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Integrative Psychiatry

The Seriously Therapeutic Elements of Play

By September 4, 2024No Comments

Who doesn’t love to play? It’s very interesting how much more difficult it can be for us as adults to do what kids and animals do so easily: step right into play.

While “play” might be defined differently for everyone, the basic qualities of play encompass voluntary, spontaneous, exaggerated or modified behavior for pure enjoyment. Play is interesting from an evolutionary standpoint because, at first glance, it does not appear to accomplish any goals that would be considered necessary for immediate survival. Yet it turns out that play offers a number of individual and collective benefits. Plus, within the mental health conversation, engagement in activities simply for the pleasure and enjoyment of it is woefully underrepresented.

If you like to nerd out about the neurophysiological “reasons” for things, then you will be interested to know that the neuroscience of play is quite complex and context dependent, and it seems to involve both cortical and subcortical regions of the brain, including the default mode network. In general, play balances task-oriented engagement and mindless wandering. Play may help support malleability of self-directed thought by facilitating a relationship between self, others, and/or the environment. Play can produce feelings of freedom, autonomy, and expressiveness and making time for play is associated with increased life satisfaction, including adaptability to change. Collaborative social play may also increase feelings of connectedness through activating mirror neurons, releasing oxytocin, and enhancing empathy. 

Play in the Therapy Office

Although the therapeutic benefits of play have been known for centuries, the practice remains unconventional. Neuropsychologists are well-versed in the benefits of play throughout the lifespan: engagement, creativity, and stress-reduction are ingredients for neuroplasticity and mind-body connection, associated with cognitive flexibility and increased resilience. Play is universal, and thus play therapy is an inclusive approach, effective across cultures, neurodiversity, and physical ability. As an exploration of each individual person’s internal landscape, play can bring up embodied experiences of positive emotions, humor, and engagement with something outside of the self.

More recently, the idea of “gamification” has entered the mental health space. Gamification refers to using gaming elements (i.e., scoring, rewards, or quests) in a non-game context, in this case, psychotherapy. While this approach is still very underutilized and understudied, it is gaining traction for its potential to increase approachability to, engagement with, and effectiveness of therapy. Types of games that have been most commonly incorporated thus far are movement-based games, art-based games, virtual reality games, biofeedback games, and cognitive behavioral therapy (CBT) games, each adapted for client goals and treatment plans.

Movement and art-based games, such as integrating martial arts, dance, or drama (to name just a few of many options), might support somatic release of psychological tension as well as practicing social engagements. While VR may be incorporated in a number of ways for any modality of game, it has gained attention for its use in exposure therapy and biofeedback; VR and biofeedback systems allow the client real-time assessment of their physiological responses, such as heart rate and respiration, to different stimuli, using the virtual space and virtual support characters as a proxy to real-life exposure. In these games, clients can watch and feel how emotional regulation mechanisms, such as intentional breathing, might impact their stress responses. CBT-based games may involve a narrative taking place in a fantasy environment, involving discussions with other characters and problem solving. Other styles of CBT games may use points, badges, and leaderboards to track lifestyle interventions like incorporating mindfulness.

Conclusion

Play is an important part of the human experience, bringing levity, joy, and mind-body-spirit engagement to life. Traditional psychotherapy may not work for everyone, particularly folks who are less inclined to use linear language as a therapeutic strategy. Therefore, play offers a unique opportunity for client-therapist dyads to explore relational dynamics, establishing meaningful connections, and improved outcomes.

Sara Reed, MS, LMFT

Sara Reed is a Licensed Marriage and Family Therapist and CEO of Mind’s iHealth Solutions, a digital health company that provides evidence based and culturally responsible mental health services for underserved groups. As a mental health futurist and clinical researcher, Sara examines the ways culture informs the way we diagnose and treat mental illness. Sara’s prior research work includes participation as a study therapist in psychedelic therapy research at Yale University and the University of Connecticut’s Health Center. Sara was the first Black therapist to provide MDMA-assisted psychotherapy in a clinical trial and continues to engage in ongoing advocacy work around health equity in psychedelic medicine.

