The Critical Nature of Therapy in Psychedelics: ACE Outcomes
Much of the narrative around psychedelic medicine places emphasises the drugs more than the accompanying psychotherapy. But with therapy being a critical component to psychedelic research, perhaps it’s time we reassessed the rhetoric to that of psychedelics aiding therapy, not the other way around.
Psychotherapy in a nutshell
Psychotherapy is a broad term referring to mental health treatment that involves talking to a specialist, such as a psychiatrist or a psychotherapist. Psychotherapy aims to help patients better understand their condition, moods, thoughts, and behaviors so that they can control these aspects in their everyday lives better.
More than three-and-a-half thousand years ago, references to “healing through words” were used by the Ancient Greeks and Egyptians, highlighting the recognition of talk therapy as important deeply embedded in human culture, and there is no doubt psychotherapy is useful. One recent review found psychotherapy had a 60% success rate in mental health patients, 10% higher than the effectiveness rate for common antidepressants.
Source - Ancient Greek medical and psychotherapeutic practice
Issues with psychotherapy alone
A pitfall of psychotherapy is that the process can take years. The patient first needs to build trust with the psychotherapist. Then, through gradually building a strong therapeutic alliance, a patient might be able to uncover some of the traumas at the roots of their current behaviors and thought patterns. By understanding these behaviors, there is then a long process of learning to change the behaviors, in such a way that is more conducive to a healthier lifestyle and mindset.
Often patients with debilitating mental health disorders don’t have the means to pay for years of therapy. And for some patients, traumas are help so deeply within their subconscious that talking therapy alone is not powerful enough. Which is where psychedelics come in.
Source: a typical psychotherapy session
Why use psychedelics?
The term “psychedelic” derives from the word “mind-manifesting.” It was recognisd by early psychedelic pioneers, such as Stanislov Grof, that psychedelics can bring to the surface subconscious thoughts, emotions, and memories. It has been long-noted that psychedelics could be used as psychotherapeutic tools, enabling patients to experience deeper parts of their inner psyche and “shadow-side” through a single experience.
Source - psychedelic art of the renowned psychiatrist Stanislov Grof, by Alex Gray
As well as revealing deeper layers, psychedelics also increase cognitive flexibility, meaning they can increase the brain’s ability to adjust behaviors and thought patterns. By integrating the psychedelic experience, new positive ways of thinking and feeling could become part of somebody’s everyday life.
A combination of inner exploration and increased cognitive flexibility, likely explain why psychedelic-assisted psychotherapy has proven to be so successful.
Psychotherapy guides the psychedelic experience
As psychedelics aid psychotherapy, psychotherapy also aids the psychedelic experience. It forms the backbone of the psychedelic healing process, guiding what is otherwise an undirected experience.
As well as providing a sense of direction to the psychedelic experience, psychotherapy also helps patients navigate challenges. Psychedelics can bring up difficult and repressed thoughts, feelings, and memories, which can be highly uncomfortable. An instinctive reaction may be to ignore what’s going on internally or become anxious or paranoid. However, the therapist will encourage patients to explore whatever arises in the experience, including both the positive and challenging, and remind the patients that obstacles faced are windows of opportunity for self-growth and transformation.
The importance of therapeutic support in psychedelics
Psychedelic experiences are unpredictable and disrupt our normal ways of thinking. Difficulties can emerge for a whole host of reasons. Challenging experiences can sometime be traumatic and without thorough preparation, guidance, and extensive integration sessions, people run a much greater risk of having what is known as a psychedelic crisis. As such, a robust therapeutic container is key to avoiding re-traumatisation or causing unnecessary psychological distress.
Lead therapist on the psilodep2 trial Michelle Baker-Jones, guiding a model patient through psychedelic therapy
The ACE therapy model
The ACE therapy model (Acceptance, Connection and Embodiment) is a psychotherapeutic model developed by researcher and therapist Rosalind Watts. Rosalind helped conduct Imperial College London’s psilocybin for depression trial in 2017 (psilodep 1). Through analysing data and interviewing participants for sox months following the study, she built the model based on key elements of the participant’s healing journey.
The model itself is designed to provide support to the preparation and integration of psychedelic experiences.
Acceptance:
The first part of the model is Acceptance, which is encouraging participants to accept, face, and learn to navigate through pain, instead of repressing it. Participants are encouraged to dive down into deeper aspects of themselves during the psychedelic experience and allow whatever emotions arise to be fully felt.
