Psychedelic-Assisted Therapy Explained

1
00:00:00,095 --> 00:00:08,963
In today's episode, we're going slightly off piste from our usual focus on complex
relationships for a special conversation about psychedelic assisted therapy.

2
00:00:09,264 --> 00:00:10,725
We're welcoming back Dr.

3
00:00:10,725 --> 00:00:15,429
Graham Campbell, who has previously joined us as a guest expert on the podcast.

4
00:00:15,710 --> 00:00:23,337
Graham is a psychiatrist and researcher specializing in psychedelic assisted therapy and
is deeply passionate about this emerging field.

5
00:00:23,337 --> 00:00:25,418
So we're really looking forward to learning from him.

6
00:01:14,462 --> 00:01:15,440
Welcome back, Rome.

7
00:01:15,440 --> 00:01:17,725
It's lovely to have you on with us today again.

8
00:01:17,824 --> 00:01:18,776
Yeah, welcome back.

9
00:01:18,776 --> 00:01:20,367
It's good to see you again.

10
00:01:21,350 --> 00:01:24,835
We've waited for this for a long time, so you've got to deliver.

11
00:01:25,093 --> 00:01:27,493
Yeah, it's been in the pipeline for a while, hasn't it?

12
00:01:27,988 --> 00:01:28,778
the pressure's on.

13
00:01:28,778 --> 00:01:29,458
it.

14
00:01:30,579 --> 00:01:35,368
It's a fascinating uh subject, I'm really looking forward to learning more about it.

15
00:01:35,368 --> 00:01:36,832
Yes, likewise.

16
00:01:37,116 --> 00:01:41,521
So Graham, could you tell us, you know, what is psychedelic assisted therapy?

17
00:01:43,199 --> 00:01:46,751
Yeah, so psychedelic therapy, sorry.

18
00:01:47,752 --> 00:01:48,692
Big question.

19
00:01:48,692 --> 00:01:49,793
Absolutely no.

20
00:01:49,793 --> 00:01:50,231
So

21
00:01:50,473 --> 00:02:03,860
psychedelic assisted therapy or psychedelic therapy is when you're using a drug that
changes your mental state, that causes an altered state of consciousness.

22
00:02:05,257 --> 00:02:17,582
you're using that in a therapeutic context, usually with sort of guided sessions with
support with somebody who is either a trained therapist or has a lot of experience in

23
00:02:17,582 --> 00:02:19,683
supporting these kinds of experiences.

24
00:02:19,683 --> 00:02:26,245
But the whole aim is to go into it with an intention for some kind of therapeutic outcome.

25
00:02:26,466 --> 00:02:30,377
So I think in its sort of basics, then that's what it is.

26
00:02:30,377 --> 00:02:33,288
So something that it isn't is

27
00:02:34,559 --> 00:02:46,284
Although people say that psychedelic substances can be therapeutic, it's not necessarily
just taking a psychedelic with friends or by yourself or something like that.

28
00:02:46,731 --> 00:02:47,128
Mm.

29
00:02:47,128 --> 00:02:57,706
difference being very much in a supported environment, a therapeutic environment of which
you're getting what you need to help you through whatever your experience is with an

30
00:02:57,706 --> 00:02:58,954
intended goal.

31
00:02:59,457 --> 00:03:01,028
Absolutely, yeah, yeah.

32
00:03:01,028 --> 00:03:06,340
And there's often a specific intention in some way.

33
00:03:06,340 --> 00:03:18,185
And obviously in the clinical trials, it might be to try and help with PTSD or anxiety or
depression, maybe even OCD or eating disorders or addiction.

34
00:03:18,886 --> 00:03:29,431
So there might be that sort of clinical intention, but sometimes there can be kind of
other intentions that are a bit more, I suppose, psychotherapeutic in there.

35
00:03:29,812 --> 00:03:30,934
in the goal.

36
00:03:30,934 --> 00:03:42,461
So that might be sort changing your relationship with yourself or finding your path
forward in life or unblocking things that are causing difficulty.

37
00:03:42,860 --> 00:03:50,860
So much like when someone attends therapy, I suppose someone might attend because they're
really struggling with some kind of mental health condition or they might come because

38
00:03:50,860 --> 00:03:56,610
they just want to learn about themselves and improve themselves.

39
00:03:56,937 --> 00:03:59,550
Yeah, yeah, absolutely, absolutely.

40
00:03:59,550 --> 00:04:11,152
think, you know, for whether it is with depression or whether it's sort of in times of
one's life, there are times where, you know, things can get quite stuck.

41
00:04:12,194 --> 00:04:17,318
People often approach this with a sense that they really want something to change.

42
00:04:17,514 --> 00:04:18,485
Okay,

43
00:04:18,786 --> 00:04:20,782
some kind of growth, personal growth.

44
00:04:21,043 --> 00:04:22,474
Absolutely, absolutely.

45
00:04:22,474 --> 00:04:33,461
And the word transformation is often used as well, um which I think is interesting, an
interesting term, it's possible.

46
00:04:33,461 --> 00:04:37,402
sometimes, well, probably all of us want to be transformed in some way that's positive.

47
00:04:37,402 --> 00:04:41,596
um But it doesn't necessarily need to be transformation.

48
00:04:41,596 --> 00:04:46,477
can be just some kind of growth, some kind of positive shift.

49
00:04:46,806 --> 00:04:48,530
So what got you into this then?

50
00:04:48,530 --> 00:04:50,102
We've got to ask this.

51
00:04:50,343 --> 00:04:52,797
Yeah, that's good question.

52
00:04:52,937 --> 00:05:07,757
I thought about this this morning actually and I think it's been a, so probably for about
35 years, I hope I don't look old enough to be able to say that, but yeah for about 35

53
00:05:07,757 --> 00:05:17,183
years I've been interested in the mind, in consciousness, in dreams and yeah one of my
first

54
00:05:17,183 --> 00:05:27,123
presentations I ever did in school was about dreams and what they might mean and what they
are and you know this sort of altered state that we all have all the time you know every

55
00:05:27,123 --> 00:05:37,412
well not every night necessarily but yeah so something we weren't very familiar with so
I've always kind of had that interest and as soon as I learned

56
00:05:37,717 --> 00:05:51,484
I suppose from the media and from psychology A level, know, about psychedelic experiences,
you know, seeing footage of Woodstock on telly or, and then reading about psychedelics as

57
00:05:51,484 --> 00:05:58,327
a, what's word, as like a model for psychosis, you know, in psychology and how they were
used.

58
00:05:58,327 --> 00:06:00,948
I was just always fascinated.

59
00:06:01,428 --> 00:06:07,200
it's been an interest of mine for a long time before I became a psychiatrist.

60
00:06:07,200 --> 00:06:07,561
Yeah.

61
00:06:07,561 --> 00:06:19,262
and it's probably influenced in some ways, or it's come from the same place in my mind
that's led me towards psychiatry.

62
00:06:19,923 --> 00:06:29,212
But until, suppose until fairly recently, maybe the last sort 10, 15 years, it's been a
latent interest, something that I've just...

63
00:06:29,909 --> 00:06:40,328
spoken about with patients occasionally when it's come up in conversation, but now the
research has taken off and with neuroimaging research and then the clinical research,

64
00:06:40,328 --> 00:06:43,629
know, it's something I sort of couldn't not get involved with.

65
00:06:44,428 --> 00:06:48,601
Yeah, that opportunity, you could really get your teeth into it then.

66
00:06:49,165 --> 00:06:50,487
Yeah, brilliant.

67
00:06:50,513 --> 00:06:52,007
It's so fascinating.

68
00:06:52,170 --> 00:07:03,129
So in terms of when people come to you and if you're thinking about when or in terms of
the research, how do you decide with people whether that's the route that they're going to

69
00:07:03,129 --> 00:07:06,802
take as opposed to maybe a more traditional therapy route?

70
00:07:07,433 --> 00:07:09,534
Yeah, that's a really, that is a really good question.

71
00:07:09,534 --> 00:07:22,651
So, I mean, in the research, I mean, one thing I'll say is sort of, I suppose, taking a
step back, there are lots of ways that people sort of find themselves, aah you know, with

72
00:07:22,651 --> 00:07:27,424
the opportunity to have psychedelic therapy and across, you know, there's, there's been an
underground...

73
00:07:27,424 --> 00:07:30,197
um

74
00:07:30,197 --> 00:07:34,289
there's been underground availability for years, you know, since the 60s and 70s.

75
00:07:34,289 --> 00:07:45,085
And, you know, that's not easy to come by, of course, and the legality and the ethical
challenges with some of that can be really quite complex.

76
00:07:46,165 --> 00:07:57,781
But in the clinical trials, and this is really the only space that I've worked with these
substances, it's probably more of a...

77
00:07:57,781 --> 00:08:04,707
more of a clinical process in the sense that people are applying to treat a specific
condition.

78
00:08:04,707 --> 00:08:20,221
So the big part of that screening process really is to meet that person, assess them as a
psychiatrist and for there to be a psychotherapy assessment as well, thinking about how

79
00:08:20,221 --> 00:08:23,824
they could relate to the therapists and what kind of

80
00:08:25,429 --> 00:08:37,820
what kind of experience that they might have or any particular challenges in the
relational field with the psychiatrist and therapists.

