Could psychedelics help patients in therapy? | Benjamin Lewis

0:03This is Ted Health, a podcast from the Ted Audio Collective, and I'm your host Dr. Shoshana Ungerleider. magic mushrooms could be more than just a psychedelic trip in his eye-opening talk dr benjamin lewis explores how psilocybin assisted therapy might be a game changer for many people from patients facing cancer to burned out health care workers and he's not just talking about individual sessions either. Imagine group therapy, but with a psychedelic twist. Curious about how these substances might reshape mental health care, or how a drug experience could bring people together? Dr. Lewis's talk might just expand your mind.

0:52No psychedelics required. And stick around after the talk for my conversation with Dr. Anthony Bach, a clinical professor at the University of Washington who's examining psilocybin as a potential treatment for burnout. But before we dive in, a quick break to hear from our sponsors.

1:19And now Benjamin Lewis takes the TED stage. Many of the mental health struggles that we see in our world come from a loss of connection, a loss of connection to ourselves, to each other, to our communities, to the earth. This loss of connection is so profound that the United States Surgeon General has called it a public health crisis. Thich Nhat Hanh said, We are all connected. When you touch one thing, you are touching everything. Whatever we do has an effect on others. Therefore, we must learn to live mindfully, to touch the peace inside each of us. Psilocybin, the active ingredient in so-called magic mushrooms, is an emerging treatment that is about reconnection.

2:06As a psychiatrist at the Huntsman Mental Health Institute, I have been running clinical trials with psilocybin-assisted therapy, working specifically with two groups, patients dealing with symptoms of depression associated with a cancer diagnosis and frontline healthcare workers experiencing burnout and depression related to the COVID-19 pandemic. These two groups appear very different on the surface, but their suffering is related to a loss of connection. Each person dealing with a cancer diagnosis is unique. However, patients face some common challenges, the uncertainty, the treatments, the impact on family and friends.

2:50This can result in symptoms of loss, grief, depression, anger, feelings of hopelessness and isolation. The COVID-19 pandemic has heightened burnout in frontline healthcare providers who feel disconnected from their work, disconnected from their patients and their suffering. They feel overwhelmed and inadequate. There are clear distinctions between these two groups, but there is overlap in this sense of disconnection. psilocybin is considered a classic psychedelic one of a group of chemicals that acts on the serotonin system in the brain the term psychedelic comes from the combination of the greek word psyche or mind and delos to reveal or make manifest so mind manifesting or expressing this idea that these chemicals can reveal aspects of the mind that we otherwise don't have access to These chemicals cause significant changes to consciousness, including experiences that are referred to as mystical or spiritual in nature, experiences characterized by a deep sense of connection to oneself, to others, and to the world.

4:08And in recent years, there has been a renewed interest in the study of these compounds for therapeutic purposes. using psilocybin in the context of a clinical trial looks quite different than it does in other settings such as recreational use for one thing while classic psychedelics are remarkably safe from a medical standpoint and don't have the same potential for abuse as other substances they nonetheless cause powerful changes to consciousness that can present risk in particular for people with a risk of psychosis or mania. This is not a treatment for everyone. Our studies employ a rigorous screening process to ensure that this is safe, both medically and psychiatrically.

4:57We also embed the dosing session within a therapeutic protocol with preparation and what we call integration sessions following. There are two qualities to this form of therapy that I'd like to emphasize that distinguish this intervention from anything else in psychiatry. The first is the importance of the experience itself. A reliable finding across multiple studies with psilocybin is that specific kinds of changes to consciousness, often with a single session, appear to be important for therapeutic changes. Patients report a sense of connection or the interconnectedness of all things, a sense of preciousness or sacredness to the experience, and a deep sense that this reveals something true or fundamental about the nature of reality.

