The future of psychedelic-assisted psychotherapy
-
0:02 - 0:05Preparing for this talk
has been scarier for me -
0:05 - 0:07than preparing for LSD therapy.
-
0:07 - 0:09(Laughter)
-
0:09 - 0:12"Psychedelics are to the study of the mind
-
0:12 - 0:15what the microscope is to biology
-
0:15 - 0:18and the telescope is to astronomy."
-
0:18 - 0:21Dr. Stanislav Grof spoke those words.
-
0:21 - 0:24He's one of the leading
psychedelic researchers in the world, -
0:24 - 0:26and he's also been my mentor.
-
0:27 - 0:32Today, I'd like to share with you
how psychedelics, when used wisely, -
0:32 - 0:35have the potential to help heal us,
-
0:35 - 0:37help inspire us,
-
0:37 - 0:39and perhaps even to help save us.
-
0:39 - 0:41In the 1950s and 60s,
-
0:41 - 0:44psychedelic research flourished
all over the world -
0:44 - 0:48and showed great promise
for the fields of psychiatry, -
0:48 - 0:50psychology and psychotherapy,
-
0:50 - 0:54neuroscience and the study
of mystical experiences. -
0:54 - 0:57But psychedelics leaked out
of the research settings -
0:57 - 0:59and began to be used
by the counterculture, -
0:59 - 1:02and by the anti-Vietnam War movement.
-
1:02 - 1:04And there was unwise use.
-
1:05 - 1:06And so there was a backlash.
-
1:06 - 1:12And in 1970, the US government
criminalized all uses of psychedelics, -
1:12 - 1:15and they began shutting down
all psychedelic research. -
1:15 - 1:19And this ban spread all over the world
and lasted for decades. -
1:19 - 1:20and it was tragic,
-
1:20 - 1:23since psychedelics are really just tools,
-
1:23 - 1:26and whether their outcomes
are beneficial or harmful -
1:26 - 1:28depends on how they're used.
-
1:29 - 1:33Psychedelic means "mind-manifesting,"
-
1:35 - 1:41and it relates to drugs
like LSD, psilocybin, mescaline, -
1:43 - 1:45iboga and other drugs.
-
1:46 - 1:48When I was 18 years old,
-
1:48 - 1:51I was a college freshman,
-
1:51 - 1:54I was experimenting
with LSD and mescaline, -
1:54 - 1:58and these experiences
brought me in touch with my emotions. -
1:58 - 2:00And they helped me have
a spiritual connection -
2:00 - 2:04that unfortunately,
my bar mitzvah did not produce. -
2:04 - 2:06(Laughter)
-
2:07 - 2:09When I wanted to tease my parents,
-
2:09 - 2:11I would tell them
that they drove me to psychedelics -
2:11 - 2:15because my bar mitzvah had failed
to turn me into a man. -
2:15 - 2:17(Laughter)
-
2:18 - 2:19But most importantly,
-
2:19 - 2:22psychedelics gave me this feeling
of our shared humanity, -
2:22 - 2:25of our unity with all life.
-
2:25 - 2:28And other people reported
that same thing as well. -
2:28 - 2:32And I felt that these experiences
had the potential -
2:32 - 2:34to help be an antidote
-
2:34 - 2:39to tribalism, to fundamentalism,
to genocide and environmental destruction. -
2:39 - 2:42And so I decided to focus my life
-
2:42 - 2:44on changing the laws
-
2:44 - 2:48and becoming a legal
psychedelic psychotherapist. -
2:49 - 2:52(Applause)
-
2:52 - 2:55Now, half a century after the ban,
-
2:55 - 2:59we're in the midst of a global renaissance
of psychedelic research. -
2:59 - 3:02Psychedelic psychotherapy
is showing great promise -
3:02 - 3:07for the treatment of post-traumatic
stress disorder, or PTSD, -
3:07 - 3:11depression, social anxiety,
substance abuse and alcoholism -
3:12 - 3:13and suicide.
