Psychedelic-Assisted Therapy Explained | The Future of Psychiatry with Dr. Reid Robison

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Hello, Welcome to the Boys Cliness Podcast. I'm your host,
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doctor John Sanders, familely physician, and today I have read
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Robinson with me. He's a physician and a psychiatrist, and
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read welcome to the podcast.
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Thanks for having me read.
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Tell us a little bit about your education and your
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journey toward medicine.
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So I went to BYU nearby as an undergrad and
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changed my major a bunch, and then they came up
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with neuroscience while I was an undergrad, So I jumped
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in in their first class because I knew I had
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a curiosity about the brain and geeked out a bit
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on science leading up to that. So I got into
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the sciences, even did some mice research some brain stuff
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while there, and then went to med school at the
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University of Utah, stuck around for psychiatry and stayed on
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faculty for a while there doing research studies. Okay, yeah,
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studying new medicines for mental health conditions, trying to find
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better options because we all know that while we have
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some options, they all too often fall short for too
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many patients. So many individuals are suffering, and we do
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need some some better tools. And so that's uh, that's
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where I'm coming from.
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I would love to start with that because I think
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we it's underwhelming what the response I think for both
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patients and for me as a family doc, I treat
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some basic anxiety, depression and ptsd s and all these things,
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and it's underwhelming the responsiveness to some of these medicines.
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Can we can we just go into like where are
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we at state of the union of current like psychiatry,
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and how are we helping people move forward from a
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medicine standpoint from maybe maybe the therapy space, and where
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are our wins? Where are our losses? Where's our shortcomings?
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Yeah, it's a it's a lot.
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It's a good question though, because I think we're at
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a very interesting point in time in psychiatry, like the
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beginning of a new chapter.
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I would say.
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Because we have these tools, thankfully like SSRISE, prosacs, all
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offt et cetera, that help maybe one in three individuals
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respond really well to them, and I find them to
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be very useful tools to have for a time, like
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especially if someone is in a state of depression or
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anxiety where therapy hasn't cut it. But they're also they
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come with side effects like any medicine. And having to
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take a daily pill with a certain percent risk of
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side effects or a certain trade off for some people
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is not ideal.
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And so also the way they work is.
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Kind of in an emotional numbing or blunting way out
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of necessity to bridge the gap to hopefully do some
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deeper work or not need those things and get to
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reconnect more fully with one's life. So that brings us
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to what's next. And this interesting point we're at is
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what some call interventional psychiatry, where you have ketamine being
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used while not formally approved for depression, good evidence and
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has helped a lot of people respond more quickly at
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least as a temporary measure. And then Spravado that came
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along in twenty nineteen as a nasal spray es ketamine
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for those who don't respond to traditional antidepressants. We have
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the first rapid acting medicine approved. And so this is
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like a new chapter where we also have TMS transcranial
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magnetic stimulation that's not a daily pill. It's like a
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big magnet that you come in for and get a
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treatment with once a day for like the better part
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of a month, and it's really flexing the neuroplasticity pathways
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in a positive direction repeatedly, and doesn't work overnight, and
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isn't the easiest thing to act, to do and access.
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But it's new and it's not and it does help
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a fair number of people. And then we may also
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talk about psychedelic medicine and what's on the horizon, but
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we're entering this era of other options that aren't a
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daily pill, like taking a medicine for more quick relief,
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and maybe even some other benefits in terms of getting
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out the root cause or bringing things to the surface
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that need to be addressed to get unstuck.
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I love how you couched the SSRI movement, like I
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think they came out in like nineteen fifties, and and
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really I love how you explain them because this is
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how I explain them too. But a lot of my
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colleagues don't. They just put them on them and say,
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good luck, Well we've got Yeah, it's what we've got,
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and you're gonna probably be on this rest of your life.
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I love the idea that it's just kind of a
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band aid for a minute to kind of stop some
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of the i'd say bleeding, but stop some of the
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harder things that are going on emotionally with you, and
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then as those things get worked on, hopefully with psychotherapy,
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with better life style, better social situations, then maybe we're
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kind of going to come off of that medicine, especially
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the SSRIs at some point, Whereas the academy is a
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little different, right because because it like actually grows part
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of your brain and spikes some BDNF and some neuroplasticity
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and provides a kind of a pathway for maybe maybe
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some of the talk therapy to kind of start working
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a little bit. Can you speak to just the talk
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therapy with regard to ketymene.
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And yeah, yeah, So ketamine is what got me into this,
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this whole field of psychedelic medicine. I was at the
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University of Utah on faculty doing studies, and along came
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the study of it was Johnson and Johnson saying, do
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you want to be a site for our study of
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IVY Academy for depression? And I sat with so many
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people as they got their standard infusion then of zero
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point five miligrams or kilogram I view over forty minutes,
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and you had to ask them questions as part of
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the study about the experience and it was fascinating what
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they were going through, and some shed tears and it
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almost seemed cathartic for individuals, and to see in real
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time some relief was really It inspired some hope and curiosity.
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So I started working with ketemine, studying it more, and
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then it opened the door to these other things. I
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started doing psilocybin studies and other psychedelics that I'm mostly
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focused on now helping bring those to market.
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That is so cool. What is it about the kedymene?
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I mean, we'll stay on the keademy for a minute,
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but I really want to dive into some of those
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other spaces with you. What is it about the ketymene
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that creates access better I don't know, better access points
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or availability to moving some things for the for maybe
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the talk therapy space.
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Thank you because I forgot to answer your original question.
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I'm realizing so good thing we have a podcast host.
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I had to bring us back on track. But so
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Ketamine I see working a few different ways. So to
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put a pin in a few of them, There's like
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one that people don't talk about as much, that ketymine
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turns off what's called a lateral hebenular burst mode. There's
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this little part of the brain we don't give much attention,
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the habenula, And there's a Nature paper maybe five years
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ago where they show ketamine kind of flips a switch
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and the burst mode is a depressed, stressed out state.
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So it's almost It gave me a potential explanation neuroscientifically
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at least for what is this cloud lifting?
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What is this relief part of.
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What lets people come up for air and do the work.
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And then you have, like you mentioned, these neuroplasticity pathways
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that are activated for a time, at least for ketymine.
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Some would estimate it's a couple of days with for psilocybin,
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labs that try and estimate this from mouse models and
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things might.
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Say a couple of weeks.
