#24: Psychedelic Integration with Susan Scharf and Rebecca Hendrix

July 7, 2019 00:59:26

Psychedelic experiences can be quite powerful and life-changing, but there are also other forms of consciousness-expanding experiences that may challenge one’s old paradigm. Sometimes even taking a big leap with a significant life-decision can challenge one’s psyche.

So what is integration? It may well be the act of weaving together new levels of understanding that arise with new experiences into our evolving life stories. It is to provide the framework for ourselves so that we may benefit from new insights, something like a psychedelic experience can be a fleeting moment or a new milestone. Without integration, our psyche may be susceptible to so many things, be it splitting from one’s reality or ego inflation. The path of consciousness expansion beckons us to harness wisdom and discernment.

On this episode, we explore psychedelic harm reduction, preparation, and integration with Dr. Susan Scharf and Rebecca Hendrix. Dr. Scharf and Rebecca founded One Integration to raise awareness around the mindful and safe use of psychedelics for the purposes of personal growth and healing. They offer individual as well as group integration for in NYC.

Dr. Scharf is a Board Certified Internal Medicine Physician and has also received advanced trained in Functional Medicine and Mind-Body Medicine. She has completed the Multidisciplinary Association for Psychedelic Studies (MAPS) therapist training and is the study physician for the phase 3 clinical trials for MDMA therapy for PTSD in New York. She has also trained with the Psychedelic Education and Continuing Care Program and the Integrative Harm Reduction Psychotherapy Program from the Center for Optimal Living.

Rebecca is a licensed marriage and family therapist. She completed her Master of Spiritual Psychology and her Master of Counseling Psychology from the University of Santa Monica She has a coaching degree from The Coaches Training Institute (CTI). She is a certified Imago Therapist and has advanced training in Emotionally Focused Therapy (EFT). She is trained in Energy Psychology by Henry Grayson. She has completed the Center for Optimal Living’s Psychedelic Education Program’s 101/102 workshops and is in a clinician group for harm reduction and psychedelic integration.

Highlights:

Psychedelic Harm Reduction and Preparation
Role of Community Integration
Ketamine Therapy, MDMA-Assisted Couples Therapy

Resources:

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Full Transcript

Thal:

Welcome Susan and Rebecca to Soulspace Podcast.

Susan Scharf:

Thank you. We are happy to be here!

Rebecca Hendrix:

Yeah. Thank you for having us. We’re so excited.

Thal:

Thank you for coming on. I guess a place where we want to start from is what got you interested in psychedelic psychotherapy and why?

Susan Scharf:

Oh, should I start?

Rebecca Hendrix:

Well, do you want me to start?

Susan Scharf:

Go ahead.

Rebecca Hendrix:

Okay. Um, I’m a traditionally trained psychotherapist, but within that I also have a specialization in spiritual psychology, which is helping people to look at their unfilled issues as a means of growing spiritually. And in doing that, um, I’ve noticed over the past few years, especially with my clients that are on medication and taking the traditional medications, they don’t always work for everybody. For the people that they work with they are a godsend. But for the people that, um, don’t find success, it’s really, really hard. And some people that are going on them have a lot of side effects even in increased thoughts of suicide going on them and coming off of them can be a lot harder than expected for some people. And I guess it was (?) years ago or so, um, I’ve been a fan of Gabor Maté for a long time with the work that he’s done with addiction and looking at all addiction as rooted in trauma. And in following him and going to some of his talks, he talks about, uh, sometimes doing Ayahuasca and leading some Ayahuasca trips. And so, um, an opportunity came up in New York where I work to do a training for clinicians called Psychedelics101 and 102 with the Center for Optimal Living. And so I did that last year and was just fascinated by all the information that they provided about how these medicines can be used and are being used in clinical trials to help people heal from things like OCD and depression and PTSD in ways that the psychopharmacological industry just aren’t. Often by using them once or twice or three times. So, um, that’s how I became interested just by kind of seeing what’s going on in my practice. Having some personal experience. One of my best friends committed suicide a number a number of years ago right when she was coming off some psychiatric medications. Um, so I’ve always just been kind of had a feeling inside that we just don’t have enough to offer and that our mental health system is a bit broke. We need mass mental health and we need more options for people that are in pain. And so that’s kind of what got me interested.

Adrian:

And just for listeners, I wanted to point out that that was Rebecca because we haven’t done a four way conversation. So people are only hearing your voices. I want it to match the voice with a name. So that was Rebecca and thank you.

Rebecca Hendrix:

Thank you. I’m Rebecca and I’m a holistic psychotherapist.

Susan Scharf:

And you guys can hear okay. Yes. Okay, good. So I’m Susan and how I got interested… I really just the process of my… it’s a longer process because I trained in internal medicine and really somehow had an awareness of other ways that we can heal, which is not really being offered to us in our traditional training, whether that’s psychological training, um, psychiatric training, medical training. And I just started exploring these other ways of approaching things and I learned about functional medicine and I was like, oh, great. Okay. That feels right. Let me go to that as fast as I can and see what that offers me, in terms of helping people. And it really opened my eyes to other ways of healing and thinking about our body, our system, and the connectedness of all of our parts and systems and how they affect each other. So I’ve kind of been approaching ever since I started medical school, just approaching everything from that. It’s all connected. So, uh, so I do practice holistic medicine as well and it’s really the mind, body, spirit, soul. It is all connected and it might sound a bit cheesy, but all these parts affect each other and things that we go through and just thinking that, um, especially the things like stress and anxiety and trauma and, um, these are not just things you take a pill for and expect it to fix a problem that has affected your life in all these areas. And although, you know, natural and holistic medicine might be geared toward non-medicine type things, a lot of these substances medicines we talk about are plants. And even then there’s, it’s just, um, it really touches upon all the aspects of a whole person to me. And that allows that person true healing, deep, healing, connected healing, and support. And when you see people getting better, you can be with people getting better from these modalities, it’s just undeniable, the help that it offers.

Thal:

Absolutely. I mean, it’s like you have this amazing role, um, of like bridging between sort of western medicine and holistic medicine. And in many ways too Rebecca, you shared like, you know, as a spiritual psychotherapist, mainstream psychotherapy tends to maybe not look at the spiritual aspects of things, but, you know, it’s like there has to be more bridging more conversation between different parts of sort of medicine, psychology, psychiatry, psychotherapy and holistic approaches to things. So, you know, that’s, um, an interesting space that you both occupy.

Rebecca Hendrix:

Thank you.

Susan Scharf:

Yeah. Thank you.

Adrian:

Can you guys share with us the, maybe the origin story for One Integration, that you guys both founded this company and it seems like you’re now offering services that are within the psychedelic integration space. Can you talk about what inspired that and tell us a little bit about One Integration?

Rebecca Hendrix:

Sure. Actually, we met in a clinician’s group, a clinicians consultation group for other therapists that have had some advanced training in working with patients who are interested in psychedelic healing through the use of psychedelics, um, through that Center for Optimal Living training. And so when we met we started chatting and we realize that, well, a lot of what we do in our clinician group is talk about integrating these experiences and different clinicians will bring forward case studies about, um, patients that are having challenges in integrating. And we will all brainstorm about the best way to help that patient to maybe integrate the experience into their life. And so we realized that, um, that there’s a real need to have a service available for people to integrate. There’s a lot of integration, well, within specialized communities. There’s some integration circles.

Susan Scharf:

There are some.

Rebecca Hendrix:

There are some that exist, but we didn’t, um, we didn’t know of another group per se that is formulated by a psychotherapist and a doctor that, because there’s a little bit of like a middle ground, the integration circles, um, the ones that I’ve been to anyway tend to have a lot of people that are quite experienced in psychedelics. Um, and that have used a good many of them. And, um, it didn’t seem like there’s a lot available for people that were curious or who might have had a recent experience in Costa Rica or someplace, people that were experimenting on their own. I started to see in my practice, um, people that are flying to different countries to use Ayahuasca or things like that, um, but weren’t necessarily integrating when they came back. And so jointly we just decided it would be a great add on to our existing businesses to make something like that available. And so we just, it was, it’s also fun and exciting because we both have a passion for this work. And so we wanted to figure out a way that we could work together and also help people.

Susan Scharf:

Yes. That was Rebecca. And this is Susan, just to keep with that. Um, I also want to add to that because that’s exactly right, that, um, two things we both I think really want to provide this, uh, service to people as a real safe place to really, uh, expand upon either these experiences or, we also talk about peak experiences. It doesn’t have to be with a specific substance, but a peak experience and really bring whatever shows up to the light and learn from it and grow from it. Um, but also, uh, as in many communities, there’s not always therapeutically, and I’m not saying there’s only one way and I’m not saying, um, I’ll finish my sentence and I’m not, there’s not always therapeutically trained people there available to support people through difficult times. And not that you have to have a certain type of training or that you need to, you know, have a psychoanalysis background, but some people that are going through these underground communities may need a lot more support than that community can provide. And, and, and we do have the training to provide that kind of support.

Rebecca Hendrix:

And I think we also feel like, you know, fingers crossed, this is the future. This, this could happen, you know, in the next five years.

Susan Scharf:

This is happening!

