Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show
Speaker 1: where we explore the stories behind the stories in the news.
Speaker 1: I'm noaffeldment. One of my favorite conversations on Deep Background
Speaker 1: this year, and judging by downloads, one of your favorites too,
Speaker 1: was my interview with Professor Carl Hart, a Columbia University
Speaker 1: neuroscientist who argues that our policies towards recreational drug use
Speaker 1: are far more harmful than the substances themselves. In today's episode,
Speaker 1: we're going to approach related issues, but from a different angle.
Speaker 1: We're going to talk about the emergent research on the
Speaker 1: efficacy of psychedelic assisted psychotherapy and the associated question of
Speaker 1: recreational use of psychedelics. There's been an explosion of research,
Speaker 1: which we're going to hear about shortly from one of
Speaker 1: the leading experts on the top. That's doctor David Raven,
Speaker 1: who's a neuroscientist aboard certified psychiatrist who does psychedelic assisted
Speaker 1: psychotherapy and is also the co founder and chief innovation
Speaker 1: officer at Apollo Neuroscience. He's going to talk to us
Speaker 1: about some of the new research in the field, what
Speaker 1: the mechanisms are for why and how psychedelic assisted psychotherapy
Speaker 1: seems to be working, and what it tells us about
Speaker 1: the brain and its capacities to heal in general. Dave,
Speaker 1: thank you so much for joining me here on deep background.
Speaker 1: I want to begin with some research that's gotten a
Speaker 1: lot of attention in the last several months, and that
Speaker 1: is research that looks at new psychedelic assisted psychotherapy approach
Speaker 1: and at least so far, seems to produce some extraordinarily
Speaker 1: impressive experimental results. And this is your field, and you
Speaker 1: both study it at a scientific level and also are
Speaker 1: a practitioner. I want to invite you to start by
Speaker 1: saying what you think of as the most impressive recent results,
Speaker 1: and then we'll talk in a little bit more depth
Speaker 1: about what those studies show. Sounds good, Yeah, I appreciate
Speaker 1: you for again for having me. Always a pleasure to
Speaker 1: share this conversation because I think that we're at a
Speaker 1: point in mental health in particular where we're starting to
Speaker 1: identify tools to treat mental illness that are reaching a
Speaker 1: level of success in terms of management of symptoms and
Speaker 1: remission long term remission of mental illness in particular like
Speaker 1: depression and anxiety that we haven't ever seen in the
Speaker 1: field of mental health, and so I think one of
Speaker 1: the things that's really exciting and also challenging about psychedelic
Speaker 1: assistant psychotherapy is that it is a full paradigm shift
Speaker 1: away from the current way that we treatment to illness
Speaker 1: to one in which we really focus on short courses
Speaker 1: of treatment. That for example, with MDMA, which is three
Speaker 1: four methylene dioxy methymphetamine, which I would say is beyond
Speaker 1: the experimental phase, it's well into the FDA phase through
Speaker 1: trials demonstrating tremendous results can vary consistently. What we're seeing
Speaker 1: is that with just three doses of MDMA with two
Speaker 1: therapists present over the course of twelve weeks of psychotherapy,
Speaker 1: those three doses of MBMA in people who are completely
Speaker 1: treatment resistant with PTSD post traumatic stress disorder, having tried
Speaker 1: everything under the sun, and never having had significant symptom
Speaker 1: remission or relief that exists that lasts over the long
Speaker 1: term without daily medication management. These people have three doses
Speaker 1: of MDMA and twelve weeks of psychotherapy. The pulsebo controlled
Speaker 1: trial in it right after the treatment is over twelve
Speaker 1: weeks and two months out something like fifty five percent
Speaker 1: of these people are completely in remission. They're no longer
Speaker 1: meeting diagnostic criteria for PTSD. However, what's even more exciting
Speaker 1: is that one year out, because we really care about
Speaker 1: durability of response, right one year out, we see that
Speaker 1: sixty seven percent of these people are no longer meeting
Speaker 1: diagnostic criteria for PTSD without any additional treatment. So that's
Speaker 1: what's really incredible is that these people seem to be
Speaker 1: able to be taught, using the medicine in an accelerated fashion,
Speaker 1: how to manage their own healing process more effectively, and
Speaker 1: then continue that process after the treatment is effectively finished.
Speaker 1: Let's dive into this study that you're talking about, and
Speaker 1: this comes out of Johns Hopkins, if I'm not mistaken,
Speaker 1: although I think there's some other affiliated centers that have
Speaker 1: been doing similar research. Is that right? So this study
Speaker 1: is not explicitly at John's Opkins. This is a international
Speaker 1: trial actually, so so the trial that is centered at Hopkins,
Speaker 1: which is equally exciting, I would say, but is at
Speaker 1: a slightly earlier stage in terms of the FDA. I
Speaker 1: believe it's in phase two, not phase three. Is a
Speaker 1: psilicided trial and that is used for predominantly for depression.
