The last twenty years has arguably led to a renaissance of scientific investigation into the therapeutic benefits and risk of a range of psychedelics. LSD, ecstasy, psilocybin and ayahuasca that are increasing in popularity as alternative therapies used to address a host of mental health challenges [1] [2] [3]. These include anxiety, depression, trauma, addiction [4] [5], existential fear, relationship issues, addiction, obsessive compulsive disorder, and post-traumatic stress disorder [6] [7].
Psychedelics can cause profound shifts in consciousness, personal belief structures, relationships and alter the trajectory of one’s life [8]. Although psychedelics may provide you with 10 years of psychotherapy in one night this does not necessarily equate to 10 years of practical insights that can be translated and integrated easily into one’s daily life. Many people require psychological support and a range of integration practices to process these profound states of consciousness [9].
High quality psychedelic integration can help facilitate deep exploration and processing of the bio-psycho-social-cultural-spiritual and political domains of the individual. Examples of these can be found across multimodal and complementary therapies such as somatic experiencing, movement, music, nature, exercise, nutrition, acupuncture, massage, yoga, breathwork, art and creative forms of expression, rituals, prayer, meditation and psychotherapies [9] [10].
What is EMDR and how can it help people integrate their psychedelic experience?
The writer is the National Practice Manager at Mind Medicine Australia Psychological Support Services. One of the writer’s psychedelic integration tools in her tool kit is Eye Movement Desensitization and Reprocessing (EMDR) therapy. EMDR can be used to support psychedelic assisted psychotherapy as an integration tool. Clients safely confront material that arose during the psychedelic experience and continue to process meaning, body sensations, emotions, blocked and challenging content.
EMDR was originally designed to reduce the distress associated with traumatic memories [11]. There have been more than 30 controlled outcome studies with positive results conducted on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. It is now recognized as an effective form of treatment for trauma by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense and Australian Medicare system.
For a detailed outline of the EMDR phases and results of clinical trials refer to www.emdr.com/frequent-questions.
EMDR had expanded beyond trauma and is often used to help clients access new perspectives, improve self-esteem and to shift and expand rigid belief systems [12]. The writer has utilized bilateral stimulation, which is a left and right repetitive eye movement technique with clients requesting psychedelic integration. The client follows the therapist’s fingers and is assisted to concentrate on a distressing memory, emotion and/or challenging and dynamic psychedelic content whilst moving their eyes rapidly back and forth [13].
People naturally do bilateral stimulation every night in during REM sleep. The left to right eye movement is believed to be storing our memories from the day [14]. Retrieving a traumatic memory and following eye movements requires more working memory capacity than is available and subsequently the clients working memory is taxed. Consequently, the client is able to experience the distressing content with fewer associations with fear, anger or sadness.
As the process unfolds, the client often taps into somatic experiencing (e.g., crying, shaking, sensations in their gut, throat etc.) and one’s natural ability to locate helpful beliefs, perspectives and anchors to process and integrate the challenging experience emerge. Clients often report a sense of experiencing new insights and downloads (e.g., information, shifts in core beliefs, a new way to interpret and experience the psychedelic content). Furthermore, clients can process any left-over tensions, emotions and energetic blocks from the previous psychedelic experience; this often results in clients feeling more relaxed, grounded and a sense of ease with the psychedelic material.
Bilateral movements also happen when we walk, run, write, read, cook, play music, and when we are making art. Therefore exercise, hobbies, creative arts, and expressive arts are effective ways to help people with trauma healing and integrating challenging psychedelic experiences.
Can EMDR be used to support Hallucinogen-Persisting Perception Disorder?
HPPD is a very rare condition which causes a person to keep reliving the visual element of an experience caused by psychedelics. Little is known about why HPPD occurs and the specific mechanisms behind the experience. However, it should be noted that HPPD does not cause people to have full delusions [15]. HPPD flashes are typically characterized by seeing bright lights, circles, blurry patterns and various size and shape distortions [15]. Due to the persistent nature of these flashbacks and the persons inability to stop them from occurring randomly people can experience agitation, fear and anxiety [15].
There are two types of HPPD
Type 1: This is where people experience HPPD in the form of random, brief flashbacks.
Type 2: People with this kind of HPPD experience ongoing changes to their vision, which may come and go.
[16].
The writer has also utilised EMDR to help people who are experiencing HPPD to confront the distressing visual content, and the associated emotions and physical responses. Throughout the session the client visualizes the hallucination and what this image means for them in regard to associated negative beliefs, fear and anger. Clients can organically construct a more meaningful narrative (whilst releasing somatic movements, sounds and sensations) and often reported seeing the visual/hallucination in a new light. In so doing, clients often make the commitment to have a different relationship with the imagery post sessions (e.g., as a reminder to ground, a teacher, a cue to slow down etc.) thus integrating the psychedelic experience and overcoming anxious and fear-based states.
To date there is little research regarding the efficacy of EMDR, psychedelic integration, and/or treatment of HPPD. Future research could explore how the mechanisms of bilateral stimulation (left and right repetitive eye movement technique) and strong therapeutic rapport can support these clinical experiences.