Rebecca Hendrix:

This is happening! And so we want to be prepared and there’s still so much stigma attached to, um, the use of psychedelics for healing. Um, even with ketamine, which is perfectly legal, there’s stigma attached. And so we wanted to, you know, kind of even proactively start to educate people or talk about it in a normal way so that people will start to see this as a possibility to help their loved ones or just to suggest to a loved one that really needs help and is struggling.

Thal:

Hmm. I mean clearly we are talking about very powerful substances and people might go through, you know, powerful experiences. And so what does integration mean? How can we integrate? Like if someone goes through something that’s so, um, either traumatic or you know, something from the past, how does integration look like?

Rebecca Hendrix:

Integration. I mean, basically what it is, is using the information you’ve learned and consciously incorporating it into your life to make changes to help you create your best life. Um, but integration in general is being really mindful of your use of it and then inquiry afterwards and doing anything that you can do to make your life better because of it. Um, you know, for people that just use these medicines recreationally, they may laugh about the fact that, you know, they saw a dinosaur, you know, in one night when they were out partying. Um, but if you’re trying to integrate an experience, you’re more being curious about that dinosaur or what that dinosaur means to you or you know, how that dinosaur, what it represents, you know, may help to heal something that is keeping you stuck in a place in your life. So it’s, it’s using, um, the experience and any information you got to be really curious and ask yourself questions and give yourself time and space and patience in order for any answers or help to come through you and to use certain tools that may assist you to do that.

Susan Scharf:

And again, I think it’s bringing mindfulness, mindful awareness to the process. Consciousness to more consciousness. Giving more space for consciousness, more consciousness to happen. Um, and of course that’s going to be still defined by the person going through it. So, uh, for example, if someone has, I mean, I’m just going to use Ayahuasca for an example because it’s one of the most powerful, um, mind expanders or consciousness expanders out there, um, in on our planet as a natural product. Um, but there are people that, um, have ceremonies with Ayahuasca that are legal when they go abroad, um, in certain areas. But some people, it could be months before they’re even able to begin the processing and maybe even a year or longer before there’s even some awareness of some of the subtleties from the experience. So every, every person’s experience is different with these medicines. And the processing of that experience can be very different as well. So it’s very much guided by the person going through the experience. And um, and like Rebecca was saying, taking the time, even finding the ability to, to allow for time and processing and openness to the process.

Rebecca Hendrix:

Yeah. It’s really just giving, you’re giving yourself the gift of time, um, and intention to get as much out of this type of experience that you, that you can and that doing the actual experience is just the beginning of it.

Susan Scharf:

Yes!

Rebecca Hendrix:

It’s the journey that you take afterwards. Um, and how you can make your life better, to be a better person, to be more loving, to heal whatever it is that you know, may be keeping you stuck.

Adrian:

Yeah. I wanted to ask, uh, perhaps what does dis-integration look like in your experience working with people? What might be some signs that, oh, someone might not be integrating? Well, what would that look like? Um, in a real case scenario,

Rebecca Hendrix:

A sign that somebody may not be integrating well, um, maybe not being able to function in their daily life. I’m finding it really hard to, you know, go back into their job, go back into their life, go back into their relationships, um, showing some signs of depression or increased anxiety..

Susan Scharf:

Isolation.

Rebecca Hendrix:

…isolation, you know, but to the extent that it really interferes with their peace and serenity. Um, and then going back to maybe old coping mechanisms, you know, which could be self medicating in one form or another. Um, isolating, shutting down, um, or throwing themselves into work or exercise or just something where they’re just, you know, instead of being with what might need to come up or getting support, they just kind of go into…

Susan Scharf:

Filling the time.

Rebecca Hendrix:

Autopilot to fill in the time, or become affected in such a way that a really can’t go about their day to day. Does that make sense?

Thal:

Yes. Yeah. It’s an interesting way to think about integration to think about dis-integration because also, um, we do have discussions around integration ourselves as psychotherapy students also interested in the work of psychedelics. And just, you know, I’m thinking about ego inflation or ego deflation. That can happen too with, um, with psychedelics and within the psychedelic community as well.

Susan Scharf:

Yeah, that’s a good point.

Adrian:

What’s coming to my mind is just that there’s such a huge potential for people to experience spiritual emergence right? Or you can even call a spiritual emergency depending on how rapid the changes are happening and that, that coincides with this potential for inflation possibly for somebody to come out of a peak experience thinking they’ve had more insight than they really had or more more healing than, than what actually happened. And so I think at one point you mentioned, you know, it could take a long time, it could be months perhaps for some folks after peak experience to begin to notice even that things are starting to shift. And, you know, um, I wanted to ask you about the role of practice, you know, because the thing, you know, most people when they seek these experiences are not doing it every day. And so they’re filling most of their life with just the regular, mundane activities. So what’s the role of having daily practices perhaps to come back to?

Susan Scharf:

Yeah, that’s good. Because that’s what we would talk about anyway. So that’s excellent way to segway into that. Um, yeah, I think even just when we talk about creating space and time and space in your life, it’s that, that’s the way to do that is to have that daily time for time with yourself, time for processing, whether that’s sitting and not actually processing, but just being quiet or time for meditation, um, or being out in nature. Um, that beingness with what is, is actually some of the ripest time for processing to happen on its own without efforting even. Um, that is the best time. Um, and we even have, we even created a little list here, we have our little notes in front of us of some of the things that people could do.

Rebecca Hendrix:

So we have a long list of integration tools that we find that we’ve compiled just from talking to a lot of people that have integrated successfully. Um, but things on it are things like working with the psychedelic friendly therapists and in terms of what you’re talking about a minute ago it, it’s really important I think to work with somebody before you go and then after you go, because before you go you can talk about what you want to get out of the experience? Why you’re thinking about doing it now? You know, for example, if you are somebody that’s working on um, a core issue of not feeling good enough and then you set that as your attention when you go into your experience and you come out of it thinking like, “wow, I’m done with that. I’m totally done with that. I know it now! I feel it in every cell of my body”. But maybe the therapist that’s working with you could help point out that. Like I know that got a lot of information on that in your experience, but maybe you still are struggling with it a little bit because you just told me about how you acted or felt when you didn’t get the promotion that you wanted. So, you know, having that continuation with somebody that knows you before and after, um, could be really supportive in terms of maybe helping to manage expectations or even point out possible realities about what has actually occurred versus what their real world experience is. Um, but we have found and encourage everybody to find the right modality that works for them to intentionally carve out time and space so that anything that can come up, you know, has a space to do so. You know, as Susan was saying earlier, doing a plant medicine or a psychedelic is not at all the only means to grow spiritually or to get information that can help you move along a path. It tends to be something that makes some of these things happen a good bit quicker, um, for some people. Um, but slowing down your life in general. For most people, especially people that we know, living in New York City is a really good idea because it is often when we’re running or when we’re meditating or when we’re communing with nature that we do get insights or information or downloads, so to speak, the same type of information that people report getting when having these experiences. So if you can have a spiritual practice that you’re practicing, preferably before you go, um, meditation, or breath work, um, journaling, um, you know, any of those, chi gong. Um, just being in nature, chanting any of those types of things, just yoga would be good because then you have that to get back to. Um, it’s almost like you’ve started it and then it’s like, ah, yes, those are my things that helped me to expand my mind. Or you know, when I do those things I tend to get information. So doing those things after a ceremony might also be that way that your, you know, inner counselor, your inner self can make a connection with you to give you that information that’s somehow been stored back away as you come back online to real life.

Susan Scharf:

And on that, just on that same note, even though we’re not, it’s not really what you brought up. You know, there’s the talk about, um, is it the medicine? Is it you? And I know we both feel quite strongly that all that information is in there. And in fact, some say these medicines help you remember yourself, get back in touch with yourself and, um, we do feel that it’s, it’s all you and it’s enhancing you. It’s helping you find those parts of yourself or remember those parts of yourself or reconnect to those parts of yourself.

Thal:

Yeah, yeah. Yeah. That is important to mention because, you know, um, you know, some people might hear this, especially people who haven’t tried psychedelics and like, “Oh, really? Like, really psychedelics is going to solve everything?” But just knowing that it’s just a tool or an amplifier of your own consciousness is an important reminder. Yeah.

Rebecca Hendrix:

Yeah. I mean, they tend to be, you know, I was listening to somebody talk the other day and they were saying, they interviewed somebody, I think it was Michael Pollan said that he interviewed somebody that had been in the smoking cessation trial using psilocybin. And the woman said that she got this very kind of banal, you know, information, which is like, “wow, I should really stop smoking. It’s not good for you and I shouldn’t kill myself that way. And there’s a lot of other things to see in the world”. And it’s, those are the types of information that you get and you know, this kind of going into it, but coming out of an experience, you know, it in a really authoritative type of way. And so then it’s, you know, okay, now that I know this, not just thought it, I like have, feel it almost in a lot of the cells in my body. What tools would support me to anchor it in and live from that place.

Thal:

Yeah, yeah.

Adrian:

Yeah. What I also notice is that there’s a real hunger for community, you know, for people who have come out of these experiences and not knowing where to turn to because perhaps their friend group isn’t friendly, you know, to talk about this stuff or their family, um, can you maybe touch on that because I see that’s one of the goals you have for One Integration is to build community and to do sort of group processing.

Rebecca Hendrix:

Yeah. Yeah.

Susan Scharf:

She’s a good talker. She should talk [laughing].