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So you have a window, but it's tighter where the
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brain becomes more malleable, where you can, hopefully with the
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right kind of intention and therapy and approach, kind of
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shift some maladaptive patterns. It could be your depressive patterns,
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it could be your anxious loops, it could be addictive
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or maladaptive behaviors that aren't serving you, and then you
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can work on those in this malleable state and hopefully
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they can stick.
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Does the m tour BDNF pathway, like, how does that
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play into the mix.
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It's part of the cascade that turns on this window
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of opportunity, if you will. And it's a complicated one.
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I just kind of from a big picture see it
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as like sprinkling a little brief miracle grow on the
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brain and you get an opportunity to use it. And interestingly,
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kenymine was not studied initially that study I did did
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not have psychotherapy with it. It was studied as a
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medicine spravado.
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Same thing.
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Adding therapy is kind of the next frontier of we
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know it's an opportunity, we know there's neuroplasticity opening up,
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and what more can we do, especially because we know
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that ketamine isn't always durable and some people might get
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months of relief, but some people days or weeks.
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Do you have.
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A form of talk therapy that you like the best
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after post psychedelics.
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Yeah, it's a really interesting, kind of multifaceted question that
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I've pondered for a long time because and I've landed
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essentially on the answer. My opinion is that it depends
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on what condition, of course, like if you're treating eating disorders,
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for example, I work with a lot of eating disorders.
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In fact, and the therapy protocols we put into studies of
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say ketemine is just psychotherapy there or psychedelics there are
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different and we might even have more sessions of dosing sessions,
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if you will, because especially for those who have been
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chronically affected by a condition, those patterns could be really
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deeply entrenched and it might take some more sessions, some
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even more intensive psychotherapy than like on the other end
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of the spectrum, the early psilocybin studies looked at end
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of life anxiety, like the anxiety one gets when they're
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faced with like a terminal cancer diagnosis. And you know,
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eighty percent of those with the psilocybin dose single dose
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had substantial relief and a mystical experience and all that,
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but it was it was not the same deeply entrenched
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pattern to something to say anorexia or treatments depression, just
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to kind of point out that it depends on the condition,
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the chronicity. And then but then even with something like depression,
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even looking at the same time course, I think my
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opinion is you could layer on a lot of different
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therapies and.
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Get good results.
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So the best I've landed on working with a ton
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of practitioners helping them do their ketamine therapy work is
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leveraging the therapy tools they're good at in the snouroplasticity
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window that make the most sense for the.
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Patient depending on what the patient is having. Eating disorders
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are among the hardest to treat. I understand, like, they're
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very entrenched and very difficult many times years and years
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and years of therapy and still having a hard time
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moving the needle. It where's depression again, sometimes very entrenched,
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and trauma and things like that. So so what I'm
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hearing is just the modality that the therapist is reasonably
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good at, and maybe that's better applied to the current scenario.
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Yeah, And the current state of the psychedelic medicine kind
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of movement and pathway toward approval is that the therapy
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has been somewhat de emphasized or at least more generalized
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in preparation for getting in front of the FDA that
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doesn't look at doesn't approve therapies right typically, So it's
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getting kind of a standard supportive therapeutic approach there that
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could be rolled out if something's approved in clinics in
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a widespread way. Because interestingly, on these medicines, more so
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I think than with ketamine, the healing happens from within
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for the most part, and the people the therapists are
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there mostly holding space as this like opens up the
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window and brings things up to the surface, and so
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we create the safety so someone can do the work themselves.
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I want to go there because you're right, ketymine kind
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of kind of like it's hard to do work under
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the influence of ketemy. You're kind of sleeping, and you
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kind of a lot of a lot of folks are
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kind of out of it, and you don't want to
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disrupt that as much, whereas in maybe some of these
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other modalities, there's there's I want to I want to
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poke into that a little bit because there's a deep
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connection and healing space that that that is available through
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some of these other modalities. Can we speak to them,
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Let's go there, let's Yeah. So we're talking about psychedelic
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therapies and some of the research that's going on, and
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you're right on the cutting edge of some of that
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research right now here in orm Utah.
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Yeah, it's exciting.
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It's it's exciting what is coming down the pipeline, if
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you will.
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So Psilocybin, are you allowed to talk about this? Yeah?
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Yeah, because and because I'm I'm basically a research site
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that does the studies for these companies like MAPS has
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been trying to get MDMA approved for PTSD, compass and
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USNA psilocybin for depression, and then other things. Mind Mad
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they change their name recently to definium mine at LSD
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for anxiety, and we did those studies with them, and
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now for depression, and uh, there's also a number of others,
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like we're doing a PGD study with a psychedelic. We
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have an anxiety study with another psychedelic that people wouldn't
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have recognized as much.
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And these are in phase three.
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Most of them Phase two or three, which is the
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last phase before you submitted the FDA for approval. So Psilocybin,
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as an example, has just wrapped up its phase three
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studies for depression and preparing to submit later this year
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is the plan to the FDA. So we may even
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have if approved and timelines go well, as early as
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next year. Psilocybin prescribable for depression like Spervado came out
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for depression under certain parameters.
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That's beautiful. Can we speak to why some of these
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have a deeper true healing potential rather than rather than
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a blunting band aid approach with the SSRIs and things
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like that, certcrohibitors, Why do these create such profound experiences
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of healing and potential, like deeper level of movement in
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our emotional space, in our spiritual spaces, in those spaces
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that trauma Like, there's lots of things that are maybe
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under the hood that we don't even recognize that maybe.
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Need to do a little bit.
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Yeah, we didn't realize how much. Like they say, you've
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got to feel it to heal it.
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In a way.
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Now, it's a bit ton in tongue and cheek, but
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I think the simple over simple answer is that psychiatry
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is finally catching up on the innate healing potential of
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the human body. Like you've known for a while as
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a family doc that if you get a cut, the
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body's going to take care of it right. You might
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need to assist with some supports, But you know, I
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think this approach we've done too often for too long
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in psychiatry. It just kind of throwing these kind of
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band aids with consequences at it for long term is
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finally kind of getting shaken up. And as these new
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modalities present where they give the person the opportunity to
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go inward where you may have been in this default
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stressed out state and just unable to face your trauma
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because it was too system overload, unable to face that,
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like that pit of despair of depression, and then you
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get a tool like this and and the right support,
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and it can melt away some of those defenses bring
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up the emotions to the surface, interestingly by another serotonin
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receptor five HD two A instead of like the SSRIs
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working in a different way on five HT one for example.
