Changing the Narrative: Why the MAPS Protocol Is Real Psychotherapy

Dr. Sandy Newes 19:40

Well, then also a block, like, it’s like, okay, you know, if we’re gonna, you know, entertain the possibility that coming right out and saying, that’s important, then how do they get that when we have this legal block? And then does that become the gatekeeper, you know, like, and how to, how to work with that? Yeah,

Rick Doblin 19:55

I think the other thing to say is that, you know, everything is like the bell curve. You know, there are some, if you look at the bell curve of therapists that have never done MDMA, the therapy bell curve, or the therapists that have done MDMA, they overlap, yeah. So there can be some therapists who’ve never done MDMA that are better than some therapists who have done MDMA, right, but each therapist would be more effective themselves if they’d have that experience. That’s what we believe. And so it’s and it is possible for a good therapist to get good results having never taken it themselves, especially if they’ve been through the initial six day therapy training program that we have, which is, what’s our treatment manual? What’s our adherence criteria, what are the interactions that happen between patients and therapists? How to do this, watching videotapes of therapy sessions, doing role play, things like that. Once you’ve got that. This just reminds me of a funny story is that we have over 100 people who have gone through the protocol to receive MDMA as

Dr. Sandy Newes 21:02

more than I thought, that’s great. We have somebody on our team who’s done it, who’s prepared. He’s a supervisor. His name is Dave McDonald. Shout out to Dave,

Rick Doblin 21:10

yeah, we’ve had over 100 and we’ve had something happen only two times, and both of these times were psychiatrists who’d never done MDMA before, and the protocol was four days long. The first day you either get MDMA or a placebo. The second day of integration, the third day, what’s called the crossover, whatever you didn’t get the first day you get the third day. Fourth day is the day of integration. Oh, nice. And this usually takes place after people have been through the six day training. Yeah. So what we had was this one. This happened with Michael and Annie, therapist training couples, and also Bruce and Marcela. One of these happened to each one of them, our most experienced therapists and trainers. But what happened was that these were psychiatrists that had never done MDMA, and they were really eager to get it, and they both felt really, really lucky that they got it on their first tie. That was this MDMA. And they go through these eight hour sessions. They have pupil dilation, they have various different things that are associated the physiological aspects of it. They work on difficult traumas that they’ve had from childhood and others, and they’re convinced that it’s MDMA. The therapists are convinced. Oh, interesting. You can see where it’s going. The second day is a day of integration, and they make further progress, and now they’re waiting for the third day where it’s going to be a placebo and it’s going to be an easy day, when he actually realized, after about an hour of taking the pill, that it wasn’t the placebo, it was the MMA, for hours, yeah, he couldn’t he was stunned, yeah. And then he would go like this, pointing at the books and the bookshelf, and then point like it’s in here. It’s the feeling. It’s not intellectual knowledge. But this has rarely happened, but it has happened that our most trained therapists are fooled into thinking that somebody got MDMA when they only got the placebo. Well, that

Dr. Sandy Newes 23:20

doesn’t surprise me at all, because when I sat there, I mean, you know, I’ve been doing psychotherapy for years, and I was also trained as a researcher, and it was psychotherapy Outcome Research, specifically, like how you evaluate I was, I did adventure therapy work before this, which doesn’t sound similar, but is because it’s an experiential process and an emerging field with a perception of risk, and It’s multi disciplinary, so, and it draws from multiple theoretic perspectives. So I watched, I Bruce and Marcel were my training trainers, amazing. And I saw, I saw the body keeps a score. I mean, I saw Bessel van der Kolk whole career like, unfold in front of me. Like, you know, you can do somatics. You have to do somatics. You have to bring the body in. Doesn’t matter if you actually get to the trauma. It’s all about the relationship. It’s about feeling safe in your body, feeling safe in the environment, feeling safe with the therapist. And then I saw this whole overlay of hakomi and psychodynamic psychotherapy with relational emphasis, like I saw it. And so when people say, like, oh, well, you know, doesn’t follow evidence based practice. And just like as if that, in and of itself, means, therefore, you should just throw it out, I’m just like, hold on. You know, this is the most well thought out model I’ve ever witnessed for trauma. It draws on all of the emerging evidence in the past decade, and it follows extremely rigid and well thought out psychotherapy outcome research principles for an emerging psychotherapy modality. Like I was like, of course, this will get approved, because it’s all that, you know, and so for me just to be like, What are you kidding me? Like, how can you say this isn’t the most effective therapy model? That could be put together well, and

Rick Doblin 25:02

the data shows it so that exactly, just to give you an example, or for the people that are listening, our second phase three study, moderate to severe. PTSD, yeah, the people that got therapy with no MDMA at all. It acted placebo. 47.6% no longer had PTSD, right?