Speaker 1: It's equally exciting work. But what we're seeing and the
Speaker 1: study that I mentioned earlier, that's the furthest along is
Speaker 1: the MDMA for Treatment Resistant PTSC study. That's an international
Speaker 1: trial at i think over twenty clinical sites that are
Speaker 1: distributed throughout Canada, the US, and the EU and Israel.
Speaker 1: Thank you, so thanks for that clarification. Let's talk about
Speaker 1: this international trial in that case. So a question that
Speaker 1: immediately came to my mind when I first read about
Speaker 1: this research is the question of placebo effect and double blinding.
Speaker 1: I think the study is billed as double blind, which
Speaker 1: means that in principle, neither the person receiving the treatment
Speaker 1: nor the psychotherapist who's doing the psychotherapy sessions is supposed
Speaker 1: to know whether the person is in the target group
Speaker 1: who has received MDMA or is not. That is correct.
Speaker 1: So how is that possible? I mean, is it conceivable
Speaker 1: that a patient would not know that he or she
Speaker 1: was on MDMA at the dosage level that is being
Speaker 1: used in the study, And is it conceivable that the
Speaker 1: therapist would not Yeah, it's a great question, and I
Speaker 1: think this is a question that has always been a
Speaker 1: challenging one to answer when we're looking at these kinds
Speaker 1: of studies, and also just to take a step back
Speaker 1: when we're looking at any study of a complex treatment
Speaker 1: program or a natural treatment, natural treatment program like a
Speaker 1: complimentary or alternative medicine program, acupuncture being a great example.
Speaker 1: It's very, very difficult, notoriously difficult, to do double blind
Speaker 1: pall cebo control trials because how do you create an
Speaker 1: adequate placebo or active control group that is consistent with
Speaker 1: the blinding process. I think MAPS Multidisciplinary Association for Psychedelic
Speaker 1: Studies that is running the MBMA trial and has run
Speaker 1: and funded most of the MBMA trials to date through
Speaker 1: the FDA, have worked very closely with the FDA to
Speaker 1: come up with a valid and clinically acceptable to cebo group,
Speaker 1: and it's evolved over time. It wasn't always the way
Speaker 1: it is today. I think I believe that in the
Speaker 1: previous trials they were using niacin, which causes a warmth
Speaker 1: and a flushing that has a lot of the physical
Speaker 1: feelings that are similar to those that are experienced with MBMA,
Speaker 1: without the emotional component as much. And I believe that
Speaker 1: in the current trial they're using a sub threshold dose
Speaker 1: of MBMA, So they're using a dose of MDMA that's
Speaker 1: lower than what would be required to provide an active
Speaker 1: peak effect, and there's a dosing threshold that we know
Speaker 1: of that's critical to achieve that peak effect. But I
Speaker 1: think the data speaks for itself because when you look
Speaker 1: at the Phase two data, which comes from the first
Speaker 1: one hundred plus veterans were mostly veterans that were treated
Speaker 1: with PTSD, you can look at the placebo groups data
Speaker 1: and both groups, by the way, are getting two therapists
Speaker 1: for the entire treatment course. They're getting the same therapy sessions,
Speaker 1: the same eight hour therapy sessions, with sleeping over afterwards,
Speaker 1: with constant care and attention. And the point of the
Speaker 1: treatment is that the therapy itself is actually very potent. Right,
Speaker 1: So even in the people who received completely inactive placebo
Speaker 1: or MBMA that was below threshold, these people just with
Speaker 1: the excellent therapy alone in the trial, with these two
Speaker 1: therapists who are extremely well trained and extremely trauma oriented
Speaker 1: in their delivery of care, we're seeing a roughly twenty
Speaker 1: seven percent remission rate in terms of people having significant
Speaker 1: reduction and symptoms after the treatment. Is completed in about
Speaker 1: two months out. However, I think the real tell is
Speaker 1: that when you go and look at one year out,
Speaker 1: the folks who received active MBMA have an increased rate
Speaker 1: of recovery, so it goes from fifty five percent to
Speaker 1: sixty seven percent symptom free. When you go back and
Speaker 1: look at the placebo group, that group actually had about
Speaker 1: fifty percent of those people relapse into symptomatic PTSD. So
Speaker 1: are cymo therapists able to tell that a patient or
Speaker 1: a research subject has received MBMA versus a placebo It's possible.