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Yeah, the five h T two A receptor is amazing.
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I've done a deep dive it recently.
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Some people get it tattooed on them.
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Yeah, I don't blame them. There's there's there's neat stuff there,
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and I think can we speak to like the dissolving
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of the ego that happens there and maybe the default
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mode network silencing and some of those internal dialogues that
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some people have hard time shutting them off and they're
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driving anxiety or they're driving depression. But but and I'd
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love to hear some of your studies that are going
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on in these spaces. But why why is it that
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these these medicines or I'm gonna call them medicines, but
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they're you know, psychedelic therapeutic modality, why they they can
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kind of help us silence those spaces?
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Is there?
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I mean, we can get a little neuroscience therity to it.
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For a moment.
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And I do like this kind of prevailing theory in
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the Psychedelic therapy space by Robin CARRT.
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Harris and colleagues.
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She was at Imperial College at the time, but he
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wrote the entropic Brain Theory based which essentially is based
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on this older free energy theory, talking about how hush
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we are predicted wired as prediction machines, Like we go
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about the world and taking all these sensory inputs and
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automatically we're adapting to the world our best prediction of
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like don't step in the road with traffic because it'll hurt,
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or like don't touch that thing again, and we get
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shaped and all these autopilot ways out of necessity by
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these magnificent machines were occupying as that is the human body,
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but that can also get us into these stuck automatic ruts,
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you know, the maladaptive patterns that shape and so along
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comes a psychedelic. That one analogy use is that it
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kind of heats up these these rigid prediction structures, so
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they can be shaped during that window of opportunity, reshaped,
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and then as the brain cools and your patterns kind
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of take shape again as a window closes, then hopefully
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you put in new kind of more adaptive ones and
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positive for your life.
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And acted expansive and healthy, maybe a little healthier, less
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clenched down on rigid thinking.
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Yeah, So as as you take a psychedelic, and as
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the one of the ways it works is kind of
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toning down what you mentioned, the default mode network, that
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kind of egoic center of the brain, if you will,
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that is just kind of you know, autopilot, not allowing as.
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Much of the creative expression or new firing in this.
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And then as that melts away, new connections can form
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new insights. And because of this serotonergic like medicine effect
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and that release of serotonin, some even have like a
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mystical experience or connect with their own spirituality in a
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deep way, and it's interestingly bringing back spirituality in a
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much need way into mental health that was kind of
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thrown out with the bathwater in kind of freud eras
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and things. But finally we're bringing back into the discussion
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because it's an important part of you know, so many
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people's lives.
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I love how you said in your previous comment, how
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the body can heal itself. We just have to give
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it the pathways to kind of accomplish that. I remember
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in residency, I had a patient in Jacksonville, Florida, and
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she had diabetes really bad, and she ended up with
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necrotizing fasciatis. It's a really bad infection of the fascia of.
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Flesh feeding on the street.
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That's all right, that's right. And she got really sick,
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ended up in the hospital for a long time. She
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had a giant wound on her abdomen. It was twenty
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centimeters deep. It was just going to make a psychiatrist ill,
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but button g's out, yeah, and he's got But it
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was very wide, very deep, and profound. It was profound.
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I tried, she didn't have insurance. I tried to get her.
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The surgeons had done all of their charity work for
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the month. It was the end of the month, and
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every evidently those surgery surgery groups have a quota, they
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cap it out. They're like, oh, sorry, we've all done
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our pro bono work for the month. And and I
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begged and pleaded, and they said they followed up with her,
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and they said she can heal this. And I said,
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are you kidding me? She's type two diabetes, she's overweight,
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she's unhealthy. This will kill her. And they said, doctor Sanders,
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you young pop ya. I was a resident right and
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I was in my you know, post grad probably second
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year in my residency, and I was mad. I remember
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getting really upset at him, and I was like, you
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guys a bunch of chirks. But over the next several
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several months, with wet to dry dressing, changes to briding
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with went to dry dressing chains. Sometimes we had dacons
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because it got in fact with some pseudomonis, because that's
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what happens. But we healed that sucker. She healed that sucker,
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and it was amazing. I was every time I saw her,
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it would get a little smaller, a little smaller, and
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a little less deep, a little less deep, and it
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was probably I don't know. It was probus sixteen inches
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by twelve inches by twenty inches deep. It was deep.
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You just stop motion on that looks like superhero stuff
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and it's healing it.
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It was amazing.
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And and I think of that giant crevice and giant
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defect and you know, even and the flesh eating pass here.
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But there are psychiatric things that are equally as devastating
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and difficult to deal with. But how incredible the body
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is that it can close down those holes and fill
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them up with with live, beautiful tissue and and heal
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that super cool?
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Yeah, there is there is, because I've I've it play
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out time and time again, this innate or interhaling intelligence,
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if you will, in the body. And but the challenge is,
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you know, kind of activating that or letting it do
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its thing and creating the right conditions for healing.
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Yeah, turns out it's the five HD two A.
400
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Yeah, that's that's certainly an incredibly useful button to hit
401
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for so many of these conditions to help create that space.
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Can you speak to like in Ketamine, I think that
403
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they've done a bunch of data and science on you know,
404
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six sessions or roughly successions with therapy tends to be
405
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a lasting change and some lasting healing to some of
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the depression PTSD space. Can you speak to some of
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these other modalities and what you're seeing, Let's let's take
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them apart. Let's maybe start with zylo cybin, if you will.
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So Psilocybin mostly studied for depression. The typical protocol is
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two doses. It's been a floored one, two, three, and
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they might be separated by a couple of weeks, two,
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three weeks and supported by you know, a therapist or
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two for holding space for that six hours or so.
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And you know, you're meeting with the person before to
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help get them ready and and you're following along and
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checking in. But the data is showing equal or better
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response and remission rates compared to traditional treatments like SSRIs
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without We're not talking about a daily pill.
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We're talking about.
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One or two doses still with benefits still president twelve
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weeks out and then there's some long term follow upcoming.
422
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So it does.
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I won't say it works for everyone and it stays
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and the benefits stay forever, and a lot of that's
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still getting figured out.
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But but I am.
