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32. The Psychedelic Rennaissance and Eating Disorder Treatment with Dr. Adele LaFrance, PhD · All Bodies. All Foods.

0:01
Hey,
0:01
I'm Sam.
0:02
Hi,
0:02
I'm Ashley.
0:04
And you're listening to All Bodies All Foods presented by the Renfrew Center for Eating Disorders.
0:09
We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.
0:19
We believe that all bodies and all foods are welcome.
0:23
We would love for you to join us on this journey.
0:26
Let's learn together.
0:29
Hello and welcome back to another episode of All Bodies.
0:33
All Food.
0:33
I'm Sam and I'm here with my co-host Ashley.
0:36
We're so excited to have our guest on today.
0:39
We have Doctor Adele Lafrance phd.
0:42
She is a clinical psychologist,
0:44
research scientist and developer of emotion focused treatment modalities including emotion focused family therapy,
0:51
a best selling author of a popular book for parents.
0:55
Doctor Lafrance offers practical resources to parents and caregivers at no cost via her website www dot mental Health foundations dot C A.
1:05
She is active in the research and practice of psychedelic medicine with a focus on Ayahuasca MD,
1:12
Ma Psilocybin and Ketamine,
1:14
a clinical trainer and supervisor for various organizations.
1:18
Adele has particular interest in mechanisms and models of healing,
1:22
including emotion processing,
1:24
spirituality,
1:26
love and family based psychedelic medicine.
1:29
Welcome to the show,
1:30
Doctor Adele Lafrance.
1:32
Thank you so much Sam and Ashley and just Adele is great.
1:36
OK,
1:37
I will call you Adele.
1:38
You know,
1:39
um I was so lucky to be at one of your trainings long,
1:44
long ago in Toronto and it was all about emotion focused therapy.
1:49
And you've been thinking outside of the box for a long time now,
1:54
as a co creator of efft,
1:56
they say,
1:57
you know,
1:57
the necessity um that necessity is the mother of invention because you had said that,
2:02
you know,
2:03
you were working with parents and caregivers and some of them were feeling really stuck,
2:10
were hitting a block in the road and you really felt like there just wasn't an approach out there,
2:16
an intervention out there that you felt like could really help these parents.
2:21
And so you,
2:23
you made one,
2:24
so you made,
2:25
you made one and,
2:26
and I was just so impressed by that.
2:29
And,
2:29
you know,
2:30
I'm always curious what you're working on now.
2:32
You know,
2:32
I sort of see you as you know,
2:34
um always thinking outside the box and today you're involved in researching psychedelic assisted therapy and eating disorder treatment.
2:42
So I thought maybe we can just start with these questions for audience.
2:46
What exactly are psychedelics and why are they helpful with someone with an eating disorder and just like emotion focused family therapy?
2:56
Is this an approach that you sort of feel like,
3:00
you know,
3:01
do you feel like it's needed because something's missing in,
3:04
in treatment as usual?
3:07
Well,
3:07
I guess I can first start off by saying when we first met in Toronto many years ago,
3:13
if you would have told me that I would be on a podcast talking about my involvement in psychedelic medicine.
3:21
I think that there was something really wrong with the version of reality,
3:25
um,
3:25
because I knew nothing about psychedelics personally or professionally.
3:31
Um And so it's,
3:33
it's still,
3:34
it's still kind of bizarre for me to kind of be on the other side of these questions because it's,
3:42
it's,
3:42
it's uh it really does speak to what you mentioned about necessity being the mother of invention.
3:49
You know,
3:51
I learned about the potential of psychedelics for healing period at a time where I was working um in a hospital for eating disorder care and in our region,
4:03
we had just lost two patients,
4:07
one to suicide and one to malnutrition.
4:13
And the,
4:14
I mean,
4:15
the timing of it,
4:17
I don't know,
4:18
I just felt was so important.
4:21
I don't know that otherwise I would have turned my attention to psychedelics because of the stigma that I had internalized about these substances.
4:32
But someone who I really respected,
4:35
Doctor Gabor Mate was speaking about the potential of Ayahuasca for healing.
4:40
And he was focused a lot on indigenous populations,
4:46
struggling with homelessness and struggling with substance uh use issues.
4:53
And so there was something really beautiful about that.
4:59
And I remember writing to him and saying to him like,
5:02
I think this could work for eating disorders.
5:05
Yeah.
5:06
And that was the beginning,
5:08
you know,
5:08
in 2000,
5:09
I guess I would have contacted him in 2013.
5:13
Um and then he invited me to participate in a,
5:16
at a retreat,
5:17
both as a participant but also as a trainee.
5:20
And at that retreat,
5:22
about a third of the participants who were there had an eating disorder or had a history of an eating disorder or disordered eating.
5:31
And oh my gosh,
5:33
the healing that I saw in that eight day retreat not even focused on disordered eating or eating disorder.
5:40
It was,
5:42
it was um mind blowing honestly.
5:46
So what are psychedelics?
5:48
Um There are so many different definitions,
5:52
I guess for me,
5:53
like a psychedelic is a substance,
5:55
whether natural or synthetic that alters one state of consciousness,
6:01
but also alters the way the body functions,
6:06
whether it's how the brain functions in terms of its connections with other parts of the brain or the brain and the body functions together or how the body.
6:15
So,
6:16
I mean,
6:18
we're just,
6:19
we're just getting to know the potential of these medicines.
6:23
Um But now I've been working in this area for almost 10 years,
6:28
which again,
6:29
I cannot believe and have been involved in research and practice with at least four different compounds.
6:37
And um Yeah,
6:40
I do feel like it could be a missing piece of a puzzle for some people.
6:45
Absolutely.