81
00:08:37,860 --> 00:08:51,032
a lot of it is looking at somebody's medical history, looking at the medicines they're
taking, assessing risk, and really, mean, in the trials, everything is so exacting.

82
00:08:51,032 --> 00:08:51,932
So...

83
00:08:51,968 --> 00:08:52,445
Mm.

84
00:08:52,445 --> 00:09:04,192
criteria, we have the inclusion and exclusion criteria and you know those come from a
protocol and everything has to be absolutely exact and meeting all criteria so actually

85
00:09:04,192 --> 00:09:11,456
very few or a smaller number of people that apply, a much smaller number actually get into
trials which is

86
00:09:12,160 --> 00:09:14,155
Is that frustrating for you in some ways?

87
00:09:14,785 --> 00:09:16,386
It is, yeah, it is.

88
00:09:16,386 --> 00:09:17,817
It's frustrating for everyone really.

89
00:09:17,817 --> 00:09:31,315
You know, I think obviously in clinical trial research there's a desire to kind of get
people into a trial as swiftly as possible for the trial to progress and then the person

90
00:09:31,315 --> 00:09:40,220
themselves wants some intervention and a lot of people when they get to that point of
applying, most people they're not sort of...

91
00:09:41,097 --> 00:09:43,329
enthusiasts in the area or anything like that.

92
00:09:43,329 --> 00:09:46,302
They're just people who really really want some help.

93
00:09:46,302 --> 00:09:47,523
Yeah, really.

94
00:09:47,523 --> 00:09:56,592
So it's actually really hard as a psychiatrist to have to say, even though we don't know
whether it's going to be helpful, it's an experimental intervention.

95
00:09:56,731 --> 00:10:00,557
Really hard to actually say, I'm sorry, you you can't go into it.

96
00:10:00,557 --> 00:10:01,879
But it's that hope, isn't it?

97
00:10:01,879 --> 00:10:10,014
Like you say, even if it's not necessarily, you don't know what the outcome's going to be
to be, to having to say no to somebody who is like you say, feeling pretty desperate,

98
00:10:10,014 --> 00:10:12,486
maybe feeling like they've tried other things.

99
00:10:12,486 --> 00:10:19,284
And also where you potentially know that there could be some benefit for them from it,
that there's that possibility.

100
00:10:19,284 --> 00:10:20,980
I can imagine that's really hard.

101
00:10:21,267 --> 00:10:22,491
It is really hard, yeah.

102
00:10:22,491 --> 00:10:23,194
oh

103
00:10:23,194 --> 00:10:26,938
say, because I think we'll probably have people listening from outside of the UK.

104
00:10:26,938 --> 00:10:34,687
um And we're talking about at the moment in the UK, it's only possible for someone to do
this via a clinical trial.

105
00:10:34,687 --> 00:10:35,702
Is that right?

106
00:10:36,033 --> 00:10:37,833
That is right.

107
00:10:37,833 --> 00:10:51,433
mean, you know, again, there are much less legal routes, which, you know, is not something
that, you know, I ever recommend people do.

108
00:10:52,853 --> 00:11:03,433
But yeah, really, it's only really available in a home office approved clinical trial
that's got all the licenses and the right support.

109
00:11:04,287 --> 00:11:09,224
So it is a really limited option, whereas in other parts of the world...

110
00:11:09,377 --> 00:11:23,754
ah Certainly in America, places, uh certainly on the west coast of America, there are
centers where you can, think Oregon actually is one of the places, there are centers where

111
00:11:23,754 --> 00:11:33,608
you can actually go, you don't have to have a mental health condition, you could go for
personal growth reasons and have a supported psychedelic session.

112
00:11:33,628 --> 00:11:39,211
And then in Australia, ah they've changed it so that in sort of

113
00:11:39,523 --> 00:11:50,637
I think really special cases and when somebody's really tried lots of other options there
is no access to psilocybin which is the active ingredient of magic mushrooms or MDMA

114
00:11:50,678 --> 00:11:51,298
therapy.

115
00:11:51,298 --> 00:11:53,881
um

116
00:11:54,241 --> 00:11:59,901
There's massive cost implications and it's very limited still in Australia.

117
00:12:00,501 --> 00:12:03,841
So, yeah, there are other parts of the world where you can do this.

118
00:12:03,841 --> 00:12:09,061
And in Holland, in the Netherlands, you can have these kind of experiences.

119
00:12:09,061 --> 00:12:17,221
But usually they are very cautious about people who have challenging mental health
problems.

120
00:12:17,221 --> 00:12:23,275
It's more of a sort growth and wellness, experiential kind of approach generally.

121
00:12:23,282 --> 00:12:30,932
Could you share with us what are the substances that are used within the trials then?

122
00:12:31,298 --> 00:12:39,903
Yeah, so the most commonly used psychedelic is psilocybin or variants of it.

123
00:12:39,903 --> 00:12:43,145
So psilocin is one of the active metabolites of psilocybin.

124
00:12:43,145 --> 00:12:47,567
So psilocybin is the active ingredient in magic mushrooms.

125
00:12:50,229 --> 00:12:58,473
people sometimes think that we're actually using mushrooms or extracting psilocybin from
mushrooms, but it's usually more of a synthetic

126
00:12:58,477 --> 00:12:59,414
Okay.

127
00:12:59,670 --> 00:13:06,112
because it has to conform to the purity standards and sort of medicine regulation
standards.

128
00:13:06,212 --> 00:13:12,674
So psilocybin is a really commonly uh used psychedelic in the trials.

129
00:13:12,674 --> 00:13:22,157
um MDMA is one of the other um common ones and that's tended to be used for PTSD.

130
00:13:22,157 --> 00:13:26,592
have been studies that look at uh

131
00:13:26,592 --> 00:13:31,265
MDMA therapy for PTSD.

132
00:13:32,006 --> 00:13:38,750
There's been a lot of work into it and a lot of positive outcomes.

133
00:13:38,970 --> 00:13:51,733
um but there have been challenges from the uh FDA, which is the American Medicines
Regulation Organisation, um challenges about the research and the outcomes and they

134
00:13:51,733 --> 00:13:59,391
haven't approved it, so there's likely to need to be more studies with MDMA and even LSD
and DMT.

135
00:13:59,391 --> 00:14:02,834
um

136
00:14:02,932 --> 00:14:05,683
LSD is a lot like psilocybin.

137
00:14:05,683 --> 00:14:14,488
ah Maybe we can talk a bit more about what these things do, but it's a much longer acting
psychedelic.

138
00:14:14,548 --> 00:14:18,590
And obviously lots of people know about LSD and it's got that kind of...

139
00:14:19,382 --> 00:14:34,330
uh what's the word maybe stigma around it from you know from the 60s 70s uh but it's much
much longer and that's that's um yeah more traditional like psilocybin dmt and 5 meo dmt

140
00:14:34,330 --> 00:14:48,159
which are two different types of of dmt they're much shorter acting um maybe even sort of
half an hour an experience but but often much more intense than or

141
00:14:48,159 --> 00:14:53,248
more, yeah, much deeper and more all-encompassing experience than these other ones.

142
00:14:53,656 --> 00:15:06,757
So how is it chosen then in a way, if you know you were saying that MDMA has been used
more with PTSD, what has been found out to allocate as it were the substance with a

143
00:15:06,757 --> 00:15:13,203
particular mental health issue or the self-development or whatever, how has that decided?

144
00:15:13,466 --> 00:15:20,426
Yeah, so I think that's really come from the experience of these substances over the
years.

145
00:15:21,206 --> 00:15:37,306
When MDMA, I mean MDMA has been around for a long time, a surprisingly long time, but when
it was synthesized in the last century, people were using it for relationship therapy,

146
00:15:38,126 --> 00:15:41,906
relationship counselling because MDMA...

147
00:15:42,466 --> 00:15:56,699
tends to bring on this experience where fear and anxiety are much less of an issue and
people find themselves able to feel more connected to other people in the experience but

148
00:15:56,699 --> 00:16:03,985
also much more able to talk about difficult things and that might be trauma and that might
be difficult relationship.

149
00:16:04,306 --> 00:16:09,109
It is a little bit more openly, a little bit more freely during the experience.

150
00:16:09,434 --> 00:16:19,157
um So MDMA has often been thought and it's much less psychedelic in the sense that you're
much more able to have a conversation with someone.

151
00:16:19,157 --> 00:16:20,939
um You're much more able to...

152
00:16:21,058 --> 00:16:25,439
ah Absolutely, yeah.

153
00:16:25,439 --> 00:16:25,856
It can

154
00:16:25,879 --> 00:16:28,921
be quite psychedelic, but usually it's a lot less...

155
00:16:28,921 --> 00:16:31,841
Yeah, people are bit more sort of in the room and a bit more able to engage.

156
00:16:31,841 --> 00:16:33,630
uh

157
00:16:33,630 --> 00:16:35,462
then I guess for couples therapy, wouldn't it?

158
00:16:35,462 --> 00:16:41,103
That would be very helpful to continue to have to be engaged with it.

159
00:16:41,103 --> 00:16:41,588
Yeah,

160
00:16:41,894 --> 00:16:51,293
and I don't know of any actual, I mean, this is probably my sort of lack of awareness of
it, but I don't know of any large trials that are really looking at couples therapy now.