427
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You know, certainly hopeful and welcoming this as a much
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needed option when we can get it into clinics. And
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as I've been working with this for the past several years,
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I have had to go to far off places sometimes
431
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have been involved in retreats with psychedelic medicine outside of
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the country at times to access it for you know,
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conditions or people who maybe wouldn't qualify for a study
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at this point.
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These couple of sessions. That's remarkable that we're having really
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positive outcomes just in a couple of sessions. Can we
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speak to I mean, I've done some study in this
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space of setting and then integration with regard to those
439
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is that being looked at it all or how important
440
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is that to kind of healing sessions.
441
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Yeah, it's an interesting time in the psychedelic therapy world
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because these medicines are preparing to go up to the
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FDA for approval, starting with psilocybin. And this is following
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the attempt to get MDMA approved for PTSD by MAPS
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that was not approved by the FDA and created a
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lot of debate around how to study these and how
447
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to how the FDA might approve them in this new
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era of they were presented with a medicine and therapy
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and you know they don't typically approve that kind of thing, right,
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a combination like that. And so now I think it's
451
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clear that the model that's been studied and used in
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the ketemine world and applied to the psychedelic therapy world
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is that you help the individual get ready beforehand by
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working with them that you call the preparation phase, and
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you get to know you know what to expect and
456
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also how to surrender to the experience how and you
457
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start to work on like what direction are we going
458
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to point this, what intention perhaps or seed are we
459
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going to plant? As we go in and do some
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work and some repeated work in the in the studies
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for depression, just doing a session or two and kind
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of following along and trying to standardize that. That's why
463
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I say it's an interesting time where you know, it
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would be too complicated to layer all the different therapies
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and get them in there, or even maybe too risky
466
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to just try one therapy modality. So it's kind of
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landed in this supportive dosing session monitor role that is
468
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a psychotherapist in our studies who is working with the
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person to repair sitting with them during usually two individuals.
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I get to do those on some of our studies,
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some they don't let me as the study doc. And
472
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then after usually they'll come in the next day for
473
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a session that we used to call integration, but the
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studies aren't calling it that anymore. But it is like
475
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a follow up session. But the whole time you're with
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them and they're going inward, coming out and maybe talking
477
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about it or maybe getting some support and how to
478
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move through things. There is the question that comes up
479
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everywhere from the FDA to just like academic circles doing
480
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thought exercises of like how much is the therapy needed,
481
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like for depression if we get out of the way.
482
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There's even some instruction when I trained in the by
483
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maps in the MDMA therapy protocol back when those studies
484
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were going on, there was an acronym that they'd give
485
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us in the therapy manual of like weight, why am
486
00:28:31.960 --> 00:28:34.880
I talking, you know, just like getting out of the
487
00:28:34.880 --> 00:28:40.119
way of that innerhaling intelligence and not over intervening.
488
00:28:40.359 --> 00:28:45.039
We as the therapy or psychiatrist group, because as I thought,
489
00:28:45.079 --> 00:28:46.559
you meant like get out of our own way with
490
00:28:46.599 --> 00:28:47.920
our ego and ourselves yeah.
491
00:28:47.799 --> 00:28:49.960
That too. Probably both of those folks get out of
492
00:28:49.960 --> 00:28:50.640
the way.
493
00:28:50.200 --> 00:28:54.480
But getting out of the way because the individual does
494
00:28:54.599 --> 00:28:57.240
have what they need inside to heal themselves.
495
00:28:57.319 --> 00:29:02.319
And that is so profound, profoundly different than it's a
496
00:29:02.400 --> 00:29:04.720
new It is a new age for psychiatry.
497
00:29:05.039 --> 00:29:05.880
Yeah, yeah, it is.
498
00:29:06.279 --> 00:29:10.160
You can kind of feel the ripple effects, and you know,
499
00:29:10.480 --> 00:29:15.319
there's still widespread kind of mental struggling and suffering out there,
500
00:29:15.400 --> 00:29:17.519
and our world is not an easy place on our
501
00:29:17.519 --> 00:29:18.119
mental health.
502
00:29:18.359 --> 00:29:22.480
Yeah, yeah, that's true. Well, this is super fascinating. The
503
00:29:23.799 --> 00:29:27.519
other studies on I don't know, are there other things
504
00:29:27.559 --> 00:29:29.440
out there to talk about as far as the studies.
505
00:29:29.519 --> 00:29:31.960
I mean, I think we've covered a lot of the
506
00:29:31.960 --> 00:29:34.279
ground of where we're at and what's coming. It is
507
00:29:34.279 --> 00:29:37.759
in this kind of last phase of the research and
508
00:29:37.920 --> 00:29:40.400
roll out, you know, I think we can learn from
509
00:29:40.400 --> 00:29:43.559
what happened with Spravado and how that was delivered with
510
00:29:43.880 --> 00:29:48.039
some new challenges, longer sessions. But I think I can
511
00:29:48.119 --> 00:29:51.440
finally look forward and see the light at the end
512
00:29:51.480 --> 00:29:53.279
of this tunnel of like when we might be able
513
00:29:53.279 --> 00:29:57.799
to prescribe this and it will still have its hoops
514
00:29:57.839 --> 00:30:01.519
to jump through and probably a rem them like spravado
515
00:30:01.599 --> 00:30:02.920
when it's as.
516
00:30:02.799 --> 00:30:03.759
A controlled substance.
517
00:30:03.799 --> 00:30:09.359
But we've come a long way since the complete ban
518
00:30:09.720 --> 00:30:14.279
of psychedelics back in the seventies, including the research labs.
519
00:30:15.440 --> 00:30:18.200
Are there things that clinicians like myself might do in
520
00:30:18.279 --> 00:30:21.519
order to prepare for best practices in this space? I mean,
521
00:30:21.720 --> 00:30:24.759
I would love to be able to get out of
522
00:30:24.839 --> 00:30:28.240
the way to let folks heal in some safe settings
523
00:30:28.279 --> 00:30:31.440
in these spaces, and you know, and I wonder if
524
00:30:31.480 --> 00:30:35.759
there's a way to explore is there additional certifications that
525
00:30:35.799 --> 00:30:39.279
we might need or things just to prepare or is
526
00:30:39.319 --> 00:30:42.599
it just hate prescribe this medicine, give them some rough estimate,
527
00:30:42.599 --> 00:30:43.880
own guidelines and.
