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Navigate the Future of Mental Health Care with Psychedelic-Assisted Therapy with Paul Liknaitzky · Hardiness with Dr Paul Taylor

0:00
Speaker 1: The scientific endeavor is one in which we try to
0:03
Speaker 1: remain in conversation with reality, pair away our biases, et cetera,
0:07
Speaker 1: and in this case, the critical reality to keep our
0:10
Speaker 1: eyes on. The critical thing to remain in a relationship
0:13
Speaker 1: with is the reality of real people's lives as we
0:17
Speaker 1: treat them, after we treat them, and sometimes that gets
0:20
Speaker 1: lost in the numbers in a paper or some public
0:23
Speaker 1: announcement or some commercial deal or whatever. I think there's
0:27
Speaker 1: so much promise in psychedelic therapies and if we're going
0:30
Speaker 1: to figure this out, we're going to need to stay
0:33
Speaker 1: very close to real patients and their real stories and
0:35
Speaker 1: their real features.
0:46
Speaker 2: Doctor Paul lick Nightski, Welcome to the podcast.
0:50
Speaker 1: Thanks Paul. Nice to beerre there.
0:52
Speaker 2: I'll tell you what setting up the audio on this
0:56
Speaker 2: is more tricky than setting.
0:58
Speaker 1: Up Not quite, but yes, that was hard.
1:04
Speaker 2: So me we met Oh Geez a couple of months
1:07
Speaker 2: ago now when we both presented to the Young President's Organization,
1:12
Speaker 2: and I was very excited to be presenting alongside you, and.
1:16
Speaker 3: The stuff that you talked about was unbelievable.
1:20
Speaker 2: So talk to our listeners about what you do and
1:25
Speaker 2: importantly how you got there.
1:27
Speaker 1: Yeah, thanks, Paul. I still can't quite believe what I
1:32
Speaker 1: do for a day job. I set up Australia's first
1:35
Speaker 1: clinical psychedelic lab in twenty twenty, not because I wanted
1:39
Speaker 1: to set up a lab or help establish a field
1:42
Speaker 1: in the country, but because I wanted to work in
1:44
Speaker 1: the space and there wasn't anything going. And what we're
1:49
Speaker 1: primarily doing at the Clinical Psychedelic Lab at Monash University
1:52
Speaker 1: is running clinical trials using psychedelics with psychotherapy for a
1:56
Speaker 1: range of different mental health condition But because we're a
2:02
Speaker 1: front runner in the space, we've found ourselves needing to
2:05
Speaker 1: be a bit more useful than that, at least kind
2:08
Speaker 1: of broadening our scope, and we are now. We have
2:11
Speaker 1: been involved in training and other education in the psychedelic space,
2:15
Speaker 1: and we're now moving into a very formal process around
2:20
Speaker 1: psychedelic education and training, and we've been involved in all
2:25
Speaker 1: sorts in policy development. Obviously, Australia is a very rapidly
2:30
Speaker 1: changing context in the psychedelic space. In fact, i'd say globally,
2:35
Speaker 1: Australia has gone through more change in the psychedelic space
2:40
Speaker 1: than any other country in the last few years. So
2:43
Speaker 1: it's a very exciting dynamic, complex space to work in,
2:47
Speaker 1: and I really feel very grateful to have work that
2:50
Speaker 1: is both interesting and seems useful.
2:53
Speaker 3: Mm.
2:54
Speaker 2: Yeah, look absolutely, and we will dig into just high
2:58
Speaker 2: useful that ease, because seeing your presentation, I was like.
3:01
Speaker 3: Oh my god.
3:01
Speaker 2: And I've been tell you, I've been following this space
3:05
Speaker 2: for a number of years. And I'll tell you where
3:08
Speaker 2: my interests started was way back in nineteen ninety six
3:13
Speaker 2: when I started to do a master's degree in social
3:17
Speaker 2: anthropology and the first subject that we did was shamanism,
3:23
Speaker 2: and I got really interested in shamanism to the point
3:26
Speaker 2: where I packed in my master's degree and went off
3:29
Speaker 2: traveling and ended up in South America and had a
3:34
Speaker 2: really interesting experience with an inca medicine woman named Dorda,
3:41
Speaker 2: and I went and did a psychedelic journey with San
3:44
Speaker 2: Pedro cactus with the active ingredients mescaline. But interestingly, I
3:51
Speaker 2: was into it for exploring consciousness. But there were two
3:55
Speaker 2: other people who were in that session, one who was
3:58
Speaker 2: a drug addict and the other in alcoholic and they
4:01
Speaker 2: had been through all sorts of treatments and they said
4:04
Speaker 2: to me that this stuff that she was doing with
4:07
Speaker 2: them was just light years ahead in terms of the
4:11
Speaker 2: impact that I actually had on them. And then I
4:14
Speaker 2: started looking into the ayahuasca church in Brazil that had
4:19
Speaker 2: like crazy remission rates for alcoholics and drug addicts. And
4:25
Speaker 2: I have actually done a whole heap of shamanic journeys
4:28
Speaker 2: in the Amazon jungle with ayahuasca, which is a pretty
4:33
Speaker 2: potent hallucinogen. So that's where my interest was a personal interest,
4:37
Speaker 2: and I've kind of kept an eye on this space
4:39
Speaker 2: because I was like, why isn't this stuff being done
4:42
Speaker 2: in mainstream?
4:43
Speaker 3: So just give our.
4:46
Speaker 2: Listeners a little bit of a history of this, because
4:49
Speaker 2: there was some stuff in the nineteen sixties, wasn't there,
4:52
Speaker 2: And then yeah, it got cibosched for quite a while.
4:56
Speaker 1: Yeah. In fact, you know, many of us think of
4:58
Speaker 1: this phase as the third wave of Western psychedelic science
5:04
Speaker 1: and therapies. The first wave was in the late eighteen
5:07
Speaker 1: hundreds early nineteen hundreds and very dappled history of Westerners
5:13
Speaker 1: having interesting adventures in indigenous contexts and bringing back stories
5:19
Speaker 1: and products and writing theses on these encounters. But a
5:24
Speaker 1: far more productive phase kicked off in the nineteen fifties
5:29
Speaker 1: and for close on two decades there was an uptick
5:33
Speaker 1: in psychedelic research and practice. Now, a lot of this
5:38
Speaker 1: work happened in that second wave prior to the prohibition
5:42
Speaker 1: of drugs like lstan, psilocybin and MDMA, so they were
5:47
Speaker 1: implemented in clinical practice alongside being tested in a lab.
