The future of psychedelicassisted psychotherapy Rick Doblin
Preparing for this talk
has been scarier for me
than preparing for LSD therapy.
(Laughter)
“Psychedelics are to the study of the mind
what the microscope is to biology
and the telescope is to astronomy.”
Dr. Stanislav Grof spoke those words.
He’s one of the leading
psychedelic researchers in the world,
and he’s also been my mentor.
Today, I’d like to share with you
how psychedelics, when used wisely,
have the potential to help heal us,
help inspire us,
and perhaps even to help save us.
In the 1950s and 60s,
psychedelic research flourished
all over the world
and showed great promise
for the fields of psychiatry,
psychology and psychotherapy,
neuroscience and the study
of mystical experiences.
But psychedelics leaked out
of the research settings
and began to be used
by the counterculture,
and by the anti-Vietnam War movement.
And there was unwise use.
And so there was a backlash.
And in 1970, the US government
criminalized all uses of psychedelics,
and they began shutting down
all psychedelic research.
And this ban spread all over the world
and lasted for decades.
and it was tragic,
since psychedelics are really just tools,
and whether their outcomes
are beneficial or harmful
depends on how they’re used.
Psychedelic means “mind-manifesting,”
and it relates to drugs
like LSD, psilocybin, mescaline,
iboga and other drugs.
When I was 18 years old,
I was a college freshman,
I was experimenting
with LSD and mescaline,
and these experiences
brought me in touch with my emotions.
And they helped me have
a spiritual connection
that unfortunately,
my bar mitzvah did not produce.
(Laughter)
When I wanted to tease my parents,
I would tell them
that they drove me to psychedelics
because my bar mitzvah had failed
to turn me into a man.
(Laughter)
But most importantly,
psychedelics gave me this feeling
of our shared humanity,
of our unity with all life.
And other people reported
that same thing as well.
And I felt that these experiences
had the potential
to help be an antidote
to tribalism, to fundamentalism,
to genocide and environmental destruction.
And so I decided to focus my life
on changing the laws
and becoming a legal
psychedelic psychotherapist.
(Applause)
Now, half a century after the ban,
we’re in the midst of a global renaissance
of psychedelic research.
Psychedelic psychotherapy
is showing great promise
for the treatment of post-traumatic
stress disorder, or PTSD,
depression, social anxiety,
substance abuse and alcoholism
and suicide.
Psychedelic psychotherapy is an attempt
to go after the root causes
of the problems,
with just relatively few administrations,
as contrasted to most
of the psychiatric drugs used today
that are mostly just reducing symptoms
and are meant to be taken
on a daily basis.
Psychedelics are now also being used
as tools for neuroscience
to study brain function
and to study the enduring mystery
of human consciousness.
And psychedelics and the mystical
experiences they produce
are being explored for their connections
between meditation and mindfulness,
including a paper just recently published
about lifelong zen meditators
taking psilocybin
in the midst of a meditation retreat
and showing long-term benefits
and brain changes.
Now, how do these drugs work?
Modern neuroscience research
has demonstrated
that psychedelics reduce activity
in what’s known as the brain’s
default mode network.
This is where we create our sense of self.
It’s our equivalent to the ego,
and it filters all incoming information
according to our personal
needs and priorities.
When activity is reduced
in the default mode network,
our ego shifts from the foreground
to the background,
and we see that it’s just part
of a larger field of awareness.
It’s similar to the shift
that Copernicus and Galileo were
able to produce in humanity
using the telescope
to show that the earth was no
longer the center of the universe,
but was actually something
that revolved around the sun,
something bigger than itself.
For some people, this shift in awareness
is the most important
and among the most important
experiences of their lives.
They feel more connected
to the world bigger than themselves.
They feel more altruistic,
and they lose some of their fear of death.
Not all drugs work this way.
MDMA, also known as Ecstasy, or Molly,
works fundamentally different.
And I’ll be able to share with you
the story of Marcela,
who suffered from
post-traumatic stress disorder
from a violent sexual assault.
