from my body so that my body could withstand whatever it needed to withstand.

And for those people that don’t know what that means, you can induce it with something like ketamine, certainly I don’t recommend that, but it’s a dissociative anesthetic. And it’s a very odd experience to describe to someone who hasn’t experienced it. Thankfully, most people haven’t, but it’s almost like your consciousness, the locus of your awareness, moves outside your body so that you’re not subject to what your body will experience or suffer through. And that’s been happening over the last 36 hours as I’ve been preparing for this conversation. And I’m just going to keep going. For a very long time, up until age 35 or so, I felt like I had no memories before age six or five. And this type of amnesia actually showed up a lot for me in the sense that whenever I had a very stressful set of circumstances, a crisis of some type, a severe injury. I would experience this dissociation and I would black out my memory for the next, let’s just call it two to five hours would disappear. I would have no recollection of what happened.

And I didn’t have any memories I could recall or did recall about this abuse until five or six years ago when I had a number of experiences with a psychedelic combination of plants called ayahuasca. And for more on that, we can refer people to other podcasts where I’ve talked about this, but at the time, let’s just call it five years ago, for sake of simplicity, the memory came up—and psychedelics are well known, not necessarily in the scientific literature, although there are some recordings of this, but more anecdotally across thousands and tens of thousands and millions of users over time, hypermnesia. So the opposite of amnesia, remembering things that you haven’t thought of in decades—the color and texture of the corduroy couch you had when you were an infant, that type of thing—and about five years ago, I would say, I had these crystal clear memories of sexual abuse come to me. The layout of the house, the other kids who were being cared of, so to speak, at the house. What the mother looked like, what the son looked like, being led up the stairs to the upstairs bedroom, the floor plan of the house. I know exactly where the house is. I know the driveway, I know the names, these are all things that I know. And it came flooding back to me. And at the time I thought to myself, “Huh, that’s interesting. That definitely happened. I remember that happening.”

And it came back to me in high resolution, but I didn’t feel any suffering associated with it. And I tucked it away, I put it back in the box, locked the box. And that was that. Until I had my first 10-day Vipassana silent retreat. And thankfully, had Jack Kornfield there as one of the lead facilitators. And to increase the depth of the experience, I’d fast beforehand. So it was fasting for about five days. And then began to use increasing dosages of psilocybin mushrooms, which contains psilocybin. So I started at 300 milligrams, went up to 600, and ultimately landed at 900. And I want to say around day six of this silent retreat, all of this abuse came back to me like a tidal wave. And it was replaying as if I were wearing a virtual reality headset.

I was immersed. I wasn’t an observer. I was actually being traumatized and re-traumatized 24/7 for this period of time. Any moment that I was awake, this movie was playing and I would sweat through my sheets at night, fall asleep for an hour or two, then wake up to go back into meditation and the movie would start again. And I was so distraught. There was so much anguish. And I felt like I was either already having a psychotic break, or certain to have a psychotic break and that I would not be able to manage life when I left the silent retreat that I sought out Jack as an emergency to spend time with him and speak with him. And he really saved me. He was the safety net. So I owe a huge debt of gratitude to Jack, who is not just an incredibly adept mindfulness practitioner, but also a clinical psychologist. And he’s worked with many, many, many different types of trauma, that’s victims of sexual abuse, you name it, very broad spectrum.

So I really owe him huge thanks. And it was at that point after that that Jack made a number of recommendations for resources that we’ll talk about later, but included books by Peter Levine, like Waking the Tiger, The Body Keeps the Score by Bessel van der Kolk and a handful of other things.

It was at the tail end of that retreat that I realized these, let’s just call it 17 seemingly inexplicable behaviors of mine, these vicious cycles or triggers that I had been treating like separate things, separate problems to be solved, were all downstream of this trauma, if that makes any sense. I don’t know if you’ve had this experience, but I was like, “Oh, now that you click that puzzle piece into place, these really strange behaviors, this self-loathing, this rage that was seemingly so exaggerated and disproportionate, leading to the near suicide in college, which was as close as you can get to taking your life without actually doing it. All of these things fell into places making sense. And on one hand there was this relief that it made sense and that I wasn’t broken in all these different ways. I had just sort of suffered this acute trauma and blocked it.

And it was also very overwhelming because I didn’t necessarily know how to work on this root cause, this trauma. And that’s when the direct work began. I cleared everything in my calendar and everything waited, everything that could wait, waited. And these memories at that point had started to trickle up to awareness. And I’ll just give another example that I’ve never spoken about publicly, which is in elementary school, feeling numb and priding myself on pain tolerance. This ability to dissociate and for whatever reason, really—well, for obvious reasons I guess, wanting to develop the ability to withstand pain. And for a very short period, I would bring this pocket knife to school and press it into the back of my left thumb, I remember this really clearly, until my thumb would start to bleed and then I’d move it a millimeter or two and then press it into my thumb and make it bleed. And do this over and over again without changing my facial expression. I’m in class, I’m sitting in math class doing this, looking at the blackboard tracking things.

And fortunately for me, after a short time of doing this, scared myself by doing it and stopped. But it didn’t strike me as particularly strange at the time. And—

Debbie Millman: Yeah. You were relieving pain. You were using that as a way to be able to release some of your trauma without even knowing it.

Tim Ferriss: I certainly think that could well be the case. And part of the reason that I’ve held off on this conversation also is that for a long time, after the realization, after ayahuasca, felt like this did not affect me, that it was a bad thing that happened, but who am I to complain? I discounted it because of all the other blessings and privileges that I have in my life, and assumed that I could put under lock and key. And after the silent retreat and this, let’s just call it a psychotic break, which is really what I think it was, whether it’s a breakdown, or a breakthrough, or both, we could debate, but I realized that whether you’re dealing with it directly and putting it in front of you as the task that hinders all other tasks and prioritizing it, or you are not dealing with it but it’s creeping out through the corners and affecting you in ways that you may not even be aware of, you’re dealing with it whether or not you choose to deal with it.

Debbie Millman: Exactly.

Tim Ferriss: And so I began working, this is a few years ago, on compiling this book on healing. And I’m very fortunate in the sense that this sexual trauma never seemed to affect my sex life, my sort of vitality in sex. It was one of the few places actually that I felt integrated and felt, period. Where I actually felt deeply without dissociating. And so I started working on this book, the healing book. And I was writing this chapter, drafting this chapter on the abuse.

And part of the reason it’s taken us so long to have this phone call is because I’ve been afraid of it. I wrote this chapter, this draft, and it totally fucked me up. I didn’t expect it would because I’d felt so invulnerable. But the day after I started drafting it, completely lost my sex drive, basically lost sexual function, any interest or ability related to sex just disappeared. And that scared the shit out of me. And fortunately that’s not—that complete paralysis hasn’t continued, but I’ve been very concerned about taking this one oasis of feeling that I’ve had consistently and fucking it up by talking about this stuff.

Debbie Millman: Well, that’s something that’s more the case than I think a lot of people talk about. I think that having any kind of enjoyment sexually after long-term abuse is really rare. And it’s not surprising that you would have that response. And I’m really happy to know that you’re able to—that that’s improved since that experience. It’s been a lifelong process for me. And one that I’m still on to sort of re-engage from that first disassociation, which for many people that disassociation is really what saves a person’s life, because you couldn’t actually integrate that level of trauma at that young age. You’d have had that psychological break then and likely never recovered.

Tim Ferriss: Totally. And I was chatting with a friend of mine before this call and I haven’t spoken to many people at all about any of this, but he also suffered quite a lot of trauma. And he said something to me, which I’ve also thought quite a bit in the last few years. And that is your childhood adaptive responses are perfect, that dissociation in a way is a miracle of evolution. The fact that we develop this ability to split our psyche, compartmentalize to survive, is really miraculous. And there just comes a point, at least for me, where these old adaptive coping mechanisms have outlived their usefulness. And that’s been a huge part of my journey. And telling my parents was also extremely difficult. I was worried about destroying them in a way, if that makes sense.

So my intention had been with this book to wait until they passed, to wait until they died to release this so they wouldn’t blame themselves for everything. And what I realized was that was too demanding for me as a burden. And I decided to have the conversation without any expectation of any response, but simply to give voice to it in a way that would hopefully free me from the weight of that being constantly on my mind, on my subconscious. And I figured I could probably speak to a few of the things that I’ve found helpful. And I’d love to hear from you as well, but perhaps you could speak to—because you’ve been sort of immersed in the therapy and treatment and sort of trauma mitigation side of things for much longer than I have. Could you speak to how common this type of sexual abuse is?

Debbie Millman: Yeah, absolutely. Well, first I just want to say that I love you, Tim. You are such a good, good man—

Tim Ferriss: Thank you, Debbie.

Debbie Millman: You have such a big heart, and a big brain and just so much generosity. And it’s just an honor to be talking to you really. And I feel very privileged to be able to have this conversation with you and if it does get released, I just I’m feeling just so grateful about the possibilities that it’s going to have to help so many people that need it. Sexual abuse is one of the most common traumas in the world. One in three women by the time they’re 18 will have been sexually assaulted in some way. The numbers that we know now are one in six boys, but given how much shame is associated with boys actually disclosing, my suspicion—and quite a lot of clinical psychologists’ suspicions—is that it’s much higher.

I don’t know why there would be any difference, frankly. But that’s a lot of people. That’s a lot of people, that’s a lot of young people. And we as a species have so much shame associated with this behavior that has been socialized, that somehow it is the victim’s fault. Just think about what rape victims go through when they report, how much they have to defend the believability of their story or what they might have done or not done to contribute. So you can only imagine how much shame there is for young people that don’t know what is happening to them or why it’s happening to them. So it’s pervasive in our world. And it is one of the most devastating behaviors that someone can enact on another at any age. If it happens before the age of 10, because we’re all still developing our brains, it changes the neural pathways in our brains to such an extent that the behaviors that I know we’re going to talk about that you’ve struggled with and that I’ve struggled with are just a normal way of responding once that kind of trauma occurs.

And for me, my trauma began, my sexual trauma began when I was nine years old and continued until I was 12. And it was something that my stepfather did to me. This was back in the early, early ’70s. And we didn’t have the conversation about sexual abuse that we do now. And I didn’t know that it happened to anyone. I thought I was the only person in the world it was happening to. And I was told by my stepfather that if I told anybody he would kill my brother and my mother. And because he was so much bigger and stronger than me—anybody at that age could have been bigger and stronger than me, any adult—I believed him. And so I didn’t tell anybody. After it happened, after my mother and he ended up divorcing—and there’s a lot of stories around that we don’t need to get into, but my abuse was a part of it, but not something that was known to the degree that it occurred.

