January 18, 2025 • 35 mins
Psychedelic therapy emerges as a transformative approach to mental health treatment, blending elements of traditional psychotherapy with the profound insights gained through psychedelics. Andrew Penn discusses the significance of set and setting, the therapeutic potential of these substances, and the intrinsic value of presence in the healing process.
• Introduction of Andrew Penn and his extensive background
• Historical context of psychedelics and therapeutic interest
• Importance of set and setting in psychedelic experiences
• Overview of the therapeutic structure: preparation, dosing, and integration
• Role of presence in nursing and its impact on therapy
• Addressing cultural misconceptions and challenges of psychedelic therapy
• Ongoing research and clinical trials in psychedelic psychotherapy
• Future prospects for nursing within psychedelic therapy
Andrew Penn's Website: andrewpennnp.com (Links to all his publications and connected activities
OPEN Nurses (community for nurses using psychedelics): www.openurses.org
Let’s Connect
Dr Dan Wesemann
Email: daniel-wesemann@uiowa.edu
Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner
LinkedIn: www.linkedin.com/in/daniel-wesemann
Dr Kate Melino
Email: Katerina.Melino@ucsf.edu
Dr Sean Convoy
Email: sc585@duke.edu
Dr Kendra Delany
Email: Kendra@empowered-heart.com
Dr Melissa Chapman
Email: mchapman@pdastats.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Yeah, just my take on things.
Speaker 2 (00:08):
My answer number two Welcome everyone to another
edition of Pep Lau's Ghost.
Thank you so much for joiningus.
We're really excited about ourguest today, andrew Penn from
the University of California,san Francisco.
Really excited to kind of learna little bit about his practice
(00:29):
and his exciting work usingpsychedelics integrated with
psychotherapy.
So really excited.
Kate Molino from UCSF, kendraDelaney from Vanderbilt and
Melissa Chapman from Minnesotathe non-nurse who keeps us in
(00:50):
line.
So thank you so much everybodyfor joining us here.
I'm going to do kind of a quickintroduction.
Andrew kind of mentioned.
We want to keep this short, butthat is not easy to do.
He is a very well-accomplishedindividual that definitely needs
to be celebrated.
So basically, andrew has beenin mental health care for over
30 years.
He is a faculty trained at theUniversity of California, san
(01:15):
Francisco.
Also teaches psychopharm there,involved with phase two of a
psilocybin-facilitated therapyfor major depression which was
published in the Journal of theAmerican Medical Association.
So that's a big deal, nice,very good.
He's also adjunct and teachesat San Francisco Veterans
(01:35):
Administration.
Co-founder of the Open Nurses, aprofessional organization for
nurses interested in psychedelicresearch.
Has also co-chaired and is onthe steering committee for the
NP Institute, also involved witha variety of other things, has
spoken kind of everywhere.
I'm looking at your bio Southby Southwest.
(01:55):
You spoke that you've had a TEDTalk and we're just sharing.
You had an interview with BBC.
So again, thank you for comingto our humble little podcast
here and I really look forwardto kind of getting to know more
from you with these questions.
So, excuse me, when?
Thank you, andrew.
So first question I have foryou when did you first get
(02:15):
interested in psychedelicpsychotherapy?
Speaker 3 (02:18):
You know, I think my interest in psychedelics
actually goes back to highschool.
I read Aldous Huxley's theDoors of Perception when I was,
I don't know, 15 or 16.
I think I heard somewhere thatthe rock band the Doors had
gotten their name from that book, and you know, this is in the
80s.
So psychedelics were definitelyin this sort of deep freeze
(02:39):
following this sort of things.
That happened, you know, bothgood and bad in the 1960s, and
so it seemed like another worldfar away.
But it was an intriguing book.
I mean, for those who aren'tfamiliar, this was Aldous
Huxley's first experience withmescaline, which was actually
given to him by a sort ofadopted Canadian Kate I'm
looking at you here HumphreyOsmond, who was really leading a
(03:04):
lot of the research in the1960s in Canada using LSD with
patients that we would now callhaving alcohol use disorder, and
so you know, psychedelics havelong been sort of in the culture
, and so I think the idea ofusing them therapeutically,
which was an idea I think Istarted reading about maybe in
(03:27):
the mid-early 2000s reallyintrigued me, and also it sort
of parallels my own experiencewith conventional psychiatric
treatment, which was that when Iwas trained I graduated UCSF in
2005.
Psychiatric treatment, which wasthat when I was trained I
graduated UCSF in 2005, you knowwe were going to save the world
with psychopharmacology.
(03:48):
Just a little pinch of that, apinch of that was going to make
everything all better and Ibelieved that for a while and I
practiced that way and after awhile I began to feel a little
bit disillusioned with this ideathat there was going to be a
pill for every ill and thatthese medications you know well.
(04:09):
You know I don't want todisparage medications.
I think that there's a lot ofuseful things we can do with
them.
But the notion of what if wecould actually move psychiatry
from a ostensibly a palliativepractice again, no shade on
palliative care, it's animportant practice but what if
we could actually start gettingpeople better to the point where
they didn't need treatment?
(04:31):
Maybe I mean cure is a reallyhubristic word but what if we
could get people well enoughthat psychiatric treatment
became more episodic rather thanchronic?
So that was another idea thatreally started to intrigue me
and I've also long had aninterest.
Also, back around that sameearly, impressionable time, I
(04:54):
read Viktor Frankl and learnedabout the idea of making meaning
from suffering and one of thethings that maybe we can talk
more about in our conversationis some of the experiences that
people have under psychedelictherapy and the process of
possibly finding meaning inthings that have often been
challenging for them in theirlives, and that is something
(05:23):
that can come start doing someof this research work working
with a lab here at UCSF on anumber of different studies that
have involved psilocybinprimarily, but I also worked on
the MDMA PTSD study about sixyears ago now, so it's been an
interesting journey.
Speaker 2 (05:42):
Thanks, Andrew.
Yeah, I think we were justtalking about this in another
conversation.
Just how things we do is kindof long time ago, kind of keep
bubbling up to the surface.
If it's, you know, somethingthat's meaningful and impactful,
I, I think we just never let itgo.
We just kind of we hold on toit and it just keeps twirling in
the back of our brain somehow.
So, yeah, thank you, Thank youfor sharing that story.
Speaker 4 (06:03):
And I just want to add you know, andrew, I
appreciate how you are both aproponent of psychedelic therapy
in the present and future andalso kind of a historian who's a
registered nurse inSaskatchewan, which was a
follow-up to an interview thatwas done with her in the 60s
(06:26):
that was published in theAmerican Journal of Nursing, if
I recall correctly so 1964, shewrote an article called
Supporting the Patient on LSDDay, which I was amazed to find
and yeah, we went andinterviewed her last winter.
Speaker 3 (06:40):
She's now 101 years old.
She's now 101 years old, sprite, spritely and currently working
on trying to transcribe andedit that interview down to it
was five hours, five hours ofrecording.
She had a lot of energy for 101year old and get that out into
(07:03):
the world in a way that peoplecan appreciate her because she
was really a visionary and apioneer.
Speaker 5 (07:09):
Well, you know I'd love to pop in and you know,
psychedelic therapy, or assistedtherapy, is something that I
feel like is such a hot topicright now, and you know I've had
, you know, patients come to meand say, well, I'd like to do
this, but like what does thatactually look like?
Could you?
Could you give our listeners,you know, a sense of what do
people actually mean when theymean psychedelic therapy?
And are you know, are there anymodalities that you integrate
(07:32):
with psychedelic therapy thatreally stand out to you?
Speaker 3 (07:36):
Yeah, that's a great question.
So this is definitely.
It's been in the media a lotand I think patients are
starting to come to us and askus questions about it.
So it's important for, even ifnurses aren't delivering this
treatment to their patients, toat least know about it so they
can point them in the rightdirection.
It's also important tounderstand that really the only
compound that is legal andreadily available that is
(07:59):
psychedelic-like would beketamine, or it's an antimers
ketamine.
In some municipalities in somestates like Colorado, there are
programs where things likepsilocybin can be used
clinically.
