1 00:00:15,356 --> 00:00:24,236 Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show 2 00:00:24,236 --> 00:00:27,876 Speaker 1: where we explore the stories behind the stories in the news. 3 00:00:28,396 --> 00:00:33,556 Speaker 1: I'm noaffeldment. One of my favorite conversations on Deep Background 4 00:00:33,556 --> 00:00:37,516 Speaker 1: this year, and judging by downloads, one of your favorites too, 5 00:00:38,196 --> 00:00:42,116 Speaker 1: was my interview with Professor Carl Hart, a Columbia University 6 00:00:42,196 --> 00:00:46,356 Speaker 1: neuroscientist who argues that our policies towards recreational drug use 7 00:00:46,796 --> 00:00:51,396 Speaker 1: are far more harmful than the substances themselves. In today's episode, 8 00:00:51,436 --> 00:00:55,156 Speaker 1: we're going to approach related issues, but from a different angle. 9 00:00:55,676 --> 00:00:59,676 Speaker 1: We're going to talk about the emergent research on the 10 00:00:59,756 --> 00:01:05,556 Speaker 1: efficacy of psychedelic assisted psychotherapy and the associated question of 11 00:01:05,716 --> 00:01:10,116 Speaker 1: recreational use of psychedelics. There's been an explosion of research, 12 00:01:10,276 --> 00:01:13,036 Speaker 1: which we're going to hear about shortly from one of 13 00:01:13,076 --> 00:01:17,036 Speaker 1: the leading experts on the top. That's doctor David Raven, 14 00:01:17,196 --> 00:01:22,676 Speaker 1: who's a neuroscientist aboard certified psychiatrist who does psychedelic assisted 15 00:01:22,716 --> 00:01:26,276 Speaker 1: psychotherapy and is also the co founder and chief innovation 16 00:01:26,316 --> 00:01:30,116 Speaker 1: officer at Apollo Neuroscience. He's going to talk to us 17 00:01:30,156 --> 00:01:33,116 Speaker 1: about some of the new research in the field, what 18 00:01:33,276 --> 00:01:37,876 Speaker 1: the mechanisms are for why and how psychedelic assisted psychotherapy 19 00:01:37,956 --> 00:01:40,636 Speaker 1: seems to be working, and what it tells us about 20 00:01:40,636 --> 00:01:49,436 Speaker 1: the brain and its capacities to heal in general. Dave, 21 00:01:49,556 --> 00:01:52,596 Speaker 1: thank you so much for joining me here on deep background. 22 00:01:53,236 --> 00:01:56,796 Speaker 1: I want to begin with some research that's gotten a 23 00:01:56,836 --> 00:02:00,836 Speaker 1: lot of attention in the last several months, and that 24 00:02:01,036 --> 00:02:08,996 Speaker 1: is research that looks at new psychedelic assisted psychotherapy approach 25 00:02:10,236 --> 00:02:13,916 Speaker 1: and at least so far, seems to produce some extraordinarily 26 00:02:13,956 --> 00:02:19,876 Speaker 1: impressive experimental results. And this is your field, and you 27 00:02:20,076 --> 00:02:22,076 Speaker 1: both study it at a scientific level and also are 28 00:02:22,076 --> 00:02:24,716 Speaker 1: a practitioner. I want to invite you to start by 29 00:02:24,716 --> 00:02:28,636 Speaker 1: saying what you think of as the most impressive recent results, 30 00:02:29,196 --> 00:02:31,276 Speaker 1: and then we'll talk in a little bit more depth 31 00:02:31,316 --> 00:02:34,276 Speaker 1: about what those studies show. Sounds good, Yeah, I appreciate 32 00:02:34,316 --> 00:02:36,796 Speaker 1: you for again for having me. Always a pleasure to 33 00:02:36,796 --> 00:02:39,916 Speaker 1: share this conversation because I think that we're at a 34 00:02:39,996 --> 00:02:43,796 Speaker 1: point in mental health in particular where we're starting to 35 00:02:44,076 --> 00:02:48,476 Speaker 1: identify tools to treat mental illness that are reaching a 36 00:02:48,556 --> 00:02:51,676 Speaker 1: level of success in terms of management of symptoms and 37 00:02:51,836 --> 00:02:55,836 Speaker 1: remission long term remission of mental illness in particular like 38 00:02:55,916 --> 00:02:59,076 Speaker 1: depression and anxiety that we haven't ever seen in the 39 00:02:59,116 --> 00:03:01,836 Speaker 1: field of mental health, and so I think one of 40 00:03:01,836 --> 00:03:05,716 Speaker 1: the things that's really exciting and also challenging about psychedelic 41 00:03:05,756 --> 00:03:10,196 Speaker 1: assistant psychotherapy is that it is a full paradigm shift 42 00:03:10,236 --> 00:03:13,236 Speaker 1: away from the current way that we treatment to illness 43 00:03:13,236 --> 00:03:17,916 Speaker 1: to one in which we really focus on short courses 44 00:03:17,916 --> 00:03:22,556 Speaker 1: of treatment. That for example, with MDMA, which is three 45 00:03:22,596 --> 00:03:27,036 Speaker 1: four methylene dioxy methymphetamine, which I would say is beyond 46 00:03:27,276 --> 00:03:30,516 Speaker 1: the experimental phase, it's well into the FDA phase through 47 00:03:30,556 --> 00:03:35,516 Speaker 1: trials demonstrating tremendous results can vary consistently. What we're seeing 48 00:03:35,796 --> 00:03:41,676 Speaker 1: is that with just three doses of MDMA with two 49 00:03:41,756 --> 00:03:46,036 Speaker 1: therapists present over the course of twelve weeks of psychotherapy, 50 00:03:46,436 --> 00:03:50,356 Speaker 1: those three doses of MBMA in people who are completely 51 00:03:50,396 --> 00:03:54,996 Speaker 1: treatment resistant with PTSD post traumatic stress disorder, having tried 52 00:03:55,076 --> 00:03:57,916 Speaker 1: everything under the sun, and never having had significant symptom 53 00:03:57,956 --> 00:04:00,956 Speaker 1: remission or relief that exists that lasts over the long 54 00:04:01,076 --> 00:04:06,436 Speaker 1: term without daily medication management. These people have three doses 55 00:04:06,436 --> 00:04:10,076 Speaker 1: of MDMA and twelve weeks of psychotherapy. The pulsebo controlled 56 00:04:10,076 --> 00:04:12,516 Speaker 1: trial in it right after the treatment is over twelve 57 00:04:12,516 --> 00:04:16,396 Speaker 1: weeks and two months out something like fifty five percent 58 00:04:16,516 --> 00:04:20,076 Speaker 1: of these people are completely in remission. They're no longer 59 00:04:20,156 --> 00:04:25,236 Speaker 1: meeting diagnostic criteria for PTSD. However, what's even more exciting 60 00:04:25,356 --> 00:04:27,756 Speaker 1: is that one year out, because we really care about 61 00:04:27,796 --> 00:04:31,876 Speaker 1: durability of response, right one year out, we see that 62 00:04:32,076 --> 00:04:34,596 Speaker 1: sixty seven percent of these people are no longer meeting 63 00:04:34,636 --> 00:04:40,196 Speaker 1: diagnostic criteria for PTSD without any additional treatment. So that's 64 00:04:40,236 --> 00:04:42,836 Speaker 1: what's really incredible is that these people seem to be 65 00:04:43,996 --> 00:04:48,316 Speaker 1: able to be taught, using the medicine in an accelerated fashion, 66 00:04:48,436 --> 00:04:51,916 Speaker 1: how to manage their own healing process more effectively, and 67 00:04:51,956 --> 00:04:56,276 Speaker 1: then continue that process after the treatment is effectively finished. 68 00:04:57,276 --> 00:05:00,316 Speaker 1: Let's dive into this study that you're talking about, and 69 00:05:00,356 --> 00:05:02,756 Speaker 1: this comes out of Johns Hopkins, if I'm not mistaken, 70 00:05:02,756 --> 00:05:04,836 Speaker 1: although I think there's some other affiliated centers that have 71 00:05:04,836 --> 00:05:07,356 Speaker 1: been doing similar research. Is that right? So this study 72 00:05:07,476 --> 00:05:10,796 Speaker 1: is not explicitly at John's Opkins. This is a international 73 00:05:10,796 --> 00:05:15,716 Speaker 1: trial actually, so so the trial that is centered at Hopkins, 74 00:05:15,716 --> 00:05:18,156 Speaker 1: which is equally exciting, I would say, but is at 75 00:05:18,156 --> 00:05:20,836 Speaker 1: a slightly earlier stage in terms of the FDA. I 76 00:05:20,876 --> 00:05:23,916 Speaker 1: believe it's in phase two, not phase three. Is a 77 00:05:23,956 --> 00:05:28,196 Speaker 1: psilicided trial and that is used for predominantly for depression. 