And then after that, another partner of my mother’s also abused me. But I didn’t think that—because I didn’t know that it had happened to anybody else when I was a little girl, I didn’t know how to understand it. The only way that I ultimately found out that it was happening to anybody else was through the Ann Landers advice column in Newsday, where I was living on Long Island. And would read Dear Ann Landers every day. And one day somebody wrote in about being abused and I cut out the article and put it under my mattress because suddenly I felt like I knew somebody else that it was happening to. It wasn’t just me. I wasn’t a freak.

And when I got older, talking 15, 16, 17 years old, at that point, I thought, “Well, I’m not going to let this impact me. I’m not going to let him win my life. I’m going to try to have the best life that I could have.” Not realizing at that young age, as you’ve mentioned, the body keeps the score. You cannot outrun your own psyche. It is not possible. It is just not possible.

Your psyche is too strong to just take those experiences and sweep them under a rug and never ever look at them again. They come back. And they came back to me in really sort of a significant way when a friend of mine died of AIDS in 1990. And he wanted to live so badly and I was 29 or 30 and feeling like I didn’t want to live. I knew that I couldn’t kill myself, but I didn’t want to be living. And the fact that he wanted so badly to live and died really for the first time sent me into significant therapy, everyday therapy for three years. And then I’ve been with that same therapist now since then. So we’re going on 30 years of therapy with the same doctor. Now I go twice a week instead of five times a week, but it’s been consistent for that entire three decades. And she saved my life. She saved my life and that work we did saved my life. But back to my experience with you, I still, up until 2017 or 2018, when I was first on your show, I was very, very secretive about my past. I still felt an enormous amount of shame. I still felt that it made me damaged goods. I was not really willing to discuss it with anyone at any length, beyond my closest, closest friends and partners. And I hadn’t even talked about it at length with my family who didn’t really seem to want to know. I had already started working with the Joyful Heart Foundation with Mariska Hargitay, who’s the star of Law & Order: SVU. And in the Q and A on my bio on the Joyful Heart website, I made a fairly innocuous statement which was that I felt that being part of the organization made my life make sense because I was helping to eradicate sexual violence, because I was working to communicate that the rape kit backlog was something that needed to be eradicated. You’ve read my bio.

Tim Ferriss: What is that?

Debbie Millman: The rape kit backlog is, whenever anybody is raped now in this country, when they report it, they go to the hospital, and they undertake what is often a multi-hour, often up to 10 or 12 or 14 hours rape kit, which is where all the DNA evidence is collected. So under your fingernails, hair clippings, your entire body is essentially, is evidence. And so you undergo just a forensic cleaning where everything is taken, all the fluids, every bit of DNA is collected, put into a kit, tested to be able to see if any DNA is already on record for other rape victims. And for many, many decades, there’s been backlog where those rape kits are processed and some of them were in storage, and there’s been hundreds of thousands of rape kits that have been destroyed because they weren’t in the correct storage, or they were in buildings that were unclean or unsupervised.

So the Joyful Heart Foundation is working now, right now their main function is to work to eradicate the rape kit backlog in this country. Mariska Hargitay made an Emmy-winning documentary about it, I Am Evidence, which is about the backlog and eradicating that backlog. But you, Tim, when you were in preparation for our interview, you found that little bio of mine on Joyful Heart’s website and asked me why working with the Joyful Heart Foundation made my life make sense. And in that moment, I had to decide: do I disclose to Tim’s millions and millions of people that are the listening audience, or do I lie? And I just took one step into the future and told the truth. And that changed my life. Because once you tell the truth, a couple of things happen.

First of all, you realize that you’re not ostracized by the people that really love you. You are not shamed by speaking your truth and people do believe you. Now that’s not the case with everyone, but it was the case for me. And I felt as a result of that experience, my life was fundamentally, irrevocably changed. Where I am now, someone that has this experience is part of who I am, but it’s not hidden, and it’s not ugly, and it’s not loathed. It’s just part of who I am now, part of my story. I’m still going through a lot of things and we can talk about that too, and the reintegration, and everything that goes along with it. But the idea of hating myself because of this happening, because of what it meant about who I was intrinsically has fundamentally changed just by the sheer virtue of speaking about it in a public way that isn’t hidden anymore. So thank you for that.

Tim Ferriss: You’re so welcome Debbie. And I feel so grateful for you having done that because the ripple effect in some ways of that for me personally, is having this conversation with you.

Debbie Millman: Yeah. And I have to say that not a week goes by where I don’t hear from somebody that’s listened to that episode and said, “Thank you. That episode changed my life.” And I just want to thank you, and I’m just overwhelmed by being able to do that for anybody. But it is a journey and for me it’s been a 30-year journey, really more because I did have a good therapist prior to seeing the doctor that I see now, that I’ve been seeing for the last 30 years, but it just wasn’t enough. I needed more clinical help than she was able to provide, and the doctor that I’ve been with since has that experience. And it’s been talk therapy, it hasn’t been aided by various other remedies that I’ve actually been thinking quite a lot about.

But because it’s talk therapy, talk therapy’s an investment, it’s really slow. And maybe it’s slow for a reason because you can’t necessarily integrate as much. Three days ago while talking with my wife and my cousin, had a major realization just like in the midst of a conversation, holy shit! So those things happen just because of doing that work for so long, but there’s no way to predict when those breakthroughs are going to happen.

Tim Ferriss: Yeah. I’d love to also take a moment just to say for people listening, who either know they have suffered abuse or trauma, right? It doesn’t have to be sexual abuse, but some type of trauma, capital T, or little t. Number one, it’s highly individualized. You can have two veterans who are in the same foxhole in wartime who respond completely differently. So there is no sort of objective scale of, or descriptor of events that qualify as trauma or non-trauma. But I’ll speak specifically to people who have suffered sexual trauma. And I’ll say a few things. The first is, and I feel this way about you Debbie, that as someone put it to me once, you have made your trauma part of your medicine. Meaning that you have the ability to empathize and deeply feel other people. And let’s face it, I mean, that’s somewhere between like one-sixth and one-quarter of the world’s population if not more. You have the ability to empathize and resonate and potentially help people in a way that you would not possess had you not gone through what you went through, if that makes sense.

Debbie Millman: Absolutely. Absolutely.

Tim Ferriss: And so for me, reframing it as to say a gift may be too strong. And I don’t want to paint it unilaterally in that way, but to be able to turn the perspective so that you can see how you can wield it for good as opposed to be contorted by it as a passive experience, it is possible to use this, I think, as a superpower of sorts, to really help other people. And for me, helping other people heal has helped me heal and working on your own healing in turn helps you to help others to heal. So it is a virtuous cycle. It has been at least for me, and I really want to underscore for people listening that, right now in my life I have more light, and joy, and compassion, and feeling of safety and security and optimism than I’ve ever had in my life. And that is for me at least a product of being blessed to find, and also having discovered different tools that have been exceptionally, exceptionally helpful, and certainly having someone, in my case, Jack Kornfield to act as a safety net.

And so I want to, before we discuss some of the things that have helped, because I’d really like to, to offer people some tactical recommendations, and I will put this in the show notes. Everything will be in the show notes for the podcast, and I’ll also create a short link, which is tim.blog/trauma with resources. Neither Debbie nor I are medical professionals so I have to say that, but we can share what has worked for us and been helpful. I would say that for me, deep immersive experiences, and I can speak to different modalities, have been critical in remembering, remembering in the conventional sense, what happened and also re-membering, right? Piecing back together these parts of myself in ultimately, a really integrative and beautiful way. I mean, certainly more beautiful than viewing myself as a broken toy, some flawed object that was loathsome.

And when you have any of these deep, immersive experiences, or perhaps even if you do talk therapy, things can come up very strongly that you may or may not be ready for. And for that reason, I was just lucky, very lucky that I went into this 10-day silent retreat and certainly augmented it with all of the various intensifiers. And what I had done in retrospect was I got on a trapeze without checking the net first. And I was just fucking lucky that Jack happened to be there pulling out the net as I was losing my grip. So I think it’s extremely important before you go into any intense, potentially intense or immersive therapy, or experiences, that you have someone who is in your corner as a safety net, who has experience with handling ideally the type of trauma that you suspect you’ve gone through, possibly went through and who is comfortable handling crisis situations. At least that’s my perspective, because if I had not had that, honestly, I don’t know what would have happened.

Debbie Millman: Yeah. I agree. It’s absolutely critical to have people that you trust in your life that can catch you if you need to be caught.

Tim Ferriss: Yeah. So I’d love to just list off a few of the things that I found particularly helpful in the toolkit. And not to imply that these will resonate for all people, but first I’ll recommend books. And these were recommended by multiple people. There are a few, The Drama of the Gifted Child, which is really the drama of the sensitive child. And I discussed that with Gabor Maté on my podcast with him at one point, or rather he discusses it. Waking the Tiger, which is Peter Levine, The Body Keeps the Score, and a lot of these relate to what Peter might call somatic experiencing since at two to four, in my case, I’m not cognitively creating spreadsheets and pro and con lists, and over-intellectualizing. It’s like a very psycho-emotional and physical experience of trauma. And in my case at least, tools that approach it from that angle have been very helpful, including psychedelic medicine work, which I’ll touch on in a moment.

On the non-psychedelic side, Internal Family Systems, something called IFS and this is one form of what might be referred to as parts work. The creator so to speak of this is Richard C. Schwartz, and the use of IFS in combination with the performance-enhancing drugs of trauma work, which I consider psychedelics such as psilocybin, or we might call an empathogen like MDMA, and I’ll come back to that. IFS looks at the mind, and I’m simplifying here, as a set of discrete sub-personalities. So you can, in the course of this type of talk therapy, have a conversation with anger, like the part of you that is deeply angry. You can have a conversation amongst these different parts, the part of you that is ashamed, the part of you that is resentful, the part of you that is sad. And you can recognize and fully feel these emotions in a way that was not accessible to me otherwise. And this type of parts work is actually very well implemented by an organization called MAPS, maps.org, in their use of MDMA, which is going through phase three trials right now for MDMA-assisted psychotherapy for posttraumatic stress disorder.

So for those of you who are familiar with my support of psychedelic science and have wondered about the missing piece, this podcast may explain one of those pieces. Few other things non-pharmacological that could be of help to people, Hakomi therapy, H-A-K-O-M-I, and I should say two incredible practitioners of parts work who have done incredible work with MAPS are Michael and Annie Mithoefer. I’ll link to these names in the show notes. Hakomi therapy, H-A-K-O-M-I, which is something that I found very helpful for learning to feel again, after a lifetime of numbing and dissociation. So as a kid who is in retrospect, very, very, very sensitive, all of what happened was just such an utter assault on my senses that it obliterated my capacity or desire to feel anything. And it’s been a process to relearn how to feel, and to embrace that sensitivity as a gift and not just a liability. So Hakumi therapy. In terms of couples work, so they’re helping my partner, my girlfriend, to better understand how this has affected me.

