As recent trials of psychedelic-assisted psychotherapy enter the last phase of testing, the coming need for many trained therapists and guides seems inevitable. Until recently, the only opportunity to train and work legally as a psychedelic therapist was in clinical trials. That will likely change over time as expanded access becomes the next step for current trials (evaluating MDMA and psilocybin) and if psychedelic-assisted therapies become FDA approved.
Many people are looking for information about psychedelic therapy and opportunities to become guides or therapists after reading Michael Pollan’s new book How to Change Your Mind: What the New Science of Psychedelics Teaches Us about Consciousness, Dying, Addiction, Depression, and Transcendence [1]. Providers are seeking trainings to become more informed about psychedelic experiences. They also want to know how to become certified to administer psychedelics in clinical trials and potentially post approval.
Still, there remain many unknowns about what training programs outside of the drug sponsors will be acceptable by FDA to dispense MDMA or psilocybin post-approval. FDA has never regulated psychotherapy, but medical devices often require training in a certified program. Demonstration of competency and maintaining of the acquired skills is required for compliance with regulatory agencies. Transcranial magnetic stimulation is one example of a specialized device with specific training requirements. It’s not yet known how FDA will regulate trainings for psychedelic-assisted therapies.
When Can I Offer Psychedelic-Assisted Therapy?
The FDA may approve MDMA for PTSD treatment as early as
2021, as MAPS has projected based on an optimistic (and likely realistic)
finding of significant and positive results from two on-going Phase 3 trials.
If so, thousands of therapists and doctors will be needed to meet the increased
demand and opportunity for greater access. PTSD can be a difficult to treat
condition with many individuals not accessing or responding to available
treatments, so this call for expanded access will be an exciting opportunity to
provide care to a much larger number of people who are currently suffering.
The next likely candidate for FDA approval after MDMA is psilocybin for the treatment of depression. In late 2018, the FDA granted Breakthrough Therapy designation for psilocybin for treatment-resistant depression, which will help expedite its approval as long as results from clinical trials remain positive
What are the Options for Training in Psychedelic-Assisted Therapy?
Despite many unknowns, some training programs already exist,
and many more are expected to become available.
In 2015, the California Institute of Integral Studies (CIIS) started a formal training program called the Certificate in Psychedelic-assisted Therapies and Research. The hybrid residential, in-person and online curriculum is a roughly 9-month course with rotating guest lecturers and a weeklong retreat. This program is broad in focus, interdisciplinary, and covers classic psychedelic medicines (e.g., psilocybin, ayahuasca, peyote, LSD) as well as the newer medicines (sometimes labeled empathogens or entactogens) like MDMA and ketamine.
To enroll in the CIIS certificate program, interested
individuals must fill out an application, complete an interview, and receive an
offer from the program’s selection committee. Applicants are required to be a
licensed mental health or medical professional, counseling attorneys, or ordained
or commissioned clergy and chaplains. The tuition cost is currently set at
$10,000. There are several information sessions scheduled throughout the year
to explain more and answer questions about the program. Each cohort generally
starts in the Spring and graduates in December.
More substance-specific trainings also exist. In anticipation of Expanded Access approval, the Multidisciplinary Association for Psychedelic Studies (MAPS) has now posted an application for the MDMA Therapy Training Program with an invitation to apply. Training is currently prioritized for providers who would likely qualify for the Expanded Access program. If accepted by FDA, more clinics will open for MDMA-assisted psychotherapy for PTSD treatment during expanded access. Requirements for clinics and providers are provided as is a forum for providers to connect with others who are interested in starting up MDMA clinics.
While no strict criteria have been released about who would qualify, the MAPS website states that at minimum one person in the therapy team pair must be licensed to conduct psychotherapy. While the other person does not need to be licensed, they “must display training in therapeutic relationship, ethics, and traumas.”
Each clinic also needs a Drug Enforcement Administration (DEA) license, which requires a licensed medical provider who can prescribe (e.g., medical doctor (MD), doctor of osteopathy (DO), or other eligible prescriber). MAPS encourages interested providers to apply now in preparation for the expected post-FDA approval. The cost for training and supervision is currently set at $9,000.
Other industry drug sponsors, such as Usona Institute and COMPASS Pathways, and researchers at various universities have devised their own trainings and ways to prepare clinicians to work on clinical trials of psychedelics. At this time, there are no details posted on websites about what the trainings consist of, but journal publications have described procedures, such as the Usona Guide Manual [2].
What Do You Learn in the Training Programs?
The CIIS program is approximately 180 hours and covers a
wider range of topics related to psychedelic therapies. More time is spent on
historical and philosophical aspects of non-ordinary states of consciousness,
including non-substance induced ones as seen in Holotropic Breathwork and deep
meditation. The learning objectives are focused more broadly on psychedelics
and empathogens, rather than specifically on MDMA-assisted psychotherapy [3].
The MAPS program is a 5-part course with didactic training and experiential learning components. Trainees start with online e-learning modules covering MDMA pharmacology and its clinical safety profile, an introduction to the MDMA Treatment Manual [4], and some basics about clinical trials. A week-long, in-person training follows where MDMA session videos are viewed and discussed with the therapists who treated the study participants. The next parts involve role playing, observing MDMA sessions, and then treating a patient with supervision and evaluation from the trainers.
Some parts of these two programs overlap significantly. For example, the weeklong in-person retreat for both programs focuses on MDMA-assisted psychotherapy and are taught by Michael and Anne Mithoefer, MDMA study therapists and lead instructors at MAPS.
What are the Experiential Learning Components of Trainings?
Dating back to the first research studies of LSD in the
1950s, a first-hand experience in a non-ordinary state of consciousness has
been perceived valuable for administering psychedelics. It’s thought that by
understanding the drug effects, the therapists can more readily establish
empathetic rapport and presence to support a person’s therapeutic process. They
can also be better able to respect the power and significance of these
experiences.
