First Randomized Trial of Psilocybin Assisted Therapy for Depression!

In recent years, psychedelics have reemerged as a popular topic in cultural, political, and scientific discourse. From Michael Pollen’s best-selling book How To Change Your Mind to legalizing psilocybin-assisted therapy through Measure 109 in Oregon, people are curious about how and why these substances may be powerful tools in psychological healing. Additional data, especially on common problems like depression, is particularly important as psilocybin therapy starts to become more widely used.  Until now, psilocybin therapy for depression has never been studied in randomized clinical trials. But now, the first data have been published, with excellent results.

In this trial, Alan K. Davis and other investigators at the Center for Psychedelic and Consciousness Research at Johns Hopkins conducted the first randomized, clinical trial exploring psilocybin-assisted therapy for treating Major Depressive Disorder (MDD). Traditional treatment methods typically include psychotherapy or pharmacotherapy, or a combination of the two. Current pharmacotherapies, such as SSRI’s, often have limited efficacy and can result in negative side effects such as suicidal ideation, decrease in sexual drive, and weight gain. Additionally, people must be on antidepressants for several weeks before experiencing any benefit, with many only partially responding. Lastly, many people do not respond to treatment, whether that’s pharmacological or psychological. Clearly more treatments are needed.

The team at Johns Hopkins treated 24 people with depression with two administrations of psilocybin combined with therapeutic support. This intervention produced strong antidepressant effects that persisted for 12 months, with 71% of their participants showing a clinically significant response 4 weeks after treatment. Unlike traditional antidepressants, psilocybin was not associated with serious adverse effects and does not have to be taken daily. The only frequent nonserious adverse effects found by Davis et al. were mild-to-moderate headaches and challenging emotions during the session itself. In sum, while this study is small, it provides excellent data to support the idea that psilocybin-assisted therapy is effective for the treatment of depression, while we await results from larger studies that are ongoing.

Although we have come far in psychological healing, there is still more work to do in order to provide services that are effective and accessible to all who need it. Antidepressants do not work for everyone, making promising treatments like psilocybin-assisted therapy worthy of further exploration. If you would like to learn more about psilocybin-assisted therapy for depression, Portland Psychotherapy is hosting a seminar series, Therapy and Research in Psychedelic Science (TRIPS), that includes a presentation from Alan K. Davis, the lead investigator in this trial. He will be discussing what this therapy looks like from the point of view of the patient along with a description of the therapeutic process involved in preparing for and integrating psilocybin experiences as a part of therapy. Click here to register for this event and check out the other events in our seminar series!

TRIPS Seminar Series

By Sarah Smith

Podcast Fights Mental Health Stigma Using Acceptance and Commitment Therapy

In a time when the public discourse around mental health struggles is permeated with sweeping generalizations of “those” mentally ill people and calls to “lock them up,” a new podcast attempts to bring common humanity back into how we discuss the psychological suffering we all face as humans. Beyond Well with Sheila Hamilton incorporates an Acceptance and Commitment Therapy (ACT) perspective on the struggles we face, ideas about psychological flexibility and mental health, and what we can all do to lead a well-lived life.

Beyond Well – The Podcast

Started by Emmy Award winning journalist, author, and longtime mental health advocate Sheila Hamilton, Beyond Well is a podcast for the general public that aims to destigmatize and depathologize psychological difficulties while offering hope and resources to the listener. Each week the podcast features a guest, usually an author, musician, actor, activist or other person in the public eye, who talks openly and honestly about the struggles they have faced, whether that be anxiety, depression, substance use, racism, shame, trauma, or grief. In addition to Sheila, the podcast is co-hosted each week by psychologists and ACT therapists Brian Goff, Ph.D. and Jenna LeJeune, Ph.D., who incorporate ACT principles like acceptance, mindfulness, values, and defusion into the conversation. Along with each episode, listeners can also find written “After the Show Thoughts” that offer a deeper dive into some of the various themes and ACT principles discussed in the episode as well as resources.

