6 ms·

At least as written, the advice for problems during medication sessions is pretty simple (though note the presence of a physician "sitter" alongside the therapi

At least as written, the advice for problems during medication sessions is pretty simple (though note the presence of a physician "sitter" alongside the therapist): > Responding to intense, painful affect states > The therapists will gently encourage the subject to “lean in” or “go towards” intense or difficult affective states, rather than try to avoid or diminish them. > Responding to agitation or restlessness > The therapist will encourage breathing exercises and grounding techniques, as described above. If these are not helpful, the participant will be invited to sit up, take off the eyeshades and make visual contact with the therapists and the room. The therapists may offer reassurance that such states are to be expected and are likely to be short lived. > Responding to marked agitation > If the subject displays significant or marked agitation and previously mentioned interventions fail, the therapist will consult with the physician regarding the possible administration of benzodiazepine or antipsychotic medication. Medical intervention will be utilized only when agitation is persistent, and no other means to help relieve the agitation are effective.

loceng 6y ago
Based on just what you've copied here, Maps.org's manual for MDMA-assisted therapy seems more thorough and detailed. Arguably this is where mainstream medicine needs to catch up, and where a lack of multi-disciplinary approach still exists: Rick Doblin (the founder of Maps.org) has suggested that if someone has difficulty processing during an Ayahuasca ceremony (a potentially more intense, more potent version of Psilocybin session/ceremony) said to give a half-therapeutic dose of MDMA (100mg to 125mg is therapeutic dose; 180-200mg is generally what's used recreationally, usually not all at once) - and so I hope sooner than later this guide is updated to replace "possible administration of benzodiazepine or antipsychotic medication" with "possible administration of MDMA;" instead of numbing a person's nervous system/emotions with a benzodiazepine or changing how their brain is actually functioning, instead use MDMA to cause the brain to release more serotonin at once than it naturally can - allowing everything to feel and be easier to connect to and process; reducing the stress level enough where it's not acting as a blocking function, hence PTSD is from extremely stressful past experiences that are too overwhelming to process.
- mpnagle 6y ago
  Because of the presence of MAOIs, mixing ayahuasca with other drugs that affect serotonin such as MDMA or anti-depressants such as selective serotonin reuptake inhibitors (SSRIs), may be particularly dangerous. via https://adf.org.au/drug-facts/ayahuasca/ https://adf.org.au/drug-facts/ayahuasca/ I imagine what Doblin meant is working with MDMA after an ayahuasca ceremony.
  - loceng 6y ago
    Good thought - but nope, and I've done it. The issue with SSRIs are them being reuptake inhibitors - they actually change how the brain functions vs. MDMA is simply causing serotonin to be released. I also happen to be taking a dopamine agonist to treat a benign brain tumour I have (prolactinoma) - first line of treatment is adding a dopamine agonist to the system, and not using an SSRI/SNRI/etc that changes the actual function was fine as well for ceremony; a caveat to research or understand/have caution with is that I had done 30+ Ayahuasca ceremonies prior to taking a dopamine agonist - and so my mind/brain was generally already "opened" how it will be. Care/caution may be necessary if a person has never "opened" up their mind/brain yet (after X ceremonies/experiences) and if they are taking dopamine for whatever reason, as maybe once the pathways that get opened from Ayahuasca et al then the impact of the dopamine would shift as well - perhaps then overcompensating for blocks that get cleared by the Aya etc - and the person may then experience undesired levels of effects from the dopamine. MDMA isn't directly changing the actual function, they're not causing inhibition; the action of how is important, the nuance is important to understand - though like from your comment - there isn't this general understanding that there is a difference, and I imagine most doctors/professionals will jump to the same conclusion without thinking about it - misattributing the different actions instead of critical thinking from foundational principles. It's not the neurotransmitter(s) that are a problem, at least not serotonin and dopamine, it's if the function change of how they're allowed to flow changes that's the problem. Interview/chat between Dr. K (Healthygamer_gg) and Rick Doblin - https://www.youtube.com/watch?v=1e2h-awLC-s https://www.youtube.com/watch?v=1e2h-awLC-s - where he mentions taking half-therapeutic dose; more of a casual conversation where you can also hear a bit of Rick's origin story. I did fairly deep research on this beforehand, looking into actual pharmacological aspect of interactions with things like dopamine, etc - a few people over the last 20 years have been keeping track of all related research. I don't have the link for the most succinct, detailed writeup I read handy.
pmoriarty 6y ago
I haven't seen any therapeutic guidelines recommending this, nor research supporting it, but anecdotally and from personal experience, doing something expressive with the body like dancing, chanting, singing, or playing an acoustic instrument during difficult experiences can help. This is, of course, something that's been done for millennia by traditional cultures in altered states of consciousness and during ritual, so there's plenty of precedent for it and it's far from a new idea. I hope some research is done on this sort of intervention, and expect the results will be positive.
- danenania 6y ago
