Y Combinator Startup Podcast - #64 - Researching Psilocybin's Effects on Depression - Dr. Rosalind Watts

Episode Date: March 15, 2018

Dr. Rosalind Watts is a clinical psychologist at the Psychedelic Research Group at Imperial College London.The Psychedelic Research Group focuses on two main areas: first, the action of psychedelic drugs in the brain and second, their clinical utility, e.g. as aides to psychotherapy, with a particular focus on depression.The YC podcast is hosted by Craig Cannon.

Hey, how's it going? This is Craig Cannon, and you're listening to Y Combinators podcast. Today's episode is with Dr. Rosalind Watts. She's a clinical psychologist at the Psychedelic Research Group at Imperial College London. And the psychedelic research group focuses on two main areas. First, the action of psychedelic drugs in the brain, and second, their clinical utility. So in this episode, Rosalind and I talk about their study of how psilocybin, aka mushrooms, can affect depression. and if you want to learn more about their research, I will link it up in the description and on the blog. All right, here we go. How did this particular research project get started? This particular research started after various other studies looking into the effects of psilocybin on the brain and LSD on the brain.

And this was the work of Robin Carhart Harris, who his interest came out of his own psychoanalytic studies and has also been. to work as a neuroscientist and he was very interested in how we can explore the unconscious mind because so much of our behaviour is controlled by the unconscious mind and yeah it's very difficult to study scientifically and psychoanalysis is very it's almost seen as more of an art than a science so he wanted to find ways in of looking at the brain the unconscious mind and he um he started studying psychedelics with david nuts so david nuts is a he's a quite well-known professor in this country for his activism in legalising drugs. He worked with the government.

He was the drugs czar. He informed them or advised them about the scientific harms of different drugs and how they should be scheduled or where they should be in the schedule of illegal drugs. And he was sacked very famously because his scientific report stated that MDMA was less dangerous than horse riding. Okay. So he was sacked for that and he has gone on to be a real innovator in drugs policy and drugs research.

Just recognising that lots of the drugs that are illegal might hold potential for healing. Yeah. Whereas alcohol and cigarettes that are legal really don't. Right. It's time for a more free-thinking approach. So it was David and Robin together that started this research and it was very difficult for them because there's so much red tape around this. Because since it was made illegal in early 70s,

it's been very hard to get a license from the home office to do this research. But once they'd gone through the process, it became easier for them to then do another study in another study. So they've really been on a role. They did some studies looking at the effects of psilocybin and LSD on the brain, and then they realized that the findings that they had indicated to them that it was time to start looking at psilocybin with a clinical. population and the key finding was that psilocybin seems to deactivate the part of your mind,

your brain that is responsible for ruminating, for negative thinking on a loop. So they realised that for people with depression this could be really, really powerful. So the study that I was involved in was a clinical study looking at 20. people with treatment resistant depression. And it was the first study of its kind in the UK. And there have been some studies in the US looking at psilocybin with people with depression and anxiety secondary to a diagnosis of a terminal illness. Okay.

So are these the studies that were happening in the 60s and 70s or are there more recent work? So in the 60s and 70s there were, well, in the 50s, 60s and 70s, there were hundreds and thousands of studies. Yeah. and the findings were really very positive and it would all look great and then it was became illegal and then the research just dropped away but then it started again in the early 2000s I think maybe 2006 around that time and maybe slightly earlier than that and some of the people that had been involved in psychedelic research in the 60s started to say

we really, you know, we really need these tools. They were really working. We need to get them back again. And I think, so Bill Richards, who's a psychologist who's been working in one of the clinics in the US. So the Maryland Psychiatrics at Res Center had this clinic there. There are some good YouTube videos showing people having LSD sessions that you can see the kind of psychiatrist sitting there with a woman who is on her LSD trip. and they yeah they basically realized that it was time to go again so they they kind of galvanized their team got a new group together and started started up again and this was just like these drugs had

existed at the university and they just had a store of them or they lobbied to to make this happen how did it go so how do they actually get the substance so I think that there are are various companies now that are synthesizing psilocybin and they can provide it to researchers with a license to use these Schedule 1 drugs. So, but in order to use them in a study, you usually need it to be GMP grade, which means it's kind of very pure and able to be used. It's gone through lots of testing. Yeah. So there are very few providers of GMP psilocybin. So it takes a lot of, a lot of the difficulty of doing this research isn't just the bureaucracy cutting through the red tape, getting the licenses, the lack of funding, because the governments obviously don't

often want to fund this, but it's also actually getting the psilocybin and getting enough of it and getting that's stable and being tested. Yeah. And so what clued you into the fact that it was working with depression versus, you know, some other trait that it might affect? Well, I think it will be helpful for so many different mental health difficulties. But with depression, it's the ruminating quality of depression, the fixation on stuff. certain ideas and concerns. So psilocybin and psychedelics seem to be very good at... When people are stuck in a very fixed pattern of thinking or of living,

psychedelics can break that pattern. They can provide this state of... When you look at the images of brain communication pathways, they go from this kind of segmented lines to this full-on explosion where things that, parts of the brain that don't talk to each other, all talk to each other, and suddenly there's this flexibility. So I'm curious about what the experience is for the following days, but I think before we jump in,

we should talk about what one of these sessions actually looks like. Yes. In the last study, there was a low dose and a high dose session. The low dose session was 10 milligrams, and the high dose was 25, and they look pretty different at these sessions. So a Lodo session So firstly the setting is that people would come into the clinic

