From Underground to Mainstream: Preparing for the Surge in Demand for Skilled Therapists

From Underground to Mainstream: Preparing for the Surge in Demand for Skilled Therapists

By Arthur Lee

Arthur Lee is a friend of the Numinus team. He wanted to share his perspective on the Psychedelic movement and the community, at large. Although the content below is his opinion, we are honored to share voices from the experience of those who helped us reach this point in access. Numinus Training is for licensed and unlicensed individuals on traditional and alternative paths. Thank you, Arthur, for your contribution! 

Psychedelic-assisted therapy is poised to transform mental healthcare. Anyone who's been paying a modicum of attention to the mainstreaming and medicalization of the field knows this, and the science is clear. For most people, psychedelic medicines are safe, suitable, and vastly more effective for a myriad of diagnosable disorders than standard therapeutic approaches. With MDMA widely expected to clear the final FDA hurdle in the United States in August 2024, we are approaching a watershed moment. A once-outlawed psychedelic drug will become legally available in a medical setting. Rather than be compelled to navigate the "underground," unlicensed market or travel to another continent in order to access legal, well-supported psychedelic care. I may soon be able to receive psychedelic-assisted therapy with licensed providers within clinics across North America. Call me optimistic, but I firmly believe this is true: The psychedelic genie is out of the bottle, and there's no turning back. 

 

Reshaping Mental Health: Recalculating The Math Of Supporting Wellbeing

As psychedelic therapy becomes legally available, one of the most pressing questions becomes: How do we meet the imminent demand for psychedelic-assisted care with skilled and trained therapists? There are currently a few thousand therapists in North America alone who are accredited by training programs provided by MAPS, Numinus, and others, but how do we serve all those who may potentially qualify for psychedelic treatment? In the United States, it's estimated that approximately 12 million American adults experience PTSD in a given year. In Canada, about 5% of the population of 40 million have been diagnosed with PTSD. Do the math. We are not yet prepared to care for all those who may benefit from these treatments. Not even close. 

And that's considering MDMA-assisted therapy for PTSD alone. What about psilocybin for depression, end-of-life anxiety, and other indications? What about ketamine therapy training for Physicians instead of just for pain centers? What about 5-MeO-DMT for addiction? What about other psychedelic medicines that have not yet been created that we will discover and their potential therapeutic use? Take all those into account, and we have a massive shortfall of trained psychedelic therapists. Long story short: It's all hands on deck to get people the help they need as the legalization of psychedelic therapy takes place. 

"While many people may have safe and even sacred experiences in the company and care of friends or informal "trip sitters,"-- overlooking the necessity for trained psychedelic therapists threatens to put many users and clients at risk of harm."

A fair question that some are asking as we wonder how to meet the projected demand is if one necessarily needs formal training or certification to support others through altered states. Survey the average person who's ingested a psychedelic substance at least once in their life, and it is far more likely they did so in the company of friends than in the presence of a clinically-trained therapist or shamanically-trained facilitator. My first time ingesting psilocybin mushrooms was with my best friend, Cody, in an RV parked in the driveway of his grandparents' northern Ontario home. In the absence of a guide, we were still thoughtful and intentional about set, setting, and dose. That unsupervised psychedelic experience was one of the most meaningful moments of my young adult life. No therapist or guide was present—honestly, that didn’t even cross our minds. In my opinion, there will always be a place for the responsible, safe, and even recreational use of psychedelics. It is a fundamental human right to possess freedom of thought and choose how to modulate our consciousness in whatever informed setting we ultimately select. This is coming from someone who has both provided nearly a hundred psychedelic experiences for others through a clinically informed lens and consumed psychedelic medicines in open-air jungle huts in South America. 

 

The "When, Why, and How" of The Increased Demand

With all that in mind, the increasingly global, clinical application of these powerful substances requires a more rigorous and specialized approach. While many people may have safe and even sacred experiences in the company and care of friends or informal "trip sitters,"-- overlooking the necessity for trained psychedelic therapists threatens to put many users and clients at risk of harm. To suggest that all one needs to receive proper care and support through a psychedelic experience is someone they trust and who knows the terrain through personal experience is irresponsible and untrue. Both of those are absolute prerequisites for psychedelic facilitators, but they're not enough. Necessary but not sufficient. 

 

Thank you, Psychedelic Alpha, for permission to use your research; full interactive link here: https://psychedelicalpha.com/data/psychedelic-laws 

While a trusted, knowledgeable companion can play an invaluable role in a person's psychedelic journey, the clinical application of these powerful medicines requires a level of training and expertise that goes far beyond informal peer support. Psychedelic-assisted therapy demands a comprehensive understanding of the pharmacology, neurobiological mechanisms, contraindications, and clinical evidence base for these substances. Practitioners must also be highly skilled in creating a safe, supportive, and therapeutically optimal setting, as well as guiding clients through the complex and emotionally charged experience. 

 

Effective psychedelic therapy also necessitates advanced therapeutic skills that go beyond just "being there" compassionately and without judgment for someone. Therapists must be adept at preparing clients, working with non-ordinary states of consciousness, navigating challenging emotional or psychological material that arises, having knowledge and skill working with transference and countertransference, and then skillfully assisting with integrating lessons and insights gleaned. This requires in-depth training in modalities like trauma-informed care, emotion-focused therapy, Internal Family Systems, Gestalt techniques, or other evidence-based approaches. 

Beyond the clinical expertise, psychedelic therapists must have also cultivated a high degree of self-awareness, emotional maturity, and comfort with the unknown. The psychedelic experience can open an intensely personal and profound process, and therapists must be willing to confront their own biases, wounds, and shadow elements in order to be fully present and effective. They must also be able to hold a steady, grounded, and compassionate space as journeyers explore the furthest reaches of their consciousness. Your buddy who’s tripped a dozen times may fulfill some but not all of these requirements. Even if nine times out of ten, sitting with an untrained guide doesn't result in a bad outcome for the client, it's that tenth vulnerable person that we must go to great lengths to protect. 