Imago therapy, I-M-A-G-O has been very, very helpful in effectively explaining how silence or feeling a necessity to self-censor or not speak truth leads me to feel ashamed and dirty and damaged, that I have a very strong need to be able to speak truth. And the cost is very high if I don’t. So any type of self-censoring that feels like silencing. If I feel like I need to withhold, or avoid giving feedback, and I don’t always have the most Nonviolent Communication style. So Imago therapy has been very helpful, as has studying Nonviolent Communication, which people can find quite easily. Just a few more things, and again, I’ll put these all in the show notes. Recently, and this is just in the last few months, two things. One is HRV training, that’s heart rate variability training, which I’ve been doing with Dr. Leah Lagos, who is an incredible practitioner. And this involves tracking your heart rate and respiration using feedback devices and working through your physiology.

In my case, I’m hyperreactive to any type of stressor. So I have a panic response, given my history, and there are other types of trauma that I’ve experienced. I was very badly physically bullied up until sixth grade. School was absolutely terrifying for me for a long time. That plus sexual trauma, plus other things, have led me to be very cardiac hyper-responsive. Even a minor disagreement or a loud noise can send my heart rate to a hundred plus beats per minute, where it will stay for hours.

Debbie Millman: And that is a very common response, Tim. I have that as well. And a lot of people that have experienced sexual trauma also have that overcompensation in some ways.

Tim Ferriss: Totally.

Debbie Millman: Responding to stress, fear, nervousness, the unknown, all of that triggers a much more robust chemical response in our bodies.

Tim Ferriss: That certainly squares with my experience over decades. And this HRV training has been very surprisingly effective. And what I like about it is that it’s turning the more common paradigm of working through words, and your psychology, to down-regulate your physiology. It’s working on physiology first. It’s saying, let’s reverse the arrow of causality and let’s work on physiology to change your psychology. And that’s been a real epiphany for me and has helped me to realize when I’m projecting, dissociating, has been a real revelation of sorts. So that’s a new addition but it’s been very powerful. And in combination with advice from a podcast guest, actually Jim Dethmer, who’s just incredible and part of The Conscious Leadership Group, who has helped me to utilize a lens that I think can be very pragmatic. And I do have part of me that’s skeptical of the Enneagram, but there are many people I respect. Tobi Lütke, CEO of Shopify, or, I could go through a very long list of names people would recognize, who used the Enneagram for preventing conflict and just greasing the wheels of interpersonal communication.

There’s a book called The Complete Enneagram by Beatrice Chestnut. And I’ve been very skeptical of the Enneagram because it reads to me often like a horoscope of sorts, like astrology. Nonetheless, I was typed, and this came after an interview with someone who’s qualified to do this as a what’s called a self-preservation six, and there are other aspects to this, but it so well captures the hypervigilance and fear-based orientation that I’ve had my whole life, towards the world and towards myself quite frankly, that it has been an incredible compliment to the HRV training.

And I would say the performance-enhancing drugs that have been layered on top of a number of these and that are also incredibly potent in and of themselves are MDMA, psilocybin, and ayahuasca. For purposes of this discussion, because ayahuasca is a very big gun and people can be knocked sideways and destabilized in a way that can last days, weeks, months, in some cases, years, I’ve seen this, so I do speak with some confidence about this. I’m not going to discuss that as a tool, but certainly MDMA and psilocybin. MDMA, which can be thought of as an empathogen compound that elicits openness, compassion, decreased fear response, self-empathy. Empathogen, a generator of empathy has been designated, has been given breakthrough therapy designation by the FDA is being used very successfully to treat people with PTSD that has been unresponsive to treatments for 15 to 20 years. So anyone who is interested in that, I highly recommend looking at maps.org.

And psilocybin, which is thought to be the psychoactive component at least for our purposes in psilocybe mushrooms can also be synthesized, which is being studied for treatment-resistant depression and many other conditions, opiate addiction, nicotine addiction, which is being studied at places like Johns Hopkins, which I support, Imperial College London, which I support, and NYU also. Many other places. But those are two tools that when used responsibly with proper facilitation have been literal life-savers for me also. And I will say they’re very, very powerful compounds, not to be taken lightly and that are currently Schedule I. So that means they are, generally speaking, not available for legal consumption. There are countries in the world where that differs, but I want to make sure that the caveat is clear. These are very powerful and what someone might consider if they want to crack the door open to non-ordinary reality in a way that might provide insight into difficult-to-retrieve memories, or simply to explore that terrain. There are different types of breathwork, like holotropic breathwork that can be helpful without any chemical agents to begin to explore this terrain.

And even without any type of compound, any type of ingestion of plant medicine or synthetics, these can bring up very powerful experiences that require the safety net I referred to earlier, having a therapist of some type. I’m still a fan of cognitive behavioral therapy, like I mentioned IFS, Internal Family Systems. There are a few that I have personally found very helpful. I think somatic experiencing has a role to play à la Peter Levine. And I’m going to stop there because that’s quite the list. And anyone who is interested in how I might sequence psychedelics, specifically breathwork et cetera, should listen to my Blake Mycoskie interview separately. But Debbie, I would be really curious to hear what you recommend when people reach out to you, say in a very raw place where they’ve realized perhaps that they have this trauma that they need to deal with it but they don’t know what to do. What do you say?

Debbie Millman: I say a lot of the things that you’re saying about being able to engage with a therapist that will help you through your journey. Now, everybody has their own journey to take. Some people will want to do things that are more conventional and make them feel safer. Some people have a much higher tolerance for risk or the uncertainty of an experience’s outcome and will be very comfortable engaging in more alternative paths. And I think it’s really important for people to understand that their path to healing is very much their own path to healing in the same way that everybody has their own path to love, or success, or family. So that is something that is really personal. I think offering these types of alternatives for people to consider is a gift so that people can really investigate what they’re most comfortable experiencing and undertaking.

For me, when I first started my journey, I was desperate for help. And through a friend, she recommended a therapist and for the first six years of my therapy, and that was in my twenties prior to engaging with the doctor I have now, I was doing group therapy, I was doing individual therapy, I was doing some family therapy. It wasn’t as rigorous as what I ultimately went towards, but I actually don’t think I would have been ready for a five day analysis, which is what I first engaged with, relational therapy, had I not had that prior six years of beginning to reveal who I was, and why I was who I was. So for me, that six years of less medical therapy, I guess that would be the way to put it, was really beneficial to me. And then in 1991, when I started my therapy, the kind of therapy I’m in now, that started as five days a week, then four, then three, and now two.

Tim Ferriss: How long did you do the five days a week before you went to four, and how long the four days a week before you went to three? Just guesstimate it.

Debbie Millman: Yeah. Absolutely. I did five days a week for three years and I did it on my lunch break. I actually found a therapist very, very serendipitously that was within walking distance to my office at the time and did that—walked to therapy and then walked back to work. And so it was a 45-minute session, so my lunch break was an hour and a half. And I did that for three years. It was enormously expensive. I was completely broke as a result. It took all of my resources to manage this, but it saved my life. And so when people talk about the cost of therapy, I like to think about it more as an investment in your life. And if this is going to make your life better, it’s going to make it more integrated, if it’s going to make it healthier, then why would you want to spend your money on anything else but that?

So I did that for three years and then I went down to four, and I think I did four times a week for about another year or so. And then did three times a week for the bulk of my therapy, I would say for probably 20-plus years.

Tim Ferriss: And in those early sessions, what did those look like? And I’m asking as someone who’s done very little talk therapy because I’ve had an aversion to words in a sense, rightly or wrongly, because I know friends who have really been saved by talk therapy. What did, or might a session look like? What do you talk about? What’s the format?

Debbie Millman: I think for me, and that’s so interesting the different responses people and bodies have to their trauma. I have often joked, and maybe it’s not really that funny, but I position it as a joke, that I am just a head. And then I’m not. I don’t know that my head is even still fully connected to my body. I am very cerebral. And my wife knows this, my former partner, Maria Popova. We joke about it all the time that I just love to talk. I am a talker. I like to analyze everything. And being connected to my body is much, much harder for me. I’m very comfortable face to face with someone, looking at them, looking into their eyes, and engaging intellectually and verbally.

Being connected to my body is still something I struggle with, Tim. Initially, the therapies that I think my therapist was hoping I’d get to would be facing away from her on a sofa, sort of very old fashioned in a lot of ways, because then you can really engage with your subconscious in a much faster way. You’re not looking at someone’s face to analyze their response. People like you and I who are highly empathetic often will organize the way that we speak, what we say, based on almost imperceptible facial recognition patterns that we understand. And to disengage with that allows you to go deeper into your subconscious, to not be assessing what the response is and how you are engaging with that response while you’re responding. There’s a whole set of clinical responses and engagements that happen when you’re speaking, body language, facial patterns that we assess really quickly. That gift that you were talking about before, we have that. And quite a lot of people that have gone through intense trauma have this ability to almost be able to calibrate the energy around someone, to be able to assess how we can best respond to them, to their comfort.

I was unable to do that. I needed to be face to face, and still to this day. So now I’ve been doing my therapy for over a decade now, maybe close to a decade online. And my therapist retired from her big-time practice and now has a much smaller practice, and I’m still working with her. We do the therapy over Skype, and we’ve been doing that for as long as Skype exists. And that’s been really helpful as well. I don’t need to be in person, but I do need to be face to face. That’s still something that is really important to me.

That’s also I think part of why my podcast has been a successful one, because up until COVID all of my episodes have been face to face. I look deeply into a person and feel them and experience them in a way that I can’t really replicate any other way. So in any case, those first therapy sessions were just a matter of allowing myself to fully break down, which is why when Brian died, I was in therapy at that point, but then did go much deeper after that. Because at that point, I needed to go on some pharmaceutical antidepressants, or my therapist was going to recommend that I—

Tim Ferriss: Can you just remind me and listeners of who Brian is?

Debbie Millman: Brian is the friend that I mentioned that died of AIDS. He desperately wanted to live. I was perfectly healthy in my body. Clinically I was, but didn’t want it anymore, but didn’t feel like I could ever take my life, but no longer wanted to be living. So sort of became a bit paralyzed in my ability to engage with the world.

So at that point, my therapist suggested that I either begin to think about an antidepressant to help calibrate my emotions, or to be admitted to hospital. And so I decided to try, I went on an anti-anxiety medication and then at that point started on Prozac, because it takes about six weeks to really kick in. So that was a really rough six weeks, but it did help take a bit of the edge of the despair away.

I think a lot of people don’t fully understand what antidepressants do. They don’t make you happy. They’re not in any way happy pills, but they are able to give you a sense of the bottom of your despair in a way that not being on them did for me. I’m just going to talk about me. It allowed me to feel like there was a bottom to the despair, so I didn’t feel like I was falling through the ether and was going to just end up crashed on the ground.