5:51
Speaker 1: It wasn't like you start in the lab and then
5:53
Speaker 1: when it's proved up you moved to the clinic. It
5:55
Speaker 1: was a very productive phase. I mean, we look back
5:57
Speaker 1: on that phase now with mixed feelings. I think in
6:01
Speaker 1: many respects, the clinical science of the day doesn't hold
6:07
Speaker 1: up to the contemporary standards that we require when we
6:10
Speaker 1: judge data, so the data is a little harder to
6:13
Speaker 1: interpret in a modern context. But it was also very
6:16
Speaker 1: productive and very experimental. ALST was the main drug being
6:21
Speaker 1: trialed and tested for a range of different psychiatric and
6:25
Speaker 1: addiction issues, principally alcohol use disorder, and there was a
6:29
Speaker 1: whole sort of fascinating experiments from using you know, moderate
6:34
Speaker 1: dose LSD with active psychotherapy which is called psycholytic psychotherapy,
6:40
Speaker 1: something that has still not been retested in the modern era,
6:44
Speaker 1: through to some rather unfortunate misadventures, for example trialing out
6:50
Speaker 1: LSD for schizophrenic children, and you know, there was a
6:56
Speaker 1: whole a whole host of experimental work done, and some
7:00
Speaker 1: of it was great, some of it was fantastic. We
7:02
Speaker 1: all estimated forty thousand doses of others to were given
7:05
Speaker 1: in controlled settings, and there were multiple international conferences and
7:09
Speaker 1: big you know, about a thousand research papers, and then
7:14
Speaker 1: you know what's now the famous kind of war on
7:17
Speaker 1: drugs kicked off led by Nixon's administration in the US,
7:22
Speaker 1: but ratified through UN conventions and a set of international
7:26
Speaker 1: treaties that really left only a very small handful of
7:29
Speaker 1: countries around the world allowing psychedelic drugs to be used legally,
7:34
Speaker 1: and the vast majority of the world banned them and
7:37
Speaker 1: banned them in the most prohibitive way, you know, put
7:39
Speaker 1: them alongside drugs like heroin and cracker caine and labeled
7:43
Speaker 1: them as you know, as dangerous with high abuse potential
7:46
Speaker 1: and so on. Now, there were many factors actually that
7:49
Speaker 1: contributed to the demise of that second wave of psychedelic
7:53
Speaker 1: experimentation in Western psychiatry. But it seems that and history
7:58
Speaker 1: seems to bear this out, that the majority of that
8:02
Speaker 1: was driven by a kind of propaganda campaign which was
8:06
Speaker 1: predicated on a set of lies. If you are to
8:09
Speaker 1: schedule a drug as a Schedule one substance in the US,
8:12
Speaker 1: which is roughly equivalent to a Schedule nine in Australia,
8:16
Speaker 1: then you have to show that that drug has a
8:18
Speaker 1: high potential for abuse. That means it's highly addictive, and
8:23
Speaker 1: you also have to show that it's got no known
8:24
Speaker 1: medical value. And at the time that happened in ninety seventy,
8:29
Speaker 1: there was already about two decades of research indicating exactly
8:34
Speaker 1: the opposite. In fact, drugs like LSD and psilocybin, the
8:37
Speaker 1: active ingredient in magic mushrooms, are anomalous in the context
8:42
Speaker 1: of psychotropic agents. If you have a drug that produces
8:46
Speaker 1: very strong psychoactive effects, typically there are whole set of
8:51
Speaker 1: side effects as well, and you get to toxic doses
8:54
Speaker 1: pretty quickly and so on. With drugs like LSD and psilocybin,
8:57
Speaker 1: you get the most unbelievably hoblit and psychoactive effects with
9:02
Speaker 1: negligible physiological harm. So quite anomalous. You know, even caffeine
9:08
Speaker 1: can be more harmful. So yeah, fast forward to ninety
9:13
Speaker 1: nine and a small group of brave researchers kicked off
9:17
Speaker 1: what is now considered the third wave of psychedelic research,
9:21
Speaker 1: sometimes a psycho renaissance, and that was a group of
9:25
Speaker 1: Johns Hopkins who quietly kicked off an initial study. Interestingly,
9:29
Speaker 1: it wasn't a psychiatric study. It was a study with
9:35
Speaker 1: so called healthy volunteers, and they published that in two
9:38
Speaker 1: thousand and six, and over that subsequent ten year period
9:42
Speaker 1: or so, the beginnings of the field took shape. And
9:46
Speaker 1: probably in the last just four or five years, we've
9:50
Speaker 1: seen just a very clear exponential uptick in productivity and
9:57
Speaker 1: commercial interest and general community awareness of psychedelics. A lot
10:02
Speaker 1: of people who know about psychedelics found out about them
10:06
Speaker 1: in the last few years, the majority of people, I
10:08
Speaker 1: would say, And so, yeah, now we really are an
10:11
Speaker 1: interesting phase right now. I would suggest we probably are
10:17
Speaker 1: rounding out or coming down from the peak of what
10:20
Speaker 1: some people call the hype cycle. There has been a
10:23
Speaker 1: lot of hype around psychedelics and a lot of misinformation
10:27
Speaker 1: about psychedelics, and we are starting to see the beginnings
10:31
Speaker 1: of less impressive results than the earlier trials. Maybe some
10:36
Speaker 1: negative reports here and there, and some criticism in the
10:38
Speaker 1: field and so on, and I think that's natural to
10:41
Speaker 1: be expected. That's healthy. My hope is that the field
10:45
Speaker 1: you know, course correct to best practicing clinical work and
10:49
Speaker 1: rigorous science, and we can avoid what comes after peak
10:54
Speaker 1: hype in many of these models, which is, you know,
10:57
Speaker 1: a trough of disillusionment. I hope we can avoid that
11:01
Speaker 1: and kind of flatten that curve into sensible, rigorous, well
11:06
Speaker 1: integrated clinical practice in the space.
11:09
Speaker 2: So let's talk now about some of the stuff that
11:13
Speaker 2: you're doing in the lab and in the clinic, because
11:18
Speaker 2: you're doing some of the world first stuff and I
11:20
Speaker 2: think you probably hinted at it there where you were
11:23
Speaker 2: talking about all this excitement and in some negative results.
11:27
Speaker 2: Presumably getting a really rigorous intervention is really key, right,
11:35
Speaker 2: an evidence based intervention that you can then replicate over
11:39
Speaker 2: and over again to get really good data, rather than
11:43
Speaker 2: having lots of different people doing lots of different things,
11:47
Speaker 2: some just using psychedelics without psychotherapy, some using it with psychotherapy.
11:52
Speaker 3: So to tell me the sort of stuff that.
11:54
Speaker 2: You're doing and give our listeners just a bit of
11:57
Speaker 2: an insight into some of the rigor that goes into
11:59
Speaker 2: the planning of this sort of stuff.
12:01
Speaker 1: Yeah, fanksful. Before jumping into a little bit of a
12:05
Speaker 1: picture of our lab admonish and what we're doing and
12:07
Speaker 1: kind of what the next five years looks like in
12:10
Speaker 1: our view, it's worth just touching on something you hinted
12:13
Speaker 1: at there, which is what I think of is the
12:17
Speaker 1: most damaging and pervasive misunderstanding or maybe misrepresentation in our field,
12:24
Speaker 1: and that is that a lot of people still think
12:28
Speaker 1: that most of this treatment is about a drug, or
12:32
Speaker 1: even that it's all about a drug, when in reality,
12:36
Speaker 1: in our experience, in our view and in the trials
12:38
Speaker 1: around the world, when psychedelics work well, they work well
12:43
Speaker 1: on account of augmenting psychotherapy, on account of facilitating a
12:48
Speaker 1: psychotherapy process. Now in all trials so far that's a
12:52
Speaker 1: formal psychotherapy program. Oftentimes you're receiving about four times as
12:58
Speaker 1: many talk therapy sessions compared to drug sessions, and they
13:01
Speaker 1: will sometimes be every week for three months, depends on
13:04
Speaker 1: the trial. And I can tell you a bit about
13:06
Speaker 1: our different trials, you know, even when whether that's kind
13:09
Speaker 1: of very extensive or more minimal, it is a psychotherapytic
13:13
Speaker 1: process that gets facilitated with the aid of these drugs.
13:18
Speaker 1: When it works well, and if you think about it,
13:20
Speaker 1: I mean clearly, when the drug is in your system,
13:23
Speaker 1: and the acute effects are at their peak. That experience
13:28
Speaker 1: is driven by the drug. You've got a compound that
13:31
Speaker 1: they've got a molecule that's crossed the blood brain barrier
13:33
Speaker 1: and stocking receptors in your brain and causing an effect. Now,
13:37
Speaker 1: for the days or sometimes weeks after your dosing session,
13:40
Speaker 1: people will sometimes report what we call the after glow effect.
13:44
Speaker 1: It might feel spontaneously different and maybe behave differently as well.
13:48
Speaker 1: They might feel more emotionally open or mobile. They might
13:52
Speaker 1: feel connected to their priorities, or decide to go for
13:56
Speaker 1: a stroller and listen to music instead of just work
13:58
Speaker 1: until dinner time or whatever might be. And some of
14:01
Speaker 1: that may be also driven by some of the drug
14:04
Speaker 1: effects or the kind of post drug reverberations in your
14:07
Speaker 1: neural networks. As you know, it comes out of your system.
14:10
Speaker 1: But with most of these drugs, the half life is
14:12
Speaker 1: in the order of six or eight hours, and clearly
14:16
Speaker 1: a week or two or three later, the drug is
14:19
Speaker 1: out of your system. And if you're going to see
14:22
Speaker 1: somebody's life transformed a year later, that is clearly not
14:27
Speaker 1: on account of a drug still working in your brain.
14:30
Speaker 1: The drug is gone. It facilitated an experience, it gave
14:34
Speaker 1: an opportunity for some sort of transformation, and then if
14:37
Speaker 1: it works, it's because some psychotherapeutic and maybe behavior change
14:41
Speaker 1: process was triggered and it's a virtuous cycle of learning
14:44
Speaker 1: and growth and development.
14:45
Speaker 2: So and it signs to me with that description that
14:49
Speaker 2: there's a bit of a combination of the drug inducing
14:55
Speaker 2: massive neural plasticity and then the psychotherapy, which may have
15:01
Speaker 2: an effect in and of itself, but then the psychotherapy
15:05
Speaker 2: then kind of steering that neural plasticity to psychological flexibility or.
15:12
Speaker 4: Just changing behavior changing goald.
15:14
Speaker 2: Sense of meaning purpose that sort of stuff is that
15:17
Speaker 2: is that kind of what's going on.