The Challenges Of Mainstreaming The Psychedelic Industry In 2024

If I sound a bit uptight about all this, it’s only because I have a profound respect and love for what these medicines can offer when approached responsibly. I’ve heard of too many accounts of people coming to great harm at the hands of unqualified “trip sitters” who were in over their heads and offering support outside of their scope of practice. People who were re-traumatized. People whose symptoms worsened. And yes, even people who took their own lives because of the inadequate support they received throughout the psychedelic process contributed to their destabilization. The mainstream adoption of psychedelic therapy has too much potential and promise for us to take any chances. We’re talking about providing the utmost level of care for people in extremely vulnerable states. The difference between a trained guide and another who isn’t could determine whether a person’s experience is healing or profoundly harmful, whether they find relief from their symptoms or are plunged even deeper into illness.  

"While the recreational and spiritual use of psychedelics will always have an important place and should be protected, the clinical application of these substances requires a level of skill, knowledge, and personal development that goes beyond informal peer support."

As psychedelic medicines become mainstream, it will be crucial to establish rigorous training and certification standards to protect the integrity of this emerging field of clinical psychedelic therapy. Regulatory bodies, professional associations, and pioneering psychedelic therapy organizations will all play a key role in developing these frameworks and ensuring that only the most qualified practitioners are entrusted with guiding people through these profound and potentially life-changing experiences in a clinical setting. While the recreational and spiritual use of psychedelics will always have an important place and should be protected, the clinical application of these substances requires a level of skill, knowledge, and personal development that goes beyond informal peer support. As we move into this new era of psychedelic-assisted therapy, we must uphold the highest standards of safety, ethics, and therapeutic excellence for those accessing these treatments through licensed medical providers.  

Numinus is leading the way in training competent providers to offer psychedelic-assisted therapy safely and effectively. They offer certification in ketamine, MDMA, and psilocybin, which are taught by highly experienced and actively practicing therapists who can give real-world guidance and support. Their pathways (subject to pending FDA approval) will also include valuable experiential learning opportunities and practicum placements to get first-hand experience with the medicines and to see real clients before certification. Their clear path to practice and highly credible curriculum will help ensure future providers offer safe and evidence-based care to clients in need worldwide. 

To get started, check out their Fundamentals of Psychedelic-Assisted Therapy program here: Fundamentals of Psychedelic-Assisted Therapy - Numinus.  

 The Fundamentals coursework is interactive, with opportunities to learn from professionals actively working in Psychedelic-Assisted Therapeutic (PAT) practices. There are live remote learning sessions with breakout rooms for peer-led learning and small group time with the mentors leading the courses. The training offers a balance of understanding the applications of PAT and personalized care for individual cases. It is perfect for those licensed and attempting to navigate their client’s needs after an altered state and those who work outside licensures and want to deepen their abilities to work with a wider variety of clients and treatments.  

 

Honoring Veterans and Addressing PTSD

As Veterans Day arrives, it's not just a time for gratitude but also a moment to shine a light on the mental health challenges faced by those who have served in the military. On a recent episode of KSL’s Dave & Dujanovic, hosts Debbie Dujanovic and Dave Noriega delved into the topic of Veteran mental health, particularly post-traumatic stress disorder (PTSD), with Numinus therapist John Ellis.

The discussion opens with personal stories, including Dave's revelation about his grandfather's World War II experience, emphasizing the often unspoken struggles that veterans carry. John Ellis, a therapist with a background in the United States Air Force Reserves, shares insights into the importance of storytelling for veterans and the therapeutic value of sharing experiences.

"A lot of veterans do keep things inside. But they have stories to tell. And when they start to tell them, it does help." John says.

Fostering an environment of connection, empathy, and emotional understanding, the need for vets to share their experiences is paramount. Our collective society's attentive listening becomes pivotal in acknowledging the importance of veterans' narratives. So, what first steps can we take? 

Let’s start with compassion. Creating a safe and supportive environment to empower veterans to openly express their feelings will help them navigate the path towards healing.

But it isn’t all that simple to create this safe space. Veterans face challenges when opening up about the past, particularly the painful memories. These experiences don’t always flow from the memory into a story - they are sometimes haunting, and dig up old wounds. "We need to help them start telling their stories a little bit. And when they do, we need to listen. It does help them, and it's hard to tell them. Even the good ones." John continues to say. Many people feel sensitive about asking questions, fearful of saying something wrong or triggering. However, there is a balance, and approaching the conversation with delicacy, kindness, and respect can make a veteran feel appreciated. Think about starting by saying something like this: “I understand that talking about your experiences in combat can be challenging, but I want you to know that if you ever feel the need to share or discuss anything, I am here to listen without judgment. Your feelings and experiences are important, and if you choose to open up, this is a supportive space. I appreciate what you've done, and I'm here whenever you're ready.”

For veterans, the emotional connection formed through shared narratives can also be built through engagements such as individual therapy, group sessions, or community resources. "There's that emotion and empathy that can be formed in connection. I think that's really where it starts, whether it's in a therapeutic relationship, just one-on-one with a family member, or amongst veterans - combat or otherwise."  John explains. 

When discussing signs of PTSD,  common indicators include flashbacks, hypervigilance, night terrors, existential dread, and fear that can linger, making it difficult for veterans to feel safe. To begin working through these unwanted feelings, starting with the Veterans Affairs (VA) system is always a solid first step. 

The door is wide open at Numinus, where we provide therapy and utilize treatments like ketamine-assisted therapy, known for its effectiveness in reducing symptoms of PTSD and suicidal thoughts. Many Numinus therapists and staff are veterans themselves, and we always do our best to pair vets-to-vets for an added layer of empathy.

At Numinus, we strongly believe in the power of psychedelic therapy. Ongoing research favors ketamine and other psychedelic medicines, such as psilocybin and MDMA, in treating mental health conditions. Numinus is helping carry the torch for this work, alongside and partnered with long-standing companies like MAPS (Multidisciplinary Association for Psychedelic Studies). The promising results from recent studies show psychedelics, when coupled with talk therapy, have a highly positive impact in relief from depression, anxiety, PTSD, and more.   

We really have learned, from the 70s to now. There really is a lot of research and some real expertise – and there are people that really know how to help navigate your experience," John says. "We’re [Numinus] really helping people rewire their brain from that trauma - that medicinal kind of regeneration of neurons that happens during a psychedelic experience.

