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Psychedelic-assisted treatment of Post-Traumatic Stress Disorder

Behandling av PTSD med psilocybin og andre psykedelika

Both acute crises such as accidents, disasters or acts of terrorism, and long-term stress such as war, abuse or a difficult childhood, can lead to PTSD. Typical of Post Traumatic Stress Disorder is that consciousness has been split up or disintegrated. The paradox is that while the traumatic and difficult in one way has become so split off that it  is not available for regular talk therapy, it can at the same time be so intrusive that it rules the life of the person affected. The trauma material is so powerful that it penetrates as intrusive memories or inappropriate patterns of reaction and action. The separation - or dissociation - is essentially a survival strategy, and is useful as long as the situation lasts. So are the intrusive memories, which don&'t let you forget that danger lurks around every corner. This can keep you alive in an extreme situation, sure, but i an ordinary everyday life becomes an obstacle to living a good, peaceful life with healthy and well-functioning relationships. 

Psychedelics have very strong associative effects - i.e. the opposite of splitting off or dissociation. In clinical situations, this manifests itself in the form that the client can experience a new connection of both good and unpleasant memories, and that it initiates a process that gives new meaning and a new perspective on the whole thing. This is often experienced as very liberating and healing. When it comes towhythis happens, brain scans of people on psychedelics, as well as before and after pictures, show that psychedelics actually create more connections in the brain - that is, that communication is established between areas that are usually more or less isolated from each other. It must be assumed that this is directly related to why psychedelics can spur completely new perspectives and ideas, as well as more adequate emotions and bodily reactions. 

It is also our own experience that psychedelics, used in the right way and in the right setting - as well as under expert guidance - has the potential to heal what is "broken". We are happy to help you take some important steps on the way back to a life of freedom and joy. 

The first Norwegian study on MDMA-assisted psychotherapy. Together with colleagues from here, Goksøyr has written a scientific article that we publish in this edition of the journal. The article is a literature review of MDMA-assisted psychotherapy in PTSD. The study concludes positively: "The results indicate that MDMA-assisted psychotherapy can be a relevant treatment option for PTSD." Goksøyr also sits on the board of the Norwegian Association for Psychedelic Science as the only psychologist specialist, and is an outspoken champion of spreading knowledge about psychedelic-assisted therapy in Norway. - Psychedelics make up a range of different substances that have in common that they change our perspective and make otherwise inaccessible processes in the mind visible. Ketamine and MDMA are at opposite ends of this spectrum, while more classic psychedelics, such as psilocybin and mescaline, lie in the middle. They all have different impact profiles. MDMA differs from the more classic psychedelics by having a more predictable effect, explains Goksøyr. - How did your interest in psychedelic-assisted psychotherapy begin? - I became a psychologist to understand the human mind and to be able to transform suffering into freedom. With increasing specialization, I have had the potential for deep healing confirmed, but I have also experienced how demanding it is to achieve. We need all the help we can get in this work, he says. Safety and efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in post-traumatic stress disorder (PTSD). The psychoactive substance MDMA may be suitable in combination with psychotherapy. What does the research say about the safety and effectiveness of MDMA-assisted psychotherapy in the treatment of PTSD? Awakening: Several years ago, Goksøyr received confidences about the therapeutic use of MDMA from people who described the experiences as transformative and life-saving. This opened him up to the field, and he was captivated by the literature that met him. - The more I read, the more amazed I became: Not only was there a tradition of MDMA-assisted psychotherapy before the prohibition era in the 70s. The World Health Organization also characterized MDMA as interesting and encouraged further research into its therapeutic potential. There were no randomized and well-controlled studies from that time, but the indications for therapeutic benefit were many and were advocated by psychiatrists, psychologists and spiritual leaders alike. We need to verify the veracity of such clinical experiences scientifically. If they are correct, we may be dealing with an important tool, says Goksøyr. MDMA, the active substance in ecstasy, is an illegal central stimulant drug. Among other things, it is being tested as a drug in the treatment of post-traumatic stress disorder. MDMA was first synthesized in 1912 and was used in talk therapy in the 1970s. MDMA was put on the UN drug list in 1986. Long sessions: MDMA-assisted psychotherapy is labor-intensive. An MDMA high usually lasts between four and six hours, but can last as long as eight. This means that a psychologist must set aside an entire working day for one patient when the MDMA drug itself is part of the treatment. - A "classic" MDMA-assisted therapy lasts a total of 30 to 40 hours. Then you have two or three sessions of eight hours where you are under the influence of MDMA, the other hours are normal hours where you process and integrate the material that came up. Intensifying the treatment dose is a move of the times, and if MDMA-assisted psychotherapy gives good long-term results in complex cases, the use of resources will pay off, says Goksøyr. - What typically happens in and to the patient when he/she is affected by MDMA during therapy? - Through the course of therapy, patients have often experienced some strong and redemptive therapy moments, but they last rather short, and you have to work hard and long to get there. With MDMA, these experiences are stretched out and last for several hours. The mechanism of action is complex, but subjectively contributes to the relaxation of the body. At the same time, one is sensitized to emotions, is cognitively clear and filled with compassion for oneself and others. The condition appears to produce a spontaneous pull towards the integration of feelings and events that are often avoided, driving symptoms. At the same time, you do not lose control. These preliminary impressions of the effect profile give hope for MDMA as a good catalyst for therapy, Goksøyr believes. Phase three: Currently, MDMA-assisted psychotherapy is mainly at the research stage, but both the USA and Israel have approved trial projects for treatment also outside of research. In the USA, the latest major phase three studies are underway, which will grant drug approval if the results from previous research phases are maintained. - In the USA it is expected that approval can be obtained in 2022. In Europe, it has fallen short, here it is probably around 2024 at the earliest that MDMA can be approved as a drug for use in psychotherapy, says Goksøyr. - Have you tried MDMA yourself? - Last summer I received MDMA-assisted psychotherapy in an American study, where therapists in future studies were offered to participate. It was a meaningful and important therapeutic experience for me. Sober and nuanced: Goksøyr is open that his interest in MDMA-assisted therapy has a personal vein. At the same time, he is at the forefront of research on MDMA in Norway. Isn't there a bias here that can affect both his research on and dissemination of this type of knowledge? - There is always a danger when I do research in a field that I also practice and am engaged in. As a clinician and a human being, I hope that it will work. This is, among other things, why there are peer processes in research. Having said that, I am not interested in MDMA-assisted therapy per se, but in anything that can contribute to our work. Nothing works for everyone, but a lot can work for some. I have chosen the field of psychedelics because few tracks seem more promising and at the same time so neglected, says Goksøyr. - Do you think society is mature enough to distinguish between therapeutic treatment with MDMA and the illegal use of ecstasy (another word for MDMA) at parties? - That medicines can also be used as drugs is nothing new, and usually the medicine is not sacrificed for that reason. I am keen to convey that taking such substances in a clinical setting is something completely different from recreational use. My wish is that we treat this field like other fields of science: that we look soberly at the data, and make good assessments of risk against benefit. First and foremost, we need to initiate more research. The pressure of suffering in the population is great. To reject promising methods just because they seem foreign is not a privilege we can allow ourselves, concludes Ivar Goksøyr.

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