Psychedelic treatments for trauma-related disorders

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Psychedelic treatments for trauma-related disorders are the use of psychedelic substances, either alone or used in conjunction with psychotherapy, to treat trauma-related disorders. [1] Trauma-related disorders, such as post-traumatic stress disorder (PTSD), have a lifetime prevalence of around 8% in the US population. [2] However, even though trauma-related disorders can hinder the everyday life of individuals with them, less than 50% of patients who meet criteria for PTSD diagnosis receive proper treatment. [3] Psychotherapy is an effective treatment for trauma-related disorders. A meta-analysis of treatment outcomes has shown that 67% of patients who completed treatment for PTSD no longer met diagnostic criteria for PTSD. [4] For those seeking evidence-based psychotherapy treatment, it is estimated that 22-24% will drop out of their treatment. [3] [4] In addition to psychotherapy, pharmacotherapy (medication) is an option for treating PTSD; however, research has found that pharmacotherapy is only effective for about 59% of patients. [5] Although both forms of treatment are effective for many patients, high dropout rates of psychotherapy and treatment-resistant forms of PTSD have led to increased research in other possible forms of treatment. One such form is the use of psychedelics. [6]

Contents

Psychedelics such as lysergic acid diethylamide (LSD) and psilocybin have been researched and used as treatments in the United States of America for mental disorders as early as 1947. [6] However, the research and use of psychedelics for treatment were halted in 1970 with the passing of the Controlled Substance Act of the Comprehensive Drug Abuse Prevention and Control Act. [6] Even though the research was hindered for many decades, there has been a renewed interest in the use of psychedelics to help with the treatment of trauma-related disorders from many organizations, with one of the most well known being the Multidisciplinary Association for Psychedelic Studies (MAPS). [6] [7] In 2017, both 3,4-Methylenedioxymethamphetamine (MDMA) and Psilocybin were given the status of breakthrough therapies by the US Food and Drug Administration (FDA) and allowed for clinical trials of both substances use in psychedelic treatments of mental disorders. [1] In 2019, the FDA approved ketamine for use in treatment as well. [1] Currently, three of the most common psychedelic drugs researched are MDMA, psilocybin, ketamine. [8] Each substance has different rationales for treatment and various treatment methods.

3,4-Methylenedioxymethamphetamine (MDMA)

MDMA was first synthesized by Merck & Co. in 1912. [6] [9] Designed initially as a blood-clotting agent, it was found to have psychotropic properties. Although the drug was found not to be an effective blood clotting medication, it was later resynthesized by the chemist Alexander Shulgin in 1976. [6] The drug grew in popularity in the 1980s because of its psychotropic properties and ability to facilitate and alter emotional states. MDMA is most commonly known by its street name, ecstasy. Currently, MDMA is classified as a Schedule I drug in the United States, meaning it is viewed as having no accepted medical use and has a high potential for abuse. [10]

Therapeutic rationale

The primary rationale behind the use of MDMA in conjunction with psychotherapy is that MDMA can help facilitate talk therapy by reducing fear and anxiety around traumatic memories and makes the processing of those memories more tolerable. [8] [11] [12] MDMA has been shown to increase emotional empathy and compassion for self and others, increase prosocial behaviors, increase subjective ratings of closeness and trust of others, and increase introspection. [8] [11] These potential benefits of MDMA usage can help the therapist during talk therapy address the traumatic events suffered by patients. MDMA is also known to decrease fear around memories and increase fear extinction of traumatic memories. [8] [11] [12] [13] [14] Lastly, MDMA helps reduce the activation of the amygdala (associated with an increase in fear) and increases the activation of the frontal cortex (associated with better processing and control) when retrieving memories. [8]

