WEBVTT - Psychedelic Medicine 0:00:15.356 --> 0:00:24.236 Pushkin from Pushkin Industries. This is Deep Background, the show 0:00:24.236 --> 0:00:27.876 where we explore the stories behind the stories in the news. 0:00:28.396 --> 0:00:33.556 I'm noaffeldment. One of my favorite conversations on Deep Background 0:00:33.556 --> 0:00:37.516 this year, and judging by downloads, one of your favorites too, 0:00:38.196 --> 0:00:42.116 was my interview with Professor Carl Hart, a Columbia University 0:00:42.196 --> 0:00:46.356 neuroscientist who argues that our policies towards recreational drug use 0:00:46.796 --> 0:00:51.396 are far more harmful than the substances themselves. In today's episode, 0:00:51.436 --> 0:00:55.156 we're going to approach related issues, but from a different angle. 0:00:55.676 --> 0:00:59.676 We're going to talk about the emergent research on the 0:00:59.756 --> 0:01:05.556 efficacy of psychedelic assisted psychotherapy and the associated question of 0:01:05.716 --> 0:01:10.116 recreational use of psychedelics. There's been an explosion of research, 0:01:10.276 --> 0:01:13.036 which we're going to hear about shortly from one of 0:01:13.076 --> 0:01:17.036 the leading experts on the top. That's doctor David Raven, 0:01:17.196 --> 0:01:22.676 who's a neuroscientist aboard certified psychiatrist who does psychedelic assisted 0:01:22.716 --> 0:01:26.276 psychotherapy and is also the co founder and chief innovation 0:01:26.316 --> 0:01:30.116 officer at Apollo Neuroscience. He's going to talk to us 0:01:30.156 --> 0:01:33.116 about some of the new research in the field, what 0:01:33.276 --> 0:01:37.876 the mechanisms are for why and how psychedelic assisted psychotherapy 0:01:37.956 --> 0:01:40.636 seems to be working, and what it tells us about 0:01:40.636 --> 0:01:49.436 the brain and its capacities to heal in general. Dave, 0:01:49.556 --> 0:01:52.596 thank you so much for joining me here on deep background. 0:01:53.236 --> 0:01:56.796 I want to begin with some research that's gotten a 0:01:56.836 --> 0:02:00.836 lot of attention in the last several months, and that 0:02:01.036 --> 0:02:08.996 is research that looks at new psychedelic assisted psychotherapy approach 0:02:10.236 --> 0:02:13.916 and at least so far, seems to produce some extraordinarily 0:02:13.956 --> 0:02:19.876 impressive experimental results. And this is your field, and you 0:02:20.076 --> 0:02:22.076 both study it at a scientific level and also are 0:02:22.076 --> 0:02:24.716 a practitioner. I want to invite you to start by 0:02:24.716 --> 0:02:28.636 saying what you think of as the most impressive recent results, 0:02:29.196 --> 0:02:31.276 and then we'll talk in a little bit more depth 0:02:31.316 --> 0:02:34.276 about what those studies show. Sounds good, Yeah, I appreciate 0:02:34.316 --> 0:02:36.796 you for again for having me. Always a pleasure to 0:02:36.796 --> 0:02:39.916 share this conversation because I think that we're at a 0:02:39.996 --> 0:02:43.796 point in mental health in particular where we're starting to 0:02:44.076 --> 0:02:48.476 identify tools to treat mental illness that are reaching a 0:02:48.556 --> 0:02:51.676 level of success in terms of management of symptoms and 0:02:51.836 --> 0:02:55.836 remission long term remission of mental illness in particular like 0:02:55.916 --> 0:02:59.076 depression and anxiety that we haven't ever seen in the 0:02:59.116 --> 0:03:01.836 field of mental health, and so I think one of 0:03:01.836 --> 0:03:05.716 the things that's really exciting and also challenging about psychedelic 0:03:05.756 --> 0:03:10.196 assistant psychotherapy is that it is a full paradigm shift 0:03:10.236 --> 0:03:13.236 away from the current way that we treatment to illness 0:03:13.236 --> 0:03:17.916 to one in which we really focus on short courses 0:03:17.916 --> 0:03:22.556 of treatment. That for example, with MDMA, which is three 0:03:22.596 --> 0:03:27.036 four methylene dioxy methymphetamine, which I would say is beyond 0:03:27.276 --> 0:03:30.516 the experimental phase, it's well into the FDA phase through 0:03:30.556 --> 0:03:35.516 trials demonstrating tremendous results can vary consistently. What we're seeing 0:03:35.796 --> 0:03:41.676 is that with just three doses of MDMA with two 0:03:41.756 --> 0:03:46.036 