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David Nutt FMedSci
Imperial College London
d.nutt@imperial.ac.uk
profdavidnutt@twitter.com
Psychedelic assisted psychotherapy -
New neuroscientific approaches to
addiction and depression
Psychedelics are an enduring feature of human
existence
Maybe also fueled Christianity?
LSD – the big breakthrough
LSD
 synthetic and more potent psychedelic
 wide medical and research use
Albert Hoffman – the
discoverer of LSD and
psilocybin - at 100
If the doors of perception were cleansed every
Thing would appear to man as it is, infinite.
For man has closed himself up, till he sees all
Things thro’ narrow chinks of his cavern.
William Blake, 1793
Aldous Huxley and mescaline
Peyote cactus
“The brain is an
instrument for focusing
the mind”
DepressionAddiction
The brain reconstructs
the image to what it
expects
But always with limitations
“Man sees thro’ the chinks of
his cavern” William Blake
1793
Neuroscience proves Huxley and Blake right
Early Psychiatric Uses for LSD
1. Psychotomimetic
2. Self-experimentation by mental health
professionals
3. Psychedelic Psychotherapy
• High dose single drug session
• Mystical / Peak experience
• Favoured in the US
4. Psycholytic Psychotherapy
• Low doses
• Frequent, regular sessions
• Favoured in the UK
7Ben Sessa
“To sink in hell or soar angelic
You’ll need a pinch of psychedelic”
Ronald David Laing: UK
Humphrey Osmond: UK CanadaUSA
Advice for those wishing to
become a psychoanalyst:
1.Read the works of Freud
2.Undergo personal analysis
3.Take LSD
Psychiatry protagonists
Clinical Interest in LSD in the
1950s and 1960s
• Hundreds of psychiatrists worldwide
• 140 NIH grants
• 1000 clinical papers
• 40,000 patients
• 40 books
• 6 International conferences
Results were overwhelmingly positive, describing safe and
effective treatments.
(Masters and Houston, 1971)
Pooled analyses in the 1960s
• 44 psychiatrists, 5000 subjects and 25,000 drug sessions:
Rate of psychosis: 0.2%
Rate of suicide of 0.04%
(Cohen S. (1960) LSD: side effects and complications. Journal of Nervous and Mental Disorders 130: 30-40)
• 700 psychedelic drug sessions:
One case of prolonged psychosis
(Chandler Al. & Hartman Ma. (1960) LSD-25 as a Facilitating Agent in Psychotherapy. AMA Arch Gen Psychiatry; 2(3):286-299)
• 350 patients over four years of outpatient treatments:
One attempted suicide
(Ling TM, Buckman J (1963) The Treatment of Anxiety with Lysergic Acid and Methylphenidate. Practitioner 191: 201-4)
• Review of 20 years of psychedelic therapy in the UK, 4000 patients and
50,000 psychedelic drug-assisted sessions.
Two completed suicides
Thirty-seven patients with a prolonged psychosis
(Malleson, N. (1971) ‘Acute Adverse Reactions to LSD in clinical and experimental use in the UK.’ Br J Psychiatry. 18(543): 229-30)
"Treatment with LSD is not without acute adverse
reactions, but given adequate psychiatric supervision
and proper conditions for its administration, the
incidence of such reactions is not great,"
Psychedelics for alcoholism?
Some years after his atropine-induced
sobriety conversion Bill Wilson, founder
of AA, came to believe that LSD could
help “cynical alcoholics” (those who did
not believe in a higher power”) achieve
spiritual awakening
Wilson’s psychedelic experience
“Suddenly the room lit up with a great white
light. I was caught up in an ecstasy which there
are no words to describe.
It seemed to me in my mind's eye, that I was on
a mountain and that a wind not of air but of
spirit was blowing.
And then it burst upon me that I was a free
man.”
And he was right re alcoholism!
6 LSD trials in alcoholism
Effect size > = all current therapies
Since the banning – one clinical trial + only two neuroscience
studies - all in last two years
Psychedelics, used responsibly and with proper caution,
would be for psychiatry,
what the microscope is for biology and medicine,
or the telescope is for astronomy
Stan Grof
- but how do they work?
A necessary research tool?
Why were psychedelics banned?
Because the CIA were worried
about American youth refusing
to fight in Vietnam – and
cultural change (flower power)
Scare stories e.g. trying to fly
The lies the media told!
LSD scares in the
film media
The usual cocktail of sex
drugs and youth
 moral outrage in the
old
LSD and all other psychedelics banned in
face of opposition from senators
Bobby Kennedy:
Why if [clinical LSD projects] were worthwhile
six months ago, why aren’t they worthwhile
now? . . . We keep going around and
around. . . . If I could get a flat answer about
that I would be happy. Is there a
misunderstanding about my question?
I think perhaps we have lost sight of the
fact that LSD can be very, very helpful in
our society if used properly.”
quoted in Lee & Shlain, 1985, p. 93)
Has there ever been a worst example of research
censorship?
Well not since …….
The banning of the telescope!
1616 The papal Congregation of the Index banned all books
advocating the Copernican system of explaining planetary motion
Not revoked until 1758
Galileo
Galilei
1564-1642
Giordano Bruno
1548-1600
Nicolaus
Copernicus
1473-1543
How the UN Conventions on drugs destroyed research
Read more about it
Nature reviews
Neuroscience 2013
March 2015
Fighting back – psychedelics for addiction
Modern replication study
Psilocybin-assisted treatment for alcohol dependence: A
proof-of-concept study
J Psychopharmacol March 2015 29: 289-299, first published
on January 13, 2015
Bogenschutz MP1, Forcehimes AA2, Pommy JA2, Wilcox
CE2, Barbosa PC3, Strassman RJ2.