If you would like to know more about psychedelic integration and EMDR please email alana@mindmedicineaustralia.org
References
[1] J. Daniel and M. Haberman, “Clinical potential of psilocybin as a treatment for mental health conditions”, Mental Health Clinician, vol. 7, no. 1, pp. 24–28, January, 2017. doi:10.9740/mhc.2017.01.024
[2] Curtis, R, Roberts, L, Graves, E, Rainey, HT, Wynn, D, Krantz, D & Wieloch, V 2020, “The Role of Psychedelics and Counseling in Mental Health Treatment”, Journal of Mental Health Counseling, vol. 42, no. 4, pp. 323–338, October, 2020. doi:10.17744/mehc.42.4.03.
[3] J. Sarris et al. “Ayahuasca use and reported effects on depression and anxiety symptoms: An international cross-sectional study of 11,912 consumers”, Journal of Affective Disorders Reports, vol. 4, 100098, pp. 1–8, 2021. doi:https://doi.org/10.1016/j.jadr.2021.100098
[4] M. Winkelman, “Psychedelics as medicines for substance abuse rehabilitation: evaluating treatments with LSD, Peyote, Ibogaine and Ayahuasca”, Current drug abuse reviews, vol. 7, no. 2, pp. 101–116, 2014. doi:10.2174/1874473708666150107120011
[5] A. Loizaga-Velder and R. Verres, “Therapeutic Effects of Ritual Ayahuasca Use in the Treatment of Substance Dependence — Qualitative Results”, Journal of Psychoactive Drugs, vol. 46, no. 1, 63–72, doi:10.1080/02791072.2013.873157
[6] M. Ot’alora et al. “3,4-Methylenedioxymethamphetamine- assisted psychotherapy for treatment of chronic posttraumatic stress disorder: A randomized phase 2 controlled trial”, Journal of Psychopharmacology, vol. 32, no. 12, pp. 1295–1307, 2018. doi:10.1177/0269881118806297
[7] M. Mithoefer et al. “Durability of improvement in posttraumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3, 4-methylenedioxymethamphetamine- assisted psychotherapy: A prospective long-term follow-up study”, Journal of Psychopharmacology, vol. 27, pp. 28–39, 2013. doi:10.1177/0269881112456611
[8] R.R Griffiths et al. “Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial”, Journal of Psychopharmacology, vol. 30, no. 12, pp. 1181–1197, 2016. doi:10.1177/0269881116675513
[9] A. Garcia-Romeu and W.A. Richards, “Current Perspectives on Psychedelic Therapy: Use of Serotonergic Hallucinogens in Clinical Interventions.” International Review of Psychiatry, vol. 30, no. 4, pp. 291–316, 2018. doi:10.1080/09540261.2018.1486289.
[10] J. Guss, R. Krauseand and J. Sloshower, “The Yale Manual for Psilocybin-Assisted Therapy of Depression (using Acceptance and Commitment Therapy as a Therapeutic frame)”, 13th August 2020, [Online], Available: https://psyarxiv.com/u6v9y/
[11] F. Shapiro, (1989). Eye Movement Desensitization: A New Treatment for Post-Traumatic Stress Disorder. Journal of Behavior Therapy and Experimental Psychiatry [Online]. 20(3), pp. 211–217. Available: https://www.sciencedirect.com/sdfe/reader/pii/0005791689900256/pdf
[12] Griffioen, B.T. Van Der Vegt, A.A. De Groot, I.W and De Jongh, A, “The effect of EMDR and CBT on low self-esteem in a general psychiatric population: A randomized controlled trial” Frontiers in Psychology, vol. 8, 1910, pp. 1–12, November, 2017. doi:10.3389/fpsyg.2017.01910
[13] F. Shapiro, “Efficacy of the Eye Movement Desensitization Procedure in the Treatment of Traumatic Memories” Journal of Traumatic Stress, vol. 2, no. 2, pp. 199–223, 1989. doi:10.1002/jts.2490020207
[14] F. Shapiro, Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. New York: Guilford Press, 2001.
[15] J. Halpern and H. Pope “Hallucinogen persisting perception disorder: what do we know after 50 years?”, Drug and Alcohol Dependence, vol. 69, no. 2, pp. 109–119, 2003. doi:10.1016/S0376–8716(02)00306-X
[16] L. Orsolini et al. “The ‘Endless Trip’ among the NPS Users: Psychopathology
and Psychopharmacology in the Hallucinogen-Persisting Perception Disorder. A Systematic Review”, Frontiers in Psychiatry, vol. 8, pp. 1–10, November, 2017, doi:10.3389/fpsyt.2017.00240
Dr Alana Roy
Ph. D Psychology, B. A Social Work (MHSW)
Dr Alana Roy is a psychologist, social worker and therapist and has spent the last 13 years working in mental health, suicide prevention, trauma, sexual abuse, family violence and the disability sector. Alana has worked with borderline personality and dissociative identity disorder in various roles in the community such as: Rape Crisis Centres with victims of ritual abuse, childhood and adult sexual assault, supporting women in the sex industry, survivors of human trafficking and now as a psychedelic integration specialist.
Alana focuses on harm reduction, community and connection. She is dedicated to psychedelic-assisted psychotherapy and plant medicines. She has engaged with, and provides integration therapeutic support services for communities across Australia. Alana works at several universities as a Research Fellow and supervisor of students on placement. Alana passionately advocates for public policy, community education and legislative changes so that these treatments are regulated and supported by a strong, connected and skilled sector.
Learn more about Alana’s experiences in: Psychedelic Medicines: How My Journey Into The Jungle Changed My Life