-
3:13 - 3:17Psychedelic psychotherapy is an attempt
to go after the root causes -
3:17 - 3:18of the problems,
-
3:19 - 3:21with just relatively few administrations,
-
3:21 - 3:26as contrasted to most
of the psychiatric drugs used today -
3:26 - 3:29that are mostly just reducing symptoms
-
3:29 - 3:32and are meant to be taken
on a daily basis. -
3:34 - 3:37Psychedelics are now also being used
as tools for neuroscience -
3:37 - 3:39to study brain function
-
3:39 - 3:43and to study the enduring mystery
of human consciousness. -
3:43 - 3:47And psychedelics and the mystical
experiences they produce -
3:47 - 3:50are being explored for their connections
between meditation and mindfulness, -
3:50 - 3:53including a paper just recently published
-
3:53 - 3:57about lifelong zen meditators
taking psilocybin -
3:57 - 3:59in the midst of a meditation retreat
-
3:59 - 4:02and showing long-term benefits
and brain changes. -
4:03 - 4:05Now, how do these drugs work?
-
4:06 - 4:08Modern neuroscience research
has demonstrated -
4:08 - 4:10that psychedelics reduce activity
-
4:10 - 4:13in what's known as the brain's
default mode network. -
4:13 - 4:15This is where we create our sense of self.
-
4:16 - 4:18It's our equivalent to the ego,
-
4:18 - 4:21and it filters all incoming information
-
4:21 - 4:24according to our personal
needs and priorities. -
4:24 - 4:28When activity is reduced
in the default mode network, -
4:28 - 4:32our ego shifts from the foreground
to the background, -
4:32 - 4:38and we see that it's just part
of a larger field of awareness. -
4:38 - 4:39It's similar to the shift
-
4:39 - 4:43that Copernicus and Galileo were
able to produce in humanity -
4:43 - 4:44using the telescope
-
4:44 - 4:48to show that the earth was no
longer the center of the universe, -
4:48 - 4:52but was actually something
that revolved around the sun, -
4:52 - 4:54something bigger than itself.
-
4:54 - 4:57For some people, this shift in awareness
-
4:57 - 4:59is the most important
-
4:59 - 5:03and among the most important
experiences of their lives. -
5:03 - 5:07They feel more connected
to the world bigger than themselves. -
5:07 - 5:09They feel more altruistic,
-
5:09 - 5:12and they lose some of their fear of death.
-
5:12 - 5:14Not all drugs work this way.
-
5:14 - 5:18MDMA, also known as Ecstasy, or Molly,
-
5:18 - 5:20works fundamentally different.
-
5:20 - 5:22And I'll be able to share with you
the story of Marcela, -
5:22 - 5:26who suffered from
post-traumatic stress disorder -
5:26 - 5:28from a violent sexual assault.
-
5:29 - 5:32Marcela and I were introduced in 1984,
-
5:32 - 5:35when MDMA was still legal,
-
5:35 - 5:39but it was beginning also
to leak out of therapeutic circles. -
5:39 - 5:43Marcela had tried MDMA
in a recreational setting, -
5:43 - 5:46and during that, her past trauma
flooded her awareness -
5:46 - 5:50and it intensified her suicidal feelings.
-
5:51 - 5:53During our first conversation,
-
5:53 - 5:57I shared that when MDMA
is taken therapeutically, -
5:57 - 6:00it can reduce the fear
of difficult emotions, -
6:00 - 6:04and she could help move forward
past her trauma. -
6:04 - 6:07I asked her to promise
not to commit suicide -
6:08 - 6:10if we were to work together.
-
6:10 - 6:13She agreed and made that promise.
-
6:13 - 6:15During her therapeutic sessions,
-
6:15 - 6:21Marcela was able to process
her trauma more fluidly, more easily. -
6:21 - 6:24And yet, she was able to tell
-
6:24 - 6:28that the rapist had told her
that if she ever shared her story, -
6:28 - 6:29he would kill her.
-
6:30 - 6:34And she realized that that was
keeping her a prisoner in her own mind. -
6:34 - 6:36So being able to share the story
-
6:36 - 6:41and experience the feelings
and the thoughts in her mind -
6:41 - 6:42freed her,
-
6:42 - 6:44and she was able to decide
-
6:44 - 6:46that she wanted
to move forward with her life. -
6:46 - 6:47And in that moment,
-
6:47 - 6:52I realized that MDMA could be very
effective for treating PTSD. -
6:53 - 6:56Now, 35 years later,
after Marcela's treatment, -
6:56 - 6:59she's actually a therapist,
-
6:59 - 7:04training other therapists to help people
overcome PTSD with MDMA. -
7:06 - 7:08Now, how does MDMA work?