Speaker 1: It is hard to tell. Sometimes in the therapeutic experience,
Speaker 1: it is possible that they know, but the delivery of
Speaker 1: therapy is the same either way. They're still working with
Speaker 1: the person to do the same work with the medicine
Speaker 1: on board or not. And that's one of the things
Speaker 1: that I think is really fascinating about psychedelic assisted psychotherapy
Speaker 1: is that it's not called psychotherapy assistant psychedelic work, right,
Speaker 1: It's called psychedelic assisted psychotherapy. What we're testing is is
Speaker 1: the medicine and catalyzing the psychotherapy experience. We would normally
Speaker 1: be offering someone and giving them or empowering them with
Speaker 1: the ability to take the healing process into their own
Speaker 1: hands and really start to work on themselves after the
Speaker 1: process is over. And that is absolutely what the data
Speaker 1: is showing, which is extremely promising, and it's directly contradictory
Speaker 1: to which I think is important to know the existing
Speaker 1: paradigm of mental health, which is, if you stop taking
Speaker 1: your SSRIs, you stop taking your antidepressants or whatever your
Speaker 1: daily prescription medicine for mental health symptoms, that your chances
Speaker 1: of relapse are almost inevitable, which is a really depressing statistic.
Speaker 1: In that case, let's turn to the question of mechanism.
Speaker 1: I would love to hear why you think this works.
Speaker 1: In general. When I have read about this and spoken
Speaker 1: to a few people, the magic word that is often
Speaker 1: deployed as though it solved all of our questions is
Speaker 1: the word neuroplasticity. That seems to me to be an
Speaker 1: opener rather than a closer. And I'm very curious to
Speaker 1: hear how you think about this. It's a great question,
Speaker 1: and I love the way that you look at neuroplasticity
Speaker 1: as an opener or not a closer. You're absolutely right
Speaker 1: when we think about psychedelic medicines on the whole taking
Speaker 1: like a ten thousand foot view kind of looking down
Speaker 1: at all the whole spectrum of medicines that we call
Speaker 1: psychedelic or psychoactive. What we're really looking at is a
Speaker 1: group or a class of medicines that are most accurately
Speaker 1: referred to as non specific amplifiers. So what this means
Speaker 1: is that if whatever you take into the experience, whether
Speaker 1: it's thoughts of self gratitude, self love, self compassion, and
Speaker 1: a therapeutic orientation towards healing yourself, or if you bring
Speaker 1: in shame and guilt and fear and a lack of
Speaker 1: safety in your environment or within yourself, whatever you bring in,
Speaker 1: that is what will be amplified by the psychedelic experience.
Speaker 1: So that is something that I think a lot of
Speaker 1: people don't necessarily understand, which is that the psychedelic medicine
Speaker 1: is non preferential to positive feelings or negative feelings. When
Speaker 1: you induce neuroplasticity in that context, you can train the
Speaker 1: brain to think differently. But if you are not prepared adequately,
Speaker 1: and you bring in a lot of negative self referential thinking,
Speaker 1: and you're not prepared to work on and you don't
Speaker 1: have the right support systems around you to work on it.
Speaker 1: You're not in a safe environment or all of the above,
Speaker 1: then you can actually increase the strength of wiring and
Speaker 1: neural connections in your brain to favor thinking about yourself
Speaker 1: in a negative way. You can actually this is completely
Speaker 1: fascinating and also a little scary. Scary, So, if I'm
Speaker 1: hearing you correctly, you know, in theory no one would
Speaker 1: think to do this. But if one ran this experiment,
Speaker 1: as it were, the opposite way, and you gave people
Speaker 1: psychedelics and put them in a connectly controlled setting and
Speaker 1: then made them feel terrible about themselves, you're suggesting that
Speaker 1: the drugs would have an amplifying effect such that you
Speaker 1: could maybe make people much much, much worse soft than
Speaker 1: they would have been without that, right, So you could
Speaker 1: amplify a PTSD experience perhaps, or a traumatic experience for example,
Speaker 1: or you could drive lack of self esteem or various
Speaker 1: other antisocial outcomes. Am I Am I hearing that correctly?