Dr. Sandy Newes 25:21

I mean, how can they just say, like, therefore, this is not actual therapy? You know, like that just doesn’t make sense

Rick Doblin 25:28

at all. And the dropout rate was lower, way lower than other things. There’s like a half the people drop out of prolonged exposure and cognitive processing therapy. The VA did a study took them six years or so, 914 veterans comparing cognitive processing therapy with prolonged exposure, and roughly half the people dropped out of the study because it was so re traumatizing right now. The other part is that we’ve been doing this since 2000 we have evidence to talk about, whether it’s evidence based or not. We’ve been in controlled clinical studies for over 25 years. The problem, or I’d say the challenge, is that what makes something evidence based is that it’s adopted by the field. Yeah, there are people actually using it, and then see how it works in, quote, real world settings, not just in research, but when you can do this with non drug therapies, you don’t have to get anybody’s permission to do it in real world settings, right? We can only do it in real world settings after it’s approved as a medicine. Everything else is research. So it’s almost by definition, it can never be, quote, an evidence based therapy, even though we’ve been studying it in highly, rigidly controlled research for 25 years, right? So it is evidence based, it is better results in other things, lower dropout rates. And I think it’s customized, both for PTSD but also for other indications, but it’s specifically for variety of different therapists, I mean, a different psychedelic therapy. So our approach can be used with ketamine, it can be used again, can be used with MDMA, psilocybin, and it’s not so much our approach. It was developed during the 50s and 60s,

Dr. Sandy Newes 27:22

right? Yeah, you can see unconditional positive regard in there. I mean, you can see the beginnings of Holotropic breath work and kind of that just non ordinary state work. I mean, you can see elements like, I know this has been kind of an also interest area view. And, you know, kind of, you can see, kind of the religious experience, the spiritual experience emerge.

Rick Doblin 27:43

Yeah, that’s a good I’m glad you mentioned that, Sandy, because there’s a general understanding, which is true, that with the work with LSD and psilocybin in the 50s and 60s, and the work with the classic psychedelics over the last 25 years, that there’s correlation between the depth of the mystical experience, as measured by the mystical experience questionnaire and therapeutic outcomes. The deeper you let go, the deeper you can move beyond your sense of self, the deeper you merge into this sort of underlying sense of interconnectedness, right where you’ll get over addiction or depression or trauma or any number of different things. However, when it comes to MDMA, we’ve used the same mystical experience questionnaire. There is no correlation. Oh. Interesting. Fundamental difference between the work with MDMA and the work with classic psychedelics is that we do not see this correlation. So that also means that our therapeutic method to support whatever emerges makes the most sense, because we don’t see that we want to move this towards a spiritual experience or any kind of things like that. It’s just wherever anybody wants to go. There are benefits from having the sense of interconnectedness. Yeah,

Dr. Sandy Newes 29:01

that’s so interesting. Because like, for people who are, you know, maybe less familiar with methodology, right? Like that’s how a model gets developed, or a theory gets developed, you look at something that’s correlated, you know, with outcome, and then you see, if you insert it into the model, if it changes, if it changes the outcome. So what I’m hearing you say is there’s no correlation. So therefore, if it emerges, we’ll be with it, but we’re not going to move it in that direction, nor make any assumptions. I mean, is that accurate? Yeah,