15:19
Speaker 1: You know, that's one lens to look through at this,
15:22
Speaker 1: and I think that sounds right to me. There's also perhaps,
15:25
Speaker 1: you know, other lenses, like more psychological or experiential psychodynamic
15:30
Speaker 1: lenses to look at this through where people might have
15:34
Speaker 1: a profound experience. The psychoic experiences are often rated as
15:39
Speaker 1: one of the most profound of a person's life. I mean,
15:41
Speaker 1: this is one of one of the amazing things about
15:43
Speaker 1: my job because it's you know, today's Monday. It's just
15:47
Speaker 1: another Monday for me. But we had an MDMA dosing
15:50
Speaker 1: session today today might be you know, one of the
15:53
Speaker 1: transformational or pivotal moments in that person's life that came
15:56
Speaker 1: to our lab today, and it's.
15:58
Speaker 2: I mean, there's a there's published a long history, like
16:03
Speaker 2: large thousand year old history of reported ecstatic experiences.
16:09
Speaker 1: Right right, And so sometimes it's ecstatic and other times
16:12
Speaker 1: it's you know, extremely painful. I mean, often we are
16:16
Speaker 1: facilitating some of the most challenging experiences of people's lives.
16:20
Speaker 1: But the value doesn't depend on whether you happen to
16:25
Speaker 1: feel good or struggle. The value is in a completely
16:29
Speaker 1: different kind of orientation to your life, or yourself or
16:33
Speaker 1: your history. And for a lot of people that're getting
16:36
Speaker 1: this kind of contact moment, like an unprecedented contact, usually
16:41
Speaker 1: with at least the sources of their distress in their
16:44
Speaker 1: life and maybe their pathology. But sometimes it's a connection
16:47
Speaker 1: or a contact with their priorities or the people that matter,
16:51
Speaker 1: or it is like a realignment. We often talk about
16:54
Speaker 1: kind of compass setting in this work. Now, compass doesn't
16:56
Speaker 1: get you to your destination, and that's what psychotherapy is for. Yeah,
17:01
Speaker 1: So the psychotherapy to contain it does many things. I mean,
17:04
Speaker 1: in the preparation phase before your first dosing day. It's
17:08
Speaker 1: mostly kind of gearing you up for a safe and
17:12
Speaker 1: productive journey. You know, we get the launch pad sorted,
17:16
Speaker 1: we get the rocket facing in the right direction. There's
17:19
Speaker 1: a whole lot of work to be done to ensure
17:21
Speaker 1: that you have a very good chance of going the
17:24
Speaker 1: distance and not fighting. And in reality, you know, every
17:27
Speaker 1: psyche that journeys quite different. But the critical thing that
17:31
Speaker 1: we need to take care of on that launch pad
17:34
Speaker 1: before we launch is trust, because without trust we fight
17:42
Speaker 1: these confronting experiences. In fact, psychedelics are in strange ways
17:48
Speaker 1: showing people the kinds of experiences or perspectives that they've
17:52
Speaker 1: spent a huge amount of time and effort trying to
17:54
Speaker 1: avoid their whole lives, but from a bit of a
17:57
Speaker 1: different angle, and there's a lot of chain lenge and
18:00
Speaker 1: there's a lot of potential for distress unless we can
18:04
Speaker 1: teach people the skills and the knowledge around how to
18:08
Speaker 1: kind of trust and go and be open and go
18:10
Speaker 1: for the right And if you can do that, then
18:13
Speaker 1: who knows what will be shown to you. But it's
18:14
Speaker 1: often unbelievably productive. People feel like they're in a waterfall
18:20
Speaker 1: of psychotherapeutic material like this's just barely have they managed
18:24
Speaker 1: to digest an insight or a priority, or a perspective
18:28
Speaker 1: or a feeling, and the next one is falling on them,
18:30
Speaker 1: and the next one again. And so the biggest challenge
18:33
Speaker 1: we face, I mean, it's quite clear how we set
18:35
Speaker 1: the launch pad up. That's actually you can prodigalize that,
18:39
Speaker 1: and we can guarantee that all but guarantee that we
18:41
Speaker 1: set that launch pad up. Well, the bigger challenge for
18:45
Speaker 1: our field is that you stand under that psychedelic waterfall
18:50
Speaker 1: with thymbols, little thimbles, and that's what you've got to
18:54
Speaker 1: take into the rest of your life. And so one
18:58
Speaker 1: of the tasks of the therapist and a whole protocol
19:01
Speaker 1: is to is to turn those symbols into bigger buckets
19:04
Speaker 1: and find ways in which those buckets can be refilled
19:07
Speaker 1: without the drug. And what I'm talking about here is
19:10
Speaker 1: the durability of effects. You know, we can get a
19:13
Speaker 1: high rate of incredibly profound, useful psychedelic experience what people
19:18
Speaker 1: will often call transformative experience, but there's often there's a
19:24
Speaker 1: difference between these peak experiences and real transformation because the
19:29
Speaker 1: challenge of the human condition and the challenge of mental
19:32
Speaker 1: illness on top of that is monumental. It's so great.
19:35
Speaker 1: We really are up against decades of habits and billions
19:40
Speaker 1: of years of evolution, and so this is I come
19:43
Speaker 1: back to this, this misunderstanding, and it's a kind of
19:46
Speaker 1: magical thinking, this idea that a person who is deeply
19:49
Speaker 1: distressed and has entrenched pathological behavior in there or thinking
19:55
Speaker 1: can take a drug and that they are sorted forever
19:58
Speaker 1: based on that way.
20:01
Speaker 2: So you've made several references to the launch part, and
20:05
Speaker 2: I remember when we were talking at the YPO gig
20:09
Speaker 2: you said, psychedelics are a rocket ship for for psychotherapy.
20:14
Speaker 2: If you're going to be in a rocket ship, you
20:16
Speaker 2: want to bloody well steer this thing. And that's the
20:20
Speaker 2: role of the psychotherapist, right, So, as you really pointed
20:25
Speaker 2: out there, it's not the psychedelics by themselves, it's that combination.
20:29
Speaker 3: With the therapy.
20:31
Speaker 2: So tell us what are some of the things that
20:34
Speaker 2: you are doing, some of the trials that you have
20:37
Speaker 2: done now that we've got all of that context set
20:39
Speaker 2: up for people, because I think it's really important, right.
20:42
Speaker 1: Yeah, So we've finished up a few studies and psyched
20:47
Speaker 1: the trials in the lab already, and I'll tell you
20:49
Speaker 1: a bit about those, and then we have a couple
20:51
Speaker 1: ongoing and a couple that are coming down the line.
20:54
Speaker 1: The first study we finished actually was a study where
20:58
Speaker 1: we gave psilocyber with support to our therapists as part
21:03
Speaker 1: of their training. And the basic question there was is
21:07
Speaker 1: there a role for having your own psychedelic experience in
21:11
Speaker 1: your competency as a psychedelic therapist. This has become a
21:15
Speaker 1: theme in our lab and one of my students is
21:17
Speaker 1: is leading this work currently where we're looking at the
21:21
Speaker 1: broader topic of psychedelic therapeutic competencies and building a framework
21:27
Speaker 1: based on prior psychotherapy frameworks to understand what is unique
21:33
Speaker 1: and what is overemphasized in the psychedelic space, What does
21:35
Speaker 1: it take to train a good clinician in the space
21:38
Speaker 1: and to assess that their competency and so on, And
21:41
Speaker 1: then in addition to that, is there a role for
21:43
Speaker 1: having your own psychedelic experience in that competency? Does it
21:46
Speaker 1: do something important? And you know the paper is forthcoming,
21:50
Speaker 1: we'll publish that soon, but the punchline is a resounding yes,
21:55
Speaker 1: it is. It seems to be incredibly useful, and it
21:57
Speaker 1: also accords with common sense in the space that having
22:01
Speaker 1: your own psychedelic experience does potentially improve your competency to
22:06
Speaker 1: be a good psychoic therapist. Although I'd say a few things.
22:09
Speaker 1: One is that is in the context of people who
22:12
Speaker 1: already trained as clinicians and then who have already had
22:14
Speaker 1: a psychedelic therapist specialist training, and then they're giving this
22:18
Speaker 1: doicing exposure on top of that, and most people indicated,
22:23
Speaker 1: and we assess both the therapist and then we assessed
22:26
Speaker 1: all their patients who they treated afterwards. Honest people will
22:30
Speaker 1: generally say yeah, but it's not necessarily the most important thing.