Psilocybin for alcoholism
Psilocybin and smoking cessation
Psilocybin and smoking cessation - Results
Krupitsky et al. Ketamine Psychotherapy for Heroin Dependence
Single Versus Repeated Sessions of
Ketamine-Assisted Psychotherapy for
People with Heroin Dependence†
Evgeny M. Krupitsky, M.D., Ph.D.*; Andrei M. Burakov, M.D., Ph.D.**;
Igor V. Dunaevsky, M.D., Ph.D.***; Tatyana N. Romanova, M.S.****;
Tatyana Y. Slavina, M.D., Ph.D.***** & Alexander Y. Grinenko M.D., Ph.D.******
Abstract— A prior study found that one ketamine-assisted psychotherapy session was significa nt ly
more effective than active placebo in promoting abstinence (Krupitsky et al. 2002). In this study of the
efficacy of single versus repeated sessions of ketamine-assisted psychotherapy in promoting abstinence
in people with heroin dependence, 59 detoxified inpatients with heroin dependence received a ketamine-
assisted psychotherapy (KPT) session prior to their discharge from an addiction treatment hospital, and
were then randomized into two treatment groups. Participants in the firs t group received two addiction
counseling sessions followed by two KPT sessions, with sessions scheduled on a monthly interval
(multiple KPT group). Participants in the second group received two addiction counseling sessions
on a monthly interval, but no additional ketamine therapy sessions (single KPT group). At one-year
follow-up, survival analysis demonstrated a significa nt ly higher rate of abstinence in the multiple KPT
group. Thirteen out of 26 subjects (50%) in the multiple KPT group remained abstinent, compared to
6 out of 27 subjects (22.2%) in the single KPT group (p < 0.05). No differences between groups were
Journal of Psychoactive Drugs 13 Volume 39 (1), March 2007
Abstract— A prior study found that one ketamine-assisted psychotherapy session was significa nt ly
more effective than active placebo in promoting abstinence (Krupitsky et al. 2002). In this study of the
efficacy of single versus repeated sessions of ketamine-assisted psychotherapy in promoting abstinence
in people with heroin dependence, 59 detoxified inpatients with heroin dependence received a ketamine-
assisted psychotherapy (KPT) session prior to their discharge from an addiction treatment hospital, and
were then randomized into two treatment groups. Participants in the firs t group received two addiction
counseling sessions followed by two KPT sessions, with sessions scheduled on a monthly interval
(multiple KPT group). Participants in the second group received two addiction counseling sessions
on a monthly interval, but no additional ketamine therapy sessions (single KPT group). At one-year
follow-up, survival analysis demonstrated a significa nt ly higher rate of abstinence in the multiple KPT
group. Thirteen out of 26 subjects (50%) in the multiple KPT group remained abstinent, compared to
6 out of 27 subjects (22.2%) in the single KPT group (p < 0.05). No differences between groups were
found in depression, anxiety, craving for heroin, or their understanding of the meaning of their lives. It
was concluded that three sessions of ketamine-assisted psychotherapy are more effective than a single
session for the treatment of heroin addiction.
Keywords—hallucinogens, heroin addiction, ketamine, psychedelics, psychotherapy, treatment
†This study was supported by the Multidisciplinary Association for
Psychedelic Studies (MAPS), Sarasota, Florida, USA and by the Heffter
Research Institute, Santa Fe, New Mexico, USA. The authors are also very
thankful to Rick Doblin, Lisa Jerome, Valerie Mojeiko, and Dr. George
Greer for assistance in editing the manuscript, and to Tatyana Volskaya,
M.A., for data management.
*Chief of the Research Laboratory, St. Petersburg Regional Center of
Addictions and Psychopharmacology, St. Petersburg State Pavlov Medical
University, St. Petersburg, Russia.
**Psychiatrist, St. Petersburg Regional Center of Addictions and
Psychopharmacology, St. Petersburg State Pavlov Medical University, St.
Petersburg, Russia.
***Anesthesiologist, St. Petersburg Regional Center of Addictions
and Psychopharmacology, St. Petersburg State Pavlov Medical University,
St. Petersburg, Russia.
****Clinical Psychologist, St. Petersburg Regional Center of
Addictions and Psychopharmacology, St. Petersburg State Pavlov Medical
University, St. Petersburg, Russia.
*****Psychiatrist and Medical Director, St. Petersburg Regional
Center ofAddictions and Psychopharmacology, St. Petersburg State Pavlov
Medical University, St. Petersburg, Russia.
******Director, St. Petersburg Regional Center of Addictions and
Psychopharmacology, St. Petersburg State Pavlov Medical University, St.
Petersburg, Russia.
Please address correspondence and reprint requests to Evgeny M.
Krupitsky, M.D., Ph.D., St. Petersburg Regional Center of Addictions and
Psychopharmacology, Novo-Deviatkino 19/1, Leningrad Region 188661,
Russia. Email: kru@ek3506.spb.edu
Psychedelic-assisted psychotherapy utilizes the acute
psychological effects of psychedelic, or hallucinogenic,
drugs to enhance the normal mechanisms of psychotherapy.
Many studies carried out in the 1950s and 1960s suggested
that psychedelic-assisted psychotherapy might be an effic
i
ent
treatment for alcoholism and addictions (Grinspoon &
Bakalar 1979). However, it is difficu l t to generalize across
these studies because of differences in methodology. After
they were scheduled in 1970, the use of psychedelic drugs
in research was strictly limited, significantly curtailing
Ketamine for heroin addiction
Ketamine one –v- three doses
heroin abstinence
Krupitsky et al. Ketamine Psychotherapy for Heroin Dependence
emotional support for the participant and carried out psycho-
therapy during the ketamine session. The psychotherapy was
existentially-oriented, focusing on assisting the participant
to consider and formulate a purposeful or meaningful life,
but also took into account the participant’s individuality,
ending or apocalypse, and often ended in an experience of
rebirth associated with oceanic, or positively experienced,
ego loss and boundlessness. All of these experiences were
emotionally intense and compelling. Many people reported
great diffic
u
l ty in expr essing their experiences in words. It
FIGURE 1
Kaplan-Meier Survival Analysis
P < 0.01
Krupitsky et al
2007
Ketamine for alcoholism
• Krupitsky, E. M., Grinenko, A. Y., Berkaliev, T. N., Paley, A. I., Tetrov, U. N.,
Mushkov, K. A., & Borodikin, Y. S. (1992). The combination of psychedelic
and aversive approaches in alcoholism treatment: The affective contra-
attribution method. Alcoholism Treatment Quarterly, 9(1), 99-105.
doi:10.1300/ J020V09N01_09
MRC-funded UK study in alcoholism underway in
UK
Celia Morgan and Val Curran with Krupitsky
The Beckley Foundation/Imperial College
Psychedelic Research Programme
Fighting back
LSD
Mescaline
Affinity for
5-HT2A
Potency in
manGlennon et al. 1984. Human dose data from Shulgin 1978
Resurrecting psychedelic research with psilocybin
All these drugs stimulate 5HT2A receptors
Psilocybin – magic mushrooms
Short acting if used iv = 30 min effect
PET image
[11C]Cimbi-36
5HT2A receptor
agonist
Copenhagen
5HT2A receptors most densely expressed cortex
Human brain has highest density of any brain
The 5-HT2A receptor in human brain revealed by
PET
Psilocybin fMRI: ONLY DECREASES in brain activity
+ regionally specific
Posterior
Cingulate
Thalamus
Anterior
cingulate
Carhart-Harris et al PNAS 2012
Psilocybin uncouples frontoparietal
connectivity (default mode network, DMN)
Saline – strong
correlations in
activity in these
regions
Psilocybin –
correlations lost
or even negative
Seed regionCarhart-Harris et al PNAS 2012
LSD disrupts default mode network
Carhart-Harris et al PNAS 2016
The default mode network & depression
A) PCC functional
connectivity
B) Greater PCC to SCC
(subgenual cingulate
cortex) connectivity in
depression
PCC - SCC functional
connectivity predicts
rumination
(Berman et al. 2011)
Brain sites of depression – PET imaging
“It is a positive and active anguish, a sort of
psychical neuralgia wholly unknown to normal life.