Tim Ferriss: Hmm. I am so glad we’re having this conversation. And I want to speak to something you just mentioned, which is that onset period for many SSRIs, where you have a period of a handful of weeks before which the effects can be felt. That can be a very dangerous period for people if they are suffering from suicidal ideation, fantasizing about suicide, perhaps planning suicide. And I will say in such cases, and I don’t recommend this much, but ketamine can be a very effective acute treatment for stopping loops of suicidal ideation. It can be very effective intramuscularly or intravenously. There are clinics that provide this in the US. It’s generally very well tolerated. It’s a very well studied compound, because it’s a dissociative anesthetic that has been used for many, many years. And it was on the World Health Organization list of most essential medicines. So for those who are in a very acute dark place that may not allow them to last those weeks until SSRIs have their felt effects, I would just mention that as a potential intermediate stopgap lifeboat for people.

Debbie Millman: And I didn’t have a medication that I took in that six weeks to help me as well, and that did help. Now, I also want to let people know that sometimes antidepressants can stop working. So I started taking Prozac in 1991, and then in 2003, inexplicably, it stopped working. And I went back into a place where I no longer wanted to be alive. And for me it wasn’t about, “I’m going to kill myself now.” It was just a matter of being unable to exist in any real world experience. I was in my home, in bed, unable to move and unable to do anything. One of my dearest friends at the time, who’s no longer alive, but she would come to my house and hope that I wasn’t dead. I didn’t want to kill myself. I just didn’t want to be alive.

At that point, I then went back into an emergency situation with my psychopharmacologist, who then prescribed Zoloft. And I started taking Zoloft, and I’ve been on Zoloft ever since. And that works much quicker. You start to feel that within three days. You actually do feel your brain being impacted by this drug. It’s a very different experience than Prozac, and my brain actually felt like it was moving. And then we worked on the right dosage, and I’ve been on that dosage ever since.

But it is really important when you’re engaging with any type of pharmaceutical to not only be working with your therapist and your psychologist, but also to be working with a psychopharmacologist, who is a medical doctor, who is going to prescribe medicine based on your body type, your body chemistry. And then in as much as I’m still taking the same dosage, I have to have twice yearly appointments with him to make sure that I’m still on the right medication and the right dosage. So it’s very important to be monitored by a medical doctor when engaging with any pharmaceutical drugs.

Tim Ferriss: And do not stop anything cold turkey.

Debbie Millman: Absolutely. Absolutely.

Tim Ferriss: Extremely important. I know—

Debbie Millman: Finding the right medication is really important. Some people work really well with Wellbutrin. I know a lot of people on Wellbutrin when I first—the original potential drug for me was Wellbutrin. And I felt like I was going to die on Wellbutrin. Did not work well for me at all. I actually felt like I might have a psychotic break. And so we did have to stop taking that. So there is a time where, and some people have to have a different cocktail of drugs. I know quite a number of people, because I’m open about taking antidepressants, I talk about it a lot with people, and there are people that have to teach two or three different types of antidepressants to get the right chemistry. Mental illness is a brain problem that has to be investigated as a way to regain the right brain chemistry. And that is something that is not always easy to find.

Part 2 follows just below.

 
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My Healing Journey after Childhood Abuse, part 2

by Tim Ferris

Tim Ferriss: I’d like to speak to something you said earlier, which is I think important. At least it has been important for me to unpack, as someone who almost committed suicide in 1999. And that is, you said you didn’t want to die, but you didn’t want to live. And an observation that was drawn for me by Stanislav Grof, who is a psychotherapist, I’m not sure he would consider himself a psychotherapist, I’m not sure what label he would apply, but very experienced psychotherapist who’s supervised thousands of sessions over his 80-plus years of life involving psychotherapy, and also assisted psychotherapy with compounds like LSD and other things. And I’m going to paraphrase this, but he said that a desire to kill oneself can be thought of as a desire to destroy your physical body, but it’s not a desire to destroy your physical body. It’s a desire to kill your ego and to stop the loops that you’re experiencing. It’s a desire, at least for me, desire for some type of relief from the relentless looping of these thought patterns that seemingly would not stop. Just like being in the impact zone in the ocean, where you’re getting hit by wave after wave after wave. I just wanted the waves to stop.

And the only option that I felt was available was to take my own life, which thankfully I did not do. People can hear my TED talk for how that unfolded. But the part that was left out of the TED talk is that I had planned to kill myself. I had the exact plan laid out. I knew exactly how and when I was going to do it. And by sheer luck, I had requested a book dealing with suicide from Firestone Library at Princeton, and I’d forgotten to change my mailing address. I was away from school. I was taking time away from school, which, surprise surprise, was recommended by the administration because they don’t want a suicide on their watch if someone seems mentally unstable. And I had forgotten to change the mailing address to where I was then living off campus.

So a postcard, when the book was available, went home to my parents, and my mom got the postcard. And she called me with a very shaky voice and asked me about it. And that snapped me out of it, because I had only been thinking about really myself and the impact that it would have on me. I was so stuck in my own loops that I had not thought about the impact it would have on other people. And as someone later put to me, killing yourself is like taking your pain times 10 and inflicting it on the people who love you the most.

So that snapped me out of it. But that was so lucky. So lucky. If you think about how that would have turned out differently, now it would have been an email or some type of notification that I would have archived, and I would not be here. So I came very, very close. And at the time, it’s because I viewed the only option for extinguishing a loop was to kill myself. And what I’ve learned since is that it is possible, and I’m not a hammer looking for the nail in the sense that I’m not recommending these tools for everyone. They do not address everything. They have risks, they have side effects. But tools like ketamine, tools like psilocybin, in some cases with trauma, MDMA for PTSD, with qualified facilitators and therapists, allow you to do what I so desperately wanted without killing yourself.

And I want to just emphasize to people, if you feel that you’re fatally flawed in a way that dooms you to unhappiness and self-loathing and a desire to kill yourself, don’t believe everything that you think. Because as I learned later, even though that seemed true in the moment, that is not true. There are tools and options available to you.

Debbie, one thing I’d love to ask you is, are there any books or resources or organizations that you’ve found particularly helpful, or that you’ve recommended to people that they’ve found helpful?

Debbie Millman: Yeah. And Tim, I just want to caveat. I know that I was talking to Roxane about a book that we’ve both been really helped by, and it’s called The Courage to Heal by Ellen Bass. But I’ve heard since that there’s some problematic issues in that. And I don’t know if it’s because of the way that they talk about trans. I don’t know. So that book was enormously helpful to me, as was Bessel van der Kolk’s books. They still continue to be helpful. And I’m happy to say that separately again, so that it’s good for the podcast, but I don’t know. Let me look into what issues there might be, because I don’t want to give anybody information or recommend a book that’s problematic for any reason.

Tim Ferriss: Yeah. And I’ll also say, we can put any disclaimer in the show notes for people. The Courage to Heal workbook has also been sent to me. And it was recommended by someone with a lot of in the trenches experience, working with trauma survivors. I will confess that I did not actually have the stomach to go into it because I was coming off six months of very deep, intense work, and just could not even digest the possibility of going through a 200- or 300-page workbook. So I have not cracked it, but it was recommended by someone who I respect tremendously as a clinician. So that’s it, so we can put that in the list.

Debbie Millman: Definitely. The Drama of the Gifted Child is a book that I also read. As I mentioned earlier, up till I was about 23, 24, I was in this mode of, “This didn’t impact me. I’m not going to let this destroy my life. I’m not going to let him win. This is something I’m going to overcome and have the best possible life for.” And I think a lot of people feel that way. And then everything comes crashing down.

I ended up at a party. It was about a year or two after I graduated college. And somebody that I admired a great deal heard about a job that I had gotten and said to me, “Oh, Debbie, I’m so jealous of you.” And I just stood there and looked at him and thought, how could he possibly be jealous of me? I’m the most disgusting, ugliest, unworthy person on the planet. And that’s when I decided I needed to go into therapy for the first time.

And when I did, the gates opened, they really did. I remember being at the Brooklyn Academy of Music, watching Einstein on the Beach, and something triggered me in that performance. And I went home and spent two days in bed, just weeping at who I was and what I was in my life. And at that point, really tried every possible, at that point this is the ’80s now. We’re talking about every possible book, workshop, nutritionist, any way that I could find to try to be better, to try to feel better, to try to change who I was. And a lot of it was trying at that time for quick fixes, didn’t want to have to—the idea at that point, if anybody told me at that point that I would be 58 years old as I am now, still working on these things, I might’ve packed it in. I was like, “Why do I have to deal with something that occurred in the first 18 years of my life for the rest of my life?”

But those are the cards that I was dealt. And my brain developed in the way that it did, with the neural pathways that it did, with the panic response that it has. And what I can say is that with all the resources that I’ve undertaken, they’re all worth it in some way, shape, or form, because they are all moving you forward to a path that isn’t completely catastrophized by what happened to you in the earlier part of your life, and gives you a way to recreate different neural pathways that lead you to the way that you want to live your life, and the way that you want to think about your life in a way that’s healthier.

So some of the books that I read in my 20s and 30s, Ellen Bass’s The Courage to Heal and her accompanying workbook. The Drama of the Gifted Child, which as you said, is the gifted child is really the more sensitive child. There was a sensitive child, Bessel van der Kolk’s books, website, resources. Anything that he’s written has helped me because of where we do keep the score, which is in the body.

And in addition to my journey as a businesswoman, as an entrepreneur, as a brand consultant and strategist, as a podcaster, as an artist, a writer, an illustrator, whatever it is, there’s always this parallel path of being a person that’s looking to understand my motivations, my place in the world, my purpose, my trauma, and how I can integrate all of that together, so that anything I do in my life isn’t just a response to the trauma. Isn’t just, I’m doing this to feel productive in the world because I’ve felt so meaningless. I’m doing this to feel meaning, because I don’t have any sense of who I am. And that’s something that I think I might be doing for the rest of my life at this point.

But for me, it’s trying to find comfort and contentment about who I am and doing what I do because I love doing it. And not because I feel if I don’t do it, I’m nothing.

Tim Ferriss: That’s really important. It’s extremely important. And it resonates with, I suppose it was a realization that I had prompted by something that Tara Brach either said or wrote. Tara Brach, very well-known mindfulness teacher. I’ll simplify her descriptors that—

Debbie Millman: Absolutely. I’ve taken workshops with her. She’s incredible.

Tim Ferriss: Incredible, incredible teacher. Her book, Radical Acceptance, which has a very generic title, but very impactful content for me, at least. Radical Acceptance. And I’m going to come back to that word acceptance, because I think it’s critically important. She said or wrote at one point, and she was quoting some apocryphal sage, but that there’s only one question that really matters. And that is: what are you unwilling to feel?

I’ve thought about this a lot because the stories we tell ourselves, the life experiences, including trauma, that we’ve had drive our behavior and drive our reality, the stories that we tell. And what I realized about myself is that increasing my pain tolerance, focusing on honing myself as a weapon of competition, basically, was in large part a way to busy myself and overstimulate myself, including with caffeine and stimulants and so on, so that I wouldn’t feel certain things.

Debbie Millman: Absolutely.

