By Brian Lissak
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According to the National Center for PTSD, 7 to 8 out of every 100 people will suffer from PTSD at some point in their lives. That’s 7-8% of the population. Tragically, 22 servicemen and women commit suicide every day, and they represent only about 10% of the population suffering from PTSD. The vast majority of PTSD cases are not caused by war-related experiences. Rather, they are caused by interpersonal trauma or violence (unexpected death of a loved one, childhood abuse, etc.), or by sexual and physical assault. Psychedelic-assisted psychotherapy seems to offer even more help, and hope, to those who suffer from PTSD.
What is Post-Traumatic Stress Disorder (PTSD)?
Approximately 55% of all humans will experience at least one trauma in their lives. Experiencing a trauma, however, does not necessarily mean you will suffer from Post-Traumatic Stress Disorder. When one experiences trauma, our “fight-or-flight” stress response kicks in. This stress response elevates our heart-rate and increases stress hormone production and oxygen intake, all in preparation for dealing with the perceived threat. This survival mechanism is found in all animals. Generally, once the threat is no longer present, the stress response subsides over the next few hours and days. At that point, body systems return to normal levels.
PTSD occurs when this stress response continues long after the traumatic event has ended. From a physiological perspective, the person is still experiencing the traumatic event. When this is the case, hyperarousal causing heightened levels of stress hormones repeatedly activates the fight-or-flight response. This stress response reduces brain activity in areas related to emotional processing, memory, rational thinking, and more. PTSD symptoms often include depression, anxiety, nervousness, and distrust. Essentially, one suffering from PTSD is living in survival mode.
Psychedelic-Assisted Psychotherapy for PTSD
Current treatment methods for PTSD include talk therapy and medications. Therapy involves revisiting the traumatic experience. This is extremely challenging and sensitive work, and in some cases can retraumatize the patient. Psychedelics seem to offer a safer way of approaching these difficult and potentially dangerous memories. Psychiatrist Dr. Julie Holland said this about psychedelic-assisted psychotherapy: “…good psychotherapy takes years…there’s a lot of fits and starts. And people run away when things get too heavy. So to have something akin to anesthesia during surgery that allows people to be more open and vulnerable and also feeling strong enough and calm enough that they can really explore their traumas, that’s incredibly helpful for the field of psychiatry.”
To date, most research has focused on MDMA. Clinical trials have shown that MDMA can reduce fear and defensiveness, enhance communication and introspection, and increase empathy and compassion. This allows for a safer, more conducive therapeutic experience allowing one to access memories and emotions that otherwise would be overwhelming or simply unavailable. Generally, MDMA-assisted psychotherapy includes non-drug preparatory and integratory sessions and 2-3 sessions with MDMA over a roughly 12 week period.
One veteran, who was cured of his treatment-resistant PTSD, had this to say about his experience with MDMA-assisted psychotherapy: “It seems that part of the magic of MDMA is that it allows traumatic memories to be brought into the open and looked at and discussed in a neutral and nonthreatening manner. Then, when you restore the memories to the crevices in the brain, they no longer bother you as much….This treatment saved my life.”
Clinical trials completed by MAPS have shown unprecedented results for treating PTSD with MDMA. All participants had chronic, treatment-resistant PTSD and had suffered on average for 17.8 years. Amazingly, two months after the trials, 61% of participants no longer had PTSD. 12 months later, 68% were PTSD-free.
FDA Approval for MDMA-Assisted Psychotherapy
On August 16, 2017, the FDA granted Breakthrough Therapy Designation to MDMA for the treatment of PTSD. This is a designation for treatments that demonstrate a potential for substantial improvements over current treatment methods.
Currently, MAPS is conducting Phase 3 clinical trials for MDMA-assisted psychotherapy. This is the final phase of research the FDA requires before deciding whether to approve MDMA as a legal prescription treatment for PTSD. If approved, MDMA administration will be restricted to trained and certified therapists in a clinical setting. Procedures will be outpatient but requiring a brief residential stay.
Although there have been no major trials thus far using psilocybin specifically to treat PTSD, there have been breakthrough studies with end-of-life anxiety and depression. Both of these conditions are strongly related to PTSD, and there is a strong rationale for using psilocybin-assisted psychotherapy to treat it.
Though mechanistically different from MDMA, psilocybin is similar in that it generates more emotional connectivity in the brain and reduces fear and stress responses. Healing from PTSD requires gaining access to traumatic memories, being able to face them without becoming overwhelmed, and reintegrating them into your life. Based on psilocybin’s effects on end-of-life anxiety and depression, it seems that psilocybin-assisted psychotherapy can be highly effective with PTSD.
In 2019, the FDA granted psilocybin Breakthrough Therapy Designation for the treatment of severe depression. As the research continues, there may be rays of hope for those suffering from PTSD.