Psychedelic-Assisted Therapy With Dr. Brian Pilecki

There’s been growing recognition in mainstream Western culture that psychedelics have a role as potential tools in personal healing and mental health. Research studies investigating the use of psychedelics in mental health treatment have rapidly increased, and many of us have questions. What does the protocol for psychedelic-assisted therapy look like? What is the difference between psilocybin, MDMA, and ayahuasca? What are the risks and benefits of psychedelics as a treatment for anxiety, PTSD?

Transcript

What is psychedelic assisted therapy and who might it be helpful for?

How does it work and what is it like when you're doing it?

That's what we're going to explore today with Dr.

Brian Pilecki on your life and process.

What is psychedelic assisted therapy?

Dr.

Pilecki specializes in the treatment of anxiety disorders,

Trauma,

And PTSD and psychedelic assisted therapy.

He practices from an orientation based in ACT and has extensive experience in mindfulness and meditation and incorporates that into his therapy.

At Portland Psychotherapy,

He's an active researcher and a study therapist on a clinical trial investigating the use of MDMA assisted therapy for the treatment of social anxiety disorder and understanding the processes of change in psychedelic therapy.

So I can't wait for you to listen and for you to meet Dr.

Brian Pilecki.

I first learned about you,

Brian Pilecki,

When at ACBS,

The big conference that we had this summer for folks that are interested in contextual science and ACT,

And you were presenting on some of your work in the arena of psychedelics.

I think that what made me really interested in having you on was first just who you are as a presenter and how you bring your own person into the picture,

But how you're able to talk about and break down what psychedelics are,

How they may be useful for us,

And actually what it looks like if you were going to go through the process of doing psychedelics,

Sort of the who,

What,

Where of psychedelics.

So I'm hoping that we can tap into all of those today,

Starting with just who you are and what brought you to doing this work.

Yeah,

Sure.

Well,

Thanks for having me,

Diana.

Yeah,

I was touched by psychedelics in college.

I had an early experience where I essentially came out to myself while under the influence of MDMA.

I had been kind of wrestling with my sexuality for several years,

Trying to come out,

But was still consumed with shame and low self-worth around my sexuality,

Around being gay.

And it was an experience of MDMA where it was really for the first time in my life,

I felt this experience of self-love,

Self-acceptance.

And it was just so clear to me that I had to come out.

I couldn't pretend to be straight anymore.

I couldn't continue that path.

And that really started me on the process of coming out.

And then,

Of course,

Sparked this interest in what is this thing,

MDMA?

I mean,

I had no intention of using it that way.

A friend gave it to me.

We went to a party.

Therapy was the farthest thing from my mind.

And yet here I found it as this tool to help me in a significant way.

And then,

Of course,

Learn that so many other folks have had similar experiences.

So that kind of started me in the path of being curious about these altered states of consciousness and how they might be combined with more traditional forms of therapy for therapeutic growth.

Yeah,

You kind of highlight something important there,

Which is many of us have this conceptualization of what psychedelics are and sort of the stigma of psychedelics if we have a stigma associated with it or it's a party thing or it's something you do with your friends at a rave.

It's newer in the West to conceptualize psychedelics as a medicine,

But it's not newer in terms of psychedelics themselves that they have been medicines for a long time.

I'm hoping that today we can talk about just even just starting with like,

What is a psychedelic?

You mentioned MDMA.

There's other ones that people are hearing about in terms of ketamine,

Psilocybin,

Ayahuasca.

Could you sort of start by breaking down what these different medicines are and then or different drugs are and then I'd love to talk about what actually looks like for folks if they're doing it in a more therapeutic setting and some of your research.

But yeah,

What's the difference between psilocybin,

Ayahuasca,

MDMA,

Ketamine?

Yeah,

They all have some similarities and they're all also very different.

We have the term psychedelic really refers to a certain group of substances that it's really another term is the classical psychedelic.

So that is psilocybin,

LSD,

Mescaline,

Ayahuasca.

They all work on the serotonergic system.

And then there's another group of substances that have psychedelic properties but are not really classical psychedelics.

So MDMA,

For example,

Has psychedelic properties and is used in a similar way to let's say psilocybin,

But is a very different substance and actually has an amphetamine-like chemical structure.

Ketamine is a dissociative.

Again,

It has psychedelic properties,

But it's not a classical psychedelic.

But we do,

Usually when I talk about psychedelics or psychedelic assisted therapy,

I'm using a broad umbrella because again,

These medicines are kind of used in similar ways.

So what was happening for you when you were having that MDMA experience biologically and in your brain?

And what is your understanding now of why that this led to you to have such a different perspective on yourself and even the courage to come out and that maybe you wouldn't have had if you didn't take that drug?

Right.

Yeah,

So MDMA releases a lot of serotonin and other hormones like oxytocin,

Which is associated with bonding and relationships.

And it engenders this feeling of love,

Self-love,

A feeling of safeness,

A feeling that things are okay.

