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In MAPS’ completed Phase 2 trials with 107 participants, 61% no longer qualified for PTSD after three sessions of MDMA-assisted psychotherapy two months following treatment. At the 12-month follow-up, 68% no longer had PTSD. All participants had chronic, treatment-resistant PTSD, and had suffered from PTSD for an average of 17.8 years.

https://maps.org/research/mdma/ptsd/phase3

Drugs used in therapy can resolve decades of treatment-resistant PTSD. Would you reconsider your position against drugs in therapy?

Would you be willing to look at the scientific results? Would you take a chance on closing your eyes momentarily to the word "drug"? This is therapy. Therapy is scientific results applied to the betterment of mankind.

To me, it would be deeply unethical to stop or ignore this work.

I've actually seen the results of "street therapy" for PTSD using MDMA by responsible adults. It was ... staggering. It's hard to express the boundless privilege of seeing PTSD melt off a person you love in an evening. And stay gone. Treatment-resistant PTSD. Decades of it. Gone. Because a substance was ingested. After endless therapy and doing all the right things. Sure, therapy worked. Glacially. There was constant pain. Constant anxiety. Gone. Just like in the studies. Rigorous, careful studies, taking decades of careful preparation in all spheres, political and medical.

But the anecdote doesn't matter. We have the studies.

I'm not an anti-drug puritan. (That would be so so hypocritical.) I think the criminalization of e.g. MDMA and the others is deeply foolish and has done a lot of harm. (To make an understatement. Frankly, I think you should be able to get clean liquid acid or MDMA at the local pharmacy. Why not? "Who the fuck are you to tell me what to do with my brain chemistry if I'm not hurting anyone?", eh?)

I don't want to take anything away from people, I just want us to think clearly about what's really going on when these kind of excellent results occur.

In the excitement over the successes with MDMA we shouldn't overlook things like Emotional Freedom Technique or Feldenkrais Technique that have also had wonderful successes with PTSD and yet don't involve ingesting substances. If we do, we risk missing out on the essential aspects of effective therapy.

Agreed!

(I want to note that I was replying to this specifically: “ I'm just against using them in therapy. It's irresponsible.” It was a rather crystallized statement, but we clearly see nuances here :) I take it that we both fully agree that drugs must not overshadow therapy, and that there are great temptations for shortcuts.)

You're totally right, I went a little overboard there, sorry.

Well met! :-)

But a lot of the time psychoactive drugs can remove psychological barriers that would otherwise prevent constructive participation in therapy. Not everyone needs it, but judging from how many people are in more-or-less-perpetual therapy, I think you might be undervaluing psychoactive drugs in that context.

> I think you might be undervaluing psychoactive drugs in that context.

I can only assure you I'm not. Your brain can already make all the psychoactive drugs you need.

These chemicals (LSD, Psilcybin) are like electroshock therapy, just a little more subtle. There are more precise and/or delicate modalities that are effective. I don't think it's too controversial to believe that we should concentrate on the precise and delicate therapy, eh?

> If we do, we risk missing out on the essential aspects of effective therapy.

No we don't; you're just moralizing against what appears to be effective treatment. No one is saying psychedelics are panacea, that's just a strawman.

Stop projecting your own misguided personal ethics. There are real people that need real help.

MDMA has a terrible comedown. Suicide Tuesdays is a thing after raves. After a 3 day festival, where you are taking molly like it's candy, Monday you're fine/ alittle hungover from the drinking but come Tuesday the world is fucking hopeless.

It's not just hitting the vacuum tube. If one just trips for the sake of tripping, then there is not much to be gained except for several hours of happy serotonin hits in the brain.

However, what we know about psychs is that there is a huge release of BDNF (brain derived neurotrophic factor) and a shutdown of the DMN.

The BDNF enables a ton of new neural connections to be built. It's like you have about 6-8 hours of a period where your brain plasticity goes back to that of an infant, just absorbing everything. So in this accelerated learning state, it's possible to work through one's emotions.

So it makes sense to prepare for several weeks to receive therapy and to outline goals and memories to revisit to process them during this heightened period. Then when the drug wears off, you're still left with the new neural connectivity and perspectives and the other benefits that were derived from the session.

