- [Jeff] Welcome to "Healthy Minds."

I'm Dr. Jeff Borenstein.

Everyone is touched by psychiatric conditions, either themselves or a loved one.

Do not suffer in silence.

With help, there is hope.

Today on "Healthy Minds."

- When we talk about psychedelic-assisted psychotherapy this isn't taking a psychedelic, this is taking a psychedelic in the context of a therapeutic process with clinicians who are trained to work with you while you are in an altered state.

And then of course, the important work, to prepare you for the altered state and then the integration afterwards.

So this is very different than recreational use.

- So the key take home message here is this is not go take a pill and listen to music or do something else.

This is something that needs to be very carefully done with professionals who have expertise in this area.

- It takes about 45 minutes or an hour for things to start happening.

You start feeling differently.

And then within a couple hours, you find that you're revisiting memories, not even necessarily the ones you thought you'd revisit.

And the therapists are checking in.

Some people have a more internalized experience and they'll talk about it the next day.

But some people do a lot of talking during the session.

Baseline psychotherapy is really very critical here.

- That's today on "Healthy Minds."

This program is brought to you in part by the American Psychiatric Association Foundation, The Bank of America Charitable Gift Fund, and the John and Polly Sparks Foundation.

Welcome to "Healthy Minds."

I'm Dr. Jeff Borenstein.

Today I speak with Dr. Rachel Yehuda about post-traumatic stress and potential new treatments for this condition.

The new treatment is called psychedelic-assisted psychotherapy.

(gentle music) Rachel, welcome to "Healthy Minds."

Thank you for joining us.

- Thank you for having me.

- I want to jump into the work that you're doing related to posttraumatic stress and in particular, the potential of psychedelic treatment, psychedelic drugs in the treatment of posttraumatic stress.

But let's start off with what is a psychedelic drug?

- Well, a psychedelic drug is a drug that changes your normal state of consciousness, and it's usually associated with a heightened acuity of your senses.

So colors may appear more vivid to you, sounds may appear more melodious to you.

Many people who take a psychedelic experience something called synesthesia, where you hear the colors and you see the sounds.

So basically it puts you in a frame of mind where you're heightened.

And there are several different chemical compounds that could be considered psychedelics.

- And what about being heightened in that way is potentially therapeutic for a person?

- Well, when you think about being heightened, right, people use psychedelics recreationally.

So a lot of times people might wanna take a psychedelic if they're dancing, or if they're in a crowd to kind of heighten their enjoyment.

But in the context of therapy, if we're talking about being heightened, well, maybe what we're talking about is the potential to do deeper, better work, to go inside and really uncover areas that really aren't accessible or difficult to access in a normal state of consciousness.

And when we're talking about something like PTSD, where the goal of PTSD therapy is to kind of integrate the traumatic experience, many people find it really hard to talk about a devastating trauma, even in therapy, because it's very distressing.

When you start to think about the trauma or remind yourself of what happened, you can get physiologically distressed, and physiologically aroused, and you wanna distance yourself and maybe not go as deep and not do the work.

So the potential here is to have the psychedelic assist the psychotherapeutic work and really allow people to access and explore traumatic and difficult situations in their lives, that they haven't really been able to do before.

- Often when a person may start to think about or speak about the experience, it's almost like they're reliving the experience, it's that painful for them.

- Yeah, you're exactly right.

Because the difference between having a memory in the context of not having PTSD, and having a memory in the context of PTSD, is that in PTSD you not only you remember what happened but you have the same physiological fight or flight response as you're having the memory of having a challenge.

And so the memory is particularly distressing.

It's like really you're being haunted by a memory because you have no control of the emotional response in the memory.

And sometimes you don't even have control over when you experience the memory because you can be triggered at any time by something in the environment that will take you right back down there - The work with psychedelics, tell us about the thinking behind that and the concerns that you may have that it could cause negative side effects.

- Yes, when I first heard about psychedelic-assisted psychotherapy, I didn't understand the logic behind it at all.

