Peplau's Ghost
Psychiatric-Mental Health Nurse Practitioners (PMHNP) discussing using psychotherapy within their practice. Four PMHNP program directors and a biostatistician from across the Unites States sharing their passion on how psychotherapy can help people with nearly all their emotional problems.
Peplau's Ghost
Psychedelic Therapy's Promise with Andrew Penn
Psychedelic therapy emerges as a transformative approach to mental health treatment, blending elements of traditional psychotherapy with the profound insights gained through psychedelics. Andrew Penn discusses the significance of set and setting, the therapeutic potential of these substances, and the intrinsic value of presence in the healing process.
• Introduction of Andrew Penn and his extensive background
• Historical context of psychedelics and therapeutic interest
• Importance of set and setting in psychedelic experiences
• Overview of the therapeutic structure: preparation, dosing, and integration
• Role of presence in nursing and its impact on therapy
• Addressing cultural misconceptions and challenges of psychedelic therapy
• Ongoing research and clinical trials in psychedelic psychotherapy
• Future prospects for nursing within psychedelic therapy
Andrew Penn's Website: andrewpennnp.com (Links to all his publications and connected activities
OPEN Nurses (community for nurses using psychedelics): www.openurses.org
Let’s Connect
Dr Dan Wesemann
Email: daniel-wesemann@uiowa.edu
Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner
LinkedIn: www.linkedin.com/in/daniel-wesemann
Dr Kate Melino
Email: Katerina.Melino@ucsf.edu
Dr Sean Convoy
Email: sc585@duke.edu
Dr Kendra Delany
Email: Kendra@empowered-heart.com
Dr Melissa Chapman
Email: mchapman@pdastats.com
Yeah, just my take on things.
Speaker 2:My answer number two Welcome everyone to another edition of Pep Lau's Ghost. Thank you so much for joining us. We're really excited about our guest today, andrew Penn from the University of California, san Francisco. Really excited to kind of learn a little bit about his practice and his exciting work using psychedelics integrated with psychotherapy. So really excited. Kate Molino from UCSF, kendra Delaney from Vanderbilt and Melissa Chapman from Minnesota the non-nurse who keeps us in line. So thank you so much everybody for joining us here.
Speaker 2:I'm going to do kind of a quick introduction. Andrew kind of mentioned. We want to keep this short, but that is not easy to do. He is a very well-accomplished individual that definitely needs to be celebrated. So basically, andrew has been in mental health care for over 30 years. He is a faculty trained at the University of California, san Francisco. Also teaches psychopharm there, involved with phase two of a psilocybin-facilitated therapy for major depression which was published in the Journal of the American Medical Association. So that's a big deal, nice, very good. He's also adjunct and teaches at San Francisco Veterans Administration.
Speaker 2:Co-founder of the Open Nurses, a professional organization for nurses interested in psychedelic research. Has also co-chaired and is on the steering committee for the NP Institute, also involved with a variety of other things, has spoken kind of everywhere. I'm looking at your bio South by Southwest. You spoke that you've had a TED Talk and we're just sharing. You had an interview with BBC. So again, thank you for coming to our humble little podcast here and I really look forward to kind of getting to know more from you with these questions. So, excuse me, when? Thank you, andrew. So first question I have for you when did you first get interested in psychedelic psychotherapy?
Speaker 3:You know, I think my interest in psychedelics actually goes back to high school. I read Aldous Huxley's the Doors of Perception when I was, I don't know, 15 or 16. I think I heard somewhere that the rock band the Doors had gotten their name from that book, and you know, this is in the 80s. So psychedelics were definitely in this sort of deep freeze following this sort of things. That happened, you know, both good and bad in the 1960s, and so it seemed like another world far away. But it was an intriguing book. I mean, for those who aren't familiar, this was Aldous Huxley's first experience with mescaline, which was actually given to him by a sort of adopted Canadian Kate I'm looking at you here Humphrey Osmond, who was really leading a lot of the research in the 1960s in Canada using LSD with patients that we would now call having alcohol use disorder, and so you know, psychedelics have long been sort of in the culture, and so I think the idea of using them therapeutically, which was an idea I think I started reading about maybe in the mid-early 2000s really intrigued me, and also it sort of parallels my own experience with conventional psychiatric treatment, which was that when I was trained I graduated UCSF in 2005.
