Psychedelic psychotherapy

Is the stigma around psychedelics overshadowing their therapeutic potential?

Writer: Jenny Seok
Editor: Karolay Lorenty
Art: Winnie Lei

What are “psychedelics”? This term was coined in the early 1950s by Humphrey Osmond, an English psychiatrist who attempted to use LSD for the first time as a psychotherapeutic agent for alcoholism. The word has a Greek origin, with psyche meaning the human mind or spirit, and dēlos, to manifest: psychedelics were thought of as a “mind-manifesting” class of drugs that could facilitate a heightened sense of consciousness. Psychedelics now comprise a wide range of substances with different pharmacological profiles; the most popular include psilocybin, LSD, and DMT. 

The therapeutic potential of psychedelics for psychotherapy was implemented by Swiss chemist Albert Hoffman who first synthesised LSD in 1938 before mediating its use in clinics and universities across the world. Between 1950 and 1965, over 40,000 patients were prescribed LSD therapy for the treatment of neurosis, schizophrenia, psychopathy, and even child autism, with the publication of over 1000 scientific papers. Despite the lack of robust experimental and clinical techniques, people began to acknowledge the potential pharmacological benefits of psychedelics.

Nevertheless, the therapeutic aspect of psychedelics soon became neglected as they were gradually abused under unsupervised and non-medical contexts, especially during the period of hippie counterculture in the 1960s where LSD was popularised in the form of soaked sugar cubes, spreading from America to the UK and the rest of Europe. Consequently, the US federal government outlawed LSD in 1968, and similarly the UK’s Misuse of Drugs Act 1971 classified many psychedelics as Class A drugs, leading to the most serious punishments and fines. As a result, psychedelic research abruptly came to an end.

However, the paradigm of psychedelic psychotherapy has recently re-emerged as governments slowly began to change their attitudes towards human-based psychedelic research over the past few decades. Studies have now uncovered that the basic cerebral mechanisms underlying the effects of psychedelics strongly correlate with the characteristic psychological effects.

Controlled clinical studies have been carried out to evaluate the pharmacological effects of these drugs, using advanced techniques such as Blood Oxygen Level Dependent (BOLC) measures and magnetoencephalography (MEG) to better follow the consequences of psychedelic administration. As opposed to the rather unstructured psychotherapies conducted in the 1950s and 1960s, all studies now acknowledge three critical elements for enhancing positive and healing experiences: the set, which corresponds to the psychological expectations of the patient; the setting, referring to the physical environment; and the clinician-patient relationship.

Three main cerebral consequences of psychotherapy have been identified. First of all, increased Cerebral Blood Flow was observed with a decrease of visual cortex alpha power (alpha waves are often signs of a relaxed mental state). Furthermore, the functional connectivity profile of the primary visual cortex was found to expand after administration. These are all elements strongly correlated with visual hallucinations, meaning that the psychedelic state enhances the visual processing of the brain. Moreover, the connectivity between the parahippocampus (region of personal memory) and the retrosplenial cortex decreased, suggesting the hierarchy of neural networks was temporarily dissolved, allowing information to travel more freely between central junctions. This malleable state of the brain meant that it was more susceptible to external stimuli, leading to a heightened sensitivity for the environment greatly associated with feelings of “ego-dissolution” and “altered meaning”.

Researchers also noticed in the 1960s that introducing music in psychedelic psychotherapy sessions increased their therapeutic efficiency. Patients reported that music rendered more personal and autobiographical mental images, making their emotions more therapeutically meaningful. Different phases in psychedelic therapy sessions were identified with a distinct set of psychological outcomes music could bring: “pre-onset”, “onset”, “building towards peak”, “peak”, “entry”, and “return”. However, the nature of this effect remains unknown.

In a recent study, it has been found that the interaction between music and LSD increased the exchange of information between the parahippocampus and the visual cortex, and these greater interactions were shown to reinforce the autobiographical and inclusive nature of mental images.  An important feature of the music played was timbre, which causes instruments and voices to sound different from each other when producing the same note. The magnitude of timbre appeared to increase the activity of the regions of the brain dedicated to process emotion and attribute meaning to sound, such as the Broca area, causing music-evoked feelings of “wonder” and “transcendence”. With both sensations being characteristic of “peak” experiences, these findings seem to support the idea that music brings more vivid and meaningful effects into psychedelics in therapy. However, more research needs to be carried out in order to fully validate this hypothesis. The study earlier reported that although some patients manifested these “peak” experiences, musical styles were not appreciated by 58% of the participants to various extents. This shows one of the biggest challenges in psychedelic research: despite having the scientific groundwork explaining the positive effects of psychedelics in psychotherapy, the subjective nature of these experiments means that more investigation needs to be done before a real implementation of psychedelic usage in clinics comes into play.

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