Rebecca Hendrix:

That’s a great point because that is one of the reasons why we got together to do this because especially living in a city like New York, community is just becoming more and more important with everything that’s going on in the world. Um, with everything that’s going on politically, like people need a place to call home. The biggest gift you can ever give anybody is the gift of attention. Yeah. So being able to, um, provide a space for people to talk about these experiences, um, to feel safe. Um, to know that that’s something that they can get back to. I mean, if you just take psychotherapy alone, a lot of the reasons why it works is because somebody has a safe space, um, to be listened to. And most of the time people in life, when we’re speaking, we’re thinking about the next thing we’re going to say when the other person stops. And so, in so doing, we’re not necessarily listening and being there for somebody else, giving them that gift of attention and to do it in community, um, in a group is just, it just makes it for the people that are open and benefit from that just makes it so much more supportive and can help their process, exponentially.

Susan Scharf:

Yes, completely agree. And um, I think also one of those important aspects of integration and integration in groups is being able to hear other people that may be going through similar but different things. Or hearing someone express something about themselves that really resonates with you and you feel a kinship there or that you’re all souls searching for things and, and creating, I will say it, a loving and safe place and we, I think we really all do want that and need that in our society has not been constructed around those values. So we do need to find a way to create them for ourselves. And I think, again, safe is key. You know, you can still have a community of people like in these underground settings that are trying to do that and they’re not always creating the safest place either. So it’s again, being mindful of safety and um, yeah, having that community is key because to try to do this on one zone, um, that’s just, it’s really difficult.

Thal:

Yeah. Um, I mean, speaking of safety, um, another thing that we’d like to know about, and I, I don’t know if you guys do work around that, is the harm reduction model.

Susan Scharf:

Yeah.

Rebecca Hendrix:

Could you speak to that, please?

Rebecca Hendrix:

Yeah. Yeah. Love to speak to that. Other than integration, that’s one of the things that we love to talk about, that we think everybody could benefit by knowing about.

Susan Scharf:

I actually think that the, um, there, I mean, there’s a harm reduction model. Well, the Center for Optimal Living is one of the places near us that takes this approach, um, for the integrative harm reduction psychotherapy. And I think that can really be applied to everything in every aspect of your life. It’s not just putting things in boxes, it’s considering the whole picture. Um, so I mean, we’re calling it Mindful Engagement, as an easier way to kind of make it make sense when we’re talking about it because not everybody wants to hear about integrative harm reduction as a term, but you know, it’s starting, uh, I hope this makes sense. But, you know, when we start to talk with people about, um, you know, even why, if they’ve never had a psychedelic experience or a peak experience, you know, start from the beginning. What are your motivations? We have actually a whole process that we’ve thought about through, of understanding one thing is, um, understanding your motivation, um, choosing a facilitator, a guide, thinking about the environment you’re going to be in, the people that you’re going to be around you. Um, your own… You guys paused, you’re still good… Your own physical and mental health. Um, it’s thinking way in advance of, well, first of all, what do I, what do I want to get out of this? If I do get out of this, what I want to get out of this, what is that going to mean for my life? How will that feel? And if I don’t, what will that mean? Or how will that feel? Um, and that’s just even the beginning. Rebecca, do you want to continue? Yeah.

Rebecca Hendrix:

Um, so I think one thing that we like to tell people is that there’s a, there’s a lot of positive talk that is going on around using these substances. Um, and it can get, it can get really easy to just get wrapped up on that and say, oh, I want to do it too.

Thal:

Absolutely.

Rebecca Hendrix:

But one of our main messages is like, stop and pause and think and focus and ask yourself why it’s not. It’s not for everybody any more than going on psychiatric medication is for everybody. Um, but you know, you have to know yourself well enough to know that you’re doing it for the right reasons and to know and to do your homework. And in terms of, you know, what could happen, considering your set and your setting, your mindset is so important. What you’re feeling as you’re going into an experience and knowing, um, you know, for example, if you’ve recently gone through a longterm relationship breakup and you’re at that stage in the very beginning where you’re just flooded with emotions and you’re crying and you’re even having trouble, like knowing which emotions you’re feeling, it may not be the best time to do one of these experiences. If you’re somebody that had been grieving your relationship for quite a while. And, you know, were not being flooded with emotions and it actually could be a good time to get some information that would help you heal. And and move forward. But it’s the process of just slowing down, doing research. There’s a lot of amazing resources online. We have a great comprehensive list on our website at www.one-integration.com, to be able to just look at all the different scenarios, look at, you know, things to consider about medication interactions, which Dr. Scharf can speak to a little bit, but there’s just a lot to consider. And harm reduction is about just that, like it considering all these possible things to reduce harm as much as possible.

Thal:

Hmm. Um, speaking of medications, like if someone is on anxiety medication or you know, depression medication and they really want to try psychedelics, what kind of advice would you give them, Susan?

Susan Scharf:

Well, of course it depends on the um, medicine that they’re using in the medicine that they want to take. Um, many of the psychedelics are not compatible with antidepressants and can be quite dangerous if combined with, uh, with antidepressants. Ketamine can be combined with antidepressants. And although I mean, Ketamine is a different, it’s very different from Ayahuasca or MDMA. Um, it is something that is legal and it’s able to be monitored. You’re able to be safely monitored by a doctor. Um, and it does provide support and relief for many people for depression. And it’s being used for some other things. It’s been studied the most in depression, but, so that is a possibility. Um, but in terms of advice, uh, we always say, you know, find a psychedelic literate practitioner who can really help you tease through the details before you go off and consider something. Because of course it is not without risk to use any of these substances or medicines that they, although they’re, they are heavy, beautiful place for healing. For many people, they, they have risks and things can happen and have happened and for various different reasons. And, um, and those, all those aspects need to, I mean, you have to consider for as a person yourself, all the aspects of what you need to know know know. You have to have the knowledge and be very judicious and aware before you participate in anything like this.

Rebecca Hendrix:

And because ketamine is already legal, it’s prescribed by a doctor. And so you could potentially even meet with a doctor that prescribes ketamine in order to talk about how you may be effected if Ketamine’s for you or they could even be knowledgeable about the other medicines perhaps. Perhaps. I mean, it’s no guarantee, but you know, yeah.

Adrian:

Because you brought up ketamine, I wanted to ask because, so it’s legal and supervised under medical context. I noticed you guys offer integration for Ketamine therapy. So there’s a group coming up on your website. Can you talk about what that would look like, the structure of it, I’m just curious, you know, to get a glimpse of, um, other forms of integration groups that might be drug-specific or experience-specific.

Susan Scharf:

Yeah, we really wanted to make this kind of, uh, modeled after a group therapy experience. We want it to be a closed group that everyone has. Uh, we’ve spoken with each person individually, um, before they enter this group. And it’s not just for people that are already involved with ketamine therapy, but even people who are interested in want to learn more. And, um, as you say, psychedelic curious. Um, so that by having this closed group of people that are committed to a certain period of time and a certain number of sessions that in fact that has its own container and safety to it so that everybody there we know is committed and, um, as much as possible. Right, to be present and hold space for each other.

Rebecca Hendrix:

And, uh, in terms of structure, what we plan to do is to have like each session somebody, will be part of the time focused on them and so they can share what they want to about their experience. And again, everybody that experiences ketamine just like the other medications may have a different experience. Some people don’t really remember much of their experience at all. Some people, you know, have a lot of of memory. So, and a lot of people that are going to see psychiatrist or the anaesthesiologist or the ER doctors that have set up ketamine clinics might not also have a psychotherapist or you know, they may just have a psychiatrist. And so it’s a space for them to add that piece of it in as well. And so as for structure, it’ll, you know, it would be everybody sharing a little bit, but each time there’s one person in particular that we can go deeper with during the eight week process and then that person also can get input from the group. Um, reflective listening, um, you know, that kind of thing.

Susan Scharf:

Yeah. About what Rebecca is saying. We’ve, we’ve found that ketamine is definitely, it’s happening in a lot of places now and it’s being, it’s very helpful for a lot of people, but it’s not generally provided, uh, from those practitioners who provide ketamine with any or very little space for any kind of integration. Although that might be with someone’s private psychotherapist, uh, we’re not finding that’s being combined often, if at all with the ketamine therapy.

Rebecca Hendrix:

Yeah, we’ve even spoke to a doctor recently who said that he feels that a lot of people are looking at it as just another drug. You know, you go into the office, you said you get your IV, the doctor could leave the room often no music, no blind fold, I mean no mask. And so that can, you know, that can affect somebody’s experience.

Susan Scharf:

Even the depth of their experience. Yeah.

Rebecca Hendrix:

Yeah. So, so making sure that, you know, providing a space that if somebody is considering using this, that they have as much information as possible on how to make that experience a good one for them. And if they have had one but they’re not quite sure how else they could be anchoring it in or even what happened to them, providing space for them to do that.

Susan Scharf:

And giving more space for transformation to occur.

Thal:

Yes.

Susan Scharf:

Transformation rather than just a receptor drug phenomenon.

Thal:

Hmm. I mean just you mentioning that I would think like what a waste to go and take, you know, and sit in a place and go through the experience and not be able to, um, go deep. It would be a shame. So yeah. Thank you for raising awareness.