And they would have had some sessions with their guides beforehand So everybody has two guides Their clinic clinicians, therapists And they get to know the participant quite well You have some sessions where you just share about their lives And hear their story And you tell them a bit about yourself And it's quite a nice human equal relationship

Very respectful and quite different to some doctor-patient kind of... Have you done both, like both type of relationships? Yes. Okay, all right, yeah. Very different. Yeah. So I suppose I was working in the NHS as a therapist with lots of patients,

and there you're so busy. You have, you know, seven people coming every day, and there's this huge need, and there's this huge need, and that often you don't really have the tools to help people, because often talking therapy doesn't really work, especially if you can only offer people six sessions. So you're aware that people have this need and that they're so desperate and in crisis,

and there's not much you can do. So in a way, what that happens is you put your barriers down, you put your boundaries down. It's like, this is what I can do, this is what I can't do, and you keep yourself a bit separate. And what happens to those people, they have to go private somewhere? Well, I guess these are usually,

people that really wouldn't have the money to go privately. So they just, they come for their sessions and you give them what you can, but you can only give them six sessions. So there's this sense of, um, of it not being enough. Yeah. And it's hard for them and it's hard for you and it's hard for everybody there. And then they will often get antidepressants because that's something that the doctor can easily prescribe and it feels like it's doing something. But then often that doesn't work either. Okay. And are antidepressants prescribed at the same rate that they are in the US here in the UK? They're prescribed incredibly frequently. So I think, think last year was our record number of antidepressant prescriptions.

There was 64.7 million prescriptions in the UK for antidepressants last year. How many people live in the UK? Oh, I don't know. But it's, I mean, it's a lot more people than you would imagine. Yeah. Yes. It's a huge, huge use of antidepressants that isn't really talked about very much. And, you know, as a short-term thing to get people through a crisis time, I think sometimes

it can be really helpful. And for some people, it works. But for a lot of people, it's a short-term fix that doesn't really change. the causes of the depression. Okay. Doesn't really, there's a root cause something's not right and it's not, it's not addressing that. Okay. So in, in these like psilocybin sessions, you, you more, you're just like having a conversation,

like you would between friends before you get going. Yeah. So someone gets comfortable with you. So you feel really comfortable. So yeah. You are, you are, you're more, you're going through something together. You're on a journey together, you know. And you've been through all the different things that can happen and how to manage

a session and oh so it's sort of like a Q and A as well so I show up and I'm like okay like here we go yeah we have so so you we'd have a couple of sessions beforehand to get to know each other okay and then you would tell me about your life story and the difficult things that had happened and the things that you were scared would come up because they often do so all the things you don't want to talk about might well come up so all the taboos you talk about sex and death and you know all the things that people hide in their closets and then when that's all you're all you know being openly talked about, then you're ready to go. And they come into the clinic.

They have the capsules on the low dose session. It's just two capsules. And then they sit there with their two guides in a room that's full of nice decoration. So it's in a hospital, but it doesn't look like a hospital room. And they have a playlist of really beautiful music that's been specially designed for this experience. And then they sit there through the day. And on a 10 milligram dose, you would tend to see more psychodynamic stuff. So internal exploration, people feeling more emotional, feeling that they maybe get some insight into different parts of their life.

And often there's a struggle because the amount of psilocybin is their ego is still intact. There is still an eye there. There is still a, you would still be there knowing who you are, just more in touch with stuff. that's going on down below that you don't often think about. So the stuff that's being pushed away. So in other words, you can, you can kind of put a finger on it and you can identify it, but you don't, you don't let go of it? Or how would you put it? So the difference between a 10 milligram dose and a 25 milligram dose usually is that a 25 milligram dose is so high that it will completely, that you can't resist it. So with a 10 milligram dose, so, okay, imagine a bit like this. With 10 milligrams,

imagine you've got this seller. Do you use the word seller? in the US? Yeah, basement. Yeah. Basement. You've got a basement. And in the basement, there are all the skeletons

and the monsters and the things that you have pushed away. And what psilocybin does is it can open the door of that stuff so that you can process it, so that you can go through those things and be freer of them as you go forward in your life.

And it's not just the monsters that are down there. There's also loads of other really amazing things, but it's intense. And it can feel a bit like taking the psilocybin is a bit like kind of opening that door and you have to let go and surrender to whatever is coming up you have to be there and welcome it with 10 milligrams it opens it a little bit and so the things come out and you might be having a conversation with a dead parent or you might be thinking about a relationship that ended and it's like a very intense turbo charge therapy session

but you can fight it you can kind of put the lid down you can decide you don't want to do it with 25 milligrams yeah you can't fight it you can't say I don't want to deal with this I I've decided I don't want to. It's open. Everything comes out and you just have to surrender and just trust in the process. And your role as a psychologist, what are you doing throughout a 10 and a 25 milligram session? Helping people surrender, helping people face the things that are difficult, helping people sit through the pain of it by being encouraging that that's the right thing to do, that they're safe. People sometimes feel that they're dying because when the ego is deactivative, that's quite common because when you're ego deactivated, you have no sense of self.

