Psychedelics, Therapy & Healing the Mind: Can Magic Mushrooms Cure What Pills Can’t?

Dustin Grinnell (00:00:00 --> 00:02:08)
I'm Dustin Grinnell, and this is Curiously.

For today's episode, I'm thrilled to introduce my guest, Dr. Sherry Siddiquim, a licensed clinical psychologist who specializes in adult psychotherapy and psychological testing. In addition to this work, Dr. Siddiquim has a unique and emerging focus in psychedelics-assisted therapy, or PAT. PAT combines the use of psychedelic substances such as psilocybin or MDMA with guided therapeutic sessions to address various various psychological conditions. Since psychedelics are currently classified as Schedule I drugs, therapists can't choose or administer these substances themselves unless it's within the context of a clinical trial or they're administering ketamine. However, in New York State, where Dr. Sitikum is based, she can still help patients who choose to use these substances independently by educating them about the potential risks and benefits of use and by helping them make sense of and process their psychedelic experiences.

This process is sometimes referred to as harm reduction. And it involves educating the patient about the possible risks and benefits of using psychedelics given the patient's individual factors, and about the importance of set and setting for safe use. If the patient chooses to move forward with using psychedelics on their own, Dr. Sitikum helps them prepare by setting intentions, discussing what they hope to gain from the experience, and providing important information about what they might encounter. She also covers the practicalities of the session, ensuring the patient knows what to expect and feels safe. Finally, as needed, Dr. Sidikum assists patients with the integration process after their psychedelic experience.

Dustin Grinnell (00:02:08 --> 00:02:11)
So without further ado, I hope you enjoy this conversation with Dr.

Dustin Grinnell (00:02:11 --> 00:02:15)
Siddiqui about the potential and challenges of psychedelics-assisted therapy.

Dustin Grinnell (00:02:18 --> 00:02:20)
Dr. Siddiqui, welcome to the podcast.

Dr. Sherry Siddiqui (00:02:20 --> 00:02:21)
Thank you. Thank you for having me.

Dustin Grinnell (00:02:22 --> 00:03:06)
So thanks so much for being willing to talk about this topic. I think it's a very fascinating topic and the implications of using psychedelics in therapy. I think I've gotten everybody very excited about their potential. And I think to start the conversation, I would love to kind of know how you became interested in psychedelics as a clinical psychologist. And I understand that you had an experience with psychedelics on a retreat, and that was in Jamaica. And I was wondering if you could just, going into as much detail as you want, talk about that experience and the impact that it had on you.

Dr. Sherry Siddiqui (00:03:07 --> 00:06:19)
And at that point, I became really curious about psychedelics. I became really curious about the therapeutic use of psychedelics, and I decided to go and have my own experience with them. And the way that I decided to do that was to, as you mentioned, go on a retreat in Jamaica where psilocybin is decriminalized. And basically the structure of that retreat is within the course of 8 or 9 days, the guests take 3 pretty large doses of psilocybin. And then there's some integration between the sessions.

There's some preparation before, which we can get more into what those things mean.. And in the course of these 3 very powerful experiences, I came to sort of encounter what was in my mind in a way that, in a way that I really hadn't before, in a way that really surprised me. I was, you know, confronting memories from very early childhood that it never even occurred to me were sort of important. And, you know, even more shockingly was that a lot of these experiences weren't so much sort of remembering or thinking about my own personal history, but they took on sort of like more of a mystical or spiritual element, an existential element where, you know, I, I was sort of sitting with, you know, things like the nature of reality and consciousness. And the way that that put my own personal life into perspective was really powerful.

And I remember as I was coming out of one of these experiences, I think it was the first one, and I was just sort of walking around outside and, you know, I was in nature and it was just so beautiful and vivid. And I just had this strong feeling that like, this is the work that I want to do in my career as a therapist. You know, I was thinking about how these substances are game changers in terms of our ability to access the subconscious and, and help people like lower their defenses to be able to work on different things and, you know, expand our consciousness and, you know, all of those things. And I sort of had this sense that therapy, the way that we've been doing it, is largely just sort of scratching the surface.. And so there's like potential for much deeper work with these medicines.

Dustin Grinnell (00:06:19 --> 00:06:49)
Okay. And so that experience led you to a curiosity for psychedelics in the context of being used for therapeutics. You read about it, you studied, you learned, but then you wanted to get a credential. I think it was, it, it led you to pursuing training in what's called psychedelics-assisted therapy or PAT. I was wondering if you could kind of just tell me how you came into that training and what it prepared you to do.

Dr. Sherry Siddiqui (00:06:49 --> 00:08:10)
As I was, you know, again, learning more and taking one-off classes at wonderful organization called Fluence in New York that provides education to clinicians about psychedelics-assisted therapies, I became aware that it was actually possible to get certified in psychedelics-assisted therapy. And the program that I attended, the California Institute of Integral Studies, or CIIS, is the first program in the US to offer psychedelics-assisted therapy certification. And basically what it is, is something like an 8 or 9 month course where we kind of get a really broad-based foundation in psychedelics medicine. So, you know, we cover topics like the pharmacology of psychedelics, history, research design, ethical concerns, and yeah, basically we learn enough foundational stuff to prepare us to hopefully get to work with these substances once they do become legal. You know, having said that, the certification doesn't mean much right now because they're not legal. There are still no standard requirements for becoming a psychedelics-assisted therapist. But yeah, the hope is that once psychedelics become rescheduled, the certification will enable me to start doing this work clinically.

Dustin Grinnell (00:08:10 --> 00:08:48)
Okay. When we talk about psychedelics, there are many, there are many substances or medicines. You mentioned that there were 3 that you know the most about. You had a personal experience with psilocybin. I think that's magic mushrooms, right? And then there was MDMA, and there was another, right? And I was wondering if you could just kind of not do like a total, you know, compare and contrast between the three, but like just kind of explain what they are and what they generally seem to do to the human mind when ingested?

