The future of psychedelic-assisted psychotherapy

Preparing for this talk
has been scarier for me

than preparing for LSD therapy.

(Laughter)

"Psychedelics are to the study of the mind

what the microscope is to biology

and the telescope is to astronomy."

Dr Stanislav Grof spoke those words.

He's one of the leading
psychedelic researchers in the world,

and he's also been my mentor.

Today, I'd like to share with you
how psychedelics, when used wisely,

have the potential to help heal us,

help inspire us,

and perhaps even to help save us.

In the 1950s and 60s,

psychedelic research flourished
all over the world,

and showed great promise
for the fields of psychiatry,

psychology and psychotherapy,

neuroscience, and the study
of mystical experiences.

But psychedelics leaked out
of the research settings

and began to be used
by the counterculture,

and by the anti-Vietnam war movement.

And there was unwise use.

And so there was a backlash.

In the 1970, the US government
criminalized all uses of psychedelics

and they began shutting down
all psychedelic research.

And this ban spread all over the world

and lasted for decades and it was tragic,

since psychedelics are really just tools,

and whether their outcomes
are beneficial or harmful,

depend on how they're used.

Psychedelic means mind-manifesting.

And it relates to drugs
like LSD, psilocybin, mescaline

iboga, and other drugs.

When I was 18 years old,

I was a college freshman,

I was experimenting
with LSD and mescaline,

and these experiences
brought me in touch with my emotions.

And they helped me have
a spiritual connection

that unfortunately,
my bar mitzvah did not produce.

(Laughter)

When I wanted to tease my parents,

I would tell them
that they drove me to psychedelics,

because my bar-mitzvah had failed
to turn me into a man.

(Laughter)

But most importantly,

psychedelics gave me this feeling
of our shared humanity,

of our unity with all life.

And other people reported
that same thing as well.

And I felt that these experiences
had the potential

to help be an antidote

to tribalism, to fundamentalism,
to genocide and environmental destruction.

And so I decided to focus my life

on changing the laws

and becoming a legal
psychedelic psychotherapist.

(Applause)

Now, half a century after the ban,

we're in the midst of a global renaissance
of psychedelic research.

Psychedelic psychotherapy
is showing great promise

for the treatment of post-traumatic
stress disorder, or PTSD,

depression, social anxiety,
substance abuse and alcoholism

and suicide.

Psychedelic psychotherapy is an attempt
to go after the root causes

of the problems,

with just relatively few administrations,

as contrasted to most
of the psychiatric drugs used today,

that are mostly just reducing symptoms

and are meant to be taken
on a daily basis.

Psychedelics are now also being used
as tools for neuroscience

to study brain function

and to study the enduring mystery
of human consciousness.

And psychedelics, and the mystical
experiences they produce,

are being explored for their connections
between meditation and mindfulness,

including a paper just recently published

about life-long zen meditators
taking psilocybin

in the midst of a meditation retreat

and showing long-term benefits
and brain changes.

Now, how do these drugs work?

Modern neuroscience research

has demonstrated that
psychedelics reduce activity

in what's known as the brain's
default mode network.

This is where we create our sense of self.

It's our equivalent to the ego,

and it filters all incoming information

according to our personal
needs and priorities.

When activity is reduced
in the default mode network,

our ego shifts from the foreground
to the background,

and we see that it's just
part of a larger field of awareness.

It's similar to the shift

that Copernicus and Galileo
were able to produce in humanity,

using the telescope to show

that the Earth was no longer
the center of the universe,

but was actually something
that revolved around the Sun,

something bigger than itself.

For some people, this shift in awareness

is the most important,

and among the most important
experiences of their lives.

They feel more connected
to the world bigger than themselves.

They feel more altruistic,

and they loose some
of their fear of death.

Not all drugs work this way.

MDMA, also known as ecstasy, or Molly,

works fundamentally different.

And I'll be able to share with you
the story of Marcela,

who suffered from
post-traumatic stress disorder

from a violent sexual assault.

