Psychedelic Therapy For Anxiety
Anxiety can be something that affects us occasionally, perhaps before a big event or an important conversation.
It can also be a regular constant feeling for some.
In fact, anxiety is the most common mental health condition in America, affecting several million adults each year. [1]
It's no surprise that many people who experience anxiety are wondering what the best forms of treatment are.
This article we will examine anxiety and how it can be helpful or harmful to us as humans dependent upon how it is used. We will then explore the ways in which the combination of psychotherapy with psychedelic mushrooms (i.e. psilocybin therapy) can have positive effects on the anxious mind.
What is anxiety?
Anxiety is the way our brain prepares us for potential threats.
Although much more commonly experienced as negative, anxiety understood in this way is essential for our daily survival.
Without our ability to anticipate potential danger, we wouldn’t wear seatbelts when we are driving, we wouldn’t look both ways when we are crossing the street, and we would not walk stealthily through the forests so as not to alert potential saber-toothed tigers of our location.
Okay maybe that last one might not be so relevant anymore, but the point remains: we couldn’t survive without our mind’s ability to prepare for potential threats.
While this may be true, it doesn’t do us much good when we’re not able to function in our daily lives because of it.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) qualifies that for all anxiety disorders (and many other mental health disorders as well), one criterion is that “the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning”. [2]
For many people, anxiety is a persistent force throughout their daily lives, pertaining to specific situations or people (phobias) or to more generalized situations and experiences (a generalized anxiety disorder).
When anxiety reaches this type of disordered level - where it is actively interfering with how we function in our day-to-day lives - some kinds of interventions are necessary. Because at this point, the mind is thinking that it needs to be in survival mode far more often than it does in actuality.
We can think of our minds like a muscle.
The more we use it in certain ways, the stronger it will grow. However, if we focus entirely on one muscle, the surrounding muscles can get weaker as they continuously defer to the stronger muscle groups over time.
Another way to understand anxiety is as the anticipation of future loss in the form of a negative outcome. For example "What if I fail my presentation? It will show my boss that I'm not qualified for this job, which will ultimately get me fire."
We do this as a means of self-protection from the anticipated negative outcome.
But if we constantly view everything in life through this lens, we are more likely to replicate these thought patterns in different situations as well.
Anxious thought patterns, physical symptoms, and feelings of worry repeat over time because they are the strongest muscle group. In a sense, our innate ability of self-protection becomes too powerful, to the point where it actually becomes at the least uncomfortable, and at the most, actively harmful to our ability to live our daily lives.
When it comes to anxiety, this “self-protection” generally takes two forms: either it overestimates the possible threat or it underestimates our ability to cope with the negative outcome itself. And this is the product of the tunnel vision we experience when trying to forecast “worst case scenarios” of situations that make us feel fear or worry.
In any form of therapy, you would work on expanding the mind so that anticipated outcomes are not solely seen to be negative. This brings a more balanced expectation to the way we experience the world around us.
Psychedelic therapy is no different, as part of the functionality of the medicine is to be able to help us expand our minds and feel less likely that we need to be in survival mode at any given time.
Over time, we learn that there are far more likely outcomes (and often more positive!) than the most negative ones we presume to be true.
How would psychedelics help with this?
While psychedelic research for generalized anxiety and other anxiety disorders is still in process, there is much reason to believe that psychedelic treatments could have positive outcomes for those experiencing symptoms of anxiety.
Part of the way psychedelic therapy may be helpful is in the way our thought patterns become rigid when experiencing anxiety.
We get stuck on catastrophic outcomes that are unlikely to happen (“I’ll get fired if I mess up this presentation), we jump to conclusions based on small amounts of evidence (“That person must be mad at me because they are not smiling”), and we overgeneralize negative experiences while discounting positive ones (“I’m probably going to mess it up, because I always mess things up”).
Again, it is important to recognize this is your mind’s attempt at keeping you safe from potential threats. However, if every presentation feels like it is going to be the end of the world or we are getting worried about every person that walks by us without smiling, we need to find a way to re-code the internal dialogue going on in our minds, because it is clearly no longer helpful.
And this is where psychedelics come in.
In his book How to Change Your Mind, author Michael Pollan writes that psychedelics may offer something of a “mental reboot that jolts the brain out of destructive patterns, affording the opportunity for new patterns to take root” (Pollan, p. 384). [3]
Pollan likens the way we think to sleds going down a snowy hill. When our thoughts ruminate, we create deeper and deeper cognitive grooves in the same way that as each sledder goes down the hill, the original path becomes more and more dug into the snow.
In the same way that it would be exceedingly difficult for a sledder to blaze a new path without eventually being routed back into the already dug out path, it is just as difficult for us to break free of rigid thought patterns.
Psychedelics act as a fresh layer of snow that allows for our minds and our thoughts to be malleable and open for expansion.