Dr. Sherry Siddiqui (00:08:48 --> 00:09:58)
So I think the 3 substances that I had referred to in terms of what I know the most about, those are, as you mentioned, psilocybin, MDMA, and ketamine. So I'll start with a caveat here, which is that technically neither MDMA nor ketamine are considered psychedelics. Ketamine is dissociative, MDMA is an empathogen. So we can talk more about what that means. But the reason that I'm most well-versed in these three substances is these are the three substances that, at least in the US right now, are being studied the most. Ketamine is legal. It's considered off-label use, but it is being used for treatment-resistant depression. And then, you know, MDMA right now is being studied for treating PTSD. There's a ton of research there. And there's also a lot of research with psilocybin when it comes to things like depression and the life anxiety addiction. So yeah, those are the 3 substances that I'm most familiar with and I can speak to.

Dustin Grinnell (00:09:58 --> 00:10:17)
Maybe just focus on psilocybin. What does it do? You know, you ingest it, you ingest the plant and, you know, what's the best way of explaining its mechanism of action, so to speak? I mean, not maybe at the pharmacological level, but like at the changing of consciousness level, like what does it do?

Dr. Sherry Siddiqui (00:10:17 --> 00:11:19)
The short answer is a lot of things, but I will sort of focus on the ones that we talk about the most when we think about what's therapeutic about psilocybin. So I'll touch on the pharmacology just a tiny bit. So when someone ingests psilocybin, first the psilocybin is converted into psilocin, So then the molecule psilocin binds to the serotonin 5H2A receptors, and this is a receptor that's implicated in a lot of different psychedelics. And so then when that happens, that sets into motion a cascade of different changes that happen in the brain. So we start to see things like increased activity in the visual cortex, and that explains some of the visuals that people experience on these substances. So seeing things like fractals or seeing colors with more Vividness. There is decreased activity in the default mode network of the brain. There's a lot to say about the default mode network, or the DMN.

Dustin Grinnell (00:11:19 --> 00:11:22)
It's like the daydreaming part of the brain.

Dr. Sherry Siddiqui (00:11:22 --> 00:12:13)
Yeah, exactly. So the default mode network of the brain is active when we are not necessarily engaged with doing something, when we're sort of like, quote unquote, idling. And, you know, in that state of idling or daydreaming, what happens a lot of the times is there's a lot of like self-referential thinking, right? We start to think about ourselves, who we are, with, you know, our memories. And this leads a lot of people to call the DMN the, like, seat of the ego or the seat of, like, our sense of identity. There's, there's some controversy about that, and there's, you know, some conversation around— there's, there are actually a lot more brain regions that are involved in that. But nonetheless, you know, something that we are seeing is decreased activity in the DMN, which might be, you know, what is contributing to the so-called ego dissolution.

Dustin Grinnell (00:12:13 --> 00:12:31)
Right. So if you sort of pull down this default mode network, you may be able to, like you said, like dissolve the ego a little bit. Those stories about ourselves are dampened. And so what happens to one's consciousness when we lose our sense of self?

Dr. Sherry Siddiqui (00:12:31 --> 00:13:31)
You know, I think one way to think about this is that so much of human suffering and so much of what we see with, you know, something like depression is based in a sense of like separation, is based in a sense of like loneliness. And so one of the things that ego dissolution, or, you know, reductively, decrease of activity in the DMN causes, is more of a sense of like connectedness with other people, with the world, something that we call like unity consciousness, right? Like this sense that everything is sort of interconnected or everything is one. And so that's sort of one of the mechanisms of action in terms of the relief that we see from depression is a relief from seeing the self as this, like, concrete, isolated, separated being.

Dustin Grinnell (00:13:31 --> 00:13:52)
Yeah. And so it's interesting because in depression, isn't one of the symptoms like rumination? So it's this kind of loop, the spiral of thinking about ourselves. And so I would think getting rid of rumination or combating it would be, you know, essentially you're attacking depression at its biggest contributor.

Dr. Sherry Siddiqui (00:13:52 --> 00:15:25)
Yes, that's exactly right. And then the other mechanism of action that I think is really central to the antidepressant or in general anti-suffering effects of a medicine like psilocybin is that what we begin to see is that the different parts of the brain become much more interconnected. So there's much more connectivity between the different regions. And why that's important is that when these different regions begin to, you know, sort of talk to each other, the person is able to come up with novel solutions to old problems in their life. See things from a new perspective.

That can lead to having profound insights, new insights, new ways of seeing things. Basically what we're seeing with a medicine like psilocybin, as well as with a lot of the other psychedelics, is that there's greater flexibility in the mind. Arguably, that's the biggest therapeutic benefit. Since so many of the mental and emotional disorders really come down to cognitive rigidity. So basically, insofar as we can increase cognitive flexibility, we're going to see a lot of relief from the symptoms of a lot of different kinds of mental health issues.

Dustin Grinnell (00:15:25 --> 00:15:33)
This may be getting like too much into the weeds, but why does one's mind become inflexible? What is it about us that gets rigid?

Dr. Sherry Siddiqui (00:15:33 --> 00:16:15)
I think part of it is that as we grow older, our brains just become less plastic. And as we often talk about, neurons that fire together wire together. And so there's a way that, like, you know, the mind kind of keeps going down the same pathways over and over again. And the more that happens, the deeper these, like, grooves become, the more, you know, the neurons that we're not using get pruned out, the more rigid the mind becomes. And my sense is that we see more of that rigidity than what's considered normal with mental health conditions like depression, like OCD, like PTSD.

Dustin Grinnell (00:16:15 --> 00:16:24)
So I was wondering if you could just give me kind of an overview of psychedelics-assisted therapy, the steps that the clinician and the patient go through.

Dr. Sherry Siddiqui (00:16:24 --> 00:17:10)
There is at first like a screening process to make sure that the person is a good candidate for psychedelics-assisted therapy. There is the preparation stage, which is basically what the name suggests, preparing the person for the experience, and that takes place over the course of 3 90-minute sessions in some of the clinical trials that we're seeing. Then there's the dosing session or dosing sessions, multiple. Then after that comes the integration sessions, which are really a very important part of the process. If we want to see the, you know, effects of these medicines persist over time.

