Therapists See Benefits and Risks in Psychedelic Therapy During Covid-19 Crisis
Covid-19 has uprooted life for many, as we hunker down indoors and physically distance from friends and loved ones. During this unprecedented global crisis, many people are feeling uniquely challenged by the anxiety and uncertainty surrounding the pandemic. Psychedelics can potentially offer tools for processing difficult emotions and navigating complex psychological terrains, as proven in a plethora of recent human trials, and countless experiential anecdotes through human history. The perspectives these experiences bring may be helpful to people looking for ways to cope with the mental impacts of the pandemic.
Lucid News spoke with therapists who work with psychedelics-assisted-therapy using MDMA and ketamine about the pandemic’s impact on their work. Along with them, we spoke with therapists whose work is oriented around integrating the psychedelic experience. They spoke to the lessons psychedelic substances might offer about how to carry ourselves and remain grounded during the uncertainty of a global crisis, while cautioning that taking psychedelics during a global pandemic may be risky.
MDMA-assisted psychotherapy “needs to be in the room.”
In the case of MDMA-assisted psychotherapy, many patient and client sessions have been suspended due to the high risk of exposure to Covid-19.
The Multidisciplinary Association of Psychedelic Studies (MAPS) is a research and educational organization that is currently hosting their Phase 3 program of MDMA-assisted psychotherapy for PTSD at 15 sites in the US, Canada, and Israel. In a statement released on Tuesday, they stated that all of their “clinical trials enrolling healthy volunteer participants are temporarily postponed.” For trials treating patients with PTSD, the “risks and benefits of ongoing participation” are being determined on a case-by-case basis. Only half of their study sites are continuing with in-person sessions using MDMA or placebo, a number that MAPS says is “likely to decrease” if risk of exposure to the virus worsens.
In order to mitigate the stress of having to pause therapy, and to provide support for the new set of challenges posed by the pandemic, Alex Belser, a study therapist for MAPS’s Phase 3 clinical MDMA trials, says that therapists involved in the study have maintained regular contact with study participants “at least once a week, if not more.”
While traditional talk therapy can be shifted to an online teletherapy session, MDMA-assisted psychotherapy doesn’t lend itself to these formats. Sessions involving the use of MDMA are typically long, lasting around 6-8 hours. Often, repressed trauma and emotions rise to the surface, which can be intense and overwhelming for a patient who is in an altered state of consciousness. MDMA-assisted therapy requires in-person oversight and the guidance of trained therapists in order to be safe and effective.
“You need to be in the room,” says Belser of MDMA-assisted psychotherapy. He explains that prior to the session, patients and clients discuss consent and what kinds of touch, like a supportive hand on the shoulder or an embrace, the patient is comfortable with. “That sort of physical comfort can be so meaningful and essential during a journey.”
An underground MDMA therapist, who preferred not to be named, says that underground therapists have shut down their practice “altogether.”
“The work is intimate,” they say. “Ninety-percent of it is just the presence of another human being on your side, warmly engaged with you. I can’t imagine this work being done remotely at all.”
Ketamine-assisted therapy goes online.
Therapists working with ketamine, however, are adapting their therapy practices to social distancing by transitioning to teletherapy sessions.
Robert Grant, vice president of the American Society of Ketamine Physicians, Psychotherapists, and Practitioners, and professor of medicine at the University of California, San Francisco, says that some practices are transitioning from intravenous infusions and intramuscular injections to lozenges that the patient can take at home. He says that during teletherapy sessions, the patient must have a sober sitter with them, so they can get additional help if necessary.
Unlike other psychedelic substances, ketamine can be reoriented around a teletherapy set-up. While MDMA sessions can be lengthy, ketamine lasts for about 1-1 and 1/2 hours. The sessions, including a preliminary 15-20 minutes to set the stage and 20-30 minutes at the end to begin the integration process, last about 2 hours total.
Because of ketamine’s dissociative effects, it’s less likely than other psychedelic substances to make people feel like they need to get up and move around, according to Grant.
“Ketamine, especially in psychedelic doses, is dissociative,” says Grant. “The mind separates from the body, and they don’t move around a lot. They just lie there.”
Jessica Katzman, a psychologist and cofounder of Healing Realms, a ketamine-assisted psychotherapy practice in San Francisco, says that Healing Realms has begun a slow and careful transition into teletherapy sessions.
