Psychedelics, Psychotherapy, and What Actually Helps with Dr. Jason Luoma

Dan welcomes Dr. Jason Luoma:  a researcher, practitioner, and co-founder of the Portland Institute for Psychadelic Science; the Portland Psychotherapy Clinic, Research, and Training Center; & host of the Research Matters Podcast.

Dr. Louma sheds light on the the emerging field of psychedelic-assisted psychotherapy, exploring its potential to help individuals struggling with deep shame and self-hatred. He highlights the importance of context in administering psychedelics, the critical role of therapists in preparing clients, and the necessity of integrating psychedelic experiences into everyday life for lasting change. Dan and Dr. Louma also touch on the current state of research and the need for evidence-based practices in this innovative therapeutic approach. 

Special Guest: Dr. Jason Luoma
https://jasonluoma.com/

The Portland Institute for Psychadelic Science
https://www.pipsinstitute.com/

Jason's Research Matters Podcast
https://jasonluoma.com/researchmatters/

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Transcript

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[Music] Psychedelic assisted psychotherapy is one of the most talked about developments in mental health right now. But once you get past the hype, the clinically interesting question is this. What might these experiences actually open up for clients who feel deeply cut off from themselves and from other people? In today's episode, my guest helps us think about that question through the lens of shame, disconnection, and evidence-based practice. We talk about why experiences of safety, love, and connection might matter so much for certain clients, why the psychotherapy piece cannot be treated like an afterthought, and why this field needs stronger links between particular psychedelics, particular problems, and particular therapeutic processes. But first, if you're new here, I'm your host, Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia. Welcome to psychotherapy and applied psychology, where I sit down with leading researchers and pull out practical insights, peek behind the curtain, and hopefully have a little bit of fun along the way. If you're getting value from the show, do me a huge favor and subscribe on your podcast player, or if you're watching on YouTube, hit the like and subscribe. It's one of the simplest ways to support the podcast and keep these conversations coming. And quick shout out to my friend, Dr. Ken Miller, who generously shared a bunch of resources with me, and helped me come up with some of the questions I asked my guest in this conversation. This episode begins with my guest responding to my question about what first drew him towards psychedelic-assisted psychotherapy. So without further ado, it is my pleasure to welcome my very special guest, Dr. Jason Loma. I mean, the big door was reading some of the earlier studies where there were very large affect sizes, and where there was talk about very self-transcendent experiences, mystical experiences, and that as a potential mediator for their facts. And the reason why that was appealing to me is that my research has primarily focused on learning how to help people who experience deep shame, self-hatred, internalized stigma, and this kind of experience of feeling like the other and feeling separated from others. And between the impressive affect sizes and kind of thinking about my clients and thinking about how hard it can be sometimes to reach folks who are stuck in really deep shame. I imagine what would it be like for somebody who was stuck in this place where they feel so disconnected and worthless and maybe even not human. What would it be like for them to have an experience of all transcending connection and love, even for a moment? As many of my clients who have extreme levels of shame, they have never felt safe. They have never felt love and just chronically feel in this place of separation. And I just thought what would it be like to have even a taste of that just for a moment, some taste of what it feels like to feel safe, to feel loved, to feel bathed in this sort of estate. And that might open up doors. And so there was that combination of the research, the really interesting research combined with just imagining my way into those places and what that kind of experience might open up for people. And that started me down the path. So when you're saying that, I'm thinking about when I first learned about this research, which was more kind of a pop culture kind of way or this sort of this approach. And it was being done with like end of life folks. And I remember listening to somebody talk about this idea of like feeling, you know, sort of feeling connected with the world and with others and these sorts of things and this sort of facilitated a sense of meaning and sort of eased that end of life process. It like, is this is any of that stuff resonating with what you're talking about? Yeah, I would say the part about feeling interconnected. You know, I think folks at the end of life, some of them are dealing with shame as a fundamental problem. But one of the issues at least I would think is about this sense of a separate self, you know, the sphere about who am I when this ends and the terror of losing or but also things like regrets about how you lived that may tie into things like shame and guilt and these kind of self-judgmental or