Dustin Grinnell (00:17:10 --> 00:17:29)
So zoom in on the first couple steps. You've got this assessment and preparation phase that happens where you gather psychosocial history, you understand what the patient hopes to gain from the experience. And so tell me a little bit more about how PAT kind of works with patients at these early stages.

Dr. Sherry Siddiqui (00:17:30 --> 00:18:31)
The preparation is A really important part of this process in terms of like really setting up the stage for what's going to be, you know, maybe one of the most important days in the person's life. And, you know, like you mentioned, part of preparation is getting the person's background history, understanding their context. If they are coming in wanting to address a trauma, understanding what that trauma is. And then helping the person really flesh out their intentions or what it is that they're hoping to get from the experience. And that's going to be important because a lot of the time the intention ends up really shaping what it is that the person gets from the experience, even if they're not like sitting there and thinking like, okay, this is what I wanted to think about, this is what I wanted to do. So the intention setting. Is another part of preparation.

Dustin Grinnell (00:18:31 --> 00:19:04)
So when a patient comes in and they have an intention, whether it's vague or specific, I was wondering maybe if you could give me an example, generally speaking, about what kinds of intentions people have. Now, I imagine their traumas, life juncture issues, maybe dealing with a separation, maybe a psychiatric disorder of some kind, depressive symptoms. What, generally speaking, are people hoping to gain when they go into a potential psychedelic experience?

Dr. Sherry Siddiqui (00:19:04 --> 00:19:42)
Yes, I think a lot of the times it is, you know, relief from different symptoms, right? So, you know, it could be relief from depression, relief from PTSD. But the way that the intentions end up looking a lot of the time are maybe a little bit more process-oriented than like the outcome, right? So the process might be that like I want to confront and resolve this big trauma in my life, or I want to understand what the meaning of my life is at this point now that my children are grown and have left the home.

Dustin Grinnell (00:19:42 --> 00:19:47)
Or it ranges from the practical to the existential, it sounds like.

Dr. Sherry Siddiqui (00:19:47 --> 00:21:21)
Absolutely, yes. And I think an important thing to keep in mind with intentions and an important thing to kind of remind patients of with intentions is that it is helpful to have a sense of what it is or what it is that you want to get from the experience or what would be helpful to you. But at the end of the day, to hold that intention lightly and to trust— we like to say in the psychedelics world a lot, trust the medicine, but also trust your own mind that what is going to come up for you, in the psychedelic session is going to be what you need to work on and what you need to confront. So don't become so sort of like attached to the intention that like if then you have your journey and something totally different comes up, you're closing yourself off to that and you're like, that's not what we're doing here. Because really you might have no idea what the fulfillment of that intention is going to look like and what it is that you're going to have to confront. Sort of in the process of getting there. So all to say, helpful to help patients kind of come up with intentions, but also to encourage them to hold it lightly or even to let them go a little bit once, you know, they, they take the medicine and let the medicine and their own sort of inner compass, or what we call the inner healing intelligence, take them to where they need to go.

Dustin Grinnell (00:21:21 --> 00:21:32)
Okay. I understand in psychedelics-assisted therapy there's a little bit more to prep. What else helps? Get the patient oriented before they go into this experience.

Dr. Sherry Siddiqui (00:21:32 --> 00:25:21)
Or another way to put it is to put the inner healer sort of in the driver's seat to kind of guide the person to wherever it is that they need to go to allow that healing to happen. So, you know, one of the important pieces of this with integration is to again prepare the patient to trust this inner healer and trust whatever it is that their process is going to look like, right? And that might mean that it might look like them stomping around the room for 3 hours. It might mean them having a really pleasant experience when they thought they would be, you know, confronting their trauma, and it would be really difficult. And then the other piece that's important about the inner healer, or the inner healing intelligence, is that the role of the therapist is to help sort of support the inner healer.

The role of the therapist is not to, as the name erroneously suggests, it's not to guide the experience. It's not to tell the person what to think about or to ask sort of directing questions in course of the dosing session. Another part of preparation is just letting the person know that they are going to be guiding the experience and that our role is to support them as they do that. The different elements of support, and again, this is something that gets discussed during the preparation. One is physical support.

If the person needs to go to the bathroom, we might first of all teach them where the bathroom is and like practice with them going to the bathroom. We can let them know that we can help them with going to the bathroom. Physically keeping them safe means also that, you know, we have an agreement with them that they are not able to, you know, leave the room or the area where the therapy is being done, that they need to give us their keys or their shoes to make sure that they, they don't, you know, run off. And then another piece of preparation that is super important is discussion of physical or therapeutic touch and having an agreement with the person in advance about what kind of touch is and isn't okay with them. There are a lot of times that people will find it really helpful and supportive to hold the therapist's hand as they're sort of closing their eyes and going within and doing their own work.

Dustin Grinnell (00:25:21 --> 00:26:08)
Okay. Yeah. All to ensure a productive and healthy experience with medicine. Now, the next phases in the process is to kind of select the psychedelic, the right medicine for the right patient, and then to have the dosing experience, and then to follow up with a, like, a rigorous integration session. Now, because of the current legality and regulations, PAT doesn't involve itself in the matching or dosing process, right? So as of now, as things work themselves out with the Controlled Substances Act, the experience would happen elsewhere, but the integration session would happen with the therapist.

Dr. Sherry Siddiqui (00:26:08 --> 00:26:32)
Is that, is that right? Yeah, that's right. I mean, there are a lot of therapists right now that offer integration therapy for patients who, you know, have their own psychedelic make experiences on their own, with other people, with people who are doing underground work. So yes, that integration can happen in the context of a more, you know, traditional psychotherapy.