6:46
In fact,
6:48
when you asked,
6:49
like,
6:49
like,
6:49
efft,
6:50
could it be a miss,
6:51
you know,
6:51
missing?
6:52
And I'm like,
6:53
well,
6:53
I think the combination actually,
6:56
all right,
6:57
um,
6:58
could be really,
6:59
really well,
7:01
could be really cool.
7:02
And we've,
7:03
we've tested it actually in,
7:04
in one of the studies,
7:06
um,
7:08
that just completed that I think we'll maybe talk about a little bit later.
7:11
But yes,
7:12
uh psychedelics can help in so many different ways.
7:15
They can help with cognitive rigidity.
7:19
They can help with um stimulating spiritual or transcendental experiences that can help people see life beyond the confines,
7:31
you know,
7:31
of the eating disorder,
7:32
thoughts urges,
7:33
they can help with increased self love,
7:36
self compassion,
7:37
which can be a beautiful relief relief from the harsh critic that often accompanies um an eating disorder and the list goes on.
7:48
Yeah.
7:49
Wow.
7:51
So it's,
7:52
it's sort of this experience,
7:56
this internal experience and this experience where your consciousness is sort of shifted that either doesn't happen in treatment as usual or doesn't happen easily or quickly,
8:10
I should say.
8:11
Mhm.
8:12
Mhm.
8:12
Yeah.
8:13
I mean,
8:13
there's so many ways that we can think about psychedelics with eating disorders.
8:17
So,
8:17
uh colleagues of mine and I are writing a chapter for the A P and a book for the A P A specifically related to the potential.
8:25
And we talk about using psychedelics to um enhance motivation for treatment.
8:32
We talk about using it as a treatment add on adjunct to intensify um the experience of treatment,
8:42
the the ability to benefit from treatment.
8:45
We talk about it as relapse prevention.
8:48
And I'm also really interested in the potential of psychedelics to help people who feel like they're at the end,
8:58
explore some of those thoughts and even some of those decisions with the benefit of psychedelics and therefore a brain that is functioning in a more coordinate manner.
9:11
Um So across that continuum,
9:14
I think there are some really great possibilities.
9:16
I think about a study that I conducted.
9:18
Actually,
9:19
I'm meeting with someone about today as we work on the manuscript for publication.
9:24
And one of the most striking findings,
9:26
it was ketamine for eating disorders and reaction.
9:29
And both specifically,
9:30
one of the most striking findings was that the day after they had a ketamine session,
9:35
they did therapy with me and we did very experiential,
9:38
very emotion focused,
9:39
very targeted work together.
9:44
And those participants rated those therapy sessions at extremely high on a breakthrough inventory.
9:53
And so I think that psychedelics can allow people to completely heal from some symptoms spontaneously and or it can help to create optimized brain conditions so that they could benefit from some of the more conventional treatment approaches that don't work for everybody.
10:15
You know,
10:16
they work for so many people.
10:17
So you'll never hear me speak negatively about them.
10:21
Um But some people do need a bit of a brain boost to be able to benefit from them in,
10:27
in similar or the same ways.
10:29
Yeah.
10:30
That's amazing.
10:31
So,
10:31
it's sort of like they are likely to have these aha moments in therapy because there's something different in their brain.
10:39
I mean,
10:40
aha moments happen in therapy.
10:41
But it's sort of like this sort of pushes it along a little more quickly.
10:47
Yeah.
10:47
It's,
10:47
it's,
10:48
it's,
10:48
I don't know how to explain it.
10:49
I just say that like,
10:49
there's an increased ma ability so that the interventions land in a way that they wouldn't be able to otherwise.
10:58
And so if you think about like,
10:59
um,
11:00
uh,
11:00
sometimes you see in the movie like the Cracked Earth,
11:03
it's so dry,
11:05
you know,
11:05
and if you put water on it,
11:06
the water doesn't even get,
11:08
doesn't even go in,
11:09
you know,
11:09
because it's so dry,
11:10
you need to put the water,
11:12
um,
11:13
frequently over long periods of time.
11:16
And that takes a long time.
11:18
You know,
11:18
if you think about the analogy of therapy for,
11:20
for serious eating disorders,
11:22
it's almost like the psychedelics like moisten the earth.
11:26
So that when we,
11:27
when we pour the water,
11:28
the therapy,
11:30
the,
11:31
the earth can absorb it and can benefit from it.
11:36
That's the best I can do in terms of,
11:39
I love that image.
11:40
And I'm also thinking about,
11:42
oh,
11:42
now you can plant seeds in there too and grow and flourish.
11:46
Oh,
11:46
I love that.
11:47
That's such a wonderful visual.
11:49
Thank you for that.
11:50
Yeah,
11:51
I Adele,
11:52
I was just at a conference last week and um listen to Doctor Amon speak if you know him about brain health and just how he was mentioning like um the brain is an organ and so so many of our other organs have targeted therapy um for them and the brain doesn't necessarily,
12:14
you know,
12:14
we do a lot of mental health work,
12:16
but it,
12:17
it's just making me think like using psychedelics to heal the brain and,
12:22
and allow it to become more malleable to soak in and to take those seeds that we're planning Sam like that.
12:29
Just,
12:29
it just seems like the right next step.
12:32
I mean,
12:32
it,
12:33
it,
12:33
if,
12:33
if it,
12:34
if that is what it's doing,
12:36
let's definitely lean into that.
12:38
And so with that,
12:39
I have a,
12:40
a question um kind of you mentioned cognitive distortions.
12:44
And um so just to break that down for some of our listeners that might be um someone that is,
12:50
is kind of maybe stuck in some black and white thinking or catastrophizing kind of um some of those things.
