How Psychedelics Change the Brain: MDMA, Psilocybin, Benefits & Risks | Dr. Rick Doblin

0:00When was that moment that you first realized this could change the course of how we treat mental health? I realized that when I was 17 and 18 and took LSD. Adam was the codename for MDMA. I started this non-profit in 1984 before MAPS. And it was to gather support to fight the DEA, the Drug Enforcement Administration, once they would eventually criminalize MDMA. Let's just talk about the term psychedelics. Psychedelic means mind manifesting. What comes up? Dreams are psychedelic. We all go into an altered state. The laws of physics don't apply in our dreams. In a dream, when it gets scary, you can wake up.

0:35But when you've taken a psychedelic, when it gets scary, you've got to work through it. Rick Doblin is the founder of MAPS, a pioneering nonprofit transforming the future of mental health by advancing psychedelic-assisted therapy for PTSD and beyond. People think about LSD or mescaline or psilocybin. We call those the classic psychedelics. And those are the ego-dissolving movie, Beyond Your Ego States. Why do some people have bad trips? When you take psychedelic, your sense of self is being weakened. That can be really scary. People have difficult experiences because we are fundamentally overdeveloped intellectually and underdeveloped emotionally and spiritually.

1:13In our first study, which was severe PTSD, 67%, two-thirds of the people, no longer had PTSD at the two-month follow-up. Empathy is one of the most important emotions, and that's something that I don't think that we speak about enough. Yeah, well, one of the things about MDMA that you see in working with people with PTSD is that they often have empathy for their perpetrators. The difference between when people take MDMA for a party or people take it for therapy, there's two main differences. One is that... Firstly, I want to say thank you to tuning in and listening to the show. It means a huge amount.

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2:31Thank you. Rick, welcome to Live Well, Be Well. I'm so glad to be here with you. I am so happy to have you in Vancouver. We're at TED. And, you know, I wish we could look underneath our bums right now and maybe look at some psychedelics and go on a psychedelic experience to have this conversation. Well, have you seen that's how I ended my TED talk? I know. That's why I opened it. I've done my research. Somebody today said the same thing. One of the speakers today was joking about, I now look under your seat. Well, it happened at our talk last night when I was hosting the dinner here. And I think you were then, you were speaking and somebody made a joke of, and if you look underneath your seat, we will all now take some drugs.

3:15Sadly, we're not. We are completely sober with some H2O next to us. But this is something that I have been so excited to talk to you about. Psychedelics is having, I want to say a renaissance, but it is in a real moment. And I know that you've been through a lot in the last 12 months that I'd also like to kind of uncover. I think there's been a lot of hope for a lot of people that this was going to get passed and we're not quite there yet and I want to uncover kind of that journey but I think this is especially I have looked into this a lot in the last 12 months this has been something that I've really wanted to understand more about because I'm so connected to mental health I want to ask you on your kind of journey from the beginning of this to now when was that moment that you first kind of realized and had recognition that this could change the course of how we treat mental health?

4:09Well, I realized that when I was 17 and 18 and took LSD. Well. The very first time, because I went beyond my sense of self. I was scared of letting go, as I described, but I could feel intimations of this interconnectedness. That was what people have talked about for thousands of years, which you can achieve through meditation or fasting. saying it doesn't need psychedelics, but psychedelics have been used throughout history. So it was this idea that there's a world beyond, that I'm part of something much bigger than just birth to death and this isolated individual person, that there's this whole matrix that extends billions of years and all that.