5:53The second quality is the combination of a drug administration with a therapeutic protocol. This is not simply about taking a pill and expecting a result. This is a form of assisted psychotherapy with specific preparation, support through the session itself, and integration following. One's intentions matter. A patient's mental preparation going into a session can profoundly shape the impact of the experience. How these tools are employed is central to their effect. One current model for understanding brain changes with psychedelic drugs examines changes in connectivity between different brain regions.

6:42With administration of psilocybin, the brain temporarily enters a state of global increase in integration and interconnection across different neural networks that are normally compartmentalized. Simply put, brain regions that normally don't talk to each other are now conversing. Of course this doesn't last, but as the brain cools from this experience, previously rigid patterns of neural connectivity related to the beliefs characteristic of, say, depression, are softened, given some wiggle room, some flexibility is introduced into the system. current models of psilocybin-assisted therapy in clinical trials involve two therapists per person through a process that is generally 20 or more hours our research group at the university of utah has naturally asked the question can we do this in groups to expand the scale on which these promising treatments can be delivered.

7:50Now, in a way, this is nothing new. Psychedelics have been used in group context for millennia by indigenous groups. This includes ceremonial use of psilocybe mushrooms, San Pedro cactus, and ayahuasca, the dimethyltryptamine-containing South and Central American brew. But when we look at modern studies, these have focused on individuals and individual sessions. But going deeper, group process is about connection and shared experience. If these forms of suffering we're looking at in our studies, depression associated with cancer, healthcare provider burnout, are characterized in part by a loss of connection, exploring these tools and supported shared experiences makes sense, potentially enhancing therapeutic aspects of group process that are already there.

8:52Last year, our research group completed the HOPE trial. This was a pilot study of group psilocybin-assisted therapy for 12 patients dealing with symptoms of depression associated with a cancer diagnosis. We ran groups of four participants at a time. Patients with cancer are a well-studied population with psilocybin in individual formats. These previous studies have shown significant and enduring therapeutic effects that have been sustained for years following even a single dosing session. Our study is the first modern trial to employ a full group format. all three of our preparatory sessions, our single eight-hour dosing session, and our three integration sessions were run as groups.

9:45This was a small study designed to look at safety and feasibility, but we found a clear signal that the group format may amplify the sense of connection that we know is important in treating depressive symptoms. The group format requires thoughtful preparation. The neighbor on your right may be giggling uncontrollably, while the neighbor on your left is sobbing. One mantra we use through this process is, all is welcome. All is welcome. We learned this mantra from Mary Kosimano, a mentor of ours at Johns Hopkins. This mantra is about saying yes. It is about opening up to whatever is coming up for you personally, but also what is coming up in the whole room.

10:44All is welcome. The processes of others around you are not a distraction. They are there for you and you for them. In this spirit, our study used a communal music playlist played over speakers rather than individual headphones to emphasize and add to this collective experience. I wonder what this would be like for all of you right now to fully welcome everything coming up in this space. excitement for this event social dynamics of a large crowd your private joys and sorrows your connection with a person on this stage maybe even your anxiety they might screw it up all is welcome our study showed that this treatment can be safely and effectively administered in a group format.

11:55Our participants demonstrated significant improvement in depressive symptoms that was sustained to our final endpoint at six months. Furthermore, participants felt strongly that the group format was a critical component of their process. We are still in the early stages of understanding how to use psilocybin-assisted therapy as a tool in mental health care. The HOPE trial was a small step in the ongoing development of this field towards understanding how to harness and sustain the kinds of connectedness that patients experience and towards expanding access for people suffering with difficult-to-treat conditions.

12:38What if instead of trying to fit psychedelic-assisted therapy into psychiatry, we asked, how can we make psychiatry more psychedelic? Thank you very much.

13:20completed the first ever clinical trial using psilocybin-assisted therapy to treat burnout in frontline healthcare workers. We're really excited to learn more. Welcome, Tony. Thanks for having me, Shoshana. Absolutely. So, Tony, can you start by telling us how you became interested in the idea of psilocybin therapy? You know, I've been an oncologist for many, many years and got very involved in the development of palliative care, which to me was dealing with end-of-life issues, I have seen a lot of suffering around it. And it is one of the places I have felt, in a way, the most helpless, the most unable to reach people.

