More profound than anything else we have done.
MDMA-assisted therapy is going mainstream: Bessel van der Kolk is not only one of the worlds leading trauma researchers, and author of the seminal book on trauma «The body keeps the score».
He is also involved in two large multi center phase-3 studies on MDMA-assisted therapy for post-traumatic stress disorder (PTSD). This makes his perspectives on this new treatment extra intriguing.
In the podcast interview right below, Bessel van der Kolk will share his experiences as the principal investigator at the Boston site. He will also share his deeply personal experiences from his own training where he recieved mdma-assisted therapy himself.
For me, it was a transformative experience where I got much more respect for what it’s like to actually carry all this pain that people dump on you.
The podcast-hosts from Psykologvirke, a private psychologist clinic in Oslo, are also involved in this research and will compare personal notes from the same training.
First and foremost you will learn a lot about both published and unpublished data from the MDMA-assisted therapy for PTSD trials.
Finally, we will touch on both possibilities and pitfalls with mdma-assisted psychotherapy both on an individual and societal level.
You get these transformations that I have not seen with any other treatment modality
Podcast interview with Bessel van der Kolk on MDMA-assisted therapy:
You can listen to the podcast and download it on our Podbean-site here or simply use the embedded spotify player below. Scroll further to read a condensed transcript of some of the main points – for those of you preferring a shorter read.
Condensed transcript: Bessel van der Kolk on MDMA for trauma
We are all in this together and we all have our crazy reactions.
Øystein Nødtvedt – Psykologvirke: So, Bessel, how how did you get involved in this research in the first place?
Bessel van der Kolk: It started 15 years ago when Rick Doblin and Michael Mithoefer (from MAPS) consulted with me on the topic of using psychedelics for PTSD. I said it was a great idea, but that they still shouldn’t do it.
In 1994, I did a symposium at the American Psychiatric Association where I called together a lot of the old LSD researchers and had them review what they found.
They were some of the most depressed people I had ever met, because politics had shut down alle the exciting resarch they had been doing. They ended up feeling they had wasted their lives.
I told Rick and Michael, don’t do it because you will probably feel like you wasted your life also, because the politics of using these drugs is just too cumbersome.
But much to my astonishment, the two of them were able to get permission to do a Phase one study. And then to do phase two studies at one point. They worked out quite well.
And when they asked me if I wanted to take part in the first phase three study. I said I’d be delighted. I mainly joined at that point to keep things very serious and very strict. Because I had seen how it blew up the last time.
Results from the first phase-3 clinical trial on MDMA-assisted therapy for severe PTSD
We know how to treat PTSD with other methods.
Øystein Nødtvedt – Psykologvirke: The results from the first big phase-3 study on mdma-assisted therapy for PTSD were published in Nature medicine earlier this year. How would you describe the data?
Bessel van der Kolk: The result in terms of numbers are interesting. But the results in terms of experiences, and the secondary analyses, are spectacular.
The numbers are that two thirds of the people lost their PTSD diagnosis. But measuring whether PTSD improves is sort of like «blah», you know, since we know how to treat PTSD with other methods.
Secondary effects of interpersonal trauma
The most interesting data yet on MDMA-assisted therapy.
The great challenge is the secondary effects of interpersonal trauma. Namely on your capacity to feel safe with people, to love yourself, to find yourself a worthwhile human being, to not be frightened about all kinds of different things, to be open, to be curious.
And that is not being measured in the main study that makes all the big press. But we did secondary analysis on self compassion, self regulation and alexithymia, understanding yourself.
To my mind, this is the most interesting data yet on MDMA-assisted therapy for PTSD. I’ve done research for 50 years, and I’ve never seen anything like it. It is stunning.
The data that we collected very much are in line with what we saw clinically in our subjects in our study. We only have a limited number of people. But every single subject that we saw had remarkable experiences of going very deeply inside.
People actually go into their trauma and they lie there and they suffer, as they go into it. But the natural defenses that keeps people from going there seem to dissolve in MDMA-assisted therapy.
