Using psychedelics in behavioral health treatment, also known as psychedelic therapy, involves the use of compounds and plants that induce hallucinations. Though the formal study of psychedelics in behavioral health treatment is relatively new, emerging research suggests psychedelics could help alleviate symptoms, particularly after other treatment methods have failed. These substances are used to treat mental health issues, such as post-traumatic stress disorder (PTSD) and depression.
Including psychedelics in your behavioral health therapy may benefit both your patients and your practice. But before you decide whether to incorporate psychedelic therapy, you should understand its uses, how it works, the types of drugs used and the benefits and risks of this therapy.
Table of Contents
- How Psychedelic Therapy Works
- Types of Psychedelic Drugs Used
- Types of Psychedelic Therapy
- Uses of Psychedelic Therapy
How Psychedelic Therapy Works
Psychedelic plant compounds like psilocybin mushrooms and LSD induce hallucinations to treat mental health issues. Combining psychedelics with behavioral health therapy can increase the treatment's success. In many cases, psychedelic therapy is used with patients who have not responded well to other therapies.
While traditional medications can take weeks to start working or only work as long as the patient is taking them, psychedelic therapy can improve a patient's condition immediately, typically with just one dose. Though these drugs do not necessarily work the same way for every person, there are a few possible ways these drugs may function for behavioral health patients:
- Greater suggestibility: A patient may be more suggestible while using psychedelics and may be more responsive to your positive suggestions or to the benefits of their hallucinations.
- Psychedelic experience: Under the influence of a psychedelic, intensely meaningful experiences may shift a patient's belief system or mindset and lead them to change their behaviors or thinking.
- Changes in neurotransmitters: A neurotransmitter is a chemical messenger in the brain, and many drugs used for mental health directly act on neurotransmitters. Similarly, a psychedelic drug may act on a patient's neurotransmitters and improve their mood by changing their brain's behavior.
Along with the drugs themselves, whether this type of therapy leads to positive outcomes depends on various factors, such as psychological expectations, the physical environment and the therapeutic relationship between therapist and patient.
Types of Psychedelic Drugs Used
A few types of psychedelic drugs can be used in this type of treatment. However, most research has been conducted on psilocybin, MDMA, DMT, LSD and mescaline.
Psilocybin is a hallucinogenic chemical that can be found in psychedelic or magic mushrooms. These mushrooms grow in the United States, Europe, Mexico and South America. Similar to other hallucinogenic drugs, psilocybin can produce feelings of sensory distortion and euphoria. Researchers are continuing to study the positive effects and safety of psilocybin's use in treating various medical conditions.
This psychedelic drug activates serotonin receptors. Typically, this process occurs in the prefrontal cortex, which is the part of the brain that impacts perception, cognition and mood. Additional regions of the brain that regulate panic responses and arousal may also be influenced by hallucinogens. While psilocybin can cause auditory or visual hallucinations, it may only distort how a person perceives the objects and people in their environment. Psilocybin's potency depends on:
- The substance's origin
- The species of mushroom
- The harvest period
- The growing conditions
- Whether the patient consumes the mushroom dried or fresh, the former of which has a much higher potency than the latter
Psilocybin can be consumed in capsule form, as a powder or with food or tea. The effects of psilocybin will depend on the patient's expectations of the experience, their past experiences and how much of the drug they consume. For many users, the effects of this substance last hours. Some patients may even report changes in thought patterns and sensory perception for days. Along with euphoria and sensory distortion, the effects of psilocybin may include:
- Dilated pupils
- Muscle weakness
- Distorted thinking
- Spiritual awakening
- Unusual body sensations
- The feeling that your surroundings are not real, known as derealization
- Visual distortion and alteration, like seeing vivid colors or halos of light
- A dream-like feeling of being disengaged from your surroundings, known as depersonalization
Known for its role in ecstasy, MDMA is a synthetic drug that induces stimulant effects and causes hallucinations. The substance comes from the sassafras tree and increases the production of norepinephrine, dopamine and serotonin, all of which influence appetite, sleep and mood. Potential effects of MDMA include:
- Distortion of time
- Increased energy
- Emotional warmth
- Decreased appetite
- Sensitivity to touch
- Distortion of the senses
The effects of MDMA can last for hours. How a patient is affected by MDMA depends on the dosage. High doses can be dangerous, leading to damaged nerve cells in the brain.