Rather than hitting the vacuum tube, this is more like re-running the radio scanner in your car to find radio stations when you've moved over to a new city and the old radio stations are now out of range while one isn't tuned to the current set of radio stations.

>If one just trips for the sake of tripping, then there is not much to be gained except for several hours of happy serotonin hits in the brain.

Which is perfectly ok and probably preferable for most who waste trips by thinking that you must think deep and just get uncomfortable.

And while obviously there are results where people make large changes my own experience about those people is that a lot of insights are like New Years Eves resolutions said when drunk and happy; the change or insight goes away when a short time has passed.

> So it makes sense to prepare for several weeks to receive therapy and to outline goals and memories to revisit to process them during this heightened period. Then when the drug wears off, you're still left with the new neural connectivity and perspectives and the other benefits that were derived from the session.

The you're describing sounds great. All I'm saying is, a sweat lodge (for example) can take the place of the drug. The "magic" is in the "set and setting" not the pill.

I'm curious what you base this opinion on. Are you just describing your personal experience, or are you saying this applies to everyone?

Yes, I would be very curious as to your sources for this. I did medically supervised psychedelic treatment; I found the setting rather unpleasant because it took place in a doctor's office and one of the many anxieties I was treating was a lifelong phobia of germs and anything medical. This was a far cry from a sweat lodge or from recreational psychedelic experiences I've had with friends in nature etc. I did not enjoy all of my trips and some were hardly even reflective experiences because they caused me so much anxiety in the moment, yet I got massive psychological benefits from them nonetheless.

This is how my doctor explained psychedelic therapy to me - it triggers a massive release in BDNF that stimulates neuroplasticity, which allows for long term changes to occur. The trip itself can be a catalyst for reflective experiences that help with the growth of positive new neural circuitry but it is by no means the most important aspect of the treatment. In the case of ketamine, which is what I did, the release of BDNF continues for hours after the trip ends.

Except initial trials of MDMA, LSD, and psilocybin in combination with guided therapy show outcomes that the therapy alone just isn't getting.

And if they work it is a whole lot safer than taking symptom management medication.

I never said that drugs don't work. I said they do work as amplifiers and "convincers". Combined with a good set and setting lots of people, myself included, have had "good trips" that include mental emotional and spiritual healing.

My concern is when people get confused and think that the "magic" is in the mushroom.

It’s true that claiming the pill will cure smoking is a lie. That’s no more true than saying the tires on your car will get you to work. The scientific studies of late depend on the use of the pill and a specially trained therapist through multiple sessions. Several drug free sessions to discuss deep issues and get to know one another, an introductory session with the equivalent of 2g of dried mushrooms, and two weeks later a full session with the equivalent of 5-6g dried mushrooms. All of this is with the trained therapist who knows the patient. And the results are undeniable. Of course it may be possible to find these benefits without the therapist, but certainly with the therapist the drug can enable deeply valuable medical treatment. Anyone who claims the drug fixes the problem by itself is either a quack or is speaking slightly incorrectly and really trying to say the drug was an important part of their solution.

If hypnosis is so effective for quitting smoking, how do you explain that studies fail to find much effect? E.g., this 2019 meta-analysis: https://www.ncbi.nlm.nih.gov/pubmed/31198991

From the conclusion: "If a benefit is present, current evidence suggests the benefit is small at most."

The effect size and certainty with mushrooms seem much greater.

Yeah, I have no idea what those folks were doing. I know I can get the result because I did, back in the day. I'm not a licensed hypnotherapist but I went through an exploratory phase in my 20's which included experimentation with hypnosis. It was easy to develop "profound" hypnotic phenomenon like arm catalepsy (your arm is basically asleep, if you feel it with your other hand it feels like someone else's arm, etc.) I don't know what to tell you.

I actually only ever tried smoking cessation once, at a party, to demonstrate hypnosis. A friend of a friend went from two packs a day to two cigarettes a day, and a month later she was still barely smoking. YMMV.