161
00:16:51,293 --> 00:16:59,521
And maybe that's part of the challenge of getting trials done and approved.

162
00:16:59,954 --> 00:17:08,673
But also maybe it isn't sort of high up on the sort of clinical priority list for certain
companies.

163
00:17:08,673 --> 00:17:15,509
there is, you know, there's quite a bit of anecdotal evidence that, you know, that can be
helpful in that supported setting.

164
00:17:17,031 --> 00:17:23,557
And psychedelics, think the more traditional psychedelics like psilocybin or LSD.

165
00:17:24,436 --> 00:17:35,452
I think, people have, over the years, reported a shift in the way that they think, a shift
in the way that they feel and relate to themselves, other people in the world.

166
00:17:35,973 --> 00:17:51,486
And often, people have described this afterglow, where after an experience, and sometimes
even after quite a challenging experience, people can sometimes feel, I don't know, sort

167
00:17:51,486 --> 00:17:53,359
of quite positive or...

168
00:17:53,389 --> 00:18:03,355
Yeah, I heard of someone who went abroad to do, I think it was MDMA, assisted therapy.

169
00:18:03,476 --> 00:18:07,958
And they described feeling a lot more connected to the world.

170
00:18:09,279 --> 00:18:14,844
And other people, like this sense of love for, we're all the same.

171
00:18:14,844 --> 00:18:17,826
We're all, yeah.

172
00:18:17,826 --> 00:18:23,299
And that gave them, well, less anxiety.

173
00:18:30,358 --> 00:18:42,703
How much have you found in the research that, um I guess there's follow-ups and whatever,
how much has it been sustained, the experience when it's been a positive experience in

174
00:18:42,703 --> 00:18:53,588
sort of one of these ways perhaps you've described and that afterglow, is it something
where people will need to come back and do it again or is it something where it seems like

175
00:18:53,588 --> 00:18:58,629
actually something shifts in that experience and that shift stays?

176
00:19:00,098 --> 00:19:01,281
they become less stuck.

177
00:19:02,132 --> 00:19:08,756
that's yeah, there's lots of parts to that question and it's...

178
00:19:09,908 --> 00:19:13,240
It's a really live research topic really.

179
00:19:13,240 --> 00:19:17,481
um How long is the duration of effect?

180
00:19:17,602 --> 00:19:30,127
And there are studies that are designed at the moment to um really look at that and to see
how long the effect lasts and whether there is benefit to having repeated doses or

181
00:19:30,127 --> 00:19:35,550
repeated dosing sessions with the psychedelic um over about a year.

182
00:19:35,550 --> 00:19:40,312
So people are really looking now at that kind of uh

183
00:19:40,555 --> 00:19:41,705
benefit.

184
00:19:41,906 --> 00:19:54,059
is a, there's, there is a, there is a, people sort of see that there is some, usually some
longer benefit than the ketamine treatment.

185
00:19:54,059 --> 00:19:57,141
So thinking about for depression, you know, the,

186
00:19:57,730 --> 00:20:11,436
probably on average, psychedelic therapy, when it works, and that's an important point to
bring in as well, can have a more sustained benefit than perhaps a ketamine therapy.

187
00:20:11,436 --> 00:20:13,237
Of course, everyone's different.

188
00:20:13,916 --> 00:20:20,900
But if you look at the averages and the duration of effect, it tends to be longer with a
psychedelic experience.

189
00:20:24,704 --> 00:20:34,147
I mean, one thing, one of the thoughts that popped up when you asked that question is, you
know, and I, I've worked in a number of trials now and I'm going to be sort of very

190
00:20:34,147 --> 00:20:35,755
general about this.

191
00:20:35,755 --> 00:20:47,861
So it's not really trial specific, but one of the things, one of the experiences or the
beliefs I've come away with really is that, that these treatments are, are not really a

192
00:20:47,861 --> 00:20:48,411
panacea.

193
00:20:48,411 --> 00:20:51,002
They're not, uh

194
00:20:51,798 --> 00:21:07,772
the evidence seems to suggest from the research that there are some real positives and
some of the earlier studies, know, a smaller numbers maybe sort of designed in a slightly

195
00:21:07,772 --> 00:21:09,413
less rigorous way.

196
00:21:09,758 --> 00:21:11,059
than the later studies.

197
00:21:11,059 --> 00:21:22,728
So if you have phase one trials with healthy volunteers, phase two with people that have a
condition and phase three, those are the sort of really big trials with really big

198
00:21:22,728 --> 00:21:24,549
numbers, multinational.

199
00:21:24,549 --> 00:21:35,717
um And when you get the really big studies, they kind of give you a little bit more
conservative outcomes because you're...

200
00:21:36,288 --> 00:21:47,193
I mean, it's all statistics really, but you kind of take out more of the outlying results
and you get more of a sort of accurate impression of what happens over a population.

201
00:21:48,578 --> 00:21:49,782
And.

202
00:21:49,782 --> 00:21:55,016
You know, there are benefits, but I think there can be a sort of hype around psychedelics.

203
00:21:55,016 --> 00:22:04,802
can be this, or there has been in the media a lot of hype about this sort of magic bullet
approach and this is going to way better than antidepressants or therapy itself or, you

204
00:22:04,802 --> 00:22:06,313
know, all of this, all of this stuff.

205
00:22:06,313 --> 00:22:15,560
But I think the thing I've come away with is that, you know, this could be a powerful
treatment for some people, but it's not going to work for everyone.

206
00:22:15,560 --> 00:22:18,762
And there are risks associated as well.

207
00:22:19,446 --> 00:22:20,986
which obviously we try.

208
00:22:22,126 --> 00:22:33,470
So it really kind of usually relates to the fact that a psychedelic experience is often
thought of as a psychedelic is like a non-specific amplifier.

209
00:22:33,470 --> 00:22:46,833
um So, you know, people have made the connection that in the past that psychedelics, the
psychedelics are a bit like the invention of the microscope or the telescope, you know,

210
00:22:46,833 --> 00:22:47,614
allows us to.

211
00:22:47,614 --> 00:22:49,460
um

212
00:22:49,460 --> 00:23:10,466
magnify things but ah it's actually exactly yeah well that's it so I'll sort go through
some of the risks in order of severity the most severe possibilities really are that it

213
00:23:10,466 --> 00:23:16,002
triggers a psychotic or manic state ah

214
00:23:16,002 --> 00:23:17,215
You

215
00:23:17,215 --> 00:23:31,146
of my role in the trials has been to really sort of explore somebody's personal history
but also family history and kind of look to see whether there is a risk of triggering

216
00:23:31,146 --> 00:23:34,149
something like mania or psychosis.

217
00:23:34,149 --> 00:23:36,871
So that's a big uh part of it.

218
00:23:36,871 --> 00:23:45,726
That risk is probably not as high as we might fear, but...

219
00:23:45,726 --> 00:23:53,446
again the trials are very careful to to make sure that that doesn't happen obviously we
try not to you know cause any harm to anybody.

220
00:23:53,805 --> 00:23:54,504
Mm.

221
00:23:54,504 --> 00:23:58,738
Beyond that, you know, the experience itself can be very challenging.

222
00:23:58,738 --> 00:24:01,080
It can be frightening.

223
00:24:01,080 --> 00:24:19,385
um I've certainly worked with people over the years in clinical setting where it's left
people with either real anxiety state or dissociative experiences or PTSD even.

224
00:24:19,385 --> 00:24:23,098
So sometimes um

225
00:24:23,394 --> 00:24:30,941
those things can happen and that is much more likely to happen outside of a sort of
well-supported clinical trial setting.

226
00:24:30,941 --> 00:24:32,830
um

227
00:24:32,830 --> 00:24:34,634
in the clinical trials.

228
00:24:35,202 --> 00:24:44,082
I know that it has, you know, I think that's, you know, know across the trials that have
happened that it has done.

229
00:24:45,682 --> 00:24:56,623
And yeah, yeah, so there isn't, it's not absolutely clear, it's not absolutely safe, you
know.

230
00:24:56,623 --> 00:24:58,576
like anything there's risks I suppose.

231
00:24:58,902 --> 00:24:59,698
Absolutely.

232
00:24:59,698 --> 00:25:09,234
in traditional therapy, you know, if you're getting not great therapy or if, you know,
there are things that can not be helpful to clients and leave them with maybe not such a

233
00:25:09,234 --> 00:25:11,395
great experience than when they came in.

234
00:25:11,395 --> 00:25:16,708
So I think I can see that maybe it's slightly different, but I think there are risks in
everything, aren't there?

235
00:25:16,708 --> 00:25:24,653
In terms of that, Graham, and the safety, I think one of the key things about this is that
it's assisted psychedelic assisted therapy.

236
00:25:24,653 --> 00:25:27,274
And I know you were saying that, you know, it's

237
00:25:27,488 --> 00:25:38,127
kind of the environment in which the trials uh take place, that there's a very clear
protocol.

238
00:25:38,127 --> 00:25:48,255
And I'm just wondering about that safety and in a way, suppose, what does a traditional
psychedelic assisted therapy session look like?

239
00:25:48,255 --> 00:25:51,566
If somebody was going to go into that, what would that be like?