And in fact, I worried very much about the potential for adverse effects.

I didn't know very much about psychedelics but I did know drugs are bad.

That's what many of us learn in mental health, and psychedelics are drugs.

And so really I didn't have a nuanced understanding, that psychedelics may offer a different opportunity.

In truth, psychedelics are not addictive.

So we don't worry so much about the addictive potential of psychedelics, but anytime you're introducing any medication to someone, you're concerned to make sure that this is safe and that side effects will be minimized.

Once I heard about the trials that were going on with MDMA assisted psychotherapy and PTSD, I still didn't quite understand what the point of this treatment was but the outcomes of these treatments were really spectacular and greater than the outcomes that we have previously seen in traditional psychotherapy or trauma focused therapy.

And also with medications that are FDA approved like antidepressants and the effects were twice as high, and sometimes three times as high as what you see.

And it wasn't just the reduction in PTSD symptoms that people were talking about who had taken these medicines, it was the feeling that they were able to rejoin their lives again.

It's one thing to reduce symptoms, and it's another thing to really wanna be present in your life- - To feel better and move forward with your life.

- Yes, and so this is what was coming out of early reports.

I was still skeptical.

- And just to clarify, the medicine that we're using is a drug of abuse, is referred to as ecstasy, when people are taking it at clubs.

So we as professionals would be certainly apprehensive about giving it to somebody therapeutically.

- Well, we would be apprehensive because it's a schedule one drug, which means that the government has designated this drug as of a potential harm and no therapeutic benefit.

But it seems like the government may have made that designation prematurely, because there wasn't a lot of data, one way or another, to either ban the drug or to support its therapeutic use.

But in the '50s, '60s, and '70s, therapists were kind of using MDMA on the down low to help open patients up, particularly in the '70s, right, leading up to both its very high recreational use and the banning of it.

So yes, I think there is always a potential for concern when you use a compound not therapeutically or not under the right supervision.

And of course, when we talk about psychedelic-assisted psychotherapy, this isn't taking a psychedelic, this is taking a psychedelic in the context of a therapeutic process, a known and trusted compound with clinicians who are trained to work with you while you are in an altered state.

And then of course the important work to prepare you for the altered state and then the integration afterwards.

So this is very different than recreational use.

- So the key take home message here is this is not go take a pill and listen to music or do something else.

This is something that needs to be very carefully done with professionals who have expertise in this area.

- Yes, you won't get the therapeutic outcome if you just take the medicine, you have to do it in the context of an entire treatment regimen.

And the deep work that is done, both during an MDMA session, but particularly afterwards.

So this really isn't about psychedelic treatment.

It's really important to emphasize that it is psychedelic-assisted psychotherapy.

It just provides a way to go deeper.

What MDMA does, it's not a classic hallucinogen or a drug that kind of dissolves your ego, but what it does is it promotes a state of deep compassion, self-compassion.

It promotes a sense of interpersonal trust and it reduces the fear of encountering traumatic memories.

Well, that's a really perfect state to be in if you need to process traumatic memories.

You have to be able to have compassion for yourself, the trauma survivor, you have to be able to trust your therapists who are working with you, and you have to not get physically aroused when you're encountering the traumatic memory.

So that might be the reason that the outcomes have been so good in early studies.

So we created the center at Mount Sinai because a lot more work needs to be done so that we can really understand these treatments better and particularly understand really who might not be suitable for psychedelic-assisted psychotherapy.

And right now there's such an excitement about this treatment.

It's really important, if we've learned anything in mental health, we've learned that not everybody will respond the same way to a treatment.

- So the research is to figure out who may respond to this and how to best use it.

- Yeah, that's a very big part of it and also truly understand more about how it works.

Because it's really important to be able to understand the mechanism of action of any kind of treatment, and the role that the medicine plays and the role of the psychotherapy.

