When you hear the words psychedelic or hallucinogenic, your mind might gravitate to the following: that iconic scene in Bridget Jones: The Edge Of Reason where the titular character finds herself tripping on magic mushrooms on a beach in Thailand, arms outstretched in wonder as she waves at non-existent images in front her. And there's no reason why your mind shouldn't go to an image such as this — psilocybin mushrooms (also known as magic mushrooms) and lab-derived substances like ketamine and MDMA, have long existed in the mainstream as medications reserved for intoxication and recreation. Lately, however, they’ve also risen in the wellness ranks as vehicles for psychedelic-assisted psychotherapy.
So, how do psychedelics affect a person? According to the National Institute on Drug Abuse, “Classic hallucinogens are thought to produce their perception-altering effects by acting on neural circuits in the brain that use the neurotransmitter serotonin.” Essentially, hallucinogenic medications act by altering serotonin receptors in the brain. This causes people to experience deep meditative states, heightened euphoria, and even altered states of reality, where one can have multiple sensory hallucinations.
There’s a slew of psychedelics that are currently undergoing trials for psychedelic-assisted psychotherapy, including the aforementioned psilocybin, MDMA, and ketamine. The latter, however, is technically the most common form of psychedelic-assisted psychotherapy, but that’s because it’s the only one that is available legally in the United States.
Social worker, psychotherapist, and director of development at psychedelic healing center Sound Mind Center in West Philadelphia Courtney Hutchison explains that once a person takes a psychedelic dose — which varies from patient to patient based on their medical record — of ketamine, for example, "People's defenses start to diminish, and they might experience emotionally intense visions, like vivid dreams or suppressed memories. Oftentimes at this point, people can experience an out-of-body experience."
This mental state can help one uncover traumas and past experiences, which can provide one the necessary information to work through what might be causing them emotional pain or blockage in their everyday life. Medical Director at Field Trip Health Dr. Ben Medrano says that ketamine-assisted psychotherapy is ideal for those who have psychiatric or trauma histories, noting that it works well for patients with treatment-resistant depression, and those who suffer from anxiety or PTSD.
But what exactly does the process of psychedelic-assisted therapy look like? Ahead, experts in the field reveal all the trippy details.
The Different Types Of Psychedelics
Just as different pharmaceutical meds have varying effects and usage suggestions, so goes the same for psychedelics. "I think it's important to make the differentiation that these claims are different for each substance, just so that people don't generalize psychedelics as a whole,” says Dr. Medrano. “When you look at all of those still in the realm of research, you'll see a whole spectrum of opinions about what is entailed for proper treatment."
Ketamine, for starters, is a lab-derived medication that has anesthetic properties. Research has shown that ketamine promotes neuroplasticity, which refers to the brain’s ability to change and adapt to situations. It’s believed that ketamine can help to re-wire the parts of the brain that play a role in depression. When used for psychedelic-assisted psychotherapy, ketamine is often administered either by injection or via a lozenge that sits under the tongue.
The lesser-used psilocybin, a compound found in more than 200 species of fungi, has been reported to have mind-altering effects that include (but are not limited to) euphoria, visual and mental hallucinations, perceived spiritual experiences, and a distorted sense of time. (Cue a happy-go-lucky Bridget Jones frolicking on a beach.)
As for MDMA, Dr. Medrano reveals that it “is typically referred to as an ‘empathogen’ or empathy-generating substance. It too works on serotonin, as well as norepinephrine and dopamine by effectively increasing concentrations throughout the central nervous system.” In short, he explains that MDMA experiences are often “stimulating, euphoric, bliss-like and commonly creating a sense of increased connection to others,” which is why multiple studies suggest that MDMA can significantly help relieve PTSD.
It’s important to note that, although psilocybin and MDMA show evidence of having lasting results on mental health, both substances are still in their clinical trial phase, meaning that specific, FDA-backed claims regarding their use in a clinical psychotherapy setting cannot be made just yet. However, MDMA is in its third phase of testing, with the hopeful outcome of being FDA-approved for psychedelic-assisted psychotherapy by 2023.
The Benefits Of Psychedelic Therapy
At this point, you might be wondering what about psychedelic-assisted psychotherapy makes it an equal (if not superior) option to pharmaceuticals. Field Trip Health psychotherapist Dr. Mike Dow says, "The goal of pharmaceuticals is symptom reduction. It's like what you see on the surface of the ocean. Psychedelic-assisted psychotherapy's goal, in short, is to dig deep and create change on a much deeper level." Dr. Dow compares the experience to taking a deep-sea dive into the unconscious mind, where one can discover the root traumas and causes of their mental health concerns.
The most common pharmaceuticals for depression or PTSD are those that target serotonin or those that target both serotonin and norepinephrine. People who use these medications must take them daily and might only start to see results in their mental health after about a month of use. Psychedelics used in therapy tend to work quicker at reducing mental health symptoms than modern pharmaceuticals and are reported to have longer-lasting results that do not require taking medication daily. Dr. Dow explains, "With psychedelics, you don't have to take the medication every day —many people with treatment-resistant depression love having this option. The results can last months, years, or a lifetime."