240
00:25:51,566 --> 00:26:03,070
yeah, talk us through like how that would look if you were a client or patient, I don't
know what you call someone and they were coming for psychedelic assisted therapy.

241
00:26:03,730 --> 00:26:09,612
Whether it be in a clinical setting or let's say in the future when hopefully is
available.

242
00:26:09,692 --> 00:26:10,872
What does that?

243
00:26:10,885 --> 00:26:12,413
Yeah, what does it involve?

244
00:26:12,832 --> 00:26:20,105
Yeah, so I'll be quite general because there are differences across different um trials
and there will be differences across different services.

245
00:26:20,105 --> 00:26:31,480
um But what it should look like, in my opinion, um and I think what it will, you know,
when it's sort of a...

246
00:26:31,480 --> 00:26:32,831
I'm going to say when.

247
00:26:36,112 --> 00:26:38,853
Yeah, yeah, the moment I'm leaning towards when.

248
00:26:38,853 --> 00:26:40,474
um

249
00:26:40,680 --> 00:26:54,562
and the results are generally positive and there just needs to be enough, it seems enough
eh scientific rigor to be able to be really clear about that.

250
00:26:58,174 --> 00:27:05,714
What it should look like is screening, you know, is to really understand the person that
you're working with really as far as you can.

251
00:27:05,714 --> 00:27:15,456
And I think that really, you know, maybe I'm biased, but psychiatry input there I think is
really quite important.

252
00:27:16,546 --> 00:27:26,290
because of the risk of uh triggering conditions that may not be obvious to the individual
or to some other practitioners.

253
00:27:26,531 --> 00:27:33,034
So I think a full psychiatric history is really, useful.

254
00:27:33,034 --> 00:27:41,977
But then really just getting to know the person, spending some time with that person,
understanding their life experiences beyond that clinical history.

255
00:27:43,042 --> 00:27:50,922
understanding early life experiences, their social network, relational network, you know,
all of these things.

256
00:27:51,822 --> 00:27:54,608
So, you know.

257
00:27:54,608 --> 00:28:00,501
initial part of getting to know the person and getting the history, building a rapport.

258
00:28:00,630 --> 00:28:01,451
Absolutely.

259
00:28:01,451 --> 00:28:13,304
And I will say that I think, you know, there might be a situation where with certain
trials or certain services in the future, there's less emphasis on some of that, you know,

260
00:28:13,304 --> 00:28:19,169
there's when it comes to uh the cost and the time.

261
00:28:19,338 --> 00:28:31,513
you know, always factor in with any kind of care approach, I think, and business needs,
then there is the risk for some of that to be lost.

262
00:28:31,565 --> 00:28:32,528
um

263
00:28:32,528 --> 00:28:34,520
is a difficult thing in some respects, isn't it?

264
00:28:34,520 --> 00:28:42,975
Because I don't know, but I'm thinking about, again, the relationship, the relationship
that you're growing with that person already from the beginning.

265
00:28:42,975 --> 00:28:55,060
And how does that contribute in a way to part of the safety when you get into the room
with them, with the, you know, with using the assisted drugs?

266
00:28:55,456 --> 00:29:10,475
Yeah, I think it's a huge part of the safety because what you're asking people to do is
really go deep into their own mind and their own psyche and have an experience that's

267
00:29:10,475 --> 00:29:12,516
absolutely, incredibly vulnerable.

268
00:29:13,456 --> 00:29:22,942
if it is frightening or if it really brings up emotions which are unfamiliar or really
difficult to manage, especially if it's things like

269
00:29:23,326 --> 00:29:36,129
anger or know even sort of fear and and a lot of distress it can be people can feel
incredibly vulnerable so they have to feel safe to really to really i think get the most

270
00:29:36,129 --> 00:29:39,922
benefit from it and to come through in the same way.

271
00:29:39,923 --> 00:29:41,817
Yeah absolutely so

272
00:29:41,831 --> 00:29:55,500
So in an ideal situation with all the money in the world and no limits, you'd spend that
time to really build the safety, the relationship, get to know your client, them to make

273
00:29:55,500 --> 00:29:57,301
sure they feel safe with you.

274
00:29:57,869 --> 00:30:02,125
And that could take quite a few sessions, I suppose.

275
00:30:02,570 --> 00:30:04,331
Yes, yeah, no it can do.

276
00:30:04,331 --> 00:30:17,266
In the trials we had like a pre-screening call, so we met somebody online first and then
we have a screening day where you know the assessment that I did might have taken an hour

277
00:30:17,266 --> 00:30:22,638
and half, two hours and then there's some psychoeducation and there's a...

278
00:30:22,924 --> 00:30:25,395
the with the therapist, this is one of the previous trials.

279
00:30:25,395 --> 00:30:37,720
um I worked with a good friend of mine, Michelle Baker-Jones, who is a really quite
well-known psychedelic therapist and she's worked a lot in this field.

280
00:30:37,841 --> 00:30:47,795
And so she would often have some time with the person and then we would meet them together
after all the different assessments and there'd be check-in calls and then we'd have

281
00:30:47,795 --> 00:30:48,325
more...

282
00:30:48,325 --> 00:30:49,922
uh

283
00:30:49,922 --> 00:30:59,782
preparation time and you know again time to build rapport the day before the dosing
experience, the day before the psychedelic experience.

284
00:31:01,662 --> 00:31:09,502
And what's really important as well is the sort of co-created collaborative approach.

285
00:31:10,482 --> 00:31:15,682
You know we call it psychedelic assisted therapy but

286
00:31:15,904 --> 00:31:33,513
What it's often not in the trials especially because of the potential to in a medicine
trial introduce bias, which is a whole issue in itself because regulators only assess the

287
00:31:33,513 --> 00:31:37,085
effect of medicines, they don't assess the effect of psychotherapy.

288
00:31:37,866 --> 00:31:38,726
So.

289
00:31:39,266 --> 00:31:44,406
The therapy approach is often very patient centered.

290
00:31:44,406 --> 00:32:00,586
It's often quite non-directive and it's really this, you know, being a presence with that
person to help them feel safe, but also to help them feel able to talk about whatever's

291
00:32:00,586 --> 00:32:01,786
coming up.

292
00:32:02,526 --> 00:32:04,820
so that's...

293
00:32:04,820 --> 00:32:11,403
Once you've guided somebody through a session, there's integration support afterwards.

294
00:32:12,587 --> 00:32:15,155
So there's the preparation, dosing and integration.

295
00:32:15,309 --> 00:32:17,931
Tell us about the dosing then, that part of it.

296
00:32:17,931 --> 00:32:27,580
So you've done that, let's say you've done the, you know, building the relationship and
the assessment and the client is willing and ready to do the dosing.

297
00:32:27,580 --> 00:32:28,971
What happens there?

298
00:32:29,536 --> 00:32:34,728
Yeah, so it's usually in a well protected space.

299
00:32:34,728 --> 00:32:50,073
So even in the clinical trial centers and sites, they have a room that's usually kind of
low lit, comfortable, quiet with music that's playing either through headphones and into

300
00:32:50,073 --> 00:32:50,526
the room.

301
00:32:50,526 --> 00:32:52,154
uh

302
00:32:52,928 --> 00:33:01,748
No, usually not, although sometimes in trials people have actually brought their own music
or been able to kind of add some tunes to a playlist.

303
00:33:01,748 --> 00:33:10,879
But usually the music is, it tends to be, well it's non-verbal, so it's much more sort of
instrumental.

304
00:33:10,879 --> 00:33:13,770
um It's usually slower, more quiet, more...

305
00:33:13,770 --> 00:33:23,198
sort of peaceful, again relaxing, but often with different emotional tones that sort of
run through it.

306
00:33:23,198 --> 00:33:33,166
Sometimes music is being thought of as the sort of extra therapist in the room really,
it's kind of helping to sort of resonate with emotion.

307
00:33:33,727 --> 00:33:42,679
So it's this kind of safe space, certainly without people bursting in or chatting outside
the room or you know, it's kind of quite protected.

308
00:33:42,679 --> 00:33:43,465
Mm.

309
00:33:43,988 --> 00:33:59,922
And then again, with a bit more preparation and really ensuring that the person feels
ready and is able to really make, give their consent to the experience and feel ready to

310
00:33:59,922 --> 00:34:00,802
do it.

311
00:34:00,883 --> 00:34:04,424
They will then have the psychedelic drug.

312
00:34:04,424 --> 00:34:12,246
then really it's a case of oh being there, letting the person have their own experience.

313
00:34:13,930 --> 00:34:20,115
encouraging them to really stay inward and to really be with whatever arises.

314
00:34:20,115 --> 00:34:32,646
uh There's an old, I wouldn't say old, but it's old for me, I suppose going back to 2018,
um this sort of phrase ah in and through.

315
00:34:32,846 --> 00:34:40,673
staying with what comes up, trying not to experientially avoid, not to sort of back away.

316
00:34:40,673 --> 00:34:42,394
um

317
00:34:42,518 --> 00:34:53,554
and sort of try and push out of your mind, try and sort of be with whatever arises, kind
of with the knowledge that you're safe and that, you know, it's something that can be

318
00:34:53,554 --> 00:34:57,466
addressed and something that can be looked in the eye in a way.