“We have to assess whether someone is a good fit for doing it at home,” says Katzman. “Is there suicidality? What’s the severity? Do they have a safety or support person to have outside the room to make sure there are no distractions, and that they’re safe?”
Katzman calls the transition to teletherapy an “organic, intuitive process” that relies on open conversation between providers and clients. She says that preparation and building a bond of trust between the therapist and patient, already an integral part of therapy, is “all the more important as we move to online work.”
Integration work – translating the experience afterwards into one’s life – plays a major role in the process. “It’s really important that people don’t just get left alone in their houses. We do next-day follow up calls, and have once-a-week integration sessions,” says Katzman.
According to Grant, the need for ketamine has never been greater. “Ketamine is highly effective therapy for suicidality, and suicidality has been on the rise since the epidemic started,” he says. Data obtained by the Center for Public Integrity and Columbia Journalism Investigations shows that the federal Disaster Distress Helpline “answered roughly 7,000 calls and received 19,000 text messages in March, a more than eight-fold increase from February.”
Studies have shown ketamine to be effective in relieving patients of treatment-resistant depression. One study, “Replication of ketamine’s antidepressant efficacy in bipolar depression: a randomized controlled add-on trial,” conducted in 2012, concluded that ketamine “rapidly improved suicidal ideation” for the subjects.
Grant says the main reason for ketamine therapy sessions continuing online is the urgency for them. “If someone is very depressed, we need to take that seriously as a life threatening illness.”
Psychedelic tools for coping with Covid-19.
The psychedelic experience can be deeply transformative. One clinical patient said they “became a different person” after the experience, reports The Guardian. Lucid News asked therapists about the insights their patients drew from sessions that could help guide us in cultivating self-care practices to stay grounded during the pandemic.
People self-isolating are likely spending a lot more time with themselves than usual. Grant says that this “creates an opportunity for us to go inside and say, who is this being? It can be frightening.”
Ketamine therapy can help patients feel more accepting of themselves. “Ketamine can give people the sense that who they are is beautiful and that they don’t have to strive to be perfect, or better than they are,” he says. “They can take genuine pleasure in being who they already are.”
Another natural response to self-isolation is feeling stir crazy, especially when there’s no discernible end in sight.
“One of the takeaways people have from psychedelics is an enhanced relationship to nature,” says Ingmar Gorman, site co-principal investigator and therapist for the MAPS Phase 3 clinical MDMA trials. “As we practice social distancing, people may assume that that means they have to stay home. Being outside and connecting to nature is an important kind of self-care, and a good way of coping, as long as we take proper precautions.”
Rachel Harris, PhD, who privately practiced therapy for thirty-five years working with people interested in psychospiritual development, and authored the book Listening to Ayahuasca: New Hope for Depression, Addiction, PTSD and Anxiety, compares psychedelic therapy with Vipassana meditation.
“One of the insights that comes out of a psychedelic therapy session is the capacity to self-observe, and self-reflect,” she says. “The person sitting doesn’t identify with what’s coming up, just notes it. That little bit of distance from the emotion or experience allows the person to not get so overwhelmed and carried away.”
This kind of mindful self-observation can be helpful when one is descending a rabbit hole of fear, she says. “Take a breath, feel the temperature of the air on your skin, your feet on the ground, to get back to the here and now. This is a time for the present.”
The preparation (like setting intentions, curating the music and environment, and bringing a meditative awareness) that goes into psychedelic therapy sessions could also be incorporated into our everyday lives, says Andrew Tatarsky, founder of the Center for Optimal Living, an NYC-based treatment and professional training center whose “Psychedelic Education and Continuing Care Program” assists people seeking to integrate their psychedelic experiences.
“I’ve sometimes wondered how much the value of psychedelic experiences has to do with all the preparation and intention that goes into it,” Tatarsky says. “How often do we set aside a day where we come together with a group of loved ones with the intention of deep exploration, group sharing, and processing, with someone guiding it?”
Given the fact that most of us are confined to our homes, he says people could gather virtually, preparing for it the same way they would a psychedelic experience.
Tatarksy also says the psychedelic experience can be “transcendent, an experience of being connected to something greater and more universal,” and that we can work on maintaining it through self-care practices.
