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Monday, 11 February 2013

Psychedelic therapy

Psychedelic therapy refers to therapeutic practices involving the use of psychedelic drugs, particularly serotonergic psychedelics such as LSD, psilocybin, DMT, and 2C-B. As an alternative to synonyms such as "hallucinogen", "entheogen", "psychotomimetic" and other functionally constructed names, the use of the term psychedelic ("mind-manifesting") emphasizes that those who use these drugs as part of a therapeutic practice believe these drugs can facilitate beneficial exploration of the psyche. Proponents of psychedelic therapy also believe psychedelics enhance or unlock key psychoanalytic abilities, and so make it easier for conventional psychotherapy to take place.

History

Psychedelic therapy, in the broadest possible sense of the term, undoubtedly dates from prehistoric knowledge of hallucinogenic plants. Though usually viewed as predominantly spiritual in nature, elements of psychotherapeutic practice can be recognized in the entheogenic or shamanic rituals of many cultures.
Some of the well known particular psychedelic substances that have been used to this day are: MDMA, LSD, Psilocybin, Cannabis, Mescaline, 2C-B, Dimethyltryptamine, Ibogaine, Gamma-Hydroxybutyric acid, Ketamine, Amanita muscaria, Bufotenine, Harmaline, Ayahuasca, and Salvia divinorum. Carbogen has also played role in psychedelic therapy research. Shamans have historically been well known throughout the world to mix two or more of some of the listed substances to produce synergistic effects. (See Psychoactive, Entheogen, Hallucinogen, Psychotherapy, Psychonaut, Meditation, Trance, Mysticism, Transcendence (philosophy).)
The use of psychedelic agents in Western therapy began in the 1950s, after the widespread distribution of LSD to researchers by its manufacturer, Sandoz Laboratories. Research into experimental, chemotherapeutic and psychotherapeutic uses of psychedelic drugs was conducted in several countries over the next 10–15 years. In addition to the release of dozens of books and creation of six international conferences, more than 1000 peer-reviewed clinical papers detailing the use of psychedelic compounds (administered to approximately 40,000 patients) were published by the mid-1960s. Proponents believed that psychedelic drugs facilitated psychoanalytic processes, and that they were particularly useful for patients with problems that were otherwise difficult to treat, including alcoholics, although the trials did not meet the methodological standards required today.
One challenge of psychedelic therapy was the greatly variable effects produced by the drugs. According to Stanislav Grof, "The major obstacle to their systematic utilization for therapeutic purposes was the fact that they tended to occur in an elemental fashion, without a recognizable pattern, and frequently to the surprise of both the patient and the therapist. Since the variables determining such reactions were not understood, therapeutic transformations of this kind were not readily replicable." Attempts to produce these experiences in a controlled, non-arbitrary, predictable way resulted in several methods of psychedelic therapy, which are reviewed below.
Researchers like Timothy Leary felt psychedelics could alter the fundamental personality structure or subjective value-system of an individual, to beneficial effect. His experiments with prison inmates were an attempt to reduce recidivism through a few short, intense sessions of psilocybin administered weeks apart with biweekly group therapy sessions in between. Psychedelic therapy was used in a number of other specific patient populations, including alcoholics, children with autism, and people with terminal illness.

In alcoholism

Studies by Humphrey Osmond, Betty Eisner, and others examined the possibility that psychedelic therapy could treat alcoholism (or, less commonly, other addictions). A review of the usefulness of psychedelic therapy in treating alcoholism concluded that the possibility was neither proven nor disproven. Early studies of alcoholics who underwent LSD treatment reported a 50% success rate after a single high-dose session. However, the studies that reported high success rates had insufficient controls, lacked objective measures of genuine change, and failed to conduct rigorous follow-up interviews with subjects. The lack of conclusive evidence notwithstanding, individual case reports are often dramatic. Bill Wilson, the founder of Alcoholics Anonymous conducted medically supervised experiments in the 1950's on the effects of LSD on alcoholism. Bill is quoted as saying "It is a generally acknowledged fact in spiritual development that ego reduction makes the influx of God's grace possible. If, therefore, under LSD we can have a temporary reduction, so that we can better see what we are and where we are going — well, that might be of some help. The goal might become clearer. So I consider LSD to be of some value to some people, and practically no damage to anyone. It will never take the place of any of the existing means by which we can reduce the ego, and keep it reduced." Bill strongly supported LSD as a potential tool for the treatment of alcoholism, but felt that it should only be undertaken by those with a rather strong superego in well supervised clinical settings.

