A New Understanding: The Science of Psilocybin – Summary and Critical Analysis

by Eric M Fortier

THE DOCUMENTARY FILM, A NEW UNDERSTANDING (2017) features the groundbreaking research of Johns Hopkins University, University of California, Los Angeles, and New York University on the use of psilocybin in palliative care and spirituality. The interviews and primary accounts of participants and researchers in the film provide powerful illustrations of the therapeutic potential of psychedelic-assisted treatments.

This analysis outlines and expands on the psycho-social implications of the film, and draws directly from the publications, interviews, supplemental panel discussion, paid archives, and from a 2016 presentation given by Dr. Jeffrey Guss, the co-principal investigator of the NYU Psilocybin Cancer Research Project (the main focus of this film), on the study’s primary clinical outcomes. A brief overview of some of the science of how psychedelics work in the brain is offered.

Psychedelics and Mystical Experience

Psilocybin (pro-drug of psilocin) is the main active component of psychedelic mushrooms and has been safely used in experimental settings to reliably induce religious-like or mystical experiences, and produce long-term relief from anxiety and depression after a single treatment, along with improvements in attitudes, moods and personality.^[1][2][3][4] Mystical experience refers to a phenomenon involving the often awe-inspiring dissolution of the boundaries of the self, and, in the words of William James (1910), “an immense spreading of the margin of the field [of consciousness], so that knowledge ordinarily transmarginal would become included,” bringing “a mass of subconscious memories, conceptions, emotional feelings, and perceptions of relation, etc., into view all at once,” often resulting in profound joy, ecstasy or rapture. Mystical experience is considered important, if not central, in a variety of religious experiences,^[5][6] and exists as a central element in Huxley’s perennial philosophy^[7] (an early hypothesis that proposed a cross-cultural common core to spirituality). Mystical experiences can be measured retrospectively using the Mystical Experience Questionnaire (MEQ), and some aspects can also be measured by the 5D-ASC (although the latter captures a broader range of experiential dimensions than the MEQ). These scales evaluate how much participants experienced psychometric factors such as sense of unity/oneness (dissolution of the boundaries of the self; the core of mystical experiences), visionary restructuralization (visions, hallucinatory phenomena), timelessness, noetic quality (tacit knowledge), sacredness (sense of significance and reverence), ineffability, and paradoxicality.^[8] The MEQ and 5D-ASC have served to further understand psychosocial and neuropsychological implications of naturally-occurring as well as drug-induced mystical experiences, and are central to this analysis. Some research suggests that it is for its potential to reliably induce mystical experiences that psychedelic-assisted therapy leaves a profound and lasting impression on the participant, often taking place as the single most, or among one of the five most meaningful experiences of their lives.^[2][4] High scores in measures indicative of “full mystical experience” are strongly correlated to positive therapeutic outcomes.

Suffering & Spirituality

Cancer diagnoses are commonly accompanied by depression, anxiety, existential (or psycho-spiritual) distress, and demoralization syndrome, especially in the terminally-ill. An end-of-life diagnosis is often characterized by the loss of sense of meaning, loss of hope, a sense of being a burden to others, loss of dignity, loss of will to live and desire for hastened death.^[9]

Depression, anxiety, and social isolation may contribute to the development and progression of disease, such as to the onset and mortality of cancer.^[10] In response, interventions focused on cultivating meaning and improving spiritual well-being and quality of life have been helpful in protecting against and treating these conditions.^[9][10]

A medicalized definition of spirituality was recently developed for these purposes, referring to “the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred,” according to the Report of the Consensus Conference on spirituality in palliative care.^[11] In line with this premise, the primary psychosocial platform used in NYU’s psilocybin-assisted psychotherapy study was meaning and the rediscovery of meaning.^[9]

Subjects

Subjects are here paired to their studies for context: Matt was a volunteer for the NYU Psilocybin Cancer Research Project which examined the safety and efficacy of psilocybin-assisted psychotherapy on psychosocial distress with advanced and/or recurring cancer. Annie was a volunteer for the UCLA Psilocybin study which examined the safety and efficacy of psilocybin-assisted psychotherapy as a treatment for psychological distress associated with the existential crisis of terminal disease. Sandy was a volunteer in a Johns Hopkins University psilocybin study which investigated the effect of mystical-type experiences occasioned by psilocybin on the attribution of personal meaning and spiritual significance. Due to a mix of overlapping aims and methods in these studies, some generalizations have been made when accurate and useful.