12:57
And so traditional,
12:59
maybe,
13:00
you know,
13:00
therapy that we've done is maybe have them reframe their thoughts or um or say,
13:06
you know,
13:06
say something differently,
13:08
add in a positive thought or something like that.
13:10
And,
13:11
and I think some of our clients with eating disorders feel stuck in that because reframing or or adding a positive when there was a negative or even a neutral,
13:22
just,
13:22
it doesn't feel true or congruent with them.
13:26
And so my thought is how does this,
13:29
how could,
13:30
um,
13:31
the use of psychedelics help this particular person navigate reframing or,
13:37
or the cognitive distortions that they have,
13:40
or,
13:40
or just getting stuck rigidly.
13:44
The rigid thinking.
13:45
Yeah.
13:45
The rigidity.
13:46
Yeah.
13:47
I mean,
13:47
yeah,
13:48
it's so cool because I've witnessed it happening in front of my eyes without my needing to intervene in any significant ways,
13:58
which is so cool.
14:00
Um,
14:00
well,
14:01
scientifically people talk about the default mode network and so the default mode is kind of like our usual way of seeing,
14:11
interpreting,
14:12
perceiving the world ourselves,
14:16
others,
14:17
right?
14:18
And so many people who have eating disorders are really sensitive to threats in their environment or experiences of dominance,
14:28
um,
14:29
you know,
14:30
uh,
14:30
are highly critical of themselves.
14:35
And so psychedelics especially,
14:37
I would say the classic psychedelics.
14:40
And I,
14:40
uh I would add MD MA,
14:43
they offer people an opportunity to get a break from that way of seeing the world and when they get a break from that default mode then they can make new connections.
15:01
Oh,
15:01
wow.
15:02
Yeah.
15:03
So if you like,
15:04
oh,
15:04
I hate myself.
15:04
I'm horrible.
15:05
I'm fat.
15:06
I'm ugly.
15:07
And then you take a psychedelic and you're lucky enough to have one of those experiences where you're like,
15:12
oh,
15:12
my gosh.
15:14
I,
15:14
I'm not fat.
15:16
What does that even mean,
15:18
why are people even using that word?
15:21
What's up with that?
15:23
And I'm not ugly.
15:25
What does that even mean?
15:27
Why are people using that word?
15:29
Like I've seen this happen?
15:32
So when the mind comes back online,
15:36
you know,
15:36
once the effects of the psychedelic wane,
15:39
they still might have those thoughts,
15:43
but their relationship with them really changes,
15:47
you know.
15:48
Um,
15:49
so that's kind of one of the ways that cognitive rigidity can,
15:55
can heal,
15:56
um,
15:57
another way.
15:58
And again,
15:59
this is just an analogy.
16:00
But you think if you,
16:02
if you have shoes that are like way too tight,
16:06
but you don't even know that,
16:07
you know,
16:08
that you think this is how shoes are supposed to fit way too tight,
16:12
like half a size,
16:14
full size,
16:14
too small and then you take them off.
16:18
It's like,
16:20
oh my gosh.
16:23
Wow.
16:24
Now I get it.
16:27
This self compassion thing.
16:28
Whoa,
16:29
this feels so good.
16:31
Why do I have to wear that tight tight shoe so that I can stay in line?
16:37
And according to someone else's beliefs about how I should be?
16:41
Oh,
16:41
God.
16:42
Take the shoe off.
16:45
You know,
16:46
that's,
16:47
that's amazing.
16:48
It's like turning off something that you don't even realize is on.
16:52
Right.
16:53
Reminds me when like the oven fan is going for so long and then finally my husband shuts it off and I'm like,
16:59
oh,
16:59
this is what peace feels like I forgot.
17:03
Right.
17:04
And it's a,
17:05
it's like,
17:06
it's a surface example,
17:07
but actually it's really profound.
17:10
Yeah.
17:11
And then when it wears off,
17:14
there's still this memory of that feeling.
17:18
Like,
17:18
even though you're sort of,
17:19
I mean,
17:20
do you sort of still go back,
17:22
you go back to your old beliefs and that sort of thing?
17:26
But there's something in,
17:27
not necessarily,
17:28
like some,
17:29
really,
17:30
some people do have spontaneous,
17:32
enduring cognitive or emotional shifts.
17:36
Ok.
17:36
So that is in the realm of possibility.
17:39
There's this thing going on right now in the psychedelic world where people are always saying it's not the medicine,
17:44
it's the work you do after the medicine shows you the path and you've got to walk it afterwards.
17:50
I don't agree.
17:51
I have seen some people and,
17:53
and I have experienced myself spontaneous remissions or spontaneous um episodes of healing that never retracted.
18:04
And I have seen and I have experienced myself,
18:08
you know,
18:09
um different types of healing where,
18:11
yeah,
18:12
I am shown something that I need to be more active in pursuing in order to kind of get to reach that goal,
18:20
you know.
18:21
So both are possible.
18:24
You can have those spontaneous like,
18:26
oh my God,
18:26
this is never gonna be a problem for me ever again.
18:29
And oh wow,
18:30
gotta keep working on it.
18:31
And so for that second example,
18:33
the analogy I use is if you imagine having an elastic band,
18:38
OK.
18:39
And during the psychedelic experience,
18:42
you take your shoe off and you feel the of that So the elastic band is like expand,
18:46
expand,
18:47
expand,
18:47
expand,
18:47
expanding.
18:48
And then you let go of the elastic band,
18:51
the elastic band will not go back to its original shape.
18:55
It will be a little looser,
18:57
you know.
18:58
Um And so that's another kind of way of thinking about the potential of,
19:04
of therapeutic change with psychedelic.