Recent Guests

Beyond well covers a wide range of topics and features guests from all walks of life. Some recent guests include:  

  • Academy Award nominated documentary film maker Skye Fitzgerald talking about compassion fatigue and the migrant crisis in the Mediterranean Sea
  • Pop star Lauv talking about his struggle with depression
  • Award winning author Mitchell S. Jackson talking about racial identity
  • Activist Anna Debenham talking about her life-changing work with individuals who are incarcerated
  • Singer-songwriter, actor, and playwright Storm Large talking about being more than her labels and embracing all parts of herself
  • Bestselling author Cheryl Strayed talking about grief

Why Beyond Well Is the Fastest Growing Mental Health Podcast on Spotify   

Every guest has an inspiring and unique story to tell. But what unites all the episodes together is an idea fundamental to ACT — that psychological suffering is not some “abnormality” that happens to others, but rather an inescapable part of the human condition. The emphasis is on our shared humanity and on developing the psychological flexibility that allows us to live a life of meaning, purpose, and integrity even in the midst of that suffering. This perspective seems to be striking a cord with listeners. In just 7 months, the show has gained a tremendous following and is currently the fastest growing mental health podcast on Spotify.

How to Learn More

You can find Beyond Well on Spotify, SoundCloud, and iTunes, or go to the Beyond Well with Sheila Hamilton website for all the past episodes and other information.

Forgiveness Therapies: Dangerous or Healing?

Forgiveness Therapies: Dangerous or Healing?Forgiveness is a new and growing target in therapies. Researchers typically define forgiveness as including two components: (1) choosing to treat someone who has wronged you as a valuable human (“decisional forgiveness”) and (2) translating negative emotions, such as resentment, into positive, other-oriented emotions, such as compassion (“emotional forgiveness”). Therapies designed to promote forgiveness typically devote a significant portion of time to first supporting clients in processing their emotions, and also include exercises, such as letter writing, designed to promote empathy and other positive emotions towards the offender in a safe atmosphere.

Forgiveness Is Not Reconciliation

Importantly, in this definition, forgiveness is distinct from reconciliation. Common understandings of forgiveness, on the other hand, may conflate the two concepts. Promoting a form of forgiveness that conflates forgiveness with reconciliation could be dangerous. For example, in a sample of 121 women in domestic violence shelters, forgiveness correlated with intentions to return to the abuser and with perceptions of the abuser’s actions as less malicious. Thus, if forgiveness is a target of therapy, clinicians must be careful to also help clients establish safe boundaries, and view forgiveness as a personal, rather than interpersonal, act.

Do Clients Seek Forgiveness-Promoting Therapies?

A significant portion of clients appear to want to work on forgiveness in therapy. In a study of 59 clients at university counseling centers, researchers found that a significant portion (75%) of those who had been hurt in the past wanted to forgive. Peoples’ willingness to work on forgiveness in therapy corresponded with the amount of time they had seen their therapist, suggesting that forgiveness is best to target later on in therapy.

Most of the research on therapies promoting forgiveness includes participants who decide to participate in an intervention explicitly designed to promote forgiveness. Peoples’ decision to participate in these forgiveness interventions does not appear to depend on the severity of the offense they experienced; for example, survivors of incest have participated in studies of forgiveness-promoting therapies.

Are Forgiveness Therapies Effective?

Therapies targeting forgiveness are consistently more effective than wait-list and attentional controls, and are successful at not only promoting more forgiveness, but also improvements in overall mental health outcomes, such as anxiety and depression.

In some cases, these therapies have outperformed standard treatments (e.g. here and here). For example, in one study, a treatment with an empathy component was more effective at promoting forgiveness than a similar treatment without an empathy component. In another study, inpatients randomly assigned to an individual therapy incorporating forgiveness experienced greater increases in forgiveness and self-esteem and greater decreases in depression, anxiety and anger than those assigned to a standard substance use treatment group.

