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LSD-assisted psychotherapy for anxiety with a life-threatening disease (sagepub.com)
119 points by aethertap on Nov 17, 2014 | hide | past | favorite | 71 comments



LSD is widely understood to be benign when used in a controlled setting (even recreational aficionados' discussions of it focus heavily on the importance of establishing a safe context under the rubric of 'set and setting'). However I think it will take another 15-20 years to see it legalized; drug warriors will harp on the crazy-making potential while paranoids will dredge up fears of gubmint mind control - both of which have roots in reality, since LSD is a powerful hallucinogenic that can lead to confusion or injury if consumed in excess or carelessly, and since the CIA did experiment with psychedelic drugs on unwitting subjects back in the 1960s.

Even limited rescheduling allowing medical treatment would be a good thing IMHO, but the reality of the US medical system is such that that the <$5 dose of LSD is likely to be dwarfed by a $3,000+ bill for clinical oversight and additional fees for administrative compliance with drug scheduling protocols.


As someone with some experience, and who ran around in counterculture circles where such things were common years ago, I would offer a more tempered view.

LSD is not chemically addictive and is basically non toxic in that there is no known LD50. On a pure physical level it is very safe. Psychologically the reality is more mixed. If used in moderation with some sense of responsibility, it can be neutral or even beneficial. But "acid casualties" really are a thing. Heavy, irresponsible abuse of LSD and similar drugs can really destroy a person's mind. I've seen people who really abused these things and sort of never came back.

While there appears to be no conventional toxicity, it would not surprise me to learn later that there is some potential for harm at the neurological level. If so it might be more a result of trauma or stress due to the effects of abuse than direct toxicity. In any case the abusers I saw did seem mentally impaired, in some cases never recovering.

So when someone asks me about these things, I always tell them to do a lot of homework on them and to be very careful. I say the same thing to people who want to play with stimulants or nootropics. In general extreme care and self awareness should be exercised when putting anything into your body, especially if it affects your mind.

Most of the people from the psychedelic world who seem to have their heads screwed on seem to advocate their use rarely, under careful setting, with at least one other experienced person that you trust, and a lot of introspection and time in between to integrate the experience.

Anecdotally harm seems to occur when recklessness precludes integration, as if not processing the experience leads to some kind of overload and trauma. It may be a form of burnout leading to something like PTSD, which can actually manifest physical brain damage. Look up some of the stuff on child abuse and PTSD victims and neurological effects.

On the upside, I have seen dramatic evidence that these things can lead to deep positive breakthroughs. They might also be able to act as "steroids for creativity," allowing extreme feats of lateral integration that are hard to even imagine in ordinary consciousness. These compounds are fascinating and powerful tools that should be studied with care. They should neither be marketed recklessly as enlightenment in a pill or ignorantly banned by fear-mongering reactionaries.


As much as I love LSD, I have no idea in what capacity it could possibly be legalized, other than in heavily controlled settings.


DMT is easily tolerated by the body and only lasts 10 minutes. There's no hangover type effect and it doesn't last hours. It's also infinitely more intense, with an overwhelming sense of love and comfort.

LSD is like riding a bicycle but DMT is more flying in a spaceship that actually travels through dimensions. There seems to be a much lower or non-existant risk of a bad trip. (Unlike the version you drink, which can take you to hell and back.)


> an overwhelming sense of love and comfort.

This is exactly how I would describe my experience with DMT. Once it hit me, I immediately felt as if nothing bad could ever happen to me. All tension, physically and mentally, was immediately removed from my body. Pure comfort and excitement. I'd never felt that level of calmness in my entire life even if everything that was happening to me visually was crazy.