78 00:05:28,396 --> 00:05:31,196 Speaker 1: It's equally exciting work. But what we're seeing and the 79 00:05:31,236 --> 00:05:34,196 Speaker 1: study that I mentioned earlier, that's the furthest along is 80 00:05:34,236 --> 00:05:38,156 Speaker 1: the MDMA for Treatment Resistant PTSC study. That's an international 81 00:05:38,236 --> 00:05:41,996 Speaker 1: trial at i think over twenty clinical sites that are 82 00:05:42,116 --> 00:05:45,916 Speaker 1: distributed throughout Canada, the US, and the EU and Israel. 83 00:05:46,916 --> 00:05:49,516 Speaker 1: Thank you, so thanks for that clarification. Let's talk about 84 00:05:49,516 --> 00:05:52,036 Speaker 1: this international trial in that case. So a question that 85 00:05:52,516 --> 00:05:55,196 Speaker 1: immediately came to my mind when I first read about 86 00:05:55,236 --> 00:06:00,436 Speaker 1: this research is the question of placebo effect and double blinding. 87 00:06:00,476 --> 00:06:02,756 Speaker 1: I think the study is billed as double blind, which 88 00:06:02,796 --> 00:06:06,436 Speaker 1: means that in principle, neither the person receiving the treatment 89 00:06:06,556 --> 00:06:10,636 Speaker 1: nor the psychotherapist who's doing the psychotherapy sessions is supposed 90 00:06:10,636 --> 00:06:13,196 Speaker 1: to know whether the person is in the target group 91 00:06:13,236 --> 00:06:16,636 Speaker 1: who has received MDMA or is not. That is correct. 92 00:06:16,876 --> 00:06:20,356 Speaker 1: So how is that possible? I mean, is it conceivable 93 00:06:20,476 --> 00:06:24,236 Speaker 1: that a patient would not know that he or she 94 00:06:24,756 --> 00:06:28,156 Speaker 1: was on MDMA at the dosage level that is being 95 00:06:28,236 --> 00:06:31,356 Speaker 1: used in the study, And is it conceivable that the 96 00:06:31,356 --> 00:06:33,796 Speaker 1: therapist would not Yeah, it's a great question, and I 97 00:06:33,836 --> 00:06:37,236 Speaker 1: think this is a question that has always been a 98 00:06:37,356 --> 00:06:40,476 Speaker 1: challenging one to answer when we're looking at these kinds 99 00:06:40,516 --> 00:06:43,316 Speaker 1: of studies, and also just to take a step back 100 00:06:43,356 --> 00:06:47,156 Speaker 1: when we're looking at any study of a complex treatment 101 00:06:47,236 --> 00:06:51,036 Speaker 1: program or a natural treatment, natural treatment program like a 102 00:06:51,076 --> 00:06:55,316 Speaker 1: complimentary or alternative medicine program, acupuncture being a great example. 103 00:06:55,676 --> 00:06:59,956 Speaker 1: It's very, very difficult, notoriously difficult, to do double blind 104 00:06:59,956 --> 00:07:02,276 Speaker 1: pall cebo control trials because how do you create an 105 00:07:02,316 --> 00:07:06,596 Speaker 1: adequate placebo or active control group that is consistent with 106 00:07:06,636 --> 00:07:11,396 Speaker 1: the blinding process. I think MAPS Multidisciplinary Association for Psychedelic 107 00:07:11,396 --> 00:07:14,356 Speaker 1: Studies that is running the MBMA trial and has run 108 00:07:14,476 --> 00:07:17,036 Speaker 1: and funded most of the MBMA trials to date through 109 00:07:17,076 --> 00:07:20,716 Speaker 1: the FDA, have worked very closely with the FDA to 110 00:07:20,796 --> 00:07:26,196 Speaker 1: come up with a valid and clinically acceptable to cebo group, 111 00:07:26,396 --> 00:07:28,876 Speaker 1: and it's evolved over time. It wasn't always the way 112 00:07:28,876 --> 00:07:31,076 Speaker 1: it is today. I think I believe that in the 113 00:07:31,116 --> 00:07:35,476 Speaker 1: previous trials they were using niacin, which causes a warmth 114 00:07:35,516 --> 00:07:38,516 Speaker 1: and a flushing that has a lot of the physical 115 00:07:38,596 --> 00:07:42,476 Speaker 1: feelings that are similar to those that are experienced with MBMA, 116 00:07:42,516 --> 00:07:46,396 Speaker 1: without the emotional component as much. And I believe that 117 00:07:46,476 --> 00:07:49,436 Speaker 1: in the current trial they're using a sub threshold dose 118 00:07:49,516 --> 00:07:52,236 Speaker 1: of MBMA, So they're using a dose of MDMA that's 119 00:07:52,556 --> 00:07:55,636 Speaker 1: lower than what would be required to provide an active 120 00:07:56,156 --> 00:07:59,036 Speaker 1: peak effect, and there's a dosing threshold that we know 121 00:07:59,116 --> 00:08:02,036 Speaker 1: of that's critical to achieve that peak effect. But I 122 00:08:02,076 --> 00:08:04,876 Speaker 1: think the data speaks for itself because when you look 123 00:08:04,876 --> 00:08:07,796 Speaker 1: at the Phase two data, which comes from the first 124 00:08:07,956 --> 00:08:11,516 Speaker 1: one hundred plus veterans were mostly veterans that were treated 125 00:08:11,556 --> 00:08:14,876 Speaker 1: with PTSD, you can look at the placebo groups data 126 00:08:14,956 --> 00:08:18,636 Speaker 1: and both groups, by the way, are getting two therapists 127 00:08:18,676 --> 00:08:21,796 Speaker 1: for the entire treatment course. They're getting the same therapy sessions, 128 00:08:21,836 --> 00:08:25,756 Speaker 1: the same eight hour therapy sessions, with sleeping over afterwards, 129 00:08:25,756 --> 00:08:29,196 Speaker 1: with constant care and attention. And the point of the 130 00:08:29,236 --> 00:08:33,476 Speaker 1: treatment is that the therapy itself is actually very potent. Right, 131 00:08:33,756 --> 00:08:39,516 Speaker 1: So even in the people who received completely inactive placebo 132 00:08:39,636 --> 00:08:43,756 Speaker 1: or MBMA that was below threshold, these people just with 133 00:08:43,836 --> 00:08:46,436 Speaker 1: the excellent therapy alone in the trial, with these two 134 00:08:46,476 --> 00:08:50,556 Speaker 1: therapists who are extremely well trained and extremely trauma oriented 135 00:08:50,556 --> 00:08:53,996 Speaker 1: in their delivery of care, we're seeing a roughly twenty 136 00:08:54,036 --> 00:09:00,076 Speaker 1: seven percent remission rate in terms of people having significant 137 00:09:00,116 --> 00:09:02,836 Speaker 1: reduction and symptoms after the treatment. Is completed in about 138 00:09:02,836 --> 00:09:06,516 Speaker 1: two months out. However, I think the real tell is 139 00:09:07,036 --> 00:09:09,436 Speaker 1: that when you go and look at one year out, 140 00:09:09,716 --> 00:09:13,796 Speaker 1: the folks who received active MBMA have an increased rate 141 00:09:13,796 --> 00:09:15,836 Speaker 1: of recovery, so it goes from fifty five percent to 142 00:09:15,876 --> 00:09:18,916 Speaker 1: sixty seven percent symptom free. When you go back and 143 00:09:18,956 --> 00:09:22,156 Speaker 1: look at the placebo group, that group actually had about 144 00:09:22,156 --> 00:09:26,356 Speaker 1: fifty percent of those people relapse into symptomatic PTSD. So 145 00:09:26,756 --> 00:09:29,436 Speaker 1: are cymo therapists able to tell that a patient or 146 00:09:29,476 --> 00:09:33,716 Speaker 1: a research subject has received MBMA versus a placebo It's possible. 