4 June 2022 | New Scientist | 49systems and society. Last month, she launched
a therapy programme called ACER Integration,
which is rooted in communities rather than
the traditional patient-doctor dynamic alone.
While therapists would still be essential for
the actual psychedelic sessions, the guidance
people need afterwards could be provided
by grassroots networks. In this model, those
receiving treatment become guides through
their own experiences, and healing is as much
about making connections with other people
as it is about a self-transcendent trip.
Watts hopes to realise what some see as
idealistic levels of patient support – and
without the price tag. “Working together in
a collaborative way to provide a safety net
and support network probably sounds very
dreamy, but it could work in terms of the
real-world translation for the future of
psychedelic medicine,” says Carhart-Harris.
Relationships are important in any kind
of therapy, adds Watts. Indeed, it is telling
that one of the best predictors of outcomes in
psychedelic therapy is a person’s rapport with
their therapist. “Psychedelics are really good
at helping us feel a sense of community with
other people,” she says. “And it’s something
that we’re really missing in our daily lives.” ❚people, he says, balancing the effectiveness,
safety and cost in each case. “For some
patients, psychedelic-assisted therapy will
be very important. The question is, do all
patients need it?”
It is hard to see how psychedelic therapy can
fit with the industrial medical narrative, where
patients are passive recipients of a treatment
and contact time is limited. To find a home
for psychedelic therapy in our cash-strapped
public healthcare systems, some say the levels
of support that were offered in clinical trials
will have to be cut back. “The cost is really
substantial and it just becomes untenable,”
says Griffiths. “So how far can you back that
down? I don’t know, but I am concerned what
will happen as this rolls out.”
Carhart-Harris fears that this cost-cutting
approach will go too far. “What you’re left
with is something which is no longer safe and
effective enough,” he says, which would not
only harm those being treated, but also create
a backlash for the practice as a whole. As part
of his efforts to make sure that doesn’t happen,
Carhart-Harris opened a lab called Neuroscape
last year where he and his colleagues are
testing how to best guide a patient’s
psychedelic experience (see “The perfect trip”,
opposite page). There, he also hopes to identify
which subjective components of psychedelic
therapy are most beneficial or essential for
safety, and so cannot be stripped away.
Meanwhile, Watts says we should rethink
the relationship between our healthcareThomas Lewton is a science
writer based in London, UKUniversity of California, San Francisco, has
developed a model that pieces together the
many levels on which psychedelics act: from
molecular interactions to large networks of
brain regions to what they call the “relaxation
of beliefs under psychedelics”.
The idea, known as the “REBUS and the
Anarchic Brain” model, is rooted in the
predictive processing theory of consciousness.
This posits that we make sense of the world
by predicting what will happen based on past
experiences and comparing it with what
we actually sense. If there is a mismatch,
it creates a prediction error that is used to
update our prior beliefs. Together, they form
our perception of the world and ourselves.
Friston and Carhart-Harris suggest that,
in all this back and forth, certain prior beliefs
can become entrenched in an unhealthy
way, sometimes as a result of traumatic
experiences. “You become an expert in
whatever your pathology is: negative
ruminative thinking and being stuck in
your head in depression, for instance,”
says Carhart-Harris. “It is planted, and very
resistant to treatment.” What psychedelics
do, according to the idea, is make the brain
more sensitive to prediction errors, creating
a temporary anarchy that allows you to
remould your prior beliefs.
Difficult conversations
Anarchy, though, comes with risks. After all, we
may dig these mental ruts for self-protection
and stability. “The outcome isn’t inevitably
and unconditionally always one of healing,”
says Carhart-Harris. “When you’re opened up,
you’re vulnerable to the conditions that you
find yourself in.” Which is why Carhart-Harris
and others attribute so much importance
to the experience you get when you take
psychedelic drugs – and the therapy too.
The reality is that the psychedelic experience
is just one part of a demanding process.
Participants in clinical trials spend many
hours with at least one therapist before, during
and after the actual psychedelic experience.
“It’s really tender and caring, and tuned to
somebody’s need. But that story doesn’t get
told. It just doesn’t get translated into scientific
journals as it’s not part of their language,”
says Watts. “People see it as fluffy and soft,
but that is the mechanism.”
Olson acknowledges that psychoplastogens
don’t act as holistically as psychedelics, but
argues that it is “not an either/or thing”.
Different drugs will be needed for different
Psilocybin, which
is found in magic
mushrooms, has
relieved depression
in clinical trialsJURIS^ KRAUL
IS/
AL
AMY