Question 1

I have heard that psilocybin has a very high LD50.  Are the positive effects reported with this drug on resistant  depression dose related?  I am working in Afghanistan and have no access to psilocybin but I would be curious to find information about dosages that that may help a client.

William Richards · Accepted Answer

True,  the median lethal dose (LD-50) for psilocybin (280 mg/kg in rats) reflects the low level of toxicity of this substance, thereby supporting physiological safety.  However, it remains of critical importance that one also consider the factors of “set and setting” that we now know are of fundamental importance in ensuring psychological safety and efficacy.   Psilocybin is not a “medication” that acts independently of a person’s preparedness to respond constructively to the opportunities its action may present within one’s field of consciousness.

Dosage is an important factor, but not exclusively important.  Low dosage is likely to trigger perceptual changes, perhaps aesthetic imagery that may be interesting or frightening, but not intrinsically therapeutic for most persons.

Medium dosage is likely to provide access to personal psychological experiences—memories from childhood, access to traumas awaiting resolution, conflicts in interpersonal relationships, etc.; High dosage (approximately 25 mg. of pure synthesized psilocybin) is usually needed to provide access to transcendental forms of consciousness.  See Chapter 16 of Richards’ Sacred Knowledge, “Maximizing the Probability of Safety and Benefit.”

Effective treatment of depression, using psilocybin as a tool within a well-established therapeutic alliance, might well entail both personal-psychological experiences and intuitive understandings intrinsic to transcendental forms of consciousness.

It may enable one to break out of the “rut” of repetitive perceptions of self, others and the world and open up new inner resources and perspectives; Dr. Robin Carhart-Harris has suggested that this may be understood as “resetting the brain”.

Question 2

Do therapists working in this field all have their own psychedelic experience? Is it a requirement that someone delivering psychedelic psychotherapy have had this?

William Richards · Accepted Answer

“Psychedelic experience”, i.e. “mind manifesting experience” or some knowledge of alternative, non-ordinary states of human consciousness, may contribute to the effectiveness of a therapist, especially when coupled with fundamental counselling sensitivities and skills.   Such knowledge may be facilitated by psychedelic substances, meditative procedures, exceptional athletic or artistic experiences, natural childbirth and unknown factors that may trigger spontaneous experiences of many different atypical states of awareness.

The therapist who possesses such experiential knowledge is less likely to become anxious and more prone to remain steady and centered when another person is experiencing alternative forms of human awareness.  Thus, well structured psychedelic experiences, including skilful and responsible preparation, guidance and integration (along with pure substance in appropriate dosage) are likely to enhance the training and skills of those who are interested in providing psychedelic therapy and/or contributing to research.

It should be noted, however, that there are persons who have ingested psychedelics repeatedly without  discovering significant psychological or spiritual insights, often due to low dosage, insufficient knowledge of how to navigate in internal experiential worlds, and the lack of sufficiently supportive “set and setting”,  and there are persons who have never taken psychedelics, but who spontaneously have experienced profoundly therapeutic and meaningful forms of consciousness.

In the 1950’s, 1960’s and early 1970’s therapists and co-therapists (often psychiatric nurses) implementing psychedelic research typically were offered psychedelic sessions as part of their on-the-job training; the present guidelines in academia have tended  to be more cautious regarding the administration of experimental substances to research personnel, requiring FDA and IRB clearance.

Question 3

What does a typical therapy session using psychedelics look like?

William Richards · Accepted Answer

Psycholytic therapy (using repetitive low or medium dosage) and Psychedelic therapy (using relatively high dosage, often in 1-3 sessions) tend to differ in the amount of interpersonal interaction during the period of drug action.  The former tends to be based in the realm of the ego, or everyday personality; the latter aims to shift consciousness at least briefly beyond the realm of the ego into transcendental states of awareness.  In either case a supportive therapeutic environment is usually provided, including interpersonal grounding, comfortable aesthetics, confidentiality and the sensitive choice of music.   The person who has received the psychedelic substance thus feels free to choose to fully “let go”, to welcome, embrace and confront whatever emerges in the inner field of consciousness, whether joyful or painful, exciting or boring.  One of the most frequently used inner mantrams in psychedelic research is simply, “Trust, Let Go, Be Open”, affirming that there is nothing to avoid or censor.   If significant anxiety or psychological resistance is encountered, the reassuring experience of reaching out for the therapist’s hand and affirming the grounding of the therapeutic relationship may prove facilitative of resolution and continuing movement in and through other experiential realms.

Question 4

What do you think are the biggest misconceptions are about psychedelics?