147 00:09:34,076 --> 00:09:37,076 Speaker 1: It is hard to tell. Sometimes in the therapeutic experience, 148 00:09:37,116 --> 00:09:39,716 Speaker 1: it is possible that they know, but the delivery of 149 00:09:39,756 --> 00:09:42,316 Speaker 1: therapy is the same either way. They're still working with 150 00:09:42,356 --> 00:09:44,436 Speaker 1: the person to do the same work with the medicine 151 00:09:44,436 --> 00:09:46,516 Speaker 1: on board or not. And that's one of the things 152 00:09:46,556 --> 00:09:50,476 Speaker 1: that I think is really fascinating about psychedelic assisted psychotherapy 153 00:09:50,796 --> 00:09:54,236 Speaker 1: is that it's not called psychotherapy assistant psychedelic work, right, 154 00:09:54,236 --> 00:09:58,236 Speaker 1: It's called psychedelic assisted psychotherapy. What we're testing is is 155 00:09:58,276 --> 00:10:02,236 Speaker 1: the medicine and catalyzing the psychotherapy experience. We would normally 156 00:10:02,276 --> 00:10:05,876 Speaker 1: be offering someone and giving them or empowering them with 157 00:10:05,956 --> 00:10:09,356 Speaker 1: the ability to take the healing process into their own 158 00:10:09,396 --> 00:10:12,516 Speaker 1: hands and really start to work on themselves after the 159 00:10:12,556 --> 00:10:15,876 Speaker 1: process is over. And that is absolutely what the data 160 00:10:15,916 --> 00:10:19,316 Speaker 1: is showing, which is extremely promising, and it's directly contradictory 161 00:10:19,316 --> 00:10:22,436 Speaker 1: to which I think is important to know the existing 162 00:10:22,436 --> 00:10:24,676 Speaker 1: paradigm of mental health, which is, if you stop taking 163 00:10:24,676 --> 00:10:27,596 Speaker 1: your SSRIs, you stop taking your antidepressants or whatever your 164 00:10:28,076 --> 00:10:32,076 Speaker 1: daily prescription medicine for mental health symptoms, that your chances 165 00:10:32,076 --> 00:10:37,436 Speaker 1: of relapse are almost inevitable, which is a really depressing statistic. 166 00:10:37,756 --> 00:10:41,156 Speaker 1: In that case, let's turn to the question of mechanism. 167 00:10:41,436 --> 00:10:45,876 Speaker 1: I would love to hear why you think this works. 168 00:10:45,916 --> 00:10:48,676 Speaker 1: In general. When I have read about this and spoken 169 00:10:48,676 --> 00:10:52,116 Speaker 1: to a few people, the magic word that is often 170 00:10:52,156 --> 00:10:55,116 Speaker 1: deployed as though it solved all of our questions is 171 00:10:55,116 --> 00:10:57,876 Speaker 1: the word neuroplasticity. That seems to me to be an 172 00:10:57,876 --> 00:11:00,756 Speaker 1: opener rather than a closer. And I'm very curious to 173 00:11:00,796 --> 00:11:03,316 Speaker 1: hear how you think about this. It's a great question, 174 00:11:03,396 --> 00:11:06,556 Speaker 1: and I love the way that you look at neuroplasticity 175 00:11:06,556 --> 00:11:08,716 Speaker 1: as an opener or not a closer. You're absolutely right 176 00:11:09,236 --> 00:11:12,596 Speaker 1: when we think about psychedelic medicines on the whole taking 177 00:11:12,636 --> 00:11:14,916 Speaker 1: like a ten thousand foot view kind of looking down 178 00:11:14,996 --> 00:11:18,356 Speaker 1: at all the whole spectrum of medicines that we call 179 00:11:18,516 --> 00:11:23,596 Speaker 1: psychedelic or psychoactive. What we're really looking at is a 180 00:11:23,636 --> 00:11:29,396 Speaker 1: group or a class of medicines that are most accurately 181 00:11:29,436 --> 00:11:34,156 Speaker 1: referred to as non specific amplifiers. So what this means 182 00:11:34,396 --> 00:11:38,996 Speaker 1: is that if whatever you take into the experience, whether 183 00:11:39,076 --> 00:11:43,076 Speaker 1: it's thoughts of self gratitude, self love, self compassion, and 184 00:11:43,196 --> 00:11:46,556 Speaker 1: a therapeutic orientation towards healing yourself, or if you bring 185 00:11:46,596 --> 00:11:50,996 Speaker 1: in shame and guilt and fear and a lack of 186 00:11:51,036 --> 00:11:54,596 Speaker 1: safety in your environment or within yourself, whatever you bring in, 187 00:11:54,956 --> 00:11:58,796 Speaker 1: that is what will be amplified by the psychedelic experience. 188 00:11:58,836 --> 00:12:01,076 Speaker 1: So that is something that I think a lot of 189 00:12:01,116 --> 00:12:04,876 Speaker 1: people don't necessarily understand, which is that the psychedelic medicine 190 00:12:05,076 --> 00:12:10,756 Speaker 1: is non preferential to positive feelings or negative feelings. When 191 00:12:10,756 --> 00:12:15,676 Speaker 1: you induce neuroplasticity in that context, you can train the 192 00:12:15,756 --> 00:12:19,876 Speaker 1: brain to think differently. But if you are not prepared adequately, 193 00:12:20,236 --> 00:12:23,876 Speaker 1: and you bring in a lot of negative self referential thinking, 194 00:12:24,116 --> 00:12:26,476 Speaker 1: and you're not prepared to work on and you don't 195 00:12:26,476 --> 00:12:28,476 Speaker 1: have the right support systems around you to work on it. 196 00:12:28,516 --> 00:12:30,436 Speaker 1: You're not in a safe environment or all of the above, 197 00:12:31,036 --> 00:12:36,436 Speaker 1: then you can actually increase the strength of wiring and 198 00:12:36,476 --> 00:12:40,556 Speaker 1: neural connections in your brain to favor thinking about yourself 199 00:12:40,596 --> 00:12:45,516 Speaker 1: in a negative way. You can actually this is completely 200 00:12:45,556 --> 00:12:49,596 Speaker 1: fascinating and also a little scary. Scary, So, if I'm 201 00:12:49,596 --> 00:12:51,956 Speaker 1: hearing you correctly, you know, in theory no one would 202 00:12:51,956 --> 00:12:54,396 Speaker 1: think to do this. But if one ran this experiment, 203 00:12:54,876 --> 00:12:58,116 Speaker 1: as it were, the opposite way, and you gave people 204 00:12:58,836 --> 00:13:01,436 Speaker 1: psychedelics and put them in a connectly controlled setting and 205 00:13:01,476 --> 00:13:06,356 Speaker 1: then made them feel terrible about themselves, you're suggesting that 206 00:13:06,396 --> 00:13:09,476 Speaker 1: the drugs would have an amplifying effect such that you 207 00:13:09,516 --> 00:13:12,276 Speaker 1: could maybe make people much much, much worse soft than 208 00:13:12,276 --> 00:13:14,636 Speaker 1: they would have been without that, right, So you could 209 00:13:14,716 --> 00:13:18,316 Speaker 1: amplify a PTSD experience perhaps, or a traumatic experience for example, 210 00:13:18,916 --> 00:13:24,356 Speaker 1: or you could drive lack of self esteem or various 211 00:13:24,356 --> 00:13:27,996 Speaker 1: other antisocial outcomes. Am I Am I hearing that correctly? 212 00:13:27,996 --> 00:13:31,116 Speaker 1: And is there any experimental evidence for that? Mk Ultra 213 00:13:31,716 --> 00:13:34,516 Speaker 1: as one example, right, I think that you know, we 214 00:13:34,676 --> 00:13:37,796 Speaker 1: see that in some of the studies that the CIA 215 00:13:37,956 --> 00:13:42,516 Speaker 1: conducted on unsuspecting folks who were given psychedelic medicine and 216 00:13:42,556 --> 00:13:47,836 Speaker 1: an unsafe or an experimental environment that was not soothing 217 00:13:47,956 --> 00:13:51,876 Speaker 1: or therapeutic, we saw very very negative outcomes, some of 218 00:13:51,916 --> 00:13:54,916 Speaker 1: which resulted in suicide. So I naively say, no one 219 00:13:54,916 --> 00:13:56,596 Speaker 1: would do this, But but you're telling me the CIA 220 00:13:56,836 --> 00:13:59,796 Speaker 1: did in fact do this in the fifties and sixties 221 00:13:59,916 --> 00:14:03,276 Speaker 1: and even into the early seventies when mkalto was going on, Right, 222 00:14:03,396 --> 00:14:06,156 Speaker 1: there is evidence that this did occur, and that there 223 00:14:06,156 --> 00:14:09,676 Speaker 1: were very substantial negative consequences from these kinds of conditions 224 00:14:09,996 --> 00:14:12,876 Speaker 1: that even resulted in self harm. And I think that 225 00:14:12,916 --> 00:14:15,516 Speaker 1: we be But the best example of this in a 226 00:14:15,636 --> 00:14:18,916 Speaker 1: non experimental setting is the real world. Right. We see 227 00:14:18,956 --> 00:14:22,556 Speaker 1: that people all the time. You know, there's estimated to 228 00:14:22,596 --> 00:14:25,956 Speaker 1: be over a million new users of MDMA every year 229 00:14:25,996 --> 00:14:29,436 Speaker 1: in the United States. Right, there's probably an almost equal amount, 230 00:14:29,436 --> 00:14:33,796 