22:35
Speaker 1: I think many people would agree you would rather have
22:39
Speaker 1: a well trained, qualified psychotherapist than somebody who's not at
22:43
Speaker 1: all trund to qualify but has had lots of psychedelic trips.
22:46
Speaker 1: So we ran that study. We can also see that
22:50
Speaker 1: a huge majority of patients prefer and sometimes demand that
22:56
Speaker 1: their therapists have had psychedelic experience, and they'll generally make
23:00
Speaker 1: appeals to the kind of common sense metaphors like what
23:03
Speaker 1: you know, how could you have a tour guide who's
23:06
Speaker 1: never been to that country, or something like that you
23:09
Speaker 1: can make the case even more strongly for you know,
23:12
Speaker 1: another planet. It's a tour guide on another plant. Yes,
23:16
Speaker 1: so that's an exciting program of work, and we are
23:19
Speaker 1: I'll talk to you soon about our planned Center of
23:22
Speaker 1: Excellence that we are planning to launch next year. One
23:26
Speaker 1: theme within the trials component of that center is to
23:31
Speaker 1: further develop our therapist training competencies work including running an
23:37
Speaker 1: expanded trial where we give therapists different psychedelic drugs and
23:42
Speaker 1: we use our new developed tools to assess their changing
23:45
Speaker 1: competencies over time. So that was exciting. There was a
23:47
Speaker 1: world first approval to give psilocybin to therapists as part
23:50
Speaker 1: of their training, and then that group of therapists went
23:55
Speaker 1: on to work on another world first trial that we
23:59
Speaker 1: concluded early this year, which was Psilocybin Assistant Therapy for
24:03
Speaker 1: severe Generalized Anxiety disorder, and that that was the first
24:06
Speaker 1: psilocybin trial to look at a primary anxiety condition. We'd
24:11
Speaker 1: seen in previous trials that psilocybin was useful in reducing
24:15
Speaker 1: anxiety symptoms for people with physical illness, people that maybe
24:19
Speaker 1: were given a terminal diagnosis and were anxious because they
24:23
Speaker 1: were told they were going to die, but no one
24:25
Speaker 1: had ever looked at psilocyberin assistant therapy to treat you know,
24:30
Speaker 1: chronic entrenched primary anxiety, the kind of anxiety that will
24:34
Speaker 1: often have an onset in late adolescents and stick around
24:38
Speaker 1: for the resculized jackage and being related to anything and everything.
24:43
Speaker 1: That was a wonderful project, very challenging in many respects.
24:47
Speaker 1: We treated seventy three participants in that study. Again, the
24:52
Speaker 1: paper is forthcoming, but the headline there was the safest
24:56
Speaker 1: psilocybin study in the modern era so far. The safety
25:00
Speaker 1: on that study was better than any so far. And
25:03
Speaker 1: that's measured in terms of what I called adverse events
25:06
Speaker 1: and suicidality. And the clinical effect size, or the the
25:12
Speaker 1: size of the benefit between the group that received psilocybin
25:15
Speaker 1: and the group that received placebo different active placebo drug
25:19
Speaker 1: was a very large effect size well size. So if
25:23
Speaker 1: you if any of your listeners are nerdy and like
25:26
Speaker 1: their coens D, it was a coen CD of just
25:29
Speaker 1: under one wow, so coens D of about zero point
25:34
Speaker 1: three two point five is considered good. Most of the
25:38
Speaker 1: treatments that are approved and registered and you can get
25:42
Speaker 1: prescribed have had trials that show CONESD of point three
25:45
Speaker 1: two point five. If you get point eight, it's considered
25:49
Speaker 1: big at large, And we were at about point at
25:53
Speaker 1: about one.
25:55
Speaker 2: So so let me give the listeners a little bit
25:58
Speaker 2: of context here that antidepressants typically have a Cohen's day
26:04
Speaker 2: of a bide depending on the on the one on
26:07
Speaker 2: the particular drug, zero point three to zero point five.
26:10
Speaker 2: So you know, zero point two marginally better than placebo.
26:14
Speaker 2: Anything better than that is reasonably good. But when you're
26:18
Speaker 2: talking about some of the side effects. You know, when
26:22
Speaker 2: we take antidepressants, recent study of eighteen hundred users, right,
26:28
Speaker 2: real worded people showed that more than sixty percent of
26:32
Speaker 2: them were are sixty percent were having really really challenging
26:37
Speaker 2: side effects. Right, So you're both in terms of your intervention,
26:43
Speaker 2: both in terms of the effects sides.
26:45
Speaker 3: And I know that was generalized anxiety disorder.
26:47
Speaker 2: I'm comparing against depression, but I think you probably have
26:51
Speaker 2: similar effects sizes for medications I'm guessing for anxiety disorder,
26:55
Speaker 2: and because the medications a lot of them are antidepressants
26:58
Speaker 2: for anxiety disorder, right, So you'll see so this completely
27:04
Speaker 2: outperforming like but by.
27:06
Speaker 3: Almost orders of latitude.
27:08
Speaker 2: That's right, both in terms of the CFD and in
27:11
Speaker 2: terms of the empower.
27:12
Speaker 1: That's right, and so the critical question, I mean, there's
27:14
Speaker 1: two big questions. One is do those benefits endure? You know,
27:19
Speaker 1: what are those people looking like in six twelve months?
27:23
Speaker 1: You know, or further down the track. We've now done
27:25
Speaker 1: our six month follow ups and we can say that
27:27
Speaker 1: the benefit endured very well to six months. Wow, we
27:33
Speaker 1: will do one and a half year, two and a
27:35
Speaker 1: half year, three and a half. We will continue to
27:37
Speaker 1: assess them. So that data is still coming in and
27:40
Speaker 1: we have some ideas about you know, how to improve
27:43
Speaker 1: dr ability through you know, low cost forms of integration
27:48
Speaker 1: and support and so on. There are all kinds of
27:50
Speaker 1: things that can be deployed. The next critical question is
27:53
Speaker 1: can you replicate that? Can that be done you know
27:56
Speaker 1: at a new clinic or a new site and so on?
27:59
Speaker 1: And that's a complicated because this is psychedelics with therapy
28:03
Speaker 1: and the type of therapy that is involved and the
28:07
Speaker 1: type of therapists that have been involved are not just
28:10
Speaker 1: run of the mill, and you know, not to disparage
28:13
Speaker 1: it anyone, I mean, most therapists have good training and
28:17
Speaker 1: attempt to do a great job but these folk have
28:19
Speaker 1: been kind of hand picked, as you know, incredibly excellent polician, psychiatrists, psychotherapist, psychologists.
28:27
Speaker 1: They've all been trained in a very intense way, and
28:31
Speaker 1: they have poured in a lot of care into this
28:34
Speaker 1: work because it's experimental, because it's often a passion project,
28:37
Speaker 1: because they are so kind of motivated to work in
28:41
Speaker 1: this way. And so that's part of why we have
28:44
Speaker 1: this big focus on capacity development in our forthcoming center,
28:48
Speaker 1: because we're wanting to understand what are the critical elements
28:52
Speaker 1: of being a good psychedelic therapist, What are the critical
28:55
Speaker 1: elements of good psychedelic therapy, How do we operationalize that,
28:59
Speaker 1: how do we train that, how do we assess for
29:01
Speaker 1: that It's not going to be a cookie cutter approach
29:04
Speaker 1: and this treatment model, if it's going to work well,
29:09
Speaker 1: if psycho lets fulfill their promise, then I don't believe
29:14
Speaker 1: they will fulfill their promise by being, you know, a
29:17
Speaker 1: drug therapy or a cookie cutter model or something that
29:20
Speaker 1: we can just kind of run off the pipeline and
29:22
Speaker 1: scale up in some extreme way. I think it will
29:25
Speaker 1: depend on nuance and human factors and you know, the
29:29
Speaker 1: wisdom and depth of the of the ecosystem around it.
29:33
Speaker 1: If we're going to see unprecedented outcomes continue into the future,
29:36
Speaker 1: I don't think it's this is this is the kind
29:38
Speaker 1: of key challenge for the field now, because of course,
29:41
Speaker 1: when something shows a signal, the next typical step is scale.
29:45
Speaker 1: That's great, we've got just let's move it out. And
29:48
Speaker 1: of course there's a possibility that the baby's thrown out
29:51
Speaker 1: with the bathwater as you scale. And my big question,
29:56
Speaker 1: you know, in the next five years, is how do
29:58
Speaker 1: we responsibly without sacrificing you know, the impressive results, the
30:05
Speaker 1: transformational experiences, the you know, the growing community of practitioners
30:10
Speaker 1: in the space who are invested in high quality work.