Marcela and I were introduced in 1984,
when MDMA was still legal,
but it was beginning also
to leak out of therapeutic circles.
Marcela had tried MDMA
in a recreational setting,
and during that, her past trauma
flooded her awareness
and it intensified her suicidal feelings.
During our first conversation,
I shared that when MDMA
is taken therapeutically,
it can reduce the fear
of difficult emotions,
and she could help move forward
past her trauma.
I asked her to promise
not to commit suicide
if we were to work together.
She agreed and made that promise.
During her therapeutic sessions,
Marcela was able to process
her trauma more fluidly, more easily.
And yet, she was able to tell
that the rapist had told her
that if she ever shared her story,
he would kill her.
And she realized that that was
keeping her a prisoner in her own mind.
So being able to share the story
and experience the feelings
and the thoughts in her mind
freed her,
and she was able to decide
that she wanted
to move forward with her life.
And in that moment,
I realized that MDMA could be very
effective for treating PTSD.
Now, 35 years later,
after Marcela’s treatment,
she’s actually a therapist,
training other therapists to help people
overcome PTSD with MDMA.
Now, how does MDMA work?
How did MDMA help Marcela?
People who have PTSD
have brains that are different
from those of us who don’t have PTSD.
They have a hyperactive amygdala,
where we process fear.
They have reduced activity
in the prefrontal cortex,
where we think logically.
And they have reduced activity
in the hippocampus,
where we store memories
into long-term storage.
MDMA changes the brain
in the opposite way.
MDMA reduces activity in the amygdala,
increases activity
in the prefrontal cortex
and increases connectivity
between the amygdala and the hippocampus
to remit traumatic memories
to move into long-term storage.
Recently, researchers at Johns Hopkins
published a paper in “Nature,”
in which they demonstrated
that MDMA releases oxytocin,
the hormone of love and nurturing.
The same researchers
also did studies in octopuses,
who are normally asocial,
unless it’s mating season.
But lo and behold, you give them MDMA,
and they become prosocial.
(Laughter)
Several months after
Marcela and I worked together,
the Drug Enforcement Administration
moved to criminalize Ecstasy,
having no knowledge
of its therapeutic use.
So I went to Washington,
and I went into the headquarters
of the Drug Enforcement Administration,
and I filed a lawsuit demanding a hearing,
at which psychiatrists
and psychotherapists
would be able to present information
about therapeutic use of MDMA
to try to keep it legal.
And in the middle of the hearing,
the DEA freaked out,
declared an emergency
and criminalized all uses of MDMA.
And so the only way
that I could see to bring it back
was through science, through medicine
and through the FDA
drug development process.
So in 1986, I started MAPS
as a nonprofit psychedelic
pharmaceutical company.
It took us 30 years, till 2016,
to develop the data that we needed
to present to FDA
to request permission to move
into the large-scale Phase 3 studies
that are required to prove
safety and efficacy
before you get approval
for prescription use.
Tony was a veteran
in one of our pilot studies.
According to the Veterans Administration,
there’s over a million veterans now
disabled with PTSD.
And at least 20 veterans a day
are committing suicide,
many of them from PTSD.
The treatment that Tony was to receive
was three and a half months long.
But during that period of time,
he would only get MDMA on three occasions,
separated by 12, 90-minute
non-drug psychotherapy sessions,
three before the first
MDMA session for preparation
and three after each
MDMA session for integration.
We call our treatment approach
“inner-directed therapy,”
in that we support the patient
to experience whatever’s emerging
within their minds or their bodies.
Even with MDMA, this is hard work.
And a lot of our subjects have said,
“I don’t know why they call this Ecstasy.”
(Laughter)
During Tony’s first MDMA session,
he lay on the couch, he had eyeshades on,
he listened to music,
and he would speak to the therapists,
who were a male-female co-therapy team,
whenever he felt that he needed to.
After several hours,
in a moment of calmness and clarity,
Tony shared that he had realized
his PTSD was a way
of connecting him to his friends.
It was a way of honoring the memory
of his friends who had died.