19:06
So either you're gonna have the,
19:08
we just turned off the light for this cognitive distortion it's over or the elastic band is lucent in terms of that thought or that experience.
19:21
And so very rarely do people go back to baseline.
19:25
Very rarely.
19:27
Yeah,
19:28
it's always exciting,
19:30
exciting news.
19:31
Yes.
19:32
Wow.
19:34
Wow.
19:35
It makes me curious and we might get to this later.
19:37
I'm not sure but Adele,
19:38
what,
19:39
what would be like the frequency like if somebody was in traditional eating disorder therapy or treatment and they started using the psychedelics alongside of that.
19:51
Is there,
19:52
is there a typical frequency or,
19:54
I mean,
19:55
you know,
19:55
if we look at the MD MA studies for PTSD that the final results have just been published this week and,
20:01
oh,
20:01
wow.
20:02
Oh my gosh.
20:03
I think 80 something percent reported significant reductions in PTSD.
20:08
70 something percent no longer met criteria for PTSD.
20:12
I think six months later,
20:13
one year later,
20:14
I can't recall exactly but really outstanding findings.
20:17
You know,
20:18
so what they did was once a month with weekly integration uh sessions in between.
20:27
Now,
20:27
if we're looking at the psilocybin studies,
20:29
like the one that I was a part of,
20:31
um,
20:32
then there was um three dosing sessions and it wasn't quite a month in between.
20:39
Um,
20:41
yeah,
20:42
and another study I think did two of them on average.
20:47
So,
20:49
and some of those people need more,
20:51
some of the people didn't need more,
20:53
which is really,
20:55
really cool.
20:56
Um I think our UU CS D study,
20:59
I think uh 50% of the sample were recovered um by whatever metric they were using,
21:06
which whatever metric they were using.
21:08
I'm still super excited about that because uh 50% is a great number in the context of eating disorder treatment.
21:16
But um you might need more,
21:17
you might need less.
21:18
It also depends on,
21:20
well,
21:20
the person's inner resources,
21:21
the person's external resources,
21:23
the quality of the care that is being provided.
21:26
Um whether or not,
21:29
you know,
21:29
psychotherapy is happening in between or some,
21:32
something that acts like psychotherapy doesn't have to be psychotherapy.
21:37
Uh Someone consulted with me recently about ketamine use for someone who had a really,
21:44
really serious disorder eating disorder.
21:46
And the provider was worried that they needed to like take more time between their experiences to integrate et cetera.
21:56
But I had a feeling that actually this person's brain was so rigid that that would be good advice under other circumstances,
22:09
but maybe not here,
22:10
maybe there needed to be more frequent um sessions with psychotherapy because I'm a really big believer in the combination of the two.
22:21
But yeah,
22:22
like nobody knows the answers to those questions.
22:24
I don't know the answers to those questions.
22:26
I'm,
22:27
I'm trying to do what I can to help figure it out.
22:31
Um And thankfully what people's experiences are tend to be.
22:38
I think the most important,
22:40
you know,
22:40
someone said to me recently,
22:42
like I think I need to take a couple months to really integrate this experience.
22:46
I'm like,
22:46
OK,
22:48
yes,
22:48
I'm not gonna pretend to be the expert about when you should think of going back to,
22:54
you know,
22:54
whatever that retreat or Ketamine or whatever it is.
23:00
Um So there's,
23:01
there's just like,
23:02
you know,
23:03
knowing that I think we can honor and respect and I think that's really a big difference in terms of the potential for psychedelic medicine,
23:11
breathing disorders versus conventional treatments.
23:14
Many people who struggle to benefit from conventional treatments have talked about like losing their sense of agency,
23:24
losing their sense of empowerment,
23:26
you know,
23:27
as a result of participating in the types of treatment that have been built um especially at the higher levels of care and in psychedelic medicine,
23:38
agency empowerment consent is paramount.
23:42
So just that can be healing for some people.
23:45
Absolutely,
23:46
especially the collaboration,
23:48
you know,
23:48
also having a voice and the pace of things and that's really important.
23:54
Um I was wondering if you could say more about this integration process.
23:58
What does that involve?
24:01
I mean,
24:02
let's see except for me,
24:05
it's an ever changing definition.
24:07
It was so funny.
24:08
I presented at a conference years ago,
24:10
it was my very first presentation on Ayahuasca,
24:13
which is,
24:14
was my very first research study in the psychedelic sphere.
24:17
And I talked about integration and I talked about how integration is necessary for everyone.
24:23
And,
24:23
oh my gosh,
24:23
I can't believe that some people are doing this without integration.
24:25
Da da da da da.
24:27
And then an anthropologist came up to me afterwards and she said,
24:32
I can't believe that you can't believe,
24:35
you know,
24:36
but whatever had just said,
24:38
I'm like,
24:38
oh,
24:40
and she's like Adele in communities where this kind of healing happens,
24:50
like as part of the fabric of the culture,
24:54
integration is not necessary because integration is weaved in already,
25:01
you know,
25:01
and I'm like,
25:02
oh my gosh,
25:03
that's so true.
25:06
And I think about like my life,
25:08
like in my,
25:09
like my family,
25:11
they,
25:11
every single person in my family has done Ayahuasca and my friends are very,
25:17
everyone's psychedelic friendly and like,
25:19
really committed to deep healing work.
25:21
And so like the idea of,
25:22
and I'm like,
25:23
oh yeah,
25:23
now I get it.
25:25
I don't have to worry about who,
25:27
who can I tell,
25:28
you know,
25:29
who can I share this with?
25:30
It's like,
25:31
it's just part of my life,
25:33
it's part of our lives,
25:34
you know,
25:36
but that's not true for everybody.