Dustin Grinnell (00:26:32 --> 00:27:03)
Okay. Now, I'm most interested in what patients, as generally speaking as you can get, or as specific as you can get, what do they report when they come back? Like, they had this experience, they came in with an intention, they maybe worked through some things. And I guess my question is, you know, what did they work through? What insights do they have? And how do you help them process it?

Dr. Sherry Siddiqui (00:27:03 --> 00:29:46)
So the answer to that is that there is a really, really wide range of experiences that people can have of, first of all, in terms of valence, right? Like some people have, you know, what they end up describing as the most beautiful or most lovely or most meaningful experience of their life that can be really like life-affirming or lift them out of depression, all the way to people, you know, reporting having the most difficult day of their life or having, you know, what they describe as hellish experiences. There's a lot in the middle there. And it's also quite common for people to have both in the context of one trip and sometimes have to kind of like move through the difficult stuff and work through the difficult stuff before they get to, you know, the lovely beautiful parts of the trip. But some different commonalities that we might see, one is like the emergence of memories, of important memories, of, of memories, you know, from childhood, and importantly, like coming to see those memories from a different perspective, or maybe we can say with a different, like, heart posture, right?

Or, you know, in the case of MDMA, you know, maybe that the person is in their regular life, like, they think about the trauma, or the trauma kind of intrudes on their mind, or they see fragments of it here and there. And when that happens in ordinary life, they become, like, very anxious, and their tendency is to, like, do whatever they have to do to to avoid thinking about those things. So, you know, someone like this comes in and they take MDMA. What ends up happening a lot of the time is that with the help of the medicine, the person is able to confront that same trauma, but to kind of confront it from a place of, A, being considerably less anxious and fearful, and B, having a lot of empathy and compassion for themselves. And the combination of both less fear and more self-compassion, self-empathy, self-love really allows the person to kind of process and integrate this trauma in a way that they hadn't been able to before, or to understand different things about themselves or have insights about themselves or themselves in relation to other people at the time of the trauma.

Dustin Grinnell (00:29:46 --> 00:31:11)
And even in the case of traumas, it's like they still know what happened, but it just doesn't have hooks in them anymore. It— they're in the driver's seat now. And I think the thing that is so profound is that it seems permanent. Like, that's what really gets me, you know. It's, uh, if you take a, you take a pharmaceutical, you could take antidepressants, you, you take it every day, and you may take it for years.

But you can come out of one or a few psychedelic experiences, and you can have resolved that trauma, that fear, the, the anxiety, in one session in some cases. And it's permanent. Like, what do you make of that, that reorientation to the trauma? And it's so long-lasting and so profound. I mean, I think that's what is so exciting about their use in a therapeutic context.

Dr. Sherry Siddiqui (00:31:11 --> 00:32:35)
It is exciting. And I think that as opposed to some, you know, traditional medication like antidepressants, they're not just treating the symptoms, they're also treating the underlying root, right? They're treating the cause of it so that, like, you know, once we can uproot the cause, or once we process the trauma, the symptoms will sort of subside on their own. Now, having said that, I think calling these kinds of effects permanent is a little misleading. And I think that this is, you know, one of the ways that all of this, you know, new enthusiasm about psychedelics has done the general public a disservice by making them seem more like a magic bullet than they actually are.

And the reality is that, you know, people do see enormous relief from all sorts of things like, you know, PTSD or, you know, existential anxiety and, and so on. And sometimes those things do last for a long time. And when they have done, you know, follow-up studies with some of these people several years later, a lot of people are back to experiencing a lot of, or at least some of the symptoms that brought them into the treatment to begin with. So I think permanent is overstating it. Sure.

Dustin Grinnell (00:32:35 --> 00:32:47)
Do you get a sense that maybe in the media we've cherry-picked the most amazing cases and potentially it's not representative of the, the true responses to these drugs?

Dr. Sherry Siddiqui (00:32:47 --> 00:34:03)
I do think that, and I, I think in a way there's a way that that's really unfortunate because the more that we we sort of inflate their effects, the more we are vulnerable to being proven wrong. And then what happens is that, you know, the pendulum kind of swings to the other direction where all of a sudden it's like, you know, all of these things that they've been saying about psychedelics is not true because see, this person took this psychedelic 2 years ago and they still have, you know, depression or whatever it is. So my hope is that in the coming months, years, we can start to have more kind of measured conversations about both the promises of these medicines, but also their limitations. And look, I mean, maybe part of the limitation is also that these are not, you know, one-and-done medicines or three-and-done medicines. Like, maybe this is, you know, a trip like this needs to be repeated once a year, once every couple of years. I think there's still very much a place for traditional psychiatric medication. There's no reason why they can't kind of work together. So I think we just need to be really careful with our enthusiasm.

Dustin Grinnell (00:34:03 --> 00:34:30)
Yeah, fair enough. I think that's a good, it's a good thing to have out there to be measured. I'm sure you have a sense of the literature right now. Like, what is the research saying in terms of their effectiveness? Maybe MDMA, psilocybin, ketamine, like what is the, maybe the current thinking from the scientific community on their effectiveness and usefulness and replicating the experience?

Dr. Sherry Siddiqui (00:34:30 --> 00:35:36)
I— high 70s, early 80s, or low 80s percent of people who undergo MDMA-assisted therapy for PTSD are in remission by the time the treatment is over. Don't quote me on that, but I think that sounds about right. With ketamine, I think we're also seeing something like 80%. I think even a little bit higher than that when we use ketamine for suicidal ideation and suicidality. It's actually pretty effective, at least again in the short term.

Psilocybin, I'm not sure. I don't have the numbers off the top of my head. But with all three of these medicines, the results that we're seeing are clinically significant. They are real. They are performing much better than placebo.

Dustin Grinnell (00:35:36 --> 00:36:05)
Now, you don't have a crystal ball, and predictions are famously inaccurate, but like, do you have a sense of, based on the studies, and like, when there may be a reclassification of psychedelics? Are we on the road there? Like, are we years away? Like, what can the public, what can clinicians, what can the medical system expect? Because right now there's a, there's a working out of things.