Rebecca Hendrix:

Exactly. Yeah. And especially like, cause I know you guys are in the field and studying to do more of this, but, um, maybe a lot and I think a lot of the people that, I don’t know, some people anyway that are going to do ketamine may never even had a therapy experience. So, and I don’t know, Dr. Scharf or Susan, tell me what you think, but I think of the psychedelics, it might be one that, um, some people could have more of a dissociative reaction to then a, um, maybe classic psychedelic experience. And so for, for, for those people that could be even more challenging, but even maybe even more necessary, I don’t know about more necessary, but definitely, um, a tool that they could use to try to, you know, just how does it feel to have taken it? What was that like for you? What does, what does it like if it isn’t, or what if it, like what is it like if it is working, right. Um, just to have a place to talk about the experience. Just as if somebody were taking, uh, getting a prescription for Zoloft. You unpack that with your therapist, you know, what are the side effects and how are you feeling and what are you do?

Susan Scharf:

You know, honestly, we know that that doesn’t happen a lot either. We want it to, but yeah.

Thal:

Ideally.

Susan Scharf:

Yeah. Right. And setting expectations and moving through those and being with them. Yeah. Being with those feelings. Yeah. Yeah, yeah, yeah. And that ideally with, even as Rebecca was saying, um, an SSRI, you might start a Zoloft medication and ideally you would process how you’re doing on that medication with your therapist or maybe even your psychiatrist, and how you’re feeling and what that’s like as much as we’d like to think that’s happening and would like that to be happening. That’s not necessarily happening everywhere either.

Thal:

I think I, yes, I think, um, I’ll see you guys brought up an important point that not a lot of people that experienced psychedelics have had a therapy session or don’t know how a therapy session looks like. And that’s important because sometimes that whole psychedelic experiences literally like five hours of therapy, it has that potential. So yeah.

Rebecca Hendrix:

Yeah, exactly. Yeah. I mean the more that we are doing talks just to try to, you know, kind of psychedelic literacy talks just to help people to understand what these medications are. Yes. Um, the more that we’re realizing that a lot of people don’t really know much about them at all, a lot of times we have to even say what a shaman is or what a shaman does or you know, why, who would be a candidate for this type of medication and why would they ever do it and how to explain that it’s not, they’re not addictive medications. I mean, anything could be addictive, but they’re not normally after you have one of these experiences, you don’t wake up saying, where can I get more? I want to do it again because it’s just such a powerful experience that that doesn’t happen. But a lot of it, a lot of just some real, you know, amazingly smart, well educated, successful people just, it’s nothing is in their awareness about it.

Susan Scharf:

And also this, I don’t know how this will land, so you’re welcome to um, cut this out. But I was just thinking how, you know, integration, just like therapy, you know, therapy is practicing practicing how you think about things and practice and practice and integration also provides some of that practice and it’s a practice to, it’s a, it’s a practice to find ourselves again after whatever this growing up in our society or going through trauma or whatnot. But it’s a practice just as mindfulness is, it’s all kind of one in the same as is giving yourself time and space, giving yourself time to be with things, looking, being a, hopefully a nonjudgmental observer of your experience and being with that. And it’s all a place for practice.

Thal:

Yeah. I can see where the name One Integration comes from. Love it. Also another thing that I’m curious about is the relational aspect of psychedelics to like, even during the experience of Psychedelic, like, um, Rebecca, I think you’re an Imago, certified therapist and um, I’ve heard about couples therapy and ketamine. Like can you talk about that? Like what’s the potential?

Adrian:

And I just want to throw in there also, um, cause I know Susan you are, you’re involved with the MDMA trials, phase three, and some of those studies were conducted with couples. Yeah. I mean, so by design they had couples go through experiences. And this is something I actually last night I was, I was thinking about is, is realizing how potentially how useful that can be for integration that your partner, your perhaps your spouse, your life partner actually goes and does it with you. Yeah. So you don’t have to go home and actually feel…

Susan Scharf:

Explain it to them.

Adrian:

Be disconnected. Yeah.

Rebecca Hendrix:

Explain as if you could.

Thal:

Yes. Hello, stranger! [laughing]

Rebecca Hendrix:

Um, I mean, I would love, I mean, I can’t wait to get to the point where, um, we can do MDMA assisted psychotherapy for couples because so, oh, many of the couples that I work with, you know, either, you know, mostly one is more of a pursuer and very open with their feelings and wanting to talk and poke at the other person, they’re much more shut down and withdraws, you know, when there’s an argument. And so to have, um, a psychedelic assisted psychotherapy session, you know, and the more trauma a couple has either one or both of them, everything gets exponentially harder to the thousandth degree because they’re also feeling issues around emotional safety that often it has nothing to do with their partner, but it’s very hard for them to block and to not act out on, in ways that make them feel very disconnected to their partner. So, you know, having a situation where MDMA could be used to basically get everybody in their loving essence, which is my main goal anyway, but when I’m working with individuals or with couples is to get them into their heart-centered self and then to speak to your partner from that place and feeling the emotions from that place versus the hard side of, you know, most of the time people might be speaking in the more defensive hard side of a feeling like anger, but underneath that there’s hurt and to get them to speak from that place. Okay. It’s in that place, that a corrective emotional experience could happen that they then could start to do at home. And that’s where healing occurs when people are relating from that space versus just the surface. I’m so upset because you’re five minutes late to our movie and you don’t care about my time and all of that. So I would love that. I’m not familiar with the ketamine assisted couple’s therapy. Um, I’ve been more familiar in and or imagining what it would look like with the MDMA. Do you know anything? Have you heard anything about..

Susan Scharf:

I know of people that have tried things, but I actually haven’t heard much on that. I would love to hear about it. Um, yeah. What’s happening with that? I know about the couple’s study I think isn’t Anne [Wagner] even part of that? Um, yeah. Or was part of that, but I don’t know the actual findings, although, um

Thal:

I guess my question was more like, it’s not about the actual medicine, but the potential of psychedelics and..

Susan Scharf:

Oh, my intuition and yeah. I mean I have a dream of also providing this to perhaps adult families, um, for, you know, for healing, all of those things that happen. Oh, such a place for, I mean, just, just even with the PTSD study. I think what it allows that, that layer to be peeled off of having to react of the, of such, the, what comes up with all the, the PTSD symptoms and experiences and flashbacks and the gamut of things. It allows the system to almost like take that layer off off and not have to be constantly reacting and protecting so that the inner, the feelings, the knowledge, the other things are gone. Just like Rebecca is talking about instead of being that defensive mode, um, from the feeling hurt by being defensive and see me and you’re just being able to be in that place, feeling those, those hurt feelings or, I mean, there’s so many different things that can happen in those instances, but, um, I think of course the study in order to move things forward in our society had to be focused on a thing. So PTSD was chosen and I think it’s a very good choice, but the implications of MDMA use for so many things are very obvious to the both of us. Yeah. It sounds like to you guys as well, and we feel that it can be beneficial in so many different areas for healing. No doubt. Absolutely. With, with the couples, with families, with, um, yeah, so many places.

Rebecca Hendrix:

Mother, daughter…

Thal:

Yeah. I was just thinking mother, daughter, father son. Siblings, right. Yeah. There’ll be no wars in the world!

Rebecca Hendrix:

Can you imagine?

Adrian:

It’s amazing, reimagine “family trips” and take it to a whole other definition.

Susan Scharf:

Like a new Disney. Yeah. Okay. I didn’t mean to make it into.. it’s not a toy! But yeah, that’s kind of something in my heart that I think about is being able to do these for sure. Relational connective experiences.

Thal:

Yeah. Sort of coming from that heart space versus Ego space.

Adrian:

Just as we, as we bring things to a close, could you guys share resources that might be helpful for people who are listening? Either they are curious. Uh, pre-experience, we mentioned maybe peri-experience, they’re really close to doing something or, post, they’re still integrating. Any helpful resources you can point to?

Rebecca Hendrix:

Gosh, um..

Susan Scharf:

Well you think, well of course Michael Pollan’s book is very helpful. Um, he’s, he’s so good at what he does and so we definitely, that is a, a place for resources. Um, we refer to that a lot. Rebecca mentioned our website for resources. I mean there are, um…

Rebecca Hendrix:

There’s one called Erowid.

Susan Scharf:

I was going to say, Erowid.

Rebecca Hendrix:

Another amazing one, just chockfull of information.

Susan Scharf:

The one thing about Erowid is that you know, you, it’s a, it’s, it’s anything, right? So you have to know that you’re coming to it. Um, that one person’s experience again may not be yours and that this is information gathered from a number of people and is not, it can’t be taken one piece at a time. It’s kind of looking at the whole so you’re not getting… I guess they kind of do have a a lot of good resources in there, but it’s not been combined into one little nugget that you can just bite. It’s a larger if that makes sense.

Rebecca Hendrix:

Yeah Chacruna.net is an amazing one and started by Bia Labate. Psychedelics Today. Um, all the Center for Optimal Living. They have a psychedelicprogram.com. MAPS.org which is one of the nonprofits that is doing a lot of the MDMA research, you know, these nonprofits are the ones that are moving these drugs forward into getting them license because they’re not being funded by the FDA or you know, a lot of bigger companies aren’t necessarily interested in getting involved in something that you’re going to take once or twice or three times. Traditionally the bigger companies are invested in something you’re going to take every day for the rest of your life. So all of the reasons why these are moving forward is because of, um, private donations and then the, um, trials that are being done by MAPS by the Hefner Haffner Institute by um, or, um, yeah.