25:38
Um And I,
25:39
I mean,
25:40
personally I've still,
25:42
I still see an integration therapist every once in a while and I come home from Peru um to help me to make sense of what happened,
25:51
how it can be meaningful for me and how I can um a line,
25:58
what I learned or how I healed with how I interface with the world so that piece can be really,
26:08
really important.
26:09
And so though I have been humbled in terms of my perspectives of the importance of integration and the importance of cultural context,
26:16
I really do strongly believe in integration,
26:19
especially because this is not something people talk a lot about but psychedelic under the effect of a psychedelic,
26:26
you can feel like you're told something that feels really,
26:29
really real,
26:30
but it's not true.
26:32
So there is some skill involved in like navigating psychedelic experiences,
26:38
especially ones that come with a lot of fear,
26:41
a lot of shame,
26:42
you know,
26:43
um like I remember one night in Peru under the effect of ayahuasca,
26:48
I was told that I had stage four bladder cancer and it was to evoke health anxiety.
26:58
I've had health anxiety my whole life,
27:00
my mom has had cancer since I was young,
27:02
like she's different illnesses.
27:04
And so I was exposed to um medical challenges from a really young age and didn't know how to integrate it.
27:12
And so I,
27:12
I have this,
27:14
I had,
27:15
I had,
27:15
I guess I could say I had really intense health anxiety.
27:19
And so it was really important for me to know like,
27:22
oh yeah,
27:23
sometimes,
27:25
sometimes you like things can come up in order to be a catalyst for,
27:30
for healing.
27:32
But it's not always true.
27:35
And I think sometimes people end up having bad trips because there are some challenging experiences that occur and they don't have the skills to navigate those challenging experiences and then they get totally lost in them.
27:49
And so integration is really important,
27:51
but I think we also can speak a lot about preparation um back.
27:57
Yeah.
27:57
So that's one of the downsides of considering psychedelics for eating disorders is that um you know,
28:05
we're still learning about the healing trajectories for people who have eating disorders.
28:11
And there,
28:12
there are definitely not enough people who are trained with psychedelics and eating disorders,
28:18
you know,
28:19
to um support people to get ready for those kinds of experiences,
28:24
but also to make sense of those kinds of experiences.
28:27
I spoke recently to somebody who,
28:30
it was a mom.
28:31
She did a journey on her daughter's behalf who's struggling eating disorder.
28:35
And she saw the spiritual reason for the emergence of the eating disorder in their lineage and it was big,
28:43
it was a lot and um and it had to do with uh protection as a like getting protection as a woman um at a time generations ago where it was even more risky than to be in a female body,
29:01
you know,
29:02
and so people like that can be really destabilizing for people.
29:06
Like what?
29:07
Oh,
29:07
my gosh,
29:08
this is huge.
29:09
Like,
29:09
how do I digest that?
29:13
So,
29:13
psycho spiritual support can be really,
29:15
really helpful and I don't know that we're quite there yet in the field of eating disorders,
29:19
in terms of considering that eating disorders are not just disorders that arise within an individual and they're not just related to genetics.
29:30
In fact,
29:32
I now question,
29:34
like,
29:34
what does genetics actually mean?
29:37
You know,
29:39
is it,
29:40
is it,
29:41
um,
29:42
an expression of a behavior that somewhere up the line was adaptive?
29:51
I don't know.
29:52
Mm.
29:53
Mhm.
29:54
So,
29:54
I'm just,
29:54
I'm just questioning so much and I'm just,
29:56
when I,
29:56
when I look at like,
29:57
oh,
29:57
how I used to write eating disorder reports,
30:00
like assessment reports.
30:02
I didn't talk about spiritual factors.
30:04
I didn't talk about intergenerational factors.
30:07
I talked about the gymnastics coach or the bullying or,
30:13
or the difficulties with emotion in the family or something,
30:16
you know?
30:16
And I'm like,
30:17
oh,
30:17
my gosh,
30:18
how,
30:19
how naive was I,
30:23
and I still have a lot to learn.
30:24
So,
30:26
yeah,
30:26
it sounds like you just have such a deeper richer perspective now.
30:31
Um,
30:31
working with eating disorders.
30:34
Oh,
30:34
my gosh.
30:34
It's been incredible.
30:36
Yeah.
30:37
So much.
30:38
So,
30:39
so much.
30:39
Yeah.
30:40
I mean,
30:40
it's a devastating illness.
30:43
It's so tricky.
30:45
Um,
30:46
but I know now a handful personally,
30:52
you know,
30:53
of women who have had 20 plus year histories of eating disorders who are now on the other side.
31:03
And when I say on the side they're like,
31:04
oh,
31:05
like,
31:05
I forget what it's like,
31:08
you know,
31:08
like that kind of other side.
31:12
That's incredible.
31:13
That really is amazing.
31:14
It makes me curious.
31:15
Adele is there,
31:16
um,
31:17
is there someone that might not be recommended to engage in psychedelics maybe within the eating disorder field or have you not seen that?
31:28
Oh,
31:28
yeah.
31:29
No,
31:29
it's,
31:29
but it,
31:30
it never has anything to do with the person.
31:32
Yeah,
31:33
it has everything to do with the limitations of the healer or the healing container.
31:39
OK.
31:40
Yeah.
31:41
So I want that to be really,
31:42
really clear,
31:43
you know,
31:44
um because in general psychedelic medicine,
31:49
there are major contraindications when it comes to schizophrenia or other psychotic disorders,
31:54
bipolar um disorders in studies.
31:59
If you have a,
31:59
if you have had any prior uh manic episode or psychosis,
32:03
you can't participate and in some studies,
32:07
um you can't participate if you have a one.