It's sort of an interestingthird way, because obviously
it's still illegal in the USunder the Controlled Substance
(08:21):
Act federally, but kind of likecannabis, which is also a
Schedule I drug.
There are beginning to be thesesort of workarounds and so when
patients come to us askingabout psychedelic therapy, they
may not be aware that thesethings are not readily available
outside of research settings.
I think it's important for allnurses to know about
(08:43):
clinicaltrialsgov, an amazinglyeasy-to-use government website
which those two words don'tusually always go together, but
it's about as easy to use asGoogle and from that you can
type in, say, depression andpsilocybin, and it will direct
you to studies that arerecruiting or may soon be
recruiting, and you can limit bygeography and such.
(09:05):
So that's a useful reference toknow.
And then the most readilyavailable sort of psychedelic
like treatment, and by that Imean you know.
I should probably clarify whatwe're talking about, because I
think sometimes people imaginethat you know what are we
talking about?
Taking LSD every day Like thatsounds not tenable and it
wouldn't be.
So the idea of using apsychedelic in a therapeutic
(09:26):
context is different than, say,taking fluoxetine or something
like that, where you're taking apill every day.
The idea is that it's really apsychotherapy model that is
enhanced with the limited use ofa psychedelic in a supervised
setting.
And so what I mean by that isthat in our studies what we do
is we have preparatory non-drugpsychotherapy.
(09:48):
So I will meet with a subjectwho's going to be in one of our
trials multiple times to talk tothem, to get to know them, get
to know what they want to workon, what concerns they have, for
them to get to know me.
So very much that nursing modelwhere there's a sort of a
bi-directional working togetherthat's happening, and then on
the day of dosing so we might dothat two or three times,
(10:10):
depending on the study protocol.
So it could be up to six hoursor so of preparatory non-drug
psychotherapy.
Then, the day they come in forthe dosing, I'm going to meet
with them again.
I'm going to have a dosingassistant with me, so there'll
be two people there the wholetime and we're going to have a
dosing assistant with me.
So there'll be two people therethe whole time and we're going
to get them settled in.
We're going to make sure theirblood pressure is okay, we're
going to make sure they'recomfortable, we're going to
revisit whatever intentions theyset in the preparatory therapy
(10:33):
and then they're going to ingestusually psilocybin it's this
you know.
Or if it's a randomized controltrial, it could be a placebo,
and we're going to settle inthere for the whole day.
It's kind of a living room-likeenvironment.
It's quiet, it's comfortable,we have soft music going in the
background.
We have eye shades available ifpeople want to kind of direct
their attention inward.
Sometimes there's talking goingon.
(10:55):
A lot of times there isn't, andwe can get more into that if we
want to.
The drug reliably has a prettypredictable pharmacokinetic
course.
So you know, typically withpsilocybin people are feeling
something within about 30 to 45minutes.
The peak effects are about twoto three hours and then there's
sort of a several hour tailwhere it wears off and usually
(11:17):
by hour five or six they're backto their sort of normal state
of mind.
Their ride picks them up thenext day.
We get on a Zoom call usuallyand we begin to integrate that
experience.
So we talk about what happenedfor you during that dosing day,
what feelings came up, whatmemories came up, what emotions,
what thoughts came up, and wetry and look for opportunities
(11:39):
to make sense out of that andalso to integrate any kind of
learnings or experiences intotheir day-to-day life.
So somebody may have had, forexample, somebody with
depression might have had therealization like, oh my gosh, I
really contribute to my ownaloneness.
You know I feel really lonelyand I also contribute to it
(11:59):
because I withdraw from peoplewho are reaching out to me, you
know.
And so you know like we mightdo with regular therapy.
We might say, well, you know,how could you do?
How could that be different?
You know, we might set a verysmall goal of like okay, so what
if you reach out to two peoplebetween now and next time we
talk to really start to takethat very kind of abstract idea
(12:21):
of like, well, you know, I hadthis realization that I was like
this one person on this littletiny island, all by myself, but
there's a bridge that I neverwent across, you know well.
Okay, so what would goingacross that bridge look like?
You know?
Well, maybe it would involve,like reaching out to people that
have been trying to reach outto me that I'm not responding to
their texts.
Okay, you know, is thatsomething you'd be willing to do
(12:42):
?
Do between now and next week?
Yeah, so you can take this veryabstract idea and try and bring
it into something that is maybeactionable and less abstract.
Speaker 4 (12:56):
Yeah, andrew, thanks so much for going through that.
I think it's so valuablebecause, I agree, I think there
is a lot of I don't know if it'sconfusion, but just maybe
mystery around.
What does you know this type ofpsychotherapy entail?
I'm curious if you would sharemaybe a success story from a
session, or you know anysessions you had that kind of
(13:17):
taught you something or you know, any sessions you had that kind
of taught you something.
Speaker 3 (13:26):
Yeah, you know, I think, about my very first one
that I did, which was this was a.
It was in the MDMA PTSD trialthat we were doing and this is a
.
You know, without getting intotoo much identifying detail, you
know somebody who hadexperienced trauma many years
before and was, you know, inmany ways a very affable,
likable person.
Tended to be very chatty, youknow, which I can relate to, but
(13:51):
also would also sometimes usetalking as a way of kind of
distracting himself from hisemotional experience.
You experience it was awell-adapted kind of trait and
so this particular protocol.
We actually had three dosings,so we kind of went through that
wash, rinse, repeat cycle threetimes on this study and there
(14:14):
was therapy in between each ofthe dosings, several
opportunities for therapywithout drug, and what we
noticed, me and my co-therapistwas that the subject tended to
talk a lot in the first session,and that sometimes happens with
MDMA.
Mdma is qualitatively differentthan psilocybin in that MDMA
(14:36):
tends to be a little more social, whereas psilocybin tends to be
a little more introspective.
Just in very broad terms, youcan certainly have introspection
on MDMA, but nevertheless hespent a lot of the first session
really talking a lot and itfelt like he was kind of almost
(14:56):
felt like he needed to entertainus and I always make that clear
with subjects that we're goingto be sitting here with you but
you don felt like he needed toentertain us.
And I always make that clearwith subjects that we're going
to be sitting here with you butyou don't need to take care of
us.
We're here to be present forthem and that's one of those
great nursing qualities that Ithink that nurses bring to this
work is a quality of presence,and a few years ago I wrote a
paper with Gene Watson aboutthis, which I can maybe talk a
(15:17):
little more about, but hownurses kind of cultivate care
through presence.
And I suggested to him in thepreparation session I said you
know, one thing that you couldtry if you wanted is that you
know that feeling like on aSunday morning when you don't
have to be anywhere and youdon't set your alarm clock and
you wake up and you're kind oflike still in a dream a little
bit, you know you don't have toget up and get anywhere, so you
(15:38):
can just kind of linger for afew minutes and kind of think
about the dream and you know, bein that half sleepy state.
I said you know what, if youspent some of your time on this
next dosing session, like justtrying that on, he says, oh yeah
, that sounds great, I'll, I'lltry that.
And so, interestingly, he camein the next time and he took the
capsules and he says I thinkI'm going to go inside for a
(16:01):
little bit.
And he says, you know, that'sterminology we use to kind of be
more introspective, maybe putthe eye shades on, put the
headphones on and really justallow yourself to be present
with that experience.
And he went in and he went infor like four hours.
And it's funny because ourprotocol was to check on if they
were quiet, to check on themevery hour and we had to do
(16:22):
vitals and that.
So you know, it was a littleopportunity to sort of gently
touch him on the arm and say youknow how you doing in there.
He says I'm doing good, I wantto stay in this space.
It was like okay, you know.
And so he really went for it andhe really, when he came out of
that, just shared with us thesesort of daydreams that he was
having and memories that he washaving about the trauma to some
(16:44):
extent, but also things thatreally gave him a lot of peace
about that experience in hislife, and so it was a great
teaching for me, I think, isthat you know, we're all so
trained as interventionists, youknow just all forms of
healthcare.
You know, I see this in ourstudents.