For indigenous communities, it’s deemed essential that
shamans or ceremonial leaders have personal experience with the psychoactive plants
they give to others. But in Western medical practices, it is rarely the case that
doctors are encouraged (or even allowed) to take a medication to understand the
effects a patient would feel.
Thus, psychedelics present a new challenge for psychiatric
medical training. If there is value in having a personal experience, then how
can providers legally pursue an experiential learning component to their
training? To date the evidence of potential benefits of doing so remain
anecdotal due to lack of approved controlled research.
CIIS’s program is an “above board” program with no use of illicit substances. MAPS, however, received approval in their sponsored, FDA-approved study that allows trainees in their program to receive one dose of MDMA in a clinical setting if they also are eligible for the research study as a participant. As with all clinical trials, participants in the approved study must meet criteria to enroll and provide data to assess potential benefits or harms. Even if they meet the basic inclusion criteria, trainees are not required to undergo an MDMA session. Some might have conditions that would counter-indicate the use of MDMA. For example, pregnant women or individuals with cardiac disease would be excluded. Trainees may also simply not want to take a drug.
As alluded to earlier, Holotropic Breathwork is one alternative to reach a non-ordinary state of consciousness without consuming any substance. Through accelerated breathing and stimulating music, a person can enter into states similar to ones induced by drugs.
CIIS incorporates Holotropic Breathwork as experiential learning in their program. Therapists may consider alternatives, but they should do so while considering carefully the legal and ethical guidelines of their licensing board and professional organizations. Psychedelic Support and its partners do not encourage or condone the illegal use of substances.
Given this reality, other possible alternatives for experiential learning do exist. They include attending plant medicine ceremonies in other countries where it is legal, shamanic drumming/chanting practices, or extended meditation. Research is needed to understand if first-hand exposure by therapists impacts patient outcomes, and if so, what type of drugs or experiences are best for training. We encourage therapists exploring this new area to consult with their colleagues and even seek out legal counsel as they deem appropriate.
What Can I do Now?
If becoming a psychedelic therapist is of interest to you, then there are things you can do now to help figure out if this path is right for you and if so, prepare for the future. You can start by reading books and articles about psychedelic-assisted therapies. If you want hands-on experience supporting individuals undergoing a difficult psychedelic experience, one great way to do so is to volunteer for harm reduction services at festivals.
Lastly, educate yourself and share what you are learning with others. A new profession is evolving, and more opportunities are becoming available for those who wish to pursue a career in psychedelic medicine.
References
Pollan, M. (2018). How to change your mind: what the new science of psychedelics teaches us about consciousness, dying, addiction, depression, and transcendence. London, United Kingdom: Penguin.
Cooper, K. (2014). Guide manual for pharmacokinetics of psilocybin in healthy adult volunteers study (Unpublished manuscript). University of Wisconsin, Madison.
Phelps, J. (2017). Developing guidelines and competencies for the training of psychedelic therapists. Journal of Humanistic Psychology, 57(5), 450-487.
Kile Ortigo, PhD is a clinical psychologist. Find out more about Kile's integration and mental health services on his profile page in the Psychedelic Support Network.
In my role as a social worker and psychotherapist, I see so many clients suffering from the repercussions of trauma—experiences of abuse, neglect, and discrimination—that have left them struggling to feel safe on a fundamental level.
Healing from these traumas invariably focuses on helping these clients overcome feelings of disempowerment and disconnection, rebuilding interpersonal trust and intimacy in the context of the therapeutic relationship.
At the same time, there is growing recognition in the mental health field that we must address trauma across multiple levels: not only interpersonally or psychologically, but physiologically. We must also heal the way trauma inscribes itself on the brain and body, leaving survivors hijacked by nervous systems that vault into fight, flight, or freeze at a moment’s notice.
That is why it is imperative that social workers, and all mental health professionals, take notice when a new promising treatment comes along that seems to treat trauma across these multiple levels: the limited, adjunctive use of MDMA (3,4-methylenedioxymethamphetamine) in psychotherapeutic treatment for posttraumatic stress disorder (PTSD) presents just such a treatment.
MDMA-Assisted Therapy as Breakthrough Treatment
Research on MDMA-assisted psychotherapy for PTSD has been growing over the past 15 years, showing remarkable success in clinical trials. The FDA granted it “breakthrough therapy” status in 2017 based on these strong results.
For example, a 2011 study found that 83% of those receiving a combination of supportive psychotherapy and two MDMA-assisted psychotherapy sessions no longer met criteria for a PTSD diagnosis after treatment, compared to only 25% of those who received the same supportive psychotherapy and a placebo [1].
Moreover, these studies were working with the hardest-to-treat cases—clients whose PTSD had failed to respond to other treatments, such as prolonged exposure therapy, other cognitive behavioral therapies, or pharmaceutical medications. Follow-up studies have shown that the majority of those helped are still PTSD-free nearly four years later [2].
These striking findings led me and my colleague, Dr. Sara Bressi, to explore the potential of this treatment, especially given the stigma often attached to MDMA as being the primary ingredient in the recreational drug “molly” or “ecstasy” (though substances found in recreational settings are rarely observed to be pure MDMA).
This article is a summary of the findings from our recent paper on this topic, including: why mental health professionals are in dire need of better treatment for PTSD, how MDMA-assisted psychotherapy works, and how important a treatment like this could be for addressing the immense burden of trauma in vulnerable communities, especially communities of color and low-income communities.
Treating PTSD is an Uphill Battle
For those with PTSD, past traumatic events intrude upon their daily life through flashbacks, nightmares, and pervasive anxiety and hyper-vigilance that makes it difficult for them to engage in day-to-day life, and can make it especially difficulty to talk about or reflect on their traumatic experiences.