32:09
what is it like a one degree relative who has experienced the same and yet outside of studies in um in South America,
32:21
I have seen highly experienced practitioners go low and slow with really tight containers,
32:31
helping people who otherwise would be deemed um inappropriate for participation,
32:40
you know,
32:40
according to the standards and the guidelines that are being talked about or,
32:45
or published at this time.
32:47
Um I mean,
32:49
I know people who have participated with psychedelics at extremely low weight because not doing it was as risky as doing it,
33:01
you know.
33:03
Um,
33:03
and it doesn't mean that bad things don't happen,
33:06
you know.
33:08
But,
33:09
uh,
33:10
I just,
33:10
I just finished writing a paper for an eating disorder journal.
33:13
It's going to be published soon.
33:15
And that's one of the things that we wrote in it was that like a lot of the contraindications that are being talked about,
33:21
including,
33:21
based on the bulk of my research.
33:24
I've never actually been tested.
33:27
Wow.
33:28
So it's like at an abundance of caution,
33:32
you know,
33:33
we wanna exclude people who have these conditions and that's important because the psychedelic medicine is new,
33:40
right?
33:41
And so we really need to approach this with an abundance of caution,
33:45
but I get emails from people all the time who don't fall into the categories that are more or less given the green light and they are human beings who are suffering and suffering greatly.
33:59
And so I think that we have a responsibility to actually verify that those contraindications are,
34:08
in fact,
34:09
you know,
34:09
risk too risky to engage in that kind of,
34:12
especially when people are really in trouble.
34:18
That's controversial.
34:19
It's controversial because like,
34:21
how do you decide?
34:22
You know,
34:23
it's like we do need the support of um people who specialize in medical ethics to help us to make those decisions.
34:32
I certainly am not qualified,
34:34
but I am qualified to be thinking about it and be talking about,
34:39
you know,
34:41
the questions and the concerns.
34:43
Yeah,
34:43
Mhm.
34:44
Mhm.
34:45
That makes me think of another question.
34:47
Um You kind of mentioned family involvement um a little bit ago and how you had a,
34:54
how you had encountered a mother that was there on behalf of her daughter.
34:58
If that's not the experience,
35:01
like,
35:01
say it's the experience of someone who is dealing with the eating disorder.
35:05
What is that um family involvement or is there?
35:10
And how do you bring them alongside?
35:13
The greatest joy of my career so far has been blending my work with Efft and Alex because I was just like,
35:22
oh,
35:22
I have these really desperate lines of clinical practice and research and I'm like,
35:27
wait a minute,
35:28
what?
35:29
No,
35:30
they have to come together because if someone engages in psychedelic medicine,
35:36
they have these like really huge shifts.
35:40
It can destabilize the system,
35:41
like the system needs to be supported and also turns out the love and support of our family members can be just as powerful as a psychedelic.
35:54
And so if we put the two together,
35:57
like,
35:57
whoa,
35:58
now it's,
36:00
it's like,
36:01
I don't want to,
36:01
I want to say next level,
36:03
it's like next,
36:03
next,
36:03
next level,
36:06
way out there.
36:07
Yeah,
36:07
way,
36:08
way,
36:08
way up there.
36:10
And so I'm part,
36:11
I was part of the study at Imperial College looking at still assignment for anorexia nervosa.
36:16
And um I was helping to get I was giving input on the design,
36:21
you know,
36:21
in the early stages.
36:22
And I'm like,
36:22
we need to bring in some sort of family involvement.
36:26
We need to,
36:26
we need to set this up as the standard,
36:28
you know,
36:29
for all of these really,
36:30
really good reasons.
36:31
And so,
36:32
yeah,
36:32
we did it.
36:33
And one of my colleagues Jennifer Danby,
36:36
who was from the Mosley,
36:37
who I met because I went over there to teach them efft,
36:41
she ended up being the lead therapist on this study and she was the efft therapist.
36:45
And so every participant in that study identified a close other,
36:50
whether it was a parent or a partner or spouse or a friend and they got efft support um to support their loved one.
37:01
And it was like,
37:02
I can't wait to write that paper,
37:06
but I can't wait,
37:06
wait to read it.
37:07
Oh my God.
37:08
And then we did the same with the study on Ketamine.
37:11
And there was this really cool quote by this one guy who was this partner of a,
37:17
of a woman who participated in the study.
37:19
And he talked about how they'd had the best communication that they'd had in their relationship and how much he benefited from being part of the study and the learning about the efft piece,
37:33
you know,
37:33
but so he didn't just use it with,
37:35
with his partner.
37:36
He talked about using it at work and with his kids and with himself.
37:41
And so,
37:42
I mean,
37:42
psychedelic medicine is,
37:43
it's almost like,
37:44
it's like a,
37:45
a container of intensity.
37:49
So if you can,
37:50
if you can infuse good stuff in there.
37:54
I mean,
37:55
we're scratching the surface in terms of what's possible.
37:58
Yeah.
38:00
Wow.
38:01
It's so exciting.
38:02
I,
38:02
yeah,
38:02
I'm really curious.
38:04
Um,
38:05
what would you say are some of the most common themes that sort of come out of these experiences?
38:12
I mean,
38:12
whether it,
38:13
I know you had your own experience with ayahuasca,
38:14
but what do,
38:16
what are you seeing?
38:17
And does it vary between the type of psychedelic,
38:22
you know,
38:22
like ayahuasca compared to seven?
38:25
Yeah,
38:25
I'm just really curious.
38:27
Hm.
38:28
Well,
38:30
Jen,
38:30
um we're doing a two day training in January for psychedelics for eating disorders and we'll talk a little bit about this.