Speaker 1: it's not more of psilocybin mushrooms. That is a huge 231 00:14:34,076 --> 00:14:36,236 Speaker 1: number of people. These are people who are using this 232 00:14:36,356 --> 00:14:41,396 Speaker 1: medicine recreationally in an generally unguided environment, and they're new 233 00:14:41,436 --> 00:14:45,356 Speaker 1: to it. And so those are the people where we 234 00:14:45,476 --> 00:14:48,116 Speaker 1: often see, like in my practice, where I'm one of 235 00:14:48,116 --> 00:14:51,676 Speaker 1: the few psychiatrists that actually not only does psychotherapy, but 236 00:14:51,756 --> 00:14:56,956 Speaker 1: I'm trained to help people navigate challenging psychedelic experiences, and 237 00:14:57,796 --> 00:15:00,436 Speaker 1: I a big part of my practice is helping people 238 00:15:01,036 --> 00:15:05,796 Speaker 1: recover from feeling retraumatized as a result of an unsafe 239 00:15:05,836 --> 00:15:08,916 Speaker 1: or unpleasant psychedelic experience. So this is a very real 240 00:15:09,236 --> 00:15:11,716 Speaker 1: thing that we see happen. Part of the reason why 241 00:15:11,716 --> 00:15:14,756 Speaker 1: we actually started the Psychedelic News Hour on Clubhouse is 242 00:15:14,796 --> 00:15:17,436 Speaker 1: to help educate the general community about how to avoid 243 00:15:17,796 --> 00:15:23,916 Speaker 1: these very specific and unpleasant experiences that are easily avoidable, 244 00:15:24,156 --> 00:15:26,876 Speaker 1: but are also easy to step into by accident if 245 00:15:26,876 --> 00:15:28,396 Speaker 1: you're not paying attention to don't know what to look 246 00:15:28,436 --> 00:15:32,236 Speaker 1: out for, but you're describing as something with very significant 247 00:15:32,356 --> 00:15:37,756 Speaker 1: risks if administered in the wrong setting. And if people 248 00:15:37,796 --> 00:15:41,476 Speaker 1: are using MDMA, for example, or psilocybin recreationally in the 249 00:15:41,556 --> 00:15:44,316 Speaker 1: numbers that you're marking, you know, a million new users 250 00:15:44,316 --> 00:15:46,676 Speaker 1: a year, that means almost everybody is using it in 251 00:15:46,676 --> 00:15:50,036 Speaker 1: an unsupervised way, and presumably a lot of those people 252 00:15:50,036 --> 00:15:54,036 Speaker 1: are going to have bad experiences. If that's right. It's 253 00:15:54,076 --> 00:15:58,596 Speaker 1: a very different narrative than sometimes one hears while there 254 00:15:58,716 --> 00:16:01,516 Speaker 1: is risk, and I appreciate you bringing off the point 255 00:16:01,676 --> 00:16:04,116 Speaker 1: that we need to make sure we understand that there 256 00:16:04,196 --> 00:16:06,756 Speaker 1: is risk from using any of these medicines to augment 257 00:16:06,876 --> 00:16:10,636 Speaker 1: or alter our stated consciousness, as they are nonspecific amplifiers. 258 00:16:10,996 --> 00:16:17,076 Speaker 1: We also should acknowledge that from an objective perspective, a 259 00:16:17,076 --> 00:16:21,476 Speaker 1: scientific perspective, the risk of these medicines is substantially lower 260 00:16:21,596 --> 00:16:24,956 Speaker 1: for most, probably ninety five ninety nine percent of people, 261 00:16:24,996 --> 00:16:30,116 Speaker 1: even than it is with things like cocaine, opiates, benzodiazepines, 262 00:16:30,276 --> 00:16:34,476 Speaker 1: and many other prescription medicines that are scheduled by the 263 00:16:34,556 --> 00:16:38,476 Speaker 1: DA at a level that is lower and more accessible 264 00:16:38,476 --> 00:16:42,876 Speaker 1: than psychedelic medicines. THC, for instance, is still Schedule one drug, 265 00:16:42,956 --> 00:16:45,756 Speaker 1: so as MBMA and soil side. I think the question 266 00:16:45,916 --> 00:16:50,676 Speaker 1: is that if these medicines are accessible to everyone through 267 00:16:50,756 --> 00:16:54,556 Speaker 1: the legalization process that is happening for example in Massachusetts, 268 00:16:54,596 --> 00:16:59,116 Speaker 1: it's happened into Denver and Oregon, in certain places in California, 269 00:16:59,436 --> 00:17:02,916 Speaker 1: then are we doing a disservice to folks if we 270 00:17:03,036 --> 00:17:06,676 Speaker 1: don't take the time to properly educate them about what 271 00:17:06,836 --> 00:17:09,116 Speaker 1: the risks are and how to do it safely. Right, 272 00:17:09,236 --> 00:17:11,996 Speaker 1: it almost seems to follow less of a cannabis path 273 00:17:12,556 --> 00:17:14,996 Speaker 1: and more of I mean it's following the cannabis path 274 00:17:15,036 --> 00:17:17,636 Speaker 1: to some extent, but it seems to be following at 275 00:17:17,636 --> 00:17:21,676 Speaker 1: a larger level the absence only education path with sex. Right, 276 00:17:21,916 --> 00:17:24,876 Speaker 1: It's like we know people from thousands of years of 277 00:17:24,916 --> 00:17:27,396 Speaker 1: research of looking back into history, we know people used 278 00:17:27,676 --> 00:17:30,316 Speaker 1: drugs to access altered states of consciousness, whether they came 279 00:17:30,356 --> 00:17:34,036 Speaker 1: from plants or we're synthesized. We know people have sex 280 00:17:34,356 --> 00:17:36,676 Speaker 1: to feel good, to bond with each other, to alter 281 00:17:36,756 --> 00:17:39,916 Speaker 1: states of consciousness. We know that both of these types 282 00:17:39,916 --> 00:17:42,996 Speaker 1: of experiences are very powerful for people, and they're going 283 00:17:43,036 --> 00:17:46,356 Speaker 1: to seek them out no matter what. If we do 284 00:17:46,436 --> 00:17:49,876 Speaker 1: not teach people how to have safe sex and what 285 00:17:49,916 --> 00:17:54,156 Speaker 1: the potential consequences are of not having safe sex, then 286 00:17:54,516 --> 00:17:57,756 Speaker 1: people are going to do what they're going to do unsafely, right, 287 00:17:57,956 --> 00:17:59,676 Speaker 1: and it's going to cause a lot of problems. And 288 00:17:59,676 --> 00:18:02,356 Speaker 1: we've seen that. And at the same time, if we 289 00:18:02,436 --> 00:18:07,036 Speaker 1: teach people how to have safe sexual relations with people, 290 00:18:07,236 --> 00:18:11,236 Speaker 1: how to use drugs safely, we see the positive outcomes there. 291 00:18:11,316 --> 00:18:14,596 Speaker 1: So I think that what we ultimately the responsibility is 292 00:18:14,876 --> 00:18:21,236 Speaker 1: not to disseminate these medicines as quickly as possible, regardless 293 00:18:21,276 --> 00:18:23,116 Speaker 1: of how people use them, and let them just choose 294 00:18:23,276 --> 00:18:25,836 Speaker 1: without having any guidance. I think the responsible thing to 295 00:18:25,876 --> 00:18:28,596 Speaker 1: do that a lot of us agree on a clinical world, 296 00:18:28,676 --> 00:18:32,156 Speaker 1: the medical world, and I believe also in the indigenous 297 00:18:32,156 --> 00:18:34,116 Speaker 1: cultures that have been using this for a long time, 298 00:18:34,876 --> 00:18:38,076 Speaker 1: is to combine our efforts and our wisdom from all 299 00:18:38,076 --> 00:18:41,836 Speaker 1: sides and say, okay, here's your guidebook. Right here is 300 00:18:41,876 --> 00:18:44,636 Speaker 1: the basics that you need to know, the few points 301 00:18:44,676 --> 00:18:47,676 Speaker 1: coming in that you need to know to prepare adequately 302 00:18:47,716 --> 00:18:49,916 Speaker 1: to have the best possible experience that you can have, 303 00:18:50,356 --> 00:18:53,836 Speaker 1: because it really, you know, like you said, there is risk. 304 00:18:53,956 --> 00:18:57,356 Speaker 1: And at the same time, if we take the time 305 00:18:57,396 --> 00:19:00,916 Speaker 1: to say, spend you know, focus on three to five 306 00:19:01,156 --> 00:19:03,436 Speaker 1: points that we can do to make sure that our 307 00:19:03,516 --> 00:19:06,916 Speaker 1: environment is safe, we're feeling emotionally