Published at Mind Medicine Australia, 2020. Co-written with Dr Alana Roy and Melissa Warner.
Psychedelic assisted psychotherapy puts the recipient into an altered state of consciousness, which enables them to explore and tune into their inner experience in order to enhance the quality of their lives and capacity to show up in the world.
But given that these therapies are not available to everyone as yet, we thought it would be helpful to explore some other practices that support the natural (and legal) development of altered states of consciousness. These practices can be used to help prepare individuals who are waiting for psychedelic-assisted psychotherapy through the SAS-B scheme, or for those who are not eligible but would like to experience the benefits of self-exploration in altered states of consciousness.
Access to Medicinal Psychedelics
Currently, psychedelics are restricted in most countries, which means that many people have been travelling overseas to visit legal psychedelic retreat providers and psychedelic therapy centres. Unfortunately, due to the restrictions on travel caused by COVID-19, this option is not currently available for most people. People in Australia who have a diagnosis of PTSD and or chronic depression may be eligible for a psychiatric assessment and treatment with MDMA and psilocybin via the SAS-B scheme. In the meantime, for those who are waiting for their SAS-B psychedelic assisted psychotherapy session (and for those who are not eligible) there are benefits from practices that support the natural development of altered states of consciousness.
How Do Psychedelics Work in Therapy?
Psychedelics create a temporary altered state of consciousness induced by a psychedelic compound. While psychedelic altered states are highly specific to particular compounds (e.g. the psilocybin experience is different to the LSD experience) and the range of effects and responses that people experience is wide, there are certain subjective features of the psychedelic experience that occur for most people. These include changes in perception, emotion and cognition. These experiences are characterized by a sense of interconnection, insight and positive feeling with a brain state which makes it easier to shift old beliefs and perceive new ideas. Psychedelics exert these effect in part, by increasing the ‘dynamic flexibility of the brain’ by decreasing the rigidness of major brain networks, such as the Default Mode Network (DMN) and increasing communication across brain regions that don’t normally communicate (Carhart-Harris & Friston, 2019).
The DMN is area of functional connectivity associated with the ‘sense of self’ as well as daydreaming and rumination. When ‘set’ and ‘setting’ are controlled, psychedelics have also been found to reliably induce mystical experiences and changes to the sense of self, including an awareness of impermanence and the interconnection between all life. Recent research suggests that the positive therapeutic effects of psychedelics are related to their ability to induce such altered states. For example, in a recent trial of psilocybin for treatment-resistant depression, found that having a transformative experience, also described as a ‘peak experience’ or ‘mystical-type experience’, predicted positive clinical outcomes (Roseman, Nutt, & Carhart-Harris, 2018) .In a therapeutic set and setting, psychedelic experiences can provide an opportunity to reorient your habitual way of thinking and experiencing, enhancing self-agency.
Meditation is an evidence-based, age-old practice of honing awareness thereby training the navigation of conscious phenomena. Against popular belief, meditation is not about silencing or quieting the mind but includes methods of increasing awareness, the capacity to ‘be with’ all conscious processes including sounds, sensations, vision, thought and emotion (Matko & Sedlmeier, 2019). The goal is to break the spell of our habitual way of thinking — to become aware of unconscious patterns of avoidance, stuckness and grasping — to cultivate an easeful state of mind.
The term mindfulness has arisen from integration of meditation into the western psychological practice. Baer, Smith, Hopkins, Krietemeyer, and Toney (2006) completed a five-factor analysis of mindfulness traits to distil the five key components of a mindful state. The facets of mindfulness are presence, being non-judgmental, non-reactive, the ability to describe one’s inner world and the capacity for self-observation. Meditation is the practice of developing these capacities with intention, attention, and compassionate awareness (Shapiro & Carlson, 2009). There is some evidence that psychedelic plants were used in rituals in the early years of Buddhism which you can read Michael Crowley’s book the Secret Drugs of Buddhism. Both psychedelics and meditation affect the DMN of the brain in similar ways, downregulating the activity of the seat of our rumination (Millière, Carhart-Harris, Roseman, Trautwein, & Berkovich-Ohana, 2018).