Dr. Sherry Siddiqui (00:36:05 --> 00:37:32)
They're still Schedule I drugs. Again, I'll, I'll speak to the 3 medicines that I'm the most well-versed in, beginning with ketamine. Ketamine is currently legal and clinicians are using it off-label to treat refractory depression. Suicidality and also things like OCD, even eating disorders. So that's sort of the best news with— so psilocybin, I believe, is currently in phase 2 of clinical trials. So I imagine it'll be years, but maybe not that many years until we're looking at rescheduling. And MDMA is, is sort of— it's an interesting time to think about this one because we are expecting a decision from the FDA about the rescheduling of MDMA in August, so in a couple months from now. But as you might know, earlier this month, the FDA Advisory Committee voted that the benefits of MDMA don't outweigh the risks, and so they're advising the FDA against rescheduling MDMA. And, you know, this was really shocking news to a lot of us who have been in this world and But they have brought up, you know, some concerns with research design, physical risks, and so forth that are going to have to be addressed before the FDA moves forward. So hard to say.

Dustin Grinnell (00:37:32 --> 00:38:22)
Do you think we're still dealing with the stigmatization of psychedelics? You know, we had the period in the '60s and '70s where psychedelics were used to maybe drive new awarenesses, new ways of thinking. And then there was this clamping down by the Nixon administration where these drugs were made illegal and research had to stop. Obviously, private use had to stop in a legal capacity. And the drugs, the medicines, they just became stigmatized. What is it about these drugs that people have such a hard time accepting? In a clinical context? And do you wonder if we're still kind of dealing with the aftereffects of those stigmas?

Dr. Sherry Siddiqui (00:38:22 --> 00:40:49)
So I think when we're talking about the stigma of psychedelics, it's helpful to bring to mind the historical context, which is that, you know, as you alluded to, in the '60s, psychedelics were being used a lot and they were associated with the counterculture movement. So now there's sort of an association between— and rightfully so, there's an association association between psychedelics and the anti-Vietnam War protests and, you know, the sexual liberation movement. And basically there's a disruption to the public order and the mores of the time. And, you know, that's when the government started to crack down on these substances. As you said, the Controlled Substances Act happened in the '70s or in 1970.

So, you know, I think I think that's partially where the stigma started in the States. And there's a lot that's happened in the last few years, especially to kind of bring them back into the mainstream, including again, you know, Michael Pollan's book, which I think did a lot of heavy lifting in terms of removing the stigma of psychedelics. But I think, you know, when you are surrounded by the types of people that I'm surrounded by who are so enthusiastic about the medicinal use of psychedelics, and, you know, I also live in New York City, so, you know, the average person tends to be pretty, at worst, neutral about psychedelics. It can be really easy to forget that there are still a lot of people who see psychedelics as quote-unquote drugs. There's a taboo against drugs.

Dustin Grinnell (00:40:49 --> 00:41:46)
This may be kind of a hard question, but I wonder if you have like a way to talk to people who are afraid to look inward and face their fears. I know myself, I mean, I've had a, like, an intellectual interest in potentially pursuing a psychedelic experience, but I'm scared, you know, what's going to happen? You know, am I going to have this hellish experience? Am I going to have the worst day of my life? Or am I going to work some things out? And what do I even need to work out? And am I ready for it? And so I'll just kick that can down the road. And I think there's a lot of people out there who think that way because of maybe the stigma, because people think they're going to lose their minds or have a psychotic break or something. What do you say to someone who's on the fence, who may be interested in using this form form of therapy to deal with their problems, but they're, they're not quite there yet?

Dr. Sherry Siddiqui (00:41:46 --> 00:44:13)
Like, you know, there was a myth in the '60s about LSD scrambling your DNA, and that is like patently false. I don't know that there are a lot of people who are actually worried about that nowadays, But I, you know, I think part of it is just helping people understand what are legitimate concerns and how they can be addressed. I'll talk more about that in a moment and what is just not true. Now, I would never personally pressure anyone into psychedelic use. I think that the fear that people feel about use is somewhat warranted in that, again, it can be a very scary and even harrowing experience sometimes.

And so So if someone is just not wanting that experience, I think that's totally fair. But you know, your question was maybe more about people who are on the fence, people who are interested, but you know, still have some misgivings. And I think to those people, I would say something like, first of all, again, set and setting are going to be really, really, really important. For example, if you take a significant dose of a psychedelic like mushrooms or LSD and go to a music festival, first of all, that setting is more likely to produce an experience that's more external and maybe having to do with appreciating music or dancing or whatever. In contrast, if the setting is you are with a bunch of people that you don't really trust, the likelihood of having a so-called bad trip or a difficult experience is a lot higher than if you are with a therapist, or at the very least with someone that you really trust in a place that's really safe.

Dustin Grinnell (00:44:13 --> 00:45:22)
Yeah, I think that's what's so appealing about psychedelics-assisted therapy to me, because it's so thoughtful in setting you up and setting expectations and helping you integrate. That seems to mitigate a lot of the potential worries that are involved. And, you know, sign me up, you know, I think I would much rather do it in the set and setting in the context of PAT than go to Peru and God knows kind of what I'm ingesting and God knows what supports around and some guy just blows smoke all over my face and, and I just have the worst night of my life, you know. So I think that's why I wanted to talk to you so much because it's like this field, this taking psychedelics in the, in the context of a clinical setting is just so appealing and it seems less risky and more productive and more healthy potentially. So I imagine you think exactly the same way as an actual psychologist. You're probably thinking, man, there's a lot of promise to this approach.

Dr. Sherry Siddiqui (00:45:22 --> 00:47:51)
So I think it can be helpful to remember that, like, whatever happens, you will come back, right? And the defenses that were removed that potentiated you having these maybe really difficult experiences are going to come back online. The ego is going to come back online for better or for worse. So I think that's another helpful thing to keep in mind. I do also just, I guess, briefly want to touch on your comment about, you know, going to Peru or, you know, participating maybe in indigenous ceremonies, which is to say, I think there are a lot of different models for how these medicines are used.