And as somebody who's always struggled with anxiety,

To be in that state where I really felt just okay being who I was in that moment.

And this is what we're seeing in the research too,

That for folks with PTSD,

Folks who have a lot of trauma in their background,

Giving them a substance that gives them this four to six hour window where they feel safe enough to go there.

They feel safe enough to process some of the pain that has otherwise been avoided because it's so painful.

So that's what I understand happened to me that this amazing drug allowed me to just see very clearly what I was doing in my life and how that was harming myself and how that wasn't working.

And even though that feeling faded of self-love,

It didn't last forever,

It gave me a memory.

It gave me a foundation of like,

Oh,

That's possible.

What would it be like if I could live a life that was more characterized by those feelings and oriented around those feelings?

And so that's where the work of integration,

We call it in psychedelic work comes in.

You might have these insights and these experiences,

And then often you need to follow up with some sort of effort to really make the most of them.

So you're doing research into a very specific protocol now of guiding people through psychedelic use in a therapeutic setting.

And it's not just about come in,

Take the drug and leave.

There's a whole process that you guide people through.

And I loved hearing about sort of what you do,

What it looks like,

What it sounds like,

What it feels like for somebody that's doing your treatment.

Can you describe that to us?

Yeah.

So one of the things about psychedelic assisted therapy is that the drugs get all the attention in the media.

Right?

Everyone,

And rightly so.

It's fascinating,

Right?

What is psilocybin?

How can it be therapeutic?

But in all of these trials,

Participants are getting a lot of therapy.

They're getting a lot of contact with two therapists,

Essentially.

And so as a therapist,

And this is my bias,

Of course,

I really value and think that the therapy part is super important.

I don't think therapy is the only way to do psychedelics.

I don't think it's like the best way or it's superior.

But it's one method.

It's one context in which psychedelic use tends to be more therapeutic.

And so that involves preparing participants for the experience,

Spending time helping them understand what whatever substance they're using is going to be like for them.

Some of them,

Many of them,

It's the first time they've taken psilocybin or MDMA.

And then the dosing sessions involve,

You know,

Two therapists being present for that eight hours.

So it's a long day,

It's usually an emotionally draining,

More intensive therapeutic experience.

And then there's the follow up sessions where you're processing what happened and helping clients or participants make meaning and make changes based on whatever happened during their dosing sessions.

So what does it look like in those dosing sessions?

Are they like in a bed?

Are they out at a park somewhere?

I mean,

What are you doing?

What does it look like?

We're doing an MDMA trial at Portland Psychotherapy where I work for social anxiety.

And in both the MDMA trials and the psilocybin trials,

Participants are laying on a couch or sitting up on a couch.

And there's a combination of time where they're spent going inwards,

Which means that they have eye shades and headphones.

And there's music that's kind of pre planned by the therapists.

They're spending time with their internal experience,

Closing their eyes and just being with what comes up.

And they're sort of coached and prepared about this method that this is kind of called like going inwards.

And then the other parts of the sessions are the participant is interacting with the therapist.

Maybe they're processing what's happening or they're asking for support.

So for MDMA,

About 50% of the time,

They're in this more inwards mode.

And then the other 50% of the time,

They're talking with their therapists.

In the psilocybin trials,

There's more time spent going inwards and less time interacting with the therapist.

And for safety reasons,

Folks are,

They agree to stay indoors in the treatment room.

Although certainly for many people with classical psychedelics,

Especially like psilocybin,

There's a strong desire to be outside and be in nature.

And I'm asking these questions,

Because I think with things that are unknown,

If you haven't experienced psychedelics,

There's a lot of fear around it.

And I what I really heard in the talk that you gave and sort of one of your missions and one of your values is,

Is around like traumatizing this,

You know,

Medicine,

Because it's been something that has a history in psychology,

There's a good amount of research from the 60s.

But then it was kind of banned,

And certainly something that was shelved for a number of years.

Can you tell us a little bit about that,

That history?

And also,

Like,

Why now why there's this resurgence of interest,

Like,

It's almost like,

Let's expedite this.

You know,

You turn on NPR at three o'clock in the afternoon,

And someone else talking about psychedelics again.

So here we are doing it on this podcast.

But tell me a little bit about that.

A lot of people don't know that psychedelics were studied in the 50s and 60s.

To a pretty large degree,

There was over 1000 papers written.

Oh,

There was over 40,

000 patients treated with LSD or psilocybin back then.

So this was not just,

You know,

A couple of studies.

This was a major movement in mental health,

A new paradigm,

It was believed it was said that psychedelics would do for the mind what the telescope did for astronomy,

There were tools for understanding the nature of consciousness.

But all of that came to a screeching halt when,

You know,

They got out to the culture,

And there was the cultural backlash.

And,

You know,

A lot of it had to do with the Nixon administration and a lot of the drug policy that was created that banned psychedelics was rooted in racism.

We know that now that these decisions were made specifically because certain drugs were associated with certain communities.

