Psilocybin-Assisted Trauma Treatment, Part I
We’re in our shrooms era.
That’s right. I said it. Psilocybin is having a glow-up in the psychotherapeutic community, fax no printer.
You might not know that psilocybin, or 4-phosphorioloxy-N, the active ingredient in psychedelic (read: magic) mushrooms, has been legal for therapeutic use in Oregon since 2020, or decriminalized in Oakland, California since 2019.(5) You also might not know that mental health researchers have been trying to figure out how it can help the brain since the 1950s.(3) You might not even know how psilocybin was recently part of a TikTok scandal involving a certain hockey draft in Canada (h/t Michael Bublé).
All you might know is that your friend’s friend Becky “micro-doses” and swears she feels, like, totally connected to nature now. And you?
You’ve been trying to heal from old wounds for years and this whole trend is kind of…getting to you.
It’s not that you’re not happy for people who get better. It’s just that you’ve been trying: to stay on the apps, talk to your parents like you’re not a demon, and not beat yourself up for sport. You might’ve even tried medication, but it wasn’t exactly like you got so excited to look inward and change; you just felt a little numbed out, like it took the edge off of an existence you already feel like you’re trudging through.(4) And therapy’s been good in the past–even revelatory, if you’re feeling sassy–but you still get…triggered.(1,2)
You told yourself for years that this whole healing thing is just a long process. You read the books everyone’s been talking about, you listen to some good podcasts every couple of weeks, and you kind of meditate at your desk when you’re really busy, right?
So why’s Becky got to go and look all zen because of some old mushrooms, huh? And why do drugs get all the credit, anyway?
To be frank, Becky’s doing it wrong. Unhinged shroom behavior isn’t helping anybody in the ways they think it might: without the right mindset, place to do it in, people to do it with, or amount you can be sure of, you can really cause yourself undue anxiety, panic, paranoia, and general bad times.(6) But you shouldn’t have had to suffer for so long when we’ve had amazing treatment potential for trauma kept inaccessible from people like you, but now that we might be approaching legalized psilocybin for therapeutic use, it’s important for you to understand why it’s shrooms’ hot girl summer.(5)
ELI5: PTSD
When people talk about triggers and trauma, they’re talking about 4 groups of symptoms: re-experiencing ones (i.e., feeling like you’re suddenly back in the trauma, nightmares about it, feeling awful when you’re reminded of it), avoidant ones (i.e., trying to not be reminded of it), changes in how you think and feel because of it (e.g., feeling like you’re the worst, everyone else is the worst, everything’s just kind of grey all of the time, you’re on the outside, looking in, etc.), and hyperarousal (e.g., reckless behavior, trouble concentrating, being on watch for the other shoe to drop at all times, etc.).
A couple of big points here: people feel disconnected from what’s happened to them, other people, and life in general; people get scared (read: triggered) even though the same thing isn’t happening all over again–their brains are simply trying to protect them before they know it when things feel similarly in umpteen different ways; feelings themselves can get scary, so people try not to tamp them down, or people get a little numb and don’t feel much at all without trying. (1,2,6,7)
These are big topics during trauma therapy treatment, on top of how to work with detachment, feelings, triggers, and patterns in their lives that can yield some insight as to how they might relate to themselves and others in ways that help them feel not only safe, but content. And yet, if you feel disconnected from other people, get pretty scared around reminders of your worst memories, and feel feelings so loudly it hurts, or so weakly that it’s a dead-end road to follow, therapy might feel a little bit like trying to catch your own tail. (1,2,3,4)
So, Is Your Magic Solution…Mushrooms?
It’s not that simple.
Hallucinogenic psychotherapy does a couple of things really differently from whatever your friends did in college.