Tim Ferriss: And this was subconscious. It was not something that was in my conscious awareness. It was subconscious. But in retrospect, that is what I was doing. I did not want to be in a room by myself with things bubbling to the surface. If I was at a slow simmer, I wanted to take something else that was boiling at a loud boil and pour it on top of that to create enough noise that I wouldn’t feel whatever needed to be felt.

Debbie Millman: That is so common. Absolutely. I did the exact same thing.

Tim Ferriss: Super common. And the part of the reason that Internal Family Systems, IFS as I mentioned, or something like it, in parts work has been so helpful to me, and Jack Kornfield is also very, very good at this type of parts work, and I’ll speak to something that I’ve done that has been very helpful in a minute, is recognizing and not hating or hurtfully judging your coping mechanisms.

I have historically had no tolerance for weakness, very little tolerance for weakness. So any type of fear, any type of shame was weakness and just was meant to be eradicated. And for me, I just had no tolerance for weakness. And as a result, I hated parts of myself, which ultimately just does not work. It just really, really does not work. And if you want to be a better competitor, by the way, this does not remove your edge. It actually gives you a greater awareness, and I think an ability to not leak energy all over the place that you could otherwise point at a worthwhile target.

So the parts practice in IFS has been a revelation. And I don’t use that word lightly. I’ve used it a few times, but I’m using it with very specific things that have actually warranted that type of word. Because the coping mechanisms, right? If you want to curl up in a fetal position and just let things happen, let things pass. If you have anger that you’ve suppressed and you judge that anger because it’s caused damage in certain areas of your life, these are very often what might be called protectors. These are things that allowed you to survive, and they’re like vestigial tails, they’re coping mechanisms that served a critical purpose at some point that perhaps are just now the only gear that you go to, or one of three default responses, reactions, I should say, that you have.

And if you disown them, if you hate them, you will deal with the ramifications and it’s messy. But if you’re able to honor them and thank them for their service, and gently put them on the table, put them on a shelf, because you don’t need them right this minute, when you’re having a huge overreaction physiologically and emotionally to some small ripple in your life, it’s much easier to find peace. And Jack Kornfield has been very helpful for me in this respect. We’ve talked about this in a number of episodes on the podcast, for people who are interested.

And one thing that he suggested that I do, and I’m simplifying this greatly, but it doesn’t need to be complicated, is to a few times a day or during, say, loving-kindness meditation, to go back to the terrified, unprotected younger version of myself, and to give that younger Tim what he needed at the time, what he craved, and to tell him everything’s going to be okay, and to console that younger version of myself, to protect that younger version of myself. And the easiest way I found to implement that was by doing that type of short meditation at meals, because setting aside separate meditation time may or may not happen, but you are going to generally eat at least once a day. And I would take just a few minutes, not a few minutes, excuse me, like 20 seconds to close my eyes and do that before eating. And it had such a tremendous impact and continues to have such tremendous impact on me. It’s hard to overstate.

And it’s such a simple concept, but there has been a transfer. It’s almost like I was able to rewind the clock and nurture myself, provide myself with what I needed so that the long-term consequences are dialed down. It’s been much more impactful than I could have imagined, given how simple it is in a way, but done routinely, that has been a real game-changer for me.

Debbie Millman: It’s really quite extraordinary how plastic the brain actually is, and how you are able to, over time, create different neural pathways that allow you to respond differently than you may have in the past. And quite a lot of people that have experienced severe trauma do have that exaggerated panic response where something that might not ruffle someone else that hasn’t experienced severe trauma might see as a minor thing, that people that have experienced severe trauma will see as catastrophic. That if one small bad thing happens, that means that everything is fucked. That means that everything is screwed up. That means that you’re just terrible. And it’s more evidence that you’re not worthy of being alive or being happy.

One of the things that I think that dealing with and managing and re-experiencing your trauma allows you to do is metabolize your experiences in a way that allows you to calibrate future unhappiness, dissatisfaction, frustration, in a way that’s more in measure with the severity of that thing at that time, as opposed to just defacto attaching it to all the previous trauma that then explodes in a much bigger way.

Tim Ferriss: Yeah, yeah, the much less catastrophizing.

Debbie Millman: Yeah, I mean—

Tim Ferriss: I mean, that’s been my tendency certainly.

Debbie Millman: Yeah, but that is absolutely the way that people that have experienced severe trauma respond. It’s if you aren’t dealing with and experiencing and managing that trauma, you never get a place to detangle any future trauma to that past trauma, and so they become instantly attached. And that’s why that sort of giant feeling of everything being that globalizes that new trauma or that new frustration or that new paper cut, whatever it is to that past trauma happens. And I don’t know why in our DNA this isn’t better integrated in our daily lives and our experiences of ourselves, but humans metabolize our emotions fairly quickly in the grand scheme of things. We have the ability when were hot to take off our sweater, if we’re cold, we put it back on. When we’re hungry, we eat and we metabolize and digest our food and so forth. But when it comes to these types of traumas, there’s a fear that somehow reengaging with them will destroy us, and it won’t. If we have the right tools to help us through these things, they won’t.

Tim Ferriss: Yeah, speaking from personal experience, you, the listener, are much stronger than you give yourself credit for, and it is possible to debug or rewrite your software. It is possible, I’m living proof of that, I feel very strongly—

Debbie Millman: We both are and we’ve both taken very different paths to it. Mine is far more conventional, but they’ve worked, they’ve worked. I could never have imagined that I could have this type of life and I’m also not finished with the work. And I’m still on this path and this journey to recovery, and I probably will be for the rest of my life. And there are moments where I’m like, “Gee, what would it have been like if I didn’t have that trauma?” And there are moments where I feel sorry for myself, and there are moments where I wish it could have been different, but it can’t and it’s not and move on. And I just have to figure out a way, as we all do, to work with what I got, and part of what—so people have asked me over the years, “Why are you so resilient? Why are you still in therapy? Why do you still try so hard?”

And ultimately, and I think that perhaps this is why you and I both didn’t kill ourselves, is that, at the end of the day, I feel like I have one notch more hope than I do shame. And I think that about you too, Tim, why are you working so hard to create a better life for yourself, to understand your motivations, to integrate your trauma? And I believe the same to be true for you, you have more hope about what your life can be about than you do what kind of shame you have about the life that you had and what happened to you.

Tim Ferriss: Yeah, I’ve never had more hope, and I think a part of that is reframing the work as, and this might sound strange, but not as recovery, even though that’s perfectly fine word to use, but just for me, and maybe I’m just too much of a semantic niggler, but it implies to me some type of incompleteness, like you haven’t yet reached wholeness because you are still recovering. And rather than view it that way for me, I’ve viewed it as work that connects me to humanity and the shared suffering that is life. And that I am training myself to be a sommelier of suffering, not to increase the intensity of suffering, but so that I can not view myself as this independent island of flaws, but rather this interconnected human who has the capacity to sympathize and empathize because no one has a monopoly on suffering.

And as someone said to me at some point, everyone is fighting a battle that you know nothing about. And by going into suffering with a somewhat neutral awareness or a curiosity, it cannot but make you closer to your fellow humans, I think if you learn to navigate it. And we’re all going to face the death of loved ones, we’re all going to face different types of trauma, we’re all going to face betrayal, we’re all going to face these common ingredients of the human experience. And for me, I suppose the podcast and the writing has been a lifeline as well, because I can take my experience and hopefully transmute it into something that is of service to other people. And I can find some redemption in that, right? I can find some meaning in it, as opposed to these memories and the traumas that are stored somatically being this meaningless infliction of anguish and horror and disgust, I can somehow translate that into something that is positive for someone.

And that’s why I’ve been thinking about some form of this conversation for years. And I’m really optimistic, I have to say it’s taken me a long time to get here, but there are tools, there are tools. People have also traveled this path before, I mean, for millennia, this is not new. And I’ll put a whole bunch of other things in the resources for people, but my friend Neil Strauss, who’s suffered quite a bit of trauma, has a quick-start guide to healing trauma, which is actually a very good blog post, listing some of the things that have been effective for him. That’s a five-minute read and includes things like the Hoffman process, which has come up on the podcast before, documentaries like Trip of Compassion and you show the before and after transformations that are possible with complex PTSD. And I really feel like the journey, the ongoing work, can be, if you frame it in a way that makes it possible, incredibly redeeming and gratifying. And that’s not how it started for me, right? It started with an, “I don’t want to deal with this. I don’t have to deal with this, it’s over and done with. Who the fuck am I to complain? There are people who are getting raped every day right now; I don’t want to deal with this. Look at my life. I’m fine. For fuck’s sake, let’s lock this away and not look at it again.” And that just did not work. It didn’t work, right?

Debbie Millman: It doesn’t.

Tim Ferriss: It was a boomerang, and it came back 10 times the size of when I threw it. And there may be people who can do that. I couldn’t and—

Debbie Millman: Tim, I have yet to meet one. I really have yet to meet anyone that has been able to integrate trauma in their lives without working on integrating the trauma into their lives. And there’s no shortcut, there’s no easy way around it. It’s just, if it happened to you, to your body, to your mind, it’s going to impact and affect you. One thing that I find really helpful is reading other stories of people that have experienced trauma and how they have integrated that trauma into their lives. Chanel Miller’s book, Know My Name. Eve Ensler’s written a bunch of books that have been extraordinarily helpful: In the Body of the World and The Apology. These stories, these memoirs—

Tim Ferriss: Radical Acceptance, the Tara Brach story also.

Debbie Millman:—yeah, really have given me courage and hope and a sense of mutuality that I think is much, much bigger than shame. And part of what I’m so hopeful for in the future is more people disclose as more people talk about their experiences, the shame gets shifted to where it really belongs, and that’s to the perpetrator. And once we can see trauma that has been inflicted on us as not our fault—that’s one of the reasons I have problems, when you talk about this semantic noodling, I have problems with the word victim. I understand where it comes from and why it’s used, but I don’t feel like a victim and I’ve never felt like a victim, nor do I feel like a survivor, it’s a process of living. And I do think there needs to be some new language around these experiences that really are more accurate as to what we are experiencing, because it makes us as other and we’re not other, there is no other.

Tim Ferriss: Yeah, I agree. And I’ve felt very conflicted about revealing or not revealing the name of the perpetrator, because I know exactly who this person is. And at least for now I have decided not to do it, I thought about doing otherwise.

Debbie Millman: Have you thought about confronting him?

Tim Ferriss: I have, and I don’t think—at least at this point that I don’t think I’m going to do it. And if he happens to be listening, don’t worry, at least a few people know who you are so if anything happens to me, there are a few things locked in the vault. But the reason that I decided not to is because I don’t want rage or vindication or vigilante justice to be what drives me.