Oh man! I just remembered what happened: I went into an online quit-smoking chatroom and offered to help people quit and they tore me a new one. People were howling for my blood! That's why I never went into business as a therapist. (That and I'm kind of an anti-social curmudgeon.)

You seem to have a supreme self confidence that most people do not. So you think that you 'hypnotized' the person to gradually stop smoking over a month from a sort session? You have some 'magical' powers. Sorry for the skepticism...

> You seem to have a supreme self confidence that most people do not.

Only in certain areas.

> So you think that you 'hypnotized' the person to gradually stop smoking over a month from a sort session?

No. The change in rate of smoking (2 packs a day to 2 cigs a day) was immediate and durable (at least up to a month, I didn't talk to her again beyond that.) Interestingly, at the very end of the session there was a momentary unconscious movement of the hand in a holding-cigarette gesture. I think the reason that she didn't stop smoking entirely was somehow connected to that gesture, FWIW.

> You have some 'magical' powers.

Maybe..? Certainly, to myself I seem nondescript.

> Sorry for the skepticism...

It's fine. You're nicer than most. I sometimes think I should write an autobiography, but then I think, who would believe it?

I'm sorry, I have to disagree friend. You're overlooking the basic neurochemistry of these substances. If you take Psilocybin or LSD, it will cause actual, scientifically observable changes in the brain. These actual changes can be of great benefit even if there is not necessarily an official therapy employed.

The whole recreational, non-study-able drug use phenomenon, the societal wave of recognition of the value of these experiences, it's all due to the fact that these have a real positive impact on the neurochemistry of the majority of people. Set and setting is important in all branches of medicine and self-improvement, but it's undeniable that these drugs will do wonders even with loosely structured goals at the outset, given proper set and setting as a baseline.

>a little 'shroom tea can be great fun.

You go out of your way to say you're not against drugs per se, but based on this statement and I can say that your attitude towards psychedelics is probably antithetical to their therapeutic potential. Having used mushrooms only once (admittedly in a larger-than-probably-responsible dose), I can say that viewing the trip as a recreational experience is misguided at best and damaging or dangerous at worst.

With that statement I was merely acknowledging a fact. Many people have had a fine old time with the aid of the "Magic" Mushroom. It can't be denied. However, personally, I agree with you that "viewing the trip as a recreational experience is misguided at best and damaging or dangerous at worst."

> (I'm great friends with Mushroom, and a little 'shroom tea can be great fun. But cramming 'im into a wee lil pill and then claiming "quit smoking" magic is in it... That's bad science and lousy magick.)

Fortunately that's not what they're finding for these classes of drugs. See the incredible stats coming out around MDMA + PTSD + therapy.

> I'm not against drugs per se I'm just against using them in therapy. It's irresponsible.

I think it’s appropriate to try something else when you’ve tried therapy, support groups, etc. Sometimes the best thing one needs especially when they’ve been focused on changing their mind and habits for a long while is something to open up all the calcified pathways.

Yes, absolutely. If you have exhausted the better options, get high.

Sure! The olotrophic breathwork developed by Grof for example is a great substitute to LSD therapy.

That's a lot of words without much analysis. Can you please explain precisely how these studies are bad science?

It would take too long to do the subject justice, but I'll try to sketch it:

The idea that psilocybin "cures" smoking addiction is like the "Virtus dormitiua"

> I am asked by the learned doctor the cause and reason why opium causes sleep. To which I reply, because it has a dormitive property, whose nature is to lull the senses to sleep.

We have no idea why magic mushroom do what they do, nor any solid scientific idea of how they do what they do. The best we can say is, "By breaking down those networks, there's a chance they won't re-form." and "It seemed to work..."

A neuroscientist friend of mine likes to say, "Psychiatry is not a branch of medicine." This still isn't it. For example: at any point were the subjects of the study given a blood test?

Not fully understanding the mechanisms doesn't mean we shouldn't use it. If that was the case, anaesthesia should have already been abandoned quite emphatically.

Of course, caution is certainly warranted with such powerful tools, especially as we try to understand them better. But if they are effective and can be used safely in the right context, then we should use them. And we have indications that this is the case.

So we must proceed carefully forward. I'm so glad that the multi-decade blockade on research is finally lifting.