A clinic that combines psychotherapy with ketamine treatment has opened in Bristol to ‘offer people new hope’
Upon hearing the phrase “psychedelic therapy” what’s the first thing that comes to mind? Is it a Goop-style trip to the rainforest where magic mushrooms help you unearth your deepest traumas whilst tripping balls? Is it a certain ayahuasca retreat in Ibiza where your journey towards opening the doors of perception comes complete with a shaman and a full moon women’s circle? Or is it a former Indian restaurant-turned-therapy-clinic in Bristol run by a psychiatrist and a clinical psychologist?
Last week saw the opening of the Awakn Life Sciences clinic in Bristol, the UK’s first provider of psychedelic-assisted psychotherapy available to the public. Until now, therapy using psychedelics (ketamine, MDMA, DMT etc.) has remained in the realm of academics and research trials. In 2016, an Imperial College London-based study found that psilocybin (the hallucinogenic ingredient in magic mushrooms) had the potential to help people with untreatable depression. Last April, experts from Johns Hopkins University said the effect of psilocybin-assisted psychotherapy in their study “was about four times larger than what clinical trials have shown for traditional antidepressants on the market”. While in December, the first clinical trial using DMT to treat depression was given the go-ahead by UK regulators.
But now, Awakn, a clinical-biotech company researching and developing psychedelic-assisted therapies, has taken the first step towards making these therapies more widely accessible with its clinic in Bristol, the first of many planned around the country in the coming years. A clean, bright space designed to make patients feel comfortable, the clinic will start with a focus on ketamine-assisted therapy – currently the only psychedelic compound that’s licensed for use as a medicine outside of research. Led by Dr Ben Sessa and Dr Laurie Higbed, both approved and trained psilocybin therapists, the clinic will offer nine-week treatment sessions for a wide range of conditions including alcoholism, depression and anxiety disorders, and addictions.
We spoke to lead psychologist Dr Higbed to find out more about the clinic and its innovative treatments.
What can a patient expect when they come to the clinic? How does the process begin?
Dr Laurie Higbed: We’ve got a careful preparation phase with the client. We’re really interested in getting to know that person because we need to establish the trust and rapport, so they feel prepared and ready for their ketamine-assisted session. We don't just see people as a diagnosis or cluster of symptoms. It's about what their story is, what's happened to them, what experiences they've had that shaped how they currently feel about and think about the world.
Then we talk to them a bit about how ketamine works, which, simply put, is that it helps with brain plasticity. That means it helps the brain become more interconnected and more flexible which enhances a person's psychological flexibility and ability to see old problems in new ways. We help the person to feel comfortable, supported, and ready to let go and be as open as they can during that ketamine-assisted session. The general protocol is 10 sessions across six weeks, and four of those are ketamine-assisted. Then there's a follow up session at week nine, three weeks later. So it’s a therapeutic intervention with ketamine use as an adjunct to support the therapy.
What do the ketamine sessions involve?
Dr Laurie Higbed: The drug experience will last a couple of hours during which the therapist will always be present. Afterwards, the client can chill out and relax in our comfortable recovery area, there's a nurse to support them until they feel ready to leave and they're accompanied home by someone of their choice. Then really importantly, they will come back the day after their ketamine session to have some talking therapy, not with ketamine. We call that an integration session to help make sense of the experience they had with the ketamine, think about the meaning of that, how they take that forward into their life, and what that means for them in terms of making changes.
Is there talking therapy during these sessions?
Dr Laurie Higbed: That can be quite dose-dependent, so at the lower doses it is possible to do a bit of talking whilst the person is under the influence of ketamine. But we are mostly supporting and encouraging someone to have an internal experience. So they will have headphones and eye shades on and will listen to music. They're really encouraged to spend that time just being open to what comes up under the influence of the ketamine. If they want to talk then they can but generally a lot of the talking comes during those integration sessions the following day. At the higher doses, where a person tends to feel a little bit more disconnected or dissociated, it is unlikely they will want to talk and will have a more internal experience.
Prior to the ketamine sessions do you provide them with prompts or guidance?
Dr Laurie Higbed: In the preparation phase we do talk about intention, so what a person would like to focus on or get from their drug-assisted session. But we also talk about having that intention and holding it lightly. What we mean by that is getting that really fine balance between knowing what you'd like to get from the experience, so that there is some focus, but also being able to be open to what comes up and not try to direct it too much.
If someone was entering into therapy because they had experienced some traumatic event or adversity in their life, we might, at some point during those drug-assisted sessions, gently encourage them if it hadn't come up naturally. But what we often find with this treatment is that one of the many things that's incredible about these compounds is what needs to come up for healing tends to come up naturally.