  Another tip, along the same lines as dancing, is to do some physical exercise. Excess physical energy and restlessness is a common side effect of psychedelics, and that can easily translate into mental anxiety. Expending some of that energy through jumping jacks, push ups, running, hiking or whatever can help calm the jitters and make it easier to relax into the experience. Just don't do anything that involves too much coordination or dealing with traffic :)
  - pmoriarty 6y ago
    A safety tip about that: Before taking whatever it is you're taking be sure to thoroughly investigate its physical effects and learn about the precautions you should be taking, and what to or not to do. For example, MDMA, which is sometimes sold on the street as Ecstacy or Molly (and sometimes other drugs are sold under those names, which is yet another danger) can interfere with the body's temperature regulation ability, so when you take it and start dancing and get hot you might not be able to cool off as effectively... which is one reason why people can die from it, especially if they're dancing a lot in already hot environments (like at an outdoor festival on a sunny day or in a hot club with poor ventilation), or when they don't drink enough water, or drink too much water.. any of these can kill you, and people have died from just this. DanceSafe's recommendations for MDMA are to drink one pint of water an hour. Below are some fantastic videos from Emanuel Sferios, the founder of DanceSafe, that he gave at UC Berkeley about MDMA (and general recreational drug) safety, which I highly recommend everyone watch. You could save your life or that of a friend by learning what's in these videos. So, everyone, please EDUCATE YOURSELF and stay safe! [1] - Part 1 - The History of MDMA https://www.youtube.com/watch?v=8ZY-ZFJnWbg https://www.youtube.com/watch?v=8ZY-ZFJnWbg [2] - Part 2 - Tips for Safer Use https://www.youtube.com/watch?v=HgUPKYrpBvY https://www.youtube.com/watch?v=HgUPKYrpBvY [3] - Part 3 - Pharmacology and Medical Use https://www.youtube.com/watch?v=UHduGGB5kJU https://www.youtube.com/watch?v=UHduGGB5kJU [4] - Part 4 - The Need for Drug Policy Reform https://www.youtube.com/watch?v=nTSiyQHm2s4 https://www.youtube.com/watch?v=nTSiyQHm2s4 [5] - Part 5 - Heather Brooks https://www.youtube.com/watch?v=O8s-nhlaACw https://www.youtube.com/watch?v=O8s-nhlaACw [6] - Part 6 - Joseph Pred https://www.youtube.com/watch?v=0wolzUE3lPk https://www.youtube.com/watch?v=0wolzUE3lPk [7] - Part 7 - Question & Answer https://www.youtube.com/watch?v=rovaoVjLnOk https://www.youtube.com/watch?v=rovaoVjLnOk [8] - Prohibition Fatalities and MDMA Complexities: Interview With Emanuel Sferios, the founder of DanceSafe https://www.youtube.com/watch?v=yHKYogJ8Yxs https://www.youtube.com/watch?v=yHKYogJ8Yxs
ericmcer 6y ago
Is it weird that I would want a therapist who had also taken psilocybin? Preferably many times. It feels like it would be demeaning to have someone who approached it in a clinical and proscribed manner.
- chiefgeek 6y ago
  Not weird at all. I did a therapeutic mdma session with an incredibly well trained therapist who was also very experienced with medicine work. It’s the same for ayahuasca, which I also experienced. You wouldn’t want a shaman who hadn’t waked the walk.
- pmoriarty 6y ago
  If I'm not mistaken, in order to get certified to do MDMA-assisted therapy in the US you have to have had the therapy yourself (and I'd be surprised if most therapists interested in doing this kind of therapy hadn't already had multiple psychedelic experiences before and during training). I'm not sure what the criteria for getting certified to do psilocybin-assisted therapy are or will be, but my guess is they'll probably be pretty similar. In general, at least for now, it's pretty safe to say that most therapists interested in doing psychedelic therapy are already interested in psychedelics and probably are already "experienced" or will be during training. For me, much more important than if they've had a psychedelic experience is if they're highly recommended by well-informed people who've gone through therapy with them and who I trust. If they green-light them, I'd feel much more secure.
  - thrav 6y ago
    That makes sense, as it’s true of many different varieties of therapy. During certification, the aspiring therapists are also required to undergo their own therapy.
trianglem 6y ago
Interesting the leaning into distressing states seems really scary if there is no way to correct the underlying problem. One of my disabled friends had a bad trip around the fact that he lost a leg and there was no way to correct that problem so he remained severely depressed for at least a year after the trip. He used to be a pretty bubbly guy before then.
- dwaltrip 6y ago
  That sounds like a very difficult experience, I’m sorry for your friend. At risk of overstepping, I wonder if the underlying issue might be better viewed as needing to rectify and update previous ways of being, self-models, and goals with the new circumstances. As well as fully grieving this loss, coming to terms with how things are, and learning to imagine all of the new possibilities that can still be realized.
  - trianglem 6y ago
    I would argue that in very specific cases being in ignorance/denial is better than wholly accepting your circumstances.
  - curryst 6y ago
    Sure, but isn't that exactly what we would be trying to treat? I would like to believe in hallucinogenic therapy, but if it can cause an underlying problem to expand to the point where it causes a negative change in behavior, that's not good. It would certainly depend on the risk, but having a risk of triggering a mental illness the person was previously coping with is not a good thing. Finding a way to deal with your problems is the best solution. In lieu of that, I would argue coping with them without handling them is the second best, with neither handling them not coping them being a distant last place.
deleted 6y ago
[deleted]
wavefunction 6y ago
You could just give them a hydrocodone or other opioid to kill the trip in about 10 to 15 minutes.
- mushlove 6y ago
  ~5mg of Trazadone works as well. Applies to LSD and other psyches