safe and comfortable and 308 00:19:06,956 --> 00:19:11,676 Speaker 1: of course physically safe, spiritually safe, and we can have 309 00:19:11,836 --> 00:19:15,316 Speaker 1: that for the course of our psychedelic experience, which is 310 00:19:15,356 --> 00:19:18,276 Speaker 1: altering our state of consciousness and making us vulnerable for 311 00:19:18,396 --> 00:19:21,116 Speaker 1: lack of a better term to shifting meaning about ourselves, 312 00:19:21,556 --> 00:19:24,476 Speaker 1: than we can actually have a lot more control over 313 00:19:24,476 --> 00:19:27,636 Speaker 1: that environment than we think. And thankfully, I would say, 314 00:19:27,756 --> 00:19:31,396 Speaker 1: looking at the recreational use cases, thankfully we do not 315 00:19:31,516 --> 00:19:34,956 Speaker 1: see as many harms being done by people misusing these 316 00:19:34,996 --> 00:19:40,436 Speaker 1: medicines as we thought we might. However, I think the 317 00:19:40,476 --> 00:19:44,436 Speaker 1: concern is that we might see more if recreationalization across 318 00:19:44,476 --> 00:19:49,876 Speaker 1: the US spreads without the accompanying education is required. We'll 319 00:19:49,916 --> 00:20:01,876 Speaker 1: be right back if I want to turn back for 320 00:20:01,956 --> 00:20:05,316 Speaker 1: the last segment of our conversation to some of the 321 00:20:05,396 --> 00:20:10,676 Speaker 1: scientific underpinnings of how this amplification and process works. And 322 00:20:10,716 --> 00:20:11,956 Speaker 1: I guess what I'd like to do is ask you 323 00:20:11,996 --> 00:20:15,036 Speaker 1: about this from two angles. The first is from your 324 00:20:15,036 --> 00:20:19,276 Speaker 1: clinicians angle, to ask you what it's like when you 325 00:20:19,316 --> 00:20:23,596 Speaker 1: are doing psychotherapy with a patient who is on a 326 00:20:23,636 --> 00:20:26,476 Speaker 1: dose of psychedelics compared to what it's like to do 327 00:20:26,596 --> 00:20:30,036 Speaker 1: the identical form of talk therapy with someone who isn't. 328 00:20:30,076 --> 00:20:31,516 Speaker 1: And then after you've talked a little bit about that, 329 00:20:31,556 --> 00:20:34,156 Speaker 1: maybe people talk about some of the underlying chemistry and 330 00:20:34,316 --> 00:20:36,996 Speaker 1: how the brain chemistry might be facilitating those differences. So 331 00:20:37,036 --> 00:20:39,476 Speaker 1: the first question is really what's it like for you 332 00:20:39,716 --> 00:20:42,076 Speaker 1: in the room when you're doing the treatment. Does the 333 00:20:42,116 --> 00:20:46,396 Speaker 1: patient feel different? That's a great question. So it's really 334 00:20:46,436 --> 00:20:50,236 Speaker 1: just about tools when we think about the psychotherapy approach. 335 00:20:50,556 --> 00:20:54,556 Speaker 1: My approach is the same, relatively the same, regardless of 336 00:20:55,236 --> 00:20:57,236 Speaker 1: who I'm working with or what their condition is. It's 337 00:20:57,316 --> 00:21:02,596 Speaker 1: empathy first, non judgment, radical acceptance, leaving my own baggage 338 00:21:02,596 --> 00:21:04,276 Speaker 1: at the door. Whatever has been going on in my 339 00:21:04,316 --> 00:21:07,556 Speaker 1: life that day or that week that might be stressful 340 00:21:07,596 --> 00:21:09,836 Speaker 1: for me, I do not bring it into the session. 341 00:21:10,196 --> 00:21:16,476 Speaker 1: I'm entirely focused on the individual I'm working with, listening 342 00:21:16,476 --> 00:21:18,876 Speaker 1: to them and making sure that they know they're heard 343 00:21:19,516 --> 00:21:23,356 Speaker 1: in the experience. And sometimes it involves holding hands, but 344 00:21:23,516 --> 00:21:28,476 Speaker 1: it definitely involves direct eye to eye contact and practice 345 00:21:28,476 --> 00:21:32,996 Speaker 1: of empathic listening where the client clearly is aware and 346 00:21:33,236 --> 00:21:37,316 Speaker 1: acknowledges that they are being heard non judgmentally by me. 347 00:21:38,396 --> 00:21:40,836 Speaker 1: That is the foundation of all psychotherapy, no matter what 348 00:21:40,916 --> 00:21:43,956 Speaker 1: kind of therapy you do, whether it's psychedelic assisted or not. 349 00:21:44,356 --> 00:21:48,476 Speaker 1: So in people who have had very mild to moderate 350 00:21:48,516 --> 00:21:52,436 Speaker 1: trump for instance, or mild to moderate issues of depression, 351 00:21:52,956 --> 00:21:56,156 Speaker 1: where I can engage with them enough and me letting 352 00:21:56,156 --> 00:21:59,076 Speaker 1: them know that they're heard makes them feel safe enough 353 00:21:59,276 --> 00:22:03,236 Speaker 1: that they can really dive into the experience and make 354 00:22:03,356 --> 00:22:07,156 Speaker 1: positive change the results of that experience because they feel safe. However, 355 00:22:07,956 --> 00:22:11,556 Speaker 1: when people have had very severe trauma or very severe 356 00:22:11,596 --> 00:22:14,556 Speaker 1: episodes of depression, it's sometimes very difficult for those people 357 00:22:14,596 --> 00:22:16,716 Speaker 1: to feel safe, and sometimes they haven't felt safe in 358 00:22:16,716 --> 00:22:18,636 Speaker 1: the years, and they can't remember when the last time 359 00:22:18,756 --> 00:22:20,996 Speaker 1: was that they did feel safe. And no matter what 360 00:22:21,116 --> 00:22:26,236 Speaker 1: I do emotionally, empathetically, even holding hands or giving them 361 00:22:26,276 --> 00:22:29,036 Speaker 1: something like Apollo or other tools that work to help 362 00:22:29,356 --> 00:22:32,916 Speaker 1: settle the body and boost the vagel parasympathetic nervous system 363 00:22:32,956 --> 00:22:36,156 Speaker 1: activity to help facilitate recovery and bonding and engagement in 364 00:22:36,156 --> 00:22:38,596 Speaker 1: the session, it just doesn't quite cut it, and they 365 00:22:38,676 --> 00:22:42,716 Speaker 1: can't lean into the experience. So for those people, when 366 00:22:42,756 --> 00:22:45,996 Speaker 1: we give them a psychedelic medicine like ketamine as an example, 367 00:22:45,996 --> 00:22:47,556 Speaker 1: which is I want to bring up because it's the 368 00:22:47,636 --> 00:22:51,036 Speaker 1: only currently legal psychedelic medicine that we have access to, 369 00:22:51,356 --> 00:22:54,436 Speaker 1: and it's very short acting and very powerful and is 370 00:22:54,476 --> 00:22:56,716 Speaker 1: safe for clients to actually use at home, we can 371 00:22:56,876 --> 00:23:02,396 Speaker 1: see that the medicine number one is catalyzing the safety 372 00:23:02,436 --> 00:23:05,916 Speaker 1: response for these people. So more importantly than anything else, 373 00:23:06,316 --> 00:23:08,996 Speaker 1: what we hear from our clients is that when they 374 00:23:09,116 --> 00:23:11,236 Speaker 1: they do therapy with us without the medicine and then 375 00:23:11,276 --> 00:23:15,596 Speaker 1: they add the medicine, they often say, I haven't felt 376 00:23:15,676 --> 00:23:20,396 Speaker 1: this safe in my recent memory, I don't remember feeling 377 00:23:20,396 --> 00:23:25,076 Speaker 1: this way about myself without judging myself since childhood. I 378 00:23:25,116 --> 00:23:29,476 Speaker 1: haven't felt my constant ruminative negative and thoughts stop or 379 00:23:29,556 --> 00:23:32,596 Speaker 1: pause for as long as I can remember. And as 380 00:23:32,636 --> 00:23:35,276 Speaker 1: soon as they have that experience, it's like a wake 381 00:23:35,356 --> 00:23:38,756 Speaker 1: up call because they remember a feeling, they remember a 382 00:23:38,796 --> 00:23:42,956 Speaker 1: state of being that they had before. It's familiar, but 383 00:23:43,036 --> 00:23:46,116 Speaker 1: it's something that they forgot how to access because of 384 00:23:46,156 --> 00:23:48,316 Speaker 1: a bunch of other stuff that happened