[HN Gopher] The Yale Manual for Psilocybin-Assisted Therapy of D...
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The Yale Manual for Psilocybin-Assisted Therapy of Depression
Author : say_it_as_it_is
Score : 224 points
Date : 2021-01-02 15:11 UTC (7 hours ago)
(HTM) web link (psyarxiv.com)
(TXT) w3m dump (psyarxiv.com)
| dukeofdoom wrote:
| yes, but did he see interdimensional elves?
| f430 wrote:
| One of the craziest thing about Psilocybin mushroom is that it is
| quite possibly one of the most bizarre things on earth literally.
|
| Here's what TM had to say about it's chemical structure:
| "I've mentioned that psilocin, which is what psilocybin quickly
| becomes as it enters your metabolism, is 4 hydroxy
| dimethyltryptamine. It is the only 4-substituted indole in all of
| organic nature. Let this rattle around in your mind for a moment.
| It is the only 4-substituted indole known to exist on earth. It
| happens to be this psychedelic substance that occurs in about
| eighty species of fungi, most of which are native to the New
| World. Psilocybin has a unique chemical signature that says, "I
| am artificial; I come from outside."
|
| However, this isn't the most bizarre thing, the _crazy feature of
| psilocybe is that you can have communications with it, you can
| tell it to be MDMA or any drug and it will produce effects very
| similar_.
|
| I've definitely tested out the latter statement as first
| discussed by TM and its a technique that I find has by far the
| most anti-depressant effect that still lingers.
|
| Many people freak out because they try to figure out what
| Psilocybin mushroom is and then all sorts of craziness is shown
| to you that can produce panic in beginners.
|
| Some people try it once, get freaked out by its deep
| introspective qualities that addresses the holes in our spirits.
|
| In fact one of the scariest experience was the second time I
| tried it where I experienced _ego death_ for the first time. It
| _literally feels like you are dying_ but funny enough it is
| because our body-mind complex is so fixated and attached to our
| ego, a mere illusion that is created by this...reality.
|
| Perhaps the most fundamental change in value systems that occurs
| during psilocybin creating a feeling of oneness and zen like
| state that reveals love is the only truth, everything else is
| falsehood and deception.
|
| It's no wonder that it poses a threat to hierarchial, dominant
| culture of centralized power by a small group.
|
| Psilocybe is not only the red pill that wakes you from the
| hypnosis of our modern reality shaped by the petrodollar economy
| that is destroying the planet, and as such, it is deemed illegal,
| taboo.
|
| One of the most frightening realization was that not the
| experiences that come out of consuming the psilocybin mushroom
| but the very reality that we live in and choose to ignore while
| focusing on only what we want to see because its too painful to
| admit what has happened in our modern world-an all out war
| against everything human: our bodies, our thoughts, our
| expressions.
|
| If we are to change this planet and our course of direction we
| _must_ continue in our discovery of the past because it holds the
| key to our salvation.
|
| If only 1% of the population can cause a shift in consciousness
| it will have butterfly impact on the rest. We simply do not judge
| or hold contempt for the close minded, instead continue
| educating, continue the discussion, so that we can wake from the
| slumber, our constant desire for novelty and meaningless
| consumption.
|
| Psilocybin works because it is a device which causes truths to
| emerge from the swamps of lies and deceptions pulled over our
| heads. Barring sensory deprived meditation states like the Yogis
| of tibet that naturally produces DMT, the descendants of the
| Stoned Apes are once again rediscovering the very thing that has
| led to their dominance on this planet.
|
| Perhaps this is what TM was talking about the great
| "transcendental attractor object", we are perhaps on the edge of
| massive transformation of not only the human psyche through
| spiritualism but physicists will reveal part of the nature of the
| universe that will add more and more backing towards this "New
| Age" era.
| [deleted]
| andred14 wrote:
| How about we get to the root of the problem ie. unlawful
| lockdowns and "safety measures" that are proven to not work and
| are not needed?
|
| "In the present study, virus culture was carried out on samples
| from asymptomatic positive cases, and found no viable SARS-CoV-2
| virus. All close contacts of the asymptomatic positive cases
| tested negative, indicating that the asymptomatic positive cases
| detected in this study were unlikely to be infectious"
|
| https://www.nature.com/articles/s41467-020-19802-w
|
| https://rationalground.com/mask-charts/
| ada1981 wrote:
| The idea of letting go and surrendering into an experience is
| useful for all types of psychedelics.
|
| We use this approach as well with http://TryWithin.com (in home
| psychedelic assisted therapy)
| intrasight wrote:
| Interesting that you have more lawyers than therapists.
| palimpsests wrote:
| How are you navigating the issue of establishing sufficiently
| strong interpersonal containers for at-home psychedelic
| assisted therapy?
|
| We know that this relationship is critical for effective and
| safe guided sessions with psychedelic medicines.
|
| And, that it's not straightforward to establish this
| relationship between two people if they have only met online
| (drastically reduced non-verbal communication bandwidth,
| difficulty/impossibility around establishing nervous system
| coregulation / entrainment).
| krmmalik wrote:
| This is super interesting. What geography do you operate in?
| Could you assist someone in the UK for example? (My concern is
| the legality of it all rather than the practical aspects)
| krmmalik wrote:
| Also. Why is your service not more well known? I've been
| researching this area quite a while. This is ground breaking
| stuff with the potential to seriously change lives. I'm
| surprised your company isn't plastered everywhere?
|
| If I can be of any help, do let me know? I'm a business
| strategist.
| troydavis wrote:
| 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.