Speaker 1: And is there any experimental evidence for that? Mk Ultra
Speaker 1: as one example, right, I think that you know, we
Speaker 1: see that in some of the studies that the CIA
Speaker 1: conducted on unsuspecting folks who were given psychedelic medicine and
Speaker 1: an unsafe or an experimental environment that was not soothing
Speaker 1: or therapeutic, we saw very very negative outcomes, some of
Speaker 1: which resulted in suicide. So I naively say, no one
Speaker 1: would do this, But but you're telling me the CIA
Speaker 1: did in fact do this in the fifties and sixties
Speaker 1: and even into the early seventies when mkalto was going on, Right,
Speaker 1: there is evidence that this did occur, and that there
Speaker 1: were very substantial negative consequences from these kinds of conditions
Speaker 1: that even resulted in self harm. And I think that
Speaker 1: we be But the best example of this in a
Speaker 1: non experimental setting is the real world. Right. We see
Speaker 1: that people all the time. You know, there's estimated to
Speaker 1: be over a million new users of MDMA every year
Speaker 1: in the United States. Right, there's probably an almost equal amount,
Speaker 1: it's not more of psilocybin mushrooms. That is a huge
Speaker 1: number of people. These are people who are using this
Speaker 1: medicine recreationally in an generally unguided environment, and they're new
Speaker 1: to it. And so those are the people where we
Speaker 1: often see, like in my practice, where I'm one of
Speaker 1: the few psychiatrists that actually not only does psychotherapy, but
Speaker 1: I'm trained to help people navigate challenging psychedelic experiences, and
Speaker 1: I a big part of my practice is helping people
Speaker 1: recover from feeling retraumatized as a result of an unsafe
Speaker 1: or unpleasant psychedelic experience. So this is a very real
Speaker 1: thing that we see happen. Part of the reason why
Speaker 1: we actually started the Psychedelic News Hour on Clubhouse is
Speaker 1: to help educate the general community about how to avoid
Speaker 1: these very specific and unpleasant experiences that are easily avoidable,
Speaker 1: but are also easy to step into by accident if
Speaker 1: you're not paying attention to don't know what to look
Speaker 1: out for, but you're describing as something with very significant
Speaker 1: risks if administered in the wrong setting. And if people
Speaker 1: are using MDMA, for example, or psilocybin recreationally in the
Speaker 1: numbers that you're marking, you know, a million new users
Speaker 1: a year, that means almost everybody is using it in
Speaker 1: an unsupervised way, and presumably a lot of those people
Speaker 1: are going to have bad experiences. If that's right. It's
Speaker 1: a very different narrative than sometimes one hears while there
Speaker 1: is risk, and I appreciate you bringing off the point
Speaker 1: that we need to make sure we understand that there
Speaker 1: is risk from using any of these medicines to augment
Speaker 1: or alter our stated consciousness, as they are nonspecific amplifiers.
Speaker 1: We also should acknowledge that from an objective perspective, a
Speaker 1: scientific perspective, the risk of these medicines is substantially lower
Speaker 1: for most, probably ninety five ninety nine percent of people,
Speaker 1: even than it is with things like cocaine, opiates, benzodiazepines,
Speaker 1: and many other prescription medicines that are scheduled by the
Speaker 1: DA at a level that is lower and more accessible
Speaker 1: than psychedelic medicines. THC, for instance, is still Schedule one drug,
Speaker 1: so as MBMA and soil side. I think the question
Speaker 1: is that if these medicines are accessible to everyone through
Speaker 1: the legalization process that is happening for example in Massachusetts,
Speaker 1: it's happened into Denver and Oregon, in certain places in California,
Speaker 1: then are we doing a disservice to folks if we
Speaker 1: don't take the time to properly educate them about what
Speaker 1: the risks are and how to do it safely. Right,
Speaker 1: it almost seems to follow less of a cannabis path
Speaker 1: and more of I mean it's following the cannabis path
Speaker 1: to some extent, but it seems to be following at
Speaker 1: a larger level the absence only education path with sex. Right,
Speaker 1: It's like we know people from thousands of years of
Speaker 1: research of looking back into history, we know people used
Speaker 1: drugs to access altered states of consciousness, whether they came
Speaker 1: from plants or we're synthesized. We know people have sex
Speaker 1: to feel good, to bond with each other, to alter
Speaker 1: states of consciousness. We know that both of these types
Speaker 1: of experiences are very powerful for people, and they're going
Speaker 1: to seek them out no matter what. If we do
Speaker 1: not teach people how to have safe sex and what
Speaker 1: the potential consequences are of not having safe sex, then
Speaker 1: people are going to do what they're going to do unsafely, right,
Speaker 1: and it's going to cause a lot of problems. And
Speaker 1: we've seen that. And at the same time, if we
Speaker 1: teach people how to have safe sexual relations with people,
Speaker 1: how to use drugs safely, we see the positive outcomes there.
Speaker 1: So I think that what we ultimately the responsibility is
Speaker 1: not to disseminate these medicines as quickly as possible, regardless
Speaker 1: of how people use them, and let them just choose
Speaker 1: without having any guidance. I think the responsible thing to
Speaker 1: do that a lot of us agree on a clinical world,
Speaker 1: the medical world, and I believe also in the indigenous
Speaker 1: cultures that have been using this for a long time,
Speaker 1: is to combine our efforts and our wisdom from all
Speaker 1: sides and say, okay, here's your guidebook. Right here is
Speaker 1: the basics that you need to know, the few points
Speaker 1: coming in that you need to know to prepare adequately
Speaker 1: to have the best possible experience that you can have,
Speaker 1: because it really, you know, like you said, there is risk.
