Therapy’s psychedelic renaissance: A different kind of healing journey, part 1
Written by Lauren Dockett
Published byPsychotherapy Networker
Last updated: 11/10/2022
It’s a gripping few minutes of video. Nicholas, a young, bearded man, lies on a raised futon in what looks like a suburban den. He could be anybody’s kid, home from school, dozing restlessly in a T-shirt and sweatpants, the spidery ends of dark tattoos peeking out of his shirt sleeves. As the camera pans out, we see an older man and woman in chairs on either side of him. There’s a discarded eyeshade and headphones near him on the mattress. His eyes flutter as he starts to talk, relating what sounds like a horrifying dream in real time.
“I never had a problem when I watched my friends die,” he says. “When I watched Manny, Cliff, burn alive. When everybody gets blown up, you don’t just sit there and cry like a little baby: You keep on pushing and finish your job. I don’t know how they get that into you, but they do.” Nicholas goes quiet for a moment, and the woman draws closer. “It just doesn’t feel right,” he says plaintively. “It feels cold to feel like that.”
The older man’s voice rises softly off camera, encouraging him to stay with his distress. “I think what this is, is a wave of something painful that needs processing,” he says.
Long back from two tours as a Humvee turret gunner in Iraq, Nicholas is a Marine combat vet in the midst of a mighty struggle with treatment-resistant posttraumatic stress disorder (PTSD). Among the symptoms he’s grappling with is uncontrollable anger, causing him to blow up frequently at his wife and other people in his life. With him are psychiatrist Michael Mithoefer, a professor at the University of South Carolina Medical School, and his wife Annie, a nurse. Together the two have been leading research into the effects of combining doses of MDMA, a pure form of the club drug ecstasy, with psychotherapy. They’re sitting with Nicholas for a session on the drug, having already prepped him in meetings beforehand to explore his trauma while under its effects.
Nicholas goes on to tell them, “I have this negative battle going on in my head, this part that’s just saying I’m a murderer and killer…that I wanted to do it, I wanted to go over there and hurt people… . That evilness—I don’t want any space for that in my life.”
“It’s a really important part of you that doesn’t want that,” Michael Mithoefer says, but reminds Nicholas that we all have parts that carry rage and the potential for violence; they just don’t need to be in charge. He suggests it may be time to understand that part of him and help it heal.
At first, the words don’t help; Nicholas says he can’t let them in because it makes him feel too helpless. But soon he’s sobbing, telling them a part of him wanted to die at war. “I just wanted to be done,” he says. The Mithoefers both put their arms around him as he cries, and they nod when he quiets and tells them, “I just don’t let myself feel sometimes, how much it hurts.”
The film skips ahead to another MDMA trip with Nicholas. He’s been listening to instrumental music to facilitate his inward journey and suddenly speaks up to tell the Mithoefers that its intensity has just reminded him that he was brave and strong in Iraq. “I saw myself in a whole new light,” he reports. “I’ve seen how low man can be…that side of the spectrum that’s so dark and so evil. There’s that other side that’s a balance to it. Accepting those things as one really just makes me feel complete.”
Now, instead of burying his past in a way that’s been hurting him, he wants to acknowledge all parts of himself, the warrior as well as the softer side. He wants to reconceive of himself as a “peaceful warrior.”
We see Nicholas a final time, in a chair on a stage wearing a well-tailored suit, his hair longer, his life different, as he talks about how he wouldn’t be here today without MDMA-assisted psychotherapy. He tells the audience that since his experience with the Mithoefers, he and his wife are going to have a baby. He says, “I finally feel like I have my head together. I didn’t want my child to see me the way I was before, and I’m so grateful for this therapy.” Without it, he adds, “I wouldn’t be alive.”
Tripping into breakthroughs
Since 2004, when the Mithoefers first started testing MDMA-assisted psychotherapy, more than a hundred vets, cops, firefighters, and sexual assault and abuse survivors have undergone treatment. The approach has proven so successful that the Food and Drug Administration has deemed it a “breakthrough therapy” for PTSD and is helping the Mithoefers speed along the final phase of trials with hundreds more trauma survivors. More than 20,000 people have already signed up to be part of it.