So people have their experiences and say: «yeah, I was raped when I was three years old. And they go like «this poor kid, this poor child who I once was, that I had to go through it».
MDMA-assisted psychotherapy is expected to become an FDA-approved treatment within the next few years. Read more on maps.org.
Learn more from the first finished phase-3 studies on MDMA-assisted psychotherapy for PTSD.
MDMA-assisted therapy promotes deep self-compassion
Here, they feel the depth of the pain they are carrying.
The big thing that we see and our data also seems to support is that MDMA is capable of giving people a very deep sense of self compassion.
So rather than hating themselves for being as weak as they were when it happened or not putting up more resistance or taking it so hard, all the different things that people blame themselves for when they get traumatized, they go into a state of deep sort of compassion.
Here, they feel the depth of the pain that they’re carrying and can say, yes, this happened to me. It is amazing that I’m still alive after having gone through this experience that happened five years ago or 10 years ago or when I was three years old. But today is just June 2021 and I’m alive.
So you get these transformations that I have not seen with any other treatment modality.
And unlike most researchers who find one particular treatment method studying the same damn thing over and over again, my career has been focused on «what else might be helpful».
So I’ve studied yoga, it turned out very well. I’ve studied EMDR, I’ve started theatre groups, I studied neurofeedback, I studied various psychiatric medications.
But what we see with MDMA-assisted therapy is really more profound than anything else we have done.
MDMA-assisted psychotherapy – a treatment of the self
We are all suffering human beings.
Øystein Nødtvedt – Psykologvirke: That is very interesting. So you’re saying basically that not only is this treatment addressing the core trauma itself, but actually many of the side effects coming out of trauma, as relational issues?
Bessel van der Kolk: We call MDMA-assisted therapy a treatment for PTSD. But it is, like yoga and neurofeedback, not a trauma treatment, it’s a self treatment. It`s a treatment about who I am.
These are parts of my life that happens to involve trauma, because that’s what we select for, but it’s not a trauma treatment. It’s a mind-expanding treatment.
We all are suffering human beings, we have all had major disappointments, we have had hurt, we have had pain in our lives, some more than others. But we’re dealing, really, with the human condition.
MDMA-assisted therapy and the resolution of trauma
We are all in this together and we all have our crazy reactions.
The first time I did EMDR research was the first time I was confronted with the notion that patients told me «it is over». The trauma is gone. Not «my PTSD core declined by a certain percentage», but people said: «It’s over. I was molested as a child, but I’m not molested now. It used to sit in my body but it no longer sits in my body».
And that is very much the experience that we saw in our exit-interviews with our subjects. Even though our main measurements did not capture that.
But the secondary data analysis to me was fascinating in that the issue of self compassion just was gigantic and people stopped judging themselves and beating up on themselves.
People also had a sense of internal generosity and they had the capacity for self acceptance. And with that, the accepting of other people. So they no longer would defend against parts of themselves they couldn’t stand and projecting on other people.
So instead of judging they can go «oh, you get angry just like I do», or «you get uptight just like I do».
So you get much more of a sense that we are all in this together and we all have our crazy reactions.The secondary measures called that very nicely.
MDMA-assisted therapy improving alexithymia-scores
What can not be told to the mother, can not be told to the self.
One thing that really struck me in the secondary analysis was the Alexithymia scales.
Alexithymia is a very complex word that most people don’t know what it means, but what it means is a lack of capacity to identify what you’re feeling, to have no language for what you’re feeling, which is very highly correlated with childhood neglect and abuse.
Basically, I see my grandchildren growing up. And these children learn how to identify who they are and to talk about what they feel and what makes them feel good and what makes them feel bad.
This is very much part of becoming a well functioning human being, to know what this creature that you inhabit, feels and knows and needs to be done.
So Alexythymia is a measure of not knowing that. Alexithymia is very much something correlated with people having no caregivers who helped and to mirror them and say this about your feeling and impact, there’s no dialogue.
