Neurological insights into psychedelic-assisted psychotherapy

Neurological insights into psychedelic-assisted psychotherapy


Psychedelic plus psychotherapy art illustration

New research suggests how drugs can lead to rapid and lasting change.

Although the brain’s ability to change is usually slow, it can be quickly enhanced through psychedelic-assisted psychotherapy. Use materials such as PsilocybinThis treatment leads to significant changes in the brain, which may help in treating mental health. However, drug-related experiences may be unpredictable, and their therapeutic use is still under researched and regulated.

The human brain can change – but usually slowly and with great effort, as when learning a new sport or foreign language, or recovering from a stroke. Learning new skills is linked to changes in the brain, as shown by neuroscience research in animals and functional brain scans in humans. Presumably, if you mastered Calculus 1, something is different now in your brain. Furthermore, motor neurons in the brain expand and contract depending on how often you exercise, a neurological reflex of “use it or lose it.”

Desire for rapid change of brain

People may want their brains to change faster, not only when learning new skills, but also when overcoming problems such as anxiety, depression, and addiction.

Doctors and scientists know that there are times when the brain can make rapid and lasting changes. Most often, these conditions occur in the context of traumatic experiences, leaving an indelible mark on the brain.

Positive transformative experiences

Conversely, positive experiences, which change one’s life for the better, can happen just as quickly. Think of a spiritual awakening, a near-death experience, or a feeling of awe in nature.

Sociologists call events such as these psychological transformative experiences or pivotal mental states. For the rest of us, they are thorns in the road. Presumably, these positive experiences quickly change some “wiring” in the brain.

A thorn in the concept of road art

A transformative experience can be a crossroads, changing the path you are on.

How do these rapid and positive transformations occur? The brain seems to have a way of facilitating accelerated change. And here’s where it gets really interesting: psychedelic-assisted psychotherapy seems to take advantage of this natural neural mechanism.

Psychedelic-assisted psychotherapy

Those who have had a psychedelic experience usually describe it as a mental trip that is impossible to describe in words. However, it can be conceptualized as an altered state of consciousness with distortions in perception, altered sense of self and rapidly changing emotions. There is supposed to be a relaxation of the brain’s higher control, allowing the brain’s deeper thoughts and feelings to emerge into conscious awareness.

Psychedelic-assisted psychotherapy combines the psychology of talk therapy with the power of the psychedelic experience. Researchers described cases in which people reported profound and personally transformative experiences after a single six-hour session with the psychedelic psilocybin, taken in conjunction with psychotherapy. For example, patients distressed by the progress of their cancer soon felt unexpected relief and acceptance of the impending end. How does this happen?

Neural mechanisms of change

Neuroscience research suggests that new skills, memories, and attitudes are encoded in the brain by new connections between neurons — like tree branches growing toward each other. Neuroscientists even call the pattern arborization.

Nervous spine

Neuronal spines are small protrusions along the spreading branches of a nerve cell. Credit: Patrick Pla via Wikimedia Commons, CC BY-SA

Researchers using a technique called two-photon microscopy can observe this process in living cells by following the formation and retraction of spines on neurons. Spines are half of the synapses that allow communication between one nerve cell and another.

Scientists have believed that permanent formation of the spine can only be achieved through focused and repetitive mental energy. However, a laboratory at Yale University recently documented rapid spine formation in the frontal cortex of rats after a single dose of psilocybin. The researchers found that mice given the mushroom-derived drug experienced a 10% increase in spine formation. These changes occurred when examined one day after treatment and continued for more than a month.

Tiny spines along the branches of nerve cells, crucial messages

Tiny spines found along the branches of a nerve cell are an important part of how one nerve cell receives a message from another. Credit: Edmund S. Higgins

The role of anesthetic molecules

Psychoactive molecules primarily alter brain function through receptors on nerve cells. The 5HT serotonin receptor, which is best known for its modulation by antidepressants, comes in a variety of subtypes. Psychedelics such as DMT, the active chemical in the psychedelic plant ayahuasca, stimulate a type of receptor cell called 5-HT2A. This receptor also appears to mediate states of hyperplasia when the brain changes rapidly.

The 5-HT2A receptors activated by DMT are found not only on the surface of the nerve cell but also inside the nerve cell. It is the 5-HT2A receptor located within the cell that facilitates the rapid change in neuronal structure. Serotonin cannot pass through the cell membrane, which is why people do not have hallucinations when taking antidepressants such as Prozac or Zoloft. On the other hand, cannabinoids infiltrate through the cell exterior and modulate the 5-HT2A receptor, stimulating dendrite growth and increasing spine formation.

This is where this story comes together. In addition to being the active ingredient in ayahuasca, DMT is an endogenous molecule that is naturally synthesized in the brains of mammals. As such, human neurons are able to produce their own ‘drug’ molecule, although probably in small quantities. It is possible that the brain uses its own endogenous DMT as a modulator – such as when it forms dendritic spines on neurons – to encode pivotal mental states. Psychedelic-assisted psychotherapy can use this naturally occurring neurological mechanism to facilitate healing.

Cautionary notes

In her essay collection These Precious Days, author Ann Patchett describes eating mushrooms with a friend who was suffering from pancreatic cancer. The friend went through a mysterious experience and came away feeling deeper connections with her family and friends. Patchett, on the other hand, said she spent eight hours “slicing up snakes in a black cauldron of lava at the center of the Earth.” It felt like death to her.

Psychedelics are powerful, and none of the classic psychedelics, such as LSD, have been approved for treatment yet. The US Food and Drug Administration in 2019 approved ketamine, in combination with an antidepressant, to treat depression in adults. Psychedelic-assisted psychotherapy with MDMA (often called ecstasy or molly) for PTSD and psilocybin for depression is in phase III trials.

Written by Edmund S. Higgins, MD, affiliated associate professor of psychiatry and family medicine, Medical University of South Carolina.

Adapted from an article originally published on The Conversation.Conversation

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