Meditation practice has great potential to prepare patients for psychedelic-assisted therapy. A meditation practice has been shown to be protective against any challenging experiences during psychedelic-assisted therapy, such as anxiety (Smigielski, Scheidegger, Kometer, & Vollenweider, 2019). Numerous phone apps, like Waking Up by neuroscientist and writer Sam Harris, provide an easy and effective support to make meditation part of your life.
Loving-Kindness and Compassion Meditation
The therapeutic effect of some psychedelics, in particular MDMA, may be due to their ability to increase feelings of compassion and empathy towards the self and others. However, while psychedelics are undoubtedly powerful healing tools, there are other ways of cultivating the connection and closeness that is the goal of MDMA assisted therapy. One way is through the practice of ‘loving-kindness’ meditation (LKM) which aims to cultivate a state of unconditional kindness towards the self and others. LKM is a particular kind of meditation, developed from the practice of ‘metta’ in traditional Tibetan Buddhist practice. Although techniques vary, practitioners of LKM typically repeat phrases such as ‘may your life be filled with happiness, health, and well-being’ while visualizing a person (e.g. another person or one’s self) experiencing the outcome of such wishes.
Research has shown that LKM results in positive effects on wellbeing, including increases in positive emotions, perceptions of social connections, and vagal tone (Kok et al., 2013). Similarly, neuroimaging studies suggest that both LKM and compassion meditation (CM; which involves cultivating deep, genuine sympathy for those stricken by misfortune, together with an earnest wish to ease their suffering) may enhance activation of brain areas that are involved in emotional processing and empathy (Hofmann, Grossman, & Hinton, 2011). Therapeutic techniques that are inspired by LKM and CM have also shown promise in the treatment of treatment-resistant conditions such as psychosis Braehler et al. (2013) and personality disorders (Lucre & Corten, 2013). Researcher and psychologist Kristian Neff has a range of loving kindness and self-compassion meditations available on her website.
“From the Sami to the Siberian shaman, the Irish bodhran to the Indian dhol, the Native Americans to the Australian Aborigines, the drumbeat has led us into song, dance and into journeys through the worlds” (Weekes, 2014) Shamanic drumming involves a repetitive and rhythmic sound in a frequency range of 4 to 7 Hertz (HZ). Drumming releases endorphins, enkephalins, Alpha and Theta brain waves in the brain, which are associated with general feelings of well-being and euphoria.
These states are commonly known in shamanic drumming circles as “trance states” are associated with deep relaxation, metal imagery and meditation (also found in hypnosis and REM vivid dreaming states (Gingras, Pohler, & Fitch, 2014). Drumming is a tool that is easily accessible and is used widely around the world for solo journeys and community (free flowing) fire circles. Drumming can facilitates self-expression, movement, and somatic releases such as grief, trauma, anger, anxiety, pain and fear (Ho, Tsao, Bloch, & Zeltzer, 2011). Drumming has been found to have many physical, psychological and spiritual benefits such as; stress reduction; boosts in your immune system (Bittman et al., 2001), increases in mindfulness and your ability to connect with rhythm and flow of your body and the natural world.
Dear diary, would you believe it, by writing in you I am alleviating both stress and improving my immune function? Believe it or not, expressive writing, the simple act of keeping a journal, can have long term benefits on stress levels, mood, confidence, mindfulness, and physical health (Pennenaker & Chung, 2011). By giving expression to our experience we translate emotions into language by writing them down, essentially making the experience graspable, suggests James W. Pennebaker, a lead researcher on expressive writing at the University of Texas at Austin. You also don’t have to write that long to reap the benefits of journaling. Even writing for 15–30 minutes during a difficult time can make a significant difference. Expressive writing can even improve immune function, decreasing the risk of illness (Pennebaker & Smyth, 2016). Expressive writing for 15–20 minutes a day around once a month over a four-month period was found to reduce blood pressure (Baikie & Wilhelm, 2005). Practices like the five-minute journal are a great place to start with a formulation of gratitude, affirmations and goal setting. The five-minute journal style is used by high performers such as Tim Ferris to ground the self and prepare for the day.