As we reflect on Veterans Day, let's carry forward a renewed commitment. Acknowledging the struggles of veterans and the importance of mental health, we extend our gratitude and encouragement. Together, let us foster a compassionate environment, embracing the healing potential of both shared narratives and therapeutic interventions. 

If you or someone you know is a veteran facing mental health challenges, remember, seeking support is a courageous and vital step. Your well-being matters, and the journey towards healing is a shared endeavor.

 

Group Ketamine-Assisted Therapy: A Therapist's Musings

Group Ketamine-Assisted Therapy From The Perspective Of A Therapist

 

When I first started bringing up the idea of group ketamine therapy to my patients as a potential option, I did so somewhat timidly, often prefacing the conversation with “ok, now hear me out” or “I know it sounds strange…group therapy but with ketamine”. This was in part because the idea and execution of it was new to me, my hopes for positive outcomes were still a hypothesis and in part, because the patients I spoke with about it were immediately incredulous and skeptical, not only of group therapy work, but also of throwing a consciousness-altering medicine into the mix. After seeing firsthand the positive outcomes of group sessions that my co-facilitator and I have led, and working closely with facilitators of other groups with similarly outstanding results, I approach the group ketamine conversation differently: with confidence and earnest convictions of the benefits for those who bravely enter this space.

I will say here what I say to my patients who I think are a good fit but who are skeptical of this model: healing happens in groups. Yes, individual work is important, and for some people that individual work needs to happen first before entering a group space, but for generations across time, across cultures, and across the world, healing has happened in communities, when we witness and are witnessed in this process and we begin to embody the sense that we are all connected in more ways than we ever dreamed.  

During the medicine sessions, this is not group talk therapy, although we are together in the same room each person is having their own experience with the medicine. Typically, everyone is wearing eyeshades and music is playing while at least two facilitators carefully watch over the group, providing support when needed, but mostly leaving participants to explore their own innate ability to heal themselves, with support from others. All are welcome in this room, laughing, crying, and complete silence, it is all ok and requires no explanation.  

When we have shared experiences of transcendence, of entering the depths of sorrow, of embodying joy and playfulness, of connecting deeply with those around us, we find that we are better able to do those things in our everyday lives: with our families, our friends, and our community. We are able to bring these learnings back to those we love, facilitating a deeper connection with others, and ourselves.  And for those who feel they lack those relationships in their lives currently, practicing this kind of vulnerability opens the door of possibility that community is not only possible but accessible. Connection often doesn’t just happen in the culture we currently live in, it's not a given - it must be sought out and practiced. Coming together in a group with a shared purpose gives each of us the opportunity to practice vulnerability and connection with others in ways we are not often afforded in our everyday lives.  

I know I keep referring to “we” and “us”.  I have done this because we come into this group together. The group is not a service we as therapists and medical providers are giving to you. We are in this place together, learning and growing along with you, and for that we thank you for taking this leap.  

 

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If you're interested in learning more about our Group Ketamine-Assisted Therapy sessions, visit our webpage. 

If you're in the Utah area, we are leading Group Ketamine-Assisted Therapy sessions focused on chronic and serious illness at our Murray Clinic starting October 9th. One-on-one intake visits are currently open until October 4th. To learn more or to book your spot email INFO-UTAH@NUMINUS.COM or call 1 (801) 369-8989.

 

 

The Impact of Psychedelic Harm Reduction In Therapy

3 Benefits of Using a Harm Reduction Framework in Your Therapy Practice

According to a recent study by the National Institute of Health, psychedelic use is on the rise. The percentages of young people who said they used hallucinogens in the past year had been fairly consistent for the past few decades, until 2020 when rates of use began spiking. In 2021, 8% of young adults said they have used a psychedelic drug in the past year, the highest proportion since the survey began in 1988. Reported hallucinogens included LSD, mescaline, peyote, shrooms, PCP and MDMA (aka molly or ecstasy).

With this increase in recreational psychedelic use, there is a growing need for mental health professionals to expand their practices to support harm reduction and psychedelic integration needs. Here are the top 3 reasons practitioners should adopt a harm reduction framework in their therapy practice.

 

1. Builds Trust & Rapport With Clients

By maintaining a non-judgemental, accepting, compassionate, curious, and positive stance when exploring a client’s substance use, as well as other risky or harmful behaviours, you are directly contributing to the trust that client has with you. Being open and curious signals to the client that they are safe to walk through their thought process and current decision-making around psychedelic use, where you can gently advise on any dangers and practices they should take into consideration. When supported in this way, these clients are more likely to stay with you long-term and if you decide to provide psychedelic-assisted therapy in the future, they may feel comfortable turning towards psychedelic care provided by you. 

 

2. Helps Clients To Make Informed Decisions

When psychedelic medicines are used outside of clinical settings, proper education, preparation, and support can mitigate potential harms and increase the likelihood of clients having productive experiences (Gorman et al., 2021).  

Particularly with the medicines used in psychedelic-assisted therapy, clients may start treatment with some inaccurate information about the psychedelic medicine being used. The internet (particularly social media platforms) is full of misinformation about psychedelic medicines, their effects, adverse effects, and anticipated experiences. 

When a client has a more fulsome understanding of experiences and the decisions associated, potential benefits and harms are affected in ways that can enhance and protect their experiences, further contributing to trust this client has with you. 

 

3. Presents A Unique Opportunity To Work With Your Clients

When discussing psychedelic use, an important role you can play with your clients is to help with the integration work. Working on integration is your opportunity to keep the positive changes engendered by psychedelic experiences alive. In this regard, good integration work with your clients will help facilitate lasting changes and could reduce the need for ingesting medicines recreationally outside of a clinical setting. Not only is this an opportunity to work more with your client, but it’s a unique opportunity to really dive into positive and meaningful changes that are important to your client, which can facilitate deeper connection and meaning making as part of your regular appointments. 

 

In Conclusion: 

“Using a harm reduction framework in your clinical practice allows you to support your clients with non-judgmental, compassionate, and acceptance-oriented care. We should expect that clients may choose to use substances outside of the clinical setting, and that providers can play an important role in mitigating any harms associated with that, through building trust and rapport. We teach a harm reduction framework in our Psychedelic-Harm Reduction and Integration course at Numinus, which includes transparent discussions around the legal and ethical responsibilities in doing this work. Psychedelic use is going to continue to rise as more folks seek the healing potential of these medicines, so education in this area is going to become increasingly important.” 