They're always listening tothink like what do I do?
(17:04):
What do I do next?
Like, oh, they said somethingabout panic, maybe I should
think about an SSRI.
You know, like we're just kindof doing this.
It's like patient care becomesthis matching test where it's
like this symptom occurs andtherefore we should do this.
And we're always thinking aboutintervention.
And you know, what I love aboutdoing this work is that it
brings it actually brought meback to nursing, which is one of
(17:28):
the core things about nursing,which was about presence.
It was like don't just dosomething, sit there and don't
discount the value of yourpresence and your witnessing in
this work and how therapeuticthat is.
And I think so often,especially when we're early
learners, we think we'resupposed to be doing something,
(17:48):
we're supposed to make someclever interpretation, or we're
supposed to identify somethingor come up with a prescription
and it's like the great thingabout this is that there's a
sort of path that's happeningand we just have to walk it with
our patients, and I think thatis really one thing that I've
appreciated about this work isit's really brought me back to
(18:09):
something that I've always likedabout nursing, which is that we
value the quality of presenceit's so wonderful to hear these
examples.
Speaker 6 (18:18):
So thank you for that Kind of on the flip side.
I'd love to hear these examples.
So thank you for that kind ofon the flip side.
Speaker 3 (18:23):
I'd love to hear, either theoretically or like
concrete examples of anyconcerns that you might have or
considerations with about usingpsychedelic psychotherapy yeah,
well, there are many um, so oneof which is that psychedelics
are a little unusual in thatthey are not like some new
compound that's coming out froma pharmaceutical company that
nobody's ever heard of.
(18:44):
Lots of people in the generalpublic have had their own
experiences with psychedelics,or they know people who have, or
they've heard stories about it.
So there's kind of thiscultural baggage around it in a
way that other novel compoundsdon't necessarily have to deal
with.
So that can go both good andbad.
So we talk about fears thatpeople have about these
(19:07):
experiences and a lot of peoplebring up kind of the fear of the
proverbial bad trip, adifficult psychedelic experience
.
So that comes up.
But there's also this flip sideto that, which is this idea
that they're miracle cures.
But there's also this flip sideto that, which is this idea
(19:35):
that they're miracle cures.
And there were these verybreathy headlines in media
outlets in the early years ofthis and even just a few years
ago one trip and cured for lifeand this kind of slow process
moving through the FDA on theone hand, but on the other hand
we have well, not only the waysthat people always access these
things, but we have increasinglydecriminalized use in certain
municipalities and states.
So patients are finding thesethings on their own, they're
(19:57):
trying them out, and I think oneof the things that's really
important to understand aboutpsychedelics is that the context
is just as important as thedrug, so what is often referred
to as set and setting, so themindset and then the physical
setting.
So one of the things that'sreally interesting about
psychedelics is their effectsare somewhat pluripotent.
So, you know, this same drugtaken in my lab with the
(20:20):
intention to help treatsomebody's depression might lead
to somebody experiencing griefabout the way depression has
impacted their life.
Or, you know, experience offeeling connected to something
larger than themselves, whereasthat same exact molecule taken
at Coachella, you know, couldmake that music sound amazing.
(20:42):
Or they could find themselvesfeeling, you know, having
experience of fantastic musicand then midway through they
start thinking about when theirmother died, when they're eight
years old.
And, you know, they have thisbig emotional experience in a
setting that doesn't really havea container for it.
You know, I used to do harmreduction work at Burning man
(21:03):
and we would get folks all thetime who thought they were going
to go out and go dancing andlisten to music and then found
themselves thinking about whentheir mom died when they were
eight, and you know and that'snot to say that that was a bad
experience for them, but it wasan unexpected experience and
thank goodness we had that kindof safe container where people
could come to and be attended toby trained volunteers who could
(21:25):
help that what could have beena really challenging experience
become, you know, at least aneutral or maybe even a positive
experience.
But this sort of hype in thespace and I've written about
this you know about how thatreally it creates these
unrealistic expectations.
And we know our patients aredesperate because our treatments
(21:46):
don't work as well as we wantthem to.
So I understand why people seekthese things out on their own,
but that can be a somewhatperilous process if you don't
know what you're doing and youdon't have good guidance.
Speaker 2 (21:58):
Gosh.
Thank you, andrew.
You know it's.
This is so enlightening.
I mean it's definitely not anarea of expertise that I have
but you know, sharing from myown practice, I'm currently
doing esketamine in my treatmentand I you know this is speaking
a lot to kind of.
You know the experience thatI've had with patients.
It's yeah, it's not a cure andI think sometimes the
therapeutic value is more thanthe substance that they take.
(22:20):
I mean, I kind of with mySpravato treatments I sometimes
wonder if it's more.
It's kind of it reminds me ofcheers, that old, you know
sitcom, where people would comeback to the clinic and the front
desk would be like, oh Joan, ohhey, how you doing, and the
people are like, oh, you know,I'm feeling accepted.
There's somebody here thatreally you know I'm bonding with
I have to come.
(22:41):
You know there's somebody herethat really you know I'm bonding
with I have to come, you know.
But it's just something that Ireally think is so meaningful
and I love how you highlightthis idea that you know there's
work in this and just what yousaid.
You know I'm thinking, you know, just because you do hear that
you know the bad trip and I'vehad a couple of patients who
come to me and just kind of likeyou know, I'm going to just
take a little bit of a mushroomat.
(23:01):
You know, night and night, Ithink that's you know, cause
that's been researched right now.
You know you have to do thewhole education though that's
not, that's just a piece of thissort of thing.
Speaker 3 (23:08):
So I appreciate, and maybe you have do want to say
about, you know what you'venoticed in your clinic, I think
is really interesting because itspeaks to the community aspect
of this Right and and one of thethings that you know I think
(23:32):
COVID really highlighted is howpsychologically deleterious it
is to be alone in the world andhow many of our illnesses that
we treat in psychiatry involvebeing alone, you know.
I mean, you know the formerInstitute of National Institutes
of Mental Health, tom Insell,wrote this book about how
(23:52):
isolation is really, you know,killing us, and so one of the
things that's interesting aboutpsychedelics is the potential
for group treatment, you know,and group therapy, when I went
through school, always felt likesort of like the low-cost
alternative, you know, and Iworked for a big insurer that
liked to push group therapy.
But really I think grouptherapy could have an amazing
(24:13):
revival through psychedelicexperiences, because one of the
things that is very common inpsychedelic experiences and I
will answer your question aboutbad trips, I'm not avoiding it
is that they often engenderexperience of feeling connected
to something larger thanyourself, and you know that can
be the experience of awe, whichis, you know, sometimes referred
to as the small self, which islike hey, I'm, you know, like
(24:36):
imagine when you've seen anamazing sunset or something, you
realize there's beauty in theworld and my little neurotic
churn that happens in my headand your head and everyone's
head maybe isn't that important.
You know that there's somethingmuch bigger than all of us and
to feel connected to that issalutary.
Now, the bad trip notion is,you know, so we often call them
(24:58):
difficult experiences orchallenging experiences.
Call them difficult experiencesor challenging experiences, and
one of the things that I doadvise subjects when they're
coming into the study,especially with psilocybin, is
that this tends to kind ofamplify emotions, and so
whatever you're coming into thiswith often will get kind of
louder in the experience.
It's also a little bitunpredictable which way it's
(25:18):
going to go.
So you know, you think you'regoing to go listen to Diplo or
something you know, and what youfind is you're crying about,
you know, when your mom diedwhen you were eight and you
weren't expecting that right,and the emotions that you're
experiencing are amplified in away that they aren't normally,
that you're not normally able tokind of maybe consciously tamp
down.
And so a lot of times whenpeople are having a difficult
(25:40):
emotional experience, it can beautobiographical.
You know there's some kind ofgrief, some kind of trauma, and
a lot of times in a therapeuticcontext.
We're specifically going intothat right.
So you know, in the MDMA PTSDwork we had an agreement with
our subjects because, as we allknow, ptsd is often marked by
avoidance.
