What to Know About Psychedelic Psychotherapy – HPP 90
We are entering a psychedelic renaissance with psychedelic therapy trials showing promising results and the shift in cultural opinions following the release of Michael Pollan’s book, How to Change Your Mind in 2018.
There are still many questions that mental health care providers have about psychedelics:
Can psychedelics cause psychosis?
If an individual has an underlying mental illness will psychedelics exacerbate the issue?
How promising are psychedelics for treating mental health conditions?
What to expect from different psychedelic medicines and what’s currently available legally for treating mental health conditions?
What spiritual experiences can be garnered from using psychedelics and can they be integrated properly?
In today’s episode, we delve into psychedelic-assisted psychotherapy and explore these questions that are on many providers’ minds.
A Psychotherapy Revolution – 02:39
“So, I had the experience for several years working with the multidisciplinary Association for Psychedelic Studies on PTSD trials using MDMA assisted therapy to effect rapid and lasting change in people and walked away from those experiences feeling incredibly excited and enthusiastic about the future of how we can help people who have some of the hardest, longest standing symptoms”
The Benefits and Pitfalls of Psychedelics – 06:13
“And for the most part, I would say, if you look at studies that look at how many people have actually done psychedelics, in a non medical setting, the rates of having a really serious negative experience are exceedingly low—but we don’t condone non medical use, because of the dangers that are posed by that that can be controlled in a medical setting, along with the reality that these drugs are still on schedule one with DEA”
What to Know About Ayahuasca – 12:35
“The way I like to think about it is that the experience is a lot more difficult to titrate or to control. So maybe that’s similar to what you’re saying, when you say aggressive? I think that when someone takes ayahuasca, they’re opening themselves up to what comes toward them, or what comes out of them, what comes out of their psyche”
How to Get the Most Out of Psychedelic-Assisted Psychotherapy – 23:57
“There’s a lot of people where psychedelics just work well for them. And they’ve, like, totally argue with us, like, this shouldn’t be medicalized—I get it, like it goes well for those people. But what you’re saying is that there’s so much more opportunity for success, of really getting the deepest benefits from these medicines, and they’re huge”
Routes of Administration – 30:42
“We’ve tried a number of different routes of administration, we tried intramuscular, we did some work with sublingual tablets. We did some ketamine nasal spray. and so just looking at the literature and the scope of the research, and also figuring out a way to provide IV“
What the Research Shows – 34:20
“A total of 42 hours of therapy, including these three MDMA sessions, over a five-month period, people who go through that protocol and come out on the other side, at the 12 month follow up, and even beyond that, about two thirds of them, who were very traumatized, don’t meet criteria for PTSD anymore—So it’s incredibly exciting, it’s a lot more effective than what we see in the research of other currently available tools”
MAPS And MDMA-Assisted Psychotherapy – 37:35
“MAPS was able to gain FDA approval to implement a training study is what they called it. And so in the training study, people like me who hadn’t taken MDMA, were given the opportunity to undergo the protocol —And I would just say that I access levels of self-awareness and comprehension of early traumatic experiences and ways of healing those early traumatic experiences from my life that had been outside of my grasp for decades
Keith Kurlander, Dr. Will Van Derveer
Dr. Will Van Derveer 00:01
A lot of times people with mild to moderate symptoms have something going on that’s very deep in their psychology that is sort of like the root cause of their symptoms. And when you take a psychedelic, that material can come out very abruptly. And I’ve seen this happen over and over again.
Keith Kurlander 00:24
Thank you for joining us for The Higher Practice Podcast. I’m Keith Kurlander with Dr. Will Van Derveer. And this is the podcast where we explore what it takes to achieve optimal mental health. Hey, there, welcome back to the show. We’re pretty excited about today’s show, because today we’re gonna get a conversation about psychedelics, and the big wave that is more kind of on the beginning of right now around the use of psychedelic medicines and psychotherapy, and exploring the promise of psychedelics and also maybe where some of those promises might not hold up, and where some of them are very much looking positive in terms of efficacy of psychedelics, and how psychedelics can be used in people’s journey where they’re struggling either with trauma or depression, anxiety. So there’s a lot of different things to cover around psychedelics, what’s happening, the pitfalls, what to look out for. So really excited about this conversation, a lot of people have a lot of questions. And this conversation is also coming off of that. We’re also about to open registration soon, in a new psychedelic therapy training, that we’re also been putting a lot of time in and super inspired about offering something to the professional field here about how to get really well trained, and how to use these medicines and this technology with people and that’s coming soon. So be on the lookout in the next couple weeks, we will be having information on our website, you’ll hear more on our podcast, about this new psychedelic therapy training, it’s going to lead to a certification that will really start to legitimize the field. So more to say about that. Alright, now we’re gonna dive in Will and I on the conversation about psychedelics and mental health. And we’ll see where this takes us. But to start us off Will.
