Thanks to the success of modern medicine, more people are surviving life threatening illnesses (LTIs) than ever before. This also means more people are living with trauma that results from surviving these conditions. Join Dr. Phil Wolfson as he explores the results of an MDMA-assisted clinical trial for people with life threatening illnesses. He’ll also discuss how psychedelic therapy could help treat, and even prevent, PTSD-LTI.
Survivors of Life Threatening Illnesses Increasing
Modern medicine’s successes are producing a vast and rapidly increasing population of survivors of life threatening illnesses (LTIs). Unfortunately, for many the cost of survival may well be trauma to the mind as well as the body. From its difficult commencement, the impact on patients may well be harmful. From the shock and life change of diagnosis, to the ensuing treatment, trauma upends lives. This not to mention the potentially arduous treatment and diminishing of physical and mental capacities, through often long term treatment, and then recovery. The nature of traumas varies in depth, symptomatology, as well as on spirit and relationships.
Our experience with 18 subjects with life-threatening illnesses who enrolled in an MDMA-assisted clinical trial led us to a conviction. We found it essential to implement psychosocial strategies at the start of the LTI diagnosis in order to prevent this trauma. Providing patients and their loved ones support during the course of the illness and its medical treatment is necessary. Furthermore, this support needs to extend through the recovery period.
It is just not enough to focus our medical skills on illness intervention. Nor can the impact on the human experience be left on the sidelines. Our study delineated the breadth and variety of the traumatic reactions. We defined these as a new Post Traumatic Stress Disorder—PTSD-LTI. Delineation of the plethora of symptoms that make for this diagnosis has been described as well as criteria for diagnosis (available from the author).
…we with our subjects were able to have significant impact on their traumatic residues, their fears for relapse and death…
MDMA Impact on LTI Survivors
MAPS sponsored our unique Phase 2 study of anxiety as the primary marker for those with LTIs and a life expectancy of at least one year. The study’s basis is what may well be the most intensive psychotherapy involving subjects who have LTI induced trauma. Using MDMA as the fundamental, focal point, our team was able to have significant impact on our subjects’ traumatic residues. For example, these residues include their fears for relapse and death, and their struggle to make recoveries with full resumption of pre-diagnosis lives. These lives faded away and morphed following diagnosis no thanks to the sudden threat of protracted illness and death itself.
MDMA-assisted psychotherapy is a reciprocal process. So, as much as our subjects responded and changed, the practitioners did too. In fact, we experienced profound changes in our awareness. Our awareness of the many ways that illness manifests, changed. Moreover, we realized the causation and breadth of trauma and our own self concepts.
Over the 3 year course of this intensive and intense study, we experienced a progressive revelation. The study revealed the diagnosis’ traumatic nature and its aftermath. Furthermore, it demonstrated its various manifestations in cognition, motivation, affect, spirit, meaning, relationships, and view of self. Being exposed to our subjects’ suffering, impacted ways of being, and to their tension with potential recurrence of illness and death changed us. We grew to be a unit for exploration and healing.
Strong Emotions and Joy in MDMA Work
Strong emotions marked many of our sessions. Additionally, we often experienced a unity with our subjects’ suffering and liberation from it. For the mind, heart and spirit are inseparable. The MDMA experience carries this at its center. There is joy in this work. Also, there’s meaning and connection that is far more possible to achieve in the long and deep MDMA sessions.
MDMA-assisted psychotherapy is a reciprocal process and as much as our subjects responded and changed, so did we as practitioners.
Poor Awareness of Trauma Continues
Anxiety was our program’s primary, enrollment marker and outcome measurement. However, the impact of trauma on our subjects was the predominant cause of their suffering. And while our focus was on the specific causation of the LTI and its aftermath, earlier trauma also was an inevitable part of the work.
We used the STAI Trait measure in conformity with other studies of psychedelic-assisted psychotherapy. But if I were to do it again, I will pursue using trauma assessments as the primary measure. We are in the process of preparing a ketamine-assisted psychotherapy study of LTIs.
Developing clarity about suffering with LTIs (and other forms of suffering) coming to the PTSD-LTI designation continues. It continues with the expansion of psychology’s reclamation of trauma. Reclaiming trauma’s true status as the overwhelming cause of human distress and dysfunction. Sadly, that realization remains incomplete.
Near attitudinal blindness continues to trauma’s effects on humans. Effects caused by prejudice and culturally embedded formats: racism, sexism, caste, war, refugee displacement, poverty, illness, and class that are forms of domination. That myopia remains and limits our evolving view. Trauma prevention remains the abiding issue for developing a healthy population instead of a wounded population. This according to the World Health Organization.
Prevention of trauma remains the abiding issue for developing a healthy population instead of a wounded population.