Adrian:

Awesome. Amazing. Thank you so much for your time ladies. That was a lot of fun.

Thal:

Thank you.

Susan Scharf:

Thank you so much. Such a pleasure.

Rebecca Hendrix:

Thank you for having us. It was great to meet both of you and we will look forward to continuing to follow you as well and see where you go on this journey as you become professionals in the industry.

Thal:

Awesome.

Susan Scharf:

We broadened our community.

Thal:

Ah, yeah.

Adrian:

Definitely.

#15: From Ecstasy to Remedy – MDMA Therapy with Anne Wagner

May 5, 2019 00:53:03

As the so-called third wave of psychedelic renaissance unfolds, the notion of self-improvement has taken a new and deeper meaning. After a long slumber, the field of mental health is waking up to the therapeutic potentialities of these powerful tools in relieving symptoms of depression, PTSD, addiction, and fear surrounding terminal illness. Targeted towards beginners, Michael Pollen’s book How To Change Your Mind, published in the summer of 2018, propelled the conversation around psychedelics to the forefront. Whether it is MDMA, LSD, psilocybin, ayahuasca, or others, the potential for consciousness expansion and psycho-spiritual growth is immense.

The FDA recently granted “Breakthrough Therapy” Designation to MDMA for the treatment of post-traumatic stress disorder (PTSD) and is currently in phase 3 clinical trials. Popularly known as a recreational drug, and as the main ingredient in ecstasy, MDMA is paving the way for the possible near-term legalization of psychedelic therapy.

On this episode, we talk to Anne Wagner, a clinical psychologist and one of the lead investigators involved in the MAPS funded clinical trials of MDMA + cognitive-based psychotherapy for PTSD. Anne tells us how she ended up working in the cutting edge of psychedelic science and what these studies offer for the future of mental health. In her clinical practice, Anne applies a cognitive-behavioural and mindfulness-based approach to therapy and she also offers preparation and integration of psychedelic and non-ordinary state experiences. We got to connect with Anne at her new clinic, Remedy in Toronto.

Highlights:

MDMA + Cognitive Based Conjoint Therapy for PTSD
Leading Psychedelic Research
The Future of Mental Health

Resources:

Listen:

Poem Inspired by This Episode

Full Transcript

Thal

Welcome Anne to the show.

Anne Wagner

Thanks so much for having me.

Thal

Thank you.

Adrian

Yeah, we’re sitting in your space, Remedy in Toronto. No, actually that’s one of the things we do want to ask you about is to learn more about the work that you’re doing here. Um, but before we dive into your current work. We tend to like to go backwards and just learn about your journey and how you got interested in the intersections between psychology, psychedelic science and specifically the MDMA studies and how did that all come together for you?

Anne Wagner

Sure. So it was not a planned path, that’s for sure. Adding these things together. So I knew pretty early on that I wanted to pursue psychology. So within, you know, the first two years of my undergrad degree, I decided that psychology was something I found really interesting. And the thing that I liked the most about it was just the breadth and depth that you could have within one field. So you could be, um, learning how to run studies. You could be seeing clients, you could be investigating all kinds of different things that have to do with the human psyche and our experiences in the world. So, uh, that to me, the ability to be able to have a life where I got to ask lots of questions and be constantly learning and changing seemed really appealing. So I started that in my undergrad and then decided that, you know, clinical psychology was probably the right route for me. And I started Grad school at Ryerson in Ryerson University in Toronto and I started that in 2007 so I started my master’s and my PhD at Ryerson and then my internship at the Centre for Addiction and Mental Health. And then I went back to Ryerson and did a five year post doc and it was during that post doc that I really, uh, developed a really strong love and interest in working with trauma. And that would have been something that I had always been interested in. And I’d done work in my PhD, uh, working with my mentor Candice Monson, uh, around treatment for post-traumatic stress disorder. And then in my postdoc that really got honed into how do we work with and improve the treatments that we have or potentially make new treatments for PTSD. So, and the reason why I found that so compelling was that the treatments we have, they worked for some people some of the time. And that’s amazing. When they work, you see such incredible change for folks, especially with PTSD. Feeling like that feels permanent or like people are totally changed from how they were before. And, um, the idea that someone can really have their world open up and be able to have a new future after that to me was absolutely compelling. And, um, you know, I tell the story sometimes that my, I think my interest really started in that given my grandfather was a World War II vet and he worked with Veterans Affairs Canada as an under administer of veterans affairs. And, um, he really, really believed in supporting the veterans in terms of their experiences. And at the time, you know, we didn’t have a word for PTSD after World War II, but he knew that there were lots of people who were struggling after their experiences. So I kind of grew up understanding that this was after really challenging and traumatic experiences oftentimes that people have no choice whatsoever in the circumstances in which they’re placed, um, that we owe our brothers and sisters, you know, the ability to help work through, move forward and heal in different ways. So, um, that all kind of started to resonate and coalesce when I was in my post doc and, uh, I was working with Candace on some studies around this treatment that she developed a called Cognitive Behavioural Conjoint Therapy for PTSD. And so it’s a couple’s treatment and that to me was so interesting and fit with my values in terms of being able to work interpersonally with folks and seeing the impact not just on the person, but on their relationships, on their families, on their communities, in terms of how trauma impacts us. So we were doing work with CBCT and testing that in various ways when Candice was approached by the team at MAPS around it, which is the Multidisciplinary Association for Psychedelic Studies about potentially collaborating. And the MAPS team had been looking at the use of MDMA for the treatment of PTSD, uh, for many years at that point, over a dozen years. And, uh, with, you know, the steps before that having taken, you know, another 15 before that. So there was some conversations and I was really lucky to just kind of parachute into this conversation right at the beginning with Candice and we decided to be open minded and give it a go. And so, um, the really exciting piece for me was that I have no idea about psychedelic use in psychotherapy at that point. Like zilch.

Adrian

What year was this?

Anne Wagner

Uh, this would have been in 2013. So I went from literally no knowledge to now running clinical trials with MDMA. And it’s been the most impactful transition for me, um, in terms of my own trajectory and growth and as both a person but also as a researcher and a clinician. So a lot has changed in six years, that’s for sure. And, uh, yeah, at that point, that’s when we started to work on this pilot study of Cognitive Behavioural Conjoint Therapy plus MDMA for the treatment of PTSD. And that started off by Candice and I getting to have our own MDMA therapy experiences through a study for therapists that gave them the experience of understanding what that feels like. And that for me was the thing that convinced me that this was going to be worth my time and energy and putting a lot of love behind this work. So yeah, that was the starting point. That session would have been in spring of 2014 and it’s been kind of history since then in terms of getting this going. So, yeah.

Thal

Um something I’m thinking about when you’re talking about PTSD, um, a lot of people connect it only with veterans. Granted veterans have, you know, they go through a lot and they see all kinds of horrible scenarios. But there are also different types of PTSD, complex PTSD. Um, there are people that, you know, due to childhood trauma have PTSD. So maybe we can, if you can just talk about PTSD a little bit.

Anne Wagner

Sure. Yeah. So PTSD arises from a whole number of different traumatic experiences in people’s lives and they can be, it can be for repeated experiences like a childhood abuse experiences. It can be from repeated exposure to adverse details. For example, first responders are prime for that experience. It can be from single incidents, like it could be from an assault or an accident or witnessing something really traumatic happening to somebody else. Um, and it can be, as you said, for veterans from the experiences of war. It can be from displacement, it can be from all kinds of different aspects of conflict. So yeah, the idea behind PTSD is it can come from all these different things. Um, but it often looks the same in terms of its presentation in terms of what it looks like and people feeling like their need to avoid things that remind them of the traumatic experience. Whatever that experience is. There’s the re-experiencing of thoughts and memories associated with the event or events. There’s a hyper arousal that goes alongside of it. So that feeling in your body of being constantly on alert or constantly activated in some way. And then there’s numbing that goes alongside of it as well. So you may have either really strong emotions and really challenging cognitions or you may end up having a numbed out experience where you’re not feeling much at all. And so all of those, that constellation of symptoms, if you will, or things that happen, they all form to make up PTSD. And, uh, the differentiation, you know, between complex PTSD and PTSD, um, is, you know, it’s one where I think people find it really helpful to talk about complex PTSD, to think about the extent of the experience that they’ve had. Um, and what would I find in the research is actually that the treatments that we have for PTSD as just PTSD work for complex PTSD as well. So I think that, um, for me, I, I would get questions around complex PTSD and what I think about that, and you know, I’ve, I’ve done some publishing actually around challenging the construct.

Thal

That there is no real difference.

Anne Wagner

Right. Yeah. And it’s simply because if we really whittle it down, what matters most…

Thal

Is the experience.

Anne Wagner

Is experience. But it’s also, if we’re going to differentiate, it’s usually because we want to figure out how to best help and best treat. And so therefore, if how we treat would be the same, why would we differentiate between the two? I mean, I’m a fan of parsimony, so.

Thal

I like that. Yeah.

Anne Wagner

Yeah. So he was very open to however, however you want to interpret your experience, 100%, that’s, that’s in your hands. Um, but how it guides how we formed treatment, I think is a different way.