319
00:34:57,706 --> 00:35:05,931
And I think, yeah, again, sort of like acceptance really, sort of being able to stay with
it.

320
00:35:05,991 --> 00:35:11,534
And sometimes going through or towards these really difficult things can...

321
00:35:11,838 --> 00:35:20,802
can sometimes be where um emotional breakthrough can come or new insights or shifts of
perspective.

322
00:35:20,802 --> 00:35:34,127
um you know, so it can be really hard work, you know, it's rare that in psychedelic
therapy, I would say that people have, you know, sort of just a blissful, expansive

323
00:35:34,127 --> 00:35:38,849
experience, you know, these things can happen, of course, the sort of more mystical
experience.

324
00:35:38,849 --> 00:35:40,570
um

325
00:35:41,302 --> 00:35:54,198
But often it can be quite gruelling for people because, you know, especially when they're
depressed, things that are really painful and really difficult can surface and we

326
00:35:54,198 --> 00:35:57,727
encourage people to go with it and to be with it and stay with it.

327
00:35:57,890 --> 00:36:05,522
Yeah, I think that, mean, that's, of course, it's going to be in a more perhaps more
intense way in terms of the psychedelic element to it.

328
00:36:05,522 --> 00:36:16,585
But, you know, I'm just thinking about our work and working again, particularly maybe with
couples as well as individuals, but with couples where, you know, ultimately it's going

329
00:36:16,585 --> 00:36:25,177
through often very difficult, vulnerable emotions, sometimes the emotions that have been
buried for a long time or really uh

330
00:36:25,505 --> 00:36:35,388
difficult to express, and especially when it's within a couple setting, to get to a point
where I've obviously done enough work for somebody to feel like they can take those risks,

331
00:36:35,388 --> 00:36:42,270
to be able to share those really painful, difficult, fearful emotions and how that's then
received.

332
00:36:42,270 --> 00:36:52,093
And I suppose I'm seeing maybe a tiny little bit of a parallel, you know, in terms of all
therapy perhaps, and that expression of emotions, which isn't necessarily easy.

333
00:36:52,139 --> 00:37:03,613
But having an environment of safety where you can go through that, where you've got that
support, where there isn't the judgment, where you are sort of wholly accepted and you

334
00:37:03,613 --> 00:37:12,713
only use the word guided in a way through, supported through it, can be so painful but so
powerful.

335
00:37:12,896 --> 00:37:15,139
Yeah, I think you're absolutely right.

336
00:37:15,139 --> 00:37:16,711
There is such a parallel and...

337
00:37:16,711 --> 00:37:19,010
um

338
00:37:19,010 --> 00:37:25,490
You know, there has been people have said, you know, it's like having 10,000 hours of
therapy in one go.

339
00:37:26,570 --> 00:37:28,890
That's hyperbole, I would say.

340
00:37:28,890 --> 00:37:35,890
It's not entirely true, but it can be that powerful.

341
00:37:35,890 --> 00:37:43,910
But that's also where the challenge can come because, you know, in longer term therapy,
there is that time to really build the safety.

342
00:37:43,910 --> 00:37:44,950
is that time.

343
00:37:44,950 --> 00:37:57,852
really get to know the therapist and to have that relationship where you really, you know,
ideally feel you can trust and go to difficult places um and gradually get past your own

344
00:37:57,852 --> 00:38:08,721
defense mechanisms, you know, you're in and in psychedelic therapy or psychedelic assisted
therapy, that's really on fast forward.

345
00:38:08,721 --> 00:38:12,170
That's really ah

346
00:38:12,170 --> 00:38:14,893
Yeah, a sort of very intense version.

347
00:38:15,094 --> 00:38:30,722
And sometimes the difficulties can be when defence mechanisms are kind of blown apart by a
very powerful experience and people are confronted with things that they've long

348
00:38:30,722 --> 00:38:31,300
suppressed.

349
00:38:31,300 --> 00:38:32,430
uh

350
00:38:32,430 --> 00:38:35,859
their defense mechanisms can also be that protection, can't it?

351
00:38:35,859 --> 00:38:38,265
You know, that they've been protected for so long in this way.

352
00:38:38,265 --> 00:38:40,158
What do they then do without that?

353
00:38:40,681 --> 00:38:41,257
You know.

354
00:38:41,257 --> 00:38:52,637
to say something because I know we're talking because we know with we're therapeutic
people we know we know the language but when we're talking about defense mechanisms so

355
00:38:52,637 --> 00:39:05,977
someone who's listening might be thinking what you're talking about but I think what you
said there about someone being in the experience and emotions coming up where normally

356
00:39:05,977 --> 00:39:10,837
someone might then move away from that emotion somehow

357
00:39:11,389 --> 00:39:13,709
in many different ways people can do that, can't they?

358
00:39:13,709 --> 00:39:24,354
Whether it be just pushing it aside, using drugs and alcohol to suppress, engaging in
behaviors to not face it.

359
00:39:24,354 --> 00:39:33,278
All these kinds of things that we as humans do to not go through that pain is partly
what's happening here.

360
00:39:33,278 --> 00:39:34,718
Is that what you're saying?

361
00:39:35,179 --> 00:39:41,079
the substance can drop someone's defenses.

362
00:39:41,079 --> 00:39:45,748
can mean that they are actually facing this pain that's within them.

363
00:39:46,018 --> 00:39:48,582
Yeah, yeah, yeah.

364
00:39:48,582 --> 00:39:54,323
normally they would be doing anything and everything to stop feeling that or seeing that,
it's there.

365
00:39:54,836 --> 00:40:01,969
Yes, yeah, and that's where it is so different from traditional psychiatry in lots of
ways.

366
00:40:01,969 --> 00:40:05,891
know, I think, well, there's a couple of things on my mind.

367
00:40:05,891 --> 00:40:21,058
I mean, traditional psychiatry, and I would say society, um you know, we're, yeah, it sort
of encourages getting rid of those difficult things or, you know, finding ways to...

368
00:40:21,314 --> 00:40:34,954
to cope and to manage and I think, and I'm not down on psychiatry otherwise, that's my
work and I know so many people don't want psychedelic therapy or wouldn't want that and

369
00:40:34,954 --> 00:40:42,974
actually just want to be able to function and feel better and get through the day and be
safe.

370
00:40:44,914 --> 00:40:50,074
But yeah, this is where it is different because...

371
00:40:50,306 --> 00:40:53,027
It really does take you there.

372
00:40:53,027 --> 00:40:56,049
ah But for some people it can take you there too quickly.

373
00:40:57,290 --> 00:41:01,392
The integration process can be really challenging.

374
00:41:01,392 --> 00:41:04,614
ah It can be challenging because...

375
00:41:04,704 --> 00:41:08,117
You know, sometimes people experience a lot of anxiety.

376
00:41:08,117 --> 00:41:19,348
can feel like one thing I was going to say was the the definition of psychedelic or the
actual meaning of the term is mind manifesting or mind revealing.

377
00:41:19,809 --> 00:41:28,337
And and so it is like, you know, you're revealing, you're seeing or experiencing more of
your mind in a sense.

378
00:41:28,665 --> 00:41:29,474
Yeah.

379
00:41:29,474 --> 00:41:35,645
And it's like once you've seen it, it's hard to unsee it sometimes.

380
00:41:35,708 --> 00:41:42,614
Which I guess is why that follow up that you're talking about afterwards is so essential,
following the experience.

381
00:41:43,146 --> 00:41:43,248
absolutely.

382
00:41:43,248 --> 00:41:43,928
Absolutely.

383
00:41:43,928 --> 00:41:44,569
Absolutely.

384
00:41:44,569 --> 00:41:53,716
And I think having that support there afterwards is really important and um managing some
of the distress and anxiety that can come with it.

385
00:41:53,716 --> 00:42:07,185
um And sometimes, know your podcast talks a lot about relationships, but that's sometimes
where some of the instability can arise because

386
00:42:08,758 --> 00:42:10,679
with this kind of experience.

387
00:42:10,679 --> 00:42:13,192
Some people refer to it as like shaking a snow globe.

388
00:42:13,192 --> 00:42:16,115
know, it kind of sometimes brings a lot to the surface.

389
00:42:16,115 --> 00:42:21,710
It shakes things up in your mind and your being and your ways of relating.

390
00:42:21,971 --> 00:42:25,284
And obviously that can be really positive.

391
00:42:25,284 --> 00:42:28,046
That can be helpful for the individual.

392
00:42:28,046 --> 00:42:34,081
That can be maybe seeing certain dynamics that have been unhelpful and...

393
00:42:34,516 --> 00:42:45,099
can be changed and worked with, that can be having a more positive connection with other
people, you know, uh connection with other people in the world and themselves and, you

394
00:42:45,099 --> 00:42:48,830
know, a lot of, a lot of shift that can happen in a positive way.

395
00:42:49,670 --> 00:43:02,324
But even if all of that positive stuff happens and people feel less depressed and it's had
a uh beneficial effect, that can still cause a real shift in the person's social network

396
00:43:02,324 --> 00:43:03,119
and, uh

397
00:43:03,253 --> 00:43:06,720
and the dynamic of a relationship if they're in a couple.