My favorite phrase in this regard is what John Bowlby said «what cannot be told to the mother, or the other, cannot be told to the self». So as long as you live with caregivers who don’t see you, that really impairs your capacity to know who you are and what you’re feeling.
And indeed, the vast majority of our subjects in the MDMA-assisted therapy study had terrible Alexithymia scores.
MDMA-assisted therapy and the rediscovery of the self
It is stunning, that sense of self that came online.
Then they have three lousy sessions of MDMA, and they know what they’re feeling and they have language for their feeling and they can articulate about who they are.
You know, this is a huge issue in the field right now. The latest neuroscience stuff in the area of trauma is very much about the loss of sense of self that comes from trauma.
What you see in the MDMA-assisted therapy is that people have a self. They say: This is who I am. This is what I feel, this is what’s important to me. That’s what’s unimportant to me.
And I’m no longer dependent on what you feel to dictate what I feel. I have my own feelings. So we saw this in our study clinically, not in our outcome measures.
For example, we had some people who had very nasty, abusive relationships. And rather than saying, my husband or my wife is such a terrible person who does all these terrible things, they said, «I’m actually married to a very dysfunctional person. I need to negotiate what I need in a calm way because that’s what I need».
I was astounded at how two of our subjects were able to negotiate, exiting their relationships in a very calm and mindful way without blowing up or becoming threatening or becoming all uptight.
They say «this is what I need and we can do right now, I see who you are. So this is how we can negotiate our relationship».
This is really stunning, that sense of self that came online. We have some data that I actually am trying to write up right now, which I hope will become a very important article in the field.
Concerns with MDMA-assisted therapy
We did not see a single serious adverse side effect.
One concern with MDMA-assisted therapy is that people will run out and start making a lot of money by the careless administration of these drugs. And I think, you know, that’s very much how the pharmaceutical industry took over psychiatry.
To my mind, psychiatry lost its soul in its marriage to the drug industry as psychiatrists largely became a bunch of drug pushers. That we have lost our minds.
Here, we have a chance to reclaim the minds. But boy, am I worried about profits. That sort of stuff can really get in the way of creating optimal healing environments.
What’s fascinating about the recently published study on MDMA-assisted therapy for PTSD is that we had no serious adverse side effects. Which really surprised me, given how painful and intense my personal experience was.
I can’t imagine having done this journey without people who are trusted and felt safe.
So I’m really worried that people will do this by themselves or with friends or in unprotected situations, because you really open up Pandora’s box with mdma-assisted therapy.
You need to have people who really help you to contain it for you. And part of it is that that makes it very expensive.
As you know, the study that you’re doing is enormously expensive because we pay two therapists an enormous amount of money to be there all the time.
How can MDMA-assisted therapy look like near you?
You can find healing where money is not involved.
My organization, the Trauma Research Foundation, is very interested, in fact, that this whole trauma field started with laypeople and it started in the feminist movements in Cambridge, Massachusetts, where some people wrote a book called «Our Body, Ourselves».
When I started in this field, we had peer support groups for veterans who did much better with each other, than professionals did. Most of that peer support is gone.
I would be very interested in having people actually trained as laypeople to in return for getting this treatment, giving it to others, to really get it out of the money world of therapy and insurance companies, etc. But this will be a major challenge for our field.
Øystein Nødtvedt – Psykologvirke: I guess that’s a cultural problem as well, as if suffering has been specialized into a certain field and there they’re going to get fixed. So the local community doesn’t really have a role in supporting the fellow man or a woman anymore.
Bessel van der Kolk: The local community, of course, it’s still there, but most psychiatrists and psychologists don’t give any credit to the local community.
And I think we need to be much more sensitive that therapists and psychologists are only a small part of the people who can help people to get better.
We have a relatively small part to play in this, and there’s all kinds of other possibilities, like 12 step programs. You can find healing where money is not involved.