4:51And that sense that when I was first doing this, this was now again 1971, and I'd just been through people going to the moon. and so it was this some of the astronauts were talking about looking back at the earth and how we're all interconnected and so it was this sense of the political implications of the mystical experience whether you receive it through psychedelics or other way once you know we're all connected then it's harder to say you're the enemy you're different from me you're somebody i can dehumanize so i was looking for something because i was scared of i described this fear i was just scared of the holocaust and scared of blowing up the world with the russians with the cuban missile crisis and scared now my own country doing vietnam and that was one of the last years of the lottery so it just was that pretty much and and so much of the 60s was hippies using psychedelics and protesting the vietnam war so i had this thought that the these experiences are potentially very healing culturally and that if more people felt that then it would be a different world can you describe the interconnectedness that you just mentioned because some people might not be used to that terminology but it's something that i'm very aligned with that we're all energy yeah and we are all we're all part of ourselves and one another and if you look at kind of energy in the universe okay like we're all atoms but we i see that we silo ourselves quite quickly especially our mind to our bodies yes yes so can you describe what interconnectedness means like what did you feel when you what was it that epiphany that you had okay so this is um later but i had this dmt experience the first time i ever tried dmt so it was with Terence McKenna, Dennis McKenna, Ralph Metzner, a bunch of the sort of Andy Weil, a group of us doing DMT at Esalen in Big Sur.

6:50And so the first thing I had was this sense that I was, I saw like a vertical line and then a horizontal line, and then it turned red, and then it became cubes, and then it became like an M.C. Escher, kind of where geometry doesn't seem to make sense anymore, and then i was blasted into this other world and then i was feeling like billions of years have gone by to build up our bodies to build life that that i was part of everything everything was part of me that that were all yeah these waves of energy and and that if it had not been for all these billions of years to build up to where we are today and that the arianums often come from stars that have exploded and and so i just had this sense of this interconnectedness and then i had this shocking thought that if i'm part of everything and everything's part of me then hitler is a part of me too and it wasn't out there it's in here and that was shattering so interconnectedness doesn't mean that it's all glory and beauty and interconnectedness we need to own the whole thing and that was really difficult for me but that that's what it means is that we are part of everything and so that makes it so it's harder to say somebody else is all evil or you know somebody else is um and that that's what we have a lot now is the projections you know it's out there but so interconnectedness just means that uh i mean it's sort of obvious i mean we all share we don't create everything we need to live we get it from other people but that when I was 16 years old, I was very scared of the Russians.

8:29So I studied Russian in high school. Also, my relatives had become immigrants leaving Russia in 1880 to America, running away from anti-Semitism. And so my parents sent me to Russia in 1970 with around 60 other U.S. high school students to study Russian. And I'd been terrified of Russians because we're told they want to kill someone blows up and so where we were was this outside of leningradst petersburg and there was this woman my age young girl you know that was working at this hotel and we went for a walk on the beach and i was like you don't want to kill me i don't want to kill you what what is going on here and that was a big wake up like that that we are essentially the same we have different political systems and we have different governments that can be but that that was also a big wake up that this this sort of demonization and fear of the russians to see that um yeah we we were similar very very similar yeah and the fear was driving you and the fear was blocking which is really interesting yeah and it's also the fact that what we see going on in america is really frightening but it's also that people through fear and through coercion end up often doing terrible things it's only the germans could do the holocaust the holocaust could happen in america and you and you see how people are buckled down in fear and and then you've got this external enemy right now it's immigrants and undocumented immigrants so i feel like we all have this capacity for love we all have this capacity for evil we all have this capacity for good so that's that's what interconnectedness means to me that we're all in it together but that we need to choose how we act that the potentials are all there but what we choose to do i think that's the biggest thing the action and the step forward that we're taking i want to talk about all the incredible work that you've done with maps but before we even get to that i think you've just mentioned and you mentioned in our pre-interview that comes out the day before on our substat, The Compassionate Cure, you mentioned about mescaline and trying mescaline when you were 17 at your university.

10:51You then just mentioned LSD. I know a lot of your work primarily focuses on MDMA. Let's just talk about the term psychedelics. And for anyone who's listening, and you also mentioned DMT, let's talk about some of these components, like what sits under the term of psychedelics. Okay, so my main work has been trying to sort of mainstream psychedelics. And so one of the ways that it's been helpful to do that is to expand the definition of what is a psychedelic. so stan groff who's my mentor and who's one of the leading lsd researchers in the world the founder of transpersonal psychology the co-founder which is also about our interconnectedness there's this once lsd was criminalized and many people who were involved in psychedelics went into meditation he developed hyper hyper ventilation he calls it holotropic breath work so that you can have a psychedelic experience without a drug just by breathing.

