Essentials: Psychedelics for Treating Mental Disorders | Dr. Matthew Johnson
Dr. Matthew Johnson discusses the science and therapeutic potential of psychedelics like psilocybin and MDMA, highlighting their ability to alter perception and self-identity for treating depression, addiction, and trauma in clinical settings. He also addresses microdosing efficacy and the dangers of recreational use.
Deep Dive Analysis
11 Topic Outline
Defining Psychedelics and Their Pharmacological Classes
Psychedelics and Altering Models of Reality
LSD, Psilocybin, and the Serotonin System
The Process of Psychedelic Clinical Trials
Letting Go and Trust in Psychedelic Experiences
Lasting Changes in Self-Representation from Psychedelics
MDMA: Dopamine, Serotonin, and Trauma Treatment
Bad Trips and the Gateway to Transcendental Experiences
Key Dangers and Risks of Psychedelic Use
Scientific Evidence on Microdosing Psychedelics
Psychedelics for Head Injuries and Neurological Repair
5 Key Concepts
Classic Psychedelics
These are substances like LSD, psilocybin, DMT, and mescaline, traditionally used synonymously with hallucinogens. They primarily act as agonists or partial agonists at the serotonin-2A receptor, profoundly altering one's sense of reality and self.
Altering Models
Psychedelics are described as profoundly altering the brain's predictive models of reality, including the sense of self. This can involve dissolving deeply held beliefs or expectations about how the world or one's identity operates.
Entactogen/Empathogen
These terms describe MDMA, suggesting its ability to help individuals 'touch within' and connect with their emotions (entactogen) or to foster empathy towards others (empathogen). MDMA stands in a class by itself due to these unique effects.
Dishabituation
This refers to the psychedelic effect of breaking down the brain's natural tendency to habituate to constant stimuli. It allows for a renewed, often profound, perception of everyday objects or sensations that are normally filtered out.
Self-Representation
This concept describes the fundamental way a person holds their sense of self and their relationship to the world. Psychedelics can induce persisting changes in self-representation, helping individuals redefine their identity beyond limiting labels like 'smoker' or 'depressed person'.
7 Questions Answered
A psychedelic substance is broadly defined by its ability to profoundly alter one's sense of reality and acutely alter the sense of self. Pharmacologically, this can span different classes, including classic psychedelics (serotonin-2A agonists) and NMDA antagonists.
Classic psychedelics primarily act as agonists or partial agonists at the serotonin-2A receptor. While the exact mechanisms are still being explored, this interaction leads to profound alterations in perception and challenges pre-existing mental models.
The process involves several days of screening, including psychiatric interviews for disorders like schizophrenia or bipolar disorder, and cardiovascular screening. If qualified, participants undergo preparation to build rapport with guides and learn about potential psychedelic effects, followed by the session day itself.
Psychedelics can lead to persisting changes in self-representation, altering how individuals fundamentally view themselves in the world. This can manifest as a renewed sense of agency or a shift in identity, allowing people to overcome long-standing issues like addiction or depression by 'deciding' to change.
The two main dangers are severe psychiatric illness (like schizophrenia or bipolar disorder) which can be exacerbated, and the 'bad trip' experience. Anyone, even psychologically healthy individuals, can have a bad trip characterized by strong anxiety, fear, or a sense of losing one's mind, especially with high doses or in non-ideal environments.
Currently, peer-reviewed studies with high credibility have not shown a benefit for microdosing. Research has ranged from finding no effect to slight impairment in tasks like time estimation, and no studies have yet modeled the specific microdosing regimens claimed by aficionados.
There are anecdotes and rodent research suggesting psychedelics might promote neuroplasticity and brain repair, potentially improving cognitive function after head injuries or stroke. This is an exploratory area, with ongoing research aiming to assess their ability to treat depression stemming from head impacts and to observe changes in brain structure.
15 Actionable Insights
1. Prioritize High-Dose Psychedelic Therapy
For profound and long-lasting changes in conditions like depression or addiction, focus on high-dose psychedelic experiences, which have shown sustained improvements months to over a year later.
2. Reshape Your Sense of Self
Understand that psychedelics can profoundly alter your self-representation and identity, allowing you to step out of limiting models (e.g., “I’m a smoker,” “I’m a failure”) and gain a new sense of agency.
3. Supercharge Personal Agency
Leverage the profound sense of agency gained during a psychedelic experience to make fundamental decisions and commit to behavioral changes, such as quitting an addiction or altering self-defeating thoughts.
4. Surrender Control During Psychedelics
To facilitate a meaningful psychedelic experience, consciously let go of the need for control and allow the experience to unfold naturally.
5. Surrender to Psychedelic Reality Shifts
When facing reality-shattering moments during a classic psychedelic experience, choose to completely surrender to it rather than trying to resist or ‘hang on,’ as resistance can lead to a ‘bad trip.’
6. MDMA for Trauma Treatment
For trauma treatment, MDMA may offer a lower chance of experiencing an extremely challenging ‘bad trip’ compared to classic psychedelics like psilocybin or LSD.
7. Explore Psychedelic Clinical Trials
If you have a diagnosable issue or are a healthy normal, you could explore participation in clinical trials for psychedelics, as issues often come to the surface even in healthy individuals.
8. Pre-Psychedelic Health Screening
Undergo thorough psychiatric and cardiovascular screening before a psychedelic experience to identify potential disqualifying conditions like severe psychiatric illnesses (schizophrenia, bipolar mania) or heart disease.
9. Prepare with Guides & Expectations
Before a psychedelic session, build trust and rapport with your guides and receive a comprehensive explanation of the wide range of possible experiences to minimize surprises.
10. Welcome All Emotional Responses
During a psychedelic session, welcome and fully express all emotional responses, including intense ones like crying hysterically, as they are part of the therapeutic process.
11. Avoid Psychedelics with Severe Illness
Do not use psychedelics if you have severe psychiatric conditions such as psychotic disorders (schizophrenia) or mania associated with bipolar disorder, as these experiences can be profoundly destabilizing.
12. Mitigate Psychedelic “Bad Trip” Risk
Be judicious about psychedelic use, as anyone can experience a ‘bad trip,’ especially with high doses or in less than ideal environments; a safe container is crucial.
13. Caution on Microdosing Psilocybin
Understand that current peer-reviewed studies do not support claims of microdosing psilocybin for improved creativity, cognition, or sustained mood, and some data suggest mild impairment, though specific long-term protocols haven’t been fully studied.
14. Have Medical Safety Protocols
Be aware that physiological responses like increased pulse and blood pressure can occur during a psychedelic session, and ensure medical protocols (e.g., nitroglycerin for high blood pressure) are available to manage them safely without disrupting the experience.
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5 Key Quotes
All of the so-called psychedelics across these distinct classes that I can talk more about, the way I put it is they all had the ability to profoundly alter one's sense of reality.
Dr. Matthew Johnson
I mean, I think of these as – psychedelics is profoundly altering models. You know, we're all – you know, we're prediction machines, and that's large – so much of that is top-down, and psychedelics have a good way of, you know, loosely speaking, dissolving those models.
Andrew Huberman
The letting go of control is an interesting feature, actually, because one of the common themes of good psychoanalysis or psychotherapy of any kind is that there's a trust built between the patient and the analyst.
Andrew Huberman
My God, it's like, I can really just decide like flicking off a bike. I can decide not to smoke.
Dr. Matthew Johnson (quoting a participant)
I'm microcynical, if you will, about this term microdose.
Andrew Huberman