Beyond Traditional Treatments for PTSD

     Amy awoke from an afternoon nap on the sofa to a stranger’s face staring down at her. Before she could utter a sound, he gagged her, raped her, and left her for dead.  When Amy found the strength to crawl to her neighbor’s apartment, she had to explain who she was, having been beaten beyond recognition. Over the next several years, Amy would attempt to regain control of her life. However, the fear and anguish she experienced on a daily basis would keep her from finishing college, having the family she always dreamed of, or even being able to live on her own.  Amy is one of millions of Americans who suffer from Post-Traumatic Stress Disorder (PTSD) after experiences such as sexual assault, combat, or responding to violent emergencies.

     Individuals with PTSD cannot process their trauma as something that happened in the past; they experience the event over and over again in the present, often with intense emotional and physical reactions. The symptoms can be debilitating, leading to depression, panic attacks, insomnia, substance abuse, and suicide. These patients typically become increasingly detached and isolated, which makes PTSD challenging to treat. Symptoms often lead to impairment in daily functioning, resulting in occupational instability, social withdrawal, marital problems, family discord, and in the extreme, suicidal tendencies.

     As a therapist, I’ve seen how psychotherapy and medication can transform people’s lives, but I’ve also experienced frustration and empathy for the often slow and incremental progress people with PTSD tend to make. Currently, Paxil and Zoloft are the only medications approved for the treatment of PTSD. Although these medications can be helpful, they must be taken daily, often with little hope of discontinuing. Many PTSD patients also rely on benzodiazepines and hypnotic sleep aids, which have side-effects, contraindications, and can cause physiological dependence. We desperately need a new approach to helping these patients. Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies (MAPS) has been working for over 25 years toward the approval of a medication which, when used just 2-3 times in the context of supportive, open-ended psychotherapy, can result in drastic reduction or elimination of PTSD symptoms.

     I had been following MAPS’ work for several years before I received an email in 2015 inviting me to a Global Psychedelic Dinner hosted in New Orleans. It was there that I met Alli Feduccia, PhD and Ray Worthy, PhD, MD. They were there to present the research thus far on MDMA-assisted psychotherapy for PTSD. My interest was piqued, but as I watched the video of Nick, one of the veterans treated in the Phase I trial, I knew I wanted to be a part of this work. Fortunately, New Orleans was already on MAPS’ radar to become a site for a Phase III study of the same therapy. Over the next year Ray and I developed a friendship based on our common interest in what MAPS was accomplishing. By the following year, we would learn that New Orleans was chosen as a Phase III study site, and we would be fortunate enough to become part of the team.

     Over the next year, I had the privilege of attending the MAPS’ Therapy Training Program, in preparation for the Phase III clinical trial investigating MDMA-assisted psychotherapy for PTSD. In October of 2016, at a retreat center in Stony Point, NY, I met other therapists-in-training from around the globe. Michael Mithoefer, MD and Annie Mithoefer, BSN, the co-therapist couple who pioneered the initiation of MDMA-assisted therapy in FDA-approved studies were there to lead the training. They conducted Phase I & II trials of MDMA-assisted psychotherapy for PTSD in Charleston, South Carolina, and would become not only my mentors, but confidants and friends.

     I will be forever grateful to Michael and Annie Mithoefer for what they taught me both explicitly and implicitly. The framework they used was a non-directive approach, pulling from a variety of modalities such as Internal Family Systems, (D. Schwartz) and Holotropic Breathwork, (S. Grof) and the use of music and body work where appropriate. They are masters at identifying what each participant needs at any given time, whether it be body work, energy release, or even simply holding a hand. The participants clearly felt supported and I sensed that a deep trust was garnered by Michael and Annie. The love and compassion they had for the participants was certainly apparent to all of us.

     The study participants agreed to have their sessions video taped in order to be used in our training. We witnessed patients with debilitating symptoms experience increased subjective feelings of connection with self and others; increased insight; the ability to reframe cognitive structures; a newfound acceptance/love/forgiveness/compassion for themselves (and sometimes for the perpetrator of their trauma); personal empowerment and hopefulness. As I joined my new colleagues, approximately fifty other researchers and psychotherapists chosen to do this work, we had no idea how much we would come to think of each other as much more than just colleagues. Many of the sessions were intensely emotional to witness, and while watching these together with the other therapists I could clearly observe everyone’s intense compassion and connection to the material. There were many times when, after watching a session video, there was nothing we could do but sing an inspired song together to express our communal emotional experience. MAPS had chosen well. We were fully ready to learn from these brave participants, from our teachers, and from each other.

     Over the past year I have watched many hours of these session videos, witnessing many different types of patients, but all who have suffered a horribly tragic event in their life that had left them broken on the inside. To watch the healing that took place with MDMA-assisted psychotherapy has been humbling and profound, but what strengthened my conviction to do this work even more was that the healing was coming deep within the participants themselves. There is a belief, rooted deep in psychedelic therapy, that patients have within them the natural resources to heal and grow. In MDMA-assisted psychotherapy the therapists facilitate healing by supporting the patients as they explore their trauma in a safe and non-threatening way but at the same time allowing the participant to guide the process. In essence, the therapists set up the conditions for the participant to let their inner-healer do the work. I have always believed that everyone has the ability to move toward wholeness if given the opportunity to do so, and MDMA-assisted psychotherapy seems to facilitate this process in ways I have never seen in any other treatment modality.

     New Orleans, in particular, is a city that has experienced trauma on a community-wide level due to hurricane Katrina. Nearly 2,000 people were killed and thousands more were injured or displaced from their homes. With over $108 billion in damages, Katrina is the costliest disaster in US history. One study showed that rates of mental illness doubled after the storm. For these individuals, and for patients like Amy, the potential for MDMA-assisted psychotherapy looks promising. I have such deep gratitude and respect for Rick Doblin and everyone at MAPS for their dedication, fortitude, and wisdom.  My hope is that the Phase 2 and 3 studies will pave the way for a new wave of psychedelic-assisted therapies to treat many difficulties including PTSD, addiction, and depression.

     If you or anyone you know has been diagnosed with PTSD and would like more information on this research, go to www.MAPS.org.