Psychedelic therapy
Psychedelic therapy refers to therapeutic practices involving psychedelic drugs, oftentimes utilizing serotonergic psychedelics such as LSD, psilocybin, DMT, MDMA, mescaline, and 2C-B. In psychedelic therapy, in contrast to conventional psychiatric medication taken by the patient regularly or as-needed, patients generally remain in an extended psychotherapy session during the acute psychedelic activity with additional sessions both before and after in order to help integrate experiences with the drug.
History
Early psychedelic therapy
Psychedelic therapy, in the broadest possible sense of the term, may have originated from prehistoric knowledge of hallucinogenic plants. They grow naturally in certain cacti, seeds, bark and roots of various plants. Since ancient times, shamans and medicine men have used psychedelics as a way to gain access to the spirit world. Though usually viewed as predominantly spiritual in nature, elements of psychotherapeutic practice can be recognized in the entheogenic or shamanic rituals of many cultures.Research in the mid-20th century
Shortly after Albert Hoffman discovered the psychoactive properties of LSD in 1943, Sandoz Laboratories began widespread distribution of LSD to researchers in 1949. Throughout the 1950s and 1960s, scientists in several countries conducted extensive research into experimental chemotherapeutic, and psychotherapeutic uses of psychedelic drugs. In addition to spawning six international conferences and the release of dozens of books, over 1,000 peer-reviewed clinical papers detailing the use of psychedelic compounds were published by the mid-1960s. Proponents believed that psychedelic drugs facilitated psychoanalytic processes, making them particularly useful for patients with conditions such as alcoholism that are otherwise difficult to treat. However, many of these trials did not meet the methodological standards that are required today.Researchers like Timothy Leary felt psychedelics could alter the fundamental personality structure or subjective value-system of an individual to great potential benefit. Beginning in 1961, he conducted experiments with prison inmates in an attempt to reduce recidivism with short, intense psychotherapy sessions. Participants were administered psilocybin during these sessions weeks apart with regular group therapy sessions in between. Psychedelic therapy was also applied in a number of other specific patient populations including alcoholism, children with autism, and persons with terminal illness.
Regulation and prohibition in the late 20th century
Throughout the 1960s, concerns raised about the proliferation of unauthorized use of psychedelic drugs by the general public resulted in the imposition of increasingly severe restrictions on medical and psychiatric research conducted with psychedelic substances. Many countries either banned LSD outright or made it extremely scarce, and, bowing to governmental concerns, Sandoz halted production of LSD in 1965. During a congressional hearing in 1966, Senator Robert Kennedy questioned the shift of opinion, stating, "Perhaps to some extent we have lost sight of the fact that can be very, very helpful in our society if used properly." In 1968, Dahlberg and colleagues published an article in the American Journal of Psychiatry detailing various forces that had successfully discredited legitimate LSD research. The essay argues that individuals in government and the pharmaceutical industry sabotaged the psychedelic research community by canceling ongoing studies and analysis while labeling genuine scientists as charlatans.Studies on medicinal applications of psychedelics ceased entirely in the United States when the Controlled Substances Act was passed in 1970. LSD and many other psychedelics were placed into the most restrictive "Schedule I" category by the United States Drug Enforcement Administration. Schedule I compounds are claimed to possess "significant potential for abuse and dependence" and have "no recognized medicinal value", effectively rendering them illegal to use in the United States for all purposes. Despite objections from the scientific community, authorized research into therapeutic applications of psychedelic drugs had been discontinued worldwide by the 1980s.
Despite broad prohibition, unofficial psychedelic research and therapeutic sessions continued nevertheless in the following decades. Some therapists exploited windows of opportunity preceding scheduling of particular substances or, alternatively, developed non-drug techniques such as Holotropic Breathwork for achieving similar states of consciousness. Informal psychedelic therapy was conducted clandestinely in underground networks consisting of sessions carried out both by licensed therapists and autodidacts within the community. Due to the largely illegal nature of psychedelic therapy in this period, little information is available concerning the methods that were used. Individuals having published information between 1980 and 2000 regarding psychedelic psychotherapy include George Greer, Ann Shulgin, Myron Stolaroff, and Athanasios Kafkalides.
Resurgence in the early 21st century
In the early 2000s, a renewal of interest in the psychiatric use of psychedelics contributed to an increase in clinical research centering on the psychopharmacological effects of these drugs and their subsequent applications. Advances in science and technology allowed researchers to collect and interpret extensive data from animal studies, and the advent of new technologies such as PET and MRI scanning made it possible to examine the sites of action of hallucinogens in the brain. Furthermore, retrospective studies involving users of illicit drugs as voluntary subjects were conducted, allowing data to be collected on how psychedelics affect the human brain while simultaneously sidestepping bureaucratic difficulties associated with providing illegal substances to subjects. The new century also ushered in a broader change in political attitude towards psychedelic medicine—specifically within the Food and Drug Administration. Curtis Wright, deputy director of the FDA Division of Anesthetic, Critical Care and Addiction Drugs explains a motivation for this change: “the agency was challenged legally in a number of cases and also underwent a process of introspection, asking 'Is it proper to treat this class of drugs differently?'"As of 2014, global treaties listing LSD and psilocybin as "Schedule I" controlled substances continues to inhibit a better understanding of these drugs. Much of the renewed clinical research has been conducted with psilocybin and MDMA in the United States with special permission by the FDA, while other studies have investigated the mechanisms and effects of ayahuasca and LSD. MDMA-assisted psychotherapy is being actively researched by MAPS. Phase two trials conducted between 2004 and 2010 reported an overall remission rate of 66.2% and low rates of adverse effects for subjects with chronic PTSD. Only six formal studies on the applications of LSD occurred between 1990 and 2017. No complications of LSD administration were observed.