Cg25
F9 F9Cg24
Treatment Resistant
Depression
William James, revisited
So can we selectively
turn the active anguish
OFF?
Mayberg et al 2005 Neuron
Red = overactive region
Blue = underactive region
z = -4
z = +4
L
Deep Brain Stimulation – stops overactivity
Cg25
mF10
oF11
Cg24
hth
Cg25
F9
ins
F46
mF
ins
3 months DBS
CBF Change
Responders
Cg24
vCd
sn Cg25 Cg25
Cg24 F9F9
F47
hth
Baseline
CBF PET
All PT vs NC
Cg25
mF10
oF11
Cg24
hth
bs
Cg25
mFF9
ins
F9
F46
Cg31
6 months DBS
CBF Change
Responders
Helen Mayberg
Cg24
vmF
dmF
Hth
Cg25
Antidepressants also switch off
this region
bs
Cg31
Hth
Cg25
bs
Cg31
DBS SSRI antidepressant
Helen Mayberg
Psilocybin
attenuates activity in
the brain region
linked to depression
Carhart-Harris PNAS 2012
fMRI BOLD image
Psilocybin attenuated mPFC activity
As do treatments for depression
SSRIs Kennedy et al. 01
CBT Goldapple et al. 04
Sleep deprivation Gillin et al. 01
ECT Bonne et al. 96
Placebo Mayberg et al. 02
Deep brain stimulation Mayberg et al. 05
Ketamine Deakin et al. 08
Meditation reduces DMN activity - basis of mindfulness therapy?
Coloured
bars
reflect
different
sorts of
meditation
Yale group
Mood and wellbeing
• Users often report enduring effects
• Formal studies – Roland Griffiths John
Hopkins – confirm this
• As did our subjects
Single high dose of psilocybin:
Two-thirds of participants rated
their experience as one of their top
5 most meaningful life experiences
(Griffiths et al. 2006)
Is this an antidepressant effect?
Our MRC psilocybin depression trial
Grant awarded 2012
Ethics – took 3 iterations – 1 year
Drug supply – 30 months
Regulatory approvals – 32 months
Cost per dose = £1500!
0
1
2
3
0
5
10
15
20
25
30
Baseline 1 week 2 weeks 3 weeks 5 weeks 3 months 6 months
Effectsize(Cohen'sd)
QIDSScore DepressionSeverity (QIDS) P1
P2
P3
P4
P5
P6
P7
P8
P9
P10
P11
P12
P13
P14
P15
P16
P18
P19
P20
MEAN
Cohen's d
Psilocybin for resistant depression
Carhart-Harris et al Psychopharmacology 2017
Fearful
Amygdala – Faces - SSRIs
Depression > “Healthy”
SSRIs reduce activity
Antidepressants and amygdala - meta-analysis
a et al. (2015), Molecular psychiatry
Reduced activity to negative emotional faces
Fearful Happy Neutral
Baseline and 1-day after therapy (“after-glow”)
Passively viewing
Blocks of 15 seconds
Amygdala in psilocybin assisted therapy
Roseman et al submitted
Fearful Happy Neutral Fearful>Neutral
y=-5 y=-2 y=-3 y=1
3.5Z=2.3
Amygdala activation increased
after psilocybin-assisted therapy
1-day after therapy > Baseline
Roseman et al submitted
More amygdala activation  better
clinical outcome
Fearful > Neutral
Remitters (n=11) > Non-remitters (n=8)
y=-1
x=20
Remission (No depression)
BDI <= 9
1 week
3.5Z=2.3
Roseman et al submitted
Anti-depressant
Psychedelic-
assisted therapy
Amygdala
Fearful
Decrease Increase
Amygdala
Happy
Mixed Increase
Strategy of therapy
Relieve negative
emotions
Confront and work
through emotions
Result = opposite to antidepressants
Carhart-Harris and Nutt – Journal of
Psychopharmacology 2017 – free download
5-HT receptors in depression - our current model
Psilocybin changes attitude
They can change patients’ outlook
Normalised
post-treatment
P < 0.01
P < 0.01
Pessimism bias
pre-treatment
P < 0.01
“My outlook has changed significantly. I'm more aware now that it's
pointless to get wrapped up in endless negativity. I feel as if I've
seen a much clearer picture.”
[Patient from depression trial, male, aged 52, >20yrs depression]
Watts et al Journal of Humanistic Psychology 2017, Vol. 57(5) 520
It was like when you defrag the hard drive on your
computer, I experienced blocks going into place, things being
rearranged in my mind, I visualized as it was all put into
order, a beautiful experience with these gold blocks going
into black drawers that would illuminate, and I thought my
brain is bring defragged, how brilliant is that! (P11)
My mind works differently [now]. I ruminate much
less, and my thoughts feel ordered, contextualized.
Rumination was like thoughts out of context, out of
time; now my thoughts feel like they make sense,
with context and logical flow. (P11) “
“
Another quote
Watts et al Journal of Humanistic Psychology 2017, Vol. 57(5) 520
Self worth/self love: ‘I had an
experience of tenderness towards
myself, a feeling of true compassion I’d
never felt before (P16)
New perspectives: ‘She was so
eloquent, she kept calling me ‘my
darling’: “Life is to be lived my
darling” She talked to me in such a
loving way, all these things to say
about my life’ (P12)
Activities: ‘I started writing music again’
(P1) (jobs, driving, acting, building, flying,
volunteering, travel)
Inner therapist: ‘Its like ingesting your
own psychotherapist’ (P19)
“
“
Connected to self
Watts et al Journal of Humanistic Psychology 2017, Vol. 57(5) 520
Connection to the world
Connection to work 7
Connection to nature 11
Connection to spiritual principle 9
Before I enjoyed nature, now I feel part of it.
Before I was looking at it as a thing, like TV
or a painting. You’re part of it, there’s no
separation or distinction, you are it. (P1)
Watts et al Journal of Humanistic Psychology 2017, Vol. 57(5) 520
Talking therapy: disconnection:
I’m sick to the back teeth of telling people again and again the backstory.