Dr. Will Van Derveer 02:39
Sure, thanks, Keith. Yeah, I’m really excited about this upcoming training as well. So for those of you who haven’t been paying attention, which probably not that many people out there who haven’t heard already that psychedelics are coming forward in mental health care, as an up and coming treatment that’s being studied pretty actively right now in research. The background is that we’ve really struggled to get a handle on rates of depression and PTSD, in particular, with standard treatments. And there are now phase three trials going on for the treatment of depression and PTSD, using psychedelics to treat these really difficult conditions, really disabling conditions, and really rampant sort of epidemic level out of control levels of depression and trauma. So, I had the experience for several years working with the multidisciplinary Association for Psychedelic Studies on PTSD trials using MDMA assisted therapy to effect rapid and lasting change in people and walked away from those experiences feeling incredibly excited and enthusiastic about the future of how we can help people who have some of the hardest, longest standing symptoms really start to get well and put PTSD behind them. There’s also big trials happening with psilocybin for depression. So the early research with psilocybin depression is really exciting to really high levels of effectiveness. And so there’s a revolution happening in the world of psychotherapy, and it’s probably the biggest change. Keith, I’m curious what you would say about this, probably one of the biggest changes that’s ever happened in terms of the field of psychotherapy.
Keith Kurlander 04:33
Yeah, that’s a good launching pad right there, which is that I think there’s been moments in the history of psychotherapy where a new modality or kind of a new school of thought starts to rise. But this is different, right? Because now we’re talking about a new technology, along with the therapy. It’s kind of like when we think about like, EMDR is rising or something, but this is really different. Because this is about a medication driven therapy, this is starting to look like it might be one of the biggest shifts in the field of psychotherapy in our lifetime. And something that probably likely influenced the field of psychotherapy for many, many, many generations in terms of what people really rely on as one of the main go to tools, I don’t think it’s going to be in every therapy obviously, and it shouldn’t be, but it’s massive, what’s coming here. So it’s exciting, and probably a good Launchpad here for us is to just kind of go over a little bit about different medicines right now, you kind of name them quickly, but just let’s go over different medicines. What people are experimenting with, in more recreational settings, non medical settings, and then we can kind of circle back to, what hopefully, we’re gonna see, hopefully make it through the phase three trials. And we can kind of give people a little bit of an overview of different medicines. And what are the kind of benefits and pitfalls of these medicines and things, it sounds like a good place to start?
Dr. Will Van Derveer 06:13
Sure, that sounds great. Yeah, absolutely. Well, I’ll just jump in and say, obviously, since the 60s, there’s been non medical use, and a lot of interest in expanding consciousness with psychedelics. And for the most part, I would say, if you look at studies that look at how many people have actually done psychedelics, in a non medical setting, the rates of having a really serious negative experience are exceedingly low. In those situations, I want to set that framework, just in terms of the massive amounts of millions and millions of people using psychedelics for their own personal psychological exploration or recreational use. And at the same time and just as an aside, we’ll probably get further into this later, but we don’t condone non medical use, because of the dangers that are posed by that that can be controlled in a medical setting, along with the reality that these drugs are still on schedule one with DEA so you can get in big trouble for holding them or using them or so what we’re seeing, and it’s really fascinating to me as a psychiatrist as people are out there, experimenting quite a bit now, the release of Michael Pollan’s book A few years ago, how to open your mind, there seems to end with the psychedelic research more and more in the press, more and more people seem to be going out and doing non medical sessions or experimenting, and they’re using LSD using psilocybin and MDMA, sometimes combinations of things ketamine, and you didn’t mention but there’s also this indigenous tradition of using psychedelics like ayahuasca or pod in a very traditional spiritual context that’s been going on for 1000s of years. So, one of the interesting things I see as a psychiatrist is that when people use psychedelics in a non medical or non indigenous, traditional setting, as a psychiatrist at best, what we see with non medical use is that someone has a mind opening experience that’s not scary or traumatic. At worst, a person could have a traumatic experience. And we see quite a bit of people coming in who have had difficult experiences, who need a lot of support. And so we would rather that people have the support that they need to fully make use of and integrate a psychedelic experience, which is why we really advocate for using these medications in a really safe and well designed setting, and with a guide, who can really help people through what they need to face in order to go well.
