Dr. Dave Rabin: Neuroscientist on How Psychedelics Heal Trauma and Create New Patterns

So humbled to be here with you all tonight, and I so appreciate the opportunity to connect with the community again. I'm a big fan of the work that Summit's been doing, and I really appreciate Kat and Kerry and the whole Summit community for throwing this wonderful event.

I'm going to share my screen here real quick. We're going to cover some interesting stuff here that hasn't been covered elsewhere, which I think you'll appreciate. And I just want to clarify one thing — I haven't organized the largest psychedelic study in the world. That is not your fault, Kat, that is something that ultimately got miscommunicated a while back. It is the largest epigenetic study of psychedelics. So we're really looking at the mechanism of psychedelic medicines and how they work, in collaboration with a lot of other groups and academic researchers worldwide who have been doing this work, including MAPS and many other folks. One of my passions is figuring out how things work, and so we really wanted to apply that to psychedelics and see what we could learn.

Because psychedelic medicines are not unique — they act in a very similar way regardless of whether they're THC, cannabis, psilocybin, MDMA, ketamine. They all have similarities in the way that they work and what they do for us, particularly around trauma, which we'll talk about.

So the first question is: why are we talking about this? And this will be really fast. The reason why we're talking about this is because people are really stressed out, and the stress is real. What happens is, when we're stressed out, when we're overwhelmed, when we're constantly surrounded by lots of changes in our environment that aren't even necessarily bad — there's lots of things changing at once — it can become very overwhelming, to the point where we don't necessarily realize anymore what is a real threat and what is a perceived threat.

And this is very important to understand, because when we're chronically stressed, when we're experiencing symptoms of what we perceive to be burnout or whatever you want to call it — just feeling overwhelmed or restless — our bodies are trained to think that our computer or our responsibilities or the news is a bear that we actually have to run from or fight. And this impacts a lot of our biology. It impacts the way our heart beats, the way we breathe, the way that we interact with our loved ones, the way we empathize — all the way down to the functioning of the core parts of our nervous system that help us heal and recover.

So these parts of the nervous system are called the sympathetic and parasympathetic system, which many of you know about. The sympathetic system is commonly referred to as the fight, flight, or freeze response system, and that is supposed to only turn on in large part when we're under threat of survival — so losing food, water, air, or physical threat to our safety or the safety of our family or loved ones. That system should turn on and divert all available resources to our skeletal muscles, our motor cortex, and the parts of us that get us out of a threatening situation into a situation of safety. We don't want resources in those situations going to our reproductive system, our digestive system, our creativity system — we just need to get out.

This system has evolved in us, and it's not unique to us. It actually exists in all mammals and pre-mammals as well, for tens of millions of years, maybe hundreds even. This system is that old. And so it's really important for us to understand the hardwiring of our system so that we can understand how to balance recovery and performance, or recovery and stress.

This actually has real consequences. We know that burnout hurts people, we know that stress kills people, we know that we lose lots of money in productivity because of this, and that our healthcare expenses go up. And this ultimately is one of my favorite slides, because it's a representation of what we're good at in Western medicine. We can open somebody up and take out parts of their body and sew them up or staple them up, and they heal and can live for another 50 years. And yet we still struggle in the Western medicine paradigm to deal with loss of hope, confusion, loss of functioning, redemption, teaching people how to heal themselves, dealing with pain, fear, and loss. All these things we still struggle with, which is why psychedelic medicine is so interesting — because it actually tackles a lot of this stuff that we haven't been very good at tackling in Western medicine.

So some of the ground rules that I think are really important, that have been developed over time — and again, these are all now well-founded in science. Back 50 or 70 years ago we didn't really know for sure, but now we know that number one: the mind and the body are intricately and irrevocably interconnected. What this means is that when we have a disturbance in our mind, over time it can impact our body. When we have a disturbance in our body, over time it can impact our mind. And this impacts emotional health as well as spiritual health. This is very important to understand.

