Group Therapy Holds Promise for Psychedelic-Based Treatments
In September 2020, three women and a man, all of them cancer patients suffering from depression, gathered at a cancer treatment center in Rockville, Md, to take a high dose of psilocybin. They prepared for the experience as a group, took the medicine at the same time and returned the following day to talk about it.
They were the first of 30 participants in a clinical trial that explored the safety, tolerability and efficacy of psilocybin-assisted therapy for major depressive disorder in patients with malignant cancers. Sunstone Therapies, a startup company that ran the trial, says it was the first time in the modern era of psychedelic research that patients were provided with group therapy, individual counseling and a psychedelic compound.
Two-and-a-half years later, with the trial now completed, participants still meet as a group for 90 minutes every month on Zoom. The meetings are led by Bill Richards, a co-founder of Sunstone and the company’s director of therapy, and Betsy Jenkins, a therapist and pastoral counselor.
Richards, who has been involved with psychedelics research since the 1960s, says he loves seeing the cancer patients form deep connections with one another. “Those meetings are beautiful,” he says. “They’ve given me a real appreciation of how empowering it is for a cancer patient to help other cancer patients.”
Drs. Paul Thambi and Manish Agrawal, longtime oncologists and co-founders of Sunstone, report that they found a “clinically meaningful change in depression systems” in 80 percent of the participants in their study. While it’s impossible to know whether the group dynamic made a difference, those involved say they believe it mattered.
“Anecdotally, it feels like there’s some additional healing that happens because of the group,” says Thambi. He said a patient in the first group of four was apprehensive at first, but came away feeling like he had “just been to war with these women.” Agrawal says the group approach “extends the caring in a way you don’t normally see.”
Working with groups has another benefit: It helps bring down the costs of psychedelic therapy, a key problem that Sunstone and other developers of psychedelic therapies are trying to address.
“Healing Happens in Community”
It’s no surprise that psychedelic experiences can be enhanced when shared. Traditional cultures that turn to psychedelics for healing or religious purposes typically administer these medicines to groups. Contemporary plant-medicine churches and ceremonial practitioners also facilitate group experiences, as do psilocybin retreat centers in Jamaica where the drug is legal. Nonprofit organizations such as Veterans of War and VETS increasingly take veterans to locations outside the U.S. to seek healing in group settings.
Wyly Gray, the founder of Veterans of War, says their groups provide “a sense of belonging and community and the accountability that comes with that.” Veterans of War has taken four veterans at a time to Peru or Costa Rica to experience ayahuasca. “Healing happens in community. A lot of veterans are dealing with isolation and that was only exacerbated by the pandemic,” says Gray.
For centuries, taking psychedelics has been a “group ritual more than an individual experience,” says Alex Trope, a psychiatrist at the University of California at San Francisco (UCSF) who co-authored a paper surveying research into psychedelic-assisted group therapy in the 20th century. Some of the best-known psychedelics research of the 1960s, including the Concord prison experiment led by Timothy Leary and the Marsh Chapel experiment led by Walter Pahnke and Leary, was conducted with groups.
Yet surprisingly few of today’s researchers into psychedelics work with groups. The Huntsman Cancer Institute in Salt Lake City, like Sunstone, has combined group therapy and high doses of psilocybin for cancer patients, with encouraging results.
Doctors at UCSF completed a clinical trial that provided psilocybin-assisted group therapy to long-term AIDS survivors in San Francisco with moderate-to-severe demoralization. This research found meaningful improvement in the well-being of these participants. Working with the Multidisciplinary Association for Psychedelic Research (MAPS), Dr. Christopher Stauffer, a psychiatrist at Oregon Health & Science University, has secured FDA approval for a trial of MDMA and group therapy for veterans with PTSD.
Sunstone Pursues Therapies for Cancer Patients
Sunstone has now begun new trials to treat patients in groups with psilocybin and MDMA. The company was founded in 2021 by four people who had worked in cancer care for years. Drs. Thambi and Agrawal, who were friends as well as oncologists, grew frustrated because they felt they were unable to fully address the emotional suffering that cancer patients and their families face. “We both had this feeling of disillusionment,” Thambi says.
Kim Roddy, Sunstone’s chief operating officer, had directed cancer care at the Aquilino Cancer Center in Rockville, Maryland where Sunstone is based. Richards was part of a team at Johns Hopkins University that conducted a pivotal clinical trial with patients who had life-threatening cancer. That study, published in 2016, found that psilocybin-assisted therapy produced “substantial and sustained decreases in depression and anxiety.” His son, Brian Richards, who now works at Sunstone, was also a therapist in the Hopkins study.
