How many things, both just and unjust, are sanctioned by custom! - Terence
Psychedelics: again the pilgrimage - current experience, lessons
" ... the current system for bringing promising biomedical research to the bedside is operating at an obsolete level of efficiency, causing great delay, and consequently resulting in the loss of many lives." Roger Rosenberg (JAMA 2003;289:1305-6)
"Any unexplained phenomenon passes through three stages before the reality of it is accepted. During the first stage it is considered laughable. During the second stage, it is adamantly opposed. Finally, during the third stage, it is accepted as self-evident." Arthur Schopenhauer
In the first post of this sequence of four - "Psychedelics: again the pilgrimage - current experience, preparing" - I asked myself why I was here again in the Netherlands (apart from the fact that it's a lovely country!). I responded that the primary reason is that emerging research clearly suggests that psychedelics can be helpful for a number of difficult-to-treat disorders like treatment-resistant depression, alcoholism & other addictions, severe end of life distress, and possibly other problems such as eating disorders and PTSD. I have written extensively on this ... as a start, see the post "Recent psychedelic research: an introduction" ... and have initiated the formation of a Scottish helping professionals special interest group on psychedelic enhanced psychotherapy (see this article for the main Scottish counselling journal). So this is the primary reason for this pilgrimage ... to become more useful for people who want to learn, ease suffering, grow more healthy & whole by journeying in this psychedelic mountain range themselves. And the second reason ... to wonder & learn myself in this often awe-inspiring (and at times frightening) landscape. And I went on to say that there were a series of questions that I would like better answers to. Here again are the questions and some notes of what I feel I've learned:
* Who do I feel comfortable mentioning when clients (or friends/colleagues) ask who I feel is a good 'tripsitter' to help maintain safety during (legal) psychedelic exploration using psilocybin truffles here in the Netherlands? I have worked (as client) with three different tripsitters now ... both individually and in a pair. This has been really interesting in a whole series of ways. It leads me to feel even more strongly what I wrote towards the end of the post "Recent psychedelic research: further exploration" - that "I think it's worth bearing in mind that the much more extensive research on what makes a psychotherapist/counsellor more or less effective pretty overwhelmingly highlights that interpersonal/general therapist qualities are more important than their expertise in specific therapies - see "Some counsellors & psychotherapists are more effective than others". And I went on to write "I believe we'll find this with psychedelic-assisted psychotherapy too ... that a degree of personal experience with psychedelics for the therapist helps somewhat in them being more effective, but interpersonal factors will be found to be even more important. Having years of experience playing top flight football doesn't automatically mean that one will be a great football trainer or manager ... but one would expect that the great trainer or manager would have had some actual experience playing the game. So probably 'yes' to therapist personal experience, and 'no' this isn't likely to be the most important factor in distinguishing more & less helpful psychedelic-assisted psychotherapists."
And on top of this, we need to be cautious about expecting similarity between the results of carefully performed psychedelic research (as for example done at John Hopkins or Imperial College) and the results of someone flying into the Netherlands, taking a psychedelic and getting some transient support from one or more tripsitters. In the research studies, the tripsitter/therapists have typically had a whole series of sessions with the client before they support them through the actual trip ... and then a whole series of sessions afterwards helping them integrate their experience. We don't know how important this is for good outcomes, but there's a strong suspicion that it is often important. Hence my interest in combining safe tripsitter support for the psychedelic experience itself with probably more extensive orientation and integration with an experienced personal therapist (either face-to-face or via the internet).
* What dose of truffles (and what kind) is it likely to be helpful to take? I've written a lot about this already - see the posts "Recent psychedelic research: lessons from current personal experience - suggestions" and the recent "Psychedelics: again the pilgrimage - current experience, high dose".