- Amanda Giesler, Director of Training

 

Learn More: 

Join us for a 2-day introductory workshop on the practice of Psychedelic Harm Reduction and Integration (PHRI) and learn the tools needed for educating clients about altered states of consciousness and how to integrate these experiences. Click here to learn more.

 

*The continuing professional development program in no way promotes, condones, or facilitates illegal activity, and is strictly for educational and harm reduction purposes only. Please be aware that certain psychedelic substances still remain illegal in many jurisdictions, including Canada. This program and the contents of this website do not constitute medical advice, and are not a substitute for professional medical advice and treatment.

The Healing Potential of Psychedelic-Assisted Therapy for Eating Disorders

Eating disorders affect millions of people worldwide, presenting complex challenges that often require comprehensive and innovative approaches to treatment. In recent years, there has been growing interest in the potential of psychedelic-assisted therapy as a transformative tool in the realm of mental health. This blog post explores the emerging field of psychedelic-assisted therapy for eating disorders, shedding light on its promising benefits and the implications it may have for the future of treatment.

Introduction

Eating disorders affect at least 9% of the population, or 70 million people, worldwide[8], and this number is increasing. A review of worldwide data found that eating disorder diagnoses more than doubled from 2000-2018, with the trend was consistent across regions, age groups, and genders.[10]

These conditions are also serious, falling among the deadliest mental illnesses, second only to opioid overdose.[8] Every year, 10,200 deaths occur as the direct result of an eating disorder—that’s one death every 52 minutes.[9]

 

Understanding Eating Disorders

“Eating disorders are a window into the struggle of the soul.”

People don’t choose eating disorders. Nobody wakes up one day and says “I’d like to have anorexia”—If they do, they’re seriously misinformed. Eating disorders aren’t choices, but rather serious multi-faceted and biologically influenced illnesses. An individual may consciously decide to purge or over-exercise at first, but before long, this disordered relationship with food and one’s body can become a deeply-ingrained subconscious pattern that takes on a life of its own. When left untreated, eating disorders can lead to serious, and sometimes life-threatening, physical and psychological consequences, underscoring the urgent need for effective therapeutic interventions.

Thankfully, eating disorder behaviors are learned behaviors and can be unlearned—but it takes time. Everyone has the capacity for full recovery. Part of the work in recovery is to uncover the meaning or purpose behind the symptoms.

 

The Limitations of Traditional Treatments

Conventional treatment approaches, including cognitive-behavioral therapy and medication, have demonstrated some effectiveness in managing eating disorders. However, there are currently no FDA-approved treatment options for anorexia nervosa and only one for bulimia nervosa and binge-eating disorder respectively. While depression commonly occurs with most eating disorders, traditional antidepressants (i.e. SSRIs) often lack efficacy in patients with anorexia. Even when patients are able to take advantage of available treatments, many continue to struggle with symptoms, and relapse rates remain high.

Studies have found that over a third of all patients treated for anorexia or bulimia end up relapsing within the first few years of completing treatment. The highest risk for relapse from anorexia occurs in the first 18 months (about 1 and a half years) after treatment, with 35% falling back into eating disordered behaviors.[1]

While the onset of bulimia usually occurs during adolescence or early adulthood, it tends to persist for several years, either chronically or intermittently. Treatment does help most people with bulimia achieve long-lasting recovery, but relapse still is a significant concern, with rates of up to 41% of former patients resuming bulimic behaviors within 2 years.[2]

Recognizing these challenges, researchers and clinicians have continued to search for new and improved ways to help individuals with eating disorders find more long-lasting and complete healing, including the use of psychedelic-assisted therapy as a potential alternative or complementary treatment modality.

 

The Role of Psychedelics in Healing

Psychedelic substances like psilocybin, MDMA, and LSD have shown promise in facilitating profound psychological healing in individuals dealing with depression, PTSD, substance abuse, eating disorders, and other mental health conditions. Though theoretical mechanisms of action of psychedelic medicines are still being investigated, a growing body of research points suggest that psychedelics create desirable brain states that can accelerate therapeutic processes and make eating disorder interventions easier to receive. The desirable brain states in

 

Research Studies

Group Ketamine-Assisted Therapy for Eating Disorders [3]

This pilot study, led by Dr. Reid Robison, Chief Clinical Officer of Numinus, explored the use of group ketamine-assisted psychotherapy (KAP) in a residential eating disorder treatment facility. 5 individuals with eating disorder diagnoses and comorbid mood and anxiety disorders received weekly intramuscular ketamine injections in a group setting followed by non-drug psychotherapy over 4 weeks.

Regarding the outcomes, the study found promising results. Group KAP was feasible and well-tolerated, with high patient satisfaction and treatment adherence rates. Participants experienced reduced symptoms of depression, anxiety and showed significant improvements in eating eating symptoms and quality of life, with effects persisting at a 6-month follow-up.

Participant quote:

“Trying ketamine allowed me to see the possibility of a life I could have. While the effects did not last, my very first experience snapped me out of a state of life-long, deep disconnection that I didn't even know I had been experiencing. Suddenly, I was able to live in the world in the way people had always described it. Though I am still trying to figure out how to attain that level of connection after catching a glimpse, that one experience was so essential. I could finally feel hunger and fullness cues. I felt what it's like to live in a body, instead of living a short distance from it. I felt connected to others and genuinely cared about their well-being. I felt human for the first time in a long time.”

 

Psilocybin-Assisted Therapy for Anorexia [4]

This study being conducted by Compass Pathways in collaboration with University of California San Diego,  is exploring the safety, tolerability, and efficacy of psilocybin-assisted therapy for patients with anorexia. Preliminary results from 10 participants who received a single 25 mg dose of synthetic psilocybin (~3.5 grams of dried psilocybin) shows:

 

Psilocybin-Assisted Therapy for Binge-Eating Disorder [5]

This Phase II study is currently underway at the University of Florida in collaboration with Tryp Therapeutics and happens to be the first ever psilocybin-assisted therapy study addressing binge-eating disorder. Interim analysis of five early participants has found:

MDMA-Assisted Therapy for Eating Disorder Symptoms [6]

This study investigated the effects of MDMA-assisted therapy on adults with severe PTSD, specifically exploring its impact on eating disorder symptoms. A total of 90 participants with severe PTSD received treatment in a double-blind, placebo-controlled trial. At baseline, 13 participants had EAT-26 scores in the clinical range, and 28 had scores in the high-risk range, despite the absence of active purging or low weight. After finishing the study, there was a significant reduction in total EAT-26 scores in the entire PTSD group following MDMA-assisted therapy compared to placebo. Moreover, significant reductions in total EAT-26 scores were observed in women with high EAT-26 scores (≥11 and ≥20) following the study protocol.

