Psychedelics are gaining in importance as potential treatments for certain mental illnesses and could soon be prescribed by doctors in some states. As clinical trials of psychedelics continue and legalization efforts grow from success to victory, schools are intensifying their efforts to train the therapists and practitioners who will administer them.
Psychedelic therapy is not nearly as easy as filling out a prescription and taking a pill at home. Instead, giving psychedelics — such as psilocybin, the ingredient in “magic mushrooms,” among others — can be a days-long experience in which the patient is constantly monitored by trained doctors.
Janis Phelps is at the forefront of training these practitioners. As a clinical psychologist, she now founded and leads the first accredited psychedelic therapy training program in the USA at the California Institute of Integral Studies. The University of San Francisco opened its doors in 1968 and offers courses in psychology, counseling, spirituality, and Eastern medicine.
The CIIS has trained around 800 students in the psychedelic program since 2016, Phelps said. And as susceptibility to psychedelics increases, more practitioners are seeking lessons. The program tripled in size after adding a training location in Boston last year, she said.
Phelps estimates that at least 8,000 newly trained therapists will be needed over the next ten years.
“We decided we needed to train so many therapists, and there are so few people in the world who know how to use that effectively, that we started training people even before it was legal, unless they took part in a research study,” said Phelps.
The psychedelic therapy program includes 150 hours of lessons and several personal training sessions. Many students are licensed therapists, psychiatrists, and doctors. Social workers, dieticians, ordained ministers, and people in other nonmedical professions may also apply.
Psychedelische Medikamente könnten helfen, Abhängigkeiten zu behandeln, zeigt eine Studie
Universities like CIIS, says Phelps, teach the methods used in clinical trials to administer psychedelics and monitor participants — protocols approved by the Food and Drug Administration.
In addition to monitoring patients for safety concerns throughout their journey, students are also taught to support and validate emotions that arise during the experience, rather than trying to influence the patient’s experience themselves, said Dr. Anne St. Goar, a former family doctor who was among the first CIIS accredited doctors and now runs the training center in Boston. Unlike talk therapy, patients are encouraged to silently process their thoughts while the therapist watches. When needed or desired, the therapist takes on a more active role by talking to his patient, calming him down, or holding hands with him in agreement.
One catch, however, is that, aside from approved use in clinical trials, psychedelics remain illegal at the federal level. This means that CIIS students are trained to conduct safe psychedelic sessions without the existing medications.
In the absence of psychedelic drugs, CIIS students are taught the so-called Holotropic Breathwork, a breathing exercise developed by a psychiatrist in the 1970s and, according to CIIS graduate Dr. Yvan Beaussant, a palliative care physician at the Dana-Farber Cancer Institute at Harvard, “uses music and breathing techniques to trigger a psychedelic state.” A 2018 report published in Frontiers in Human Neuroscience hypothesized that breathwork could alter activity in the same brain network associated with sleep, meditation, and psychedelics.
Starting in January, CIIS graduates can apply for practice in Oregon, the first state to legalize supervised psilocybin sessions. Moderators must complete an approved training program, such as the one offered by CIIS, pass an exam, and pay license fees. And licensed centers in the state will eventually serve as experimental training grounds for future students.
Oregon officials hope the state “shows that we’re doing this in a safe way and can really help people with their healing and wellness — and promote more options for people looking for another option,” said Angela Allbee, department manager of Oregon Psilocybin Services.
So why the growing interest in using psychedelic drugs for mental health?
half a century, the federal government has regarded psychedelics as drugs of abuse for which “there is currently no recognized medical benefit.” In the 1950s, however, psychedelics caught the attention of the medical world. Early research suggested that in the right environment, some hallucinogens increase empathy in therapeutic work and are effective in treating a wide range of hard-to-treat mental illnesses, including alcoholism.
Studies came to a standstill in the 1970s after psychedelics gained a reputation as dangerous recreational drugs. But scientists from Johns Hopkins University and New York University revisited their medical potential at the end of the 2000s, heralding a renaissance in psychedelic research.