All the talking therapies, each time you go for an 8 or 6 week course of
that stuff, you spend the first few weeks going over the stuff, they ask all
the questions again then its session 4, and then, you think who’s learning
something here, ‘cos I’m not. You are! (P13)
They all seemed to be trying to fit a person into a preconceived set of
patterns: ‘try to do this’, ‘make this your goal, and we’ll measure it’. But
just having these goals set for you is more pressure and when you don’t
meet those goals, you feel even worse because you’re letting them down,
and you already feel let down yourself! (P1)
TOO DIRECTIVE
TOO SHORT
“
“
I got up the courage to tell him, I’d never told anyone. And [the
psychiatrist] just looked at his shoes.’ (P16)
DON’T ADDRESS TRAUMA:
“
“Those who cannot change their minds cannot
change anything”
George Bernard Shaw (1856-1950)
Can our research help change peoples’ mind about psychedelics?
 a new Enlightenment perhaps.....
Acknowledgements
Mendel Kaelen, Leor Roseman, Mark Bolstridge, Chris Timmermann, Tim Williams,
David Erritzoe, Ben Sessa, Suresh Muthukumuraswamy, Richard Wise, Luke Williams,
Kevin Murphy, Robert Leech, Eduardo Schenberg, Neiloufar Family, Matt Wall, Val
Curran, Karl Friston, Rosalyn Moran, David Nichols, Robin Tyacke, James Stone,
Laurence Reed, Nadar Abbasi, Enzo Tagliazucchi, Dante Chialvo, Roland Griffiths,
Katherine MacLean, Matt Johnson, Charlie Grob, Bill Richards, Jeff Guss, George
Goldsmith, Ekaterina Malievskaia, Celia Morgan, Mitul Mehta, Alexander Lebedev,
Pete Hellyer, Csaba Orban, John McGonigle, Remi Flechais, Michael Bloomfield, Steve
Pilling, Matt Brookes, Tim Nest, Paul Expert, Giovanni Petri, James Rucker, Camilla Day,
Shlomi Raz, Catherine Scrace, Kabir Nigam, John Evans, Peter Hobden, Wouter Droog,
Yvonne Lewis, Mark Tanner, Ineke de Meer; Alison Diaper, Ann Rich, Sue Wilson,
volunteers, patients and more…
Robin Carhart-Harris Amanda Feilding
Brain sites of depression – PET imaging
“It is a positive and active anguish, a sort of
psychical neuralgia wholly unknown to normal life.
Cg25
F9 F9Cg24
Treatment Resistant
Depression
William James, revisited
So can we selectively
turn the active anguish
OFF?
Mayberg et al 2005 Neuron
Red = overactive region
Blue = underactive region
z = -4
z = +4
L
Deep Brain Stimulation – stops overactivity
Cg25
mF10
oF11
Cg24
hth
Cg25
F9
ins
F46
mF
ins
3 months DBS
CBF Change
Responders
Cg24
vCd
sn Cg25 Cg25
Cg24 F9F9
F47
hth
Baseline
CBF PET
All PT vs NC
Cg25
mF10
oF11
Cg24
hth
bs
Cg25
mFF9
ins
F9
F46
Cg31
6 months DBS
CBF Change
Responders
Helen Mayberg
Cg24
vmF
dmF
Hth
Cg25
Antidepressants also switch off
this region
bs
Cg31
Hth
Cg25
bs
Cg31
DBS SSRI antidepressant
Helen Mayberg
Bhagwager et al 2006 Am J Psychiatry
Recovered depressed patients have
increased 5HT2A receptors
Maybe an attempt to make up for deficiency of 5HT?
So would psilocybin
replace what’s missing ?
Figure 3a. 5-HT2A binding in frontolimbic regions
correlates with trait neuroticism in 84 healthy
subjects38
.
Figure 3b. Cortical 5-HT2A binding correlates with
dysfunctional attitudes (pessimism) in medicated
free depressed patients39
.
Figure 3c. Regions where 5-HT2A binding correlates
positively with pessimism in med-free depressed
patients39
.
More 5HT2A receptors  pessimism
Meyer et al
Maybe an attempt to make up for deficiency of 5HT (serotonin)
Could psilocybin rectify this?
“The future may teach us
how to exercise a direct
influence, by means of
particular chemical
substances, upon …the
neural apparatus. It may
be that there are other
still undreamt of
possibilities of therapy.”
From An Outline of Psychoanalysis
Sigmund Freud
London 1938.
64
But we were not the first!
Was Freud the forefather of psychedelic therapy?
If the doors of perception were cleansed every
Thing would appear to man as it is, infinite.
For man has closed himself up, till he sees all
Things thro’ narrow chinks of his cavern.
iam Blake, 1793
Aldous Huxley and mescaline
Peyote cactus
“The brain is an
instrument for focusing
the mind”
DepressionAddiction
The brain reconstructs
the image to what it
expects
But always with limitations
“Man sees thro’ the chinks of
his cavern” William Blake
1793
Neuroscience proves Huxley and Blake right
By switching of the “control centres” psilocybin
increases brain connectivity
Petri et al J. R. Soc. Interface 11: 20140873. http://dx.doi.org/10.1098/rsif.2014.0873
Normal Psilocybin

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PROFESSOR DAVID NUTT - PSYCHEDELIC ASSISTED PSYCHOTHERAPY – NEW NEUROSCIENTIFIC APPROACHES TO ADDICTION AND DEPRESSION

  • 1. David Nutt FMedSci Imperial College London d.nutt@imperial.ac.uk profdavidnutt@twitter.com Psychedelic assisted psychotherapy - New neuroscientific approaches to addiction and depression
  • 2. Psychedelics are an enduring feature of human existence
  • 3. Maybe also fueled Christianity?