 

Other studies:

 

GROUP PHASE INDICATION STATUS
MAPS Phase II MDMA for anorexia and BED Anticipated start date in 2023
Johns Hopkins Phase I Psilocybin for anorexia Enrollment complete
Imperial College Phase I/II Psilocybin for anorexia Enrollment complete
TRYP Phase II Psilocybin for BED Enrolling
XPIRA Phase II Psilocybin for Anorexia Anticipated start date in 2023
COMPASS Phase II Psilocybin for Anorexia Enrolling

 

 

Integrating Psychedelics with Conventional Models

Integration of psychedelic-assisted therapy with conventional eating disorder treatment requires careful consideration of medical and safety factors, as well as the crucial involvement of specialized eating disorder clinicians. These clinicians have the expertise to navigate the unique challenges and triggers associated with eating disorders, helping patients access and integrate psychedelics in a safe and therapeutic manner. Their involvement ensures a comprehensive treatment approach that combines the benefits of psychedelic therapy with the tailored support required for individuals with eating disorders, leading to more effective and sustainable outcomes. We view the role of psychedelics as an adjunctive to traditional treatments, not a “replacement.”

 

Conclusion

Psychedelic-assisted therapy represents a promising frontier in the treatment of eating disorders, offering new possibilities for deep healing and transformation. While further research is needed to fully understand its effectiveness and establish appropriate guidelines, preliminary studies and anecdotal evidence suggest that this approach holds tremendous potential. As the field progresses, it is essential to strike a balance between innovation and responsible practice, ultimately providing individuals with hope and a path toward recovery from their eating disorders.

 

References

  1. Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74
  2. BMC Psychiatry. 2019; 19: 134. Published online 2019 May 6. doi: 10.1186/s12888-019-2112-9
  3. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00588-9
  4. https://compasspathways.com/comp360-psilocybin-therapy-shows-potential-in-exploratory-open-label-studies-for-anorexia-nervosa-and-severe-treatment-resistant-depression/
  5. https://tryptherapeutics.com/updates/tryp-therapeutics-announces-interim-results-for-its-phase-ii-clinical-trial-for-the-treatment-of-binge-eating-disorder-with-psilocybin-assisted-psychotherapy
  6. https://www.sciencedirect.com/science/article/pii/S0022395622001303
  7. https://pubmed.ncbi.nlm.nih.gov/9797933/
  8. (Ghaderi et al., 2018, Ward et al., 2019)
  9. Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
  10. Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. Am J Clin Nutr. 2019;109(5):1402-1413. doi:10.1093/ajcn/nqy342

Experience & Collaboration: A Practitioner's Approach To Teaching

Foundational Psychedelic-Assisted Therapy Training, Taught By Experts. 

Dr. Steve Thayer is a licensed clinical psychologist and psychotherapist. He started his career in the U.S. Air Force, overseeing a mental health clinic and managing programs for preventing and treating alcohol and drug abuse. Currently, he focuses on helping his clients through psychedelic-assisted psychotherapy, teaching counselling courses, and co-hosting a podcast on psychedelic therapy. Steve is facilitating the upcoming cohort of the Fundamentals of Psychedelic Assisted Therapy, and we asked him questions about the course and his teaching approach.

 

What experience do you bring to the Fundamentals of Psychedelic-Assisted Therapy course?

As a clinical psychologist specializing in psychedelic-assisted therapy, I have helped thousands of clients navigate their own healing journeys. I have been trained by MAPS in MDMA-assisted therapy, provide ketamine-assisted therapy in my practice, and serve as lead therapist on several psychedelic clinical trials. I also supervise clinicians providing psychedelic-assisted therapy and facilitate psychedelic medicine retreats abroad.

 

What can students learn from you?

Students can expect to learn the essential skills, qualities, and principles necessary to provide effective, compassionate, and ethic psychedelic-assisted therapy. I like to emphasize the importance of clinician self-knowledge, self-development, and self-care as a key component to doing this work well.

 

How do you approach teaching this course?

I take a collaborative approach to teaching. There is so much we can learn from each other! I try to draw out the collective wisdom of each group I teach so that we can elevate and support one another .

 

Why should people take this course?

This course will equip professionals with the foundational knowledge and skills to practice psychedelic-assisted therapy. I have extensive experience teaching, supervising, and mentoring therapists and I am committed to helping the rising generation of practitioners wield psychedelic tools safely, powerfully, and responsibly.

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To learn more about the Fundamentals of Psychedelic-Assisted Therapy, click here. To listen to Steve on the Psychedelic Therapy Frontiers Podcast, visit Spotify, here.

Feeling Clearly: How Ketamine-Assisted Psychotherapy Helped a Father Overcome Severe Social Anxiety and Childhood PTSD

By Greg Ferenstein

An Unrelenting Specter of Judgment

Tom* couldn’t shake his constant fear of being perceived as awkward and unworthy of friendship.

“I always felt like the outcast,” he recalls. The crippling self-doubt kept all of his relationships at a cold distance, even his wife.

In everyday social situations, even light-hearted water-cooler conversations at work, Tom was haunted by thoughts about why people right in front of him—freely engaging with him in conversation—silently judged him as unpleasant.

Tom had done the work to figure out the source of his dread. After years of therapy, he knew it came from an abusive childhood growing up in a religious culture that used shame and bullying to enforce conformity. As a result, he ran away as a teenager.

One notable symptom of trauma is “hyper-vigiliance”, or an over-sensitivity to threats in everyday situations.

“I was on high alert all the time," he remembers.

His relationships were shallow because he avoided social activities. Even surrounded by those who loved him, he was still alone and fearful.