William Richards · Accepted Answer

1.  The idea that the experience is “in the drug” rather than “in the human psyche”.  The same dose of the same drug, even in the same person, can facilitate different experiences on different occasions.  This does not mean that the effect of the psychedelic is “unpredictable”, so much as that individually choreographed scenarios are unfolding with psychological and spiritual content appropriate to particular people at particular times in their lives.  In this framework, the drug “unlocks the door” to other states of consciousness; what one does with that opportunity depends on “set and setting”.

2. The irrational sensationalism of the 1960’s is fading.  Psychedelics need to be used wisely and they are “not for everyone”; however they do not make people jump off skyscrapers and create deformed babies.  Most psychedelics are minimally toxic and non-addictive.   In my book I suggest a parallel with downhill skiing; it’s smart to get some basic instruction and begin on an easy slope.  One who simply puts on a pair of skiis without preparation and heads downhill is likely to injure himself/herself or others; yet we do not declare skiing “illegal” because some persons are irresponsible.

3. When profoundly beautiful experiences that many call “sacred” or “spiritual” occur, people often report the discovery or rediscovery of an “eternal world”.  Impressive and meaningful as such experiences may be for many persons, the integrative task is to apply those insights in the everyday world of time and space.  Huston Smith was the first to point out that “religious experiences” do not always translate easily into “religious lives.”   What does the “enlightened man” do?  He “chops wood and carries water”.  This takes conscious effort for many, often in a context of community support.

Question 5

Has the research been able to tease out whether you are simply getting a placebo effect vs actual biological drug response to the psychedelics?

William Richards · Accepted Answer

Yes.  Well-designed studies have employed different strategies to control for suggestion and expectation.  See heffter.org.  However, the response to a psychedelic substance is more than a “biological drug response”; it includes “set and setting” that are supportive of safety, courage, interpersonal grounding and responses that are likely to be beneficial.

Note:  Griffiths, R.R., Richards, W.A., McCann, U. & Jesse, R., Psilocybin can Occasion Mystical-Type Experiences Having Substantial and Sustained Personal Meaning and Spiritual Significance, Psychopharmacology, 2006, 187,3,  268-283.   Reprinted in Psychedelic Medicine, Vol. 2, ed. M.J. Winkelman & T.B. Roberts eds,., Westport CT: Praeger, 2007, pp. 227-254.

Question 6

Will these substances actually even be taken off the Schedule 1 list and accepted for medical use?

William Richards · Accepted Answer

Research protocols designed in collaboration with the FDA are currently being implemented, focusing on the use of psilocybin the treatment of depression, by Compass Pathways in London and the Usona Institute in Madison.  If the findings of these research projects demonstrate safety and efficacy, it is reasonable to expect the removal of psilocybin from Schedule 1 within the next few years, rendering it available for use in treatment by qualified providers.

Question 7

Can or should psychedelics be used with “healthy people” for happiness, well-being and flourishing?

William Richards · Accepted Answer

Research projects have been designed to investigate the use of psychedelic substances with “normal healthy persons” who are interested in their educational or religious potentials or in their possible facilitation of creativity.

Some of those completed studies are easily found at heffter.org.    Some envisage retreat centers in the future where basically healthy persons interested in having a psychedelic session could receive responsible medical screening, skilled preparation, session guidance as needed and integrative support (and pure substance in appropriate dosage).

Cultural change often proceeds gradually, however, and the current focus of the research community is on investigating their safety and effectiveness in the medical treatment of such conditions as depression, addictions, post-traumatic stress disorder and the existential anxiety that often impedes fullness of living as the end of life approaches.

If the day comes when our culture sanctions psychedelic use for anyone interested and knowledgeable about the risks that may be involved, a major educational task must first be advanced for much more is involved than the ingestion of the substance itself.

Books by authors such as Michael Pollan, James Fadiman and myself, and documentary films like “A New Understanding:  The Science of Psilocybin” and “Fantastic Fungi” (both available for download from the web) may prove helpful in providing the understandings of psychedelics needed for their risks to be decreased in the culture as a whole and respectful tolerance of their use to be established.  This is not about “getting high”; it’s potentially about human personal and spiritual development.

Question 8

Do you see a time when we will have prescription psychedelics? Or is that already here in some countries?

William Richards · Accepted Answer

Other than Ketamine, if considered a psychedelic, the writing of prescriptions is still limited to FDA-approved projects of research.  Some countries allow the use of psychedelics in religious contexts (i.e. ayahausca in Peru, etc.) without prescription.

Question 9

Can you talk about microdosing?

William Richards · Accepted Answer

This is a new area of research, still in its early stages.  It is not my own area of expertise, but the results of surveys and other investigations are being published and available on the web.  Early findings suggest it may be helpful for some people, perhaps those who are basically well-integrated, for limited time periods.   Google James Fadiman, Microdosing for more information.

Question 10

Do psychedelics have a role in couples therapy?

