The Yale Manual for Psilocybin-Assisted Therapy of Depression
psyarxiv.com
psyarxiv.com
> Responding to intense, painful affect states
> The therapists will gently encourage the subject to “lean in” or “go towards” intense or difficult affective states, rather than try to avoid or diminish them.
> Responding to agitation or restlessness
> The therapist will encourage breathing exercises and grounding techniques, as described above. If these are not helpful, the participant will be invited to sit up, take off the eyeshades and make visual contact with the therapists and the room. The therapists may offer reassurance that such states are to be expected and are likely to be short lived.
> Responding to marked agitation
> If the subject displays significant or marked agitation and previously mentioned interventions fail, the therapist will consult with the physician regarding the possible administration of benzodiazepine or antipsychotic medication. Medical intervention will be utilized only when agitation is persistent, and no other means to help relieve the agitation are effective.
Arguably this is where mainstream medicine needs to catch up, and where a lack of multi-disciplinary approach still exists: Rick Doblin (the founder of Maps.org) has suggested that if someone has difficulty processing during an Ayahuasca ceremony (a potentially more intense, more potent version of Psilocybin session/ceremony) said to give a half-therapeutic dose of MDMA (100mg to 125mg is therapeutic dose; 180-200mg is generally what's used recreationally, usually not all at once) - and so I hope sooner than later this guide is updated to replace "possible administration of benzodiazepine or antipsychotic medication" with "possible administration of MDMA;" instead of numbing a person's nervous system/emotions with a benzodiazepine or changing how their brain is actually functioning, instead use MDMA to cause the brain to release more serotonin at once than it naturally can - allowing everything to feel and be easier to connect to and process; reducing the stress level enough where it's not acting as a blocking function, hence PTSD is from extremely stressful past experiences that are too overwhelming to process.
via https://adf.org.au/drug-facts/ayahuasca/
I imagine what Doblin meant is working with MDMA after an ayahuasca ceremony.
I also happen to be taking a dopamine agonist to treat a benign brain tumour I have (prolactinoma) - first line of treatment is adding a dopamine agonist to the system, and not using an SSRI/SNRI/etc that changes the actual function was fine as well for ceremony; a caveat to research or understand/have caution with is that I had done 30+ Ayahuasca ceremonies prior to taking a dopamine agonist - and so my mind/brain was generally already "opened" how it will be. Care/caution may be necessary if a person has never "opened" up their mind/brain yet (after X ceremonies/experiences) and if they are taking dopamine for whatever reason, as maybe once the pathways that get opened from Ayahuasca et al then the impact of the dopamine would shift as well - perhaps then overcompensating for blocks that get cleared by the Aya etc - and the person may then experience undesired levels of effects from the dopamine.
MDMA isn't directly changing the actual function, they're not causing inhibition; the action of how is important, the nuance is important to understand - though like from your comment - there isn't this general understanding that there is a difference, and I imagine most doctors/professionals will jump to the same conclusion without thinking about it - misattributing the different actions instead of critical thinking from foundational principles. It's not the neurotransmitter(s) that are a problem, at least not serotonin and dopamine, it's if the function change of how they're allowed to flow changes that's the problem.
Interview/chat between Dr. K (Healthygamer_gg) and Rick Doblin - https://www.youtube.com/watch?v=1e2h-awLC-s - where he mentions taking half-therapeutic dose; more of a casual conversation where you can also hear a bit of Rick's origin story.
I did fairly deep research on this beforehand, looking into actual pharmacological aspect of interactions with things like dopamine, etc - a few people over the last 20 years have been keeping track of all related research. I don't have the link for the most succinct, detailed writeup I read handy.
While you can read about mechanisms and in vitro this and that all day, this is not the same as quality applied clinical research, which frankly just doesn't exist in any meaningful quantity. I am a practitioner, and I am very sympathetic to the movement of alternative treatments counter to established standards of care, however at the end of the day it doesn't change the fact that the controlled research is non-existent or poor, and things like the MAPS manual are essentially woo.
And specifically the problems I have is that ironically, these alternative treatments which are supposedly trying to overcome boundaries of established care are extremely proscriptive themselves.. they're limited, just differently, and the justifications have very little evidence based backing.
Many studies have been done, not just in vitro but in real people with just about the most severe mental issues there are: severe depression and PTSD, and the results have been positive, and these studies have been published in peer reviewed journals and been well received by the scientific and medical community.
So can you describe what evidence you're looking for and what would satisfy you?