blaming processes. And a lot of those revolve around that sense of self, your story about who you are, who you are in relation to others, who we are in relation to the world. And this sense of separation that is our ordinary way of being, you know, the Buddhist really understand this very well, this kind of delusion from their perspective of how we're separate. And psychedelics can give people a really not everybody know all the time, but pretty frequently when they're used in a facilitated, you know, well constructed context container. They, the psychedelics can give people a taste of what it's like to have that sense, separate sense of self fall away or kind of become more porous and for us to have a sense of being part of something larger no longer separate. And that can also come along with with these kind of self-transcented emotions that often co-emerge with that like love, like compassion, like awe. These are all the kinds of things that often kind of also come along with that and those can be very powerful emotions for people. Both in the face of death and life reviews and people also dealing with this kind of intense separation and self-judgment that is more of what I focus on. Do you think about psychedelic assisted psychotherapy as like an extension of evidence-based psychotherapies or or more as a distinct modality with different underlying assumptions, training needs, etc? I mean, that's a good question. I would, I hope that it will become more integrated with evidence-based therapies and evidence-based principles. I think the current state of the field is that the therapy approaches that are usually used alongside psychedelics are not typically very tied to the evidence-space and they emerge more from kind of ideas emerging out of psychedelics, transpersonal kinds of ideas. Neither does don't have some worth but not so much tied to the evidence-based, there's this whole transpersonal psychology field. A lot of it emerges from that. A lot of it emerges from various traditions underground guiding traditions. We treat contexts, you know, all indigenous ideas, which of course have value as well but they're not scientific in the sense that we talk about it. And a lot of what is being done is emerging more out of those topics and also, the therapy approaches that are not considered as evidence-based. And so I would say at this point, a lot of the psychotherapy part of PAT is not very connected to an evidence-based and that's part of what I'm trying to do is strengthen that connection to try to develop treatments, develop approaches that do tie more to the evidence-based around psychotherapy and to try to collect processed data, data about psychedelics as to therapy and, you know, what do we observe as the change processes, you know, the crises are complicated and rich and multi-factorial but what do we observe and then what does that say about how we would design therapies or pick parts of therapies or select certain theories? What would it say about that? You know, why would we pick those in relation to certain psychedelics? Different psychedelics have different biological effects, they have different subjective effects. And so I would think that, you know, as a scientist, we'd want to think about, well, how do we take account, how do we take into account, like, what are the effects of that particular psychedelic? What are we trying to target? You know, whether we're thinking about that from a process-based perspective or a DSM perspective? And what are the, what does that science say about what tends to work? And how do we kind of put those together into a coherent model? And, you know, right now that's not being done a whole lot but that's some of what we're trying to do. And where I hope things would go the time. So, so what I would, I'm, where you'd like to see things go is that the practitioner who's using some sort of a existing evidence-based approach that they would be able to see, okay, there are certain situations in which my clients are really struggling with a certain facet of, in your case, you know, shame or certain experience or whatever, and that this could be a tool in my toolbox in the larger approach that I'm taking with this client to help them potentially get over that hurdle that they're struggling with. I don't think that was what I was saying, but I also hope that happens. I think I just, I do hope that that's one of the things that happens. I mean, assuming the data continues to hold up and we have good evidence, you know, and the, the, the study studies are still pretty preliminary, you know, we're, we really need to be cautious about overinterpreting where we are in terms of the strength of the evidence, but assuming they're, you know, this continues to work and we get clear and clear about where it works and where it doesn't. And we deal with all the safety issues. I do hope that clinicians see that as like this is a tool that they can make use of, they may not deliver it themselves, they may refer, etc. So I think a lot of this is going to be done probably inside specialty clinics and things like that, especially at first. But when there's FDA approval, assuming that happens. But what I was saying was I, there's, you know, when we're thinking about psychedelic assisted therapy, we have the psychedelic that's administered, but we also have the psychotherapy that goes along with it. And I was talking about how do we develop the most