Treating mental disorders with psychedelic psychotherapy
Millions of Australians suffer from a myriad of mental health issues. Depression, PTSD and addiction to name a few. But what if we could help them by trying something a little trippy?
Every day in Australia, more than eight people die by suicide. Millions more suffer mental health issues. We have treatments available, but in Australia, we're missing out on therapies that are showing great promise in other parts of the world.
Why? Because they use psychedelic drugs.
Psychedelic drugs and mental health issues may sound like a terrible combination—and it can be in the wrong setting.
But increasing evidence suggests that using controlled portions of these drugs with trained psychotherapists could help people overcome several mental health disorders.
Even healthy people might be able to benefit in the future.
Dr. Stephen Bright is Senior Lecturer of Addiction at Edith Cowan University (ECU) and Vice President of Psychedelic Research in Science and Medicine (PRISM). He's hoping to bust the myths about psychedelic drugs and push through the politics so that Australians may one day benefit from these potentially life-saving therapies.
What is psychedelic psychotherapy?
First, let's cover the basics.
Psychedelic psychotherapy involves using small amounts of psychedelic drugs in a controlled, clinical setting with trained psychotherapists. There are different drugs used for different purposes, but some of the main ones are psilocybin (magic mushrooms), LSD and MDMA (also called ecstasy). The drugs used in this type of therapy aren't like ones you'll find on the street. They are pharmaceutical grade, meaning you know the exact dose and what's in it.
All psychotherapies aim to help patients overcome a problem or make a positive change to their life—usually by facing it head on.
Take post-traumatic stress disorder for example. Someone with PTSD may avoid thinking about the bad experience they had. In psychotherapy, the therapist will actually direct them towards facing that bad experience to help them to work through it.
Adding psychedelic drugs to the mix generally helps patients get there faster. The therapists 'hold the space', allowing the patient to mostly guide the session. The therapists will usually only need to intervene if the patient is avoiding facing their issues or bad feelings.
"It never fails to amaze me how much spontaneous insight people gain in the MDMA sessions. It would take 10+ weeks of normal psychotherapy to guide a person to the insights that the patient spontaneously come up with while on MDMA," Stephen said.
Stephen explains that this is a technique he often used while 'trip sitting' at festivals.
"The further they push against [the bad feelings], the worse their experience becomes. So we try to talk to them about what they're experiencing and allow them to approach it and work through it rather than avoid it, and doing so seems to have a therapeutic response."
But patients aren't thrown in the deep end like someone having a difficult trip at a festival. Psychedelic therapy involves planning and preparation.
The preparatory sessions are thorough, so the patient knows exactly what they need to do and therapists know how best to support them.
"The person is fully prepared beforehand for what they're going to experience, and they have some coping strategies."
A mystical experience
So what is it about psychedelic drugs that patients find therapeutic?
Neurologically, we're not sure. But Stephen said the secret often lies in the mystical experience you can have on psychedelic drugs. It's difficult to explain, but it's a spiritual sense of oneness. Kind of like having an epiphany. The mystical experience usually happens with the more psychedelic drugs like psilocybin, rather than MDMA.
A study at New York University found that patients with life-threatening cancer who had this mystical experience from psilocybin psychotherapy had improved quality of life and decreased depression and anxiety. This has huge implications for palliative care.
"That spiritual experience seems to be the catalyst in allowing them to come to terms with their situation," Stephen explains.
But this isn't exactly a new discovery. The co-founder of Alcoholics Anonymous, Bill Wilson, said the spiritual awakening he experienced on LSD is what started his own sobriety.
"The problem is spiritual experiences are hard to create but we know, with psychedelics, we can induce these mystical experiences in a clinical setting in the right context with the right trained therapists involved," said Stephen.
This is why research has also looked into psychedelic psychotherapy as a treatment for addictions like smoking. One study found that psilocybin psychotherapy helped people quit smoking, with 60% still smoking-abstinent after 12 months.
"That's remarkable when you consider Champix—which is the leading pharmacotherapy for nicotine cessation—that has a success rate of 21% at 12 months," said Stephen.
"[Subjects in this study] reported that this mystical experience that's induced by the psilocybin is ranked as one of the top five most significant experiences of their life."
Your brain on psychedelics
Not only has this therapy shown good results in PTSD, palliative care and addiction, it's also being looked at as a treatment for depression because of the effect it has on the brain.
"Another area that's in its infancy is psilocybin and depression. There's been an open label study published by Imperial College in London among people who hadn't responded to other treatments for depression. They found a number gained significant benefits from psilocybin-assisted psychotherapy".
In this study, they also took a look at what was going on in the brain of patients with neuroimaging. Using this, they found a change in the brain was linked to a reduction of depressive symptoms.
It turns out psilocybin can temporarily switch off a part of the brain called the default mode network, which correlated with patients having that mystical experience.
"The default mode network is a series of interconnected neural pathways. It's activated all the time when we're in a waking state. It allows you and me to have this conversation at the moment because we can concentrate on what we're doing," said Stephen.
"If we turn off the default mode network, we end up with a lot of cross-talk happening within the brain,"
"In the context of depression, perhaps having all those different interconnected pathways allows the person to see the world, themselves and others in a completely different perspective."
He likens the default mode network to a conductor in the brain. Turning off the default mode network with psychedelics is like putting the conductor on "paid service leave for 6 to 12 hours". Without the conductor, the orchestra starts playing all kinds of things.
"In that cacophony of noise comes epiphanies."
Inducing everyday epiphanies
If you're like me, by now you're probably thinking you could use an epiphany too. Surely this can't only be useful for mental health disorders?
I asked Stephen to play the hypothetical game of looking into the future and letting me know if there will ever be a day this could be accessed by anyone needing to make a big life decision.
"People can go when they want to engage in some sort of spiritual contemplation or they're not sure about something in their life and they can utilise the psychedelic experience to help them with that."
But before we get there, we have some serious catching up to do.
What's stopping us?
You may have noticed that all the studies referenced in this article have been from the US and the UK. That's because Australia has been seriously lagging behind in psychedelic research.
Stephen said there are a few reasons for this, namely "academic conservatism", which is why I swell with uni pride when Stephen tells me my old stomping ground ECU has thrown their support behind psychedelic science.
"We've been banging our heads against the wall for about 8 or 9 years now, and things are really starting to look quite positive. I don't want to get too optimistic, but things are starting to look really positive," he said.
"The fact that ECU is supportive of it is fantastic."
Stephen's worked in both the policy and scientific spheres to try and get Australia to embrace and get involved in psychedelic research. In particular, he's been leading the charge for MDMA-assisted psychotherapy.
Right now, the Multidisciplinary Association for Psychedelic Studies (MAPS) is in the process of phase 3 trials for MDMA-assisted psychotherapy for PTSD, after phase 2 yielded promising results.
"What we're hoping in Australia, and what ECU's supporting, is that Perth will be a site for a phase 3 trial," said Stephen.
"If we can demonstrate we have the people and infrastructure to do MDMA-assisted psychotherapy, then we can come on board as a phase 3 site, and so all we need to do to demonstrate that is just run a very small pilot feasibility study. And so that's what we're working on at the moment."
Getting Australia on board means we will be able to access psychedelic psychotherapies and won't be left behind.
"Hundreds of thousands of Australians will no longer needlessly suffer from depression, post-traumatic stress disorder and anxiety associated with dying … we will see less suicides occurring among war veterans," said Stephen.
"Australians won't need to travel overseas to access these treatments because we will have clinics and trained therapists available in Australia who can provide these therapies."
So it's probably time that Australia had an epiphany and took psychedelic science a little more seriously.