Dimethyltryptamine (DMT) is a hallucinogenic chemical found in some plants in South America, Mexico and parts of Asia. DMT is similar to mushrooms and LSD, though the intense hallucinogenic experience tends to be briefer than with other substances. Possible effects of DMT include:
- Visual hallucinations
- Auditory hallucinations
- Shifts in perceived reality and identity
- Altered sense of time, body and space
How quickly and how long a patient experiences the effects of DMT depends on how the drug is consumed and how much is ingested. Typically, the drug is either smoked, vaporized, snorted, injected or consumed orally in a brew. When DMT is consumed in a brew, such as the South American tea ayahuasca, the patient will have to wait to experience the effects, but these could last for hours. When the substance is smoked, on the other hand, the effects can be felt almost immediately and last only a few minutes.
Lysergic acid diethylamide (LSD) is a hallucinogenic, semi-synthetic drug made from a combination of man-made and natural substances. LSD is derived from diethylamide, a non-organic chemical, and a fungus known as ergot. This hallucinogen activates serotonin receptors, stimulating the production of serotonin in the brain and allowing more stimuli to be processed. From this overstimulation, a user may experience changes in perception, emotion, attention and thought.
LSD is potent and can blur the lines between imagination and perception, with effects lasting for hours. Though sensations seem real, they are created by the brain and can involve multiple senses. Some users experience synesthesia, which is the blending of the senses. A patient who uses LSD may report “seeing” a sound or “hearing” a color. Other effects of LSD may include:
- Dry mouth
- Unusual insight
- Reduced appetite
- Terrifying thoughts
- Tremors or shaking
- Rapid mood swings
- Accelerated thoughts
- Heightened awareness
- Sense of transcendence
- Distorted perception of time
- Visual effects like distorted shapes, blurred vision, halos of light and vivid colors
Mescaline is a hallucinogen found in cacti like the peyote cactus, though it can also be produced synthetically. Similar to those who use LSD, DMT or psilocybin, a mescaline user may experience visual hallucinations. This drug can be consumed raw, dried or in a capsule. A patient can also smoke this hallucinogen. How long the effects of mescaline last depends on the dose. Along with visual hallucinations, users may experience:
- Pupil dilation
- Distortion of time
- A dream-like state
As with other psychedelic drugs, the use of mescaline may be beneficial when combined with behavioral health therapy.
Types of Psychedelic Therapy
Similar to the variety of psychedelic drugs that can be used, therapists can use different types of psychedelic therapy in their practices. Below are a few kinds of psychedelic therapy:
- Psychedelics only: This type of psychedelic therapy refers to using a psychedelic drug alone without any additional treatment.
- Drug-assisted therapy: This type of psychedelic therapy refers to using psychedelics alongside traditional treatments like psychotherapy.
- Guided behavioral therapy: This type of psychedelic therapy refers to guiding a patient through the psychedelic experience while helping them remain calm and offering therapeutic suggestions.
Uses of Psychedelic Therapy
There are many possible uses for psychedelic therapy, including addiction, terminal illness, eating disorders, anxiety, depression and post-traumatic stress disorder (PTSD).
1. Substance Abuse and Addiction
The use of psychedelic therapy may help ease substance abuse and addiction symptoms. Mental health symptoms like depression often commonly occur with addiction, and by reducing these symptoms, psychedelic therapy could make it easier for a patient to stop abusing substances. Patients with alcohol addiction who receive psychotherapy alone may not decrease their alcohol use, but patients who receive both psychotherapy and psychedelic therapy may drink significantly less.
