In this episode of the Psychedelic Medicine Podcast, Paul Thambi, MD joins to discuss insights on the optimal delivery of psychedelic experiences stemming from his recent trial on psilocybin therapy for cancer patients suffering from major depressive disorder. Dr. Thambi is a medical oncologist with nearly 20 years of experience treating patients in a private practice. He now serves as CMO Sunstone Therapies, a company focused on how to best deliver psychedelic therapies.  In this conversation, Dr. Thambi shares the details of the design of his recent study, which involved two preparatory sessions, a treatment session, and two integration sessions. He also discusses the efficiency of delivering psychedelic therapy to a group rather than to individuals, allowing the therapist to help more patients at once while still providing focused one-on-one guidance during the psychedelic experience. Additionally, Dr. Thambi discusses the importance of music and space design to provide an optimal state of mind going into the therapy and while under the influence of the psychedelic.  Dr. Thambi is happy to report very positive data from this initial trial, with both patients with active cancers and those with no current signs of disease showing great improvement in depression scores. He looks forward to continuing to work to better optimize the delivery of psychedelic therapies, not only for the patients but also for the therapists. Currently, he is pursuing a new “diad trial” of psychedelic therapy for cancer patients and a loved one which may have the potential to ease the suffering caused to a family system by these diseases.    In this episode: The design of Dr. Thambi’s study of psychedelic therapy for cancer patients struggling with depression Group versus individual forms of psychedelic therapy Crafting an ideal setting for psychedelic therapy with music, artwork, etc. Changes in depression scores, anxiety, and pain amongst the participants in Dr. Thambi’s trial Optimizing the experience for psychedelic therapists as well as patients Dr. Thambi’s on-going “diad trial” for cancer patients and a loved one    Quotes: “What we were trying to do was create something that… could be used when it needed to be for a lot of people—something that was scalable. So something that was efficient, but still had compassion to it. And that’s how we came up with the [study design].” [22:16] “80% of [participants] had their MADRS score cut in half or greater within one week of the treatment. And half of those people had what we called a sustained remission, which means a MADRS score of less than or equal to ten on each of the measurements we took, including the last one, which was done at week eight.” [23:54]   Links: Sunstone Therapist website “Psychedelics may ease cancer patients’ depression, anxiety” article by Manish Agrawal California Institute for Integral Studies (CIIS) Certificate in Psychedelic-Assisted Therapies and Research Previous episode: Psychedelics and the Chemistry of Connection with Dr. Julie Holland Previous episode: How Setting Can Affect Psychedelic Journeys with Frederick Barrett, PhD Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Joel Castellanos and Jim Harris join to discuss the possibilities of addressing spinal cord injuries using psychedelic medicine. Dr. Castellanos is a board certified physical medicine and rehabilitation and pain management physician and an associate professor in the department of anesthesiology at University of California, San Diego School of Medicine. Jim Harris is a National Geographic photographer who suffered a spinal cord injury during one of his adventures who became notable in the psychedelic space with the article in Outside “Jim Harris Was Paralyzed. Then He Ate Magic Mushrooms.” Jim starts off by sharing his own backstory of how he broke nine vertebrae in his spine during a 2014 ski expedition in Patagonia, Chile, leading to significant loss of motion and sensation. After some promising success in traditional rehabilitation and physical therapy settings, Jim details his surprising experience of healing with psilocybin.  In this vein, Dr. Castellanos discusses the importance of neuroplasticity in healing for spinal cord injury patients. He talks about how forming new neural pathways can help a patient regain function and sensation in a part of the body that had previously been paralyzed, and leveraging this neuroplasticity using psychedelics and other tools may be a promising way to improve outcomes among these traditionally underserved patients.  Considering the unique needs of spinal cord injury patients, Jim wonders whether lower doses of psychedelics may be more beneficial for this population, as it would allow them to maintain a greater degree of sobriety and groundedness to pursue physical therapy and rehabilitation activities while under the influence of the substance.  Dr. Castellanos expresses excitement about the possibilities of psychedelic therapies for these patients, as not only does early anecdotal evidence such as Jim’s story suggest that these substances may be effective in helping to facilitate regain of function and sensation, but also because of the mental changes brought on by a psychedelic experience. Patients may feel more optimistic and eager to apply themselves following a psychedelic experience, which will facilitate healing beyond just what occurs as a result of the effects of the substance itself. He is also encouraged by current research into different forms of neuroplasticity which have different mechanisms. Dr. Castellanos suggests employing these in combination, such as using psychedelic therapy alongside vagus nerve stimulation, may offer more effective treatment options for spinal cord injury patients.  At the end of this conversation, Jim poses Dr. Castellanos a fascinating question: whether there may be any downsides to over-encouraging neuroplasticity. Dr. Castellanos responds that there could be certain risks of increasing pain in patients, as neuroplasticity encourages new connections to be formed in the brain, but it matters what specifically becomes more interconnected. As such, there is reason to proceed with caution even as neuroplasticity offers significant benefits.  In closing, Jim shares some hard reduction tips for other spinal cord injury patients interested in exploring psychedelic healing. Both he and Dr. Castellanos are optimistic at the possibilities of psychedelic therapies used in conjunction with other treatments for patients like Jim.    