Keith Kurlander 09:12
I agree with that perspective to obviously and it seems like so obviously, there’s going to be plenty people out in the world that are going to be doing psychedelics till the end of time on their own and a lot of kind of garage shamans popping up these days, running circles in their garages or whatever, and that’s going to happen and there’s so much that comes out of psychedelic use. Some people obviously have near death experiences on them, they can have a catalyst experience, it’s something a spiritual experience, they can have a regressive experience into their own psyche and get into childhood experiences and transpersonal experiences and you know that it’s it’s such a smorgasbord of what could go down on psychedelics and for better or worse, I mean, some of that’s amazing. And some of it, if you don’t have the right support, like you’re saying, I can actually be severely traumatizing, because you’re left to kind of fend for yourself in your own mind. And sometimes things can get too chaotic too quickly and if not the right support, it’s overwhelming. So that’s where we’re at right in the context of just culture is we’ve got a lot of people very interested right now on psychedelics, a lot of young people, particularly are interested in psychedelics right now. And then we have the whole medical field that got interested, to really take a good look at it, which is so exciting. And it might be useful just to break down a few psychedelics that are being used often, right now. And again, for the listener, what will kind of differentiate between what’s being researched very heavily, versus what people are just sort of doing in their own way recreationally and that’s not even probably the best term. A lot of people don’t believe they’re using them recreationally. But why don’t we start just with the first ayahuasca? It’s a big one, it’s on a lot of people’s minds, some people don’t even know what it is. And we could just say a little bit about this one’s not that far along in research, in terms of, we’re not even in any FDA trials, are we Will with ayahuasca?
Dr. Will Van Derveer 11:28
Not in the US, which is what you mean by FDA, obviously, but there have been some top of the line placebo controlled trials in Brazil for depression, treating ayahuasca for depression, it’s really difficult to study ayahuasca for a number of reasons. One being that it’s a blend of different plants that has a different recipe for almost every batch in different indigenous traditions, there’s different ingredients in it. And the traditional context is to drink, ayahuasca in a circle with the shaman leader. And so in terms of Western kind of American scientific study design, you’ve got a large effect that’s coming from the context from the community from the shaman. And then you’ve got a substance that is kind of a potpourri of different plants. And so in terms of studying ayahuasca, there’s a lot of different kinds of feelings people have about this, but you’d have to isolate out one or two components to try to study it. So it’s difficult to study, that’s all I’d say.
Keith Kurlander 12:35
Right, it’s difficult to study and in terms of just people’s knowledge, there’s a lot of people experimenting with ayahuasca, sometimes that’s within like more of a sanction church, sometimes people fly to South America, Central America or different places. And ayahuasca tends to be a fairly powerful psychedelic we could say right? It tends to be a powerful, strong experience, not always, but tends to be, it’s definitely not for the faint of heart, it tends to be something that can induce a lot of regressive experiences in oneself, they can induce a lot of physical discomfort, and overwhelm, can also obviously, some people experience a lot more of this spiritual transpersonal stuff with like with ayahuasca. But I think overall, like the takeaway with ayahuasca is, obviously, it’s not legal to be doing outside of a sanctioned church. But outside of that issue, it seems to be a more aggressive psychedelic, would you agree with that?
Dr. Will Van Derveer 13:43
The way I like to think about it is that the experience is a lot more difficult to titrate or to control. So maybe that’s similar to what you’re saying, when you say aggressive? I think that when someone takes ayahuasca, they’re opening themselves up to what comes toward them, or what comes out of them, what comes out of their psyche, or as you said, from the transpersonal realm, and it’s extremely common for people to take ayahuasca to encounter incredibly challenging and difficult and scary material. So I don’t know if I would call it aggressive, but I would say that it’s just really hard to know what kind of experience you’re going to have. And so I would say it’s definitely not for the beginner Psychonaut because there is a level of kind of progression of being able to navigate psychedelic spaces that you wouldn’t necessarily want to throw somebody into an ayahuasca experience early in their exploration of psychedelics.
Keith Kurlander 14:52
Yeah, I think that’s a good way of saying it, it’s definitely not generally speaking one of the softer experiences that these medicines could be used for which tends not to be soft so that’s ayahuasca. Now I’ll share for a minute just a little story of being in Colombia in a beautiful indigenous ayahuasca church in Colombia on the beach. And with 100 year old essentially shaman and the shaman below him and the shaman ball him in the shower him and very beautiful context, and satin setting everything’s right, and then also knowing that many nights in a row and first night, everything was just more kind of like being in touch with nature and being in the jungle there and connecting to the jungle and feeling that connection and wonderful. And then night two, for me it was like laying next to the fire thinking it was the last night of my life and witnessing everybody at my funeral. And so I think, my takeaway with iosa. And is that seven setting obviously matters and also like the right support matters, and also we don’t know a lot about Iosco in terms of like if we’re really talking about mental health, which is focus about what you and I focus on, that spiritual experiences are like just mental health, like what that really means and possibility of getting into mental illness like we just don’t know a lot about ayahuasca at this point in terms of what is it really good for and space mental health and what it’s not good for? And when to avoid it, and when to use it? Would you agree that at this point, we just don’t know that much?