Speaker 1: And at the same time, if we take the time
Speaker 1: to say, spend you know, focus on three to five
Speaker 1: points that we can do to make sure that our
Speaker 1: environment is safe, we're feeling emotionally safe and comfortable and
Speaker 1: of course physically safe, spiritually safe, and we can have
Speaker 1: that for the course of our psychedelic experience, which is
Speaker 1: altering our state of consciousness and making us vulnerable for
Speaker 1: lack of a better term to shifting meaning about ourselves,
Speaker 1: than we can actually have a lot more control over
Speaker 1: that environment than we think. And thankfully, I would say,
Speaker 1: looking at the recreational use cases, thankfully we do not
Speaker 1: see as many harms being done by people misusing these
Speaker 1: medicines as we thought we might. However, I think the
Speaker 1: concern is that we might see more if recreationalization across
Speaker 1: the US spreads without the accompanying education is required. We'll
Speaker 1: be right back if I want to turn back for
Speaker 1: the last segment of our conversation to some of the
Speaker 1: scientific underpinnings of how this amplification and process works. And
Speaker 1: I guess what I'd like to do is ask you
Speaker 1: about this from two angles. The first is from your
Speaker 1: clinicians angle, to ask you what it's like when you
Speaker 1: are doing psychotherapy with a patient who is on a
Speaker 1: dose of psychedelics compared to what it's like to do
Speaker 1: the identical form of talk therapy with someone who isn't.
Speaker 1: And then after you've talked a little bit about that,
Speaker 1: maybe people talk about some of the underlying chemistry and
Speaker 1: how the brain chemistry might be facilitating those differences. So
Speaker 1: the first question is really what's it like for you
Speaker 1: in the room when you're doing the treatment. Does the
Speaker 1: patient feel different? That's a great question. So it's really
Speaker 1: just about tools when we think about the psychotherapy approach.
Speaker 1: My approach is the same, relatively the same, regardless of
Speaker 1: who I'm working with or what their condition is. It's
Speaker 1: empathy first, non judgment, radical acceptance, leaving my own baggage
Speaker 1: at the door. Whatever has been going on in my
Speaker 1: life that day or that week that might be stressful
Speaker 1: for me, I do not bring it into the session.
Speaker 1: I'm entirely focused on the individual I'm working with, listening
Speaker 1: to them and making sure that they know they're heard
Speaker 1: in the experience. And sometimes it involves holding hands, but
Speaker 1: it definitely involves direct eye to eye contact and practice
Speaker 1: of empathic listening where the client clearly is aware and
Speaker 1: acknowledges that they are being heard non judgmentally by me.
Speaker 1: That is the foundation of all psychotherapy, no matter what
Speaker 1: kind of therapy you do, whether it's psychedelic assisted or not.
Speaker 1: So in people who have had very mild to moderate
Speaker 1: trump for instance, or mild to moderate issues of depression,
Speaker 1: where I can engage with them enough and me letting
Speaker 1: them know that they're heard makes them feel safe enough
Speaker 1: that they can really dive into the experience and make
Speaker 1: positive change the results of that experience because they feel safe. However,
Speaker 1: when people have had very severe trauma or very severe
Speaker 1: episodes of depression, it's sometimes very difficult for those people
Speaker 1: to feel safe, and sometimes they haven't felt safe in
Speaker 1: the years, and they can't remember when the last time
Speaker 1: was that they did feel safe. And no matter what
Speaker 1: I do emotionally, empathetically, even holding hands or giving them
Speaker 1: something like Apollo or other tools that work to help
Speaker 1: settle the body and boost the vagel parasympathetic nervous system
Speaker 1: activity to help facilitate recovery and bonding and engagement in
Speaker 1: the session, it just doesn't quite cut it, and they
Speaker 1: can't lean into the experience. So for those people, when
Speaker 1: we give them a psychedelic medicine like ketamine as an example,
Speaker 1: which is I want to bring up because it's the
Speaker 1: only currently legal psychedelic medicine that we have access to,
Speaker 1: and it's very short acting and very powerful and is
Speaker 1: safe for clients to actually use at home, we can
Speaker 1: see that the medicine number one is catalyzing the safety
Speaker 1: response for these people. So more importantly than anything else,
Speaker 1: what we hear from our clients is that when they
Speaker 1: they do therapy with us without the medicine and then
Speaker 1: they add the medicine, they often say, I haven't felt
Speaker 1: this safe in my recent memory, I don't remember feeling
Speaker 1: this way about myself without judging myself since childhood. I
Speaker 1: haven't felt my constant ruminative negative and thoughts stop or