So unfortunately,

The research halted for a while.

And your question about why now is super interesting.

I would say it's a combination of factors.

One,

People have been able to get a couple of studies up and going and the data have been really strong.

And these are very well tightly controlled studies.

So these early,

Smaller sample studies are showing good results,

Right?

And so that is hard to argue with the data.

I think there's also just changes in cultural attitudes.

And there's a lot of suffering now,

Right?

We're,

As a culture,

Really struggling.

And I think people are looking for new methods,

People are looking for new ways to seek relief.

A lot of the clients that I work with call me because,

You know,

Traditional therapy or traditional medications have failed them.

Yeah,

What I write about in terms of the populations that psychedelics are being used most with is PTSD,

Which is certainly so much suffering.

And then also end of life,

Folks that are at the end of life have a terminal diagnosis.

And I was really struck by the video compilation that you put together of folks sharing about their experiences.

And these were folks that had a terminal diagnosis and how profound it was to have a psychedelic experience,

How it completely shifted their perspective on feelings of gratitude and feelings of connectedness.

And tell me a little bit about what you hear and what the research is showing in terms of the impact of these psychedelics on folks,

Especially folks that are suffering.

Yeah,

It's really quite varied,

Right?

So one of the interesting things about psychedelics is that they don't just have one particular effect,

Right?

They can change a person in any number of ways.

But some of the more common themes that we see are a sense of interconnectedness,

A greater sense of connection or belonging,

Either with community,

With people,

Or with Earth,

Or the universe,

Or with God.

There's a greater sense of belonging or connection that can be different based on people's worldview or religiosity,

Etc.

And of course,

We live in a very disconnected culture,

And so you could easily see how that could be really helpful.

Folks often will say that they are more in touch with themselves and what it means to be human.

They're more connected to their values and what matters to them.

Psychedelics seem to have this ability sometimes to just get to the heart of the matter pretty quickly.

And one of the things that happens a lot with psilocybin,

And I think the more classical psychedelics,

Is just simply getting in touch with their own mortality,

Which most of us are in denial of for most of the time.

We don't like to face that,

And our culture doesn't like to face that.

And so one of the lessons that people often come back from psychedelic experiences sharing is that they want to take care of their bodies.

They want to eat better.

They want to exercise more.

They realize that we have limited time here,

And what do I want to do with it?

Some of the studies that I showed,

We could link the clip that I showed in my talk,

Which was these folks with terminal illness,

Who had just a couple of psychedelic experiences saying things like,

I'm not afraid of death anymore.

I've looked it in the eye.

I've had an experience that felt like it was like dying.

And I have trust now.

That's okay,

And it's a natural process,

And I don't need to be afraid of it.

So it's pretty remarkable how folks can get there,

And the speed at which they can get there versus other methods that can often take longer and may not engender that same sense of trust or that same sense of belongingness.

I appreciate what you say about the speed at which someone can get there,

Because I had this conversation with some folks about psychedelics,

And I'm not going to say who did what or who didn't do what.

Keep this under wraps.

But it was like Dan Siegel and this llama.

We were talking about psychedelics,

And one of the things that the llama said was,

Oh yeah,

That's what meditation has done for me.

I feel that way in terms of the interconnectedness and the belonging,

And I don't fear death and contact with impermanence.

And this is someone that has practiced really deep meditative practices for years and years and years.

And one of the things that Dan Siegel said was,

Yeah,

Because it's working on the same parts of your brain when you're doing this Tibetan meditation and when you're doing psychedelics.

And what he also said was,

And what we're finding about psychedelics,

Some of the changes in the default mode network are somewhat sustained.

So can you talk a little bit about that,

Like what's happening with the default mode network and how,

Because it does,

There's like these parallels where,

Yeah,

You could use,

You could go this way,

But then you got to meditate a whole lot.

Not everyone,

Everyone wants to do that.

Or that's not even interest to do that.

It's an interesting topic or even a debate in psychedelics or in more contemplative practices like Buddhism,

Right?

There's certain teachers and schools of Buddhism which criticize psychedelics as being a shortcut and spiritual bypassing,

And it's not doing the work.

It's,

You know,

The way I see it is that meditation and psychedelics can often get one to similar places,

And they're both very different methods.

And I think psychedelics,

You can give you a glimpse,

But you do need to do the work.

I don't think just having a psychedelic experience in and of itself is enough to lead to change.

Maybe for some people it does,

But not the majority.

And that's where the idea of integration comes in.

And I think that's part of the lesson two of the sixties was that people were having these really powerful experiences,

But didn't really know what to do with them.

Now some people did and made changes in their lives,

Etc.

But I think having both a regular contemplative practice of some sort,

Whether it's yoga or meditation or even exercise for some people,

Like having some daily method for being present with ourselves,

Being attuned to our experience,

Some of the processes of psychological flexibility,

Being in the present moment,

Acceptance of emotions.

And then there's the role for the big experiences.

