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What Is Psychedelic Therapy & How Does It Work?

October 19, 2021

The Dire Need for Alternative Therapies

In 2020, rates of depression in the U.S. tripled. This turmoil amplified existing questions about how to best respond to the growing mental health crisis.  Antidepressants can help people navigate their symptoms, but they rarely treat pain at its source. While talk therapy can drive meaningful changes over time, some individuals take years to respond to therapy on its own or with antidepressants. The costs of these long-term treatments can themselves cause stress.

Psychedelic therapy is now gaining momentum due to the limitations of these models and the growing popularity of holistic and natural health solutions. The third wave of the psychedelic renaissance began in 2000 when researchers at Johns Hopkins University were the first to resume research into the therapeutic properties of psychedelics. 

There is now ample proof that psychedelic-assisted therapy can treat addiction, depression, post-traumatic stress disorder (PTSD), distress associated with life-threatening diseases, and many other conditions. When combined with a biopsychosocial perspective and the tools of biomedicine, psychedelic therapy can supplement symptom-based approaches that have proven insufficient against the mental health crisis we face. 

The History & Evidence Behind Psychedelic Therapy

Indigenous people around the world have used naturally occurring psychedelics, such as Psilocybin mushrooms and Ayahuasca, in religious ceremonies since before recorded history. Lysergic Acid Diethylamide (LSD), first synthesized by Albert Hoffman in 1938, drove significant paradigm shifts in the study of the brain, revealing information about the structure and functions of the neurotransmitter serotonin.  

In the 1950s and 60s, clinicians and researchers already had evidence that psychedelics could treat depression, anxiety, addiction, and even help everyday people better navigate stress. During this time, psychedelics were understood in positive or even neutral terms. However, hyperbolic media coverage, confusion about risks, and other cultural backlash led to a long pause in research and the categorization of psychedelics as Schedule I substances in 1970.

However, over the last two decades, Johns Hopkins University, the Multidisciplinary Association for Psychedelic Studies (MAPS), and other organizations have published groundbreaking studies on the therapeutic capacities of these unique compounds. 

Although personality was thought to stabilize after the age of 30, research in the Journal of Psychopharmacology described significant rises in the “Big Five” trait openness from Psilocybin use even after a one-year follow-up. Openness is linked to intellectual curiosity and an expanded appreciation for a wide range of emotions and experiences. These shifts partially explain the success of psychedelics in helping people resourcefully navigate difficulties like terminal illness or addiction, covered below.

Psychedelic Research into Anxiety, Depression, PTSD & Other Hard-to-Treat Conditions

LSD for end-of-life anxiety: Scientists have thoroughly explored LSD for its effects on anxiety related to terminal illness. This study, for instance, followed individuals with life-threatening cancers 12 months after receiving LSD-assisted psychotherapy. Participants reported sustained reductions in anxiety, improvements in quality of life, and cathartic confrontations with emotions that gave them “new baselines” for how they viewed their situations. These effects could in part be due to alterations in the functional connectivity of the default mode network (DMN), which is involved with mood regulation and the felt sense of self. Changes in blood flow in regions of the DMN could lead to perspective shifts and experience re-evaluation. 

Psilocybin for end-of-life distress, smoking, and OCD: Psilocybin is also helpful in alleviating end-of-life distress. Dr. Roland Griffiths (often considered the father of the current “Psychedelic Renaissance”) was among the first to study Psilocybin on anxiety and depression associated with late-stage cancers. He noted that those who described their experience with Psilocybin as highly mystical benefited most from the treatment. While psychedelics aren’t a panacea, Griffiths explained their capacity to help people grasp a deeper sense of meaning. These perceptual shifts also allow a glimpse into a larger, clarifying frame where they can see beyond previous fears.

On a different front, this pilot study found that 67 percent of former smokers remained abstinent 12 months after Psilocybin-assisted therapy. Intriguingly, 13 of the participants described their experiences as among the most “personally meaningful and spiritually significant of their lives.” Obsessive-Compulsive Disorder (OCD), a condition characterized by repetitive and compulsive thoughts and urges, has also responded well to Psilocybin therapy. This study described the serotonergic activity of Psilocybin as useful in reducing OCD-related doubt and rumination.