In an attempt to minimize their symptoms, individuals with PTSD often avoid anything that could trigger them, and begin to isolate themselves from the world and others—consequences that tragically cut them off from the potentially healing effects of relationships, both within their personal lives and within the context of therapy.
Existing PTSD treatments try to reduce these symptoms in a few different ways: psychiatric medications try to change brain chemistry to reduce anxiety; exposure therapies try to de-link trauma triggers from the strong fear response; skills-focused therapies target areas such as emotional coping and interpersonal skills; other trauma-informed approaches try to create a sense of safety in session that rebuilds trust over time and extends outside of the therapy room.
Unfortunately, these treatments often have mixed results and do not meet the needs of all people with PTSD: studies in veterans, for example, show that more than 70% of those engaging in PTSD treatment do not see significant improvement [3].
How Does MDMA-Assisted Psychotherapy Work?
In MDMA-assisted psychotherapy, the MDMA acts as a catalyst for the therapeutic process, working synergistically with regular psychotherapy sessions. Biochemically, MDMA releases chemicals that increase a sense of well-being, enhance empathy and feelings of closeness to others, and dramatically reduce fear and anxiety [4].
A potentially key ingredient in this process is oxytocin, sometimes called the “love hormone” because we release it when we bond socially, when we are with people we care about, and even when we cuddle with our pets.
In a course of MDMA-assisted psychotherapy, traditional talk therapy is interspersed with two or three medicated sessions. These medicated sessions occur over 6-8 hours (the drug’s duration plus a few hours), under medical supervision, and consist of periods of quiet introspection and client-led discussion of traumatic material, facilitated by two therapists [5].
Non-drug psychotherapy sessions then help process and understand what came up for client while on the drug. After treatment, which generally occurs over 8-15 weeks, the majority of participants are not only PTSD-free, they report an “increased self-awareness,” “increased ability to feel emotions,” and “improved relationships in general” [6].
Though research on why MDMA is such a powerful catalyst is still new, in our paper we hypothesize that MDMA’s fear-reducing and pro-social affects work together to help clients tap into their capacity to heal, allowing them to engage in therapy faster and more profoundly than they could otherwise.
The fear-reducing effects help clients think and talk about their trauma without being as hijacked by flashbacks or panic symptoms, allowing them to gain perspective on what happened to them and integrate it into a larger narrative of their lives.
The pro-social effects help clients trust and bond with their therapists and “take in” the support and empathic attunement they provide—a task that is especially difficult for those who have had their trust violated through interpersonal trauma and abuse.
Moving Forward: How this Treatment Could Be a Game-Changer
That MDMA-assisted psychotherapy has worked so rapidly, and so effectively, in many people who have not responded to existing treatments is a powerful testament to its potential—especially for low-income communities and communities of color who disproportionately experience trauma [7].
At the same time, it is unclear what access to this treatment will be like for these populations. Given that people of color and low-income individuals already face the dual hurdle of being more likely to experience trauma, and less likely to have reliable access to health care, it will be essential that social workers be attuned to these potential barriers and be fierce advocates for access to this breakthrough treatment [8].
First
and foremost, trauma survivors have experienced ruptures in trust—trust in
others, in the safety of the world, and in their own inherent value [9]. Too
often, these ruptures are then tragically re-experienced in relationships with
loved ones, clinicians, and institutions.
If MDMA-assisted psychotherapy, in helping clients move toward spaces of empathy and trust, can facilitate and accelerate repair of these ruptures, its use will have repercussions far beyond the treatment of PTSD symptoms.
It could enable clinicians to more readily, more consistently, and more profoundly tap into what psychotherapy at its best offers: a pathway toward more fully, authentically, and lovingly engaging with themselves and their lives.
References
Mithoefer, Michael, Mark T. Wagner, Ann T. Mithoefer, Lisa Jerome, and Rick Doblin. “The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant Posttraumatic stress disorder: The first randomized controlled pilot study.” Journal of Psychopharmacology 25, no. 4 (2011): 439-452.
Morina, Nexhmedin, Jelte M. Wicherts, Jakob Lobbrecht, Jakob, and Stefan Priebe. “Remission from post-traumatic stress disorder in adults: A systematic review and meta-analysis of long term outcome studies.” Clinical Psychology Review 34, no. 3 (2014)” 249-255.
Steenkamp, Maria M., Brett T. Litz, Charles W. Hoge, and Charles R. Marmar. “Psychotherapy for military-related PTSD: A review of randomized clinical trials.” JAMA 314, no. 5 (2015): 489-500.
de la Torre, Rafael, Magi Farré, Pere Roset, Neus Pizarro, Sergio Abanades, Mireia Segura, Jordi Segura, and Jordi Cami. “Human pharmacology of MDMA: Pharmacokinetics, metabolism, and disposition.” Therapeutic DrugMonitoring 26, no.2 (2004): 137-144.
Mithoefer, Michael. A manual for MDMA-assisted psychotherapy in the treatment of PTSD (Santa Cruz, CA: Multidisciplinary Association for Psychedelic Studies, 2017).
Mithoefer, Michael C., Mark T. Wagner, Ann T. Mithoefer, Lisa Jerome, Scott F. Martin, Berra Yazar-Klosinski, Yvonne Michel, Timothy D. Brewerton, and Rick Doblin. “Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: A prospective long-term follow-up study.” Journal of Psychopharmacology 27, no. 1 (2013): 28-39.
Slopen, Natalie, Jack P. Shonkoff, Michelle A. Albert, Hirokazu Yoshikawa, Aryana Jacobs, Rebecca Stoltz, and David R. Williams. “Racial disparities in child adversity in the U.S.: Interactions with family immigration history and income.” American Journal of Preventive Medicine 50, no. 1 (2016): 47-56.