-
7:08 - 7:10How did MDMA help Marcela?
-
7:10 - 7:14People who have PTSD
have brains that are different -
7:14 - 7:16from those of us who don't have PTSD.
-
7:16 - 7:20They have a hyperactive amygdala,
where we process fear. -
7:20 - 7:24They have reduced activity
in the prefrontal cortex, -
7:24 - 7:25where we think logically.
-
7:25 - 7:28And they have reduced activity
in the hippocampus, -
7:28 - 7:32where we store memories
into long-term storage. -
7:32 - 7:36MDMA changes the brain
in the opposite way. -
7:36 - 7:38MDMA reduces activity in the amygdala,
-
7:38 - 7:42increases activity
in the prefrontal cortex -
7:42 - 7:45and increases connectivity
between the amygdala and the hippocampus -
7:45 - 7:49to remit traumatic memories
to move into long-term storage. -
7:50 - 7:54Recently, researchers at Johns Hopkins
published a paper in "Nature," -
7:54 - 7:57in which they demonstrated
that MDMA releases oxytocin, -
7:57 - 8:00the hormone of love and nurturing.
-
8:01 - 8:04The same researchers
also did studies in octopuses, -
8:04 - 8:08who are normally asocial,
unless it's mating season. -
8:08 - 8:11But lo and behold, you give them MDMA,
-
8:11 - 8:13and they become prosocial.
-
8:13 - 8:14(Laughter)
-
8:15 - 8:18Several months after
Marcela and I worked together, -
8:18 - 8:23the Drug Enforcement Administration
moved to criminalize Ecstasy, -
8:23 - 8:25having no knowledge
of its therapeutic use. -
8:25 - 8:27So I went to Washington,
-
8:27 - 8:31and I went into the headquarters
of the Drug Enforcement Administration, -
8:31 - 8:33and I filed a lawsuit demanding a hearing,
-
8:33 - 8:36at which psychiatrists
and psychotherapists -
8:36 - 8:40would be able to present information
about therapeutic use of MDMA -
8:40 - 8:42to try to keep it legal.
-
8:42 - 8:45And in the middle of the hearing,
the DEA freaked out, -
8:45 - 8:48declared an emergency
-
8:48 - 8:50and criminalized all uses of MDMA.
-
8:50 - 8:53And so the only way
that I could see to bring it back -
8:53 - 8:56was through science, through medicine
-
8:56 - 8:58and through the FDA
drug development process. -
8:58 - 9:01So in 1986, I started MAPS
-
9:01 - 9:05as a nonprofit psychedelic
pharmaceutical company. -
9:06 - 9:09It took us 30 years, till 2016,
-
9:09 - 9:12to develop the data that we needed
to present to FDA -
9:12 - 9:16to request permission to move
into the large-scale Phase 3 studies -
9:16 - 9:19that are required to prove
safety and efficacy -
9:19 - 9:22before you get approval
for prescription use. -
9:23 - 9:26Tony was a veteran
in one of our pilot studies. -
9:27 - 9:29According to the Veterans Administration,
-
9:29 - 9:32there's over a million veterans now
disabled with PTSD. -
9:33 - 9:36And at least 20 veterans a day
are committing suicide, -
9:36 - 9:39many of them from PTSD.
-
9:40 - 9:44The treatment that Tony was to receive
was three and a half months long. -
9:44 - 9:46But during that period of time,
-
9:46 - 9:49he would only get MDMA on three occasions,
-
9:49 - 9:53separated by 12, 90-minute
non-drug psychotherapy sessions, -
9:53 - 9:56three before the first
MDMA session for preparation -
9:56 - 10:00and three after each
MDMA session for integration. -
10:00 - 10:04We call our treatment approach
"inner-directed therapy," -
10:04 - 10:08in that we support the patient
to experience whatever's emerging -
10:08 - 10:10within their minds or their bodies.
-
10:11 - 10:14Even with MDMA, this is hard work.
-
10:14 - 10:16And a lot of our subjects have said,
-
10:16 - 10:18"I don't know why they call this Ecstasy."
-
10:18 - 10:20(Laughter)
-
10:20 - 10:23During Tony's first MDMA session,
-
10:23 - 10:26he lay on the couch, he had eyeshades on,
-
10:26 - 10:28he listened to music,
-
10:28 - 10:30and he would speak to the therapists,
-
10:30 - 10:31who were a male-female co-therapy team,
-
10:31 - 10:34whenever he felt that he needed to.