Dr. Will Van Derveer 16:38
Well, we have some very early studies on ayahuasca, like I said, there was a placebo controlled trial in a hospital in Brazil, studying ayahuasca for depression that returned a positive result, small trial way too early to say whether, that would ever become some kind of widespread approved treatment. And FDA would have to go through a process to even look at that, which it’s not doing currently. So the other thing that has been reported observationally out of Brazil, is that people with addiction who regularly use ayahuasca in a spiritual tradition, seems to maintain higher rates of sobriety than people who don’t. So there is that, but again, it’s pretty limited in terms of the research.
Keith Kurlander 17:31
Anything else happening in Peru, obviously for addiction.
Dr. Will Van Derveer 17:35
Yeah, absolutely and another thing that I’ve seen a number of times in my clinical work is people coming back from Peru, having taken ayahuasca and having a really, I would just say frankly, a traumatic experience in Peru. Usually, what’s traumatic about those experiences is when you’re working with a shaman who doesn’t have a much understanding of the North American kind of neurotic structure, or the North American psychological issues that we face that are different from the common challenges people have in indigenous situations. And so I’ve worked with a number of people who came back from Peru, having had fracturing experiences with Ayahuasca, that they needed a huge amount of integration in trauma work to heal and get stable again. So having ayahuasca experiences inside of indigenous or traditional setting is not necessarily an automatic protection from getting fractured and having a difficult experience that takes weeks or months to integrate.
Keith Kurlander 18:51
So one thing you’re pointing out Will too, is that to set and setting, with any psychedelic matters a lot, but it’s actually not the whole issue like that is a very important set of setting. Your guide matters a lot, that’s one issue which is that the person trained to guide these experiences, if we just get out of ayahuasca for a second, their training matters. Because if they don’t have a lot of training around ego development, trauma, psychological splits and states and mental illness and mood disorders and all that stuff, like it’s hard to, like, we could obviously guide people in more of a spiritual context. And that’s one type of person that can handle just being guided in a spiritual context. But when we get into more of these mental health states, a good amount of training is important to recognize what’s going on. The other thing I wanted to add there Will, that you were talking about is like we were talking about ayahuasca but you mentioned something that’s really challenging, which is like, the dose and the dose of any of these medicines. And it’s very easy when we’re outside of medical settings, and I think this is the biggest drawback outside of medical settings, it’s so easy to actually take more than you need, and end up basically getting in over your head with a medicine. And I think that’s a really important thing is the reason there’s a scientific method in testing medicines and dosages. And it’s the same thing in psychedelics, which is that it’s so easy to actually take more than you need. And so many people respond differently to psychedelics based on their metabolic structure. And so it’s easy to get in over your head, especially like we were talking about ayahuasca that’s really easy to get in over your head. And you have no idea how concentrated that liquid is you’re drinking, you have no idea how much you actually need if you’ve never done it before. And I think that’s a real factor that is not really handled. Typically speaking that well outside of the medical setting. Just like, how much is going to really be useful here, and how much is going to be too much. And now you’re just dealing with too much medicine in your system, and you’re overwhelmed. And really just needing to hold on with a guide hopefully. Right?
Dr. Will Van Derveer 21:16
Right. Yeah, absolutely, and there’s another dimension here which kind of goes to what you’re saying about the training of the guide. But I just want to put this out there for all of our listeners that a lot of times people with mild to moderate symptoms have something going on that’s very deep in their psychology, that is sort of like the root cause of their symptoms. And when you take a psychedelic, that material can come out very abruptly. And I’ve seen this happen over and over again, not just in our ketamine clinic, but also in the MDMA trials that I participate in with maps, and also in my trips that I’ve made to South America to experience ayahuasca, I’ve seen people who didn’t know that they had a very serious childhood sexual abuse, or didn’t know that they had a massive abandonment from their parents, or they didn’t know that they’ve been insisted as a child or things happen, that the psychology of a person walls off until there’s a crack in the vault. And they, it’s like the scene in Ghostbusters where all the ghosts come out in New York City. It’s like, I think the question that we’re talking about here is the question about, if someone has a really fracturing experience, with a psychedelic in a particular setting, I think what we’re talking about here is, it wouldn’t have been possible if we had an alternate reality for that person, to actually not have to have such a difficult path to get well, right? And some people listening to this might say, well, that’s a big assumption to make, right? And it is, it is a big assumption to make that so and so might have had an easier time of getting well, if they didn’t have to be all blown out and psychotic after ayahuasca for a year or something like that. But what you’re talking about is really important is that it’s almost like the whole point of setting a fractured leg in an ER versus setting a fractured leg on the battlefield, is that the idea is that you’re going to get a better result. Because you have all of this support in the environment. So it’s kind of the same principle, I think we’re talking about psychology here. Psychology is like, let’s create a very supportive, controlled environment so that we can try to reduce negative outcomes.