therapists present over the course of twelve weeks of psychotherapy, 0:03:46.436 --> 0:03:50.356 those three doses of MBMA in people who are completely 0:03:50.396 --> 0:03:54.996 treatment resistant with PTSD post traumatic stress disorder, having tried 0:03:55.076 --> 0:03:57.916 everything under the sun, and never having had significant symptom 0:03:57.956 --> 0:04:00.956 remission or relief that exists that lasts over the long 0:04:01.076 --> 0:04:06.436 term without daily medication management. These people have three doses 0:04:06.436 --> 0:04:10.076 of MDMA and twelve weeks of psychotherapy. The pulsebo controlled 0:04:10.076 --> 0:04:12.516 trial in it right after the treatment is over twelve 0:04:12.516 --> 0:04:16.396 weeks and two months out something like fifty five percent 0:04:16.516 --> 0:04:20.076 of these people are completely in remission. They're no longer 0:04:20.156 --> 0:04:25.236 meeting diagnostic criteria for PTSD. However, what's even more exciting 0:04:25.356 --> 0:04:27.756 is that one year out, because we really care about 0:04:27.796 --> 0:04:31.876 durability of response, right one year out, we see that 0:04:32.076 --> 0:04:34.596 sixty seven percent of these people are no longer meeting 0:04:34.636 --> 0:04:40.196 diagnostic criteria for PTSD without any additional treatment. So that's 0:04:40.236 --> 0:04:42.836 what's really incredible is that these people seem to be 0:04:43.996 --> 0:04:48.316 able to be taught, using the medicine in an accelerated fashion, 0:04:48.436 --> 0:04:51.916 how to manage their own healing process more effectively, and 0:04:51.956 --> 0:04:56.276 then continue that process after the treatment is effectively finished. 0:04:57.276 --> 0:05:00.316 Let's dive into this study that you're talking about, and 0:05:00.356 --> 0:05:02.756 this comes out of Johns Hopkins, if I'm not mistaken, 0:05:02.756 --> 0:05:04.836 although I think there's some other affiliated centers that have 0:05:04.836 --> 0:05:07.356 been doing similar research. Is that right? So this study 0:05:07.476 --> 0:05:10.796 is not explicitly at John's Opkins. This is a international 0:05:10.796 --> 0:05:15.716 trial actually, so so the trial that is centered at Hopkins, 0:05:15.716 --> 0:05:18.156 which is equally exciting, I would say, but is at 0:05:18.156 --> 0:05:20.836 a slightly earlier stage in terms of the FDA. I 0:05:20.876 --> 0:05:23.916 believe it's in phase two, not phase three. Is a 0:05:23.956 --> 0:05:28.196 psilicided trial and that is used for predominantly for depression. 0:05:28.396 --> 0:05:31.196 It's equally exciting work. But what we're seeing and the 0:05:31.236 --> 0:05:34.196 study that I mentioned earlier, that's the furthest along is 0:05:34.236 --> 0:05:38.156 the MDMA for Treatment Resistant PTSC study. That's an international 0:05:38.236 --> 0:05:41.996 trial at i think over twenty clinical sites that are 0:05:42.116 --> 0:05:45.916 distributed throughout Canada, the US, and the EU and Israel. 0:05:46.916 --> 0:05:49.516 Thank you, so thanks for that clarification. Let's talk about 0:05:49.516 --> 0:05:52.036 this international trial in that case. So a question that 0:05:52.516 --> 0:05:55.196 immediately came to my mind when I first read about 0:05:55.236 --> 0:06:00.436 this research is the question of placebo effect and double blinding. 0:06:00.476 --> 0:06:02.756 I think the study is billed as double blind, which 0:06:02.796 --> 0:06:06.436 means that in principle, neither the person receiving the treatment 0:06:06.556 --> 0:06:10.636 nor the psychotherapist who's doing the psychotherapy sessions is supposed 0:06:10.636 --> 0:06:13.196 to know whether the person is in the target group 0:06:13.236 --> 0:06:16.636 who has received MDMA or is not. That is correct. 0:06:16.876 --> 0:06:20.356 So how is that possible? I mean, is it conceivable 0:06:20.476 --> 0:06:24.236 that a patient would not know that he or she 0:06:24.756 --> 0:06:28.156 was on MDMA at the dosage level that is being 0:06:28.236 --> 0:06:31.356 used in the study, And is it conceivable that the 0:06:31.356 --> 0:06:33.796 therapist would not Yeah, it's a great question, and I 0:06:33.836 --> 0:06:37.236 think this is a question that has always been a 0:06:37.356 --> 0:06:40.476 challenging one to answer when we're looking at these kinds 0:06:40.516 --> 0:06:43.316 of studies, and also just to take a step back 0:06:43.356 --> 0:06:47.156 when we're looking at any study of a complex treatment 0:06:47.236 --> 0:06:51.036 program or a natural treatment, natural treatment program like a 0:06:51.076 --> 0:06:55.316 complimentary or alternative medicine program, acupuncture being a great example. 