Psychedelic Practitioner Core Training

Brief History of Psychedelic and Psilocybin Usage

Psychedelic plants and fungi have been used by a variety of different cultures for a variety of purposes for centuries or millennia (Schultes et al., 2001). A number of different cultures have used plants and fungi such as ayahuasca, peyote, San Pedro cacti, psilocybin mushrooms, and iboga. Despite this usage being separated by time and space, they tend to be used for very similar purposes, including the diagnosis of disease, physical, mental, and spiritual healing, problem-solving and guidance, seeking lost or stolen objects, and promoting cultural and community cohesion. Despite this ancient usage, clinical research only began in earnest in the 1950s (Rucker et al., 2018).

Psilocybin is the most highly researched psychedelic in the modern era. Once used by the Aztecs in a variety of contexts, psilocybin mushrooms have an ancient history of usage among a number of indigenous Mexican groups, including the Mazatec. The epicenter of usage is thought to be among the Mazatec, who are considered to possess the greatest knowledge of mushroom lore and refer to mushrooms as Los Santos Niños (“the Little Saints”).

The Mazatec mushroom ceremony, or velada setting, is usually in the curandera’s home, in a room with a traditional altar adorned with beeswax candles, flowers, and offerings of tobacco. The altar includes images of local deities and Christian imagery. The altar is an anchor for orientating the experience and navigating challenging content when necessary. This is deemed an invaluable exercise in training one’s perception in order that one can navigate what the mushroom presents with a clear and centered mind. Mushrooms are consumed fresh, in pairs, and are chewed slowly, sometimes with unsweetened cacao, this also being a custom practiced by the Aztecs. Veladas are performed during the night, often in darkness or sometimes with candlelight. This is to minimize distractions and focus the mind. Distinct from the clinical therapeutic approach, velada participants are encouraged to focus on the candles and images with sustained attention and avoid “falling” into the trance, maintaining their intention of invoking the sacred. There are strict rules in place regarding how the mushrooms are handled after harvesting and preparation for people who will be undergoing a session. Mazatec shamans may sing or chant and perform bodywork on patients. Sessions may be one-on-one or in small, often family groups.

Modern Interest in Psychedelics Ignited

Outside an indigenous context of psychedelic usage, a pivotal event that catalyzed the modern interest in psychedelics was the invention and subsequent discovery of the psychedelic properties of LSD by Sandoz chemist Albert Hofmann, who felt the substance would have useful applications in “pharmacology, in neurology, and especially in psychiatry” (Hofmann, 1980). Sandoz began offering LSD in 1947 under the trade name Delysid to clinicians for free in the hope that a medical use would be found for it. LSD would be used in the treatment of a wide range of conditions, including neurotic disorders, psychosomatic disorders, alcoholism, pain associated with terminal cancer, schizophrenia

This clinical psychedelic research in the 1950s and ’60s primarily focussed on LSD, with mescaline occasionally used but much more sparingly. Psilocybin did not appear on the scene until much later. In June 1955, R. Gordon Wasson and Valentina Pavlovna Wasson were among the first Westerners ever to be admitted to a Mazatec psilocybin mushroom velada conducted by the Mazatec curandera, or medicine woman, Maria Sabina. In 1957, Valentina Wasson gave an interview in This Week magazine and stated that she felt psilocybin could have potential in the treatment of a number of mental disorders. The same year, R. Gordon Wasson published a highly influential article, ‘Seeking the Magic Mushroom,’ which was published in Life Magazine. Among others, then Harvard University psychologist read the article, which prompted him to journey down to Mexico to sample the mushrooms himself, this ultimately leading to the foundation of the Harvard Psilocybin Project. Maria Sabina gifted some mushrooms to Wasson, and Albert Hofmann isolated and synthesized psilocybin in 1958 (Hofmann, 1959), which Sandoz offered under the trade name Indocybin. However, LSD had been invented and discovered 15 years previously and was already an established experimental drug in psychiatry, so it was perceived by clinicians as a safer bet to stick with, and psilocybin was only offered by Sandoz for six years before being discontinued. As a result of this, in contrast to the modern psychedelic research renaissance, where psilocybin is the main focus, it was used sparingly in isolated cases and wasn’t studied in a clinical context.

Evolution of Psychedelic Therapy

Initial research was on LSD’s potential to act as a psychotomimetic, being thought to catalyze a model psychosis state that could be usefully applied in gaining insight into schizophrenia. No thought was given to the set and setting, and experiences were framed negatively by researchers described using negative terminology. Given the amplifying quality of psychedelics such as LSD and the importance of context for determining outcomes, this resulted in highly negative experiences. Ultimately, this approach of using LSD to induce a model psychosis fell out of favor, but from it emerged new frontiers of research, where the intent was to use LSD in a therapeutic context to treat mental health conditions.