However, these findings are not conclusive. It’s important to consider that the participants in these studies are people with a desire to forgive. Researchers partial to the therapy under investigation also typically conduct these studies in which the forgiveness-promoting therapy outperforms the standard therapy, leaving open the possibility that an allegiance to the therapy contributes to these findings.

Some researchers argue that common factors, such as social support, are more integral to therapies than are specific ingredients, such as forgiveness. For example, in one study comparing relaxation training, a forgiveness intervention based upon theoretical components (e.g. empathy building), and a forgiveness intervention not based upon theoretical components, researchers found that all were equivalently effective at changing participants’ levels of forgiveness. Other researchers have similarly found that, when compared to a standard treatment, interventions promoting forgiveness led to similar improvements in forgiveness and mental health measures. Studies in which forgiveness therapies do not outperform standard therapies are typically shorter in duration, and group-based, leaving open the possibility that duration and therapy modality are important factors.

Clinical Take-Away

The safest conclusion to draw from existing research is that forgiveness can be a useful target in therapy for those who are open to forgiveness. These clients are highly likely to benefit from evidence-based techniques that encourage forgiveness. The research is less extensive on those who are less open to forgiveness, but it’s possible that they are likely to benefit as well. For example, Christian clients in both religious and non-religious settings rated a moderate to high amount of comfort with forgiveness-promoting interventions, and surveys of clinicians indicate that clinicians tend to believe forgiveness can be brought up ethically and effectively within therapy. Forgiveness is correlated with a variety of physical and mental health benefits (e.g. here and here). In one study, amongst college women, forgiveness related to a specific offense predicted less psychological distress four months later. Therapies targeting forgiveness involve helping clients process their own emotions and are typically effective if the forgiveness-promoting component is incorporated into therapy later on. As with any therapy, therapists must empower clients to make choices that best align with their own unique set of values and acknowledge that forgiveness is but one way that a client can respond to a situation or a person.

Incorporating Forgiveness into Clinical Practice

Worthington’s REACH model of forgiveness is one example of a well-established model that outlines steps therapists can take to help clients forgive in therapy. Each letter in the acronym outlines a key step in the forgiveness process: R (Recall the event), E (Empathy for the transgressor), A (give forgiveness as an Altruistic gift), C (Commit to the forgiveness through a written and/or spoken statement) and H (Hold onto forgiveness in moments of doubt). Portland Psychotherapy is hosting a training workshop with Dr. Worthington September 28th, 2019 for those therapists interested in learning more. If you would like to sign-up or read more about this workshop, please go to Eventbrite.

Further Learning

Written by Christina Chwyl, B.A.

Introducing ACT With Compassion

Dear reader,

We feel a bit like a rude guest, who has forgotten to introduce you to their friend. If you’re reading this post, you’re probably a therapist looking for resources to learn and grow professionally. We think you might be interested in meeting this friend, “ACT With Compassion,” a website dedicated to helping therapists who are interested in bringing more compassion and effectiveness to their work with clients struggling with self-criticism and shame. Actwithcompassion.com is created by therapists at Portland Psychotherapy and is a place where we:

  • List all the latest training events for therapists that we can find that relate to things like self-compassion, compassion-focused therapy, and working with shame prone clients
  • Publish original resources for therapists (e.g. handouts, and exercises) that we’ve created that therapists can use in their practices to help clients with self-criticism and shame
  • Write blog posts about research and resources related to shame, self-criticism and self-compassion.

In our free time, we travel around the web, curating content (e.g. readings, videos, and measures) on self-compassion, shame and self-criticism. It’s possible that actwithcompassion.com might just become your go-to place for book and audio recommendations on these topics.

We apologize for the tardy introduction, but do hope you will become acquainted soon.

Sincerely,
Portland Psychotherapy

Written by Christina Chwyl, B.A.