And in traditional Buddhism,

That was like the retreat.

The retreat is an intensive experience.

And I've had personal experiences at the end of a long meditation retreat that felt like it was at the end of a psychedelic retreat.

It felt to me very often like they do get me to the same place in terms of feeling more grounded and more centered.

So I think there's a role for both of those.

And one of the advantages of psychedelics is that for folks who maybe aren't interested in meditating or like it can give a glimpse of what's possible.

And in meditation,

Often you've got to really work hard and be patient to sort of experience some of those same effects.

So you mentioned psychological flexibility.

And one of the things that you've been talking about is how ACT with psychedelics and that integration component using ACT as part of that feels like such a perfect marriage.

Can you say more about that?

Why you think ACT in particular is useful?

If someone asks,

Why do psychedelics work or how does psychedelic assisted therapy work?

We really don't know from an evidence based perspective.

I should say we're just at the beginning of scratching the surface here.

We're just starting out.

We know some things,

But there's so much we don't know.

And these trials in the last 10 years,

They've been more on outcome rather than what's the underlying processes of change involved with psychedelic therapy.

And so one of the candidates,

And there is some evidence to suggest that psychedelics work by enhancing psychological flexibility.

And so the ACT model,

I think,

Is a really good model for talking about psychedelic experiences and integrating from psychedelic experiences.

Things about ACT that I think are relevant are the focus on acceptance and being with all of our emotions,

Not avoiding,

Not resisting.

That's pretty common advice in psychedelic experiences and indigenous cultures who've used them.

And we hear over and over again this prescription to surrender,

To let go,

To open up to,

To trust,

To allow.

And that's a big piece of psychological flexibility.

I think in ACT,

We talk about holding language lightly and how language,

How ideas,

How symbolic thinking create suffering because we can always think of something better and we can always remember something that's past or imagine a catastrophe.

And what better way to help somebody step out of their minds than to totally disrupt it with a psychedelic experience.

And in a deeper experience,

It's common that people will lose language.

They lose the ability to speak.

They lose the ability,

Like language doesn't have the same meaning,

Which can sound scary and it can be.

And it could also be tremendously freeing and liberating to have a experience of being alive,

But being outside of that normal mind that we were in it every day so we don't see really what it is.

It's like a fish jumping out of water.

You know,

You jump out of the water and you can like,

You have something now to compare water to air and water then starts to make more sense or you've got some perspective which to understand that.

And it's the same with our language.

We're swimming in a sea of language all the time.

We don't realize we often live more in a world of ideas than the actual sensory world we're inhabiting.

And so psychedelics kind of push us into our sensory experience and disrupt language.

And so it's a really great fit for a lot of the interventions that we do enact.

You used a word in there and that whole sequence that my mind caught and this is the nature of language,

Which was scary.

You said something like,

You know,

It can feel kind of scary if you lose your language.

And my early exposure to psychedelics was not personally taking psychedelics,

But was the stories that my parents told me.

My parents lived on hate street in San Francisco in the 60s.

And they lived in a commune.

They were like the classic San Francisco hippies,

Right?

And they lived in a commune and one person in their commune had a bad trip,

I guess,

And developed schizophrenia.

So the story that was told to me as a child,

Which it was basically,

If you use psychedelics,

You're going to develop schizophrenia.

And it was like,

Oh,

Okay,

Scary bad news.

Don't go there.

And I also have bipolar disorder in my family.

So my grandfather had bipolar I disorder and there was a lot of concern about risk for developing psychosis or psychotic disorder.

So how do you respond to,

I mean,

Everything from fears of what if I have a bad trip and it's like,

You know,

I have a lot of,

I have a high self critic or anxious person in here and it just sort of takes over in my trip to what if it makes me develop psychosis in terms of the risk factors and stories and the language that we have around psychedelics that our minds,

I guess,

Grab onto.

Yeah.

Yeah.

Yeah.

That's,

I mean,

It's so true,

Right?

That we really can,

Like that story sounded like that was really impactful for you and stuck with you.

Right.

And I remember hearing stories.

I grew up in the,

You know,

The 80s and the war on drugs.

And I remember,

You know,

The police,

You know,

They'd send cops to our school and they tell us these stories.

And it's like,

Oh my God,

You know,

I don't want to,

I definitely don't want anything to do with that.

And you know,

I think it is a challenge to talk about psychedelics because of all of this stigma and myth.

And it's true that there are some risks and we don't actually fully know the risks in terms of psychosis.

It's probably most likely that it's not,

Can't create psychosis when there's no underlying predisposition,

But it could,

If you have that vulnerability,

It could catalyze a psychotic episode or a manic episode.

It's something we don't understand fully.

I hope to,

I hope that we can someday with more research,

But in terms of the,

You know,

The,

So it's not,

They're not going to make you go crazy.

Right.

If you're not,

Uh,

Like that,

That's part of the myth too,

That they stay in your spine forever or they damage your chromosomes or,

You know,

There's,

They're,

They're actually pretty physically safe.