(26:00):
As we all know, ptsd is oftenmarked by avoidance, and so we
had an agreement with oursubjects that if we haven't
talked about the trauma duringthe course of the session, the
therapist will bring it up.
Honestly, because of the prepwork that we did, we really
rarely ever had to evoke thatbecause the subjects came in
wanting to talk about that.
(26:22):
But sometimes under apsychedelic experience, the
ability to kind of hold backdifficult memories or difficult
thoughts is eroded and those canbe overwhelming if people are
not prepared for it.
Yeah, there can also be somekind of panic-type symptoms that
people will have.
You know, just feeling weird.
(26:42):
You know, many of our patientswith anxiety disorders and panic
disorders are often verysensitive to kind of that
internal experience of feelingoff, feeling weird, not being
able to turn a thought off.
You know that can beanxiety-generating.
So this is why it's really,really important to have that
preparatory work in place whereyou've got a known person there
(27:04):
in the room with you who you'vealready talked about these
concerns, and that person isknown to you.
You've already talked aboutways of calming yourself maybe
deep breathing or grounding andalso it's really important to
know that these experiences inpsychedelic experiences, are
transient.
You know that while it may bereally intense right now, five
(27:28):
minutes from now your mind mightshift to something else, and
that's often what happens isthat you know, I've seen people
be crying and then 30 secondslater they're laughing.
You know, or they're laughingand then they're crying.
It's just, you go through thesewaves of emotional experience
and then they're crying.
It's just you go through thesewaves of emotional experience
(27:50):
and a lot of times what seems tohappen from that is the
experience of actively notavoiding the emotion is salutary
.
So we know that one of thethings that really predicts for
things like depression isemotional avoidance.
When people deploy a lot ofstrategies and use a lot of
energy to not feel theirfeelings, it comes at a price,
right, and that price may bedepression or PTSD symptoms, and
(28:13):
so what this is an opportunityis to maybe go into them and
realize like, oh, that was hard,but it wasn't so terrible.
I was able to do that in muchthe same way that a vaccine
challenges your immune system.
Remember when we all got ourCOVID shots and everyone was
like, oh, how'd you feelafterwards?
Oh, I was tired.
For a couple of days, I feltkind of feverish.
(28:33):
Well, that was your immunesystem charging up right and it
made you stronger as a result.
And so maybe there's apsychological corollary to that
as well, that we get to makemore possible or more tolerable
with the combination of therapyplus drug.
Speaker 5 (28:51):
I have a follow-up to that.
So you know, as you were talking, I was just thinking.
You know, with other traumamodalities, you know, sometimes
we can see, even with likepreparation into work on the
very specific trauma experience,in that specific trauma, like
while doing work on thatspecific trauma, we still find
that patients sometimes areflooded and overwhelmed.
And you know, though we did thebest that we could to prepare
(29:13):
there, it's still, you know thatwe they still had that flooding
experience.
And you know, on the other sideof that, you know, in my
experience I've sometimes seenthat that flooding and that
overwhelm of emotion cancontinue on for, you know, days,
weeks, even months depending onintervention afterwards.
And I was hearing you say that,you know, one of the things
(29:36):
that's really unique aboutpsychedelic work is that
patients are really getting thisexperience of noticing how
transient our emotions can be inreal time.
In your experience have younoticed, you know, in when
unexpected intense emotions comeup in while a patient or an
individual is going under apsychedelic experience, does
(29:56):
that tend to reverberate untillater, like the days and weeks
and months coming, likesometimes we can see it with
other traditional trauma work,or is that something that you
tend to see remain prettytransient as well.
Speaker 3 (30:10):
It's a great question , kendra.
I mean it can you know?
Because and these experiences,you know, particularly in sort
of less regulated, lessintentional settings, you know,
can be destabilizing for people.
So that is something that wehave to keep in mind and it's
one of the reasons why you havethat integration therapy so
(30:30):
closely proximal to theexperience, so that you can kind
of catch that.
You know.
One of the things that'sinteresting about MDMA in
particular is that you know whatyou were describing there, the
sort of tolerability window.
You know what you weredescribing there, the sort of
tolerability window you know,which is somewhere between when
people get totally flooded orwhen they shut down and get
dissociated, is pretty narrow inmost people with PTSD and so it
(30:53):
doesn't take too much to getthem flooded or get them shut
down.
And what's interesting aboutMDMA is it appears to sort of
widen that window.
And part of the reason it maydo that on a sort of biological
substrate level is that MDMA hasan interesting thing of sort of
quieting the right amygdala,which is where a lot of that
sort of fear response resides.
(31:13):
And so there's actually beenneuroimaging studies, fmri
studies, looking at the activityof the right amygdala, at the
activity of the right amygdala,and so that activity tends to go
down and the prefrontal cortexactivity tends to go up.
Which is what we need in orderto kind of contextualize
traumatic memories and be ableto work with them is to not be
flooded by that fear responseand be able to use our
(31:35):
prefrontal lobes to think moreflexibly about them.
And so that may be part ofwhat's going on biologically
which allows this to happen.
It's not just kind of feelinggood, you know, and what that
means in the therapy room isthat people can actually
tolerate talking about theirtrauma for a longer period of
time or more deeply than theywould have been otherwise.
Speaker 2 (31:59):
That's really interesting, that's really
interesting.
Yeah, sorry, kendra, steppingon, you apologize, but yeah, I I
think this whole conversationhas been just fascinating and
just want to, um, unfortunately,look at the clock and say that
we're kind of running out oftime here, but I want to express
my my deepest uh thanks to uh,mr andrew penn here, um, who's
sharing his expertise and andjust, I hope, enlightened
(32:20):
everybody who listened to this,because I think this is just
something that we will continueto see and I think, if maybe
that's kind of our final thought, if you wouldn't mind sharing,
andrew, what do you see as thefuture of psychedelic
psychotherapy, either withinnursing or outside, or just in
general?
Big question for like a minute,sorry, yeah.
Speaker 3 (32:39):
I really just want to impress upon how well-suited
nursing is to psychedelictherapy.
Quite honestly, psychedelictherapy made me fall back in
love with nursing because when Irealized and this is the thrust
of the paper that I co-wrotewith Gene Watson and I'm happy
to send you a link to it butreally these core values of
(33:00):
nursing that Gene has reallyspent her whole career kind of
describing, like what is thisineffable thing that we call
care and, honestly, a lot ofJean's work, when I read it as a
nursing student I didn'tunderstand what the heck she was
talking about, because it'skind of mystical, right, and
it's kind of you know.
But when I looked at it throughthe frame of the work that I do
in psychedelics, it's like, oh,this totally makes sense now,
(33:24):
and so much of what we do, whichis like care and presence and
endurance, like think about it,these are eight to ten hour
sessions sometimes.
Well, you know, a lot of mypsychotherapist colleagues are
like that's a long day.
I'm like that's just like ashift in the icu with a
delirious patient, like we canroll with that, um, you know,
and we take care of thepatient's body too, like if they
had an episode of incontinence.
(33:45):
I'm not squicked out by dealingwith that.
I'm a nurse and if the persongets hypertensive which is
something that we have to keeptrack of, I can manage that.
But more critically, it's aboutthis quality of presence and
not necessarily needing to dosomething other than show up
fully, and that's what nursesare so good at doing when we're
(34:09):
not being pulled in 10 differentdirections by our EHR and silly
mandates that we have to follow.
But the beautiful thing aboutthese days that I get to do
these is that I have nothingelse pulling on my threads.
I can just be there with thatpatient fully for the duration
of the experience, and that iswhy I got into this work to
begin with.
Speaker 2 (34:31):
All right, that's a yeah a round of applause.
You can't see it, this is audiopodcast.
But yes, thank you so much andagain, just very much appreciate
it.
It's a great way to finish PepLau's ghost episode here and
really kind of highlighting,nursing.
So thank you again.
We'll be out with a new episodesoon, so please feel free to
like, subscribe, comment andwe'll see you at our next
episode.
Speaker 1 (34:57):
Take care Before it's true.
Work hard until those thoughtsare finally leaving so you can
be you.