William Richards · Accepted Answer

Insofar as some psychedelic experiences provide new perspectives, resolve conflicts and self-doubts and enhance the capacity to give and receive love, it is reasonable to explore their potential for enhancing the effectiveness of couples therapy.  Little well-designed research in this area has been done to date.  Early studies with the entactogen, MDMA showed promise before the substance was placed on Schedule 1.

Question 11

I’ve heard of breakthroughs that people have in psychedelic therapy being described as the result of ‘cognitive flexibility’. Can you explain this?

William Richards · Accepted Answer

“Cognition” (i.e. knowing) during the action of psychedelics often is intuitive rather than akin to usual rational “thinking”.  In fact “thinking” (i.e. intellectualization) can constitute a defense mechanism that impedes new discoveries, especially during the onset and peak periods of the response to a psychedelic substance.

Suddenly, one may experience the conundrums of life from new perspectives that allow shifts in how one views oneself, others and the world (i.e. “reality”).  One could visualize this process as dormant neural pathways being activated or, in terms of dream imagery, instead of walking past doors, entrances to tunnels and winding staircases, opening the doors, exploring the tunnels, seeing where the winding staircases may lead, i.e. choosing to “enter into” the unfolding content emerging within consciousness.

This “intention” (and the trust, courage and humility it requires) is of critical importance if one desires to maximize the probability of safety and efficacy during the action of a psychedelic.

Question 12

Can you comment on the optimal physical setting for this type of treatment?

William Richards · Accepted Answer

The optimal physical setting provides both physical and psychological safety, including the privacy and confidentiality required to welcome whatever content emerges within consciousness, whether initially experienced as positive or negative.   With moderate or high dosage, safety may be maximised by allowing the body to relax into a couch or bed, especially during onset and peak periods of drug action.

Though one may choose to wear an eyeshade during significant periods during the day (i.e. One “sees more with one’s eyes closed”), there usually are intervals when one sits up with open eyes to interact with guides, focus on objects of potential meaning, or make a trip to the bathroom.  During those intervals, as on arrival and at the end of the day, a physical setting that reflects attention to aesthetics and care may be appreciated.

Most current research is conducted in interior spaces to maximise safety; perhaps retreat centers that may offer psychedelic experiences in the future may also allow for walking in natural settings with open eyes, especially during the latter hours of psychedelic action.  During the intense period of a moderate or high-dose session, the body may relax deeply, as if in trance; if one is lying down, one knows one’s body will be safe as the mind “wakes up.”

Question 13

What protocols are therapists using to mitigate the risk of extreme restlessness or even violence in psychedelic-assisted psychotherapy?

William Richards · Accepted Answer

When interpersonal grounding (i.e. an effective therapeutic relationship) is established in 4-8 hours in preparatory meetings prior to the day of drug administration, “extreme restlessness” is very improbable and “violence” essentially nonexistent.

There may be periods for some people when energies are expressed in bodily movements; should such movements become intense enough to evoke concerns about possible self harm (i.e. by hitting the edge of a piece of furniture), the therapist/guide will provide strong verbal reassurance and physical support if needed in order to ensure safety.  The well prepared person is motivated to explore and confront whatever content may emerge within his/her field of consciousness during the day and knows he/she can reach out for physical grounding and support if needed.

Restlessness tends to be associated with insufficient preparation and attempts to repress or escape from the experiences that are emerging during the period of drug action.  One needs to be open to reliving and resolving traumatic life experiences, including grief and guilt, as well as to encountering experiences of beauty that may be considered of profound personal or spiritual significance.  Sometimes intense emotion, whether fear, laughter or joy,  needs to be expressed and tears (or curses) need to flow freely.

Question 14

What do you think about people seeking out psychedelic substances to have “ego death” experiences?

William Richards · Accepted Answer

“Ego death” or the process of awakening to an eternal realm within consciousness, often described as non-dual, unitive or mystical, is described in most religious heritages of the world and given many names, such as moksha, nirvana, satori, the beatific vision, wu-wei, sekhel mufla or baqa wa fana.  The Hindu tradition offers the image of the drop of water of the Atman (everyday self) merging with the ocean of Brahman (universal Self).  This state of consciousness is very difficult to express in language using our familiar rational categories, as it is by definition beyond space and time.

However, those who find the memory of this state in their minds following a psychedelic session typically recall it as having felt “more real” than our usual awareness in everyday existence.  Philosophers might refer to it as “essence” rather than “existence”.   Some call it “homecoming” or a moment of “waking up” or a taste of “enlightenment”.  Typically it entails an intuitive conviction that ultimately all is well which, for example, appears to contribute to the way cancer patients who discover this quality of experience during the action of psilocybin, often tend to live the remainder of their lives with less depression and anxiety.

