What Happens When you mix Psychedelics With Therapy
When Clark Martin tripped on magic mushrooms for the first time, he was flanked by two researchers in a small room at New York University.
An avid sailor, Martin said the first few hours of the experience reminded him of a time he'd been knocked off his boat by a powerful wave and lost track of the vessel.
"It was like falling off the boat in the open ocean, looking back, and the boat is gone. Then the water disappears. Then you disappear," he said.
But the panic was temporary. Over the next few hours, Martin felt overwhelmed by an enduring sense of tranquility and a feeling of oneness with his surroundings.
"The whole 'you' thing just kinda drops out into a more timeless, more formless presence," Martin told Business Insider last year.
That shrinking of the sense of self and feeling of connection with the wider world has been linked with a fairly immediate reduction in symptoms of depression and anxiety. The effect has been observed to last anywhere from several months to several years, according to clinical trials of magic mushrooms' active ingredient, psilocybin, in cancer patients at Johns Hopkins and New York University. Martin was one of those patients.
Still, questions about why the drugs appear to elicit that shift have remained. But two new studies published this month shed light on some potential answers.
The first, published in the journal Frontiers in Psychopharmacology, found that the quality of the psychedelic trip was directly linked with how much someone's depressive symptoms decreased. In other words, the more connected someone felt during and immediately after the trip, the longer those feelings lasted and the less depressed they felt. That said, a high quality trip should not to be confused with "good" or "bad" feelings, since some highly therapeutic trips can involve a fair amount of anxiety.
"This report further bolsters the view that the quality of the acute psychedelic experience is a key mediator of long-term changes in mental health," the researchers wrote in their paper.
The second piece of research, a small pilot study published in the Journal of Psychopharmacology, suggested that after a trip, people may feel more connected to nature and less supportive of authoritarian views.
These results suggest that something about psychedelics reinforce feelings of connection and unity, as opposed to the feelings of isolation or alienation that are so common in depression.
'Psychedelics disrupt that process so people can escape'
David Nutt, one of the authors of the recent paper on trip quality, is the director of the neuropsychopharmacology unit at Imperial College London. He told Business Insider in January that a key characteristic of mental illnesses like anxiety, depression, and addiction is overly strengthened connections in some brain circuits — specifically those involved in the sense of self.
"In the depressed brain, in the addicted brain, in the obsessed brain, it gets locked into a pattern of thinking or processing that's driven by the frontal, the control center," Nutt said.
Brain scan studies and several clinical trials suggest that psychedelic drugs tamp down on the activity in these circuits, potentially providing relief that may last a few weeks, several months, or even years.
"Psychedelics disrupt that process so people can escape," Nutt said. "At least for the duration of the trip, they can escape about the rumination about depression or alcohol or obsessions. And then they do not necessarily go back."
Researchers say the drugs' apparent ability to induce such powerful, positive changes in personality could offer a way to address the foundations of mental illness and therefore one day be used to help treat mental illnesses.
"Psychedelic therapy ... offers an opportunity to dig down and get to the heart of the problems that drive long-term mental illness in a much more effective way than our current model, which is take daily medications to mask symptoms," psychiatrist Ben Sessa said at a recent conference in London on the science of psychedelics.
The drugs are not a treatment in and of themselves, Sessa said. Rather, they are a tool that can be used in conjunction with therapy to help people address underlying issues.
In most of the clinical trials of psychedelics in people with depression, in fact, taking the drug is part of a larger experience that occurs alongside traditional therapy. A trained psychiatrist or therapist is usually in the room with the patient when they take the drug; often they hold hands. As the trip progresses, an experience that usually lasts between four and six hours, patients talk through their experience with the therapist, enabling them to push through any anxiety-provoking thoughts and sensations. That has suggested to researchers that the best way to achieve the beneficial results from these drugs is by combining them with traditional therapy, also known as drug-assisted psychotherapy.
"It's using the drugs to enhance that relationship between the therapist and the patient," Sessa said.
Psychiatrist Julie Holland is currently serving as the medical monitor for a study of MDMA and psychotherapy in veterans with PTSD. She said at the London conference that using psychedelics alongside therapy could be a powerful way to address issues that patients may never deal with on existing anti-depressant medications.
Those medications "are sort of sweeping symptoms under the rug," Holland said. "Psychedelic psychotherapy takes the rug out back and beats the hell out of it and vacuums the floor and puts the rug back down."