Yoga consists of a range of techniques including postures, breathing exercises, and meditations. While many people think of yoga as a physical exercise, when practiced mindfully, yoga develops strength, balance, and flexibility of both the body and the mind. Recently there has been a growing interest in yoga for mental health and research is showing promising results. For example, a study by de Manincor et al. (2016) found that yoga plus regular care (e.g. medications, complementary therapies, counselling, psychotherapy, or other mental health services) was more effective in reducing symptoms of depression compared to regular care alone.
How does yoga influence mental health? The positive effects of yoga seem to be related to its capacity to reduce stress and allostatic load, balance the sympathetic and parasympathetic functions of the autonomic nervous system, reset the vagus nerve and downregulate the hypothalamic-pituitary-adrenal (HPA) axis. Evidence suggests that practicing yoga might also decrease the level of certain hormones such as cortisol, adrenaline and noradrenaline, while increasing serotonin, melatonin, and gamma-aminobutyric-acid (GABA) (for a review of possible mechanisms see de Manincor et al., 2016). A recent systematic review also found a positive effect of yoga practice on the structure and/or function of various brain regions and networks, including the hippocampus, amygdala, prefrontal cortex, cingulate cortex and the default mode network (DMN) (Gothe, Khan, Hayes, Erlenbach, & Damoiseaux, 2019). Programs like Down Dog offer various levels of training and are an easy and accessible way to start practising right at home, for any level of experience.
Although breathing comes naturally to us all, methods of conscious breathing have been shown to have a variety of positive impacts on both mental and physical health. Breathwork has played an important role in the wellbeing practices of many cultures throughout history.
The prolific Buddhist monk Thích Nhất Hạnh once wrote “The breath is the bridge which connects life to consciousness”. Changes in both physiology and consciousness can occur when changing the pacing of the breath, holding the breath, or focusing on nasal breathing. The physiology behind these changes is linked to the activation of the “rest and recover” branch of the autonomic nervous system (ANS), the parasympathetic system (McCraty & Zayas, 2014) .
Heart rate variability (HRV) is a measure of the variation in time intervals of the beat-to-beat changes in heart rate. HRV is a reliable biological measurement that indicates the activity of your ANS, with increased variability indicating a more relaxed state (Kim, Cheon, Bai, Lee, & Koo, 2018). HRV can be modulated and trained with breathwork practices such as cardiac coherence, which involves paced breathing with a longer exhale. Practices such as cardiac coherence can provide immediate relief from anxiety and long term, can improve psychological resilience by permanently modifying neural circuits (Zaccaro et al., 2018). A variety of devices like Heart Math’s Inner Balance, which is now also available in Samsung’s Galaxy Watch, can support your breathwork and HRV training by providing live feedback. There are also a number of free apps like My Cardiac Coherence which help guide breathwork to improve HRV without biofeedback.
Some breathwork practices can even produce altered states. Holotropic breathwork, was developed by Stanislav Grof, a pioneering psychedelic-psychiatrist and his wife Christina Grof, to naturally recreate aspects of the psychedelic-experience. After psychedelic therapy was made illegal in response to “the war on drugs” in the 1970s there was a great need in psychiatry for an alternative to method of increasing patient receptivity and access to unconscious material. Holotropic breathwork takes place with guided fast paced, deep breathing, which induces an alternate state of consciousness, only through the breath. One benefit of Holotropic breathwork is that the depth of the altered state can be lessened or deepened by simply modulating the breath. A report reviewed reports of 11,000 Holotropic breathwork participants found most reported significant benefits of emotional release with no adverse reactions reported (Eyerman, 2013). Further clinical research would be beneficial to develop a greater understanding of the benefits of Holotropic breathing. It is advised to only explore Holotropic Breathwork with a trained Holotropic Breathwork practitioner.
Research is demonstrating what many of us already know intuitively — that time spent in nature is good for us. For example, nature therapy or ‘ecotherapy’ is a form of therapy that involves spending time with nature to enhance healing. According to an ecotherapy perspective, human health is directly connected to the health of the Earth, and time spent in nature helps to remind us that we are all part of an interconnected ecosystem. Ecotherapy might involve horticultural therapy, or animal-assisted therapy, however, it doesn’t need to be complicated.