* If one's going to use a music playlist during one's psychedelic journey, what are the pluses & minuses of using a home-made one or of using a pre-designed one ... for example those offered by John Hopkins or Imperial College? And what are some of the practical issues about doing this? This is an interesting question that breaks down into a number of sub-questions. One is why use a musical playlist at all? I talk a bit about this in the penultimate paragraph of "Psychedelics: again the pilgrimage - current experience, low/moderate dose". A second is, if one is using a playlist, is one likely to do better with one that has been carefully designed by a research expert or actually would one be more likely to benefit from one where the music has been personally selected? Intriguing question ... and I would tentatively suggest using one of the expert 'off-the-shelf' playlists from John Hopkins or Imperial College to start with. These are just a quick internet search away ... for example look for 'Psilocybin research John Hopkins' in iTunes playlists or on Spotify; and also on Spotify see Imperial College's 'Psychedelic therapy playlist 1' or alternatively visit YouTube.
When I went back to psychedelics earlier this year after a near 50 year interval, I used the John Hopkins playlist a couple of times. I think it's special. It's thoughtfully put together with awareness of the usual timing of onset, peak & plateau when taking oral psilocybin. Deep into the trip, it can be moving knowing that this same journey ... with this playlist ... has been taken by (and produced great benefit for) so many other people, of whom a high proportion were facing deep suffering and maybe too their impending deaths. For the third high-dose trip I took, I decided to experiment with my own playlist. Here it is on Apple Music (for some reason a few tracks have been dropped on publishing this list - so Schubert's Nacht und traume should appear after O salutaris hostia; Arvo Part's Spiegel im spiegel after the Violin sonata; Faure's Cantique de Jean Racine after Absalon, and so on - but you can see the overall playlist pattern). This self-designed playlist took a while to put together. The main points it illustrates are a gentle, favourite tune studded take-off, a more emotionally mixed mid-section, and a more vocal-inclusive favourite tunes re-entry. It's also a bit shorter than some psilocybin playlists ... I seem to typically come down fairly quickly even from high-dose trips. Did I prefer it to the John Hopkins list ... yes, especially on take-off and come-down when my personal 'ego' preferences seem more important. I went even deeper on the Mystical Experiences Questionnaire (MEQ30) on the trip using my own playlist, which is likely to be a key measure of playlist success. And when on a more recent medium-dose trip, I tried the Imperial College playlist, I found for me this rated behind both my own selection & the John Hopkins offering (both for personal preference and for how helpfully it took me into areas beyond my everyday ego states). This seems very much about personal musical taste.
And equipment? If one is planning to send the playlist into headphones via Bluetooth for the person on the trip at the same time as broadcasting the music out loud to help the trip-sitter stay in the loop musically ... this takes a little technical fiddling with Audio Midi Setup on a Mac laptop. It may be easier to play to two outputs using Windows ... and probably with future versions of Mac software too. A quick websearch gives the know-how if you need help. On this more recent high-dose trip I used headphones that allowed me to increase/decrease volume, stop the music, and jump forward or backwards with the tracks. This felt helpful, on balance ... but when really dissolved on a high dose, choice can become an interesting issue and I found myself just going with the flow, rather than being bothered with choices, during that phase of the trip.
* How is it good to prepare for a psychedelic trip ... and to respond once one is in it? I think for most people, being prepared is useful. Recent findings from the Psychedelic ceremony study found that Preparedness reduced the chances of Challenging experience during the trip itself (see lower down this earlier post for more on this). Reading beforehand ... for example Michael Pollan's How to change your mind, James Fadiman's The psychedelic explorer's guide, and so on ... looking at the wealth of information on the internet ... for example Tripsafe.org, DrugsandMe, Erowid and this Good Medicine website ... and talking to others with experience of this territory ... all makes good sense. Good too to be reasonably clear about one's intentions for taking the trip. Is it curiosity? To have a good time? For therapeutic reasons? For spiritual reasons? All of these intentions can be reasonable ... although 'To have a good time' may be more achievable on lower rather than higher doses. It's often sensible to start with lower doses before possibly moving to higher doses. Remember that two of the best validated mechanisms for longer term benefit are higher scores on either or both of the Mystical Experience Questionnaire and the Emotional Breakthrough Inventory. It seems that the EBI may be a particularly relevant mechanism when one is starting with fairly low well-being levels and is prepared to work with challenging emotions. Therapeutic support is likely to be particularly relevant here. Interestingly, longer term benefits of trips often involve better relationships and it's an intriguing research question whether group retreat formats might reinforce the likelihood of benefits in the depth & warmth of how we relate to others. I'm also interested in recent work showing the benefits not just of focusing on old pains but also of a focus on clearing 'the doors of perception' ... of helping open our eyes & hearts to the huge blessing of being alive. See 'Reinvigorating the approach system: an exciting new psychotherapy development' for more on this.