Rick Doblin 29:26

totally. That’s exactly it. And it spits within we support whatever’s emerging. Yeah, preference. I mean, when you work with LSD or psilocybin, there is this inherent kind of dissolution of the sense of self, yeah, resistance or fear or openness to it, and so the more that you open to this flow, the better able you are to heal, yeah, but that’s not the case with MDMA, so it’s fundamentally different. And some of the criticisms has been, oh, you know, you’ve got a missed. Goal experience that that doesn’t make sense that people have to have, or your inner healing intelligence is this non scientific phrase concept, and it’s more like, I would say, this inner healing intelligence. It’s more like the serotonin theory of depression. You know, it’s a mechanism, but it’s not something you have to believe in. It’s not anything that you know, yeah, it’s just the therapists support what’s emerging. It’s sort of whole point of it, in a way, is to develop a sense of safety and trust for difficult things that are emerging. Yeah, there’s an order to it, that there’s a wisdom to the psyche, bringing this to your attention. And you know, what we say is that difficult is not the same as bad, and the difference is resistance. If it’s something different, difficult, you can work through it. It can be the most valuable therapeutically. But it turns bad is when you resist it and you’re just, you know, holding it off well.

Dr. Sandy Newes 31:05

And it’s interesting because we actually, my business partner, Signi, she did a, she did a kind of a briefer interview with Michael as a follow up, just about exactly this inner healing intelligence and what it does and does not mean. Because you know what Michael says, and what I witness is it doesn’t mean you don’t do anything. What it does it mean is that you use multiple types of interventions that have a reason and a theory and a training and an understanding behind them to be to work in whatever way the client is showing up, keeping in mind, it’s an eight hour session, and you’re helping remove and work through these defensive blocks so that the inner healing intelligence can emerge. It’s not like you just sit there and hang with it, right?

Rick Doblin 31:50

Yeah. And Sandy, I think something else that’s really important is just this idea that it’s eight hours. Mm, hmm. That you know, when you think about therapy, most people think, oh, it’s once a week, one hour once a week. Yeah, but you get to the therapist’s office, it takes you a few minutes to sort of settle in, then doing this deeper discussions. But then after not too long, you have to start really, you know, wrapping it up and be ready to go out into the world and drive and do all these different things, if you’ve drove or take public transportation, or however you got there, and while you’re there, because it’s a limited time, you kind of want to get straight to the particular issue that’s at the forefront of what’s going on when you have an eight hour session, it’s the luxury of time totally and also you don’t have to go directly to the trauma. That’s one of the reasons why I think this eight hour session produces a lot lower dropouts. Yeah, there’s no sense that you must get to this right away, even if you’re not ready. That’s your problem. You can get to happy experiences. You can go wherever you go, and it can alternate between the happy and difficult or positive to build strength, you know? And then with MDMA, there’s the sort of what I would say, you know, if you had to boil down, what does MDMA do? My main word would be self acceptance. Oh, interesting. Uh huh. Is it worth self compassion or this sense of self love that you settle into the moment? That’s the other part of it is that you’re not thinking so much about what you need to do next or what you did before, or you settle into this moment. You’re open hearted. You’re able to have your fear response to traumas reduced by the chemical agent, by the way that the MD may work, yeah, you can look in a more full way, or look, feel experience, in the ways that when the trauma was happening, it kind of focused on survival or other things. Yeah, I

Dr. Sandy Newes 33:52

have an emerging theory. Can I ask you what your thoughts on? Yeah, like, so I have kind of a hypothesis that I’m working with that really kind of, you know, again, like Bessel van der Kolk was another one of my, like, most influential people, both in interactions and in teachings, and have tracked it pretty closely. And, you know, so the inability to feel safe with self, world or others, right? And then, and then, I’ve been kind of tracking Rick Hansen’s work, Buddha brain, and the neuroscience of resilience, and kind of based on that and a bunch of other things, what you just said, the emergence of self compassion and the ability to feel ease, like what I think would be interesting with psychedelics and what is not enough voice put to even though you just did it, but it could belong in the model, is the ability to notice, tolerate and sit with well being like to that that is actually as much of an outcome that we should look for, deepen into and facilitate, then processing of the difficult stuff, because that’s to me, is where the rubber meets the road. Do you actually feel better? Yeah. And can you stay in the softness and ease and stay in a place where the hyper vigilance is decreased enough to appreciate the fact that spring is really pretty on my window right now? Yeah,

Rick Doblin 35:11

that’s right now. I put a link to a paper in the chat and maybe make it available to Bess van der Kolk paper. And what he talks about is exactly what you’re talking about. But he calls about effects of MDMA assisted therapy for PTSD on self experience.