0:06:55.676 --> 0:06:59.956 It's very, very difficult, notoriously difficult, to do double blind 0:06:59.956 --> 0:07:02.276 pall cebo control trials because how do you create an 0:07:02.316 --> 0:07:06.596 adequate placebo or active control group that is consistent with 0:07:06.636 --> 0:07:11.396 the blinding process. I think MAPS Multidisciplinary Association for Psychedelic 0:07:11.396 --> 0:07:14.356 Studies that is running the MBMA trial and has run 0:07:14.476 --> 0:07:17.036 and funded most of the MBMA trials to date through 0:07:17.076 --> 0:07:20.716 the FDA, have worked very closely with the FDA to 0:07:20.796 --> 0:07:26.196 come up with a valid and clinically acceptable to cebo group, 0:07:26.396 --> 0:07:28.876 and it's evolved over time. It wasn't always the way 0:07:28.876 --> 0:07:31.076 it is today. I think I believe that in the 0:07:31.116 --> 0:07:35.476 previous trials they were using niacin, which causes a warmth 0:07:35.516 --> 0:07:38.516 and a flushing that has a lot of the physical 0:07:38.596 --> 0:07:42.476 feelings that are similar to those that are experienced with MBMA, 0:07:42.516 --> 0:07:46.396 without the emotional component as much. And I believe that 0:07:46.476 --> 0:07:49.436 in the current trial they're using a sub threshold dose 0:07:49.516 --> 0:07:52.236 of MBMA, So they're using a dose of MDMA that's 0:07:52.556 --> 0:07:55.636 lower than what would be required to provide an active 0:07:56.156 --> 0:07:59.036 peak effect, and there's a dosing threshold that we know 0:07:59.116 --> 0:08:02.036 of that's critical to achieve that peak effect. But I 0:08:02.076 --> 0:08:04.876 think the data speaks for itself because when you look 0:08:04.876 --> 0:08:07.796 at the Phase two data, which comes from the first 0:08:07.956 --> 0:08:11.516 one hundred plus veterans were mostly veterans that were treated 0:08:11.556 --> 0:08:14.876 with PTSD, you can look at the placebo groups data 0:08:14.956 --> 0:08:18.636 and both groups, by the way, are getting two therapists 0:08:18.676 --> 0:08:21.796 for the entire treatment course. They're getting the same therapy sessions, 0:08:21.836 --> 0:08:25.756 the same eight hour therapy sessions, with sleeping over afterwards, 0:08:25.756 --> 0:08:29.196 with constant care and attention. And the point of the 0:08:29.236 --> 0:08:33.476 treatment is that the therapy itself is actually very potent. Right, 0:08:33.756 --> 0:08:39.516 So even in the people who received completely inactive placebo 0:08:39.636 --> 0:08:43.756 or MBMA that was below threshold, these people just with 0:08:43.836 --> 0:08:46.436 the excellent therapy alone in the trial, with these two 0:08:46.476 --> 0:08:50.556 therapists who are extremely well trained and extremely trauma oriented 0:08:50.556 --> 0:08:53.996 in their delivery of care, we're seeing a roughly twenty 0:08:54.036 --> 0:09:00.076 seven percent remission rate in terms of people having significant 0:09:00.116 --> 0:09:02.836 reduction and symptoms after the treatment. Is completed in about 0:09:02.836 --> 0:09:06.516 two months out. However, I think the real tell is 0:09:07.036 --> 0:09:09.436 that when you go and look at one year out, 0:09:09.716 --> 0:09:13.796 the folks who received active MBMA have an increased rate 0:09:13.796 --> 0:09:15.836 of recovery, so it goes from fifty five percent to 0:09:15.876 --> 0:09:18.916 sixty seven percent symptom free. When you go back and 0:09:18.956 --> 0:09:22.156 look at the placebo group, that group actually had about 0:09:22.156 --> 0:09:26.356 fifty percent of those people relapse into symptomatic PTSD. So 0:09:26.756 --> 0:09:29.436 are cymo therapists able to tell that a patient or 0:09:29.476 --> 0:09:33.716 a research subject has received MBMA versus a placebo It's possible. 