Guided discovery Identifyingchallenge in your beliefs, core
beliefs, reframing your mind.
Negative thoughts release, letit go.
These cognitive distortionsdecrease until they cease.
Yeah, guided discoveryIdentifying challenge in your
beliefs, core beliefs, reframingyour mind.
Yeah, just my take on things.
Speaker 2 (00:08):
My answer number two Welcome everyone to another
edition of Pep Lau's Ghost.
Thank you so much for joiningus.
We're really excited about ourguest today, andrew Penn from
the University of California,san Francisco.
Really excited to kind of learna little bit about his practice
(00:29):
and his exciting work usingpsychedelics integrated with
psychotherapy.
So really excited.
Kate Molino from UCSF, kendraDelaney from Vanderbilt and
Melissa Chapman from Minnesotathe non-nurse who keeps us in
(00:50):
line.
So thank you so much everybodyfor joining us here.
I'm going to do kind of a quickintroduction.
Andrew kind of mentioned.
We want to keep this short, butthat is not easy to do.
He is a very well-accomplishedindividual that definitely needs
to be celebrated.
So basically, andrew has beenin mental health care for over
30 years.
He is a faculty trained at theUniversity of California, san
(01:15):
Francisco.
Also teaches psychopharm there,involved with phase two of a
psilocybin-facilitated therapyfor major depression which was
published in the Journal of theAmerican Medical Association.
So that's a big deal, nice,very good.
He's also adjunct and teachesat San Francisco Veterans
(01:35):
Administration.
Co-founder of the Open Nurses, aprofessional organization for
nurses interested in psychedelicresearch.
Has also co-chaired and is onthe steering committee for the
NP Institute, also involved witha variety of other things, has
spoken kind of everywhere.
I'm looking at your bio Southby Southwest.
(01:55):
You spoke that you've had a TEDTalk and we're just sharing.
You had an interview with BBC.
So again, thank you for comingto our humble little podcast
here and I really look forwardto kind of getting to know more
from you with these questions.
So, excuse me, when?
Thank you, andrew.
So first question I have foryou when did you first get
(02:15):
interested in psychedelicpsychotherapy?
Speaker 3 (02:18):
You know, I think my interest in psychedelics
actually goes back to highschool.
I read Aldous Huxley's theDoors of Perception when I was,
I don't know, 15 or 16.
I think I heard somewhere thatthe rock band the Doors had
gotten their name from that book, and you know, this is in the
80s.
So psychedelics were definitelyin this sort of deep freeze
(02:39):
following this sort of things.
That happened, you know, bothgood and bad in the 1960s, and
so it seemed like another worldfar away.
But it was an intriguing book.
I mean, for those who aren'tfamiliar, this was Aldous
Huxley's first experience withmescaline, which was actually
given to him by a sort ofadopted Canadian Kate I'm
looking at you here HumphreyOsmond, who was really leading a
(03:04):
lot of the research in the1960s in Canada using LSD with
patients that we would now callhaving alcohol use disorder, and
so you know, psychedelics havelong been sort of in the culture
, and so I think the idea ofusing them therapeutically,
which was an idea I think Istarted reading about maybe in
(03:27):
the mid-early 2000s reallyintrigued me, and also it sort
of parallels my own experiencewith conventional psychiatric
treatment, which was that when Iwas trained I graduated UCSF in
2005.
Psychiatric treatment, which wasthat when I was trained I
graduated UCSF in 2005, you knowwe were going to save the world
with psychopharmacology.
(03:48):
Just a little pinch of that, apinch of that was going to make
everything all better and Ibelieved that for a while and I
practiced that way and after awhile I began to feel a little
bit disillusioned with this ideathat there was going to be a
pill for every ill and thatthese medications you know well.
(04:09):
You know I don't want todisparage medications.
I think that there's a lot ofuseful things we can do with
them.
But the notion of what if wecould actually move psychiatry
from a ostensibly a palliativepractice again, no shade on
palliative care, it's animportant practice but what if
we could actually start gettingpeople better to the point where
they didn't need treatment?
(04:31):
Maybe I mean cure is a reallyhubristic word but what if we
could get people well enoughthat psychiatric treatment
became more episodic rather thanchronic?
So that was another idea thatreally started to intrigue me
and I've also long had aninterest.
Also, back around that sameearly, impressionable time, I
(04:54):
read Viktor Frankl and learnedabout the idea of making meaning
from suffering and one of thethings that maybe we can talk
more about in our conversationis some of the experiences that
people have under psychedelictherapy and the process of
possibly finding meaning inthings that have often been
challenging for them in theirlives, and that is something
(05:23):
that can come start doing someof this research work working
with a lab here at UCSF on anumber of different studies that
have involved psilocybinprimarily, but I also worked on
the MDMA PTSD study about sixyears ago now, so it's been an
interesting journey.
Speaker 2 (05:42):
Thanks, Andrew.
Yeah, I think we were justtalking about this in another
conversation.
Just how things we do is kindof long time ago, kind of keep
bubbling up to the surface.
If it's, you know, somethingthat's meaningful and impactful,
I, I think we just never let itgo.
We just kind of we hold on toit and it just keeps twirling in
the back of our brain somehow.
So, yeah, thank you, Thank youfor sharing that story.
Speaker 4 (06:03):
And I just want to add you know, andrew, I
appreciate how you are both aproponent of psychedelic therapy
in the present and future andalso kind of a historian who's a
registered nurse inSaskatchewan, which was a
follow-up to an interview thatwas done with her in the 60s
(06:26):
that was published in theAmerican Journal of Nursing, if
I recall correctly so 1964, shewrote an article called
Supporting the Patient on LSDDay, which I was amazed to find
and yeah, we went andinterviewed her last winter.
Speaker 3 (06:40):
She's now 101 years old.
She's now 101 years old, sprite, spritely and currently working
on trying to transcribe andedit that interview down to it
was five hours, five hours ofrecording.
She had a lot of energy for 101year old and get that out into
(07:03):
the world in a way that peoplecan appreciate her because she
was really a visionary and apioneer.
Speaker 5 (07:09):
Well, you know I'd love to pop in and you know,
psychedelic therapy, or assistedtherapy, is something that I
feel like is such a hot topicright now, and you know I've had
, you know, patients come to meand say, well, I'd like to do
this, but like what does thatactually look like?
Could you?
Could you give our listeners,you know, a sense of what do
people actually mean when theymean psychedelic therapy?
And are you know, are there anymodalities that you integrate
(07:32):
with psychedelic therapy thatreally stand out to you?
Speaker 3 (07:36):
Yeah, that's a great question.
So this is definitely.
It's been in the media a lotand I think patients are
starting to come to us and askus questions about it.
So it's important for, even ifnurses aren't delivering this
treatment to their patients, toat least know about it so they
can point them in the rightdirection.
It's also important tounderstand that really the only
compound that is legal andreadily available that is
(07:59):
psychedelic-like would beketamine, or it's an antimers
ketamine.
In some municipalities in somestates like Colorado, there are
programs where things likepsilocybin can be used
clinically.
It's sort of an interestingthird way, because obviously
it's still illegal in the USunder the Controlled Substance
(08:21):
Act federally, but kind of likecannabis, which is also a
Schedule I drug.
There are beginning to be thesesort of workarounds and so when
patients come to us askingabout psychedelic therapy, they
may not be aware that thesethings are not readily available
outside of research settings.
I think it's important for allnurses to know about
(08:43):
clinicaltrialsgov, an amazinglyeasy-to-use government website
which those two words don'tusually always go together, but
it's about as easy to use asGoogle and from that you can
type in, say, depression andpsilocybin, and it will direct
you to studies that arerecruiting or may soon be
recruiting, and you can limit bygeography and such.
(09:05):
So that's a useful reference toknow.
And then the most readilyavailable sort of psychedelic
like treatment, and by that Imean you know.
I should probably clarify whatwe're talking about, because I
think sometimes people imaginethat you know what are we
talking about?
Taking LSD every day Like thatsounds not tenable and it
wouldn't be.