And sometimes that's a beautiful experience. I mean, when I talk about the basement being opened, it sounds like it's always really difficult. It's often a really beautiful experience for people. Often, there'll be a bit of both. But when you die on a psychedelic experience, when you have an ego death, that can either feel like,

oh, I'm at one with the planet, I am the plants and the trees, I am everything, or it can feel like I'm physically being killed, I'm dying. Really? So you experience physical pain? Yeah. Okay. Sometimes. And you're just saying to them you're okay?

This is exactly what you came here to do, you know? This is, it's counterintuitive. Yeah. You know, if you feel that you're going mad, great, go mad. If you feel like you're dying, go die. If you're exploding, let's see what it's like to explode. It's about, in a way, the whole concept of mindfulness and meditation is about allowing things in and just sitting with them rather than distracting or pushing them away

or trying to always be kind of achieving or feeling good, but never feeling your feelings. And it's about that. It's like turbocharged mindfulness. It's whatever is here, let it be here. Don't fight it. Don't push it away. Don't try and nullify these negative emotions.

Do sadness. Do suffering fully. And is there like, is there a certain vocabulary that you train someone in before they get going? I just wonder if someone is more precise with their language, does that affect the experience? Or is it kind of open to anyone? Interesting. Well, often the experience has had this noetic quality, which means that they're beyond words.

You can't put them into words. So I think really people's kind of vocate, it doesn't really matter. If you go beyond that, you go to a different level beyond that often. But we do talk to them a little bit. We don't prepare them for any kind of experience because we don't want to prime them in any way. so we just say you might have if you feel that you're dying that that's okay you're not actually physically dying we'll look after you it's all fine yeah um but we don't really prepare them because we just don't know where they're going to go so we just the

main preparation is just surrender that's the one word surrender and both are both other people in the room psychologists or they they serve different roles so there's in our next study that's just about to start we're going to have one lead guide and then one assistant guide it's a kind training program, a way of people that can get experience. And then they'll also be the psychiatrist that's not in the room most of the time, but is on site if we need him. And then, yeah, so. Okay. And so are you taking notes? Are you just hanging out? What do you do? Last time, we would take a book in with us sometimes, because there's a lot of time when they're just got the earphones in, the eye shades on, and they're just lying back on the bed. And so

it's just silence for a long time. But this time, I think we're going to try not to do that, because actually it's just good to be there fully with them, even though it's a long day. It's like six hours that they might be on this experience. But just really just being with them and seeing the subtle changes and listening to the music and being the moment, you know. That's so great.

And so the people that have participated in the study so far, do they have any shared qualities or traits? Like how does someone end up in this study? Well, so in the last study, people had treatment-resistant depression, so it meant that they tried at least two different types of treatments that hadn't worked. Yeah. So I would say when I think back up those 20 people, they weren't all psychedelic enthusiasts.

A couple of them had tried it before, but like 20 years ago. And actually the one that had tried it before had had a terrible LSD experience. So he was really put off by it. Yeah. So the expectations about psychedelics were quite negative in many ways. There was a lot of anxiety around them. But I guess also that maybe people had accessed some media coverage of the positive possibilities of Cesar Sivan, so it was a bit mixed.

There were some expectations that it might help them, but they were scared about how they were going to get to that good outcome. Right, well, because they've all opted in to the same. Yeah, they've all opted in. But the reason they opted in, and I think this is all of them, is because they were absolutely desperate for something that was going to help them. They had tried everything. They'd had depression for an average of 18 years, and they tried between, I think,

three and 11 types of antidepressants. Imagine trying 11 types of antidepressants. And every time you go and your doctor gives you a different packet and they have side effects and they take weeks to work and they don't and then they don't help you. 11 types. So and they'd also had like lots and lots of talking therapy up to six different courses of talking therapy. So these are people that they would try anything. For some of them it was like ECT was the next option which is the electric shock therapy of the brain. So people were like, well, I'll try this and then if this doesn't work, I'll try ECT because it's either this or.

I can't carry on living like this. It's either this or I'm out. And is ECT proven to be effective? Well, in some very severe cases, there's some, it might help some people, but there's also cognitive problems as a result of it can lead to severe cognitive difficulties and memory loss. And it's, I mean, I think sometimes it works for people, but it's really the last resort. And so are these, before you start taking cell suburb, so you're taking these antidepressants,

they're super common, way too common in the US. Are there long-term effects of taking these medications? Because I know so many people are also manipulating their brain who don't necessarily have depression. You know, they're taking neutropics, they're taking these focused drugs or whatever it might be. Have you found there to be any long-term effects? With psilocybin?

Not psilocybin. Oh, yeah, yeah. The research into the effect of antidepressant drugs often is very short term. It looks at them for a very short period. time without much follow-up. Yeah. So, because that serves the purposes of the people making these drugs.

So I don't know of long-term follow-up research. All I know about is there was experiences of people that I've spoken to. So in my clinical work, as a clinical psychologist, seeing people saying, they make me feel worse. Often people would say they made them feel worse. And often, in terms of the long-term... I think with antidepressants, if they work well for people, then they keep taking them. If they don't work, then they stop taking them.

So we would be interested in the long-term effects of antidepressants for people for whom they are effective. But I suppose for those people for whom they are affected, they're a complete lifeline. Right. So, yeah, I don't know about the research on that. Well, yeah, I don't understand it to the same degree as you do. Is it common for someone, if they do find an antidepressant to be effective? Yeah. To maintain use forever?

