Here is the full transcript of psychiatrist Benjamin Lewis’ talk titled “Could Psychedelics Help Patients in Therapy?” at TED Talks 2024 conference.
Listen to the audio version here:
TRANSCRIPT:
The Loss of Connection and Mental Health
Many of the mental health struggles that we see in our world come from a loss of connection — a loss of connection to ourselves, to each other, to our communities, and to the Earth. This loss of connection is so profound that the United States Surgeon General has called it a public health crisis. Thich Nhat Hanh said, “We are all connected. When you touch one thing, you are touching everything.”
Whatever we do has an effect on others. Therefore, we must learn to live mindfully, to touch the peace inside each of us. Psilocybin, the active ingredient in so-called “magic mushrooms,” is an emerging treatment that is about reconnection.
As a psychiatrist at the Huntsman Mental Health Institute, I have been running clinical trials with psilocybin-assisted therapy, working specifically with two groups: patients dealing with symptoms of depression associated with a cancer diagnosis; and frontline health-care workers experiencing burnout and depression related to the COVID-19 pandemic.
The Common Thread of Disconnection
These two groups appear very different on the surface, but their suffering is related to a loss of connection. Each person dealing with a cancer diagnosis is unique. However, patients face some common challenges: the uncertainty, the treatments, the impact on family and friends. This can result in symptoms of loss, grief, depression, anger, feelings of hopelessness and isolation.
The COVID-19 pandemic has heightened burnout in frontline health care providers who feel disconnected from their work, disconnected from their patients and their suffering. They feel overwhelmed and inadequate. There are clear distinctions between these two groups, but there is overlap in this sense of disconnection.
Understanding Psilocybin and Psychedelics
Psilocybin is considered a classic psychedelic, one of a group of chemicals that acts on the serotonin system in the brain. The term “psychedelic” comes from the combination of the Greek words psyche, or mind, and delos, to reveal or make manifest. So mind manifesting. Or expressing this idea that these chemicals can reveal aspects of the mind that we otherwise don’t have access to.
These chemicals cause significant changes to consciousness, including experiences that are referred to as mystical or spiritual in nature, experiences characterized by a deep sense of connection to one’s self, to others, and to the world. And in recent years, there has been a renewed interest in the study of these compounds for therapeutic purposes. Using psilocybin in the context of a clinical trial looks quite different than it does in other settings, such as recreational use.
Safety and Protocol in Clinical Trials
For one thing, while classic psychedelics are remarkably safe from a medical standpoint and don’t have the same potential for abuse as other substances, they nonetheless cause powerful changes to consciousness that can present risk. In particular, for people with a risk of psychosis or mania. This is not a treatment for everyone.
Our studies employ a rigorous screening process to ensure that this is safe, both medically and psychiatrically. We also embed the dosing session within a therapeutic protocol with preparation and what we call integration sessions following. There are two qualities to this form of therapy that I’d like to emphasize that distinguish this intervention from anything else in psychiatry.
The Importance of Experience and Therapeutic Protocol
The first is the importance of the experience itself. A reliable finding across multiple studies with psilocybin is that specific kinds of changes to consciousness, often with a single session, appear to be important for therapeutic changes. Patients report a sense of connection, or the interconnectedness of all things; a sense of preciousness or sacredness to the experience; and a deep sense that this reveals something true or fundamental about the nature of reality.
The second quality is the combination of a drug administration with a therapeutic protocol. This is not simply about taking a pill and expecting a result. This is a form of assisted psychotherapy with specific preparation, support through the session itself and integration following. One’s intentions matter. A patient’s mental preparation going into a session can profoundly shape the impact of the experience. How these tools are employed is central to their effect.
Brain Changes and Neural Connectivity
One current model for understanding brain changes with psychedelic drugs examines changes in connectivity between different brain regions. With administration of psilocybin, the brain temporarily enters a state of global increase in integration and interconnection across different neural networks that are normally compartmentalized. Simply put, brain regions that normally don’t talk to each other are now conversing.
Of course, this doesn’t last, but as the brain cools from this experience, previously rigid patterns of neural connectivity related to the beliefs characteristic of, say, depression, are softened, given some wiggle room, some flexibility is introduced into the system.
Current models of psilocybin-assisted therapy in clinical trials involve two therapists per person through a process that is generally 20 or more hours. Our research group at the University of Utah has naturally asked the question, can we do this in groups to expand the scale on which these promising treatments can be delivered?
Group Therapy and Indigenous Practices
Now, in a way, this is nothing new. Psychedelics have been used in group context for millennia by Indigenous groups. This includes ceremonial use of psilocybe mushrooms, San Pedro cactus and ayahuasca, the dimethyltryptamine containing South and Central American brew. But when we look at modern studies, these have focused on individuals and individual sessions.
But going deeper, group process is about connection and shared experience. If these forms of suffering we’re looking at in our studies, depression associated with cancer, health care provider burnout, are characterized in part by a loss of connection, exploring these tools in supported shared experiences makes sense, potentially enhancing therapeutic aspects of group process that are already there.