And that rage has been my default for decades, right? I mean, I’ve always wanted to return vengeance upon anyone who harms me or attacks me tenfold, right? I mean, smashing flies with a sledgehammer. And I no longer want that to be a driver for me, so I’ve really tried to look at it, and I know this will make some people cringe, but—I mean, I don’t know how old this son was when it happened, maybe, I don’t know, 10, 12, 14, I really don’t know exactly. But it makes me wonder what happened to this kid also, right? I mean, this is before the Internet, so it’s just like how would that behavior even manifest? Right? And I’m not trying to wade into moral relativism where I say it’s okay, it’s absolutely not okay. It’s completely fucked and atrocious and damaging but I’ve tried to look at it through multiple perspectives.

Debbie Millman: I actually have confronted one of my perpetrators and it didn’t quite have the result that I was hoping and expecting.

Tim Ferriss: Could you speak to what you expected and what happened?

Debbie Millman: Sure, and I wrote a short story about it called The Man, which I’ll send you a link to as well. Well, I had a person in my life at the time that I was seeing, this is before I came out, I didn’t come out until I was 50. So before 50, I was primarily dating men and had been married. But I was seeing someone, I had reengaged with somebody who was a high school boyfriend. And this was 20 years ago, 20 years ago this happened. And he knew about my history, because at the time my stepfather was still living on Long Island near where I grew up, I was able easily to find him. And so my then-boyfriend and I went to his house, my boyfriend was a bodybuilder, so he was somebody that I felt could help me.

Tim Ferriss: Yeah, helpful enforcer to have.

Debbie Millman: Yeah, I mean, it’s sort of a complicated cast of characters, which I’ll talk a little bit more once I’ve finished this part. But I decided that with his sort of physical presence, I might feel safe going to his house, to my stepfather’s house and ringing the bell and saying what I needed to say, so I did. And I remember it very vividly, as you mentioned, it’s just really extraordinary what we remember and what we forget. But I rang his bell, I was wearing a yellow coat and a black beret and it was the fall, and the air was very crisp. And I rang the bell and his third wife answered the phone, I mean, came to the door, answered the bell. And I asked if he was there, and she looked at me skeptically, “Who are you, asking for my husband?” And I said, “Well, I was…” That my mother had been married to him years and years and years ago, and I was his stepdaughter.

She then thought I was like a prodigal daughter coming back for reconnection and family, she didn’t know why I was there. She only saw this as a positive thing. So she squealed, she was like, “Oh, my God, that’s amazing, come in.” And I said, “No, no, actually it’s okay, I’d like to just sit here out on the stoop,” and “is your husband home?” And she’s like, “Yes.” And she yells for him, and she’s so excited. He comes walking over and he looks at me and I looked at the wife and I said, “Can I have a few minutes with your husband by myself?” She’s like, “Absolutely, of course, you sure you don’t want to come in?” I’m like, “No, no, I’m good.” And she scampers away and she then yells in the background, “Let me know if you’d like some coffee.” It’s just surreal, so not what I expected, Tim.

So then he looks at me and I said, “Do you know who I am?” And I think he maybe was a little bit senile, I don’t know. At that point he was probably 70, no, 65 or so. And he said, “You were [BLEEP]’s daughter.” I said, “That’s right. Do you remember what you did to me?” And he didn’t say anything, just kept staring at me, the exact same eyes. He was much heavier and he had a beard, but he was—the same exact hands, and I was so scared, Tim. I was scared.

Tim Ferriss: It sounds so fucking intense.

Debbie Millman: I was so scared. My heart was beating, I could hear it in my ears. And I said, “Do you remember what you did to me?” And he just said, “You were [BLEEP]’s daughter.” That’s all he said, again. And all I could say, and it wasn’t strong enough and it wasn’t what I wanted exactly to say, but I was so nervous. And everything had stopped, time stopped, and the only thing that was moving forward was my heartbeat. And I just said, “You’re going to burn in hell for what you did to me.” And I walked away and I left.

And there’s this really dumb movie called The Specialist with Sharon Stone and Sylvester Stallone, and she has quite a lot of vengeance in the movie to make up for her parents being killed by this drug dealer. At the end of the movie, Sylvester Stallone says, after they’ve been vigilantes and killed everybody he says, “How do you feel?” She says, “Better.” And I relate to that, if somebody’s, “How did you feel?” “Better.” But not that much better that it changed anything about how I felt about myself and again, that work still had to be done by me and only me. But I still keep tabs on him… I know exactly where he lives, I’ve looked on Google Maps. I keep track of him, but I haven’t ever felt the need to do anything more.

Tim Ferriss: That’s a very intense story, Debbie. I would be worried that I would kill him, I would.

Debbie Millman: Yeah, I’ve fantasized—.

Tim Ferriss: I mean, I’m physically capable of it. If I were to be in that proximity, I would worry that I would actually do something that would put me in jail.

Debbie Millman: And we don’t want that.

Tim Ferriss: No, no, that would not be good for anybody—

Debbie Millman: Yeah, I fantasize a lot because I do work with Mariska Hargitay and I have these sort of fantasies about sort of an SVU episode of vengeance. But I just don’t think I have it in me. That rage, I still do overreact to things. I still, when something bad will happen, I’ll feel doomed, but not anywhere as near what it was, what it used to be. And I have become so much more sensitive to life and to things that are living that I don’t think I have it in me anymore to do that, but I haven’t forgiven him. I’m wondering in the work that you’ve done, have you been able to forgive your perpetrator?

Tim Ferriss: I’m laughing because this is a word I’ve always had great trouble with.

Debbie Millman: Me too, me too.

Tim Ferriss: Forgive, forgiving, forgiveness. Only in the last six months, is in any conventional sense I would say, no. I do not find it permissible, I’m not going to have a drink with them, let bygones be bygones in any conventional sense. I would much rather put a bullet in his head, but of the, what I have come to use as a definition of forgiveness, very recently, this is only in the last year, that makes sense to me because forgiveness almost as a concept, given some of the horrible things that have happened, just never even made sense. It was a nonsensical concept to me. Is letting go of hatred, forgiveness is letting go of hatred. And if I think of hatred as swallowing poison and expecting it to kill your enemy, I have found holding resentment and hatred to be so corrosive and so destructive to me personally, right? I hold it in like this hermetically sealed bottle of acid that just for purely practical reasons, I have come to view and pursue forgiveness as the letting go of hatred, because I do not find it serves me.

And there’s a place for anger, there is a place for anger. And I think a lot of my work that remains to be done is working with anger. And as Jim Dethmer has put it to me, finding a clean-burning anger, an anger that can be felt fully burned through cleanly—

Debbie Millman: Yes, that’s key. Absolutely key.

Tim Ferriss:—so there is no residue, because I’ve kept it bottled inside me for so long, for decades. But letting go of hatred as my definition of forgiveness, which I certainly found through someone else’s quote I’m sure, has been helpful. So finding a meaning for that word has been helpful and that’s the meaning that has been most palatable to me. That’s a definition of forgiveness that I can get onboard with.

Debbie Millman: As you think about forgiveness or changing the way you view your rage, how does that help you? Or how has that changed your understanding of yourself and your behavior?

Tim Ferriss: Oh, so far, and the work is not done, and in a way I look forward to the work because as I do more work and learn more than I can hopefully share more. But I will say, just in the progress that I’ve made in the last handful of years I’ve realized through say the HRV training, looking at my cardiac hyper-reactivity to very small things, little noises, certainly different situations, tense conversations, I have a full blown panic response, even though I can keep a calm face, and part of that is retreating into stories. And this is something I repeat to myself, and this is while I’m sober, although it began as a realization in the space of working with psychedelics, is “Don’t retreat into story, don’t retreat into story.” And retreating into story means defaulting to these old stories that I’ve used for so long that I never, for decades, questioned them, right?

And one of the stories is related to personalizing things. So if somebody does something that I take to be a breach of trust, a betrayal of some type and I begin to spin this story and construct this narrative of how this person has completely betrayed me. I am unsafe. This person is dangerous, they are a threat. I have to cut them out of my life. It is very binary, black and white. And I think there’s a place for that, there is a place for that. I mean, the “Fool me once, shame on you, fool me twice, shame on me” type of mentality, I do think there is a place for that. But it has been such a default, like if you choose that as a response, that is fine. If it is a reaction, if you’re like a slug that’s getting poked with a stick and you’re just reacting, reacting, reacting, then I think it’s worthy of reexamination.

Debbie Millman: Yeah, if you feel like it’s involuntary. Sometimes these responses, you almost feel like you don’t have any control over how you respond.

Tim Ferriss: Right, it’s just a Pavlovian response. So for me, I’ve used observing anger and rage as a way to try to identify, and this comes back to some of the descriptions in the Enneagram book by Beatrice Chestnut, which again, I’m going to warn everyone in advance, if you’re hyper-analytical like I am and skeptical, a lot of it is going to sound like astrology, so just be forewarned. But the description of the self-preservation six, including a tendency to project outward that which we do not want to feel ourselves, I have realized is a default of mine, right? If there’s something I strongly don’t want to feel and I can take that unease, that fear and provide a target in the form of someone who has made a mistake or done something that I view as a betrayal, having some conscious awareness of the fact that that is a tendency has allowed me to work with anger more productively. It’s just cultivating an awareness so there’s a gap between stimulus and response, so just taking advantage of that gap.

Debbie Millman: Yeah. I think that if someone has the ability to evaluate their response to anger and sees that it might be excessive relative to the experience, it’s a way to understand that that’s what your body has experienced. And that’s the degree that you are trying to protect yourself. Your sense of being betrayed or your sense of being hurt really is what you’re feeling. The anger is relative to the hurt and the grief.

Tim Ferriss: Yeah. And I would also say that looking at it through the lens, just as an exercise, of using physiology to change psychology, working on and training the heart as a muscle so that you can take what we think of as an autonomous function heartbeat and actually gain some control over it, shows me, at least in certain instances, that I’m not creating a story that then gives me a physical response. I’m having a nonverbal panic response to a perceived threat that is nowhere in my prefrontal cortex. I mean, this predates language. And then given that really strong physiological response, I’m crafting a story to justify it. Does that make sense?

Debbie Millman: Absolutely, and it’s such incredible insight, Tim, such self-awareness.

Tim Ferriss: Yeah. And look, I’m certainly not the Buddha. I’m not rolling around like the Dalai Lama with perfect self-awareness, but it is something that can be cultivated over time. And in my case, it has become clear, not always, but a lot of the time, I’m having this almost reptilian panic response. And then my prefrontal cortex kicks in, and within a nanosecond manufactures a story that justifies the huge physical response. And then my mind will find evidence to support that story.

Debbie Millman: Yeah, absolutely. And you can’t control your reptilian brain. As hard as we try, you can’t will that adrenaline to kick in. It just doesn’t work that way.

Tim Ferriss: Yeah. So it’s been fascinating to work at it from both ends, meaning working on the psychology, using words, using books, using resources, exercises that are clearly prefrontal cortex, to affect my physiology, to calm myself, to decrease hypervigilance, which is extremely energetically expensive. I mean, I’ve battled fatigue my whole life. And I think that’s a big part of it is that I’m always, as my friend Josh Waitzkin would put it, I’m always at a simmering six of sympathetic nervous system activation, like fight or flight. I’m always at a six.