Speaker 1: pause for as long as I can remember. And as
Speaker 1: soon as they have that experience, it's like a wake
Speaker 1: up call because they remember a feeling, they remember a
Speaker 1: state of being that they had before. It's familiar, but
Speaker 1: it's something that they forgot how to access because of
Speaker 1: a bunch of other stuff that happened in the meantime
Speaker 1: that interfere. And now once they're reconnecting with that part
Speaker 1: of themselves and they realize that something they can access,
Speaker 1: then we use the medicine as a tool to teach them,
Speaker 1: not that they require the medicine to access that state
Speaker 1: every time they want to get there, but that the
Speaker 1: medicine is a teacher and a tool to show them
Speaker 1: experientially that they can feel safe and that they let
Speaker 1: me ask you about that's totally fascinating, and let me
Speaker 1: ask you about what you think is happening. So when
Speaker 1: the person then says, oh, I remember what it was
Speaker 1: like to feel safe, and now I can get back
Speaker 1: to that again. Is it your view that there was
Speaker 1: a kind of neural pathway that was it was always
Speaker 1: it always existed, It still existed, but it was difficult
Speaker 1: to access it, and you are helping the person to
Speaker 1: access it and then learn to access it without your
Speaker 1: presence or is that too literal? On that account, You're
Speaker 1: not necessarily creating a new pathway. You're just opening an
Speaker 1: access point to a pathway that already existed at an
Speaker 1: earlier life stage, but that was kind of thwarted. That's
Speaker 1: exactly right. And going back as far as Hippocrates is
Speaker 1: thought to be the founder of Western medicine, Hippocrates said
Speaker 1: that healing comes from I'm on a butcher's quote, but
Speaker 1: the healing comes from within us and within the individual.
Speaker 1: That it is not for us as clinicians to be
Speaker 1: the to identify as the source of a patient or
Speaker 1: client's healing experience. It is for us to use the
Speaker 1: tools we have access to and use our own healing
Speaker 1: abilities to facilitate that person. It's empowerment to learn that
Speaker 1: they can heal themselves and that is the source of
Speaker 1: their healing. Is it possible for that small number of
Speaker 1: patients whose trauma was introduced already in the earliest stages
Speaker 1: of childhood that for such a person, the approach might
Speaker 1: be less effective because that person might never have managed
Speaker 1: to create the sense of safety or security that you're
Speaker 1: describing that you're trying to access. But that might not
Speaker 1: be the same as building that from scratch if you
Speaker 1: didn't have it. That's a great point. I'm sure there
Speaker 1: is a subset of people that has a much more
Speaker 1: difficult time finding that familiar feeling of safety from the
Speaker 1: past and reconnecting with that. There are also people who
Speaker 1: connect with it very easily, and then there's everyone in between.
Speaker 1: I think that, interestingly enough, it doesn't necessarily matter when
Speaker 1: the trauma has happened. And the reason why I say
Speaker 1: that is because of the work of Rachel Yehuda from
Speaker 1: Mount Sinai over the last thirty or four years showed
Speaker 1: that these changes that trauma induces to our bodies are
Speaker 1: actually store not just in the way that our neurons
Speaker 1: talk to each other, like Eric Candell found, but they're
Speaker 1: actually stored all the way down into the epigenetic code,
Speaker 1: which is the code that's on top of our DNA
Speaker 1: that tells every cell in our body to either increase
Speaker 1: or decrease expression of certain proteins like CORSO, which we're
Speaker 1: all familiar with. This one of the most important stress
Speaker 1: response proteins. And so if you've experienced trauma in a
Speaker 1: certain way, that trauma does not even have to be
Speaker 1: from your own lifetime. It can be trauma from your parents,
Speaker 1: it can be trauma from your grandparents that they experienced
Speaker 1: that caused changes to their geniue expression patterns as what
Speaker 1: was likely an evolutionary coping mechanism to help them adapt
Speaker 1: stress in their environment, but they never actually processed it
Speaker 1: or sorted it out when they were restored to an
Speaker 1: environment of safety, and so they ended up passing on
Speaker 1: the epigenetic changes or these expression pattern gene expression pattern
Speaker 1: changes to their offspring that they were born with, and
Speaker 1: that results now we know, thanks to Rachel's work, in
Speaker 1: a predisposition to developing PTSD and other mental health disorders
Speaker 1: and potentially even metabolic disorder. But whether or not psychedelic
Speaker 1: medicine assisted psychotherapy is less equipped to be able to
Speaker 1: treat something like that, I think it's still up for debate.