398
00:43:07,424 --> 00:43:08,099
Yeah.

399
00:43:08,099 --> 00:43:18,562
again, that's not necessarily, I mean, I don't know whether it's more extreme in terms of
the intensity of the experience with psychedelics, but I mean, that can also happen in the

400
00:43:18,562 --> 00:43:19,912
course of therapy, can't it?

401
00:43:19,912 --> 00:43:27,204
Where somebody's, you know, worked through stuff and making changes for themselves and
then going into their relationship or whatever.

402
00:43:27,204 --> 00:43:34,466
And that being then unfamiliar for the person they're with and can sometimes be tried to
be pulled back into what they've known.

403
00:43:34,528 --> 00:43:39,133
rather than accepting maybe what these changes are or that they've gone through.

404
00:43:39,330 --> 00:43:39,850
absolutely.

405
00:43:39,850 --> 00:43:44,510
And when it happens quickly, you know, after a powerful experience.

406
00:43:45,170 --> 00:43:46,910
Absolutely, absolutely.

407
00:43:46,910 --> 00:44:00,770
I've certainly known people who, I mean, just to sort of boil it down to its very basics,
have become less depressed and remarkably so.

408
00:44:00,770 --> 00:44:07,150
I mean, we'll say in this situation, this person and then...

409
00:44:07,362 --> 00:44:09,864
another member of the family has become incredibly depressed.

410
00:44:09,864 --> 00:44:22,333
There's something that is evident that exactly the dynamic in the family is affected quite
profoundly.

411
00:44:28,040 --> 00:44:38,606
I wonder also in terms of, just thinking about with what you're saying about depression
and I mean, I don't know enough about the medical side of it as it were, but it seems to

412
00:44:38,606 --> 00:44:48,532
me, and you can correct me on this, that a lot of the medications that have been used for
depression have remained the same for a long time.

413
00:44:48,532 --> 00:44:56,446
That it seems as if there hasn't been a shift in that area to give people a

414
00:44:56,446 --> 00:45:03,671
better experience, if you like, or to help them improve differently their depression.

415
00:45:03,671 --> 00:45:15,520
And I'm wondering if you've experienced that and if you find therefore that your interest
in the trials that you're doing and when you said, you know, hopefully this is when not

416
00:45:15,520 --> 00:45:24,226
if, is there a part of that for you that you haven't seen enough change necessarily in the
standard?

417
00:45:24,483 --> 00:45:28,817
medical input as it were to help people, for instance, who are depressed.

418
00:45:29,962 --> 00:45:33,502
Yeah, that's a great question.

419
00:45:33,502 --> 00:45:36,682
think, so there's a number of things.

420
00:45:36,682 --> 00:45:40,182
It's organizing my thoughts around all of these parts.

421
00:45:41,542 --> 00:45:47,542
it is true that there hasn't been a lot of new developments with medicines.

422
00:45:47,542 --> 00:45:54,702
I know that there are trials in process looking at other types of medical approaches to
depression.

423
00:45:57,884 --> 00:46:10,632
I think, you know, is true, I think, it's very likely that, you antidepressants are
perhaps they've been overused at times and people stay on them for too long and...

424
00:46:10,632 --> 00:46:12,564
and they don't always work for people.

425
00:46:12,564 --> 00:46:20,811
It's very much the case that they might have worked at the beginning, they're not working
now, or they don't quite get people well enough.

426
00:46:21,192 --> 00:46:25,285
But at the same time, I do prescribe antidepressants.

427
00:46:25,285 --> 00:46:30,030
I do see them work for anxiety, for depression, for OCD, for a whole range of conditions.

428
00:46:30,030 --> 00:46:32,978
So I think it...

429
00:46:32,978 --> 00:46:45,835
And one of the studies that I was involved with showed that for the primary outcome of the
study, which is reducing depression, treating depression, the psychedelic experience was

430
00:46:45,835 --> 00:46:59,153
kind of found statistically to be as good as an antidepressant, uh but without the need to
be taken daily with maybe fewer side effects, with other sort of quality of life benefits.

431
00:46:59,153 --> 00:47:01,574
And, you know, it's kind of it's quite nuanced.

432
00:47:01,706 --> 00:47:16,015
um But I think what I find really interesting um is that sort of combination of
neuroscience and biology, you know, I still um really enjoy learning about those things

433
00:47:16,015 --> 00:47:20,817
and thinking about that in the context of depression and mental illness.

434
00:47:21,640 --> 00:47:36,498
the bringing together neuroscience and medicine and biology with psychotherapy and a more
uh an approach that can really help people get unstuck from very um maybe habitual

435
00:47:36,498 --> 00:47:43,602
patterns of thinking very rigid and sort of stuck patterns of being as well as thinking
and feeling.

436
00:47:43,682 --> 00:47:47,300
And so that bringing together of yeah, of

437
00:47:47,474 --> 00:47:49,489
It sounds much more holistic in a way.

438
00:47:49,489 --> 00:47:53,067
You're looking at every aspect of a person rather than just one part.

439
00:47:53,438 --> 00:47:54,909
Yeah, think it is.

440
00:47:54,909 --> 00:47:55,980
think it is.

441
00:47:55,980 --> 00:48:02,465
you know, in my own practice, I've kind of wanted to try and, you know, think about all
these things.

442
00:48:02,465 --> 00:48:08,249
I think there's often a criticism of psychiatry that it's just overly biological and
medical and reductionist.

443
00:48:08,249 --> 00:48:09,380
I don't think it always is.

444
00:48:09,380 --> 00:48:10,540
I think that can be the case.

445
00:48:10,540 --> 00:48:13,052
I think it's also a caricature of psychiatry.

446
00:48:13,052 --> 00:48:15,530
oh

447
00:48:15,530 --> 00:48:26,938
ah Yeah, I think there's something really, really positive about psychedelics in sort of
bringing all of this stuff together and sort of healing a bit of a split really between

448
00:48:26,999 --> 00:48:30,201
sort of science and medicine and therapy.

449
00:48:30,321 --> 00:48:40,409
And the other factor is that psychedelic substances, like a lot of antidepressants, have
been shown to...

450
00:48:40,409 --> 00:48:42,108
um

451
00:48:42,108 --> 00:48:44,582
affect the brain in the same kind of way.

452
00:48:44,582 --> 00:48:50,570
So actually helping with connections in the brain, growing um new connections.

453
00:48:50,570 --> 00:48:52,077
uh

454
00:48:52,353 --> 00:49:01,537
And that must be fascinating to see because like you say you're getting the imaging aren't
you so that you are able to see exactly I guess what's happening with that I imagine

455
00:49:01,752 --> 00:49:03,014
of sorts yeah.

456
00:49:03,014 --> 00:49:05,277
there were some imaging studies kind of

457
00:49:05,386 --> 00:49:15,546
hopefully on the horizon, which really look into that in a lot more detail, kind of
looking at the, we call it the arborization of neurons, is the neurons are like trees and

458
00:49:15,546 --> 00:49:20,446
it's like the trees grow more branches and they connect with other branches of other
neurons.

459
00:49:20,926 --> 00:49:33,386
you're sort of correcting potentially the biological change that is related to depression
with a psychedelic or even with a standard antidepressant.

460
00:49:33,386 --> 00:49:35,460
So there's a similarity.

461
00:49:35,460 --> 00:49:50,745
biologically um and ideally what you might have is somebody having you know very useful um
psychotherapeutically useful you powerful experience but also the plasticity after the

462
00:49:50,745 --> 00:49:53,818
experience to to help

463
00:49:54,211 --> 00:49:56,223
more lasting and changing effect.

464
00:49:56,223 --> 00:49:58,794
Yeah, permanent, more permanent effect.

465
00:49:59,455 --> 00:50:01,276
Yeah, that's incredible.

466
00:50:02,438 --> 00:50:03,358
Yeah.

467
00:50:04,278 --> 00:50:06,244
biological side is important too.

468
00:50:06,431 --> 00:50:07,213
Yeah.

469
00:50:07,433 --> 00:50:21,437
again, the importance of the aftercare as well, the support afterwards to maintain that
because whilst you're saying there's going to be new connections, connections can change.

470
00:50:22,378 --> 00:50:28,360
So is it also important that that person doesn't just go back to their old ways?

471
00:50:29,160 --> 00:50:32,091
That I don't know if I'm making sense here.

472
00:50:32,104 --> 00:50:32,594
you are.

473
00:50:32,594 --> 00:50:33,594
You are, absolutely.

474
00:50:33,594 --> 00:50:35,466
I think it is.

475
00:50:35,466 --> 00:50:43,930
I've worked with people who have been able to make quite a lot of changes and maybe have
had some flexibility and space in their lives to do so.

476
00:50:43,930 --> 00:50:59,777
I've worked with people who have gone straight back to very challenging work or family,
social situations, socioeconomic challenges, and haven't had necessarily the space to do

477
00:50:59,777 --> 00:51:00,047
so.

478
00:51:00,047 --> 00:51:01,868
um

479
00:51:01,868 --> 00:51:19,391
you're right that plasticity, whether it's with an antidepressant or a psychedelic, if
that means that you're adjusting um more to a difficult situation or adapting more to a

480
00:51:19,391 --> 00:51:26,505
difficult situation instead of changing that situation, that can be potentially
problematic.