What kinds of patients will respond well to this therapy?
Dr Laurie Higbed: Current treatments that psychiatry or mental health services have to offer work well for many people but there is a cohort who don't get better on the current medicines or talking therapies that are available. So this is really offering people new hope. There’s an evidence base to suggest that ketamine-assisted therapy can be very useful for people with alcohol problems. There’s also evidence that it's useful to treat depression, and emerging evidence around people with anxiety problems and eating difficulties.
We’re really lucky at Awakn that we have Professor Celia Morgan working with us from Exeter University who has just completed a study using ketamine-assisted psychotherapy for alcohol use disorder. What came up in the study is that the combination of the ketamine with psychotherapy seems to really help reduce relapse rates and gives longer lasting change. Typically with alcohol, you’ll find three quarters of people are likely to relapse within a year. But in Morgan's study, it was around half that rate so it made a real difference over time.
“Ketamine enhances a person’s psychological flexibility and ability to see old problems in new ways” – Dr Laurie Higbed, Awakn Life Sciences
Would you ever say to someone, I don't think you're the right candidate for this therapy?
Dr Laurie Higbed: Yeah, absolutely. Just as with any treatment it's not a one size fits all, and it's not for everybody. If someone came to our clinic wanting to try ketamine-assisted therapy as a first line treatment, we would encourage them to try other things first. For example, a conventional talking therapy like CBT. Those treatments do work. It's just we understand they don't work for everybody all the time. So not everybody will be suitable and that's part of the assessment phase as well, just to check that the person is potentially suitable for this therapy and might benefit from it.
What are the differences between using ketamine or MDMA or another psychedelic in the therapy?
Dr Laurie Higbed: The similarity is they all support this kind of psychological flexibility. So they help a person go towards challenging internal experiences rather than avoid them which could be the key to processing those difficulties and, ultimately, recovery. So MDMA, ketamine, other psychedelic compounds, they share that ability but they do that in slightly different ways.
I'll give MDMA as an example. MDMA has been used most widely in PTSD research, to treat people with post traumatic stress disorder. The reason MDMA is a particularly great compound, in combination with therapy, for PTSD, is because MDMA switches off the fear response. In the brain, the amygdala, which gives us the fight, flight, or freeze response to fear, is really turned down when you take MDMA. In standard therapy, if you're trying to support somebody to talk through and process their trauma, what happens is, as they start thinking or recalling their trauma, the fear response is elicited, and the amygdala is firing. It becomes really difficult for them to talk about it, to think about it, and therefore to process it. With MDMA, you do that but with the amygdala dampened down. And people can find it’s the first time in their lives that they can think and talk about their traumatic experiences, and therefore start to process them.
Is there an equivalent emotion that ketamine targets?
Dr Laurie Higbed: Ketamine works more around the connectivity in the brain, so allowing it to be more flexible and open to change. You may have heard this analogy before, it isn’t mine, but in psychedelic research we often talk about these compounds as shaking the snowglobe. So as we grow, and we have experiences, some of which might be traumatic or adverse, we tread a certain path through the snow. And for somebody who's struggling, that path might make them feel quite stuck, and it might be quite rigid. As they keep going down that path it becomes harder to divert from it. You become entrenched and stuck in what might be an unhelpful way of thinking and viewing the world and yourself and other people.
Psychedelics shake the snow globe and throw all that up in the air and then allow that snow to resettle. Then you can create a new path through the snow. I really liked that analogy because it’s showing that those compounds just create the environment and the opportunity for the individual to create a new, hopefully more helpful path for themselves.
Some people are of the opinion that a clinical medical environment may not be the best place for a patient to use psychedelic substances. What is your response to that?
Dr Laurie Higbed: What the clinical environment provides us with is control over the setting in which these compounds are taken, and the insurance that there will be high quality therapy provided as part of this intervention. So we're just ensuring safety and effectiveness as best we can by delivering it in this environment.
The aim is for these treatments to eventually be available on the NHS – do you have a timeline for that?
Dr Laurie Higbed: As long as it takes! And how we can contribute to that is by producing the evidence base to demonstrate that these are safe and effective drugs. There's been a real surge in this field, in research with psychedelic compounds, but there's a lot of approvals to get, a lot of liaison with the home office and MHRA (Medicines and Healthcare Products Regulatory Agency). But the more we do it, and the more people involved, the more hope we have that we can continue this area of research.
We'll be bringing our research with MDMA into the next phase of development and there'll be more ketamine research coming from Awakn as well. So I can’t say when the MHRA will agree that it can be achieved, or when the NHS will feel that it can be funded. All we can do is try to contribute to the evidence.