While glimpsing this unitive state is a goal within many religious disciplines, it is usually not viewed as an end in itself.  The goal of the awakening bodhisattva is compassionately to return from “the mountaintop” to the world of daily routines to “chop wood and carry water” in the marketplace.  Some may find a parallel of this theme in the tradition of the “suffering servant” in Deutero-Isaiah.  In psychedelic therapy, this is often considered an important part of the process of “integrating experiences.”  Ego-rebirth follows ego-death.

These experiences tend to vividly remain in memory and provide a sense of security when everyday life becomes confusing or challenging.   Often there is no need to repeat them.  It should be noted that they occur not only on some occasions during the action of psychedelic substances, but also spontaneously, within the context of meditative practices, during times of creative fervor or athletic heights and sometimes during natural childbirth or exceptional sexual experiences.  The psychologist Abraham Maslow, who spontaneously experienced such states of consciousness, called them “peak experiences.”

Question 15

Aren’t you concerned about the risk of hallucinogen-persisting perception disorder (HPPD)?

William Richards · Accepted Answer

The psychedelic research community takes HPPD very seriously and continues to collect information regarding its occurrence in follow-up interviews.   It appears that it may be more likely to occur in situations where multiple substances have been ingested, often including substances of questionable or unknown origin or content.  In research settings in which a pure psychedelic is administered in appropriate dosage, reports of HPPD are extremely rare.

Question 16

I’m skeptical about this approach. Sure patients may experience unity, positivity and have a mystical experience but what happens when the substance wears off? Is there any evidence that these treatments have an enduring treatment effect?

William Richards · Accepted Answer

Your skepticism is valued.  There are many different “psychedelic experiences”.  When transcendental experiences occur, some seem so compelling that they shift one’s views of the nature of oneself, others and the world and manifest almost immediately in changed behavior patterns in everyday living.

At other times, such experiences appear to “sit in memory”, awaiting conscious effort to apply their insights in the everyday world.  It’s easy to “love all mankind”; loving your spouse or co-workers usually takes more effort.  Most religious traditions stress the importance of returning from “the mountaintop” to compassionately “chop wood and carry water" in the marketplace.  This integration of non-ordinary experiences with the routines of daily living may be enhanced by group/community interaction and support.

There is research evidence that some people do report enduring treatment effects, even years after the occurrence of transcendental experiences.  See heffter.org.

Question 17

Hi William, can you comment on the treatment protocol for using ketamine as a antidepressant? What are the indications and contraindications and dose etc?

William Richards · Accepted Answer

Sorry, but ketamine is not within my area of expertise.  The research community is exploring the safety, efficacy and duration of symptom relief when ketamine is administered in different ways with different degrees of preparation, support and integrative assistance.  We should have more knowledge from well-designed research studies in the near future.

Question 18

What are the best ways and arguments to help both professionals and those needing help to be more open to the controversial treatments you talk about? I know in the Netherlands psilocybin therapy is allowed but still there are only very few professionals practicing this

William Richards · Accepted Answer

Let’s continue designing, implementing and publishing well-designed research studies with psychedelics, especially with psilocybin at the present time.  The cache of scientific literature is rapidly expanding.  Current studies in process that may support the reclassification of psilocybin, designed in collaboration with the FDA, are being implemented by Compass Pathways and the Usona Institute.

In terms of educating the public at large, books like Michael Pollan’s How to Change Your Mind, James Fadiman’s, The Psychedelic Explorer’s Guide,  and my own, “Sacred Knowledge:  Psychedelics and Religious Experiences” may be helpful, along with documentary films such as A New Understanding:  The Science of Psilocybin  and Fantastic Fungi (both downloads from the web).  Two new concepts are of critical importance in the mental health professional community;  (1) the power of the memory of a single experience in changing attitudes and behavior [as opposed to relying on the biochemical activity of an antidepressant drug taken repeatedly]; and (2) the potential presence of transcendental forms of awareness within each human mind—forms of consciousness that often appear to be intrinsically therapeutic rather than “psychotic”.

One “old concept” may be important to restate, namely, the value and importance of the trust, courage and openness inherent in a healthy therapeutic relationship.  Psychedelic therapy entails more than receiving a psychedelic substance; it requires attention to “set and setting”, especially interpersonal grounding.

Question 19

I've read that psilocybin can be utilized in the treatment of suicidality. I'd love to know more about the relationship between the two.

William Richards · Accepted Answer

Effective psychotherapy can be effective in decreasing depression and supporting people in living more fully, with or without the use of psychedelics.  There are different types or strata of “psychedelic experiences”, accessed through variations of dosage, set and setting.

Some experiences may focus on the resolution of prior traumatic events or situations; others may include transcendental states of awareness that usually are described as being of profound beauty and meaning.

