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Ben Hearn Sep 20, 2018

Understanding Psychedelics and Therapy - Dose

Today, I’d like to broadly begin discussing the differences between how psychedelic drugs are often used recreationally compared to how they may be used therapeutically. Specifically, we’ll discuss how the concepts of set, setting, and dose play a role both in recreational use and therapeutic use. We’ll start with dose first which is perhaps the most strongly correlated to the intensity of psychedelics’ effects.

Sub-perceptual doses are those which do not alter an individual’s cognitive processes or exert any significant effects. Individuals taking these doses in research studies often serve as a control group, in which the sub-perceptual dose acts as an active placebo. Outside of research studies, doses taken at this level would be considered to be ‘micro-dosing’, a trend which is becoming popular in tech fields as a means to boost creativity and productivity as well as for other individuals who self-medicate for mental health disorders such as anxiety, depression, and even obsessive compulsive disorder. Given that this level of dosing is used often as a control group and remains largely unresearched, its benefits are questionable but beginning to be studied. Of particular note, sub-perceptual level doses of psilocybin have been found to be helpful for management of OCD symptoms in a 2006 by Moreno, Wiegand, Taitano, & Delgado. Additionally, a study evaluating the effects of microdosing LSD is underway at the Imperial College of London.

The next level of dose would be considered a “threshold” to moderate level in which the effects of the drug is readily apparent, but the individual retains the majority of their ability to engage in tasks and activities, making it the most likely dose to be taken in settings such as parties or clubs. These doses may also be beneficial for talk therapies as many psychedelic drugs work to expand one’s feeling of connection to others, deepen emotions, and provide individuals with unique and novel viewpoints from which to understand themselves. Working with a therapist in a more traditional talk-therapy capacity while experiencing the effects of a low to moderate dose is most properly described as psycholitic therapy (Gasser et al., 2014). To my knowledge, the majority of MAPS’ research on MDMA as a treatment for PTSD would be considered psycholitic therapy.

Finally, high doses of these drugs (with the exception of MDMA), often produce mystical, transpersonal, religious, and/or spiritual experiences. An individual experiencing a high dose of psychedelic drugs is likely to lose their capacity for self-report and engage in basic functions for the duration of the drug’s peak activity. Such experiences are often described as ineffable, unable to be described by language, and to transcend time and space and measured by the Mystical Experiences Questionnaire, (Dakwar et al., 2014) and are often described as being some of the most significant in a person’s life  (Maclean, Johnson, & Griffiths 2011). In some research, the degree to which an individual had such a mystical experience was correlated with their ability remain abstinent from nicotine (Garcia-Romeu, Griffiths, & Johnson, 2015). When these drugs are given in high doses with the intention of eliciting a mystical and cathartic experience, it is then considered psychedelic therapy, and the therapist's’ role may then begin to take on a much more alien form than we are familiar with.

In conclusion, dosing of psychedelic and psychedelic like drugs can take multiple forms, ranging from individuals who microdose before going into work to those who ingest large doses and may be seeking mystical or divine experiences. Therapeutic services appear to at least have anecdotal benefits at each level, though further research is likely to ascertain which approaches are most appropriate for which individuals and which disorders. It is also important to remember that dose is not the only factor which contributes to intensity. Set and setting also play a role, which we will explore in my next blog entry.

Sources:

Dakwar, E., Anerella, C., Hart, C. L., Levin, F. R., Mathew, S. J., & Nunes, E. V. (2014).         Hood’s Mysticism Scale--Modified. Psyctests, doi:10.1037/t33393-000

Garcia-Romeu, A., Griffiths, R., & Johnson, M. (2015). Psilocybin-occasioned mystical 
     experiences in the treatment of tobacco addiction. Current Drug Abuse Review,
     7(3), 157-164.

Gasser, et al. (2014). Safety and efficacy of LSD-assisted psychotherapy for anxiety associated with life-threatening diseases. Journal of Nervous Mental Diseases, 202(7), 513-520 

LSD Microdosing: http://beckleyfoundation.org/microdosing-lsd/

Maclean, K., Johnson, M., Griffiths, R. (2011). Mystical esperiences occasioned by the
     hallucinogen psilocybin lead to increases in the personality domain of openness. 

Journal of psychopharmacology, 25(11), 1453-1461. doi:10.1177/0269881111420188.

Moreno, F., Wiegand, C., Taitano, E., & Delgado, P. (2006). Safety, tolerability, and
     efficacy of psilocybin in 9 patients with obsessive-compulsive disorder. Journal of
     Clinical Psychiatry, 67
(11).

______________________________________________________________________
Ben Hearn is a new professional who is currently working as a school-based counselor. He is passionate about working with trauma and enjoys applying the fields of neuroscience, philosophy, ethics, and psychopharmacology to counseling practice. 

 

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