It is quite common for people to use it for a long time. So for example, one of our participants had been on antidepressants, even though they hadn't really helped him. They helped him a little bit. So the way he described it was life was really unbearable and the antidepressants took off the peaks and the troughs. So the highs of the highs, the lows of the lows. So it just made the range a bit more bearable. So even though he still felt very, very depressed, they kind of kept him going. he wouldn't say they worked

but he took them anyway because we need and the real reason and this is the real thing that I do and he gets talked about enough the real reason I think so often people stay on the antidepressants is because when they try and go off them it's awful

so there was this one participant who'd been on antidepressants even though they hadn't worked for 20 years and in our study people have to come off their antidepressants in order to participate because it really psilocybin is not nearly as effective

if you're on antidepressants it really takes the and it takes the highs in the lows. Yeah, yeah, exactly. Yeah. It stops it from working, essentially. Coming off his antidepressants before the study, he was in, he was tearful the whole time. People describe electric shocks going off in their brain, bed wetting sometimes. That was somebody else. And how long are they off of these before they take psilocybin? Well, for some people, you have to withdraw them for quite a while. Yeah, yeah. So, you know, you can't go into a psilocybin session when someone's so

turbulence so that was a shock for us one of the big shock findings was oh my goodness me withdrawing from antidepressants for these people was absolute hell often and so I think that's why some people could stay on them because coming off is too difficult yeah but then a lot of people so we can talk about obviously the effects of the psilocybin but it seems to for most people last for about two or three months and then the depression started to come back and I think that's because for lots of reasons but partly because we didn't this isn't psychedelic therapy so we're not giving people integration really. We're not giving people the full package. What is integration? So a psychedelic

intervention has to have three sections. Preparation, the session itself and integration. Preparation is, as we've talked about, getting used to how it's going to be, getting to know each other, the trust, building the trust. The session itself is about surrender, being there together, and then the integration is about the participant themselves, weaving a narrative about what on earth they have just seen and gone through they may have had mystical spiritual experiences they may have had experiences of dying of amazing insights into their life

it's a weird and wonderful world and they need to piece it together in a way that makes sense to them so that when they, in the months and years that follow they know what that experience means and it helps them live their life because there's no use in having this incredible opening if you then go back to your same old life so what psychedelics do is they give you

this window of opportunity. So, um, okay, so like, if you imagine like, so this is one of my colleagues, analogy,

I'm stealing it from him. If you imagine like a snowy mountain and then, and you go sledging and you go sledging down the same track and you always go. So when there's a track in the snow, it gets deeper and deeper and deeper. Mm-hmm. When any time you go down that mountain, you're going into the same track because it's just the groove is getting deeper and

deeper. If you imagine that as your mind, in depression, you go through the same thought. ruminating about the same things, worthlessness, whatever it is, whatever your ruminations are, just sticking in that rigid pattern. People describe it as like a mental prison, they're stuck in the same old patterns. And then with psilocybin or psychedelics, it's like you've got this mountain with this, like, deep, deep ridges that you always get at.

And then with psilocybin, it's like a snowplow that just comes across and wipes everything through. So in this state of brain-connectedness or the entropic brain or the integrated brain, however you want to talk about it, It's this, it kind of wipes it clean. Not that it doesn't like wipe your brain clean in the sense that it takes everything out of it, but it just provides this opportunity of flexibility. And then you can kind of sledge anywhere you want to go. So after a psychedelic experience, people have this window of feeling really, often really fantastic for a number of weeks or even months. And this flexibility, I can, I can try this, try new things.

And so if in that window of opportunity, they start new habits, they change their relationships, they make those life changes, then we think that it can really last long, the effect can last longer. But if you just give someone a psychedelic and you don't encourage them to make the most of the window of opportunity, then what we found with our participants is that the depression came back after three months or so. I mean, it makes sense, right? Your life is already structured in such a way. It's not like your memory is wiped clean. So you kind of fall into your habits as you would. Absolutely. Interesting. Okay, so let's go into the actual effects, right? So what are, I mean, let's be specific, right?

So without sharing anyone's name? Yeah. Yeah. What's happened? What's happened? So of our 20, well, the first thing to say is that they all said that they would prefer it to any other treatment they tried. Three of them didn't have a real effect from it. But they still, even though it hadn't really worked for them, they still felt that the whole something about the process was very different to normal, you know, it's different.

from getting a pack of pills. It's you're sitting there. You're talking to people. You're getting to know them. They're listening to your life story. It's very human. And all of these people had had therapy before. Yeah. Okay. So it was even different from that. It's different to talking therapy. Yeah. This difference in the relationship. It's not the therapist sitting there and kind of trying to help, but not really having time to help. It's like there's something different about the way you, you go into it together. It's a, there's a bond. There's a bond. You develop a bond. Even if it wasn't effective for them, there's something powerful about that therapeutic bond. Because it's quite different to how we do things in this, in our culture.

It's, yeah, there's a different philosophy. Yeah. I mean, I've heard it frequently mentioned in the context of couples. Like having these, like, experiences where they, you know, they take mushrooms or whatever it might be. And for whatever reason, they can, like, work through something. Or, like, people who work together, take it together or all these things. And it's not the same thing as, like, let's have a coffee and talk. Yes, exactly.

