Lori Tipton recently walked into a psychotherapist’s office in New Orleans and took a dose of MDMA; this wasn’t the start of her psychedelic journey. Weeks of work with a psychotherapist had led Lori to this point. Despite failed attempts to treat her post-traumatic stress disorder (PTSD) with antidepressants, three years after her MDMA-assisted therapy, Lori would go on to say “My life is so remarkably different to how it was before, it’s almost hard for me to put myself in the mental space of who I was”.
But how did psychedelic-assisted therapy help Lori overcome her PTSD? And why were the effects so long-lasting? It seems like every few months, a new psychedelic drug hits the headlines as the next miracle cure. The different psychedelics, from LSD to MDMA, have been quickly progressing through clinical trials as potential treatments for psychiatric disorders.
Research is revealing psychedelics to be powerful tools for long-term healing. Though, this is when coupled with extensive psychotherapy to help patients through the hallucinogenic experience, colloquially known as ‘the trip’.
What is psychedelic-assisted therapy?
In short, psychedelic-assisted therapy is what it says on the tin. The psychedelic substance creates an internal experience through which a therapist guides the patient. Leading to more personal and in-depth realisations and unearthing repressed trauma. But, as psychedelic-assisted therapy finds its feet as a medical practice, neuroscientists are questioning how best to use this potentially life-changing tool.
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In late 2019, psilocybin (the active ingredient in magic mushrooms) was categorised as a “breakthrough drug” for treatment-resistant depression, by the Food and Drug Administration. In the same year, a long-term study explored the effect of MDMA-assisted psychotherapy on patients with PTSD. Mirroring Lori’s experience, over 95% of patients experienced relief from their symptoms one year after their sessions.
So how does this miracle therapy work? Uncovering how psychedelics lead to long-term healing could not only benefit the patient but could streamline therapy and reveal insights into how the human brain heals.
The psychedelic trip
There is currently a consensus among experts that patients undergoing psychedelic-assisted therapy need to be psychologically prepared to handle the potentially intense experiences and emotions that may arise. This preparation can involve sessions with a trained psychotherapist who can help the patient develop coping strategies and build a trusting relationship to facilitate the healing process.
The Zendo Project is an organisation that aims to support individuals in psychedelic experiences by providing a safe and comfortable environment and trained staff to help manage any potential challenges or difficult emotions that may arise. By providing this support, the Zendo Project helps reduce the risk of harm and increase the potential benefits of psychedelic-assisted therapy.
Lori explained that she experienced the feeling of playing in the snow with her late brother, Davin, during her psychedelic-assisted sessions. “I hadn’t felt that level of joy for so long in my life, and at that point, I hadn’t thought of Davin very much,” she said. Lori also highlighted that losing her mother overshadowed her brother’s death, and the psychedelic experience allowed this to resurface.
Without help, this hallucinogenic experience could have been a traumatising experience. But, with the help of the therapist, Lori was able to heal. But what if all this preparation isn’t needed? Is it possible that psychedelics could work pharmacologically behind the scenes?
A divide is growing in the psychedelic space. As pharmacological mechanisms are investigated further, some researchers are questioning whether the trip is necessary for psychedelic-induced healing.
Psychedelic-Assisted Therapy: How important is the ‘trip’ experience?
Earlier this year, the psychedelic medicine news outlet Psychedelic Alpha published their predictions for 2023. These predictions addressed a key debate between neuropharmacologists and psychotherapists – how important is the trip experience for patients?
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Current practice in psychedelic therapy emphasises the importance of the subjective experience during a psychedelic trip, which is believed to enhance and guide the therapy session, leading to psychological insights and the resurfacing of repressed trauma. However, some neuroscientists, such as David Olson, associate professor at the University of California, argue that psychedelics primarily work on a neuropharmacological level, inducing changes in the brain’s neural pathways through a process known as neuroplasticity.
It is important to note that both perspectives may have merit. Further research is needed to fully understand the complex mechanisms underlying the therapeutic effects of psychedelics. Nevertheless, the growing interest in psychedelic therapy and the potential for these substances to revolutionise mental health treatment has led to increased funding for research in this area.
What is neuroplasticity?
Neuroplasticity describes the brain’s ability to adapt to its environment by growing new connections and rewiring neural pathways. This happens whenever you learn a new dance, or remember how to play the piano. Though neuroplasticity is essential for learning and memory, highly neuroplastic states are abnormal. If the brain is in a state of high neuroplasticity it is more adaptable to rewiring neural pathways.
Olson argues that the trip is not essential for the healing power of psychedelics. He believes that long-term changes in the structure and function of the brain caused by neuroplasticity are responsible for the therapeutic results of clinical trials. And there is a growing evidence base for Olson’s perspective.
This essentially means that the long-term therapeutic benefits seen in clinical trials are due to pharmacological effects rather than the subjective psychological and hallucinogenic experience caused by the drug. People with psychiatric disorders, like depression and PTSD, have low neuroplasticity. By opening a window of high neuroplasticity, psychedelics could allow the brain to learn from new experiences and overcome rigid thought patterns.
At the recent Psychedelic Assisted Therapy Global Summit, Chief Medical Officer at AWAKN Life Sciences clinic, Dr Ben Sessa, compared psychedelic-induced neuroplasticity to “a fresh snowfall”. Dr Sessa explained that negative neural pathways in patients with psychiatric conditions are like paths in the snow. It is easier to keep taking the same trodden path again and again rather than dig a new one. Taking a psychedelic is like a fresh snowfall, the snow is less hard to move and we can dig new pathways.
The idea is that the “snow” is the brain becoming more malleable after taking the psychedelic. And the “digging” is the psychotherapy or lessons learnt from the trip. But, interestingly, Olson says we should throw out the shovel altogether.
Psychoplastogens are altered psychedelics that cause rapid neuroplasticity without subjective internal experiences. These drugs are being developed to get rid of the trip characteristic of psychedelics like LSD while retaining the therapeutic benefit. If these non-hallucinogenic psychoplastogens prove to be just as effective as psychedelic-assisted therapy, the practice can be streamlined to avoid the extra costs of training psychotherapists and carrying out preparation sessions.
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According to Olson, another significant benefit of this approach comes when considering patients with psychotic disorders. Cutting out the trip will allow these patients to benefit from enhanced neuroplasticity without worsening symptoms of hallucinations. Besides patients with psychosis, removing the trip from psychedelic medicines could potentially eliminate the stigma lingering in the hangover from the War on Drugs. Making the drug more likely to be accepted by the general population.
However, others argue that psychedelics treat psychiatric disorders through their subjective effect on perception. While most scientists support the development of psychoplastogens for certain patients, many believe the trip is a key part of the gold-standard treatment. David Yaden, a researcher in the field from Cambridge University and colleagues go as far as saying depriving patients of therapeutic psychedelic experiences is medically unethical.
According to Yaden: “Patients who are treated with psychedelic-assisted therapy often attribute the amelioration of their symptoms to a psychological breakthrough achieved during a psychedelic-induced altered state of consciousness.”
Looking ahead, this year we can expect to see the first early-stage clinical trials using psychoplastogens in humans. The results of these trials have the potential to not only change our minds, but the entire face of the psychedelic-assisted therapy space.