In terminal illness

Richard Yensen, Albert Kurland and other researchers collected evidence that psychedelic therapy could be of use to those suffering from anxiety and other problems associated with terminal illness. In 1965, research consisting of providing a psychedelic experience for the dying was conducted at the Spring Grove State Hospital in Maryland. Of 17 dying patients who received LSD after appropriate therapeutic preparation, one-third improved "dramatically", one-third improved "moderately", and one-third were unchanged by the criteria of reduced tension, depression, pain, and fear of death.

Restrictive regulation

One reason that psychedelic therapy was eventually restricted was concern about the use of drugs by the general public. In the mid-1960s, in response to concerns regarding the proliferation of the unauthorized use of psychedelic drugs by the general public (especially the counterculture), various steps were taken to curtail their use. Bowing to governmental concerns, Sandoz halted production of LSD in 1965, and in many countries LSD was banned, or made available on a very limited basis that made research difficult. Gradually, increasing restrictions were placed on medical and psychiatric research conducted with LSD and other psychedelic substances. In a congressional hearing in 1966, Senator Robert Kennedy questioned the shift of opinion with regards to this potentially rewarding form of treatment, noting that, "Perhaps to some extent we have lost sight of the fact that (LSD) can be very, very helpful in our society if used properly" (Subcommittee on Executive Reorganization, 1966 p. 63).
By 1970, LSD and many other psychedelics were placed into the most-restrictive "Schedule I" category by the United States Drug Enforcement Administration, along with widely-used drugs like heroin. Schedule I compounds are claimed to possess "significant potential for abuse and dependence" and have "no recognized medicinal value", effectively rendering them illegal for any purpose without special difficult-to-obtain approvals. The arguments in favor of this regulation are seemingly contradicted by hundreds of scientific and medical articles on the use of psychedelics as aids in psychotherapy. In 1968, Dahlberg and colleagues published an article in the American Journal of Psychiatry that detailed the way in which various forces had successfully discredited legitimate LSD research. The essay argues that individuals in government and the pharmaceutical industry influenced research in the medical community by canceling any ongoing studies and analysis in addition to labeling genuine scientists as charlatans. Despite objections from the scientific community, authorized research into therapeutic applications of psychedelic drugs had been discontinued worldwide by the 1980s.

Continuing trials

Research and therapeutic sessions have nevertheless continued to be performed, in one way or another, to the present day. Some therapists have exploited windows of opportunity preceding scheduling of particular substances (e.g. MDMA, LSD, Psilocybin, Cannabis, Mescaline, Dimethyltryptamine, Ibogaine, Gamma-Hydroxybutyric acid, Ketamine, Amanita muscaria, Bufotenine, Harmaline, Ayahuasca, Salvia divinorum) or developed extensive non-drug techniques for achieving similar states of consciousness (e.g. Holotropic Breathwork). For the most part, however, since the early 1970s, psychedelic therapy has been conducted by an underground network of people willing to conduct therapy sessions using psychedelic substances. Board-certified therapists, in doing this, risked losing both their career and their liberty. In recent years, some researchers, including Charles Grob and Michael Mithoefer, have obtained permission for human studies of psychedelics as possible treatments.

Recent Resurgence

There has been a recent resurgence in the study of psychedelic drugs for medicinal purposes. A study in 2006 conducted by Griffiths et al. used psilocybin to facilitate a mystical experience. Fourteen months later, 21 of 36 patients rated the experience as one of the top five most meaningful of their lives. The New York Times wrote an article in 2010 outlining some of the other findings, including resumed work with terminally ill patients.

Methods

The effects of psychedelic drugs on the human mind are complex, varied and difficult to characterize, and as a result many different "flavors" of psychedelic psychotherapy have been developed by individual practitioners. Some aspects of published accounts of methodologies are discussed below.

Psycholytic therapy

Psycholytic therapy involves the use of low to medium doses of psychedelic drugs, repeatedly at intervals of 1–2 weeks. The therapist is present during the peak of the experience and at other times as required, to assist the patient in processing material that arises and to offer support when necessary. This general form of therapy was utilized mainly to treat patients with neurotic and psychosomatic disorders. The name, coined by Ronald A. Sandison, literally meaning "soul-dissolving", refers to the belief that the therapy can dissolve conflicts in the mind. Psycholytic therapy was historically an important approach to psychedelic psychotherapy in Europe, but it was also practiced in the United States by some psychotherapists including Betty Eisner.
An advantage of psychedelic drugs in exploring the unconscious is that a conscious sliver of the adult ego usually remains alert during the experience. Throughout the session, patients remain intellectually alert and remember their experiences vividly. In this highly introspective state, they also are actively cognizant of ego defenses such as projection, denial, and displacement as they react to themselves and their choices in the act of creating them.
The ultimate goal of the therapy is to provide a safe, mutually compassionate context through which the profound and intense reliving of memories can be filtered through the principles of genuine psychotherapy. Aided by the deeply introspective state attained by the patient, the therapist assists him/her in developing a new life framework or personal philosophy that recognizes individual responsibility for change.