in the meantime 385 00:23:48,876 --> 00:23:53,116 Speaker 1: that interfere. And now once they're reconnecting with that part 386 00:23:53,116 --> 00:23:55,436 Speaker 1: of themselves and they realize that something they can access, 387 00:23:55,996 --> 00:23:59,316 Speaker 1: then we use the medicine as a tool to teach them, 388 00:24:00,076 --> 00:24:02,556 Speaker 1: not that they require the medicine to access that state 389 00:24:02,596 --> 00:24:04,636 Speaker 1: every time they want to get there, but that the 390 00:24:04,756 --> 00:24:07,596 Speaker 1: medicine is a teacher and a tool to show them 391 00:24:07,756 --> 00:24:14,516 Speaker 1: experientially that they can feel safe and that they let 392 00:24:14,516 --> 00:24:16,956 Speaker 1: me ask you about that's totally fascinating, and let me 393 00:24:16,996 --> 00:24:19,876 Speaker 1: ask you about what you think is happening. So when 394 00:24:19,876 --> 00:24:21,916 Speaker 1: the person then says, oh, I remember what it was 395 00:24:21,956 --> 00:24:24,756 Speaker 1: like to feel safe, and now I can get back 396 00:24:24,756 --> 00:24:26,716 Speaker 1: to that again. Is it your view that there was 397 00:24:26,756 --> 00:24:29,596 Speaker 1: a kind of neural pathway that was it was always 398 00:24:29,596 --> 00:24:32,196 Speaker 1: it always existed, It still existed, but it was difficult 399 00:24:32,236 --> 00:24:36,116 Speaker 1: to access it, and you are helping the person to 400 00:24:36,236 --> 00:24:39,396 Speaker 1: access it and then learn to access it without your 401 00:24:39,436 --> 00:24:42,636 Speaker 1: presence or is that too literal? On that account, You're 402 00:24:42,636 --> 00:24:45,636 Speaker 1: not necessarily creating a new pathway. You're just opening an 403 00:24:45,636 --> 00:24:48,956 Speaker 1: access point to a pathway that already existed at an 404 00:24:48,956 --> 00:24:51,796 Speaker 1: earlier life stage, but that was kind of thwarted. That's 405 00:24:51,836 --> 00:24:55,436 Speaker 1: exactly right. And going back as far as Hippocrates is 406 00:24:55,716 --> 00:24:58,916 Speaker 1: thought to be the founder of Western medicine, Hippocrates said 407 00:24:59,636 --> 00:25:02,516 Speaker 1: that healing comes from I'm on a butcher's quote, but 408 00:25:02,516 --> 00:25:05,556 Speaker 1: the healing comes from within us and within the individual. 409 00:25:05,956 --> 00:25:08,796 Speaker 1: That it is not for us as clinicians to be 410 00:25:08,836 --> 00:25:11,396 Speaker 1: the to identify as the source of a patient or 411 00:25:11,436 --> 00:25:14,836 Speaker 1: client's healing experience. It is for us to use the 412 00:25:14,876 --> 00:25:17,156 Speaker 1: tools we have access to and use our own healing 413 00:25:17,436 --> 00:25:21,516 Speaker 1: abilities to facilitate that person. It's empowerment to learn that 414 00:25:21,556 --> 00:25:23,756 Speaker 1: they can heal themselves and that is the source of 415 00:25:23,796 --> 00:25:28,356 Speaker 1: their healing. Is it possible for that small number of 416 00:25:28,356 --> 00:25:32,796 Speaker 1: patients whose trauma was introduced already in the earliest stages 417 00:25:32,796 --> 00:25:36,116 Speaker 1: of childhood that for such a person, the approach might 418 00:25:36,156 --> 00:25:40,796 Speaker 1: be less effective because that person might never have managed 419 00:25:40,836 --> 00:25:43,196 Speaker 1: to create the sense of safety or security that you're 420 00:25:43,196 --> 00:25:45,556 Speaker 1: describing that you're trying to access. But that might not 421 00:25:45,596 --> 00:25:47,356 Speaker 1: be the same as building that from scratch if you 422 00:25:47,396 --> 00:25:50,436 Speaker 1: didn't have it. That's a great point. I'm sure there 423 00:25:50,596 --> 00:25:52,716 Speaker 1: is a subset of people that has a much more 424 00:25:52,796 --> 00:25:58,076 Speaker 1: difficult time finding that familiar feeling of safety from the 425 00:25:58,116 --> 00:26:03,116 Speaker 1: past and reconnecting with that. There are also people who 426 00:26:03,156 --> 00:26:06,116 Speaker 1: connect with it very easily, and then there's everyone in between. 427 00:26:06,916 --> 00:26:12,916 Speaker 1: I think that, interestingly enough, it doesn't necessarily matter when 428 00:26:13,556 --> 00:26:17,676 Speaker 1: the trauma has happened. And the reason why I say 429 00:26:17,716 --> 00:26:20,516 Speaker 1: that is because of the work of Rachel Yehuda from 430 00:26:20,516 --> 00:26:23,476 Speaker 1: Mount Sinai over the last thirty or four years showed 431 00:26:23,556 --> 00:26:28,556 Speaker 1: that these changes that trauma induces to our bodies are 432 00:26:28,636 --> 00:26:32,316 Speaker 1: actually store not just in the way that our neurons 433 00:26:32,356 --> 00:26:34,756 Speaker 1: talk to each other, like Eric Candell found, but they're 434 00:26:34,796 --> 00:26:38,636 Speaker 1: actually stored all the way down into the epigenetic code, 435 00:26:39,276 --> 00:26:41,996 Speaker 1: which is the code that's on top of our DNA 436 00:26:42,076 --> 00:26:45,716 Speaker 1: that tells every cell in our body to either increase 437 00:26:45,836 --> 00:26:48,996 Speaker 1: or decrease expression of certain proteins like CORSO, which we're 438 00:26:49,036 --> 00:26:50,876 Speaker 1: all familiar with. This one of the most important stress 439 00:26:50,916 --> 00:26:55,156 Speaker 1: response proteins. And so if you've experienced trauma in a 440 00:26:55,196 --> 00:26:58,236 Speaker 1: certain way, that trauma does not even have to be 441 00:26:58,436 --> 00:27:01,956 Speaker 1: from your own lifetime. It can be trauma from your parents, 442 00:27:01,996 --> 00:27:05,756 Speaker 1: it can be trauma from your grandparents that they experienced 443 00:27:06,196 --> 00:27:09,996 Speaker 1: that caused changes to their geniue expression patterns as what 444 00:27:10,196 --> 00:27:14,276 Speaker 1: was likely an evolutionary coping mechanism to help them adapt 445 00:27:14,356 --> 00:27:17,956 Speaker 1: stress in their environment, but they never actually processed it 446 00:27:18,036 --> 00:27:20,236 Speaker 1: or sorted it out when they were restored to an 447 00:27:20,316 --> 00:27:24,516 Speaker 1: environment of safety, and so they ended up passing on 448 00:27:25,276 --> 00:27:29,156 Speaker 1: the epigenetic changes or these expression pattern gene expression pattern 449 00:27:29,236 --> 00:27:33,516 Speaker 1: changes to their offspring that they were born with, and 450 00:27:33,676 --> 00:27:36,236 Speaker 1: that results now we know, thanks to Rachel's work, in 451 00:27:36,276 --> 00:27:40,636 Speaker 1: a predisposition to developing PTSD and other mental health disorders 452 00:27:40,636 --> 00:27:44,436 Speaker 1: and potentially even metabolic disorder. But whether or not psychedelic 453 00:27:44,556 --> 00:27:47,676 Speaker 1: medicine assisted psychotherapy is less equipped to be able to 454 00:27:47,716 --> 00:27:50,556 Speaker 1: treat something like that, I think it's still up for debate. 