Thus the question becomes a matter of which types of experiences facilitated by psilocybin may be most helpful in decreasing suicidality for different people.  It is of notable interest that cancer patients who experience transcendental states of awareness during the action of psilocybin often report loss of a fear of death and a convincing awareness of the reality of an eternal dimension within human consciousness; yet they do not become suicidal and generally appear to treasure whatever time may remain while their bodies are still capable of functioning.  Thus they tend to “live until they die” with minimal depression, anxiety, interpersonal isolation and preoccupation with pain.

Question 20

I'm interested in the relationship between therapeutic use of psilocybin and patients experiencing psychosis. I was wondering if you could unpack this?

William Richards · Accepted Answer

It’s a fascinating, though very complex topic as there are many different states of consciousness facilitated by psilocybin in various doses under various conditions of set and setting—and there are many different states of consciousness that we may label “psychosis”.  Personally, I’ve come to reserve the term “psychosis” for mental states characterized by extreme confusion, panic and paranoia, often entailing the misinterpretation of whatever may be occurring in the environment.  There clearly are alternative states of human consciousness that appear correlated with unique creativity and profound intuitive insights (some that may be interpreted as religious revelation) that occur both spontaneously and in conjunction with the activity of meditative procedures or psychedelic substances.

If one takes the pragmatic stance of philosophers and psychologists like William James, saying “By their fruits ye shall know them”, it appears that many of these profoundly alternative states are indeed positively correlated with subsequent attitudes and behavior that we generally view as positive—i.e. increased personality integration, decreased depression and anxiety, enhanced creativity, improved interpersonal relationships, deepened feelings of inner harmony and “feeling at home in the world.”

Psychiatrists such as Loren Mosher and R.D. Laing have posited that initial “psychotic breaks” for some people may be spontaneous attempts of their psyches to reset or reintegrate themselves in new patterns, and that, if initial treatment was strongly respectful and supportive (with interpersonal warmth, safety and structured music), new insights might fall into place and the period of spontaneous alternative states of consciousness might be limited.  This model has yet to be adequately tested, though a beginning was made in Mosher’s “Soteria House” in San Jose California and similar treatment facilities in some countries of Western Europe.

Instead we tend to handcuff frightened people in the backseats of police cars, leave them deserted in hospital emergency rooms and then administer drugs that sedate or terminate states of consciousness we don’t understand or have the time and personnel to adequately explore.  Some see this pattern as a reliable way of generating confusion, panic and paranoia, then trying to return the person to the “pre-psychotic state” without addressing the unresolved underlying issues.

Whether spontaneously-occurring or facilitated by psychedelic drug administration, alternative states of consciousness may be seen as opportunities for exploration, resolution, insights and new ways of being-in-the-world.  How one responds to these opportunities, however, is crucial and strong interpersonal support in a safe environment appears helpful for many persons.  If one “runs from the monster”, panic and paranoia will reliably occur; if one “looks the monster in the eye” and approaches it in search of understanding its origin and nature (perhaps while holding the hand of a trusted person), insight and healing are probable.

Question 21

Has psilocybin been utilized as part of end-of-life care?

William Richards · Accepted Answer

One of the most promising applications of psilocybin therapy is its offering as a mental health intervention in the context of palliative and perhaps hospice care.  See heffter.org for research publications from Johns Hopkins, New York University and Harbor-UCLA.  Sustained decreases in anxiety and depression, coupled with increased engagement with others and life have been documented following a single psilocybin experience under supportive conditions.

Study participants who experienced transcendental states of consciousness during the action of psilocybin tended to report the most significant improvement and also the loss of a fear of death.  This research builds on earlier studies with LSD and DPT in the treatment of the existential distress of cancer patients in the 1960’s and early 1970’s.  Research is continuing as an increasing number of oncologists and other physicians are designing studies to further explore this treatment frontier, both in the United States and Western Europe.

Question 22

What do you wish more people knew about psychedelics?

William Richards · Accepted Answer

There are many answers to this question.  Above all, I look forward to the time when the promise of psychedelics in medicine, education and religion (when used with skill and respect) will be more fully appreciated in mainstream Western culture, irrespective of whether or not an individual person chooses to take whatever risks may be entailed in their use.

Substances like psilocybin are not addictive and they are essentially non-toxic; however they need to be administered with attention to purity and appropriate dosage in supportive contexts if safety and efficacy are to be maximised.   Akin to activities like downhill skiing, it is wise to learn some skills of navigating in inner experiential worlds and to be well prepared before beginning to explore the non-ordinary states of awareness that may emerge during the action of psychedelic substances.

In many ways it is helpful to view the experiences that occur, not as being “in the drug”, but rather “in the human mind.”  Thus the ingestion of a psychedelic provides an opportunity, but what one does with that opportunity depends on one’s psychological structure and on preparation, or what is known as “set and setting.”