30:13
Speaker 1: It's not only about using psychedelics to facilitate change in
30:18
Speaker 1: a patient's life. It's about seeing whether we can use
30:21
Speaker 1: psychedelics to facilitate change in the mental health cases.
30:25
Speaker 2: Well, I was going to say, I would presume that
30:28
Speaker 2: you have one eye on the naysayers in the mental
30:32
Speaker 2: health system who are looking for any excuse for this
30:36
Speaker 2: to feel and so I would imagine you're having to
30:39
Speaker 2: step forward a lot more carefully than you would do
30:43
Speaker 2: if this was just a brand new field with no
30:47
Speaker 2: existing dinosaurs should we call it in the field, or
30:51
Speaker 2: people with this interest against you.
30:53
Speaker 1: Yeah, that's right. I mean there's the old stigma, you
30:56
Speaker 1: know that these are drugs and they make you crazy,
30:58
Speaker 1: and you know. And then there's the news stigma, which
31:00
Speaker 1: is about the evangelism of the field, and I understand,
31:05
Speaker 1: I understand that concern, you know, and in a funny way,
31:08
Speaker 1: you know, this is the This is the strange place
31:10
Speaker 1: I work at this interface between stigma and hype. It's
31:13
Speaker 1: right there, and both of them feed off each other.
31:16
Speaker 1: And really the future depends on us striking a very
31:21
Speaker 1: clear course through the middle of that with our eyes
31:25
Speaker 1: on the future of our patients, the very real people
31:29
Speaker 1: who depend on us, because that is I mean, the
31:33
Speaker 1: whole project of science is all about remaining in conversation
31:38
Speaker 1: with reality. You know, there's all kinds of endeavors that
31:42
Speaker 1: that human beings engage in. The scientific endeavor is one
31:45
Speaker 1: in which we try to remain in conversation with reality,
31:50
Speaker 1: pair away our biases, et cetera, test it, to try
31:53
Speaker 1: retest it, and in this case, the critical reality to
31:58
Speaker 1: keep our eyes on. The critical thing to remain in
32:00
Speaker 1: a relationship with is the reality of real people's lives
32:05
Speaker 1: as we treat them, after we treat them, and sometimes
32:07
Speaker 1: that gets lost in the numbers in a paper or
32:10
Speaker 1: some public announcement or some commercial deal or whatever. I
32:14
Speaker 1: think there's so much promise in psychedelic therapies, but I
32:17
Speaker 1: think it's not a straightforward thing to do a good
32:22
Speaker 1: job of it. And if we're going to figure this out,
32:25
Speaker 1: we're going to need to stay very close to real
32:27
Speaker 1: patients and their real stories and their real futures. And
32:30
Speaker 1: I think, you know, yeah, there are may sayers out
32:33
Speaker 1: there for sure, that's fine. You know. I think there's
32:36
Speaker 1: a whole lot of diversity emerging in the space, and
32:38
Speaker 1: I think a healthy ecosystem is a diverse one. I
32:41
Speaker 1: think opposition and competition keeps you sharp. That's all. I
32:46
Speaker 1: welcome it all. What I am concerned about are the
32:50
Speaker 1: inherent biases that seem to be in our space that
32:55
Speaker 1: can lead us away from remaining in this kind of
32:58
Speaker 1: conversation with reality and getting good outcoms in the end,
33:01
Speaker 1: and those biases are towards scale and toward profit. And
33:06
Speaker 1: it's a it's an alliance between the regulators who have
33:11
Speaker 1: built systems that regulate drugs and not therapy and commercial
33:17
Speaker 1: ventures that can make more money out of products than
33:20
Speaker 1: services and so on.
33:21
Speaker 2: Yeah, I get that, just a little aside a minute,
33:25
Speaker 2: and then we'll come back to the stuff.
33:26
Speaker 3: That you're doing on a boat to do. Is there a.
33:29
Speaker 4: Clear reason in your mind why the FDA quite recently
33:33
Speaker 4: knocked back ketamine as a was it a treatment for
33:37
Speaker 4: depression that they was just going through approval in the
33:41
Speaker 4: FDA knocked at back?
33:42
Speaker 1: Do you mean for PTSD?
33:44
Speaker 3: Maybe maybe it was MDMA rather than KAM PTSD.
33:49
Speaker 1: Ketymine in the form of supravatos kidamine was approved by
33:53
Speaker 1: the FDA a few years back for depression. Although that's
33:56
Speaker 1: you know, people argue about this, it's not really a
33:59
Speaker 1: psychedelectric eatment in the way that it's delivered, and it's
34:02
Speaker 1: certainly not with psychotherapy. But now MDMA assisted therapy got
34:06
Speaker 1: knocked back in a recent application, and basically that whole
34:11
Speaker 1: program of work was probably delayed by a year or two.
34:14
Speaker 1: It's not to say that that train is derailed, it's
34:17
Speaker 1: just probably delayed. And it's a particular program of work
34:21
Speaker 1: headed up by MAPS, the Multi Disciplinary Assization for Psycholic Studies.
34:24
Speaker 1: So of course there are many other companies and trials
34:27
Speaker 1: around the world of different universities involved in MDMA and
34:30
Speaker 1: other psychedelic work. That it's complex as to why that
34:35
Speaker 1: got declined, and it's controversial. There are many different perspectives
34:39
Speaker 1: on it. I don't really want to wagh too heavily
34:41
Speaker 1: in on it because I already don't have viewing under
34:45
Speaker 1: the hood, both on the FDA and the MAP side.
34:48
Speaker 1: But what I can say is, you know, MAPS are
34:52
Speaker 1: an unusual organization. There are grass Roots Pharmaceutical Development Company,
34:57
Speaker 1: which is kind of almost a contradiction into They started
35:01
Speaker 1: in nineteen and six, you know, got funded by Rick Doblin,
35:05
Speaker 1: and he put in this unbelievable long and valiant effort
35:09
Speaker 1: to raise nearly two million dollars in philanthropy and to
35:14
Speaker 1: basically build an organization initially a charity and then it
35:18
Speaker 1: branched into having both a charity and a for profit
35:20
Speaker 1: public benefit side. And while I know a lot of
35:25
Speaker 1: the group of MAPS well, and I think there was
35:28
Speaker 1: a lot of good work and a lot of good intentions,
35:30
Speaker 1: and they focused on what many of us think of
35:33
Speaker 1: as the priorities doing good clinical work and so on.
35:35
Speaker 1: They probably didn't dot their eyes across their teas to
35:39
Speaker 1: the degree that a big well healed pharmaceutical company does,
35:43
Speaker 1: and so there were these kind of you know, there
35:46
Speaker 1: was an accumulation of little anomalies. I've never had any
35:50
Speaker 1: reason to suspect the integrity of their work, but technically
35:55
Speaker 1: there was some question marks and they were asked to
35:57
Speaker 1: get more data.
35:58
Speaker 2: Okay, so I watch this based on that one. Okay,
36:01
Speaker 2: So back to what you guys are doing in the lab.
36:04
Speaker 2: Are you just using at the minute salo cybin and
36:09
Speaker 2: then what other studies you're doing nigh and what ones
36:12
Speaker 2: are there in the future.
36:14
Speaker 1: So currently we're in the final phases of recruiting for
36:18
Speaker 1: two trials, and the first is MDMA Assistant Therapy for
36:23
Speaker 1: post Traumatic Stress Disorder, specifically in the treatment of veterans,
36:27
Speaker 1: military veterans and first responders. And that study is, yeah,
36:33
Speaker 1: in its final stages of recruitment. We've treated a number
36:36
Speaker 1: of people. There's a total of twenty four people that
36:38
Speaker 1: we're recruiting for that study. So it's a smaller study,
36:41
Speaker 1: although it is by far the largest MDMA for PTSD
36:45
Speaker 1: studying in the country, and it's got a few innovations
36:49
Speaker 1: to it. It's focused on PTSD acquired during adulthood in
36:55
Speaker 1: those particular roles of being veteran or first respondent military
37:00
Speaker 1: first responder, and we've also built the treatment to be
37:05
Speaker 1: potentially more cost effective and more acceptable. One of the
37:11
Speaker 1: key complaints that many trials and groups have received in
37:15
Speaker 1: the space is that while the treatment is incredibly intense
37:18
Speaker 1: and profound, the end of the whole treatment package comes
37:25
Speaker 1: very suddenly, and because it's not a service, it's a
37:29
Speaker 1: one sized footsalt, you know, clinical trial design people will
37:33
Speaker 1: often feel like they've plumbed the depths of their psychees
37:37
Speaker 1: and formed these unbelievable bonds with their therapists, and the
37:40
Speaker 1: work is rarely unfolding. Maybe they're even destabilized. We have
37:43
Speaker 1: this kind of post operative pain phenomenon as well anogously,
37:47
Speaker 1: and then you know, maybe two weeks after the last
37:50
Speaker 1: dosing day they say goodbye to their therapist. Right, it's
37:54
Speaker 1: a big cliff edge. And so we've tried to build
37:56
Speaker 1: that trial in a manner that doesn't have the cliff edge,
37:58
Speaker 1: that holds them for quite a few weeks afterwards, a
38:02
Speaker 1: couple more than a month afterwards, and also is a
38:05
Speaker 1: kind of program that we think could be actually feasible
38:09
Speaker 1: to just lift out of the lab and put in
38:11
Speaker 1: a clinic for that kind of patient group, whereas PTSD
38:16
Speaker 1: that's far more complex, that's typically related to early adverse
38:21
Speaker 1: experiences and so on. It's generally less feasible to say well,
38:24
Speaker 1: we've got a two dose, three month package and that's it.