There's something. And there's something about the bravery of you're going through this unknown thing together. There's something inherently bonding about that. So, yeah, so for three people, it didn't work. They didn't have a psychedelic experience in that they didn't really see anything, even though they're on the high, the same dose as everyone else. And we've got some ideas about why that might be, but we need more research to really work it out. So three of them, it didn't work.

Then for six of them, at the sixth month follow-up, they were still depression-free. So for six of them, it really, really, it was, you know, life-changing, incredible. Yeah. Yeah, that's why. And then we've stayed in touch with people now so that we know that actually of those six people, for most of them, the depression did start to come back at some point around the year point, but that some of them have had their own follow-up treatments. Okay. So they have managed to keep themselves well through finding, because if you've tried something that works and you want to try and find a way of accessing it again. So they found places in the world where you can legally have it again.

Okay, so but they need someone with them for the second, third. Well, let me tell you about the other 11. And then when I've done that, I'll go to those. So six of them, it was still well after six months. Three of them, it didn't work. And then for 11 of them, and this is, yes, the majority of them, they were really well for three months, depression-free or very mild symptoms of depression. But then after three months, the depression started to come back again.

And didn't go quite back to how they had been before for most of them, but the depression came back. So what's been really hard for us is to have these people. So 17 out of 20, and these are people that nothing has worked for for years and years and years. 17 out of 20 people come and they have these experiences and it's just a day. You know, it's not even that complicated. They take some capsules and they sit there for a day with you and they feel better for months and months and months. And their partners say they have a sparkle in their eye that they haven't had for decades.

They're starting new hobbies. They're playing with their children more. it's beautiful to see and then the depression starts to come back and then you have to say to them I'm really sorry but we can't give you another session because we're a research study with no funding we all work for free all the time

we all cut corners in every way we can because we don't there's no money here our team is we're based on the funding of one incredibly generous donor and apart from that we don't have funding really so we're so financially constrained that we the budget that we do have We need to use on forward, bringing this research forward.

Right. So we have an obligation to people with depression everywhere to get this treatment available to them. So our next study, we're going to be looking at psilocybin versus antidepressants. We're going to be comparing them. And that's an important thing to do. But we're spending all of our budget that we have on that study, which means that we just cannot give sessions to the previous people. Because if we did, we wouldn't be able to do the next study.

Right. So we have to say to them, we said to them from the beginning, we can't give you follow up doses. We have to keep forward in our research. We can't. So it's incredibly difficult and ethically hard to open people's eyes to something that works. One person said it was like turning on the lights in a dark house and then it's like the lights fade again. But they still say that now they've tried something that work, they have the hope that they can access it again. And some of them have been able to access it again. Man. Yeah. I mean, it totally makes sense it's like anything it's like exercise right if you if i were to go on a run every three months and

that would be all i needed to stay in shape that would be amazing so it's incredibly effective yeah but it also makes sense that you have to keep at it yeah and so are they are they swapping it out for you know like people talk about going on these like iawaska retreats and you know you list the other comparables so the only legal way of of having this experience is there's there's a couple of places where mushrooms are legal are legal and they're retreats, but they're very far away on the other side of the world. And there are places in Europe where you can have ayahuasca ceremonies and then there's South America. So it's very difficult and you require units for people with money. You need cash.

Yeah. So a couple of our participants were able to access those. But the rest of them have not been able to. Okay. So is it common for them to get back onto the antidepressants or what are they trying to do? A lot of them have stayed off the antidepressants. Really? Yeah. But some of them have gone back on just because they say, oh, I just, you know, I need something to help me get through. You know, it's just life is just really tough because, you know, things happen and someone's farm got flooded and there's kind of life happens. And people, when they're suffering from depression, they just, they need something and that's the only thing that's available at the moment. So could you walk me through. Because I haven't been to therapy of any kind of format. I probably should. But like, like, uh, I think you should.

Well, walk me through, like, how the conversation might flow, because I just kind of would like some context. Yeah. So the conversation in the actual session itself. Yeah. Okay. So on a high-dose session, it would be quite, you would expect, it's different every time, so you just really don't know, but it would be quite common, I guess, to have, the participant is lying there and I'm sitting there and sometimes hold. their hand if they're going through something painful, sometimes not just sometimes just, sometimes just sitting there. And for a lot of the time, it's silence. And in their world, they're battling things, crying. And what you see is very little, that they're just lying there. So it's very internalised often. But then sometimes they might say, oh, this, you know, I don't want to go there. I'm not. I can't, they're kind of struggling with something. And so you're just helping them to kind of face whatever is there.

and then sometimes people are having a kind of rebirth experience. You're a bit more like a midwife than a therapist. You know, there's kind of noises and sounds and you're reassuring, but you're not really in an intellectual conversation because getting into the mind is, we want to get out of the mind and into the heart and into the body. So as soon as you start, what is that? What does it look like?

Then you're back in the mind. And the brilliant thing about psychedelics is that they turn off that kind of ego, frontal parts and you can go into the body and into the heart and so you've had to totally retrain yourself like that's completely against everything you studied i imagine and so are you asking different kinds of questions or is it is it just encouragement honestly it's love it's just love it really is it's that sounds really like like ridiculous but it when you boil it down that's what it is so it's presence it's presence and it's love and to me they're kind of the same thing and that when you're there in the same way as when you're well i think actually my own like experience

of having a baby and looking after a small child which has happened alongside it so i was doing guiding in my maternity leave so i had a like three month old baby at home and i was going you know for the first time when i first started doing this work and now she's nearly three and so i think my parenting work or my mothering is actually probably something that helps me the most and understanding what the presence that is needed. It doesn't mean that it can't be men as well. Men and women both, you know, can bring that kind of... I guess it's a kind of like unconditional...