Connection:
The second part of the model focuses on Connection. Psychedelics characteristically increase a sense of unity and feelings of connectedness with the natural world. Disconnection can be a common theme in psychological disorders, so therapists will encourage participants to use psychedelics to help them move from a mental state of disconnection to connection. One participant from the psilodep 1 trial quoted following their psilocybin experience:
“I was everybody, unity, one life with 6 billion faces, I was the one asking for love and giving love, I was swimming in the sea, and the sea was me.”
Embodiment:
The final part of the model is Embodiment, where participants are encouraged to explore sensations of their body. Patients with depression or anxiety often ruminate or overthink the same negative thought patterns. The guided visualization invites the participant to be in touch with feelings in the body as they arise and prepares them for the psychedelic experience. It can enable them to feel into their emotions more deeply which can momentarily create some reprieve from the ruminative thinking which often accompanies depression.
The body scan during psychedelic therapy has been likened to diving beneath the turbulent surface of the ocean (the mind) into unexplored depths (the emotional body and repressed thoughts and feelings).
ACE outside of psychedelic-assisted psychotherapy
Beyond psychedelics, the ACE therapy model provides a framework that could be used by all people in everyday life, with key principles fundamental to the wellbeing of our population.
Acceptance:
All humans experience difficult emotions, but social pressure means we might be discouraged from revealing how we feel or showing our emotions physically. When we experience emotional difficulty, our reaction may be to distract ourselves with things like television, food, or mind-numbing substances. By continually repressing and distracting ourselves from emotions, we allow them to build up and accumulate. However, moving towards a framework of acceptance, difficult emotions can be felt and dealt with when they arise.
Connection:
The current pandemic and spending time indoors isolated has highlighted to many the importance of connection both with the natural world and with others. Connectedness to nature has been shown scientifically to have several psychological and physical benefits. Conversely, the effects of loneliness have proven to be detrimental. Individually, sociologically and ecologically, increasing connectedness has a significant gain.
Embodiment:
In modern Western culture, we often spend far too much time in our thinking mind, with long working hours and ongoing connection to social media. Therefore, it’s important we find time to quiet the mind, which we can do by focusing our attention on our body. It is in these moments when we are able to think and feel together that we are able to know what is of importance to us. Embodiment practices such as yoga and tai chi are also beneficial for our health.
Still from our documentary of psychedelic therapist and researcher and ACE therapy model developer Ros Watts
Looking to the future of psychedelic-assisted psychotherapy
Psilocybin hit news headlines last month as the Imperial College London psilodep 2 trial highlighted it to be more effective than conventional medication in treating depression. What the headlines didn’t highlight, however, is that the patients’ group who took the antidepressants still had a relatively effective outcome in reducing their symptoms. Both patient groups received the ACE therapy, highlighting how the therapeutic model itself likely played a major role in the positive outcomes.
The media-focus on the critical nature of the therapy in psychedelics needs to be improved, or else the public won’t be aware of all the necessary steps required to maximise the benefits of psychedelics. Furthermore, without the safety of the therapeutic container, experiences could even leave people in a worse mental headspace than before they took psychedelics.
As the prospect of mainstream psychedelic therapy becomes more and more likely, mental health companies administering psychedelics mustn’t jeopardise the therapeutic approach. Psychedelics can offer a solution to address the root causes of psychiatric disorders. Yet, without direction, integration, or support, they may only provide temporary solutions. It’s therefore disconcerting that scientists have recently looked to removing the psychedelic component of psychedelic drugs to reduce the costs of associated therapy. Would taking away the experience and the therapy make psychedelics simply another pill that only masks symptoms and doesn’t treat the underlying cause?
Michelle-Baker Jones is a counselor and psychedelic integration therapist. She has been working in close association with Imperial College London’s psychedelic research center and was the lead therapist for the psilodep 2 trials. In the making of this article, she shared with us her written content on the ACE therapy model, an important quote she shared:
“The integration of therapeutic work that ensues really determines whether this experience becomes one of growth or contraction... It is believed that these moments can provide a springboard for a deeper more healing therapeutic process to unfold, one that will need a robust therapeutic container to hold this work.”
A photo of Michelle and the therapy team who worked on the psilodep 2 trial
Michelle Baker-Jones - Michelle is the lead therapist in a current DMT trial exploring DMT-assisted psychotherapy, she plans to use the ACE therapeutic approach with patients.
