Leveraging the Power of Psychedelic-Assisted Therapy in PTSD

By Rachel Yehuda, Ph.D.

As a neuroscientist with a long-time interest in trauma research, I have been very excited lately about the potential of psychedelics in the treatment of trauma-related conditions such as post-traumatic stress disorder (PTSD), depression, and anxiety disorders. More than 70% of people in the U.S. will be exposed to at least one traumatic event in their lifetime, so the number of people who could be helped by these medicines is substantial.

But even more, the adoption of psychedelic psychotherapy by the field of psychiatry could revolutionize how mental health care is conceptualized and delivered. It’s not a moment too soon.

What we currently do for patients with trauma-related conditions like PTSD, depression and anxiety is attempt to moderate disruptive symptoms like dysphoria, irritability, anxiety and sleep problems so that they can continue their lives with as little interference to their interpersonal relationships and professional functioning as possible. In addition to tempering such symptoms, a critical goal of pharmacotherapy is to lessen the generalized hyperarousal experienced by trauma survivors so that they can usefully engage in psychotherapy and in processing painful experiences without the emergence of overwhelming distress.

The benefits of psychotherapies are often incremental and hard-won. It may take months or years before patients can talk about a traumatic memory in therapy, let alone learn effective coping strategies or get their symptoms under control well enough so that they can be withdrawn from psychotropic medications.

Psychedelic therapy is like a surgical intervention

Psychedelics offer a completely novel model of treatment—in which the goal is to achieve a personal transformation rather than stabilization of symptoms. Psychedelic therapy can bring about dramatic healing, the kind that will no longer require the same level of chronic care or surveillance. Think of this kind of approach as more like a surgical intervention, with preparation, a big procedure and follow-up, but then, a lot less clinical involvement due to reduced symptom expression.

Psychedelic medicines promote a change in the normal state of consciousness that allows a person to experience themselves and the world differently for a brief period of time—generally six to eight hours. Since an effect of some psychedelics, particularly MDMA, is to reduce fear and increase self-acceptance, traumatic memories can be re-experienced from a novel perspective and then processed.

During this window of opportunity of an altered state, people may see things that perhaps they would not see under ordinary states of consciousness, allowing them to make insights that then catalyze psychological transformation. The patient then works with the therapist to further explore these insights—a process called integration.

Constructing a new narrative

Psychedelic-assisted therapy represents the ultimate integration of a medicine and psychotherapy, leveraging the power of both. The process allows the patient to construct a new narrative about what happened and what it means, in a way that leads to profound and positive change. Indeed, this is what healing from trauma requires.

Healing from the effects of trauma results from being able to reflect on what happened without being flooded by the usual feelings of fear, shame, guilt, and self-recrimination that obscure or distort an understanding of one’s own experience. Even if more than one exposure to the psychedelic occurs within the treatment, the episode of care with psychedelics is relatively brief —perhaps occurring over several months—compared with the often years or sometimes decades that trauma survivors spend seeking relief from their symptoms.

Too good to be true?

Are psychedelics too good to be true? How can transformation towards healing occur so quickly and continue to elicit positive change well after the medicine and psychotherapy are no longer administered?

Trauma survivors know that the world can change quickly. An experience that sometimes lasts moments can be a watershed that shatters and negatively impacts one’s life and outlook for decades.

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We now understand many of the neurobiological and epigenetic mechanisms that result in long-term changes following brief and discrete traumatic episodes. So we already know that brief events can have enduring impacts that continue to shape one’s experience and perception over time. Why would analogous biological mechanisms not be operational when it comes to healing? Just as a profoundly negative experience can induce epigenetic and psychological changes, so too, pivotal and positive transformational experiences are likely to mobilize enduring molecular and neural mechanisms to promote healing.

It is incumbent upon us to apply the scientific tools we have already developed towards a new science that will help us understand the underlying mechanisms of recovery promoted through the therapeutic use of psychedelic drugs. The important science may not even be what happens to our brains and bodies while under the influence of a psychedelic but, rather, how critical brain networks and epigenetic programs become transformed and reorganized by the experience of psychedelic-assisted psychotherapy and integration. That is, we need a new science of integration, healing and post-traumatic growth.

Source: Rachel Yehuda PhD, used with permission

Rachel Yehuda PhD, is Director of the Center for Psychedelic Psychotherapy and Trauma Research, and Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai in New York. Dr Yehuda is a recognized leader in the field of traumatic stress studies. She is the recipient of numerous federal grants, has authored more than 500 published papers in the field of traumatic stress and the neurobiology of PTSD, and is a member of the National Academy of Medicine.