Two forms of psychedelic therapy grew from the previous psychotomimetic approach - psycholytic (‘psyche loosening’) and psychedelic (‘psyche loosening’) therapy. Early trials use a range of individual, group, and milieu therapy  (therapeutic community) approaches, and you’ll be given a handout with a summary of all the studies, including the populations treated and the study findings. The psycholytic therapy approach tended to employ repeated low-medium doses (25-150mcg) of LSD and was pursued in Europe, largely pioneered by English psychiatrist Dr. Ronald Sandison at Powick Mental Hospital in 1953. His research attracted media attention at the time and led to the construction of the first purpose-built LSD unit at the hospital, where up to 5 patients could be treated at once. LSD was used in combination with psychodynamic therapy, with each patient given their own room, with a chair, sofa, and record player. The intent was to break down ego defenses and enable repressed unconscious material to emerge, allowing the subject to relive long-lost memories that they could then discuss with attending therapists. Patients met together to discuss their experiences in daily group sessions. This form of therapy was used to treat neuroses, including depression, anxiety, and psychosomatic diseases.

Across the Atlantic in Canada, Humphry Osmond and Abram Hoffer were pioneering a high-dose LSD psychedelic therapy approach. In this context, treatment primarily consisted of one single high-dose LSD (200-800 mcg) experience, where the intent was to trigger a peak or mystical-type experience, which could bring about a shift in perspective and behaviors. An LSD session involved therapeutic preparation and support, eyeshades, and classical music played through headphones. Many of the early trials using the psychedelic therapy approach were using LSD to treat alcoholism, and responses were mixed, although it seemed to hold promise (for a review, see Fuentes et al., 2020). Taken together, the findings of both psycholytic and psychedelic therapy suggested that psychedelics may hold potential, but it was still unclear to what degree. This was largely down to limitations with this early research. 

Limitations with Pre-Prohibition Research

Clinicians in the 1950s and 1960s weren’t often trained in research techniques. Studies conducted often lacked randomization and a control condition or group, and there was an absence of standardized diagnostic techniques and measures of symptom severity and selective or under-reporting of study findings (Carhart-Harris & Goodwin, 2017). In addition, there is great heterogeneity in these early trials with regard to the number of therapeutic support people received, and there was often a lack of longer-term support post-psychedelic sessions (Fuentes et al., 2020).

Prohibition Ends Clinical Usage and Research on Psychedelics

Due to growing socio-political concern over the illicit use of LSD and other psychedelics, they were placed in Schedule 1 of the 1967 UN Convention on Drugs, and in 1970 they were placed in Schedule 1 of the United States Controlled Substances Act, classified as having no medical use and a high potential for abuse. This halted their application in medicine, and research dwindled until the turn of the millennium. Prior to its prohibition, LSD had been administered to over 40,000 patients and generated over 1,000 scientific papers, numerous books, and six international conferences (Belouin & Henningfield, 2018).

Evolution of ‘Set And Setting’

While the concept of ‘set and setting’ is attributed to Timothy Leary, the recognition of the importance of the context of psychedelic experiences in determining their effects and outcomes has its roots in ancient, traditional shamanic usage (Hartogsohn, 2017), with psychedelics only tend to be used in ritualistic or ceremonial contexts. Ronald Sandison, who spearheaded psycholytic therapy in England, took great care to ensure a comfortable setting for people undergoing psychedelic sessions, with each person given their own room, with a chair, sofa, and record player. Sandison introduced a colorful figure known as Alfred Matthew Hubbard to LSD in 1951, widely known as the “Johnny Appleseed of LSD.” Hubbard would, in turn, play an important role in developing the set and setting for use in psychedelic therapy on the other side of the Atlantic. Hubbard was a proponent of a comfortable and soothing setting, incorporating music and religious iconography into his LSD sessions. Hubbard is reputed to have introduced over 6,000 people to LSD, including key figures from various walks of life, among them Aldus Huxley. He played a key role in the early dissemination of the idea that the context and setting of LSD’s usage had important implications for therapeutic outcomes. His ideas influenced Osmand and Hoffer, and they incorporated new elements in their treatment settings and impressed prominent LSD researcher Sidney Cohen. In 1957, Cohen hired Betty Eisner to develop the optimal psychedelic setting, and building on Hubbard’s and Osmond’s ideas, she rigorously studied the effects of setting on the outcomes of the psychedelic experience.

Modern Approach to Psychedelic Therapy and Research

The modern psychedelic setting and approach effectively combine aspects of the psycholytic and psychedelic therapy models, but modern psychedelic trials have tended to focus on higher psychedelic doses, with the intent to bring about positive change through one or two sessions. People undergoing modern psilocybin therapy sessions in a clinical context typically have therapeutic preparation prior to the session to help build rapport with facilitators and prepare the participants for the session. In the session itself, participants are instructed to “trust, let go, be open” and instructed to focus their attention inwards (Johnson et al., 2008). The way in which modern clinical studies on psychedelics are conducted has also been refined, with much more attention given to improved study designs incorporating randomization and use of control conditions and groups, greater ethical standards, and greater application of therapeutic approaches alongside the administration of psychedelics. The first wave of research ultimately got shut down, largely because these substances escaped the clinic and were more widely used in unsupervised contexts - the modern second wave of research has sought to avoid controversy and distance itself from the events of the 1960s that tarnished the reputation of psychedelics in a scientific and medical context.

