Imagine a treatment that ushers in profound new perspectives, alternative insights into past events and relationships, an experience of profound emotions that leads to self-healing or self-understanding — a treatment that can lead to transformation over several sessions instead of years (Penn, 2021). What if people could tune into their inner healing knowledge, see the root of their pain and how it has woven itself into the tapestry of their lives, and then allow that root to become a golden thread, bringing understanding, context, truth, and beauty into their present being?

“I can have compassion. I can carry forgiveness. I can carry love. I can carry joy. I do not have to have sadness or embody remorse to carry compassion and forgiveness. I can carry joy for myself and continue to show others love. Being joyful is a choice that I have for myself.

Yes, the water is cold on my feet, but I don’t have to be. I am free.”

The message above was written after my own experience within breathwork, a method of using breathing to induce a non-ordinary/psychedelic-like state of consciousness without a drug. This experience made me understand that despite my pathophysiology of hyperventilation and carpal-pedal spasms, when my body is completely contracted, I have the power of choice. I asked myself, “does this have to be?” In that moment, I chose to be fluid, and I was immediately able to move like water, bicycling with my legs in the air, my arms as if I were swimming, my jaw muscles relaxing and hands able to wiggle like spirit fingers.

Rediscovering this freedom, choice, and agency is some of the potential that lies embedded within psychedelic-assisted therapies.

The Potential of Psychedelic-Assisted Therapies

Psychedelics have trans-diagnostic and pan-therapeutic applications (Rauniyar, 2023). Currently, there is research being performed not only for treatment-resistant depression, but also for many other disorders from cluster headaches to end-of-life spiritual distress to disorders surrounding use of opiates, cocaine, and alcohol, throughout the adult lifespan. They are also being applied in the context of professional exposure to traumas suffered by military veterans, first responders, and healthcare workers. Other hypotheses surrounding the mechanism of action of psychedelics include entropic brain theory (Carhart-Harris, 2014; Rankaduwa, 2023), critical window reopening, neuroplasticity, and reduced experiential avoidance (Zeifman, 2020). We have only begun to explore the effects of intracellular 5-HT 2A receptors and contributions to cortical neuroplasticity (Vargas, 2023). Scientists hypothesize that psychedelics also reopen a critical period that allows for metaplasticity, psychological flexibility, social learning, and an opportunity to reevaluate our thoughts (Nardou, 2023). LSD and psilocybin have been found to bind 1000x greater to the receptors that activate brain growth factor (Moliner, 2023) which contributes to increasing neural connections, with the potential to rebuild healthier neuronal pathways.

Beyond traditional western diagnostics, psychedelics are also being researched in those experiencing stress and sleep issues, as well as how they impact spiritual and religious effectiveness in clergy, their effect on social and emotional memories, and on professional burnout, specifically among healthcare personnel. At the time of this writing, clinicaltrials.gov currently lists 148 trials involving psilocybin, 101 involving MDMA, 57 studies involving LSD, six studies using ibogaine, six studies researching mescaline, and one study involving ayahuasca. Through these empirical studies, we are gaining an alternative, molecular, and pharmacodynamic understanding of indigenous and traditional practices with these plant and fungi-based compounds.

Why Consider Psychedelic-Assisted Therapy?

It is clear there are many promising studies showing the potential for these types of therapies, but healthcare professionals may be hesitant to dive into these options. As healthcare professionals, however, we know that people who face health challenges such as addiction, chronic pain, and mental health diagnoses have few treatment options, and the ones they have sometimes do not provide satisfactory outcomes. Although cognitive-based therapy or other thought-based methods can be important for some, for others, it is difficult to engage because they don’t resonate. The messages these people receive from these therapies are consistently inconsistent with what the person has experienced through their interactions with the world. It would be like telling someone who is colorblind that a cardinal is red. Eventually, they may start saying that the cardinal is red because others see it that way, but to them, it looks different, and, as a result, so is their foundational belief. Often, as human beings, we end up learning “the hard way” or by experiencing something ourselves rather than accepting a lesson based on the experiences of others.

When discussing the potential of psychedelics for healing our inner selves, I often use the analogy of a train tunnel. At first, the darkness of this tunnel is completely overwhelming, and until our eyes adjust, it’s pitch black. When entering the darkness of this tunnel, it seems at first that the only escape is to head towards the light on the other end. We imagine the walls as solid, immovable, and even stifling. Psychedelics have the potential ability to enhance our vision, allowing us to see the doors that line the walls of the tunnel and, if we choose, explore those alternatives. They challenge our underlying assumption that the only way out is the opening at the end by showing us that there are alternatives. They can also call into question our perception of the tunnel and instead of seeing it as dark and overwhelming, we may instead see the darkness as the presence of all spectrums of light, to find comfort in being held by the earth around us as it provides shelter from the elements outside, or find strength in its ability to hold the weight of itself so firmly and without fail. In this, one may ask what is real — is the blackness real? Is the rainbow spectrum of layered colors real? Is my discomfort real? Or is it imagined?

These core beliefs often lie below our conscious awareness together with implicit memories (held by our bodies) which were formed before our brains were developed enough to create explicit memories. Accessing these subconscious beliefs, bringing them to the surface, and exploring or modifying them is one proposed mechanism of action based within psychological frameworks. To do so, many use mindfulness practice, such as that practiced in the field of Hakomi Mindfulness-Centered Somatic Psychotherapy (Weiss, 2015), holotropic-style or transpersonal-style breathwork pioneered by Stanislav and Christina Grof (2010), meditation, a variety of hallucinogenic plant medicines, and psychedelics.