38:29
Speaker 1: Usually longer term care is required in those situations.
38:32
Speaker 2: That makes perfect.
38:33
Speaker 1: So yeah, so that trial is ongoing, and then we
38:36
Speaker 1: have another trial. We're a site on a multi side
38:40
Speaker 1: trial that's sponsored by Beckley Cytek in the UK, and
38:43
Speaker 1: that trial uses FIVEO DMT with psychotherapy in the treatment
38:49
Speaker 1: of depression. And so for listener who aren't we're a
38:52
Speaker 1: five meo DMT. It's derived from the poison of a
38:58
Speaker 1: sonora and desert hoad. Yeah, yeah, and it probably doesn't
39:04
Speaker 1: have a very long indigenous history of use. Probably was
39:07
Speaker 1: discovered quite recently. Maybe even the uses were in the
39:11
Speaker 1: seventies when somebody thought to squeeze the squeeze the venom
39:15
Speaker 1: out of the gland and smoke it in a hot pipe.
39:17
Speaker 1: The creative innovation of our species.
39:21
Speaker 3: We use this and is that is that different part too?
39:24
Speaker 3: Regular d MT and its chemical.
39:26
Speaker 1: Compositions on very slightly different in its molecular form or structure,
39:33
Speaker 1: but its psychoactive effects are actually very different in some
39:37
Speaker 1: ways at the opposite end of the psychedelic spectrum. So
39:40
Speaker 1: the d MT that you're referring to, which is called
39:43
Speaker 1: n N d m T and DMT stands for dimethyl
39:46
Speaker 1: tryptomy n N d m T, is a very rapid
39:50
Speaker 1: onset and very intense and very hallucinogenic drug. It takes
39:55
Speaker 1: people into what they'll often report as other realms, where
39:59
Speaker 1: they'll often encounter other beings or agents, and they'll often
40:05
Speaker 1: come back with a sense that those agents or that
40:08
Speaker 1: space has its own independent reality of my experience, Like
40:12
Speaker 1: more like I kind of traveled there through a porthal
40:14
Speaker 1: of DMPT and discovered another place rather than that was
40:18
Speaker 1: my mind.
40:19
Speaker 2: Keven, it's the active ingredient in Iowaska, I can attest
40:22
Speaker 2: that experience. Yeah, I was just wondering if that was
40:25
Speaker 2: a difference. Yeah, because yeah, it's so.
40:27
Speaker 1: So fived from the TOAD is hardly hallucinogenic. It's more
40:35
Speaker 1: like white light and egodith. It's very intense. It's also
40:39
Speaker 1: rapid onset, and it's less clear at this point how
40:45
Speaker 1: it will work and how to work with it with
40:47
Speaker 1: psychotherapy compared to psilocybin and MDMA, we really do know
40:51
Speaker 1: a lot about how to work well with psilocybin and MDMA.
40:54
Speaker 1: We're still, you know, working many things out, but the
40:57
Speaker 1: basics of the fundamentals are very clear. We understand and
41:00
Speaker 1: it works. We know why it worked. In general with
41:03
Speaker 1: five or d MT, it's so fast and so radically
41:07
Speaker 1: different that it's quite hard to build bridges from here
41:09
Speaker 1: to there, and it's it's just earlier in its stage
41:13
Speaker 1: of development in terms of understanding best practice and also
41:16
Speaker 1: whether it's going to work. So those two trials are
41:19
Speaker 1: ongoing in the lab, and anybody who is interested can
41:21
Speaker 1: go to monash dot edu forward slash Psychedelics and there
41:27
Speaker 1: you'll find a page for participants and there's a little
41:30
Speaker 1: email address. You just email that to find out more.
41:32
Speaker 1: And we'll only be recruiting on those two projects for
41:37
Speaker 1: the next month or two until we reach out quotas.
41:41
Speaker 2: So yes, and sorry, just remind me again, the five
41:44
Speaker 2: or d MT is for depression.
41:47
Speaker 1: Depression, okay, and particularly it's for depression that hasn't responded
41:52
Speaker 1: to prior therapies. What's sometimes referred to as treatment resistance
41:56
Speaker 1: treatment recession.
41:57
Speaker 2: Yeah, okay, cool, And and I was going to ah,
42:00
Speaker 2: and just on that what And you may have just
42:03
Speaker 2: answered the question by the study that you're doing, But
42:06
Speaker 2: what in your mind are the psychedelics with the greatest
42:10
Speaker 2: potential for treating depression.
42:13
Speaker 1: Yeah. I My sense is that psilocybin, which has got
42:19
Speaker 1: the most evidence to date in the treatment of depression,
42:22
Speaker 1: is you know, clearly the front runner. It makes a
42:26
Speaker 1: lot of sense for why it's useful for depression. We
42:28
Speaker 1: know how to work with psychotherapy. Again, I think there
42:32
Speaker 1: are more questions around what does best practice look like
42:34
Speaker 1: and how do we get durable outcomes and all of that,
42:37
Speaker 1: But certainly the best evidence we have so far is
42:40
Speaker 1: for psilocybin in depression. There is you know, and then
42:43
Speaker 1: MDMA is the best evidence we have for PTSD is
42:47
Speaker 1: for mdmaassystem therapy. And then there are a whole lot
42:51
Speaker 1: of ideas out there that haven't yet been tested. I'm
42:55
Speaker 1: quite keen to do some of this work in the
42:57
Speaker 1: near future in combining an MDMA or an MDMA like
43:02
Speaker 1: drug with psilocybin or another classical psychedelic type drug over
43:07
Speaker 1: the course of treatment. Not necessarily in the same dosing day,
43:09
Speaker 1: although that's that's of interest too, But more over the
43:13
Speaker 1: course of the treatment span. MDMA is not really a
43:17
Speaker 1: classic psychedelic. It's what's sometimes called an mpathogen. It massively
43:21
Speaker 1: increases your tolerance for distress and allows you to feel
43:27
Speaker 1: incredibly comfortable, you know, comfortable to the degree that you
43:31
Speaker 1: recognize that you and I and everybody are pretty much
43:35
Speaker 1: a bit anxious all the time at the very least. Yeah,
43:38
Speaker 1: So this profound comfort can set in, and that allows
43:43
Speaker 1: you to explore your mind or your history, or your
43:46
Speaker 1: life or your priorities in a far less constrained way
43:50
Speaker 1: and in a way that feels more sober, or more
43:54
Speaker 1: broad or more flexible. I mean this is Psilocybin and
43:58
Speaker 1: MDMA do quite different things, but both of them, I
44:02
Speaker 1: think open up. Huxley is reducing valve, if you like.
44:07
Speaker 1: By by analogy, Huxley al. Huxley refer to this reducing
44:10
Speaker 1: valve which constrained our perception and our thinking and our
44:13
Speaker 1: behavior towards our survival prerogatives. And you know, my sense
44:19
Speaker 1: is that reducing valve is tightened through anxiety and MDMA's
44:24
Speaker 1: path to releasing that or loosing that valve is through
44:29
Speaker 1: allowing people to feel incredibly comfortable. MDMA could be very
44:34
Speaker 1: useful in kind of commencing a treatment journey where people
44:37
Speaker 1: can not only feel comfortable, but feel a lot of
44:41
Speaker 1: compassion for others and for themselves and just have the
44:45
Speaker 1: sense of safety that I'm able to start exploring the
44:47
Speaker 1: things that are under the surface or that I've avoided.
