What's The Deal With Psychedelic Assisted Therapy?
/ALL ABOUT PSYCHEDELIC ASSISTED THERAPY
Below is “The 2010 ISCD study "Drug Harms in the UK: a multi-criteria decision analysis" found that alcohol scored highest overall and in Economic cost, Injury, Family adversities, Environmental damage, and Community harm” as found on Wikipedia at “https://en.wikipedia.org/wiki/Psychoactive_drug”.
What is Psychedelic Assisted therapy?
Hello! Welcome to the blog of Integrative Psychotherapy San Francisco. I’d like to explore the topic of Psychedelic Assisted therapy in this blog. Many news articles have been highlighting the study results of many different studies of psychedelic treatment that are making waves in the medical field and in the news. In order to accurately represent what psychedelic assisted therapy is, I think that it’s important to acknowledge a brief history behind psychedelics, and how they came to be illegal for so many years in the United States.
Many psychedelics and psychotropic substances occur naturally in plants and some animals, like the psilocybin mushroom, they peyote cactus, mescalin, 5-meo-dmt (or frog toad), iboga, ayahuasca, the marijuana plant, the cocoa plant, and many others. Many species including our own have been known to partake in consuming substances to create an altered state of mind. Similar to medications and drugs that are prescribed, some psychedelics were created and introduced in labs by scientists as well, such as LSD, Ketamine, and MDMA. Similar to psychiatric medications, psychedelics interact with some of the same brain chemicals that anxiety and depression medications target.
First of all, I’d like to acknowledge that many indigenous cultures have been using psychedelics in community and in ceremonial and religious contexts for thousand of years. Psychedelics are only new to western cultures. Synthetic Psychedelics were used extensively in research starting in the 50s and were initially recognized for their therapeutic use. When LSD was first discovered, the government tested LSD on non-consenting civilians in San Francisco and New York. The government program was called MK-ULTRA program and ran for 11 years from 1953-1964. The doses were secretly and randomly administered to people in their drinks at restaurants and at bars. Civilians who tried to talk about their experience of hallucinating were often dismissed as being psychotic prior to the program details becoming public. As psychedelics became more known and more popular in the alternative communities, people explored altered states of mind using LSD and Psilocybin and MDMA. MDMA specifically was being used therapeutically for couples therapy sessions and for therapy sessions in research and by therapists before psychedelics were criminalized. There were a few cases that highlighted the danger of using psychedelics in a casual setting, which begin to characterize psychedelics as dangerous in the media.
Psychedelics, being a non-specific amplifier of emotions and of mental health, can sometimes onset psychotic episodes, psychotic breaks, and suicidal feelings if someone is already on the way to have these mental health issues or are currently experiencing these emotions. One case in the media publicized the death of a young women who jumped off a building while using psychedelics in a casual setting. Other recent studies have reported suicidal ideation in some cases involved in psychedelic therapy lab research studies. Many of the early studies (most of which were conducted at well known Universities such as Stanford and John Hopkins) used psychedelics with people who were already displaying severe psychotic disorders, which where not very well understood during that time of our therapy and medical history. Richard Nixon criminalized the use of psychedelics in 1968. Many people hypothesize that Nixon’s war on drugs specifically targeted putting people of color in prison and painting antiwar activist hippies as criminals.
What Is Psychedelic Preparation?
Preparation refers to the therapy process that emotionally, physically, and psychologically prepares a client to engage in psychedelic assisted therapy. When someone decides to pursue psychedelics as a form of therapy, it is recommended to engage in a deep process of understanding why they are choosing this healing modality, helping them gain clarity on what their intentions are for the journey into the unconscious material, and aiding them in identifying and managing their expectations around what the psychedelic journey will do for them. Psychedelics aren’t a quick fix. They often shift and open up deeper material that can then be brought to therapy to be worked on. Many people may be attracted to psychedelic assisted therapy because they believe it will work faster than regular therapy. From what I’ve observed, it works differently from regular therapy. People often do find the shift that they are looking for, but sometimes that shift can be very painful, and in a different direction than what they were hoping for or expecting. Preparation also ideally includes preparing one’s community and loved ones around them to help support them after they go through the journey and they feel the most vulnerable and raw psychologically and emotionally, which can sometimes last for months.