First off, you get evaluated by a doctor and a therapist to make sure you don’t have any contraindications for using the specific hallucinogen (i.e., if you have a history of psychosis, you likely won’t be cleared for psilocybin treatment should it become legal).(1) Second, you have several preparation sessions before you take it, where a therapist works with you to talk about what it might be like, sets detailed intentions with you for what you want out of the medicine, and builds trust with you so that you feel comfortable while you’re doing it.(1) Third, your therapist is there the whole time.(1) For the whole trip. Not like a trip sitter, but your therapist Sally who knows about what a tech-bro your ex-boyfriend is. And fourth, you meet with your therapist afterward for “integration,” where you talk through what happened during your experience and make new connections to and meaning out of it that relates back to those intentions of yours.(1)
That might sound like a bummer, but it turns out that the “trippy” visuals and changes in how you see the world and yourself while you’re on shrooms can be intentionally used for boosting mood, becoming more insightful and mindful, avoiding negative emotions less, and feeling less existential dread.(1,3,4) In other words, if you work with someone who’s trained to make connections with you, you can intentionally open your mind with them and make those connections. And we already have good evidence it works with a lot of conditions with significant overlap with PTSD.(3) There’s a good amount of evidence behind its efficacy in treating treatment-resistant depression and OCD, eating disorders, alcoholism, and quitting smoking (or vaping, while you feel all that existential dread).(2,3,4,5)
In other words, Sally could help you turn a trip into OP therapy.
In this blog series on psilocybin, we’ll be discussing its short-term and long-term therapeutic benefits, as well as that elusive “ego death” some people talk about on tumblr posts that low-key terrified and intrigued you once upon a life. Until then, think of it like a tool for lowering your defenses enough to let connection and introspection in, and imagine how your life might be different with an integrative therapist who could guide you on a journey to get there. (2,5,6) Psilocybin can bring in more warmth, openness, and curiosity regarding your oldest wounds, and knowledge about your treatment options in the not-so-far-off future is power. (2,5)
Are you interested in taking a step deeper into trauma healing with hallucinogenic treatment? While psilocybin-assisted psychotherapy isn’t legal yet, Ketamine, a dissociative hallucinogen, is available and can help. Check out how Woven does Ketamine-Assisted Therapy here. You can also reach out to Ocean for a free consultation at ocean@gideonpsych.com or (310)361-5538, or book a therapist matchmaking session with our therapist matchmaker below.
Interested in learning more about our unique approach to trauma therapy?
These blogs talk more about the basics of EMDR:
You can read more about Ketamine Assisted Psychotherapy here:
References:
1. Averill, L. A., & Abdallah, C. G. (2022). Investigational drugs for assisting psychotherapy for posttraumatic stress disorder (PTSD): emerging approaches and shifting paradigms in the era of psychedelic medicine. Expert Opinion on Investigational Drugs, 31(2), 133–137. https://doi.org/10.1080/13543784.2022.2035358
2. Smith, F., Neill, J., & Wainwright, V. (2022). An Interpretative Phenomenological Analysis of the use of psilocybin by veterans with symptoms of trauma. Drug Science, Policy and Law, 8, 205032452211241. https://doi.org/10.1177/20503245221124117
3. Biscoe, N., Bonson, A., Slavin, M., Dr Walter Busuttil, MacManus, D., Cox, A., & Murphy, P. (2023). Psilocybin-assisted psychotherapy for the treatment of PTSD in UK Armed Forces Veterans: A feasibility study protocol. European Journal of Trauma & Dissociation, 100359–100359. https://doi.org/10.1016/j.ejtd.2023.100359
4. Smith, W. R., & Sisti, D. (2020). Ethics and ego dissolution: the case of psilocybin. Journal of Medical Ethics, medethics-2020-106070. https://doi.org/10.1136/medethics-2020-106070
5. Turkia, M. (2022, April 25). Underground small-group therapy of treatment-resistant depression and complex post-traumatic stress disorder (C-PTSD) with psilocybin—A retrospective case study. ResearchGate. https://doi.org/10.13140/RG.2.2.24250.06089
6. Miller, C. (2023). Effects of Psilocybin on Context-Based Fear Learning, Extinction, and Reinstatement. Honors Capstone Enhancement Presentations.https://digitalcommons.onu.edu/honors_presentations/25/
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