Keith Kurlander 23:57
Yeah, I like that, and there’s a lot of people where psychedelics just work well for them. And they’ve, like, totally argue with us, like, this shouldn’t be medicalized, blah, blah, blah, and it goes well for them. And that’s why they’re arguing that. And that’s fine, I get it, like it goes well for those people. But what you’re saying is that there’s so much more opportunity for success, of really getting the deepest benefits from these medicines, and they’re huge. The benefits are huge, when it’s medicalized, because now we can control as many factors as possible and have the right train person in there, in the space with people. They think when that’s all right, there’s just so many opportunities for success, it really mitigates the damages that could happen. And like you’re saying, like I don’t even know if that was really set up properly. I mean, we don’t know if there it’s not looking like in some of the trials, there’s that many damages really happening, where there’s the Severe fragmentation that goes on for so long. And so I’m a big fan as you are medicalizing this right now, as we learn more about medicines, and giving people the opportunity to have profound healing in medical settings, where we can control some things, and obviously, there’s always gonna be people doing anything on the planet by themselves. And that’s just gonna happen, and that’s fine. And I just think that it’s going to be amazing right now we have ketamine. And we could talk about that maybe just a little bit, too. But it’s just amazing that now there’s medicines becoming available, that people who have not experimented with psychedelics or maybe had a bad experience, they want to come back, because they have some real deep healing to do and they’ve tried other things it’s not going to happen. They’ve tried and tried and tried, and they need extra help. And so it’s an exciting time, let’s take a journey through just a few more of the medicines off so that people can get acquainted. So why don’t we talk about ketamine a little bit, which is cool, because ketamine, you can now go to a medical setting and get it so Will, you want to give us a little overview of ketamine.
Dr. Will Van Derveer 26:11
Sure, so ketamine is an anesthetic that was developed in the 60s. It’s been around for 50 years under FDA approval, so it’s not illegal. And it’s actually a very important tool in a lot of different medical settings, commonly used in pediatric emergency procedures, like sewing up a cut on a child’s face in the ER. And while in the background, there were a few people in the 1970s and 80s and even in the 90s, using ketamine to treat mental health conditions, it didn’t really show up on the map for in the mainstream until the year 2001 when a study came out about its effectiveness for depression, which then eventually led to some studies at NIMH showing that IV ketamine had very rapid, anti suicidal and also in an depressant effects for people with treatment resistant depression. So that later led to the development by Johnson and Johnson on a nasal spray. That is some people call it filtered ketamine, so it’s part of what’s in the IV ketamine. And so nowadays, you can go to a clinic and you can guesstimate that you can have a 70% chance of having a robust antidepressant experience with ketamine. And along with the antidepressant effect and anti suicidal effect with ketamine, you have a psychedelic experience, which is different in a lot of ways from some of the other psychedelic effects. It has a completely different neuro chemistry from traditional psychedelics like LSD and psilocybin. But there are also benefits of that in that people really shouldn’t be taking drugs that interact with serotonin. If they’re taking psychedelics, traditional psychedelics, but with ketamine, because it doesn’t interact directly with the serotonin system, it’s completely safe to have ketamine treatment while you’re taking that serotonin drug which a lot of people have depression or anxiety are already taking. So another difference of ketamine is that it is much shorter acting than some of the other psychedelics so you could have a session for an hour or two in the clinic and get a ride home and be done. Right, which is really different from say, a 12 hour journey on LSD or a six hour journey on psilocybin.
Keith Kurlander 28:42
Totally different and there’s some real benefits to that right, of being able to have a shorter experience to work with and come out of and process after. And do you say ketamine is a dissociative, it’s in a dissociative class. So it tends to be a very different experience than some of the other psychedelics but as any psychedelic, we see treated lots of patients now, there’s a lot of different experiences that can happen even on ketamine. Just like other psychedelics, so many different experiences can happen, and it’s really interesting that there’s obviously the dissociative quality of the psychedelic nature where you can feel a kind of out of your body and maybe even in more of a transpersonal state, that happens all the time. There’s also happens more of that regressive quality where people can go into our psyche and experience traumas and things from childhood and having to be working that, and it’s really interesting that ketamine can have that quality of actually bringing up trauma and people doing trauma work on ketamine that happens every day in the clinic. Right? So, ketamine is a blunt tool for depression, which is great. It just gets right at it, there’s really nice advocacy with ketamine for depression, and then we also see that this is kind of a broader scope of the psychedelic aspect of it where people can really have an experience that changes their completely alters their reality. And they can hopefully do some great work with a therapist on really diving into their psyche and seeing if they can get to the underlying issues of their depression or trauma. So it’s a pretty exciting tool that’s available right now. And well, do you want to say a little bit more about just we tend to lean toward IV ketamine, you want to just say a little bit more just so people get educated on, you know, different routes and what your preferences are?