What does the psychedelic journey look like?
The psychedelic journey is different for everyone, as each individual processes emotions and digests substances differently in their bodies. A psychedelic assisted therapy journey can last anywhere from three to ten hours. Some people prefer internal processing and silence during the journey, while others may be actively engaged in a therapy process the whole duration of the journey. People may experience joy, may access fear, may end up letting go of grief that they are holding in their body. Psychedelics used as a medicine in a therapy setting can help lower defenses and inhibitions, which can make it easier to access and let go of things that are stored in the body and in the psyche. Some may be surprised by what comes up, others may know what they will face in the journey. Stepping into this work is facing the unknown, that’s one of the helpful pieces of work for people.
What is Psychedelic integration?
After a psychedelic assisted therapy session, one must process the material that came up during the session and integrate it into their ordinary state of mind. Often people may feel surprised, raw, or disconnected from what they’ve experienced. It’s helpful to make meaning of what was opened. Often, integration includes not only making meaning of what materials have come up, but also, learning new skills to resource and soothe these old wounds that have been reopened. One example could include the new awareness of how harsh of an inner critic one has, and the new gentleness and lovingness that can be brought to this wound moving forward in everyday life. Another example could be the discovery that one is not letting certain people into what they are going through, and moving forward, the small steps that are taken to invite people in. Being in an altered state of mind can make us incredibly vulnerable to ourselves, and we may need to find different ways to be with ourselves in the aftermath that could work better for us than what we’ve been doing.
Who does Psychedelic Assisted Psychotherapy benefit the most?
Research has indicated psychedelics as being useful for a broad range of mental health issues. They have also been identified as counter indicated to healing certain personality disorders and certain psychotic disorders, as psychedelics can be destabilizing. There are four major areas of research that psychedelics were found to be very helpful in, with different psychedelics being specifically helpful for different issues. Below are 4 researched areas of use for psychedelics that are being talked about:
Ketamine and Severe/ Major Depressive Disorder: People with major or suicidal depression are in a lot of psychological and physical pain that they often do not get a break from. Ketamine, originally known to be an anesthetic, has a dissociative and psychedelic affect on the person using the medicine. The person experiencing severe depression often gets a physical and emotional break from the pain that they experience in this depression, and they also find new perspectives to what they are going through while on the medicine. The effect of consistent treatment over the period of 6 to 8 sessions tends to be very affective for interrupting severe depression.
MDMA and Post Traumatic Stress Disorder- the research project MAPS, now known as the entity Lykos, has been conducting the efficacy of MDMA for PTSD for 30 years now. Their research speaks of an 80% efficacy rate for PTSD. Lykos recently brought their research to the FDA to be approved, and the panel recommended against it for several reasons. One, unlike most psychiatric medications, MDMA cannot be proven helpful without the involvement of therapy, thus putting into question whether MDMA alone is a treatment by the food and drug administration. Within the 30 years of research, there were several cases of sexual abuse within the studies perpetrated by the researchers. These harmful researchers have most likely lost their therapy licensed and have hopefully been held accountable, but unfortunately, their damage cannot be ignored. Furthermore, several people came out against the research protocol and shared their experiences of being asked not to talk about the suicidal ideation that they experienced during the trials. This information is very concerning, and it makes sense why the FDA would choose not to approve MDMA. However, no other treatment has been shown to be effective with the combination of MDMA and therapy. Many of the veteran communities were relying on the legalization of MDMA assisted therapy to help them treat their PTSD. Other forms of PTSD include sexual assault and sexual abuse trauma, complex trauma and complex PTSD, PTSD from violence, and even attachment trauma stemming from emotional abuse, which is a form of complex PTSD.
