On Thursday, July 30th, 2020, we hosted a video AMA on the Osmind community with Andrew Penn, UCSF researcher and MAPS Phase III MDMA-assisted psychotherapy therapist. You can find the full video here. Here is a summary of some of the key questions and answers from the AMA:
What do you think is the biggest challenge for MDMA-assisted psychotherapy to gain widespread adoption if/when it is approved?
One of the things you have to keep in mind with this different modality is that this is way more than the medicine. Something that often happens is that the medicine will be put in the center. Not to say that medicine is not important but therapy should be in the front and the medicine should be catalyzing the therapeutic process.
So who is going to be able to give this therapy?
Historically, the role of the FDA has been to ensure that the drugs approved by their agency for clinical use are safe and effective. The FDA is good at regulating drugs but not good at regulating therapy, it’s a little uncharted for them. There are a lot of conversations about who should be allowed to be in the room during MDMA-assisted psychotherapy and the credentials of what those people should be, whether that be an MD, nurse, psychotherapist, etc.
We don’t know who the FDA will deem to be fit to provide this sort of therapy and it is yet to be determined. Ultimately, it is not entirely in our (the providers’) hands to decide.
What is psychedelic-assisted therapy like? As someone who has just done ketamine infusions, I can’t imagine trying to talk through one. It seems like that would take away from the inner experience. Can you explain a bit about how it works and how it feels from the patient perspective?
It depends on the drug. With ketamine and higher doses, it’s more difficult to talk and it does tend to detach people from their body. Out of ketamine, MDMA, and psilocybin, MDMA is more conducive to conversation and has a prosocial profile. People tend to be more talkative and socially engaged with MDMA.
With that said, I’ve also seen people do deep inner work in that paradigm so it does vary from person to person.
What is the role of a guide during the psychedelic experience? Who is fit to be a guide?
- Speaking from my Zendo experience, one of the things we train guides to do is to use certain aphorisms such as difficult does not equal bad. Sometimes people refer to a “bad trip” where you can have some very difficult experiences in psychedelics. I don’t really consider psychedelics to be recreational in my opinion, but people certainly take them as such in those settings. There is a small set of people that are challenged and harmed from these psychedelic experiences.
- One of the things that people get into trouble with emotionally is when they try and steer the experience in one direction or another. The important thing about psychedelic experiences is to remain very open about what may come up. Have intentions but hold them very loosely. Sometimes people get so caught up in the emotional experience that they forget to take care of their bodies. The guide should be there to help you make sure you are staying safe and taking care of your physical state. A guide could say, “Hey you haven’t had anything to drink in a while, can I get you some Gatorade or some tea?”
- Zendo is set up as a safe, comfortable, and gentle space. A guide should be somebody that you feel comfortable with saying whatever comes up out loud. If you have strong feelings about your guide, whether good or bad, that may be an indicator that maybe they are not the right guide for you. It’s important to have an environment and guide that is ok with whatever may come up during the psychedelic experience.
What steps does grief psychotherapy take?
Psychotherapy and grief is something I’ve had much interest in. We live in a culture that is very phobic of grief, the average job has a three-day funeral bereavement leave. We have this idea that grief should be very time-limited, but the reality is often much different. Francis Weller is a good colleague of mine who talks beautifully about grief and does research on the stages of grief. He discusses how there are many different strata of grief. For example, there is the obvious grief for things we care about and there is the grief for things we wanted to have but never had. We carry grief for the state of the world, especially now. We employ many different emotional strategies to avoid having to engage with grief:
- There’s a dissolving quality that many psychedelics have that may create a really intense experience that allows people to deal with their grief, it can be flooding and overwhelming.
- Grief can also have regressive qualities when we didn’t have the resources or support to feel them at an earlier time, those emotions can also come back intensely during psychedelic sessions.
- Sometimes people don’t know that they have been carrying grief, it’s kind of like the air that they breathe, they only know it’s been there when it’s not available. These experiences can be really powerful and require a lot of care.
- When people have difficult experiences during psychedelic sessions, it can be because they’re finally letting themselves feel grief.
Grief should be a communal experience, and what’s tragic about COVID is that we can’t have funerals in the way that we normally would. We kind of have to shake off our grief experience.
How can I get involved in a local MAPS study?
The best way to find any information on clinical trials is to go to https://clinicaltrials.gov/, which is a National Institute of Health (NIH) sponsored website. Any study starting out needs to register through this site. It’s very user-friendly with a google type interface where you can search for a certain drug or condition and find clinical trials related to what you’re looking for!
Andrew also had a question for the Osmind community. If you’ve ever had a psychedelic-assisted therapy session, we’d love for you to share your experience. Make sure to stay tuned in on the community platform for the next AMA!
Osmind’s mission is to maximize patient access to innovative mental health treatments where other therapies have failed. We do that by building software to improve the patient experience, empower providers to deliver better care, and help life sciences organizations get psychedelic medicine and other groundbreaking therapies onto the medical market.