Speaker 3:Psychiatric treatment, which was that when I was trained I graduated UCSF in 2005, you know we were going to save the world with psychopharmacology. Just a little pinch of that, a pinch of that was going to make everything all better and I believed that for a while and I practiced that way and after a while I began to feel a little bit disillusioned with this idea that there was going to be a pill for every ill and that these medications you know well. You know I don't want to disparage medications. I think that there's a lot of useful things we can do with them. But the notion of what if we could actually move psychiatry from a ostensibly a palliative practice again, no shade on palliative care, it's an important practice but what if we could actually start getting people better to the point where they didn't need treatment?
Speaker 3:Maybe I mean cure is a really hubristic word but what if we could get people well enough that psychiatric treatment became more episodic rather than chronic? So that was another idea that really started to intrigue me and I've also long had an interest. Also, back around that same early, impressionable time, I read Viktor Frankl and learned about the idea of making meaning from suffering and one of the things that maybe we can talk more about in our conversation is some of the experiences that people have under psychedelic therapy and the process of possibly finding meaning in things that have often been challenging for them in their lives, and that is something that can come start doing some of this research work working with a lab here at UCSF on a number of different studies that have involved psilocybin primarily, but I also worked on the MDMA PTSD study about six years ago now, so it's been an interesting journey.
Speaker 2:Thanks, Andrew. Yeah, I think we were just talking about this in another conversation. Just how things we do is kind of long time ago, kind of keep bubbling up to the surface. If it's, you know, something that's meaningful and impactful, I, I think we just never let it go. We just kind of we hold on to it and it just keeps twirling in the back of our brain somehow. So, yeah, thank you, Thank you for sharing that story.
Speaker 4:And I just want to add you know, andrew, I appreciate how you are both a proponent of psychedelic therapy in the present and future and also kind of a historian who's a registered nurse in Saskatchewan, which was a follow-up to an interview that was done with her in the 60s that was published in the American Journal of Nursing, if I recall correctly so 1964, she wrote an article called Supporting the Patient on LSD Day, which I was amazed to find and yeah, we went and interviewed her last winter.
Speaker 3:She's now 101 years old. She's now 101 years old, sprite, spritely and currently working on trying to transcribe and edit that interview down to it was five hours, five hours of recording. She had a lot of energy for 101 year old and get that out into the world in a way that people can appreciate her because she was really a visionary and a pioneer.
Speaker 5:Well, you know I'd love to pop in and you know, psychedelic therapy, or assisted therapy, is something that I feel like is such a hot topic right now, and you know I've had, you know, patients come to me and say, well, I'd like to do this, but like what does that actually look like? Could you? Could you give our listeners, you know, a sense of what do people actually mean when they mean psychedelic therapy? And are you know, are there any modalities that you integrate with psychedelic therapy that really stand out to you?
Speaker 3:Yeah, that's a great question. So this is definitely. It's been in the media a lot and I think patients are starting to come to us and ask us questions about it. So it's important for, even if nurses aren't delivering this treatment to their patients, to at least know about it so they can point them in the right direction. It's also important to understand that really the only compound that is legal and readily available that is psychedelic-like would be ketamine, or it's an antimers ketamine.
Speaker 3:In some municipalities in some states like Colorado, there are programs where things like psilocybin can be used clinically. It's sort of an interesting third way, because obviously it's still illegal in the US under the Controlled Substance Act federally, but kind of like cannabis, which is also a Schedule I drug. There are beginning to be these sort of workarounds and so when patients come to us asking about psychedelic therapy, they may not be aware that these things are not readily available outside of research settings. I think it's important for all nurses to know about clinicaltrialsgov, an amazingly easy-to-use government website which those two words don't usually always go together, but it's about as easy to use as Google and from that you can type in, say, depression and psilocybin, and it will direct you to studies that are recruiting or may soon be recruiting, and you can limit by geography and such. So that's a useful reference to know. And then the most readily available sort of psychedelic like treatment, and by that I mean you know. I should probably clarify what we're talking about, because I think sometimes people imagine that you know what are we talking about? Taking LSD every day Like that sounds not tenable and it wouldn't be. So the idea of using a psychedelic in a therapeutic context is different than, say, taking fluoxetine or something like that, where you're taking a pill every day.