528
00:30:43.720 --> 00:30:48.920
It's to be determined. Like, I think, there's so much
529
00:30:49.000 --> 00:30:52.880
we can do to prepare, and most of that is
530
00:30:52.920 --> 00:30:58.000
probably just doing our own work as well tuned individuals
531
00:30:58.039 --> 00:31:01.359
who have walked these tough roads of like facing all
532
00:31:01.400 --> 00:31:06.079
our inner stuff and changing the sticky patterns that have
533
00:31:06.200 --> 00:31:10.240
not been you know, good for our lives and be
534
00:31:10.359 --> 00:31:14.839
able to you know, have the capacity to hold those
535
00:31:14.839 --> 00:31:18.240
big emotions that might come up as people do this work.
536
00:31:18.599 --> 00:31:21.480
And then as these things get closer to proval, we'll
537
00:31:21.480 --> 00:31:24.759
get more guidance on practically speaking, how to prepare and
538
00:31:24.839 --> 00:31:27.200
what you know, who needs to register for what to
539
00:31:27.240 --> 00:31:29.839
be a prescriber, to be a you know, a therapist
540
00:31:29.880 --> 00:31:33.599
in these and whatnot. But many are seeking out trainings
541
00:31:33.640 --> 00:31:39.640
in the meantime and working with ketamine and or psychedelics
542
00:31:39.640 --> 00:31:44.119
in other states even and so I think the field
543
00:31:44.240 --> 00:31:46.480
is progressing on multiple fronts regardless.
544
00:31:46.839 --> 00:31:49.480
I think that's gold. The advice you give tip for
545
00:31:49.599 --> 00:31:51.519
us to just do our own work, do our own
546
00:31:51.599 --> 00:31:55.799
emotional intelligence work, our own your aulasticity work. Are we stuck?
547
00:31:55.880 --> 00:31:58.079
Are there are there things that we're struggling with that
548
00:31:58.079 --> 00:32:00.640
we might need to free up as clinicians so that
549
00:32:00.720 --> 00:32:03.079
we can better show up for these folks as they're
550
00:32:03.319 --> 00:32:06.440
looking to embark on the similar journey. That's really smart,
551
00:32:06.519 --> 00:32:11.920
that's cool, and it relieves us of the hubris of
552
00:32:12.240 --> 00:32:16.200
certifications and additional this and like like, actually, just do
553
00:32:16.319 --> 00:32:17.400
your work. It's fine, Like.
554
00:32:17.880 --> 00:32:20.279
It will it will need to get worked out, but
555
00:32:20.319 --> 00:32:23.200
I can tell you it's not difficult to get like
556
00:32:23.799 --> 00:32:26.720
registered as a spravado provider. It's not going to be
557
00:32:27.319 --> 00:32:31.000
so simple for these other medicines, but you know it's
558
00:32:31.599 --> 00:32:35.119
it's not going to be how the training programs and
559
00:32:35.200 --> 00:32:38.279
things were for the clinical trials five years ago. It's
560
00:32:38.720 --> 00:32:41.680
it's working towards that kind of clarified path.
561
00:32:42.319 --> 00:32:44.200
Can we speak a little bit to the spiritual space,
562
00:32:44.240 --> 00:32:47.160
because if this is introducing kind of this heart opening,
563
00:32:47.319 --> 00:32:51.200
expansive spiritual experience, kind of that that can go in
564
00:32:51.359 --> 00:32:54.640
and heal us deeply some of our broken spaces that
565
00:32:54.680 --> 00:32:58.440
we sometimes don't even see, can we speak to the
566
00:32:58.480 --> 00:33:01.920
spiritual aspect of this and how that is becoming integrated
567
00:33:01.960 --> 00:33:03.279
into the psych space.
568
00:33:04.000 --> 00:33:08.119
Yeah, it's it's interesting if you look at like the
569
00:33:08.160 --> 00:33:14.680
history of mental health treatment and psychedelics during that era
570
00:33:14.759 --> 00:33:17.519
we were just talking about of say the seventies. Like
571
00:33:18.160 --> 00:33:23.039
one example is Bill Wilson, the founder of Alcoholics Anonymous.
572
00:33:23.599 --> 00:33:25.559
And was head of the board of that.
573
00:33:26.920 --> 00:33:32.640
For quite some time, and had an experience himself with
574
00:33:32.960 --> 00:33:36.279
a psychedelic that he attributes his sobriety to and it
575
00:33:36.319 --> 00:33:38.200
was a mystical one and he's written the story and
576
00:33:38.240 --> 00:33:39.839
you can look it up, and he's standing on top
577
00:33:39.880 --> 00:33:43.279
of a mountain and like in this vision experience that
578
00:33:43.359 --> 00:33:46.599
he had on a classic psychedelic and that five AHG
579
00:33:46.720 --> 00:33:51.400
two a receptor and he said, you know, we've got
580
00:33:51.400 --> 00:33:54.480
to he said to his AA colleagues, like we gotta
581
00:33:55.279 --> 00:33:56.759
you know, we got to explore this or whatever. They
582
00:33:56.759 --> 00:33:58.680
would not have it and which he like even had
583
00:33:58.720 --> 00:34:02.720
to leave there. But it's different now. And I think
584
00:34:02.839 --> 00:34:08.760
many people in addiction treatment, in mood disorders, in kind
585
00:34:08.800 --> 00:34:13.880
of eating disorders and all sorts of other things, not all,
586
00:34:13.920 --> 00:34:17.840
but more and more are really kind of sharing and
587
00:34:17.880 --> 00:34:21.239
being able to talk about more freely, like their experience
588
00:34:21.320 --> 00:34:25.599
with connecting with something bigger than themselves, Like that is
589
00:34:25.679 --> 00:34:30.199
outside of this constrained kind of default mode place that
590
00:34:31.119 --> 00:34:35.639
just translates into leaps and bounds of progress, or like
591
00:34:36.199 --> 00:34:40.000
really getting to see the forest from the trees for
592
00:34:40.119 --> 00:34:42.960
a time and putting it in perspective.
593
00:34:43.280 --> 00:34:46.440
Yeah, can we talk about it like in the clinical
594
00:34:46.480 --> 00:34:48.840
setting a little bit, like is therapists and things?
595
00:34:48.880 --> 00:34:49.480
Is that okay?
596
00:34:49.639 --> 00:34:51.159
Or is that still kind of round upon?