Speaker 1: I think what we see is that it actually works
Speaker 1: fairly well on all of these folks, whether or not
Speaker 1: they remember a traumatic event specifically or not, whether or
Speaker 1: not they can recall an event in their specific lifetime
Speaker 1: or not. I think, going back to your original question,
Speaker 1: what we're about the mechanism, what we're seeing happen neural biologically,
Speaker 1: is that these medicines are facilitating activation of the five
Speaker 1: HT two, a serotonin receptor that is highly localized in
Speaker 1: the emotional cortex, but it's in our cortex as a
Speaker 1: whole of our brains, which is where all our memories
Speaker 1: are stored, all our memories about how we know ourselves
Speaker 1: in the world are stored, or turns out from a
Speaker 1: lot of other work with antidepressant medications like SSRIs which
Speaker 1: also increase serotonin at those receptors, and psychedelic work from
Speaker 1: Franz Voldwire in Switzerland with LSD and silcybin, that it's
Speaker 1: verily clear at this point that the activating that receptor
Speaker 1: in a burst manner with a burst of serotonin, not
Speaker 1: constant serotonin, but a burst which psychedelic medicine facilitate and
Speaker 1: meaningful experiences facilitate, induces a state of perceptual shift in meaning,
Speaker 1: or an opportunity to change the way we perceive meaning
Speaker 1: from our environment and from ourselves. So if you think
Speaker 1: about the nonspecific amplifier idea, when you take a psychedelic medicine,
Speaker 1: you can change your meaning of the world to be
Speaker 1: potentially more positive or more negative or stay the same
Speaker 1: based on the environment that you go into, your inside
Speaker 1: set and your outside environment setting that you bring into
Speaker 1: that experience, and you have a setting of safety, what
Speaker 1: happens is we can become aware of things that have
Speaker 1: happened in the past, things that possibly have been buried
Speaker 1: beneath our memory, or things that have even happened in
Speaker 1: past generational trauma that we did not know about or
Speaker 1: to not know much about. And then people have the opportunity,
Speaker 1: a very unique, time limited opportunity to re experience and
Speaker 1: go back through their lives the most salient and critical
Speaker 1: events that were most meaningful to them, that to them
Speaker 1: made them who they were, and reevaluate those from a
Speaker 1: standpoint of radical safety and non judgment, so that we
Speaker 1: can understand that these events or experiences that we thought
Speaker 1: and made us who we are are just experiences that
Speaker 1: we make who we are out of. One last question
Speaker 1: about this, Dave, because what you're saying is very, very
Speaker 1: rich and fascinating and probably deserves its own a further conversation.
Speaker 1: It's interesting to me that one of the things that happened,
Speaker 1: you know, sort of roughly speaking, in the eighties and nineties,
Speaker 1: with the rise of interest in the underlying neurochemistry as
Speaker 1: a determinant of mental wellbeing, is that there was a
Speaker 1: simultaneous reduction in respect for talk therapy as an effective
Speaker 1: means of improving people's mental wellbeing. In what you're saying,
Speaker 1: where you describe the serotonin burst creating the possibility of
Speaker 1: a perceptual shift, you set a perceptual shift in meaning,
Speaker 1: and then you described the psychotherapeutic process in terms that
Speaker 1: would have been extremely attractive to classic talk therapy addict.
Speaker 1: It's really going all the way back to Freud, in
Speaker 1: which the human being with God and conversation and with
Speaker 1: another human being is achieving shifts in meaning. And on
Speaker 1: that account, the non specific amplification of psychedelics works because
Speaker 1: talk therapy works. It works, not because it's in any
Speaker 1: way independent of and that's what makes it go. And
Speaker 1: so I guess I'm wondering if you would maybe close
Speaker 1: with just some reflection on you know, has this science
Speaker 1: gone a pretty far distance towards rehabilitating the idea of
Speaker 1: talk therapy as meaning making. But through this mechanism of
Speaker 1: amplification preacing the probability that that shift in meaning making
Speaker 1: could take place more reliably, more rapidly, and for a
Speaker 1: larger number of patients. Absolutely, And I think that since
Speaker 1: you brought it up just to jtapose what was happening
Speaker 1: in the Freudian era of psychotherapy versus the current era,
Speaker 1: I think what is really interesting is that the original
Speaker 1: Freudian approach in large part was about the therapist making
Speaker 1: meeting for the patient. Right, So it was a very
Speaker 1: what we call now a directive approach and in the
Speaker 1: current paradigm, but I think that what psychedelic medicine assisted
Speaker 1: psychotherapy has taught us in the therapy world is really
Speaker 1: emphasizing the importance of safety to an autonomy. In an autonomy,
Speaker 1: and by atony, I mean like agency in the individual
Speaker 1: clients experience, The client that seeks to be healed has
Speaker 1: to be the person where the ideas about healing come from. Right,
Speaker 1: then we as particularly in the psychedelic space, to a
Speaker 1: non directive approach where we guide the individual insight to
Speaker 1: discover from themselves, what they want out of their healing
Speaker 1: process and what their inner voice for their intuition is
Speaker 1: telling them they want to and then we work with
Speaker 1: them to sort out what that means. And so instead
Speaker 1: of meaning making for them, which is the old way
Speaker 1: of thinking about it from the FRONTI perspective, we are
Speaker 1: teaching them how to make meaning for themselves with the
Speaker 1: medicine as a facilitator and tool. And that is really
Speaker 1: the transformation that I think mental health is going to
Speaker 1: take in the future. That's a very rich, attractive vision.