481
00:51:27,295 --> 00:51:27,906
Yeah.

482
00:51:28,522 --> 00:51:39,192
So in terms of people who, I mean, is your trial something which is like, you've got
everybody now and there's nobody else who's sort of going on to that trial.

483
00:51:39,192 --> 00:51:50,112
I'm just wondering, how do you select who, I know you said it's kind of you go through a
procedure, but in terms of, I'm aware that funding is a huge thing.

484
00:51:50,112 --> 00:51:55,066
I don't imagine this is through the NHS that it's happening, is it?

485
00:51:55,230 --> 00:52:03,462
So, you how do people engage with this if they think it's something that they might like
to find out more?

486
00:52:04,114 --> 00:52:09,996
Yeah, so I would say, you know, look online.

487
00:52:09,996 --> 00:52:19,118
There are certainly adverts that pop up from different trial ah research sites asking,
looking for volunteers.

488
00:52:19,618 --> 00:52:27,900
Some of the main ones are Imperial College in London, King's College, which is sort of NHS
affiliated as well.

489
00:52:27,900 --> 00:52:32,241
There is a sort of link with the NHS at King's College.

490
00:52:33,758 --> 00:52:38,830
There are research sites like Hammersmith Medicines Research or St.

491
00:52:38,830 --> 00:52:41,231
Pancras Clinical Research, which is where I work.

492
00:52:41,231 --> 00:52:48,543
There's another called Clark and Well, and you will find others across the country.

493
00:52:48,543 --> 00:52:53,345
uh MAC was another one up in Liverpool, Manchester.

494
00:52:53,345 --> 00:52:55,856
uh

495
00:52:55,856 --> 00:53:08,852
there are a number of trials happening with different substances, with different
approaches to therapy and uh for different conditions with different criteria as well.

496
00:53:09,292 --> 00:53:12,914
you can either look for those adverts online.

497
00:53:13,274 --> 00:53:25,400
Sometimes when people see a GP or a psychiatrist, know, they might have that discussion
and then not necessarily be referred, you know, suggested to do that and sort of seek

498
00:53:25,880 --> 00:53:33,736
the different trials but new trials are coming up you know not all the time but there's
still new trials happening.

499
00:53:34,257 --> 00:53:39,454
Okay, yeah that's useful for people to know isn't it because people might want to take
part in a studying.

500
00:53:39,454 --> 00:53:41,893
Or find out more at least, yeah.

501
00:53:41,994 --> 00:53:42,762
Yeah.

502
00:53:45,952 --> 00:53:48,340
it's been so fascinating, hasn't it, Ali?

503
00:53:48,584 --> 00:53:50,289
It's been great, Grim.

504
00:53:50,521 --> 00:53:51,861
do have one more question.

505
00:53:51,861 --> 00:53:54,521
Well, I have lots of questions, but I know we're running out of time.

506
00:53:58,261 --> 00:54:02,981
Are there any side effects to actually taking the substance?

507
00:54:03,061 --> 00:54:10,899
You know, like if you're if you're having alcohol or something, you might have a hangover
or a come down off a drug.

508
00:54:11,464 --> 00:54:13,135
Yeah, yeah.

509
00:54:13,175 --> 00:54:21,419
So, I mean, it's interesting because, you know, in the clinical trials, we have to sort of
document any sort of adverse events.

510
00:54:21,419 --> 00:54:33,724
And sometimes, you know, the things we have to document are the things that the drug does,
you know, can be illusions, hallucinations, kind of, you know, visual sensory disturbance.

511
00:54:33,724 --> 00:54:34,085
So.

512
00:54:34,085 --> 00:54:37,614
um

513
00:54:37,614 --> 00:54:47,107
I think probably again some of the side effects can be powerful emotion, uh anxiety, uh
fear.

514
00:54:47,107 --> 00:54:54,777
uh I think as we touched on really, there's been research looking at the effect of...

515
00:54:55,262 --> 00:55:04,494
being around the wrong people or people that aren't going to be sort of conducive to a
positive experience, especially if they're also taking the drug.

516
00:55:04,494 --> 00:55:14,118
There's unfamiliar situations, there's risky situations, there's the risk of combining
different drugs or combining with alcohol or other...

517
00:55:14,118 --> 00:55:14,668
substances.

518
00:55:14,668 --> 00:55:24,662
So there's lots and lots of factors that can make an experience sort of harmful or yeah
really really challenging.

519
00:55:24,662 --> 00:55:41,740
When it comes to sort of lingering after effects, um the sorts of things, mean tiredness,
headache, anxiety, some sleep disturbance can happen so that people can experience some

520
00:55:41,740 --> 00:55:42,850
insomnia

521
00:55:43,306 --> 00:55:58,799
Occasionally people have described um almost a little bit like a sort of ADHD inattention,
know, forgetting things, not quite, you know, being as organized as they would normally

522
00:55:58,799 --> 00:55:59,248
be.

523
00:55:59,647 --> 00:56:01,724
short-lived or yeah.

524
00:56:02,542 --> 00:56:04,284
short lived, usually short lived.

525
00:56:04,284 --> 00:56:04,944
Absolutely.

526
00:56:04,944 --> 00:56:08,847
m So not, not, not inducing ADHD.

527
00:56:08,847 --> 00:56:11,189
uh Absolutely.

528
00:56:11,189 --> 00:56:12,360
ah

529
00:56:12,360 --> 00:56:13,771
So those things can happen.

530
00:56:13,771 --> 00:56:25,134
One other potential adverse event or side effect that can happen is something called
hallucinogen persisting perceptual disorder.

531
00:56:26,035 --> 00:56:34,207
For some people, there can be lingering sensory changes that come from the experience.

532
00:56:34,207 --> 00:56:35,032
Yeah.

533
00:56:35,528 --> 00:56:46,301
So occasionally people describe things like visual snow, know, kind of just seeing pixels
really in your vision or things waving or color intensity being different.

534
00:56:46,381 --> 00:56:58,825
It's quite rare and it is, some people argue it's not as rare as we think, but it is much
less likely to happen again in one of these safe, supported environments.

535
00:56:59,845 --> 00:57:02,766
Probably more likely to happen in a sort of uncontrolled

536
00:57:02,890 --> 00:57:09,537
ah situation but yeah it's a potential side effect that we let people know about.

537
00:57:09,674 --> 00:57:19,681
Which I guess then just you saying about the uncontrolled environment, you this is what's
really important, isn't it, about safety and how, you know, people are going to, you know,

538
00:57:19,681 --> 00:57:28,721
how this is experienced for people that it's so important to do it in an environment
that's safe, that's got the right professional experience around

539
00:57:28,768 --> 00:57:30,494
it.

540
00:57:30,494 --> 00:57:31,334
Yeah.

541
00:57:31,334 --> 00:57:33,287
Because there's so much to know as well.

542
00:57:33,287 --> 00:57:43,272
And um we have touched on the legality a little, um these drugs, the traditional
psychedelics like LSD, psilocybin.

543
00:57:43,272 --> 00:57:44,358
um

544
00:57:44,358 --> 00:57:58,369
they're actually class A still in this country, and schedule one, which means that still
officially the law views them as something that has no therapeutic benefit and is just a

545
00:57:58,369 --> 00:58:02,793
dangerous recreational drug that can cause a lot of harm.

546
00:58:02,793 --> 00:58:04,994
um

547
00:58:05,642 --> 00:58:17,472
the legality is something that kind of has to be, people have to be aware of, but the
legality and the stigma around these things can also stop people seeking help.

548
00:58:18,153 --> 00:58:31,735
that's where integration, absolutely, that's where psychedelic integration groups can be
helpful, which are, we've run one in Brighton for a number of years and then in London as

549
00:58:31,735 --> 00:58:33,165
well, where people can...

550
00:58:33,450 --> 00:58:39,770
can come together and talk about experiences in a safe, supported setting.

551
00:58:39,830 --> 00:58:49,130
It's more of of conversation group and discussion group, completely away from any
substances.

552
00:58:49,130 --> 00:58:52,710
There's nothing not related to substances or accessing substances.

553
00:58:52,710 --> 00:58:59,145
It's very much about being able to talk about your experience and feel heard and listened
to.

554
00:58:59,145 --> 00:58:59,972
Mm-hmm.

555
00:59:00,072 --> 00:59:12,373
because while it's criminalised still, the risk is that people um either get into serious
trouble with the law or that they just feel that they can't actually share it.

556
00:59:12,373 --> 00:59:18,213
um Certainly younger people, know, have criminal response.

557
00:59:18,741 --> 00:59:21,675
I have to admit, I'm very curious about it.

558
00:59:21,675 --> 00:59:29,855
Part of me thinks I'd love to try it, but then I am someone who likes control and the idea
of not having control feels quite scary to me.

559
00:59:29,855 --> 00:59:34,759
And I would imagine that's probably true of quite a few people with anxiety.

560
00:59:35,454 --> 00:59:36,938
Yeah, yeah, absolutely.

561
00:59:36,938 --> 00:59:40,828
And I think that, I would say that really has to be respected.

562
00:59:41,288 --> 00:59:42,160
Hmm.