0:09:34.076 --> 0:09:37.076 It is hard to tell. Sometimes in the therapeutic experience, 0:09:37.116 --> 0:09:39.716 it is possible that they know, but the delivery of 0:09:39.756 --> 0:09:42.316 therapy is the same either way. They're still working with 0:09:42.356 --> 0:09:44.436 the person to do the same work with the medicine 0:09:44.436 --> 0:09:46.516 on board or not. And that's one of the things 0:09:46.556 --> 0:09:50.476 that I think is really fascinating about psychedelic assisted psychotherapy 0:09:50.796 --> 0:09:54.236 is that it's not called psychotherapy assistant psychedelic work, right, 0:09:54.236 --> 0:09:58.236 It's called psychedelic assisted psychotherapy. What we're testing is is 0:09:58.276 --> 0:10:02.236 the medicine and catalyzing the psychotherapy experience. We would normally 0:10:02.276 --> 0:10:05.876 be offering someone and giving them or empowering them with 0:10:05.956 --> 0:10:09.356 the ability to take the healing process into their own 0:10:09.396 --> 0:10:12.516 hands and really start to work on themselves after the 0:10:12.556 --> 0:10:15.876 process is over. And that is absolutely what the data 0:10:15.916 --> 0:10:19.316 is showing, which is extremely promising, and it's directly contradictory 0:10:19.316 --> 0:10:22.436 to which I think is important to know the existing 0:10:22.436 --> 0:10:24.676 paradigm of mental health, which is, if you stop taking 0:10:24.676 --> 0:10:27.596 your SSRIs, you stop taking your antidepressants or whatever your 0:10:28.076 --> 0:10:32.076 daily prescription medicine for mental health symptoms, that your chances 0:10:32.076 --> 0:10:37.436 of relapse are almost inevitable, which is a really depressing statistic. 0:10:37.756 --> 0:10:41.156 In that case, let's turn to the question of mechanism. 0:10:41.436 --> 0:10:45.876 I would love to hear why you think this works. 0:10:45.916 --> 0:10:48.676 In general. When I have read about this and spoken 0:10:48.676 --> 0:10:52.116 to a few people, the magic word that is often 0:10:52.156 --> 0:10:55.116 deployed as though it solved all of our questions is 0:10:55.116 --> 0:10:57.876 the word neuroplasticity. That seems to me to be an 0:10:57.876 --> 0:11:00.756 opener rather than a closer. And I'm very curious to 0:11:00.796 --> 0:11:03.316 hear how you think about this. It's a great question, 0:11:03.396 --> 0:11:06.556 and I love the way that you look at neuroplasticity 0:11:06.556 --> 0:11:08.716 as an opener or not a closer. You're absolutely right 0:11:09.236 --> 0:11:12.596 when we think about psychedelic medicines on the whole taking 0:11:12.636 --> 0:11:14.916 like a ten thousand foot view kind of looking down 0:11:14.996 --> 0:11:18.356 at all the whole spectrum of medicines that we call 0:11:18.516 --> 0:11:23.596 psychedelic or psychoactive. What we're really looking at is a 0:11:23.636 --> 0:11:29.396 group or a class of medicines that are most accurately 0:11:29.436 --> 0:11:34.156 referred to as non specific amplifiers. So what this means 0:11:34.396 --> 0:11:38.996 is that if whatever you take into the experience, whether 0:11:39.076 --> 0:11:43.076 it's thoughts of self gratitude, self love, self compassion, and 0:11:43.196 --> 0:11:46.556 a therapeutic orientation towards healing yourself, or if you bring 0:11:46.596 --> 0:11:50.996 in shame and guilt and fear and a lack of 0:11:51.036 --> 0:11:54.596 safety in your environment or within yourself, whatever you bring in, 0:11:54.956 --> 0:11:58.796 that is what will be amplified by the psychedelic experience. 0:11:58.836 --> 0:12:01.076 So that is something that I think a lot of 0:12:01.116 --> 0:12:04.876 people don't necessarily understand, which is that the psychedelic medicine 0:12:05.076 --> 0:12:10.756 is non preferential to positive feelings or negative feelings. When 0:12:10.756 --> 0:12:15.676 you induce neuroplasticity in that context, you can train the 0:12:15.756 --> 0:12:19.876 brain to think differently. But if you are not prepared adequately, 0:12:20.236 --> 0:12:23.876 and you bring in a lot of negative self referential thinking, 0:12:24.116 --> 0:12:26.476 and you're not prepared to work on and you don't 0:12:26.476 --> 0:12:28.476 have the right support systems around you to work on it. 0:12:28.516 --> 0:12:30.436 You're not in a safe environment or all of the above, 0:12:31.036 --> 0:12:36.436 then you can actually increase the strength of wiring and 0:12:36.476 --> 