Speaker 3:The idea is that it's really a psychotherapy model that is enhanced with the limited use of a psychedelic in a supervised setting. And so what I mean by that is that in our studies what we do is we have preparatory non-drug psychotherapy. So I will meet with a subject who's going to be in one of our trials multiple times to talk to them, to get to know them, get to know what they want to work on, what concerns they have, for them to get to know me. So very much that nursing model where there's a sort of a bi-directional working together that's happening, and then on the day of dosing so we might do that two or three times, depending on the study protocol. So it could be up to six hours or so of preparatory non-drug psychotherapy. Then, the day they come in for the dosing, I'm going to meet with them again. I'm going to have a dosing assistant with me, so there'll be two people there the whole time and we're going to have a dosing assistant with me. So there'll be two people there the whole time and we're going to get them settled in. We're going to make sure their blood pressure is okay, we're going to make sure they're comfortable, we're going to revisit whatever intentions they set in the preparatory therapy and then they're going to ingest usually psilocybin it's this you know.
Speaker 3:Or if it's a randomized control trial, it could be a placebo, and we're going to settle in there for the whole day. It's kind of a living room-like environment. It's quiet, it's comfortable, we have soft music going in the background. We have eye shades available if people want to kind of direct their attention inward. Sometimes there's talking going on. A lot of times there isn't, and we can get more into that if we want to.
Speaker 3:The drug reliably has a pretty predictable pharmacokinetic course. So you know, typically with psilocybin people are feeling something within about 30 to 45 minutes. The peak effects are about two to three hours and then there's sort of a several hour tail where it wears off and usually by hour five or six they're back to their sort of normal state of mind. Their ride picks them up the next day. We get on a Zoom call usually and we begin to integrate that experience. So we talk about what happened for you during that dosing day, what feelings came up, what memories came up, what emotions, what thoughts came up, and we try and look for opportunities to make sense out of that and also to integrate any kind of learnings or experiences into their day-to-day life.
Speaker 3:So somebody may have had, for example, somebody with depression might have had the realization like, oh my gosh, I really contribute to my own aloneness. You know I feel really lonely and I also contribute to it because I withdraw from people who are reaching out to me, you know. And so you know like we might do with regular therapy. We might say, well, you know, how could you do? How could that be different?
Speaker 3:You know, we might set a very small goal of like okay, so what if you reach out to two people between now and next time we talk to really start to take that very kind of abstract idea of like, well, you know, I had this realization that I was like this one person on this little tiny island, all by myself, but there's a bridge that I never went across, you know well. Okay, so what would going across that bridge look like? You know? Well, maybe it would involve, like reaching out to people that have been trying to reach out to me that I'm not responding to their texts. Okay, you know, is that something you'd be willing to do? Do between now and next week? Yeah, so you can take this very abstract idea and try and bring it into something that is maybe actionable and less abstract.
Speaker 4:Yeah, andrew, thanks so much for going through that. I think it's so valuable because, I agree, I think there is a lot of I don't know if it's confusion, but just maybe mystery around. What does you know this type of psychotherapy entail? I'm curious if you would share maybe a success story from a session, or you know any sessions you had that kind of taught you something or you know, any sessions you had that kind of taught you something.