Roberts, Andrea L., Stephen E. Gilman, Joshua Breslau, Naomi Breslau, and Karestan Koenen. “Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States.” Psychological Medicine 41, no. 1 (2010): 71-83.
Herman, Judith L. Trauma and recovery. (New York, NY: BasicBooks, 1997).
Courtney Hutchison, LSW, MPH is a licensed social worker and psychotherapist based in Philadelphia, practicing with adolescents and adults struggling with anxiety, depression, substance abuse, and trauma. Previously Courtney worked for 8 years as a journalist and public policy advocate, focusing on racial and economic justice. She is lead author on "MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder: Implications for Social Work Practice and Research", published in Clinical Social Work Journal.
Dan is beaming as he declares, “Dang, you’re so beautiful! Does your man know how lovely you are?” Dan’s wearing a t-shirt and shorts, but it’s the middle of winter. He’s talking fast and gesticulating wildly as he tells me about his new discoveries in sacred geometry.
I’ve only met Dan once before and our interaction at the time was brief and professional, so I’m a little taken aback by his intimate tone with me now. But as a healthcare provider, I also understand what’s going on: Dan is showing signs of mania, a state characterized by elevated mood, hyperactivity, and a reduced need for sleep. Mania is commonly seen in people with Bipolar 1 Disorder (formerly known as manic depression), though manic states can also be seen in those without the condition.
Extended periods of sleep deprivation, major
stressors such as the death of a loved one, and childbirth in women can all
trigger manic states. Drugs, too, can bring on mania. This includes both
pharmaceutical medications, like some anti-depressant drugs, as well as psychedelics.
It’s for this reason that those with a personal history or a strong family
history of Bipolar 1 or psychosis (like schizophrenia) are advised to avoid using
psychedelics altogether or, at least from a harm reduction standpoint, to use very
high levels of caution when taking substances like LSD, psilocybin, and ayahuasca.
Shortly after bumping into Dan, I called a
mutual friend of ours, Matthew. He explained that Dan had been drinking
ayahuasca on an almost weekly basis, in spite of several friends expressing
their concerns and asking him to take a break.
Unsurprisingly, Dan ended up in the hospital a few days later and I found myself feeling very angry. Not with this bright-eyed, cavalier young man who was trying to get a handle on his early childhood trauma, but rather with the medicine carrier that kept serving him ayahuasca week after week, even after – I learned from Matthew – Dan began showing signs of mania. I think most people would agree that Dan’s story is an unfortunate one. And while I do not doubt that there were some positive elements to Dan’s break down, I also think this episode did Dan more harm than good, in both the short and long term.
Now, having a manic episode or even psychotic break can be a powerful, meaningful experience for some people, but it is by no means the only path, nor the ideal one. There are a myriad of safer ways to learn, grow, and awaken without having to end up in the hospital or seriously freak out one’s friends and family.
Why psychosis and psychedelics don’t always mix well
Part of how psychedelics work is by increasing the amount of entropy, or chaos, in the brain. In fact, in a paper titled, “The Entropic Brain: A Theory of Conscious States Informed by Neuroimaging Research with Psychedelic Drugs,” neuropsychopharmacologist Dr. Robin Carhart-Harris and his co-authors explore this very nature of psychedelics [1]. They propose that conditions like depression, obsessive-compulsive disorder (OCD), and addiction result from too much order, or rigidity, in certain parts of the brain. Psychedelics, they argue, may help heal these conditions by disrupting that rigidity, through a mechanism much like shaking a snow globe.
Courtesy Dr. Erica Zelfand
Psychedelics appear to disrupt the neural patterns upon which rigid patterns of thought and behavior – such as those seen in depression, OCD, and addiction – rest. The accompanying graphic, which I’ve adapted from a similar image found in Carhart-Harris’ paper, shows how some of us are on the rigid, or low chaos, end of the consciousness spectrum, and some of us are more on the entropic, or high chaos end.
Courtesy Dr. Erica Zelfand
If we think of psychosis and mania as high chaos states, we can see how taking a chaos-increasing medicine like LSD might just push someone with a propensity towards mania or psychosis over the edge. When a patient’s brain is in the middle of a blizzard, after all, they don’t need their metaphorical snow globe shaken. Dr. Carhart-Harris and his team have also performed other studies in which the brain scans of people on psychedelics were compared to baseline images [2]. This work reveals that psychedelics enhance neural crosstalk – the phenomenon by which novel connections are made between parts of the brain that don’t normally communicate with one another.
The following is a simplified illustration of the neural connections tracked in the brains of study participants upon receiving placebo (a) vs. psilocybin (b). The participants who received psilocybin were observed to have many more neural connections than those who received placebo [3].
Image Courtesy of the Beckley/Imperial Research Programme [3]
Someone with depression whose thoughts are focused on a very tight loop of negative, self-denigrating sentiments may very well benefit from a little increased cross talk. More neural connections might allow them to realize that life can actually be pretty awesome (or at least bearable), and that so many things are interconnected. They may realize that it’s not so scary after all to take the risk of asking somebody out on a date, to read more about geometry, science, or self-growth, or to spend a little money on a stylish new haircut.
Someone in a manic or psychotic state, however, doesn’t need a nudge in that direction. In fact, they’re already at high risk of seeing synchronicity where there is none, being overly familiar (as Dan was with me), becoming obsessed with fractals (or whatever has caught their interest), and racking up credit card debt in the pursuit of whimsies. It is perhaps for these reasons that most if not all of the studies on psychedelic medicine exclude those with a personal history of Bipolar 1 or psychosis from enrolling.
The right medicine for the right condition, at the right time
We are all hopefully able to stay aware of
our connection with reality and give our bodies and brains the support they need.