In 2018, the Journal of Contemporary Psychotherapy compared MDMA-assisted psychotherapy to talk therapies. The authors found Trauma-Focused Cognitive Behavioral Therapy and Cognitive Processing Therapy produced clinical improvement in 44% of their PTSD subjects. They also found commonly prescribed drugs, like Paxil, Zoloft, and other SSRIs, were effective 20% to 30%of the time. But in Mithoefer’s original phase-2 study with treatment-resistant PTSD subjects, who averaged 19 years with the disorder, a remarkable 83% of participants no longer met the criteria for PTSD after completing treatment.
When they followed up with them 45 months later, 74% had held onto improvement. They also reached out to subjects from all six of their phase-2 studies at the one-year mark. When they pooled those results, 68%still didn’t have PTSD, and one of the trial sites in Colorado says 80% of its subjects stayed well.
The neurochemical action of MDMA seems custom-made to treat PTSD. It releases a jumble of feel-good neurotransmitters, including serotonin, dopamine, and norepinephrine. It puts oxytocin, the hormone that increases our positive feelings about one another, in play. And it quiets the amygdala, the brain’s fear center, while amplifying the higher processing of the prefrontal cortex. The result is an exact reversal of the hyperanxiousness of the PTSD state, and it allows people to process deeply entrenched trauma without the clouding of an overwhelming emotional response.
Like Nicholas, all of Mithoefer’s study subjects are coached by therapists in lead-up sessions to try to let go and follow the drug wherever it takes them. This way, the MDMA can help people dive unimpeded into difficult places and break down hardened defenses through a deep, visceral sense of compassion for all aspects of their selves, past and present, before trauma and after. Also, the prosocial effects that have made MDMA a base for the popular club drug ecstasy accentuate feelings of trust in the therapists and the support they offer. It’s an effect that subjects say makes them feel deeply cared for during the experience.
The New York Times recently reported that these early study results have given hope to combat vets, some of whom are so desperate for relief from their PTSD symptoms that they’ve taken to doing MDMA illegally at home. This is concerning to the Mithoefers and their study funder, the Multidisciplinary Association of Psychedelic Science (MAPS), which is providing nearly $30 million for the research. They’re emphatic that for the treatment to work, the drug must be paired with therapy.
Preparatory therapy sessions help people feel safer on the drug and set an intention for their trip that can bring them to the heart of what they need to heal. And follow-up therapy sessions are a must, given that the powerful and often painful places MDMA takes them can trigger backlash later on—including flashbacks, heightened anxiety, and in some cases, suicidal ideation. Integrating those destabilizing feelings is critical, but doing this kind of work isn’t easy on therapists. While the standard appointment calendar of most trauma therapists revolves around weekly, 50-minute sessions, the kind of MDMA-assisted psychotherapy the Mithoefers envision necessitates a complete overhaul of their ordinary work pattern.
The MDMA protocol requires the drug to be prescribed in a clinic setting with a staff of at least two therapists, an assistant to stay overnight with the client after the trips, and a prescribing doctor. Therapists must commit to long, quiet hours supporting clients as they go inward on the drug. They must also be available afterward for three 90-minute integrative sessions following each of the three trips, which are spaced weeks apart, and for phone contact 24 hours a day for the immediate week after each.
Talking with subjects in the Mithoefer study, one hears again and again how the treatment “saved” them and gave them back their life. Journalists are hearing similar tales and producing a steady stream of stories, on not only the success of the MDMA trials for PTSD, but the work of research teams focused on the therapeutic potential of psilocybin (the active ingredient in “magic mushrooms”), LSD, ayahuasca, and the psychedelic ibogaine, to treat depression, anxiety, addiction, OCD, eating disorders, and fear of death for cancer patients.
ABC, CBS, CNN, NBC, NPR, PBS, Chelsea Handler, the Guardian, The Late Show with Stephen Colbert, the Los Angeles Times, The New Yorker, the New York Times, Rolling Stone, Scientific American, and TIME have all beaten the drum about psychedelics being the next big thing in therapy. Even a conservative Fox News host encouraged viewers to have a psychedelic experience before they died.
The untapped promise of a good trip
Bill Richards, a grandfather of psychedelic science who’s still associated with Johns Hopkins’s psilocybin therapy investigations, likes to remind people that psychedelics have been used to promote healing for thousands of years. Ancient Mesopotamians did them so often that traces of the drugs still cling to their pottery. Cave paintings in northern Algeria showing human figures with psychedelic mushrooms date back to 5000 BCE. And 32 million Americans, including plenty of therapists, have taken these mind-expanding drugs.
