Psychedelic-assisted Psychotherapy

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Psychedelic drugs have been around for thousands years, both in the depths of the Amazon and in Western culture. The stereotype which lies around psychedelics however is extremely negative. During the 1950’s and 60’s, there was a psychedelic renaissance where everyone was experimenting and there were multiple clinical trials running, testing to see if these drugs could cure the mentally ill. These initial trials were extremely successful and the future of psychedelic-assisted psychotherapy was looking extremely promising. However, in the late 1960’s, psychedelics fell into the hands of the anti-Vietnam war movement and all psychedelic drugs were suddenly made illegal and all trials came to holt. It was not until the 1990’s that hidden deep underground, small organizations began to revisit these trials and psychedelic-assisted psychotherapy was reinvented in underground America and eventually all across the world. Fast forward now to 2020 and there are several government approved trials running across the US and the world.There are multiple different forms of psychedelic-assisted psychotherapy including MDMA-assisted psychotherapy for PTSD sufferers and psilocybin-assisted psychotherapy for those who suffer from anxiety, depression and end of life related anxiety. It is psilocybin-assisted therapy which will be the focus of this essay however as MDMA is not technically classified as a classic psychedelic drug however, it will still be explored in this essay.

Psychedelic-Assisted Psychotherapy by definition means: “The skillful use of psychedelics in conjunction with psychotherapy by a licensed or registered psychotherapist, psychologist or other mental health professional (Sax, n.d).” Therapy sessions usually involve a series of meetings before the psychedelic experience, these are essential for patients to build a level of trust and understanding with the psychologist (or equivalent) who will be monitoring and supervising the psychedelic-assisted sessions. (Sax, n.d) There are three major contributing factors to a psychedelic experience which will determine whether it is successful or not, these factors are: set, setting and dosage. 

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“Set,” is the predetermined mind-set which one carries into the psychedelic session, this includes mood and expectation which have a vital role in determining the outcome of the experience. 

“Setting,” is the environment in which the session takes place. Most psychedelic-assisted therapy sessions today take place in a replicar living room setting as it is often associated as a place of safety and comfort compared to hospitals and sterile clinics where trials have previously run. Getting the “dosage” correct is vital in order to undergo a successful psychedelic experience. Whilst studies today are still experimenting with dosage in order to determine how much of the drug is required to be most beneficial, most psychedelic sessions involve two stages, one session with a ‘placebo pill which contains a miniscule amount of the desired substance which will barely have an effect and another with a ‘high-dose,’ which is where the patien receives a full dose of the desired drug and is guaranteed to have an effect (Griffiths, 2016). 

Follow up sessions between the patient and the psychologist who was present during the experience are also provided. These are put in place so that the patient can determine what happened during their trip and be able to grasp a better understanding of their experience (n.d, n.d). Psilocybin is the main active compound which can be found in ‘magic mushrooms’ and can be administered in many different forms for assisted psychotherapy including micro-dosing and double-blind trials. One area of mental health where psilocybin is proving to be extremely beneficial is for those who suffer from end of life related anxiety REF. A trial that was conducted in the US suggested that out of 51 cancer patients that underwent a psilocybin-placebo based therapy, 80% of participants felt a decrease in symptoms of anxiety and depression. 

The trial was split into three sections: placebo, low-dose and high-dose administrations of psilocybin which was conducted by random selection on the trial participants. The trial ran over a series of meetings between the patient and the session monitors including two to three before the psilocybin-admission, two meetings to complete the administration of the psychedelic and then three follow up appointments at one month, three months and six months post psilocybin (Griffiths, 2016). Before the mass psychedelic ban in the 1960’s, studies being conducted around psychedelics and their benefit to the mentally ill showed initial promising results however upon recent review, it has been revealed that there were significant variables which were not controlled which may have led to false or inaccurate results. In clinical trials today, researchers use a double-blind experiment method which consists of using two pills: one with an active dose of the desired substance and another with an extremely low dose known as a placebo pill. This method allows for more accurate results as two readings will often provide a more in depth and expansive result than just one. (Ursa, 2015) 

It is believed that humans have been ingesting psychoactive plants for around 10,000 years in ceremonial rituals in small tribal communities before they were discovered by Western society. The use of psychedelics from plant extracts has been used all throughout history however it wasn’t until Western scientists began experimenting with these substances that chemicalized drugs like LSD were created (n.d, 2007). There is currently substantial evidence backing up claims that Native Americans having been ingesting the drug peyote since around 3780 BCE, due to evidence which was found and could be carbon dated back to this time however there is no evidence to show how long ‘magic mushrooms’ have been used due to a complete destruction of records by the Roman Missionaries in Mexico (nil, 2007). Upon the Spanish invasion of the Americas, psychedelic drugs in their original form were seen as a threat to Christianity as they caused strange visions of higher beings and a wider scope of the universe, thus leading to their suppression within Mexico and beyond (Psychedelics, Explained, 2019). Within the Americas, the use of psychoactive plants has been a key component for both Mexican and Guatemalan culture as ancient tribes in these regions dedicated rock paintings and temples to the spirits of the native psychoactive plants (n.d, 2007). During the ancient rituals which would often take place within tribes in both Mexico and South America, a shaman or elder was always present at all psychedelic-assisted rituals to oversee the experience and to aid those ingesting the substance. This same methodology of shamans has been adopted in modern psychedelic-assisted psychotherapy trials as scientists and psychologists have become modern shamans, overseeing the psychedelic ingestion and aiding those who are undertaking the experience (Psychedelics, Explained, 2019). 