Also, you say you're a practitioner. I wonder what you are a practitioner of exactly. If it's some sort of traditional therapy you should be aware that for PTSD and severe depression the evidence is that traditional therapy is very ineffective. So what would you suggest for those suffering from these conditions if not psychedelic-assisted therapy, which from my reading is actually far more effective for these conditions than traditional therapy?
I’ve also sat a comparable amount of ceremony — and so of course there’s strictness about SSRIs...but I have never thought about the mechanisms like this. It just wouldn’t have occurred to me to explore in this way.
If you do find the succinct, detailed write up I’d love to see. Thank you for finding the YouTube link, I want to check it out!
The restlessness and agitation you're speaking of is often why people go dancing as when taking it primarily for recreational purposes, as it can have therapeutic effect as well; it can release energy that you need to do something with.
Doses between 60 and 100 mg of crystal that I have tested with Marquis reagent to be MDMA, as accurate as that test can be (there's no substance testing available for public in my country).
I had read beforehand that the comeup can feel uncomfortable especially right before the full effect hits. During my first experience I was kind of surprised how restless and annoyed I became at everything and I attributed it to not being able to be alone (I'm an introvert). On subsequent experiences alone I have come to realize that it's just part of the comeup for me and now I know to just ride it out. I read somewhere that MDMA triggers the release of norepinephrine which would make sense. One of my friends also commented that during comeup he too gets quite annoyed, to the point of ready to fight someone.
Basing on my experiences, the long comeup and the additional agitation is why I find it surprising to recommend MDMA for psychedelic crises. A benzodiazepine like Xanax has a quick onset of action and calms people down which makes more sense to me for these kinds of situations.
This is, of course, something that's been done for millennia by traditional cultures in altered states of consciousness and during ritual, so there's plenty of precedent for it and it's far from a new idea.
I hope some research is done on this sort of intervention, and expect the results will be positive.
Before taking whatever it is you're taking be sure to thoroughly investigate its physical effects and learn about the precautions you should be taking, and what to or not to do.
For example, MDMA, which is sometimes sold on the street as Ecstacy or Molly (and sometimes other drugs are sold under those names, which is yet another danger) can interfere with the body's temperature regulation ability, so when you take it and start dancing and get hot you might not be able to cool off as effectively... which is one reason why people can die from it, especially if they're dancing a lot in already hot environments (like at an outdoor festival on a sunny day or in a hot club with poor ventilation), or when they don't drink enough water, or drink too much water.. any of these can kill you, and people have died from just this.
DanceSafe's recommendations for MDMA are to drink one pint of water an hour.
Below are some fantastic videos from Emanuel Sferios, the founder of DanceSafe, that he gave at UC Berkeley about MDMA (and general recreational drug) safety, which I highly recommend everyone watch. You could save your life or that of a friend by learning what's in these videos.
So, everyone, please EDUCATE YOURSELF and stay safe!
[1] - Part 1 - The History of MDMA https://www.youtube.com/watch?v=8ZY-ZFJnWbg
[2] - Part 2 - Tips for Safer Use https://www.youtube.com/watch?v=HgUPKYrpBvY
[3] - Part 3 - Pharmacology and Medical Use https://www.youtube.com/watch?v=UHduGGB5kJU
[4] - Part 4 - The Need for Drug Policy Reform https://www.youtube.com/watch?v=nTSiyQHm2s4
[5] - Part 5 - Heather Brooks https://www.youtube.com/watch?v=O8s-nhlaACw
[6] - Part 6 - Joseph Pred https://www.youtube.com/watch?v=0wolzUE3lPk
[7] - Part 7 - Question & Answer https://www.youtube.com/watch?v=rovaoVjLnOk
[8] - Prohibition Fatalities and MDMA Complexities: Interview With Emanuel Sferios, the founder of DanceSafe https://www.youtube.com/watch?v=yHKYogJ8Yxs
A VR motion game like Beat Saber might work better in a clinical setting, because it'd be weird for a patient to dance or chant with a therapist, and the other options require considerable skill.
I'm not sure what the criteria for getting certified to do psilocybin-assisted therapy are or will be, but my guess is they'll probably be pretty similar.
In general, at least for now, it's pretty safe to say that most therapists interested in doing psychedelic therapy are already interested in psychedelics and probably are already "experienced" or will be during training.
For me, much more important than if they've had a psychedelic experience is if they're highly recommended by well-informed people who've gone through therapy with them and who I trust. If they green-light them, I'd feel much more secure.
At risk of overstepping, I wonder if the underlying issue might be better viewed as needing to rectify and update previous ways of being, self-models, and goals with the new circumstances. As well as fully grieving this loss, coming to terms with how things are, and learning to imagine all of the new possibilities that can still be realized.