In this episode: Leveraging neuroplasticity using psychedelics and other tools to help physical medicine and rehabilitation patients regain function Anecdotes of other spine injury patients who’ve regained function or sensation following a psychedelic experience The connection between spasticity and psychedelics How the response to psychedelics has changed over time for Jim  Connecting physical therapy and psychedelic therapy to improve efficacy of rehabilitation How different mechanisms of neuroplasticity may be used in concert to promote recovery Harm reduction tips   Quotes: Jim: “[when I first took psilocybin] all of a sudden I had an ability to contract my hamstring and… lift my heel off the ground, like up toward my butt, and I hadn’t been able to do that up until that time.” [9:12] Joel: “My primary focus is on neuroplasticity and ways that we can creatively modulate the nervous system to optimize recovery and optimize quality of life, whether that’s from a pain perspective or a regaining motor strength perspective.” [13:34] Joel: “If we can demonstrate that through psychedelics we can optimize and improve and make recovery more efficient, it is something that will be a huge deal for a great number of patients, and make my job as a rehab physician easier.” [14:37] Jim: “The reason I’ve become interested in psychedelics as medicine has been trying to figure out… what are all the ways that I can have some sort of personal efficacy in my own recovery.” [19:22] Jim: “I do know of other anecdotes kinda similar to mine, of people—maybe especially it seems like with a first psychedelic experience—suddenly regaining sensory or motor functions.” [22:41] Jim: “It seems there’s maybe some reason to suspect that some of the nerve plasticity that psychedelics can allow may reopen the critical period of this pivotal mental state where, say having a psychedelic and doing physical therapy in that state and maybe even the days afterwards, might result in a bigger functional change than just doing the therapy alone.” [24:28] Jim: “My hypothesis would be that a useful physical therapy dose [of psychedelics] might be a lot less than what Johns Hopkins and other institutions are dosing as a therapeutic dose. It seems to me that maybe a really high dose psychedelic experience is going to make it harder to stay connected to your body, connected to doing a task.” [29:17] Joel: “If I can identify three or four different ways to open up neuroplasticity that each have different mechanisms, it allows me to leverage those to give robust functional recovery and that’s what I’m interested in.” [33:56] Joel: “If psychedelics can reframe someone’s cognition and reframe their situation where that gives them a little bit of hope, along with having a supportive therapy team, along with it working on descending inhibition and activating muscles that were previously paralyzed, that’s multiple different levels of approaching someone that just had the worst thing in their whole life happen to them… It builds resilience and then it’s also working on the neuromuscular pathway to improve functional recovery.” [37:30] Joel: “I don’t think just taking a psychedelic or other medication on its own is always going to be efficacious in solving that maladaptive pattern. But, when combined with specific and guided therapy, whether that’s physical therapy, or psychotherapy, or cognitive therapy, I think that’s where you can guide those neurons to a healthier connection through neuroplasticity.” [50:17]   Links: “Outside article: Jim Harris Was Paralyzed. Then He Ate Magic Mushrooms.” Psychedelics and Health Research Initiative at University of California San Diego Dr. Castellanos on Twitter Jim on Instagram Previous episode: Psychedelic Therapies for Pain with Joel Castellanos, MD Fireside Project website Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Agnieszka Sekula joins to discuss her research into the applications of virtual reality in psychedelic-assisted therapy. Agnieszka is a researcher at Swinburne University and co-founder of Enosis Therapeutics. Her research focuses on investigating therapeutic mechanisms in psychedelic treatment that can be strengthened through experience design and translating findings of this research into real-life applications by developing virtual reality scenarios. Additionally, she has recently conducted the first ever case study of VR and psychedelics. In her research, Agnieszka considers many possible uses of virtual reality in the context of psychedelic therapy, as well as potential dangers. The first application she discusses is using VR to promote relaxation prior to a psychedelic journey. Similar to the synergy between psychedelics and meditation, Agnieszka suggests that the immersive experience of VR could be useful in promoting states of calmness which are ideal for a person about to enter into a psychedelic experience. Additionally, she suggests that the otherworldly imagery and soundscapes possible with VR technology can help prime a client for the shifts and intensifications of perception caused by psychedelics. Having the opportunity to explore these states prior to the experience helps the patient to feel more prepared for the experiences, especially since with VR these explorations occur in a context where one maintains a connection with sober consciousness and can easily opt out if things become overstimulating.  Next Agnieszka discusses the potential of augmenting peak psychedelic experiences with VR. Considering both psychedelics and virtual reality have the potential to occasion dramatic shifts in consciousness and affect, pairing these together is likely to be synergistic in promoting mystical experiences in the therapeutic process—something which appears to be closely tied to the efficacy of psychedelic-assisted therapy. Though little research currently exists in this area, Agnieszka believes that VR may have the potential to more reliably facilitate experiences of ego dissolution and deep awe during the psychedelic journey. Perhaps one of the most novel proposals in Agnieszka’s research is using VR to facilitate greater recollection of the psychedelic journey in order to promote more effective integration. She proposes that by building models of the psychedelic experience in the VR space, a patient can more readily return to the experience in sober consciousness by encountering these same stimuli again in virtual reality. The immersive experience of virtual reality may help facilitate access to feelings, memories, and intuitions which arose during the psychedelic session, leading to an easier process of integration.  