14:01And then I started to hear about this research using psilocybin therapy, and I heard that it really changed them, and it made them more capable of going to those deep truths, less caught up in all these little machinations about what should I be doing. You know, I live in Seattle and practice there, and I knew that people would be asking me. So I thought, well, if I'm ever going to make a credible recommendation, I need to try it myself. I had never even smoked pot before I did this. And I arranged for a guide to give me the same kind of sequence that is in the research studies. A couple of preparation sessions, then the psilocybin session, then integration sessions.

14:50And I had this deep, amazing experience. And I thought, I want to be part of bringing this into the world in a way that people can access it. Along these lines of suffering, burnout among healthcare workers has been a problem for a long time, but the COVID-19 pandemic made it worse and more magnified. How did your research address this ongoing issue? And why did you think that psilocybin would be a useful treatment for this? Well, when COVID landed in the United States, and remember, Seattle was the first city, right? I was on these emergency response calls with 200 other physicians. And we would be hearing about the latest horror stories of all these patients coming in and then all of a sudden gasping for breath and dying right in front of them.

15:43And the people in the emergency room sounded traumatized to me. No ICU doctors had seen that much death so quickly and felt so incapable of managing what was going on. That made me really think there's this huge grief. Nobody has time to process it. In a way, the same qualities that make psilocybin useful for people who are facing death from cancer, for example, maybe that could make a difference for all these clinicians who are struggling to just go into work the next day. You recently had this study published in the Journal of the American Medical Association, JAMA, but I would love for you to share some of the key findings with us now.

16:32Well, the key finding was a comparison between clinicians. These were doctors, nurses, advanced practice providers, who all got two sessions of preparation therapy, followed by either psilocybin or a placebo. And then they all got three sessions of integration psychotherapy from two therapists. And the main finding was that people who got psilocybin had a much larger reduction in their symptoms of depression than the people who got the placebo. The benefit was in questions like, do you feel sad all the time? Do you feel like things are hopeless? Do you feel like there's any meaning? Do you still enjoy the other things that you are doing?

17:20And in those kinds of questions, which are symptoms of depression, which in this case, I think of as burnout that's progressed to a really significant degree. The symptoms for the people in the psilocybin group were dramatically better. So fascinating. Wow. Walk us through briefly what it's like to be in a trial like this. Yeah, well, first you had to recognize the issue in yourself enough to want to sign up and take a internet quiz. And then you had a phone screen. And then you had an in-person visit with us, with me and my study coordinator. And of course, it turns out there was much more interest in the study than we could accommodate.

18:032 ,200 people applied to get into the study for which we had 30 slots. That's the nature of need that we documented just by starting the study. But in the first preparation session, we would start with, tell us how you got here. What's your professional story? What got you into this work? What did you love about it? And what's happening now? And then the second preparation session was your personal story, which is how did you get into being a doctor or a nurse or advanced practice provider? What made you interested in healing people? Totally outside medicine, but things that influenced you and formed your moral compass.

18:50How would you like to be after this? Like, what is it that you want to explore in yourself? What is it that you would like to understand better about what happened to you? What is it that you'd like to overcome in trying to move forward past whatever you're up against? And so that was the setup for going into the psilocybin session. So what happens during the psilocybin session? a whole bunch of things come up and many of them touch directly onto the issues that you identify. And then you go into your psilocybin session and your mind just puts together all these associations and helps you explore parts of your experience that you don't do in your normal waking consciousness because you're not sure what other people will think.

