The latest wave of psychedelic research has led to many significant advances in a short period of time. However, this complex and mysterious field remains in relative infancy, with a number of key themes still little known. Among these, perhaps no question is more central (nor is it of more interest to modern pharmaceutical companies) than that of the therapeutic value of the psychedelic experience.
What about psychedelics that seem to make them so useful in helping to treat depression, addiction, and other mental health disorders? Is it the drug alone, which acts physiologically on the brain, or is it the subjective, living response generated by the drug?
New research on the treatment of obsessive-compulsive disorder (OCD) with psilocybin, the active ingredient in magic mushrooms, can help unravel this riddle.
Hard to let go
Three studies are currently investigating the use of psilocybin to reduce psilocybin symptoms OCD, a condition that has so far received relatively little attention in psychedelic research. Although studies use different treatment protocols, their combined testing may be critical in helping researchers better understand the therapeutic mechanism of psychedelic drugs.
This is so OCD it is generally characterized by a failure to surrender or release control, exactly what usually requires a full psychedelic experience. “People with OCD they try to control their experience in a way that becomes very, very counterproductive and very painful, ”says Adam Strauss, a New York comedian who used psychedelics to overcome OCD. “OCD it’s really a control disorder. “
Strauss recounted his experience in the award-winning individual theater show Mushroom care. “For me,” he explains, “the experience of giving myself up, of not trying to change my inner experience, of not trying to get rid of thoughts, of not trying to get rid of feelings, seems to be the key factor in psychedelic healing is this subjective experience of letting go, surrendering and allowing. ”
Although Strauss experimented and gained some benefits from low and moderate doses, he found that higher doses, especially of psilocybin mushrooms, were most effective in teaching him to “let go” and therefore , offered the most therapeutic value. “I find it hard to imagine having the results I’ve had without these experiences that seem so essential,” he said.
A pioneering study
Strauss first had the idea to treat his OCD with psychedelics from a pioneer 2006 study at the Journal of Clinical Psychiatry. Nine patients were given psilocybin up to four times each, in doses ranging from “very low” to “frankly hallucinogenic.” The nine not only showed immediate improvement in OCD symptoms after at least one of the test sessions, but the drug was also shown to be safe and well tolerated. (Interestingly, and contrary to Strauss’s later experience, the researchers did not find that dose size had a significant effect on the results).
To date, this study is the only one of the modern era that investigates the use of psilocybin to treat OCD. But in the next two years, at least three more will be added. One of them is led by the University of Arizona professor of psychiatry, Francisco Moreno, the same researcher who led the innovative study and is now widely cited since 2006.
Released in October 2017, Moreno’s new study – this time with 15 subjects – has been on hold since early 2020 due to the coronavirus pandemic. But it should restart soon, Moreno reported in an email. “We have people ready to go and I hope we start dosing this spring COVID the restrictions match our institutional requirements and our ability to do so in accordance with the usual parameters and the presence of two seated in the room for extended periods of time, ”he wrote.
For a better understanding of how physiological changes in the brain and subjective psychedelic experience can be associated with a therapeutic benefit OCD after low and high doses of psilocybin, Moreno’s team will analyze both brain scans and patients ’responses to a variety of standardized questionnaires, including the 5-dimensional consciousness rating scale and the experience questionnaire. mystic.
This should allow researchers to determine if there are improvements in OCD symptoms observed up to six months after the last dose are more closely aligned with patients ’experience with the drug or with specific aspects of brain activity after treatment. The study should be complete by the end of 2021, Moreno said.
High dose therapy
Meanwhile, on the other side of the country, a second largest study with 30 participants is underway at Yale University, and it doesn’t lag behind. Principal Investigator Benjamin Kelmendi, an assistant professor of psychiatry, said the study has already resumed after a nine-month break for COVID and is now enrolling in subjects, with a planned completion date in early 2022.