However, Agnieszka’s research also considers potential dangers in combining VR and psychedelics. These include the risk of overstimulation and the potential of a trauma being triggered by certain imagery or auditory input. More mundanely, there is also the possibility of “cyber-sickness” and physical discomfort caused by the VR headset. Despite these potential drawbacks, however, Agnieszka is confident there are powerful applications of VR in psychedelic therapy, particularly in allowing for a more holistic and integrated approach to the altered states of consciousness theorized to be at the center of the efficacy of these new treatments.    In this episode: Using VR to induce relaxation in preparation for psychedelic journeys Augmenting peak psychedelic experiences with VR VR as a technology which may promote therapeutic alliance Using VR to store memories of psychedelic experiences to facilitate integration Transitioning between normal consciousness and altered states with the help of VR VR as a “digital diazepam” for decreasing the intensity of a psychedelic experience without pharmacological intervention The potential dangers of overstimulation or triggering traumas with VR and psychedelics   Quotes: “VR in itself is just a tool—it’s a method of delivery—but in itself it's not the active ingredient. So whenever we speak of VR we think about the way of delivering the content, and the content is that active ingredient.” [2:22] “The best way to prepare someone for what an altered state experience feels like is by actually experiencing an altered state, and here again VR can be very helpful in approximating… what that psychedelic experience might feel like.” [18:51] “VR is used as a multi-sensory canvas where the patient is building the model of their psychedelic experience so that they can store it for themselves and return to it later.” [28:17] “Using VR just as beautiful content, or… contextual design for the entire experience might not be beneficial because it might work more as a distraction than as something that supports the journey.” [49:15] “For me the most important thing is to start looking at psychedelic treatment as an experience in its totality and to look a little bit more deeply into design principles that could be used to maximize that experience of the patient, of the client.”  [53:46]   Links: “Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy” Enosis Therapeutics website Agnieszka on LinkedIn Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Andrew Penn joins to discuss the recent BrainFutures white paper on the elements of psychedelic-assisted therapy which he co-authored. Andrew is a psychiatric nurse practitioner and a professor at UC San Francisco who is also a psychedelic psychotherapy researcher and nationally invited speaker. Additionally, Andrew is the co-founder of the Organization of Psychedelic and Entheogenic Nurses (OPENurses). In this conversation, Andrew discusses his white paper and breaks down the five key elements which need to be present in all psychedelic-assisted psychotherapy to ensure safety and efficacy. These five elements are safety and establishing set & setting; screening and assessment; preparation; the medication session; and integration.  In terms of screening and assessment, Andrew mentions the interesting place the field finds itself in currently, as up to this point screening practices have been rather intensive and erring on the exclusionary side since this is the standard when drugs are being tested in clinical trials. However, with psychedelic therapy continuing to become more accessible with patient options outside of these trials on the horizon, the field will need to decide what makes the most sense in terms of balancing accessibility with potential risks, and in doing so more data will be collected which will give a better picture of exclusion criteria. Andrew also stresses the need for psychiatric screening in addition to focusing on medical consideration, mentioning that it’s essential for a psychedelic therapist to know a patient’s trauma history, as this is something that may come up in a session and the more preparation the better.  When it comes to preparation, Andrew suggests that this should include establishing a relationship of trust, educating the patient, obtaining informed consent, and establishing safety measures. On the topic of consent, Andrew discusses the intricacies of dealing with this gracefully in a context where a patient will be undergoing a drug experience where consent cannot be adequately given in that moment. As such, he stresses the importance of explicit conversations between the patient and therapist around topics such as whether or not the patient would want their hand held during an intense moment. Rather than dry, procedural conversations, Andrew thinks discussions of consent are actually crucial moments where the therapist and patient can establish a relationship of trust and also more thoroughly explore the possibilities of what may come up for the patient in the session so that they feel better prepared. In terms of the psychedelic therapy sessions and integration, Andrew suggests that the therapists play different roles in these two contexts, with the medicine sessions being more about supporting the patient in their experience without providing too much direction or prompting so that the experience may unfold naturally and autonomously, whereas in integration the therapist can take a more active role in helping the patient explore what the experiences brought up. One interesting feature about psychedelic therapy, and a reason why integration is so important, is that the intensity of the medicine experiences and the insights triggered during sessions can actually be destabilizing initially. As such, Andrew maintains that integration is a crucial aspect of psychedelic therapy in order to better ensure that these experiences can lead to deep and lasting healing.  Andrew hopes that this white paper can introduce the crucial elements of psychedelic therapy to a wider audience and encourage a standard of practice.   In this episode: How might screening and assessment change once psychedelic therapies are more widely authorized and not only accessible as clinical trials?  