Dr. Will Van Derveer 30:42
Sure, yeah, I was looking carefully at this a few years ago, when we were deciding what kind of ketamine approach to take and in the beginning, tried a number of different routes of administration, we tried intramuscular, we did some work with sublingual tablets. We did some ketamine nasal spray. and so just looking at the literature and the scope of the research, and also figuring out a way to do to provide IV Academy and then a really warm kind of living room like environment in our clinic led all the roads pointed toward IV ketamine with psychotherapy, for me sort of the best of the psychotherapy approach, which we should also talk about and get into a little bit because it’s so different from ordinary psychotherapy, and then the best of what we know in evidence based medicine around the effectiveness of ketamine. So, hopefully, we’ll have more research as time goes on to differentiate different routes of administration and ketamine to see studies that show like bigger studies that show intramuscular versus IV or sublingual versus intramuscular spravato, the left-handed ketamine with head to head trial against IV ketamine, we don’t have that evidence. So my thought is, let’s go with what we have in terms of the evidence at this point. And finally, I’ll just say, piggybacking on what you were just saying about ketamine therapy and what can happen and ketamine therapy around trauma that although ketamine is a dissociative by class, and when people use it in a non medical environment to dissociate or go into a keyhole kind of experience, in the medical setting with the right dose titration, what we often see is what you’re saying is that people have a full blown psychedelic experience, they have visual experiences behind the eye shades, they experience symbols that can be meaningful, and that can be worked with and the therapy, they get downloads about what needs to happen next in their life. They experience transcendental states and mystical states union with divinity and so forth and so on. So, it’s extremely different every session for people typically. So in terms of the experiential side, I think it’s very much a psychedelic and that’s sometimes a misconception that people have from people who don’t have a lot of experience with ketamine that they think of it as a dissociative, meaning you just leave your body and that’s all that happens in ketamine, and that’s far from the truth.
Keith Kurlander 33:35
Right? Yeah, thanks for that overview. I think ketamine is definitely something we mentioned in the training earlier, like ketamine is something we’re going to focus on, because it’s available. And I think it’s good for people to know that right now, as ketamine is already available. And really the things that are further along than other two medicines that are the furthest along is MDMA, which is kind of next in line potentially, and then psilocybin. So should we should probably just talk a little bit about MDMA, and what it’s been researched for, and you could say, maybe just a little while about that. It’s in phase three, what does that even mean? What does phase three mean? And yeah, why don’t we hit MDMA a little bit here?
Dr. Will Van Derveer 34:20
Great. So the bulk of the research has been done by this amazing nonprofit, multidisciplinary Association for psychedelic studies, which was founded by Rick Doblin, who has been on our podcast before people can go listen to that episodes a great conversation with him last summer about where we are with MDMA, psychotherapy research. But in a nutshell, over the last 20 years, there’s been a gradual and very thoughtful, methodical progression of research of MDMA psychotherapy for PTSD. So, what we’re seeing, again, as a broad kind of synthesis overview of the results from that research so far is that people with chronic treatment resistant PTSD, who go into this protocol. And that might be the protocol might be another conversation for another episode here, but essentially three exposures to MDMA while getting psychotherapy, eight hours psychotherapy session. Total of 42 hours of therapy, including these three MDMA sessions, over a five-month period, people who go through that protocol and come out on the other side, at the 12 month follow up, and even beyond that, about two thirds of them, who were very traumatized, don’t meet criteria for PTSD anymore, that 12 month follow up and beyond. So a group of people with severe trauma coming into a study, having very high trauma rating scales and high levels of symptoms, going to non meeting PTSD criteria, in a durable way for a year up to three or some of the follow up studies go up to three and a half years, still don’t meet criteria. So it’s incredibly exciting, it’s a lot more effective than what we see in the research of other currently available tools, whether it’s CBT, or whether it’s Paxil, for PTSD. So currently, we’re in phase three trials. And what that means is, this is the final phase before the FDA would potentially review MDMA psychotherapy for approval as a legal treatment with medical indication in this country. So the schedule one is a designation for a drug that has no medical use and as a high potential of abuse. And so when MDMA was put on schedule, one in 1985, the claim was that it had no medical indication, no medical use. So the argument would be made at the end of phase three, assuming that the study goes as planned to say, look, we have a serious epidemic of PTSD. People are dying by suicide every day, 22 veterans a day in this country, we need better tools, and here’s a tool that’s passed the test. So that’s what’s happening. And a phase three trial is a trial where you have hundreds of patients or hundreds of people participating, and you are conducting the trial in multiple centers.