455 00:27:50,596 --> 00:27:53,596 Speaker 1: I think what we see is that it actually works 456 00:27:53,636 --> 00:27:56,876 Speaker 1: fairly well on all of these folks, whether or not 457 00:27:56,956 --> 00:28:00,316 Speaker 1: they remember a traumatic event specifically or not, whether or 458 00:28:00,316 --> 00:28:02,836 Speaker 1: not they can recall an event in their specific lifetime 459 00:28:02,916 --> 00:28:05,316 Speaker 1: or not. I think, going back to your original question, 460 00:28:05,836 --> 00:28:09,996 Speaker 1: what we're about the mechanism, what we're seeing happen neural biologically, 461 00:28:10,636 --> 00:28:15,716 Speaker 1: is that these medicines are facilitating activation of the five 462 00:28:15,876 --> 00:28:19,876 Speaker 1: HT two, a serotonin receptor that is highly localized in 463 00:28:19,916 --> 00:28:22,476 Speaker 1: the emotional cortex, but it's in our cortex as a 464 00:28:22,516 --> 00:28:25,196 Speaker 1: whole of our brains, which is where all our memories 465 00:28:25,236 --> 00:28:27,876 Speaker 1: are stored, all our memories about how we know ourselves 466 00:28:27,876 --> 00:28:31,116 Speaker 1: in the world are stored, or turns out from a 467 00:28:31,196 --> 00:28:36,436 Speaker 1: lot of other work with antidepressant medications like SSRIs which 468 00:28:36,476 --> 00:28:40,636 Speaker 1: also increase serotonin at those receptors, and psychedelic work from 469 00:28:40,676 --> 00:28:44,196 Speaker 1: Franz Voldwire in Switzerland with LSD and silcybin, that it's 470 00:28:44,516 --> 00:28:47,836 Speaker 1: verily clear at this point that the activating that receptor 471 00:28:47,876 --> 00:28:50,996 Speaker 1: in a burst manner with a burst of serotonin, not 472 00:28:51,196 --> 00:28:55,636 Speaker 1: constant serotonin, but a burst which psychedelic medicine facilitate and 473 00:28:55,996 --> 00:29:01,916 Speaker 1: meaningful experiences facilitate, induces a state of perceptual shift in meaning, 474 00:29:01,996 --> 00:29:05,596 Speaker 1: or an opportunity to change the way we perceive meaning 475 00:29:05,636 --> 00:29:08,836 Speaker 1: from our environment and from ourselves. So if you think 476 00:29:08,836 --> 00:29:13,516 Speaker 1: about the nonspecific amplifier idea, when you take a psychedelic medicine, 477 00:29:14,316 --> 00:29:17,036 Speaker 1: you can change your meaning of the world to be 478 00:29:17,116 --> 00:29:19,756 Speaker 1: potentially more positive or more negative or stay the same 479 00:29:20,556 --> 00:29:23,716 Speaker 1: based on the environment that you go into, your inside 480 00:29:23,876 --> 00:29:27,276 Speaker 1: set and your outside environment setting that you bring into 481 00:29:27,316 --> 00:29:31,276 Speaker 1: that experience, and you have a setting of safety, what 482 00:29:31,356 --> 00:29:34,276 Speaker 1: happens is we can become aware of things that have 483 00:29:34,316 --> 00:29:37,636 Speaker 1: happened in the past, things that possibly have been buried 484 00:29:37,676 --> 00:29:40,276 Speaker 1: beneath our memory, or things that have even happened in 485 00:29:40,796 --> 00:29:44,236 Speaker 1: past generational trauma that we did not know about or 486 00:29:44,276 --> 00:29:47,556 Speaker 1: to not know much about. And then people have the opportunity, 487 00:29:48,156 --> 00:29:51,556 Speaker 1: a very unique, time limited opportunity to re experience and 488 00:29:51,636 --> 00:29:54,836 Speaker 1: go back through their lives the most salient and critical 489 00:29:54,836 --> 00:29:58,316 Speaker 1: events that were most meaningful to them, that to them 490 00:29:58,676 --> 00:30:01,716 Speaker 1: made them who they were, and reevaluate those from a 491 00:30:01,716 --> 00:30:04,676 Speaker 1: standpoint of radical safety and non judgment, so that we 492 00:30:04,716 --> 00:30:08,116 Speaker 1: can understand that these events or experiences that we thought 493 00:30:08,156 --> 00:30:11,716 Speaker 1: and made us who we are are just experiences that 494 00:30:11,956 --> 00:30:14,636 Speaker 1: we make who we are out of. One last question 495 00:30:14,716 --> 00:30:17,316 Speaker 1: about this, Dave, because what you're saying is very, very 496 00:30:17,436 --> 00:30:21,076 Speaker 1: rich and fascinating and probably deserves its own a further conversation. 497 00:30:21,796 --> 00:30:24,356 Speaker 1: It's interesting to me that one of the things that happened, 498 00:30:25,116 --> 00:30:28,076 Speaker 1: you know, sort of roughly speaking, in the eighties and nineties, 499 00:30:28,756 --> 00:30:32,956 Speaker 1: with the rise of interest in the underlying neurochemistry as 500 00:30:32,956 --> 00:30:36,196 Speaker 1: a determinant of mental wellbeing, is that there was a 501 00:30:36,236 --> 00:30:43,196 Speaker 1: simultaneous reduction in respect for talk therapy as an effective 502 00:30:44,036 --> 00:30:48,116 Speaker 1: means of improving people's mental wellbeing. In what you're saying, 503 00:30:48,156 --> 00:30:52,276 Speaker 1: where you describe the serotonin burst creating the possibility of 504 00:30:52,316 --> 00:30:55,756 Speaker 1: a perceptual shift, you set a perceptual shift in meaning, 505 00:30:56,636 --> 00:30:59,676 Speaker 1: and then you described the psychotherapeutic process in terms that 506 00:30:59,716 --> 00:31:04,196 Speaker 1: would have been extremely attractive to classic talk therapy addict. 507 00:31:04,236 --> 00:31:06,756 Speaker 1: It's really going all the way back to Freud, in 508 00:31:06,796 --> 00:31:10,676 Speaker 1: which the human being with God and conversation and with 509 00:31:10,676 --> 00:31:14,556 Speaker 1: another human being is achieving shifts in meaning. And on 510 00:31:14,556 --> 00:31:21,756 Speaker 1: that account, the non specific amplification of psychedelics works because 511 00:31:21,996 --> 00:31:26,396 Speaker 1: talk therapy works. It works, not because it's in any 512 00:31:26,436 --> 00:31:30,236 Speaker 1: way independent of and that's what makes it go. And 513 00:31:30,276 --> 00:31:32,996 Speaker 1: so I guess I'm wondering if you would maybe close 514 00:31:33,036 --> 00:31:37,076 Speaker 1: with just some reflection on you know, has this science 515 00:31:37,676 --> 00:31:42,036 Speaker 1: gone a pretty far distance towards rehabilitating the idea of 516 00:31:42,156 --> 00:31:46,796 Speaker 1: talk therapy as meaning making. But through this mechanism of 517 00:31:46,796 --> 00:31:51,076 Speaker 1: amplification preacing the probability that that shift in meaning making 518 00:31:51,196 --> 00:31:55,476 Speaker 1: could take place more reliably, more rapidly, and for a 519 00:31:55,556 --> 00:31:59,676 Speaker 1: larger number of patients. Absolutely, And I think that since 520 00:31:59,716 --> 00:32:02,996 Speaker 1: you brought it up just to jtapose what was happening 521 00:32:02,996 --> 00:32:05,636 Speaker 1: in the Freudian era of psychotherapy versus the current era, 522 00:32:06,076 --> 00:32:10,476 Speaker 1: I think what is really interesting is that the original 523 00:32:10,556 --> 00:32:15,036 Speaker 1: Freudian approach in large part was about the therapist making 524 00:32:15,116 --> 00:32:18,756 Speaker 1: meeting for the patient. Right, So it was a very 525 00:32:18,836 --> 00:32:23,596 Speaker 1: what we call now a directive approach and in the 526 00:32:23,636 --> 00:32:28,916 Speaker 1: current paradigm, but I think that what psychedelic medicine assisted 527 00:32:28,916 --> 00:32:32,916 Speaker 1: psychotherapy has taught us in the therapy world is really 528 00:32:33,076 --> 00:32:39,316 Speaker 1: emphasizing the importance of safety to an autonomy. In an autonomy, 529 00:32:39,356 --> 00:32:42,596 Speaker 1: and by atony, I mean like agency in the individual 530 00:32:42,716 --> 00:32:46,436 Speaker 1: clients experience, The client that seeks to be healed has 531 00:32:46,476 --> 00:32:51,956 Speaker 1: to be the person where the ideas about healing come from. Right, 532 00:32:52,316 --> 00:32:55,876 Speaker 1: then we as particularly in the psychedelic space, to a 533 00:32:55,916 --> 00:32:59,956 Speaker 1: non directive approach where we guide the individual insight to 534 00:33:00,116 --> 00:33:03,476 Speaker 1: discover from themselves, what they want out of their healing 535 00:33:03,516 --> 00:33:07,476 Speaker 1: process and what their inner voice for their intuition is 536 00:33:07,556 --> 00:33:10,756 Speaker 1: telling them they want to and then we work with 537 00:33:10,796 --> 00:33:13,796 Speaker 1: them to sort out what that means. And so instead 538 00:33:13,836 --> 00:33:16,196 Speaker 1: of meaning making for them, which is the old way 539 00:33:16,196 --> 00:33:18,716 Speaker 1: of thinking about it from the FRONTI perspective, we are 540 00:33:18,836 --> 00:33:21,556 Speaker 1: teaching them how to make meaning for themselves with the 541 00:33:21,676 --> 00:33:25,516 Speaker 1: medicine as a facilitator and tool. And that is really 542 00:33:25,516 --> 00:33:27,716 Speaker 1: the transformation that I think mental health is going to 543 00:33:27,756 --> 00:33:31,236 Speaker 1: take in the future. That's a very rich, attractive vision. 