Psychedelics and Health Psychology PDF

Paul Ritvo, PhD, Professor, York University - Rediscovered effects in rigorous pharmacology research - Psychedelics can promote health behaviour engagement: a. mindfulness – based interventions b. aerobics (mild-moderate-vigorous) c. diet (sensitization to dietary effects with generally sensitizing...

Paul Ritvo, PhD, Professor, York University - Rediscovered effects in rigorous pharmacology research - Psychedelics can promote health behaviour engagement: a. mindfulness – based interventions b. aerobics (mild-moderate-vigorous) c. diet (sensitization to dietary effects with generally sensitizing pharmacotherapy effects) d. alcohol abstention for problem drinkers (antiaddictive)…other addictions may be treatable Psilocybin is a potent & (for some) long lasting antidepressant Ketamine (blood) infusions can bring about the cessation of a depression within hours or days (but inconsistencies in duration effects) MDMA (methylene-dioxy-methamphetamine) has been especially effective with post traumatic stress disorder LSD is effective across decades of experimentation, especially for alcoholism disorders & drinking cessation ¨ ¨ ¨ ¨ Toronto – based services as examples: Field Trip – integrated ketamine therapy for treatmentresistant depression, anxiety disorder & Post Traumatic Stress Remedy – MDMA treatment based on randomized controlled trials. Therapist is available for 8 hours - the usual length of a ‘trip’. “We are with them to support strong emotions or somatic experiences that come up” Canadian Rapid Treatment Centre of Excellence – must qualify for treatment-resistant depression. Ketamine treatments last between 45 and 60 minutes using a moderate dose of 0.5 milligrams per kilogram. ¨ ¨ ¨ Research began in 1950’s in a Canadian facility (H. Osmond, MD & A. Hoffer, MD). Osmond was Deputy Director of Weyburn Mental Hospital in Saskatchewan. Hoffer was a staff psychiatrist. They began treating patients with LSD in 1953. Two alcoholic patients were successfully treated – their drinking ceased within 6 months Research continued & by the end of the 60s, they treated 2,000 patients with consistent results – one large LSD dose was effective in the tx of alcoholism (~ 40 – 45% of cases) ¨ ¨ ¨ Research difficulties followed Harvard adopted LSDbased research Their non-clinically based studies resulted in experimentation with grad & undergrads. Harvard’s psychology department (D. McClelland, Chair) shut down research & confiscated drugs. T. Leary continued experimentatyion with LSD under the International Foundation for Internal Freedom (IFIF). With Richard Alpert, PhD, he was fired from the Harvard faculty LSD & other psychedelics went from clinical use to indiscriminant use following the cultural frame of ‘entertainment drugs’ ¨ ¨ Griffith took a research area considered unethical, wasteful & dangerous & transformed it into ‘useful’ research with breakthrough findings Excellent research designs were key: 1. Randomization to multiple drug & assistance conditions 2. Dose-response curve comparisons (that addressed placebo effects) 3. Careful investigation of meaning & mood effects with valid psychometric instruments 4. Blinding (double-blinding) of participants & research staff ¨ ¨ ¨ Psilocybin affects different serotonin neurotransmitters than SSRIs (Selective Serotonin Reuptake Inhibitors) or SNRIs (Serotonin Norepinephrine Reuptake Inhibitors) The 5HT – 2A neurotransmitter is the primary locus for Psilocybin effects while SSRIs/ SNRIs affect the 5HT – 2C and 5HT- 6 loci. Psilocybin produces a chemical impact that may reflect a lengthy history of use, given imagery on Spanish prehistoric murals & rock paintings that suggest use predates recorded history Psilocybin-causes mystical-type experiences in combination with meditation (& other practices) producing enduring positive changes in psychological functioning & trait measures of positive social attitudes & behavior Journal of Psychopharmacology, 32(1), 49-69. 2006 This double-blind study evaluated the acute & longer-term effects of a high dose of psilocybin relative to a comparison compound (Ritalin) administered under supportive conditions. The ‘treatment’ causing positive changes was ‘spiritually important’ xxxxx The Psilocybin experience involves therapeutic alliance + drug effects – the high support condition entails in-depth attention https://www.youtube.com/watch?v=FyAgx_tzh80 All patients received the standard psychiatric care available at CAMH. © 2018 NexJ Health Inc. Confidential and Proprietary. Experimental subjects additionally received the online CBT – MM intervention. Changes in behaviours originate from support the spiritual experiences… © 2018 NexJ Health Inc. Confidential and Proprietary. Investigation of psilocybin doses & the frequency/intensity of support provided for spiritual practice using a battery of attitudinal-behavioural tests in N = 75 normal volunteers The dose manipulation was double-blind (neither participant nor research staff knew who was ingesting highest [30 mg. per 70 kg.], the next highest [20 mg. per 70 kg.] & very low dose (1 mg. per 70 kg) At 6 months, compared to low dose, high dose participants showed large significant gains in longitudinal measures of interpersonal closeness, gratitude, life meaning/purpose, forgiveness, death transcendence, daily spiritual experiences, religious faith and coping. Psilocybin can cause enduring trait-like changes in positive prosocial attitudes & healthy psychological functioning Across 4 studies ( n = 117 subjects), within-group, prepost & pre-follow up effects on depression & anxiety were large (Hedges g = 1.16 to 1.47). Across 3 placebo-controlled studies, pre-post placebocontrolled effects were also large (Hedges g = 0.82 to 0.83). No serious adverse effects reported ¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨ Carhart-Harris, 2018 -1 arm – n = 20 … 6 months f/u Griffith, 2016 – RCT – n = 29 ….6 months f/u Grob, 2011 – RCT – n = 6 …. 