Sessions

All studies in the film began with 1-3 preparatory psychotherapy sessions to allow each patient to tell their stories, build a therapeutic alliance, undergo a meaning-making intervention and life review exercise, and prepare them for the dosing session. Two clinicians trained to devote reverent, focused attention to their actions and intentions then accompanied the patients throughout each 6-8 hour psilocybin experience. Dosing sessions occurred in a welcoming, comfortably furnished room, and patients were invited to lie down, put on eye shades, listen to carefully pre-selected instrumental music, and direct their attention inward and allow themselves to experience negative emotions instead of moving away from them. Follow-up integrative psychotherapy sessions helped patients contextualize and understand the experience, and prepare them for re-adjustment following the end of the therapeutic relationship.

In print

Results from these studies, and others like them, reveal a remarkable and sustained relief from anxiety, depression, and existential distress, as measured by STAI, BDI, and HADS scales, respectively.^[12][13][14] Concomitantly, improvements were observed in mood; psychological and spiritual wellbeing; personality; attitude towards self, life, disease progression, and death; pain perception; life-satisfaction; quality of life; with altruistic/positive social effects; and moderate to extreme positive behavioral changes. No psilocybin-attributed serious adverse events occurred, and there were no medical nor psychiatric side-effects.^[12]

In principle

Positive therapeutic outcomes have been associated with depth of mystical experience,^[13][15] intensity of Visionary Restructuralization,^[16][17] experience of epiphany, lasting memory of the experience, and sense of love: “a loving kindness towards self, a love for people in their lives and people earlier in their life, and then this broader sense of universal or cosmic or God love” (see discussion panel).

Bossis mentions in the supplemental discussion that these therapies can help patients relive guilt, grief and work through anger. In the film, Sandy re-experienced and grieved her father’s death for the first time:

“I was just a sobbing mess during the session. Sobbing. And I experienced it as waterfalls. My body–I was a waterfall. It was just flowing. It was like my heart cracked… My heart cracked open.”

Sandy then re-experienced vivid memories of her husband and saw in him “a core of divinity,” a sense which she has retained ever since.

These experiences contain what some scientists call visionary restructuralization (VR, sometimes VIR or VIS—so as not to be conflated with Vigilance Reduction), wherein episodic memories are experienced at a similar level to external stimuli, in fact interrupting it, perhaps emerging from the medial temporal lobe and flooding the visual cortex.^[18] The result is a lifelike surfacing of varying levels and combinations of psychodynamic and autobiographical content.

In his session, Matt had a vision of whirling dervishes spinning to the Turkish tune that was playing, “and the faster they spun, the closer they felt to God–or the pinnacle of love.” Vividness of visionary restructuralization is strongly correlated to experience of meaning and significance^[19] and to measures of subjective well-being at follow-up. Psilocybin’s propensity to facilitate episodic recall^[20] in this way may help patients explain and understand where their fears are coming from and how to better deal with pain. This is akin to the acceptance and mindfulness strategies applied in acceptance and commitment therapy, in which patients are encouraged to open up and explore their unpleasant emotions and their causes.

Long-term reductions in pain and fear (or anxiety) could be accomplished through a process of primary re-appraisal, leading to more healthy responses to distressing thoughts and experiences. With the eye-shades off, for example, Matt re-appraised frightening masks hung up in the room instead as “designed to scare the fear out of you,” and added that psilocybin could help “take people out of feeling paralyzed and filled with fear.”