11:50I can tell you that is true. I've done a lot of polytrophic breath work. Yeah, and dreams are psychedelic. Interesting. Yeah, because we all go into an altered state at night, and we operate in different ways. The laws of physics don't apply in our dreams in different ways. But dreams are this. So psychedelic means mind manifesting. What comes up? So fasting can be psychedelic. Even if you know this, some of the Native Americans use pain through the sun dances where they put little hooks, barbs in their muscles and they dance until the barbs pull out. Yeah. So people have used all sorts of things.

12:31So I want to move psychedelic away from just drugs to all these tools. Experiences that are mind manifesting. So, and when you say dreams, then everybody feels like, oh, maybe psychedelics aren't so scary because I have this. Lucid dreams? Lucid dreams are just any dreams. Yeah. The difference I would say is that in a dream, when it gets scary, you can wake up. But when you've taken a psychedelic, when it gets scary, you've got to work through it. You've got to do the work. You've got to do the work. Yeah. Okay. So that's really important. Other people have said MDMA is not a psychedelic. Well, that was also a distinguishing question I wanted to have to you because I naturally wouldn't have said that MDMA wasn't psychedelic, but you would.

13:12Well, I would. And I think that it's mind manifesting. So the question is, people think about LSD or mescaline or psilocybin as the classic. So we call those the classic psychedelics. And those are the ego dissolving, move you to this sort of beyond your ego states. and so I think ketamine can be psychedelic MDMA so it's again a way to say there's a range of different things that so it's very true that MDMA is different than the classic psychedelics but I think broadening the term is a way to help people grapple with it and accept it and your work is about well first of all congratulations it's been 39 years yeah yesterday was the anniversary since you created maps yeah tell me the reason behind maps or because well not tell i actually know the reasons but tell our listeners the reasons behind you created maps 39 years ago yeah well i was from the time that i was really 18 after i had all this trouble letting go i went to the guidance counselor at school and i said help me with my tripping and he gave me a book to read and it was realms of the human unconscious observations from lsd research by stan groff and what was amazing was that this book really helped me decide to focus my life on psychedelics because what it was about was also the research when i read it the the research was being shut down so this was now 1972 the backlash had already happened and research was shut down all over the world but what stan was talking about was a scientific lens so i didn't really trust religion religion is so mythology and and things that you're sort of asked to believe by faith or whatever but a lot of it doesn't make sense so but i trusted the science lens and it was he talked about three basic areas of the mind the first is biographical he called it freudian just to say it's like what is it that happens to our life and how does it impact that Then the second he called Otto Rank was the therapist, it was the birth trauma.

15:20And that we all go through this process where when you're getting born, there's moments where you might think you're dying. It's scary. There's no exit. So there's this whole section on birth trauma that sometimes you can get in touch with. And then beyond that is the Jungian sort of transpersonal states. And that's where there was this idea of this interconnectedness. But within all of that was the reality check of therapy. It was not about all these theories and trying to prove the way it was. It was trying to say, how do you use these experiences and use this understanding of the mind to actually help people?

15:59So that the therapy, you could have endless discussions about different spiritual realms or all this, but what's it for unless it helps people lead deeper lives? so i really i asked my guidance counselor if if i could contact stan to talk to him about how to become a psychedelic therapist and the book was published in 1975 my guidance counselor had a manuscript copy directly from stan and so i wrote a letter to stan so he's md phd he's just leaving johns hopkins i'm a super confused 18 year old and i'm giving asking him for advice on becoming a psychedelic therapist one day and and he wrote me back and and he said it's important what you're trying to do i'm giving a workshop this summer you can come and see it and so i i met him in 1972 for this workshop so it was then that i decided to focus my life on psychedelics okay but i knew i wasn't ready it took me like 10 years to get grounded i had the delusion that i think some people have that the more drugs you take the faster you evolve iron is one of the most common deficiencies that I see in clinic, especially in women.