597
00:34:51.920 --> 00:34:55.840
No, that's I'd say that's kind of been welcomed with
598
00:34:55.960 --> 00:34:59.199
open arms. And even in the clinical DRIUT protocols people
599
00:34:59.239 --> 00:35:02.800
think it's devoid of spirituality, but no, like people are
600
00:35:02.800 --> 00:35:06.159
having spiritual experiences in a clinical trial and I have
601
00:35:06.199 --> 00:35:08.079
to document it in a chart, you know what I mean,
602
00:35:08.119 --> 00:35:10.800
It's like and you put it in your concise way,
603
00:35:10.840 --> 00:35:15.039
but we are it's an interesting time to do clinical
604
00:35:15.039 --> 00:35:18.679
trials because a side effect of medicine might be like
605
00:35:19.679 --> 00:35:24.800
a visual hallucination, and that could be like a blissful
606
00:35:24.840 --> 00:35:28.639
experience for one, it could be scary for another, but
607
00:35:29.320 --> 00:35:32.519
part of an experience for many that is very different
608
00:35:32.719 --> 00:35:37.639
and unique, and it's it's shaken up. Psychiatrip made us
609
00:35:37.719 --> 00:35:42.079
expand our nomenclature quite a bit, and I'd say it's
610
00:35:42.079 --> 00:35:45.679
also kind of bringing a much needed renewed focus on
611
00:35:46.400 --> 00:35:51.159
emotions in general, which you know, I've always seen are
612
00:35:51.199 --> 00:35:55.119
quite connected to our spirituality and because part of our
613
00:35:56.000 --> 00:35:59.760
emotions exist as signals to tell us how to navigate
614
00:35:59.800 --> 00:36:03.440
the world world like fear warns and anger protects and
615
00:36:03.440 --> 00:36:03.920
things like that.
616
00:36:03.960 --> 00:36:04.920
But also there's.
617
00:36:04.840 --> 00:36:09.079
Meaning making that we as humans really do with those things,
618
00:36:09.199 --> 00:36:14.480
and that's both part of how psychedelics work, kind of
619
00:36:14.480 --> 00:36:18.079
bringing emotions to the surface. You know, you got to
620
00:36:18.360 --> 00:36:20.480
go through it. The only way out is through in
621
00:36:20.519 --> 00:36:26.000
some of those difficult emotions because they exist to kind
622
00:36:26.000 --> 00:36:28.800
of rise and fall and pass, and because we've swatted
623
00:36:28.840 --> 00:36:32.360
them away or numb them out or done something else.
624
00:36:32.400 --> 00:36:36.079
So part of it is kind of bravely going on
625
00:36:36.119 --> 00:36:41.000
that hero's journey to feel the unfelt feelings with the
626
00:36:41.039 --> 00:36:43.360
support so you can get to the other side of it.
627
00:36:44.519 --> 00:36:47.559
Can we talk about like some of the caveates, maybe
628
00:36:47.599 --> 00:36:50.599
some of the contraindications, or maybe some of the maybe
629
00:36:50.599 --> 00:36:54.440
we should pause and consider not doing this where some people, Yeah,
630
00:36:54.480 --> 00:36:58.159
if you are in a certain way, where would be
631
00:36:58.159 --> 00:36:59.400
the cautions that you would give?
632
00:36:59.519 --> 00:37:04.960
I'd say, like, the big caution is is just these
633
00:37:05.039 --> 00:37:08.800
are not toys, and there is a very real risk
634
00:37:08.960 --> 00:37:13.079
of a difficult experience for many people. If you look
635
00:37:13.079 --> 00:37:18.119
at say the psilocybin studies or the natural survey studies
636
00:37:18.119 --> 00:37:24.159
of people using it outside of clinic settings, it's a
637
00:37:24.239 --> 00:37:28.039
high rate of people having both difficult experiences and even
638
00:37:28.119 --> 00:37:31.559
needing some support like a clinic visit or whatever. But
639
00:37:31.719 --> 00:37:34.639
equally and overlapping with that, a very high rate of
640
00:37:34.719 --> 00:37:36.880
having one of the most meaningful experience of their lives
641
00:37:37.199 --> 00:37:42.679
that they say was profound. But so the bottom line
642
00:37:42.719 --> 00:37:45.400
from that is that you know, doing these in an
643
00:37:45.440 --> 00:37:50.159
unsupported way is considered risky, and there are subpopulations that
644
00:37:50.199 --> 00:37:54.880
are especially at risk, like those with any kind of
645
00:37:55.679 --> 00:37:58.800
history or even family history of psychotic illness.
646
00:37:59.360 --> 00:38:02.400
Where it's it's perhaps a risk.
647
00:38:02.280 --> 00:38:06.119
Of losing touch with reality more substantially and kind of
648
00:38:06.679 --> 00:38:10.159
and losing that grip in a way that you know,
649
00:38:10.239 --> 00:38:14.119
could be you know, not so useful for someone's life.
650
00:38:14.159 --> 00:38:18.840
And same thing with bipolar and active substance use patterns,
651
00:38:18.840 --> 00:38:21.360
perhaps that might interfere. Like there's a lot of data
652
00:38:21.400 --> 00:38:24.840
out on the rate of difficult experiences on psilocybin goes
653
00:38:24.920 --> 00:38:28.320
up quite a bit. There's two main factors, not having
654
00:38:29.400 --> 00:38:32.960
a sober sitter, and two is combined with cannabis, for example,
655
00:38:33.599 --> 00:38:37.159
And so people, you know, take one thing that might
656
00:38:38.079 --> 00:38:39.639
kind of throw them for a loop, but you combine
657
00:38:39.639 --> 00:38:42.400
it with something else and it can be very disorienting.
658
00:38:43.639 --> 00:38:46.000
Addiction potential here with some of these things, I mean,
659
00:38:46.039 --> 00:38:49.079
are we going into a new opiate crisis thing? We're
660
00:38:49.079 --> 00:38:51.960
looking at their thankfully. I think that's the big dogma
661
00:38:52.199 --> 00:38:54.760
right from the sixties, Like folks are like, oh, you
662
00:38:54.800 --> 00:38:55.960
don't want to you know.
663
00:38:56.159 --> 00:38:56.719
You get Yeah.