6 months f/u Ross, 2016 – RCT – n = 14 …. 6 months f/u Carhart-Harris, 2018 -1 pre-intervention mtg, 1 post mtg & 1 phone call Griffith, 2016 – 2 pre-intervention mtgs, 4 post-mtgs (2 per dose) Grob, 2011 – RCT – n = 6 …1 pre-intervention mtg & monthly phone calls Ross, 2016 – RCT – n = 14 …. 6 hrs of psychotherapy + monthly follow up telephone calls Six double-blinded RCTs, conducted between 2004 - 2017 Active doses (75 – 125 mg. ) & placebo doses ( 0 – 40 mgs.) were administered to individuals diagnosed with PTSD during (two or three) psychotherapy sessions lasting 8 hrs in ‘blocks’ spaced a month apart. Sessions were preceded by three 90 minute non-drug sessions and followed by three or four (90 minute) non-drug sessions. Altogether, 20 - 30 hours of therapeutic meeting time used in drugbased & non drug-based sessions Significantly greater reductions in the CAP IV self report scale in the active groups vs. controls. Cohen’s d effect size was 0.8 (large). After treatment, 54% no longer met criteria for PTSD dx (were ‘in remission’). Results caused the Federal Drug Administration (US) to grant the treatment ‘breakthrough’ status. Pooled analysis of 6 RCTs. Cohen’s d = 0.8 Ketamine & psychotherapy in treatment of chronic neuropathic pain Neuropathic pain is caused by tissue damage & is difficult to treat with high risks for analgesic addiction. We undertake n = 3 blood infusions of ketamine, each 2 hours while 16 sessions of cognitive behaviour therapy precede & follow infusions. © 2018 NexJ Health Inc. Confidential and Proprietary. Protocol based on systematic review: Ketamine assisted psychotherapy: a systematic narrative review of the literature (Journal of Pain Research) Sandra J. Drozdz1, Akash Goel1,2, Matthew W. Mcgarr3, Joel Katz4,5, Paul Ritvo4,5, Gabriella F. Mattina1, Venkat Bhat6,7, Calvin Diep1,8,9, Karim S. Ladha1,8,9,10 N = 9 semi-structured interviews completed © 2018 NexJ Health Inc. Confidential and Proprietary. Goal is better understandings of motivations, goals and experiences of individuals who ‘microdose’ Two popularly adopted protocols (Stamets and Fadiman) focus on dividing 7 days into microdose days & microdose-free days A microdose is lower than the dose that changes visual & other sensory perceptions © 2018 NexJ Health Inc. Confidential and Proprietary. 1. M-dosers are often in psychiatric treatment 2. Past treatment experience was dominated by pharmacological effects deemed ‘insufficient’ 3. In m-dosing, they seek ‘sufficient’ drug effects 4. They are not necessarily interested in chronic mdosing. They envision achieving ‘changes’ that render further intake unnecessary 5. They reflect vulnerability to negative moods & anxieties they want to resolve – m-dosing offers a glimpse of resolution (social fluency, creativity, meaning) on a day-to-day basis © 2018 NexJ Health Inc. Confidential and Proprietary. 6. M-dosers are not necessarily effectively achieving goals but signal interests & aspirations in adopting behaviours that improve m-dosing effects 7. Addictive potential of m-dosing seems minimal 8. M-dosers tend to be highly educated & understand & are influenced by experimental findings; some introduced in therapeutic contacts 9. With decriminalization, none concerned re: prosecution 10. Cautious about whom they inform about m-dosing Quotes: © 2018 NexJ Health Inc. Confidential and Proprietary. “ I want to micro-dose because with macro-dosing I’ve felt more relaxed, observant and able to enjoy”. “Better than previously prescribed psychiatric drugs.” Fourth year female medical student “ {I feel} calmness, peacefulness, optimism, appreciative, grateful, with decreased fear & anxiety, more ‘in the moment’ & less concerned about the future; I’m more energetic, eat slower, and feel healthier physically” 31 year old male diagnosed with ADD & currently attending university Psychedelic agents are significantly influencing mental health therapy Indications of significant benefit in research trials - disciplined processes of participants, researchers & clinicians Protocols are associated with treatment success. Outside of the protocols derived in research settings, there are no valid measures of efficacy. Remember the 1960’s & 70’s – these are not entertainment drugs – they are powerful agents © 2018 NexJ Health Inc. Confidential and Proprietary. The addictive potential of psychedelics is low but not non-existent With proper use, psychedelics can assist sensitization & self reflection. Use often precedes adoptions of behaviours effective in improving & sustaining health