Secondly, psychedelic or altered states of consciousness are normal states of perception. They are not unusual. They are accessible with lots of different techniques, drugs and non-drugs, and they are states where new meaning-making is possible. We can access these states in lots of different ways. They can be perceived as positive, negative, or both. And they don't require medicine or drugs to access. For example, deep meditation, breathwork, holotropic breathwork — many of you I know are familiar with — and lots of other strategies can be used: touch therapy, massage, shiatsu, energy work, qigong. All these kinds of things can be used to access what we call psychedelic states.

And the reason for that is, getting to the root of what "psychedelic" means — it doesn't mean crazy '70s drugged-out dance party. It actually means "mind manifesting" or "to show the mind." When we think about what that means, that's actually a very powerful sentiment. Mind manifesting really goes back to this ancient understanding that we have all this stuff that we're aware of all the time, and then we have stuff that is beneath awareness, which is what we call the subconscious. Subconscious material is still there, and by far it outnumbers the amount of stuff that we're actually aware of.

So what "psychedelic" means is it's almost like entering into a dream-like state where the filter between our awareness and our beneath-awareness — everything that we're normally able to pay attention to for our survival, the ego stuff, the day-to-day stuff — that filter helps us to be productive and to maintain our day-to-day without getting distracted by all the craziness going on in the world around us all the time. For example, the feeling of our clothes on our skin is not useful to us, and so we ignore it. Our bodies quickly train themselves to habituate to the feeling of the clothing on our skin, and then we ignore it because it's not useful to us in the moment. But that information is still going into our subconscious. This is the same for experience.

And so these psychedelic states, which can be radically transformative for people, allow us to access these deeper states of ourselves, this subconscious material that allows us to heal. These states are facilitated by safety, presentness, and intention. And the meaning of these experiences is not just encoded in our neurons, in the connections between our neurons, but also on our DNA — epigenetically. This is something that was more recently found by Rachel Yehuda at Mount Sinai, who studied traumatic experience in people for a very long time. These changes to DNA expression of stress response genes can actually regulate the way that we feel and respond to stress, not only in the moment but also over time, and it can be passed on to our children.

The history of this is really interesting, because plants have been used ceremonially for inducing these psychedelic states for millennia — tens of thousands of years and maybe more. People in ancient tribes have been using psilocybin and mushrooms of all different kinds to induce these altered states of consciousness, and they've been used exquisitely safely.

Interestingly, in the last hundred years we've had this development of synthetic psychedelic medicines, and they were discovered in search of new treatments for hard-to-treat mental illnesses. And they actually did a good job, because even though psychedelics were made illegal in the '60s and '70s — which was unfortunately a tragedy — we actually discovered a lot about how the mind and the body work together. We discovered a lot about the serotonin system, how serotonin levels impact our health, and it helped us to develop many of the common drugs we use in mental health right now.

But despite all of those drugs that have been developed, what's most important is that these psychedelic medicines — like psilocybin mushrooms and MDMA and ayahuasca — many of these medicines have shown greater promise to safely treat these chronic, treatment-resistant mental illnesses than any other medicine that we've ever found.

And to give you an understanding of exactly how radical these medicines are in terms of a paradigm shift for psychiatry and medicine in general: with clinical psilocybin and MDMA, we're looking at 50 percent of people who receive just one dose of psilocybin with psychotherapy reporting no longer meeting diagnostic criteria for depression six months out. With MDMA, with just three doses of medicine and 12 weeks of psychotherapy, 67 percent of people who are treatment-resistant to PTSD treatments in the past — for over 17 years on average — at one year and five years out, 67 percent of these people no longer meet diagnostic criteria for PTSD.

And these are people who have tried everything and have never received a benefit. Just three doses of MDMA and 12 weeks of therapy, and 67 percent are no longer meeting diagnostic criteria. And it's not just right after the treatment's done — it's years later, without any additional treatment. That is fascinating, because there's no other medicine that we have that can produce these kinds of treatment results.