Speaker 3:Yeah, you know, I think, about my very first one that I did, which was this was a. It was in the MDMA PTSD trial that we were doing and this is a. You know, without getting into too much identifying detail, you know somebody who had experienced trauma many years before and was, you know, in many ways a very affable, likable person. Tended to be very chatty, you know, which I can relate to, but also would also sometimes use talking as a way of kind of distracting himself from his emotional experience. You experience it was a well-adapted kind of trait and so this particular protocol. We actually had three dosings, so we kind of went through that wash, rinse, repeat cycle three times on this study and there was therapy in between each of the dosings, several opportunities for therapy without drug, and what we noticed, me and my co-therapist was that the subject tended to talk a lot in the first session, and that sometimes happens with MDMA. Mdma is qualitatively different than psilocybin in that MDMA tends to be a little more social, whereas psilocybin tends to be a little more introspective. Just in very broad terms, you can certainly have introspection on MDMA, but nevertheless he spent a lot of the first session really talking a lot and it felt like he was kind of almost felt like he needed to entertain us and I always make that clear with subjects that we're going to be sitting here with you but you don felt like he needed to entertain us. And I always make that clear with subjects that we're going to be sitting here with you but you don't need to take care of us. We're here to be present for them and that's one of those great nursing qualities that I think that nurses bring to this work is a quality of presence, and a few years ago I wrote a paper with Gene Watson about this, which I can maybe talk a little more about, but how nurses kind of cultivate care through presence. And I suggested to him in the preparation session I said you know, one thing that you could try if you wanted is that you know that feeling like on a Sunday morning when you don't have to be anywhere and you don't set your alarm clock and you wake up and you're kind of like still in a dream a little bit, you know you don't have to get up and get anywhere, so you can just kind of linger for a few minutes and kind of think about the dream and you know, be in that half sleepy state. I said you know what, if you spent some of your time on this next dosing session, like just trying that on, he says, oh yeah, that sounds great, I'll, I'll try that.
Speaker 3:And so, interestingly, he came in the next time and he took the capsules and he says I think I'm going to go inside for a little bit. And he says, you know, that's terminology we use to kind of be more introspective, maybe put the eye shades on, put the headphones on and really just allow yourself to be present with that experience. And he went in and he went in for like four hours. And it's funny because our protocol was to check on if they were quiet, to check on them every hour and we had to do vitals and that. So you know, it was a little opportunity to sort of gently touch him on the arm and say you know how you doing in there. He says I'm doing good, I want to stay in this space. It was like okay, you know.
Speaker 3:And so he really went for it and he really, when he came out of that, just shared with us these sort of daydreams that he was having and memories that he was having about the trauma to some extent, but also things that really gave him a lot of peace about that experience in his life, and so it was a great teaching for me, I think, is that you know, we're all so trained as interventionists, you know just all forms of healthcare. You know, I see this in our students. They're always listening to think like what do I do? What do I do next? Like, oh, they said something about panic, maybe I should think about an SSRI. You know, like we're just kind of doing this. It's like patient care becomes this matching test where it's like this symptom occurs and therefore we should do this. And we're always thinking about intervention.
Speaker 3:And you know, what I love about doing this work is that it brings it actually brought me back to nursing, which is one of the core things about nursing, which was about presence. It was like don't just do something, sit there and don't discount the value of your presence and your witnessing in this work and how therapeutic that is. And I think so often, especially when we're early learners, we think we're supposed to be doing something, we're supposed to make some clever interpretation, or we're supposed to identify something or come up with a prescription and it's like the great thing about this is that there's a sort of path that's happening and we just have to walk it with our patients, and I think that is really one thing that I've appreciated about this work is it's really brought me back to something that I've always liked about nursing, which is that we value the quality of presence it's so wonderful to hear these examples.
Speaker 6:So thank you for that Kind of on the flip side. I'd love to hear these examples. So thank you for that kind of on the flip side.
Speaker 3:I'd love to hear, either theoretically or like concrete examples of any concerns that you might have or considerations with about using psychedelic psychotherapy yeah, well, there are many um, so one of which is that psychedelics are a little unusual in that they are not like some new compound that's coming out from a pharmaceutical company that nobody's ever heard of. Lots of people in the general public have had their own experiences with psychedelics, or they know people who have, or they've heard stories about it. So there's kind of this cultural baggage around it in a way that other novel compounds don't necessarily have to deal with. So that can go both good and bad. So we talk about fears that people have about these experiences and a lot of people bring up kind of the fear of the proverbial bad trip, a difficult psychedelic experience. So that comes up. But there's also this flip side to that, which is this idea that they're miracle cures. But there's also this flip side to that, which is this idea that they're miracle cures. And there were these very breathy headlines in media outlets in the early years of this and even just a few years ago one trip and cured for life and this kind of slow process moving through the FDA on the one hand, but on the other hand we have well, not only the ways that people always access these things, but we have increasingly decriminalized use in certain municipalities and states.