The singular track tunnel vision that fuels our anxious mind is simply opened up to the possibility that there are other ways of thinking and feeling. And this alone is revolutionary to the anxious mind.
For people that feel entrapped in their anxious thoughts, it would feel like being locked in a jail cell only for someone to reveal there that one of the walls was made out of paper and that escape was possible all along.
A significant part of treating anxiety is simply being able to see that there are alternatives to the rigid thoughts that we may hold so dearly.
Being “outside” the anxious self
Have you ever had an experience of being out in public and you make some kind of mistake?
Maybe you trip on the sidewalk.
Immediately your thoughts go to “that was so embarrassing; everyone probably saw that”.
You try and collect yourself and then look around hoping nobody noticed your social faux pas. In reality, the likelihood of people noticing you or truly caring if you do something stupid is small. But at some moments, our self-conscious mind tells us otherwise.
These self-absorbed types of thoughts have one primary goal in these moments: preserve the self - or the ego - from harm. In this instance, we would be referring to the harm of social embarrassment, a very common driver of anxious thoughts and feelings.
Psychedelic mushrooms and anxiety
What we know about psychedelic drugs such as psilocybin (the active psychedelic ingredient in magic mushrooms), LSD (stands for lysergic acid diethylamide), or DMT is that they have an effect on the Default Mode Network (DMN) of the brain. [4]
This is generally understood to be the area of the brain at work when our mind is wandering, predicting for the future, remembering the past, or experiencing meta-cognition (thinking about thinking).
For someone experiencing a disordered ego due to an anxiety disorder, the DMN would typically be a very active part of the brain, that is in a way contributing to the persistent anxious thoughts and feelings.
By essentially turning off this part of the brain, psilocybin and other psychedelics allow us to experience life outside of our default settings to try and predict an unpredictable future. This is perhaps the key to understanding how psychedelic therapy could be effective in the treatment of anxiety disorders and mood disorders.
For people experiencing disordered anxious thoughts or feelings, this viewpoint of life - where most things are regarded as a potential threat - becomes the only way of conceptualizing the world.
That way of thinking and feeling becomes so normative it can be near impossible to even imagine viewing the world in any other way.
Psychedelic mushroom treatment gives people the opportunity to step outside the ego - step outside our anxiety - and see that there are alternative ways of being. This alone has deep healing potential.
“Ego death” is a commonly noted symptom of a psychedelic experience that can be somewhat difficult to conceptualize if you have not experienced it.
While our goal in psychedelic therapy sessions should probably not be to “kill” the ego (that would be very bad for many reasons!), the idea of receiving a break from the constant regard of the self as the Center of the Universe actually has immense therapeutic potential.
The fact of the matter is that anxious thoughts are selfish thoughts (or at the least, self-interested). "If I go to this party, everyone is going to notice how awkward I am" is a self-centered way of looking at the world. But for someone experiencing social anxiety disorder, it is the automatic way of conceptualizing a future event, where the safety of self is paramount.
Learning to exist and think outside of the self is a healthy restructuring of the mind that can, over time, rewrite the scripts that make it feel essential to constantly be in self-preservation mode.
As Pollan writes, “when the ego dissolves, so does the bounded conception not only of our self but of our self-interest. What emerges in its place is invariably a broader, more open-hearted and altruistic…idea of what matters in life. One in which a new sense of connection, or love, however defined, seems to figure prominently” (390). [3]
While our anxious mind draws us inward, the mind on psychedelics is drawn outward, offering a new way of experiencing the world around us.
The power to realize that you do not have to exist trapped in your head, alone with your thoughts and your feelings, is liberating.
Given the opportunity to see an alternative, we can more accurately assess the threats in our day-to-day lives, realizing the possibility that going to that party is not as dangerous as it once seemed or that not everyone noticed if we tripped and fell on the street.
In doing so, we get to experience the opposite effect, which is to form more meaningful relationships and connections, that are ultimately a long-form way of treating anxiety as well.
What does the clinical research say?
To date, most published research and major clinical trials on psychedelic drugs have focused on the treatment of major depressive disorder, post traumatic stress disorder, obsessive-compulsive disorder, and alcohol use disorder.
This is partly because of generalized anxiety's high rate of comorbidity with various other mental health issues, making it difficult to specifically isolate anxiety symptoms in a way that would produce meaningful clinical trials and results.
With that being said, the research in these other areas has been very positive and suggests a high potential for efficacy in treating long-term anxiety disorders as well.
One study conducted at Johns Hopkins University reported that psilocybin produced "substantial and sustained" decrease in depressive and anxious symptoms in patients with life-threatening cancer. Additionally, cancer patients saw an increase in overall feelings of optimism, meaning in life, and quality of life. [5]
These anti depressant effects led to significant reductions in negative outcomes for those with cancer related depression. Unsurprisingly, psychedelic drug research started to pick up enthusiasm for treating anxiety and depression related to life threatening diseases.