Treatment procedure

Most MDMA-assisted psychotherapy treatments start with the administration of MDMA orally, with initial doses ranging from 75 to 125 mg. After one to two hours, a second dose of half the initial dose is offered to patients. [8] [11] [12] [14] During these sessions, patients are encouraged to alternate between introspection periods and talking with the therapist. [11] [14] Usually, two therapists accompany each patient while under the influence of MDMA and help facilitate introspection and encourage remembering and processing the traumatic events. Patients are given time to relax and listen to music to help induce periods of introspection. [8] [11] [14] Therapy sessions last 6 to 8 hours and usually end when the drug's effects on the patients return to baseline. Patients are monitored and stay the night at the clinic and can leave the following day. [11] [12] [14] Three integration sessions where patients can discuss the experience of the MDMA session, process emotions, and receives psychoeducation are held the morning after or shortly after the MDMA session. In most cases, the process of MDMA sessions followed by the integration sessions is repeated three times, usually a month apart. [11] [12]

Evidence of effectiveness

In multiple trials, MDMA-assisted psychotherapy has been shown to significantly reduce PTSD symptoms after treatment, [8] [11] [12] [13] and the improvement in symptoms continued at 12 months follow ups [12] with patients reporting quality of life improvements in addition to trauma-related symptom reduction. [15] [16]

Psilocybin

Psilocybin is the chemical commonly found in a variety of mushrooms. Although it has been used for centuries by the native people of Central and South America, they were not fully introduced to the United States until the 1950s. Commonly referred to as "magic mushrooms," the compound of Psilocybin was successfully synthesized by Roger Heim and Albert Hofmann and no longer requires mushrooms to be produced. [6] Psilocybin can cause sensory perception changes such as auditory and visual illusions. Currently, Psilocybin is classified as a Schedule I drug in the United States. [17]

Therapeutic rationale

The main rationale behind using Psilocybin combined with psychotherapy is that Psilocybin is shown to increase fear extinction around emotions and increase emotional empathy. [8] [18] Much like MDMA, the effects of Psilocybin have been shown to help therapists during talk therapy. Psilocybin has been shown to increasing emotional empathy, creative thinking, mindfulness, and insightfulness in patients, which can help the therapist work with the client to overcome their trauma. [8] Also, like MDMA, Psilocybin has been shown to decrease amygdala activation during emotional processing. [8] Most treatments using Psilocybin are focused on reducing depression and anxiety, which are common co-morbid diagnoses with trauma-related disorders and share many similar symptoms (i.e., anhedonia, sleep disturbance, negative cognitions, feelings of guilt and shame). [8] [18] [19] [20] [21]

Treatment procedure

Psilocybin treatments start with orally administering 10 to 25 mg of Psilocybin. Much like a session with MDMA, Psilocybin-assisted psychotherapy sessions are non-directive. They alternate between periods of allowing the patient to relax, listen to music, and look introspectively and periods of talking with the therapist. [8] [19] [20] Shortly after the Psilocybin session, usually the following day, an integration follow-up psychotherapy session is done with the patient to discuss the experience and provide psychotherapy. The goal of these integration sessions is to help process emotions, process the traumatic event, provide psychoeducation, and address concerns of the treatment. Two more psychotherapy sessions follow this in the next weeks. After the three follow-up sessions, there is a second Psilocybin session, followed by three more integration sessions. [19] [20]

Effectiveness

There is only weak evidence psilocybin may be useful for treating PTSD. [8]

Ketamine

Ketamine is a useful anesthetic and is widely used throughout the world. [1] First synthesized in 1962 and later approved for use as an anesthetic in 1970, Ketamine has dissociative psychedelic effects. [8] In addition to these effects, Ketamine is a fast-acting antidepressant. [1] [8] In the United States, Ketamine is classified as a Schedule III drug, [22] meaning it is considered substantially safe and can be used for medical purposes under pharmacist management.

Therapeutic rationale

The main rationale behind the use of ketamine-assisted psychotherapy is its recognition as an effective antidepressant. [1] [8] [23] [24] With depressive symptomology being a major co-morbid problem with trauma-related disorders, treating depression can help treat the trauma and provide opportunities for the therapist to address other issues. In addition to this, Ketamine has been shown to increase synaptic and neuronal plasticity, [8] which can help remodel traumatic memories.

