By Eve Ekman, Gabrielle Agin-Liebes | Greater Good Magazine
My earliest exposure to psychedelics came from growing up near the Haight Ashbury in San Francisco, well past the glory days of the Summer of Love. The Haight Street of my youth was a tourist destination for hippiesque consumerism, not a countercultural hub, though I was aware that a drug called lysergic acid diethylamide (LSD) created much tie-dye and “the best music of our time,” according to those who were allegedly there. My parents’ own Summer of Love included stories of pot and protest but no near brushes with acid, as LSD is sometimes called. At one point, my dad (an emotion researcher) was poised to study the impact of LSD on emotion—but then its ban came down in 1968, and that was that.
Fast forward some decades to 2016, to an intimate, informal, and friendly potluck made up of pioneering researchers and underground therapists who had been illicitly guiding hundreds of clients through psychedelic-assisted therapy. Surprisingly, this gathering was in my living room. A few weeks earlier, I had attended an inspiring research presentation on psilocybin therapy at the Osher Center for Integrative Medicine, where I was a postdoctoral fellow. I learned that psychedelics are a class of substances—including psilocybin, LSD, and DMT—known to initiate brief, potent effects on consciousness. Anthony Bossis, a New York University researcher, shared the results of a study with dying cancer patients. His data, though with a small group, was impressive. The patients in his study had hugely improved their quality of dying and relative well-being—and this far surpassed any other intervention tried for this group. As Bossis described, the participants were freer from anxiety and distress, and they were able to be present for loved ones and face death with peace.
I had not expected to see this kind of talk in the conservative halls of a University of California medical school. My department of integrative medicine is aggressively rigorous, including only the highest-caliber research trials on mindfulness; they are a stalwart against the woo-woo. My own research focused on meditation and emotion-regulation interventions to prevent burnout for health care workers. Bossis’s talk was so inspiring because I shared the goal of reducing stress by turning with compassion toward stress and difficulty. Bossis presented another pathway.
After the talk, I recognized a friend from graduate school and discovered he was helping organize an end-of-life study at the University of California, San Francisco, that tested psilocybin, a psychedelic substance derived from a fungus. I offered my help as a qualitative researcher, but my greatest asset at that planning stage was a large living room that could be used for meetings. We held these psychedelic research potlucks in my own and others’ homes because being associated with this research is dangerous for one’s career—one physician in our group had been pushed out of his department for suggesting a study. The therapists needed a private meeting to speak freely because they were engaging in illegal activities by providing psychedelics to their patients outside of the research paradigm. Together, we were able to strategize and overcome governmental and institutional red tape. (There was another reason why the group needed to be invitation-only: We didn’t want to attract a group more interested in dropping acid than studying it.)
The enthusiasm among these researchers and pioneering therapists was contagious. I wondered if this was similar to what had been felt in gatherings of meditation teachers and researchers thirty years earlier. I learned a lot about meeting many accomplished researchers and guides, including the co-author of this piece, Gabrielle Agin-Liebes, who was a project manager and qualitative researcher in the New York University study with Bossis. Everyone shared a fervent desire to alleviate the suffering of their patients and clients by providing an opportunity to transcend and gain insight into the causes of this distress.
These conversations expanded the direction of my own research. I decided to embark on a study with Gabrielle. Our mission: to design, deliver, and analyze qualitative interviews with a group of long-term survivors of HIV and AIDS immediately following, and then three months after, their participation in a study using psychedelic-assisted therapy. We’re discovering from this study (and many others) that psychedelics can dramatically improve quality of life and reduce existential distress and depression. We’re more and more convinced that we need to consider testing psychedelics in other domains—and explore how they might interact with mindfulness practices.
Meditation and psychedelics
Meditation describes a wide variety of mind and body practices, but most research has focused on Mindfulness-Based Stress Reduction (MBSR). MBSR is a highly manualized eight-week training where participants gather to learn practices, discuss themes of present-moment awareness and compassion, and ask questions. Researchers administer surveys, biological and behavioral measurements of stress and attention, brain scans, and interviews before and after MBSR training is complete—which sometimes are repeated months later. According to many of these studies, meditation appears to involve gradual and incremental shifts that promote steady growth in qualities like resilience and compassion.