“We don’t live in that place all the time. But we can work in our daily lives to stay connected through practices like yoga, meditation, self-compassion, and connection to nature. Even if we don’t feel it in an immediate sense, we can recall it,” he says.
For all of psychedelic medicine’s “heart-centered transformation,” it can also be a “confrontation with death,” says Belser. He says the experience could be thought of as a “death rehearsal.” He is referring to the phenomenon known as “ego death,” in which an individual experiences a complete loss of subjective identity.
“[Ego death] allows us to come into an understanding of ourselves that is far broader and deeper than our tiny little brains,” he says. “Many people come out of it feeling deeply connected to one another, and that the illusion of their separateness has been bridged.”
Belser suggests that the threat Covid-19 poses could be an opportunity for us to confront our own mortality, and reassess our values.
“We may learn once again what is most meaningful in our lives and in the world,” he says.
Ketamine in particular may bring up “themes of death and dying” because of its “liminal” quality, says Will Barone, a psychologist at Healing Realms. He says that in certain dose ranges, ketamine “can be experienced as an in between space, or something very different from the norm.” With increased awareness around Covid-19, these themes may become more prevalent in sessions with ketamine and other psychedelics, and could require attention in preparation and integration, says Barone.
Some patients, however, reported that their ketamine treatment has led to a more life-affirming perspective on the situation, says Barone. “Two separate people, who started with considerable anxiety about the Coronavirus, described experiences that led them to feel more hope about the crisis, and began to see that this time could be an opportunity for healing as individuals and collectively.”
The underground MDMA therapist says that MDMA will have a “huge role” to play after the pandemic due to its effectiveness in treating trauma.
“We’re all living in a traumatic situation, all impeded from living our lives, touching, hugging. This will be a factor in our psychic load going forward,” they say of the pandemic’s impact on our collective emotional and mental health. “MDMA is of prime utility and value in releasing trauma.”
The FDA has shown support for this kind of therapy. In 2017, it granted MAPS breakthrough therapy designation for MDMA-assisted psychotherapy for the treatment of PTSD, thereby expediting the development of MDMA as a legal medicine for PTSD. In a 2017 press release, MAPS said this meant the FDA “has agreed that this treatment may have a meaningful advantage and greater compliance over available medications for PTSD.”
In a study conducted by MAPS in 2019, “Breakthrough for Trauma Treatment: Safety and Efficacy of MDMA-Assisted Psychotherapy Compared to Paroxetine and Sertraline,” researchers concluded that MDMA “has the potential to favorably impact the lives of thousands who suffer from PTSD world-wide.”
Taking psychedelics right now may be risky.
The therapists interviewed for this story recommend people exercise caution when considering whether or not to take psychedelics in the midst of a global pandemic.
“Paranoia and fear is so endemic in the culture right now. It should certainly be a concern when contemplating any sort of strong psychedelic work,” says Belser, who adds that he does not condone people using it without a trained therapist whom they trust. The real threats the health crisis poses to our safety and security can be “terrifying,” says Tatarksy. “Put that under the psychedelic lens, which magnifies things, and it could precipitate real, disorganizing panic.”
It’s also important to be aware that psychedelic work may bring up “dark material,” and open doors that the user “may not be prepared to deal with,” says Katzman.
A challenging experience could be “valuable,” as long as the user is prepared for it, according to Katzman. “It’s about consent, and going into it willingly, knowing it could bring up challenging material,” she says.
Among that challenging material could be past trauma. Tatarsky says that external crises like the pandemic can “dredge up earlier traumas.” “A lot of the intense feelings people have now are not just from the pandemic, but from past trauma. “This activates people on many different levels,” he says.
For the underground MDMA therapist, “it’s a personal decision.” They caution against it “mildly,” saying it is “discretionary to the individual.” They add that MDMA is an immunosuppressant, meaning it reduces the immune system’s strength.
In regards to ketamine specifically, Barone says “there is a relaxing component along with having pretty psychedelic properties in certain dose ranges.” However, he adds that there are potential risks when it is taken outside of a clinical context.
“All psychedelic substances have the potential to magnify emotions, and in a time of increased global stress, grief, and unknown, it is especially important to use them with intention and the proper preparation, support, and integration,” says Barone.