17:10And it's not just about feeling tired. Low iron can impact your energy, your focus, your mood, and even your immune system. It's something we really need to be aware of because if left untreated, iron deficiency can become very serious. Now, UK data shows that around 20 to 35 % of women aged 18 to 50 do not need the recommended dietary guidelines for iron intake. And if you're pregnant, menstruating, or following a vegetarian or vegan diet, your needs are even higher, and therefore you're more at risk. So that's why I often recommend Spartone. Now this is a naturally sourced iron-rich water that comes from the Welsh hills.

17:52It contains ferrous iron, the most absorbable form, with studies showing up to 40 % absorption, so your body can actually use what it takes in. Now, it's also incredibly gentle. It's one natural ingredient, there's no harsh tablets, and there's no digestive issues. I use it myself, and it is my go-to in clinic. You can pick up Spartone at Boots, and if you've been feeling low in energy, it's absolutely worth checking in on your iron with your doctor or GP. Absolutely. And it's just taking the drugs that gives you the answer, and it's not that. That at all. I completely underestimated the integration process.

18:31I'm so happy you said that. Yeah. Because I think people miss that part out. Oh, completely. Because that's become an ayahuasca trait now, where a lot of people are doing ayahuasca, but the integration part is left out from a lot of their kind of coming back to daily life. Yeah. Well, particularly you go to Brazil or Peru to do it, and then you come back. Yeah. So I realized that I was not where I wanted to be. I needed to do this integration process. So then I spent 10 years really getting grounded, building things. I dropped out of college. I was getting ready to focus directly on psychedelics.

19:06I was trying to get mature enough and comfortable enough in my trips to do that. It took me 10 years. And then I started college again in 1982. And my first semester, I went to spend a month at Esalen in Big Sur, California with Stan and Christina Groff. It was a workshop called The Mystical Quest. and it was really delightful and this woman debbie harlow came by and said there's a new drug it's called adam it's being used as this underground therapy it's not illegal but it's also starting to become a party drug under the name ecstasy and she said how it makes you feel love it makes you feel connected it makes you a better listener and i thought i am in love and i'm a good listener and and then i saw a group of people doing mdma in a circle and they were talking to each other and i was like when you take 250 micrograms of lsd you can't talk for a couple hours you know it's like so i i i love to say that i was stupid enough to underestimate it but smart enough to buy some and i i took it home and i did it with my girlfriend and that That was profound.

20:20It was way more profound than I realized. And we were able to talk about things in a way that I felt I was a better human. I was less defensive, more, we were able to navigate difficult emotions. It was just, so I felt like MDMA is more gentle, but super profound. And I thought it would be the tool that would really go through society more likely first than LSD or psilocybin or anything like that. And I felt like I woke up to LSD after the backlash. Now I'm waking up to MDMA before the backlash. And I thought, okay, now I can get politically involved. And there will inevitably be this backlash on MDMA because now it is being a party drug.

21:02adam was the name the code name for mdma and so i started this non-profit in 1984 before maps and it was to gather support to fight the dea the drug enforcement administration once they would eventually criminalize move to criminalize mdma so the way the world worked at the time is you you had to put in the federal register the dea would put that they are their intention to criminalize something and there would be like a month public comment period with the psychedelic community we had done some underground studies that were safety studies and so I also worked with monks and rabbis and various people who did MDMA to meditate and monasteries and so we had this really sophisticated media campaign so we had this rabbi compare MDMA to the Sabbath we had the monks a brother David Stein to Ross a monk spends his whole life trying to get this enlightened attitude that you can get from mdma he was using it in the monastery to meditate and so we were winning this case and we were winning in the court of public opinion and winning in the courts and the judge said in the end mdma should be available as a medicine which is what we were trying to do but the the administrator of the dea rejected that we sued twice in the appeals courts and won both times but then on the third time we finally lost the dea lawyers figured out how to keep mdma away from being a legal medicine that's where i realized i had to start maps that we couldn't use the legal system we had to go through the fda that would be the only way i thought to bring it back so that's where i started maps as basically a non-profit psychedelic pharmaceutical company and i didn't know that it would ever succeed but i felt that that was the the real doorway and basically the only doorway to people at that time were told that if you take mdma it's going to damage your brain and you're going to have neurotoxicity and you're going to have all these functional consequences and so there's so much fear so scientific research can generate data that can be used to sort of evaluate all these exaggerated drug war propaganda that.