loceng 6y ago

Based on just what you've copied here, Maps.org's manual for MDMA-assisted therapy seems more thorough and detailed. Arguably this is where mainstream medicine needs to catch up, and where a lack of multi-disciplinary approach still exists: Rick Doblin (the founder of Maps.org) has suggested that if someone has difficulty processing during an Ayahuasca ceremony (a potentially more intense, more potent version of Psilocybin session/ceremony) said to give a half-therapeutic dose of MDMA (100mg to 125mg is therapeutic dose; 180-200mg is generally what's used recreationally, usually not all at once) - and so I hope sooner than later this guide is updated to replace "possible administration of benzodiazepine or antipsychotic medication" with "possible administration of MDMA;" instead of numbing a person's nervous system/emotions with a benzodiazepine or changing how their brain is actually functioning, instead use MDMA to cause the brain to release more serotonin at once than it naturally can - allowing everything to feel and be easier to connect to and process; reducing the stress level enough where it's not acting as a blocking function, hence PTSD is from extremely stressful past experiences that are too overwhelming to process.

mpnagle 6y ago
Because of the presence of MAOIs, mixing ayahuasca with other drugs that affect serotonin such as MDMA or anti-depressants such as selective serotonin reuptake inhibitors (SSRIs), may be particularly dangerous. via https://adf.org.au/drug-facts/ayahuasca/ https://adf.org.au/drug-facts/ayahuasca/ I imagine what Doblin meant is working with MDMA after an ayahuasca ceremony.
- loceng 6y ago
  Good thought - but nope, and I've done it. The issue with SSRIs are them being reuptake inhibitors - they actually change how the brain functions vs. MDMA is simply causing serotonin to be released. I also happen to be taking a dopamine agonist to treat a benign brain tumour I have (prolactinoma) - first line of treatment is adding a dopamine agonist to the system, and not using an SSRI/SNRI/etc that changes the actual function was fine as well for ceremony; a caveat to research or understand/have caution with is that I had done 30+ Ayahuasca ceremonies prior to taking a dopamine agonist - and so my mind/brain was generally already "opened" how it will be. Care/caution may be necessary if a person has never "opened" up their mind/brain yet (after X ceremonies/experiences) and if they are taking dopamine for whatever reason, as maybe once the pathways that get opened from Ayahuasca et al then the impact of the dopamine would shift as well - perhaps then overcompensating for blocks that get cleared by the Aya etc - and the person may then experience undesired levels of effects from the dopamine. MDMA isn't directly changing the actual function, they're not causing inhibition; the action of how is important, the nuance is important to understand - though like from your comment - there isn't this general understanding that there is a difference, and I imagine most doctors/professionals will jump to the same conclusion without thinking about it - misattributing the different actions instead of critical thinking from foundational principles. It's not the neurotransmitter(s) that are a problem, at least not serotonin and dopamine, it's if the function change of how they're allowed to flow changes that's the problem. Interview/chat between Dr. K (Healthygamer_gg) and Rick Doblin - https://www.youtube.com/watch?v=1e2h-awLC-s https://www.youtube.com/watch?v=1e2h-awLC-s - where he mentions taking half-therapeutic dose; more of a casual conversation where you can also hear a bit of Rick's origin story. I did fairly deep research on this beforehand, looking into actual pharmacological aspect of interactions with things like dopamine, etc - a few people over the last 20 years have been keeping track of all related research. I don't have the link for the most succinct, detailed writeup I read handy.