So, you know, in the future, if we can unlock the mystery of how this works, we might be able to have these kinds of therapeutic outcomes without a psychedelic or maybe we might be able to find ways to even improve the kind of psychedelics that are out there now.

- And I think a key point in the phrase, psychedelic-assisted psychotherapy, is just assisting in the probably more important work of the therapy itself.

Tell us a little bit about what happens in the therapy.

- Well, the first stage is preparation, where the, so this is an unusual therapy, because there are two therapists that are working with the patient the whole time.

So the two therapists meet with the patient to try to get a sense of what some of the issues are, why they're motivated for the treatment, talk a little bit about some of the traumatic experiences and the symptoms, and really answer a lot of questions about what it will mean to work in an altered state, which sometimes people have tried psychedelics, sometimes they haven't.

Then after three of those kinds of sessions, there's a dosing session, which can last about eight hours where a patient is given MDMA early in the morning.

And the two therapists are with the patient for the entire day.

And the therapy's usually done in a very nonclinical like environment, kind of like a living room situation, where the patient can recline and the therapists are sitting in comfortable chairs, it is eight hours and there's music that has been curated for this experience, and there are eye shades.

And the patient is asked in the beginning to kind of go under, see what happens when you put on the headphones, and you put on the eye shades.

It takes about 45 minutes or an hour for things to start happening, you start feeling differently.

And then within a couple hours, you find that you're revisiting memories, not even necessarily the ones you thought you'd revisit.

And the therapists are checking in.

Some people have a more internalized experience and they'll talk about it the next day.

But some people do a lot of talking during the session.

The MDMA generally will make your body feel good, but the kind of memories that you may be revisiting if you have PTSD, are probably terrible.

And so you basically have a better feeling in your body so that you can also do this kind of work.

You may have insights about the traumatic event or about yourself or about the situations leading up to it or afterwards.

And then about eight hours later, the MDMA wears off.

And the first of three integration sessions begin the next day.

So that you're talking a lot about that dosing session, you're spending almost as much time talking about what happened in the session as the hours of the session.

And then in the research protocol that has been studied now, there are several dosing sessions and they're all followed by three 90 minute integration sessions.

So this isn't a quick fix.

It's not you take a psychedelic one day, and your post-traumatic stress disorder is gone.

This is 12 90-minute sessions and three dosing sessions.

And it can take about a three month period in order to have a course of a psychedelic-assisted psychotherapy with MDMA.

- Often people have suffered with posttraumatic stress symptoms for many years.

So if three months can help relieve that it's worth the time to make that happen.

- Yes, completely.

In the MAPS trials for getting FDA approval.

They only studied treatment resistant patients, meaning that you had to have failed two therapies before you could be admitted into the trial.

But that's not at all uncommon.

People have been, people with PTSD have generally tried many many different kinds of approaches, ranging from traditional to non-traditional approaches and many experienced benefits from traditional and non-traditional approaches.

But what is rare to see are patients that have a course of treatment, feel that their symptoms go away, and then are really fully wanting to reconnect with their lives and their loved ones and their careers or finding a purpose for themselves, or finding that they have made meaning out of the traumatic experience.

This requires like a transformational therapeutic experience.

And I think that the psychedelic-assisted psychotherapy can provide the basis for having that kind of a transformation.

- I wanna shift gears a little bit.

You've conducted research on intergenerational issues and I'd like you to speak about that.

- We have done research that show that the effects of PTSD or trauma in a parent can really also be present in their offspring.

And so offspring seem to carry the effects of a parental trauma.

Many people don't know how to treat this, especially if the symptoms that they have are quite negative.

We in particular, studied adult children of Holocaust survivors, and they came to the clinic saying that my life is good but I just feel like any day the other shoe is gonna fall.

I can't trust the good, because I know the kind of life that my parents experienced, or they have imagery of death and death camps, or they fantasize Zyklon B coming out of the shower instead of water.

They have a lot of issues kind of loving and connecting to people because they're afraid of loss.

What happens if the person dies or gets taken away?