I myself wavered at the edge of the psychedelic universe for years as a college student. Long before I knew anything about their potential for therapy, I was at a school awash in psychedelics, but I was too frightened of having a long, bad trip to try any of them. Instead, I fell into the role of “trip sitting” friends on MDMA or LSD, until eventually one begged to return the favor with what he swore would be a mild and short-acting experience on magic mushrooms. He’d stay sober and glued to my side, he promised, for the entire time. On a quiet weekend night, I agreed to a small amount, and we squashed bits of the dry, icky-tasting fungus into Oreo cookies. Like a cheerful suburban parent, he handed them to me on a porcelain plate, along with a tall glass of milk. “Down the hatch, sweetpea!” he giggled.
Once I’d choked them down—even Oreos can disguise only so much of the taste of petrified vegetable rot—I immediately lay down, expecting some head-spinning image parade. But after 10 minutes of ceiling staring and nervous expectation, it never materialized. So we gathered ourselves up and headed out into the warm night to try our luck at a campus party. When we crossed the threshold into a packed dorm room I suddenly felt overcome by a stunning and unfamiliar sensation—utter, unequivocal calm.
At this point in my college career, I’d become accustomed to being around proud geeks, some tortured for their nerdiness in high school, who’d found their intellectual nirvana and could spend hours drunkenly humiliating one another in searing, no-holds-barred debates. I found this practice and these young men, many of whom surrounded me in the room, abjectly cruel. But along with the odd sense of calm, this night I felt something else in their presence that I can still feel palpably as I write—a deep awakening to the profound depths of our mutuality.
It was as if I’d entered a room bathed in acceptance, and each person in it embodied a core of kindness and love that all their verbal battling had previously obscured for me. Now, for the first time, I saw their truth. They were good. I was good. My trip-sitting friend was so good he was glowing like a two-armed Vishnu. They were suffering. I was suffering. And whatever the lot of us had said or done to one another, whatever grandstanding, ignorance, or insecurities we’d all acted on in the time we’d been together, were just inessential, fluffy distractions: the blurting of groundless fears. Nothing personal. Nothing substantial. Nothing lastingly true.
This sense of oneness and profound acceptance that overtook me is the quintessential gift of the drug that Richards unabashedly equivocates with mysticism. In his book “Sacred Knowledge: Psychedelics and Religious Experiences,” he remarks on how we’re on the cusp of making these mystical healing powers of psychedelics come alive again. “For those who deeply believe in the promise of these sacred substances,” he says, “it is a hopeful time.”
Back in that dorm room, I felt myself smiling softly at each of the other partygoers. Many smiled back, some fully, some halfheartedly. With the halfhearted smilers, I felt a deep ache arching between us—the pain of having to disguise our essential bond to one another, as some protective part in them pretends at disconnection and difference.
I knew when I started thinking this way that it was the drug. But I didn’t discount or disbelieve what was happening. It was like watching an absorbing and hopeful documentary that was speaking to a reality I’d normally failed to see. I’d dug up an unassailable truth, I thought, that was mine now forever. And if I remembered it well enough, once the mushrooms finished their work, it might just reshape, in some significant way, my world view.
I turned to my friend. “I think I’m tripping now.”
He gazed at me with delight. “It’s great, isn’t it?”
I still call up my stirring, dorm-room trip when I have to give a lecture or defend my ideas to a group of overeducated meanies. It’s become my version of imagining an audience in their underwear. So you can bet that the idea of going back to the drug these many decades later—now with trained therapists and a real intention to roll back my various irrational fears—has grown exponentially more appealing with each new story of breakthrough or revelation I hear.
It’s intriguing, isn’t it? The idea of making huge strides in the span of a few trips with a treatment that, rather than requiring daily maintenance on drugs, or emotional sustenance in weekly therapy, might just last a deeply healing decade or two, or maybe even a lifetime.
So why have we left it on ice for so long?
Read Part 2 of this article to learn about the history of psychedelic-assisted therapy and what its use may look like in the future.
Lauren Dockett is the senior writer at Psychotherapy Networker.
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For nearly 50 years, the Psychotherapy Networker magazine has been celebrated for its incisive and heartfelt articles on the challenges of clinical practice, the therapeutic innovations shaping the field, and the extraordinary experience of being a therapist.
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