MDMA-assisted psychotherapy and societal implications
This work makes you very loving towards the people you work with.
Øystein Nødtvedt – Psykologvirke: Right. And that’s interesting because maybe there is a sense that community is actually dissolving, with the current increases of loneliness. The UK have their own minister of loneliness now. We’re kind of living on our own islands, so to speak.
Do you think MDMA or rather that the movement with the psychedelic research and this form of thinking in terms of humanism and compassion for all, could that play a role in the mitigation of this development?
Bessel van der Kolk: Very interesting question. It’s a very good question to ask ourselves. Is it possible?
One thing i am Impressed by, is that in my own MDMA-assisted therapy team, of disparate people from different backgrounds, are so deeply connected with each other. And how this work makes you very loving towards the people you work with.
I’ve seen very little of the stuff you usually see in academic environments of people getting competitive and hierarchical. I’ve not come across that very much up to now. It’s been a very healthy, generous culture.
Human beings are what they are, so it is almost too good to believe that this can persist over time. But I hope and think MDMA has the potential of actually contributing to exactly what you’re talking about.
We will see, human nature being what it is. Its tricky.
Is it safe to open Pandoras box?
If you become careless, I am sure bad things will happen.
Ivar Goksøyr – Psykologvirke: I would like to just rewind a little bit to what you said about the importance of having an appropriate frame for doing this, opening Pandora’s box.
It’s important for listeners who may think, hey, let’s just take some MDMA. But also, I think, when this is coming for psychiatry. Many medical doctors are still thinking of MDMA-assisted therapy for PTSD as mainly a psychopharmacological treatment.
There is a huge challenge in communicating the integrative nature of this treatment, the inner work that needs to be done both before, during and after the experience, to both laypeople and our friends in the medical field.
Bessel van der Kolk:That’s a cultural a cultural shift, then.
Ivar Goksøyr – Psykologvirke: Yes, right. So another criticism relates to what you said, opening pandoras box. Do MDMA-assisted therapy open up too fast, too quickly. Is it safe? Is it advisable? Have you seen, for example, adverse events or people having opened up too much too soon, and not being able to repress the material as functional in the aftermath?
Bessel van der Kolk: So actually there are two issues here. What I find troubling is that now we are talking everywhere about how great MDMA is, but it’s still an illegal substance. And I get emails every day asking «where can I get MDMA treatment?» And I have to say that it will not be legal for another copule of years.
So right now we are going to slowly.
Then the question is, what will happen if it goes too fast and we all will lose control? That is a question that we need to pay attention to and be very cognizant of. But you and I cannot control it. We can just put our stuff out.
As I said before in our study, the MAPS study of all these different sites, there was not a single serious adverse effect. But that’s really because the protocol was so careful. I’m sure that if you start opening this up and become careless, that bad things will happen.
I’m also very worried that one bad experience may stop this whole process. And so, for God’s sake, be very, very careful for now so that we don’t stop the medicalization process. But let’s also be very careful after that so we don’t open up to much.
Fading effects over time?
If we say careful, it will probably hold its power.
Ivar Goksøyr – Psykologvirke: This is new and the people involved is really engaged. Can a phenomena like the Hawthorne effect partly explain the good results? Treatments performing very well in research can fade over time as they are implemented in clinical practice?
Bessel van der Kolk: So it’s a good question to ask. Of course, we won’t know. It’s something to be on the alert for. It’s quite possible as people losen their standards and their training. It is very worth paying attention to.
But I must say, for example, my first entry into effective non-conventional trauma treatments was EMDR, which was about 20 years ago now. I must say that EMDR does as well today in my hands and in my colleagues, as it did 30 years ago, I’ve not really seen it not work for people over time.
So if we say careful, it will probably hold its power.
Therapists getting their own session of MDMA-assisted psychotherapy
This stuff had burrowed itself into the very core of my being.
Ivar Goksøyr – Psykologvirke: As part of the training of being a therapist in these studies, therapists are allowed to enroll in an FDA-approved protocol, having MDMA-assisted psychotherapy themselves.