Speaker 3:So patients are finding these things on their own, they're trying them out, and I think one of the things that's really important to understand about psychedelics is that the context is just as important as the drug, so what is often referred to as set and setting, so the mindset and then the physical setting. So one of the things that's really interesting about psychedelics is their effects are somewhat pluripotent. So, you know, this same drug taken in my lab with the intention to help treat somebody's depression might lead to somebody experiencing grief about the way depression has impacted their life. Or, you know, experience of feeling connected to something larger than themselves, whereas that same exact molecule taken at Coachella, you know, could make that music sound amazing. Or they could find themselves feeling, you know, having experience of fantastic music and then midway through they start thinking about when their mother died, when they're eight years old. And, you know, they have this big emotional experience in a setting that doesn't really have a container for it.
Speaker 3:You know, I used to do harm reduction work at Burning man and we would get folks all the time who thought they were going to go out and go dancing and listen to music and then found themselves thinking about when their mom died when they were eight, and you know and that's not to say that that was a bad experience for them, but it was an unexpected experience and thank goodness we had that kind of safe container where people could come to and be attended to by trained volunteers who could help that what could have been a really challenging experience become, you know, at least a neutral or maybe even a positive experience. But this sort of hype in the space and I've written about this you know about how that really it creates these unrealistic expectations. And we know our patients are desperate because our treatments don't work as well as we want them to. So I understand why people seek these things out on their own, but that can be a somewhat perilous process if you don't know what you're doing and you don't have good guidance.
Speaker 2:Gosh. Thank you, andrew. You know it's. This is so enlightening. I mean it's definitely not an area of expertise that I have but you know, sharing from my own practice, I'm currently doing esketamine in my treatment and I you know this is speaking a lot to kind of.
Speaker 2:You know the experience that I've had with patients. It's yeah, it's not a cure and I think sometimes the therapeutic value is more than the substance that they take. I mean, I kind of with my Spravato treatments I sometimes wonder if it's more. It's kind of it reminds me of cheers, that old, you know sitcom, where people would come back to the clinic and the front desk would be like, oh Joan, oh hey, how you doing, and the people are like, oh, you know, I'm feeling accepted. There's somebody here that really you know I'm bonding with I have to come. You know there's somebody here that really you know I'm bonding with I have to come, you know.
Speaker 2:But it's just something that I really think is so meaningful and I love how you highlight this idea that you know there's work in this and just what you said. You know I'm thinking, you know, just because you do hear that you know the bad trip and I've had a couple of patients who come to me and just kind of like you know, I'm going to just take a little bit of a mushroom at. You know, night and night, I think that's you know, cause that's been researched right now. You know you have to do the whole education though that's not, that's just a piece of this sort of thing.
Speaker 3:So I appreciate, and maybe you have do want to say about, you know what you've noticed in your clinic, I think is really interesting because it speaks to the community aspect of this Right and and one of the things that you know I think COVID really highlighted is how psychologically deleterious it is to be alone in the world and how many of our illnesses that we treat in psychiatry involve being alone, you know. I mean, you know the former Institute of National Institutes of Mental Health, tom Insell, wrote this book about how isolation is really, you know, killing us, and so one of the things that's interesting about psychedelics is the potential for group treatment, you know, and group therapy, when I went through school, always felt like sort of like the low-cost alternative, you know, and I worked for a big insurer that liked to push group therapy. But really I think group therapy could have an amazing revival through psychedelic experiences, because one of the things that is very common in psychedelic experiences and I will answer your question about bad trips, I'm not avoiding it is that they often engender experience of feeling connected to something larger than yourself, and you know that can be the experience of awe, which is, you know, sometimes referred to as the small self, which is like hey, I'm, you know, like imagine when you've seen an amazing sunset or something, you realize there's beauty in the world and my little neurotic churn that happens in my head and your head and everyone's head maybe isn't that important. You know that there's something much bigger than all of us and to feel connected to that is salutary. Now, the bad trip notion is, you know, so we often call them difficult experiences or challenging experiences.