Keith Kurlander 37:35
That’s what you did as part of your training to be an investigator from MAPS, you actually underwent an MDMA session? Right. Yeah. Do you want to share a little bit about just what that was like for you and coming, obviously, you had a long-standing background in medicine at that point, and just what that session was like for you and what you got out of it, give people a little flavor of MDMA?
Dr. Will Van Derveer 38:01
Sure. So a little more context, MAPS was able to gain FDA approval to implement a training study is what they called it. And so in the training study, people like me who hadn’t taken MDMA, were given the opportunity to undergo the protocol that as a part of our training, so that we would know what it felt like to be on the receiving end of the therapy. And this was many years ago now. But the material that surfaced during that journey, is still incredibly vivid in my mind, and still guides some of my personal journey as a human being. And I would just say that I access levels of self-awareness and comprehension of early traumatic experiences and ways of healing those early traumatic experiences from my life that had been outside of my grasp for decades. And I was a person who, as a psychiatrist, really embraced going to therapy as part of my training. And after my training was over. In psychiatry residency, I continued to see a therapist off and on for many, many years, hundreds and hundreds of sessions that I went to for my own personal healing and then going to the MAPS site and having an MDMA experience. As a training, I sort of went into it as a training of thinking, Oh, this is going to help me really get what it’s like to be on the medicine and it definitely did that. But I wasn’t prepared to I didn’t know that there were conflicts you don’t know what you don’t know. And so then you find out things with the support of a psychedelic that had me wondering afterward like are there levels of feeling that are simply put completely beyond our ability to get to an ordinary consciousness. So was a massive experience that was held with a lot of care, and really opened my eyes and an experiential way, in a personal way to the possibilities, that nice medicines when combined with the right therapy really represented humanity.
Keith Kurlander 40:25
Yeah, yeah, that’s, I mean, anecdotally, I did MDMA once when I was in college. And it wasn’t a big part of my experience. And I think I’ve told you this, though again this is one person’s story, but I had severe social anxiety. You can almost call it a social phobia, it was so severe. And I did MDMA, and it nearly completely eradicated my entire social anxiety after a lifetime of it till that point. And there’s other issues for me with MDMA that happened and to which I did, because I didn’t know I was bipolar at the time. So I got a little hypomanic. And that’s a different issue with MDMA. But I think that MDMA does show some really strong promise. I know, we’re very hopeful to see what happens here. As phase three wraps up. I know, when we talked to Rick last time, which is a good thing that you’ve referenced, it’s a good podcast to go listen to his hope is that assuming everything does pan out with phase three that we’re looking at, by the beginning of 2023, because what he had last said, I think is that right? Is that what you remember?
Dr. Will Van Derveer 41:32
That sounds about right to me?
Keith Kurlander 41:34
Yeah, so of course, that’s a moving target, because there’s a lot of powers that are here, so MDMA obviously seems to be a really wonderful option for PTSD. And that’s really what it’s focus has been in the research is PTSD. So why don’t we spend just a little time on psilocybin? Because that’s one of the other medicines that is really being heavily researched right now. So Will, is that going into phase three? Is that your understanding? Or is that already undergone phase three?
Dr. Will Van Derveer 42:06
My understanding is that it’s about to go into phase three.
Keith Kurlander 42:11
Yeah, so we want to say that psilocybin, there’s some really interesting indications, right of end of life depression, being used with cancer patients. So we want to save on psilocybin?
Dr. Will Van Derveer 42:23
Well, psilocybin seems to be I mean, first of all, it’s performing really well, in the early studies, in terms of rapid and sustained antidepressant effect from just one exposure to psilocybin, which is really exciting. It also has been, as you said, it’s been studied in the ways that you mentioned, I’ll just add a couple more smoking cessation, and addiction protocols. So very highly successful, again small studies, but showing people who really couldn’t stop smoking cigarettes, saying on the other side of their psilocybin and experience, I don’t really, cigarettes are kind of irrelevant anymore in my life. So that’s really exciting for those folks to have such a big support in overcoming addiction. Psilocybin is definitely another tool from the indigenous tradition that I want to keep coming back to because I think that it’s important for us to acknowledge to Western as providers of Western and North American medicine. There’s a whole tradition here that spans back 1000s of years. And from that indigenous perspective, which is the perspective I speak from, I can only imagine how silly it must sound that we have these incredibly arduous and complicated pathways to get to a place where we say that psilocybin is a good thing for people to use to get well from something.
Keith Kurlander 43:59
It’s like the long journey home, it’s sort of like science catching up to technologies that we’ve known about for 1000s of years that help people and of course, though, science catching up in a good way, which is, well let’s refine the approaches to a very complicated Western, it’s a very complicated human minds at this point on the planet.