Like any form of therapy, results and healing vary by person. And psychedelic-assisted therapy is far from a one-and-done experience. Hutchison states, "for ketamine, it varies. Some people might do one or two treatment sessions, and some might do six, seven, or eight. Some people might even do it once every six months as a tune-up." The idea, she says, is not necessarily that a patient would be taking ketamine in perpetuity — instead, they would spread out sessions to have an appropriate amount of time in between to unpack the information uncovered in the last session, while allotting time to prepare for the next session that lies ahead.
The Approach To Psychedelic-Assisted Psychotherapy
So what if, you might wonder, one wants to simply take a psychedelic like ketamine in the comfort of their home, and attempt this form of therapy sans medical supervision? Dr. Medrano reveals that obtaining psychedelics from unfamiliar or non-medical sources could be a risky move as you would have no way to know what might be mixed in with the substance. “Ketamine, when sold on the street, typically comes in powder form,” he explains. "The reality is it's hard to know what you buy recreationally unless you test it. I don't mean to be a fear-monger here, but fentanyl has found its way into all kinds of white powders that are being sold on the street." Hutchison also notes the legal repercussions and criminal charges one can incur when taking ketamine recreationally, given that ketamine is classified as a schedule III medication under the DEA Controlled Substances Act. Dr. Medrano suggests only exploring this under the supervision of a skilled professional.
A DIY approach to psychedelic therapy can also hinder the quality of the therapeutic experience. "That container of a therapeutic space and a trained professional guiding you through the process is essential,” says Hutchison. “We know from anecdotal reports that when people self-medicate without that therapeutic container, it’s not nearly as effective."
Additionally, it is critical to seek out a clinic specializing in ketamine-assisted psychotherapy instead of ketamine-infusion centers. Hutchison explains, "Regarding ketamine infusion clinics, there's robust evidence for the immediate alleviation of depressive symptoms and suicidality. These effects are usually temporary and require ongoing, repeat administration, which is more akin to traditional psychiatric medication." However, Hutchison goes on to explain that without something else (like therapy to help process thoughts, emotions, and change behavior), the effect typically doesn’t last. Ketamine-assisted psychotherapy seeks to use the ketamine state itself to catalyze change, accelerating and deepening the progress in psychotherapy.
The Phases Of Psychedelic-Assisted Therapy
Within the world of psychedelic-assisted therapy, there are three phases one must go through to ensure a proper therapeutic experience: preparation, setting, and integration.
In this phase, Dr. Medrano reveals, "the first step is to see a psychiatrist or a psychiatric nurse practitioner or a licensed prescriber who has psychiatric training," to go through a screening process that determines whether an individual is emotionally, psychologically, and physically fit to undergo psychedelic-assisted therapy. After that, he adds, “we dive into the details of their trauma history or the specific symptoms or struggles associated, struggles that they're having in life that bring them to us." During this phase, a patient will start to uncover the things about them that they would like to work on and set intentions for the treatment itself.
The ideal setting aims to provide ample comfort and a safe space for people to experience their psychedelic treatment, with as few triggers around them as possible. In a typical clinic that provides psychedelic-assisted psychotherapy, one can find many things inside the therapy room, such as zero gravity chairs, weighted blankets, blackout eyeshades, and noise-canceling headphones. In addition to this, there are typically atmospheric sounds or soothing music chosen by the patient, if they choose to listen to anything at all.
However, some may argue that the physical space itself is just a part of having a setting conducive to actual healing—one must feel safe in the presence of their therapist or physician, as well. Hutchison states, "In the context of ketamine-assisted psychotherapy, safety and trust have to be a priority. You need to build trust with that therapist beforehand during prep." If things like past traumas become too much to handle, you have a trusted person there with you to act as an ally in getting you back on track to healing.
Once a patient comes down from their trip, it's critical to unpack the things they've learned during the setting phase of ketamine-assisted psychotherapy. In this phase, the patient will discuss their significant experiences with their psychotherapist in the style of a therapy session and learn how to integrate the things they've uncovered into their healing process. Dr. Medrano explains, “We try to target that sweet spot in the dosing where people are able to let go and venture out into the realms of consciousness and possibly into the unconscious while still being able to recollect what occurred. Although much of what is experienced is somewhat ineffable, we still find that there is typically some kind of information that comes through that is relevant to their intention or goals of care.”
Yet, integration lasts long after this session is complete. Dr. Dow explains that psychedelic-assisted therapy can act as a therapy-enhancer, and integration can last for a while after one completes treatment. "People should absolutely seek talk therapy after completing ketamine-assisted therapy. The a-ha moments, insights, and after-effects of the mystical experience they bring are long-lasting and pervasive, [where, in some cases,] patients have insights months after [a session]. The work they do with us tends to make their ongoing psychotherapy richer."