As of 2016, Johns Hopkins University and New York University have conducted large randomized, placebo-controlled studies. These two studies are some of the first large controlled studies measuring the effects of psychedelic therapy on depression and anxiety in cancer patients. Across clinician-ratings and self-ratings, the psychedelic treatment produced statistically significant lowered anxiety and depression, with sustenance for at least 6 months. Importantly, adverse effects from the drugs were not noted.
Both studies also attributed the efficacy in part to patients experiencing a “mystical experience”. A mystical experience is a very personal introspective experience where some sort of unity or transcendence of time and space is described. More research is necessary to expand generalizability of the conclusions. Also, more research is necessary to understand the biological properties of a mystical experience.
Applications
Psychedelic substances which may have therapeutic uses include psilocybin, LSD, and mescaline. Although the history behind these substances has hindered research into their potential medicinal value, scientists are now able to conduct studies and renew research that was halted in the 1970s. Some research has shown that these substances have helped people with such mental disorders as obsessive-compulsive disorder, post-traumatic stress disorder, alcoholism, depression, and cluster headaches. Some of the well known particular psychedelic substances that have been used to this day are: LSD, DMT, psilocybin, mescaline, 2C-B, 2C-I, 5-MeO-DMT, AMT, ibogaine and DOM. In general, however, the drugs remain poorly understood. Their effects are strongly dependent on the environment in which they are given and on the recipient's state of mind.In alcoholism
Studies by Humphrey Osmond, Betty Eisner, and others examined the possibility that psychedelic therapy could treat alcoholism. One review of the usefulness of psychedelic therapy in treating alcoholism concluded that the possibility was neither proven nor disproven. Another thorough meta-analysis from 2012 found that "In a pooled analysis of six randomized controlled clinical trials, a single dose of LSD had a significant beneficial effect on alcohol misuse at the first reported follow-up assessment, which ranged from 1 to 12 months after discharge from each treatment program. This treatment effect from LSD on alcohol misuse was also seen at 2 to 3 months and at 6 months, but was not statistically significant at 12 months post-treatment. Among the three trials that reported total abstinence from alcohol use, there was also a significant beneficial effect of LSD at the first reported follow-up, which ranged from 1 to 3 months after discharge from each treatment program."Early studies of alcoholics who underwent LSD treatment reported a 50% success rate after a single high-dose session. However, the studies that reported high success rates had insufficient controls, lacked objective measures of genuine change, and failed to conduct rigorous follow-up interviews with subjects. The lack of conclusive evidence notwithstanding, individual case reports are often dramatic. Bill Wilson, the founder of Alcoholics Anonymous participated in
medically supervised experiments in the 1950s on the effects of LSD on alcoholism. Bill is quoted as saying "It is a generally acknowledged fact in spiritual development that ego reduction makes the influx of God's grace possible. If, therefore, under LSD we can have a temporary reduction, so that we can better see what we are and where we are going—well, that might be of some help. The goal might become clearer. So I consider LSD to be of some value to some people, and practically no damage to anyone. It will never take the place of any of the existing means by which we can reduce the ego, and keep it reduced." Wilson felt that regular usage of LSD in a carefully controlled, structured setting would be beneficial for many recovering alcoholics. However, he felt this method only should be attempted by individuals with well-developed super-egos. In 1957 Wilson wrote a letter to Heard saying: "I am certain that the LSD experiment has helped me very much. I find myself with a heightened colour perception and an appreciation of beauty almost destroyed by my years of depressions." Most AA members were strongly opposed to his experimenting with a mind-altering substance.