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Jeffrey Guss, MD is a psychiatrist, psychoanalyst, and researcher with specializations in psychoanalytic therapy and the treatment of substance use disorders. He was Co-Principal Investigator and Director of Psychedelic Therapy Training for the NYU School of Medicine’s study on psychedelic-assisted psychotherapy in the treatment of cancer-related existential distress, which was published in Journal of Psychopharmacology, 2016. He currently is a study therapist in the NYU study on Psychedelic-Assisted therapy in the treatment of Alcoholism, a collaborator with Yale University’s study on psychedelic-assisted therapy for Major Depressive Disorder and a study therapist with the MAPS (Multidisciplinary Association for Psychedelic Studies) study on treatment of Post Traumatic Stress Disorder with Psychedelic-Assisted Psychotherapy. 

Dr. Guss is interested in the integration of psychedelic therapies with contemporary psychoanalytic theory and has published in Studies in Gender and Sexuality and Psychoanalysis, Culture and Society. He has published (with Elizabeth Nielson, PhD) a paper on “the influence of therapists’ first had experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training” in The Journal of Psychedelic Studies, August, 2018. He is an Instructor and Mentor with the California Institute of Integral Studies’ Center for Psychedelic Therapies and Supervisor in NYU’s Fellowship in Addiction Psychiatry. 

Dr. Guss maintains a private practice in New York City.

Will Van Derveer, MD

Will Van Derveer, MD is Co-Founder of Integrative Psychiatry Institute and Integrative Psychiatry Centers. Dr. Van Derveer was co-investigator on a phase 2 MAPS study of Psychedelic-assisted psychotherapy for treatment-resistant PTSD, and co-authored the publication of this study in 2018. He has also provided Psychedelic-assisted psychotherapy in two MAPS training studies. An active provider of KAP at his clinic in Boulder, CO, he has been teaching others KAP therapy for several years. Dr. Van Derveer contributed a chapter on mescaline in the 2021 "Handbook of Medical Hallucinogens" (edited by Charles Grob and Jim Grigsby). He is co-host of the Higher Practice Podcast.

Dr. Van Derveer regards unresolved emotional trauma as the most significant under-recognized root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass.


Scott has been a student of consciousness since his honors thesis on that topic at the University of Arizona in the 1970s under the tutelage of Dr. Andrew Weil. Following medical school, Scott studied Jungian therapy and acupuncture while working as a primary care physician in a rural area for four years. Psychedelic-assisted psychotherapy became a facet of his practice before this medicine was scheduled in 1985. He then completed a psychiatry residency at Columbia program in New York. Scott studied cross-cultural psychiatry and completed a child/adolescent psychiatry fellowship at the University of New Mexico.

In 2010 he founded Wholeness Center in Fort Collins. This innovative clinic provides cross-disciplinary evaluation and care for all mental health concerns. Scott serves as a site Principal Investigator and therapist for the Phase III trial of psychedelic-assisted psychotherapy for PTSD sponsored by (MAPS). He has also published numerous articles about his research on (CBD) in mental health. Currently, Scott works extensively with psychedelic-assisted-psychotherapy. He lectures all over the world to professional groups interested in a deeper look at mental health issues, safer tools, and a paradigm-shifting perspective about transformative care.

Will Van Derveer, MD is co-founder of Integrative Psychiatry Institute (IPI), along with friend and colleague Keith Kurlander, MA. He co-created IPI as an expression of what he stands for. First, that anyone can heal, and second that we medical providers must embrace our own healing journeys in order to fully command our potency as healers.

Dr. Van Derveer spent the last 20 years innovating and testing a comprehensive approach to addressing psychiatric challenges which transcends the conventional model he learned in medical school at Vanderbilt University and residency at University of Colorado, while deeply engaging his own healing path.

He founded the Integrative Psychiatric Healing Center in in 2001 in Boulder, CO, where he currently practices. Dr. Van Derveer regards unresolved emotional trauma as the most significant root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass. In addition to his clinical work and teaching, he was co-investigator in 2016 a Phase II randomized clinical trial, sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). He continues to support this protocol, now in a Phase III clinical trial under break-through designation by FDA.

Dr. Van Derveer is a diplomate of the American Board of Integrative and Holistic Medicine (ABoIHM) since 2013, and he was board certified in the first wave of diplomates of the new American Board of Integrative Medicine (ABIM) in 2016.