After the experience was over, Annie expressed a loss of rumination about death and about medical procedures. Matt echoed this, stating “I feel I can die now with peace in my heart.”

It is possible that reductions in pain perception could be explained by the lasting relief from anxiety and stress, which are also known to contribute to the development and exacerbation of disease.

An alternative explanation could involve a modification of the neuro-matrix, in which the self is viewed as distinct from its surroundings and “the perception of unity of the body with all of the surrounding qualities felt from the body, including pain.”^[21] The core feature of mystical experience is a sense of unity and oneness, characterized by a dissolution of the boundaries of the self. It is possible that this temporary disruption in the neuro-matrix could alter self-perception and therefore the experiences of pain and distress. How exactly this occurs in the brain is still a matter of debate.

Some neuroscientific observations correlated with psilocybin-induced experiences with potential therapeutic implications: reductions in thalamic gating, allowing for internal and external stimuli to flow throughout the brain;^[22][23] disintegration of the normal anti-phase relationship between active and resting brain states (the task-positive and default-mode networks) characterized by greater inter-connectivity and tightly synchronized communication between their respective anatomical regions;^[24] reduced amygdala activity with increases in orbito-frontal and anterior cingulate (ACC) cortices, having known implications for mediating the disagreeableness of pain.^[22] These findings offer an array of possible explanations for why psilocybin affects things like pain, anxiety and depression.

In pain

Pain has been implicated in disrupting interpersonal relationships, in affecting the ability to engage in work and maintain healthy economic circumstances, in contributing to depression and anxiety, and in the propensity for substance abuse.^[21] Psilocybin may reduce pain through its potent anti-inflammatory properties due to its high activity at the serotonin-2A receptor.^[25] However, immuno-surveillance can help prevent disease progression, and the immunomodulatory effects of psilocybin are still poorly understood.^[26]

Social isolation and lack of social support also contributes to disease progression. Even when social support is available, interpersonal distress often accompanies cancer diagnoses. Hopelessness, helplessness and pessimism contribute to poor psycho-social adjustment and well-being.^[21] Recent research finds psilocybin effective for reducing social pain and enhancing empathy.^[27] Recent pilot studies also show promise for psilocybin-assisted treatment for tobacco and alcohol dependence.^[28][29][30]

Transformation

In the film and in the contributor panel, doctors witnessed in their participants a transformation and healing of interpersonal relationships. After Annie’s diagnosis, she became irritable and started quarreling with her husband, whom was her primary caretaker. When she returned home, her husband said that “it was like someone had put on a light bulb inside of Annie’s head. She was literally glowing,” and found that she was no longer as irritable.

Similarly, Guss describes Matt’s transformation as an “experience of being profoundly loved. Bathed in light and love and a security that stayed with him throughout the remainder of his life. And he went from being somebody who could not let himself be taken care of to somebody who could depend on others and let others love him.” This experience appears to be common and may contribute to trusting in health care providers, which could affect adherence to medical procedures.

These examples, including Sandy’s re-acquaintance with her husband, display how psilocybin-assisted psychotherapy can have important implications beyond the individual, into social and interpersonal domains, and could result in improved social support. Interesting, psilocybin has been found to acutely increase levels of oxytocin,^[31] which could improve the ability to manage stress,^[32] and contribute to increased trust in the health-care providers, possibly improving adherence to their recommendations.

A recent study found a moderate lasting increase in personality trait Openness, and that 90% of patients reported increased psychological and physical self-care, after a single psilocybin session, and that these changes were recognized by family members.^[33]

A New Hope

The profound effects of psychedelic-assisted therapy on depression and anxiety, for the individual and those around them, along with its short-term duration compared to traditional psychotherapy, provides research opportunities that could lead to reduced cost of palliative and health care along with priceless human experiences for the dying. The researchers hope to eventually make psilocybin-assisted psychotherapy available to those with diagnoses of major depression and other anxiety disorders.

Eric M. Fortier, 2018 – Psychoactive Press

Appendix

References