Psychedelic-Assisted Therapy In the 1950s and 1960s, psychedelics were viewed as useful tools to enhance psychotherapy (Krediet et al., 2020). During this period, significant research was being conducted on the use of psychedelics in the treatment of a variety of disorders. However, use outside medical contexts led to most psychedelic drugs being scheduled (i.e., strictly regulated by the federal government) in the mid-1960s and research came to a halt (Krediet et al., 2020). In recent decades and particularly in the past five years, there has been a renewed interest in how psychedelics can play a role in the treatment of various conditions, including PTSD. Since 2018, the U.S. Food and Drug Administration (FDA) has recommended MDMA and psilocybin be given a breakthrough therapy designation and have approved ketamine for treatment-resistant depression (Krediet et al., 2020). In a review of various psychedelic- assisted approaches, Krediet and colleagues (2020) describe the rationale for this approach in that “these drugs can catalyze the psychotherapeutic process, for example, by increasing the capacity for emotional and cognitive processing through pharmacologically diminishing fear and arousal, by strengthening therapeutic alliance through increased trust and rapport, or by targeting processes of fear extinction and memory consolidation” (p. 386). Some concerns about the potential for abuse have been expressed; however, there is not current research to support this concern and negative experiences or “bad trips'' are shown to be most associated with individual use in which there was no formal regulation of drug purity or potency or monitoring of safety (Averill & Abdallah, 2022). Currently, the substance that has the most research supporting its use specifically for the treatment of PTSD is MDMA. MDMA- assisted psychotherapy uses MDMA as a part of a larger psychotherapeutic treatment that involves several nondrug preparatory sessions as well as integrative therapy sessions after MDMA sessions (Krediet et al., 2020). This approach follows a standard treatment manual for MDMA-assisted psychotherapy (Mithoefer et al., 2017). Currently, MDMA-assisted psychotherapy for PTSD is in a multicenter phase 3 trial seeking full FDA approval. Promising results across several studies have found that MDMA-assisted psychotherapy results in a majority of patients no longer meeting criteria for PTSD and increased posttraumatic growth (Mithoefer et al., 2013; Mithoefer et al., 2018; Ot’alora et al., 2018), with effects being stable for a period of 3.5 years (Mithoefer et al., 2013). The intense approach to set and setting for MDMA-assisted psychotherapy may be a large component of its effectiveness but also warrants consideration for how it can be integrated into healthcare systems in a way that promotes scalability and safe and responsible use (Averill & Abdallah, 2022). Several other psychedelics have shown effectiveness for other conditions and are beginning to be studied for their utility with PTSD. Ketamine has been FDA approved for the treatment of treatment-resistant depression. In the community, ketamine is being more frequently used to treat PTSD, but fewer studies have been conducted for its treatment. Compared to MDMA, ketamine is typically administered in a clinical facility without formal preparation or integration settings; however, some providers do use ketamine within a larger psychotherapeutic approach (Krediet et al., 2020). Similar to its use with depression, treatment of PTSD using ketamine tends to show rapid, but short-lived, remission of symptoms. Albott and colleagues (2018) showed that repeated infusions can lead to more sustained benefits, but still showed a median time to relapse of 41 days. Psilocybin has received a breakthrough designation from the FDA for use in depression (Krediet et al., 2020). Although there is currently little to no research on the use of psilocybin for the treatment of PTSD, several studies are currently underway at Baylor, the Ohio State University, and Johns Hopkins (Averill & Abdallah, 2022). Historical literature of various classical psychedelics (psilocybin, LSD, ayahuasca) supports their use
for the treatment of PTSD, but more formal clinical trials are needed. Of all substances, cannabis has been one of the most widely discussed and deregulated, with the World Health Organization proposing that it be rescheduled to allow for medical applications. Despite cannabis being widely accepted for medical use for PTSD, it differs from other psychedelics in that it is mainly utilized for temporary relief of symptoms rather than treatment (Krediet et al., 2020). Additionally, while cannabis can be utilized as a therapeutic intervention, its use can serve as a means of avoidance for some individuals. PTSD has been found to be the most highly co-occurring psychiatric disorder with cannabis use disorder, and a recent study by Metrik and colleagues (2020) found cannabis use to be linked to increased severity of trauma-related intrusion symptoms over time. Considerations may be needed for how cannabis use can be a facilitator of treatment rather than being relied upon as a stand- alone intervention. For example, some evidence has shown cannabis to increase fear extinction and disrupt fear memory consolidation, which could be utilized to enhance the efficacy of exposure-based psychotherapies (Krediet et al., 2020). Integrating Body and Spirit into the Healing Process In addition to the previously discussed theoretical perspectives, attention to the client’s body and spirit will provide the healing approach that is most likely to aid in integration and consolidation of a healthy self (Levine, 2015). The body is the scene of the crime for survivors of interpersonal violence. There are a number of means by which one can incorporate the body into the treatment. The Limitations of Talk Therapy for Trauma Survivors Talk therapy for trauma survivors is only one aspect of an overall healing protocol. Although somatosensory intrusions and memories need to be transformed into language and named, thus engaging the thinking brain and disengaging the limbic system from its habitual instinctual response, language alone can also be a tyranny and a trap. If traumatized people talk only about the trauma, without enlisting help from “the imaginal, emotional, sensory, and somatic capabilities of their right brain, the symptoms can get worse instead of better” (Naparstek, 2004, p. xviii). The language centers in the brain have been compromised by the flood of neurochemical responses released at the time of the trauma because Broca’s area, responsible for the production of speech, becomes inhibited during states of high arousal (Cozolino, 2014). To quote the title of Bessel van der Kolk’s 2014 book, “the body keeps the score” in regard to trauma. Effective treatments must, at times, sidestep the logical hypnotherapeutic techniques can gently guide the client into an experience of calm, mastery, and the ability to access internal resources. According to Naparstek (2004), guided imagery is: a form of deliberate directed daydreaming—a purposeful use of the imagination, using words and phrases designed to evoke rich multi-sensory fantasy and memory, in order to create a deeply immersive receptive mind-state that is ideal for catalyzing desired changes in mind, body, psyche, and spirit. (p. 150) The traumatized brain is compelled to move away from language and verbal cues in order to focus on the nonverbal cues—such as body movements, facial expression, and tone of voice—and to search and scan for threat-related information embedded in the environment (van der Kolk, 2014). Guided imagery, with its calm, soothing tones, images of safety, and (often) use of music, can settle down a hypervigilant brain, which then allows the higher brain functions to do their jobs. brain and treat the ingrained biology. Guided Imagery and Dreamwork The use of dreamwork, guided imagery, and certain
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Book Code: PYFL4024
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