Marcela and I were introduced in 1984,

when MDMA was still legal,

but it was beginning also
to leak out of therapeutic circles.

Marcela had tried MDMA
in a recreational setting,

and during that, her passed trauma
flooded her awareness

and it intensified her suicidal feelings.

During our first conversation,

I shared that when MDMA
is taken therapeutically,

it can reduce the fear
of difficult emotions

and she could help move forward
past her trauma.

I asked her to promise
not to commit suicide

if we were to work together.

And she agreed and made that promise.

During her therapeutic sessions,

Marcela was able to process
her trauma more fluidly, more easily.

And yet, she was able to tell

that the rapist had told her
that if she ever shared her story,

he would kill her.

And she realized that that was
keeping her a prisoner in her own mind.

And so being able to share the story,

and experience the feelings
and the thoughts in her mind,

freed her,

and she was able to decide

that she wanted
to move forward with her life.

And in that moment,

I realized that MDMA could be very
effective for treating PTSD.

Now, 35 years later,
after Marcela's treatment,

she's actually a therapist,

training other therapists to help people
overcome PTSD with MDMA.

Now, how does MDMA work,

how did MDMA help Marcela?

People who have PTSD

have brains that are different
from those of us who don't have PTSD.

They have a hyperactive amygdala,
where we process fear.

They have reduced activity
in the prefrontal cortex,

where we think logically,

and they have reduced activity
in the hypocampus,

where we store memories
into long-term storage.

MDMA changes the brain
in the opposite way.

MDMA reduces activity in the amygdala,

increases activity in the frontal cortex

and increases connectivity
between the amygdala and the hypocampus

to [unclear] traumatic memories
to move into long-term storage.

Recently, researchers at Johns Hopkins
published a paper in "Nature"

in which they demonstrated
that MDMA releases oxytocin,

the hormone of love and nurturing.

The same researchers
also did studies in octopuses,

who are normally asocial,
unless it's mating season.

Bu lo and behold, you give them MDMA

and they become pro social.

(Laughter)

Several months after
Marcela and I worked together,

the Drug Enforcement Administration

moved to criminalize ecstasy,

having no knowledge
of its therapeutic use.

So, I went to Washington,

and I went into the headquarters
of the Drug Enforcement Administration

and I filed the law suit
demanding a hearing,

at which psychiatrists
and psychotherapists

would be able to present information
about therapeutic use of MDMA

to try to keep it legal.

And in the middle of the hearing,
the DEA freaked out,

declared an emergency,

and criminalized all uses of MDMA.

And so the only way
that I could see to bring it back,

was through science, through medicine,

and through the FDA
drug development process.

So in 1986, I started MAPS

as a nonprofit psychedelic
pharmaceutical company.

It took us 30 years, til 2016,

to develop the data that we needed
to present to FDA

to request permission to move
into the large-scale phase-three studies

that are required to prove
safety and efficacy,

before you get approval
for prescription use.

Tony was a veteran
in one of our pilot studies.

According to the Veterans Administration,

there's over a million veterans now
disabled with PTSD.

And at least 20 veterans a day
are committing suicide,

many of them from PTSD.

The treatment that Tony was to receive,

was three and a half months long.

But during that period of time,

he would only get MDMA on three occasions.

Separated by 12 90-minute
non-drug psychotherapy sessions,

three before the first
MDMA session for preparation,

and three after each
MDMA session, for integration.

We call our treatment approach
interdirected therapy.

And that we support the patient
to experience whatever's emerging

within their minds or their bodies.

Even with MDMA this is hard work.

And a lot of our subject have said,

"I don't know why they call this ecstasy."

(Laughter)

During Tony's first MDMA session,

he lay on a couch, he had eye shades on,

he listened to music,

and he would speak to the therapists

who are a male-female co-therapy team,

whenever he felt that he needed to.

After several hours,

in a moment of calmness and clarity,

Tony shared that he had realized

that his PTSD was a way of connecting him

to his friends.

It was a way of honoring the memory
of his friends who had died.