When that fails, however, that’s where our friends, families, and mental health
professionals can help us out. This is also when it’s time for medicine
carriers to have frank conversations with their guests, connect them with
mental health resources, and refuse to serve them more medicine until they’re grounded
again (if ever).
When psychedelic users begin losing touch with reality, going days without sleeping, and showing other signs of mania or psychosis, the answer isn’t more chaos-inducing medicine. The answer, more often than not, is rest, sobriety (include a break from sacred medicines like rapé), re-grounding, integration therapy, community support, and/or self-reflection.
If researchers and practitioners in this
emerging area continue to think of psychedelics as medicines, it’s easy to see
that as with all medicines, psychedelics are not appropriate for every
situation. Antibiotics, for example, have saved countless lives due to their
ability to combat bacterial invasion. But, as they can only fight bacteria, they
are completely useless in the milieu of viral or fungal infections. Antibiotics
also carry risks, such as disruption of the microbiome (the diversity and balance
of good and bad microbes in the gut), and most concerning of all, they contribute
to antibiotic-resistant superbugs. Antibiotics are not the appropriate solution to every kind of infection. So why,
then, would we think that psychedelics could be the right medicine for every
kind of mental/emotional ailment? Every
medicine has its indications, and every
therapy comes with risk.
When individuals begin showing signs that
they’re losing touch with reality, it’s usually a sign that it’s time to take a
break from psychedelic use. It’s also likely time to work with a therapist or
integration counselor to make sense of what occurred and find any wisdom to be gleaned,
to cut back on work and social obligations, to rest, to connect with loved
ones, to spend time in nature, and to get both feet firmly rooted – both
physically and psychologically – back here on Earth.
You can’t launch into outer space, after all, without good ground control. And some of us – whether it’s due to social circumstances, genetics, or medical influences – just don’t have good ground control. And that’s ok. There are other medicines, other therapies, and other pathways to insight, growth, and healing.
References
Carhart-Harris, Robin Lester, Robert Leech, Peter John Hellyer, Murray Shanahan, Amanda Feilding, Enzo Tagliazucchi, Dante R. Chialvo, and David Nutt. “The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs.” Frontiers in human neuroscience 8 (2014): 20.
Carhart-Harris, Robin L., Suresh Muthukumaraswamy, Leor Roseman, Mendel Kaelen, Wouter Droog, Kevin Murphy, Enzo Tagliazucchi et al. “Neural correlates of the LSD experience revealed by multimodal neuroimaging.” Proceedings of the National Academy of Sciences 113, no. 17 (2016): 4853-4858.
Petri, Giovanni, Paul Expert, Federico Turkheimer, Robin Carhart-Harris, David Nutt, Peter J. Hellyer, and Francesco Vaccarino. “Homological scaffolds of brain functional networks.” Journal of The Royal Society Interface 11, no. 101 (2014): 20140873.
Find out more about Erica and her health services on her profile page in the Psychedelic Support Network. Contact her today to find out how she can support you.
What is it like to participate in an MDMA clinical trial?Lori Tipton shares her experience of undergoing MDMA-assisted psychotherapy for her severe PTSD at a clinical trial in New Orleans. After receiving ‘Breakthrough Therapy’ designation by the FDA in 2017, phase 3 trials have begun for this promising treatment.
Watch this clip from Lori’s MDMA session.
Video: Session footage from MAPS Phase 2 Clinical trial New Orleans, LA 2018 courtesy MAPS. For study details and how to participate in the MAPS MDMA trials visit clinicaltrials.gov.
Lori’s Tape
When the tape is playing, we listen to the tape. There is no not playing the tape.
You have to stay vigilant. If you don’t stay vigilant, bad things are going to happen. Lock the doors. Check the window latches. Check to make sure the back door is locked; it can be fussy, and not everyone is as careful as you. You locked the front door, but make sure it’s still locked, too. Make sure you always know where the exit is. If somebody comes in through that exit, look for the next one. If they come in through both exit doors, hide behind a barricade. If they find you behind your barricade, fight them off. You’re brave. You’re vigilant. That’s me, that’s who I am. And if they kill me, so be it.
At work, if someone walks into the bar and they look mad, they’re going to kill you. You can tell from their face; this is the person who has come to kill you. They’ve come to kill everybody. Something bad is going to happen. You can feel it, you know it in your gut. Something terrible. Dying would be good. This is what makes sense. You’re alone anyway. We’re all alone. Nobody’s not alone. But even if you weren’t alone, nobody’s going to understand you. Nobody loves you; how could anybody love you? You’ve been through this thing. Nobody wants to be with someone who’s worthless. Nothing can pull me out of this way of thinking. You can’t go to a therapist and get on drugs, because you don’t need that. You’re strong. You’re vigilant. You’re brave. You can function. Only people who can’t function need that. Besides, even if you took it, it’s not going to work because nothing else has worked. You’re special in this pain, because nobody knows exactly what this feels like.
When the tape is playing, we listen to the tape. There is no not playing the tape.
My husband interrupts: “Lori, in all my life, working as a bartender and living my life, the worst thing I’ve seen is people get in a fistfight. You walked into your mother’s house and found two people dead, and your mother had killed herself. Your idea of the worst thing that can happen is so much further than mine. You can fill that space with so much more violence, because you’ve literally experienced that.”
When the tape is playing, we listen to the tape. There is no not playing the tape. Rewind the tape, and play it again. You have to stay vigilant. If you don’t stay vigilant, bad things are going to happen…
Preparation
“At night before I’d go to bed, I sometimes spend hours looking at session tape.” As part of his psychiatry residency, Dr. Ray Worthy, M.D. worked as an adherence rater for a research program on MDMA-assisted psychotherapy for post-traumatic stress disorder. “It was enthralling. Clearly, people were processing really difficult stuff, and they were doing it in a different way than what we normally see in psychotherapy. What I saw were catharses, insights, and a-ha moments that clearly seemed to be transformative.”