Reckoning with the exclusion criteria around psychedelic therapies The importance of thorough preparation in achieving the best patient outcomes The dynamics of consent in preparation versus in the midst of the session and how therapists can more intentionally approach these questions What should therapists do when a patient is not in a calm state of mind at the time of the scheduled psychedelic therapy? Why integration is critical to facilitating healing in psychedelic therapy   Quotes: “Trauma is likely to come up during the session and we want to at least know if there’s something there then we can anticipate that and also start to create a safer environment for that patient.” [7:53] “We’re gonna have to figure out what is the right dose of medical screening, and then, certainly, introducing some level of psychological screening will be really important.” [10:27] “Informed consent is this ongoing conversation with the patient where the patient can withdraw their consent at any time—they can revoke that—but people really need to know what they’re getting into if they’re going to make meaningful informed consent.” [16:12] “What we’ve learned from psychedelic therapy is that there’s a lot of value in just letting things unfold… really the goal of the therapist should be to support that inward focus, and not try to influence the session itself in one direction or another other than to maintain safety.” [33:19] “Psychedelics are things that tend to shove your face in whatever you’ve been avoiding and that’s something that therapists need to be really aware of—that they might encounter patients who get worse after the session, at least for a transient period of time.” [44:41]   Links: Andrew's full white paper on BrainFutures: "An Expert-Informed Introduction to the Elements of Psychedelic-Assisted Therapy"  Previous episode: When *Not* to Proceed with a Planned Psychedelic Journey with Rick Barnett, PsyD OPENurses website  Psychedelic Medicine Association Translational Psychedelic Research Program - TrPR Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Kurt Rasmussen joins to discuss the potential benefits of non-hallucinogenic psychedelic drugs currently in development. Dr. Rasmussen is the Chief Scientific Officer at Delix Therapeutics and was previously at the National Institutes of Health where he led the Division of Therapeutics & Medical Consequences since 2018. Here, he directed the medications development program and played an integral role in evaluating the safety and efficacy of pharmacotherapies, behavioral therapies, and devices to treat substance use disorders. He is also Fellow in the American College of Neuropsychopharmacology and has over 100 publications and patents to his name. Dr. Rasmussen begins by discussing the ways psychedelics can bring out physical changes to brain structure, mentioning that this is an important mechanism for the therapeutic effect of these medicines. He mentions that these structural changes are theorized to be relatively distinct from the experiential, hallucinogenic component of psychedelics, and as such it may be possible to develop new drugs which condition the same cascade of events in neuronal structure without leading to intense subjective experiences and major alterations in perception. But what would the benefits of such drugs be? Dr. Rasmussen explains that the availability of non-hallucinogenic psychedelics could have the potential to significantly increase the accessibility of these substances and their associated therapies—both in populations for whom contraindications exist for traditional psychedelic medicines (such as patients with schizophrenia) and for individuals who may be resistant or fearful of the hallucinogenic experiences that can come with psychedelics. Rather than attempting to replace traditional, hallucinogenic psychedelics, Dr. Rasmussen hopes that these non-hallucinogenic alternatives would be able to serve populations or conditions where current psychedelics are not the best option. In fact, Dr. Rasmussen suggests that perhaps hallucinogenic and non-hallucinogenic psychedelics could be used powerfully in conjunction with one another, hypothesizing that the personally meaningful journeys conditioned by traditional psychedelics may be more effective for kickstarting healing from a condition like depression, but perhaps the non-hallucinogenic substances could be more convenient maintenance, as they would not require regular intense experiences facilitated by specially trained therapists to continue promoting neuroplasticity. Dr. Rasmussen does emphasize, however, that a psychotherapeutic component would still be recommended even with non-hallucinogenic psychedelics, as the combination of medication and therapy leads to greater efficacy. But, this also depends on the particular condition being treated. A patient with a mental health condition will likely benefit from the addition of therapeutic work, but a patient who is exploring psychedelic treatment for something like migraines or cluster headaches may only need the structural changes caused by these substances in the brain in order to feel better—another reason why non-hallucinogenic psychedelics may be preference for certain patients with various conditions.  In closing, Dr. Rasmussen reiterates that the exploration of non-hallucinogenic psychedelics is all about increasing patient options and broadening the cools in the psychiatric toolbox to tailor treatments to particular patients and conditions. Whether hallucinogenic on non-hallucinogenic, Dr. Rasmussen sees psychedelic medicine as an important and promising paradigm shift in psychiatry.    In this episode: How both hallucinogenic and non-hallucinogenic psychedelics may be used together to reach a greater patient population Why the hallucinogenic component of psychedelics may not be necessary for their efficacy Contraindications involving the hallucinogenic component of psychedelics Potential cardiovascular concerns with regular psychedelic use due to action on serotonin receptor 5-HT2B  Why it may be desirable to have a range of psychedelic medications which produce different intensities of subjective effects to treat a wider range of patients   Quotes: “There are changes in your brain as a result of administration of these compounds that occur. It’s not just a sensory and emotional experience, but actually there are physical changes in your brain, in different circuits, very specific circuits.” [5:28] “SSRIs and other antidepressants can have effects by themselves, psychotherapy can have an effect by itself, but the real efficacy, the magic is when you combine the two and I have no doubt that these compounds [non-hallucinogenic psychedelics] will benefit from psychotherapy associated with it.” [11:07] “We need more options for patients for sure, and hopefully the psychedelic medications with the hallucinations will help a certain set of patients and hopefully we’ll have other non-psychedelic compounds that are neuroplastic that will help patients.”  [18:25] “I think different compounds will be affecting different circuitry or different microcircuits… in the brain so that different compounds will have varying levels of efficacy for different indications, and like I said the indications can be from neurology to psychiatry.”  [25:58]   Links: Dr. Rasmussen with his puppy Ruby Dr. Rasmussen on LinkedIn Delix Therapeutics website  Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Max Wolff joins to discuss his 2020 study exploring how psychedelics can facilitate the healing process of “letting go.” Dr. Wolff is a psychologist, psychotherapist and head of psychotherapy training and research at the MIND Foundation. He is also therapist and researcher in the EPIsoDE Study, a government funded clinical trial investigating psilocybin-augmented psychotherapy for treatment resistant depression at CIMH Mannheim and Charité Universitätsmedizin Berlin.  In this conversation, Dr. Wolff shares insights from his study, “Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance,” which appeared in Frontiers in Psychiatry in February 2020. In this paper Dr. Wolff and colleagues explore how psychedelic assisted therapies can help patients work through maladaptive avoidant behaviors at the root of many mental health conditions. Dr. Wolff explains that there are two fundamental motivations systems at work in human beings—the approach system and the avoidance system. In healthy individuals, both of these have important and adaptive roles to play as people work towards goals and seek balance in life. However, adverse experiences in unsafe environments can cause individuals to develop unhealthy avoidance, often leading to mood disorders such as anxiety and depression in more severe cases.  One of the goals of psychotherapy—psychedelic or otherwise—is to facilitate a safe container where an individual can work through avoidance, says Dr. Wolff. Psychedelic assisted therapy may be especially effective to this end, as the introspective nature of the experience precludes avoidant thought patterns or behaviors and there is nothing to use as a distraction in the therapeutic context. However, this isn’t the only way psychedelics facilitate the process of letting go.  Dr. Wolff also discusses the effect of psychedelics on relaxing the beliefs of the patient. This recent theory, called “relaxed beliefs under psychedelics” (REBUS), considers how psychedelics encourage an open mindedness and curiosity around perceptions and ideas that would often be dismissed or ignored in sober states due to rigid structures of beliefs and assumptions. This is important in the context of avoidance, Dr. Wolff explains, as it means that the patient is primed to explore issues where typically an avoidant response would be triggered due to a fixed belief about the stressfulness of the topic at hand.  As a result, psychedelic assisted psychotherapy can be particularly effective in empowering patients to revise avoidance-related beliefs at the root of many mental health conditions. By helping patients work through fear and let go of traumas and stress around tender topics, Dr. Wolff thinks psychedelic therapy can make an important contribution to the broader field of psychotherapy.    In this episode: The approach and avoidance systems of human motivation How avoidant behaviors can develop into mental illnesses  How working through avoidance is crucial for both conventional and psychedelic therapies The experience of avoidance in psychedelic therapy and how this can be conducive to acceptance  How the idea of relaxed beliefs under psychedelics intersects with avoidance Different mechanisms for MDMA and classic psychedelics for facilitating letting go   Quotes: “The less favorable the environment is, or the conditions in which we develop are, the more likely we are to have interactions with our environment that are threatening to our psychological needs, or even perhaps violating to our psychological needs—that is where a lot of avoidance behaviors or avoidance schemas can develop.” [5:43] “Only by withstanding the urge to run away, and only by breaking this vicious circle of avoidance, you get the chance of revising the assumptions that underlie the anxiety.” [27:42] “In psychedelic experiences, one factor that may work in concert with this operant conditioning process of learning to let go is the emotional depth and richness that comes with psychedelic experiences and also the increased likelihood of actually encountering deeply felt fears.” [30:00]   Links: Dr. Wolff’s study: “Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance” MIND Foundation website MIND Foundation training for aspiring psychedelic therapists Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Aaron Cherniak joins to discuss the intersection between psychedelic experiences and psychological attachment styles. Aaron is a clinical psychologist and researcher who examines a variety of topics in psychedelic science, including subjective experiences, outcomes, and mechanisms. He is also a Rabbi and the director of the JPSYCH lab of Jewish spirituality and mental health. His recent research looks at how psychedelic experiences are integrated into peoples’ narratives of life-long religious and spiritual development and contribute to culturally competent therapeutic models. In this conversation, Aaron shares the science of attachment styles and explores its implications in psychedelic therapeutic contexts. He frames attachment theory as a form of personality psychology, mentioning that someone’s attachment style is typically something that stays consistent for long periods of time, though certain traumatic events such as abusive relationships can influence one to develop insecure attachment.  The two forms of insecure attachment are avoidant attachment and anxious attachment, which are two different behavioral expressions resulting from an underlying sense of insecurity or lack of safety within a relationship. This is contrasted with a secure attachment style in which a person feels safe in a relationship and does not feel a compulsion to engage in either avoidant or anxious behaviors out of a sense of self-preservation.  