Our view of trauma from within psychiatric diagnostic categories (i.e. depression and anxiety) tends to be only partially reflective of lives lived and affected by past and ongoing trauma. Focusing on limiting clusters of symptoms, diagnoses can be constraining conceptual structures. Structures that prevent clear views of the complex matrix of existence. These same structures also do not see the fullness of the expressions of suffering in their myriad aspects.
Evolving the View of Suffering
It is essential to turn to a comprehensive and phenomenological view of suffering. Viewing suffering’s prolongation beyond the intruding traumas that are immediately afflictive. The view needs an inclusive awareness of prolonged traumatization, along with developmental trauma and its diverse expression in different people.
This enables the therapeutic conversations that provide recognition and validation to trauma victims in need of understanding themselves and for being understood. This engenders the conscious connections that are healing in themselves and lead to the alleviation of suffering. At least, alleviating that suffering to the extent we are able. It also nurtures the prospect for better caring of those who have been afflicted with traumas (See Van der Kolk for a full explication of this-–The Body Keeps the Score 2016).
What makes this so appealing has been the demonstration of efficacy in small Phase 2 studies with MDMA in PTSD; with psilocybin for LTIs, and now, ours, the first to test MDMA as a treatment for this indication.
Attention to the experience of those facing death from LTIs has become a more prominent part of palliative care. It has also become part of hospice consciousness and a variety of psychotherapies are now available. However, only in recent years has it been possible to resume clinical interest in psychedelic medicine potential. Specifically, those provided in an assisted psychotherapy format-to address PTSD-LTIs.
Effectiveness of MDMA
What makes this so appealing has been the demonstration of efficacy in small Phase 2 studies with MDMA in PTSD; with psilocybin for LTIs, and now, ours, the first to test MDMA as a treatment for this indication. Prior psilocybin studies have demonstrated the value of peak experiences on PTSD-LTIs and anxiety and depression reduction. MDMA offers a different modality for psychotherapy. This owes to MDMA being less of a hallucinogen. Also, it operates through a variety of means to promote empathic connection to oneself and others.
With its wide variety of manifestations, the treatment of PTSD-LTI is an individualized matter. Yet, clusters of concerns emerge. These concerns include: personality, family, history, morality, religiosity, culture, gender, class, ethnicity and more. One common path is to “take stock” as life faces a threat. So too is ‘denial’, even until the very end. So too is the great fear of cessation and non-being. We question and wrestle with who we are and who we feel ourselves to have been. We also ponder peace or dissatisfaction, love or rage, and the mishmash of it all. Confusion is common to us. It comes and goes.
The compassionate non-judgmental work of being a therapist in such a crucible is many sided. The work is moving, frustrating, loving, opening, patient, persevering, available, and self-reflective. Besides that, it is resonant, orchestrating, social working, family system conscious, and above all respectful of the differentiation of each of us. It relies on assisting in the access to each of our own desires for healing, connection, and realization.
Desirable MDMA Treatment Outcomes
In essence, for PTSD-LTI patients, there is a relatively specific set of treatment outcomes that are desirable and are relevant to the diagnosis. These can be clustered as follows with ratings provided subjectively:
- Did your experience help you with recovery from the emotional effects of being diagnosed and treated for a life-threatening illness?
- Do you feel more vital?
- Are you able to feel more pleasure?
- Do you have a greater sense of peace?
- Did your experience help you to connect and integrate with the important others in your life?
- Did your experience help you with your fears of death and dying?
- Was your experience helpful to think about and plan for what you consider your remaining life span?
- Have you been able to find and give meaning to your remaining life?
- Do you feel you have made peace with the possibility of having a limited future?
- Have you been held by or found a spiritual or religious path?
- Have you been helped in planning for future treatment options and for your ultimate death?
- Do people in your life notice a difference in you in these ways and other ways?
Improvements for PTSD-LTI Subjects
The improvements as expressed by the assessment measures used in our study certainly indicate these issues being addressed. Although, it was in the therapeutic work with our subjects over the many days of contact in which these concerns were delineated and assistance rendered. Our study highlights the need for more sensitive measures that reflect the manifestations of PTSD-LTI. Moreover, there’s also a need to allow for treatment benefit assessment for this difficult state.
It also supports the benefit of an intensive psychotherapeutic approach applied within a brief therapy context. The six-month follow-up assessment and psychotherapy session validated the continuing impact of our MDMA-assisted psychotherapy. This is in contrast to the usual 8-week evaluative period for antidepressant trials. It argues for the intensity of contact between therapists and subjects as a cost-effective process.
It argues for the intensity of contact between therapists and subjects as a cost-effective process.
MDMA-assisted psychotherapy provides a unique approach to conscious work with patients. Therapists are more available to patients. Also, they must present as human beings in greater fullness than in conventional work. This is thanks to prolonged sessions lasting 6-8 hours. Interaction is more alive and fruitful. This owes to therapist training to be cautious of countertransference, while working dyadically.