Due to the prohibitive costs and regulations currently in place that limit opportunities for conducting clinical studies, some researchers use naturalistic research studies to gather data on psychedelics and their effects. This may take the form of survey studies or observational studies. Survey studies are commonly conducted via an internet survey, either retrospectively or prospectively, prior to an experience. Naturalistic observational studies tend to take place in a group context arranged by someone other than the researchers, examples including things such as spiritual or well-being group retreats, treatment centers, or music festivals.

A seminal study that helped ignite the modern psychedelic research renaissance was one conducted by Roland Griffiths, Bob Jesse, and a team at Johns Hopkins. While not a clinical study, looking instead at the occurrences of mystical-type experiences among a clinically healthy, spiritually interested cohort, it showed that psychedelics such as psilocybin could be administered safely, with a high level of scientific rigor, and that further research was warranted (Griffiths et al., 2006). This acted as a green light to interested research groups elsewhere in the world. Following this, clinical research with psychedelics continues to advance, with the bulk of modern research involving psilocybin. Research conducted so far has revealed promising evidence for the potential of psychedelic therapy to treat major depression (Osorio et al. 2015; Carhart-Harris et al., 2016, 2021; Palhano-Fontes et al., 2019; Davis et al., 2021), existential anxiety associated with a terminal cancer diagnosis (Grob et al., 2011; Gasser et al., 2014; Griffiths et al., 2016; Ross et al., 2016), addiction (Garcia-Romeu et al., 2014; Bogenschutz et al., 2015), AIDS-related demoralization (Anderson et al., 2020) and OCD (Moreno et al. 2009). In addition, psilocybin is beginning to be examined for its potential role as chemotherapy, where the focus is more centered on its pharmacological drug action rather than its therapeutic effect, with a promising preliminary study recently promised suggesting it may be helpful in treating migraines (Schindler et al. 2021). In these studies, the quality of the acute psychedelic experience and the occurrence of mystical-type experiences have been found to be predictive of long-term beneficial outcomes, with the therapeutic support that is part of these studies being a key aspect of both of the latter. So far, there has only been a single study incorporating a group study approach (Anderson et al., 2020), with preliminary results suggesting this could be beneficial in some contexts.

Results of Long-Term Follow Ups of Modern Trials

A number of long-term follow-ups of psilocybin therapy have been conducted. A 6-month qualitative follow-up of the first psilocybin for depression study found that an enduring result of psilocybin therapy was a shift from a state of disconnection (from self, others, and the world) to connection (Watts et al., 2017). A quantitative follow-up of the same cohort at the same time frame noted there was still a clinically significant response to psilocybin therapy, but depression scores for a number of patients were getting higher again at this time point (Carhart-Harris et al., 2018). A 12-month follow-up of psilocybin therapy for smoking cessation found that 9 (60%) of 15 study participants were still smoking abstinent (Johnson et al., 2017). A long-term follow-up of cancer patients who underwent a psilocybin session to treat existential anxiety showed that reductions in anxiety, depression, hopelessness, demoralization, and death anxiety were sustained at the first and second follow-ups at 3.2 and 4.5 years following psilocybin administration (Agin-Liebes et al., 2020). At the second follow-up, the majority of participants met the criteria for clinically significant antidepressant or anxiolytic responses. Patients overwhelmingly attributed positive life changes to the psilocybin therapy and rated it as among the most personally and spiritually significant experiences of their lives.

Future Outlook of Psychedelic Research and Therapy

Further studies exploring the effectiveness of psilocybin therapy in the treatment of anorexia nervosa, chronic pain, PTSD, and early-stage Alzheimer’s are currently ongoing or in the pipeline, in addition to other studies examining the effects of psilocybin in healthy populations. Following successful completion of Phase III studies, psilocybin will be rescheduled from Schedule 1 to Schedule 2 substance by the Food and Drug Association in the US and by the Home Office in the UK. In the UK, this will likely occur through evidence obtained on psilocybin’s application as a treatment of major depressive disorder, with Phase III trials imminent. In the US, Phase III trials are underway evaluating the potential of psilocybin as a treatment for existential anxiety associated with a terminal cancer diagnosis. In both cases, if psilocybin is rescheduled from a Schedule 1 to a Schedule 2 substance, it will make it much easier for clinicians and researchers to access it, which will help spur further research. In addition, it will allow for off-label prescriptions for conditions related to the main indication.

Aside from the possibility of medical rescheduling, decriminalization initiatives continue to unfold rapidly, particularly in the US, moving from city to state level, with Oregon the first state to legalize psilocybin mushrooms for use in therapy.

It’s important also to consider that some indigenous groups have concerns that decriminalization could be disruptive (including cultural appropriation and over-use of plants damaging the ecosystem they are a part of, benefiting tourists but not the local population who have carried the tradition through great personal commitment). The Indigenous Peyote Conservation Communication Committee (IPCCC) has written a statement that is worth reading in full.

The modern psychedelic research renaissance is essentially still in its early stages. With subsequent research trials and the growing recognition of the medical potential of psilocybin, there is likely to be wider societal acceptance, and rescheduling will help fuel further research, suggesting such work will expand dramatically in the years to come.