23:14So I started MAPS because I felt like it was through science. And basically it's to go where the suffering is, that people will listen when they're suffering. Other times they might not listen. So that if we can go to try and make MDMA into a medicine to cure certain kinds of suffering. And then the other big issue was, well, it was a strategic sense of all the psychedelics, which would I pick? It was MDMA. And then what should it be for? And at the time we needed sympathetic patients so the main um there was a lot of people from vietnam who had ptsd this is now quite a while 86 now but there were still a lot of people from vietnam that had ptsd that had not been treated so we needed sympathetic patients we needed a disease that was potentially causing suicide that would be very expensive that would lead as you're saying with the stress to lead to all sorts of physical illnesses that was expensive.

24:09And I had worked with a woman in 1984 who had PTSD and saw it helped. So MDMA for PTSD became the vehicle to go through the FDA. I think that's something where I've become really aware of, that there is no treatment legally, I'll put that in, for PTSD. And I think people now still go to the doctors with PTSD, and they're prescribed SSRIs, which doesn't work. Yeah, there was an incredible image of, this was an image of a soldier who was like wading through a river and carrying his gun so it wouldn't get wet, but the river was filled with pills. He was wading through SSRIs because that's all the VA was giving and it wasn't really helping.

24:56No. Yeah. How does MDMA work with the brain and PTSD? Ah, okay. This is an easy one. All right. So the first step is, how does PTSD change your brain? So PTSD is this post-traumatic stress disorder. People are fearful very much of whatever happened before is not really in the past. It's going to happen again. And so your amygdala, the part of your brain that is more processing fear, is hyperactive. There's more activity in the amygdala for people that have PTSD than average normal people. The other thing about PTSD is that it's hard to separate out what's real threat, what's not. People are always triggered by different things.

25:42So there's less activity in the prefrontal cortex where we think logically. So you're sort of short-circuited by your emotions. So you see somebody that looks like somebody that assaulted you, and now you feel like you're about to be assaulted again. if you had a moment to think about it it's a whole different person it's a whole different context it's not that and then these traumatic memories are never really put into the past and so the hippocampus which is the part of our brain that stores memories into long-term storage there's lower activity in the hippocampus and less connectivity between the amygdala and the hippocampus when you have ptsd right so that's kind of how your brain changes and you've got these real circuits that are activating all the time so mdma works great for ptsd but we found later that or not we other people found we felt that if we focus on the healing other people will do the neuroscience so what we know is that mdma reduces activity in the amygdala so that when you are remembering a traumatic memory it's not as fearful mdma increases activity in the prefrontal cortex so you're able to sort of think logically more so and then mdma increases connectivity between the hippocampus and the amygdala so that you're able to process memories and put them into long-term storage then the other big part of what it does is oxytocin so the hormone of love and connection of self-compassion of self-love yeah my favorite one yeah so mdma releases oxytocin and there's a woman gul dolan a neuroscientist who has done studies that show that in mice that the oxytocin is released by mdma and that's what promotes neuroplasticity and that's what we really need with ptsd is that we need to create more of these neural highways and kind of shunt them off from the trauma loop and create new neural highways.

27:40So we're having new processing methods, right? Yeah, you definitely can have one session where you rewire your brain and then if you do the therapy. Now, I should add though that, for example, this woman that I worked with in 1984 who had PTSD, MDMA, by reducing this fear response to traumatic memories can be destabilizing as well as healing so she initially did it with a friend of hers and memories of past sexual abuse came up and it so destabilized her she'd previously attempted suicide she'd been medicated she'd been hospitalized from this trauma and under mdma even in a safe place relatively with a lover these memories came up and she felt that they were overwhelming so she checked herself into a hospital not to kill herself and while she was there they stabilized her but they gave her the same SSRI stuff that she'd had before whatever medicine she didn't think it would work so she was more suicidal when she got out so I I don't want people to think you take MDMA and now all of your problems you can deal with if you're not in a safe therapeutic setting you you can trigger traumatic memories and then they can be overwhelming so it's the context more than the drug that is what produces the healing.