I'm curious if you or the grandparent poster have encountered the DMT gnomes/elves? Apparently it's not uncommon on DMT to have the gnomes/elves appear and tell you the secrets of the universe or something. They're described here by Terence McKenna:

http://en.wikipedia.org/wiki/Terence_McKenna#Machine_elves

(And now I have to listen to Shpongle's Divine Moments of Truth song, which perhaps coincidentally clocks in at a touch over 10 mins long. https://www.youtube.com/watch?v=s1-2d6wxudE )


I have numerous times. They come in varying degrees depending upon how much you smoke and the manner in which you smoke (its a bit tricky to figure it out at first). The first "level" (if you will) is a sort of cartoonish kaleidoscope of cards or images, almost 2d. The second level is when you loose the notion that you are on your couch; the experience becomes totally immersive and "you" can no longer be separated from "it". People describe it as a room, but this description is far, far, far from accurate. The third level is when you quite literally come in contact with some kind of extraterrestrial or extra-dimensional entities (these are the only words I know to describe what they are). They seem to be infinite in number because no experience is ever the same, with each contact being immensely different. One common theme however is telepathy; communication most certainly takes place, but it is not with words. Its like immediate meaning and understanding without the limitation of time. It has happened to me during every single encounter and has led me to have a much greater understanding of post linguistic possibility.

Another thing I would like to add is that DMT is the only psychedelic that I know of (maybe mushrooms can hit this place at certain very high dosages) where open-eye reality can be completely transformed, when looking around you are no longer laying on your couch but in some kind of pod and the pipe you are holding suddenly contains a beautiful jewel and is embroidered with some kind of alien language and where, with each subtle movement of your eyes the pod you find yourself in transforms into different shapes with different panels, each wired to your optic nerve. Holy fucking shit people: what is going on out there? More than meets the eye. Its remarkable and weird and beautiful and scary and the greatest of mysteries.

Apologies for the total insufficiency of my words. Everyone -- everyone -- should try it sometime, and particularly atheists and general skeptics. Your faith in your own certainty will be dismantled immediately and forever. The experience is anything and everything but a mere hallucination; its like turning the frequency on a dial and suddenly hitting some kind of super powerful organic SETI message that knows you are going to arrive.


I have never ingested DMT, so thanks for the interesting write up. Salvia Divinorum is another psychedelic that might can produce incredibly strong visuals. It is the most potent naturally occurring hallucinogen, and produces far stronger hallucinations than LSD or mushrooms. As with DMT it is very short lived, the effects lasting around 5-10 minutes. It was used in shamanistic ritual, so perhaps it also offers the same spiritual/metaphysical properties. However my environment wasn't really ideal for introspection so I didn't experience that side of things.


Salvia == absolute abject animal-like terror. Wouldn't recommend


You just described the plot of Contact with Jodie Foster :)


I know! I was even going to mention that in my post.


Not that I can remember. Although I really do want to experience it. There are parts of my experience I can remember quite vividly and other parts that are just blank gaps in between.


People I've seen use DMT have met 'elves', 'machine beings' playful spirits, and all kinds of other entities.


I usually describe the body/mood response from DMT as similar to that of some mellow MDMA (without any speedy additives).

When it hits me (DMT) I feel a warmth spread throughout my entire body. I've done DMT somewhere between 300-500 times, though it's been years now.


>some mellow MDMA (without any speedy additives).

so, comparable to MDA?


I did not get an overwhelming sense of love and comfort (5-MeO). I got the opposite. The experience is what taught me that I shouldn't personally be dicking around with my consciousness that way.


If you ever change your mind in the future, I think you would have a more positive experience with N,N-DMT. DMT is very similar to serotonin and trytophan so perhaps that's why it's well tolerated by the body.

With a breakthrough dose (e.g. 4 hits), you simply cannot believe what is happening as it's happening. It feels like you are in a dimension of hyperspace with a sensation of intelligent forces communicating with you; laughing at you in a ultra high definition resolution of colors, geometric shapes and positivity. It feels more real than reality. Whatever it is, it is certainly a grand mystery of life.


My understanding is that 5-MeO DMT is very different from DMT. Have you tried both?


Nope. That's why I mentioned the variety, though.


5-meo-dmt is a completely different beast than N,N,DMT.

For one, while 5-meo-dmt is endogenous to many organisms (Bufo Alvarius/Colorado River Toad/Sonoran Desert Toad being one of them) it is not found in the human brain.

It's also said to be more intense in an uncomfortable direction than DMT.


FYI, DMT production in the human brain is not supported by any scientific studies. There were studies that found negligible amounts in rat brains, but those have not been successfully duplicated. So it's possible that it's there, but it's commonly stated as a fact when in reality, we just don't know.


