Psychedelic-Assisted Therapy (PAT)

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The History of Psychedelic-Assisted Therapy

Psychedelic-assisted therapy has a complex history, rooted in ancient practices and evolving through scientific research, cultural shifts, and legal changes.

Indigenous cultures have used naturally occurring psychedelics like psilocybin mushrooms, ayahuasca, peyote, and iboga for thousands of years. These substances were integral to religious and healing ceremonies, guided by shamans to address psychological and emotional issues.

Modern scientific exploration began in the mid-20th century with Albert Hofmann's synthesis of LSD in 1943. Researchers like Humphry Osmond and Abram Hoffer studied LSD and mescaline for their therapeutic potential, particularly in treating alcoholism. The 1950s and 1960s saw a proliferation of studies on psychedelics for mental health conditions like depression, anxiety, and addiction. Prominent figures like Timothy Leary and Richard Alpert advocated for psychedelics in therapy and personal development, aligning with the countercultural movement.

The 1960s' widespread use of psychedelics led to societal concerns, resulting in strict regulations. The U.S. Controlled Substances Act of 1970 classified LSD, psilocybin, and other psychedelics as Schedule I drugs. Due to the powerhouse that America continues to be in democratic countries across the world, eventually Australia (Controlled Substances Act 1984) and other democratic countries followed the rescheduling of these substances, subsequently, halting most research. Despite this, researchers like Stanislav Grof continued exploring non-drug techniques like Holotropic Breathwork. The field of trans-personal psychology also kept interest in psychedelic therapy alive.

The late 20th and early 21st centuries saw a resurgence of interest in psychedelic-assisted therapy. The Multidisciplinary Association for Psychedelic Studies (MAPS) and other organizations advocated for and funded new research. Studies on MDMA for PTSD and psilocybin for depression and anxiety have shown promising results. In 2017, the FDA granted "breakthrough therapy" designation to MDMA-assisted psychotherapy, recognizing its potential benefits.

Modern psychedelic therapy emphasizes safety, with sessions conducted in controlled environments by trained therapists. This approach maximizes therapeutic benefits while minimizing risks.

Recent years have seen significant legal and cultural shifts. Some U.S. cities and states have decriminalized or legalized certain psychedelics for therapeutic use. Countries like Canada and the Netherlands have also adjusted their regulatory frameworks. Public perception is shifting, aided by documentaries, books, and media coverage, which help destigmatise psychedelics and highlight their potential benefits.

Psychedelic-assisted therapy has evolved from ancient shamanic practices to modern clinical research. It continues to offer promising new avenues for healing and understanding the mind, reflecting humanity's enduring quest for psychological and emotional well-being.

PAT History in Australia

Australia’s history with psychedelics dates back to the mid-20th century, paralleling global trends. In the 1950s and 1960s, psychedelics such as LSD and psilocybin were subjects of scientific curiosity and clinical research. Researchers explored their potential to treat mental health disorders, leading to numerous studies that suggested positive outcomes. However, the socio-political backlash against the counterculture movement and concerns over uncontrolled use led to the criminalization of these substances.

In Australia, psychedelics are classified as Schedule 9 substances under the Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP). This classification means that substances like LSD, MDMA, and psilocybin are considered prohibited substances with no approved medical use, making their legal use in therapy highly restricted. However, there are exceptions for approved scientific research.

The early 21st century has seen a revival of interest in psychedelic research globally, and Australia is no exception. Organizations such as Psychedelic Research in Science & Medicine (PRISM) and the Australian branch of the Multidisciplinary Association for Psychedelic Studies (MAPS) have been at the forefront of advocating for and conducting psychedelic research. These organizations focus on advancing scientific understanding of psychedelics and their potential therapeutic benefits.

In recent years, Australian researchers have undertaken several significant studies. For example, the University of Melbourne and St Vincent’s Hospital have conducted clinical trials investigating psilocybin-assisted therapy for anxiety and depression in terminally ill patients. Additionally, Edith Cowan University in Western Australia has explored the potential of MDMA-assisted therapy for treating PTSD.

In a landmark decision, the Therapeutic Goods Administration (TGA) of Australia has downscheduled psilocybin and MDMA, effective July 2023, reclassifying them from Schedule 9 (prohibited substances) to Schedule 8 (controlled medicines). This change permits their use in a clinical setting for the treatment of specific mental health conditions under strict regulatory conditions.

The decision is based on mounting evidence from clinical trials indicating the effectiveness of psilocybin and MDMA in treating conditions such as treatment-resistant depression and post-traumatic stress disorder (PTSD). This move positions Australia at the forefront of global psychedelic therapy research and applications, allowing approved psychiatrists to prescribe these substances within a controlled therapeutic framework.

The TGA’s decision reflects a growing recognition of the potential therapeutic benefits of psychedelics, shifting the focus from prohibition to regulated medical use. It also opens new avenues for research, providing hope for patients who have not responded to conventional treatments. As Australia leads in integrating psychedelic therapies, this regulatory change marks a significant step towards innovative mental health treatment options and a broader acceptance of psychedelics in medical practice.