0:12:40.556 neural connections in your brain to favor thinking about yourself 0:12:40.596 --> 0:12:45.516 in a negative way. You can actually this is completely 0:12:45.556 --> 0:12:49.596 fascinating and also a little scary. Scary, So, if I'm 0:12:49.596 --> 0:12:51.956 hearing you correctly, you know, in theory no one would 0:12:51.956 --> 0:12:54.396 think to do this. But if one ran this experiment, 0:12:54.876 --> 0:12:58.116 as it were, the opposite way, and you gave people 0:12:58.836 --> 0:13:01.436 psychedelics and put them in a connectly controlled setting and 0:13:01.476 --> 0:13:06.356 then made them feel terrible about themselves, you're suggesting that 0:13:06.396 --> 0:13:09.476 the drugs would have an amplifying effect such that you 0:13:09.516 --> 0:13:12.276 could maybe make people much much, much worse soft than 0:13:12.276 --> 0:13:14.636 they would have been without that, right, So you could 0:13:14.716 --> 0:13:18.316 amplify a PTSD experience perhaps, or a traumatic experience for example, 0:13:18.916 --> 0:13:24.356 or you could drive lack of self esteem or various 0:13:24.356 --> 0:13:27.996 other antisocial outcomes. Am I Am I hearing that correctly? 0:13:27.996 --> 0:13:31.116 And is there any experimental evidence for that? Mk Ultra 0:13:31.716 --> 0:13:34.516 as one example, right, I think that you know, we 0:13:34.676 --> 0:13:37.796 see that in some of the studies that the CIA 0:13:37.956 --> 0:13:42.516 conducted on unsuspecting folks who were given psychedelic medicine and 0:13:42.556 --> 0:13:47.836 an unsafe or an experimental environment that was not soothing 0:13:47.956 --> 0:13:51.876 or therapeutic, we saw very very negative outcomes, some of 0:13:51.916 --> 0:13:54.916 which resulted in suicide. So I naively say, no one 0:13:54.916 --> 0:13:56.596 would do this, But but you're telling me the CIA 0:13:56.836 --> 0:13:59.796 did in fact do this in the fifties and sixties 0:13:59.916 --> 0:14:03.276 and even into the early seventies when mkalto was going on, Right, 0:14:03.396 --> 0:14:06.156 there is evidence that this did occur, and that there 0:14:06.156 --> 0:14:09.676 were very substantial negative consequences from these kinds of conditions 0:14:09.996 --> 0:14:12.876 that even resulted in self harm. And I think that 0:14:12.916 --> 0:14:15.516 we be But the best example of this in a 0:14:15.636 --> 0:14:18.916 non experimental setting is the real world. Right. We see 0:14:18.956 --> 0:14:22.556 that people all the time. You know, there's estimated to 0:14:22.596 --> 0:14:25.956 be over a million new users of MDMA every year 0:14:25.996 --> 0:14:29.436 in the United States. Right, there's probably an almost equal amount, 0:14:29.436 --> 0:14:33.796 it's not more of psilocybin mushrooms. That is a huge 0:14:34.076 --> 0:14:36.236 number of people. These are people who are using this 0:14:36.356 --> 0:14:41.396 medicine recreationally in an generally unguided environment, and they're new 0:14:41.436 --> 0:14:45.356 to it. And so those are the people where we 0:14:45.476 --> 0:14:48.116 often see, like in my practice, where I'm one of 0:14:48.116 --> 0:14:51.676 the few psychiatrists that actually not only does psychotherapy, but 0:14:51.756 --> 0:14:56.956 I'm trained to help people navigate challenging psychedelic experiences, and 0:14:57.796 --> 0:15:00.436 I a big part of my practice is helping people 0:15:01.036 --> 0:15:05.796 recover from feeling retraumatized as a result of an unsafe 0:15:05.836 --> 0:15:08.916 or unpleasant psychedelic experience. So this is a very real 0:15:09.236 --> 0:15:11.716 thing that we see happen. Part of the reason why 0:15:11.716 --> 0:15:14.756 we actually started the Psychedelic News Hour on Clubhouse is 0:15:14.796 --> 0:15:17.436 to help educate the general community about how to avoid 0:15:17.796 --> 0:15:23.916 these very specific and unpleasant experiences that are easily avoidable, 0:15:24.156 --> 0:15:26.876 but are also easy to step into by accident if 0:15:26.876 --> 0:15:28.396 you're not paying attention to don't know what to look 0:15:28.436 --> 0:15:32.236 out for, but you're describing as something with very significant 0:15:32.356 --> 0:15:37.756 risks if administered in the wrong setting. And if people 0:15:37.796 --> 0:15:41.476 are using