Well, the humanistic psychologist used to talk about unconditional positive regard, which is a kind of a broad approach of just whatever you do, I accept you. And... But it's kind of one step further, because when you're seeing people going through this kind of pain, you do feel a sense of like love in a different way. It's just human, it's not like falling in love with patients, it's like a human compassion and feeling of shared humanity together and a feeling of you're just so, you're just so with them.

And it's like, and they're vulnerable, they're vulnerable. So they're like, they, you know, there's, there's just something special about that kind of therapeutic relationship. It's very different. Yeah. And so as someone who's been on the, other side of therapy like traditional what what is your experience how does it contrast well so I did some research into this and I I interviewed people and I from the study and I asked them to compare it to

the previous therapy they'd had and it was it was in a way it did really surprise me because I'd been doing like CBT you know it's kind of like cognitive behavioral therapy for years and as my that was my practice and and and I thought it it had been kind of helpful-ish. I mean, I always knew that it wasn't really that helpful and people weren't always getting better, but it was kind of helpful. But what people in our study said

was that once I'd had the psilocybin and they'd experienced what it was like to have something that was kind of a different kind of relationship, they looked back on the talking therapy they'd had and just felt that it was quite, and I think they'd had bad experiences.

It's not always like this. I know, I mean, I have colleagues that are brilliant therapist and I know that their clients wouldn't feel this way, but sometimes it can be really directive. So it's like, I've studied all this. I know what the theory is. I know what the model is. This links to this, links to this.

And we have all these diagrams that we learn when you're training to be a clinical psychologist of like eating disorder, OCD, depression, and you have all these arrows. It's like, this happens here, here, here. So you've got like the kind of, you know, you've got the system in your head. Yeah, it's like you are INFJ. This is what you do.

Exactly. And I've got to get you to hear. And there's quite a lot of pressure on you to get. them there. And you do this thing called Socratic questioning, which is this technique where you kind of know what the answer is, but you need to make the person feel that they're getting to the answer. So it's, oh, but I wonder what would happen. It's directive because you're trying to get them somewhere.

You think you know the answer. And you're the therapist. Right. And you're the one that trained and you're the expert, and they're coming to see you. And with psilocybin, it's completely different because the expert is themselves. They are the expert because what's happening, the healing power of this is something in the unconscious mind, their own unconscious mind is writing itself. There's a homeostatic principle at play here, I'm sure of it, so that whatever things, if you think of your body is a system, your body and mind is a system, whatever things need dealing with, whatever problems there are in the system, forget our

manual of A, B, C, D, whatever is actually going on in this holistic system, the psilocybin helps just kind of goes there somehow. So the unconscious mind is incredibly intelligent and knows which parts of the system are a bit weak or a bit faulty in which need changing. So it can fix the glitches in the system somehow. And this is this kind of brain connectivity, all the parts are talking to each other.

So it's like almost this kind of scanning process of like, okay, we've got all the information where do we need to go to? So what that means in terms of the relationship is that there's complete respect for them because they are the ones that going on their own journey, you can't go on it for them. Yeah.

So it's not directive in any way. We have no idea where they're going to go. I have no. So say you were coming for a session, I would have no idea, really, about what would be the right thing. Whenever I tried to have ideas when I first started, they were always wrong because the person's own mind is infinitely more intelligent than I am. Right.

Well, I mean, they just know themselves. They know themselves. Exactly. You're in a constant conversation to yourself. One thing I always wondered about therapy. having known a bunch of people that have gone through it. Is it that matchmaking process? Yeah.

Because I've often met someone who's a therapist and I don't know if like you're the right fit for me. Yeah. Is that, do you find that to be a real thing or is that just like my own resistance to like not wanting to do it? It's a very important point. Absolutely for talking therapy, especially if it's longer term talking therapy when you're going weekly for someone for maybe a year or something or a couple of years. So key that relationship. Yeah. All the work is done within that relationship.

But with psychedelics, the work is really, really done on the inside. So I think the match is important in the sense that if there was a dislike there, you know, we all meet people that sometimes, for whatever reason, they activate something in us that makes us think about someone we don't like. Or if there was a dislike and there wasn't trust, that would be a problem. So the participant and the guide have to trust each other, really, really trust each other. But that, you know, that's usually, it's usually okay. As long as you kind of, obviously not all therapists would be guides.

It takes a particular kind of approach. Not needing to be the expert, not needing to talk about stuff in an intellectual way, being comfortable with emotions, being comfortable with not knowing, being comfortable with being a loving presence and patient. You know, it's not something that is going to suit all therapists, not everyone. And not all people would be kind of, would really trust the process enough to be able to go through it. some people might be quite suspicious of it or just not really feel it was right for them. So it's not right for everybody.

Okay. But for the people through our screening process, the people that we had come through. And the therapist that we had, it was tended to be fine. Yeah. I can think of one person I think who wasn't fully trusting and of his guides before it went through. And actually he had a good outcome. But I think he could have done with a few more sessions beforehand. Yep.