Debbie Millman: You’re vigilantly ready.

Tim Ferriss: Yeah. And it’s just much more effective. It’s much more enjoyable to be at either a zero or a one, and then being able to jump to 10 when action is required. But if you’re constantly at a low boil, you’re just exhausted. So to work with words to decrease that hypervigilance and to change my physical response, and then also to work on the physical response directly to work on nonverbal, say somatic release and so on, to then relax the cognitive gum that keeps familiar stories playing as defaults. And so I’ve tried to work in both directions.

Debbie Millman: What kind of work are you doing in that way?

Tim Ferriss: Well on the physical, and let’s just call it psycho-emotional, where you have different types of physical release—for me, it would really be limited to HRV training, including breathwork that’s associated with that that’s prescriptive, and the use of psychedelics. It would be those two primary toolkits right now. And I know there are other tools. There are different types of physical expression and so on that can be used and that many people have found extremely effective, and some of them are in that Quick-Start Guide to Healing Trauma by Neil Strauss, which I’ll link to in the show notes. Personally, I have found psychedelics or psychedelic-assisted psychotherapy plus HRV training to be very helpful for that bottom-up component that I was describing.

Debbie Millman: In addition to the way that you express anger, have you found that your childhood trauma has shown up in your life and contributed to other behaviors, the way that you work or the type of work that you do, or your drive?

Tim Ferriss: I absolutely think so, but what I think I’ve become aware of as a question is—again, it’s very basic, but what are you unwilling to feel? And the reason I bring that up in the context of, let’s just say work, is if there’s something, and again, much of this is subconscious that I don’t want to feel, or that I’m finding very uncomfortable, I will plunge into projects and work.

Debbie Millman: Yeah, I’ve used work as a distraction.

Tim Ferriss: Yeah, as a way to just overwhelm whatever the truth of that experience might be otherwise. And the truth of an experience—I’ve mentioned the word revelation a few times. Sometimes the truth and the solution is put right in your face. It’s a gigantic billboard put in your face, and the message is obvious. But very often for me, the truth and the solution, and maybe the alternative to your old stories and patterns, is a whisper from across the room, and you really have to pay attention to get the message. And if you’re not subconsciously or consciously ready to do that, well, going through 1,000 emails and having 15 conference calls and committing to three new projects, well, turn on the music in the room to such a high volume that you’re never going to hear the whisper. And I think I’ve voluntarily drowned out the signal as a coping mechanism.

Debbie Millman: Yeah, I have too. It’s a wonderful coping mechanism, because you feel productive in the world, but all it really is, is avoiding the inevitable.

Tim Ferriss: Right. And my partner, my girlfriend, has been very helpful for pointing that out when I do that.

Debbie Millman: Good.

Tim Ferriss: Not that I should have to rely on the emotional police to give me—

Debbie Millman: Oh, but it’s good to have a support system.

Tim Ferriss: It’s helpful to have a support system or an accountability partner, somebody who you are going to check in with on a regular basis who can call a spade a spade. And that certainly has been very helpful, and I have a few friends who are doing similar work. And I will say Debbie, also, I have talked about this history of sexual abuse with not many people. Maybe a dozen male friends, let’s say, and at least half of them reciprocated with telling me their own story of sexual abuse. The percentage blew my mind. It was at least half, and I would say maybe closer to 75 percent. I was astonished how many of my very close male friends had stories of sexual abuse. I mean, it was staggering. And that’s also given me some solace that I’m not in this alone. Like you said, you thought you were the only person who had ever experienced this.

Debbie Millman: Right.

Tim Ferriss: I mean, this is a mainstay. I hate to say it, but it’s a mainstay of human experience.

Debbie Millman: It really is.

Tim Ferriss: This is a very common experience.

Debbie Millman: And it’s particularly hard for boys. It’s like there needs to be, in addition to the #MeToo movement, maybe there needs to be a #HeToo movement just so that men can feel like they can disclose without feeling shame. I mean, I think one thing that would be really important to talk about for your listeners, for anybody that is being disclosed to—so if you’re someone and somebody you care about is coming to you and shared this information, what do you think is the best way for people to respond to someone that is being told? Because being believed is so important.

Tim Ferriss: Yeah. Well, I can only speak to my experience, since I wouldn’t claim to have this as an area of expertise. But I will tell you that the first thing that Jack did, Jack Kornfield, when I was in a complete tailspin—I mean, I was really fracturing at every edge, and felt like I was about to sort of irretrievably break. And when I told him about the history, and I’m paraphrasing here, so Jack, please forgive me—but he is such an incredible empath, and such a conscious and focused listener. He listened and he said, “Tim, that’s awful, and that never should have happened to you. That never should have happened to you. That should never happen to anyone.” And he consoled me, and that meant so much to me, and had such a visceral emotional impact.

I feel like that was the primary parachute. It’s like you have the primary parachute, then you have the backup parachute. And I’ve never been asked that question. So I’m improvising here, but the backup parachute, which is still so important to have, might be the prescriptive advice-giving. “You should do this. Here’s advice on how to address this.” But if he had skipped directly to that, I would have been in no condition to begin to digest the recommendations. It would have felt like I was being deflected. So for me, the critical safety net was just being with me and witnessing what I was going through, not rushing, and simply saying, “I’m so sorry. That never should have happened to you.”

Debbie Millman: Yeah. That’s the perfect response. People, I think, always rush to, “What can I do to help?” Or, “How can I help you get over this?” And I think just listening, being present, hearing and holding someone’s truth is what we need most from the people that we care about the most.

Tim Ferriss: Yeah. And also what he said to me was, “When this retreat ends, I’m not going to leave you. I will not leave you stranded. I will help you.” So he just made a commitment to be available, to send me to resources, to introduce me to people who might be able to help, given his breadth of experience with all of these things. And so those two things I think, feeling seen and heard, and then being told, “I’m not going to leave you alone. I’m not going to leave you hanging. I will help you.” Because through all of these experiences that we’re talking about, I felt completely unprotected. I felt 100 percent hopeless and vulnerable. There was no protection, and I’ve felt that for decades. And to have someone say in effect, “I have your back. I’m not going to leave you alone,” allowed me to exhale enough to get through the next several days of that silent meditation retreat.

Debbie Millman: And that helps you create these neural pathways in understanding that there is someone that you can trust, and that there is someone that understands you. And that really does help change how you view yourself and your place in the world. That’s a really important experience.

Tim Ferriss: Yeah. Certainly if this is ever released, I’ll send it to Jack, but I’ve mentioned to him—of course he knows, but I’ve mentioned it very indirectly and kind of obliquely in couched language on previous podcasts with him how—not indebted. That’s not the right word, because he would never view it as a debt, but just how grateful I am and how lucky I am that he happened to be there. Because if he hadn’t been there, given the complexity in a sense, the intensity of the experience, I don’t know what would have happened, which comes back to the point that I made really early on. In other words, learn from my mistakes. If you go into some very intense, immersive experience, these things can come up. I had no idea this was going to come up. I did not expect this to come up, and I did not have a therapist or someone else cultivated.

I did not have that relationship to catch me when I came out of the silent retreat. So I would just reemphasize: it’s extremely important to have that support system, that safety net in place, before you go into these deep immersive experiences, whether that’s a silent retreat, the Hoffman process, psychedelics, or otherwise.

Debbie Millman: In understanding your trauma, in looking to understand it and integrate the various experiences you’ve had, does it change how you see yourself and how you see your life to this point?

Tim Ferriss: Totally. The work has totally changed it. And I will say that the work sometimes takes a long time, and you can also have moments that completely change you in an instant. And if we look at change, life changing moments, from a negative perspective, could a horrific car accident change your life in an instant? Yes. Could the death of a loved one change your life in an instant? Yes. There are examples from the healing side of the equation. There are things that for some people in some instances can really have transformative effects in a very short period of time. So I would say that there are a few things. Let’s look at the title of this book, The Drama of the Gifted Child. And this is not how this title is intended, but I’ve tried to ask myself, “How can I turn this into a gift? How can this be a gift for myself, and even more so for other people? How can I make meaning out of this? How can I translate this?”

Rather than looking at it as a shameful fragmented piece of my psyche that needs to be relegated to some locked cellar, a compartment. Rather than viewing it that way, which I did for several years, although I thought I had banished it successfully, which of course I had not, I’ve tried to expose it to light and to use it to find more light. So I think there’s a reframing that has taken place for me. And if you look at the last few years of my life and an intense, dedicated focus to supporting psychedelic science and phase three trials of MDMA-assisted psychotherapy, there’s a reason that these are the largest, certainly at the time that I made them, the largest financial commitments I’d ever made to anything. The largest energetic time commitments I had ever made to anything.

And the pursuit of, and discovery of, tools that actually work beyond my wildest imagination, and my doubling down and tripling down and quadrupling down on acting as a sort of boundary walker between different worlds to try to facilitate legal change, regulatory change that will make these compounds in a regulated fashion available to hopefully millions of people, has given me a tremendous sense of purpose. And rather than keeping my experiences completely secret, speaking to friends of mine who have suffered sexual trauma and trying to be a resource has given me a feeling of tremendous purpose.

Debbie Millman: Yeah, I understand that too. It’s extraordinary. It’s heart-opening.

Tim Ferriss: It is, it’s heart-opening. And for me, and I think for many people who’ve had their hearts closed or cauterized seemingly from trauma, it’s healing for me to feel that sense of purpose. It is restorative and nourishing to me to take that on. So it’s given me a tremendous sense of purpose, and I’m happy to be where I am. And—

Debbie Millman: What more can you ask for?

Tim Ferriss: There’s more to do. Yeah, exactly. And there’s more to do, and honestly, I look forward to it. It’s not going to be easy. I know that there will be challenges along the way. There always are. But as someone who I suspect you know pretty well, Janna Levin, has said to me before, “There is no underlying path. The obstacles are the path.” And I’m paraphrasing, but these checkpoints, these challenges, I try to view these setbacks in some cases, where you take three steps forward and one step back, or maybe one step forward and three steps back, are part of the human experience.

Debbie Millman: Yeah, that’s just a dance.

Tim Ferriss: Yeah. They’re not reflective of any unique flaw that you have. And for me, and I think Jordan Peterson said this—I’m also just going to butcher this quote. But he said, “The point is not to eliminate suffering. It’s to find a sense of purpose that is so meaningful that the suffering becomes irrelevant.” Something along those lines. And Jordan, I apologize if I’m misquoting you, but even if I am, I like it. Somebody shared that with me. And I do think that having a “why” has allowed me to endure more than I could have ever conceived possible. And not just endure by the skin of my teeth, but like endure quite easily, some real challenges. It’s not always easy, but those types of reframes and work on my physiology as an adjunct has brought me to this place. So a lot of things are different.