Thal

I think the main thing is that because a lot of people who are suffering from PTSD and they’re not veterans, they don’t legitimize their, you know, they feel like, you know, or, or they perceive like, “do you really have PTSD?” Like you, yeah, we’re not in a war zone or something like that.

Anne Wagner

Yeah, yeah, exactly. And I do think that helps in terms of, or can I notice it more actually in terms of, uh, folks having a broader understanding of their experience if they feel like they identify with one term another and yeah. I think whatever means to be able to own and accept the experience is useful. Yeah.

Adrian

I put a flag down when you mentioned, um, having that experience with, with Candice the first time you were sort of, sort of convinced that you wanted to do this research.

Anne Wagner

Yeah.

Adrian

Are you comfortable sharing what that experience was like?

Anne Wagner

Sure. Yeah. Um, so yeah. Okay. So the experience of having an MDMA therapy session, uh, so the way it was designed in that first, the thing I participated in, we had one active session and then one placebo session of course that you don’t know which one you’re going to get first and uh,

Adrian

But you’ll pretty quickly know which one… [laughing]

Anne Wagner

Yes. Well, I figured it out, although it was pretty funny about an hour in, I wasn’t, I was not perceiving any effect at that point. And I thought to myself, I was like, “you know, this is probably placebo. All right. Like I’ll have to wait.”

Thal

“Oh, no it’s not!”

Anne Wagner

Oh yeah, exactly. Yeah. Like within 10 minutes. You know, it’s funny, everyone else had seen my blood pressure spike, but I had not seen the, um, the recording side. I had eye shades on and they were all, you know, waiting. And then I’m like, wow. Yeah. Um, so that experience for me was, uh, it was so interesting. It was the most impactful therapeutic experience I’ve ever had. It felt like I was able to check in and all these areas in my life really quickly where without any extra layers on top of it. Like it took away my own judgment and shame and guilt around things. And it let me literally just go through all the areas of my life and go, what do we think about this? What do we think about this? How about that? And it felt like I wasn’t particularly intending to check in these areas, but it allowed me to do that. And it felt like I reached my conclusion easily and readily. And even if that conclusion was ambivalence about something, I was like, great, I’m ambivalent about that. That’s the answer. So it let me not second guess a lot of things that were happening in my internal world. Um, and I found that, that the effects of it lasted for a really long time. I mean, it, it literally that session I felt like I was integrating and processing for, you know, weeks if not months later. But the overall impact for me has been, yeah, well it really, it changed my life and a lot of ways, not just because of the therapy, but also what it had then led to. And I think that that sense of that deep investigation and exploration can really help to shape your trajectory. So, um, yeah, so that was, and I was actually great, really grateful to have a placebo session next. Cause then I just got to integrate the whole experience a few days later. Talk about it going like, wow. All right, so all this stuff happened in that session. I get to chat about it. Now.

Adrian

I guess at that point then, um, what were the next steps after having the experience and then you can ask to go go ahead with the research. Was that the deciding point to, to move along and then to move ahead.

Anne Wagner

Yeah, it, yeah, it certainly was for me, I think we went in pretty open minded, like, you know, curious to explore it, but using that as a, uh, a test to see did we think that this might have value or could you see this working? Um, and so after that we ended up.. Initially we were thinking a lot about, okay, so we’ll go into the experience. So she had these questions in mind and we should think of that. And then as soon as I got into the MDMA experience, I was like, forget it. I’m just having my own experience. I’m not thinking about methodology for study. Right. We basically, we both chose to use that week just to have our own experiences and think through that. And then with time, you know, I quickly made the decision that I wanted to use this as a tool for therapy, but we then gave ourselves a bit of space to then actually start thinking up what that would look like in terms of a treatment and a protocol and things.

Thal

So, so you guys combined the MDMA therapy with uh, you said CBCT. That’s right. It, can you talk to us about that please?

Anne Wagner

Sure. So, um, we use, so CBCT Cognitive Behavioural Conjoined Therapy for PTSD is a 15 session treatment that’s designed for two people to go through the treatment together and uh, those two people could be in any way in relation with each other. It’s generally speaking, is romantic couples who choose to go through treatment together, but it doesn’t mean it has to be. Um, and so within that treatment folks are taken through kind of three main phases of therapy. The first phase is really understanding PTSD. Um, doing some psychoeducation about what PTSD is, what it might look like in your relationship, how it’s impacting you as well as talking about, uh, how anger and aggression can impact the relationship and just beginning to understand what those look like in the relationship and building some skills to counteract that and cope with. And then moving into phase two, we go more specifically into other skill building. So communication skills, like paraphrasing and some problem solving skills and beginning to approach things that the couple has been avoiding. And so we designed these approach tasks with the couple to help them be able to live a life of approach where they’re, you know, engaging together and doing things that they may not have been doing otherwise. And then the third phase specifically moves into making meaning of the traumatic event. And so thinking about areas where each of them, and together they may be stuck around the trauma, um, and thinking through some core themes that are related to trauma. So acceptance and blame are a big one. A control, power, trust, esteem, intimacy, um, post-traumatic growth. So using those. And then, uh, so that’s the framework of CBCT. And then what we did when we added MtMDMA to it was, we put it in strategic places in the protocol where we thought, uh, you know, if we were going to want to boost the effect of what we’re doing, we’d maybe want it in these two places. So one was in right after they’ve learned the communication skills. And so being able to have those skills as a bit of a template to be able to work with the experience together, both during and after. And then again, we placed one right in the heart of the trauma processing. So they’d started some and then we put the MDMA session to allow them to see what else could unravel in that moment and then work with them to integrate it after.

Thal

I think he had mentioned that it’s not only romantic couples, right. Have you guys had different types of dynamics?

Anne Wagner

So in the pilot with the MDMA, it was only romantic couples. Uh, we were open to, the recruitment was open for any type of diet, but it was only couples who came in. Um, but then in case studies that we’ve worked with outside of that study, we’ve seen, um, parent-child, we’ve seen, um, good friends go through it together and trying to think who have had siblings. Yeah. So there’s been a few different constellations.

Thal

And, and do you think the impact of the therapy would be different if it was just singular? Like, just like the person that’s suffering from PTSD without the conjoint.

Anne Wagner

So, I mean there are other therapies…

Thal

Yeah, cause I’m just thinking about the difference between both. Yeah. Um, but I, I do see the benefit of the relational aspect.

Anne Wagner

It’s definitely a different frame in which to conduct the therapy and, um, you know, the individual treatment. Um, for example, Cognitive Processing Therapy, which is going to be the next pilot study that we’re running with MDMA. Um, it is an individually delivered.

Thal

Oh, so you’re going to do that okay.

Anne Wagner

Yeah and the work that’s been done up until now, so, uh, that the MAPS team has been running, has been an individually delivered treatment and it’s with an inner directive supportive psychotherapy for PTSD. So not, uh, specifically one modality, but kind of allowing what comes up. Uh, so partly one of our goals with doing the know the CBCT and now the CPT plus MDMA was to use treatments that have already been tested for treatment for PTSD. And to see when we add MDMA, do you have even broader or stronger effect? Uh, so they’re giving us a different starting point in terms of the evidence in which to see if it’s effective.

Adrian

I wanted to ask if the subjects who were part of that first pilot that you were involved in, were they diagnosed as treatment resistant PTSD? Have they tried other forms of treatment prior to the study?

Anne Wagner

Yeah, so in this, in the pilot we ran, they didn’t specifically have to be treatment resistant, but they all were. Um, so it was, it just so you know, it people are not necessarily jumping the gun to do this without having tried many different things. So yeah, everyone had had lots of different treatments in the past.

Adrian

I’m so curious. Um, yeah, there’s so many, so many questions. Yeah. I’m thinking a juicy place to dive into is their first experience, you know, if you can share with us perhaps maybe what their experiences were leading up to it and, and the, what the day looked like, when they had it for the first time?

Anne Wagner

Sure. So, um, so folks had some preparation ahead of time, so obviously they’d gone through a consent process. And lots of conversation about what this whole treatment was going to look like. And then they’d had some intensive days or a day and a half, basically of CBCT. So we squished the equivalent of five sessions into a day and a half of CBCT. Um, and so, and some of that day was in the morning of their MDMA session. So they were, uh, mostly quite nervous before their MDMA sessions. Especially a lot of them were either psychedelic or entactogen naive or the experiences they had had where like 20, 30, 40 years ago and you know, university at some point. Um, so never in this context and never with the presumption that they’re going to be talking about trauma. So, uh, yeah, so there was definitely anxiety ahead of time, which we work with and a lot of the partners were quite anxious too, cause you know, they really, okay,

Adrian

They’re coming along for the ride.

Anne Wagner

So yeah. And everyone went through with it and did it. And, uh, so the way the room is designed, when we were doing the sessions, uh, there would be two recliner chairs. And so the couple would sit in those recliner chairs and be able to either have the option of sitting up or lying back, not completely flat, but you know, quite reclined. And then the two therapists would be in the room with them and facing them. And then if people were feeling really activated and they want some support from the therapist, we had like small camper chairs that we would sit beside them on the recliner chairs. So, um, they could have, it’s a little bit space or closeness and, uh, they were close enough to each other that if they reached out, they could touch hands or hold hands or can choose not to if they wanted to as well. And so the way the day was, there really was no structure to the day other than, um, you know, we would encourage them to spend time as we deemed it inside, which means, uh, with headphones on, eyeshades on and just reflecting internally and that experience and other times where they’d be talking with us, talking with their partner in sharing the experiences that were coming up or reflections. Um, so, you know, we’d go through different periods of time inside time outside, and we learned how to better orchestrate interaction between the couple in terms of, you know, at some point someone’s ready to talk and the other one’s deeply in process with something else. So we would, um, we learned how to kind of check in with one or the other, maybe jot down a note and say we’d hold that, that thought for them. And they could go back inside and we’d raise it again when everyone was, you know, out in the room. Yeah. So that’s basically what it looked like.