So,

So I've been LSD,

Um,

But even,

You know,

Even in a safe therapy,

The therapeutic environment there,

There are often challenging moments during psychedelic experiences and when navigated in under the care and support of a therapeutic environment or any sort of safe environment,

They,

Those challenges can often lead to some sort of growth or insight or benefit.

Right.

And it's like regular therapy is like that regular therapy is scary.

Yeah.

You know,

You're,

You're,

You're facing things,

You're,

You're facing emotions,

You're crying,

You're dealing with painful stuff.

And so,

But with psychedelics,

You know,

They,

Those there's a greater intensity that's possible.

So we have,

You know,

More intense,

Positive emotions,

And we could have more intense and negative emotions.

Um,

And if you talk to people who've had experiences,

They will say that it's part of the deal.

That's,

That's part of the territory.

It's part of the healing.

Uh,

And,

And so the idea of a bad trip,

You know,

That's a,

That's a very loaded term.

It means a lot of things to different people,

But I think really the bad trips are the ones that are happening in uncontrolled environments.

Right.

And I'm not saying that you should only do psychedelics with a therapist,

But you know,

If you're out in public or if you're in a situation where you don't know people as well,

Like the more variables that you introduce that might increase anxiety or might be unpredictable.

Right.

You're in a vulnerable state when you're under a psychedelic.

So,

Um,

Everything gets amplified.

So if something goes wrong,

That is going to,

You're going to feel that more intensely.

Uh,

So in the trials,

We haven't seen anybody like totally freak out the whole time or have a,

You know,

What,

What is often referred to as a bad trip,

But we do see people having challenging parts of their trip.

Uh,

Which again,

Uh,

Often at the end of it,

Participants might say things like,

Not always,

But very often say things like,

You know,

That was part of something I needed to work through.

And traditionally with psychedelics,

They were,

They were used in ceremony or in rites of passage or an often with a guide.

So it sort of makes sense that it would be good idea to have a experienced guide with you when you're using a,

You know,

A powerful intervention like this right now.

You know,

These aren't available legally for,

Um,

We all want to come in to your Portland psychotherapy clinic and do this with you,

Brian,

But we can't unless we're in your research study.

So,

You know,

What are you recommending?

Are you,

Are you doing coaching with people that then go out and do it on their own?

Are you recommending,

Do you recommend people go to places like Peru or Costa Rica?

And,

You know,

If someone's interested in this,

Should we,

Should we wait until it's available,

Which may not be for a while?

Yeah,

It's,

It's so such an important question because people want,

Want relief now,

Right?

They're looking for access now.

And part of my clinical work is,

Um,

Helping people make these decisions,

Right?

So I can use,

I use like a harm reduction approach to help people learn about the options and then make,

You know,

Help them make a choice that's right for them.

And for some people,

That means that they decide to go on a retreat in a different country where psychedelic is legal.

For other clients,

They,

They find an underground guide to work with.

Other clients,

They do it on their own.

They create their own kind of experience.

And again,

It's something that,

That I could help them with,

Or that they could find other resources to help them sort of design an experience that's going to maximize,

You know,

Benefit and minimize risk.

But a lot of folks are,

Are prefer to wait until it's a legally available option.

And that's,

You know,

That's where some people are at.

I think when people ask me as a psychologist,

I'm still erring on the side of,

You know,

I think that there's gonna be really good protocols that are going to come out and,

You know,

That you may want to wait until you can go work with somebody that's been trained in this.

And that's more for me is like my,

My comfort level with a,

With a client,

But then with a friend,

I may have a different angle in terms.

And then with myself,

Have it,

You know,

Another angle too.

So I guess it really depends also just in terms of,

You know,

What you're comfortable with in terms of your profession and,

You know,

All those things.

But is there any data on frequency and is this something we should be doing on a yearly basis?

Is this a,

You know,

Like maintenance of the benefits?

What,

What do we know about that at this point?

We really don't know anything from a research perspective on that.

And that's a very common question folks have.

How is this like a thing I'm doing for the rest of my life or how often do I need to do this?

You know,

If we look to the psychedelic community,

You know,

Folks who have been using psychedelics,

You know,

On their own,

Illegally,

Of course,

Or maybe in legal context,

If they're going to retreats,

You know,

People will find their own sort of rhythm.

So some people,

They use psychedelics a handful of times or maybe a lot of times,

And then they feel,

Okay,

I've gotten what I'm going to get out of that.

And that's enough.

And they're not called to move back to them.

Other folks are more drawn to a regular use and they'd like to once a year,

They go trip out with their friends or maybe a couple of times a year.

So I think it really depends.

I think some people do kind of build a lifestyle around this and do find it helpful to continually use these medicines for growth and kind of dip back into those,

Those altered states for,

You know,

For just continued wisdom and continued,

You know,

Continued insights.

But we don't really know in terms of recommending what's a good frequency at this point.