Debbie Millman: I have one question I want to ask. If you do release this, and people do listen, what do you want them to take from this conversation? Or what would you like them to get from this conversation?

Tim Ferriss: That’s a damn fine question. I would say at the very core—I could give a very long answer, but the short version is I would like people to realize, and to believe, that no matter the trauma, they’re not alone. They’re never alone, and it is never hopeless. Because I’m speaking to you, Debbie, as someone who came within a hair’s breadth of killing himself with utter conviction, no reservation, and it wasn’t necessary. It was not necessary, but I had lost hope. I felt like I was permanently damaged, flawed, incapable of feeling happiness, even when things were going well. Objectively, I was like, “My life is good and I’m unhappy, therefore I’m never going to be happy, so what’s the fucking point? Let’s end this now.”

You’re never alone, you are not uniquely flawed, and it’s never hopeless. There are tools. There are tools that really fucking work. And if you had told me that in 1999, I would not have believed you. But having experienced the things I’ve experienced, and having seen similar results in other people—and by other people, I don’t mean one or two people, I mean dozens of people firsthand. I know there are tools that work, and there are curative tools that work. So I would just say, “You’re not alone, and it’s never hopeless. You are never alone, and it’s never hopeless. There are tools.” That’s what I would want people to take away from this.

Debbie Millman: Thank you.

Tim Ferriss: Thank you, Debbie. I think this may be a good place to put a bow on it. And I’m so grateful to you for being such a skilled and empathic and loving midwife and shepherd for this conversation. You’ve been such a wellspring of strength for me to lean on. You’ve taken many late night phone calls for me when I felt like I was broken. You can tell that I’m getting emotional. Yeah, where I just felt like I was breaking, and it’s been fucking hard at points. It’s been really hard, and you’ve always been there. And there is light. There is light.

Debbie Millman: Yeah. I mean, I can’t begin to tell you how having that moment to share opened my heart and opened my world, and opened my mind in a way that I could never, ever have predicted or planned for, even. You were talking about suffering, and we all suffer. And sometimes, I think we do everything in our power to avoid suffering when the suffering isn’t as hard as the avoidance.

Tim Ferriss: Yeah, or the isolation.

Debbie Millman: Right. And so thank you for being there for me, and for giving me the opportunity to be part of this extraordinary conversation. And it’s so interesting, because we’ve had such different journeys to this moment. And if my helping you understand the benefits of talk therapy is helpful, that makes me thrilled, but also know that your talking to me about the ways that you’ve worked through some of your trauma has given me the opportunity to think about alternatives that might also help me and things that I’ve never considered before that I’m now considering.

Tim Ferriss: And on that point, I am talking to two different people twice a week right now.

Debbie Millman: Oh, that’s great.

Tim Ferriss: So I am using that tool in the toolkit, and that’s in no small measure due to you.

Debbie Millman: Thank you.

Tim Ferriss: And I would also say that a lot of what we’ve said alluded to this, I think, but another key takeaway for me, or just a mantra perhaps that I try to remind myself of that might be helpful to people listening is, how can you use your suffering to connect with people rather than isolate yourself from people? How can you use your suffering? This is the water in which we all swim. How can you use your suffering to better connect to others, rather than isolate yourself? It is possible. And of course, I’ll include all the resources that we’ve talked about, and I’m sure it’ll be a growing list on the blog, in the show notes. So I’ll just mention two things, tim.blog/podcast for this podcast, assuming it gets released, and tim.blog/trauma. And I’ll make that a live resource that will no doubt change over time. So Debbie, you’re a lovely, lovely human being, and I so appreciate you. And I just want to extend my love and sincerest thanks for being so patient with me as I hemmed and hawed and postponed for so long before this conversation.

Debbie Millman: It’s all good. I love you dearly. Dearly. I feel like we’re brother and sister.

Tim Ferriss: Yeah, I love you too, Debbie. And to everybody out there, one more time. You’re never alone, it’s never hopeless. There are tools. And until next time, thanks for listening.

 
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How psilocybin helped me find pleasure after Trauma​




In this episode, we are joined by X Razma who, through a large dose of mushrooms, had a life-changing experience that helped them create a roadmap back to pleasure after experiencing severe sexual trauma. X RAZMA cares about making trauma informed healing accessible to those healing from sexual assault, intergenerational war trauma, emotional abuse, depression, and OCD / BFRB.​
 
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Tackling Trauma with Pharmahuasca and DMT*

by Nathan White, PhD | Psychedelic Science Review | 24 Feb 2022

Psychedelics may hold the key to a novel PTSD treatment.

Post-traumatic stress disorder (PTSD) typically develops in response to an extremely threatening or distressing experience (or a series of experiences), with symptoms presenting as re-experiencing the trauma through dreams and vivid intrusive thoughts, avoidant behaviour, anxiety, and a persisting state of hypervigilance. People afflicted with PTSD have been shown to present with prolonged inflammation due to an increased level of pro-inflammatory molecules, such as interleukin-1 beta (IL-1β).

In addition, the levels of reactive oxygen species (ROS), which are typically generated through normal cellular processes, are also found in excess. In this scenario, the ROS are implicated in premature cell ageing and induce mutagenesis, i.e., they can modify DNA. Sustained inflammation and ROS delays healing, resulting in altered cell behaviour or even cell death, and eventually leading to disease. The mechanisms underlying inflammation and ROS are interconnected, which makes them an attractive potential target for future PTSD therapies.

Dimethyltryptamine (DMT) is a compound capable of inducing potent psychedelic experiences that are typically much shorter than other “classical” psychedelics such as psilocybin or LSD. Despite its discovery in western medicine in the late 50’s by Dr. Stephen Szara, indigenous tribes of the Amazon rainforest have been using DMT ritualistically for hundreds of years in the form of a brewed tea, commonly known as ayahuasca.

Ayahuasca is a complex mixture containing DMT, the monoamine oxidase inhibitors harmine and harmaline (which prevent the body from breaking down DMT when ingested orally), as well as various other compounds that may have clinical relevance. However, these mixtures vary in their composition from batch to batch. To ensure treatments are replicable, the complexity of the mixture can be standardized and reduced to a combination of DMT and a monoamine oxidase inhibitor such as harmine or harmaline, known as “pharmahuasca”.

Study aims

Psychedelics have shown promising efficacy in treating mental health disorders, with potential mechanisms including the promotion of neural plasticity, reducing inflammation, or even stimulating positive emotional processes. Exposure to a single dose of a psychedelic is enough to sustainably ablate the fear response in animal models of anxiety, however the potential of DMT (or ayahuasca) to treat PTSD has not been extensively investigated. In a recently published paper, Dr. Kelley and colleagues sought to bring new light to this matter by exploring the mechanisms through which DMT and pharmahuasca could help treat PTSD.

Study Overview

Validation of the Rat PTSD Model

To study how DMT and pharmahuasca affect the expression of genes associated with PTSD, a previously developed PTSD model induced in rats (henceforth referred to as PTSD rats) was used. Although the behavioural and biochemical profiles of the PTSD rats were previously established, it is unclear which genes are differentially expressed (DEGs) when compared to a control (i.e., rat models without PTSD) and to what extent they overlap with DEGs in humans affected by PTSD.

The researchers identified around 200 genes expressed in PTSD rats to be differently regulated in contrast to controls. This compares to around 400 DEGs in the brains of humans affected with PTSD relative to healthy individuals. When comparing the DEGs identified in both human and rat datasets, they found an overlap of 20 DEGs (henceforth referred to as ‘PTSD genes’) that are involved in processes including inflammation, cell growth, and cell signalling between neurons (GABA signalling – a pathway found to be affected in PTSD patients).

Rescue of differentially expressed genes

When PTSD rats were administered DMT, harmaline, or pharmahuasca, around 4000, 5000, and 3000 genes were found to be differently regulated, respectively, compared to controls. Out of the 20 overlapping ‘PTSD genes’ between PTSD rats and PTSD afflicted humans, the expression of 9, 12, and 14 genes was restored closer to that of the controls after DMT, harmaline, or pharmahuasca treatment, respectively. DMT treatment also downregulated genes involved in the production of ROS and upregulated those associated with neurotransmission and neural plasticity. Harmaline does not only inhibit the enzymes that prevent DMT from being degraded, but it also plays an active role in both reducing the levels of ROS products and promoting neuroplasticity.

Unlike harmaline or DMT alone, pharmahuasca did not rescue the expression of the gene encoding somatostatin, a molecule involved in neurotransmission and found to be downregulated in both this rat PTSD model and in PTSD sufferers. Nevertheless, pharmahuasca increased the expression of genes encoding the receptors to which somatostatin binds to. In addition, pharmahuasca was shown to downregulate the expression of a major factor (NFKB2) involved in regulating the inflammatory response and to upregulate the expression of genes implicated in pathways which allow neurons to form connections to other neurons (synaptogenesis). Interestingly, pharmahuasca reduced the expression of an enzyme involved in the production of endogenous DMT, which is expressed in the brains of both humans and rats.

ROS production reversed

It was previously shown that PTSD rats have an increased level of ROS products in their brain and other tissues. The study conducted by Dr. Kelley and colleagues not only corroborated these findings, but also demonstrated that both DMT and pharmahuasca treatment can reduce the levels of ROS closer to those found in a non-PTSD control group.

Study limitations

Previous research has shown that a single treatment of a serotonin receptor binding psychedelic results in lasting synaptic structure changes. In this study, however, it is unclear whether the rescued expression of the ‘PTSD genes’ following the treatments is sustained in their absence and longer timepoints would be required to observe this. Although expression of ‘PTSD genes’ was restored to levels similar to the control groups after treatment, it is unclear whether the behaviour of the PTSD rats changed, an observation that could have strengthened their results.

In addition, the neuroanatomy of the brains of PTSD affected individuals is known to be structured differently compared to non-affected individuals, however, no histological examinations of the brains from PTSD rats that underwent the various treatments were performed. Consequently, it is unclear whether the neuroanatomy is altered in this PTSD model, although this is something that could be further explored in future research to strengthen the model. Lastly, this study was largely limited to gene expression analysis, which does not necessarily translate into the function of the cells. Nevertheless, they did show that actual ROS levels were reduced, complimenting some of their gene expression data.

Some of these limitations were discussed by the authors of this study, who emphasized that their aim was to expand the knowledge regarding transcriptional regulation following psychedelic treatment by building and analyzing a large gene expression dataset.

Conclusion

The results presented in the study carried out by Dr. Kelley and colleagues advanced our knowledge regarding the validation of an animal model of PTSD and the expression of genes after psychedelic exposure. They also showed a decrease in the actual levels of ROS following psychedelic treatment, emphasizing the validity of their gene expression data. This study expands our understanding of PTSD and opens an avenue of developing effective psychedelic based treatment regimens for this disorder.

*From the article (including references) here :
 
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