Studies have shown that simply exercising in nature (‘green exercise’) can have significant benefits. For example, Akers et al., (2012) found that during cycling, green scenery brought about greater improvements in mood compared with grey scenery. Similarly, Aspinall et al., (2015) found that people were more likely to experience meditative-like brain waves and exhibit less frustration if they were walking in a green space, compared to an urban shopping street or busy commercial district. Psychological benefits have been shown to occur with as little as five minutes (Barton & Pretty, 2010) to thirty minutes (Shanahan et al., 2016) of green exercise. One of the benefits of psychedelic-assisted therapy found in trials is an increased sense of ‘connectedness to nature’ (Lyons & Carhart-Harris, 2018). Happily, going for a walk or sitting in the garden with a book and tea is accessible to many of us. Especially during periods of social distancing, going for a walk to a green space can alleviate tension and stress.
Connected to our relationship with our appreciation of the vast and complex natural ecosystem is the experience of awe. Recent research from psychology suggests that the experience of awe — the feeling evoked by being in the presence of something vast that transcends our current frames of reference — can have beneficial effects on wellbeing (Anderson, Monroy, & Keltner, 2018). This is not surprising given that awe commonly involves positive feelings of wonder and amazement. However, perhaps more interestingly, evidence suggests that awe can also significantly alter the self-concept by triggering a sense of ‘smallness’ of the self in relation to the environment and the greater world (Piff et al., 2015). This perspective shift may be beneficial because it temporarily shifts our attention away from personal day-to-day concerns and reminds us that we are part of something far greater than ourselves (Shiota et al. 2017).
Interestingly, recent research suggests that the experience of awe may be associated with reduced activity in the brain’s default mode network (DMN) (van Elk, Arciniegas Gomez, van der Zwaag, van Schie, & Sauter, 2019). Neuroimaging studies that have used psychedelics such as psilocybin to induce ‘ego dissolution’ have also shown that this experience is accompanied by a reduced activation of the DMN (Lebedev et al., 2015). Therefore, seeking out opportunities to experience awe such as live music, art galleries, museums, spending time in nature, or simply allowing unstructured time for exploration may be an easy and accessible way to transcend the small self and re-connect with the mysteries of the world around us. Therapeutic virtual reality programs are also being developed which combine awe-inspiring virtual environments with meditation practices (Guardian, 2019). Even watching an episode of Cosmos, Carl Sagan’s classic voyage through our universe or David Attenborough’s Planet Earth may be enough to spark a visionary mood.
The Benefits of Wellbeing Practices
Regular wellbeing practices are rituals of personal meaning and growth which can be engaged with at any time to enhance psychological wellbeing. Practices such as eco-therapy, meditation, journaling, breathwork or yoga support the preparation for psychedelic-assisted therapy and may even be more suitable for certain individuals. Our practices act as a foundation for growth and support us to connect with the process of cultivating a meaningful life. Practices can also be a consistent and conscious container in which to connect to a local group or community either physically or online. Each day is an opportunity to turn towards the opportunities of our unique and precious life.
Akers, A., Barton, J., Cossey, R., Gainsford, P., Griffin, M., & Micklewright, D. (2012). Visual color perception in green exercise: positive effects on mood and perceived exertion. Environ Sci Technol, 46(16), 8661–8666. doi:10.1021/es301685g
Anderson, C. L., Monroy, M., & Keltner, D. (2018). Awe in nature heals: Evidence from military veterans, at-risk youth, and college students. Emotion, 18(8), 1195–1202. doi:10.1037/emo0000442
Aspinall, P., Mavros, P., Coyne, R., & Roe, J. (2015). The urban brain: analysing outdoor physical activity with mobile EEG. Br J Sports Med, 49(4), 272–276. doi:10.1136/bjsports-2012–091877
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. doi:10.1177/1073191105283504
Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11(5), 338–346. doi:10.1192/apt.11.5.338
Barton, J., & Pretty, J. (2010). What is the Best Dose of Nature and Green Exercise for Improving Mental Health? A Multi-Study Analysis. Environmental Science & Technology, 44(10), 3947–3955. doi:10.1021/es903183r
Bittman, B. B., Berk, L. S., Felten, D. L., Westengard, J., Simonton, O. C., Pappas, J., & Ninehouser, M. (2001). Composite effects of group drumming music therapy on modulation of neuroendocrine-immune parameters in normal subjects. Altern Ther Health Med, 7(1), 38–47.