563
00:59:44,190 --> 00:59:55,258
That's where it's so important for people to have as much information as they can about
what might happen in the experience, about what they might experience, about what's normal

564
00:59:55,258 --> 01:00:00,742
essentially for such a powerful experience ah and to be able to feel safe to go into it.

565
01:00:00,742 --> 01:00:09,973
uh the challenge around informed consent is that nobody knows how the experience is going
to really unfold.

566
01:00:09,973 --> 01:00:10,893
Mm.

567
01:00:11,306 --> 01:00:24,086
And being able to articulate and describe that accurately to someone who has never had an
experience like it before is really hard because people can imagine that they're going to

568
01:00:24,086 --> 01:00:28,186
feel blissful, they're going to maybe have hallucinations or see things.

569
01:00:28,186 --> 01:00:36,986
But the degree of reality change and the physicality sometimes of the experience can be

570
01:00:37,758 --> 01:00:41,441
profoundly disorientating and frightening.

571
01:00:44,404 --> 01:00:49,348
we often encourage people to sort of relinquish control and feel able to relinquish
control.

572
01:00:49,348 --> 01:01:02,018
But for a lot of people, either it's very hard to do or the inability to do it can cause a
lot of challenge in the experience, a lot of difficulty in the experience.

573
01:01:02,018 --> 01:01:05,821
it has to be approached with a lot of caution and care.

574
01:01:06,450 --> 01:01:08,158
and for that to be respected.

575
01:01:08,158 --> 01:01:09,040
Hmm.

576
01:01:09,732 --> 01:01:22,589
So do you see, where do you see this going in terms of, do you see there is something on
the horizon where it could be available much more widely here, like it is in America and

577
01:01:22,589 --> 01:01:23,870
other countries?

578
01:01:24,467 --> 01:01:25,271
Um

579
01:01:26,846 --> 01:01:36,310
Well, I think one of the first things that needs to happen is that there's a rescheduling
of the substance.

580
01:01:36,370 --> 01:01:40,422
And really all that means is it doesn't change the legality of it.

581
01:01:40,422 --> 01:01:43,653
It just means that it's easier for people to research it.

582
01:01:44,111 --> 01:01:45,225
Okay.

583
01:01:45,225 --> 01:01:46,457
interesting.

584
01:01:47,041 --> 01:01:47,474
Yeah.

585
01:01:47,474 --> 01:02:00,751
it's still so, there's so much, what's the word, bureaucracy, but also it's so expensive
and difficult to actually do these trials that it's prohibitive for a lot of researchers.

586
01:02:00,751 --> 01:02:05,583
that needs to happen, in my opinion.

587
01:02:05,583 --> 01:02:11,245
And when it comes to the social changes that allow for, you

588
01:02:11,860 --> 01:02:14,144
wider use or decriminalization.

589
01:02:14,144 --> 01:02:21,948
I'm not that hopeful that our society and politics is moving in that direction.

590
01:02:22,919 --> 01:02:24,756
um

591
01:02:24,756 --> 01:02:26,152
doesn't it at the moment.

592
01:02:26,954 --> 01:02:27,795
I think it is.

593
01:02:27,795 --> 01:02:41,377
uh But the other thing is, um know, one of the other challenges that psychedelics and
psychedelic therapy will have is a little bit like what happened with ketamine when

594
01:02:41,377 --> 01:02:51,716
ketamine became a medicine that was licensed or that, you know, can well can be used to
treat very severe depression um is the cost benefit analysis.

595
01:02:51,716 --> 01:02:53,817
And so we've

596
01:02:54,026 --> 01:03:05,772
probably heard about NICE, which is the National Institute of Clinical Excellence, they
assess the cost benefit analysis of all medicines and haven't approved ketamine for

597
01:03:05,872 --> 01:03:13,676
routine use in the NHS because of the expense of the medicine and the process around it
and the actual cost of it.

598
01:03:16,414 --> 01:03:28,141
There's going to be this tension, I think, between making it a therapy that is possible to
be used in a cost-effective way whilst retaining all the things that make it safe and

599
01:03:28,302 --> 01:03:29,562
effective.

600
01:03:29,783 --> 01:03:38,368
And if people can get that right, then there's a possibility that the National Health
Service could do something with that.

601
01:03:39,229 --> 01:03:41,550
But I think, you know, what's...

602
01:03:41,610 --> 01:03:55,130
probably more likely to happen is that it's a therapy that comes into the private and
independent sector and then there's going to be there's going to be a lot of probably a

603
01:03:55,130 --> 01:03:59,663
lot of difficulty for a of people about actually being able to access that because of the
cost.

604
01:03:59,948 --> 01:04:01,668
just feels so wrong, doesn't it?

605
01:04:01,668 --> 01:04:12,303
For me anyway, it feels so wrong and it feels such a shame because, you I don't know again
enough about this, but I wonder about how much is uh looked at in terms of the prevention

606
01:04:12,303 --> 01:04:22,988
or that if something in, if this is a really effective way of helping people with
depression, let's say how much money is spent in other ways on a much longer term basis,

607
01:04:22,988 --> 01:04:23,998
perhaps.

608
01:04:24,336 --> 01:04:30,181
In terms of this cost effectiveness, sometimes, mean, whether it's my simple way of
looking at it, but it just doesn't seem cost effective.

609
01:04:30,181 --> 01:04:36,716
It doesn't seem an easy way of looking at it by just saying, well, no, this is too
expensive and we're not going to use it.

610
01:04:37,016 --> 01:04:44,219
If they looked at the longer term impact on finances, maybe actually it would be much more
cost effective.

611
01:04:44,648 --> 01:04:45,429
Yeah, absolutely.

612
01:04:45,429 --> 01:04:46,530
And people have been doing that.

613
01:04:46,530 --> 01:04:59,971
So there's an organization called Drug Science, which is, David Nutt is involved and sort
of the prominent researcher involved with drug science, but they, people are doing these

614
01:04:59,971 --> 01:05:04,256
analyses, but they,

615
01:05:04,624 --> 01:05:18,177
Yeah, I think the ones that I've read, have concern about cost effectiveness, but there
hopefully will be ways in which we can A, get a really good picture of whether actually

616
01:05:18,177 --> 01:05:19,489
they can overall.

617
01:05:19,489 --> 01:05:20,870
um

618
01:05:20,870 --> 01:05:25,692
save, help save money with the treatment of mental health problems.

619
01:05:26,492 --> 01:05:36,875
And so that's the challenge, but also hopefully there's ways in which we can do this if
it's licensed, you know, in a safest way, with the most effective way, but also in a way

620
01:05:36,875 --> 01:05:41,013
that people can access, uh people that need it most

621
01:05:41,038 --> 01:05:41,835
can access.

622
01:05:41,835 --> 01:05:43,417
feels so important, doesn't it?

623
01:05:43,417 --> 01:05:48,793
It's not that it's just one sort of group of people who might end up being able to
potentially afford it.

624
01:05:48,793 --> 01:05:56,883
It feels so important that it's across the spectrum of people and their socioeconomic
backgrounds and cultures and whatever.

625
01:05:56,883 --> 01:05:58,274
It feels so important.

626
01:06:00,308 --> 01:06:04,024
Graham, we could keep talking to you all morning.

627
01:06:04,286 --> 01:06:05,829
It's so interesting.

628
01:06:05,829 --> 01:06:08,923
Thank you so much for being with us again.

629
01:06:09,322 --> 01:06:10,046
You're very welcome.

630
01:06:10,046 --> 01:06:10,406
you.

631
01:06:10,406 --> 01:06:18,836
It's a really interesting topic and yeah, could talk for hours and learn more, but I you
could.

632
01:06:19,156 --> 01:06:20,439
much more to say as well.

633
01:06:20,439 --> 01:06:21,740
That's the challenge.

634
01:06:22,123 --> 01:06:23,546
But and so much I've left out.

635
01:06:23,546 --> 01:06:24,306
but

636
01:06:24,370 --> 01:06:30,430
Is there anything that you think that we could have asked you that actually feels a really
important thing for you to say?

637
01:06:30,430 --> 01:06:34,056
Or do you feel like we've sort of covered broadly enough?

638
01:06:34,150 --> 01:06:36,923
I think we've covered it quite broadly.

639
01:06:36,923 --> 01:06:45,142
Yeah, I think we've sort of scaled the peaks of the mountain range of this subject, I
suppose.

640
01:06:45,142 --> 01:06:48,112
But um yeah, thanks so much for all your questions.

641
01:06:48,112 --> 01:06:56,816
come on again when, you know, further down the road when your research reaches another
level maybe and um let us know how that's going.

642
01:06:57,066 --> 01:07:00,186
Absolutely, well things are changing all the time, so yeah.

643
01:07:01,003 --> 01:07:01,384
Great.

644
01:07:01,384 --> 01:07:02,005
Thank you.

645
01:07:02,005 --> 01:07:03,348
Thanks so much, Graham.

646
01:07:03,348 --> 01:07:04,084
Thank you.

647
01:07:04,084 --> 01:07:12,561
And if you can remember to like and subscribe and follow and share this with anybody you
think that might find it really interesting, which I'm sure they will, we certainly have

648
01:07:12,561 --> 01:07:14,672
and we'll look forward to seeing you next time.

649
01:07:15,071 --> 01:07:15,982
See you then.