664
00:38:57.320 --> 00:39:01.480
I was asked by I a group a couple of
665
00:39:01.559 --> 00:39:03.800
years ago to go up to Capitol Hill in Utah
666
00:39:03.880 --> 00:39:07.280
here and testify on behalf of the mushroom if you will,
667
00:39:07.320 --> 00:39:10.880
like psilocybin, to just cite the science and safety, and
668
00:39:10.960 --> 00:39:13.360
so it was because a bill that was trying to
669
00:39:13.400 --> 00:39:16.079
get past at the time that didn't and so I
670
00:39:16.159 --> 00:39:18.840
gave my summary and so do some others. Then they
671
00:39:18.880 --> 00:39:22.679
opened up for comment, and some of the comments were
672
00:39:22.840 --> 00:39:26.079
really energized around how could.
673
00:39:25.840 --> 00:39:28.760
You open these up? The children are.
674
00:39:28.880 --> 00:39:30.880
Going to get them and get addicted or something like that.
675
00:39:30.960 --> 00:39:34.880
But that's grossly misinformed. And I agree with being extremely
676
00:39:34.880 --> 00:39:38.360
cautious with addictive substances, and I agree with being cautious
677
00:39:38.400 --> 00:39:43.079
with ketamine as a substance that some people get addicted to.
678
00:39:44.199 --> 00:39:47.079
But I have not encountered a psilocybinn addiction. I've encountered
679
00:39:47.079 --> 00:39:50.519
a lot of reckless use of it. But thankfully those
680
00:39:50.559 --> 00:39:53.880
medicines tend to come with some inherent anti addictive potential,
681
00:39:54.280 --> 00:39:59.119
and there's another wave of study is looking at them
682
00:39:59.599 --> 00:40:04.920
for addiction, like the first psychedelic to treat it. Yeah, yeah, alcoholism.
683
00:40:05.320 --> 00:40:09.159
Really good data on psilocybin for alcoholism, some data on
684
00:40:09.280 --> 00:40:10.199
opius disorder.
685
00:40:10.559 --> 00:40:12.679
The first study that the US.
686
00:40:12.599 --> 00:40:15.239
Government funded of a psychedelic since they banned them in
687
00:40:15.280 --> 00:40:21.159
the seventies was psilocybin for smoking cessation, like a single
688
00:40:21.199 --> 00:40:26.119
dose and with some really positive response rates. So it's
689
00:40:25.960 --> 00:40:29.000
a it's a very important question. And thankfully on these
690
00:40:29.039 --> 00:40:34.519
ones they don't come with that inherent abuse potential that's
691
00:40:34.519 --> 00:40:39.159
something like ketamine a benzo or opius do And I
692
00:40:39.159 --> 00:40:41.480
don't think. I think ketamine can be used very well
693
00:40:41.760 --> 00:40:45.599
to treat some like addictive disorders at the right phase,
694
00:40:45.599 --> 00:40:48.159
and I've used it that way, and I've used it
695
00:40:48.199 --> 00:40:50.840
a lot in clinic with the right parameters that I
696
00:40:50.880 --> 00:40:53.159
feel comfortable with it. But I just know a lot
697
00:40:53.159 --> 00:40:56.280
of individuals who and have have had a lot of
698
00:40:57.519 --> 00:41:02.199
like encounters with like the smaller subpopulation who is at risk,
699
00:41:02.360 --> 00:41:05.880
and it needs to be extra careful with.
700
00:41:06.639 --> 00:41:09.960
Yeah, very good. And my understanding is like unlike opioids,
701
00:41:10.000 --> 00:41:14.440
these don't hit that MEW receptor the euphoria space on
702
00:41:14.519 --> 00:41:15.760
a neuroscience standpoint.
703
00:41:16.079 --> 00:41:18.360
Yeah, there, all of this has to.
704
00:41:18.320 --> 00:41:22.440
Be alcohol hits it, opioids hit it strong strongly.
705
00:41:22.800 --> 00:41:27.280
Yeah, So it's it's all w's when any medicine goes
706
00:41:27.280 --> 00:41:30.159
to the FDA to start as trials has to come
707
00:41:30.199 --> 00:41:31.400
with this.
708
00:41:32.840 --> 00:41:33.079
Drug.
709
00:41:33.239 --> 00:41:36.639
This information, this file of all that's known about the
710
00:41:36.760 --> 00:41:40.000
drug ever and a lot of studies on animals and
711
00:41:40.079 --> 00:41:45.679
beyond of its abuse potential and everything else. And so yeah,
712
00:41:45.679 --> 00:41:51.199
thankfully that's really well established as these aren't addictive medicines,
713
00:41:51.239 --> 00:41:53.239
but they will come out in a way that they're
714
00:41:53.280 --> 00:41:56.159
not going to be in people's homes either, Like Spravado.
715
00:41:56.239 --> 00:41:59.239
When I got approved, it was approved to be delivered
716
00:41:59.239 --> 00:42:02.480
in clinics, and so the area that I work in
717
00:42:02.559 --> 00:42:06.079
as a as a physician and a researcher is in
718
00:42:06.119 --> 00:42:09.719
the clinic path. And there are other groups working on
719
00:42:10.320 --> 00:42:16.679
getting these allowed for more psycho spiritual purposes or descheduled politically,
720
00:42:17.320 --> 00:42:22.079
because you know, I'll admit they did get over regulated overscheduled,
721
00:42:22.440 --> 00:42:25.599
but I'm focused on like bringing them to clinic use,
722
00:42:26.880 --> 00:42:28.119
which is safe, you.
723
00:42:28.079 --> 00:42:32.480
Know, controlled environments and not Yeah, I fail you. That's great,
724
00:42:33.360 --> 00:42:35.880
doctor Reed, Thank you so much. This has been so
725
00:42:36.400 --> 00:42:40.559
expansive and enlightening my understanding of some of the psychedelic space,
726
00:42:40.639 --> 00:42:43.559
some of the therapy space, and and even some of
727
00:42:43.800 --> 00:42:46.360
nudging me toward you know, doing some of my own
728
00:42:46.400 --> 00:42:49.039
deeper work in this space. I think it's lovely. Tell
729
00:42:49.119 --> 00:42:52.719
us about your shop, inner space research, yes, tell us
730
00:42:52.760 --> 00:42:54.800
about how one might get a hold of you, and
731
00:42:55.320 --> 00:42:57.480
you know, what are you looking for? As far as
732
00:42:57.599 --> 00:43:00.239
people to enroll in your in your trial and how
733
00:43:00.320 --> 00:43:01.119
might they get hold of you.