Braehler, C., Gumley, A., Harper, J., Wallace, S., Norrie, J., & Gilbert, P. (2013). Exploring change processes in compassion focused therapy in psychosis: results of a feasibility randomized controlled trial. Br J Clin Psychol, 52(2), 199–214. doi:10.1111/bjc.12009
Carhart-Harris, R. L., & Friston, K. J. (2019). REBUS and the Anarchic Brain: Toward a Unified Model of the Brain Action of Psychedelics. Pharmacol Rev, 71(3), 316–344. doi:10.1124/pr.118.017160
de Manincor, M., Bensoussan, A., Smith, C. A., Barr, K., Schweickle, M., Donoghoe, L. L., . . . Fahey, P. (2016). Individualized yoga for reducing depression and anxiety, and improving wellbeing: a randomized controlled trial. Depress Anxiety, 33(9), 816–828. doi:10.1002/da.22502
Eyerman, J. (2013). A Clinical Report of Holotropic Breathwork in 11,000 Psychiatric Inpatients in a Community Hospital Setting.
Gingras, B., Pohler, G., & Fitch, W. T. (2014). Exploring Shamanic Journeying: Repetitive Drumming with Shamanic Instructions Induces Specific Subjective Experiences but No Larger Cortisol Decrease than Instrumental Meditation Music. PLoS One, 9(7), e102103. doi:10.1371/journal.pone.0102103
Gothe, N. P., Khan, I., Hayes, J., Erlenbach, E., & Damoiseaux, J. S. (2019). Yoga Effects on Brain Health: A Systematic Review of the Current Literature. Brain Plasticity, 5, 105–122. doi:10.3233/BPL-190084
Ho, P., Tsao, J. C. I., Bloch, L., & Zeltzer, L. K. (2011). The impact of group drumming on social-emotional behavior in low-income children. Evidence-based complementary and alternative medicine : eCAM, 2011, 250708. doi:10.1093/ecam/neq072
Hofmann, S. G., Grossman, P., & Hinton, D. E. (2011). Loving-kindness and compassion meditation: potential for psychological interventions. Clin Psychol Rev, 31(7), 1126–1132. doi:10.1016/j.cpr.2011.07.003
Kamboj, S. K., Kilford, E. J., Minchin, S., Moss, A., Lawn, W., Das, R. K., . . . Freeman, T. P. (2015). Recreational 3,4-methylenedioxy-N-methylamphetamine (MDMA) or ‘ecstasy’ and self-focused compassion: Preliminary steps in the development of a therapeutic psychopharmacology of contemplative practices. J Psychopharmacol, 29(9), 961–970. doi:10.1177/0269881115587143
Kim, H.-G., Cheon, E.-J., Bai, D.-S., Lee, Y. H., & Koo, B.-H. (2018). Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature. Psychiatry investigation, 15(3), 235–245. doi:10.30773/pi.2017.08.17
Kok, B. E., Coffey, K. A., Cohn, M. A., Catalino, L. I., Vacharkulksemsuk, T., Algoe, S. B., . . . Fredrickson, B. L. (2013). How Positive Emotions Build Physical Health:Perceived Positive Social Connections Account for the Upward Spiral Between Positive Emotions and Vagal Tone. Psychological Science, 24(7), 1123–1132. doi:10.1177/0956797612470827
Lebedev, A. V., Lövdén, M., Rosenthal, G., Feilding, A., Nutt, D. J., & Carhart-Harris, R. L. (2015). Finding the self by losing the self: Neural correlates of ego-dissolution under psilocybin. Hum Brain Mapp, 36(8), 3137–3153. doi:10.1002/hbm.22833
Lucre, K. M., & Corten, N. (2013). An exploration of group compassion-focused therapy for personality disorder. Psychol Psychother, 86(4), 387–400. doi:10.1111/j.2044–8341.2012.02068.x