| pmoriarty wrote:
| 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 wrote:
| 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 wrote:
| 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
|
| [2] - Part 2 - Tips for Safer Use
| https://www.youtube.com/watch?v=HgUPKYrpBvY
|
| [3] - Part 3 - Pharmacology and Medical Use
| https://www.youtube.com/watch?v=UHduGGB5kJU
|
| [4] - Part 4 - The Need for Drug Policy Reform
| https://www.youtube.com/watch?v=nTSiyQHm2s4
|
| [5] - Part 5 - Heather Brooks
| https://www.youtube.com/watch?v=O8s-nhlaACw
|
| [6] - Part 6 - Joseph Pred
| https://www.youtube.com/watch?v=0wolzUE3lPk
|
| [7] - Part 7 - Question & Answer
| 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
| retrac wrote:
| To add to that, it's probably sensible to not engage in
| particularly strenuous activities like weightlifting or
| very intense aerobic training on MDMA. It is still an
| amphetamine-class stimulant on top of its other effects,
| with the hypertension and increased heart rate.
| danenania wrote:
| Yes, good points!
| ericmcer wrote:
| 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 wrote:
| 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 wrote:
| 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 wrote:
| 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.
| loceng wrote:
| 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 wrote:
| _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/
|
| I imagine what Doblin meant is working with MDMA _after_ an
| ayahuasca ceremony.
| loceng wrote:
| 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 -
| 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.
| catblast wrote:
| > I did fairly deep research on this beforehand, looking
| into actual pharmacological aspect of interactions with
| things like dopamine, etc
|
| While you can read about mechanisms and in vitro this and
| that all day, this is not the same as quality applied
| clinical research, which frankly just doesn't exist in
| any meaningful quantity. I am a practitioner, and I am
| very sympathetic to the movement of alternative
| treatments counter to established standards of care,
| however at the end of the day it doesn't change the fact
| that the controlled research is non-existent or poor, and
| things like the MAPS manual are essentially woo.
|
| And specifically the problems I have is that ironically,
| these alternative treatments which are supposedly trying
| to overcome boundaries of established care are extremely
| proscriptive themselves.. they're limited, just
| differently, and the justifications have very little
| evidence based backing.
| JacobSuperslav wrote:
| as far as my recreational common knowledge goes: mixing MDMA
| with any other triptamines is risky. Read up on risks of
| "candyflipping"
| murm wrote:
| Interesting. For me, MDMA comeup is 45 minutes of
| restlessness and agitation. I'm not sure how I would be able
| to tolerate that if I'm already at a point where a medical
| intervention is needed to calm me down. Though the actual
| effects of MDMA would be wonderful for processing the
| difficult emotions, I agree.
| loceng wrote:
| What's the environment/setting? Who were you with? What
| dose? Most people hit peak from a dose between 70-90
| minutes. How were you onboarded, what was told to you about
| how to deal with "restlness and agitation"/anxiety or if
| anything came up for it that felt hard/difficult for you?
| Also are you 100% sure it was just MDMA and not something
| that may have been mixed with something like meth/speed,
| etc - e.g. was it tested?
|
| The restlessness and agitation you're speaking of is often
| why people go dancing as when taking it primarily for
| recreational purposes, as it can have therapeutic effect as
| well; it can release energy that you need to do something
| with.
| [deleted]
| trianglem wrote:
| 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 wrote:
| 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.
| loceng wrote:
| Here's MAPS.org's 69 page manual (PDF; 2015) for MDMA-assisted
| therapy for PTSD (and other): https://maps.org/research-
| archive/mdma/MDMA-Assisted-Psychot...
| c-c-c-c-c wrote:
| Maps could learn a thing or two from the typesetting of the
| Yale manual.
| canada_dry wrote:
| > "placibo sessions" are noted in a couple parts of the paper.
|
| I can't imagine any participant _not realizing_ they 've been
| subject to a placibo after no more than an hour into the session
| (unless they have no idea it is a psilocybin study).
| Alex3917 wrote:
| Scientists usually use active placebos for psilocybin therapy,
| so the difference isn't necessarily going to be obvious.
| budoso wrote:
| Huh, didn't know that active placebos existed. (I'm not in
| the medical field) Would you go more in depth on this? What
| would they use as a placebo, if not psilocybin? Couldn't an
| active placebo affect the patients and skew the
| results/measured effectiveness of the main drug being
| studied?
| cuspycode wrote:
| I'm not in the medical field either, but I remember they
| used niacin (a form of vitamin B3) as an active placebo in
| the Good Friday Experiment[0] in 1962. The niacin doses
| produced some noticeable physiological effects, but it
| didn't take long before it became abundantly clear for
| everyone present who had gotten the psilocybin and who had
| gotten the niacin.
|
| [0]. https://en.wikipedia.org/wiki/Marsh_Chapel_Experiment
| twirlock wrote:
| I should be allowed to take mushrooms. Telling me that someone
| needs a credential to give me mushrooms is a violation of
| separation of church and state. It shouldn't be that legislators
| and law enforcement can only learn obvious things from dickheads
| in labcoats or in the media.
| imperio59 wrote:
| Right. You're depressed, so the best solution must obviously be
| to consume drugs and take a trip that could potentially render
| you psychotic for life.
|
| This is not medecine. It is no better than the voodoo doctors of
| old who made you take the "funny herbs" to cure your "demons".
| This is garbage and not science.
| lifty wrote:
| I'm sorry, but you are clueless.
| Felony_Fred wrote:
| Cutting edge ->
|
| Matthew Johnson: Psychedelics | Lex Fridman Podcast #145
|
| https://www.youtube.com/watch?v=ICj8p5jPd3Y
|
| Matthew W. Johnson is a professor and psychedelics researcher at
| Johns Hopkins.
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