Psilocybin and Existential Anxiety, with a focus on End-of-Life Transition: Psilocybin has been shown to greatly reduce existential anxiety and depression, and has been found to be specifically very effective to help people face the end of their life as they face the fear and the grief of dying. Many of the studies with psilocybin have included people facing a cancer diagnosis and the pain of illness included. The use of psilocybin helps reduce severe depression and anxiety in these populations. Psilocybin is decriminalized for possession and personal use in Oregon, the Bay Area, and Colorado, as it is one of the least toxic and poisonous substances for the body to process, with alcohol and cigarettes being the most toxic and harmful substances for the body and the most widely and legally available substances as well.
Iboga and Addiction Treatment, which a specification for opioid addiction: They have found a very high success rate with using the plant medicine called Iboga, a bark from Africa, with the extracted compound Ibogaine, for treating severe heroine and opioid addiction. Ibogaine seems to work as well for severe alcoholism, meth use, and many other addictions as well. The results have shown a 40-80% first time success rate using ibogaine, which is quite high considering that buprenorphine only has an 18% success rate, and treatment centers in the US have a 30% first time success rate. The medicine seems to get rid of withdrawal symptoms right away, completely in some cases.
Iboga or ibogaine has shown to be lethal to a small percentage of people who have cardiac issues or heart failure. There have been 33 deaths total reported in the last 20 years. The likelihood of death, while small, is not very well known due to the legal blocks around studying the medicine. In the year 2022 alone, 81,806 opioid deaths were recorded in the United States. While Ibogaine poses a threat, the threat of dying from opioid addiction alone is about 49,579 times more likely according to these numbers if the opioid crisis is to continue contributing to deaths as it has been in the last couple of years. For this reason, the medical community is reevaluating ibogaine as a potential option for saving lives.
The Current Psychedelic Assisted Therapy Climate:
The war on drugs has seemed to shift towards the well know pharmaceutical companies and the opioid crisis, as the opioid crisis has become a leading cause of death. The Fentanyl crisis has also taken the attention as it so often has killed so many people. Psychedelic assisted therapy has proven to have great results in the studies conducted at prestigious universities over the last 30 plus years, and their level of harm is being reconsidered. Ketamine was approved by the FDA as one of the safer anesthetics for animals, children, and adults in the 1960’s and was more recently approved as a medical treatment for severe depression. In 2019, Ketamine assisted therapy ( the use of ketamine in a therapy setting with a therapist) was approved. Psilocybin assisted therapy has been legalized in Oregon, and the legal standards and licensing process had been rolling out this year. The state of Colorado decriminalized the personal use of psilocybin and has voted to approve psilocybin assisted therapy, which is in process through the state regulation board for therapists to apply to become licensed providers by the end of this year.
As discussed earlier, MDMA will probably not be approved yet as a medicine and therapy treatment for PTSD. Although Lykos has been working with the FDA for a long time now to conduct their study properly, the treatment for PTSD will have to wait until the research can be conducted and proved in a different way. Iboga, or Ibogaine, has also not been approved by the FDA. Fortunately, people who are at the end of their lives are more able to access psilocybin. Hopefully the path to approving psychedelics will unfold as they can be proven as safer and more reliable. So many medicines and therapy treatments must go through this path to become verifiably effaceable. All information of the research and studies being conducted can be found on the internet. I strongly encourage anyone who is curious about psychedelic assisted therapy to do their own research on this topic.
Bianca Aarons is a therapist licensed in both California and Colorado. She completed Naropa University’s Psychedelic Assisted Therapy Training Program in 2023. She has been an attachment based, psychodynamic and relational therapy practitioner in San Francisco for 11 years, and she is working towards her Psychedelic Assisted Therapy License in Colorado as it rolls out in the end of 2024. She currently offers preparation and integration therapy sessions, she recently started a remote end-of-life support group, and she runs a bi-monthly psychedelic integration group remotely.