  • 4. LSD – the big breakthrough LSD  synthetic and more potent psychedelic  wide medical and research use Albert Hoffman – the discoverer of LSD and psilocybin - at 100
  • 5. If the doors of perception were cleansed every Thing would appear to man as it is, infinite. For man has closed himself up, till he sees all Things thro’ narrow chinks of his cavern. William Blake, 1793 Aldous Huxley and mescaline Peyote cactus “The brain is an instrument for focusing the mind”
  • 6. DepressionAddiction The brain reconstructs the image to what it expects But always with limitations “Man sees thro’ the chinks of his cavern” William Blake 1793 Neuroscience proves Huxley and Blake right
  • 7. Early Psychiatric Uses for LSD 1. Psychotomimetic 2. Self-experimentation by mental health professionals 3. Psychedelic Psychotherapy • High dose single drug session • Mystical / Peak experience • Favoured in the US 4. Psycholytic Psychotherapy • Low doses • Frequent, regular sessions • Favoured in the UK 7Ben Sessa
  • 8. “To sink in hell or soar angelic You’ll need a pinch of psychedelic” Ronald David Laing: UK Humphrey Osmond: UK CanadaUSA Advice for those wishing to become a psychoanalyst: 1.Read the works of Freud 2.Undergo personal analysis 3.Take LSD Psychiatry protagonists
  • 9. Clinical Interest in LSD in the 1950s and 1960s • Hundreds of psychiatrists worldwide • 140 NIH grants • 1000 clinical papers • 40,000 patients • 40 books • 6 International conferences Results were overwhelmingly positive, describing safe and effective treatments. (Masters and Houston, 1971)
  • 10. Pooled analyses in the 1960s • 44 psychiatrists, 5000 subjects and 25,000 drug sessions: Rate of psychosis: 0.2% Rate of suicide of 0.04% (Cohen S. (1960) LSD: side effects and complications. Journal of Nervous and Mental Disorders 130: 30-40) • 700 psychedelic drug sessions: One case of prolonged psychosis (Chandler Al. & Hartman Ma. (1960) LSD-25 as a Facilitating Agent in Psychotherapy. AMA Arch Gen Psychiatry; 2(3):286-299) • 350 patients over four years of outpatient treatments: One attempted suicide (Ling TM, Buckman J (1963) The Treatment of Anxiety with Lysergic Acid and Methylphenidate. Practitioner 191: 201-4) • Review of 20 years of psychedelic therapy in the UK, 4000 patients and 50,000 psychedelic drug-assisted sessions. Two completed suicides Thirty-seven patients with a prolonged psychosis (Malleson, N. (1971) ‘Acute Adverse Reactions to LSD in clinical and experimental use in the UK.’ Br J Psychiatry. 18(543): 229-30) "Treatment with LSD is not without acute adverse reactions, but given adequate psychiatric supervision and proper conditions for its administration, the incidence of such reactions is not great,"
  • 11. Psychedelics for alcoholism? Some years after his atropine-induced sobriety conversion Bill Wilson, founder of AA, came to believe that LSD could help “cynical alcoholics” (those who did not believe in a higher power”) achieve spiritual awakening
  • 12. Wilson’s psychedelic experience “Suddenly the room lit up with a great white light. I was caught up in an ecstasy which there are no words to describe. It seemed to me in my mind's eye, that I was on a mountain and that a wind not of air but of spirit was blowing. And then it burst upon me that I was a free man.”
  • 13. And he was right re alcoholism!
  • 14. 6 LSD trials in alcoholism Effect size > = all current therapies Since the banning – one clinical trial + only two neuroscience studies - all in last two years
  • 15. Psychedelics, used responsibly and with proper caution, would be for psychiatry, what the microscope is for biology and medicine, or the telescope is for astronomy Stan Grof - but how do they work? A necessary research tool?
  • 16. Why were psychedelics banned? Because the CIA were worried about American youth refusing to fight in Vietnam – and cultural change (flower power) Scare stories e.g. trying to fly
  • 17. The lies the media told!
  • 18. LSD scares in the film media The usual cocktail of sex drugs and youth  moral outrage in the old
  • 19. LSD and all other psychedelics banned in face of opposition from senators Bobby Kennedy: Why if [clinical LSD projects] were worthwhile six months ago, why aren’t they worthwhile now? . . . We keep going around and around. . . . If I could get a flat answer about that I would be happy. Is there a misunderstanding about my question? I think perhaps we have lost sight of the fact that LSD can be very, very helpful in our society if used properly.” quoted in Lee & Shlain, 1985, p. 93) Has there ever been a worst example of research censorship? Well not since …….
  • 20. The banning of the telescope! 1616 The papal Congregation of the Index banned all books advocating the Copernican system of explaining planetary motion Not revoked until 1758 Galileo Galilei 1564-1642 Giordano Bruno 1548-1600 Nicolaus Copernicus 1473-1543
  • 21. How the UN Conventions on drugs destroyed research
  • 22. Read more about it Nature reviews Neuroscience 2013 March 2015
  • 23. Fighting back – psychedelics for addiction Modern replication study Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study J Psychopharmacol March 2015 29: 289-299, first published on January 13, 2015 Bogenschutz MP1, Forcehimes AA2, Pommy JA2, Wilcox CE2, Barbosa PC3, Strassman RJ2.
  • 26. Psilocybin and smoking cessation - Results
  • 27. Krupitsky et al. Ketamine Psychotherapy for Heroin Dependence Single Versus Repeated Sessions of Ketamine-Assisted Psychotherapy for People with Heroin Dependence† Evgeny M. Krupitsky, M.D., Ph.D.*; Andrei M. Burakov, M.D., Ph.D.**; Igor V. Dunaevsky, M.D., Ph.D.***; Tatyana N. Romanova, M.S.****; Tatyana Y. Slavina, M.D., Ph.D.***** & Alexander Y. Grinenko M.D., Ph.D.****** Abstract— A prior study found that one ketamine-assisted psychotherapy session was significa nt ly more effective than active placebo in promoting abstinence (Krupitsky et al. 2002). In this study of the efficacy of single versus repeated sessions of ketamine-assisted psychotherapy in promoting abstinence in people with heroin dependence, 59 detoxified inpatients with heroin dependence received a ketamine- assisted psychotherapy (KPT) session prior to their discharge from an addiction treatment hospital, and were then randomized into two treatment groups. Participants in the firs t group received two addiction counseling sessions followed by two KPT sessions, with sessions scheduled on a monthly interval (multiple KPT group). Participants in the second group received two addiction counseling sessions on a monthly interval, but no additional ketamine therapy sessions (single KPT group). At one-year follow-up, survival analysis demonstrated a significa nt ly higher rate of abstinence in the multiple KPT group. Thirteen out of 26 subjects (50%) in the multiple KPT group remained abstinent, compared to 6 out of 27 subjects (22.2%) in the single KPT group (p < 0.05). No differences between groups were Journal of Psychoactive Drugs 13 Volume 39 (1), March 2007 Abstract— A prior study found that one ketamine-assisted psychotherapy session was significa nt ly more effective than active placebo in promoting abstinence (Krupitsky et al. 2002). In this study of the efficacy of single versus repeated sessions of ketamine-assisted psychotherapy in promoting abstinence in people with heroin dependence, 59 detoxified inpatients with heroin dependence received a ketamine- assisted psychotherapy (KPT) session prior to