As is accepted as baseline in religious communities that value ayahuasca, psilocybin mushrooms or Peyote, these substances appear to be intrinsically sacred and their use needs to be approached with wisdom and respect.

In psychedelic research we are not only exploring the potential use of different substances in the treatment of different human conditions (i.e. depression, post-traumatic stress disorder, addictions, end-of-life anxiety, inhibited creativity, etc.); we are also exploring the mysteries of human consciousness—the nature of what we are.  This is a frontier, not only of neuroscience and medicine, but also of philosophy and religion.

Question 23

Hello William! I was just wondering if there is scope for future use of psychedelics with children and young people?

William Richards · Accepted Answer

This is one of those questions that we cannot answer as the research required has yet to be designed and implemented.   In the indigenous religious use of psychedelics such as ayahuasca, psilocybin mushrooms and Peyote, young people are sometimes included in the shared rituals of the community with the support of elders.

It might be noted that spontaneously-occurring experiences of alternative states of consciousness sometimes are reported in adolescence, whether in the context of vision-quests or totally unexpected (perhaps associated with the endogenous generation of DMT or similar biochemical processes).

There may be some wisdom in the saying, “You have to have an ego to lose an ego”, which would argue for first developing a sense of personal identity before exploring other states of human consciousness, perhaps in the mid 20’s or beyond.

Question 24

What are the latest types of psychedelics and what are the short term and long terms effects on the person with addiction?
What is the best treatment for such clients?

William Richards · Accepted Answer

Research in recent years has focused and continues to focus on the use of psilocybin-assisted psychotherapy in the treatment of addictions to alcohol, narcotics, cocaine and nicotine with promising results (see heffter.org and other information on the web).  Ibogaine may be uniquely effective in the treatment of narcotic addiction.  In all cases, more is involved than the structure of the unique molecule; when treatment is effective; the interpersonal context in which the drug is administered, the “set and setting”, constitutes an important variable.  “Addiction” is a complex concept in itself; I recommend Gabor Mate’s book, In the Realm of Hungry Ghosts.

Question 25

Wondering about the use of psilocibin for anxiety?  In a documentary "Fantastic Fungi" it was suggested specifically for anxiety.

William Richards · Accepted Answer

Psychotherapy assisted with psilocybin often appears to resolve the inner conflicts that generate anxiety, allowing the suffering person to approach, confront, understand and resolve the source of the distress.

This may occur during one 6-hour psilocybin session and it appears that it is the memory of particular experiences in alternative states of awareness and concomitant new insights that constitutes the healing factor.   One of the most promising applications of psilocybin therapy is in palliative care, allowing people to approach the end of life with less anxiety (see heffter.org).

Fantastic Fungi is an exceptionally fine documentary film, now available as a download on the web.

Question 26

What is psychedelic treatment?

William Richards · Accepted Answer

Generally “psychedelic treatment” refers to psychotherapy assisted by one or a few administrations of a psychedelic drug in a supportive environment.  Historically, the word “psychedelic” implied moderately high or high dosage, contrasted with “psycholytic treatment” which employed the use of low doses of psychedelic substances, often on several days during the week, in a more psychoanalytic framework.  “Psychedelic” means “mind-manifesting”; “Psycholytic” means “mind-releasing.”

Question 27

I'm seeing therapists in Colorado announcing "psychodelic-assisted therapy" and I'm wondering about the legal and ethical issues, training requirements, contra-indications.

William Richards · Accepted Answer

Keep tuned!  This is a fascinating and potentially important frontier of knowledge and treatment and there are many issues and procedures to clarify and delineate as the legal use of psychedelic substances begins to be accepted.

At present different research and educational organizations have similar training requirements for their therapists (i.e. Compass Pathways, the Usona Institute, MAPS, CIIS, the Beckley Foundation, individual university departments, etc.); eventually common standards and certification procedures are probable.

One may see a parallel with the hospice movement which began with Cicely Saunder’s original treatment site called St. Christopher’s in London, but now extends into hospice and palliative care centers throughout the world, including training procedures for hospice workers, specified ethical standards, international conferences and organizations and insurance coverage by Medicare and other companies.

At the present time the psychedelic research community seeks to police itself, promoting standards that are ethical, safe and effective.  One formulation of guidelines, “Code of Ethics for Spiritual Guides”, can be found on Bob Jesse’s website, csp.org.

Question 28

What are the biggest barriers you’ve faced with this research?

William Richards · Accepted Answer

1.  The cultural forces that rendered psychedelic research dormant from 1977-1999 (except for Rick Strassman’s DMT research in the early 1990’s), symbolized by President Nixon’s statement that Timothy Leary was “the most dangerous man in America”.  “LSD” appears to have become a symbol for significant cultural change in many sectors, including the Vietnam war, the women’s movement and race-relations.  Even government issued pamphlets promoted propaganda that was scientifically inaccurate during that period of time.  Fortunately, the rebirth of psychedelic research during the past two decades generally has been without sensationalism, reflected in a sober press that has been respectful of science and well-designed research studies.