Perpetrator Closeness Matters When Considering Effects of Trauma

Perpetrator Closeness Matters When Considering Effects of Trauma

A new study conducted by Portland Psychotherapy’s Melissa Platt, along with colleague Jennifer Freyd, finds that perpetrator closeness matters when considering the effects of trauma. In this study, 124 female survivors of trauma were recruited to participate. Participants completed a set of questionnaires related to trauma, shame, dissociation, and fear. Next, they were randomly assigned to either see a set of images depicting threatening events of an interpersonal nature such as depictions of sexual harassment and interpersonal violence, or a set of images depicting threatening events of a non-interpersonal nature such as depictions of car accidents and natural disasters. After viewing the images, participants again completed self-reports of fear, shame, and dissociation.

Our hypotheses were guided by betrayal trauma theory, which proposes that people who experience traumatic events perpetrated by someone close, trusted, or depended on for survival (high betrayal trauma; HBT), are more likely to dissociate the abuse from awareness compared to survivors of events perpetrated by someone not close, or non-interpersonal events (low betrayal trauma; LBT). Several studies provide support for betrayal trauma theory as it relates to dissociation. In the current study, we aimed to extend the scope of betrayal trauma theory by assessing whether people who have experienced HBT may also be more likely to experience shame, rather than fear, in the context of trauma-relevant cues. The rationale for this has to do with survival. If a person is assaulted by a stranger, it is likely to be adaptive for that person to experience fear and its action tendency to flee and get the heck out of the dangerous situation and away from the source of threat. However, if a person is assaulted by someone who is depended upon for survival, or someone who feels needed for survival such as a life partner, fleeing may seem to be life-jeopardizing, and in the case of abuse by a caregiver, fleeing truly may be life-jeopardizing.

Rather than responding to HBT-relevant cues with fear, we predicted that people would respond with shame (in addition to dissociation). Shame is an emotional experience that is very painful, tends to stop a person in her tracks, and tends to elicit sympathy in others. In addition, shame either shifts the person’s attention inward to thoughts of being flawed or bad, or else causes the mind to go blank. In either case, awareness is shifted away from cues to suggest that the person is being harmed by someone they need and/or love, and therefore protects the relationship with that person, albeit at a cost.

Results of the study showed that, first of all, there was no overall difference in responses between the interpersonal and non-interpersonal threatening images. It was only when we took into account the person’s individual history of HBT and LBT experiences, that differences in responses to the images showed up. In particular, people with a higher number of HBT experiences in their history became more ashamed and dissociative when they saw the interpersonal threatening images, but not the non-interpersonal ones. What’s more, they did not experience an increase in fear in response to either set of images. On the other hand, people with a higher number of LBT experiences in their history became more afraid when they saw the non-interpersonal images. What’s more, they did not experience an increase in shame or dissociation in response to either set of images.

Thus, we found evidence supporting the idea that shame and dissociation may serve a similar function in survivors of HBT, and that HBT and LBT survivors may have quite different experiences in the context of trauma reminders. This would also suggest that treatment needs may differ depending on type of trauma(s) the person has endured. We believe that these findings have particular significance for exposure therapies, such as prolonged exposure, which has a theoretical underpinning based on fear habituation. Before beginning PE with your client, it may be worthwhile to assess whether your client’s primary emotional reaction is indeed fear rather than shame or some other emotional experience and whether he/she tends to dissociate when reminded of the trauma, which may interfere with the ability to learn that memories are not dangerous and thereby the opportunity to heal.

UPCOMING TRAINING EVENTS

How to be Experiential in Acceptance and Commitment Therapy

Jason Luoma, Ph.D.
April 23, 2021 from 12-1pm

Acceptance and commitment therapy (ACT) is, at its core, an experiential treatment, but is frequently delivered in a non-experiential way. Experiential learning involves going beyond verbal discussion, insight, and explanations of experience. But how do we do this in ACT and how do we know when we are spending too much time engaged in non-experiential modes of learning? This workshop will outline a simple model you can use to identify when you are in less or more experiential modes during therapy and easy methods to switch to more experiential modes. You will then have a chance to practice it in breakout groups and get feedback. Read More.