Speaker 1: I think it deserves greater exploration and thought beyond what
Speaker 1: we can do here. But I really want to thank
Speaker 1: you for an exemplary clarity in your description, Dave, in
Speaker 1: helping us see both the practical side and the scientific side,
Speaker 1: and the underlying theories of mechanism that are emerging, and
Speaker 1: helping us understand some of the research. It was a
Speaker 1: really fantastic conversation. I learned a huge amount and I'm
Speaker 1: really grateful to you. Thank you, No problem, my pleasure.
Speaker 1: We'll be back in a moment. Listening to doctor Dave Rabin,
Speaker 1: I was genuinely fascinated and in certain ways really surprised
Speaker 1: by some of the conclusions of his analysis. First, very helpfully,
Speaker 1: he defines psychedelics as non specific amplifiers, that is, substances
Speaker 1: that amplify a series of psychological processes, either to encourage
Speaker 1: and amplify good results such as empathy, connection, and safety,
Speaker 1: and thereby to help us overcome bad trauma, but also
Speaker 1: neutrally as capable of amplifying negative experiences. And as he
Speaker 1: pointed out, that's not just pure abstract theory. There actually
Speaker 1: is some evidence from unsanctioned CIA experiments with psychedelics from
Speaker 1: the nineteen fifties to the nineteen seventies that suggests some
Speaker 1: very bad results when the amplification was negative. From this
Speaker 1: analysis of psychedelics as non specific amplifiers, lots of fascinating
Speaker 1: things emerge. One is the tremendous importance of anyone who's
Speaker 1: going to use psychedelics doing it in a context and
Speaker 1: a setting that will amplify in a positive way and
Speaker 1: not in a negative way. That's a topic that deserves
Speaker 1: much more conversation in the course of the policy discussion
Speaker 1: about the potential legalization of psychedelics that's going on right now,
Speaker 1: And it suggests that the paradigm that many of us
Speaker 1: have been expecting, where gradual legalization in a handful of
Speaker 1: symbolic venues leads to a broad societal reconsideration may have
Speaker 1: to be rethought through the lens of the question of
Speaker 1: what harm can be done using psychedelics alongside the question
Speaker 1: of the benefits. Now, doctor Abin was very clear that
Speaker 1: in his view, the positive capacities of psychedelics vastly outweigh
Speaker 1: their negative capabilities. At the same time, he was open
Speaker 1: to the idea that we ought to think carefully about
Speaker 1: context and setting in order to assure that all of
Speaker 1: that happens. Then, on the question of the fundamental underlying science,
Speaker 1: I was truly fascinated to hear that the goal of
Speaker 1: the non specific amplification is actually to facilitate, through bursts
Speaker 1: of serotonin, a change in perception that counts as in
Speaker 1: his view, meaning making. Those shifts in meaning making, according
Speaker 1: to the theory that doctor Abin is expanding, are shifts
Speaker 1: that can fundamentally alter in positive ways the way we
Speaker 1: experience the world, not just during those experiences, but more
Speaker 1: broadly and in the follow on. This mechanism is still
Speaker 1: at the stage of being a hypothesis, but It's fascinating
Speaker 1: hypothesis and one very much worth exploring in months and
Speaker 1: years ahead. Broadly speaking, I think it's fair to say
Speaker 1: that the United States is undergoing the beginnings of a
Speaker 1: substantial shift in public attitudes and understanding towards psychedelics, and
Speaker 1: this conversation helped me tremendously to begin to understand some
Speaker 1: of the working theories and some of the practices that
Speaker 1: are being used by practitioners in the field to try
Speaker 1: to make sense of how our mental health might be
Speaker 1: improved and engaged through psychedelic assisted psychotherapy. Until the next
Speaker 1: time I speak to you, breathe deep, think deep thoughts,
Speaker 1: and have a little fun. Deep Background is brought to
Speaker 1: you by Pushkin Industries. Our producer is Mola Board, our
Speaker 1: engineer is ben Toalliday, and our showrunner is Sophie Crane mckibbon.
Speaker 1: Editorial support from noahm Osband. Theme music by Luis Gara
Speaker 1: at Pushkin. Thanks to Mia Lobell, Julia Barton, Lydia Jeancott,
Speaker 1: Heather Fain, Carlie Migliori, Maggie Taylor, Eric Sandler, and Jacob Weissberg.
Speaker 1: You can find me on Twitter at Noah R Feldman.
Speaker 1: I also write a column for Bloomberg Opinion, which you
Speaker 1: can find at bloomberg dot com slash Feldman. To discover
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