Lyons, T., & Carhart-Harris, R. L. (2018). Increased nature relatedness and decreased authoritarian political views after psilocybin for treatment-resistant depression. J Psychopharmacol, 32(7), 811–819. doi:10.1177/0269881117748902
Matko, K., & Sedlmeier, P. (2019). What Is Meditation? Proposing an Empirically Derived Classification System. Frontiers in Psychology, 10(2276). doi:10.3389/fpsyg.2019.02276
McCraty, R., & Zayas, M. A. (2014). Cardiac coherence, self-regulation, autonomic stability, and psychosocial well-being. Frontiers in Psychology, 5(1090). doi:10.3389/fpsyg.2014.01090
Millière, R., Carhart-Harris, R. L., Roseman, L., Trautwein, F.-M., & Berkovich-Ohana, A. (2018). Psychedelics, Meditation, and Self-Consciousness. Frontiers in Psychology, 9(1475). doi:10.3389/fpsyg.2018.01475
Northrup, C. (2020). 10 Health Reasons to Start Drumming. Retrieved from https://www.drnorthrup.com/health-benefits-drumming/
Pennebaker, J. W., & Chung, C. K. (2011). Expressive writing: Connections to physical and mental health. In The Oxford handbook of health psychology. (pp. 417–437). New York, NY, US: Oxford University Press.
Pennebaker, J. W., & Smyth, J. M. (2016). Opening up by writing it down : how expressive writing improves health and eases emotional pain.
Piff, P. K., Dietze, P., Feinberg, M., Stancato, D. M., Keltner, D., & Kawakami, K. (2015). Awe, the small self, and prosocial behavior.(interpersonal relations and group processes)(Report)(Author abstract). Journal of Personality and Social Psychology, 108(6), 883. doi:10.1037/pspi0000018
Roseman, L., Nutt, D. J., & Carhart-Harris, R. L. (2018). Quality of Acute Psychedelic Experience Predicts Therapeutic Efficacy of Psilocybin for Treatment-Resistant Depression. Frontiers in Pharmacology, 8(974). doi:10.3389/fphar.2017.00974
Shamanic, D. (2020). Shamanic drumming. Retrieved from https://shamanicdrumming.com/rhythmhealing.html
Shanahan, D. F., Bush, R., Gaston, K. J., Lin, B. B., Dean, J., Barber, E., & Fuller, R. A. (2016). Health Benefits from Nature Experiences Depend on Dose. Scientific Reports, 6(1), 28551. doi:10.1038/srep28551
Shapiro, S. L., & Carlson, L. E. (2009). The art and science of mindfulness: Integrating mindfulness into psychology and the helping professions. Washington, DC, US: American Psychological Association.
Shiota, M. N., Keltner, D., & Mossman, A. (2007). The nature of awe: Elicitors, appraisals, and effects on self-concept. Cognition and Emotion, 21(5), 944–963. doi:10.1080/02699930600923668
Smigielski, L., Scheidegger, M., Kometer, M., & Vollenweider, F. X. (2019). Psilocybin-assisted mindfulness training modulates self-consciousness and brain default mode network connectivity with lasting effects. NeuroImage, 196, 207–215. doi:https://doi.org/10.1016/j.neuroimage.2019.04.009
van Elk, M., Arciniegas Gomez, M. A., van der Zwaag, W., van Schie, H. T., & Sauter, D. (2019). The neural correlates of the awe experience: Reduced default mode network activity during feelings of awe. Hum Brain Mapp, 40(12), 3561–3574. doi:10.1002/hbm.24616
Weekes, J. (2014). Benefits of Shamanic Drumming. Retrieved from https://www.herondrums.co.uk/info/2018/11/9/benefits-of-shamanic-drumming
Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Frontiers in Human Neuroscience, 12(353). doi:10.3389/fnhum.2018.00353