MDMA, for example, or psilocybin recreationally in the 0:15:41.556 --> 0:15:44.316 numbers that you're marking, you know, a million new users 0:15:44.316 --> 0:15:46.676 a year, that means almost everybody is using it in 0:15:46.676 --> 0:15:50.036 an unsupervised way, and presumably a lot of those people 0:15:50.036 --> 0:15:54.036 are going to have bad experiences. If that's right. It's 0:15:54.076 --> 0:15:58.596 a very different narrative than sometimes one hears while there 0:15:58.716 --> 0:16:01.516 is risk, and I appreciate you bringing off the point 0:16:01.676 --> 0:16:04.116 that we need to make sure we understand that there 0:16:04.196 --> 0:16:06.756 is risk from using any of these medicines to augment 0:16:06.876 --> 0:16:10.636 or alter our stated consciousness, as they are nonspecific amplifiers. 0:16:10.996 --> 0:16:17.076 We also should acknowledge that from an objective perspective, a 0:16:17.076 --> 0:16:21.476 scientific perspective, the risk of these medicines is substantially lower 0:16:21.596 --> 0:16:24.956 for most, probably ninety five ninety nine percent of people, 0:16:24.996 --> 0:16:30.116 even than it is with things like cocaine, opiates, benzodiazepines, 0:16:30.276 --> 0:16:34.476 and many other prescription medicines that are scheduled by the 0:16:34.556 --> 0:16:38.476 DA at a level that is lower and more accessible 0:16:38.476 --> 0:16:42.876 than psychedelic medicines. THC, for instance, is still Schedule one drug, 0:16:42.956 --> 0:16:45.756 so as MBMA and soil side. I think the question 0:16:45.916 --> 0:16:50.676 is that if these medicines are accessible to everyone through 0:16:50.756 --> 0:16:54.556 the legalization process that is happening for example in Massachusetts, 0:16:54.596 --> 0:16:59.116 it's happened into Denver and Oregon, in certain places in California, 0:16:59.436 --> 0:17:02.916 then are we doing a disservice to folks if we 0:17:03.036 --> 0:17:06.676 don't take the time to properly educate them about what 0:17:06.836 --> 0:17:09.116 the risks are and how to do it safely. Right, 0:17:09.236 --> 0:17:11.996 it almost seems to follow less of a cannabis path 0:17:12.556 --> 0:17:14.996 and more of I mean it's following the cannabis path 0:17:15.036 --> 0:17:17.636 to some extent, but it seems to be following at 0:17:17.636 --> 0:17:21.676 a larger level the absence only education path with sex. Right, 0:17:21.916 --> 0:17:24.876 It's like we know people from thousands of years of 0:17:24.916 --> 0:17:27.396 research of looking back into history, we know people used 0:17:27.676 --> 0:17:30.316 drugs to access altered states of consciousness, whether they came 0:17:30.356 --> 0:17:34.036 from plants or we're synthesized. We know people have sex 0:17:34.356 --> 0:17:36.676 to feel good, to bond with each other, to alter 0:17:36.756 --> 0:17:39.916 states of consciousness. We know that both of these types 0:17:39.916 --> 0:17:42.996 of experiences are very powerful for people, and they're going 0:17:43.036 --> 0:17:46.356 to seek them out no matter what. If we do 0:17:46.436 --> 0:17:49.876 not teach people how to have safe sex and what 0:17:49.916 --> 0:17:54.156 the potential consequences are of not having safe sex, then 0:17:54.516 --> 0:17:57.756 people are going to do what they're going to do unsafely, right, 0:17:57.956 --> 0:17:59.676 and it's going to cause a lot of problems. And 0:17:59.676 --> 0:18:02.356 we've seen that. And at the same time, if we 0:18:02.436 --> 0:18:07.036 teach people how to have safe sexual relations with people, 0:18:07.236 --> 0:18:11.236 how to use drugs safely, we see the positive outcomes there. 0:18:11.316 --> 0:18:14.596 So I think that what we ultimately the responsibility is 0:18:14.876 --> 0:18:21.236 not to disseminate these medicines as quickly as possible, regardless 0:18:21.276 --> 0:18:23.116 of how people use them, and let them just choose 0:18:23.276 --> 0:18:25.836 without having any guidance. I think the responsible thing to 0:18:25.876 --> 0:18:28.596 do that a lot of us agree on a clinical world, 0:18:28.676 --> 0:18:32.156 the medical world, and I believe also in the indigenous 0:18:32.156 --> 0:18:34.116 cultures that have been using this for a long time, 0:18:34.876 --> 0:18:38.076 is to combine our efforts and our wisdom from all 