Psychedelics have the potential to transform a wide array of mental and physical ailments
Psychedelic therapy involves psychotherapy sessions before and after the dosing session, typically lasting six hours each. Patients build rapport with the therapist, set intentions, and discuss what to expect during the treatment. The dosing session lasts all day, followed by another therapy session to integrate the experience. The hypothesis for how psychedelics work is that they induce a state of brain plasticity, which allows for changes in ingrained patterns of thoughts, emotions, and behavior.
Psychedelic drugs have garnered increased attention in recent years as a potential treatment for mental health conditions. Dr. Josh Woolley, a psychiatry professor at UCSF, joined us on our podcast to discuss this emerging field. In his research on psilocybin therapy for AIDS survivors suffering from trauma, guilt, and existential distress, Dr. Woolley has found that the treatment may be a model for helping those with PTSD, addiction, and depression. Studies are also examining its effectiveness for treating lower back pain, Parkinson’s, and bipolar disorder.
Offering up the example of PTSD, Dr. Woolley explains how opening up the mind to a critical moment can help change your habits. “Something horrible happens and you’ve now adapted…you’re ready for danger all the time, which is good if you’re in a war zone, but it’s not so good if you’re a civilian,” he explains. “You could imagine that if you could reopen a critical period, maybe you could go back” to ease these thought patterns.
Psychedelics have a “vanishingly rare” potential for addiction, and the “lethal dose is theoretical.” While 10 percent of Americans have used psychedelics, with the number going up every year, these mostly recreational users aren’t using it alongside therapy to address a critical moment. “It was just a plastic state. But it matters what you do during that state,” he says.
Even with the promise of psychedelic therapy, Dr. Woolley cautions against excitement that we’ve found a “miracle cure.” He points to past examples of opioids, benzodiazepines, and methamphetamine, which were initially touted as effective treatments for various disorders but ultimately had significant downsides. “We have been burned many times before,” he says.
But with continued research and clinical trials, psychedelic therapy may provide a new avenue for treating a wide array of ailments.
Paying attention to the mind can help break unhealthy habit loops
Dr. Jud Brewer, a renowned addiction psychiatrist and neuroscientist, first came to mindfulness training after a breakup in medical school. He realized, “You can actually start to alleviate some of this stress by paying attention in your mind,” he says on our podcast, Inside Medicine.
Dr. Brewer’s approach to habit change starts from a place of curiosity. “People [often] aren’t aware that they’re anxious,” says Dr. Brewer. If he notices that this unaware form of anxiety is causing someone suboptimal living, he treats it with motivational interviewing. A response to someone saying they worry, might be: “Why don’t you worry more?” Or to someone who smokes cigarettes: “Why don’t you smoke more?” “It helps people really touch into their direct experience to see how something isn’t actually serving them that much,” says Dr. Brewer. Starting in this place of identification helps people map out their pain points and unhealthy habit loops.
“How can we become okay with uncertainty and shift from our panic zone into our growth zone?”
“If we look at these standard dictionary definitions of anxiety, it’s basically a feeling of nervousness or unease about something with an uncertain outcome,” says Dr. Brewer. But life and the future are inherently uncertain, so “how can we become okay with uncertainty and shift from our panic zone into our growth zone?”
Our brains don’t like uncertainty. The fear mechanism in our brain is meant to alert us to potential danger. “Fear is a helpful survival mechanism. Planning for the future is a helpful survival mechanism. When you mush the two together – fear of the future – not so helpful.”
Our increasingly digital world creates many opportunities for distraction, or avoidance. But “if we’re curious about something, we’re probably going to pay attention to it,” he says. “Meditation can help train us to be aware and curious… Yet we don’t have to meditate to do it.” Dr. Brewer’s research emphasizes informal mindfulness to create habit change. It’s foundational to his app-based therapeutics Craving to Quit (for smokers), Eat Right Now (to manage stress-eating), and Unwinding Anxiety (to manage anxiety). This mindfulness training has even helped wean people off less-effective anxiety medications and create impactful change in their daily lives.
Mindfulness can bring us closer to meaning and connection
“Meditation can mean a lot of different things depending on who’s talking about it,” says Dr. Jay Sanguinetti, assistant director at the Center for Consciousness Studies at the University of Arizona. In our Inside Medicine interview with him, he explains that in his lab they view meditation objectively – its effect on the brain and body can be measured and observed.
The lab looks at three attention components in meditation: the ability to concentrate, sensory processing, and equanimity. “Practicing meditation is practicing all of these attention skills together,” Dr. Sanguinetti says. In the lab, they measure brain states with an EEG test (which measures brain waves), finding that “after a couple of years, a meditator can efficiently put their brain into a different state.”
While this state is hard for researchers to define, Dr. Sanguinetti says that consciousness is even more difficult (“impossible, according to some,” he says). What they can measure is the correlates of consciousness. For example, if you take magic mushrooms and get an MRI, that changes the correlates of consciousness. “The hard problem is knowing how the correlates cause consciousness, and that is a bridge that we may never cross with our current tools.”
“We’re actually quite far away from what’s right in front of us… That’s why it’s important to train it with mindfulness practice… to have more access to what is immediately present.”
The real challenge for Dr. Sanguinetti’s lab is supporting people through psychological shifts. Modern society may allow us to live longer and healthier, but there is still a lot of suffering. “We’ve created tools that have separated us from the things that are helping us have meaning and purpose,” he explains. He lists out experiences in our lives that help us reconnect: having a baby, falling in love, losing someone in your life. “The dirty secret of all of this is it’s right there,” he says of these moments for connection.
Beyond digital tools for distraction, someone with chronic pain might also have trouble connecting because the pain is more central. “We’re actually quite far away from what’s right in front of us,” he says. “That’s why it’s important to train it with mindfulness practice… to have more access to what is immediately present, which is your child or the food in front of you or the music you’re listening to. It’s all right there, but you got all this stuff happening in the mind that’s preventing you from it.“