2.  I think of Alan Watt’s reflection on “the taboo of knowing who you are”.   Why have many in our culture feared what essentially may be viewed as personal and spiritual development?   If each of us has potential access to other states of awareness that may have therapeutic, creative or religious value, why do we tend to devalue tools that may provide such access for those who seek it?

3) I look forward to the time when funding by the federal government in the United States will again become active in the support and advancement of psychedelic research.  At the present time, most research is funded by private philanthropy.

Question 29

Are psychedelics effective in treating addiction?

William Richards · Accepted Answer

Research projects using psilocybin-assisted therapy have yielded promising results in the treatment of addictions to alcohol, cocaine and nicotine (see heffter.org); studies applying psilocybin in the treatment of narcotic addiction are beginning.

Research using LSD and DPT in the 1960’s and early 1970’s also showed promise before investigations using psychedelic substances became dormant.  This is generally not viewed as a purely chemotherapeutic effect, but rather the result of new perspectives and insights that occurred during the period of psychedelic activation (about a 6 hour period with psilocybin) and the memory of those experiences.

For some this entails the resolution of personal conflicts, such as unresolved grief or guilt or problems in interpersonal relationships—issues that instead of being confronted had been avoided through addictive patterns of behavior.

For others, especially when transcendental forms of experience have occurred during the period of psychedelic action, there appears to be a subsequent shift in how one views oneself, others and the world.  This often includes an awareness of inner worth and resources and the reality of what AA and NA call “the higher power.”

Question 30

Which demographics have the strongest evidence base for therapeutic use of psychedelics?

William Richards · Accepted Answer

Here’s a potential thesis topic for someone!   One could look both at particular research projects, each with their own selection criteria, and also at communities where psychedelic substances are administered in religious contexts.  Prior research has generally included adult participants of differing educational, racial and occupational groups, both men and women.  What appears to matter most when psychedelic therapy is effective is not demographics, but the quality of the therapeutic relationship that has been established prior to drug administration.

Question 31

Can you please explain the concept of sacred molecules?

William Richards · Accepted Answer

Maybe all molecules (and life itself) could be viewed as  “sacred”, but the molecules we call psychedelic (“mind-manifesting”), when administered with adequate purity and dosage in supportive contexts, sometimes provide access to realms of experience within human consciousness that we usually consider “spiritual” or “eternal”.

These experiences typically feel more real than everyday existence, may be of almost unspeakable beauty and meaning, and typically are claimed to be ineffable, transcending time, space and the concepts we usually use in thinking and language.  Some view these experiences as being revelatory and influential in the origin of world religions.

Question 32

Are psychedelics effective in a group setting?

William Richards · Accepted Answer

That would of course depend on how which psychedelics are used and the nature of the particular group.  There’s a big difference between “the rock concert scene” and a small group sharing a psychedelic sacrament in a religious context or taking it together as part of psychological treatment or for purposes of personal or spiritual development.

Research with groups is becoming increasingly important, in part to make the cost of psychedelic therapy more manageable as insurance companies consider coverage for psilocybin therapy and similar therapeutic interventions.  Clearly the manner in which the group is structured is of fundamental importance to enhance the probability of safety and efficacy.

Question 33

Are there particular demographics that are precluded from psychedelic use?

William Richards · Accepted Answer

Each research project is designed with specific selection criteria, approved by the local Institutional Review Board and the FDA.  Thus there’s a specific age range for a particular study and various exclusion criteria in realms of physical and mental health.  Most studies to date have been designed to exclude people with prior forms of severe mental illness (i.e. schizophrenia, bipolar disorder, brain tumors, etc.), or often those with family histories that may reflect genetic tendencies related to psychoses.

This is to standardize a specific sample of research participants and avoid possible risks of adverse or prolonged reactions to the psychedelic substance.  This does not mean we know that some of these people could not benefit from a well-designed psychedelic experience; it could be that some could benefit, but may require more hours of preparation and integrative assistance than the particular research project is able to provide.  Eventually, new research projects will investigate some of these unanswered questions, but at the present time our knowledge is limited.

Question 34

Have there been studies done on single dosage versus multiple dosages over time? Was there a difference in outcomes?

William Richards · Accepted Answer

Different research protocols have specified different parameters relating to the number of drug administrations, the dosage, the number of hours permitted for preparation and for initial integration and other factors, so it’s hard to generalize.

Sometimes a second psychedelic session, even with the same drug and dosage, does seem to include content that was not encountered in the first session, supporting the idea of an unfolding process of conflict resolution or self-actualization.