38:36
But one of the things that Jen talked about having been the main therapist on so many of the psilocybin assisted journeys for eating disorders specifically,
38:46
um that I have also seen with different compounds was loneliness,
38:52
core,
38:53
loneliness and also mistrust,
38:56
mistrust of self mistrust of others.
39:00
And that um those themes I think honestly,
39:05
they're universal for us at this time,
39:11
just how disconnected we live from each other and from ourselves.
39:17
But they seem to be more pronounced perhaps in people with eating disorders.
39:25
And um it's really hard to hold space for someone who's in that deep pit of loneliness,
39:34
you know,
39:34
to be with them in that place,
39:37
but being with them in that place also helps to neutralize that force that ends up fueling,
39:45
you know,
39:45
so many eating disorder,
39:46
thoughts,
39:47
uh urges and behaviors.
39:50
And um so,
39:51
yeah,
39:51
so those are two themes.
39:53
The other theme though that I've kind of noted is um difficulties with love.
40:01
Mhm.
40:02
Difficulties with receiving love or even acknowledging that it's there never mind receiving it,
40:09
but also difficulties with the vulnerable expression of love.
40:15
And that's,
40:16
that's a,
40:17
that's a prison cell.
40:19
You know,
40:21
like I think again,
40:22
most of us struggle with giving and receiving love,
40:28
but I think it's more pronounced um with people who struggle with eating disorders.
40:34
Yeah.
40:35
Um So the loneliness and the difficulty receiving and accepting love.
40:42
What was the other one?
40:44
Mistrust,
40:45
mistrust.
40:46
What changes after these experiences?
40:50
Um Well,
40:53
experiencing the companionship and the care of the guides in that experience of deep loneliness is a neutralizing experience.
41:06
You can't both be lonely and beheld,
41:11
you know,
41:11
so that's really,
41:12
really cool.
41:15
Um That's one of the ways that it can change and um trust.
41:22
Well,
41:23
trust is built.
41:24
Yeah.
41:25
So um with one participant,
41:29
you know,
41:29
the participant had to ask for things and then see that they could receive it or,
41:34
or ask the guide what they thought about something and then,
41:40
and then see if they trusted the answer like in their bodies,
41:43
you know,
41:43
in the energetic space between them,
41:45
do I trust what you're saying?
41:47
And babies learn to trust themselves through trusting their caregivers.
41:53
So it's normal to expect that you can replicate that experience um with psychedelics,
42:02
with,
42:02
with really good guides.
42:04
Um I,
42:06
I train psychedelic guides and one of the most important um guiding principles is as a guide.
42:16
You must always tell the truth.
42:18
Always.
42:20
If the participant asks you.
42:23
Are you hungry?
42:24
Hm.
42:26
You must check in to see.
42:28
Am I hungry?
42:30
Even?
42:30
Just a little bit because if you're like,
42:32
oh,
42:32
no,
42:32
no,
42:32
no,
42:32
I'm fine.
42:32
I'm fine.
42:34
And they can actually sense your hunger because they are,
42:37
their radar is on high.
42:38
You know,
42:38
because of the psychedelic and,
42:41
and you say no,
42:43
two things can happen.
42:45
They lose trust in you because they're like,
42:48
huh?
42:49
It's really funny.
42:49
I could have sworn that I could sense that you had a need of that nature and then worse than that it can violate their trust in themselves.
43:01
Huh?
43:02
I had that instinct but guess I was wrong.
43:05
Mm.
43:07
So,
43:08
um,
43:09
the interpersonal nature of the work in psychedelic assisted therapy can go a long way in helping people to re-establish trust in others and themselves because those processes are,
43:22
are deeply intertwined.
43:25
It's really neat to hear you say,
43:26
I guess I,
43:27
you know,
43:28
originally my knowledge and awareness of psychedelics,
43:31
I didn't realize that there was a guide or a person to be there with you in this case can be.
43:38
Yeah.
43:38
And that,
43:39
that does seem like everything that you're saying that they can get out of this.
43:44
I feel like we could spend months in treatment or in talk therapy,
43:48
like trying to build this trust.
43:51
And then,
43:52
but then there's this opportunity for this.
43:54
You,
43:54
you mentioned it earlier,
43:56
but this just container of intensity in this moment to have that and to know then like fully to their core that it can be different totally.
44:08
I mean,
44:09
I there's a woman,
44:10
I have a video of her.
44:11
She's,
44:12
she's so beautiful.
44:13
Oh my gosh,
44:14
like her healing trajectory has been so beautiful.
44:18
She talked about how she remembered like the first time she felt love from the therapist who was holding space for her.
44:27
And she's like,
44:28
oh my God,
44:29
oh my God,
44:29
this therapist loves me.
44:30
Oh my God,
44:31
I'm loved.
44:32
And she could feel the love metabolize into worthiness.
44:37
And then uh when you think you're worthy,
44:39
you don't want to hurt yourself,
44:41
right?
44:41
And when you believe you're worthy,
44:43
you don't want other people to hurt you.
44:45
Yeah.
44:46
So it was like,
44:48
wow.
44:49
But now I'm gonna put a big old red flag.
44:53
So you hear how,
44:54
how delicate it can be these inter these interpersonal processes,
45:00
you know,
45:01
in this container of intensity when things go wrong,
45:05
they can go really wrong,
45:09
you know.
45:10
Absolutely.
45:11
Yeah.
45:12
So the importance of really good training.
45:16
Yeah.
45:17
Paramount.
45:18
And I'm a strong believer in um if we're talking about so psychedelic assisted therapy that there would be two guides present.
45:27
Hm.
45:28
Mhm.
45:29
Um Just in case one guide becomes triggered.