Treatment procedure

Unlike MDMA and Psilocybin treatments with Ketamine can be done independently of psychotherapy sessions. [25] [26] [27] In these treatments, Ketamine is given to patients either intravenously or orally in controlled doses over weeks. [8] [25] [26] [27] In other settings, Ketamine is given to patients before psychotherapy to help induce a state that will help facilitate therapeutic discussions. [23] [24] Sometimes, in addition to the dose given before the session, small controlled quantities may be allowed for patients to take at home between sessions with a therapist. [23]

Evidence of effectiveness

Studies that used Ketamine in addition to psychotherapy showed that it was effective at reducing depression, anxiety, and PTSD symptoms. [23] [24] Treatments that used Ketamine with no psychotherapy sessions were shown to be associated with decreased rates of developing PTSD after experiencing a traumatic event, [26] as well as reducing PTSD symptoms. [8] [25] [27]

Risks, safety, and concerns

Because most psychedelics are controlled substances in the US, there are concerns for their use in treating mental health disorders, including trauma-related disorders. Adverse effects and addiction are significant concerns people have when discussing psychedelics for the benefit of treatment. Like with any substance introduced to the body, there is always a risk of an adverse reaction to it. Because of this and the stigma around psychedelics within the US, nearly all studies researching psychedelics for treatment report adverse effects and addiction risks. A meta-analysis of 43 research studies looking at psychedelics for use in mental health treatment found that 59% of the studies reported that at least one participant with a mild adverse effect of taking psychedelics; however, none of these situations required medical interventions. [28] These adverse effects range from physical effects such as blood pressure changes, muscle tension, headaches, and vomiting, to cognitive impacts such as experiences of panic or fear, confusion, and low mood. [28] Even with these possible adverse effects, all events were tolerated well by the patients. The drugs seem to have a good safety profile, and patients and clinicians saw the long-term benefits of psychedelics treatment to outweigh acute aversive reactions. [28] [29] The other primary concern of addiction is also monitored during research. It's been found that the psychedelics used for treatment have very low drug dependency rates, with participants reporting no drug addictions to the substances used in their treatment. [29]

See also

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Psychedelic therapy refers to the proposed use of psychedelic drugs, such as psilocybin, MDMA, LSD, and ayahuasca, to treat mental disorders. As of 2021, psychedelic drugs are controlled substances in most countries and psychedelic therapy is not legally available outside clinical trials, with some exceptions.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences, with extreme examples being violence, rape, or a terrorist attack. The event must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD).

The Multidisciplinary Association for Psychedelic Studies (MAPS) is an American nonprofit organization working to raise awareness and understanding of psychedelic substances. MAPS was founded in 1986 by Rick Doblin and is now based in San Jose, California.

<span class="mw-page-title-main">Rick Doblin</span> American drug activist

Richard Elliot Doblin is an American drug activist and executive who is the founder and former executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS).

Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in 2006. The goal of TF-CBT is to provide psychoeducation to both the child and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war. More recently, TF-CBT has been applied to and found effective in treating complex posttraumatic stress disorder.

Eclectic psychotherapy is a form of psychotherapy in which the clinician uses more than one theoretical approach, or multiple sets of techniques, to help with clients' needs. The use of different therapeutic approaches will be based on the effectiveness in resolving the patient's problems, rather than the theory behind each therapy.

<span class="mw-page-title-main">Psilocybin therapy</span> Experimental use of psilocybin to treat anxiety & depression

Psilocybin therapy is the use of psilocybin in treating a range of mental health conditions, such as depression, anxiety, addictions, obsessive compulsive disorder, and psychosis. It is one of several forms of psychedelic therapy under study. Psilocybin was popularized as a psychedelic recreational drug in the 1970s and was classified as a Schedule I drug by the DEA. Research on psilocybin as a medical treatment was restricted until the 1990s because of the sociocultural fear of dependence on this drug. As of 2022, psilocybin is the most commonly researched psychedelic due to its safety and low potential for abuse and dependence. Clinical trials are being conducted at universities and there is evidence confirming the use of psilocybin in the treatment of depression, PTSD and end of life anxiety.