Meditation is perfectly legal, but psychedelics are not—which means we have much less scientific knowledge of their effects. There are thousands of meditation studies, but perhaps two dozen contemporary studies of psychedelics. Moreover, meditation studies have far higher numbers and types of participants.
Mindfulness research began with a focus on reducing mental stress for chronic pain patients in the late 1970s. Similarly, today’s psychedelic research is focusing on lowering existential distress for terminal patients. In both kinds of studies, so far, the participants describe experiencing heightened body-based sensory experience; heightened meta-awareness (e.g., breaking habitual patterns of negative rumination); emotions such as friendliness and compassion towards ourselves and others; and natural states of gratitude, openness, and acceptance.
Secular interventions like MBSR and psychedelic-assisted therapy draw from ancient practices and specific cultural contexts. Much mindfulness today is devoid of traditional symbols such as bowing and chanting, and it also lacks a Buddhist teacher. Secularization does create important accessibility, but various mindfulness studies found that, indeed, the “teacher effect” shapes the benefit of the intervention. There are likely hundreds of mindfulness teacher-certification programs, and efforts to create a global evaluation of mindfulness teaching skills are underway. Something similar is happening with psychedelics: The California Institute for Integral Studies, an alternative university in San Francisco, is pioneering the first year-long psychedelic-assisted psychotherapy training program for mental health professionals.
Three ways psychedelics can be good for us
Our own study of people living with HIV and AIDS is the first one of psychedelics to be approved by the University of California, San Francisco. Thus far, the results are small and preliminary, but the reductions in depression and existential distress have been remarkable. This is a “safe” clinical population, which means they are already facing the ultimate bad outcome: death. Modern medicine can extend their lives with medication, but it provides few solutions for their own lived experience of having a terminal illness.
For our study, we developed specific questions to ask participants the day after their psilocybin treatment, and three months later. Our goal is to understand not just whether the experience was beneficial, but the what, how, and why of the experience. Like other studies, ours includes therapists who support group experiences leading up to and following the treatment. Our aim, as with most psychedelic research, is to create a specific mindset for the participants—a goal or intention that is often worked on for weeks ahead of the treatment. The setting is a room that does not look like a hospital laboratory (think woven, groovy, patterned rugs, low lamp lighting, and a comfy couch) and emotion-evoking music played through headphones.
In the work to date, we have been struck by how the themes we were hearing resonated with research into meditation and mindfulness. Here are three key insights that are emerging from the interactions of these two branches of research.
1. Emotional awareness
Mindfulness practice and psychedelic experiences can positively alter one’s emotional process in two primary ways: increasing one’s ability to be in direct contact with the present moment (instead of being caught in emotions of the past or anticipation of the future) and enhancing experiences of positive emotions. Being with feelings in the present moment includes reducing our negative mind-wandering and bringing kindness and friendliness to difficult emotions.
A single psilocybin session helped most participants let go of rigid, negative thought patterns—in other words, it gave them a break from the relentless barrage of self-criticism and judgment, and it increased openness to their emotions. For many in the study, these acute experiences carried over into their daily lives, helping them to be present and break free of their habitual tendencies to become entangled with stressful patterns and negativity. Moreover, psychedelics and mindfulness meditation have been found to decrease reactivity in brain regions that process fear.
Similarly, after meditation, participants report being able to approach stressful situations—to which they would typically react automatically and unconsciously—in the alternative, more helpful ways. For example, a person who discovers that her flight is delayed at the airport by several hours may realize that being delayed may provide her the opportunity to call a friend she has not spoken within a while.
2. Overriding our default mode
We all have roles to play with other people that define us. Mom, dad, son, daughter, teacher, student, nurse, doctor. Memories, beliefs, impressions, and sensations accumulate to form a sense of who you are, where you have been, and what you have done. These become your personal story and the backdrop of the moments of your life. This is your identity—and the source of your ego.
“Awe may be a critically important emotional experience during psychedelic treatment in generating compassion, empathy, and overall well-being”
But identity can also become a trap. We can fall back on our default settings—our duties, our routines—sleepwalking through our days. We also tend to experience ourselves as bounded and separate entities from our surroundings. Our ego can come to exist as if it were a city with a dense wall surrounding it, living in stark separation from the rest of the landscape. This separation can be helpful in that it creates a sense of structure and organization. It helps to protect us from dangers and cope with life’s hardships.