Tempering his enthusiasm, Worthy notes: “If it’s too good to be true, it’s usually not true. We owe it to ourselves with the Phase III trials to see if it can be replicated.”
By Worthy’s account, one-year follow-up results have been “unprecedented:” 68% of participants no longer had PTSD. In August 2017, the United States Food and Drug Administration designated MDMA as a “breakthrough therapy” for the treatment of PTSD. The FDA grants this designation when preliminary clinical evidence for treatments of serious or life-threatening diseases or conditions demonstrates substantial improvement over existing therapies.
The impact of the work also fascinated New Orleans-based therapist Dr. Shari Taylor, who first encountered the results through watching the documentary The Spirit Molecule. Her interest led her to work done by the Multidisciplinary Association for Psychedelic Studies (MAPS) and Worthy. “If there’s any way I can be involved in this, I want to,” she said to Worthy.
“In the field of psychiatry, there haven’t been a lot of advances, and working with PTSD can be frustrating,” Taylor said. “In the early trials with MDMA, people were getting better and better as time went on. They didn’t have to continue to take medication, which is huge. The thought of being able to take a medicine just three times, and then to continue to get better, was remarkable to me—and still is.”
If it’s too good to be true, it’s usually not true. We owe it to ourselves with the Phase III trials to see if it can be replicated.
Dr. Ray Worthy
MAPS has been training co-therapist teams in leading MDMA-assisted psychotherapy sessions. These differ from other types of psychotherapy in many ways, and Worthy is careful not to sell short traditional psychotherapy, which he’d recommend to anyone as a path to growth. “Don’t get me wrong: Those can be powerful lunch hours. This is a special journey.”
“The boundaries are different than traditional therapy,” Taylor said. “You’re spending eight hours with someone who’s essentially in an altered state, and you become very close to them. There’s this level of trust, and you get in this space of feeling this love for the person and wanting them to heal. We can do things that aren’t allowed in traditional therapy: hold their hand, do bodywork. On one hand, it’s really important to have boundaries. On the other hand, people need to feel like you care.”
As a therapist team, Worthy and Taylor work with the participant to create a setting of trust and rapport in therapy sessions leading up to working with MDMA. “We get the broad brushstrokes of the trauma material out in the open before the medicine sessions so that we’re all on the same page when that comes up in the sessions,” Worthy said. “Inevitably, it comes up. If it doesn’t, we as therapists will take the role of a gentle reminder to check in with folks to see if they want to look at some of that stuff.”
While the therapist team can remind the participant about traumatic material they may want to face, the participant’s experience of taking the medicine guides the session. Both Worthy and Taylor take it upon themselves not to interfere. “As therapists with MDMA, our job in large part would be to get out of the way. Never obstruct that process as natural unfolding. The MDMA is a catalyst for that natural process unfolding,” said Worthy.
The work operates under the notion of an “inner healer” guiding the participant toward addressing their own trauma. “The medicine brings to you what you need to work with,” Taylor said. In her own medicine sessions as part of the therapist training, Taylor’s “inner healer brought things up that I hadn’t even thought about in so long, and didn’t even really recognize were things I was still dealing with.”
The inner healer concept comes from Dr. Stanislav Grof, an early researcher of psychedelic-assisted psychotherapy. MAPS’s MDMA-assisted psychotherapy protocol draws heavily upon Grof’s work. Worthy summarizes the inner healer concept: “If there’s a cut in the skin, there’s a tendency toward healing and wholeness. The theory is, and I certainly ascribe to it, that the same is true of the psyche. We’re looking for healing. We know when there’s a level of wellness.”
When the therapists do interact with the participant, Taylor sees the main objective as “reflecting the client’s truth back to them. You hold space and allow them to feel connected and open while they have their own insights and witness their own healing happen.”
Session
The trials for MDMA-assisted psychotherapy have been for people suffering from PTSD where no other available treatment had been effective. Lori Tipton enrolled in one of the MAPS studies. “I tried all the legal, recommended things for the problems I was having. I went to all the doctors, and I saw all the specialists. I tried all the antidepressants and the antianxieties. I tried all the naturopathic ways. Put a f***ing oil on me, and I’ll sit in meditation for ten hours, and I still had f***ing PTSD.”
Trepidation consumed Lori Tipton leading up to her first MDMA-assisted psychotherapy session. If it did work, she wondered, “What if I don’t like who I am? How do you know you’re going to like who you become?” The fear didn’t win: “I didn’t go into this all rainbows and butterflies, thinking this is going to be the thing. I went into this as open-hearted as I could, open to whatever happens.”
The medicine session began gently, and suddenly she would remember things not even tied to her traumas.
“It was like somebody had opened my brain’s filing cabinet and pulled out beautiful memories for me.
Instead of them becoming just a passing nuance, I was fully engaged, feeling the memory throughout my entire body. In one session, I kept having all these memories of my brother and I as children at water parks and the beach. It was just so beautiful to me, because I don’t even remember the last time I’d thought of those memories.
I tear up thinking about it, because it was so powerful to have moments knowing I had been so joyous then. I could feel that joy, in my heart and radiating from me. That’s the magic of this situation: allowing you to understand that you have at your disposal access to these emotions at all times.”
Liberation comes from the ability to respect and accept the memory without allowing it to create the same reality.
Lori Tipton
How Tipton experienced her emotions was the first of many revolutionary insights from the session. “We are just passing through these situations and emotions. We’re going to feel joy and happiness, as well as terror and anger at some points. Those things don’t have to attach and define us.” Her own skepticism jumped in to verify it: “I am not attached to this? I can feel this, and I can experience it, but then I can know that it’s going to pass, and that’s okay?”