In Western society, it took a long time after their discovery for psychedelic drugs to become part of the culture. In the late 1800’s, a small group of scientists and philosophers began to experiment with nitrous oxide, peyote and mescaline and their results, which were published in the British Medical Journal, showed that the drugs gave them a deeper understanding of their science and theory. (n.d, 2007). 

During World War Two, psychedelics began to merge into the Western world as their medical potentials were being unveiled. In 1943 in Basel, Switzerland, Albert Hoffman had began to experiment with LSD with the theory that it may be able to help aid the treatment of various psychiatric disorders (n.d, 2007). Hoffman discovered that LSD’s molecular structure was similar to that of serotonin, a chemical found in the human body which helps regulate feelings of anxiety and depression. It was during that same in year in Basel that the first LSD experience was recorded. Hoffman decided to test his new drug on himself however, the dosage that he took was around 250 micrograms, double the amount which is usually ingested today. The effects which Hoffman recorded included: dizziness, anxiety, visual distortions, temporary paralysis and uncontrollable laughter. He also duly noted that the effects grew stronger over the cause of the evening (Psychedelics, Explained, 2019). 

This discovery was just the start of the first psychedelic renaissance as the 1960’s brought over 40,000 patients who had participated in psychedelic-assisted psychotherapy trials and over 1000 papers and books published on the matter (n.d, 2007). It is even believed that in the late 1940’s, the US navy had been experimenting with mescaline as a possible ‘truth serum’ after Dr Humphrey Osmand had published studies relating to a similar molecular structure between mescaline and adrenaline (n.d, 2007). It was then in the 1960’s that psychedelic drugs infiltrated the American scene when Hoffman’s LSD made its way into the Spring Grove Mental Health Facility in the USA where the US government had authorized a trial for LSD-assisted psychotherapy. Although the trial was extremely limited, initial results were promising. It was also then in the early 1960’s that psychedelics merged into mainstream American culture after LIFE magazine published an article in 1957 titled, “The Discovery of Mushrooms that Cause Strange Visions.” Psychedelic drugs soon became popular and they became a strong right of passage for the younger generation. Renowned Harvard professor Timothy Leary soon became a ‘ psychedelic celebrity’ as he heavily promoted the use of psychedelic drugs and started the catchphrase: “turn on, tune in and drop out.” With the use of psychedelics being legal in the 1960’s, they were being used consistently for both recreational and medical purposes however by the middle of the decade, US President Richard Nixon came to the conclusion that psychedelic drugs were fuelling the US counterculture and thus made them illegal. All psychedelic drugs including marijuana were added to the dangerous drugs list at a schedule one degree and a further 184 UN states followed suite with the ban on these drugs. All medical trials ceased funding and came to a holt and Timothy Leary was sentenced to imprisonment. The image of psychedelic drugs shifted drastically and were know being promoted as a highly addictive substance that will result in chromosome damage, brain damage and can lead to birth defects. With this new information circulating around America and the world, psychedelic use for medical purposes was now a thing of the past and it was not then until the 1990’s that psychedelic-assisted psychotherapy was rediscovered as a form of mental health treatment (Psychedelics, Explained, 2019). 

A study which was conducted in 2005 aimed to explore the long-term effects on the Native Americans who for centuries have ingested peyote. Peyote is a psychedelic and hallucinogenic which is extracted from a cactus plant and has been used for medical purposes by the Native Americans for thousands of years. The results of this study suggested that those who regularly ingested peyote had been affected healthwise no more than those who have hardly used it. When compared to the results of people who have regularly ingested alcohol and tobacco however, the results suggest that the regular use of those substances in question has largely impacted the Native American’s overall health and wellbeing (PopeJra, 2005). Psychedelics work by dissolving our inner ego allowing for more connections to be made within the human body and the outer world. Up until 2014, no trial had ever been seriously conducted to establish what happens to the brain under psychedelic control however during 2014, trials were conducted to study the effects of psychedelic drugs on the human brain REF. Psychedelic drugs including Lysergic acid diethylamide-25 (LSD), psilocybin, mescaline and ayahuasca contribute to major changes in the brains functions. The default mode network (DMN) in the brain has a suppressed working activity as a result of the ingestion of psychedelics and more neurological pathways are created as a result also (Williams, 2019). 