Dr. Sandy Newes 35:27

Uh huh. Oh, what nice. I need to read that

Rick Doblin 35:32

really, really important study because Great. It looks at people that have had difficult attachment styles from childhood wounds, childhood traumas. It looks at the looks of thy media, different ways of where people can no longer experience emotions they’re not sure what they’re feeling. Self Compassion. Scale, yeah, those elements that he thinks are really the sort of transformative elements to help people get over PTSD. And part of it is this self compassion that you just accept yourself as you are, you relax into it, and you don’t have to be constantly self critical in these certain ways, the self love, yeah, the sense of you’re all cool and heal. And it’s in part this oxytocin release that MDMA produces certain kind of hormones. But the main thing is just you settle into yourself and you accept yourself as more of a complex being, right? What’s even more astonishing to me a lot is that people develop compassion for the perpetrators, not that it’s forgiving or saying it didn’t matter, but they they can often see the perpetrators as people that are hurting themselves, right? That’s really important,

Dr. Sandy Newes 36:52

right? Like, I can see how my parents, I mean, stereotypical, but I see how my parents were not mine. I mean, well, yeah, whatever. But I see how these people, it came from a multi generational lineage of trauma, and they were, you know, doing the best they could in any given moment, but they were impacted by theirs as well. So therefore, right? We’re all just in this world doing the best that we can. Yeah,

Rick Doblin 37:19

now that actually raises just another point that that I want to mention, which is this idea of working with adolescents and younger kids traumatized. Yeah. So, you know, the the idea there, for me is this, we want to help people closer to the trauma and yeah, part of the rhetoric of the drug war, which people listening may have heard of is, oh, kids brains are still developing. They’re developing into the 26 and therefore we have to protect their brains from any kind of outside influence while they’re still developing. And that’s why they should never smoke marijuana and all. However, of course, we think nothing of that when it comes to ADHD drugs, for

Dr. Sandy Newes 38:04

sure. Here have some Ritalin, have some Adderall. Be fine.

Rick Doblin 38:08

This idea though, that if you’ve been traumatized when you’re young, your brain is developing in a warped manner, right? What we see is you have hyperactive amygdala. You respond to fear more rapidly, you have reduction of activity in the prefrontal cortex. These are neuroscience observations from people with PTSD. You have lower activity in the amygdala, well, which reduces fears, but lower connectivity with the hippocampus, where memories are put into long term storage so the memories never fully get processed, and it does the opposite of that. It increases activity in the amygdala. And the connection, I mean, increase activity in the hippocampus, and the connection with the increases activity in the prefrontal cortex, decreases activity in the amygdala. So that this idea that young people who are traumatized, they should be treated as soon as possible. One of the things that makes me think it will work is this octopus study that was by Alney.

Dr. Sandy Newes 39:16

You know of the study? No, I know nothing about the octopus study. Oh,

Rick Doblin 39:20

this is fantastic. Okay, so Google Dolan is the reason she was at Hopkins, though. Oh,

Dr. Sandy Newes 39:25

I know about the mice. I just don’t know about the octopus. I’ve been following her work. She’s amazing, yeah.

Rick Doblin 39:31

So we’ve, we’ve supplied the MDMA for this octopus study. Uh huh. People have seen octopus teach. My octopus teacher, they’re very smart animals, but they’re also very solitary. They will kill other octopuses. They don’t want to be busses until the end of their life, when it’s mating season, right? So 600 million years ago, more or less humans in act more or less what different directions the. Good cursors, but octopuses still process serotonin. Oh, intro, Blue was wondering what happens if you give MDMA to octopus? So there’s this experimental device. You put them in the middle. It’s a box, and it’s got two doors out. One goes to another octopus and a bird cage that can’t move. The other goes to like a ball, an inanimate object. And no matter how you switch up the sexes, the octopus spends more time with the inanimate object. And when it’s with the other octopus, it’s just around the perimeter and doesn’t really engage. However you you put the MDMA in the water, you soak the octopus in the water. It took them a while to figure out the right dose, yeah, then you got a octopus high on MDMA, and you put them back in this contraption, and now they spend more time with the other octopus. Oh, that’s fascinating. So it’s pre verbal, evolutionary conserved. There’s a fundamental pharmacological effect independent of the therapy, right? That will work in children, but children also, when you give them the support and this sort of the traumas that come to the surface, I think it’s going to be really the sort of psychiatry psychotherapy of the future is going to be to try to treat people closer to the trauma. And we have another situation, somewhat like that, where there’s a lot of work with veterans, in the Veterans Administration, with MDMA therapy.

