Leiden University’s Prof. Eric Vermetten asks: ‘what is the added value of psychedelics to trauma treatment?’
In a personal tour and reflection on the use of psychedelics to treat PTSD, Prof. Vermetten began by citing Dutch neurologist and psychiatrist Jan Bastiaans and his work during the 1970s using LSD to help treat survivors of the holocaust. Bastiaans work, he said showed the power of “the reappraisal of the transformative experiences in a non-ordinary state of mind. This is what psychedelics do.”
A staff psychiatrist at Department Psychiatry at Leiden University Medical Center, Prof. Eric Vermetten served the Dutch Armed Forces in capacity as Head of Research Military Mental Health. He was trained at Yale and Emory in neuroscience, applying these approaches to validate PTSD and assess trajectories of change and has pioneered novel approaches in PTSD treatment focusing on active and post-active service members. He is interested in non-ordinary states of consciousness and aims to bridge mental and spiritual practices in trauma treatment. He was the Principal Investigator of the first open label trial of MDMA assisted therapy (MDMA-AT) for PTSD in Europe.
Prof. Vermetten explained that under MDMA-AT, the patient’s amygdala isn’t “on alarm”, so they can revisit and reappraise the traumatic experience in a different way, without the overwhelming fear response. In this respect the sessions are a “meta-cognitive experience” in which the patient can view thoughts and emotions as transient mental events and not absolute truths, acknowledge fear and distress without resistance or avoidance, and develop flexible thinking which allows a patient to move from self-blame to self-understanding.
“In psychedelic-assisted therapy, there is a new reality being created.”
– Prof. Eric Vermetten
However, the challenge in practice and research are significant. He counselled that psychedelic-assisted psychotherapy was different in practice to standard, gold-standard psychotherapies and as such poses different demands on the clinician. For example, with a half-life of five hours, MDMA-AT necessitates long sessions. “You need to like this work,” he said. “Some colleagues didn’t like it, they don’t want to sit five to eight hours with one patient.” Three, eight hour sessions with two clinicians in attendance may also be costly.
How the clinician engages with the patient differs too. “You need to be able to look at people like a fly would – look at the minutiae changes, engage with that and meet patients at different level. You’re going to be very close – metaphorically on the skin of the patient.” There is an extra layer – you can’t do this five days a week; one patient a week maybe.”
Many other considerations need to be made: who should receive psychedelic-assisted therapy, when and for how many sessions? In a staged model of PTSD treatment (Nijdam et al., 2022) he suggests MDMA-AT is most appropriate when symptom resistance to treatment or relapses are becoming evident, potentially when at least two other evidence-based treatment have failed to elicit a response. Due to the “meta-cognitive experience”, whether or not a patient is ready to engage in intensive emotional processing and tolerate potential distress is also a major consideration. As too is whether or not they are open to experiencing drug-induced non-ordinary states of consciousness.
More widely, psychedelic-assisted therapy is not a singular, homogenous approach. Whilst his work has primarily focused on MDMA, other psychedelic compounds have been used to assist trauma therapy. Ketamine, psilocybin, LSD and cannabinoids all may produce different effects and require different approaches (Krediet et al., 2020). Most importantly, many of these compounds are prohibited in law and the regulatory framework differs across countries and jurisdictions. This currently can make research and subsequent clinical application difficult, whilst also facilitating parallel unregulated ‘self-medication’ by patients using unlicensed compounds and methods. In response to the challenge, Prof. Veremetten and colleagues started the Ethical Psychedelic International Community (EPIC) platform to develop regulatory frameworks via a sandbox approach, harmonise clinical standards and address ethical and safety concerns whilst engaging with policy makers and the wider public (see also: Herpers et al., 2024).
Whilst the evidence-base on treatment impact and effect longevity in European and North American trials is expanding, so too are the questions that need to be answered as regulatory frameworks appear to continue to lag behind. “The paperwork is incredible, but research is possible in many countries,” he said. “Naturalistic research is the key here, across all of Europe. However, this is easily said, but not easily done.”
UKPTS Bites is a series of short, free, online lunchtime sessions on topics related to PTSD, trauma and beyond. It is hosted in partnership with the ESTSS. More details on upcoming sessions can be found on our events page.