Speaker 3:Call them difficult experiences or challenging experiences, and one of the things that I do advise subjects when they're coming into the study, especially with psilocybin, is that this tends to kind of amplify emotions, and so whatever you're coming into this with often will get kind of louder in the experience. It's also a little bit unpredictable which way it's going to go. So you know, you think you're going to go listen to Diplo or something you know, and what you find is you're crying about, you know, when your mom died when you were eight and you weren't expecting that right, and the emotions that you're experiencing are amplified in a way that they aren't normally, that you're not normally able to kind of maybe consciously tamp down. And so a lot of times when people are having a difficult emotional experience, it can be autobiographical. You know there's some kind of grief, some kind of trauma, and a lot of times in a therapeutic context. We're specifically going into that right. So you know, in the MDMA PTSD work we had an agreement with our subjects because, as we all know, ptsd is often marked by avoidance. As we all know, ptsd is often marked by avoidance, and so we had an agreement with our subjects that if we haven't talked about the trauma during the course of the session, the therapist will bring it up. Honestly, because of the prep work that we did, we really rarely ever had to evoke that because the subjects came in wanting to talk about that.
Speaker 3:But sometimes under a psychedelic experience, the ability to kind of hold back difficult memories or difficult thoughts is eroded and those can be overwhelming if people are not prepared for it. Yeah, there can also be some kind of panic-type symptoms that people will have. You know, just feeling weird. You know, many of our patients with anxiety disorders and panic disorders are often very sensitive to kind of that internal experience of feeling off, feeling weird, not being able to turn a thought off. You know that can be anxiety-generating.
Speaker 3:So this is why it's really, really important to have that preparatory work in place where you've got a known person there in the room with you who you've already talked about these concerns, and that person is known to you. You've already talked about ways of calming yourself maybe deep breathing or grounding and also it's really important to know that these experiences in psychedelic experiences, are transient. You know that while it may be really intense right now, five minutes from now your mind might shift to something else, and that's often what happens is that you know, I've seen people be crying and then 30 seconds later they're laughing. You know, or they're laughing and then they're crying. It's just, you go through these waves of emotional experience and then they're crying. It's just you go through these waves of emotional experience and a lot of times what seems to happen from that is the experience of actively not avoiding the emotion is salutary. So we know that one of the things that really predicts for things like depression is emotional avoidance.
Speaker 3:When people deploy a lot of strategies and use a lot of energy to not feel their feelings, it comes at a price, right, and that price may be depression or PTSD symptoms, and so what this is an opportunity is to maybe go into them and realize like, oh, that was hard, but it wasn't so terrible. I was able to do that in much the same way that a vaccine challenges your immune system. Remember when we all got our COVID shots and everyone was like, oh, how'd you feel afterwards? Oh, I was tired. For a couple of days, I felt kind of feverish. Well, that was your immune system charging up right and it made you stronger as a result. And so maybe there's a psychological corollary to that as well, that we get to make more possible or more tolerable with the combination of therapy plus drug.
Speaker 5:I have a follow-up to that.
Speaker 5:So you know, as you were talking, I was just thinking.
Speaker 5:You know, with other trauma modalities, you know, sometimes we can see, even with like preparation into work on the very specific trauma experience, in that specific trauma, like while doing work on that specific trauma, we still find that patients sometimes are flooded and overwhelmed.
Speaker 5:And you know, though we did the best that we could to prepare there, it's still, you know that we they still had that flooding experience. And you know, on the other side of that, you know, in my experience I've sometimes seen that that flooding and that overwhelm of emotion can continue on for, you know, days, weeks, even months depending on intervention afterwards. And I was hearing you say that, you know, one of the things that's really unique about psychedelic work is that patients are really getting this experience of noticing how transient our emotions can be in real time. In your experience have you noticed, you know, in when unexpected intense emotions come up in while a patient or an individual is going under a psychedelic experience, does that tend to reverberate until later, like the days and weeks and months coming, like sometimes we can see it with other traditional trauma work, or is that something that you tend to see remain pretty transient as well.