And as to 'how to respond once one is in the trip' ... so much of this is about letting go. The recent paper "Replication and extension of a model predicting response to psilocybin" highlights this with its abstract including the comments ... "While generally positive, responses to psychedelic drugs can vary according to traits, setting, and mental state (set) before and during ingestion. Most earlier models explain minimal response variation, primarily related to dosage and trust, but a recent study found that states of surrender and preoccupation at the time of ingestion explained substantial variance in mystical and adverse psilocybin experiences. Objectives The current study sought to replicate the previous model, extend the model with additional predictors, and examine the role of mystical experience on positive change. Method A hierarchical regression model was created with crowdsourced retrospective data from 183 individuals who had self-administered psilocybin in the past year. Scales explored mental states before, during, and after psilocybin ingestion, relying on open-ended memory prompts at each juncture to trigger recollections. Controlled drug administration was not employed. Results This study replicated the previous model, finding a state of surrender before ingestion a key predictor of optimal experience and preoccupation a key predictor of adverse experience. Additional predictors added to the explanatory power for optimal and adverse experience. The model supported the importance of mystical experiences to long-term change. Conclusion Mental states of surrender or preoccupation at the time of ingestion explain variance in mystical or adverse psilocybin experiences, and mystical experiences relate to long-term positive change. The capacity to recognize this optimal preparatory mental state may benefit therapeutic use of psilocybin in clinical settings." So 'surrender' and openness seem so important. In a deep sense the psychedelic can be a teacher for us ... in one of the best senses of teaching ... providing us with deep, powerful opportunities for learning. So when preparing for the trip, it seems helpful to have a clear intention (although there may be deep experiences that provide opportunities over & beyond one's intention).
I have found personally that sometimes as one is moving into the trip (for example 30 to 90 minutes after taking psilocybin truffles), there may be a somewhat 'bumpy' phase. For me this can involve yawning, feelings of hot & cold, a sense of pressure, some shakiness, some anxiety. It's helpful to know that ... if you experience something like this (and I think it varies from trip to trip and truffle to truffle!) ... it's probably just a phase. Two metaphors I find helpful here are the space launch and experiencing birth. The space launch metaphor is that often the journey is bumpier in the initial phases as the launch takes us up through the atmosphere. Once out into space, it's typically much more serene, profound, extraordinary (but not so bumpy). The metaphor falls down however, in that return back through the atmosphere as the trip comes to a close, for me is typically gentle, wonderful, open (rather than experiencing a bumpy reentry). Another metaphor is experiencing birth. It's as if the psychedelic (temporarily) frees us from the tight womb of our small ego/small mind. As we slip out into the bigger world ... a more expanded consciousness ... the birth process can temporarily feel tight & a bit challenging. Then we're through & out into the wonder of the opened up universe. Again, returning from the trip the metaphor definitely falls down!
* When does it make sense to take psychedelics in a group setting and when on one's own (typically with tripsitting support)? Well, I've taken half a dozen psilocybin trips this year on my own ... three high dose (30 to 44gm of truffles) with a trip sitter alongside me, and three moderate dose (12.5 to 15gm) on my own. In late October I'll be going on a seventh trip, but this time in a group with the UK Psychedelic Society. So I'll write more about this when I've experienced both formats.
* How is it good to integrate one's experiences?
More to follow ...