‘Psychedelic’ is derived from the word “psyche” meaning the human mind or “soul” in ancient Greek (ψυχή (psukhḗ, “mind, soul”), and ‘delein‘ meaning to manifest (δῆλος dêlos, “manifest, visible” + ic), the term coined by an English psychiatrist Humphry Osmond in 1956 in a letter to Aldous Huxley a renowned writer and philosopher. The word refers to substances that produce altered or expanded states of consciousness, and heightened awareness. As a whole, the word psyche-delic suggests that these altered and expansive states of consciousness can encourage access into the mind or soul to unlock unused potentials of the human mind.
Today, these powerful psychedelic substances are used for a wide variety of purposes, including recreationally, for spiritual or mystical experiences, personal growth and self-exploration, creativity and problem solving, nature connection, social bonding, and last but certainly not least for therapeutic purposes.
Many will attest to taking psychedelics for some or many of these reasons, but most likely not for therapeutic reasons. It’s a shame really…because psychedelic-assisted therapy has been used in ancient cultural practices for healing and spiritual connection well before western science discovered its remarkable effects. In modern science, Psychedelic therapy is a new domain of practice that is yet to be fully approved by the FDA (food and drug administration). But the research goes back as far as the 1970s. Certain psychedelics like MDMA and Psilocybin have been proven to generate incredibly positive results for people with certain psychological ailments like ANXIETY, DEPRESSION, PTSD and ADDICTION when it is properly combined with an approved psychotherapy, qualified psychotherapists and guides, and within the safety of the controlled therapeutic ‘set and setting’.
So, what are the forms of ‘Psychedelic therapy’?
Below I provide a brief overview of the current types of psychedelic-assisted therapies followed by some important considerations and research developments in the field of these uniquely effective therapies.
1. Psilocybin-Assisted Therapy
Substance: Psilocybin – a psychoactive compound contained in hallucinogenic mushrooms
Physical effects: Nausea, Vomiting, Muscle weakness, Lack of coordination, Confusion, Drowsiness, Dizziness, Pupil dilation.
Psychological effects: Euphoria, visual and mental hallucinations, changes in perception, distorted sense of time, and perceived spiritual experiences.
Therapeutic Applications:
- Depression: Clinical trials have shown psilocybin to be effective in reducing symptoms of depression, including treatment-resistant depression.
- Anxiety: Psilocybin has been used to alleviate anxiety, especially in patients with terminal illnesses.
- Addiction: Studies suggest psilocybin can help in treating addiction to substances like nicotine and alcohol.
Approach: Patients typically undergo several preparatory therapy sessions before the psilocybin experience, which is conducted in a controlled and supportive setting. The trip itself is an inward experience where the patient wears an eye mask and headphones to avoid external stimuli – the lack of vision and the carefully curated music helps to guide the individual to focus on observing their own thoughts and experiences within the trip. The session is followed by integration therapy, where insights from the experience are processed in a supportive and professional manner.
2. MDMA-Assisted Therapy
Substance: MDMA (3,4-methylenedioxymethamphetamine), commonly known as ecstasy.
Physical effects: Increased heart rate and blood pressure, Increased body temperature, Muscle tension, Nausea, Chills or sweating, Lowered inhibitions, Changes in sensory perception, Increased sexual arousal.
Psychological effects: MDMA can cause changes in verbal, visual, and short-term memory, reasoning, and recognition. There is a marked increase in empathy towards others, and elevated mood. It can also cause hallucinations, anxiety, depression, confusion, paranoia, and psychosis.
Therapeutic Applications:
- PTSD: MDMA-assisted therapy is particularly effective for PTSD, helping patients process traumatic memories with reduced fear and anxiety.
- Anxiety in Autism: Some studies have explored MDMA’s potential in reducing social anxiety in adults on the autism spectrum.
Approach: MDMA sessions are conducted in a therapeutic setting, often with a pair of therapists, and are accompanied by preparatory and integrative therapy sessions. The trip itself is very much an inward experience where the patient wears a mask to avoid external stimuli therefore directing the focus of the drug inward into the brain. In addition to that, carefully chosen music is also utilized to mimic the ups and downs of the trip deepening the experience.
3. LSD-Assisted Therapy
Substance: Lysergic acid diethylamide (LSD).
Physical effects: Dilated pupils, increased blood pressure, and increased body temperature are typical.
Psychological effects: LSD manifests primarily mental, visual, and auditory hallucinations.
Applications:
- Anxiety and Depression: LSD has been studied for its potential to alleviate anxiety and depression, particularly in terminally ill patients.
- Cluster Headaches: Some anecdotal reports and small studies suggest LSD may help in reducing the frequency and intensity of cluster headaches.
Approach: Similar to other psychedelic therapies, LSD therapy involves preparation, the psychedelic session with the use of an eye mask and often music, and integration therapy. The therapy aims to help patients explore their consciousness and gain insights into their issues.
4. Ayahuasca Therapy
Substance: Ayahuasca, a traditional Amazonian brew containing DMT (dimethyltryptamine) and MAO inhibitors.