Speaker 3:It's a great question, kendra. I mean it can you know? Because and these experiences, you know, particularly in sort of less regulated, less intentional settings, you know, can be destabilizing for people. So that is something that we have to keep in mind and it's one of the reasons why you have that integration therapy so closely proximal to the experience, so that you can kind of catch that. You know.
Speaker 3:One of the things that's interesting about MDMA in particular is that you know what you were describing there, the sort of tolerability window.
Speaker 3:You know what you were describing there, the sort of tolerability window you know, which is somewhere between when people get totally flooded or when they shut down and get dissociated, is pretty narrow in most people with PTSD and so it doesn't take too much to get them flooded or get them shut down.
Speaker 3:And what's interesting about MDMA is it appears to sort of widen that window. And part of the reason it may do that on a sort of biological substrate level is that MDMA has an interesting thing of sort of quieting the right amygdala, which is where a lot of that sort of fear response resides. And so there's actually been neuroimaging studies, fmri studies, looking at the activity of the right amygdala, at the activity of the right amygdala, and so that activity tends to go down and the prefrontal cortex activity tends to go up. Which is what we need in order to kind of contextualize traumatic memories and be able to work with them is to not be flooded by that fear response and be able to use our prefrontal lobes to think more flexibly about them. And so that may be part of what's going on biologically which allows this to happen. It's not just kind of feeling good, you know, and what that means in the therapy room is that people can actually tolerate talking about their trauma for a longer period of time or more deeply than they would have been otherwise.
Speaker 2:That's really interesting, that's really interesting. Yeah, sorry, kendra, stepping on, you apologize, but yeah, I I think this whole conversation has been just fascinating and just want to, um, unfortunately, look at the clock and say that we're kind of running out of time here, but I want to express my my deepest uh thanks to uh, mr andrew penn here, um, who's sharing his expertise and and just, I hope, enlightened everybody who listened to this, because I think this is just something that we will continue to see and I think, if maybe that's kind of our final thought, if you wouldn't mind sharing, andrew, what do you see as the future of psychedelic psychotherapy, either within nursing or outside, or just in general? Big question for like a minute, sorry, yeah.
Speaker 3:I really just want to impress upon how well-suited nursing is to psychedelic therapy. Quite honestly, psychedelic therapy made me fall back in love with nursing because when I realized and this is the thrust of the paper that I co-wrote with Gene Watson and I'm happy to send you a link to it but really these core values of nursing that Gene has really spent her whole career kind of describing, like what is this ineffable thing that we call care and, honestly, a lot of Jean's work, when I read it as a nursing student I didn't understand what the heck she was talking about, because it's kind of mystical, right, and it's kind of you know. But when I looked at it through the frame of the work that I do in psychedelics, it's like, oh, this totally makes sense now, and so much of what we do, which is like care and presence and endurance, like think about it, these are eight to ten hour sessions sometimes. Well, you know, a lot of my psychotherapist colleagues are like that's a long day.
Speaker 3:I'm like that's just like a shift in the icu with a delirious patient, like we can roll with that, um, you know, and we take care of the patient's body too, like if they had an episode of incontinence. I'm not squicked out by dealing with that. I'm a nurse and if the person gets hypertensive which is something that we have to keep track of, I can manage that. But more critically, it's about this quality of presence and not necessarily needing to do something other than show up fully, and that's what nurses are so good at doing when we're not being pulled in 10 different directions by our EHR and silly mandates that we have to follow. But the beautiful thing about these days that I get to do these is that I have nothing else pulling on my threads. I can just be there with that patient fully for the duration of the experience, and that is why I got into this work to begin with.
Speaker 2:All right, that's a yeah a round of applause. You can't see it, this is audio podcast. But yes, thank you so much and again, just very much appreciate it. It's a great way to finish Pep Lau's ghost episode here and really kind of highlighting, nursing. So thank you again. We'll be out with a new episode soon, so please feel free to like, subscribe, comment and we'll see you at our next episode.
Speaker 1:Take care Before it's true. Work hard until those thoughts are finally leaving so you can be you. Guided discovery Identifying challenge in your beliefs, core beliefs, reframing your mind. Negative thoughts release, let it go. These cognitive distortions decrease until they cease. Yeah, guided discovery Identifying challenge in your beliefs, core beliefs, reframing your mind.