19:39You're not sure that would be a good thing to really explore, right? And all that material comes up, and it's kind of like this big, complicated dream. All this stuff happens, you're not sure what it all means. And in the integration sessions, which start the day after, we have you tell the story of your trip, and talk about what happened to you and what you saw, and then what you thought about it. And over the next couple of sessions, what we do is help you see your own insights. And then how can you put those into practice? Because people have all kinds of insights, but to make them stick and to make the benefit of this therapy stick, what you usually need to do is build some things into your daily routine or weekly routine that help you remember about what you really learned about yourself.

20:31Because what's interesting about this psilocybin therapy is it's really about finding what you actually know. It's the wisdom within you that comes up. And you not only understand it, but you feel it. You feel it in your body. And that embodied wisdom is what really sticks with you. And so the question later is, how do I hang on to that? Do I do a little mindfulness? Or is it just do I take a walk? Or is it just do I actually take a little time to take care of myself to let myself decompress after a really hard day? Tony, what are some misconceptions about psychedelic therapy that you hope that your research can help to dispel?

21:15One of the big misconceptions that I hear a lot about is, well, I've tried magic mushrooms, and I went to a concert and nothing happened to me. Well, yeah, but it's a totally different experience than when somebody sets you up to explore the issues that are really troubling you. And then during the trip says, go back inside, like look inside yourself, see what is coming up, see what kind of wisdom your body is telling you and your psyche is telling you. Then the second misconception I would say is that, well, I'll just get some mushrooms and do it myself. I'm a clinician, right? I should be able to do this.

21:55You know, what I saw is the kinds of issues that come up. Those are really big issues to handle by yourself. And I think any one of us needs the support of a peer who you feel like has your back. So really, the vibe that we tried to create for these people was like, we're your colleagues. And we know exactly the kind of thing you have been facing. And so what stands out to you in terms of feedback that you receive from participants about their experience with the therapy? And how did the sessions impact their views on their work and on their personal lives? I mean, people had these, I have to say, heartbreaking accounts of what happened to them during the pandemic.

22:40And one of them who is a senior physician in an emergency room said, I feel more disposable than a used COVID swap. It was a whole sequence of what felt like betrayals from the administrative leadership. And this person came kind of in this state of despair, like, how am I going to go on? There was a nurse who said, it seemed to me after a while that I was just participating in torture because there was so much care that they worked so hard on that turned out not to really help people. right? And then there were a bunch of other people who said, you know, I feel really terrible because I go to work and I feel like a robot.

23:22I can hear myself saying the right words and I'm doing the right things technically, but I don't feel anything. And I know that means something is drastically wrong with me. Starting with those kinds of feelings, what happened to those people during their psilocybin sessions was they would be able to go back to some of the situations that haunted them. They would be able to look at themselves in a less judgmental way in terms of what they were able to accomplish and how hard they had worked. They were able to be less critical of themselves in terms of not doing exactly the right thing every single moment.

24:06How did you deal with the stigma around seeking help for mental health issues, especially using psychedelic therapies among clinicians? Well, it was a big issue. There was a chief medical officer in one of the large systems in Seattle who heard about the study. And he said, do you think we should let people come back to work after they've had this therapy? And I was like, oh, whoa. I mean, that's the level of knowledge that there is out there. And so I was very aware of that. And also that in some states, and we have people from all over the country, you have to report to your state licensing board if you have sought mental health treatment.

24:46And it's publicly discoverable. It's on a website for everyone to see. So what we did was a couple of things. One was we didn't diagnose anyone with depression. So we would measure symptoms of depression. And I said to everybody, we are not making an official diagnosis of depression with you. We are just measuring your symptoms. This is a clinical trial that is about symptom control. And you don't have to report this as mental health therapy. You were participating in a clinical trial, right? So that was one part. The second part was we actually got a certificate of confidentiality from the FDA.

25:25That means that we don't have to disclose anybody's names to anyone, even if subpoenaed, so that we could protect the identity of the people participating in the trial. We really worked hard to try to protect the confidentiality for people because we knew it was really sensitive. Oh, so important. And so based on your results, how do you think psilocybin therapy will be used in health care to help folks recover from burnout, from depression, stress in the future? And do you think that studying psilocybin therapy for doctors and nurses will change how health care workers in general view psychedelic medicines?