their discharge from an addiction treatment hospital, and were then randomized into two treatment groups. Participants in the firs t group received two addiction counseling sessions followed by two KPT sessions, with sessions scheduled on a monthly interval (multiple KPT group). Participants in the second group received two addiction counseling sessions on a monthly interval, but no additional ketamine therapy sessions (single KPT group). At one-year follow-up, survival analysis demonstrated a significa nt ly higher rate of abstinence in the multiple KPT group. Thirteen out of 26 subjects (50%) in the multiple KPT group remained abstinent, compared to 6 out of 27 subjects (22.2%) in the single KPT group (p < 0.05). No differences between groups were found in depression, anxiety, craving for heroin, or their understanding of the meaning of their lives. It was concluded that three sessions of ketamine-assisted psychotherapy are more effective than a single session for the treatment of heroin addiction. Keywords—hallucinogens, heroin addiction, ketamine, psychedelics, psychotherapy, treatment †This study was supported by the Multidisciplinary Association for Psychedelic Studies (MAPS), Sarasota, Florida, USA and by the Heffter Research Institute, Santa Fe, New Mexico, USA. The authors are also very thankful to Rick Doblin, Lisa Jerome, Valerie Mojeiko, and Dr. George Greer for assistance in editing the manuscript, and to Tatyana Volskaya, M.A., for data management. *Chief of the Research Laboratory, St. Petersburg Regional Center of Addictions and Psychopharmacology, St. Petersburg State Pavlov Medical University, St. Petersburg, Russia. **Psychiatrist, St. Petersburg Regional Center of Addictions and Psychopharmacology, St. Petersburg State Pavlov Medical University, St. Petersburg, Russia. ***Anesthesiologist, St. Petersburg Regional Center of Addictions and Psychopharmacology, St. Petersburg State Pavlov Medical University, St. Petersburg, Russia. ****Clinical Psychologist, St. Petersburg Regional Center of Addictions and Psychopharmacology, St. Petersburg State Pavlov Medical University, St. Petersburg, Russia. *****Psychiatrist and Medical Director, St. Petersburg Regional Center ofAddictions and Psychopharmacology, St. Petersburg State Pavlov Medical University, St. Petersburg, Russia. ******Director, St. Petersburg Regional Center of Addictions and Psychopharmacology, St. Petersburg State Pavlov Medical University, St. Petersburg, Russia. Please address correspondence and reprint requests to Evgeny M. Krupitsky, M.D., Ph.D., St. Petersburg Regional Center of Addictions and Psychopharmacology, Novo-Deviatkino 19/1, Leningrad Region 188661, Russia. Email: kru@ek3506.spb.edu Psychedelic-assisted psychotherapy utilizes the acute psychological effects of psychedelic, or hallucinogenic, drugs to enhance the normal mechanisms of psychotherapy. Many studies carried out in the 1950s and 1960s suggested that psychedelic-assisted psychotherapy might be an effic i ent treatment for alcoholism and addictions (Grinspoon & Bakalar 1979). However, it is difficu l t to generalize across these studies because of differences in methodology. After they were scheduled in 1970, the use of psychedelic drugs in research was strictly limited, significantly curtailing Ketamine for heroin addiction
  • 28. Ketamine one –v- three doses heroin abstinence Krupitsky et al. Ketamine Psychotherapy for Heroin Dependence emotional support for the participant and carried out psycho- therapy during the ketamine session. The psychotherapy was existentially-oriented, focusing on assisting the participant to consider and formulate a purposeful or meaningful life, but also took into account the participant’s individuality, ending or apocalypse, and often ended in an experience of rebirth associated with oceanic, or positively experienced, ego loss and boundlessness. All of these experiences were emotionally intense and compelling. Many people reported great diffic u l ty in expr essing their experiences in words. It FIGURE 1 Kaplan-Meier Survival Analysis P < 0.01 Krupitsky et al 2007
  • 29. Ketamine for alcoholism • Krupitsky, E. M., Grinenko, A. Y., Berkaliev, T. N., Paley, A. I., Tetrov, U. N., Mushkov, K. A., & Borodikin, Y. S. (1992). The combination of psychedelic and aversive approaches in alcoholism treatment: The affective contra- attribution method. Alcoholism Treatment Quarterly, 9(1), 99-105. doi:10.1300/ J020V09N01_09 MRC-funded UK study in alcoholism underway in UK Celia Morgan and Val Curran with Krupitsky
  • 30. The Beckley Foundation/Imperial College Psychedelic Research Programme Fighting back
  • 31. LSD Mescaline Affinity for 5-HT2A Potency in manGlennon et al. 1984. Human dose data from Shulgin 1978 Resurrecting psychedelic research with psilocybin All these drugs stimulate 5HT2A receptors Psilocybin – magic mushrooms Short acting if used iv = 30 min effect
  • 32. PET image [11C]Cimbi-36 5HT2A receptor agonist Copenhagen 5HT2A receptors most densely expressed cortex Human brain has highest density of any brain The 5-HT2A receptor in human brain revealed by PET
  • 33. Psilocybin fMRI: ONLY DECREASES in brain activity + regionally specific Posterior Cingulate Thalamus Anterior cingulate Carhart-Harris et al PNAS 2012
  • 34. Psilocybin uncouples frontoparietal connectivity (default mode network, DMN) Saline – strong correlations in activity in these regions Psilocybin – correlations lost or even negative Seed regionCarhart-Harris et al PNAS 2012
  • 35. LSD disrupts default mode network Carhart-Harris et al PNAS 2016
  • 36. The default mode network & depression A) PCC functional connectivity B) Greater PCC to SCC (subgenual cingulate cortex) connectivity in depression PCC - SCC functional connectivity predicts rumination (Berman et al. 2011)
  • 37. Brain sites of depression – PET imaging “It is a positive and active anguish, a sort of psychical neuralgia wholly unknown to normal life. Cg25 F9 F9Cg24 Treatment Resistant Depression William James, revisited So can we selectively turn the active anguish OFF? Mayberg et al 2005 Neuron Red = overactive region Blue = underactive region
  • 38. z = -4 z = +4 L Deep Brain Stimulation – stops overactivity Cg25 mF10 oF11 Cg24 hth Cg25 F9 ins F46 mF ins 3 months DBS CBF Change Responders Cg24 vCd sn Cg25 Cg25 Cg24 F9F9 F47 hth Baseline CBF PET All PT vs NC Cg25 mF10 oF11 Cg24 hth bs Cg25 mFF9 ins F9 F46 Cg31 6 months DBS CBF Change Responders Helen Mayberg
  • 39. Cg24 vmF dmF Hth Cg25 Antidepressants also switch off this region bs Cg31 Hth Cg25 bs Cg31 DBS SSRI antidepressant Helen Mayberg
  • 40. Psilocybin attenuates activity in the brain region linked to depression Carhart-Harris PNAS 2012 fMRI BOLD image Psilocybin attenuated mPFC activity As do treatments for depression SSRIs Kennedy et al. 01 CBT Goldapple et al. 04 Sleep deprivation Gillin et al. 01 ECT Bonne et al. 96 Placebo Mayberg et al. 02 Deep brain stimulation Mayberg et al. 05 Ketamine Deakin et al. 08
  • 41. Meditation reduces DMN activity - basis of mindfulness therapy? Coloured bars reflect different sorts of meditation Yale group
  • 42. Mood and wellbeing • Users often report enduring effects • Formal studies – Roland Griffiths John Hopkins – confirm this • As did our subjects Single high dose of psilocybin: Two-thirds of participants rated their experience as one of their top 5 most meaningful life experiences (Griffiths et al. 2006) Is this an antidepressant effect?
