Alicia Danforth on ethical challenges in psychedelic medicine

Alicia Danforth, PhD, is a licensed clinical psychologist and researcher and has participated in three major studies on psychedelic-assisted therapy, the latest of which is still unpublished. She began her work in clinical research with psychedelic medicines as a coordinator and co-facilitator on the pilot study of psilocybin treatment for existential anxiety related to advanced cancer. More recently, she was an investigator for the first study of MDMA-assisted therapy for the treatment of social anxiety in autistic adults.
Your first study with psychedelics was about end-of-life anxiety, the second one was about social anxiety, and this latest one also has to do with anxiety to some extent. Is there a thread regarding anxiety in your research work?
I didn’t set out to go that way. The first study had to do with anxiety facing the end of life, yes. But to be candid, social anxiety wasn’t the initial focus of the autism research. I had made the false assumption that autistic individuals lack empathy, which isn’t more than an outdated cliché that I mistakenly took at face value. My initial thinking was that MDMA is an empathogen, so it might help this population experience empathy.
Once I started interviewing autistic adults for my dissertation, I found out that they were quite empathic in many domains of empathy, and they told me what they were struggling with is social anxiety. The desire to connect was there, but the ability to read social cues and to know how to integrate into a group conversation or initiate a friendship is what they needed help with. That’s how working with social anxiety as an indication came about.
So with hindsight, yes, you could say that anxiety is a thread that has run through most of the clinical work that I’ve been involved with. Anxiety disorders are the most common mental health diagnoses in the United States, and they have been a good match so far with psychedelics-assisted therapy.
Your latest research with psychedelics is about psychological distress in long-term AIDS/HIV survivors. Can you tell us more about this new study?
I want to clarify that I’m not one of the investigators on this study, I’m a lead clinician. I co-facilitated the therapy groups and the psilocybin treatment sessions. Dr. Brian Anderson initiated this study at UCSF. San Francisco has been a hub of HIV medicine, and Brian became aware that there’s an underserved population of long-term survivors who acquired the HIV virus back in the 1980’s or early 1990’s. As a result of losing so many of their friends and because of the impact of HIV on their lives and on the community, they were living with a high degree of demoralization.
Dr. Anderson wanted to explore if treatment with psilocybin-assisted therapy could help improve overall quality of life and reduce anxiety and depression symptoms. The first phase has been completed, the data are analyzed, and a manuscript has been prepared. All I can say right now is that the outcomes were encouraging.
One way in which this study was very innovative is that we worked with a group therapy model, where the participants prepared as a group, and then each one had an individual psilocybin-assisted therapy session, and they came back together to do their integration work as a group. We’re frequently asked if everyone took the psilocybin all together, and they did not. I don’t think we’re quite there yet, but I couldn’t help but wonder what that might be like someday.
At the upcoming ICPR 2020 conference in April, you’ll speak about ethical challenges within psychedelic medicine. Can you explain its importance?
It’s no secret that psychedelics present unique challenges when it comes to ethical considerations and boundaries. These substances place people in profound altered states of consciousness, and with that shift can come increased suggestibility and vulnerability. We’re working with such novel treatment paradigms that we need novel approaches to how the individuals who are entrusted with the roles of therapist or guide should be vetted, trained, and supervised.
Could you elaborate?
Well, it became very apparent to me that there are certain personality types that are drawn to situations in which they’re in close proximity to people who are vulnerable and open. They seek to manipulate and have a very unhealthy relationship with power. Back in the 60’s and early 70’s, when people were working with these substances in controlled and uncontrolled settings, there were problems with individuals who would transgress boundaries. And today, we’re plunging headlong into a new era where billions of dollars are accruing to throw money at this enterprise; there’s such a rush to do it quickly.
But, we don’t have the structures in place to keep the participants in research settings -and eventually customers in commercial settings- safe from abuses of power. So, I’ve started proposing that we need to look at other medical professions where they have to accommodate similar levels of vulnerability, such as anesthesiologists, pediatricians and gerontologists. We need to agree on which methods we’re going to have to employ to train and supervise peers. We don’t have a good system for winnowing out individuals who seek to do this work who have clinically significant narcissistic traits or psychopathy. How are we going to gatekeep? If we don’t talk about this responsibility and address it, we’re at risk of running into trouble again.
Alicia Danforth’s talk at ICPR 2020 will be entitled: “Getting Our House in Order: Advancing the Ethics of Psychedelic Medicine and Psychotherapy from Storming to Norming”