Addictive Attempts

Determined to be more social, Tom looked for solutions. While they did improve his anxiety, they also came with troubling trade-offs.

One was a popular and controversial legal drug, Phenibut, a synthetic anti-anxiety supplement originally synthesized in the USSR for cosmonauts.

Phenibut acts on the central nervous system by inhibiting the neurotransmitter, GABA. Essentially, it can dull reactions to perceived dangers. Because Tom was not in any true danger, it was a workable solution that gave him the confidence to be more social.

Unfortunately, Phenibut is highly addictive and there are reports of painful withdrawal. Tom remembers one occasion when he forgot to take one of his various anti-anxiety supplements on the way to a movie with his wife and they had to immediately turn back, making them late for the show.

Being tethered to addictive, unapproved medical treatments was clearly not helping him or his relationships.

Ketamine and a Feeling of Unconditional Love

Tom came across a Facebook ad for a new therapy at Novamind’s Cedar Psychiatry in Utah using ketamine, a surgical-grade general anesthesia that was being used to treat mental illness, including social anxiety disorder.

“I didn't quite know what to expect," he recalls of his general aversion to psychedelic-assisted therapy. “This was kind of my last hope."

Desperate for better options, Tom scheduled an appointment and brought his wife with him for support.

Tom remembers the luxury gravity chair that he sat in while the IV ketamine infusion was placed in his arm. He began drifting off into a dream-like state and felt as if he was tipping over backward in the chair, but the fear subsided.

“It’s ok, just let go," he recalls telling himself. For Tom, the psychedelic aspect of ketamine was not about wild hallucinations, but a feeling of ease. “I fell into this black space."

Tom’s thoughts drifted to his wife and he felt unconditional love. Prior to the appointment, he had worried about bringing her, since he felt silently judged for turning to psychedelics for treatment, even though she had never expressed skepticism about the approach.

But that feeling was replaced with one of acceptance. With ketamine, “You get to see yourself in third person," Tom explains. He experienced, at a visceral level, how others saw him and he knew they didn't judge him as he feared they did.

Instead, he could simply be beside his wife. “She held my hand; I felt so loved."

Feeling Less Judged

"Our marriage has skyrocketed," Tom says proudly. He also has more energy to enjoy swimming and going to the gym with his wife.

"I feel like going outside because I don't feel like there are eyes everywhere judging me."

Tom still has more ketamine treatments to go but feels he’s on a better path.

He seems to take challenging social experiences less personally. If someone disagrees with him, there is “zero emotion attached" to the argument.

Without constant rumination about what he’s doing wrong, he’s able to put challenges into perspective.

What Seemed to Work

Tom says that two things, in particular, stand out in his mind about what helped, aside from his wife being at his first treatment.

The first was listening to unfamiliar music. Music can have a calming, meditative effect during psychedelic episodes, allowing people to more deeply drop into a dream-like state. However, listening to familiar music can dredge up unpleasant memories that could distract from seeing oneself in a new light.

The second was Tom’s experience with mindfulness therapies prior to ketamine, including meditation and another called Eye Movement Desensitization and Reprocessing (EMDR).

The basis of both strategies is to embrace difficult thoughts and memories as they come up. Tom doesn’t know whether having these psychological tools in his toolbelt made the difference between successful and unsuccessful ketamine treatment, but he did have the honed skills to address challenging thoughts during the treatment.

So, it is worth noting that people who have come from therapy might be able to use the tools they’ve learned from previous counselors with ketamine. This is why Cedar Psychiatry is careful to prepare patients with the mindfulness tools they’ll need to navigate the psychedelic experience and integrate insights afterward.

It certainly seemed to work for Tom. "It changed my entire life," he concludes.

*Tom is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Friends With Myself: How Ketamine Helped a Frontline Therapist Overcome Panic Attacks

By Greg Ferenstein

On the surface, Emily* had a blessed life: a supportive husband, a loving son, and a solid career as a frontline therapist. She had all the professional training and social support to manage her mental health, yet she was plagued by debilitating panic attacks.

Even when nothing was wrong, she couldn’t escape intrusive, catastrophic daydreaming of how she was likely to wreck her family and community. She knew the thoughts were purely imaginary, yet the uncontrollable episodes of sobbing that accompanied these ruminations took a toll on both her family and office administrators.

As an example, Emily recalls being mildly afraid that she might cheat on her husband. That same day, she went through a grocery checkout line with a male cashier and was bombarded with thoughts of cheating on her husband.

“I immediately just lost it,” she says. “I cheated on my husband because I went through this line that had a male cashier.”

She burst into her home, began crying, and apologized to a very confused partner. She remembers thinking that “I just can't, I can't live like this.”

As a working mental health professional and current master’s degree student, Emily was surrounded by treatments and strategies to help her deal with her panic attacks.

And she did on occasion find them helpful.

Yoga, for example, helped give her space to contemplate quietly. “I was able to lay there and relieve some of my self-loathing and self-hatred and difficulty in accepting myself as a human.”

Unfortunately, nothing seemed to stick, partly because Emily was terrified to let her mind wander. “I get a little skittish around trying to create images in my mind because I don't trust my brain; any moment, this self-compassion exercise could be totally taken over by myself.”

As bad as the attacks were, Emily could still function as a loving mother and run a therapy practice while going to grad school.

But COVID tipped the scale; intrusive fears became too intense. Shopping at Target was a panic-inducing experience. “What if the girl that is spraying the carts right now doesn't believe in COVID? And so she actually just put water in the spray bottle …. And now I'm going to take it home, and we're all going to die?”

The constant fear became too much. She needed new solutions.

The ketamine experience

At this point, Emily was open to anything that could help. She heard about a clinical pilot for frontline healthcare workers offered by Novamind, a mental health startup specializing in ketamine-assisted psychotherapy.

Ketamine, a dissociative anesthesia, was showing promise for a range of mental health issues, including suicidal ideation and depression.

Novamind’s clinic pioneered a method of pairing ketamine sessions with intensive psychotherapy.

Growing up in a religious community, Emily felt uncomfortable with psychedelics. But she was desperate for solutions and decided to sign up.

Emily was placed in a trial with other frontline healthcare workers exploring how ketamine-assisted therapy could help them overcome their mental health challenges.