  • 43. Our MRC psilocybin depression trial Grant awarded 2012 Ethics – took 3 iterations – 1 year Drug supply – 30 months Regulatory approvals – 32 months Cost per dose = £1500!
  • 44. 0 1 2 3 0 5 10 15 20 25 30 Baseline 1 week 2 weeks 3 weeks 5 weeks 3 months 6 months Effectsize(Cohen'sd) QIDSScore DepressionSeverity (QIDS) P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13 P14 P15 P16 P18 P19 P20 MEAN Cohen's d Psilocybin for resistant depression Carhart-Harris et al Psychopharmacology 2017
  • 45. Fearful Amygdala – Faces - SSRIs Depression > “Healthy” SSRIs reduce activity
  • 46. Antidepressants and amygdala - meta-analysis a et al. (2015), Molecular psychiatry Reduced activity to negative emotional faces
  • 47. Fearful Happy Neutral Baseline and 1-day after therapy (“after-glow”) Passively viewing Blocks of 15 seconds Amygdala in psilocybin assisted therapy Roseman et al submitted
  • 48. Fearful Happy Neutral Fearful>Neutral y=-5 y=-2 y=-3 y=1 3.5Z=2.3 Amygdala activation increased after psilocybin-assisted therapy 1-day after therapy > Baseline Roseman et al submitted
  • 49. More amygdala activation  better clinical outcome Fearful > Neutral Remitters (n=11) > Non-remitters (n=8) y=-1 x=20 Remission (No depression) BDI <= 9 1 week 3.5Z=2.3 Roseman et al submitted
  • 50. Anti-depressant Psychedelic- assisted therapy Amygdala Fearful Decrease Increase Amygdala Happy Mixed Increase Strategy of therapy Relieve negative emotions Confront and work through emotions Result = opposite to antidepressants
  • 51. Carhart-Harris and Nutt – Journal of Psychopharmacology 2017 – free download 5-HT receptors in depression - our current model
  • 52. Psilocybin changes attitude They can change patients’ outlook Normalised post-treatment P < 0.01 P < 0.01 Pessimism bias pre-treatment P < 0.01 “My outlook has changed significantly. I'm more aware now that it's pointless to get wrapped up in endless negativity. I feel as if I've seen a much clearer picture.” [Patient from depression trial, male, aged 52, >20yrs depression] Watts et al Journal of Humanistic Psychology 2017, Vol. 57(5) 520
  • 53. It was like when you defrag the hard drive on your computer, I experienced blocks going into place, things being rearranged in my mind, I visualized as it was all put into order, a beautiful experience with these gold blocks going into black drawers that would illuminate, and I thought my brain is bring defragged, how brilliant is that! (P11) My mind works differently [now]. I ruminate much less, and my thoughts feel ordered, contextualized. Rumination was like thoughts out of context, out of time; now my thoughts feel like they make sense, with context and logical flow. (P11) “ “ Another quote Watts et al Journal of Humanistic Psychology 2017, Vol. 57(5) 520
  • 54. Self worth/self love: ‘I had an experience of tenderness towards myself, a feeling of true compassion I’d never felt before (P16) New perspectives: ‘She was so eloquent, she kept calling me ‘my darling’: “Life is to be lived my darling” She talked to me in such a loving way, all these things to say about my life’ (P12) Activities: ‘I started writing music again’ (P1) (jobs, driving, acting, building, flying, volunteering, travel) Inner therapist: ‘Its like ingesting your own psychotherapist’ (P19) “ “ Connected to self Watts et al Journal of Humanistic Psychology 2017, Vol. 57(5) 520
  • 55. Connection to the world Connection to work 7 Connection to nature 11 Connection to spiritual principle 9 Before I enjoyed nature, now I feel part of it. Before I was looking at it as a thing, like TV or a painting. You’re part of it, there’s no separation or distinction, you are it. (P1) Watts et al Journal of Humanistic Psychology 2017, Vol. 57(5) 520
  • 56. Talking therapy: disconnection: I’m sick to the back teeth of telling people again and again the backstory. All the talking therapies, each time you go for an 8 or 6 week course of that stuff, you spend the first few weeks going over the stuff, they ask all the questions again then its session 4, and then, you think who’s learning something here, ‘cos I’m not. You are! (P13) They all seemed to be trying to fit a person into a preconceived set of patterns: ‘try to do this’, ‘make this your goal, and we’ll measure it’. But just having these goals set for you is more pressure and when you don’t meet those goals, you feel even worse because you’re letting them down, and you already feel let down yourself! (P1) TOO DIRECTIVE TOO SHORT “ “ I got up the courage to tell him, I’d never told anyone. And [the psychiatrist] just looked at his shoes.’ (P16) DON’T ADDRESS TRAUMA: “
  • 57. “Those who cannot change their minds cannot change anything” George Bernard Shaw (1856-1950) Can our research help change peoples’ mind about psychedelics?  a new Enlightenment perhaps.....