Finding a way to deal with your problems is the best solution. In lieu of that, I would argue coping with them without handling them is the second best, with neither handling them not coping them being a distant last place.
10.0 Appendix B: Suggested Reading List
Considering building it out a bit more
Would love any feedback or suggestions anyone might have
I can't imagine any participant not realizing they've been subject to a placibo after no more than an hour into the session (unless they have no idea it is a psilocybin study).
Matthew Johnson: Psychedelics | Lex Fridman Podcast #145
https://www.youtube.com/watch?v=ICj8p5jPd3Y
Matthew W. Johnson is a professor and psychedelics researcher at Johns Hopkins.
We use this approach as well with http://TryWithin.com (in home psychedelic assisted therapy)
We know that this relationship is critical for effective and safe guided sessions with psychedelic medicines.
And, that it's not straightforward to establish this relationship between two people if they have only met online (drastically reduced non-verbal communication bandwidth, difficulty/impossibility around establishing nervous system coregulation / entrainment).
In general, tele-therapy has shown to be as effective when done properly and we are seeing similar results at Within.
I am curious to see about the more longer form medicines like MDMA and Psilocybin, but low dose ketamine is proving to be an effective tool for remote work.
We’ll be adding more therapists.
We were just excited to add our partnership with the Plant Medicine Law Group - they aren’t in house counsel.
But I get it.
If I can be of any help, do let me know? I'm a business strategist.
We’d love help! We do think we can help more people and that we haven’t solved the best way to reach them.
Here's what TM had to say about it's chemical structure:
“I’ve mentioned that psilocin, which is what psilocybin quickly becomes as it enters your metabolism, is 4 hydroxy dimethyltryptamine. It is the only 4-substituted indole in all of organic nature. Let this rattle around in your mind for a moment. It is the only 4-substituted indole known to exist on earth. It happens to be this psychedelic substance that occurs in about eighty species of fungi, most of which are native to the New World. Psilocybin has a unique chemical signature that says, “I am artificial; I come from outside.”
I've definitely tested out the latter statement as first discussed by TM and its a technique that I find has by far the most anti-depressant effect that still lingers.
Many people freak out because they try to figure out what Psilocybin mushroom is and then all sorts of craziness is shown to you that can produce panic in beginners.
Some people try it once, get freaked out by its deep introspective qualities that addresses the holes in our spirits.
In fact one of the scariest experience was the second time I tried it where I experienced ego death for the first time. It literally feels like you are dying but funny enough it is because our body-mind complex is so fixated and attached to our ego, a mere illusion that is created by this...reality.
Perhaps the most fundamental change in value systems that occurs during psilocybin creating a feeling of oneness and zen like state that reveals love is the only truth, everything else is falsehood and deception.
It's no wonder that it poses a threat to hierarchial, dominant culture of centralized power by a small group.
Psilocybe is not only the red pill that wakes you from the hypnosis of our modern reality shaped by the petrodollar economy that is destroying the planet, and as such, it is deemed illegal, taboo.
One of the most frightening realization was that not the experiences that come out of consuming the psilocybin mushroom but the very reality that we live in and choose to ignore while focusing on only what we want to see because its too painful to admit what has happened in our modern world-an all out war against everything human: our bodies, our thoughts, our expressions.
If we are to change this planet and our course of direction we must continue in our discovery of the past because it holds the key to our salvation.
If only 1% of the population can cause a shift in consciousness it will have butterfly impact on the rest. We simply do not judge or hold contempt for the close minded, instead continue educating, continue the discussion, so that we can wake from the slumber, our constant desire for novelty and meaningless consumption.
Psilocybin works because it is a device which causes truths to emerge from the swamps of lies and deceptions pulled over our heads. Barring sensory deprived meditation states like the Yogis of tibet that naturally produces DMT, the descendants of the Stoned Apes are once again rediscovering the very thing that has led to their dominance on this planet.
Perhaps this is what TM was talking about the great "transcendental attractor object", we are perhaps on the edge of massive transformation of not only the human psyche through spiritualism but physicists will reveal part of the nature of the universe that will add more and more backing towards this "New Age" era.
This is not medecine. It is no better than the voodoo doctors of old who made you take the "funny herbs" to cure your "demons". This is garbage and not science.
I began hearing of an interesting idea that depression can be treated with CBT because that therapy teaches the patient not how to ruminate less, but instead, how to ruminate more efficiently. Presumably, more efficient rumination on problems leads more quickly to acceptable solutions, ideas, etc, which can then be integrated by the person.