When I was talking with a guide,

He's actually up in the Northern California area.

And what he was saying is that he,

When he does an MDMA,

I think he does a combination of MDMA and then also psilocybin,

Is that he waits a period of time between them.

I think he does three sessions and he waits a period of time because of the serotonin system needing to,

Is that accurate?

Yeah.

So for MDMA,

You know,

There's,

There,

You know,

Too much use can have,

You know,

A negative effect,

Right?

It could deplete serotonin.

The toxicity in terms of some of the research that's been done,

It's been done on really high levels or very frequent users.

So if you're using ecstasy or molly every weekend,

Right,

And that goes on for months and months,

Like that's,

You know,

That's probably not a good thing.

That might get to be harmful.

And,

And yes,

So for MDMA,

I hear a lot of folks in the underground talk about,

You know,

Spreading it out every three months or every six months just to be safe at those,

You know,

That,

That seems to be a frequency for MDMA.

And again,

This is not like a research perspective.

This is just my own experience.

Like that seems to be community wisdom that's developed,

You know,

Around MDMA in particular.

Now,

Something like psilocybin doesn't have that same effect on serotonin.

You could take psilocybin on Monday and then you could take it on Wednesday.

It might have some diminishing return,

But there is the same risk.

So it's good to know whatever medicine or substance you're planning to use,

The particular profile and the particular risks and benefits associated with it.

Because again,

Each drug is going to be different.

And each drug lasts for a different amount of time in your system.

So ayahuasca being sort of a longer experience,

A longer journey compared to psilocybin and MDMA.

I imagine people are curious about how long is this thing going to be in my system?

How long is my journey?

Which one's the most intense?

And then which one do I use for what?

Because you mentioned MDMA for social phobia and then for PTSD,

Maybe we're doing something different.

Like what?

Walk us through that a little bit.

It's a complicated answer,

Right?

Because there's a lot of information.

And you'll hear people talk about,

You know,

I think MDMA might be better for this and I think psilocybin might be better for that.

Like my opinion is that,

You know,

For folks who are newer,

Psilocybin or MDMA or ketamine can be good introductory drugs or substances or psychedelics to try.

You know,

MDMA is typically out of your system and the trip is over in four to six hours.

But it's not like this black and white thing.

It's sort of,

I describe it like if you've ever gone on vacation and you're away for a while and you come back,

Everything's a little different for a little while.

Right?

So it's,

It's sort of has this tail to it.

And sometimes that tail is longer and that's not necessarily predictable.

We don't really understand.

But usually within four to six hours,

You know,

Both psilocybin and MDMA and ayahuasca,

You know,

They're the main part of the trip is ending.

But sometimes the folks are in this,

This after period where things are very different for a little while.

And some people do report like ongoing,

You know,

Lingering qualities of their,

Of their trip.

Sometimes that's too stressful.

Sometimes that's very pleasant.

So,

You know,

I don't,

The one,

I think one,

And it does depend on dose as well,

Like how much you're taking.

LSD tends to be longer.

And that's probably one of the biggest reasons why it's not used as much in research.

So whereas psilocybin four to six hours,

You know,

LSD starts to get up to be eight to 10 to 12 hours depending on the dose.

So it's less practical to fit into a workday.

And you mentioned,

You didn't mention ayahuasca,

But you said that's not necessarily the introductory one.

I personally don't recommend ayahuasca as an introductory psychedelic unless someone feels really called to it.

I've worked with clients who have never done therapy.

I'm thinking of this one person in particular.

He was never did therapy and just wanted to do a 10 day,

You know,

Five ayahuasca session retreat.

And that's what he was set on and he did it and it worked out for him.

And,

But ayahuasca tends to be,

Again,

This is my opinion,

A more like heavy duty kind of experience.

It's a more intense experience.

In my personal experience,

You know,

It's like all of my psychedelic experiences could be kind of grouped together.

Then ayahuasca was like way different way out there.

Yeah,

It's like going to the amusement park.

You can like start on the small roller coasters and there's that always that one giant roller coaster with the double loop de loop and you know,

Yes,

Some people want to go there first,

But right.

You have to try out some of the smaller ones,

Get a little handle on what it's like,

What the ride is like before you get on that big,

Big one.

And I also think for ayahuasca,

And I know some folks would disagree with me on this probably,

But I think there's more of unpredictability with it.

Like it's,

You know,

I think about it as like,

It's a serious spiritual step.

You know,

It's sort of like you wouldn't go on a 10 day silent meditation retreat if you've never meditated before.

And so you want,

You know,

To go on an ayahuasca,

You know,

A ceremony,

Like you need to have some preparation for that.

So it's not to say that you couldn't do that as your first psychedelic,

But you really want to be prepared for what you're getting into to understand what that medicine is about.

And again,

I think psilocybin and MDMA tend to be a little bit more gentler,

Tend to be a little bit more predictable in terms of having manageable experiences for beginners.