Thal

What about the role of music.

Anne Wagner

Music plays a very important role and kind of assisting the process. So, you know, allowing for an arc in the experience and having, um, supportive music kind of at the beginning. And then active music as you kind of getting peak effect and then, uh, music that helps with resolution and closer to the end. Um, but you also need to, you know, we had, we were flexible with the music within it. So, um, Annie Mithoefer who is one of the investigators and she’s a great Dj. So she was our DJ for all the sessions, which I’m going to have to learn how to do when I’m running the sessions here and, uh, yeah, so both members of the dyad would have earphones on and we’d also have it playing in the room so everyone could hear the music. And so we had splitters to do that and then at times we turn the music off when they’re talking and yeah.

Thal

I was going to ask like do you turn off when they’re talking?

Anne Wagner

Yeah or turn it down. Just mostly so it’s easier for everyone can hear each other.

Adrian

How many couples were there in total in that study?

Anne Wagner

Yeah, so it was a small number. So we ran six couples through it and it’s really, originally we were thinking of going up to 10, but, uh, for a number of different reasons, including time and money. And, uh, but also the main reason was because our effects were looking very good. We decided to stop at six. Um, to be able to kind of had enough evidence to show we can do it. It’s feasible, it’s safe, people tolerate it and people improve. And as enough of a signal to say, we need a larger study. So in designing the larger study that would have a control condition.

Adrian

I imagine all the internal experiences vary greatly between participants. But were there any commonalities you guys noticed, um, in, in those, uh, in the six that you, you were sitting with.

Anne Wagner

Uh yes. I mean, one thing that I think was very interesting as someone who does a lot of trauma therapy with folks outside of a MDMA work is just how consistently people would go into their trauma memories and recount the experiences unprompted with MDMA. And so that was fascinating and I’d heard that that had been the case, uh, with the other studies, but that it, like clockwork would happen every time. And um, you know, it was no priming no asking people to go into the memory. We don’t even actually require that at all if people in CBCT to actively go over the memory. But it happened for everyone.

Thal

It’s like they went through the files of…yeah, amazing.

Anne Wagner

Yeah. That analogy is used a lot actually like putting files in a row and you know, I had that experience myself of like checking in. It’s like checking all the files and then other people with PTSD when they’re going through this you know, checking through the files, the memories. And so then the role of the therapist, um, is really the major role is pre and post the experience. Like during the experience of course you’re holding the space for the, for the clients, but it’s, it’s, it seems like from what you’re saying that it’s like, um, self guided in a way. Yeah. The MDMA session itself, we’re definitely there to hold space and to help when people are stuck. And so I think that piece is also very important. Um, and you know, sometimes when we think about like being non directive, in fact there’s moments where we’re actively working with folks in session to help the experience or if people are feeling particularly stuck in a thought or a memory we’re there to help them work through that and you know, gently, you know, be socratically questioning, you’re asking different things or exploring. But the massive chunk of that work is before and after.

Adrian

So what happened after the first session? What’s the next stage in the protocol of the study?

Anne Wagner

Yeah, so they’d gone through equivalent to five sessions of CBCT before and then they had the MDMA session and then the next morning we would talk about experience, integrate it a bit and set them up with out-of-session work for the following week. And then they would do the equivalent of four sessions of CBCT. In this case we did it over video, um, simply pragmatically, cause we’d all didn’t live in the same place. And then they came back together about three weeks later, I had another day where they did two sessions of CBCT and then they had a second MDMA session. Integrated that and then finished out the protocol, which was four more sessions of CBCT. So they received MDMA twice this whole thing. Yeah. It took about two months to get through everything.

Adrian

What were the results? Sort of dying to hear the summary of the findings.

Anne Wagner

So they are not published yet, but I can let you know. So we actually published a case study last week. Um, so that has the first results are out in the world.

Adrian

Congrats.

Anne Wagner

Thank you. Very exciting. It’s in the Journal of Psychoactive Drugs, so that’s good. Um, so yeah, overall the results were very strong. We had really good results for PTSD, both from the report of the person with PTSD, so their self report as well as the clinician rated report. And so that’s an independent rater. So not the people who treat them, it’s from someone who doesn’t know where they are in treatment and whatnot. And they also, we saw significant improvements in relationship satisfaction as well. And that was really interesting because not all the couples were distressed coming in. And I think that’s important because a lot of the time, you know, we think about actually how PTSD lives in relationships. People have to make sense of it and therefore, oftentimes they accommodate the other person as we all do in our lives. We accommodate the people we love. So it’s, you know, you’re trying to make it okay and especially when something’s not okay in a system, it creates a very difficult system. But that works for some people. And so that can be a challenge sometimes when things change, the system disrupts because everything’s been, you know, trying to hold tight to keep it together. So the fact that we saw improvement for folks who even already we’re starting okay. Which meant there might’ve been some accommodation was really interesting. Yeah. So more to come.

Thal

So it’s not really couples therapy, it’s, it was, it’s conjoined therapy, but um, that the, you know, the couple’s therapy is like that bonus part that came.

Anne Wagner

Yeah. Yeah, exactly. I mean the way we structure it, I mean it really, it is a couples therapy. Yeah. It could be any version of couple that you think of. Um, but the idea is the relationship is actually the client in CBCT. So it’s not the person with PTSD, it’s not the partner. It’s the couple or the relationship. And having that be the focus is really useful. So that one person doesn’t feel like the other person is their other therapist or that they’re responsible for the person, they’re doing it together.

Adrian

Are you, are you able to share any of the self reports by the subjects, um, things that they shared with you, whether it’s during the study or afterwards that you might want to share with listeners?

Anne Wagner

Sure. So, um, I mean, people spontaneously had really incredible, you know, things that they wanted to say or share. And, um, I’m, you know, feeling like they’d gotten their lives back or that they felt renewed hope for the future. And, um, you know, in the session itself, you know, I had people say that, you know, this is really, it felt like they had gotten their marriage back or that they now have a sense of feeling connected. Um, I got an email a few months ago, which marked like a year since one of the couples had started the study and it was just a reach out of gratitude and thanks. And reporting that they felt like they had a completely different life and they were very grateful and that they just thought it was all really cool. So that was a really neat thing to receive.

Thal

It’s amazing. How rigorous was it for you like to go through the daily experience of going through the study and, yeah.

Anne Wagner

Yeah. It’s a labor of love doing the clinical trial, that’s for sure.

Thal

I can imagine.

Anne Wagner

It’s, you really have to want to do it. And, uh, I remember, you know, Candice once told me, this is not for the faint of heart. I’m like, no, it was very, very true. It’s a lot of details and a lot of planning. Um, it a ton of work for a little bit of data, but it’s in my mind, so worth it. And you know, the days when you sit in the sessions with folks, um, and you see them change right there in front of you and you were like, wow, this idea we had, I think it’s working like this. That’s unreal. Um, that feels, that feels pretty cool. And, uh, so yeah, it’s, it’s, I found working on this particular study to be incredibly inspiring and so that certainly helps drive all the rest of the work and is now shaped what I’m doing going forward,

Adrian

If I remember correctly, most of the subjects, if not all, had improvements in their symptoms of PTSD. How, how did they do afterwards? Post study? What was the timeframe for the follow up and checking in on them?

Anne Wagner

Yeah, so the vast majority, well, I mean, there’s only six couples. The majority, not everyone, uh, a resolution their PTSD, but most did and those gains were maintained through six month follow-up. So that’s the, the most, the furthest data we have. Yeah.

Adrian

That’s really cool. Yeah. I mean, one of the things that we often hear a lot in psychedelic research and, and, and, um, just discourses the integration after these experiences. Can you share any wisdom that you might have gained from this study about how to better integrate or, or to tie back to their daily lives?

Anne Wagner

For sure. I think a big piece is that integration isn’t just like your next session with your therapist. Integration happens over time as you begin to put the lessons you’ve learned into action and it might shape your approach to something or how you feel in general. Or you might have an echo of it, you know, a year later and go like, oh, yeah, so it’s, it’s being open to that being the case, I think is the key thing with integration as you go forward. And we certainly saw that, you know, in some cases we saw people continue to make gains over the six months afterwards. And that for us was really interesting because that means that they’re still learning and growing. And that is ideal because you’re basically setting people up for a new baseline, a new place to start from. And that happens often when people find success with treatment without MDMA. Um, but it was particularly highlighted for me when the use of a psychedelic or entactogen.

Thal

I’m thinking about a psychotherapist listening to this wondering when will legalization happened. When can I start training?