Physical effects: General effects differ from person to person, but initially there is typically a form of physical purging involving vomiting, diarrhea, and/or hot/cold flashes, increased blood pressure, tremors, dilated pupils.
Psychological effects: Can cause visual hallucinations, euphoria, paranoia.
Spiritual effects: In addition, many attest to having Mystical experiences and spiritual revelations regarding their purpose on earth, the true nature of the universe, and deep insight into how to be the best person they possibly can.
Applications:
- Depression and Anxiety: Ayahuasca has been used to treat depression and anxiety, with some studies showing lasting improvements in mood.
- Addiction: It has also been used in the treatment of addiction, particularly in ceremonial settings.
Approach: Ayahuasca is typically consumed in a group ceremony led by a trained facilitator or shaman. Integration sessions help participants process and apply their experiences.
5. Ketamine-Assisted Therapy
Substance: Ketamine, an anesthetic with dissociative properties.
Physical effects: Can cause sedation, pain relief, immobility, and amnesia. It can also produce disorientation, confusion, drowsiness, nausea, vomiting, dizziness, and dysphoria.
Psychological effects: Changes in perception, including intense feelings of either dissolving into or being disconnected from the environment, mood swings, problems with memory and thought processes, confusion, paranoia, emotional volatility, diminished attention, hallucinations and dreamlike states.
Applications:
- Depression: Ketamine is effective in rapidly reducing symptoms of severe and treatment-resistant depression.
- Suicidal Ideation: It has been shown to reduce suicidal thoughts quickly.
Approach: Ketamine can be administered intravenously, intramuscularly, or orally in a clinical setting. Therapy sessions help patients integrate the dissociative experience into their therapeutic process.
6. Ibogaine Therapy
Substance: Ibogaine, a psychoactive compound derived from the African iboga plant.
Physical effects: Can cause Nausea, tremors, headaches, irregular heartbeat, low blood pressure.
Psychological effects: Mental confusion, manic episodes, insomnia, irritability, emotional instability, delusions, aggressive behavior, and thoughts of suicide.
Ibogaine also produces neuroplasticity and can have neuroadaptive properties.
Applications:
- Addiction: Ibogaine is primarily used in the treatment of addiction, especially for opioids and other substances.
Approach: Ibogaine therapy often involves a single high-dose session followed by integration therapy. The experience can be intense and physically demanding, requiring medical supervision.
Important Considerations for Psychedelic Therapy
Set and Setting: The environment and mindset in which therapy takes place are crucial for a positive and therapeutic experience. For example, typically in MDMA and Psilocybin-assisted therapy they incorporate a standardized psychotherapeutic approach, that is the preparatory, medication, and integrative phases with the assistance of supportive and trusted therapists whilst having reasoned differences unique to the drug being administered. The psychological and clinical outcomes are improved dramatically in a safe, neutral, non-judgmental, comfortable set and setting. The same is true for many of the other psychedelic assisted therapies with slight changes given the nature of the drugs, their effects, administration, and the kind of guide supporting the experience.
A Standardized Psychotherapeutic Approach: The combination of a psychedelic, a safe and comfortable setting, and a qualified and trusted psychotherapist operating a standardized 3 phase procedure allows for a smooth and supportive therapeutic outcome. Firstly, the preparatory phase essentially prepares the individual by providing understanding of the drug’s effects, laying out intentions of the therapy and the safety parameters. Secondly, the medication phase where the appropriate dosage is measured and administered safely in an appropriate set and setting. Finally, the integration phase involves post-session therapy often in the form of psychotherapy that is vital to a successful therapeutic outcome as it helps patients process their experiences and apply insights to their lives.
Legal and Safety Aspects: The legal status of psychedelics varies by region, and safety protocols must be followed to minimize risks.
Current Research and Developments
The field of psychedelic therapy is rapidly evolving, with increasing research supporting its efficacy. “The FDA currently oversees phase 3 trials of MDMA for the treatment of post-traumatic stress disorder and phase 2 trials of psilocybin for the treatment of drug-resistant depression. In addition to being funded by private donors, existing trials often lack diversity and exclude populations who may benefit from psychedelics, such as people with histories of severe trauma and self-harm. An infusion of federal funds could be used to make psychedelics research more equitable and inclusive” (Marks et al., 2021). Clinical trials are ongoing to better understand the mechanisms and optimize protocols for these therapies.
While some psychedelics are still classified as Schedule I substances in many countries, there is a growing movement towards decriminalization and medical legalization. The likes of Ayahuasca and Ibogaine have been used by Indigenous communities for hundreds or thousands of years, they are based on ancient cultural and spiritual healing ceremonies, and thus are far less studied. Many who attend these ceremonies speak highly of these therapies attributing their healing to their experiences on the drugs highlighting the need for further scientific investigation and approval within these psychedlic-assisted therapies.
References:
Marks, M., Cohen, I.G. Psychedelic therapy: a roadmap for wider acceptance and utilization. Nat Med 27, 1669–1671 (2021). https://doi.org/10.1038/s41591-021-01530-3