What is Psychedelic Therapy?
Psychedelic therapy could be one of the most significant breakthroughs in the recent history of mental health. Ben Sessa has said MDMA could be as important to mental health as the development of antibiotics was to controlling infection.
If psychedelics are poised to reshape psychiatry, this has enormous implications for people with mental health issues and the therapeutic professionals who treat them. This post will define psychedelic therapy and look at its history and modern forms. We'll also present a real-world case and suggest important considerations for consumers seeking psychedelic therapy.
Photo by Oleg Ivanov on Unsplash
What is Psychedelic Therapy?
Psychedelic therapy is the use of psychedelic substances for therapeutic purposes. The most common substances used are psilocybin (found in Psilocybe mushrooms or "magic truffles"), MDMA, and LSD. Modern psychedelic therapy usually takes the form of psychedelic-assisted therapy, as the substance is not the treatment by itself. Instead, the psychedelic experiences and psychological therapies complement each other to produce the best outcome.
Indigenous cultures that utilize psychedelics have a long history of their use for therapeutic purposes, both as healing agents and helping healers determine the cause of illness. This history is rich and varied, and I can't summarize it in a paragraph, let alone a blog post. It does exist, though, and while we're not discussing it today, it's worth remembering that none of the advances in therapy we're seeing would be possible without Indigenous peoples' traditional cultural and medicinal knowledge.
Psychedelics entered western scientific and therapeutic usage primarily after Albert Hoffman discovered lysergic acid diethylamide, now known as LSD. After World War II, psychedelic science appeared to be off to a good start. By 1947, Sandoz had completed safety trials for LSD. During the late '40s and early '50s, psychiatrists such as Werner Stoll had begun experimenting on themselves and their patients. These historical approaches were often more "psycholitic," utilizing low-medium doses repeatedly over many sessions.
Throughout the 1950s, Dr. Humphrey Osmond used LSD to treat alcoholism with great success. Utilizing it as a tool for therapeutic self-exploration was increasingly popular in Hollywood, with Cary Grant reportedly undertaking over 100 "LSD sessions" at the Psychiatric Institute of Beverly Hills. Clinicians working at this time were beginning to formulate what the best therapeutic approaches could be. Still, research was cut short by the criminalization of psychedelics and the broader War on Drugs. (This is a massive simplification. We can talk about the politics and nuances of prohibition another time.)
Contemporary researchers have slowly picked up this work over the last 20 years. An overall pattern of psychedelic therapy has emerged: psychedelic-assisted therapy. This approach includes psychological counseling before and after the psychedelic experience.
Therapists screen patients for conditions incompatible with psychedelics and take them through preparation counseling or activities across several sessions. This process aims to ensure that patients know what to expect during the experience and are equipped with strategies to deal with challenging experiences. Importantly, this also means that they can give fully-informed consent for the treatment.
Unlike some methods employed earlier in the 20th century, modern psychedelic-assisted therapy utilizes higher doses of psychedelics, generally enough to produce intense experiences of visionary or mystical states. Patients are usually kept in comfortable surroundings during the psychedelic session, with soft furnishings, blankets, and eye-masks. The venue may provide music, and the question of which is best for psychedelic therapy or exploration is a whole emerging field of study by itself. Therapists do not generally seek to talk with the patient during their experience and avoid physically interacting with them any more than is necessary. Instead, therapists are present to ensure physical safety and provide a grounding or reassuring presence.
Integration is essential, both for overall mental health and solidifying positive outcomes. After the psychedelic experience, patients undergo counseling to help integrate what they went through. They may be encouraged to keep reflective journals or find different ways to express what has come up for them physically. The overall purpose of these activities is to allow them to make sense of the experience, see what changes they may want to make to their lives, and find a new equilibrium.
Integration activities are most important in the weeks after a psychedelic experience. However, people may still find themselves going through meaning-making processes many years later, particularly if the experience was intense. Perceived intensity or impact of the experience seems to affect therapeutic efficacy. In some trials, participants who experience more mystical states seem to experience better therapeutic outcomes.
It's important to note that challenging experiences can occur for some people, even in clinical and controlled settings. While these feel difficult at the time, many research trial participants who experience them still rate them as being highly worthwhile, and many would still undertake further psychedelic treatment.
Why is Psychedelic Therapy Important?
If psychedelic therapy turns out to work as well as the research suggests, this will be a huge deal for how we approach many mental health issues. One reason for this is the ability of psychedelic-assisted therapy to help people where existing treatments and medications have not.
Both open-label and randomized controlled trials into using psilocybin-assisted therapy to address treatment-resistant depression have indicated a high level of success. So, at a personal level, access to more efficacious treatments will make an enormous difference to people in this situation. But this reaches further. Research indicates that 2.8 million people experienced treatment-resistant depression in the past 12 months in the US alone. Addressing this would alleviate a great deal of human suffering and reduce a considerable economic cost.
Research is ongoing into how psychedelic-assisted therapy can be used in a range of hard-to-treat disorders, including anxiety, end-of-life distress, and eating disorders - to name a few. If successful, millions of people may find new treatment options where others had previously failed.