So the idea of using apsychedelic in a therapeutic
(09:26):
context is different than, say,taking fluoxetine or something
like that, where you're taking apill every day.
The idea is that it's really apsychotherapy model that is
enhanced with the limited use ofa psychedelic in a supervised
setting.
And so what I mean by that isthat in our studies what we do
is we have preparatory non-drugpsychotherapy.
(09:48):
So I will meet with a subjectwho's going to be in one of our
trials multiple times to talk tothem, to get to know them, get
to know what they want to workon, what concerns they have, for
them to get to know me.
So very much that nursing modelwhere there's a sort of a
bi-directional working togetherthat's happening, and then on
the day of dosing so we might dothat two or three times,
(10:10):
depending on the study protocol.
So it could be up to six hoursor so of preparatory non-drug
psychotherapy.
Then, the day they come in forthe dosing, I'm going to meet
with them again.
I'm going to have a dosingassistant with me, so there'll
be two people there the wholetime and we're going to have a
dosing assistant with me.
So there'll be two people therethe whole time and we're going
to get them settled in.
We're going to make sure theirblood pressure is okay, we're
going to make sure they'recomfortable, we're going to
revisit whatever intentions theyset in the preparatory therapy
(10:33):
and then they're going to ingestusually psilocybin it's this
you know.
Or if it's a randomized controltrial, it could be a placebo,
and we're going to settle inthere for the whole day.
It's kind of a living room-likeenvironment.
It's quiet, it's comfortable,we have soft music going in the
background.
We have eye shades available ifpeople want to kind of direct
their attention inward.
Sometimes there's talking goingon.
(10:55):
A lot of times there isn't, andwe can get more into that if we
want to.
The drug reliably has a prettypredictable pharmacokinetic
course.
So you know, typically withpsilocybin people are feeling
something within about 30 to 45minutes.
The peak effects are about twoto three hours and then there's
sort of a several hour tailwhere it wears off and usually
(11:17):
by hour five or six they're backto their sort of normal state
of mind.
Their ride picks them up thenext day.
We get on a Zoom call usuallyand we begin to integrate that
experience.
So we talk about what happenedfor you during that dosing day,
what feelings came up, whatmemories came up, what emotions,
what thoughts came up, and wetry and look for opportunities
(11:39):
to make sense out of that andalso to integrate any kind of
learnings or experiences intotheir day-to-day life.
So somebody may have had, forexample, somebody with
depression might have had therealization like, oh my gosh, I
really contribute to my ownaloneness.
You know I feel really lonelyand I also contribute to it
(11:59):
because I withdraw from peoplewho are reaching out to me, you
know.
And so you know like we mightdo with regular therapy.
We might say, well, you know,how could you do?
How could that be different?
You know, we might set a verysmall goal of like okay, so what
if you reach out to two peoplebetween now and next time we
talk to really start to takethat very kind of abstract idea
(12:21):
of like, well, you know, I hadthis realization that I was like
this one person on this littletiny island, all by myself, but
there's a bridge that I neverwent across, you know well.
Okay, so what would goingacross that bridge look like?
You know?
Well, maybe it would involve,like reaching out to people that
have been trying to reach outto me that I'm not responding to
their texts.
Okay, you know, is thatsomething you'd be willing to do
(12:42):
?
Do between now and next week?
Yeah, so you can take this veryabstract idea and try and bring
it into something that is maybeactionable and less abstract.
Speaker 4 (12:56):
Yeah, andrew, thanks so much for going through that.
I think it's so valuablebecause, I agree, I think there
is a lot of I don't know if it'sconfusion, but just maybe
mystery around.
What does you know this type ofpsychotherapy entail?
I'm curious if you would sharemaybe a success story from a
session, or you know anysessions you had that kind of
(13:17):
taught you something or you know, any sessions you had that kind
of taught you something.
Speaker 3 (13:26):
Yeah, you know, I think, about my very first one
that I did, which was this was a.
It was in the MDMA PTSD trialthat we were doing and this is a
.
You know, without getting intotoo much identifying detail, you
know somebody who hadexperienced trauma many years
before and was, you know, inmany ways a very affable,
likable person.
Tended to be very chatty, youknow, which I can relate to, but
(13:51):
also would also sometimes usetalking as a way of kind of
distracting himself from hisemotional experience.
You experience it was awell-adapted kind of trait and
so this particular protocol.
We actually had three dosings,so we kind of went through that
wash, rinse, repeat cycle threetimes on this study and there
(14:14):
was therapy in between each ofthe dosings, several
opportunities for therapywithout drug, and what we
noticed, me and my co-therapistwas that the subject tended to
talk a lot in the first session,and that sometimes happens with
MDMA.
Mdma is qualitatively differentthan psilocybin in that MDMA
(14:36):
tends to be a little more social, whereas psilocybin tends to be
a little more introspective.
Just in very broad terms, youcan certainly have introspection
on MDMA, but nevertheless hespent a lot of the first session
really talking a lot and itfelt like he was kind of almost
(14:56):
felt like he needed to entertainus and I always make that clear
with subjects that we're goingto be sitting here with you but
you don felt like he needed toentertain us.
And I always make that clearwith subjects that we're going
to be sitting here with you butyou don't need to take care of
us.
We're here to be present forthem and that's one of those
great nursing qualities that Ithink that nurses bring to this
work is a quality of presence,and a few years ago I wrote a
paper with Gene Watson aboutthis, which I can maybe talk a
(15:17):
little more about, but hownurses kind of cultivate care
through presence.
And I suggested to him in thepreparation session I said you
know, one thing that you couldtry if you wanted is that you
know that feeling like on aSunday morning when you don't
have to be anywhere and youdon't set your alarm clock and
you wake up and you're kind oflike still in a dream a little
bit, you know you don't have toget up and get anywhere, so you
(15:38):
can just kind of linger for afew minutes and kind of think
about the dream and you know, bein that half sleepy state.
I said you know what, if youspent some of your time on this
next dosing session, like justtrying that on, he says, oh yeah
, that sounds great, I'll, I'lltry that.
And so, interestingly, he camein the next time and he took the
capsules and he says I thinkI'm going to go inside for a
(16:01):
little bit.
And he says, you know, that'sterminology we use to kind of be
more introspective, maybe putthe eye shades on, put the
headphones on and really justallow yourself to be present
with that experience.
And he went in and he went infor like four hours.
And it's funny because ourprotocol was to check on if they
were quiet, to check on themevery hour and we had to do
(16:22):
vitals and that.
So you know, it was a littleopportunity to sort of gently
touch him on the arm and say youknow how you doing in there.
He says I'm doing good, I wantto stay in this space.
It was like okay, you know.
And so he really went for it andhe really, when he came out of
that, just shared with us thesesort of daydreams that he was
having and memories that he washaving about the trauma to some
(16:44):
extent, but also things thatreally gave him a lot of peace
about that experience in hislife, and so it was a great
teaching for me, I think, isthat you know, we're all so
trained as interventionists, youknow just all forms of
healthcare.
You know, I see this in ourstudents.
They're always listening tothink like what do I do?
(17:04):
What do I do next?
Like, oh, they said somethingabout panic, maybe I should
think about an SSRI.
You know, like we're just kindof doing this.
It's like patient care becomesthis matching test where it's
like this symptom occurs andtherefore we should do this.
And we're always thinking aboutintervention.
And you know, what I love aboutdoing this work is that it
brings it actually brought meback to nursing, which is one of
(17:28):
the core things about nursing,which was about presence.
It was like don't just dosomething, sit there and don't
discount the value of yourpresence and your witnessing in
this work and how therapeuticthat is.
And I think so often,especially when we're early
learners, we think we'resupposed to be doing something,
(17:48):
we're supposed to make someclever interpretation, or we're
supposed to identify somethingor come up with a prescription
and it's like the great thingabout this is that there's a
sort of path that's happeningand we just have to walk it with
our patients, and I think thatis really one thing that I've
appreciated about this work isit's really brought me back to
(18:09):
something that I've always likedabout nursing, which is that we
value the quality of presenceit's so wonderful to hear these
examples.