But he was able to shift and see himself
through the eyes of his dead friends.
And he realized that they
would not want him to suffer,
to squander his life.
They would want him to live more fully,
which they were unable to do.
And so he realized that there was
a new way to honor their memory,
which was to live as fully as possible.
He also realized that
he was telling himself a story
that he was taking opiates for pain.
But actually, he realized,
he was taking them for escape.
So he decided he didn’t need
the opiates anymore,
he didn’t need the MDMA anymore,
and he was dropping out of the study.
That was seven years ago.
Tony is still free of PTSD,
has never returned to opiates
and is helping others less fortunate
than himself in Cambodia.
(Applause)
The data that we presented to FDA
from 107 people in our pilot
studies, including Tony,
showed that 23 percent of the people
that received therapy without active MDMA
no longer had PTSD
at the end of treatment.
This is really pretty good
for this patient population.
However, when you add MDMA,
the results more than double,
to 56 percent no longer having PTSD.
(Applause)
But most importantly,
once people learn that if they don’t need
to suppress their trauma,
but they can process it,
they keep getting better on their own.
So at the 12-month follow-up
one year after the last treatment session,
two-thirds no longer have PTSD.
And of the one-third that do,
many have clinically significant
reductions in symptoms.
(Applause)
On the basis of this data,
the FDA has declared MDMA-assisted
psychotherapy for PTSD
a breakthrough therapy.
FDA has also declared psilocybin
a breakthrough therapy
for treatment-resistant depression
and just recently approved
esketamine for depression.
I’m proud to say that we have now
initiated our Phase 3 studies.
And if the results are as we hope,
and if they’re similar
to the Phase 2 studies,
by the end of 2021, FDA will approve
MDMA-assisted psychotherapy for PTSD.
If approved,
the only therapists who will be able
to directly administer it to patients
are going to be therapists that
have been through our training program,
and they will only be able
to administer MDMA
under direct supervision
in clinic settings.
We anticipate that over
the next several decades,
there will be thousands
of psychedelic clinics established,
at which, therapists will be able
to administer MDMA,
psilocybin, ketamine
and other psychedelics
to potentially millions of patients.
These clinics can also evolve
into centers where people can come
for psychedelic psychotherapy
for personal growth,
for couples therapy
or for spiritual, mystical experiences.
Humanity now is in a race
between catastrophe and consciousness.
The psychedelic renaissance is here
to help consciousness triumph.
And now, if you all just
look under your seats …
Just joking!
(Laughter)
Thank you.
(Applause)
(Laughter)
(Applause)
Thank you.
(Applause)
Corey Hajim: You’ve got to stay
up here for a minute.
Thank you so much, Rick.
I guess it’s a supportive audience.
Rick Doblin: Yes, very.
Many of them have also
been to Burning Man.
(Laughter)
CH: There’s some synergy.
RD: (Laughs)
CH: So, in your talk, you talked
about using these drugs
to address some pretty serious traumas.
So what about some more common
mental illnesses
like anxiety and depression,
and is that where microdosing comes in?
RD: Well, microdosing
can be helpful for depression,
I do know someone that has been using it.
But in general, for therapeutic purposes,
we prefer macro-dosing
rather than microdosing,
in order to really help people
deal with the root causes.
Microdosing is more for creativity,
for artistic inspiration,
for focus …
And it also does have
a mood-elevation lift.
But I think for serious illnesses,
we’d rather not get people thinking
that they need a daily drug,
but do more deeper, intense work.
CH: And what about outside
the United States and North America,
is this research being done there?
RD: Oh yeah, we’re globalizing.
Our Phase 3 studies
are actually being done
in Israel, Canada and the United States.
So once we get approval in FDA,
it will also become approved
in Israel and in Canada.
We’re just starting research in Europe.
And we’re actually going to be training
some therapists from China.
CH: That’s great.
We were going to do an audience vote
to see if people felt
like this was a good idea
to move forward with this research or not,
but I have a feeling I know
the answer to that, so …
Thank you so much, Rick.
RD: Thank you. Thank you all.
(Applause)