Psilocybin-Assisted Psychotherapy - New Remedies for Treatment-Resistant Mental Illness
Mental health is a growing concern in the United States with more than 1 in 5 Americans living with a mental illness; over 51 million individuals in 2019 (National Institute of Mental Health, 2021). The most prevalent mental illnesses in the United States are depression and anxiety spectrum disorders such as Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD).
Pharmaceutical and psychotherapeutic treatments for depression and anxiety offer varying degrees of relief. But for some, symptoms continue. When symptoms of depression and anxiety persist despite treatment with known pharmaceutical and psychological interventions, the condition is referred to as treatment-resistant mental illness (TRMI). Recent research into the use of the plant-based compound psilocybin among patients with TRMI offers promise for new approaches to psychological healing for millions of Americans.
Psilocybe cubensis, a species of psychedelic mushroom containing the active compound psilocybin, has been used as a recreational and experimental substance in the United States since the 1940s. Prior to its emergence in Western counterculture, psilocybin was used in sacred ceremonies among indigenous Mexican communities as a spiritual rite of passage. But recent clinical research shows promising potential for integrating psilocybin with modern psychotherapy in patients with treatment-resistant depression and anxiety.
Modern interventions, called Psychedelic-Assisted Psychotherapy (PAP), include clinically administered psilocybin accompanied by ongoing psychotherapeutic support. The practice holds promise as an alternative plant-based treatment that could bring relief for many from the troubling psychological states of depression and anxiety.
Psilocybin (PY, 4-phosphoryloxy-N,N-dimethyltryptamine) is the name for the active psychedelic compound found in psilocybe mushrooms. The existence of a “magic mushroom” first appeared in the American awareness following a landmark article in Time magazine written by the amateur mycologist Gordon Wasson (Wasson, 1957). The article “Seeking the Magic Mushroom” was published in 1957 following Wasson’s experience in a sacred Mazatec ritual in Oaxaca, Mexico. In the article Wasson spoke of profound mystical visions that he experienced while consuming the psilocybes.
For many, psilocybin is known only for its connection with bias-laden terms like “shrooms” and “magic mushrooms”. Such terms evoke images of a by-gone era of counterculture protesters wearing psychedelic clothing and paraphernalia. Since Wasson’s article in Time, Psilocybin has been used experimentally by many psychonauts; individuals who experiment with altered states of consciousness often under the influence of psychedelics). In anecdotal reports, it is not uncommon for users to state that their experience with psilocybin was one of the most important moments of their life; bringing meaningful and positive changes for months and years to come. These firsthand accounts strongly suggested that the psychedelic compound was helping people navigate the challenges of life and relieve symptoms psychological conflict.
Recent research into the possible clinical usage of psilocybin as a treatment option for depression has steadily increased since the late 1990s (Carhart-Harris, 2017). The use of psychedelics for the treatment of mental illness is called Neuropsychopharmacology. The findings of neuropsychopharmacology are now being translated into practical strategies to implement psychedelics into the therapy room.
A Rich History of Sacred Use
Psilocybin has been used for millennia in sacred healing rites for its healing properties
As described in Wasson’s landmark article, previous approaches to the use of psilocybin in healing center around the sacred practices of indigenous Mexican cultures. In Mexico, up to 53 species of hallucinogenic mushrooms comprise “the most important and diverse group of sacred mushrooms used by Mexican indigenous cultures” (Guzmán, 2008). Wasson describes receiving 12 small mushrooms in a ceremonial cup from his Mexican guide. He was instructed to chew them slowly over the course of about thirty minutes. While he chewed, the guide broke a flower from a small altar in the room, snuffed out all candlelight in the room, and left Wasson and his companion alone in the dark. The administering of the mushrooms was accompanied by ceremonial guides and observers who danced, clapped, prayed, and meditated while Wasson experienced psilocybin’s psychotherapeutic effects (Wasson, 1957).
As notoriety of the magic mushroom grew in the United States, Westerners who acquired psilocybin created their own set of sacred rites for administrating the healing fungus. As the counterculture popularity of psilocybin grew, so did awareness of the need for consideration to what psychonauts call set and setting. Set refers to the mindset and expectations of an individual before they begin a psychedelic journey. Setting refers to an individual’s physical and social environment while taking a psychedelic substance (Haden, 2019). Clandestine organizations of psychedelic guides developed robust manuals for guiding psychedelic experiences. One such volume is the Manual for Psychedelic Guides by Mark Haden (Haden, 2019).