But usually the trust is there. But beyond that trust, I don't think. the matching matters because in the session, okay, say I've got issues with my mother. It might be that when I go and have talking therapy, I might want to go and see a woman, maybe, to work through that relationship. And I might want someone kind of my mom's age and it might, you know, maybe, maybe not. Sure. Those kind of factors don't really matter in psychedelics because you're going to be going through your

month, if you've got an issue with your mother, you're going to maybe be going through that in your session, perhaps, if that's the area that the scanning process decides is most relevant. but you're going to be doing it yourself. You might be face to face with your mother in the session. Yeah. But it's not, the guides aren't there to take part in the psychodrama. They're, the work isn't done with them. They're just, they're just kind of nice people helping you be there.

They're not, they're not so much part of the healing. Okay. Yeah, that's a very different process. With talking therapy, I always, my concern was that I was just going to look for confirmation. Yes. And so I would look for someone that's so close that it would just like, wouldn't necessarily break through. And that's the other thing, great thing about psychedelics as well, actually,

is that I think sometimes, and actually I can own this from being an exhausted psychotherapist in the NHS, seeing lots of people. By the time the eighth person came through the door on a Friday, I was so exhausted. I might not remember their notes, and I might sit there, and what I would fall back on is just being nice, you know, being a nice kind person. Like, I hear you and I'm there for you. But when I talk about the love of a psychedelic session, it's like a tough. love. I mean, it's the, um, there's no nice about it. As a guide, you're like, you're sometimes

pushing them to, to face really difficult things. And the psilocybin experience itself is often extremely confronting. Yeah. So there's no like platitudes or confirmation of like, yeah, you're doing great. You keep going. No. But, but then like, I mean, you, you've seen it, right? There's, there's, there's kind of this, this period where it works and then it stops working. Well, I mean, the long-term effects aren't necessarily. Yeah. How are you thinking about setting someone up for success? Like you have another study coming out.

What are you going to do to get someone on the right track? There is, I mean, if someone gave me like a license to you, still aside illegally and loads of money, then I guarantee you I can set up something that would, well, we all, you know, loads of people working this field. We all have ideas. I mean, we know we've working on the work of the people that were doing this decades and decades ago.

Sure. And there are loads of different models. we think would be really useful to mix together, like various psychological models that actually lend themselves really well for this. And meditation is the key thing, like mixing meditation and this. So in a perfect world, I think it would be seen as something that it's a journey, it's a long journey into the deepest, deepest parts of yourself. And from that place, you're hoping to find a self-acceptance, a self-knowing, a self-love that enable you to radically transform your relationships with yourself, with other people and the world around

you. So that was the theme that came out of my research looking at the outcomes was that people felt more connected to themselves to other people in the world around them. So I would look at things that help people continue that process. So it would start off with the prep phase. It would go into the sessions and then the integration would be something that help people maintain their learning and maintain a sense of community stay connected to other people and a sense of meaning in the world

like we're not just doing it in vacuum there's people have real insights about their values and about the way the world should be and the way the world is and they change their behaviour in line with it so things to help people continue with that and it's not the therapist saying because that's the other thing I would do

is in talking therapy before I would say we need to set some goals what things are important to you let's set these goals and the feedback I got from the participants in our study was that they didn't like when they had that kind of thing before. They didn't like it because it was someone's kind of telling them what kind of goal to have and they would feel that they would fail at them and it would just make them feel worse and who knows what the right goal is.

But with this psychedelic experience, people can, they come out with this strangest, most unpredictable goals because actually what you thought was right for someone wasn't going to be right. But they get this idea that what I really need to do is A, B and C. So it would be supporting people to maintain those insights and new goals. But the key thing as well, it wouldn't be like a kind of one session then you're okay forever. It would be, I think, it would be, the long journey would be one where people might have a psilocybin experience every six months.

They might have a period where they had like four, six months apart and then they're okay for like 10 years and then they might come for a top up. But it would be very individually decided upon. Like you'd work out with someone if they needed another session or not. But it's a life journey, you know, it would be something that they would then, um, for, for deep self-reflection, through different life stages. So maybe someone, you know, in their 30s, they would have three sessions and then feel pretty well in their 30s and 40s and then 60, they retire and things get really difficult. They're having to recalibrate things and they come back for another psychedelic session and they go back

inside and they... Interesting. So I'd see it's an ongoing thing. So that, that, like, confidence to make a change. Is change a more common thing with versus talking therapy rather than, like, is it? Is it, is talking therapy more conducive to like, this is kind of, it's not the exact word, but like coping? Like this is, like you have this certain situation.