I have a lot of respect for the way that, you know, plant medicines have been used indigenously. I have a lot of respect for, you know, the shamans who are running some of these retreats in Peru, not all of them, but many of them. And so I personally don't think those are quote unquote wrong settings to do psychedelics in. But I think for, you know, the average American and in a certain maybe like, you know, white collar setting or something like that, a medical model is going to be more approachable. It's going to be more comfortable.

Dustin Grinnell (00:47:51 --> 00:48:27)
Yeah, one thing I like about the medical model is the, maybe the final step in the process of psychedelics-assisted therapy, which is, you know, integration, right? You touched on it a little bit, but I was wondering if you if you could talk about it a little bit more, and maybe add some color to it as well, if you can. So the patient has their dosing session, they have an experience, they then have a session or sessions with you, where you talk about it. What do you talk about? What do they come back with? And how does the integration process really happen?

Dr. Sherry Siddiqui (00:48:27 --> 00:53:17)
Yeah, I'm glad you're asking me about integration, because because integration is really going to be a crucial step in helping the effects of the medicine be long-lasting. Right. So without integration, much more likely than not, the person is going to come out feeling great. They're going to feel like they've had all these insights and their life is going to be different. And what inevitably happens is they go back to their regular life and they fall back into the patterns that they fall into behaviorally, cognitively, and so forth.

And, you know, within a span of a few weeks, maybe a couple of months, they sort of end up back where they started. So integration is really the process of, like, integrating the insights from the psychedelic experience into day-to-day life. So I'll talk a little bit about what that looks like. I'll start off by saying, first of all, that, you know, psychotherapy or talk therapy is not the only way to integrate. Verbal integration is not the only kind of integration, right?

So integration for people can look like doing yoga, it can look like doing breathwork, it can look like spending more time in nature, exercising, journaling, right? So psychotherapy is one part to verbal integration, or cognitive integration is one part of what's hopefully a more robust sort of integration package. But as for what happens in therapy and again, what's happening in these clinical trials and 3 more 90-minute sessions spaced out a week apart from each other post the final, I think a week, maybe longer. Post the dosing sessions is that first of all, the person just talks about their experience. They maybe talk about the memories that came up, the images, the visuals, the emotions.

And I think that, you know, this process of like almost building a narrative around the experience, um, is a really important one because, you know, we're storytelling creatures. And, and having a story around what happened, I think, is, is a really important one just in terms of being able to hold on to it and hold on to the sense of meaning. So that's part of it. You know, as therapists, we help clients sort of elaborate on the insights and, and what it means to to them. So a person might say something like, I realized that the abuse that happened to me actually wasn't my fault, and, you know, I'm basically a good person.

So that's a really important insight, and I, I think it can be really helpful to kind of talk more about that. And what do you mean by that? And yeah, I think another thing to actually keep in mind in terms of integration is that following the use of psychedelics, there is going to be a neuroplastic window. With different substances, that neuroplastic window is going to look longer or shorter. But basically, within that neuroplastic window, like, the person is no longer, you know, tripping, but the brain is still really sort of receptive to learning, to basically adapting new behaviors.

So it's really important to kind of like strike while the iron is hot in terms of like new learning in that period where the brain is just sort of like biologically in a much more receptive state. The other part of integration is like once we have a sense of what these insights or realizations are, helping the person figure out how do you actually implement these insights in your day-to-day life. So let's say another insight is the person comes up with, you know, I realize that my physical health is so important to me and that my life would be really miserable if I were to get sick, um, or if I were to have more aches and pains or whatever. And so, okay, so the way we would translate that insight is maybe like, do you need to exercise more? Do you need to like see a dietitian to figure out how to eat in a different way?

Dustin Grinnell (00:53:17 --> 00:54:25)
Like, for example, you said that many people have this feeling, you know, if like selflessness or self-orientation kind of goes down, there's a feeling of connectedness, the interconnectedness. With other beings, with nature. That seems like a commonality. But there's also, it seems like if you're reading Michael Pollan's work, it's like the word love always comes up. It's all about love kind of thing.

I wonder how you help patients or even yourself when you experienced a psychedelic experience. How do you make sense of, how do you give meaning to that? Because that seems to be really really deep and hard to work with in a sense. Like, how do you come back to your day job, your job, your life, and know that it's all love? It's all— we're all interconnected.

Dr. Sherry Siddiqui (00:54:25 --> 00:56:25)
How do you hold on to that? Yeah, it's such a good question. Because I think that without the feelings that accompany a sentiment like that in a psychedelic experience, you know, phrase like, it's all love can ring so hollow. Like, okay, what is— what does that mean? What's all love.

It's my refrigerator love, right? Or like, there's a term that's used in the psychedelic space a lot, which is like the noetic quality of a realization. And basically what that means is that like, with psychedelics, when people have realizations, there's just like this sense or this feeling that the realization is true. And it feels true, like there's something about it that feels very real, or as some people would say, like even realer than real. And, you know, I think that noetic quality can sort of leak out as time goes by.

And, you know, what we're left with is like just, yeah, you know, like a Hallmark phrase. And it's like, what do I do with that? And I mean, I can speak a little bit to my personal experience of this and like what integration has looked like, which is if I make love a priority in my life, right? Like, so what would that look like? What does that look like?

For me, it looks like service, it looks like charity, it looks like calling my parents more often, you know, to see how they are. It looks like doing, you know, metta or loving kindness meditation. So, you know, I think something like that is going to look different from person to person. But that, you know, especially again, the period shortly after the psychedelic experience is one where the person can sort sort of more easily think through what do you do with this realization. And again, like, what do you do with your hands?