DMT production (or even existence) in the brain hasn't been conclusively demonstrated, but it has been found in other human tissue, so it is produced somewhere in the body. Dr. Rick Strassman (who has written books on specifically this subject) seems to make a good case for its production in the brain, but you're right that it isn't accepted as scientific fact yet.


as Doug Stanhope once said: "There's only two types of people who are against drugs: the people who have never done drugs and the people who really sucked at doing drugs."

Try again with straight DMT.


What did he say about the type of person who can't hear anything negative about any drug without trying to turn it into a debate about prohibition? Are they just sort of intuitively good at psychopharmacology? If so, I'll get right on that recommendation.


it appears you classify yourself as the "sucked at doing drugs" category.

As to your question, I don't think you've listened to much Stanhope if you're asking that.


Whoosh.


No, he's just really good at doing drugs


"an overwhelming sense of love and comfort"

Funny, I would describe my experiences with meditation using exactly the same words. Combined with really wonky visual effects.

(with meditation in the zen-buddhist context I think this perception alteration is probably just considered a potentially harmfull side-effect.)

I see no harm in chemically induced warmth and comfort but chemicals are not the only thing that can make us experience altered states of perception and relaxation.

I would definetly understand why this would be beneficial in a therapeutic setting.

We are probably still laking in proper terminology but this anxiety reduction caused by these techniques is something that really should become part of the general medical practice. I think some people become substance abusers because they seek this release from their inner turmoil and loose themselves in excess or desperation.

I would definetly understand why this would be beneficial in a therapeutic setting.


I have been to a number of indescribably beautiful alien places with DMT, places that have completely shaken my notion of what is, but I have most definitely met beings that could only be described as pure power and evil. Tred lightly


You don't seem to know what you're talking about... the chance of bad tripping with DMT is about the same as with other psychedelics. It's just waaay more intense and has a shorter duration. And actually, most people argue that Ayahuasca is more likely to give you an easy ride than pure DMT, which can be "just too crazy".


Absolutely agree. I've taken ayahuasca dozens of times, and am pretty comfortable with it (not to say I don't still experience at least a momentary frisson just before drinking most every night), but I still have tremendous trepidation about straight DMT.

As a friend who's done both described the latter, "Load universe into cannon, aim at head, and fire."


Arguably the short duration helps quite a bit... bad trips don't start instantly....they are more of a gradual building of anxiety that builds to a sort of panic attack.


If you smoke DMT and don't have a breakthrough you may feel a lot of discomfort, which may cause anxiety. That's exactly what happened the first time I tried DMT, and I was already pretty experienced with other psychedelics...


You are absolutely right and I should had said a proper or significant dose. A small dosage of DMT can be very uncomfortable and cause anxiety. But if you take 3-4 hits, or otherwise get a proper dosage, I have never experienced a negative result.

And, as I said in my original comment, drinking DMT in Ayahuasca can take you through a hellish experience.


corroborating the grandparent's post. I've personally done DMT more than 10 times, and haven't experienced a bad trip yet. I've had bad trips on mushrooms, several, in fact. Not a single bad trip on DMT.


Well, I have the exact opposite experience. I've always had pleasant trips with shrooms (over 10 trips) but at my first DMT trip I experienced some anxiety (didn't break through)... nothing traumatic but I could imagine it going much worse. Because of that I went on to read "The Psychedelic Experience" as it contains lots of advice on ego death trips, and if you read it you'll realize bad trips on DMT are just normal.


A guy I served with credits weekly shroom trips with helping him deal with his PTS symptoms. He was not exactly a tree hugging hippie when we were both in uniform so it's good to see him being so open minded about solutions to his problems.

The utility of psychedelics in therapy has been a "known quantity" to the medical community since the 1950's at least, so it's good to see that mainstream acceptance of such is gaining ground.



It's awesome that these kinds of studies are finally able to happen again.

Scientists had already determined the usefulness of LSD and other psychedelics in Psychotherapy of this sort back in 1950 (http://www.psymon.com/psychedelia/articles/busch.htm), but since the controlled substance act in 1970, it hasn't been possible to do any real science in this area. Good to see this finally starting to change.