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30:06So what is the context? Because I remember watching in your TED talk, there was different phases and you've also spoken about the integration, which for you, you know, you had to ground yourself in for 10 years. And so I think, you know, so many times when people talk about psychedelics, whether it's on a scientific podcast or more of a societal podcast or a spiritual podcast. We'll talk about the science of the brain and we'll talk about just the experience. But I think we kind of forget that middle ground as the integration. So how does treating somebody with PTSD or potentially other mental health conditions work in an integration process?

30:40Like when do you take the drug? What's kind of the in-between time? Do you then retake it again? Yes. Okay, so our model that was used in phase three is three and a half months of treatment, and during which you only get MDMA three times, one month apart. And there's 12 90-minute non-drug psychotherapy sessions, three for preparation and three for integration after each MDMA session. So the research into psychotherapy outcome research has shown that the most important factor is not the school of therapy, whether it's prolonged exposure, cognitive processing therapy, gestalt therapy, behavior therapy, whatever it happens to be.

31:19The therapeutic alliance is the most important factor. And so what the therapeutic alliance means is it's the sense of safety that you and the therapist are aligned to help you get better and you can trust them and you can feel safe. That's the key factor in therapy. So what we do is we have three of these 90-minute preparation sessions to build the therapeutic alliance. And so the patient tells their stories. The therapist tries to teach them about what MDMA does, but also builds a sense that we're aligned here. And ideally, you have a therapist that can go to the depth of the pain that you're experiencing without being triggered themselves.

31:58so that they get, so that's a big issue for therapists, that they can be exposed to so much pain that if they haven't worked on that themselves, they can get triggered. And then they're not thinking about the patient, then they're thinking about themselves. All right. So the first part is this preparation session where you build the therapeutic alliance. Then we've structured it. We were funded by donations in the beginning. And so our goal was to maximize therapeutic outcomes. and people often who are traumatized have had prior people who develop PTSD often have had multiple traumas in their lives often going to childhood not always you can just be great childhood and then just be traumatized by something that happens but we've created a system where we mostly work with a male female team of two therapists for one person so we're not trying to do what's the least expensive way we can get just good enough results to get it approved we had to overcome a whole social stigma and the whole demonization of psychedelics so we have two therapists often because people will have childhood trauma and you want a well-functioning male female team and of course we'll have we've had studies there are two women two men people can be trans people can be gay does you know but it's this idea that you you've got often this support um that people often didn't have when they were in childhood that can be really helpful so we have two two therapists and then we've made it so it's an eight-hour session so people are used to thinking oh i go to therapists for one hour once a week or something like that when they're doing the trip when they're doing the how much are you giving them what's the dosage well we have learned over time we spent um 16 years from 2000 to 2016 in what's called phase two studies trying to figure out what's the right doses there was enormous known from the underground from the middle 70s to the 80s, but the first MDMA experience is 80 milligrams.

33:58And then to keep it longer, after two hours, we give half the initial amount, and that makes it into an eight-hour experience. Our normal dose was 120 milligrams, 125 milligrams, followed by half of that, but we discovered in one of our studies that really surprised us that the group that got 75 milligrams did really really well so this is sort of their introduction is this 80 milligrams followed by 40 the first session and that's what it is for everybody the second session and the third session they negotiate between the therapists and the patients and they talk about do you want to go higher to 120 milligrams followed by 62 hours later and over 90 go up there and over 90 stay at that level but if um if 75 or you know 80 milligrams seems enough for people they can keep that dose in the second and third sessions as well.

34:51And what happens after? Because I'm thinking you're getting a huge amount of a chemical release into your brain, right? And everyone's going to be thinking, wow, is that going to be quite a heavy comedown? Well, people have often heard a lot about how people are depressed the day after MDMA, and there's this Suicide Tuesdays, people talk about that kind of stuff. But we do not see that. We don't see that more in the MDMA group than in the control group. Part of it is because we start the MDMA at 10 in the morning. The experience is pretty much subsided by around 6 p.m. We often, but not always, have people spend the night in the treatment center.