The therapeutic crucible is based on the reality testing that is forthcoming from this contact.
Uniqueness of MDMA Psychotherapy
Under MDMA’s particular influence, an open mind ensues. This open mind then entertains the possibility of letting go of persistent traumatic embedded attitudes caused by the LTI impact. While MDMA is not significantly hallucinogenic, it is powerfully trance and reverie inducing.
The MDMA mind moves in both recollection and imagination. The mind releases its usual constraints and inhibitions. It opens the floodgate of compassion for self and others. Consequently, suffering is realized, contextualized and expressed. MDMA reduces the alarm system’s traumatically induced hypervigilance and self-protective mechanisms. When balanced with the presence of therapists, and the nest that has been constructed with its down lining of the assurance of safety, the combination unlocks the fear-shut awareness of suffering and its causes. The ensuing rush of the spring waters of healing and balancing anew gush forth.
Each person, in their particular idiosyncratic fashion, may well experience the restructuring of self. They may also experience an awakening of view leading down new paths that results in the ripening of the fruit of new life. Imagine an inherent internal force awaiting its liberation. When free, it resumes being the guide to life lived ethically and passionately, creatively and in connection.
MDMA Therapy Changes the Therapist Too
Rarely do psychiatrists and therapists write or speak of the exhilaration of having the opportunity to work intensively with their patients. Our study success reflects in the deeply moving experience of working with our subjects as well as in the outcome measures.
To succeed in psychotherapy, therapists must find compassion, respect and understanding for their patients—at least to some extent. MDMA-assisted psychotherapy brought us into intimate contact with the deepest of life’s struggles. While maintaining a therapeutic stance, we also participated in the intimacy of a shared human experience that touches us all.
MDMA-assisted psychotherapy has this particular nature to it. It does not work in this manner for everyone. No therapy is universally successful or applicable to all the ways in which humans are conflicted or suffering. So, as we build the psychedelic psychotherapy toolbox, our potential for administering a broader range of experiences adds to our hopeful success rate in alleviating and ameliorating suffering.
Other Options for LTIs
The work with psilocybin for LTIs demonstrates its utility in providing a hallucinogenic experience that benefits those suffering with PTSD-LTI. This occurs with a different therapeutic construction. It is deeply experiential in its inner liberation, and not primarily of a psycholytic nature as is the case with MDMA. The nest is built and the therapeutic relationship is supportive. Above all, the experience/experiencer interaction does the liberating rectification relying on the ‘mystical experience’ of the journey. This process performs elegantly. The process began decades ago with mushrooms and LSD.
Ketamine-assisted psychotherapy is the only legal psychedelic available at this time. Ketamine is entirely different. It can be psycholytically applied at low doses. These low doses reduce defensiveness and create access somewhat in the same vein as MDMA. On the other hand, a more robust dose creates a time-out from ordinary mind, leading to ego dissolution and access to realities of new construction.
Freed from obsessions, daily concerns and debilitating moods, the journey liberates. Upon return, the experience enables a reconstruction of self and the recognition that not all is inevitable suffering and despair. Ketamine is a profound hallucinogen. Ketamine is beneficial for all sorts of human predicaments when used in its particular therapeutic format. Finally, marijuana deserves its place. The practice of marijuana-assisted psychotherapy is growing. It is legal now in most states and can be amalgamated with ketamine or stand on its own.
All psychedelics tend to move a person into a spaciousness of mind that is meditative in nature given our separation from constraints, usual attitudes and prejudices.
The Promising Future of Psychedelic Therapy
The intent of all psychedelic psychotherapies is to reduce mental attachments and enable freedom to explore our lives without being so encumbered. All psychedelics tend to move a person into a spaciousness of mind that is meditative in nature given our separation from constraints, usual attitudes and prejudices.
Psychedelic experiences tend to enhance one’s ability to imagine and be fresh and creative. When psychedelics integrate with daily practices and the active realization of our connectedness to all things and all beings, flourishing happens. This psychedelic flourishing tends to bring a person closer to others and ourselves, leading to lives lived in gratitude, sharing, love and community. It is up to us to realize their potential as we build our practices and learn the potentialities for the therapeutic application of psychedelic medicines.
In the psychedelic gladiator’s arena, confusion arises. A tendency to extol the virtues and superiority of one medicine over another conforms to the ‘ownership’ of the psychedelic pharma development of their uses for prescription. Money, fame, and first to the finish line motivation all create mystification.
In fact, all psychedelic medicines have potential for broad effects and broad applications. Head-to-head studies may occur but seem frivolous. As therapeutic application realms of our medicines become available our understanding widens. Our understanding of our patients, their particularities, personalities and struggles, along with our knowledge of the best practices and the therapeutic prospects emerge form our work together. This is the best way to proceed!