pmoriarty 6y ago

I haven't seen any therapeutic guidelines recommending this, nor research supporting it, but anecdotally and from personal experience, doing something expressive with the body like dancing, chanting, singing, or playing an acoustic instrument during difficult experiences can help. This is, of course, something that's been done for millennia by traditional cultures in altered states of consciousness and during ritual, so there's plenty of precedent for it and it's far from a new idea. I hope some research is done on this sort of intervention, and expect the results will be positive.

danenania 6y ago
Another tip, along the same lines as dancing, is to do some physical exercise. Excess physical energy and restlessness is a common side effect of psychedelics, and that can easily translate into mental anxiety. Expending some of that energy through jumping jacks, push ups, running, hiking or whatever can help calm the jitters and make it easier to relax into the experience. Just don't do anything that involves too much coordination or dealing with traffic :)
- pmoriarty 6y ago
  A safety tip about that: Before taking whatever it is you're taking be sure to thoroughly investigate its physical effects and learn about the precautions you should be taking, and what to or not to do. For example, MDMA, which is sometimes sold on the street as Ecstacy or Molly (and sometimes other drugs are sold under those names, which is yet another danger) can interfere with the body's temperature regulation ability, so when you take it and start dancing and get hot you might not be able to cool off as effectively... which is one reason why people can die from it, especially if they're dancing a lot in already hot environments (like at an outdoor festival on a sunny day or in a hot club with poor ventilation), or when they don't drink enough water, or drink too much water.. any of these can kill you, and people have died from just this. DanceSafe's recommendations for MDMA are to drink one pint of water an hour. Below are some fantastic videos from Emanuel Sferios, the founder of DanceSafe, that he gave at UC Berkeley about MDMA (and general recreational drug) safety, which I highly recommend everyone watch. You could save your life or that of a friend by learning what's in these videos. So, everyone, please EDUCATE YOURSELF and stay safe! [1] - Part 1 - The History of MDMA https://www.youtube.com/watch?v=8ZY-ZFJnWbg https://www.youtube.com/watch?v=8ZY-ZFJnWbg [2] - Part 2 - Tips for Safer Use https://www.youtube.com/watch?v=HgUPKYrpBvY https://www.youtube.com/watch?v=HgUPKYrpBvY [3] - Part 3 - Pharmacology and Medical Use https://www.youtube.com/watch?v=UHduGGB5kJU https://www.youtube.com/watch?v=UHduGGB5kJU [4] - Part 4 - The Need for Drug Policy Reform https://www.youtube.com/watch?v=nTSiyQHm2s4 https://www.youtube.com/watch?v=nTSiyQHm2s4 [5] - Part 5 - Heather Brooks https://www.youtube.com/watch?v=O8s-nhlaACw https://www.youtube.com/watch?v=O8s-nhlaACw [6] - Part 6 - Joseph Pred https://www.youtube.com/watch?v=0wolzUE3lPk https://www.youtube.com/watch?v=0wolzUE3lPk [7] - Part 7 - Question & Answer https://www.youtube.com/watch?v=rovaoVjLnOk https://www.youtube.com/watch?v=rovaoVjLnOk [8] - Prohibition Fatalities and MDMA Complexities: Interview With Emanuel Sferios, the founder of DanceSafe https://www.youtube.com/watch?v=yHKYogJ8Yxs https://www.youtube.com/watch?v=yHKYogJ8Yxs