35:31So we want them to still think about what's happened, not get distracted by going home, going out in traffic and things like that. And then there's integrative therapy the next day. so and then there's weekly integrative sessions before the next the second session so it's this after the therapy becomes the integration process and that's where you're trying to reinforce this neuroplasticity this ability to process information in a different way you're now more open to that for a certain period of time after the mdma so that's where the the difference between when people take mdma for a party or people take it for therapy there's two main differences one is that when they take it for a party they're just looking for the short-term effect they're not looking to learn from it in a sense they're just looking for fun and the second part is when you take it for a party you're looking for good experiences you're not looking for whatever happens and when you take it for therapy whatever emerges frightening pleasurable and often it alternates between that in the eight hours so it's this constant freedom of the patient to go our essence of our therapeutic method is that we help people to heal themselves they're doing the hard work so the power dynamics are that we don't call ourselves guides because we don't know where people need to go they know their unconscious knows they don't even know sometimes their unconscious knows or their body knows or they remember things we call it inner healing intelligence there's we know our body does that heals itself when it's wounded and and the thought is that whatever is emerging there's a wisdom to it and we need to open up to it and so then then you do the integration process which is you talk about what you learned you try to put it into practice and then a month later another mdma experience and what we've seen is that many people go deeper the second experience than the first i imagine because they feel safe they kind of know what's going to happen right yes exactly they're predicting that it's all going to be okay yeah yeah yeah and they know that they can maneuver with it and they also know that if they get into really profound experiences they have the time with an eight-hour session you have the time to say i'm not ready for this and then it comes back an hour later or so and often the the third session many people are pretty much healed you could say after two sessions but there's a the people that have more attachment problems you know they didn't have a real good childhood often they need three sessions some people will occasionally need more but in our protocol everybody had to get the same thing so it's three sessions so having the third session gives people confidence that in the second session they can go really, really deep.

38:17And if they haven't finished everything, then they'll have another opportunity to go deep again. So having the third session makes the second session even more valuable. And yeah, so that's the basic. And what's the success rate? Is it around 80 % that I saw of people that kind of go into these with PTSD? Yeah, well, there's two ways. Well, there's multiple ways to think about what's success. So we work with what's called the CAPS, the Clinician Administered PTSD Scale. So that's the gold standard measure required by the FDA, required by MHRA and EMA, the European Medicines Agency. And so in our first study, which was severe PTSD, 67%, two-thirds of the people no longer had PTSD at the two-month follow-up.

39:04So we didn't want to do a follow-up a week or two after. People would say, oh, it's a psychedelic afterglow, whatever. So 67 % no longer had PTSD, but another 21 % had what's called clinically significant reductions of PTSD symptoms. So they're responders. They still have PTSD, but they've had enough reduction in symptoms that their life has changed in some ways. That's transformative for them. Yeah. So it's 88 % in that sense, 12 % non-responders. The second phase three study that we did, we moved it from severe PTSD to moderate to severe PTSD. And in that, three quarters were severe PTSD, but we had 72 % no longer had PTSD.

39:46And around 15 % also had clinically significant reductions. But in that study, 46... Okay, so in the first study where we had 67%, 32 % no longer had PTSD from the therapy without MDMA at all in the control group. Wow. That surprises me because I feel like people with PTSD don't get on with therapy as well because it kind of cements the trauma. Yes, well, the prolonged exposure and cognitive processing therapy are the two main treatments, non-drug therapies for PTSD. And they have roughly 50 % dropout rates because it's too difficult to confront your trauma. They force you to confront that you've got this hour meeting.

40:27Can you confront your trauma? So when you have the time to come at it, when you are ready for it, and often people go to positive experiences to build strength, then they go to the difficult ones. So, we get really good results in that first study with the therapy without MDMA. That's as good as these other therapies with a lower dropout rate. But then when we did moderate to severe PTSD, we had 46 % no longer had PTSD in the group that got no MDMA at all. And most of them could tell that they had the placebo. And so, people have said one of the criticisms has been that your therapists believe it works, therefore they're biased.