In preparation for the treatment, they were given worksheets and instructions on how to mentally navigate the psychedelic experience. In between treatments, the group would come together for discussions and integration.

Emily recalls one particularly powerful psychedelic episode that rooted out the source of her panic attacks.

As she began to feel the effects of the ketamine, she remembers seeing a visualization of a black hole and asking the overseeing physician how she should interact with the bizarre object.

“The doctor encouraged me to go toward it and that he would be there if I needed. I asked to hold his hand.”

Images morphed, and she recalled herself a young religious missionary in South America. As an adult, she was no longer a member of her same church, and since leaving, maintained intense shame around trying to force religious beliefs on the local residents.

During the psychedelic experience, Emily felt the people of the town forgive her. They told her that her missionary work did not harm the community and that they were grateful to have known her.

Then, with that same compassion, Emily turned to speak to her childhood self, “I told her these thoughts that you have are called ‘obsessive compulsive disorder’, and you don't have to repent for them.”

Emily and her younger self openly discussed all the complex feelings around moral purity and guilt they would experience in their life. She forgave herself. And, in that moment, Emily acknowledged it as a significant source of panic attacks.

“It was a closure I didn't even know I needed.”

Better at managing attacks

Emily still experiences episodes of shame, but now, they don’t spiral out of control.

She recalls one recent example of an incident that would have triggered a panic attack prior to her ketamine treatment.

One day, she had thrown away a bunch of plastic. Normally this slight moral transgression would trigger intense feelings of guilt about how she was wrecking the planet.

“Yes, I will have the thought of like, ‘Oh my gosh, what am I doing to the earth’, but within moments, I'm able to go to a place of ‘Emily’, this is so hard for you, I'm so sorry that you struggle with this—everything's going to be okay.”

Emily estimates that before, she would have a debilitating episode about once every three weeks, and then more minor attacks in between.

Since her treatment, she has experienced just one triggering episode, but it was not as severe, and she was able to adopt new coping mechanisms.

In addition to a more stable family life, Emily believes she’s become a more empathetic and present therapist. “I'm able to be fully present in their story, instead of letting my mind wander off into my own story.”

Emily is a therapist in a community with a lot of mental health distress around religion. Her clients have become curious about her personal transformation and the role of psychedelic-assisted therapy. Emily says that she would recommend Novamind.

“Dr. Reid Robison and Dr. Stephen Thayer were really great at setting us up for success,” she exclaims. “I can't imagine doing this with any other people.”

*Emily is a pseudonym. Some quotes edited for clarity.

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

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Fully Present: How Ketamine-Assisted Therapy Helped One Woman Out of Depression

By Greg Ferenstein

Michelle* lived with constant anxiety that she would explode during an argument and enter into a months-long depressive episode. She’d tried so many strategies to manage her mental health, from group discussions to cognitive behavioral therapy, but nothing seemed to work well.

“Most of the therapy I’ve done just kind of muted my symptoms mostly, but I am still walking around with heavy, heavy depression and really terrible anxiety.”

Depressive episodes would socially paralyze her.

“I wouldn’t feel like I had any energy to do anything. I’d isolate myself,” she says. “I'm not social. I don't function besides what I absolutely have to function for.”

She could work but that was about it.

Unfortunately, the most effective solutions for her had intolerable side effects. The generic version of Zoloft, Sertraline, managed her major mood swings but came with “horrible” sweats that left her “drenched” in the middle of the night. Perhaps worse, it severed her emotions.

“It made me not care at all,” Michelle recalls. “I just kind of didn't feel anything.”

After her doctors recommended trying a higher dose, she went looking for something else. Her friends said good things about ketamine, a dissociative psychedelic that is known to help people confront painful topics and manage a range of mental health conditions, including depression.

Michelle was nervous. She had some not-so-positive experiences with psychedelics when she was younger. Even though it was years ago, she didn’t like the idea of losing control of her mind.

The therapists at Numinus made her feel more at ease with their Emotion-Focused Ketamine-Assisted Psychotherapy, which pairs intensive emotional management and trained mental health professionals with multiple rounds of in-person ketamine sessions.

The Ketamine Experience

The psychedelic portions of ketamine treatment typically last an hour and many people report hazy dreams representing unprocessed challenges.

After years of therapy, Michelle believed she knew the source of what she might encounter: being abandoned by her mother as an adolescent and subsequent years in-and-out of near homelessness.

Instead, her most healing psychedelic experiences were simple and pleasant experiences.

She remembers telling her husband, “Maybe this is what it feels like to feel normal.”

The simple absence of anxiety was profound. After one session, she burst into tears.

“I just started crying and crying and crying,” she recalls. “I really felt like it helped me release those emotions, and relieve some of that pain and all of the struggle that I had when I was a child with my family.”

During another psychedelic experience, Michelle set an intention and drifted into a meditative state, daydreaming of swimming. Usually, when water was involved in Michelle’s dreams, it was a nightmare drowning sensation. This watery dream, though, was superbly healing.

“I have been a hyper-vigilant person, always looking for the next thing to crumble in my life,” she says. “But with ketamine, just to even have that feeling that I'm okay—and that I'm happy—was huge for me.”

Introspection, fewer explosions, less depression

In the three months since Michelle had her first ketamine treatment with Numinus, she has learned to better manage her emotional triggers.

One example stands out. Because of their shared traumatizing past, her family has had a tendency to set her off. But the last time they had a fight, Michelle recalls being able to remove herself from the argument, sensing that she was about to explode, and embrace her feelings without becoming overwhelmed by them.

“It's getting easier for me to recognize, even in conversation.”

She feels more in touch with her emotions, and if things start feeling really bad, she can discuss her emotions openly in a way that defuses the situation.

Her relationship with her husband has improved and she is no longer burdened with extended bouts of depression. She’s made incredible progress, but Michelle still struggles with explosive episodes and depression. So, she continues to go in for occasional ketamine treatments.

But she no longer needs antidepressants.

“It has really, really, honestly been the only thing that has helped me feel normal without taking a pill every single day.”

