By Rachel Dundas, Registered Psychologist Certified Trauma Practitioner
The Role of Psychedelics in Therapeutic Breakthroughs
One of the main goals of psychotherapy is to guide patients toward therapeutic
breakthroughs – defined as a significant, sometimes sudden, step forward or important realization. Oftentimes, in therapy, breakthroughs come after long, unproductive plateaus. Such realizations must come from the client themselves; while the therapist’s role involves guiding the client, honest and complete acceptance and understanding must come from within. Breakthroughs are important because they are a critical step for patients to make meaningful life changes.
In conventional psychotherapeutic models, breakthroughs often come after months or years of therapy; one of the remarkable aspects of psychedelics is that breakthroughs can come after just one session, and can have long-lasting effects, allowing for patients to progress further and faster than via conventional practices. There are two important mechanisms by which psychedelics produce these rapid and sustained effects: the mystical experience and changes in neurochemistry. Insights largely surface as a result of the intense and vivid mystical experience. Modifications in neurochemistry result in changes in cognitive patterns, allowing for these insights to be adopted into one’s life for long-term effects.
The mystical experience is composed of both introvertive and extrovertive
phenomenological content. Introvertive content encompasses a sense of unity or
oneness, the transcendence of time and space, a deeply felt positive mood, a sense of awesomeness, reverence and wonder, meaningfulness of psychological or philosophical insight, and ineffability, while extrovertive phenomenological content is that of sensory-perceptual, somatosensory, or introspective mystical content. The ‘entity encounter experience’ is a particularly interesting extrovertive feature whereby people meet autonomous entities described as ‘beings,’ ‘spirits,’ ‘angels,’ etc., who possess intelligence and agency, and are felt to be powerful, wise, and loving. Emotions such as joy, trust, and love are often felt with such encounters.
Studying the mystical experience can be challenging due to the subjective and ineffable nature of the experience. Further, operationally defining the mystical experience carries the risk of depersonalizing individual experiences. While the questionnaires that are used in research to operationalize the mystical experience (e.g., the Mystical Experience Questionnaire – MEQ-30) are necessary in order to standardize comparisons across studies, it is important to avoid reducing the mystical experience to a simple questionnaire, and to not dismiss the individual stories of transformation and healing that occur as a result. These stories give meaning to both the mystical experience and to psychedelic medicine. Breakthroughs that once seemed unlikely or impossible are able to emerge as a result of psychedelic use, and it does the medicine a disservice by reducing such ground-breaking experiences to a questionnaire that does not encapsulate the individual experience.
There are changes in neuropathways that accompany the mystical experience. The Default Mode Network (DMN) is one important network that is involved in the long-term effects of the psychedelic experience. The DMN consists of neural pathways that are activated during stimulus-independent thought – thoughts that occur when the brain is ‘at rest’ or when the mind is wandering, and are not triggered by external stimuli (vs. stimulus-dependent or task-oriented thinking). Such thoughts have a general theme of ‘the self,’ including thoughts pertaining to self-awareness, self-recognition, self-control, a sense of agency, theory of mind, and self-identity, to name a few. Psychedelics reset the DMN by dampening its activity, allowing for individuals to direct their attention away from internal emotional and cognitive states, and embrace a different, more holistic pattern of thinking, by which breakthroughs are able to emerge. In addition, while conventional anti-depressant medications decrease the fear response via inhibition of the amygdalae, psychedelics take this a step further and increase activation in response to positive emotional stimuli.
Rapid and sustained breakthroughs are important for several reasons. First, the rapid breakthroughs that result from psychedelic-assisted therapy tend to be more intense than those experienced in regular psychotherapy; although potentially overwhelming, with proper psychotherapy, such intense breakthroughs have the potential to result in more significant cognitive and behavioural changes. Second, in terms of quality of life for the patient, the quick onset and long-lasting relief that psychedelics provide is the ideal scenario for patients – such a scenario is not typically seen with conventional anti-depressant medications, often resulting in patients struggling for months or even years. Third, for many patients, time is of the essence. Psychedelics have been shown to be effective in relieving end-of-life anxiety experienced by palliative care patients. Palliative care patients do not have the luxury of waiting months or years to test different anti-depressants to find the most effective one for them. Additionally, it is often the content of the mystical experience that provides therapeutic insight.