However, it’s important to honor not only “having experiences” but applying their insights in the everyday world and thereby ‘integrating experiences”.    When drugs like psilocybin become approved for treatment in general clinical situations, it may be considered reasonable to offer a second or third session, perhaps a month, 6 months or a year down the road, just as one may choose to periodically participate in religious retreats.

Question 35

What are some of the indicators that a therapeutic relationship is strong enough to support a positive experience with psychedelics?

William Richards · Accepted Answer

Good question, though the answer is basically an intuitive judgment.  Have the therapist and the person preparing to receive a psychedelic established a feeling of “being-in-the world” together characterized by focused attention, honesty, courage, genuine caring and acceptance?  The “patient” may not have discussed every dark secret or concern of his/her life, but he/she should feel that there is nothing that could arise during the psychedelic session that could not be experienced and disclosed to the therapist.

Thus the intent is established to welcome, even to embrace, whatever content should emerge during the period of drug action, irrespective of whether it initially appears frightening or beautiful, boring or fascinating.   With most people this requires at least four hours (preferably eight) spread over several different days to allow the relationship to mature.  If the therapist feels sufficient rapport has not been established, either more time is required in preparation or the person should be dropped from the research study.

One technique to help assess readiness for a session is the “dress rehearsal” of lying on the couch with eyeshade and headphones during a “waking dream”, often on the day prior to psychedelic administration.  Can the person allow a flow of imagery to occur?  Can the person relax without feeling unduly self-conscious or pressured to perform?  Can the person explore the imagery that appears (i.e. follow paths, enter houses, see where tunnels and staircases may lead, etc.)?   Can the therapist enter into a meditative space and “be present” without playing with his/her i-Phone or attending to paperwork?  Has a “safe container” for the psychedelic experience been established?

Question 36

Which parts of the brain do psychedelics act on?

William Richards · Accepted Answer

Investigations including fMRI scans by such researchers as Robin Carhart-Harris, Franz Vollenweider and Frederick Barrett have noted decreased activity in the “default mode network” of the brain, which is generally understood to be the area associated with our everyday ego-related activities.

These studies and others of similar nature constitute a fascinating frontier in our understanding of the relation of the brain to consciousness, but it is only a beginning and the fundamental mystery of the “mind-body problem” is far from solved.  What is causation and what may be correlation?  What is going on in our brains right now without psychedelics?

Question 37

How important is client diagnosis in interventions where psychedelics are being used?

William Richards · Accepted Answer

Clinical research projects tend to be designed to investigate the impact of a treatment regimen (i.e. psilocybin-assisted psychotherapy) on a limited sample of persons suffering from a specified diagnosis (i.e. alcohol addiction, depression, post-traumatic stress disorder, etc.).

Thus, diagnosis (generally in accord with current nomenclature and codes used for billing insurance companies) is important in the research world.  In the broader picture, however, most human beings do not neatly fall into diagnostic categories.

Psychedelics appear to have significant promise in the treatment of an increasing number of medical conditions, but they also may have educational and religious value when competently used, perhaps contributing someday to what Robert Jesse has named “the betterment of well people.”

Question 38

Are there particular conditions or populations where use of psychedelics is not appropriate?

William Richards · Accepted Answer

At this stage of research, there is much that we do not yet know.  We estimate the degree of risk that may be involved in giving psychedelics to people with certain conditions and may well design studies that exclude some people, not because we know for sure that they wouldn’t benefit, but because we need to standardize small samples for research purposes and don’t want to take any unnecessary risks that might cause adverse reactions (which in turn might cause an institutional review board to put a study on hold while an investigation is conducted).   Thus, for example, a person with a brain tumor would most likely be excluded, simply because it is an unknown and the location of the tumor might be a factor in the response.

Someday, however, a study confined to persons with a specific type of brain tumor might be designed, approved and implemented with all the informed consents required, and then our knowledge base would increase.  This applies to persons with psychotic histories or relatives, to persons taking various non-psychedelic medications (notably SSRIs), to persons with various forms of cardiac or renal problems, etc.

We don’t know what we don’t know, but it’s prudent and responsible to be conservative as our cache of research knowledge gradually increases.    We tend to view research volunteers through the lens of medical screening procedures; it should be noted that there is a long history of the use of psychedelics in indigenous cultures, often in religious or healing rituals, where no one even takes a baseline blood-pressure.

Though the risks entailed in psychedelic use may be higher for some people than for others, they appear to be non-addictive and physically safe for many persons.  Psychological safety entails attention to “set and setting” (See Johnson, M.W., Richards, W.A., & Griffiths, R.R., Human Hallucinogen Research:  Guidelines for Safety, Journal of Psychopharmacology, 2008, 22: 603-619, or Chapter 16 of Richards, W.A., Sacred Knowledge.)

Psychedelics in Psychotherapy