Augmented therapies: psychedelic substances, scientific evidence (Henrik Jungaberle)

Augmented therapies combine therapy and the taking of psychedelic substances. In Germany, the development of this emerging technique is supported by the MIND Foundation, which participates in scientific studies, organizes an international congress and trains doctors. A request is even underway for doctors in training to be able to experiment with these psychedelic substances themselves. It must be said that the clinical results of this innovative treatment look promising, particularly for the treatment of recalcitrant depression. Explanations from Dr Jungaberle, director of the MIND Foundation.

We created this non-profit organization five years ago to support research, scientific communication and continuing education for doctors and psychotherapists. For two years, OVID Clinics has provided a clinical setting in which we can treat patients.

We are probably the first organization in the world, in the field of psychedelics, whose work is entirely based on scientific evidence. We consider psychedelic treatments to lie exactly at the intersection of medicine and psychotherapy. And we want to bring this form of therapy to the heart of international medicine.

What is augmented psychotherapy?

We have a certain conception of psychedelic therapy, and it differs from that defended, for example, by Stan Grof 1 in the 1960s and 1970s. We believe that psychedelic therapy is a very particular form of psychotherapy. But here, the medical perspective joins the psychotherapeutic perspective.

The pharmaceutical product used is special because it generates particularly profound experiences in patients, and this requires a framework. This framework, which we believe to be rigorous, beneficial to patients and also ethical, is called psychotherapy.

What does “increase” mean? This is what psychiatrists know when certain medications are potentiated, generally by another substance. For us, this means that psychotherapy and psychedelics influence each other in their effects.

This may not be easy to imagine for someone who usually only works in organic medicine, but it's actually easy to explain: The effect of psychedelics depends on environment and attitude interior of the person who absorbs them. This means that there is an increase in this direction.

Conversely, this also means that the effect of the therapy depends on the psychedelic. This, for example, enormously influences the relationship between therapist and patient. It can accelerate the establishment of the relationship or even strengthen it.

THE PSYCHOTHERAPEUTIC POINT OF VIEW OF PSYCHEDELIC-ASSISTED TREATMENT

The psychotherapeutic setting offers a highly controllable and supportive environment that most likely differs from the patient's other past and present environments. As time passes, the patient regularly exposed to this therapeutic environment gradually adapts to it. In doing so, it slowly updates its high-level forecasts that were formed in less controllable environments and therefore indicate large uncertainty. Because the therapeutic environment strongly contradicts the rigid prediction of uncontrollability and uncertainty, the sensory prediction error becomes larger and larger. At a certain point, the sensory inputs that signal safety and support can no longer be explained, initiating an updating process.

Psychedelics appear to amplify the restorative effect of real relationships. From a psychological point of view, we have already said that psychedelics tend to increase feelings of connection with the therapist. The socializing effect of MDMA is typical.

Psychedelics (to some extent) give us what we expect to get from them, like a placebo. This is not a new idea. Weil (1972) described psychedelics as a kind of active placebo: while they certainly do something, most of what it is may come from the users themselves.

Grof (2008) argues that “psychedelics function more or less as nonspecific catalysts and amplifiers of the psyche.” Finally, Matthew Johnson, quoted by Pollan (2018) says about psychedelic treatment: “Whatever we are delving into here, it is in the same realm as placebo. But a placebo on a rocket.”

Psychotherapy has also been described as a placebo (open-label). Consequently, we can say that a psychedelic session enhances the placebogenic effects of psychotherapy, making psychedelic-assisted treatment a sort of super placebo.

Psychotherapy (co)defines a patient's set and setting, i.e. his internal and external environment: it induces expectations of repair and provides a safe environment. When the brain enters an anarchic state due to the supposed effects of psychedelics, the bottom-up signals sent from these internal and external environments become more influential. In this way, the patient should be able to transfer the safety and controllability of the therapeutic environment to his own generative model, enhancing the path of the real relationship. Similarly, psychedelics also appear to enhance the expectation pathway.

On the one hand, it is hypothesized that the impact of restorative expectations is less limited by higher-level forecasts. Any positive basic feelings and attitudes a patient may have towards a psychedelic experience tend to be amplified with psychedelics.