Post-traumatic stress disorder (PTSD) can affect about 3.6% of the U.S. population each year, and 6.8% of the U.S. population over a lifetime. 8.4% of people in the U.S. are diagnosed with substance use disorders (SUD). Of those with a diagnosis of PTSD, a co-occurring, or comorbid diagnosis of a SUD is present in 20–35% of that clinical population.

MDMA-assisted psychotherapy is the use of prescribed doses of MDMA as an adjunct to psychotherapy sessions. Research suggests that MDMA-assisted psychotherapy for post-traumatic stress disorder (PTSD), including Complex PTSD, might improve treatment effectiveness. In 2017, a Phase II clinical trial led to "breakthrough therapy" designation by the US Food and Drug Administration (FDA) for potential use as a treatment for PTSD.

<span class="mw-page-title-main">Narrative exposure therapy</span> Short-term therapy for trauma-related disorders

Narrative Exposure Therapy (NET) is a short-term psychotherapy used for the treatment of post-traumatic stress disorder and other trauma-related mental disorders. It creates a written account of the traumatic experiences of a patient or group of patients, with the aim of recapturing self-respect and acknowledging the patient's value. NET is an individual treatment, NETfacts is a format for communities.

Una D. McCann is a board certified psychiatrist and researcher at Johns Hopkins School of Medicine in the Department of Psychiatry. She is also the Director of the Anxiety Disorders Program, and Co-Director of the Center for Interdisciplinary Sleep Medicine and Research, and Associate Program Director at the Johns Hopkins Bayview Medical Center. McCann is considered to be an expert in anxiety and stress disorders and her primary areas research revolves around amphetamine-induced monoamine neurotoxicity and neurobiology of anxiety disorders.

In psychology, Trauma-informed feminist therapy is a model of trauma for both men and women that incorporates the client's sociopolitical context.

Psychoplastogens are a group of small molecule drugs that produce rapid and sustained effects on neuronal structure and function, intended to manifest therapeutic benefit after a single administration. Several existing psychoplastogens have been identified and their therapeutic effects demonstrated; several are presently at various stages of development as medications including Ketamine, MDMA, Scopolamine, and the serotonergic psychedelics, including LSD, psilocin, DMT, and 5-MeO-DMT. Compounds of this sort are being explored as therapeutics for a variety of brain disorders including depression, addiction, and PTSD. The ability to rapidly promote neuronal changes via mechanisms of neuroplasticity was recently discovered as the common therapeutic activity and mechanism of action.

Ketamine-assisted psychotherapy(KAP) is the use of prescribed doses of ketamine, the drug, as an adjunct to psychotherapy sessions. KAP shows significant potential in treating mental disorders such as treatment-resistant depression (TRD), anxiety, obsessive–compulsive disorders (OCD), post-traumatic stress disorders (PTSD), and other conditions. It can also be used for those experiencing substance abuse and physical pain. While it is primarily used as a veterinary anaesthetic, ketamine has also been found to have rapid analgesic and hallucinogenic effects, which has sparked interest in its use as an antidepressant. Despite initial trials of its use in the treatment of mental disorders focussing primarily on its antidepressant effects, newer studies are attempting to harness its psychedelic effects to bring about altered states of consciousness, which will augment the adjunct psychotherapy. Ketamine's neuroplasticity-promoting effects strengthen the cognitive restructuring that takes place through traditional psychotherapy, thereby leading to long-lasting behavioural change. KAP offers promising directions for research on new antidepressant alternatives, but is still not sufficiently defined or evaluated as a treatment combination.

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