44:50
Speaker 1: And then psilocybin, you know, could be a fantastic next
44:54
Speaker 1: session that allows people to have often far more profound,
45:00
Speaker 1: dramatic shifts in their perspective or you know, visionary kind
45:04
Speaker 1: of lessons that that system in their lives in difficult
45:08
Speaker 1: to predict ways. And then md may you know again,
45:12
Speaker 1: may it may be a good way to kind of
45:14
Speaker 1: round things out. So there's all these ideas about how
45:16
Speaker 1: we combine these drugs in in the future, and I think,
45:19
Speaker 1: I think the future of psychotic therapy is is a
45:22
Speaker 1: far more diverse thing than the than the models of
45:25
Speaker 1: care that we see today at the trials.
45:27
Speaker 3: Mm hm. There Wow.
45:30
Speaker 2: So that that leans me to think about the next
45:33
Speaker 2: the next question I have that just popped into my head.
45:37
Speaker 3: I read a research paper recently. I only only spared
45:40
Speaker 3: read and I've got to go back.
45:41
Speaker 2: To it where it was shown that in depression there
45:45
Speaker 2: were were different functional brand networks that were amplified. So
45:51
Speaker 2: are you doing or do you have plans to do
45:55
Speaker 2: functional MRI scans of people pre and post treatment to
46:00
Speaker 2: see if there are any specific areas of the brain
46:04
Speaker 2: that are changing in terms of activity.
46:06
Speaker 1: We made that in the future. We haven't done it
46:08
Speaker 1: yet in our lab, although many of our colleagues around
46:10
Speaker 1: the world have done these kinds of brain scanning studies
46:14
Speaker 1: for sure, and it's interesting to note and we've seen,
46:17
Speaker 1: you know, some consistent signals. For example, with psilocybin dosing
46:22
Speaker 1: you refer to hyperactive regions in depression, and we've seen
46:26
Speaker 1: some of those typical hyperactive regions in depression down regulated
46:31
Speaker 1: or go more quiet under psilocybin. You know, the two
46:35
Speaker 1: most common or consistent patterns with the neuroimaging studies with
46:39
Speaker 1: psilocybin are that psilocybin and LSD. There's been some LSD
46:43
Speaker 1: studies as well with imaging. These drugs cause what's called
46:48
Speaker 1: your default mode network to get quiet. And this default
46:53
Speaker 1: mode network is kind of your brain's idle mode. It's
46:58
Speaker 1: as it says in the name, it's the default activity
47:00
Speaker 1: of your brain. And what a typically instantiates our thoughts
47:05
Speaker 1: about yourself and how things relate to yourself, thoughts about
47:08
Speaker 1: the future, thoughts about the past is called mental time travel,
47:11
Speaker 1: abstracted thinking, and so on. And if you think about that,
47:14
Speaker 1: if you actually think a lot about the past and
47:16
Speaker 1: the future and yourself, it's actually a recipe to get depressed,
47:19
Speaker 1: even if you weren't to start with. And so that
47:22
Speaker 1: goes down, and it quietens down and through a process
47:25
Speaker 1: of disinhibition, other areas light up. Another common pattern in
47:31
Speaker 1: psilocybin imaging work is that parts of the brain that
47:35
Speaker 1: are typically not quote unquote in conversation get in conversation.
47:40
Speaker 1: So what the majority of the nerve cells or the
47:44
Speaker 1: neurons in your brain are what are called inhibitory neurons.
47:48
Speaker 1: They dampen down other neurons. And that's a good thing
47:52
Speaker 1: because our brains need to be highly specific or specialized
47:55
Speaker 1: in their tasks that they're achieving. A lot of people
47:58
Speaker 1: will say, you know what, shame you only use whatever
48:01
Speaker 1: ten percent of your brain wouldn't be great. If you
48:03
Speaker 1: could use one hundred percent, it would be chaos. If
48:05
Speaker 1: you use it would be you'd be seeing everything, hearing everything,
48:09
Speaker 1: and doing everything at the same time. So the thing is,
48:13
Speaker 1: when you activate a certain network in your brain, part
48:15
Speaker 1: of what it's doing is is inhibiting other networks. So
48:19
Speaker 1: it can be specific, it can do that job, it
48:21
Speaker 1: can think that thought. And so we have quite distant
48:26
Speaker 1: nodes in the brain, or hub areas in the brain
48:28
Speaker 1: that are what are called anti correlated. When one lights up,
48:32
Speaker 1: the other one gets dampened, and vice versa. They kind
48:35
Speaker 1: of are in competition with one another, and under psychedelics
48:39
Speaker 1: they light up together. And so this does a couple
48:44
Speaker 1: of things. One is it makes you less functional, like
48:47
Speaker 1: it's hard to drive a car or have a conversation.
48:50
Speaker 1: And the other thing it does is it allows you
48:52
Speaker 1: to join distant dots, or to have a feeling about
48:57
Speaker 1: a thought when previously was just an abstract the thought,
49:00
Speaker 1: or to just connect things in quite different ways. And
49:03
Speaker 1: so that might be the neurobiological correlate of the very
49:07
Speaker 1: new and deeply felt perspective that psychedelics turn to con for.
49:11
Speaker 1: But in you know, I guess what I would say is,
49:13
Speaker 1: while I'm interested in the neurobiology, this I would say
49:16
Speaker 1: that we are getting far more granular in understanding how
49:22
Speaker 1: psychedelics work and how to do a better job of
49:24
Speaker 1: it through what's called phenomenological inquiry, asking people about the
49:30
Speaker 1: nature of the experience. Yeah, because these experiences are so
49:34
Speaker 1: complex and profound, and my guess is that we are
49:39
Speaker 1: a very long way from the neural correlates of what
49:43
Speaker 1: matters under psychololis. Hmm.
49:46
Speaker 2: Yeah, I can say why that is the priority, and
49:48
Speaker 2: that they're looking at the networks. Is the icing on
49:51
Speaker 2: the key once sorted everything out, and how it actually works.
49:55
Speaker 2: A couple of comments actually on the default network that
49:59
Speaker 2: the Dalai la has for years run this thing called
50:02
Speaker 2: the Mind and Life Conference, wherea's a bunch of neuroscientists
50:06
Speaker 2: and Tibetan monks who get together. And when Richard Davidson,
50:10
Speaker 2: who was one of the first researchers to talk about
50:13
Speaker 2: the neuroscience of meditation, when they explain to the Dalai
50:17
Speaker 2: Lama the default mode network, he said to them, ah,
50:21
Speaker 2: you mean monkey yabba yaba, yaba yaba.
50:24
Speaker 3: And it strikes me that that.
50:26
Speaker 2: Increased activity in the default mode network. You mentioned about
50:32
Speaker 2: thinking about the past, thinking about the future in Japanese psychology.
50:36
Speaker 3: They say it's about the.
50:38
Speaker 2: Flashlight of your attention, and that people get in trouble
50:42
Speaker 2: when they shine the flashlight of their attention in their
50:46
Speaker 2: own heads for too long. Interesting, which is kind of
50:49
Speaker 2: that nice analogy to that overactive and default mode network.
50:54
Speaker 3: So, men, I am aware of time. I'd love this
50:57
Speaker 3: to go on for hours of really, but what are
51:00
Speaker 3: what are some of the next steps for your group?
51:03
Speaker 1: Yeah? Thanks, Paul. So I am most focused on and
51:07
Speaker 1: most energized by our planned Center of Excellence that we're
51:12
Speaker 1: intending to launch early next year. The reason for that
51:16
Speaker 1: is that over the last four years or five years,
51:21
Speaker 1: we have not only seen the promise of psychedelic therapies,
51:25
Speaker 1: we've seen all the kind of complex factors that need
51:31
Speaker 1: to be coordinated for that promise to be fulfilled. And
51:36
Speaker 1: in many respects, my view is that if we don't
51:40
Speaker 1: achieve a set of key outcomes over the next few years,
51:46
Speaker 1: that promises in peril. And so the center is attempting
51:49
Speaker 1: to move beyond one trial, one question, one project, or
51:54
Speaker 1: one course at a university, et cetera, into a more
51:57
Speaker 1: coordinated venture with interlinked parts. And there are three interlink parts,
52:03
Speaker 1: but then there's multiple parts beneath those. The three parts
52:06
Speaker 1: are innovative trials, and we'll be doing a number of
52:09
Speaker 1: world first studies that I'm very excited about. And it's
52:12
Speaker 1: the kind of studies that are either not commercially obvious
52:19
Speaker 1: to an industry funder and maybe too early or complex
52:23
Speaker 1: for government agency to fund, but nonetheless are the kinds
52:27
Speaker 1: of trials that have a high probability of success and
52:31
Speaker 1: high impact if they do. And so that is the
52:33
Speaker 1: perfect remit for philanthropy. And so this center will commence
52:37
Speaker 1: with a philanthropic call, and anyone who's interested in finding
52:41
Speaker 1: out more can reach out to me through our website.