-
10:34 - 10:35After several hours,
-
10:35 - 10:38in a moment of calmness and clarity,
-
10:38 - 10:42Tony shared that he had realized
-
10:42 - 10:48his PTSD was a way
of connecting him to his friends. -
10:48 - 10:52It was a way of honoring the memory
of his friends who had died. -
10:52 - 10:57But he was able to shift and see himself
through the eyes of his dead friends. -
10:57 - 10:59And he realized that they
would not want him to suffer, -
10:59 - 11:01to squander his life.
-
11:01 - 11:03They would want him to live more fully,
-
11:03 - 11:04which they were unable to do.
-
11:04 - 11:08And so he realized that there was
a new way to honor their memory, -
11:08 - 11:11which was to live as fully as possible.
-
11:12 - 11:15He also realized that
he was telling himself a story -
11:15 - 11:17that he was taking opiates for pain.
-
11:17 - 11:20But actually, he realized,
he was taking them for escape. -
11:21 - 11:24So he decided he didn't need
the opiates anymore, -
11:24 - 11:25he didn't need the MDMA anymore,
-
11:25 - 11:27and he was dropping out of the study.
-
11:28 - 11:29That was seven years ago.
-
11:29 - 11:32Tony is still free of PTSD,
-
11:32 - 11:34has never returned to opiates
-
11:34 - 11:38and is helping others less fortunate
than himself in Cambodia. -
11:39 - 11:44(Applause)
-
11:44 - 11:46The data that we presented to FDA
-
11:46 - 11:49from 107 people in our pilot
studies, including Tony, -
11:49 - 11:55showed that 23 percent of the people
that received therapy without active MDMA -
11:55 - 11:58no longer had PTSD
at the end of treatment. -
11:58 - 12:01This is really pretty good
for this patient population. -
12:01 - 12:04However, when you add MDMA,
-
12:04 - 12:08the results more than double,
to 56 percent no longer having PTSD. -
12:09 - 12:13(Applause)
-
12:13 - 12:14But most importantly,
-
12:14 - 12:17once people learn that if they don't need
to suppress their trauma, -
12:17 - 12:19but they can process it,
-
12:19 - 12:21they keep getting better on their own.
-
12:21 - 12:25So at the 12-month follow-up
one year after the last treatment session, -
12:25 - 12:28two-thirds no longer have PTSD.
-
12:28 - 12:30And of the one-third that do,
-
12:30 - 12:33many have clinically significant
reductions in symptoms. -
12:33 - 12:37(Applause)
-
12:38 - 12:39On the basis of this data,
-
12:39 - 12:44the FDA has declared MDMA-assisted
psychotherapy for PTSD -
12:44 - 12:45a breakthrough therapy.
-
12:46 - 12:49FDA has also declared psilocybin
a breakthrough therapy -
12:49 - 12:51for treatment-resistant depression
-
12:51 - 12:55and just recently approved
esketamine for depression. -
12:57 - 13:02I'm proud to say that we have now
initiated our Phase 3 studies. -
13:03 - 13:05And if the results are as we hope,
-
13:05 - 13:08and if they're similar
to the Phase 2 studies, -
13:08 - 13:13by the end of 2021, FDA will approve
MDMA-assisted psychotherapy for PTSD. -
13:14 - 13:15If approved,
-
13:15 - 13:19the only therapists who will be able
to directly administer it to patients -
13:19 - 13:23are going to be therapists that
have been through our training program, -
13:23 - 13:25and they will only be able
to administer MDMA -
13:25 - 13:28under direct supervision
in clinic settings. -
13:29 - 13:33We anticipate that over
the next several decades, -
13:33 - 13:36there will be thousands
of psychedelic clinics established, -
13:36 - 13:40at which, therapists will be able
to administer MDMA, -
13:40 - 13:43psilocybin, ketamine
and other psychedelics -
13:43 - 13:46to potentially millions of patients.
-
13:47 - 13:51These clinics can also evolve
into centers where people can come -
13:51 - 13:54for psychedelic psychotherapy
for personal growth, -
13:54 - 13:56for couples therapy
-
13:56 - 14:00or for spiritual, mystical experiences.