Psychedelic therapy

Psychedelic therapy involves the use of very high doses of psychedelic drugs, with the aim of promoting transcendental, ecstatic, religious or mystical peak experiences. This approach differs strongly from the dialog-based processing of psychodynamic material upon which many other methodologies are based. As such, it is more closely aligned to transpersonal psychology than to traditional psychoanalysis. Psychedelic therapy is practiced primarily in North America. The psychedelic therapy method was initiated by Humphry Osmond and Abram Hoffer (with some influence from Al Hubbard) and replicated by Keith Ditman.

Other variations

In Czechoslovakia, Stanislav Grof developed a form of treatment that appeared to bridge both of these main forms. He analyzed the LSD experience in a Freudian or Jungian psychoanalytic context in addition to giving significant value to the overarching transpersonal, mystical, or spiritual experience that often allowed the patient to re-evaluate their entire life philosophy.
The Chilean therapist Claudio Naranjo developed a branch of psychedelic therapy that utilized drugs like MDA, MDMA, harmaline, and ibogaine — substances that do not involve the same degree of perceptual and emotional alteration as LSD.

Anaclitic therapy

The term anaclitic (from the Ancient Greek "ἀνάκλιτος", anaklitos – "for reclining") refers to primitive, infantile needs and tendencies directed toward a pre-genital love object. Developed by two London psychoanalysts, Joyce Martin and Pauline McCririck, this form of treatment is similar to psycholytic approaches as it is based largely on a psychoanalytic interpretation of abreactions produced by the treatment, but it tends to focus on those experiences in which the patient re-encounters carnal feelings of emotional deprivation and frustration stemming from the infantile needs of their early childhood. As a result, the treatment was developed with the aim to directly fulfill or satisfy those repressed, agonizing cravings for love, physical contact, and other instinctual needs re-lived by the patient. Therefore, the therapist is completely engaged with the subject, as opposed to the traditional detached attitude of the psychoanalyst. With the intense emotional episodes that came with the psychedelic experience, Martin and McCririck aimed to sit in as the "mother" role who would enter into close physical contact with the patients by rocking them, giving them milk from a bottle, etc.

Hypnodelic therapy

Hypnodelic therapy, as the name suggests, was developed with the goal to maximize the power of hypnotic suggestion by combining it with the psychedelic experience. After training the patient to respond to hypnosis, LSD would be administered, and during the onset phase of the drug the patient would be placed into a state of trance. Levine and Ludwig found the combination of these techniques to be more effective than the use of either of these two components separately.

Developments from 1980–present

Owing to the largely illegal nature of psychedelic therapy in this period, little information is available concerning the methods that have been used. Individuals having published information on psychedelic psychotherapy in this period include George Greer, Ann Shulgin (TiHKAL, with Alexander Shulgin), and Myron Stolaroff (The Secret Chief, about the underground therapy done by Leo Zeff) and Athanasios Kafkalides.

Current research and therapy

Current legal research into possible therapeutic value of psychedelics has been ongoing for several years. The only published pilot study (and Phase I FDA safety study) so far is one that showed that Psilocybin could be safely given to those with OCD and showed trends for improvement of symptoms but the study did not clearly establish whether or not the patients were helped by the treatment.
There are also several ongoing or recently finished clinical trials that have not yet published their results. A study by Charles Grob, sponsored by the Heffter Research Institute, used psilocybin with cancer patients, with the intention of helping them come to terms with their condition, and for pain relief. Roland Griffiths and colleagues at Johns Hopkins are also studying if people with anxiety or poor mood due to current or past cancer can benefit from psilocybin. Unlike the Grob study, the Griffiths study does not require participants be terminally ill. Another ongoing study with cancer patients is with John Halpern at Harvard Medical School's McLean Hospital, but this study is with MDMA, more commonly known as Ecstasy. MDMA is also being investigated as a possible adjunct to psychotherapy for Posttraumatic stress disorder (PTSD) in people who did not benefit from available PTSD treatments. Research conducted by Torsten Passie has shown that patients who also suffer from anxiety and depression can especially benefit and make significant progress in healing when given doses of MDMA and other entactogens that stimulate social and emotional effects. Studies of MDMA and PTSD are currently underway in the United States (South Carolina), Switzerland, and Israel, all sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). MAPS has a twelve-person study in Switzerland to see whether a moderately large dose of LSD (200 mcg) is more helpful as part of psychotherapy for patients with life-threatening illnesses than a lower dose (20 mcg).