26:06Well, what's really interesting about this trial is that if you look at the interventions for burnout or depression in clinicians, there's not actually very much that works. And much of the effort in burnout has been on changing health systems with the idea that, you know, it's the environment that you're in that creates the burnout. There has been this idea that it's really the system problem. And I think what this study is telling us is that there actually is another profound effect that is internal to the clinician. It is about how they interpret the events that are happening to them. So I think that's why we are calling it in the paper a new paradigm for addressing symptoms of depression and burnout.

26:52And what I am hoping is that when psilocybin is approved for depression, that it can be used for symptoms of depression for healthcare clinicians who are dealing with all the kinds of struggles that come up for everybody, but for some people turn into things that are really debilitating. And it has huge consequences for them, but it also has consequences for their patients. So I'm hoping that this can be the beginning of a new way of thinking about what could happen for doctors and nurses and advanced practice providers, and also what's possible for them. There is a kind of renewal that is possible for all of us.

27:35Oh, I love that. And so what ways do you think that your findings can help other professions that are experiencing high levels of burnout? Well, I think what these findings are telling us is that the kind of burnout that is turning into depression is a really great point for intervention for psychedelics. The people in my study did not have a history of mental health issues or diagnoses prior to COVID. Actually, without an exception, they were working at a high technical level at the time they entered the study, even though they were really symptomatic. But I think this idea of early intervention in a really stressful situation at a time when you have some substantial symptoms that have turned into something where actually you don't enjoy going into work.

28:26And that is the kind of thing that, you know, lots of us would recognize. And so I think this is a different kind of mental health intervention that could really be valuable for people who find themselves in that situation. Yeah. Okay, Tony, last question for you. What broader implications do you see your research having on mental health treatment and really overall societal well-being? What I see in our culture now is a whole conglomeration of stresses that I think are actually qualitatively different than what we've had before. I think the way social media has changed our nervous systems, the way that our fast-paced lives have undermined the kind of community and informal social structures that we all have or had, the way that even now in the post-COVID era in medicine, the social structures in our hospitals and clinics are not the same.

29:29I work in a safety net hospital in downtown Seattle. And during COVID, massive turnover. And so you go to the nurse's stations now, and where it used to be everybody was kind of chit-chatting and catching up, nobody knows each other. And I think that makes this kind of relational and technical work way harder. And I think that has created this kind of situation where mental health for everybody is now on the edge. And so I am hoping that these psychedelic therapies can create a new wave of change in how we are mentally and how we are present with each other. And then also a way to give us the grounding that it will take to change these systems to more human systems.

30:25We've modeled the modern hospital after a machine. And now we feel like we're all trying to catch up with the machine all the time. And somehow we have to create the possibility of continuity with patients, that there is time and space for that relationship building that we know is so important. That is at the root of the loss of trust that the public has in medicine right now. And so I'm hoping that these new ways of dealing with our own mental health can be part of that. Dr. Tony Bach, wow. Thank you for doing this work. Thank you for having this conversation with me. You are truly leading the way in healing the healers, which will have such an impact on all of society.

31:11So I'm just grateful. Well, thank you so much for inviting me here, Shoshana. It's great to talk to you.

31:23And that's it for today's episode. Thank you so much for listening. TED Health is part of the TED Audio Collective. This episode was produced by me, Dr. Shoshana Ungerleiter, and Jess Shane. Edited by Alejandra Salazar and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lages, Farrah Degrunge, Daniela Balarezo, Constanza Gallardo, Tansika Sung Marnivong, and Roxanne Hilash. If you enjoyed today's episode, rate and review the show on your favorite platform. It helps other people to find us. And I'd really love to hear your feedback. Send me a DM at ShoshanaMD on Instagram.