734
00:43:01.559 --> 00:43:05.320
So about a year ago I set up this clinic
735
00:43:05.440 --> 00:43:09.239
in Orum with my colleague and friend, doctor Steve Thayer.
736
00:43:09.280 --> 00:43:11.599
He's a psychologist. We've been working together.
737
00:43:11.840 --> 00:43:18.119
On psychedelic studies and working with helping train clinicians and
738
00:43:18.199 --> 00:43:20.800
ketamine work and et cetera for quite some time, and
739
00:43:20.880 --> 00:43:26.119
so we kind of architected this research site close to
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00:43:26.159 --> 00:43:30.000
home with everything we've learned in the right. We bought
741
00:43:30.800 --> 00:43:34.079
a former midwiffery, so it's got a lot of cozy
742
00:43:34.119 --> 00:43:37.199
spaces for these psychedelic studies. And we are doing a
743
00:43:37.280 --> 00:43:41.039
number of psychedelic studies all for mental health conditions, and
744
00:43:41.159 --> 00:43:46.800
are currently enrolling for studies of silcybin type medicines for
745
00:43:46.920 --> 00:43:51.760
depression soon for PTSD. We have an LSD study for
746
00:43:52.320 --> 00:43:57.119
depression as well. We have psychedelic study for PTSD and
747
00:43:57.559 --> 00:44:00.639
psychedelic for generalized anxiety disorder. Where people just go to
748
00:44:01.239 --> 00:44:04.920
interspace research dot com, look at the list of studies,
749
00:44:05.440 --> 00:44:09.119
you know, give us a call, submit a form, and
750
00:44:09.159 --> 00:44:10.920
then we just get on the phone and go through
751
00:44:10.960 --> 00:44:12.519
to see if they seem like they might be a
752
00:44:12.519 --> 00:44:14.639
good fit, if they seem like if they come in
753
00:44:14.679 --> 00:44:17.519
and visit and we'll sit down and do the you know,
754
00:44:18.199 --> 00:44:23.320
do the official kind of diagnostic assessments or whatever. And
755
00:44:23.400 --> 00:44:25.920
even if people don't qualify, they get to come in
756
00:44:26.119 --> 00:44:30.679
and learn some things about themselves and contribute to science.
757
00:44:30.719 --> 00:44:33.880
And we even do blood work and EKGs and happily
758
00:44:33.920 --> 00:44:36.400
share those results of people free of charge. I mean,
759
00:44:36.440 --> 00:44:39.760
we actually compensate people for their time and travel and research,
760
00:44:40.199 --> 00:44:46.360
which is nice. So if there are individuals you know
761
00:44:46.519 --> 00:44:50.880
in your circles, anyone listening with depression anxiety PTSD, and
762
00:44:50.920 --> 00:44:52.880
you want to check out the website, we would love
763
00:44:52.920 --> 00:44:54.400
to see if we can help.
764
00:44:54.880 --> 00:44:57.880
And as clinicians, we can refer directly to that website Interspace,
765
00:44:58.440 --> 00:45:02.440
Interspace Research dot com, Space for Sure, dot com. It's awesome. Well,
766
00:45:02.679 --> 00:45:05.239
I have several clients that I'm already thinking about for that.
767
00:45:05.320 --> 00:45:06.920
Would you know, We've been trying to help for a
768
00:45:06.960 --> 00:45:10.480
long time and they're seeking other options and other solutions,
769
00:45:10.519 --> 00:45:12.960
and so I'm excited for your research to be on
770
00:45:13.000 --> 00:45:15.440
the cutting edge of such a new chapter in mental
771
00:45:15.519 --> 00:45:18.320
and emotional wellness. At some point, I'd love to bring
772
00:45:18.360 --> 00:45:20.960
you back and just just talk about ways that we
773
00:45:21.039 --> 00:45:26.360
can maintain emotional wellness and maybe like maybe just recognize
774
00:45:26.400 --> 00:45:29.280
if there is something the matter, Like there were things
775
00:45:29.320 --> 00:45:32.119
in my I've done some work in this space, and
776
00:45:32.159 --> 00:45:35.360
there were some things in my heart that I didn't see.
777
00:45:35.519 --> 00:45:39.559
I just didn't Yeah, and I didn't realize that it
778
00:45:39.639 --> 00:45:43.519
was affecting my default, no network, it was it was
779
00:45:43.719 --> 00:45:47.760
becoming part of the way I showed up. And so
780
00:45:48.159 --> 00:45:49.719
it was. It's been a fun journey for me to
781
00:45:49.840 --> 00:45:53.000
like mostly through foraging in the wilderness and taking deep
782
00:45:53.079 --> 00:45:56.880
breaths of the pine and mushrooms that grow up there,
783
00:45:57.159 --> 00:45:59.039
you know, to being able to dive deeper into my.
784
00:45:59.000 --> 00:46:02.360
Heart and figure out this. Yeah, that's really neat.
785
00:46:02.559 --> 00:46:06.119
Yeah, I would love to talk about you about that
786
00:46:06.239 --> 00:46:09.320
with you more and explore that it's a topic near
787
00:46:09.320 --> 00:46:13.000
and dear to my heart. As like as clinicians especially,
788
00:46:13.000 --> 00:46:17.840
we gotta both practice what we preach and kind of
789
00:46:18.000 --> 00:46:21.599
maintain our capacity to do the work well. Right.
790
00:46:21.679 --> 00:46:24.239
Yeah, So in the meantime, let's take our sixteen year
791
00:46:24.239 --> 00:46:25.760
olds up into the mountains and get them out of
792
00:46:25.760 --> 00:46:28.840
there breathe in the AIRA that would be amazing, Dochory.
793
00:46:28.880 --> 00:46:29.960
Thank you for your time.
794
00:46:30.000 --> 00:46:32.960
Thanks has been really really fun and to our listeners,
795
00:46:32.960 --> 00:46:35.599
I hope you learned some cool stuff today. As always,
796
00:46:35.639 --> 00:46:38.159
our mission is just to expand the knowledge and wisdom
797
00:46:38.199 --> 00:46:40.639
of our community and to bring on really great hosts
798
00:46:40.719 --> 00:46:43.360
or guests. And the host is not bad either, but
799
00:46:44.840 --> 00:46:45.800
it's just really fun.
800
00:46:45.840 --> 00:46:47.760
So yeah, thank you, thanks, I've enjoyed it.