For Bill Richards, administering psychedelics to cancer patients was nothing new. During the early 1970s, he and Czech psychologist Stanislav Grof provided LSD and a psychedelic compound called DPT (dipropyltryptamine) together with talk therapy, to cancer patients at the Spring Grove State Hospital near Baltimore, which was then a leading center for psychedelic research in the U.S. Earlier research was conducted by Dr. Eric Kast, a Chicago anesthesiologist, who administered LSD as a pain reliever to about 300 patients and reported that they “showed unusual detachment from concern with their physical condition,” according to a 1964 article in the Journal of the American Medical Association.
Before they formed Sunstone, Drs. Thambi and Agrawal studied the prior research, met with scientists at Johns Hopkins, and decided to train as psychedelic therapists at the California Institute of Integral Studies, where Bill and Brian Richards are on the faculty. Roddy, their longtime colleague, proposed that they form a company to develop psychedelic therapy, in part because they all saw parallels between treatment methods for cancer patients and for those seeking psychedelic therapies.
Chemotherapy and psychedelic therapy, Roddy says, both require “teams of highly specialized people with different job functions” who aim to coordinate care in ways that are effective, but also efficient so they can be reimbursed by insurers and accessed by those in need.
Roddy worried that treatment protocols requiring two therapists to spend an entire day with a single patient–the approach taken by MAPS in its PTSD research–would prove too expensive.
“We’re focused on the delivery of care,” Roddy says. “We need to think about what a sustainable, scalable model looks like.”
Sunstone Pursues Continuing Clinical Trials
In its first clinical trial, Sunstone administered 25 mg doses of psilocybin simultaneously to four patients. Each had a dedicated therapist, with a fifth therapist providing guidance and relief as needed. The company also wants to investigate just how much preparation and integration is needed by patients, with an eye on costs. “There’s been lots and lots of debate about that,” Brian Richards says.
Sunstone’s approach has attracted partners to help finance its work. The 30-person cancer trial was funded by COMPASS Pathways, which is researching psilocybin therapy for treatment-resistant depression. COMPASS is also sponsoring a follow up trial with Sunstone. Sunstone has FDA approval to begin a new trial using LSD to treat chronic anxiety, which would be funded by the startup company MindMed. The LSD study will not be restricted to cancer patients.Sunstone is also part of an expanded access program sponsored by MAPS to treat veterans with treatment-resistant PTSD with MDMA.
Also underway is what’s called a dyad study in which MDMA is given simultaneously to a cancer patient and a close relative or friend. “There’s grief work to be done by both,” says Bill Richards. MDMA, which is not a classic psychedelic, builds trust and connection and often helps people become more loving, he says.
After decades in academia, Richards, who is 82, says he likes working with the close-knit team at Sunstone, which has 16 employees. “The lack of bureaucracy is a wonderful thing,” he says.
The company operates out of a newly-built set of offices and treatment rooms with minimalist decor, soft lighting, curved walls and light wood, all of it expressly designed for psychedelic therapy. It’s been named the Bill Richards Center for Healing. “I don’t know why they couldn’t have waited until I died,” he jokes.
So far, Sunstone has funded its research and operations through sponsored trials, philanthropic donations and investments from friends and family. Supporters include Michael Aquilino, a real estate executive who was the lead donor for the cancer center that bears his name, and the Bob and Renee Parsons Foundation, which funds psychedelic therapy for veterans.
Financial Models for Group Therapies
It’s unclear, even to insiders, precisely how Sunstone intends to become a profitable business.
Thanbi says the company plans to support “various aspects of care delivery.” They could train therapists and support staff, create platforms to monitor and improve care, and develop or license regional “centers of excellence.” These centers are envisioned as places where psychedelic therapy can be provided, not just to cancer patients, but to anyone in need of healing.According to Sunstone, they could offer services across the psychedelics supply chain, consult with pharmaceutical companies and produce training videos for patients and their families.
Matias Serebrinski, a venture capitalist at PsyMed Ventures, says PsyMed and other investors are interested in group therapy. “The benefits include cost effectiveness [and] a feeling of connectedness among patients,” he says. “We see a world where one-on-one works for some patients and diagnoses, while the group therapy model will work better in other cases.”
Researchers are experimenting with various permutations of therapists, patients and groups. At the Huntsman Cancer Center, for instance, the treatment plan calls for a one-to-one therapist to patient ratio. Four patients were given psilocybin at the same time in semi-private bays in an infusion room ordinarily used for chemotherapy. One said afterwards that “the stories and the healing journeys of the other participants were woven into my own story.”
This spring, Stauffer, who’s working with MAPS in Oregon, expects to begin recruiting veterans for a trial that will use teams of four therapists with six patients. The patients will take MDMA together, and hope to benefit from “the unique healing properties of the group,” Stauffer says.
Brian Richards is among those who have become true believers in the power of groups to help people integrate the powerful experience of taking psychedelics. Otherwise, he says: “What do you do with it? How do you honor it? It’s important to be able to share the positive and negative aspects of the experience.”
Image: Sunstone Therapies