MDMA for PTSD: MAPS conducted this phase 2 trial describing the results of six randomized, double-blind controlled clinical trials with participants suffering from PTSD. Participants who received active doses of 3,4-Methyl​enedioxy​methamphetamine (MDMA) had significant reductions in symptoms. In fact, in a one-year follow-up, two-thirds of the participants no longer met the diagnostic criteria for PTSD. Changes in dopamine, serotonin, norepinephrine and other hormones and neurotransmitters drive perceptual shifts that make it easier for people to reflect on, be open to, and work through difficult emotions. 

Ketamine for depression: Ketamine is the only compound with legal approval for use in psychedelic-assisted therapy. It’s currently used pharmacologically in a liquid or powder form under the brand name Ketalar, or as a nasal spray, as Spravato. Ketamine isn’t a serotonergic psychedelic but an N-methyl-D-aspartate (NMDA) receptor agonist. It’s known for its fast-acting antidepressant effects. In this study, Ketamine improved symptoms of depression within a single day in 71 percent of those who received it.

Of course, this list isn’t exhaustive. There’s also research into the therapeutic effects of psychedelics like Ibogaine, Ayahuasca, 5-MEO-DMT, and other compounds. 

Stages of the Process

The process of psychedelic therapy can be broadly understood in terms of four main parts: intake, preparation, facilitation, and integration.  During intake, practitioners use in-depth questionnaires to assess an individual’s emotional state. In holistic mental healthcare (psychedelic therapy included), the practitioner aims to understand the client as a whole person, not simply as a series of symptoms. Factors like family and trauma history, use of medication, as well as insights into their spiritual, social, and emotional life guide practitioners on how to best support each person. Rather than a purely biomedical approach, this biopsychosocial analysis helps practitioners use a combination of clinical insight and personal intuition to create individualized approaches to care.

Intake is followed by a preparation session, involving conversations about the dynamics of the psychedelic experience and how to best negotiate with challenging emotions and experiences. Factors like dosing, sourcing of the medicines, administration methods, and the timing of a psychedelic session are responsibilities of practitioners and vary based on individual needs.

While therapy sessions might involve reclining on a couch, dim lighting, a carefully curated soundtrack, and a weighted blanket, the rapport between the practitioner and individual—known as “therapeutic alliance”—is the most vital aspect of set and setting. Unlike conventional medical care, psychedelic practitioners tend not to position themselves as authority figures who alone make healing possible. The psychedelic practitioner instead encourages individuals to trust their innate healing intelligence. The practitioner uses their comprehensive grasp on a client’s emotional life to discern when to intervene throughout the experience, if at all. 

Psychedelic integration is often described as the most fundamental part of the process. After a psychedelic session, the practitioner and client put challenging emotions into context. Because psychedelics can induce vulnerability, awaken traumas, and bring subconscious material to the surface, disorientation is common. Even if the immediate felt impact is immensely positive, absorbing insights in a constructive way takes time, patience, and reflection. Integration is paramount because it helps participants find ways of relating to paradigm-shifting experiences so they promote long-term behavior change and real-world action.

How to Legally Use Psychedelics

Apart from personal dosing in decriminalized cities, there are a few ways to legally pursue psychedelics. Ketamine- and cannabis-assisted therapy are both available in the U.S. Additionally, the FDA has an expanded access program, which allows individuals to access non-FDA-approved psychedelic treatments when clinical trials are not available. Understood as a “compassionate use” measure, this program is particularly for people with conditions that haven’t responded to available treatments, and in cases wherein the benefits of receiving psychedelic therapy unequivocally outweigh the risks. 