How psychedelic-assisted therapy compares to existing medications is connected to the personal, therapeutic, and economic implications. Rather than taking medication for months or years, this form of treatment only requires the substances to be used a few times or even just once. As previously discussed, the psychedelic experiences still generally need therapy to prepare for and work through afterward (i.e., integration.) But the positive changes tend to be long-lasting, produce fewer side effects, and may still end up costing less overall.
Combining potential cost-effectiveness and an enormous untapped market has made corporations developing psychedelic therapies desirable to investors. Expect to see even more hype and noise in this area, but also discussions around the accessibility of treatments and decriminalization.
Real Example of Psychedelic Therapy
Because so few people have been able to undertake psychedelic-assisted therapy legally, public accounts are relatively hard to find.
In August 2020, Thomas Hartle became the first Canadian to undergo legal psilocybin-assisted therapy. Hartle, who had been diagnosed with inoperable colon cancer, was looking for a way to cope with the overwhelming anxiety his condition was causing him. After a lengthy legal battle, authorities permitted him to utilize psilocybin in the form of psilocybe mushrooms in a psychedelic-assisted therapy framework. Using preparation and integration, and under the supervision of his therapist, Hartle was able to experience freedom from his fears around mortality.
“As I listened to the music, every instrumental piece seemed to create a different Universe… and out of all of the Universes I experienced, this is the only one where pain and suffering existed….my transition from this life to whatever the next place might be, is not so scary”.
Other accounts of people benefitting from psychedelic use abound on the internet, though most of them are not officially or formally considered therapy. These stories increasingly involve celebrities, e.g., Will Smith detailing his positive experiences with ayahuasca or Mike Tyson crediting 5-MeO-DMT with his return to boxing.
In addition to these accounts, population studies suggest recreational psychedelic use may be correlated with better mental health. This result indicates that while psychedelic-assisted therapy may be the most effective therapeutic use of psychedelics, it isn't the counseling doing all the work. It might also imply that there are other, as yet undiscovered ways people can utilize psychedelics.
Tips and Reminders for Psychedelic Therapy
If you are thinking of seeking out psychedelic-assisted therapy, there are a few things to keep in mind.
Psychedelic therapy is a newly emerging science and is a work in progress. While results from trials have been good, it may be too soon to say if every therapeutic claim will produce the same benefits for most people when rolled out on a large scale. Publicly traded psychedelic companies seeking to keep their share price up have a vested interest in encouraging hype around these treatments, as do some nonprofit organizations hoping to provide services or collect donations. So whether you are a potential patient or a potential investor, make sure you do your research and consider the opinions of organizations or individuals who don't have anything to gain from your decisions.
Because psychedelic therapy is not legal in many places, you may find that you need to travel to experience it unless you can participate in research. Psychedelic retreats may or may not have a clinical approach outside of research settings. If you have a severe mental or physical illness, some of these retreats may not be equipped to give the care you need. Always answer intake questionnaires wholly and honestly. Ask as many questions as you can about the care you will receive: Who will supervise you, what are their qualifications, what emergency procedures are in place, and will they provide ongoing integration support?
While most therapists who have participated in delivering psychedelic-assisted therapy (predominantly for research) and retreat facilitators who provide psychedelic experiences act with the utmost care for their patients and conduct themselves with integrity, this is not always the case. Even high-profile therapists and educators such as Aharon Grossbard and Francoise Bourzat have been implicated in incidents of highly inappropriate and abusive behavior with people in their care. Whether at a retreat or clinical trial, always look up the organization and individuals working with you. As well as googling potential providers, make contact with your local psychedelic society and ask around. Because psychedelics are still essentially criminalized in most places, word-of-mouth in these communities will provide information you won't find elsewhere.
While psychedelics are generally physically safe, the experience can be disturbing and exacerbate some mental health issues. If you have a severe mental health concern, using psychedelics to treat yourself is probably not the best idea - this is especially important if you have a family history of schizophrenia. If you won't take this advice and are determined to do this, please follow these harm-reduction guidelines at least:
Don’t trip alone - always have a trusted (preferably experienced) friend to be with you as a “sitter.”
Have a plan for what your sitter will do if you have a challenging experience or require emergency care.
Have a safe, comfortable, and quiet setting where you won’t be disturbed and won’t disturb others.
If using mushrooms, make sure they are the right ones. If using LSD or other chemicals, always use a test kit or drug-checking service to ensure you have the suitable substance.
Arrange to have an integration specialist to work with afterward. Your local psychedelic society or websites such as psychedelic.support can help you with this.
Finally, you need to understand that no matter who provides them, psychedelics and psychedelic therapy are not "magic bullets." They may not work for everyone. And even if they do, there is still hard emotional and cognitive work involved, and you are the one who has to do it! For most people, sustained and lasting change requires focus, intention, and effort.
Where to from here?
Psychedelic therapy has been around for many years in some form or other. But in terms of science, there is still some work to be done. Likewise, regulation around psychedelic therapy is almost non-existent because it is either illegal or operating in a gray area of local laws. For all of these reasons, if you think you might want to have psychedelic-assisted therapy, it's vital that you educate yourself about substances and processes and do diligent research on any potential providers. Both of these things are easier if you're part of a community of people who have experience with psychedelics and underground knowledge of who may (or may not) be a trustworthy facilitator or guide. Local psychedelic societies can significantly assist you in this regard. Until psychedelic therapy is part of mainstream mental health, connection to the community is the best way to get good information and stay safe.
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