Dr. Sandy Newes 41:24

I think the veteran, I think the VA, is going to end up leading the charge. Go VA do it, yeah.

Rick Doblin 41:31

But Congress has gave 10 million to the Department of Defense, and they’ve put out grants to do MMA therapy with active duty soldiers, yeah, so again, this idea of

Dr. Sandy Newes 41:43

that’s amazing, isn’t it, people don’t believe me when I tell them that, yeah. Well, it’s

Rick Doblin 41:47

really, really true, right? It’s really good. And I think this possibility, you know, if we really can fully integrate psychedelics, I think the benefits are going to be enormous, particularly for younger people who are traumatized, so that you don’t have to live in this kind of fearful, extra fearful, distorted way. Yeah, just keep getting worse. And I think

Dr. Sandy Newes 42:13

people don’t realize, like, you know, if you don’t do trauma work from this perspective or understand it, but really the essence of PTSD, or developmental trauma complex, PTSD is not feeling safe in relationship with self, world or others. So you’re you will see information that confirms your fears that you’re going to be hurt, rejected, you know, kicked out of the tribe, kicked out of the family, and you know, and then you we begin to act as such, and then we create that which we’re the most fearful of, right? So the fear leads to distorted perception, which leads to distorted behavioral patterns, which then confirm belief. And

Rick Doblin 42:51

what you just said too about being kicked out of the tribe, there was Adam Kinzinger, was a Republican on the House committee looking at the insurrection, and what he said is that, and this really stuck with me. He said that he’s realized that there’s something people fear more than death. It’s being kicked out of your tribe,

Dr. Sandy Newes 43:12

totally, right? Because humans can’t survive alone, so it ties into the survival mode, and isolation is the worst punishment of all.

Rick Doblin 43:21

Right? That’s where people can end up believing the big lie and things like that, because they don’t leave the drive, even though it doesn’t make logical sense when

Dr. Sandy Newes 43:31

that’s where we get back to the psychotherapy model. Because what I think, what I feel like I witnessed, kind of in the training and watching the videos, and I know it’s not the same, but there are similarities. Like I do, I do series of ketamine sessions, like two in a week, so I do three in six weeks, and then titrate. And it’s all a trauma model. And I’m not here to sell that, but I’m really doing very similar things as the MAPS training and what I and the and I know, so what I witness in good, effective trauma treatment, is, how quickly can we get, you know, how can we escalate and amplify the ability to feel connected and feel safe in that connection? And so people who are like, Oh, this isn’t an evidence based clinical model. I’m like, I know, but this is what we’re doing, and this data supports it, and it is, it just might not be clear to you, but if you know what you’re seeing, sorry, I could go on about that, but

Rick Doblin 44:24

you know, yeah, yeah, I think that there’s going to be a real change over the next 510, years. I think MDMA, psilocybin, the five, MEO, DMT, other psychedelics, are going to be approved, and therapists will then be cross trained in the different modalities, and then able to customize treatments for each individual patient. So that’s the vision for the future, and then that’s also what we want to take around the world as much as possible.

Dr. Sandy Newes 44:54

I mean, it is so needed, and I love to salute back, just in case we don’t. I don’t want to lose that point about the. Adolescents, because I ever that as well. People like, gasp, you know, give drugs to kids, and it’s like, no, you know, because I work daily with people who are traumatized as children and adolescents, and trying to unravel the effect in the nervous system. And if we can get in there and do that before all the defenses build up around it, right right before they get more rigidly entrenched, then that’s amazing. Yeah.

Rick Doblin 45:25

I mean, one of the visions are that we’ll explore in the future, moving more and more into group therapy, is when we work with refugees or migrants or people victims of war, that you have families that are all traumatized together. Yeah. So I think the will try to explore treating families together as well, parents and children all at the same time, and they can create this safe family space together. Mm, hmm, feel together more likely. How

Dr. Sandy Newes 45:54

do does somebody like me who’s cheering you on, cheering the field on, trying to contribute in the ways that I can, like, how can we help get there, to a world in which families can be treated to a world in which we can effectively utilize these powerful tools, like, what needed to happen in the short term?