Anne Wagner

It’s a good question. Um, so what is looking like right now? So all of the movement to have MDMA legalize as a treatment for PTSD? It’s, it started in the US because that’s where all of the studies have happened so far. It’s looking, we’re hopeful that it will be within the next few years that it will be legal. Because right now there’s a phase three study, which is a drug development study happening in multiple different sites across North America, uh, sponsored by MAPS. And they at that point they will, after phase three, it’s possible that MDMA will get the indication to be a treatment for PTSD. So that’s the doorway to it being legal. Um, and so the hope is we would quickly follow suit in Canada using the evidence for the US. So, I mean my fingers are crossed that it’s going to be within the next few years. Um, there is also in the states there’s something called Expanded Access where when things are demonstrating strong effect and people are at risk for death, that you can potentially be using um, a medication that’s still being investigated for specific cases to be used. So, uh, the training that’s happening right now for folks to become MDMA assisted psychotherapist is for this idea of Expanded Access or those of us who are studying it you doing through the research. Um, so that, I mean, could be as soon as later this year we’re expanded access could be available in some places, uh, in Canada. We’ve different regulations around that. So it may not be as straight forward, um, but potentially could still be a possibility. And then of course, I mean the psilocybin work is another area where, um, you know, we’re seeing fast movement in terms of potentially there being indications for treatment-resistant depression and other things. So that might be another area where we might be seeing the potential legal use of psychedelics and treatment.

Adrian

Yeah. I know everyone’s got their fingers crossed, right? It’s like, it’s, you know, it seems like this is the opportunity but also not to mess it up. And so it definitely, you know, important that this time around this renaissance that’s happening is to do it properly so that it is sustained.

Anne Wagner

Exactly. It’s extremely important that we don’t squander this opportunity over here. Uh, this, there has been so much work that has gone to this place and so many have been paving the way for this to be the case. And, um, I’m very conscious of just how measured we need to be and just how careful and thoughtful around all of this use.

Adrian

Can you talk about the other studies so that with the CPT plus MDMA that is.. Is it currently underway?

Anne Wagner

It’s in development right now. So I’m just finishing the protocol for it. Uh, so our hope is that we’ll be recruiting in the fall for that study, but that’s pending a bunch of different approvals that need to go through. Um, so that study design is very similar to the couple’s study. Um, it’s going to be, but it’s an individual treatment and using CPT. So cognitive processing therapy, which is one of the most widely used and most widely researched and has some of the strongest evidence for the treatment of PTSD. And it’s usually 12 sessions. And so right now we’re just, you know, we’re finding exactly where we’re going to place the two MDMA sessions within the protocol. Um, but it will likely have a similar structure in terms of having a masked dosing of treatment before the first time. Do you may session spread out over three weeks, second MDMA and then finish it out. And this time, not over video cause we’ll do it here in person.

Adrian

How is, um, how’s the recruitment for that? So how do people, uh, if they’re interested in joining the study or being a participant, how does that happen? How does that work?

Anne Wagner

So right now we’re not, we don’t have open recruitment since the study isn’t approved yet. Um, but if people are interested in it, uh, if it will be for PTSD. So it is specifically for PTSD and people don’t have to already have a diagnosis of PTSD because it will end up, you know, they will have to go through assessment through the study. Um, but they can always contact us at Remedy and, we have a contact us button on our homepage and can be added to a list to learn more. And so that would, uh, it doesn’t guarantee anything, but it just would allow folks to get updates as to, for example, when the study is starting to recruit or updates along the way as we get going.

Thal

Awesome. So maybe, um, then talk to us about Remedy?

Anne Wagner

Sure. Okay. So Remedy, um, it’s where we’re sitting right now. So Remedy is a center for mental health, innovation in Toronto. And, uh, the idea behind remedy was to have a home where research and practice really live together. And the idea that we want to be continually open to growth and exploration as clinicians, as researchers, as people who are working in mental health. And that includes our own growth as well as the growth of the field. Um, so the idea here at Remedy is everyone who’s involved as invested in the idea of innovating mental health. And that can be in a whole host of different ways. So, uh, for example, one of the ways we do that is going to be through MDMA research here. Uh, but also we have folks who are innovating how we manage a practice, how, um, you know, we run trauma-informed Yoga, how we do care for folks that’s integrating different types of treatments together. We have all kinds of different things. Someone is going to be writing, you know, pop psychology book based on evidence. So it’s innovating how we think about an access, mental health and, and thinking about it in a broader way so that we don’t feel stuck or stymied in how we do that. So we offer a clinical services, but also we do research here and we collaborate with different likeminded group to create a community who are all with the same vision.

Adrian

I imagine it’s part of the vision, um, to consider post legalization and what that might look like. Can you share a little bit about your vision for once it’s legal, what the clinic might look like and how it’s offered to the public?

Anne Wagner

Yeah, absolutely. So my vision for that will be, we’ll have basically two tracks. We’ll have our research stream, which will be running and testing interventions, uh, which you know, is where my love is there and that I’m also a clinician and I want to be able to offer this in terms of people being able to come in and receive MDMA psychotherapy for PTSD in the practice here. So it will be either people can participate through research or through being able to come in. And you know, have that treatment. So, uh, yeah, we’ll be set up here to be able to offer that given that war already going to be set up to run the research. And so we’ll be ready and opening our doors to that the minute it’s legal. So yeah, we’ve got a team here who, uh, actually I just took a team down to Asheville, North Carolina for the most recent MDMA therapist training and so we’ve got a team who are raring to go.

Thal

That’s awesome.

Adrian

I’m just imagining if, if you had infinite funding and resources from a, from a research side, what would excite you as far as future research studies that you might want to explore and go into?

Anne Wagner

I’ve already designed my next big one. So it would be a randomized controlled trial for the couples study. So it would be, um, CBCT plus MDMA in one condition and then with a placebo control and the other maybe a crossover design at the end. So, but that would be the, we really need to test it out with more people and more diverse sample. I think that was a massive thing is, you know, in the pilot study it was heterosexual Caucasian folks in that sample. And that is not representative of …

Adrian

The globe.

Anne Wagner

The globe. We are here in Toronto. And um, you know, I think particularly, I’ve done a lot of community work in queer communities here and I think, you know, expanding especially what that looks like in terms of our, you know, constellations of folks participating in the treatment and as well as the therapists that they, we have, uh, we’re really excited about what that’s gonna look like. And when we test it on a bigger scale, like what’s it gonna look like for everybody.

Thal

Yeah. It’s going to look very different. Hopefully it’s going to be legal very soon. It’s going to look different when it’s, you know, out there and different people are accessing it.

Anne Wagner

Yeah, yeah, exactly.

Thal

Can’t wait. Yeah.

Adrian

Yeah. We’re super stoked for your work. I mean, you’re right in the trenches, so it’s, it’s a real honour actually. Yeah. To be, to be in your space and to get a glimpse of the journey so far.

Anne Wagner

Aww thank you.

Thal

Any more questions? Feel pretty good there. Yeah. Is there anything that you’d like to add, something that you have not been able to share in other lectures or other interviews?

Anne Wagner

Um, that’s a great question. I think, you know, it’s a really exciting time for this work. Um, I think it’s the, the possibilities for growth and exploration are also huge when it comes to psychedelics and entactogens and I don’t want to lose sight of that. And I think oftentimes when we are focusing so much on the clinical work and the clinical indications, that sometimes feels like maybe gets pushed to the side when, you know, there’s so many cultures around the world who’ve used psychedelics as forms of ritual, as forms of growth and learning and healing that, um, you know, this is not new. This is not new at all. I want to honor that.

Thal

In fact it’s ancient.

Anne Wagner

Exactly, exactly. Yeah. Just so happens that we’re conceptualizing, it’s used right now with how we understand this particular version of how we present …

Thal

And in our modern context, which is fine.

Anne Wagner

Yeah, exactly. Yeah. So I think I want to make sure we know that, that this, you know, while it feels “cutting edge” it is completely ancient. And this, we’re not, uh, coming up with new ideas particularly, but, uh, but really honored also to bring it forward into the here and now. So there’s that piece. Um, yeah, I think that’s a biggie. That’s on my mind.

Thal

Yes. And, uh, hopefully that will, you know, um, rev revolutionize mental health, which is, you know, the thing, you know, coming up now.

Anne Wagner

Yeah, I think so. Yeah. And I think we have so much possibility there. You know, I do think we’re at a time where folks are far more reflective about their own internal world and the possibilities for that and that this might be one tool to really assist in that.

Adrian

I guess just one final thing to a, I’m reminded of, um, the way Michael Pollan shared just the excitement beyond the pathological use or, you know, addressing pathological, um, experiences and just for the betterment of, well-people, I think it was the way that he was putting it and I think yeah, starting to redefine mental healthy on sort of the, the sort of, the highly stigmatized, um, cultural perspectives that we have.

Anne Wagner

For sure. Yeah. I have hope that one day we’ll be able to offer, um, you know, MDMA assisted psychotherapy for couples, right? Just not because there’s PTSD, but because you know, people want to explore and grow together and understand the relationships and their dynamics or for individuals and you know, still thoughtfully and with precaution and all the good context of set and setting and a good container. But the idea that that would be a tool would be lovely.

Adrian

Thank you so much for your time today.

Anne Wagner

Thanks so much.

Thal

Thank you.

mdma

#24: Psychedelic Integration with Susan Scharf and Rebecca Hendrix

#15: From Ecstasy to Remedy – MDMA Therapy with Anne Wagner

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