Measure 109 & 110: Psilocybin-Assisted Therapy Is Here! (But Not Until 2023)

Measure 109 in Oregon was recently approved by voters, making Oregon the very first state in the U.S.A. to legalize psilocybin-assisted therapy. While many are eager to begin providing or receiving this breakthrough service, psilocybin-assisted therapy will not be officially available until sometime in 2023. This is because the Oregon Health Authority (OHA) will be in charge of creating a program that establishes training requirements for facilitators and suppliers which will begin in January of 2021. It will take two full years to implement before psilocybin-assisted therapy is available. When it is available, it will be restricted to people 21 years of age and older.

Although many want to access these services immediately, there are steps that must be taken to ensure that health and safety factors are not overlooked. For example, the OHA will determine what eligibility requirements need to be met for individuals to obtain a license to provide this service. This includes establishing guidelines for what qualifications, education, training, exams, and professional codes of conduct will be necessary. Therefore, for now, this service is still unavailable and illegal until these rules and regulations have been established.

Measure 110 was also recently passed in Oregon, making personal non-commercial possession of controlled substances, such as psilocybin, MDMA, cocaine, and heroin, no more than a Class E violation, with a max fine of $100. This measure also includes the establishment of a drug addiction treatment and recovery program, wherein individuals who are charged a fine up to $100 for a Class E violation have the option to complete a health assessment instead of paying the fine. This new approach establishes that personal use of controlled substances will be decriminalized, shifting the approach from criminalization to one of health and safety. Like Measure 110, the implementation period has yet to be completed. The amendments voted in through Measure 109 do not become law until February 1st of 2021.

Although we are all eager for these measures to be officially implemented, we must be patient for a little longer. At the moment, Portland Psychotherapy therapists are not able to provide psilocybin-assisted therapy because it is still illegal. For people who are wanting to use psychedelics for personal growth or healing, we are able to meet with you before or after your use of psychedelics in order to help you understand the risks and benefits, maximize safety, and integrate experiences into your life.

If you would like to learn more about our harm reduction and integration services, please click here. And If you’d like to learn more about Measure 109 and Measure 110, please check out voteyeson109.org and voteyeson110.org.

By Sarah Smith

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

Understanding Risks in Practicing Psychedelic Harm Reduction and Integration Therapy: Advice for Clinicians

You may have noticed that the buzz around psychedelic assisted therapy has grown by leaps and bounds within the last several years. Many therapists are eager to become involved in this newer form of mental health treatment, though psychedelics remain largely illegal. Using a harm reduction approach, some therapists have begun to incorporate client’s personal use of psychedelics into therapy by offering a safe space to prepare for or integrate psychedelic experiences. However, many therapists may be cautious to practice in this area due lack of clarity about potential risks for themselves. Here are some tips that might be helpful when considering practice in psychedelic harm reduction and integration (HRIT).

Know the law. First, most psychedelics are illegal. Therefore, clients who discuss plans to use psychedelics will likely be discussing plans to engage in an illegal activity. While therapists are unable to encourage illegal behavior, a harm reduction approach can be used to help clients identify potential risks and benefits and make their own informed choices. Even if you are in one of the increasing number of cities where psychedelics have been decriminalized, they remain federally illegal. The legal risks for working with psychedelics will vary by your local jurisdiction. If you want to do integration work around psychedelics, it’s a good idea to consult with a local attorney who knows criminal defense so you can understand how risky it is in your area to do this work.

Consider your licensing board. It is helpful to consider how practicing HRIT may be perceived by your licensing board. Will they consider this outside your scope of professional expertise? What happens if a client has an adverse event involving psychedelics after one of your harm reduction sessions? Licensing boards are unlikely to give direct approval or permission to practice HRIT.  Nonetheless, it still is helpful to anticipate how your own board may view such therapy.

Consider your norms. When deciding whether to practice HRIT, it is helpful to consider the norms of the area you live in. Geographic locations that are more politically conservative or mental health settings that are more traditional may confer greater risk.

Decide for yourself. Practicing HRIT involves some degree of legal and regulatory risk. We suggest that therapists reflect on the level of risk they are willing to take on given their own circumstances. For example, therapists who are not trained in harm reduction or who do not feel comfortable engaging in helping clients plan how to stay safe when using psychedelics could consider limiting services to psychedelic integration, or therapy that is focused on helping clients after they have already used psychedelics.

Get prepared. If practicing HRIT is of interest to you, there are several things that you can do to prepare. First, identify gaps in education or knowledge and seek out training opportunities to address such gaps. Second, consult with therapists who are practicing HRIT to learn more about how to incorporate this newer clinical area into your practice. Third, stay up to date. This is a rapidly evolving clinical area that is likely to develop more fully over the next several years. One option for learning more is our TRIPS Seminar Series, which can help you get up to speed.

As more people are using psychedelics for personal growth and therapeutic purposes, there is a greater need for therapists to provide support and information. Taking the time to learn about potential risks as a therapist can be helpful in deciding whether this is right for you.

Written by Brian Pilecki, PhD

Dr. Brian Pilecki is a licensed clinical psychologist who earned his Ph.D. from Fordham University and completed his postdoctoral training at the Warren Alpert Medical School of Brown University. He specializes in the treatment of anxiety disorders, trauma and PTSD, and matters related to the use of psychedelics. Additionally, Dr. Pilecki has experience in mindfulness and meditation and practices primarily from an orientation based on Acceptance and Commitment Therapy (ACT). He is also engaged in scientific research on psychedelics.