For me, it was a profound experience. And even though it came late in my involvement in this field, it was an important confirmation that I’m on the right track, devoting some time of my career and life to to promote this work.
Would you like to share some of your own experiences during the training?
Bessel van der Kolk: Well, I’m actually curious to ask you what your experience was, but let me tell you about my experience.
So I have a friend who is a former commissioner of Child Protective Services in Massachusetts. He told me that a number of years ago he went to Bolivia and took Ayahuasca. And while he took Ayahuasca, all the abused children in the world who ever lived came to visit him.
So my friend told me extensively about his experience and how, at the end, it helped him. And I said to him, well, good for you, I hope that never happens to me!
Well, I was wrong. I took my MDMA, which is probably not as powerful as ayahuasca. And all the traumatized people I have treated came to visit me. Not in a cognitive way.
I just experienced all the pain that people had dumped on me in my 50 year work of seeing traumatised people.
And I was just lying there going «oh, shit. Oh, no. Are you sure this is a party drug»? Because I felt all the pain that had been dumped on me throughout the years.
Up to that point, people asked me all the time: How do you deal with all this stuff?
Limitations to a good support system
Trauma is not a picnic.
And I always said to people «oh, as long as you have a good support system and as long as you have a good marriage and you have good friends, you get to talk about your stuff, It doesn’t really become part of you».
Well, I was wrong. And so on MDMA, I got to see that indeed this stuff had come inside of me and had burrowed itself into the very core of my being.
So it was a transformative experience where I got much more respect for what it’s like to actually carry all this pain that people dump on you. And it has affected me, my perception of things.
And to some degree, that is very similar to what our study participants also experienced. They experienced that trauma is not a picnic, but they say that’s how it is.
That’s what’s happened to me. That was my experience.
MDMA-assisted therapy for PTSD: The role of the therapist
The body heals its own wounds.
What is also important, the people who are your guides are just there. They don’t do very much. Actually, you do all the work. Michael Mithoefer (a renowned clinician and researcher on MDMA-assisted therapy for PTSD) just spoke at my annual conference and he said something that really resonated with me.
He said «I used to be an emergency room doctor and all I did in the emergency room, people would come in wounded and hurt and I would clean their wounds. And so by cleaning their wounds, I did not make the wounds heal.
The body heals its own wounds.
As a doctor, the only thing I did was to clean out the side of the lesion so the natural healing processes of the body would be able to take place. And boy, that’s exactly how it is.
As a therapist, you don’t do the healing. We shouldn’t even call ourselves healers. We should call ourselves guides that make room for the healing process to take place. But the patients do the healing.
All the guide do for you is to be there as you go through this very painful process.
MDMA-assisted therapy for mental health professionals
MDMA allows you to be more honest with yourself.
Ivar Goksøyr – Psykologvirke: Yeah, that’s beautiful. I can relate, at least partly, to your experience. Main part of it was deeply personal, discovering more trauma in my own life than I actually had realized in a way.
It was nothing new coming up. But really, discovering the depth of the things that I already knew about and the widespread impact they actually have had.
It was quite amazing after having had quite a lot of useful therapy before in my life to see how much there still was to see and, in a way, how easy it was to see through everything and straight the truth of things.
Bessel van der Kolk: Because we have our internal ways of coping by walling things off and putting it away. And of course, that’s very good for people. People need to do that.
But the MDMA allows you to be, one way of putting it is to be more honest with yourself and to allow reality to come in. The reality that at that time may have been too hard for us to handle.
Bringing your pain to the grave
Give people the possibility to experience their own psyche in such depths
Ivar Goksøyr – Psykologvirke: Yeah, for sure. And I also had some part of the experience sort of taking in the pain of all the people in my own life, and in a way our ancestors.
And the painful fact that so many of them died and will die without ever getting the same chance for healing as I myself have been given.