0:18:38.076 --> 0:18:41.836 sides and say, okay, here's your guidebook. Right here is 0:18:41.876 --> 0:18:44.636 the basics that you need to know, the few points 0:18:44.676 --> 0:18:47.676 coming in that you need to know to prepare adequately 0:18:47.716 --> 0:18:49.916 to have the best possible experience that you can have, 0:18:50.356 --> 0:18:53.836 because it really, you know, like you said, there is risk. 0:18:53.956 --> 0:18:57.356 And at the same time, if we take the time 0:18:57.396 --> 0:19:00.916 to say, spend you know, focus on three to five 0:19:01.156 --> 0:19:03.436 points that we can do to make sure that our 0:19:03.516 --> 0:19:06.916 environment is safe, we're feeling emotionally safe and comfortable and 0:19:06.956 --> 0:19:11.676 of course physically safe, spiritually safe, and we can have 0:19:11.836 --> 0:19:15.316 that for the course of our psychedelic experience, which is 0:19:15.356 --> 0:19:18.276 altering our state of consciousness and making us vulnerable for 0:19:18.396 --> 0:19:21.116 lack of a better term to shifting meaning about ourselves, 0:19:21.556 --> 0:19:24.476 than we can actually have a lot more control over 0:19:24.476 --> 0:19:27.636 that environment than we think. And thankfully, I would say, 0:19:27.756 --> 0:19:31.396 looking at the recreational use cases, thankfully we do not 0:19:31.516 --> 0:19:34.956 see as many harms being done by people misusing these 0:19:34.996 --> 0:19:40.436 medicines as we thought we might. However, I think the 0:19:40.476 --> 0:19:44.436 concern is that we might see more if recreationalization across 0:19:44.476 --> 0:19:49.876 the US spreads without the accompanying education is required. We'll 0:19:49.916 --> 0:20:01.876 be right back if I want to turn back for 0:20:01.956 --> 0:20:05.316 the last segment of our conversation to some of the 0:20:05.396 --> 0:20:10.676 scientific underpinnings of how this amplification and process works. And 0:20:10.716 --> 0:20:11.956 I guess what I'd like to do is ask you 0:20:11.996 --> 0:20:15.036 about this from two angles. The first is from your 0:20:15.036 --> 0:20:19.276 clinicians angle, to ask you what it's like when you 0:20:19.316 --> 0:20:23.596 are doing psychotherapy with a patient who is on a 0:20:23.636 --> 0:20:26.476 dose of psychedelics compared to what it's like to do 0:20:26.596 --> 0:20:30.036 the identical form of talk therapy with someone who isn't. 0:20:30.076 --> 0:20:31.516 And then after you've talked a little bit about that, 0:20:31.556 --> 0:20:34.156 maybe people talk about some of the underlying chemistry and 0:20:34.316 --> 0:20:36.996 how the brain chemistry might be facilitating those differences. So 0:20:37.036 --> 0:20:39.476 the first question is really what's it like for you 0:20:39.716 --> 0:20:42.076 in the room when you're doing the treatment. Does the 0:20:42.116 --> 0:20:46.396 patient feel different? That's a great question. So it's really 0:20:46.436 --> 0:20:50.236 just about tools when we think about the psychotherapy approach. 0:20:50.556 --> 0:20:54.556 My approach is the same, relatively the same, regardless of 0:20:55.236 --> 0:20:57.236 who I'm working with or what their condition is. It's 0:20:57.316 --> 0:21:02.596 empathy first, non judgment, radical acceptance, leaving my own baggage 0:21:02.596 --> 0:21:04.276 at the door. Whatever has been going on in my 0:21:04.316 --> 0:21:07.556 life that day or that week that might be stressful 0:21:07.596 --> 0:21:09.836 for me, I do not bring it into the session. 0:21:10.196 --> 0:21:16.476 I'm entirely focused on the individual I'm working with, listening 0:21:16.476 --> 0:21:18.876 to them and making sure that they know they're heard 0:21:19.516 --> 0:21:23.356 in the experience. And sometimes it involves holding hands, but 0:21:23.516 --> 0:21:28.476 it definitely involves direct eye to eye contact and practice 0:21:28.476 --> 0:21:32.996 of empathic listening where the client clearly is aware and 0:21:33.236 --> 0:21:37.316 acknowledges that they are being heard non judgmentally by me. 0:21:38.396 --> 0:21:40.836 That is the foundation of all psychotherapy, no matter what 0:21:40.916 --> 0:21:43.956 kind of therapy you do, whether it's psychedelic assisted or not. 0:21:44.356 --> 0:21:48.476 So in people who have had very mild