-
14:01 - 14:08Humanity now is in a race
between catastrophe and consciousness. -
14:08 - 14:14The psychedelic renaissance is here
to help consciousness triumph. -
14:14 - 14:18And now, if you all just
look under your seats ... -
14:18 - 14:19Just joking!
-
14:19 - 14:21(Laughter)
-
14:21 - 14:22Thank you.
-
14:22 - 14:24(Applause)
-
14:24 - 14:25(Laughter)
-
14:25 - 14:30(Applause)
-
14:30 - 14:31Thank you.
-
14:31 - 14:35(Applause)
-
14:36 - 14:39Corey Hajim: You've got to stay
up here for a minute. -
14:39 - 14:40Thank you so much, Rick.
-
14:40 - 14:42I guess it's a supportive audience.
-
14:42 - 14:44Rick Doblin: Yes, very.
-
14:46 - 14:48Many of them have also
been to Burning Man. -
14:48 - 14:49(Laughter)
-
14:50 - 14:51CH: There's some synergy.
-
14:51 - 14:52RD: (Laughs)
-
14:52 - 14:57CH: So, in your talk, you talked
about using these drugs -
14:57 - 14:59to address some pretty serious traumas.
-
14:59 - 15:02So what about some more common
mental illnesses -
15:02 - 15:04like anxiety and depression,
-
15:04 - 15:06and is that where microdosing comes in?
-
15:06 - 15:09RD: Well, microdosing
can be helpful for depression, -
15:09 - 15:12I do know someone that has been using it.
-
15:12 - 15:15But in general, for therapeutic purposes,
-
15:15 - 15:18we prefer macro-dosing
rather than microdosing, -
15:18 - 15:21in order to really help people
deal with the root causes. -
15:21 - 15:23Microdosing is more for creativity,
-
15:23 - 15:25for artistic inspiration,
-
15:25 - 15:26for focus ...
-
15:27 - 15:30And it also does have
a mood-elevation lift. -
15:30 - 15:32But I think for serious illnesses,
-
15:32 - 15:35we'd rather not get people thinking
that they need a daily drug, -
15:35 - 15:37but do more deeper, intense work.
-
15:37 - 15:41CH: And what about outside
the United States and North America, -
15:41 - 15:43is this research being done there?
-
15:43 - 15:45RD: Oh yeah, we're globalizing.
-
15:46 - 15:48Our Phase 3 studies
are actually being done -
15:48 - 15:51in Israel, Canada and the United States.
-
15:51 - 15:52So once we get approval in FDA,
-
15:52 - 15:56it will also become approved
in Israel and in Canada. -
15:56 - 15:59We're just starting research in Europe.
-
15:59 - 16:03And we're actually going to be training
some therapists from China. -
16:04 - 16:05CH: That's great.
-
16:05 - 16:06We were going to do an audience vote
-
16:06 - 16:09to see if people felt
like this was a good idea -
16:09 - 16:11to move forward with this research or not,
-
16:11 - 16:14but I have a feeling I know
the answer to that, so ... -
16:14 - 16:15Thank you so much, Rick.
-
16:15 - 16:17RD: Thank you. Thank you all.
-
16:17 - 16:19(Applause)
- Title:
- The future of psychedelic-assisted psychotherapy
- Speaker:
- Rick Doblin
- Description:
-
Could psychedelics help us heal from trauma and mental illnesses? Researcher Rick Doblin has spent the past three decades investigating this question, and the results are promising. In this fascinating dive into the science of psychedelics, he explains how drugs like LSD, psilocybin and MDMA affect your brain -- and shows how, when paired with psychotherapy, they could change the way we treat PTSD, depression, substance abuse and more.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 16:32
Oliver Friedman edited English subtitles for The future of psychedelic-assisted psychotherapy | ||
Brian Greene approved English subtitles for The future of psychedelic-assisted psychotherapy | ||
Brian Greene edited English subtitles for The future of psychedelic-assisted psychotherapy | ||
Camille Martínez accepted English subtitles for The future of psychedelic-assisted psychotherapy | ||
Camille Martínez edited English subtitles for The future of psychedelic-assisted psychotherapy | ||
Camille Martínez edited English subtitles for The future of psychedelic-assisted psychotherapy | ||
Ivana Korom edited English subtitles for The future of psychedelic-assisted psychotherapy | ||
Ivana Korom edited English subtitles for The future of psychedelic-assisted psychotherapy |