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.
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. Last year, our research group completed the HOPE trial.
The HOPE Trial: Group Psilocybin-Assisted Therapy
This was a pilot study of group psilocybin-assisted therapy for 12 patients dealing with symptoms of depression associated with a cancer diagnosis. We ran groups of four participants at a time. Patients with cancer are a well-studied population with psilocybin in individual formats. These previous studies have shown significant and enduring therapeutic effects that have been sustained for years following even a single dosing session.
Our study is the first modern trial to employ a full group format. All three of our preparatory sessions, our single eight-hour dosing session and our three integration sessions were run as groups. This was a small study designed to look at safety and feasibility, but we found a clear signal that the group format may amplify the sense of connection that we know is important in treating depressive symptoms.
The All-Welcoming Approach
The group format requires thoughtful preparation. The neighbor on your right may be giggling uncontrollably while the neighbor on your left is sobbing. One mantra we use through this process is, “All is welcome.” We learned this mantra from Mary Cosimano, a mentor of ours at Johns Hopkins.
This mantra is about saying, “Yes!” It is about opening up to whatever is coming up for you personally, but also what is coming up in the whole room. All is welcome. The processes of others around you are not a distraction. They are there for you, and you for them.
Collective Experience and Results
In this spirit, our study used a communal music playlist played over speakers rather than individual headphones, to emphasize and add to this collective experience. I wonder what this would be like for all of you right now to fully welcome everything coming up in this space. Excitement for this event, social dynamics of a large crowd, your private joys and sorrows, your connection with a person on this stage. Maybe even your anxiety, “They might screw it up.” All is welcome.
Our study showed that this treatment can be safely and effectively administered in a group format. Our participants demonstrated significant improvement in depressive symptoms that was sustained to our final endpoint at six months. Furthermore, participants felt strongly that the group format was a critical component of their process.
Conclusion and Future Perspectives
We are still in the early stages of understanding how to use psilocybin-assisted therapy as a tool in mental health care. The HOPE trial is a small step in the ongoing development of this field towards understanding how to harness and sustain the kinds of connectedness that patients experience, and towards expanding access for people suffering with difficult-to-treat conditions. What if, instead of trying to fit psychedelic-assisted therapy into psychiatry, we asked, how can we make psychiatry more psychedelic? Thank you very much.