Aaron explains that there are many potential points of relevance for exploring psychedelic experiences and attachment styles together. For example, it may be the case that therapeutic psychedelic experiences could actually shift a person away from insecure attachment—a finding which would be very significant considering how stable attachment styles typically are. Another idea would be to consider the existing attachment style of a patient entering into psychedelic-assisted psychotherapy, and explore how this could affect the patient-therapist relationship and the efficacy of the therapy.  In the context of spirituality and religiosity, Aaron explains that a person’s attachment style often influences how they hold spiritual beliefs. In an Abrahamic religious context, a person with a secure attachment style stemming from a healthy home life is more likely to interpret God through lenses that emphasize divine love and God’s all-embracing concern, whereas someone with an insecure attachment that developed out of an early childhood experience that was colored by neglect or even abuse is more likely to see God primarily as responsible for bad experiences and potentially even capricious. In the context of spirituality outside of traditional religion, this could be the difference between a person viewing the universe as having a purpose and meaning within it, or seeing the cosmos as only cold and uncaring towards the wellbeing of the creatures within it.  Aaron suggests this is relevant for psychedelic research as patients often report transcendent experiences of divine realities during psychedelic experiences, but how such experiences can be integrated may vary significantly based on a person’s interpretation of religion and spirituality stemming from their attachment style. Though this work is still in the theoretical stage, Aaron is excited about the potential findings from research into psychedelic experiences and attachment styles.    In this episode: What are the different attachment styles? Could attachment style influence the connection between a patient and a psychedelic therapist? How attachment styles impact peoples’ interpretations of mystical experiences Psychedelic research as an opportunity to study the psychology of spiritual experiences    Quotes: “Attachment theory has provided a very fruitful model of life-long personality development generally, and specifically religion and spirituality.” [5:41] “If a psychedelic session can change something that is normally stable over 35 years, that would be a very impressive finding.” [14:12] “People talk about the psychedelic substance in attachment terms—people talk about the grandmother or the plant healer… An attachment figure is a stronger, wiser other to whom we seek proximity for closeness, to help us overcome challenges.” [19:47] “I think we have a responsibility to develop therapeutic frameworks to help people translate those experiences of safety, of love and all those things into long lasting therapeutic change.” [34:55]   Links: Aaron’s article: Psychedelic Science of Spirituality and Religion: An Attachment-Informed Agenda Proposal Aaron on Twitter JPSYCH Attached: The New Science of Adult Attachment and How It Can Help You Find—and Keep—Love  Psychedelic Medicine Association Porangui

In this episode of the Plant Medicine Podcast, Adam Aronovich returns to discuss the phenomenon of psychedelic narcissism. Adam is a doctoral candidate at the Universitat Rovira i Virgili in Spain, focusing on Medical Anthropology and Cultural Psychiatry. He is an active member of the Medical Anthropology Research Center (MARC) and part of the Ayahuasca Community Committee at the Chacruna Institute for Psychedelic Plant Medicines. In the last four years he has conducted extensive fieldwork in the Peruvian Amazon, where he has been doing qualitative research in collaboration with ICEERS, the Beckley Foundation, and, more recently, the Centre for Psychedelic Studies at Imperial College. Beyond his work conducting and coordinating research, Adam regularly facilitates workshops at the Temple of the Way of Light, a prestigious healing center in the Iquitos area. In this wide-ranging conversation, Adam unpacks some of the darker sides of the modern psychedelic movement, discussing the psychosocial dynamics around psychedelic use which can lead to things such as ego inflation, conspiratorial thinking, and narcissism. Adam recalls his own experiences slipping into messianic fantasies during a period of initial enthusiasm around psychedelic experiences. He views issues of alienation and lack of social support as being instrumental in leading to these types of delusions following profound spiritual experiences. While it is difficult to reach people who’ve slipped into psychedelic narcissism, Adam suggests that communal support is the best safeguard against these dangers and the most effective strategy for grounding people who’ve lost touch with reality. Drawing on his academic expertise, Adam distinguishes traditional uses of plant medicines from the Western paradigm for approaching psychedelics. He stresses the relational and communal aspects of the spiritual traditions which use psychedelics ceremonially. The pro-social aspects of these wisdom traditions, he claims, help safeguard against the traps of psychedelic narcissism and ego inflation, as there are established mechanisms for keeping people grounded following intense spiritual experiences.  Adam closes the discussion with an insightful analysis of modern gurus and self-proclaimed shamans. Adam encourages people to beware of deeply held spiritual fantasies, where a master can appear as more than human. Instead, he emphasizes that even skillful and well-intentioned healers are themselves nothing more than human beings, so there will always be imperfection and messiness. This does not, however, mean that impactful work cannot happen—in fact, this insight helps protect against the idolization of charismatic psychedelic personalities, which can lead to harmful experiences.   