We also see that both of these medicines improve coping with stress and end-of-life distress. They improve a sense of safety when used in the clinical setting or the ceremonial setting. They improve feelings of connectedness — connectedness to others, connectedness to ourselves. They're also rated commonly as one of the most meaningful and powerful experiences somebody's ever had in their entire lives. And they only require a short dosing course. So again, this is really incredible, and this is why these medicines have gotten fast-track status through the FDA. Psilocybin and MDMA are currently in Phase 3 trials.

So how do they work? Well, the way they work is based originally on the work of Eric Kandel. Remember, earlier I said that the way we learn and the stress response recovery response nervous systems actually date back to these ancient sea snails called Aplysia, that are close to 300 million years old. These snails actually form memories the same way that we do and that almost all animals do. Eric Kandel won the Nobel Prize for discovering this in 2002, showing that basically what our parents told us growing up is still true: practice makes perfect.

The more we practice doing anything — whether it's serving us in a positive way or not serving us — it's still getting wired into our brains. Our brains make stronger connections between our neurons, in the synapses between the neurons and the other cells that surround the neurons, the supportive cells, every time we do something, every time we think about ourselves in a certain way — whether that's in a positive way or a self-critical way, whether it's practicing a behavior like eating an ice cream every time we're stressed out. These little things we don't necessarily realize actually get ingrained and entrained into our brains.

And they're not untrainable — they're absolutely retrainable or remodelable. But the behavior and the thought process and these patterns do get ingrained, and the more we practice them, the tighter those entrainments get.

What these entrainments create is what's called the default mode network. For those of you who haven't heard of the default mode network: these are the parts of our brains that are talking to each other in a very specific way when we're not doing anything. That's why it's called the default mode. When we are just sitting there, not really paying attention to anything, this system is active, and these parts of the brain are talking to each other. When these parts are talking to each other, it's most consistent with our ego, survival-focused self — thinking about our identity, our sense of self, decision-making, and things of that nature. This is the system that is primarily active at rest, when we're not doing anything.

And why is this important? Because psychedelics disrupt this network. It's now been shown through significant work by Robin Carhart-Harris at Imperial College London — incredible work that has shown that the default mode network, this part of our network that is consistent with ego and our sense of self, has a dose-dependent reduction in activity with psychedelic medicines like mushrooms. So the more mushrooms you take, the less this network is active.

And why is that important? Well, if this network of brain parts that are talking to each other represents ego and this part of ourselves that's so focused on survival all the time — the entrainment of that network occurs for a reason. It's to automate survival patterns, to automate behavior so that we don't have to think about survival all the time. The default mode network keeps us in the realm of what we know.

As soon as you disrupt that network, it's like you had eight feet of powder dropped on top of you and you can choose anywhere you want to go. You don't have to ski down the same tracks you just skied, or that someone else taught you to ski years ago. You literally have the opportunity in this moment to make a decision to go any way you want.

And the default mode network activity shows this, because the parts of the brain that were active before are still active and they're still talking, but they're not talking to each other the way they were before in the sober state. So psychedelic medicines, advanced meditative states, and other altered-state experiences actually reduce default mode network activity. They attenuate ego and they leave us with: anything is possible.

And this is important because it allows us to create new patterns. It allows us to recognize, for a brief moment, when we set the intention to heal, that we can reflect on ourselves with compassion, with gratitude, with self-love and forgiveness, and say: hey, buddy, maybe this thing that I've been doing my entire life or a good portion of my life to cope with stress, to cope with whatever it is that's going on, whatever behavior — maybe this isn't helping me anymore. Maybe this behavior I developed as a child is actually no longer serving me.

And so when we recognize that opportunity, it's literally like a light bulb going off that says: wait, I can make a different decision right now. I don't have to ski down the same run that I've been skiing down forever. I can choose a different path. And as soon as we start choosing a different path, we're signaling to our brains that we have the ability to form new neural connections consciously, that we can change the way our brain parts talk to each other.

So this is really interesting, because when we think about what we're talking about — it's the way that trauma is experienced by us. And trauma is often stigmatized as "people who can't deal with stress," and that is by no means the truth. That couldn't be further from the truth. What trauma really is, is one or multiple negative or perceived threatening, intense, meaningful experiences over time.