You're going to be able to deal with it in such a way versus psilocybin therapy where someone might be like, I can't do this anymore. I'm going to become a painter or something like that. Is that a difference? That's an interesting one. I don't think it's quite, so certain types of talking therapy are more like, so CBT and things like that, short term therapies are more about coping, coping strategies, helping people. kind of keep going in the situation they're in, whereas things like psychoanalysis are more about

deep internal change, like understanding the unconscious mind and how it's infecting your behaviour and making deep changes, but it takes many, many years to get to that. So I'd like psychedelics are a bit more like psychoanalysis and that it's learning to understand yourself much, much better in a very deep way and making changes. And whereas the psychoanalysis, it might be a bit more grahamysis, it might be a bit more gradual that people might get to know each other much better over say 10 years of analysis and many many thousands and thousands of pounds spent on it they might start to understand themselves better and make those changes with psychedelics it can suddenly seem a bit more yeah you know

revolutionary yeah but we do encourage people after a session not to make any big changes for a couple of weeks oh okay just to let it sit and percolate and yeah because people often say i want to change my job or i want to do this right and in our sample of 20 people people did make changes new jobs, did things I'd been frightened up for a long time, change relationships. People did make big life changes. But, yeah, we do encourage caution. Yeah. And so for the people who don't necessarily have access to, you know, traveling to South America

or participating in your session, what do you advise them to do? I mean, you've mentioned meditation before. We talked about it before we even started recording. Like that seems pretty important. Yeah. Yeah, what do you tell them? You can access these states without psychedelic drugs. Psychedelic drugs are just one way of accessing these dates.

Breathwork, holotropic breathwork, was developed by Stan Groff. So after psychedelics were made illegal, Stan Groff had been working in psilocybin and LSD research in the States in the same place as Bill Richards, so I mentioned before, for decades. And then when they became illegal, he developed with his wife, this other technique to enable people to get to the same. state. Yep.

So you can do holotropic breathwork workshops. We're actually we're doing training for our new therapists this week and on Saturday

we're all going to be doing a holotropic breathwork workshop together because it's a legal way of inducing these experiences. Meditation, like deep, deep meditation practice. It might take a long time

to get there, but you can access very, very similar states as well. And also yeah, in a way that it's easier. Psychedelic experience can be really, well, it's hard to find. And then even if you do find it, you access it.

It's even with the people in our study or at a ceremony. It's intense and hard and draining. Whereas meditation, you can start small and build up and you can fit it in your day. And I've had a meditation experience that was fully expansive. And I've only had one ever. May never have another one. But it was enough to make me know that it's serious. You know, in the same way that psychedelics, if they do,

deactivate the default mode network, which is your kind of ego structure, the brain base of the ego. Meditation does that too. It quietens down that's mental control. The monkey mind. It's quieting the monkey mind. That's all, I would say, really, we're doing with psychedelics and with meditation. And then what about maintaining the change? Maintaining the desire to change? With, you mean with meditation or just generally? All of the above. I'm thinking of, yeah, from the perspective, because like the reality is that like most people listen. or watching whatever, like probably won't go through this process. But they, I think almost everyone knows that feeling.

Yes. Of like I, um, there's this book, the, the War of Art. Have you ever read it before? No. It's by an author, Stephen Pressfield. And he talks about resistance. And oftentimes the resistance to like push through to really go for your creative project or whatever it might be.

Um, because so often people who deep down kind of know the thing that they want to be working on but there's a fear or there's a pressure there are a million reasons to not do that thing yeah um so yeah i'm i guess i'm just kind of curious if if you often recommend like a book or a certain thing to someone i think getting connected is the thing i think that's what um when you when you when you when you deactivate the kind of the thing that keeps you trapped yeah and you can get down to your real, when you turn off the kind of the mind or the ego, however you do that, whether it's meditation or walking in nature, or whatever you do, you turn that off and you get down to your, I would call it your soul, but your space of who I really am, that little voice inside you that

knows what it really wants to do, when you know what it is that your life is about or the thing that's going to make you feel meaning and feel happy and feel that you have a purpose, that then don't let go of that for anything. But the way to, the way to make that happen is to is to get connected because it's very easy to you know we're trapped in our head and we're in our culture in the west we're very very disconnected from each other and from ourselves most at the time kind of whatever addictions we've got whether it's Netflix or you know beer or whatever we're just kind of like operating this frenzy kind of hamster wheel existence when you turn that all off and you get down into what you who you really are you need to honor that so the theme as I said before

about what psychedelics do is making more connected to yourself others and worlds around you that is the thing. That's kind of my motto anyway of like connection to myself. What's my connection to myself? How am I nourishing myself? How am I listening to that voice? How am I prioritizing that voice over the other chatter of the world? Connection to others.

It's difficult to achieve anything on your own. But finding your tribe, finding the other people that you were going to do this with, whatever your dream is, find other people that you're going to do it together. And then connecting to the world is really just, yeah, kind of thinking. about what it means and the ethical roots of what you're doing and the valley systems and and helping it spread wider and wider so connectivity I mean the interesting thing about mushrooms in a forest you've got all the different trees and like I think two thirds of the forest is underground you can see one third of it which is like trees but two thirds of it is underground

is like the roots that go down and the way trees communicate with each other is through mycelium and mycelium is mushroom, it's fungus. So the whole of the forest communicates through this layer of mushroom. So I think mushroom is a great, it's a great connector. And you can think about that analogy, really. If you imagine, like, you imagine yourself as a tree. Okay. And you've got your trunk, which is your connection to yourself.

And if you've got your branches, which is your, kind of your ideas going out, and then you've got your roots. And you've got this layer of mycelium, and you're connected to all these other people. And so to make your tree grow really strong, it's about, yeah, your place in the forest. You're not standing alone. That's great. I think that's a great place to stop.

Well, thank you so much for your time. Thank you. All right. Thanks for listening. So as always, you can find the transcript and the video at blog. combinator.com. And if you have a second, it would be awesome to give us a rating and review wherever you find your podcast. See you next time.