Until 2017, the FDA had classified MDMA — also known as Ecstasy and Molly — as a “breakthrough therapy” because it has the potential to treat post-traumatic stress disorder more effectively than existing options. Of the 12 million adults in the US who suffer from PTSD in a given year, 5 out of 10 respond to talk therapy and 4 out of 10 are estimated to achieve remission with medication alone.
A clinical trial by the Multidisciplinary Association for Psychedelic Studies, a nonprofit organization that raises money for psychedelic research, found that talk therapy using MDMA was twice as effective in treating PTSD as talk therapy alone. The group completed data collection for their second phase 3 trial — an advanced phase of drug testing that compares them with existing treatments — in November. In 2023, MAPS is expected to submit its data to the FDA for a possible approval review.
Several other clinical trials have found therapeutic uses for another psychedelic drug, psilocybin. A recent study from the NYU Langone Center for Psychedelic Medicine found that two doses of psilocybin combined with therapy helped reduce alcohol consumption in people with alcohol abuse over eight months. Another found that psilocybin helped cancer patients feel less stressed about their condition. A large clinical trial is due to begin at the end of the month to see whether psilocybin can treat depression when other approaches have failed.
Switch on, switch on, get off?
Treatment with psychedelic drugs is not as easy as giving the patient a pill to take at home, and it is not for everyone. Psychedelics can produce profound visual and sensory distortions as well as emotionally challenging experiences for patients. Harmful drug interactions can also occur when the user is taking certain medications. Therefore, patients in clinical trials are examined before they start.
Half a dozen psychedelic-trained therapists who spoke to CNNBreakingNews.net said that the course of a trip depends largely on the “set and setting” — the mindset with which the patient begins treatment and the physical environment in which they find themselves. For this reason, patients lie down and dim eye screens and headphones in a room that looks more like a cozy cave than a hospital room during the medication session.
A session with MDMA or psilocybin can last up to eight hours. During this time, the patient can review events and emotions once again with the support of the therapist. In clinical trials, therapists also work with participants a few sessions before taking the medicine and several sessions afterwards to process the experience.
This experience “strangely resonates with most people in a unique and meaningful way,” said Beaussant from the Dana-Farber Cancer Institute, which is researching psilocybin to alleviate end-of-life suffering. “People are usually able to better communicate areas of their psyche that feel unresolved and to process trauma or grief.”
We have a long journey ahead of us
As the largest clinical trial of psilocybin to date is due to start this month, several countries have tried to ease restrictions on this substance in particular. Voters in Oregon passed a measure in 2020 to legalize supervised use of psilocybin by adults. And in November, Colorado was the second state to do so.
But much of the fine print about how and which patients will have access to psychedelic therapy and under what conditions must be decided by the FDA.
A letter from the US Department of Health and Human Services in May pointed out that the Biden government is considering setting up a federal task force to solve the complexities of approving psychedelic drugs. And state-issued groups in Oregon and Colorado are tasked with familiarizing themselves with the details of approval, dosing, and other protocols.
Kevin Franciotti, a licensed addiction counselor in Denver who is trained in the off-label use of ketamine in psychotherapy, said the increasing demand for psychedelic therapies is a double-edged sword.
“Patients will be very happy about this and then suddenly be very disappointed and frustrated because there may be a significant shortage of qualified doctors outside the big cities,” he added.
Franciotti supported the move to legalize psilocybin in Colorado and told CNNBreakingNews.net it was the state’s chance to provide residents with alternative treatment options and to take action against existing drug policies.
With renewed attention to psychedelics in medicine, some psychiatrists are questioning how drug regulations, which still make psychedelics illegal at the federal level, are affecting research.
“There are a lot of psychedelics out there and no one is researching them,” said Dr. Franklin King IV, emergency psychiatrist and training director at the Center for the Neuroscience of Psychedelics at Massachusetts General Hospital. “It’s difficult to study drugs with limited safety data and get FDA approval, so the hurdles are high, even for psilocybin.”
“Legalization is consistently the biggest barrier to psychedelic research,” King said, adding that it can often be easier to obtain funding to research other psychoactive drugs that are known to be harmful, such as opioids, than to obtain remedies for psychedelics. “Psychedelics won’t eradicate or replace all of these other treatments we have, but they have huge benefits and demand.”