The patients with alcohol addiction who are more likely to quit drinking are those who report intense psychedelic experiences. Psychedelic drugs like psilocybin may also help patients quit smoking, even for those who have not been able to quit smoking with other medications or therapy alone. Another plant compound that may be useful in treating extreme addiction is ibogaine.
2. Anxiety and Depression
Many people experience symptoms of anxiety and depression, and psychedelic therapy can help ease these feelings. After a psychedelic experience, patients may report a significant reduction in their anxiety, depression and stress. Additionally, your patients may have less frequent rumination and greater self-compassion.
Psychedelic therapy can be especially helpful for patients who have depression that has proven resistant to other treatments. A patient with severe depression may only need a couple of doses of a psychedelic drug like psilocybin to experience a reduction or even remission of their depression. Keep in mind that participants may be more likely to report these improvements if they had a quality psychedelic experience.
3. Terminal Illness
For many who have been diagnosed with a terminal illness, the thoughts of sickness and death could lead to feelings of anxiety and depression. Psychedelic therapy may help to alleviate these feelings of depression and anxiety, along with easing existential dread. For example, a patient with cancer may feel less cancer-related hopelessness, dread, anxiety and depression after a single dose of psilocybin mushrooms compared to those who take a placebo. Even months later, patients who take psilocybin may continue to experience improvements in their moods and relationships.
These patients may have a spiritualistic or mystical experience in which they glimpse death, better envision their conception of the divine or feel like everything is connected. These experiences may mediate rates of depression and anxiety.
4. Eating Disorders
With psychedelic therapy, the mystical experience a patient has may help shift their body image to more positive thoughts and potentially ease the symptoms of an eating disorder. While under the influence of a psychedelic drug, a patient with an eating disorder may receive new insights that encourage them to adopt healthier habits. Eating disorders are often accompanied by other mental health symptoms, so psychedelic therapy may ease the symptoms that have led to disordered eating. For example, psychedelic therapy may significantly reduce a patient's depression symptoms.
5. Post-Traumatic Stress Disorder (PTSD)
Hallucinogenic drugs that produce psychedelic effects may also help ease the effects of trauma or post-traumatic stress disorder (PTSD). Psychedelic drugs like MDMA and ketamine have been studied in the treatment of trauma, though MDMA has generally been found to be more effective than ketamine, even when combined with psychotherapy. A dose of psilocybin may also be effective in reducing a patient's feelings of demoralization.
Risks of Psychedelic Therapy
The use of psychedelic drugs in behavioral health therapy may pose some risks to patients, such as:
- Potential for abuse: Many psychedelic drugs are considered Schedule I substances. This means the Drug Enforcement Administration (DEA) considers these substances to have a high potential for abuse. Though not chemically addictive, psilocybin and LSD may cause patients to experience psychological addiction or withdrawal. Other drugs like MDMA can be addictive.
- Negative effects: Users may experience negative effects from using a psychedelic substance, such as anxiety, panic or disturbing hallucinations, agitation, fear, psychosis, delirium and confusion. A user may also experience withdrawal side effects. After taking MDMA, for example, a patient may experience insomnia, reduced appetite, confusion, anxiety, depression, irritability, memory problems or decreased interest in sex.
- Hallucinogen-persisting perception disorder: Hallucinogen-persisting perception disorder may occur in some patients. This condition refers to distressing, persistent alterations to how they see the world. Visual flashbacks can be experienced for weeks or years following the use of a hallucinogen, causing the patient to recall an intensely upsetting experience.
- Psychotic breaks: In susceptible patients, using a psychedelic can lead to a psychotic break. For example, LSD may induce schizophrenia. Those with a family history or personal history of psychosis or bipolar disorder may be at greater risk during psychedelic therapy.
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