Psychedelic substances, with proper patient screening and preparation, have relatively safe risk profiles and have been used in other cultures for medicinal and spiritual purposes for millennia. That being said, the risk of these is not zero; therefore, risk/benefit conversations are an important part of the provider's role together with appropriate patient selection.

The Role of the Nurse

In this emerging field of medicine, it is nurses who speak the sacred language of caring science (Watson, 2023) as Susan Ezra so beautifully put, “We, though, have now created a new archetype of what it is to be a nurse: as the holder of sacred space and the one that can facilitate the empowerment of another to access their own innate healing abilities within their body, mind, heart, and spirit. Through this partnership and the mutuality that happens, we’re aiding others in healing as well as nurses, learning to heal ourselves” (Carter, 2020). This holistic approach of nursing coupled with unitary caring science (Watson, 2023) is one perfectly designed for the nurse's presence at the patient’s side during treatment with psychedelics (Penn, 2021). The nurse, trained to understand pathophysiology, monitor biological responses, and think critically, can be both the anchor in the physical and the bridge between the sacred and scientific.

Andrew Penn, MS, NP, PMHNP-BC, clinical professor at the School of Nursing, University of California, and attending NP at the San Francisco Veterans Administration, collaboratively discusses some of the major elements surrounding the professional development pathway, along with your own inner inquiry, into internal bias surrounding psychedelics (Penn, 2021), in “Psychedelic-Assisted Therapy: Emerging Treatments in Mental Health Disorders.” This work contains excellent resources for education and building connection with others in the field.

I have heard the fellowship among psychedelic-informed professionals described as one that offers a deep sense of shared connection. These are relationships that hold compassionate curiosity in tension with scientific evidence and foster hope for new ways of being within healthcare and what it means for humanity to be well. 

References

Carhart-Harris, R. L., Leech, R., Hellyer, P. J., Shanahan, M., Feilding, A., Tagliazucchi, E., Chialvo, D. R., & Nutt, D. (2014). The Entropic Brain: A Theory of conscious states informed by neuroimaging research with psychedelic drugs. Frontiers in Human Neuroscience, 8. https://doi.org/10.3389/fnhum.2014.00020

Carter, L. (2020, June 16). The nurse: Wounded healer with 10,000 faces. YouTube. https://youtu.be/YHIBKMZviAY?si=41JxCgCDs3jUwYw5

Grof, S., and Grof, C. (2010). Holotropic breathwork: A new approach to self-exploration and therapy. State University of New York Press.

Moliner, R., Girych, M., Brunello, C. A., Kovaleva, V., Biojone, C., Enkavi, G., Antenucci, L., Kot, E. F., Goncharuk, S. A., Kaurinkoski, K., Kuutti, M., Fred, S. M., Elsilä, L. V., Sakson, S., Cannarozzo, C., Diniz, C. R., Seiffert, N., Rubiolo, A., Haapaniemi, H., … Castrén, E. (2023). Psychedelics promote plasticity by directly binding to BDNF receptor trkb. Nature Neuroscience, 26(6), 1032–1041. https://doi.org/10.1038/s41593-023-01316-5

Nardou, R., Sawyer, E., Song, Y. J., Wilkinson, M., Padovan-Hernandez, Y., de Deus, J. L., Wright, N., Lama, C., Faltin, S., Goff, L. A., Stein-O’Brien, G. L., & Dölen, G. (2023). Psychedelics reopen the social reward learning critical period. Nature, 618(7966), 790–798. https://doi.org/10.1038/s41586-023-06204-3

Penn, A., Dorsen, C. G., Hope, S., & Rosa, W. E. (2021). CE: Psychedelic-assisted therapy. AJN, American Journal of Nursing, 121(6), 34–40. https://doi.org/10.1097/01.naj.0000753464.35523.29

Raj, P., Rauniyar, S., & Sapkale, B. (2023). Psychedelic drugs or hallucinogens: Exploring their medicinal potential. Cureus. https://doi.org/10.7759/cureus.48719

Rankaduwa, S., & Owen, A. M. (2023). Psychedelics, entropic brain theory, and the taxonomy of conscious states: A summary of debates and perspectives. Neuroscience of Consciousness, 2023(1). https://doi.org/10.1093/nc/niad001

Vargas, M. V., Dunlap, L. E., Dong, C., Carter, S. J., Tombari, R. J., Jami, S. A., Cameron, L. P., Patel, S. D., Hennessey, J. J., Saeger, H. N., McCorvy, J. D., Gray, J. A., Tian, L., & Olson, D. E. (2023). Psychedelics promote neuroplasticity through the activation of intracellular 5-HT2A receptors. Science, 379(6633), 700–706. https://doi.org/10.1126/science.adf0435

Watson, J. (2023, September 14). Watson’s Caring Science & Theory. Watson Caring Science Institute. https://www.watsoncaringscience.org/jean-bio/caring-science-theory/

Weiss, H. (2015). Hakomi mindfulness-centered somatic psychotherapy: A comprehensive guide to theory and practice. W.W. Norton and Company.

Zeifman, R. J., Wagner, A. C., Watts, R., Kettner, H., Mertens, L. J., & Carhart-Harris, R. L. (2020). Post-psychedelic reductions in experiential avoidance are associated with decreases in depression severity and suicidal ideation. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00782