to moderate 0:21:48.516 --> 0:21:52.436 trump for instance, or mild to moderate issues of depression, 0:21:52.956 --> 0:21:56.156 where I can engage with them enough and me letting 0:21:56.156 --> 0:21:59.076 them know that they're heard makes them feel safe enough 0:21:59.276 --> 0:22:03.236 that they can really dive into the experience and make 0:22:03.356 --> 0:22:07.156 positive change the results of that experience because they feel safe. However, 0:22:07.956 --> 0:22:11.556 when people have had very severe trauma or very severe 0:22:11.596 --> 0:22:14.556 episodes of depression, it's sometimes very difficult for those people 0:22:14.596 --> 0:22:16.716 to feel safe, and sometimes they haven't felt safe in 0:22:16.716 --> 0:22:18.636 the years, and they can't remember when the last time 0:22:18.756 --> 0:22:20.996 was that they did feel safe. And no matter what 0:22:21.116 --> 0:22:26.236 I do emotionally, empathetically, even holding hands or giving them 0:22:26.276 --> 0:22:29.036 something like Apollo or other tools that work to help 0:22:29.356 --> 0:22:32.916 settle the body and boost the vagel parasympathetic nervous system 0:22:32.956 --> 0:22:36.156 activity to help facilitate recovery and bonding and engagement in 0:22:36.156 --> 0:22:38.596 the session, it just doesn't quite cut it, and they 0:22:38.676 --> 0:22:42.716 can't lean into the experience. So for those people, when 0:22:42.756 --> 0:22:45.996 we give them a psychedelic medicine like ketamine as an example, 0:22:45.996 --> 0:22:47.556 which is I want to bring up because it's the 0:22:47.636 --> 0:22:51.036 only currently legal psychedelic medicine that we have access to, 0:22:51.356 --> 0:22:54.436 and it's very short acting and very powerful and is 0:22:54.476 --> 0:22:56.716 safe for clients to actually use at home, we can 0:22:56.876 --> 0:23:02.396 see that the medicine number one is catalyzing the safety 0:23:02.436 --> 0:23:05.916 response for these people. So more importantly than anything else, 0:23:06.316 --> 0:23:08.996 what we hear from our clients is that when they 0:23:09.116 --> 0:23:11.236 they do therapy with us without the medicine and then 0:23:11.276 --> 0:23:15.596 they add the medicine, they often say, I haven't felt 0:23:15.676 --> 0:23:20.396 this safe in my recent memory, I don't remember feeling 0:23:20.396 --> 0:23:25.076 this way about myself without judging myself since childhood. I 0:23:25.116 --> 0:23:29.476 haven't felt my constant ruminative negative and thoughts stop or 0:23:29.556 --> 0:23:32.596 pause for as long as I can remember. And as 0:23:32.636 --> 0:23:35.276 soon as they have that experience, it's like a wake 0:23:35.356 --> 0:23:38.756 up call because they remember a feeling, they remember a 0:23:38.796 --> 0:23:42.956 state of being that they had before. It's familiar, but 0:23:43.036 --> 0:23:46.116 it's something that they forgot how to access because of 0:23:46.156 --> 0:23:48.316 a bunch of other stuff that happened in the meantime 0:23:48.876 --> 0:23:53.116 that interfere. And now once they're reconnecting with that part 0:23:53.116 --> 0:23:55.436 of themselves and they realize that something they can access, 0:23:55.996 --> 0:23:59.316 then we use the medicine as a tool to teach them, 0:24:00.076 --> 0:24:02.556 not that they require the medicine to access that state 0:24:02.596 --> 0:24:04.636 every time they want to get there, but that the 0:24:04.756 --> 0:24:07.596 medicine is a teacher and a tool to show them 0:24:07.756 --> 0:24:14.516 experientially that they can feel safe and that they let 0:24:14.516 --> 0:24:16.956 me ask you about that's totally fascinating, and let me 0:24:16.996 --> 0:24:19.876 ask you about what you think is happening. So when 0:24:19.876 --> 0:24:21.916 the person then says, oh, I remember what it was 0:24:21.956 --> 0:24:24.756 like to feel safe, and now I can get back 0:24:24.756 --> 0:24:26.716 to that again. Is it your view that there was 0:24:26.756 --> 0:24:29.596 a kind of neural pathway that was it was always 0:24:29.596 --> 0:24:32.196 it always existed, It still existed, but it was difficult 0:24:32.236 --> 0:24:36.116 to access it, and you are helping the person to 0:24:36.236 --> 0:24:39.396 access it and then learn to access it without your 0:24:39.436 --> 0:24:42.636