However, excessive separation can make our lives very small. We can begin to exist inside this bounded city as if we were an autocratic leader, attempting to control it and all the surrounding cities at all costs. It can render us emotionally alienated from other people. Researchers have found that this state can be associated with depression, anxiety, and addiction.
What happens when we create a space and a time when we tear those walls down, let go of our identities, and allow for the emergence of a new sense of self, however temporary?
Meditation and psychedelics can both take us outside of ourselves, helping us to connect with others and our environment. This process of “decentering” refers to the capacity to recognize thoughts and emotions as passing mental phenomena. Neurophysiological evidence by Judson Brewer and Robin Carhart-Harris suggests that certain types of meditation and psychedelics can disrupt a network in the brain that becomes activated when we engage with self-focus (the default mode network), which reduces rumination and mind-wandering. In effect, both types of experience—meditation and psychedelics—retrain and rebalance the activity of our ego, so that it protects us when needed and rests during times of safety.
Learning to relax this excessive self-focus—for brief amounts of time, in an intentional manner—can help us expand our notion of self into greater harmony with our environment. We can integrate our sense of who we are with the things around us. We can still operate with some independence, while also existing in unity with the surrounding landscapes. Or, at least, that’s what research to date suggests—though there is still much work to be done in understanding how and why this happens.
3. Prosocial motivations, emotions, and behaviors
Compassion, empathy, and altruism. They can be motivations, feelings, and actions—but in all their forms, they bring us together. That’s why scientists call these keys to well-being “prosocial,” as opposed to antisocial. When humans lived in small tribes, we needed to share the responsibilities of daily life, such as foraging food, childrearing, hunting, and protection against animal threats. Today, a prosocial orientation is essential for overcoming some of the greatest threats to our planet, from climate change to inequality.
There is tremendous scientific evidence suggesting that meditation and compassion-based programs foster prosocial emotions such as empathy, kindness, gratitude, and awe. For example, practicing meditation increases brain activation associated with compassion when we’re shown pictures of suffering, and it also seems to lead to more compassionate behavior.
Could the same be true of psychedelic therapies? At this point, we can only speculate. A critical review of 77 studies completed by Henrick Jungaberle and colleagues from the MIND European Foundation for Psychedelic Science suggests that psychedelics increase prosocial behaviors, empathy, cognitive flexibility, creativity, personality factors like openness, value orientations, nature-relatedness, spirituality, self-transcendence, and mindfulness-related capabilities. In a recent theoretical paper, the University of Alabama professor Peter Hendricks suggests that awe may be a critically important emotional experience during psychedelic treatment in generating compassion, empathy, and overall well-being. This is turning up in our own study, as participants report feelings of awe after their session. In one case, a participant described how an everyday, mundane walk outside felt profound. Others reported feelings of deep connection to the entire world, often in contrast to prior feelings of isolation and cynicism.
It has only been a few years since I first hosted the psychedelic potluck, and I have witnessed a sea change in the level of interest in the therapeutic use of psychedelics. Last year, influential journalist Michael Pollan kicked off a round of public discussion and controversy by publishing How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence. His book hits on many of the themes that turn up in our research:
Habits are undeniably useful tools, relieving us of the need to run a complex mental operation every time we’re confronted with a new task or situation. Yet they also relieve us of the need to stay awake to the world: to attend, feel, think, and then act in a deliberate manner. (That is, from freedom rather than compulsion.) If you need to be reminded how completely mental habit blinds us to experience, just take a trip to an unfamiliar country. Suddenly you wake up! And the algorithms of everyday life all but start over, as if from scratch. This is why the various travel metaphors for the psychedelic experience are so apt.
Thanks in part to Pollan, we’re seeing more and more interest from journalists, therapists, institutions, entrepreneurs, and others. It’s hard to say where all this is going. We don’t yet know as much as we need to know about psychedelic-assisted therapies. While the public asks questions and debates legalization, we’ll keep using scientific tools to understand the impact of psychedelics on our well-being.