52:44
Speaker 1: I'll tell you a little bit about some of these
52:45
Speaker 1: studies that I'm so excited to kick off. In addition
52:49
Speaker 1: to that pillar, if you like, we will have another pillar,
52:52
Speaker 1: which is around education and training. We've run a number
52:56
Speaker 1: of trainings around the country. We've trained quite a few
52:57
Speaker 1: groups that are doing this work around Australia with a
53:00
Speaker 1: lot of assistance from international leaders in the space, and
53:03
Speaker 1: we will continue to run various training programs. We've just
53:08
Speaker 1: last week got approval to commence our psychedelic education program
53:13
Speaker 1: that's monishor credited, which is very exciting. So we commence
53:16
Speaker 1: it with four courses, two undergrad and two postgrade courses
53:20
Speaker 1: in twenty twenty five, and they will build from there
53:24
Speaker 1: into proper or proper is the wrong word, into substantial
53:28
Speaker 1: psychedelic therapists and prescriber trainings that have full university endorsement,
53:36
Speaker 1: but they are aligned to the research and best practice
53:39
Speaker 1: in the space. And then there's a third aspect to
53:41
Speaker 1: this center, which is around immediate impact and real world
53:46
Speaker 1: impact at scale. That includes everything from standards and frameworks
53:52
Speaker 1: through to health economics and working up the right kinds
53:58
Speaker 1: of data and the right kinds of relationships that can
54:01
Speaker 1: allow for far greater access as the different programs of
54:05
Speaker 1: work show themselves to be safe and effective, so you know,
54:10
Speaker 1: we might discover that, for example, psilocybin and as system
54:13
Speaker 1: therapy is indeed safe and effective for depression. But if
54:18
Speaker 1: it costs thirty thousand dollars for a standard course of
54:21
Speaker 1: psilocybin and system therapy and no one in the insurance
54:26
Speaker 1: sector or government will fund it, then it's going to
54:29
Speaker 1: remain niche and inaccessible, and that's a problem. So we
54:33
Speaker 1: are really focused on access and affordability. And if we
54:38
Speaker 1: can show that the promise so psyechyalst can be fulfilled,
54:41
Speaker 1: if we can get the durable outcomes, the high rates
54:43
Speaker 1: of remission in the long term, then it will save
54:48
Speaker 1: the payer money, whoever the payer is. And in the
54:51
Speaker 1: case of reimburses, they will want to reimburse it. So
54:54
Speaker 1: that is a critical step. Yeah, And so just a
54:58
Speaker 1: final peace on that center, which is to say, the
55:02
Speaker 1: idea with having these multiple interlinked parts is that what
55:07
Speaker 1: we can do in a center like that is greater
55:11
Speaker 1: than the sum of its parts. It all feeds off
55:15
Speaker 1: each other, and it all informs each other in terms
55:18
Speaker 1: of efficiencies, in terms of knowledge and translation and so on.
55:21
Speaker 1: It'll be multi institutional, have a whole set of international
55:25
Speaker 1: stakeholders and national stakeholders, and the express mission is to
55:29
Speaker 1: add value using psychedelic therapies in the mental health space
55:35
Speaker 1: without you know, the biases and the limitations of industry
55:41
Speaker 1: or government or university or whatever it is. We're keeping
55:44
Speaker 1: that patient clearly in view. That is the primary thing
55:48
Speaker 1: we're focused on. And so I'll give you an example
55:52
Speaker 1: of one of our innovative trials that will be an
55:55
Speaker 1: initial flagship trial that will kick off early on. Just
55:58
Speaker 1: as an example of many, it's a study that is
56:02
Speaker 1: using MDMA assistant therapy to treat co parents with high
56:09
Speaker 1: levels of conflict. Oh wow, so this is not a
56:12
Speaker 1: psychiatric study. We're not treating a mental health disorder. In fact,
56:16
Speaker 1: because you cannot diagnose a relationship, you cannot get an
56:20
Speaker 1: industry sponsor to fund a trial like this because the
56:24
Speaker 1: regulator doesn't know how to regulate a drug for a relationship.
56:27
Speaker 1: But we can. We can do it through philanthropy. We
56:30
Speaker 1: can actually get it to market if you like. And
56:33
Speaker 1: the idea here is that this is one for the children.
56:36
Speaker 2: I mean, it's a bite to see you do you
56:37
Speaker 2: just do you just get me goosebumps on that, because
56:40
Speaker 2: if you can help with relationships. You know, what we
56:45
Speaker 2: know is someone of as you well know, right, But
56:49
Speaker 2: one of the biggest drivers of per mental health is
56:53
Speaker 2: coming from a broken totally.
56:54
Speaker 1: I mean, you know, the people argue about this, but
56:56
Speaker 1: I would say, and it looks like the evidence really
56:59
Speaker 1: suggests that the single biggest predictor of psychopathology and addiction
57:07
Speaker 1: is early adverse experiences. You know, and that's often in
57:12
Speaker 1: the home, but being exposed to big T trauma and
57:16
Speaker 1: little T trauma, little T traumas behind every fourth Australian
57:20
Speaker 1: suburban door what are considered to be problematic high levels
57:24
Speaker 1: of conflict. It is a problem that's hidden in plain sight.
57:27
Speaker 1: And really like the idea here is we are dealing
57:32
Speaker 1: in the mental health space in a reactive way. We're
57:36
Speaker 1: dealing with the effects of early traumatic causes and what
57:41
Speaker 1: we need to do is deal with the causes. So
57:45
Speaker 1: absolutely so.
57:46
Speaker 2: And add to that lesmeit Eddies is one of the
57:49
Speaker 2: biggest predictors of PTSD in the military being ex military.
57:53
Speaker 2: Is that early life stress and drugs are alcohol in
57:57
Speaker 2: one of the parents. Right, answer yes to those two
57:59
Speaker 2: qui Uessians, and you are very likely to get a
58:02
Speaker 2: patasting here to comeback. This has been unbelievable. Look, I
58:07
Speaker 2: have a brilliant job that I absolutely love. You're one
58:11
Speaker 2: of the few people who has a job that I'm
58:13
Speaker 2: a bit jealous of.
58:14
Speaker 3: I've got to tell you you are a modern.
58:17
Speaker 2: Day explorer because this is for me, it's something that
58:24
Speaker 2: really has to be explored and it's very very important work.
58:28
Speaker 2: So may I tip my hat to you. And also
58:32
Speaker 2: the rigorous way that you're actually going about this and
58:37
Speaker 2: the fact that everything is about patient centered. I think
58:41
Speaker 2: it's bloody awesome and it's a credit to you and
58:43
Speaker 2: your team, So keep doing your awesome stuff. Now, just
58:48
Speaker 2: tell us where can people go to find out more
58:50
Speaker 2: about you and your work and importantly if they want
58:53
Speaker 2: to also contribute philanthropically. I know from both an individual
58:58
Speaker 2: listener perspective, but there's also people who listen to this
59:01
Speaker 2: podcast are involved in health insurance and life insurance and
59:05
Speaker 2: I think that they are people are our organizations that
59:09
Speaker 2: should be looking at funding this. So where can people
59:12
Speaker 2: go to find out more and also to support.
59:15
Speaker 3: What is a very necessary colture.
59:17
Speaker 1: Thanks Paul, really appreciate the support and your kind words. Yeah,
59:20
Speaker 1: and just to say I feel incredibly grateful to have
59:23
Speaker 1: the work I do have, and a big shout out
59:26
Speaker 1: to my team. It's not me. There's forty of us
59:29
Speaker 1: in our group, and these are tremendous human beings who
59:33
Speaker 1: are amazing on the tools and have got such bright
59:36
Speaker 1: minds and such good hearts, and this work it takes
59:39
Speaker 1: a village, so it's important to just acknowledge that there's
59:42
Speaker 1: a big team of us as well. To find out more.
59:45
Speaker 1: Monash Dot Edu Forward slash Psychedelics and by all means,
59:50
Speaker 1: if anybody is interested in finding out more about our
59:53
Speaker 1: planned center of excellence and maybe has an interest in
59:56
Speaker 1: understanding what we're trying to achieve and so on, please
59:59
Speaker 1: write to me me through that website and we can
1:00:02
Speaker 1: arrange a coal and maybe opposite, we've got a wonderful
1:00:05
Speaker 1: lab in in Victoria.
1:00:08
Speaker 2: Awesome man, Thank you, great, thank you, Paul Jess appreciate it.