Ethical & Legal Considerations in Psychedelic Integration Therapy

Jason Luoma, Ph.D. and Brian Pilecki, Ph.D.
May 7, 2021 from 12-2pm

This workshop is based on extensive research and writing we have conducted into the legal and ethical issues of working with psychedelics in the current regulatory climate, as well as clinical practice doing harm reduction and integration therapy with psychedelics. It is informed by consultation with multiple experts on harm reduction, as well as attorneys knowledgeable about criminal and civil matters relating to drug use and professional practice. We will share with you all we know so that you can be more informed in the decisions you are making in your practice and be better able to decide whether to jump into this kind of work if you are considering it. Read More.


Case Conceptualization in Acceptance and Commitment Therapy

Jason Luoma, Ph.D. and Brian Pilecki, Ph.D.
May 21, 2021 from 12-2pm

This workshop provides a chance to learn concrete methods for conceptualizing cases from the perspective of Acceptance and Commitment Therapy. Formulating a useful case conceptualization is a foundational clinical skill that is essential in delivering effective treatment, and one that can be often overlooked in the process of working with clients. Participants will learn several formats for doing formal case conceptualization outside of session as a means to further develop knowledge and skill with ACT theory, as well as to learn a means to enhance treatment planning. The importance of ongoing case conceptualization throughout a course of treatment will be emphasized, as well as common pitfalls in conceptualizing client problems. Participants will also have a chance to practice newly learned skills with a case in breakout groups. Read More.


ACT Precision Training: In-Session Case Conceptualization in Acceptance and Commitment Therapy to Help You be Focused and Strategic in Your Interventions

Jason Luoma, Ph.D. and Jenna LeJeune, Ph.D
June 18, 2021 from 12-2pm

This workshop provides a chance to learn and practice in-session, in-the-moment case conceptualization of cases from the perspective of Acceptance and Commitment Therapy. This workshop focuses on helping you use ACT theory & in-session clinical markers to make more precise and strategic interventions. The main goal of this workshop is to help you become more adept at identifying in-session client behaviors that are indicators for particular ACT processes that are likely to be most relevant. The workshop uses a process we call ACT Circuit Training, which involves intensive analysis of a video of an ACT session and intentional practice in conceptualizing client behavior and generating possible ACT responses, followed by discussion and feedback. Read More.


ACT Agility Training: In-Session Case Conceptualization in Acceptance and Commitment Therapy to Increase Flexible Responding

Jason Luoma, Ph.D. and Jenna LeJeune, Ph.D
July 16, 2021 from 12-2pm

This workshop provides a chance to learn and practice in-session, in-the-moment case conceptualization of cases from the perspective of Acceptance and Commitment Therapy. This workshop is intended to help therapists be more flexible and nimble in their use of ACT processes, strengthening their ability to fluidly shift as needed between processes within sessions. Therapist learning ACT often develop tunnel vision, focusing too much on particular processes or responding rigidly when more flexibility is needed. Read More.


Therapy and Research in Psychedelic Science (TRIPS) Seminar Series

Second Friday of each month from 12:00 PM – 1:00 PM (PT)

TRIPS is an online seminar series that hosts speakers discussing science-informed presentations and discussions about psychedelics to educate healthcare professionals. This series was created to guide healthcare providers and students preparing to be professionals towards the most relevant, pragmatic, and essential information about psychedelic-assisted therapy, changing legal statuses, and harm reduction approaches in order to better serve clients and communities. This seminar series is a fundraiser for our clinical trial of MDMA-assisted psychotherapy for social anxiety disorder that Portland Psychotherapy investigators are preparing for and starting in the Fall of 2021. All proceeds after presenter remuneration will go to fund this clinical trial. Read more.

April 9th, 2021 – Ketamine 101: An Introduction to Ketamine-Assisted Psychotherapy with Gregory Wells, Ph.D.
May 14th, 2021  Research on MDMA and Psychedelic-Assisted Therapy: An Overview of the Evidence for Clinicians with Jason Luoma, Ph.D.
June 11th, 2021 Becoming a Psychedelic-Informed Therapist: Toward Developing Your Own Practice with Nathan Gates, M.A., LCPC