According to The Manual for Psychedelic Guides, the procedures to ensure a “good trip”; an experience with the drug that achieves the desired therapeutic effect. To begin, the guide must screen the participant to make sure that they are legally an adult, of stable lifestyle, not suffering from a psychotic disorder (such as schizophrenia), not on pharmaceutical medications, and not experiencing suicidal or homicidal ideation. Items needed to ensure the psychedelic sojourner’s comfort during the session include a warm blanket, pillows, spare clothes, and eye shades. The room should also have juice, fruit, water, fresh flowers, and craft supplies so that the participant can document any meaningful psychological discoveries during the trip. Prior to taking psilocybin, the guide explains some of the experiences that a participant might encounter and provides some rules for the session including prohibitions on sexual touching and leaving the therapeutic space. The participant is provided an appropriate dose of psilocybin and instructed to lay back with the eyeshades on and listen to a prepared playlist of instrumental music while the psychedelic substance takes effect.
A New Framework for Psychedelic-Assisted Psychotherapy
According to Eduardo Ekman Schenburg in a 2018 article published in the academic journal Frontiers in Pharmacology entitled “Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development”, “psilocybin is the third most studied psychedelic substance for clinical applications. It has a very high safety ratio and very low-risk profile even in unsupervised settings” (Schenburg, 2018).
In Schenburg’s article, he suggests a “paradigm shift”; a novel framework with which to approach psychiatry. His paradigm shift suggests an explanation for the current crisis in psychiatry; why diagnosis of mental illness is increasing while the emergence of novel psychiatric solutions is decreasing. Schenburg shows the current framework of psychiatric treatment; a specific disorder is categorized by a clinician, treated with a specific pharmaceutical drug, and explained to the patient as brain dysfunction. Schenburg states that the existing framework causes “intense debates on the current diagnostics and explanations for mental disorders” (Schenburg, 2018) and confounds progress in the development of new pharmacological solutions.
Shown as a solution to the current psychiatric crisis, the PAP framework goes beyond the current crisis in psychiatry of identifying one of hundreds of diagnoses for mental illness and prescribing a specific medication based on the diagnosis. The PAP framework advances “a multidimensional approach to diagnosing mental disorders in a continuous spectra” (Schenburg, 2018). The new framework leverages holistic treatments and explains diagnoses in terms of mental injury.
The PAP approach combines knowledge gained from the indigenous use of psilocybin, the experience and guidelines developed by the clandestine community, and recent clinical research showing psilocybin’s effectiveness in the treatment of depression and anxiety. According to one study conducted at John Hopkins, taking psilocybin followed by psychotherapy resulted in a significant decrease in depression. An incredible 67 percent of the study’s participants had a 50% reduction in their symptoms. Four weeks after the treatment, 54% of the participants no longer reported symptoms of depression at all (Davis et al, 2021). The researchers concluded that “psilocybin-assisted therapy was efficacious in producing large, rapid, and sustain antidepressant effects in patients with major depressive disorder” (Davis et al, 2021).
These new findings add legitimacy to a substance that has been stigmatized by culture and the law for many years. Scientists are now focusing on how to develop therapeutic interventions that can be replicated in treatment centers around the country.
As new legislation legalizes the use of psilocybin for therapeutic use, individuals with depression and anxiety will be able to benefit from psilocybin’s healing potential in a professional setting.
Legalizing the Healing Potential of the Magic Mushroom
Because psilocybin is classified as a schedule A drug in most states, clandestine psychedelic guides and therapists risk legal repercussions if they use the healing mushroom’s properties to treat clients with depression or anxiety. However, recent scientific research has legitimized the use of psilocybin in clinical settings and provided a set of procedures to administer the drug that could soon be legalized for use by licensed professionals. Currently, Oregon is the only U.S. state to allow the therapeutic use of psilocybin. But as stigma towards the “magic mushroom” decreases and awareness grows as to its benefit for treating individuals with TRMI, perhaps more states will allow this effective plant-based substance to be integrated with evidence-based psychotherapies and administered by licensed practitioners to those in need.
References
Davis AK, Barrett FS, May DG, et al. Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2021;78(5):481–489. doi:10.1001/jamapsychiatry.2020.3285
Guzmán, G. (2008). Hallucinogenic Mushrooms in Mexico: An Overview. Economic Botany, 62(3), 404–412. https://doi-org.ezproxy.umgc.edu/10.1007/s12231-008-9033-8
Haden, Mark (2019) Manual for psychedelic guides. Retrieved from: https://uploads-ssl.webflow.com/5f7390dfac8708fbb8e78a8c/5fb9cd63019a29942351bce5_Psychedelic-treatment-manual-jan-7-2019.pdf
National Institute of Mental Health (2021) Mental Illness. Retrieved from: https://www.nimh.nih.gov/health/statistics/mental-illness
Schenberg E. E. (2018). Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development. Frontiers in pharmacology, 9, 733. https://doi.org/10.3389/fphar.2018.00733
Wasson, R. G. (1957). Seeking the magic mushroom. Life, 42(19), 100-120.