In a time of crisis ie. a car crash or mass shooting, there is a response system which is installed within the body which kicks in: flight, fight or freeze. In a time where the chance of survival is at risk, one of these mechanisms will infiltrate the body and mind and so to do so, the frontal lobe of the brain which is responsible for thinking and judgment is switched off in order to increase chances of survival. If the victim of the situation flees and survives, the brain will have no recollection of that certain moment in which the frontal lobe was deactivated and so processing the event can be extremely difficult, thus resulting in possible PTSD. With psychedelic-assisted psychotherapy for PTSD (most commonly MDMA-assisted) however, the neurological pathways between the critical thinking frontal lobe and the immediate response sector of the brain can reopen and allow for process and judgment which offers a chance for the victim to understand and heal after the incident. REF It has recently been revealed that psychedelics have been linked to promote the function of neuroplasticity which may eventually lead to clinical trails being conducted in regards to psychedelic therapy for neurodegenerative diseases such as Alzheimers and Parkinsons disease (Inserra, 2019). Clinical trials all across the world are showing promising results for Psychedelic-Assisted Psychotherapy for both mental health treatment purposes and for potential …. however, in Australia and New Zealand, the potential of psychedelic therapies are yet to be explored. It appears that the Australian Government still regards psychedelic compounds to be dangerous and harmful (Inserra, 2019), much like the US did back in the 1960’s when psychedelics were first made illegal. Currently in Australia, there are no government authorized trials or research programs running for psychedelic-assisted psychotherapy and all psychedelic-assisted therapy sessions within Australia are still being conducted underground. 

Many psychologists within Australia have been pushing for Federal authorization to conduct clinical trials and research for psychedelic-assisted psychotherapy ever since the US and UK started publishing favorable results. However, many of them worry that the continuation of underground therapy sessions in uncontrolled environments could have detrimental effects towards the future of psychedelic-assisted psychotherapy in Australia and New Zealand. The use of psychedelics in underground therapy sessions pose more risks to the patients than they do in clinical trials as therapists present cannot be monitored or authorized and there have been more cases of the session going wrong. Stories have emerged of therapists assaulting their patients and people self-diagnosing themselves and friends for psychedelic-assisted therapy sessions. Leading psychologists for the authorization of psychedelic-assisted psychotherapy fear that stories like this from within Australia could taint the image of clinical psychedelic trials and that unauthorized therapy could lead to the prevention of the government conducting trials like the US and UK in Australia (Valentish, 2018). As Australia enters a COVID-19 recovery phase, it has been made apparent that the country is amongst an emerging menta health crisis. 

Mental health organization Beyond Blue has recently experienced an all time high of connectivity within Australia as many individuals find that COVID-19 has had detrimental effects to many individuals mental health. With no current introduce trials for psychedelic-assisted psychotherapy, the Australian government has recently been called out by former coalition MP Andrew Robb who has openly called for an introduction of psychedelic-assisted therapy trials within Australia and stated that “psychedelic-assisted psychotherapy should be available as a medical treatment in the same way cannabis is,” (Nguyen, 2020). Along with the lack of funding and support from the Australian Federal government to start trials within Australia, Dr Stephen Bright has been investigating as to whether or not there is a shortage of available therapists and psychologists within Australia to perform the necessary supervision which accompanies a psychedelic-assisted therapy session (Yussuf, 2020). Despite the fact that there are currently not enough trained psychologists to support the demand for psychedelic-assisted psychotherapy sessions within Australia, should PAT become legal it is evident that there is a need to support and train more psychologists in order to meet the rising demand. Mind Medicine Australia, a non-for profit organization leading the psychedelic front in Australia are holding an international summit for psychedelic-assisted psychotherapy training for therapists in the November of 2020 to meet the demand of required sessions should psychedelic-assisted psychotherapy become legal within Australia (MMA, n.d).

 With ‘true’ psychedelic drugs such as LSD and psilocybin taking the forefront of psychedelic-assisted trials along with a lesser known psychedelic ayahuasca, there has been much confusion around the role that 3,4-Methylenedioxymethamphetamine or MDMA has in psychedelic clinical trials. MDMA is currently being explored as an effective treatment proposition for PTSD sufferers along with initial studies for management of young adults who suffer from autism (MAPS, n.d). There is uncertainty that lies around MDMA however as it is not classified as a ‘true’ psychedelic like the others that are also being explored in clinical trials for mental health treatments. MDMA acts upon different neurological pathways within the brain, naturally resulting in a different target response within the brain. Results that have been published within MDMA-assisted trials prove that they are equally as effective as other psychedelics like LSD and psilocybin (Pollan, 2018).

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