effective psychotherapies to go along with particular psychedelics for particular conditions. And that's the part where the evidence space isn't really coming into what the psychotherapy part it is at this point. It's pretty much growing up more out of a kind of traditions of, of, you know, I would say more less evidence-based traditions. I mean, they would say there's an evidence-based, to some extent, but, you know, they're definitely not the more the stronger ones. So semantics, therapies, for example, or, you know, internal family systems therapy, which, you know, claims to be an evidence-based therapy, but has one, you know, one trial with rheumatoid arthritis. You know, it's just not, it doesn't stand up to any scrutiny in terms of being evidence-based. So there, you know, things like that are quite popular, despite relatively, you know, limited evidence-based for those approaches. Yeah, not to go, we won't get off what attended here, but the internal families, this system's thing. I just, I learned about it for the first time a year or two ago, and I feel like it's like every second student that I have right now is just like that's very-- It's very popular. It's very-- It's very-- It's very-- It's very-- It's very-- Exploded. And I don't really know how or what, but-- Yeah, it's very, very popular despite, you know, very limited evidence-based. Yeah, what I also find that as I get older, you know, when people are talking about, oh, this new approach to this thing, no matter what they say, I'm like, we've already done that. Like, that's just like this, so that's just like this. So there is this like, get off my lawn thing that I experienced. Like, how much of this just me getting old and cranky? Yeah, I totally understand that, yeah. Yeah. So, how do you think about the psychotherapy part of the experience rather than simply juxtaposed with, here take this, you know, we're going to give you a room, here take this drug. Yeah. More like a medication. Yeah, so, you know, when we think about most psychiatric medications, we don't really attend much to the context in which they're taken, right? We just kind of assume that they operate the same, no matter how they're administered, no matter who gives them and how what they say, you know, that-- in theory matters. I mean, the reality of the research is that that does actually matter quite a bit, you know, and that's true across pretty much any psychoactive substance that the effect of the psychoactive substance is pretty heavily influenced by the kind of context, including, you know, how people think about it, how they can strew it. Like, the messages they have, like, who gave it to them? What the pill looks like? All of these sort of things affect the effectiveness of the drug. It's just kind of generally downplayed in psychiatry, but there's just hordes and hordes of studies that show this. Well, what--what's true about psych--psychedelics, is that is amplified even more? So, psychedelics are these substances, you know, fungi, plants, et cetera, that we're talking about it, but there are these substances that are just extremely sensitive to context. Their effects are just super, super sensitive to context. So, you know, I mean, pretty much most of us have met people who've taken psychedelics and not had things help them, right? Maybe they even had really bad things happen. And that's because--I mean, I would say a lot of that's because of the context of administration, the context of which they took it. And the research is quite clear that, you know, the context--I'm using that as a broad term, but we're talking about, you know, what happened before--how they're thinking about it. Was it with the therapist? Was it with the lump? Was it alone? Was it with friends? Was it out of festival? What was there--what else were they taking with it? Did they eat that day? You know, did they--how healthy were they at the time? They took it. All of these contextual variables--what's the cultural story behind how these drugs affect you? All of that profoundly influences the effect that psychedelics have on you. This is often referred to as set and setting. And I think that's where the psychotherapy comes in. So, the idea is that if we're importing psychedelics into a health care context, which is what we're doing, typically with psychotherapy, well psychotherapy is the kind of main container and where we try to influence that context. And that's called preparation. And, you know, and then just what we do during the dosing sessions and how we arrange that very carefully. And the best research that we have suggests that that context--all of those things that you do before and during administration greatly affect what's going to happen when the person, you know, ingest the substance. And so that's that's what the psychotherapy is for. And then you have the experience. If we're thinking--I'm a psychologist, so I'm mostly thinking about this more at the psychological, phenomenological level, not the brain, you know, chemical level. You can talk about it at that level too. But if we're thinking about it at that level, then you have--so you have the preparation, all this stuff that hopefully maximizes the chance that you're going to have a good outcome that's going to kind of move towards whatever goals you have. And then you have the experience and that, you know, you learn something there because you had a new experience and that's what