SET AND SETTING. IT IS ALL SET AND SETTING.


As a person who has an anxiety problem I'd be worried about having a bad trip. I have never done LSD though..


Having a bad trip is definitely a possibility, but it's not something that's very predictable, as the entire experience is completely foreign. You can significantly reduce the chance of a bad trip by putting yourself in a comfortable and safe environment, however.

Also, I've found "bad" trips to be just as valuable psychologically as "good" ones, though they can seem life threatening in the moment.


The benefit of using LSD in a psycho-therapeutic environment is the opportunity to work through the anxiety that comes up during the trip.

For a lot of people, an emotional breakdown can act as the catalyst for a life changing emotional breakthrough.

edit to add: 'bad trip' is a subjective term.


You're certainly right in the subjective use of "bad trip". I think the term has been applied to maybe too wide a spectrum of psychedelic experience, I've usually seen it manifest itself as one of these two:

A. An unpleasant experience where the user is forced to confront uncomfortable realities about themselves and the "world". This is usually a feature of most trips, it could last a few minutes or hours. This can often be a net-positive experience as the user navigates their way out of it and realize the baselessness of some of their more troubling assumptions.

B. An experience where the user entirely loses touch with "reality". Sometimes this resembles the symptoms of a very strong panic-attack. It includes feelings of imminent death or the feeling that the user has permanently altered their psychology forever or has gone irreparably insane. This can last for the entire duration of the trip and have permanent, lasting effects long after the drug has worn off.

As someone mentioned further up the thread, "A" can sometimes spiral out of control into "B".


Just an anecdote... I've had several "A" style bad trips, and they all ended up being net-positive for me. I've had one "B" style bad trip in the late 90s, and still haven't gotten 100% over it.


I have an anxiety problem and I did LSD before it was diagnosed (but not before I had been suffering anxiety issues for years).

My trip was pretty normal, but I freaked out in the weeks and months afterwards. I knew next to nothing about LSD, and managed to whip myself up into an anxious (also ignorant) frenzy about the dangers of the drug, the possibility that I would now go insane, etc. These were not pleasant or productive times.

So, two bits of advice for anyone with anxiety thinking about hallucinogens:

- Know the facts.

- Be aware of possible negative interactions with popular meds (e.g. SSRIs, etc.)

Note: I haven't done LSD again. I'd like to try Ectasy, but I'm on meds for anxiety/depression that don't mix well with MDMA.


I would try to find pure mdma, plan on getting off your meds a couple weeks in advance, and then give it a spin with a friend you can really talk honestly with. I've known two people who have completely eliminated their anxiety after one dose which subsequently cured their depression (address the cause (anxiety) and the problem goes away).


Shouldn't be a problem in a safe environment, specially when you're well informed about what's going to happen. Most bad trips are due to fear of the unknown, too high dose or a bad environment.


Lower dose = lower probability of having a bad trip, FWIW.


If you have a problem with anxiety, don't mess around with this stuff without the oversight of a professional.


The term "professional" should be taken euphemistically here. You will likely have a much better time with someone highly experienced with hallucinogen usage rather than a scientist in lab conditions.


I would be concerned that a lot of people feel like they're a lot more capable of tripsitting someone with an anxiety disorder than they really are.


That may be true, but scientific and academic credentials do not qualify anyone any more than direct experience. Would you trust a spelunking guide that has 100 trips down a cave, or someone who got a PhD in spelunking without taking any actual trips?


Are those my only two choices? I might instead choose not to cave at all.


No, they aren't. I was responding to the implied meaning that you only have one choice, that being professionally trained medical/scientific experts.


On hacker news we are only allowed binary decision making no matter how analog the situation, but obviously the optimum solution is to talk to / work with both, although I'm guessing they aren't going to literally work with each other at the same moment. Which is really too bad. I could totally see a GP, Specialist, and Patient relationship developing.


smoke an indica first to lower your anxiety.


Does weed actually lower anxiety? I've heard the opposite. Sorry, total nooob here :).


I think a lot of it depends on the individual and I've been told several times that the variety and strain can make a big difference.

Anecdotally, it used to make me relaxed and only occasionally a little anxious if I had to unexpectedly play "straight" while under the influence.