544 00:33:31,476 --> 00:33:35,076 Speaker 1: I think it deserves greater exploration and thought beyond what 545 00:33:35,076 --> 00:33:36,876 Speaker 1: we can do here. But I really want to thank 546 00:33:36,876 --> 00:33:40,916 Speaker 1: you for an exemplary clarity in your description, Dave, in 547 00:33:41,036 --> 00:33:44,156 Speaker 1: helping us see both the practical side and the scientific side, 548 00:33:44,196 --> 00:33:47,276 Speaker 1: and the underlying theories of mechanism that are emerging, and 549 00:33:47,436 --> 00:33:49,716 Speaker 1: helping us understand some of the research. It was a 550 00:33:49,716 --> 00:33:52,756 Speaker 1: really fantastic conversation. I learned a huge amount and I'm 551 00:33:52,756 --> 00:33:55,716 Speaker 1: really grateful to you. Thank you, No problem, my pleasure. 552 00:33:56,556 --> 00:34:10,596 Speaker 1: We'll be back in a moment. Listening to doctor Dave Rabin, 553 00:34:11,036 --> 00:34:14,756 Speaker 1: I was genuinely fascinated and in certain ways really surprised 554 00:34:15,076 --> 00:34:20,396 Speaker 1: by some of the conclusions of his analysis. First, very helpfully, 555 00:34:20,716 --> 00:34:26,556 Speaker 1: he defines psychedelics as non specific amplifiers, that is, substances 556 00:34:26,596 --> 00:34:31,796 Speaker 1: that amplify a series of psychological processes, either to encourage 557 00:34:31,836 --> 00:34:37,716 Speaker 1: and amplify good results such as empathy, connection, and safety, 558 00:34:38,516 --> 00:34:43,076 Speaker 1: and thereby to help us overcome bad trauma, but also 559 00:34:43,276 --> 00:34:48,796 Speaker 1: neutrally as capable of amplifying negative experiences. And as he 560 00:34:48,876 --> 00:34:52,516 Speaker 1: pointed out, that's not just pure abstract theory. There actually 561 00:34:52,596 --> 00:34:57,436 Speaker 1: is some evidence from unsanctioned CIA experiments with psychedelics from 562 00:34:57,476 --> 00:35:00,316 Speaker 1: the nineteen fifties to the nineteen seventies that suggests some 563 00:35:00,516 --> 00:35:04,636 Speaker 1: very bad results when the amplification was negative. From this 564 00:35:04,716 --> 00:35:09,716 Speaker 1: analysis of psychedelics as non specific amplifiers, lots of fascinating 565 00:35:09,756 --> 00:35:14,356 Speaker 1: things emerge. One is the tremendous importance of anyone who's 566 00:35:14,396 --> 00:35:17,236 Speaker 1: going to use psychedelics doing it in a context and 567 00:35:17,316 --> 00:35:20,396 Speaker 1: a setting that will amplify in a positive way and 568 00:35:20,516 --> 00:35:23,636 Speaker 1: not in a negative way. That's a topic that deserves 569 00:35:23,796 --> 00:35:27,196 Speaker 1: much more conversation in the course of the policy discussion 570 00:35:27,436 --> 00:35:31,836 Speaker 1: about the potential legalization of psychedelics that's going on right now, 571 00:35:32,396 --> 00:35:34,836 Speaker 1: And it suggests that the paradigm that many of us 572 00:35:34,916 --> 00:35:38,796 Speaker 1: have been expecting, where gradual legalization in a handful of 573 00:35:38,796 --> 00:35:42,996 Speaker 1: symbolic venues leads to a broad societal reconsideration may have 574 00:35:43,116 --> 00:35:46,116 Speaker 1: to be rethought through the lens of the question of 575 00:35:46,116 --> 00:35:51,076 Speaker 1: what harm can be done using psychedelics alongside the question 576 00:35:51,316 --> 00:35:55,116 Speaker 1: of the benefits. Now, doctor Abin was very clear that 577 00:35:55,196 --> 00:36:00,316 Speaker 1: in his view, the positive capacities of psychedelics vastly outweigh 578 00:36:00,356 --> 00:36:03,916 Speaker 1: their negative capabilities. At the same time, he was open 579 00:36:03,996 --> 00:36:06,556 Speaker 1: to the idea that we ought to think carefully about 580 00:36:06,756 --> 00:36:09,316 Speaker 1: context and setting in order to assure that all of 581 00:36:09,356 --> 00:36:14,076 Speaker 1: that happens. Then, on the question of the fundamental underlying science, 582 00:36:14,556 --> 00:36:18,996 Speaker 1: I was truly fascinated to hear that the goal of 583 00:36:19,036 --> 00:36:23,876 Speaker 1: the non specific amplification is actually to facilitate, through bursts 584 00:36:23,876 --> 00:36:28,716 Speaker 1: of serotonin, a change in perception that counts as in 585 00:36:28,796 --> 00:36:34,396 Speaker 1: his view, meaning making. Those shifts in meaning making, according 586 00:36:34,436 --> 00:36:37,956 Speaker 1: to the theory that doctor Abin is expanding, are shifts 587 00:36:37,956 --> 00:36:41,676 Speaker 1: that can fundamentally alter in positive ways the way we 588 00:36:41,716 --> 00:36:45,636 Speaker 1: experience the world, not just during those experiences, but more 589 00:36:45,676 --> 00:36:50,076 Speaker 1: broadly and in the follow on. This mechanism is still 590 00:36:50,116 --> 00:36:53,156 Speaker 1: at the stage of being a hypothesis, but It's fascinating 591 00:36:53,236 --> 00:36:57,676 Speaker 1: hypothesis and one very much worth exploring in months and 592 00:36:57,756 --> 00:37:02,196 Speaker 1: years ahead. Broadly speaking, I think it's fair to say 593 00:37:02,276 --> 00:37:04,956 Speaker 1: that the United States is undergoing the beginnings of a 594 00:37:05,076 --> 00:37:10,156 Speaker 1: substantial shift in public attitudes and understanding towards psychedelics, and 595 00:37:10,236 --> 00:37:14,556 Speaker 1: this conversation helped me tremendously to begin to understand some 596 00:37:14,636 --> 00:37:17,796 Speaker 1: of the working theories and some of the practices that 597 00:37:17,876 --> 00:37:20,716 Speaker 1: are being used by practitioners in the field to try 598 00:37:20,716 --> 00:37:24,116 Speaker 1: to make sense of how our mental health might be 599 00:37:24,156 --> 00:37:29,836 Speaker 1: improved and engaged through psychedelic assisted psychotherapy. Until the next 600 00:37:29,876 --> 00:37:33,436 Speaker 1: time I speak to you, breathe deep, think deep thoughts, 601 00:37:33,916 --> 00:37:39,916 Speaker 1: and have a little fun. Deep Background is brought to 602 00:37:39,956 --> 00:37:43,556 Speaker 1: you by Pushkin Industries. Our producer is Mola Board, our 603 00:37:43,596 --> 00:37:47,516 Speaker 1: engineer is ben Toalliday, and our showrunner is Sophie Crane mckibbon. 604 00:37:48,196 --> 00:37:52,636 Speaker 1: Editorial support from noahm Osband. Theme music by Luis Gara 605 00:37:52,716 --> 00:37:56,396 Speaker 1: at Pushkin. Thanks to Mia Lobell, Julia Barton, Lydia Jeancott, 606 00:37:56,636 --> 00:38:01,836 Speaker 1: Heather Fain, Carlie Migliori, Maggie Taylor, Eric Sandler, and Jacob Weissberg. 607 00:38:02,276 --> 00:38:04,436 Speaker 1: You can find me on Twitter at Noah R Feldman. 608 00:38:04,836 --> 00:38:07,236 Speaker 1: I also write a column for Bloomberg Opinion, which you 609 00:38:07,276 --> 00:38:10,876 Speaker 1: can find at bloomberg dot com slash Feldman. To discover 610 00:38:10,956 --> 00:38:14,396 Speaker 1: Bloomberg's original slate of podcasts, go to bloomberg dot com 611 00:38:14,396 --> 00:38:17,716 Speaker 1: slash podcasts, and if you like what you heard today, 612 00:38:17,716 --> 00:38:21,076 Speaker 1: please write a review or tell a friend. This is 613 00:38:21,116 --> 00:38:22,076 Speaker 1: deep background