happens when you have experiences, especially if they're news. Something changes, it affects you in some way. But it's a single time experience. And so oftentimes without really purposeful what we call integration afterwards, you know, it fades into history. One thing we know about psychedelics is that you often--most people will rapidly forget what happened in their psychedelic session. If they don't carefully record it somehow, write it down, journal, describe it, turn it into art, and things that somehow make it concrete and externalize it so they have these prompts that help them to remember it. If you don't do that, often you'll forget most of the journey, like within 12 hours. The next morning, a lot of it will be gone. And so with--and that's just the most basic part of integration would be just recording it and so that you can come back to it. But then there's all kinds of other things that you--you know, we want to do to help people to take that experience and somehow make it part of their life. You can hear that in the term integration, right? It's like it can either be this thing that's split off and separate and not really influence your life or can become integrated. So you take this experience that is unusual often in some ways and sometimes profoundly unusual. And the integration process is taking this thing and making it whole. So it's not split off, but it becomes part of the whole of you, including all of your behavior and your emotions and your thinking and your relationships. And, you know, this weird thing that happened, this unusual thing that happened now comes in and it shifts the gestalt, shifts the whole. And that's that integration process. And that's what the therapist is there for in the psychotherapy model. That's what the therapist is there for to help you take what happened in that dosing session and make it part of your life and take the things that are going to help your life. And then also the things that maybe aren't helpful, you might just leave aside or sometimes it can cause problems that then you need to they're challenging and they may be ultimately helpful or sometimes they're just challenging or harmful. And that's part of that integration process as well. So that's kind of the whole arc of psychotherapy. I would say and why we why we need it or why we use it when we're importing psychedelics into a healthcare setting versus just you know, bring somebody in, give them a drug and send them home. Right. And what you're saying makes complete sense to me. This idea of I'm going to have this experience which facilitates insight, whatever language you want to use. Right. And that it but it is going to be particularly unique. Right. And it's and and you're so you need to do something to I mean, I think the word integration is actually really nice word for it's intuitive in terms of like what you're doing. Right. So it's it's part of making it your part of your I mean, people could use words like schema core beliefs, whatever right. But like actually integrated into your experience of yourself and others in life have have has there been much work done looking at the integration process in psychedelic assisted psychotherapy. There's been a lot of thinking and talking and and some writing but in terms of the research, it's it's pretty limited. I mean, there aren't that many studies. Yeah. Right. I was just thinking that like that in terms of some of the process stuff, you know, even just having even just having clients, you know, journaling after their experiences, right. Like that they're, you know, particularly if it's prompted or whatever like that there would be a very reasonable ways to sort of study this sort of and highlight the importance of this integration. Yeah. And it's starting and people are doing that. But there aren't, you know, start that many people in this field. There's not a lot of funding and it's relatively new. So it's, you know, it's starting, but but there's not a lot yet. So how has it been? This is one of the questions that I had was that you know, I think one of the reasons that there aren't that many folks who are doing this work other than it being new, it's just everybody thinks, God, this would be a real pain in the ass. Like dealing with all the legalities, all the ethical challenges and that I mean, you know, your importance would think that you mean? Yeah. Well, and researchers too, right? Like your important I'm in Vancouver. We're in two of potentially the two most open places to do this sort of work in North America. Yeah. And I guarantee you there's lots of people who still in these places is like, oh, forget it. That's just like research is hard enough as it is. So I'm just curious what your experience of that has been? It does make it more costly. So I mean, there are many regulatory hurdles that you have to overcome and also contractual hurdles because there's always you know, your drug supplier that you have to sign all their contracts too. So there's not just the DA, there's the FDA. Sometimes their state regulated regulatory groups like special in California. And then there's the contracts with the company that's going to supply your drugs. All of those have to be negotiated and all of those influence your study design. And then the courses, the federal regulations that come out of the FDA that you know, impinge a lot in many ways. And oftentimes the safety requirements are really high. Like