Well,

I'm super curious about social anxiety and MDMA because,

You know,

PTSD and end of life terminal illness,

Those are maybe less frequent even in our population than something like social anxiety,

Which is common mental health concern that we have.

And what are you finding in terms of your research there?

Yeah,

It's interesting how,

Like in my grad school training,

You know,

It was sort of like anxiety disorders in particular,

But like social anxiety too.

It's like,

Well,

We've already got good enough treatments for that.

Like,

We're not going to pay too much attention to this,

You know,

And you're right.

It is actually a very,

Very common mental health disorder.

And so we thought it's a good fit for MDMA because so much of social anxiety involves this core self-hatred or self-dislike or low self-worth,

The sense that if I am authentic and vulnerable and show who I am,

You're going to reject me.

It's also very common in social anxiety for people to have trauma like experiences or even trauma experiences.

You know,

They really remember the time they screwed up that third grade presentation.

And so we thought MDMA and its work with PTSD helping folks process their past was a good fit.

And again,

You know,

Engendering these feelings of self-love and self-acceptance.

What if someone who really like hates themselves or feels like they're broken or they're flawed could have an experience where they feel genuinely whole and can share that with,

You know,

Therapists and then later others in their life and have that be reinforcing,

Have that go well.

So it's like,

Wow,

I can be myself and I'm accepted for it.

And I think that's such a part of,

That's part of my own MDMA story.

It's such a common part of MDMA that you hear and folks who talk about how it's been helpful for them.

Yeah,

That's the thread that I was picking up on of how the research you're doing right now is so closely linked to how this started for you.

And when you can make that connection for yourself,

It makes you I think a better researcher too,

Because there's a lot.

This is hard work to do to,

You know,

Carry out studies like this,

Especially in the conditions that you're carrying them out.

I mean,

This is like extra hard because it's not,

You got to get people on board to taking this thing and then you got to work with all of the logistics.

I'm glad that you're doing this work.

Is there anything else that you want to share that,

You know,

Anything that I missed that you know that you think would be helpful for listeners to know?

I would just name some of the cultural issues that are implicated in this work.

You know,

It didn't say that,

You know,

These medicines are thousands of years old.

And I think you said they're not new,

Right?

These are actually been around.

They haven't been part of our mainstream culture necessarily.

But there's some issues that come up with our culture increasing interest in psychedelics.

One of them is,

You know,

Kind of reinforcing colonialism in that a lot of Westerners,

Americans are going to places to use psychedelics.

And the result of that is that those cultures or communities don't have as much access,

Like they're running out of medicines.

There's less peyote,

There's less ayahuasca,

There's less iboga because of the West's interest in it.

So there's,

You know,

There's a direct harm that's being done on certain cultures.

And there's also the issue of access,

Right?

This is going to be a very expensive treatment.

And a lot of that has to do with the fact that the model that exists involves two therapists.

So imagine your hourly rate times eight hours times two,

Right?

That's one session.

And that's,

You know,

Usually clients get two to three sessions.

So the estimate for the same MDMA therapy that folks got in the trial,

The cost estimate is somewhere between like nine and $14,

000.

And it's unclear if insurance companies will cover it.

There was a paper that was recently published,

Or it was a couple years ago now that showed that even at that high cost,

It would be cost saving over the,

You know,

En masse over time because treatment and meds are also expensive.

So initially,

There's going to be few psychedelic therapists,

There may not be insurance coverage.

And so who will have access to it first,

It'll be people who have more resources.

So that's something that's really,

I think,

Important to name as a problem with this and something that many of us are trying to figure out.

And most of the current research is also done on predominantly white populations with predominantly white therapists.

Yes,

Exactly.

Right.

And so there's been an underrepresentation of people of color and gender and sexual diversity,

Women,

Etc.

And we need that we need research on those communities because this treatment needs to be adapted,

Right?

It's not going to be the same for every culture.

Even things like taking a drug has a very different meaning for folks depending on their identities.

Yeah,

And who you're taking the drug with.

Yeah,

Exactly.

A lot of communities,

You know,

Have mistrust of for good reason of providers or,

You know,

Healthcare professionals because of the history of harm,

You know,

That they've experienced either personally or within their communities.

So,

You know,

You can imagine folks who are distrustful of professional mental health professionals to begin with,

Then saying,

Oh,

Yeah,

Come take this drug and trip out with me for nine hours.

Yeah,

That's,

You know,

That's gonna fly.

Yeah.

Yeah.

So you've got it.

We've got,

You know,

There needs to be an awareness around that.

And I hope the cost thing,

You know,

One way to get around that that's being looked at as group administered psychedelics.

So what if we gave psychedelics to small groups of people,

Which I think actually has some therapeutic benefits besides having cost benefits?

Yeah,

That's interesting.

Wow.

We're so we're just really it's like,

There's this long history.

And then we're also at the very beginning of so much in terms of our knowledge as well,

In terms of the science behind this.