Nowadays it's like a 50/50 shot whether it will just give me a "buzz" or whether it will make me incredibly anxious. I've mostly chalked it up to the stronger stuff I'm more likely to come across now that I'm not a broke college kid buying the cheap stuff but I also think a large part of it is that I'm a different person that I was 15-20 years ago and perhaps I just don't react as well to it anymore.

Either way, I mostly abstain these days except when I'm in a situation where the potential for anxiety is incredibly low.


I tried the cbd type of weed that's suppose to be good for anxiety and found no benefit. I'll note the dispensary did not have any means for testing for chemical components, other than a pen that detects counterfit currency. I found for my constitution less is definetly more. I found it slightly helped with depression--sometimes--at a very low dose(like 1/2 a small puff). I sometimes think most of the benefits claimed are Placebo? That said--it's easy to get a prescription for. In the Bay Area, getting a doctor to write a script(good for one year) cost $100.00. When I got my script, the doctor was seeing a patient every 3-5 minutes, and only took cash. What a business?


Honestly depends on the strain. There are three types of Cannabis (Sativa, Indica, and Ruderalis) which all have different psychoactive effects.

If you smoke a Sativa-dominant strain, you will be lost in your own head for a good while, and will experience paranoia/anxiety as a common side-effect.

Cannabis Indica, however (White Widow, Hash Plant, etc) is a full-on couch-lock body high. I have high anxiety, and after smoking a bowl of indica, I'm about as mellow as can be.


YMMV. When I used to have serious anxiety, it would sometimes make me have a full on panic attack. I don't know if it was indica or sativa.

But I know people who have sworn by it as a treatment.

Now that legalization is becoming a reality, maybe we'll get better science on this issue and find out the what, when, how and whom of its effects on anxiety.


I'd put money on your anxiety coming from a sativa. I've had Sativa panic attacks before (even on a 50/50 hybrid) from half a joint, whereas I could smoke massive bowls full of indica and not have a problem.


Related topic: I just finished reading "Waking Up: A Guide to Spirituality Without Religion" by Sam Harris and it has become my book recommendation for people that don't understand psychedelics or meditation. Sam talks about both in the most lucid way possible. Highly recommended!



IMHO religion has little to do with spirituality. I'm not necessarily saying it's all bad, just that it's all about politics, philosophy, enforcing a certain set of norms to allow cooperation, etc. The relationship of religion to spiritual experience is along the lines of the relationship between space themed fiction like Star Trek to actual space flight.


I would rephrase this as that religious practices of unfamiliar religions can have very little relationship to an individuals spirituality. Obviously some people are very strongly tuned to the religious practices of their religion.

Large organizations such as churches all have politics and structure beyond the "core service" they provide. And as social groups they evoke tribalism, cliques, etc, etc. The religious services are one aspect of these organizations that are designed to offer spiritual experiences to the congregation. The organization specifies the framework for these events. The fact that the organization has other aspects as well does not mean it would not fulfill this core service. Does it fulfill it, and to whom, is another question entirely.

We probably still lack proper psychological vocabulary to discuss spirituality as a phenomenon of human psyche in disconnect from the metaphysical frameworks that religions offer.

As an atheist, I feel "spirituality" - in this context it means perhaps most of all a certain mood and a state of mind - is very important to me. I just don't connect it to any religious framework. I understand that you mean that organized religion does not necessarily have anything to do with spiritual experience but I still think it's quite incorrect to make this into a generalization.


Religion is a classifying term for a variety of cultural languages in which the vast majority of spirituality has been framed throughout history. Saying they have little to do with one another is, at best, uninformed.

One does not necessitate the other, but that does not mean they are anywhere near as dissociated as you suggest.


> The relationship of religion to spiritual experience is along the lines of the relationship between space themed fiction like Star Trek to actual space flight.

If you look at actual definitions of the word 'religion' used by academics who study religion, there is actually a pretty tight relationship. E.g.

http://www.youtube.com/watch?v=lM-yinhpOgQ


Here's the first chapter of the book, read by Sam Harris himself: https://soundcloud.com/samharrisorg/waking-up-chapter-one


just ordered this. thanks for the recommendation!




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