there's just a layer of safety stuff that is very, very, very conservative and adds a lot of expense. And so yeah, there are a lot of regulatory barriers. I think the risk barriers, I mean, if you're in the research context, I don't know that there's that much of a heightened risk really to be doing research in this area. I mean, you're pretty well, I don't know that's that much different than we're else if you're doing it all legally. But people who are doing therapy and underground, you know, legal, etc. Or in some of these gray areas. I mean, there is some more risk there. And I think that what that risk is, the uncertainty of that risk, not fully understanding it does impede clinicians for sure and getting involved. But the research is I would just say, you know, it just makes it complicated and expensive. And are you able? Right. One of the challenges with, I mean, doing any drug related research sort of big picture is that I have to make sure the drug that I'm giving people is the drug that I'm intending to give people. And it is the right dose, right. And like to the right, you'd be as exact as possible. This is exactly what the dose is because that's part of your design. That's incredibly important. Are you able to and your peers who are doing this work along with you able to find reputable companies and be able to get these drugs and feel? Yeah, that's all very well established at this point. Yeah, it's multi-million dollar laboratories using good manufacturing practices, which is this kind of specification. And it's all at the same level of quality as anything else, you know. And do practitioners have access to those as well? No, no, no, because there's no FDA approval. So it's all research only got it. Yeah. Okay. Yeah. So we're all in that pre-approval phase. So there's tiny quantities being manufactured, but there are labs set up, you know, cost millions of dollars to set them up. They set them up. And they're mainly produced for the pharma trials, right, to get through all the way through phase three and to the FDA. So they're all kind of betting on that. And then these companies will sometimes allow researchers to purchase some of the substance that they're using in their trials to for outside studies. But most of the trials or a lot of trials at least are in the pharma regulatory pathway, you know, where they're secretive and, you know, very locked down and not, you know, they don't, of course, they don't engage in anything like open science with the way those companies are functioning for the most part. It's your typical kind of pharma pathway, commercial pathway. So you're talking about, so when you're talking about the pharma pathway, what you're saying is like the pharma pharmaceutical companies developing a drug and then doing whatever is required so that they can basically sell it. Exactly. Yeah. Okay. And then there are scientists who are wanting to do research for scientific purposes, right? And that's like me and some of us will try to approach those companies and ask will you sell some of that to us to be able to use in our in our research in our clinical studies. And then, you know, they, some of the companies will do it. Sometimes it comes with a lot of strings, sometimes less strings attached. But that's one of the, you know, that's one of the costs is you have to negotiate these contracts with companies, for example. And when you say strings, like, like what? You know, they might want control over the research design in some way, some of the companies, I think this is less common these days, but some of the companies we want to have control over your data. So let's say, you know, you've found your head findings that we're not promising, they might want to suppress you from publishing it. You know, so some of the companies were doing that. I haven't heard about that happening recently, but it might still be happening, I don't know, but those are, those are some of the things that happen. It's far, it's standard pharma stuff, you know, they're the motor vistomic billions of dollars, right? So, right. They don't want to let you run a study that risks their investors money. Right. So they're engaged in a commercial enterprise, and where you're engaged in a scientific enterprise, enterprise slash a helping enterprise. Yeah, at least you hope, right? Yeah. That's the idea. It's hopefully it's altruistic and meant to be given away. Yeah. Right. So maybe this would be a good time to sort of chop these up a little bit, and, you know, not all of the drugs, but perhaps like the drugs that you see as either the ones that are most promising, the ones that are, that are sort of most under investigation. And I think most importantly, the ones that you've been most engaged with in research or you think are most promising. So just talk a little bit about them. Yeah. Like what do you, what are the big, you know, three or four that you see? And then I'm also really curious about like thoughts about how they work differently, because these aren't all the same. They do have different effects. No, they're quite different. Yeah. Depends on which, which class you're talking about. Well, there's ketamine, which some people consider a psychedelic. It's more of a dissociative. That's a wrap on our conversation. As I noted at the top of the show, be much appreciated if you spread the word to anyone else who you think might enjoy it. Until next time...[MUSIC PLAYING][Music]