PAT Treatment Protocol

Psychedelic-assisted therapy (PAT) protocols are designed to provide a structured and supportive environment for patients undergoing treatment. These protocols generally include several key phases: preparation, dosing sessions, and integration. Below is an outline of a typical protocol based on current clinical practices and guidelines:

1. Preparation Phase

Initial Assessment:

Medical and Psychological Evaluation: Comprehensive assessments are conducted to determine the patient's suitability for PAT. This includes medical history, psychological evaluations, and ensuring no contraindications such as certain psychiatric conditions or medications.
Informed Consent: Patients are thoroughly informed about the therapy process, potential risks, and benefits, and must provide informed consent.

Therapeutic Alliance:

Building Trust: Establishing a strong therapeutic relationship is crucial. This involves multiple preparatory sessions where the therapist and patient build rapport and discuss treatment goals.
Setting Intentions: Patients are encouraged to set intentions for their therapy, identifying specific issues they wish to address.

Education:

Psychedelic Effects: Patients are educated about the effects of the psychedelic substance they will be using, including potential experiences and emotional responses.
Coping Strategies: Techniques and strategies for managing challenging experiences during the psychedelic session are discussed.

2. Dosing Sessions

Environment:

Safe Setting: The sessions take place in a controlled, comfortable environment designed to make the patient feel safe and supported.
Therapeutic Support: A therapist or a trained facilitator is present throughout the session to provide guidance and support.

Substance Administration:

Initial Dose: The patient receives a carefully measured dose of the psychedelic substance (e.g., MDMA or psilocybin).
Monitoring: Vital signs and emotional responses are monitored throughout the session to ensure patient safety.

Session Structure:

Duration: Sessions typically last between six to eight hours, depending on the substance and the patient’s response.
Therapeutic Interaction: While some sessions may involve dialogue with the therapist, others may be more introspective, with the therapist providing support as needed.

3. Integration Phase

Post-Session Debrief:

Immediate Reflection: After the effects of the substance have worn off, the patient and therapist discuss the experience, focusing on insights gained and emotions felt.

Ongoing Integration:

Follow-Up Sessions: Multiple integration sessions are held to help the patient process and make sense of their psychedelic experience.
Applying Insights: Patients work on integrating the insights from their sessions into their daily lives, which may involve changes in behavior, mindset, or emotional processing.

Supportive Therapy:

Continuous Support: Patients receive ongoing therapeutic support to help them navigate any emerging issues and to reinforce positive changes.

Safety and Ethical Considerations

Trained Professionals: Only trained and certified therapists should administer PAT. They must have specific training in psychedelic therapy, including understanding the pharmacology, therapeutic techniques, and emergency procedures.
Ethical Guidelines: Therapists must adhere to strict ethical guidelines to ensure the safety, confidentiality, and well-being of the patient.

Take a Closer Look

PAT History in Australia

Australia’s history with psychedelics dates back to the mid-20th century, paralleling global trends. In the 1950s and 1960s, psychedelics such as LSD and psilocybin were subjects of scientific curiosity and clinical research. Researchers explored their potential to treat mental health disorders, leading to numerous studies that suggested positive outcomes. However, the socio-political backlash against the counterculture movement and concerns over uncontrolled use led to the criminalization of these substances.

In Australia, psychedelics are classified as Schedule 9 substances under the Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP). This classification means that substances like LSD, MDMA, and psilocybin are considered prohibited substances with no approved medical use, making their legal use in therapy highly restricted. However, there are exceptions for approved scientific research.

The early 21st century has seen a revival of interest in psychedelic research globally, and Australia is no exception. Organizations such as Psychedelic Research in Science & Medicine (PRISM) and the Australian branch of the Multidisciplinary Association for Psychedelic Studies (MAPS) have been at the forefront of advocating for and conducting psychedelic research. These organizations focus on advancing scientific understanding of psychedelics and their potential therapeutic benefits.

In recent years, Australian researchers have undertaken several significant studies. For example, the University of Melbourne and St Vincent’s Hospital have conducted clinical trials investigating psilocybin-assisted therapy for anxiety and depression in terminally ill patients. Additionally, Edith Cowan University in Western Australia has explored the potential of MDMA-assisted therapy for treating PTSD.

In a landmark decision, the Therapeutic Goods Administration (TGA) of Australia has downscheduled psilocybin and MDMA, effective July 2023, reclassifying them from Schedule 9 (prohibited substances) to Schedule 8 (controlled medicines). This change permits their use in a clinical setting for the treatment of specific mental health conditions under strict regulatory conditions.

The decision is based on mounting evidence from clinical trials indicating the effectiveness of psilocybin and MDMA in treating conditions such as treatment-resistant depression and post-traumatic stress disorder (PTSD). This move positions Australia at the forefront of global psychedelic therapy research and applications, allowing approved psychiatrists to prescribe these substances within a controlled therapeutic framework.

The TGA’s decision reflects a growing recognition of the potential therapeutic benefits of psychedelics, shifting the focus from prohibition to regulated medical use. It also opens new avenues for research, providing hope for patients who have not responded to conventional treatments. As Australia leads in integrating psychedelic therapies, this regulatory change marks a significant step towards innovative mental health treatment options and a broader acceptance of psychedelics in medical practice.