Speaker 6 (18:18):
So thank you for that Kind of on the flip side.
I'd love to hear these examples.
So thank you for that kind ofon the flip side.
Speaker 3 (18:23):
I'd love to hear, either theoretically or like
concrete examples of anyconcerns that you might have or
considerations with about usingpsychedelic psychotherapy yeah,
well, there are many um, so oneof which is that psychedelics
are a little unusual in thatthey are not like some new
compound that's coming out froma pharmaceutical company that
nobody's ever heard of.
(18:44):
Lots of people in the generalpublic have had their own
experiences with psychedelics,or they know people who have, or
they've heard stories about it.
So there's kind of thiscultural baggage around it in a
way that other novel compoundsdon't necessarily have to deal
with.
So that can go both good andbad.
So we talk about fears thatpeople have about these
(19:07):
experiences and a lot of peoplebring up kind of the fear of the
proverbial bad trip, adifficult psychedelic experience
.
So that comes up.
But there's also this flip sideto that, which is this idea
that they're miracle cures.
But there's also this flip sideto that, which is this idea
(19:35):
that they're miracle cures.
And there were these verybreathy headlines in media
outlets in the early years ofthis and even just a few years
ago one trip and cured for lifeand this kind of slow process
moving through the FDA on theone hand, but on the other hand
we have well, not only the waysthat people always access these
things, but we have increasinglydecriminalized use in certain
municipalities and states.
So patients are finding thesethings on their own, they're
(19:57):
trying them out, and I think oneof the things that's really
important to understand aboutpsychedelics is that the context
is just as important as thedrug, so what is often referred
to as set and setting, so themindset and then the physical
setting.
So one of the things that'sreally interesting about
psychedelics is their effectsare somewhat pluripotent.
So, you know, this same drugtaken in my lab with the
(20:20):
intention to help treatsomebody's depression might lead
to somebody experiencing griefabout the way depression has
impacted their life.
Or, you know, experience offeeling connected to something
larger than themselves, whereasthat same exact molecule taken
at Coachella, you know, couldmake that music sound amazing.
(20:42):
Or they could find themselvesfeeling, you know, having
experience of fantastic musicand then midway through they
start thinking about when theirmother died, when they're eight
years old.
And, you know, they have thisbig emotional experience in a
setting that doesn't really havea container for it.
You know, I used to do harmreduction work at Burning man
(21:03):
and we would get folks all thetime who thought they were going
to go out and go dancing andlisten to music and then found
themselves thinking about whentheir mom died when they were
eight, and you know and that'snot to say that that was a bad
experience for them, but it wasan unexpected experience and
thank goodness we had that kindof safe container where people
could come to and be attended toby trained volunteers who could
(21:25):
help that what could have beena really challenging experience
become, you know, at least aneutral or maybe even a positive
experience.
But this sort of hype in thespace and I've written about
this you know about how thatreally it creates these
unrealistic expectations.
And we know our patients aredesperate because our treatments
(21:46):
don't work as well as we wantthem to.
So I understand why people seekthese things out on their own,
but that can be a somewhatperilous process if you don't
know what you're doing and youdon't have good guidance.
Speaker 2 (21:58):
Gosh.
Thank you, andrew.
You know it's.
This is so enlightening.
I mean it's definitely not anarea of expertise that I have
but you know, sharing from myown practice, I'm currently
doing esketamine in my treatmentand I you know this is speaking
a lot to kind of.
You know the experience thatI've had with patients.
It's yeah, it's not a cure andI think sometimes the
therapeutic value is more thanthe substance that they take.
(22:20):
I mean, I kind of with mySpravato treatments I sometimes
wonder if it's more.
It's kind of it reminds me ofcheers, that old, you know
sitcom, where people would comeback to the clinic and the front
desk would be like, oh Joan, ohhey, how you doing, and the
people are like, oh, you know,I'm feeling accepted.
There's somebody here thatreally you know I'm bonding with
I have to come.
(22:41):
You know there's somebody herethat really you know I'm bonding
with I have to come, you know.
But it's just something that Ireally think is so meaningful
and I love how you highlightthis idea that you know there's
work in this and just what yousaid.
You know I'm thinking, you know, just because you do hear that
you know the bad trip and I'vehad a couple of patients who
come to me and just kind of likeyou know, I'm going to just
take a little bit of a mushroomat.
(23:01):
You know, night and night, Ithink that's you know, cause
that's been researched right now.
You know you have to do thewhole education though that's
not, that's just a piece of thissort of thing.
Speaker 3 (23:08):
So I appreciate, and maybe you have do want to say
about, you know what you'venoticed in your clinic, I think
is really interesting because itspeaks to the community aspect
of this Right and and one of thethings that you know I think
(23:32):
COVID really highlighted is howpsychologically deleterious it
is to be alone in the world andhow many of our illnesses that
we treat in psychiatry involvebeing alone, you know.
I mean, you know the formerInstitute of National Institutes
of Mental Health, tom Insell,wrote this book about how
(23:52):
isolation is really, you know,killing us, and so one of the
things that's interesting aboutpsychedelics is the potential
for group treatment, you know,and group therapy, when I went
through school, always felt likesort of like the low-cost
alternative, you know, and Iworked for a big insurer that
liked to push group therapy.
But really I think grouptherapy could have an amazing
(24:13):
revival through psychedelicexperiences, because one of the
things that is very common inpsychedelic experiences and I
will answer your question aboutbad trips, I'm not avoiding it
is that they often engenderexperience of feeling connected
to something larger thanyourself, and you know that can
be the experience of awe, whichis, you know, sometimes referred
to as the small self, which islike hey, I'm, you know, like
(24:36):
imagine when you've seen anamazing sunset or something, you
realize there's beauty in theworld and my little neurotic
churn that happens in my headand your head and everyone's
head maybe isn't that important.
You know that there's somethingmuch bigger than all of us and
to feel connected to that issalutary.
Now, the bad trip notion is,you know, so we often call them
(24:58):
difficult experiences orchallenging experiences.
Call them difficult experiencesor challenging experiences, and
one of the things that I doadvise subjects when they're
coming into the study,especially with psilocybin, is
that this tends to kind ofamplify emotions, and so
whatever you're coming into thiswith often will get kind of
louder in the experience.
It's also a little bitunpredictable which way it's
(25:18):
going to go.
So you know, you think you'regoing to go listen to Diplo or
something you know, and what youfind is you're crying about,
you know, when your mom diedwhen you were eight and you
weren't expecting that right,and the emotions that you're
experiencing are amplified in away that they aren't normally,
that you're not normally able tokind of maybe consciously tamp
down.
And so a lot of times whenpeople are having a difficult
(25:40):
emotional experience, it can beautobiographical.
You know there's some kind ofgrief, some kind of trauma, and
a lot of times in a therapeuticcontext.
We're specifically going intothat right.
So you know, in the MDMA PTSDwork we had an agreement with
our subjects because, as we allknow, ptsd is often marked by
avoidance.
(26:00):
As we all know, ptsd is oftenmarked by avoidance, and so we
had an agreement with oursubjects that if we haven't
talked about the trauma duringthe course of the session, the
therapist will bring it up.
Honestly, because of the prepwork that we did, we really
rarely ever had to evoke thatbecause the subjects came in
wanting to talk about that.
(26:22):
But sometimes under apsychedelic experience, the
ability to kind of hold backdifficult memories or difficult
thoughts is eroded and those canbe overwhelming if people are
not prepared for it.
Yeah, there can also be somekind of panic-type symptoms that
people will have.
You know, just feeling weird.
(26:42):
You know, many of our patientswith anxiety disorders and panic
disorders are often verysensitive to kind of that
internal experience of feelingoff, feeling weird, not being
able to turn a thought off.
You know that can beanxiety-generating.
So this is why it's really,really important to have that
preparatory work in place whereyou've got a known person there
(27:04):
in the room with you who you'vealready talked about these
concerns, and that person isknown to you.
You've already talked aboutways of calming yourself maybe
deep breathing or grounding andalso it's really important to
know that these experiences inpsychedelic experiences, are
transient.