Yeah.

It's a bit of an experiment.

You know,

Our culture doesn't really have a place for psychedelics,

And they don't really fit neatly anywhere.

There's a study that came out recently to show that a large proportion of people change their beliefs about religion,

Spirituality.

They come out,

You know,

They go in as atheists and they come out something different.

And so,

You know,

There's a lot of people who criticize therapy that they shouldn't be in a therapeutic context.

They should be in a spiritual context.

And maybe therapy needs to embrace more spirituality.

Exactly.

Exactly.

Exactly.

And vice versa.

Maybe spiritual context.

Now,

I need to embrace psychological concerns so that we can bridge the two.

But yeah.

So,

Yeah,

I mean,

They don't fit in the culture really in a neat way,

And they kind of blow up a lot of the traditional systems.

And that might be good,

Right?

Like a lot of people,

For example,

Come out with,

You know,

The sort of stereotypical liberal values of like interconnection and less capitalistic and that sort of thing.

And so there are people who really still believe that these could not only be tools for individual change,

But they could be tools for cultural change.

Yeah.

There was a researcher that I won't say her name,

But that I talked to that was really into like anti-aging research.

And after her psychedelic experience,

Shifted over to climate change.

There you go.

Yes.

Yeah.

I'm kind of like,

I'm more interested in saving our planet right now.

That's a great example.

So,

Yeah,

You kind of have maybe a perspective shift that could be beneficial in a bigger way.

Well,

Thank you.

Thank you so much for taking this time.

And I know that you have a podcast as well for folks that just want to keep on going with this conversation and keep on hearing you talk about this topic.

Can you tell us a little bit about that?

Sure.

Yeah.

I do a podcast called Altered States of Context with Nate Gates.

And it's a podcast that talks about psychedelics and psychotherapy.

We tend to prioritize a contextual behavioral science perspective,

But it's really open to all therapists and the general public as well.

So come check us out.

We're on Spotify and Apple and all the other platforms as well.

Okay.

We'll be sure to link that in the show notes.

We're also going to put a link to that sequence of stories of people telling about their experiences with psychedelics.

You mentioned that we could link that,

Which is a really it's like seven minutes long and it's a really lovely listen.

And then also anything else that you want to share about where people can find you,

Portland psychotherapy clinics,

Anything else?

Sure.

I can provide a link to some resources we put up on our webpage for the general public.

We found a lot of folks asking very similar questions,

You know,

What kind of training should I get or what drug is right for me?

And so we try to put together some introductory resources for folks that can be used as a resource if people are interested in learning more about this topic.

Great.

Well,

I'm so glad you came on.

I love having your voice on the show and something that feels kind of,

You know,

Amorphous,

Unpredictable,

Feel more understandable to folks.

So thank you for taking the time with me today.

Yeah,

Thanks for having me.

It's been great to talk with you and your audience.

All right.

So how do I create a daily practice based on psychedelic assisted therapy?

I'm not necessarily going to send you out to go take a dose of MDMA or psilocybin this week,

But I do think that there are some things to learn from this episode with Dr.

Brian Pilecki.

First,

Take a moment to look at what are your stories around psychedelics?

What are some of the stigmas or beliefs that you have based on what you've been told or your learning history?

And maybe consider taking a different perspective on them based on what you learned in today's episode.

I also would really highly recommend you start having some conversations with folks about psychedelics.

Many people have had experiences with them or are afraid of them or are curious about them.

And this episode can be a launching point to start to destigmatize psychedelics.

Share this episode with folks and have some conversations with them about it.

And number three,

Dr.

Pilecki talked about some of the preparatory steps towards psychedelic use.

Things like a meditation or yoga practice that open up your state of being to a more interconnected one.

Yes,

Psychedelics can be a fast track to that experience,

But there's also other ways to get there.

Things that you can start working on right now that would be a benefit for you,

Whether you choose to have a psychedelic experience or not.

Some of those experiences may be like signing up for a weekend meditation retreat,

Trying out some ecstatic breathing,

Engaging in chanting or dance with groups,

Exploring activities that help you feel more interconnected and step out of your ego a bit.

Thank you so much for listening and go check out the resources that Brian Pilecki mentioned,

Including that YouTube video of people who have a terminal illness that are talking about their psychedelic experiences.

It's pretty profound.

And I look forward to seeing you next week.

Thank you so much for listening to this episode of Your Life in Process.

When you enter your life in process,

When you become psychologically flexible,

You become free.

If you like this episode or think it would be helpful to somebody,

Please leave a review over at podchaser.

Com.

And if you have any questions,

You can leave them for me by phone at 805-457-2776 or send me a voicemail by email at podcast at your life in process dot com.

I want to thank my team,

Craig,

Angela Stubbs,

Ashley Hyatt,

Abby Deal,

And thank you to Ben Gold at Bell and Branch for his original music.

This podcast is for informational and entertainment purposes only,

And it's not meant to be a substitute for mental health treatment.