Dr. Will Van Derveer 44:21
Right. One of the things that’s really interesting about psilocybin is the rate of return of the default mode network that has been done. A lot of it has been done at the Imperial College in London with Robin Carr Harris, looking at connectivity between networks in the brain, and how psilocybin can actually open up new pathways or new connections that are there’s cross talk that happens between locations in the brain that normally don’t talk to each other. And it’s easy to extrapolate conceptually, from that observation, from neuroscience that psilocybin can open up your mind to seeing different perspectives, different possibilities for your life. Different futures that you could create for yourself. So, psilocybin is also primarily being studied in combination with psychotherapy for depression, and very similar psychotherapeutic protocols. And I want to make sure we get to the protocols because I think it’s important for people. We have a lot of psychotherapists in our audience who might not be aware of psychotherapy, and probably need to be on a psychedelic.
Keith Kurlander 45:29
Right, yeah, so I think it’s just good to know. I mean obviously, these medicines all interact differently, psilocybin tends to be a longer experience, is it a six hour protocol, or is an eight hour protocol? Do you know,
Dr. Will Van Derveer 45:45
I don’t know how long the sessions are at Hopkins, but the psilocybin experience is typically a six hour experience.
Keith Kurlander 45:52
Right? So it’s a bit longer it can be an experience that comes with a lot of hallucination, it doesn’t always visual hallucinations, auditory, all kinds of things can happen on psilocybin, but it’s starting to look like a very powerful tool that hopefully, we’ll all have access to, in the coming years. Let’s just as we’re wrapping up, we covered ayahuasca, which is important, because a lot of people are asking questions about it, or going and flying places and doing it and we covered ketamine, which is important, because it’s actually something you can go get access to right now at a clinic, we covered MDMA, which is important because it’s actually in phase three, and things are looking very positive, and that might be something available within one to two years. And then psilocybin is similarly where it seems like psilocybin is looking very positive for depression, and some other indications. So I think for today, maybe we don’t get into the other hallucinogens that people experiment with, like LSD or pods or other things, too. Maybe we don’t get into that, per se. But I think what I would like to wrap up with here is that, particularly as a therapist, in my mind, as a therapist, being a therapist and to me, it seems like at this point, this is going to become you said this at the beginning well, this is going to become a major part of one of the tools available to psychotherapy. And I think that every therapist in the next one to five years will need at least a good solid education around psychedelics, even if they don’t choose to get involved directly with psychedelics, or really understanding the tool, because a lot of clients, it’s looking like a lot of clients are going to be using these tools in coming years. And so it’s exciting, we are basically on a revolution in mental health care. Right now, with the coming of psychedelics, and I have a lot of faith, we’re going to do this properly this time, and use these properly and really help a ton of people, a ton of people get really good help because of how seriously people are taking how to use these medically doing research properly. And so it’s a really exciting time. Anything you want to add to that Will?
Dr. Will Van Derveer 48:14
Yeah, it is a very exciting time for mental health care. And I think it’s going to be important for people just I’m just going to speak from my own experience as psychiatrists, but I would say 25 hours of psychotherapy, providing a week kind of psychiatrists, so I was pretty much a psychotherapist to prescribe medication, and integrative care with people for many years until I got recruited onto this map study. And I’ll just tell you that the level of that I had to undergo to be able to provide effective MDMA psychotherapy was substantial. And so psychedelics are not just a bolt on that you add to your role as a psychotherapist, you’ve got to learn new tools. And there are a lot of reasons for that, I mean, probably the main one being that when someone is on a psychedelic, their cognitive functioning is extremely altered. And so doing any kind of cognitive therapy or any kind of interpretation kind of therapy, which is something a lot of people do, doesn’t work very effectively. And so somatic techniques, trauma therapy techniques, being able to hold space with very disturbing content and not interfere with the process of the client. These are all tools that a lot of therapists really don’t have much background with. So it’s a unique and potentially massive shift in how we orient toward resolving PTSD and depression.
Keith Kurlander 49:59
Yeah, Thanks for adding all those pieces. And we’re really excited. Everybody stay tuned. So, in the coming weeks, we’re gonna be talking about registration being open for a psychedelic therapy training program. We’re super excited about it, and we’re gonna really this program is going to focus on getting people up to speed on what Will just talked about. Understanding first the medicines, the research of the medicines, just super important having that education, and then really understanding how to practice with those medicines and hold that space that Will’s talking about. So more to come, we won’t tell you yet who’s going to be teaching in this program. But again, we’re excited we’ve got some amazing people that we’ll be talking about in coming weeks. And Shall we end there Will? All right, thanks. We look forward to connecting with you again on the next episode of the higher practice podcast where we explore what it takes to achieve optimal mental health.