*Michelle is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Healing My Worth: How Ketamine-Assisted Therapy Helped One Woman Out of Depression

By Greg Ferenstein

 

Sarah* couldn’t understand why she felt such debilitating depression. On paper, she seemed to be doing everything right. She practiced yoga, ate well, and was raising two well-adjusted children. Her supportive family and healthy lifestyle helped her overcome a difficult cancer treatment, yet she was consumed by dark ruminating.

“I find myself constantly apologizing to everyone,” she recalls, of the crippling self-doubt that led to serious suicidal ideation.

Intuitively, she knew people loved her, but couldn’t stop her reaction to apologize as never being good enough for her family. Sometimes, the mere gentle embrace of her husband would send her into a sobbing fit.

“My kids were scared when I got really suicidal,” she admits.

Traditional therapy and medications had been somewhat helpful. One of the anti-depressants that she tried, specifically, Zoloft, took the edge off of otherwise brutal, constant rumination.

“I was more stable—I was much more approachable.” With Zoloft and talk therapy, Sarah’s relationships were more manageable. She could work, raise her kids, and not break down crying around her husband.

But, eventually, the trade-offs from Zoloft, and anti-depressants generally became too much. First, Sarah’s cancer medications interacted poorly with Zoloft.

Second, it strained relations with her husband in unexpected places like the bedroom. “There’s kind of a sexual dampening effect.”

Her husband wanted to be desired physically, but as an emotional ‘zombie’, Sarah just couldn’t feel it.

“I wasn’t filling that need for him because I wasn’t feeling it within myself,” she recalls. “I wanted to feel well, but I also wanted to feel everything.”

Eventually, Sarah’s therapist proposed a relatively new psychedelic pharmaceutical treatment, ketamine, a widely used surgical general anesthesia known to have potent antidepressant effects. In the dreamlike state of this powerful analgesic, patients can often process memories that are too painful to deal with normally.

Sarah’s initial ketamine treatments were positive, but they did not seem to alleviate her issue, nor did they help her understand the source of the depression.

So, she decided to try a new ketamine provider, Novamind, a growing mental healthcare company specializing in psychedelic-assisted therapy. Having treated thousands of patients using various ketamine therapies, Novamind was uniquely equipped to address Sarah’s challenging situation. In her case, Novamind providers used Emotion-Focused Ketamine-Assisted Psychotherapy or “EF-KAP”. EF-KAP is a special type of ketamine-assisted psychotherapy that focuses on helping patients learn to identify, cope with, and transform emotions related to their mental health condition. It is based on principles found in Emotion-Focused Therapy, an approach to psychotherapy that clinical research has shown is very effective.

A transformational visualization

Initially, Sarah remembers feeling “terrified” of psychedelics. Her fears ran the whole gamut of disaster scenarios, from suffering a hypothetical permanent psychosis to simply not ‘returning’ to her normal psychological state of being able to care for her family.

“I’m kind of a control freak,” she says.

But, she was desperate and willing to trust in the confidence of her mental health team.

Under Novamind’s care, Sarah recalls the trip that transformed her mental health. Sitting in a comfortable chair and dimly lit room, a ketamine IV was placed in her arm and she drifted off into a state that felt like the semi-conscious awareness of waking up from a long sleep.

In her dream, a building stood out in the middle of a big, cosmopolitan city. She peered in and could empathize with the hundreds of families seen through the windows. Soon, she witnessed the glow of different family members dissolving from what looked like divorce. But, it wasn’t a sad occasion, as each person floated into another room with a new, loving family unit.

To Sarah, this was a revelation: as the child of a difficult divorce, she realized how the scars of feeling unloved during her parents’ separation never fully healed. But, in her psychedelic vision, she understood separation as a natural part of life.

“My energy can now leave and go flow elsewhere.” Sarah did not have to take the scars of being unloved from her childhood into her role as a mother. “I equated trying to be perfect with getting love.”

She says that she could choose to accept the unconditional love of her husband and children, even if she is imperfect.

No more apologizing or suicidal thoughts

Sarah recalls feeling unusually pleasant in the days after the experience. Her first assignment was to ditch her knee-jerk reaction to apologize—and it worked.

She was determined to be “more mindful every time I wanted to say ‘sorry’.” Instead, she knew, “I could just show up and be enough.”

Soon, relations at home improved. Before the therapy, Sarah had become physically estranged from her husband, who had stopped being affectionate for fear of triggering a depressive episode. But, now, he could embrace her with a loving hug. It was the little things like this that gave her more confidence and began the road to repairing intimacy in her marriage.

Initiating intimacy ran both ways: now that she felt a fuller and more intense range of emotions, Sarah is comfortable in her body. She is less judgmental about her weight and image. In the bedroom, she enjoys connecting and is less likely to cover under the sheets.

“Years of eating disorders and body dysmorphia, and body shame had prevented me, for a long time, from really being present in my body.”

Sarah still has shaky days, but is staying vigilant in her practice of mindfulness. She finally believes, at her core, “I’m worth being here”.

Exploring the nuances of what worked

Sarah was no stranger to psychedelics; she’d experimented liberally years ago with LSD and psilocybin, both of which are known to have antidepressant properties in therapeutic settings. And, she had come to Novamind recently for ketamine treatments.

So, what was different about this particular transformation experience?

Novamind’s Dr. Stephen Thayer, who oversaw her care, credits two things in particular to the healing process.

First, Sarah was instructed how to ‘recall’ her psychedelic experience in her everyday life as a method of integrating the insights she learned while on ketamine. During challenging times, Sarah takes a moment to breathe and mindfully reflect on these insights, allowing her to emerge fortified and less self-critical. Dr. Thayer describes this process as following breadcrumbs back to insights first encountered during the ketamine experience.

Second, both Dr. Thayer and Sarah credit the unobtrusive talk therapy during the trip with a trusted counselor.

In many ketamine infusion clinics, clients go through the experience without supportive psychotherapy.

Sarah’s case is a fascinating example of why this kind of support may be crucial to the healing process. Ordinarily, she admits, anxiety would get the best of her and she would feel the need to do anything else but sit with her difficult emotions. That guidance involved open-ended questions, invitations to be curious, and reminders that she was safe. Being invited to describe the visualizations mid-trip helped uncover the meaning of the dream-like state and gave her the courage to dive deeper into the experience.

For Sarah, it made all the difference.

*’Sarah’ is a pseudonym. Some quotes edited for clarity.

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.