Dustin Grinnell (00:56:26 --> 00:58:07)
You know, I think as someone who's, uh, just curious about this field and has, you know, even seen kind of like the Netflix documentary How to Change Your Mind, there are some just really compelling stories about people who had these experiences and literally say it was the best moment of their life, like maybe up there with having a child or getting married. And one guy who was dealing with like very severe OCD symptoms for his entire life, and it was like affecting him as a parent, he had this experience where he just— all of his symptoms more or less went down to the point of going away after an experience with, I think, psilocybin. And he says he thinks about his life before the experience and after the experience. It did change his life in a very profound way. He, he even looked different on camera, like he just looked like a different person, and he was a different parent and a different husband and Again, it may not be representative of everyone's experience, maybe the best-case scenario. But I wonder what you think about the promise here and the potential, not just for depression, anxiety, and OCD, but addiction and what else. Like, where, where are we going here? Because the stigma is going away. The classifications may change in the near future., and you're poised as a practitioner to help people in a very deep way. What to you is the promise?

Dr. Sherry Siddiqui (00:58:07 --> 01:00:43)
It shows people that gaining some distance from your trauma or from thinking about yourself as a traumatized person or an isolated person is possible. Not being depressed is possible. And I think that's really nothing to sneeze at, right? Like, especially for people who have had, let's say, persistent depression for years and years and years, you know, beginning in childhood, and they're sense of self feels so sort of intermingled with being a depressed person, just the experience of not feeling depressed or feeling hopeful or seeing life with more color and vividness can be extremely invaluable in just showing them that this is possible for you, right? Like this, like this this place exists.

And again, a lot of the times after these experiences, you know, people slowly end up reverting back to whatever their baseline mood was, maybe a little bit better, maybe now they, you know, and you know, that, that's too bad. But I think that part of the promise is they are able to remember, they are able to envision themselves again as being people who are capable of not being depressed. Or, you know, another thing to think about is if you have a very mystical experience or you have an experience that there's something bigger out there and there's something smarter out there than my own mind, I might go back to being kind of whatever, egocentric or out of touch with that. But just remembering the experience of there was a moment in which it was so clear to me that there's a higher power out there, that in itself can be really powerful. Just sort of like knowing that there's a there there, right?

Dustin Grinnell (01:00:43 --> 01:01:02)
So one of the things you said earlier in the conversation that was maybe common about mental illnesses kind of in general is this kind of cognitive rigidity that you spoke about. I wonder if you can elaborate a little bit more about rigidity and maybe where psychedelics play into that.

Dr. Sherry Siddiqui (01:01:02 --> 01:03:42)
So there's a way of thinking about mental health issues as having a common core of cognitive rigidity. And what I mean by cognitive rigidity is sort of resistance to change, right? Resistance to changing beliefs, resistance to changing behaviors. I think we're talking about sometimes really extreme thinking or black and white thinking, good or bad, like very sort of like judgy thinking. I think it's sort of not being able to sometimes put our problems in a larger context than becoming really fixated on them.

Sometimes it's rumination or persevering on a certain incident or thought. Those are all different facets of a very fixed mind or a very rigid mind. Again, with psychedelics, what we see is more cognitive flexibility. What that means is more openness to new ideas, to new ways of thinking about things. It's also like flexibility in terms of like the connection between the different regions of the brain that are now kind of communicating with each other a little bit more.

And that allows for like new ideas and new insights to come up. And, you know, there's also a lot to be said about the neuroplasticity that persists after the acute effects of the drug wear off. And again, depending on what the drug is, that's gonna look like a few days to sometimes a couple of weeks or even a couple of months. And I think what's really important, or interesting rather, to say here is that there is currently people that are working on developing psychedelics that don't have psychedelic effects. So it doesn't, you know, you're, you're not going to be tripping, but what it will do is kind of promote that kind of cognitive flexibility, neuroplasticity.

Dustin Grinnell (01:03:43 --> 01:04:14)
One thing you talked about, like earlier in the process of psychedelics-assisted therapy, is this process of finding the right medicine for the right patient for the right problem, a kind of matching process, so to speak. Like, how does that happen? So people come in with a certain set of things they want to or expect to deal with? And then how do you get to the point of like choosing the right medicine for their specific problem?

Dr. Sherry Siddiqui (01:04:15 --> 01:07:25)
So I think part of it sort of remains to be seen in terms of, you know, what the outcomes of these different studies are. But putting, you know, that sort of piece of it aside, something that we might want to think about is there are different factors to consider, is what I'm trying to say. And it's important to understand how these medicines work in order to kind of be able to make a good choice about what medicine might be appropriate for whom. So for example, one thing we might consider is like the gentleness versus the intensity of the medicine. So typically MDMA is considered to be one of the most gentle psychedelics/quasi-psychedelics.

And this is what we talked about earlier in terms of the person can feel a lot of empathy, compassion, love. There are a lot of pleasant states that are associated with MDMA. Again, I will stress, not always. Sometimes people confront trauma. Like with MDMA and they have a trauma response and it can still end up being really therapeutic and helpful, but it's not pleasant.

Putting that aside, MDMA tends to be a more gentle psychedelic. Then on the other end of the spectrum, we have things like LSD, ibogaine. These are substances where the trip is going to last anywhere between 12 hours for LSD and I think up to 36 hours for ibogaine. And these are really, really intense, not entirely pleasant, physiologically difficult experiences. So we want to consider, you know, what the person is coming in with.

We want to consider what their tolerance might be for a more intense trip that might also be sort of more spiritual, more mystical. So they're also getting a lot out of it. But with something like PTSD, where fear is already felt in such an intense and overwhelming way, a substance like MDMA is likely to be more appropriate because it's more gentle, because it kind of suppresses the fear response. So, you know, those are some factors. And then there are also sort of practical concerns like time.

So a substance like ketamine is really fast acting. You know, the whole trip is like 40, 45 minutes, another hour, the person's in the clinic. Quick, maybe 2-3 hours max. Whereas again, if you're doing, you know, therapy for anxiety with LSD, which there are currently some studies for, that's going to be, you know, a 12-hour, like, long trip. And then when you, when you consider the fact that you're paying the practitioner by the hour, you know, I imagine that some treatments are going to be a lot more affordable for other than other ones, considering factors like time.