Similarly, the “Right to Try” act allows people with terminal illnesses to use investigational treatments if they’ve exhausted other modes of treatment and don’t have opportunities to enter a clinical trial. These acts come in response to the growing recognition that people often seek palliative care not for physical pain but for emotional distress and crises of meaning. Also, for individuals with late-stage diseases, antidepressants and anxiolytics may interact with other medications, cause confusion and mental fogginess, and require weeks to take effect. Psychedelic care offers a direct, low-risk way to approach the existential un-ease often surrounding terminal illness. 

Church sanctions also provide legal routes to psychedelic use. The 1978 American Indian Religious Freedom act freed the Native American Church from the Controlled Substances Act, permitting their use of peyote as a religious sacrament. Multiple churches use Peyote, Ayahuasca, and Cannabis ceremonially, including the União do Vegetal (UDV) and Santo Daime churches, which both use Ayahuasca.

Legal Challenges

Apart from these opportunities, psychedelic therapy is not, at the time of writing, legal in the U.S. The following are the only states that have decriminalized psychoactive compounds, such as Ayahuasca, Ibogaine, and Psilocybin. In addition to this list, there is Oregon, which was the first state to vote on the legalization of psilocybin with Measure 109, 

  • Oakland, CA
  • Santa Cruz, CA
  • Washington DC
  • Denver, CO (Psilocybin only)
  • Ann Arbor, MI
  • Somerville, Cambridge, and Northampton, MA

Fortunately, the FDA has determined that both psilocybin and MDMA can support “breakthrough therapies” for depression and PTSD respectively. A “breakthrough therapy” designation refers to the process intended to accelerate the study of a drug that appears to offer significant relief compared to other available therapies. MAPS is currently conducting Phase 3 clinical trials on the use of MDMA for treating PTSD. MAPS founder Rick Doblin has announced that MDMA-assisted therapy for PTSD is likely to receive approval by 2022, while approval for psilocybin to treat alcohol misuse is also progressing.

Logistical Bottlenecks 

Despite this progress, there are still logistical barriers that complicate psychedelic therapy’s availability. The field of psychedelic care lacks a system of universal best practices to guide its execution and demonstrate its clinical viability. These predicaments put ceilings on the number of people who can benefit from it. Due to legal challenges and the highly intuitive, personal nature of psychedelic transformations, there aren’t many resources practitioners can use to document their processes.

Without the proper infrastructure to record the results of their clients’ psychedelic journeys, practitioners commonly resort to hand-written note keeping and memory. Some look toward manual assessments to keep track of their clients’ health progression, which can be laborious and time-consuming. These issues reduce the scalability of psychedelic business models. They also obstruct the flow of communication about therapeutic progress with the rest of the psychedelic professional and research community. And they often leave patients unsure of whether their treatment produced a lasting positive effect. 

Without universal guidelines, there will not only be limited clinical access to psychedelic therapy but inconsistencies or inadequacies in treatment protocols that may hurt the public’s growing interest. Not only could this sabotage the progress of research in this area, but it would limit many people from safely receiving psychedelics under the guidance of trained practitioners.

There’s also the concern the public will see psychedelic therapy not as an adjunct to committed self-reflection, but as a cure-all that can be administered like any common pill. The “one-disease-one-pill” paradigm reverberates throughout much of the allopathic medical system, and the positioning of psychedelics within this system inevitably presents the risk they’ll be fundamentally misunderstood.

Fortunately, the merging of psychedelic therapy with modalities like measurement-based care can alter the way mental healthcare is perceived and conducted. The Maya Health platform was designed to address the stumbling blocks to the full blossoming of safe and accessible psychedelic therapy. The platform offers standardized well-being assessments that help practitioners create personalized protocols, securely store data, and remain HIPAA-compliant. Maya also connects providers, participants, and researchers to bridge the gap between real-world evidence and academic research. These connections are generating a collaborative knowledge base that informs safe and accessible psychedelic practices.  

By combining clinical and real-world evidence, academic research, and the lived-experiences of practitioners and participants, we can uncover best practices to make psychedelic medicine practices safe and accessible. By supplementing intuition and cultural wisdom with data-driven approaches, psychedelic therapy can become a reliable source of relief for everyone in need.

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