Is there a place for psychedelics in trauma-informed care?
We all experience trauma at some point in our lives, but our health depends on how well we manage the effects of that trauma.
Trauma can manifest into disorders: serious psychological reactions that develop following exposure to a traumatic or stressful event.
There are five types of trauma-related disorders:
- Adjustment Disorders include the development of emotional or behavioural symptoms in response to an identifiable stressor, such as leaving home for college or having problems at work.
- Disinhibited Social Engagement Disorder involves a pattern of culturally inappropriate, overly familiar behaviour with unfamiliar adults and strangers.
- Post-Traumatic Stress Disorder (PTSD) is characterized by psychological distress lasting more than a month following exposure to a traumatic or stressful event.
- Acute Stress Disorder is similar to PTSD, but the duration of the psychological distress lasts only three days to one month following exposure to a traumatic event.
- Reactive Attachment Disorder involves problems with emotional attachment to others.
Symptoms can be similar for each disorder and may involve:
- Excessive anxiety or worry in safe situations
- Feelings of being on alert or inability to relax
- Feeling of loss or guilt for surviving instead of others
- Flashbacks
- Nightmares or night terrors
- Participating in dangerous behaviours
- Reacting violently or with extreme fear in safe situations
- Sensory inputs that can bring back memories of a traumatic event
- Trouble forming or maintaining relationships
- Thoughts of hurting oneself or others
It’s estimated that 76 percent of Canadians report having experienced a traumatic event during their lifetime (Ameringen, Mancini & Boyle, 2008). Eight percent of these Canadians develop PTSD (Canadian Mental Health Association, 2013). Though men tend to experience potentially traumatic events more frequently than women, women are more likely to meet the criteria for PTSD (Tolin & Foa, 2006).
Conventional approaches to trauma therapy include cognitive-behavioural therapy (CBT), psychodynamic therapy, sensorimotor therapy, eye movement and desensitization reprocessing (EMDR), and pharmacological treatment. Patients can benefit from “trauma-informed” care, which involves therapeutic approaches that validate and are tailored to the experience of a person with PTSD. Trauma-informed care understands the symptoms of trauma as coping strategies that have developed in reaction to a traumatic experience, and recognizes that a person with PTSD may have behavioural, emotional, or physical adaptations that develop in response to stressors.
Studies have suggested that therapy, antidepressants, and antipsychotics do not work well for people who have had chronic disorders or multiple traumas over the course of years. This offers more opportunities to discover better treatments.
The potential for psychedelics to treat trauma
Recognizing the various therapeutic modalities that exist for trauma-related disorders, the potential for treatment using psychedelics lies on the efficacy of psychedelic-assisted psychotherapy to reduce the symptoms of the disorder.
Although trauma-related disorders were not named until the 1980s, psychedelic studies were underway decades before. The late 20th century brought a resurgence in psychedelic research in treating PTSD, as have the last few years.
A 2013 University of South Florida study on mice found that psilocybin (a compound found in hallucinogenic mushrooms) stimulates neurogenesis, the growth and repair of brain cells in the hippocampus, the brain’s emotion and memory centre. Mice given psilocybin overcame fear conditioning better than mice given a placebo, supporting the hypothesis that psilocybin could help break the traumatic cycle for patients with PTSD.
A NYU Langone study on terminally ill cancer patients in 2016 found that one-time treatment with psilocybin very quickly brought relief from distress that had lasted more than six months in 80 percent of study subjects.
A strong argument against the psilocybin use for PTSD is the chance of a “bad trip.” This entails a scary or anxiety-inducing experience a patient may feel when experiencing the drug’s psychoactive effects, flashbacks, or physical effects that could include increased blood pressure or body temperature, loss of appetite, nausea, vomiting, and muscular issues.
Despite these potential effects, NYU psychiatrist Dr. Ross hopes that psilocybin will eventually become legal. “If larger clinical trials prove successful, then we could ultimately have available a safe, effective, and inexpensive medication—dispensed under strict control—to alleviate the distress that increases suicide rates among cancer patients,” he said.
The International Journal of Neuropsychopharmacology published a review of preclinical and clinical studies in 2020, showing evidence for four types of psychedelics for the treatment of PTSD. Another review published that year said that most evidence exists for MDMA-supported psychotherapy, while relatively little research is available on ketamine and classic psychedelics.
On July 28, 2017, the Multidisciplinary Association for Psychedelic Studies (MAPS) and the FDA reached an agreement on the Special Protocol Assessment for Phase 3 clinical trials. On August 16, 2017, the FDA granted Breakthrough Therapy Designation to MDMA for the treatment of PTSD. Results of the study were published in Nature in May of this year and suggested that MDMA-assisted therapy induced rapid onset of treatment efficacy even in those with severe PTSD, and in those with associated comorbidities including dissociative PTSD, depression, history of alcohol and substance use disorders, and childhood trauma.
Also covered by The New York Times, the study summarized that MDMA-assisted therapy was effective for individuals with severe PTSD, and may also provide improved patient safety. Researchers said that compared with existing pharmacological and behavioural therapies, MDMA-assisted therapy had the potential to dramatically transform treatment for PTSD and should be evaluated for clinical use.
The scientific community has also begun exploring the potentials of psychedelic therapy in Complex PTSD (C-PTSD) treatment. It’s estimated that one in five adults have suffered childhood abuse.
In a recent study, scientists investigated adults who were victims of childhood abuse. Adults who had used MDMA multiple times with therapy had lower scores on a DSO scale, a measure of C-PTSD core features that include low self-worth, problems with regulating emotions, and difficulties in relationships. Results also showed those who had more intentional psychedelic uses revealed decreased levels of self-shame, another C-PTSD symptom.
The researchers believe psychedelics could play a role in the healing process of C-PTSD.
Vancouver-based Numinus is also conducting a study with about 20 volunteers on the safety and effectiveness of MDMA-assisted therapy.
The Center for Psychedelic Psychotherapy and Trauma Research located at Mount Sinai and the James J. Peters Department of Veterans Affairs Medical Center in New York is also focusing on both MDMA-assisted psychotherapy and psilocybin and will expand to studying psychedelic-assisted therapy with other compounds. They hope to accelerate the understanding of how both MDMA and psilocybin work and will hold clinical training sessions for therapists in anticipation of FDA approval and lead in education, including a monthly lecture series.
These advances in psychedelic-assisted psychotherapy show promise in treating trauma-related disorders. By encouraging our loved ones to access treatments that are already available—or seeking them out ourselves—we can hopefully reduce the stigma associated with these disorders and normalize treatments for all.