You know that while it may bereally intense right now, five
(27:28):
minutes from now your mind mightshift to something else, and
that's often what happens isthat you know, I've seen people
be crying and then 30 secondslater they're laughing.
You know, or they're laughingand then they're crying.
It's just, you go through thesewaves of emotional experience
and then they're crying.
It's just you go through thesewaves of emotional experience
(27:50):
and a lot of times what seems tohappen from that is the
experience of actively notavoiding the emotion is salutary
.
So we know that one of thethings that really predicts for
things like depression isemotional avoidance.
When people deploy a lot ofstrategies and use a lot of
energy to not feel theirfeelings, it comes at a price,
right, and that price may bedepression or PTSD symptoms, and
(28:13):
so what this is an opportunityis to maybe go into them and
realize like, oh, that was hard,but it wasn't so terrible.
I was able to do that in muchthe same way that a vaccine
challenges your immune system.
Remember when we all got ourCOVID shots and everyone was
like, oh, how'd you feelafterwards?
Oh, I was tired.
For a couple of days, I feltkind of feverish.
(28:33):
Well, that was your immunesystem charging up right and it
made you stronger as a result.
And so maybe there's apsychological corollary to that
as well, that we get to makemore possible or more tolerable
with the combination of therapyplus drug.
Speaker 5 (28:51):
I have a follow-up to that.
So you know, as you were talking, I was just thinking.
You know, with other traumamodalities, you know, sometimes
we can see, even with likepreparation into work on the
very specific trauma experience,in that specific trauma, like
while doing work on thatspecific trauma, we still find
that patients sometimes areflooded and overwhelmed.
And you know, though we did thebest that we could to prepare
(29:13):
there, it's still, you know thatwe they still had that flooding
experience.
And you know, on the other sideof that, you know, in my
experience I've sometimes seenthat that flooding and that
overwhelm of emotion cancontinue on for, you know, days,
weeks, even months depending onintervention afterwards.
And I was hearing you say that,you know, one of the things
(29:36):
that's really unique aboutpsychedelic work is that
patients are really getting thisexperience of noticing how
transient our emotions can be inreal time.
In your experience have younoticed, you know, in when
unexpected intense emotions comeup in while a patient or an
individual is going under apsychedelic experience, does
(29:56):
that tend to reverberate untillater, like the days and weeks
and months coming, likesometimes we can see it with
other traditional trauma work,or is that something that you
tend to see remain prettytransient as well.
Speaker 3 (30:10):
It's a great question , kendra.
I mean it can you know?
Because and these experiences,you know, particularly in sort
of less regulated, lessintentional settings, you know,
can be destabilizing for people.
So that is something that wehave to keep in mind and it's
one of the reasons why you havethat integration therapy so
(30:30):
closely proximal to theexperience, so that you can kind
of catch that.
You know.
One of the things that'sinteresting about MDMA in
particular is that you know whatyou were describing there, the
sort of tolerability window.
You know what you weredescribing there, the sort of
tolerability window you know,which is somewhere between when
people get totally flooded orwhen they shut down and get
dissociated, is pretty narrow inmost people with PTSD and so it
(30:53):
doesn't take too much to getthem flooded or get them shut
down.
And what's interesting aboutMDMA is it appears to sort of
widen that window.
And part of the reason it maydo that on a sort of biological
substrate level is that MDMA hasan interesting thing of sort of
quieting the right amygdala,which is where a lot of that
sort of fear response resides.
(31:13):
And so there's actually beenneuroimaging studies, fmri
studies, looking at the activityof the right amygdala, at the
activity of the right amygdala,and so that activity tends to go
down and the prefrontal cortexactivity tends to go up.
Which is what we need in orderto kind of contextualize
traumatic memories and be ableto work with them is to not be
flooded by that fear responseand be able to use our
(31:35):
prefrontal lobes to think moreflexibly about them.
And so that may be part ofwhat's going on biologically
which allows this to happen.
It's not just kind of feelinggood, you know, and what that
means in the therapy room isthat people can actually
tolerate talking about theirtrauma for a longer period of
time or more deeply than theywould have been otherwise.
Speaker 2 (31:59):
That's really interesting, that's really
interesting.
Yeah, sorry, kendra, steppingon, you apologize, but yeah, I I
think this whole conversationhas been just fascinating and
just want to, um, unfortunately,look at the clock and say that
we're kind of running out oftime here, but I want to express
my my deepest uh thanks to uh,mr andrew penn here, um, who's
sharing his expertise and andjust, I hope, enlightened
(32:20):
everybody who listened to this,because I think this is just
something that we will continueto see and I think, if maybe
that's kind of our final thought, if you wouldn't mind sharing,
andrew, what do you see as thefuture of psychedelic
psychotherapy, either withinnursing or outside, or just in
general?
Big question for like a minute,sorry, yeah.
Speaker 3 (32:39):
I really just want to impress upon how well-suited
nursing is to psychedelictherapy.
Quite honestly, psychedelictherapy made me fall back in
love with nursing because when Irealized and this is the thrust
of the paper that I co-wrotewith Gene Watson and I'm happy
to send you a link to it butreally these core values of
(33:00):
nursing that Gene has reallyspent her whole career kind of
describing, like what is thisineffable thing that we call
care and, honestly, a lot ofJean's work, when I read it as a
nursing student I didn'tunderstand what the heck she was
talking about, because it'skind of mystical, right, and
it's kind of you know.
But when I looked at it throughthe frame of the work that I do
in psychedelics, it's like, oh,this totally makes sense now,
(33:24):
and so much of what we do, whichis like care and presence and
endurance, like think about it,these are eight to ten hour
sessions sometimes.
Well, you know, a lot of mypsychotherapist colleagues are
like that's a long day.
I'm like that's just like ashift in the icu with a
delirious patient, like we canroll with that, um, you know,
and we take care of thepatient's body too, like if they
had an episode of incontinence.
(33:45):
I'm not squicked out by dealingwith that.
I'm a nurse and if the persongets hypertensive which is
something that we have to keeptrack of, I can manage that.
But more critically, it's aboutthis quality of presence and
not necessarily needing to dosomething other than show up
fully, and that's what nursesare so good at doing when we're
(34:09):
not being pulled in 10 differentdirections by our EHR and silly
mandates that we have to follow.
But the beautiful thing aboutthese days that I get to do
these is that I have nothingelse pulling on my threads.
I can just be there with thatpatient fully for the duration
of the experience, and that iswhy I got into this work to
begin with.
Speaker 2 (34:31):
All right, that's a yeah a round of applause.
You can't see it, this is audiopodcast.
But yes, thank you so much andagain, just very much appreciate
it.
It's a great way to finish PepLau's ghost episode here and
really kind of highlighting,nursing.
So thank you again.
We'll be out with a new episodesoon, so please feel free to
like, subscribe, comment andwe'll see you at our next
episode.
Speaker 1 (34:57):
Take care Before it's true.
Work hard until those thoughtsare finally leaving so you can
be you.
Guided discovery Identifyingchallenge in your beliefs, core
beliefs, reframing your mind.
Negative thoughts release, letit go.
These cognitive distortionsdecrease until they cease.
Yeah, guided discoveryIdentifying challenge in your
beliefs, core beliefs, reframingyour mind.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.
True Crime Tonight
If you eat, sleep, and breathe true crime, TRUE CRIME TONIGHT is serving up your nightly fix. Five nights a week, KT STUDIOS & iHEART RADIO invite listeners to pull up a seat for an unfiltered look at the biggest cases making headlines, celebrity scandals, and the trials everyone is watching. With a mix of expert analysis, hot takes, and listener call-ins, TRUE CRIME TONIGHT goes beyond the headlines to uncover the twists, turns, and unanswered questions that keep us all obsessed—because, at TRUE CRIME TONIGHT, there’s a seat for everyone. Whether breaking down crime scene forensics, scrutinizing serial killers, or debating the most binge-worthy true crime docs, True Crime Tonight is the fresh, fast-paced, and slightly addictive home for true crime lovers.