Acceptance and Commitment Therapy is Making Waves in Psychedelic Science

In case you missed it, a renaissance in psychedelic science is happening! In January, the Journal of Contextual Behavioral Science published a special issue in the area of psychedelic medicine.  Many of studies in this issue made the case for why Acceptance and Commitment Therapy provides such an appropriate therapeutic framework for conducting psychedelic-assisted psychotherapy. Namely, it seems that when used in safe and supportive settings, psychedelics may enhance psychological flexibility and therefore be useful in treating a wide variety of psychological problems including anxiety and depression. In addition, ACT is being used as the therapeutic framework in clinical trials of psychedelic assisted therapy at The Imperial College in the UK and at Yale/NYU in New York. ACBS members can download all these articles by logging into their member account at contextualscience.org first.

For a summary of the research on psychedelic assisted therapy, we just published the most comprehensive meta-analysis of placebo-controlled trials to date. This will give you a good overview of the research evidence so far and why people are excited about the potential of psychedelic-assisted therapy for a range of psychological problems.

While it will still be several years before psychedelics can be legally administered, it is currently possible for people to meet with a therapist to discuss psychedelic experiences they may have had on their own. These services are often called psychedelic integration and safety servicesand refer to the use of a harm reduction approach where clients can have a safe non-judgmental space to talk about their interests in psychedelics, receive support in learning about the risks and benefits of psychedelic use, and process any prior experiences. We offer these services at Portland Psychotherapy and while we do not facilitate access to psychedelic experiences in any way, clients are welcome to discuss their interest in the therapeutic use of psychedelics with a trained professional. We’ve also begun offering training on the topic as well.

Portland Psychotherapy is currently planning what we believe will be the first trial of psychedelic assisted therapy in the Pacific NW. The study will be a randomized trial studying MDMA-assisted psychotherapy in the treatment of adults with severe social anxiety. We are currently preparing our submission to the FDA for approval to run the trial and hope to contribute to the understanding of the mechanisms of action of MDMA-assisted therapy, which to this point has mostly been used in treating PTSD.

Finally, this year’s ACBS virtual world conference will include a workshop on psychedelic integration and harm reduction therapy, as well as a symposium with several recent papers related to psychedelic-assisted therapy. If you are a member of ACBS, please also consider joining the Psychedelic and Non-Ordinary States of Consciousness Special Interest Group (SIG) to find more ways to connect with like-minded peers and stay up-to-date with the latest in psychedelic science.

Written by Brian Pilecki, PhD & Jason B. Luoma, PhD

Dr. Brian Pilecki is a licensed clinical psychologist who earned his Ph.D. from Fordham University and completed his postdoctoral training at the Warren Alpert Medical School of Brown University. He specializes in the treatment of anxiety disorders, trauma and PTSD, and matters related to the use of psychedelics. Additionally, Dr. Pilecki has experience in mindfulness and meditation and practices primarily from an orientation based on Acceptance and Commitment Therapy (ACT). He is also engaged in scientific research on psychedelics.

Jason is a psychologist who researches ways to help people with chronic shame and stigma and also works clinically with people struggling with those same problems.

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.

UPCOMING TRAINING EVENTS

An Introduction to Exposure Therapy for Anxiety Disorders: Traditional and Inhibitory Learning Approaches

Dr. Brian Pilecki
January 29, 2021 from 12:00pm-1:30pm PST
Exposure therapy is the gold-standard treatment for anxiety and obsessive compulsive and related disorders. The aim of this workshop is to provide a solid foundation in theory and knowledge for those newer to exposure therapy. This workshop will include a brief history of exposure therapy, including a description of its roots in classical and operant conditioning. Read More.


Using Acceptance and Commitment Therapy to Guide Flexible Exposure

Dr. Brian Thompson
February 26, 2021 from 1-2:30pm

Drawing from the ACT model, participants will learn to conceptualize and create exposure exercises to maximize flexibility. We will explore common pitfalls in using ACT as a context for exposure and how to create ACT-consistent exposure exercises for clients who are skeptical of “acceptance” and appear disinterested when you try to engage them about values. The presenter will use practice-based data to support these principles (Thompson, Twohig, & Luoma, in press). Read More.


An Introduction to Psychedelic-Assisted Psychotherapy for Clinicians

Dr. Brian Pilecki and Jason Luoma, Ph.D.
March 26, 2021 from 9am-12:10pm

Psychedelic assisted therapy is emerging as a highly effective form of mental health treatment. This workshop will provide health care professionals an overview of this new clinical area. The workshop will highlight the importance of preparation and integration in therapy using a harm reduction approach. The current legal status of psychedelics will be reviewed, including Oregon’s recent passing of an initiative to legalize psilocybin-assisted therapy. Finally, diversity issues around lack of access for underserved and non-majority populations will be explored. Read More.


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.


Case Conceptualization in Acceptance and Commitment Therapy

Jason Luoma, Ph.D. and Dr. Brian Pilecki
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.

December 11th, 2020 – Ethical and Legal Considerations in Providing Psychedelic Integration Therapy with Brian Pilecki, Ph.D. & Jason Luoma, Ph.D.
January 8th, 2021 – What’s it Like to Trip? The Patient Experience in Psychedelic-Assisted Therapy with Brian Pilecki, Ph.D.
February 12th, 2021 – 5-MEO-DMT with Rafael Lancelotta, M.S.
March 12th, 2021 – What does Psilocybin-Assisted Therapy for Depression Look Like? A Clinical Case Presentation based on a Recent Clinical Trial from Johns Hopkins with Alan K. Davis, Ph.D.
April 9th, 2021 – 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.