Dustin Grinnell (01:07:25 --> 01:07:49)
Okay. Another question I wanted to ask, because it seems so important in the context of healing and therapy, is what is the importance of the bond or connection or allegiance between the patient and the therapist or the practitioner? What qualities need to be there in order to promote like the best outcomes?

Dr. Sherry Siddiqui (01:07:49 --> 01:09:32)
I would start off by saying that the therapist— I mean, we can think about the therapist as a really really important part of the setting, which is going to really shape the psychedelic experience. Insofar as there is trust in the therapeutic relationship, trust both in terms of like, you are not going to cross my boundaries, you're not going to violate anything, but also trust in terms of like, you are competent at your job, you are not going to be judgmental, you're going to accept me, you're going to really be present with me and not be checked out. So insofar as those things exist, what happens is that the psychedelic ends up facilitating a sort of relationally reparative experience, right, where the person might, for what might be the first time in their life, have the experience of going to a place of deep sadness, deep anger, and having someone there with them who is caring, who's not judging them, who's not trying to like cheer them up, who's not rejecting them. And, you know, experiences like that can be extremely powerful, again, when especially when the mind is more sort of suggestible, plastic, able to sort of integrate these experiences. So yeah, I really can't overstate the importance of a solid therapist-client relationship and rapport for psychedelics-assisted therapy.

Dustin Grinnell (01:09:32 --> 01:10:17)
I just have a couple last questions. One of the things I wanted to ask is, you know, you're a clinical psychologist, a therapist, but you've also obtained this training in psychedelics-assisted therapy. And so you have your feet in both worlds. And I wonder what you think maybe traditional psychotherapy can or can't do that psychedelic-assisted therapy can or can't do. Like, is there something that a psychedelic experience that, that can touch, something that can unlock a certain aspect of, of our minds that traditional therapy can't get at? Or have you thought about that comparison before?

Dr. Sherry Siddiqui (01:10:17 --> 01:13:49)
You know, one thing I will say is something that's heard a lot is people saying like one psychedelic experience was like doing 10 years of psychotherapy. And I don't know, I think that's an overstatement in some ways. It's, you know, but I think what it gets at is that the work can just happen a lot more rapidly because, you know, part of what these substances do is that they lower our characteristic defenses against feeling certain things, thinking certain things. And so when we're actually able to really confront those feelings, we're able to resolve them in the context of the psychedelic session. It can sometimes take years and years for a person in psychotherapy to get to a place where these defenses are sort of lowered enough and where the person feels safe and trusting enough with the therapist to be able to, let's say, like confront a particular their trauma.

Now, obviously, there are better ways of doing psychotherapy. There are worse ways of doing psychotherapy. There are more effective and less effective ways of doing psychotherapy. And, you know, obviously, that's, that's a whole other conversation. But I think on average, psychedelics-assisted therapy is going to allow people to move more deeply and quicker than they would in traditional therapy.

And I think that's a huge deal, right? Like, if you are able to do really significant work with psychedelics-assisted therapy in the span of, let's say, 3 months versus 3 years, you know, that's like in regular, you know, traditional therapy, that's like 2 years and change of your life that you, you know, can live in a more fulfilled and happy way. So yeah, that's sort of one big thing I would, I would point to. And then the other piece of this is what we were talking about earlier in terms of the inner healing experience. I think by and large, and again, there is variation between different kinds of therapy and different theoretical orientation, but by and large, psychotherapy is fairly directive, right?

And that the, you know, hopefully in a collaborative way, but really the therapist still has a significant role role in sort of identifying like, okay, these are the important things that we need to address. This is your treatment plan. This is what, you know, how I think we're going to get there, right? So most traditional therapy is going to be at least partially directed by the therapist, partially led by the therapist. And I think that can be necessary, right?

Dustin Grinnell (01:13:49 --> 01:13:56)
What do you think about the future of psychedelics and therapy? What do you hope for?

Dr. Sherry Siddiqui (01:13:56 --> 01:15:13)
What is your hope? My hope is, first of all, that following, you know, rigorous research into both the efficacy and the safety of these medicines, they are rescheduled. Certainly my hope is also that they're decriminalized, but that's for recreational use, but that's a different conversation. My hope is that they come to be seen as a powerful tool that can be used amongst a set of other tools to help people move toward healing. A concern I have is that psychedelics come to be seen as the thing, as the magic bullet. Now there's no more, you know, use for traditional psychotherapy. There's no more use for psychotropic medication, support groups, and all of that. And, and I think that's simply not true. So my hope is that we can take both sort of an optimistic attitude to work with these substances, but also a measured and, might I say, sober view to them in terms of being able to see their potential as medicines.

Dustin Grinnell (01:15:13 --> 01:15:30)
So, Dr. Sherry, Dr. Siddhikum, thank you so much for coming on the podcast to talk about your work. I just want to give you a chance to direct listeners to where they could learn more about your work. So if you'd like to let us know where we can, we can learn more or follow up with you, please do.

Dr. Sherry Siddiqui (01:15:30 --> 01:15:46)
Thank you so much for having me, Dustin. Yeah, I am at drsherry.com, the word doctor spelled out. D-o-c-t-o-r-s-h-e-r-r-y.com. And if any of your listeners want to get in touch, they can contact me through my website.

Dustin Grinnell (01:15:46 --> 01:16:10)
Right. Well, thank you again. Thanks for listening to this episode of Curiously. I hope you enjoyed this conversation with Dr. Sheri Siddiqui. If you're enjoying this podcast, please consider leaving a review. They encourage people to listen and help attract great guests. If you like what you've been hearing and would like to sponsor the podcast, please consider supporting me on my Patreon account. Thanks again for listening and stay tuned for more conversations with people I meet along the way.