And so it wasn't clear to us as we're listening to these very compelling narratives that adult children of Holocaust survivors were talking to us about, whether this is PTSD, and whether it should be treated as PTSD.

After all, some of it is anticipatory trauma, right?

Some of it is just the fear that something bad will happen or that if it does, they might not be able to cope as well as their parents.

Some had issues separating from parents but that's not exactly a trauma per se, although people experienced this as stressful.

A treatment like psychedelic-assisted psychotherapy may allow people to go very deep inside and really articulate more what some of the issues are including maybe some of the positive effects that they carry with them as a result of being the children of trauma survivors.

We talk a lot about out the intergenerational effects, the negative ones, because trauma's bad, the effects of trauma might also be bad.

But when we talk about having a remnant of an intergenerational trauma in a parent, this could also be the coping mechanisms and resilience that help the parents survive, and may also have a lot of that.

So if you're able to kind of go deep into a state where you can really explore things in a very different way, you might be able to learn something that will help you to kind of transform your perspective about what it means to be a child of a trauma survivor.

In other kinds of psychedelics, MDMA doesn't particularly do this, but when you talk about medicines like Psilocybin or Ayahuasca that are more what we call ego dissolving, some people even report kind of hearing or sensing the presence of an ancestor, kind of reassuring them or giving them wisdom or giving them advice.

So again, it's really about heightening and deepening a normal experience, but the normal experience, the baseline psychotherapy is really very critical here.

- If somebody's watching right now and they've experienced a traumatic event they may have post-traumatic stress, what should they do?

- Well, almost all of us are traumatized.

So I think we wanna put that out there, that trauma is something that is likely to happen to every person, at least once in their lifetime.

And a trauma is an event that really is enormously challenging, a watershed event that causes fear and helplessness or horror.

It's an event which could have taken your life, an event that threatened your physical integrity.

And unfortunately, according to statistics, traumatic events are increasingly common.

What's also common is to experience PTSD following a traumatic event.

And PTSD involves having symptoms like intrusive memories, flashbacks, nightmares, physiological arousal, really being hyper alert and not being able to concentrate and really avoiding reminders of what happened, and even to some extent, avoiding people more generally.

And if you find that you have those symptoms then what you really have to do is number one know that they're real, they're not in your head, you're not making them up, you are not weak.

This is your body telling you that you have to do some work to integrate the traumatic memory into who you are.

So I have to normalize this for you, that it's not a personal failing.

Self care is very important.

Trauma survivors with PTSD often neglect their personal health.

They don't always eat right or exercise, because they're very preoccupied with what happened in the past, they're not always available to really take care of themselves in the present or look towards the future.

So it's really very important to try to do a lot of things for yourself, not necessarily relying on a provider to do them for you, and really just understand that this is a real thing and it probably won't go away on its own especially if you've been struggling for a long time and the trauma was a long time ago.

So I think that those are the important things.

- People shouldn't suffer in silence.

They should seek help, seek professional help, seek help from friends and family, sharing their experience and getting that support.

But don't suffer.

- Don't suffer in silence.

- Get the help they need.

- Don't suffer alone - And you're not alone, there are other people who have gone through this.

That's part of the help that a support group can offer somebody.

Rachel, I want to thank you for joining us today for the research that you've done, research that you're continuing to do which will help so many people.

- Well, thanks for having me, Jeff, I appreciate it.

(gentle music) - Psychedelic-assisted psychotherapy to treat post-traumatic stress is a promising new research endeavor, but it's not yet ready for prime time.

Fortunately, there are other treatments that are available.

If you or a loved one are experiencing post-traumatic stress, don't suffer in silence, get the help that you need and deserve.

With help, there is hope.

(gentle music) Do not suffer in silence, with help, there is hope.

This program is brought to you in part by The American Psychiatric Association Foundation, The Bank of America Charitable Gift Fund, and The John and Polly Sparks Foundation.

Remember with help, there is hope.

(gentle music)