Like Moreno’s study, Kelmendi’s will measure the effects of psilocybin (in this case only a high dose) in both objective and subjective terms, and then compare these effects with the clinical results of OCD. This will allow researchers to determine whether, across the study population, the degree of improvement is more accurately predicted by changes in brain connectivity as measured by RMF or by self-reported subjective experience.
Another way the two studies are similar (and different from most other recent and ongoing studies investigating psychedelics as treatments for mental health disorders such as addiction and depression) is that they will not include any form of conversation therapy. In contrast, as in Moreno’s first pilot study, any beneficial effect will be directly attributable to the drug’s pharmacology and the changes it causes in the brain, the psychedelic experience it precipitates, or some combination of the two.
This is not the case with the third simultaneous study in psilocybin i OCD, led by renowned psychedelic researcher David Nutt at the Psychedelic Research Center at Imperial College London. Nutt’s new study will combine a moderate dose of psilocybin, low enough that it is not expected to provoke a traditional psychedelic experience, with a form of conversation therapy widely used by OCD called acceptance and commitment therapy. This therapy will not be carried out under the influence of the drug, but rather after the most direct effects have been exhausted during the “integration” of the treatment, Nutt said in an email.
A great challenge
In a online chat discussing the new study last May, Nutt acknowledged that based on the findings of his previous research in the treatment of depression with psilocybin, I would expect higher and more psychedelic doses to be more effective in the treatment OCD – with subjective experience that has at least a partial role.
“It’s a big challenge to take a trip or something you’ve never had before and possibly go somewhere that can be very dark and unpleasant, but depressed people have agreed to do it,” Nutt said in the talk. . “They’ve often had a lot of uneasiness about it, but when they’ve done it, they usually come back and say, ‘Wow, it was tough, but I’m glad I did it.’
However, Nutt and his collaborators decided not to offer a high dose this time after soon determining the members of the OCD the patient population was not interested. “They made it clear that they would not accept a‘ full ’dose,” Nutt confirmed in an email to Project CBD.
Thus, the research team turned to a slightly different treatment model, in which subjects “will still be monitored” throughout the process. Ideally, they should also be prepared for the drug at some level to be more receptive to targeted therapy immediately afterwards, Nutt said in the video: “We call it psychedelic enhanced psychotherapy.”
Recruitment for the full study begins in April 2021.
Acceptance & surrender
Adam Strauss believes his own healing was allowed with higher doses and powerful subjective experiences, but he still sees the potential for significant therapeutic value in moderate doses combined with acceptance and commitment therapy. ACT it is a form of cognitive-behavioral therapy that he underwent for years, without much success, until he combined his well-deserved knowledge of its key principles with the self-directed use of psychedelics.
“I couldn’t really do that kind of acceptance and surrender until I started using psychedelics,” he said. “Many of my key experiences in psychedelics were basically done ACT techniques while treading ”.
Although the lower dose of the Imperial College study is not expected to produce a full psychedelic experience in patients, researchers will still measure subjective responses to psilocybin using questionnaires, which will allow them to correlate the effect. perceived with the therapeutic benefit.
But beyond the specific conclusions of any study, studying the three studies together could give the best view of the treatment of OCD with psychedelics and the greater question of the therapeutic value of the “journey.” These are experiences with high doses or effects that involve “letting go” really better to treat them OCD eventually? Or is a moderate and controlled trip followed by conversation therapy so effective?
With pharmaceutical companies already obsessed with the prospect of developing without travel (or at least free from bad travel) psychedelic, the subject is more than academic. For better or worse, it has important implications for the incipient efforts to commercialize and medicalize psychedelic drugs. If these three studies go as planned, in a year or so we can have a better idea of whether the psychedelic experience will be seen as a feature or an error on the part of the medical establishment.
Nate Seltenrich, a freelance science journalist based in San Francisco Bay, covers a wide range of topics such as environmental health, neuroscience and pharmacology.
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