So what are psychedelic altered-state experiences? They are one or multiple transformative, healing experiences that are positive and meaningful over time. And that is so interesting, because psychedelic medicines, when used in the proper setting and in the proper context — ceremonially or clinically — actually reverse the symptoms of trauma, not just in the moment but for years after.

The only way that this could be happening — that a single dose of medicine or three doses of medicine with therapy could last years later — is that it's actually changing the expression of our DNA through the epigenetic markers. We can't change the genetics, but we can change the code that is on the genetics, which is what we call epigenetic — on the DNA, which tells the DNA what to turn on and what to turn off at different times. So the epigenetics, for example, in people who have trauma are set to increase the secretion of stress response hormones in response to threat, and that's not necessarily useful for us.

So psychedelic medicines with therapy offer this opportunity to retrain that pathway — not just in our brains and our neural connections, but what we believe to be all the way down to the epigenetic markers in our individual cells, which is incredibly fascinating. And this is the study that we're currently running with MAPS right now.

So what makes meaningful experiences meaningful and healing? Safety is number one, and this is the most important thing for all of our therapy sessions that we do with anyone, whether you're in a tribal setting or you're in a clinical setting. Safety is number one. Presentness and mindfulness is number two. And number three is having the intention to heal ourselves, the intention to grow.

What happens when we cultivate these three things is that when we have reliable safety, presentness, and intentional experiences, we're able to create new pathways in our brains for meaning-making. And that meaning-making literally reshapes our pathways so that we follow a path of thinking and feeling that's serving us, rather than one that's not serving us. And with respect to trauma, this is really important.

This is literally one of the most important ways to optimize our human potential, because it allows us to step out of the most fundamental trap that we set for ourselves as humans — which is believing that we know who we are and believing that we know what we're capable of, which we just don't. We are told what we are, we're told who we're supposed to be, and we're often told what we're capable of. And none of that is about self-discovery, and none of that is about figuring out what we actually are and what we're actually capable of.

What we do when we work with people in this capacity is actually passing on the understanding that it's okay to not know what we're capable of. And once we accept that, we become capable of anything.

So going back to these medicines — once we curate safety, once we curate intention to heal, and the experience that facilitates this setting, psilocybin and MDMA become radically transformative. This is a different effect than you might experience with these medicines if you take them at a rave or if you take them at Burning Man. It doesn't mean you can't have powerful transformative experiences in those settings — it just means they're not as likely to happen when they're outside of this context.

The next steps that we're working on right now: we currently have this large controlled study of the epigenetic mechanisms of healing with psychedelics and altered states, which is currently underway in collaboration with MAPS, the Multidisciplinary Association for Psychedelic Studies, with their MDMA participants. We are collecting saliva samples with our collaborators at USC and Yale and Modern Spirit to track epigenetic changes before MDMA — this 12-week, three-dose course — and then after MDMA, to see if we're actually changing the expression patterns of stress response genes.

We're collecting those samples and actually doing the first round of analysis now, so we'll probably have results back in — I don't know, on the academic timescale, like three months or so. And since it's all being done by USC, we're comparing the effects of many different psychedelic medicines. We're starting with MDMA but then branching out into not just MDMA but traditional ayahuasca ceremony, as well as psilocybin mushrooms used in clinical settings and in tribal settings, and then looking at other plant medicines — peyote, people who use cannabis for trauma, ketamine — all these different groups, because we believe that they might have the same mechanism. They are all used to treat trauma when used in this specific way. So if they're all treating trauma, then perhaps we may find a similar mechanism.

The future of this really involves two things. One is developing an understanding of these medicines, which we're on the way to doing, so that we can replicate benefits with technology. Apollo is our first take on that technology — ways to replicate psychedelic or altered-state experiences. It's not fully psychedelic, but they are altered-state experiences that facilitate recovery and healing. There are a couple other devices that people are working on that are coming out in this regard.

And then, to further understand the mind-body connection so that we can figure out how to treat chronic physical illnesses more effectively — not just mental, because we know that physical and mental are tightly tied together.

And that is all I have for you. Thank you so much for joining us.

[applause]