Rick Doblin 46:14

Well, first off, you know, there’s a saying that the politics is downstream of culture. Yeah, it’s also science is downstream of culture. The culture was scared of psychedelics during the 60s, and then we had decades and decades of complete suppression of psychedelic reason. Yeah. So I think what people can do is to speak out and tell your stories. So, you know, look at gay rights and gay marriage. What really helped that was people coming out. So psychedelic coming out, we need more and more people telling their psychedelic stories, particularly to people that might be scared of it, or that might, you know, might not be sympathetic. Mm, hmm. Think that everybody can do that doesn’t cost any money. It’s like a reputational risk, yeah, but it’s what will really do it. So one of the you know, the medical marijuana like, Mm hmm, the move from medical marijuana to marijuana legalization in many different states, the polling done by the advocates for marijuana legalization showed that one of the most important factors as to whether somebody was in favor of the legalization of marijuana they knew a medical marijuana patient.

Dr. Sandy Newes 47:28

Oh, interesting, right? I mean, that makes sense, because, you know, that’s what people you know, racial attitudes change if you have exposure. It makes, just makes sense. Attitudes change with exposure, yeah, and

Rick Doblin 47:39

also, you don’t really know what to trust with the media, but if you know somebody and they tell you something that seems consistent with what you’ve seen in their lives, you believe it right. I think so. One thing is people can come out, and we need that even more than ever before. The other is come to psychedelic science and really learn, yeah. And the other, of course, is to donate to MAPS or to other non profits, because we’re trying to do this in a way that’s more open science public benefit. So the pharma company, I wish, were all funded by donations, but I wasn’t able to do that,

Dr. Sandy Newes 48:14

right? I mean, it was valiant effort. You got really far thanks to those early donors were sitting here,

Rick Doblin 48:22

raised over right now. And just the April 8, actually was MAPS 39 amazing, raised about $150 million in donations, which is a lot so

Dr. Sandy Newes 48:34

amazing that you have devoted your entire life to this like and again, I’m really grateful so. So one last question, what you know? What is your heart? What does your authentic self want to share in this moment, just in this interview, but also just at this moment in time? What do you want people to know about you, about this effort, about the world?

Rick Doblin 48:57

Well, I think that psychedelics have been around for 1000s of years. They’re woven into the human evolution, human it’s not that. What I would say is that the suppression of psychedelics, the fear of psychedelics, is not about their inherent dangers. It’s more about politics and power. Yeah. So when we think about what we’re trying to do with the psychedelic renaissance and in Western culture, really, the last time that psychedelics were fully integrated was around 396, you know, that was the Eleusinian mysteries that the cradle of democracy, the Greeks, those running mystery ceremony we know of in the history of the world, 2000 years, whitened out by the Catholic Church, uh huh, because they want to be the intermediary between you and spirituality. I want people to know that the psychedelics are and have been, incredible survivors in the face of massive. Repression. Sure, what we’re trying to do is not just bring psychotics back like they were 50 years ago in the 60s, or anything like that, or 60 years ago now, that really it’s this transformation of consciousness that has been suppressed for millennium and a half or more, and then that, I guess. And the last thing to say is that, sorry, the last thing I’ll say is that dreams are psychedelic. Hyperventilation is psyched. It’s not just linked to drugs, right?

Dr. Sandy Newes 50:34

Singing can be dance

Rick Doblin 50:37

can be meaning mind manifesting. It’s more

Dr. Sandy Newes 50:40

non ordinary. Great. Well, I appreciate you, and I really appreciate your time and and I really enjoyed this, and I hope that you did as well. And anything you want to, you know, kind of plug again, psychedelic science coming up, everybody should be there. Anything else? Want to

Rick Doblin 50:59

check out, maps.org, and you’ll learn about all sorts of projects. Awesome.

Dr. Sandy Newes 51:03

All right. Well, thank you so much. Rick, I really appreciate it. 

Rick Doblin 51:07

Terrific. Sandy,

Outro 51:10

thanks for listening to Living Medicine. We’ll see you again next time, be sure to click Subscribe to get future episodes.