The major insights from MDMA-assisted psychotherapy work because they’re understood on an emotional level, not just intellectually. As Tipton notes, “The drug placed me in the state of wellbeing, where you’re more easily able to open up to those feelings. You can then create the space between your feelings and your ego. It may be the tiniest space, but within it is this perspective shift. You get to see differently the same old story of your life.”
After Tipton’s mother died, she visited a psychic medium who claimed she could communicate with the dead. The medium claimed that her mother’s energy was “locked in a state of unpredictable sickly energy, and she hasn’t moved on past that.” This message resonated with Tipton, feeling that it accurately represented her mother. The claim depressed Tipton, who concluded that when people die they’re stuck in the troubles of their life’s final throes.
In her session an insight broke through to her about this message and her relationship with her mother:
“I sit up, and I’m like, ‘Oh, my God. I’ve figured it out.’ I’m with Shari and Ray, the most lovely human beings ever. We became very close, but I can only imagine it looks like this person being pretty high on drugs shouting for them to listen.”
“I wrote this down: ‘Perhaps the way we hold space for the memories of people keeps them locked in that state of energy. Liberation comes from the ability to respect and accept the memory without allowing it to create the same reality.’ I knew the psychic wasn’t reading my mother’s energy. The psychic was reading the way I was holding my mother’s energy.
Because I had never forgiven her. Inside of me, I was holding her in that state. I needed to work past that, because that wasn’t all she was.
That was really powerful for me. I realized, ‘Oh, once again, I’m doing this.’ Not in a self-defeating way, but in a way of understanding I’m actually in control of how I’m going to feel about this. One glimpse changed everything for me.”
Participants in MDMA-assisted psychotherapy sessions commonly experience these flashes of insight. Tipton said, “I felt like I’ve walked around my whole life with dirty glasses on, and now somebody wiped the lenses clean. I didn’t even know the glasses were dirty.”
Integration
“You can have really great insights,” Dr. Shari Taylor said. “But if you don’t then figure out a way to implement what you’ve learned into your everyday life, then it can be wasted.”
Taylor recommends participants take each insight and ask themselves, “What can I do in my everyday life to facilitate working on that?”
Dr. Ray Worthy notes that the MDMA-assisted psychotherapy sessions can be the beginning of insights unfolding: “Usually these early insights and revelations only got more deeply integrated with the passage of time, as we’ve seen in the Phase II study trials.”
The thought of being able to take a medicine just three times, and then to continue to get better, was remarkable to me—and still is.
Dr. Shari Taylor
[ Dr. Shari Taylor is a therapist the Psychedelic Support Network. ]
One year later, Lori Tipton feels she’s been better able to accomplish important goals in her life, especially with her relationship with her child. Before the therapy, her child saw her as the authoritarian, the enforcer, the worrier. “Now, when my five-year-old says to me, ‘You’re the most fun,’ it’s the best f***ing thing in the world. That is worth whatever. That is priceless.”
She’s also the first to admit that she’s not completely healed and still has sadness. Importantly, “my reactions to things have drastically improved that all my interpersonal relationships have flourished. I have stronger connections with my husband, with my dearest friends, with my co-parents. All of those things are better than they were before. None of them are worse. That is the truth. They have all improved. Even if it’s a minuscule improvement, it’s still an improvement.”
Before this work, whenever an event would trigger Tipton, her reaction had to play through until the end. “If I felt like I was being abandoned, then I’d be spurred to lash out at the person and then prove to them how they’re going to abandon me.” A metaphor she gained from further reflection after her therapy sessions was of a tape. “It wasn’t until doing this work that I realized, ‘Oh, yeah, that’s the tape.’ Somebody pressed play on it, and there was no stopping it.” The insights gained from the therapy showed her how to handle these triggers: “I don’t have to press play, and if play does get pressed, I can press pause. Because the tape does not have to play to the end.”
Coda
Since Tipton completed her participation in the MDMA-assisted psychotherapy study, she’s been dedicating her energy and attention to raising awareness about the medicine’s impact.
“The fact that I’m alive right now, and that I love myself, that’s a miracle. This drug should not be illegal. I want this not only decriminalized, I want this accessible for everyone,” Tipton said. “I live in New Orleans, where almost everybody suffers from some form of trauma. I don’t want people to be unable to have the option to do this.”
She remains cautious, though: “I’m trepidatious about saying ‘MDMA will heal everybody,’ because I don’t believe it’ll heal every single person. But I do think that the potential for it to heal most people is so significant that everybody should have access to it.”
After being involved in the MDMA-assisted psychotherapy study, Tipton was in touch with another study participant who had the same MDMA treatment.
“I emailed him, and I said, ‘I just have a simple question: do you regret doing this?’ He called me on the phone, and we had a very brief conversation. He said, ‘Lori, you sound like you’re… What are you? In your 30s?’ I said, ‘Yeah, I’m almost 40.’ He said, ‘I’m almost 60. I would have basically given anything, because I have no idea how much more I would have accomplished in my life, had I had the opportunity to participate in MDMA therapy earlier.”
Dan Bernitt is an American author, playwright, and performer, whose worked has been performed in venues across the United States, as well as in Ireland and Italy. His books, Dose: Plays & Monologues and Phi Alpha Gamma, were named finalists for the Lambda Literary Award.
Counter to popular belief, cannabis can be an excellent tool for personal growth and insight. Many people in today’s society are not utilizing cannabis’s full potential. It’s common to use a substance to escape pain, and cannabis’s euphoric effect can be rather seductive for this reason. However, when used with careful intention, cannabis’s ability to amplify and clarify sensations, emotions, and thoughts while simultaneously softening defenses makes it a wonderful psychotherapeutic facilitator.