45:33
Yeah.
45:34
Or has a health issue emerges?
45:38
Like what if they get food poisoning?
45:41
Yeah,
45:41
I have to go to the bathroom seven times.
45:43
Like that can be highly traumatizing for a person to be left alone,
45:49
you know.
45:49
So some people are really concerned about the cost of two guides for like a 78 hour day of psychedelic assisted therapy.
45:59
But um for eating disorders,
46:02
I would say that I hope people view this as essential.
46:06
You know,
46:07
if we're gonna move forward in this way because yeah,
46:12
you can keep each other in check as well.
46:13
Like the guides can keep each other in check too because when it,
46:18
when it doesn't go well,
46:19
like there are numerous accounts of people who have talked about being traumatized in the context of a psychedelic therapy session because of things that happened that in any other context would have been traumatizing like sexual abuse,
46:33
for example.
46:35
But also because of things that happened that wouldn't necessarily have been traumatizing outside of a psychedelic.
46:41
But because you're so open and because you're so vulnerable,
46:45
then it can hurt you much more deeply.
46:50
Yeah.
46:50
Makes sense.
46:52
It really does and how careful you really do have to be with this work.
46:57
It's so important.
46:58
I have one last question.
47:00
I know we're running out of time and I'm so sad about that because I want to talk more about you.
47:05
Talk so much about this concept.
47:08
Well,
47:09
the concept of love in therapy,
47:11
you know,
47:12
and this is a word we don't hear in the mental health field very much at all.
47:15
You know,
47:15
we hear a lot about how you have to be a blank slate.
47:18
You need boundaries.
47:19
We hear tons about that.
47:20
But love,
47:21
I mean,
47:21
this is something,
47:22
this is a concept that you be,
47:24
you believe belongs in therapy between patient and,
47:29
you know,
47:29
between therapist and client and um you believe it can be even studied and measured and you know,
47:36
brought into the research.
47:37
So my question is,
47:39
what are your hopes for love in the mental health field?
47:42
Hm I mean,
47:43
my hope really is so simple is that we can just talk about in a straightforward manner.
47:51
What we know fundamentally works in psychotherapy and you can call it unconditional positive regard.
47:59
But if you want to be fucking brave,
48:02
you can call it love,
48:04
love.
48:08
Like the whole blank slate thing is actually really,
48:12
really important if you're doing psychoanalytic psychotherapy,
48:17
right?
48:18
If that's the mechanism of healing that you're employing,
48:22
right?
48:23
Because then the blank slate is essential for the work to be done.
48:28
But who is doing psychoanalytic psychotherapy and treating eating disorders?
48:34
Nobody.
48:35
It's almost like saying like um you have to put a seatbelt on when you're in the shower.
48:40
No,
48:41
the seatbelt belongs in the car.
48:44
Like this blank slate belongs on the therapy couch in four or five times a week psychoanalytic psychotherapy in the work that we are doing unconditional positive regard.
48:59
Eye roll,
49:00
love.
49:01
Yeah.
49:02
Love and love exists with boundaries like it's not like peop I think some people are,
49:09
I mean I was gonna say some people are scared.
49:11
Yeah.
49:11
No shit.
49:11
They're scared because many patients have been hurt under the guise of love.
49:17
Yes.
49:18
Mhm.
49:19
And we are in need of some major global rehab.
49:27
You know,
49:28
like everybody in terms of what love is and what it love isn't.
49:33
And so that people are scared,
49:34
I respect that deeply.
49:38
So I think the first step is really just thinking about unconditional positive regard and then thinking about love,
49:44
just transferring that over.
49:46
You know,
49:46
it's like,
49:47
oh that's what it is.
49:49
So you still can be professional,
49:51
you can still be whatever the word means,
49:54
you can still be bounded,
49:56
you know,
49:56
you can still finish the session on time.
49:59
Uh You still do not touch people in romantic or sexual ways,
50:05
you know.
50:06
Yeah.
50:07
Yeah.
50:07
You can still let them know your deep affection that you have for them as a fellow human.
50:14
I love that.
50:15
So healing and so powerful.
50:17
Thank you so much Adele for coming on.
50:20
This was such a wonderful conversation and just so grateful that you,
50:25
that you joined the show.
50:27
Yeah,
50:27
Adele quickly you mentioned a training in January.
50:31
Do you want to catch on that real quick?
50:32
Oh my God.
50:33
That would be wonderful.
50:33
Thank you.
50:34
Yeah.
50:34
So Jen Danby,
50:35
the lead uh therapist on the psilocybin study.
50:39
And I are going to be leading a two day training January 25th and 26th.
50:45
And we welcome people who are interested,
50:48
you know,
50:49
in um thinking about doing work with psychedelics with eating disorders.
50:55
I would love to have eating disorder professionals come because we all have so much um to share with the psychedelic world actually because we've been doing this,
51:08
you know,
51:08
we know a lot about what we're doing a lot of the time.
51:12
So,
51:12
yeah,
51:13
I,
51:13
I really hope uh people um come out and join us for two days of what I think will be some pretty amazing training.
51:22
Awesome.
51:23
Well,
51:23
thank you so much and we will add all of your information to our um podcast details.
51:30
So everybody will have that.
51:32
So,
51:32
Adele,
51:33
thank you again.
51:34
This was so lovely and I just feel so honored and privileged to be able to sit across from you and hear from you.
51:40
So,
51:41
and thank you to our listeners for joining us for another episode of All Bodies All Foods.
51:45
Thanks everyone.
51:50
Thank you for listening with us today on All Bodies All Foods presented by the Renfrew Center for Eating Disorders.
51:57
We're looking forward to you joining us next time as we continue these conversations.