  • 58. Acknowledgements Mendel Kaelen, Leor Roseman, Mark Bolstridge, Chris Timmermann, Tim Williams, David Erritzoe, Ben Sessa, Suresh Muthukumuraswamy, Richard Wise, Luke Williams, Kevin Murphy, Robert Leech, Eduardo Schenberg, Neiloufar Family, Matt Wall, Val Curran, Karl Friston, Rosalyn Moran, David Nichols, Robin Tyacke, James Stone, Laurence Reed, Nadar Abbasi, Enzo Tagliazucchi, Dante Chialvo, Roland Griffiths, Katherine MacLean, Matt Johnson, Charlie Grob, Bill Richards, Jeff Guss, George Goldsmith, Ekaterina Malievskaia, Celia Morgan, Mitul Mehta, Alexander Lebedev, Pete Hellyer, Csaba Orban, John McGonigle, Remi Flechais, Michael Bloomfield, Steve Pilling, Matt Brookes, Tim Nest, Paul Expert, Giovanni Petri, James Rucker, Camilla Day, Shlomi Raz, Catherine Scrace, Kabir Nigam, John Evans, Peter Hobden, Wouter Droog, Yvonne Lewis, Mark Tanner, Ineke de Meer; Alison Diaper, Ann Rich, Sue Wilson, volunteers, patients and more… Robin Carhart-Harris Amanda Feilding
  • 59. Brain sites of depression – PET imaging “It is a positive and active anguish, a sort of psychical neuralgia wholly unknown to normal life. Cg25 F9 F9Cg24 Treatment Resistant Depression William James, revisited So can we selectively turn the active anguish OFF? Mayberg et al 2005 Neuron Red = overactive region Blue = underactive region
  • 60. z = -4 z = +4 L Deep Brain Stimulation – stops overactivity Cg25 mF10 oF11 Cg24 hth Cg25 F9 ins F46 mF ins 3 months DBS CBF Change Responders Cg24 vCd sn Cg25 Cg25 Cg24 F9F9 F47 hth Baseline CBF PET All PT vs NC Cg25 mF10 oF11 Cg24 hth bs Cg25 mFF9 ins F9 F46 Cg31 6 months DBS CBF Change Responders Helen Mayberg
  • 61. Cg24 vmF dmF Hth Cg25 Antidepressants also switch off this region bs Cg31 Hth Cg25 bs Cg31 DBS SSRI antidepressant Helen Mayberg
  • 62. Bhagwager et al 2006 Am J Psychiatry Recovered depressed patients have increased 5HT2A receptors Maybe an attempt to make up for deficiency of 5HT? So would psilocybin replace what’s missing ?
  • 63. Figure 3a. 5-HT2A binding in frontolimbic regions correlates with trait neuroticism in 84 healthy subjects38 . Figure 3b. Cortical 5-HT2A binding correlates with dysfunctional attitudes (pessimism) in medicated free depressed patients39 . Figure 3c. Regions where 5-HT2A binding correlates positively with pessimism in med-free depressed patients39 . More 5HT2A receptors  pessimism Meyer et al Maybe an attempt to make up for deficiency of 5HT (serotonin) Could psilocybin rectify this?
  • 64. “The future may teach us how to exercise a direct influence, by means of particular chemical substances, upon …the neural apparatus. It may be that there are other still undreamt of possibilities of therapy.” From An Outline of Psychoanalysis Sigmund Freud London 1938. 64 But we were not the first! Was Freud the forefather of psychedelic therapy?
  • 65. If the doors of perception were cleansed every Thing would appear to man as it is, infinite. For man has closed himself up, till he sees all Things thro’ narrow chinks of his cavern. iam Blake, 1793 Aldous Huxley and mescaline Peyote cactus “The brain is an instrument for focusing the mind”
  • 66. DepressionAddiction The brain reconstructs the image to what it expects But always with limitations “Man sees thro’ the chinks of his cavern” William Blake 1793 Neuroscience proves Huxley and Blake right
  • 67. By switching of the “control centres” psilocybin increases brain connectivity Petri et al J. R. Soc. Interface 11: 20140873. http://dx.doi.org/10.1098/rsif.2014.0873 Normal Psilocybin

Editor's Notes

  1. This study also showed decreases in visual cortex at the acute state
  2. Most participants for whom it was effective (really out of 17) described a mental Reset, reboot, their mind being reconfigured. Many of them used these terms. Some quotes. And where I give quotes I’ll give an example of that theme happening during the session, and then how that theme looks 6 months down the line. So here, P11 talking about his mind being reset during the experience, and then his experience of his mind still feeling kind of optimised, improved 6 months later: freeflowing, more orderly, ruminating less. Less stuck
  3. Inner therapist: sense of knowing what’s best for the self
  4. Some of them were also offered therapy: typically 5-8 sessions of CBT or counselling. And it hadn’t worked for any of them. Many of them had gone back time and time again to get another course of the same 8 sessions of CBT. One person had 6 courses of therapy. So that’s 48 sessions, a year of therapy, but chopped into 6 little chunks of hello and goodbye with 6 different people. I trained as a clinical psychologist so that I could be talking therapist, and I believe in this process, when it is done properly. Susie Orbach, a British psychotherapist and writer describes how therapy works when it does work (which is only about half the time): ‘therapists don’t so much solve issues as attempt to open up new doors- emotional intelletcual physical, - to expand their notions of the roots and interplay of their difficulties so that they can intervene with themselves and others differently’ But that takes time and well trained therapists, and many of participants described a process where they had been subjected to ‘therapy’ without either of these things. So when I interviewed them, they described three main reasons that the therapy they received had actually made them feel worse, more disconnected. QUOTES (too directive: QUOTES) All coming from the therapist, therapist is the expert, patient feels disempowered. There were some really sad stories, t people felt patronised, condescended to, ignored. But even those who had quite good rapport with their therapists still felt that the motivation and ideas about to change were kind of being imposed from the outside, not coming from inside. The ideas were often coming from a textbook or what the therapist thought would be good for the patient, rather than a genuine process of inner transformation. (trauma) this participant had suffered from childhood sexual abuse, talking about a short series of sessions he’d had: and he was not alone. Three of them described similar things happening. And probably the health professionals involved were well meaning, but a lot of the short term therapy manuals do emphasis keeping sesison content to the here and now, which can mean steering people away from talking about early trauma. So rather than therapy bringing moments of connection, it was actually bringing moments of disconnection and shame, that were then remembered for years, So, ADS and therapy were repeating and reinforcing the disconnection that they knew was a fundamental feature of their depression. Treatments were seen as promoting a view of psychological pain as something that should be systematically suppressed, rather than explored as a symptom of an underlying problem that needs to be accessed and processed And that was one of the reasons why they preferred psilocybin treatment (all of them said they preferred it to any other treatment tried): they valued the chance to connect with their emotions in a safe space: the guides just there to support them, not direct them, as they connected to themselves in a genuine real way, in the way that was right for them, as an individual, no textbooks, no preconceived sets of patterns, no preconceived goals, no steering away from pain.
  5. We’ve used 3 different imaging modalities to understand the brain effects of psilocybin and now also LSD. Also, done fMRI work with MDMA but I will focus on the classic psychedeout lics in the presentation. And particularly LSD.