Cannabis as Entheogen: Manifesting the God Within
Humanity’s relationship with cannabis is thousands of years old. It is one of the most ancient and universal entheogens known to man. People all over the world have continually and consistently been drawn to the sacred states of mind that cannabis can produce. With current developments in research and legalization, cannabis is being recognized once again for its medicinal value. Here in Oakland, CA, where cannabis is legal, recreational and medicinal use are much more widely accepted. However, cannabis’s role as a holy sacrament has been largely lost, and therefore so has its potential as a transformational tool. By changing our relationship to this plant into one that respects its power, we can begin to achieve greater self-awareness, insight, and liberation from painful emotional patterns.
Solitary use and exploration with cannabis can result in visions and breakthroughs; but utilizing the plant’s potential as a facilitator for spiritual and psychological growth in psychotherapy is different. By working within the therapy relationship, the ways of relating to others and sharing emotions become a focal point of the healing and growing process. I am bringing my full presence and intention to witness, validate, understand, deepen and share my client’s journey with cannabis. The medicine is in the relationship to the plant’s energy, the relationship with the therapist, and ultimately, the relationship with oneself.
Cannabis as Facilitator: Value in Psychotherapy
As both a depressant and a stimulant, cannabis has a balancing effect on the nervous system. It amplifies, enhances, softens and opens as breathing deepens and the mind and body become relaxed yet alert. Cannabis melds the fight or flight response with the relaxation response and a sense of unity, wholeness, or oneness ensues. The senses become more acute with the oxygenated blood in the organs as the body releases and expands. Intimately connected to the body is the mind, which responds with a loosening of defenses and heightened awareness. There is greater access to repressed fears and unconscious thoughts, memories, and beliefs. The narratives woven into our psyches that typically operate outside of our awareness become available for closer examination and transmutation.
There’s quite a range of possibilities when it comes to cannabis’s effect on the mind and body. This can depend on strain, dose, individual differences, mindset, and setting. Levels of enhancement can vary from mild to shamanic and ego dissolving. For the purposes of cannabis-assisted psychotherapy, finding a strain and a proper dose may take a bit of trial and error prior to the session. The aim is to achieve a state of heightened awareness and presence without having trouble speaking or staying awake. The method of ingestion is also important. Edibles can be tricky to use because it can be challenging to time the onset and monitor the intensity of the experience. Cannabis smoke is pungent and may contain irritants and gases or particles that potentially cause harm to the body. Vaping is the most highly recommended method of ingestion for psychotherapy. It’s less harmful than smoking and easy to start out small and slow until the desired effect is achieved.
Cannabis as Collaborator: Procedure for Use in Psychotherapy
Prior to bringing cannabis into psychotherapy, I spend time assessing the client’s relationship to the plant. What is the level of familiarity with cannabis’s effects? What is the length of use, frequency, and experience with various dosages over time? Perhaps most importantly, what were the person’s previous intentions with using cannabis? Clarifying the intentions for the cannabis-assisted psychotherapy session is an integral part of the process. Often, this isn’t something people consciously and carefully consider when engaging with the plant. Setting clear intentions is a way of aligning with the plant’s energy and power even before ingesting it. Focusing on what the client wants to be uncovered, learned, experienced, felt or known sets the stage for allowing these things to happen.
It’s important to have several preparation sessions before and several integration sessions after the first cannabis session. Getting to know who I’m working with guides me in providing questions, reflections, suggestions and meeting needs that may arise during and after the session with cannabis. In the preparation phase, we go over personal history, challenging symptoms or conditions to address, one’s previous relationship to cannabis, and the intentions/hopes/desires for the cannabis session. In order to interact with the plant in a new and different way, I ask that my clients abstain from cannabis use a week before the cannabis-assisted psychotherapy session, if possible.
At the beginning of the cannabis session, upon ingestion, I suggest that people pause and recall their intentions. Once the desired level of enhancement has been achieved, I offer breathing techniques and visualizations to encourage mindfulness, presence, and emotional release. The goal is to achieve a level of receptivity to one’s inner wisdom. Diaphragmatic and alternating nostril breathing while sitting with the back straight enhances the relaxed yet alert effect that works with the plant’s balancing properties. Openness to spontaneous visions is encouraged but I may offer suggested visualizations based on the client’s set intentions. Deep breathing, mindfulness practices, and visualizations are valuable techniques for managing emotion, and continuing these practices is one way to integrate the session into daily life.
Cannabis as Truth Serum
Cannabis is a wonderful tool for experiencing subtler bodily sensations. Trauma is held in muscles, the nervous system and even DNA. Carefully tuning into the body while being supported and guided can lead to profound insights as well as energetic release and emotional catharsis. Reverie and openness to whatever experience may arise in the moment is also an effective method for connecting with one’s bodily wisdom.
The experiences and understanding gained in the cannabis session are often lurking underneath the surface, outside of normal awareness. As emotions, thoughts, memories, and sensations become known and expressed, they can then be integrated during and after the session. Integration is about taking the lessons and changes obtained in the cannabis therapy and applying them to everyday life. I meet with my clients several more times after the cannabis session to discuss the experience and to incorporate, process, hold on to, and implement the acquired insights and wisdom.
By working with cannabis in this way, we learn to enter liminal space where perception shifts and we experience our observing self. Observation leads to awareness, and awareness leads to insight, catharsis, and empowerment. Cannabis-assisted psychotherapy is about changing one’s relationship to cannabis, another person (the therapist), and one’s self. Defensiveness, fear, avoidance, fragmentation, disembodiment, and shame can transform into reverence, receptivity, tolerance, energetic and emotional release, self-compassion, and connection.
Find out more about Sarah's integration and mental health services on her profile page in the Psychedelic Support Network. Contact today for an appointment.