In this episode: Defining psychedelic narcissism Clinical vs colloquial understandings of narcissism The intersections of the psychedelic movement and conspiracy theories The importance of social and communal support for avoiding ego inflation following psychedelic or spiritual experiences How psychedelic experiences can actually deepen ego attachments and accentuate narcissistic tendencies The importance of humor in combating spiritual narcissism   Quotes: “Many of the underlying ideologies upon which Western cultures were built, like hyper-individualism and so on, kind of predispose us and prime us for certain aspects of narcissism.” [5:36] “Ego inflation, spiritual narcissism, messianic episodes—all of these are things that are fairly common within both people who are in some sort of spiritual or psychedelic path.” [12:17] “In traditional societies for the most part really there isn’t such a thing as a self-proclaimed shaman. A person doesn’t wake up one morning and is like ‘oh, I’m the shaman’—that’s a title or a role or a recognition given to that person by the community.” [38:03] “The best measure of whether somebody is genuine and helpful is not whatever credentials or titles he assigns to himself, but rather what other people feel. So, you know, you will know a tree by its fruits.” [45:08] “Having these experiences by themselves does not necessarily mean spiritual growth or psychological development or any enhanced benefit if we’re not constantly, painfully, mindful of how we actually integrate and embody those things in daily life over very long periods of time.” [54:29]   Links: Adam on Instagram Temple of the Way of Light Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Ben Medrano joins to discuss the intricacies of meaning making in psychedelic healing. Dr. Medrano is the former senior vice president and US medical director of Field Trip Health and has extensive experience in the evolving field of integrated approaches. He is also the current co-medical director of Nue Life Health where he is continuing his efforts in expanding access to ketamine therapies. Dr. Medrano additionally still serves as medical director of Field Trip NYC and DC clinics while continuing his private practice. Dr. Medrano begins this conversation sharing a bit about his background and how he came to be interested in psychedelic medicine and the issues surrounding meaning making. He talks about his experience growing up in a family where mental illness was prevalent and how this planted the seeds for taking an empathetic approach to treating these conditions in his career as a psychiatrist. He also discusses his initial exposure to psychedelics in the Chicago rave scene of the 1990s. It was then that he first realized both the transformative potential of psychedelic-induced altered states and the potential dangers of using these substances without proper precautions or care for set and setting.  Following these formative experiences, Dr. Medrano began a practice of meditation within the Tibetan Buddhist tradition. It was through exposure to these spiritual practices and deep teachings that he began to see the importance of this process of meaning making and cultivate various resources suited to this project. Dr. Medrano stresses the importance of self-awareness in realizing one’s own approach to meaning making and how this has been shaped by unique personal experiences. This self-awareness helps one realize that a given patient may be approaching their own experiences from a very different angle, but there are still ways in which it is possible to support and encourage this personal meaning making. Dr. Medrano stresses the importance of working with narratives in psychedelic healing. Psychedelic-induced peak experiences can be packed with insights and symbols which may be brimming with significance, but there’s a lot of work to be done in understanding this material in light of the personal narratives of a patient’s life. Through therapeutic integration, a patient can use their psychedelic experiences to critically examine their narratives and reflect more personally on the potential meanings of given revelations in light of how they understand themselves.  Additionally, Dr. Medrano distinguishes the roles a facilitator should play to support meaning making in high dose versus low dose contexts. When a patient is in the midst of a high dose psychedelic experience, Dr. Medrano emphasizes that the facilitator should primarily seek to affirm the experiences of the patient, being a calming and secure presence that doesn’t introduce any additional complexity or uncertainty into an already intense experience. On the other hand, in lower dose, “psycholytic” experiences, the facilitator may take a more active role, helping facilitate the patient’s meaning making in the midst of the experience through asking questions and engaging with ideas as they arise.  In terms of preparation and intentionally building psychedelic experiences more conducive to meaning making, Dr. Medrano emphasizes the importance of ceremony. Through a more ceremonial approach, a psychedelic experience can be given additional structure which may be reassuring for the patient, and additionally this provides an opportunity to more proactively incorporate things which may already be extremely meaningful for a given person. These can be practices such as prayers, or physical objects which have a certain deep personal significance. All of these help to encourage more meaningful content in the psychedelic experience, while also providing something grounding and familiar in the midst of altered consciousness. Because of how effective Dr. Medrano has found various psychedelic therapies to be in helping people make meaning in life, he is primarily focusing his energies on expanding access to these powerful medicines at this stage in his career.    In this episode: Dr. Medrano’s background and how he got involved in psychedelic medicine and spiritual practices How does Dr. Medrano help clients make meaning out of drug-induced altered states Why Dr. Medrano refers to ketamine as “the great imitator” The importance of understanding a patient’s cultural and meaning making background How to work more intentionally with set and setting and incorporate ceremonial practices Shifting away from a “goal-oriented” perspective of psychedelic experiences   Quotes: “I think telling our stories is part of this process of healing.” [5:20] “Just getting your mind blown by a psychedelic substance is not going to fix things. That’s something I had to learn really quick.” [11:00] “I think for us to do this work, we all need to actually have a good sense of who we are and how we’re approaching the conversation.” [19:01] “Trying to really invite in a sense of inspiration, energy, and support is really what the goal—or part of the goal—of ceremony is.”  [28:20] “Really your role as a guide is honoring and affirming the experience. It’s as simple as that. And being supportive. So, having a dialogue is not necessarily encouraged in higher doses.” [31:22] “Basically the process of integration is to not let anything that comes into the experience not be honored or seen in some way, to allow it to be explored, and of course not to push too much.” [38:27]   Links: Dr. Medrano’s website Nue Life Nue Network Field Trip Health New article: Safety, effectiveness and tolerability of sublingual ketamine in depression and anxiety: A retrospective study of off-label, at-home use Previous episode: Psychedelic Apprenticeship: Validating Psychedelic Insights and Revelations with Chris Timmermann, PhD The Body Keeps the Score by Bessel van der Kolk Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Ben Sessa joins to share results of his investigation into MDMA-assisted psychotherapy for alcohol use disorder. Dr. Sessa is a trained MDMA and psilocybin therapist and the chief medical officer at Awakn Life Sciences, a biotechnology company researching, developing, and commercializing therapeutics to treat addiction with specific attention on alcohol use disorder in the near-term.  Dr. Sessa begins sharing his story of how he got interested in the potential clinical uses of psychedelics as a psychiatrist, discussing his experiences of rave culture and making connections with Rick Doblin and MAPS early in the so-called “psychedelic renaissance,” a term he coined. Looking at the work MAPS was doing, he was inspired by the potential of psychedelics to heal trauma and began looking for ways to further contribute to this research.  When it came to alcohol use disorder (AUD) specifically, Dr. Sessa mentions how poor the current best treatments are, with relapse rates sometimes being as high as 90%. This being so, there is significant potential for novel treatments to provide better outcomes, and considering the prevalence of AUD, this could be a huge net positive for society. Dr. Sessa explains that AUD is particularly common in individuals with a history of trauma and/or adverse childhood experiences, so considering the potential of MDMA to address these underlying factors, he immediately saw the potential for psychedelic treatments of this condition.  Working off of these hypotheses, Dr. Sessa undertook a study of MDMA for alcohol use disorder which showed some extremely promising results. The study found that only 21% of the trial participants returned to previous levels of drinking following MDMA-assisted therapy. In addition to this, about half of the individuals for whom the treatment was effective were actually able to have an occasional drink without relapsing—an outcome that is exceedingly rare with current treatments, hence the insistence on complete abstinence. Though this was only a safety and tolerability study and thus additional research is needed to confirm these initial findings, Dr. Sessa is extremely encouraged by the potential of this novel treatment and he is happy to report that he and his colleagues have just submitted a clinical trials application for a placebo-controlled study of MDMA for AUD, so additional insights into the efficacy of this treatment are hopefully not far off.  Dr. Sessa concludes this conversation with an interesting discussion of MDMA “hangovers”—sometimes referred to as “blue Mondays.” He mentions that it is an established fact that many recreational ecstasy users experience a rather significant drop in mood and sense of wellbeing following using the drug. However he theorizes that this may be due more to confounding factors rather than the drug itself. Considering the typical contexts of recreational MDMA use, things such as lack of sleep, lack of food, excessive exercise, impure sample, and concomitant drug use could all contribute to negative emotion after a drug experience. And Dr. Sessa’s research seems to lend support to this theory, as the MDMA patients in the clinical setting of his study did not experience these side effects, and actually many experienced just the opposite—they felt an “afterglow” following MDMA therapy, where they noted elevated mood for up to a week after the experiences.   In this episode: How Dr. Sessa first became interested in MDMA-assisted psychotherapy Why Dr. Sessa decided to focus his work on alcohol use disorder The study design for Dr. Sessa’s MDMA for alcohol use disorder trial The types of talk therapy employed in this MDMA therapy trial Does MDMA-assisted therapy have potential for treating other kinds of addiction? Why patients aren’t seeing a “blue Monday” hangover after MDMA-assisted psychotherapy   Quotes: “In the MDMA state you can work with those forbidden, avoidant memories that normally you wouldn’t go to.” [5:20] “In fact, most addictions—apart from perhaps nicotine—have this link with childhood adversity and trauma.” [8:36] “We didn’t just look at drinking outcomes, we looked at mental health, physical health, relationships, quality of life—all these kinds of things… And there were improvements across the board in all of those people who responded well to the MDMA therapy, which was 80% of them.” [20:46] “Across 26 MDMA sessions (which was in 13 patients), we found no comedowns. So they all had MDMA and at the end of the day when the MDMA wore off, they didn’t feel low, they didn’t feel rotten, they felt fine—in fact they felt good.” [26:06] “I think if people took MDMA lying in silent darkness like they take mushrooms, I think we’d see a lot more in the way of mystical, spiritual experiences.” [32:42] “[Psychedelic-assisted therapy] is much more like surgery than it is psychiatry. It’s not daily maintenance treatment with SSRIs for the next sixty years of your life just to suppress symptoms. It’s an intensive, up-front piece of an intervention, like mending a broken bone, that gets you better so you don’t have to sit on antidepressants for the rest of your life.” [36:26]   Links: Dr. Sessa’s study on MDMA for Alcohol Use Disorder: First study of safety and tolerability of 3,4-methylenedioxymethamphetamine-assisted psychotherapy in patients with alcohol use disorder Dr. Sessa’s study on MDMA hangovers: Debunking the myth of ‘Blue Mondays’: No evidence of affect drop after taking clinical MDMA Awakn Life Sciences website Dr. Sessa’s website Dr. Sessa on Twitter Psychedelic Medicine Association Porangui