Another study that aimed to focus on psilocybin treatment for treatment-resistant depression noted substantial decreases in depressive symptoms, in large part due to the psilocybin's ability to create new neural pathways within the brain. Notable and sustainable improvement in symptoms of anxiety were additionally observed within this study. [6]
At UCLA, psychedelic researcher Charles Grob has looked at the impact of psychedelics and psychotherapy for helping treat autistic adults who experience social anxiety with MDMA-assisted psychotherapy. [7]
Additional research is in progress, but early results have suggested incredibly promising efficacy in the treatment of mood and anxiety disorders with psychedelics. [8]
Psychedelic medicine is tracking to serve as an alternative to traditional anxiety treatment such as talk therapy, selective serotonin reuptake inhibitors (SSRIs), or serotonin norepinephrine reuptake inhibitors (SNRIs).
There is growing clinical evidence that psilocybin-assisted therapy and various other forms of psychedelic therapy can be used to treat a variety of mental health disorders. However, there is still much to learn and understand about each psychedelic substance and psychedelic assisted therapies. [9]
For now, psychedelic-assisted psychotherapy instills much hope and excitement for people that may greatly benefit from the therapeutic effects to treat depression and anxiety.
Intentional Psychedelic Use For Anxiety
Many people are choosing to engage in intentional psychedelic use and pairing it with talk therapy or integration therapy sessions to address mental illness or general life challenges.
Psychedelics are tools for our health and wellbeing.
When used responsibly, these substances can have a profound, positive impact on our lives.
So too can mindfulness activities like yoga, breath work, and meditation.
In fact, intentional psychedelic use may be even more effective when it's paired with meditation or spiritual practices. [10]
Anxiety related to consuming psychedelic medicine (psychedelics anxiety) is completely understandable given how new of an experience it can be for someone.
Working with a psychedelic therapist or guide can be a pivotal step in your healing journey because it can provide a safe, structured environment to mitigate risks and allow for someone to focus on the experience itself and the internal process.
If you're looking to work through anxiety with intentional psychedelic use, consider reaching out to us at Pivot.
Sources:
Anxiety Disorders - Facts & Statistics. (n.d.) Anxiety & Depression Association of America. https://adaa.org/understanding-anxiety/facts-statistics#Facts%20and%20Statistics
Diagnostic and statistical manual of mental disorders: DSM-5. (2017). CBS Publishers & Distributors, Pvt. Ltd.
Pollan, M. (2019). How to change your mind: The new science of psychedelics. Penguin Books.
Randy L. Buckner (2013) The brain's default network: origins and implications for the study of psychosis, Dialogues in Clinical Neuroscience, 15:3, 351-358, DOI: 10.31887/DCNS.2013.15.3/rbuckner
Griffiths RR, Johnson MW, Carducci MA, et al. (2016) Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology. 2016;30(12):1181-1197. doi:10.1177/0269881116675513
Carhart-Harris, R. L., Bolstridge, M., Rucker, J., Day, C. M., Erritzoe, D., Kaelen, M., Bloomfield, M., Rickard, J. A., Forbes, B., Feilding, A., Taylor, D., Pilling, S., Curran, V. H., & Nutt, D. J. (2016). Psilocybin with psychological support for treatment-resistant depression: An open-label Feasibility Study. The Lancet Psychiatry, 3(7), 619–627. doi:10.1016/s2215-0366(16)30065-7
Danforth AL, Struble CM, Yazar-Klosinski B, Grob CS. MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults. Prog Neuropsychopharmacol Biol Psychiatry. 2016 Jan 4;64:237-49. doi: 10.1016/j.pnpbp.2015.03.011. Epub 2015 Mar 25. PMID: 25818246.
Carhart-Harris RL, Bolstridge M, Day CMJ, Rucker J, Watts R, Erritzoe DE, Kaelen M, Giribaldi B, Bloomfield M, Pilling S, Rickard JA, Forbes B, Feilding A, Taylor D, Curran HV, Nutt DJ. Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. Psychopharmacology (Berl). 2018 Feb;235(2):399-408. doi: 10.1007/s00213-017-4771-x. Epub 2017 Nov 8. PMID: 29119217; PMCID: PMC5813086.
Barber GS, Aaronson ST. The Emerging Field of Psychedelic Psychotherapy. Curr Psychiatry Rep. 2022 Oct;24(10):583-590. doi: 10.1007/s11920-022-01363-y. Epub 2022 Sep 21. PMID: 36129571; PMCID: PMC9553847.
Griffiths RR, Johnson MW, Richards WA, Richards BD, Jesse R, MacLean KA, Barrett FS, Cosimano MP, Klinedinst MA. Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors. J Psychopharmacol. 2018 Jan;32(1):49-69. doi: 10.1177/0269881117731279. Epub 2017 Oct 11. PMID: 29020861; PMCID: PMC5772431.
