Throughout human history, our species has used psychoactive plant medicines to heal people. Over the past two thousand years, imperial, colonizing states that sought to exert control over their populations repressed this legacy. From the Roman Empire to the European invasion of the Americas, to the United States today, a population able to heal their own trauma through plant medicine has been considered a threat to these systems of control and exploitation. Thanks to the diligent work of psychedelic advocates and scientists over the last few decades, however, the truth is finally beginning to emerge. Psychedelic therapy is now set to return to its rightful place at the centre of our approaches to emotional and psychological healing.
What is Psychedelic Therapy?
Psychedelics produce altered states of consciousness that have the potential to heal. By taking us out of our usual, habitual way of seeing and being in the world, these substances help us gain insights into the roots of our emotional and psychological challenges. This isn’t guaranteed, however, as psychedelics are powerfully affected by context. Depending on how seriously you engage in harm reduction and integration practices, you could end up having an overwhelming experience as opposed to a healing one.
Psychotherapy is a relatively recent western invention, just over a century old. Therapy consists of interacting with trained psychotherapists who can guide you though your own mind. They can help you gain insight into the dynamics of your mental suffering and provide a safe container for this process. Psychedelic Therapy represents the ingenious combination of these two approaches. The psychedelic compound makes it possible for the individual to gain deeper insights than would be possible during normal states of consciousness. Meanwhile, therapy acts as a container for the experience, creating a context that maximizes the chances of a healing outcome and allowing the person to go deeper than they might be able to alone.
General Effects of Psychedelics
Psychedelics act in the brain by altering activity in particular brain cells in particular areas of the brain. The psychological result is that we hold less tightly to our preexisting beliefs about ourselves and the world. It then becomes possible for our minds to explore a far greater range of perspectives. In daily life we spend most of our time in a problem-solving state of consciousness. What time is it? Do I need to make lunch? Do I have anything planned for this afternoon? Our minds automatically run through such questions and this way of being helps us navigate the world effectively.
In this way of being there is rarely a good opportunity to delve deeply into our memories or into the root causes of our current emotions. Such activities are typically at odds with this goal-directed, problem-solving state of consciousness. Psychedelic experiences and therapy sessions can be occasions where we switch modes and take time to turn inwards and explore ourselves.
Why Do Psychedelic Therapy?
Therapy can be a powerful approach for gaining greater self-knowledge and for healing emotional and psychological issues. However, even after exploring therapy there can be issues whose roots run so deep that they cannot be resolved in ordinary states of consciousness. In such states one’s habitual beliefs are still very strong, and it can be difficult to see through and revise them. At this point, psychedelic therapy may make it possible to access these root emotional causes. It may let us resolve them in a way that would not be possible without the psychedelic compound’s assistance.
Common Approaches and Substances
Researchers widely explored LSD-assisted psychotherapy in the 1950s and ’60s. They identified it as a potential wonder drug, capable of treating a variety of mental health issues. This research focused on treating alcoholism, as well as anxiety and depression in cancer patients. No strict protocols were developed but two broad approaches to psychedelic therapy emerged during this time: psychedelic and psycholytic. During high-dose psychedelic sessions, therapists typically withheld input but were on hand for the individual undergoing the experience. The therapeutic mechanism under these circumstances appeared to be linked to the occurrence of mystical experiences, which profoundly alter one’s perspective on reality and one’s place within it.
Psycholytic therapy typically used lower doses. The intent was to use the substance to loosen the mental state without inducing the dramatic changes in consciousness produced by high doses. This created a situation in which more conventional talk therapy could occur, but with the added depth of insight occasioned by the psychedelic.
Sandoz, the pharmaceutical company that first distributed LSD, would provide any clinician interested in exploring its effects with ampoules containing 25 microliters (mics) of the substance. For psycholytic talk therapy, therapists would typically give doses between 100 and 200 mics. They would start with 100 mics,. Then they would increase in steps of 25 until the appropriate level was reached for the particular individual. Full psychedelic doses would typically be higher than this, between 250 and 500 mics.
Psilocybin is the psychoactive compound in magic mushrooms. It has been found to be highly effective in treating depression, anxiety, and PTSD. It can induce experiences in which the individual temporarily drops their psychological identity and associated issues. These mystical states have been found to be particularly effective. By surrendering their identity as an individual that is separate from the rest of the world, people routinely experience feelings of deep connection to the rest of existence in a way that can resolve the core emotional pain underlying their anxiety or depression. Psilocybin therapy can also help with healing trauma. In the psychedelic state, they experience significant events in a way that can result in the cathartic release of the associated emotions and the healthy reprocessing of memories in the brain.
High doses are used in order to induce mystical experiences. These are generally 20–30 mg of psilocybin (the amount contained in approximately 3–5 grams of dried magic mushrooms). Lower doses would typically be used for psycholytic therapy.
MDMA, the active ingredient in Ecstasy, has been used in conjunction with psychotherapy to successfully treat post traumatic stress disorder (PTSD). Clinical trials with MDMA are further along than any other form of psychedelic therapy. This is largely due to bipartisan support in developing effective treatments for healing PTSD in military veterans. MDMA therapy has therefore been leading the way in determining best practices when it comes to combining psychedelics and therapy. Typically, individuals will meet several times with two therapists, one male and one female, before the session with MDMA.
After cultivating a therapeutic relationship, the person takes the MDMA, puts on a blindfold, and listens to music. This stage allows a turning inwards and creates the opportunity for unconscious material to surface. When ready, the person can engage with the therapists, who will typically offer minimal direction. Instead, they will gently guide the person through the experience. After the MDMA session there’s typically a process of integrating the insights from the experience with the therapists’ help.