In terminal illness
During the early 1950s and 1960s the National Institute of Mental Health sponsored the study of psychedelic drugs such as psilocybin and LSD to alleviate the debilitating anxiety and depression patients with terminal diagnoses may feel. While these early studies are hard to find, the resurgence of interest in psychedelic drugs to treat humans end of life mindset has led to some small studies in the 21st Century. The more recently published research strengthens the findings from the 1950s and 1960s showing the drug is extremely effective in reducing anxiety and depression in this patient population once carefully screened and has few adverse effects when administered in a psychotherapy setting and under medical supervision. The psychologists leading psychedelic drug therapy trials found that end of life patients often suffer from the emotional turmoil of dying more than the physical aspects. This mindset makes it difficult for patients to find meaning and enjoyment in life during their last few months or years. While all patients have completely different experiences on these mind altering drugs the research subjects interviewed all expressed they had, "heightened clarity and confidence about their personal values and priorities, and a renewed or enhanced recognition of intrinsic meaning and value of life."In post-traumatic stress disorder
Studies conducted by the Multidisciplinary Association for Psychedelic Studies seek to understand how MDMA could be helpful in the treatment of post-traumatic stress disorder. The Phase 2 trials of these studies consisted of 107 participants who had chronic, treatment-resistant PTSD, and had suffered from PTSD for an average of 17.8 years. Out of the 107 participants, 61% no longer qualified for PTSD after three sessions of MDMA-assisted psychotherapy two months after the treatment. At the 12-month follow-up session, 68% no longer had PTSD. As of 2019 MAPS is continuing their research in Phase 3 trials.In depressive and anxiety disorders
There is some evidence indicating that psilocybin with psychological support may be effective for ameliorating treatment-resistant depression. A study published in 2019 tested the hypothesis that psychedelic microdosing is effective in treating mood and anxiety disorders. The study found that chronic, intermittent, low doses of N,N-Dimethyltryptamine produced an antidepressant-like phenotype and enhanced fear extinction learning without impacting working memory or social interaction.The FDA has granted 'breakthrough therapy' designation for studying the effects of psilocybin. First in 2018 for treatment-resistant Major Depressive Disorder and in 2019 for Major Depressive Disorder.
Methods
The effects of psychedelic drugs on the human mind are complex, varied and difficult to characterize, and as a result many different "flavors" of psychedelic psychotherapy have been developed by individual practitioners. Some aspects of published accounts of methodologies are discussed below.Psycholytic therapy
Psycholytic therapy involves the use of low to medium doses of psychedelic drugs, repeatedly at intervals of 1–2 weeks. The therapist is present during the peak of the experience and at other times as required, to assist the patient in processing material that arises and to offer support when necessary. This general form of therapy was utilized mainly to treat patients with neurotic and psychosomatic disorders. The name, coined by Ronald A. Sandison, literally meaning "soul-dissolving", refers to the belief that the therapy can dissolve conflicts in the mind. Psycholytic therapy was historically an important approach to psychedelic psychotherapy in Europe, but it was also practiced in the United States by some psychotherapists including Betty Eisner.An advantage of psychedelic drugs in exploring the unconscious is that a conscious sliver of the adult ego usually remains alert during the experience. Throughout the session, patients remain intellectually alert and remember their experiences vividly. In this highly introspective state, they also are actively cognizant of ego defenses such as projection, denial, and displacement as they react to themselves and their choices in the act of creating them.
The ultimate goal of the therapy is to provide a safe, mutually compassionate context through which the profound and intense reliving of memories can be filtered through the principles of genuine psychotherapy. Aided by the deeply introspective state attained by the patient, the therapist assists him/her in developing a new life framework or personal philosophy that recognizes individual responsibility for change.
In Germany :de:Hanscarl Leuner|Hanscarl Leuner has designed a psycholytic therapy, which was developed officially, but was used also by some socio-politically motivated underground therapists in the 1970s.
Psychedelic therapy
Psychedelic therapy involves the use of very high doses of psychedelic drugs, with the aim of promoting transcendental, ecstatic, religious or mystical peak experiences. Patients spend most of the acute period of the drug's activity lying down with eyeshades listening to nonlyrical music and exploring their inner experience. Dialogue with the therapists is sparse during the drug sessions but essential during psychotherapy sessions before and after the drug experience. There are two therapists, one man and one woman. The recent resurgence of research uses this method. It is more closely aligned to transpersonal psychology than to traditional psychoanalysis. Psychedelic therapy is practiced primarily in North America. The psychedelic therapy method was initiated by Humphry Osmond and Abram Hoffer and replicated by Keith Ditman.During psychedelic therapy, the focus is on psilocybin and ayahuasca, as patients are provided with high doses of the drug. During the trials, one must analyze both Cognitive Behavioral Therapy and/or Motivational Enhancement Therapy. Within a structured CBT intervention and a dose of psilocybin, patients are given the opportunity to experience cognitive and emotional states that are altered. With these psychedelic effects, cognitive reframing of detrimental schemas and self-identity can be modified positively. In a MET environment, patients are able to reflect on their own behaviors to make changes in problematic manners, such as chronic alcohol abuse. Additionally, it could potentially enhance motivation to change and decrease possible ambivalence about behavioral changes. Within psychedelic drug session, through a reevaluation of the concept of self and reconnecting with core beliefs and values, this can be achieved.
Other variations
In Czechoslovakia, Stanislav Grof developed a form of treatment that appeared to bridge both of these main forms. He analyzed the LSD experience in a Freudian or Jungian psychoanalytic context in addition to giving significant value to the overarching transpersonal, mystical, or spiritual experience that often allowed the patient to re-evaluate their entire life philosophy.The Chilean therapist Claudio Naranjo developed a branch of psychedelic therapy that utilized drugs like MDA, MDMA, harmaline and ibogaine.