ericmcer 6y ago

Is it weird that I would want a therapist who had also taken psilocybin? Preferably many times. It feels like it would be demeaning to have someone who approached it in a clinical and proscribed manner.

chiefgeek 6y ago
Not weird at all. I did a therapeutic mdma session with an incredibly well trained therapist who was also very experienced with medicine work. It’s the same for ayahuasca, which I also experienced. You wouldn’t want a shaman who hadn’t waked the walk.
pmoriarty 6y ago
If I'm not mistaken, in order to get certified to do MDMA-assisted therapy in the US you have to have had the therapy yourself (and I'd be surprised if most therapists interested in doing this kind of therapy hadn't already had multiple psychedelic experiences before and during training). I'm not sure what the criteria for getting certified to do psilocybin-assisted therapy are or will be, but my guess is they'll probably be pretty similar. In general, at least for now, it's pretty safe to say that most therapists interested in doing psychedelic therapy are already interested in psychedelics and probably are already "experienced" or will be during training. For me, much more important than if they've had a psychedelic experience is if they're highly recommended by well-informed people who've gone through therapy with them and who I trust. If they green-light them, I'd feel much more secure.
- thrav 6y ago
  That makes sense, as it’s true of many different varieties of therapy. During certification, the aspiring therapists are also required to undergo their own therapy.

trianglem 6y ago

Interesting the leaning into distressing states seems really scary if there is no way to correct the underlying problem. One of my disabled friends had a bad trip around the fact that he lost a leg and there was no way to correct that problem so he remained severely depressed for at least a year after the trip. He used to be a pretty bubbly guy before then.

dwaltrip 6y ago
That sounds like a very difficult experience, I’m sorry for your friend. At risk of overstepping, I wonder if the underlying issue might be better viewed as needing to rectify and update previous ways of being, self-models, and goals with the new circumstances. As well as fully grieving this loss, coming to terms with how things are, and learning to imagine all of the new possibilities that can still be realized.
- trianglem 6y ago
  I would argue that in very specific cases being in ignorance/denial is better than wholly accepting your circumstances.
- curryst 6y ago
  Sure, but isn't that exactly what we would be trying to treat? I would like to believe in hallucinogenic therapy, but if it can cause an underlying problem to expand to the point where it causes a negative change in behavior, that's not good. It would certainly depend on the risk, but having a risk of triggering a mental illness the person was previously coping with is not a good thing. Finding a way to deal with your problems is the best solution. In lieu of that, I would argue coping with them without handling them is the second best, with neither handling them not coping them being a distant last place.

deleted 6y ago

[deleted]

wavefunction 6y ago

You could just give them a hydrocodone or other opioid to kill the trip in about 10 to 15 minutes.

mushlove 6y ago
~5mg of Trazadone works as well. Applies to LSD and other psyches