Aid Through Therapeutic Protocols
This approach can be powerful in healing PTSD, allowing people to reexamine trauma and accept that it’s in the past. MDMA reduces activity in the amygdala, the brain’s fear centre. Once you feel less fear it becomes possible to face traumatic memories that would otherwise be overwhelming. This allows the memory to go from being stored as a fight-flight-or-freeze response, that hijacks the person’s physiology, to a normal conscious memory stored in the hippocampus without the overwhelming emotional content.
The presence of a trained therapist is particularly crucial when treating trauma with MDMA. This is in order to navigate the process, as otherwise the traumatic material may be overwhelming and can be re-traumatizing. There is also promise for the use of MDMA in couples therapy. The same action on the amygdala can lower people’s inhibition and defensiveness, allowing for greater mutual understanding and connection.
During MDMA therapy for PTSD, an initial dose of 125 mg is typically given. A half-size follow-up dose is usually given two hours later in order to prolong the effects.
Psychotherapy is a Western container for the healing that can occur when taking psychedelic stances. Indigenous cultures have their own therapeutic approaches to working with plant medicine. In a typical Shipibo ceremony, several people gather in a structure called a maloka and a shaman administers the ayahuasca. They then sing icaros, songs intended to guide people through the experience. Many ayahuasca retreat centers have trained psychotherapists who offer sessions before and after the experience. They can help create a synthesis of psychotherapeutic and indigenous approaches. Ayahuasca ceremonies have been helpful in treating addiction and PTSD. Research is currently underway to quantify these effects.
Ayahuasca dosing is more of an art than a science. Doses are typically measured in cups but cup sizes vary, as does the strength of the brew. During a ceremony, participants typically start with one cup. They wait to see how it is affecting them. They can return for a second or third dose, or even more, depending on how strong the effects are.
Ibogaine is a psychoactive substance found in the African shrub iboga. It is traditionally used for healing in the Bwiti tradition. It can be powerful in the treatment of addiction. Iboga therapy can reduce the likelihood of relapse, and ease the withdrawal process.
Small amounts of iboga are traditionally used to suppress hunger, thirst, and tiredness in indigenous communities. Full therapeutic doses are typically around 20 mg/kg of body weight, but are spaced out into several doses.
Since 1985, ketamine has been designated as an essential medicine by the World Health Organization, creating fewer barriers to its use in psychedelic therapy. As a result, ketamine therapy is currently being used to treat depression in many clinics. Treatment with ketamine typically does not involve talking to a therapist during the experience; instead, one receives an intravenous dose while wearing a blindfold. The altered state of consciousness is reported to offer some respite from the symptoms of depression, but the exact therapeutic mechanism is still unknown. It is likely distinct from the action of classical psychedelics, which act on different neurochemicals in the brain.
Doses at or above 0.5 mg/kg of body weight for the individual have been found to be most effective in treating depression when delivered intravenously in clinics.
Where Do They Offer Psychedelic Therapy?
One way to access psychedelic therapy before it is made widely available to the public is to take part in clinical trials. Lists of current clinical trials can be found at psychedelic.support and maps.org. Legal psilocybin therapy can also be found in the Netherlands and Jamaica; a directory can be found at tripsafe.org. Ayaadvisors.org can help to find reputable ayahuasca retreats near you. A directory for ketamine clinics can be found at ketamineclinicsdirectory.com, and ibogaine clinics can be found at ibogainealliance.org
How to Choose the Right Psychedelic Therapy for You
If you have undergone traditional talk therapy but still suffer from symptoms such as depression, psilocybin therapy may help in uncovering and resolving the underlying emotional and psychological issues. This form of therapy can also prove helpful in navigating painful life events and in generally improving one’s emotional well-being. For depression that resists such approaches, ketamine therapy may be a useful alternative. If you suffer from PTSD, taking part in an MDMA assisted psychotherapy trial may be an appropriate option for you. If you are aware that there are particular traumas in your past but do not have PTSD diagnosis, ayahuasca may be suited to you. Finally, Ibogaine therapy may be able to help those struggling with addiction issues.
Questions to Ask Before Going to Psychedelic Therapy
Have you already explored traditional talk therapy? If not, is psychedelic therapy the right approach for you right now? Do you have people in your life who can offer you emotional support during the integration phase? And importantly, are you at risk for psychosis? If the answer is yes, psychedelic therapy may not be the right option for you.
Psilocybin therapy for depression and MDMA therapy for PTSD are on track to be prescribable by 2023. Add these to the ketamine clinics that currently exist and the range of retreats that offer psychedelic experiences for general well-being and you have a whole suite of psychedelic therapies that will be on offer in years to come. Such therapies are set to transform our approach to mental health over the coming decades, and they may also be able to create transformative change in you too.
RS Contributing Author: Dr. James Cooke
Dr. James Cooke is a neuroscientist, writer, and speaker, whose work focuses on consciousness, with a particular interest in meditative and psychedelic states. He studied Experimental Psychology and Neuroscience at Oxford University and is passionate about exploring the relationship between science and spirituality, which he does via his writing and his YouTube channel, YouTube.com/DrJamesCooke. He splits his time between London and the mountains of Portugal where he is building a retreat centre, The Surrender Homestead, @TheSurrenderHomestead on Instagram. Find him @DrJamesCooke on Instagram, Twitter and Facebook, or at DrJamesCooke.com.