In a way, it was a really hard experience, but it was also a lot of comfort in it, a lot of shared humanity, realizing how much we’re the same.
And that there might not be anything special about my pain. It comes in a different form. And of course, there are levels and some people are more lucky than others. But still there is something profoundly human and common there, uniting us.
So I really enjoyed what you said about the artificial distinction between the patients and and us.
Moreover, I would really like to see studies being set up for mental health professionals with MDMA to give people the possibility to experience their own psychology in such depths.
Managing the profound manifestations
Where can I get this damn drug?
Bessel van der Kolk: I’m really glad with what you said because it’s also my experience. What I’m worried about is that once people hear you and me talk, they’ll go like, oh, my God, I’ve got to do this!
I wonder how we can to keep these things contained. I think we’re lucky to be here at the beginning of this revelation. Basically, when things are still well organized and nobody’s trying to make money off it, or exploit it yet.
So I’m worried what will happen to this, because the last time people had the same experience back in the 60s people got too enthusiastic about it. So things went out of control. And as I hear you speak, I go like: where can I get this damn drug?
So the question is, how are people capable of managing the profound manifestations that come from this work?
The work has to be done
My body released reactions that had surfaced enough to trigger unconcious anxiety in all sorts of triggering situations, but still was trapped.Ivar W. Goksøyr
Ivar Goksøyr – Psykologvirke: Yeah, I would also like to add that the experience itself was profound. I really felt that some some pieces were healed, for example some symptoms of anxiety were gone for good.
Even though I’m pretty good at spotting anxiety in my patients, I didn’t even recognize this symptom in me as anxiety before this treatment. I always thought of it as simply a kind of motivation to get things done.
However, it always came in situations involving responsibilities. I could see how it was trauma-related from taking a lot of responsibility in overwhelming situations from a young age, just as many psychologists and other helpers do.
During my MDMA-assisted therapy my body released much of the reactions and feelings that had been stored there. Feelings and reactions that had surfaced enough to provoke unconcious anxiety in all sorts of triggering situations, but still was trapped.
It is huge that this anxiety is gone, but still, life is also recognizable after the experience. And a lot of stuff is a work in progress and some things are not worked through. So the idea of it being a wonder drug or a magic pill is not accurate.
It is truly remarkable and it does very deep things. But there are also limitations and the work has to be done.
Rediscovering yourself in MDMA-assisted therapy for PTSD
Their lives were complex beyond our wildest imagination, and we saw them grow tremendously.
Bessel van der Kolk: Yeah, and I think there’s a lot to be learned in this regard also. In the protocol for our study, as you know, people get three sessions. You and I as investigators only got one session. Actually I wish I had three sessions, and I’m sure I will before too long.
But for many of our subjects, their lives were complex beyond our wildest imagination, and we saw them grow tremendously. But I felt like a number of them should have had some more sessions.
Along the lines of what you’re talking about is that these should be experiences that should be used, and should be grown into and revisited on a regular basis.
One of the main things that I am left with from our study is that covid has really had a major impact here, is that we have been so isolated for a long time.
I think what we need more of is retreat centers and places where we can go to have these very sacred experiences on a regular basis.
Our societies should actually have centers where people can go not only on the basis of how much money you earn, but to make it available for people.
So you can actually take a retreat to rediscover yourself. I think we need to have more contexts in which this can occur.
End of interview
Øystein Nødtvedt – Psykologvirke: So then its just for me to say that it has been a real pleasure talking to you. You have a lot of interesting points, experiences and data to share.
We are excited about the future and to see wether MDMA-assisted therapy can reach more people that is not reached by existing methods.
Ivar Goksøyr – Psykologvirke: I would also like to thank you for your involvement in this field, and also for all the other stuff you’ve been you’ve been working on for all these years.
So a really big thanks from our hearts to you and and we are looking forward to cooperate in the future, maybe on some exciting research protocol!
Bessel van der Kolk: I’m glad you guys are contributing to this research being done in Norway.
It’s wonderful, actually.
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