But he was able to shift and see himself
through the eyes of his dead friends.

And he realized that they
would not want him to suffer,

to squander his life,

they would want him to live more fully,

which they were unable to do.

And so he realized that there was
a new way to honor their memory,

which was to live as fully as possible.

He also realized that
he was telling himself a story

that he was taking opiates for pain,

but actually, he realized,
he was taking them for escape.

And so he decided he didn't need
the opiates anymore,

he didn't need the MDMA anymore,

and he was dropping out of the study.

That was seven years ago.

Tony is still free of PTSD,

has never returned to opiates,

and is helping others less fortunate
than himself, in Cambodia.

(Applause)

The data that we presented to FDA,

from 107 people in our
pilot studies, including Tony,

showed that 23 percent of the people
that received therapy without active MDMA

no longer had PTSD
at the end of treatment.

This is really pretty good
for this patient population.

However, when you add MDMA,

the results more than double,
to 56 percent no longer having PTSD.

(Applause)

But most importantly,

once people learn that if they
don't need to suppress their trauma,

but they can process it,

they keep getting better on their own.

So at the 12-month follow-up,
one year after the last treatment session,

two thirds no longer have PTSD.

And of the one third that do,

many have clinically significant
reductions in symptoms.

(Applause)

On the basis of this data,

the FDA has declared MDMA-assisted
psychotherapy for PTSD

a breakthrough therapy.

FDA has also declared psilocybin
a breakthrough therapy

for treatment-resistant depression,

and just recently approved
esketamine for depression.

I'm proud to say

that we have now initiated
our phase-three studies.

And if the results are as we hope,

and if they're similar
to the phase-two studies,

by the end of 2021, FDA will approve
MDMA-assisted psychotherapy for PTSD.

If approved, the only therapists

who would be able
to directly administer it to patients,

are going to be therapists that
have been through our training program,

and they will only be able
to administer MDMA

under direct supervision
in clinic settings.

We anticipate that over
the next several decades

there will be thousands
of psychedelic clinics established,

at which therapists
will be able to administer MDMA,

psilocybin, ketamine,
and other psychedelics,

to potentially millions of patients.

These clinics can also evolve
into centers where people can come

for psychedelic psychotherapy
for personal growth,

for couples therapy,

or for spiritual mystical experiences.

Humanity now is in a race

between catastrophe and consciousness.

The psychedelic renaissance is here
to help consciousness triumph.

And now, if you all just
look under your seats ...

Just joking.

(Laughter)

Thank you.

(Applause)

(Laughter)

(Applause)

Thank you.

(Applause)

Corey Hajim: Stay up there for a minute.

Thank you so much, Rick.

I guess it's a supportive audience.

Rick Doblin: Yes, very.

Many of them have also
been to Burning Man.

(Laughter)

CH: There's some synergy.

So, in your talk, you talked
about using these drugs

to address some pretty serious traumas.

So what about some more common
mental illnesses,

like anxiety and depression

and is that where micro dosing comes in?

RD: Well, micro dosing
can be helpful for depression,

I do know someone that has been using it,

but in general, for therapeutic purposes,

we prefer macro dosing,
rather than micro dosing,

in order to really help people
deal with the root causes.

Micro dosing is more for creativity,

for artistic inspiration, for focus.

And it also does have
a mood elevation lift,

but I think for serious illnesses,

we'd rather not get people thinking
that they need a daily drug,

but do more deeper, intense work.

CH: And what about outside
the United States and North America,

is this research being done there?

RD: Oh yeah, we're globalizing.

Our phase-three studies
are actually being done

in Israel, Canada and the United States.

So once we get approval in FDA,

it will also become approved
in Israel and in Canada.

We're just starting research in Europe.

And we're actually going to be training
some therapists from China.

CH: It's great.

We were going to do an audience vote

to see if people felt
like this was a good idea

to move forward with this research or not,

but I have a feeling
I know the answer to that.

So, thank you so much, Rick.

RD: Thank you.

(Applause)