Treating Anorexia with Psilocybin with Dr. Stephanie Knatz Peck
Alisa Nappa
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Anxiety can wreak havoc on people and develop into more serious disorders including Anorexia nervosa. We chat with UCSD Associate Clinical Professor & Psychologist, Psychedelic clinician and researcher, Dr. Stephanie Knatz Peck, to dive deep into this topic and explore the use of Psilocybin assisted therapy as potential treatment. What are eating disorders? How do they develop? What current treatments are out there? what is the promise of using Psilocybin assisted therapy? and more.
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TRANSCRIPT
Alex 0:11 Welcome, welcome. You are listening to the mushroom revival podcast. This is your host Alex Dore. And we are absolutely obsessed with the wonderful, wacky world of mushrooms and fungi. And we bring on guests and experts from all around the world to geek out with us. And today we have Stephanie to talk about mushrooms and anorexia and all the healing that goes into that. So Stephanie, how are you doing today? Speaker 2 0:40 Good. Thanks for having me here excited to speak to you about this topic. Alex 0:45 So for people that don't know you and your work, who are you? And what are you? What are you up to? Speaker 2 0:52 Yeah, I am a clinical psychologist by training based in San Diego, and I am an assistant clinical professor at the University of California, San Diego and the Department of Psychiatry. And I'll be talking today about a study where we were basically evaluating psilocybin therapy for anorexia nervosa, my background is in both providing treatment and conducting clinical treatment research. And I've spent the majority of my career actually studying eating disorders. I have had a very long standing personal and professional interest in exploring altered states of consciousness and the way that they can occasion healing. So about five years ago, I had the opportunity to get involved in studies that were occurring at UCSD evaluating psilocybin for other mental health indications, and have been involved with other you know, other psychedelic compounds and their potential applications. And a few years ago, got funded for this study, which was a dream of mine, because it was really the intersection of two really big interests, eating disorders, and psychedelics. And yeah, I mean, before that I also direct an eating disorder program at UCSD, I've spent the majority of my career really studying and treating people with eating disorders, I recovered from an eating disorder myself when I was younger. So it's really been kind of such a privilege for me to do this work. Alex 2:24 And how did you get introduced to psychedelics as a whole? And then particularly mushrooms? Speaker 2 2:31 Yeah. I feel like there's two pathways to answer that question. And I, I guess I'll give both of them. Like I said, I guess from a professional perspective, having treated eating disorders, and I guess, mental health, mental illness in general, there's treatments that we conduct that work pretty well for about 30 to 50% of the people who get them and those are the kind of like gold standard treatments, like the best treatments out there. But as a clinician, you know, I see people all the time who are, where treatments are failing them, they're just really not getting better. And it's not a matter of them not trying hard enough, or not doing enough or willpower or whatever. It's just really, we don't have adequate treatments. And you know, and I feel that a lot in my career, just not being able to provide people with sufficient tools to get better. So I've always really been interested in novel treatment modalities. And psychedelics are kind of one of those that have really shattered the way that we've done treatment prior. And so, yeah, so it kind of matches with my professional interests. And, personally, I've always been interested in altered states. So even when I was seven, eight years old, I remember doing things like holding my breath for extended periods of time taking really cold showers, and not really even understanding why but I think it was like my early my early way of just exploring how to change the mind with different, you know, through different avenues. And yeah, personally, I've also kind of grown up in the underground dance community. So I've been exposed to a lot of communities where I think medicines are being used in community formats that are really powerful as well. And yeah, so all of that combined, I guess, I would say. Alex 4:22 So for people that are not as familiar Can you define what anorexia nervosa is? Speaker 2 4:29 Yeah. So the anorexia nervosa is really an illness that is characterized by sort of like incessant, kind of insidious desire to change body shape or weight, or reduce, you know, body weight. And so what that results in is really sort of like repeated intrusive thoughts that are really surrounding how to control weight and shape, right, repetitive ritual ballistic behaviors that sometimes look kind of like OCD and nature, compulsive exercising and all of this is like in a feat to control body right in some way, shape or form. Why? Whether it's because you know, body feels too big or shape feels too big or there's this sort of irrational belief that if you change the way that you're conducting your behaviors around, let's say, exercise or food that you're gonna gain weight. And it's not an it's not really about weight, I guess I should say, but it's more about what weight and shape represent in terms of self esteem, right? So like, most people will be able to identify and hopefully we can help them identify what are, what is it that makes you feel so attached to maintaining this body weight or shape, and it's usually because it is this huge valuation of or source of self esteem, right. And sometimes that comes from early messages. Sometimes people just really don't understand. But what people will describe is feeling this sort of like how difficult it is to do things that are otherwise normal for most of us eat normal amount of foods that for us, makes us feel good, it releases, you know, chemicals that literally make us feel like we're better. And for people with eating disorders, anorexia, specifically, I should say often eating or, you know, in the way that maintains a normal body weight or healthy kind of behaviors is actually really anxiety inducing. So there's it's a very multifaceted thing, but that kind of breaks down some of the main characteristics of, of most people who meet criteria for anorexia nervosa. Alex 6:29 And would you say all people who have anorexia nervosa also have body dysmorphia? Speaker 2 6:36 That's an interesting question. No, that's a really good question. So you know, it's interesting, because I think a lot of times people either arrive or have always been in the place where they objectively understand that they're underweight. And there's a lot of different ways that can present its you know, I mean, I think sometimes we think of anorexia as like, a monolith illness, but there's having studied it for so long, having recovered myself, like there's, there's a lot of different ways that you can look at one can be that objectively, you can understand that you're underweight, like factually underweight. And you feel you do not feel that way. Like there's so dysmorphia in that sense. Sometimes people feel underweight, no, they're underweight. And yet, the drive or the ability to kind of overcome that is still so difficult. Right. But yeah, I mean, I think there is like a token trait around sort of feeling and sensing your body differently than the way that it is perceived on the outside by others. And that that definitely characterizes a large part of people who have anorexia. Alex 7:38 And, you know, obviously, it's different case by case, but I'm sure there are consistent themes, like I was reading 90% of people that have anorexia nervosa are, are, or women are female, or girls who have it. And so, typically, you know, is there what's, what's the most common way it starts? And when when is the most common timeframe in which it starts for for? Speaker 2 8:14 Yeah, good questions. Yeah, it's interesting about the prevalence rates, because you that is consistent it is true that you know, it is much more prevalent in females. And, you know, I have colleagues who study male eating disorders and body dysmorphia, and males, who would also argue that part of that is lack of appropriate screening and diagnosis and males, because it's so over identified as a female disorder. Now, how much that accounts for the difference? Probably not all the way right. And then you think about the sort of like conditioned pressures around shape and weight that gets sort of people get bought into in general, but specifically females, right, and how that plays into the illness. But I should say, to answer your question around, like, why did why do people develop anorexia? And that's it. That is the question of the century for us in the field, and it's multifaceted. I think different people would argue different things. But you know, it does appear that there is some sort of interaction between particular biology or predisposition, and some societal influences. So there's pretty like compelling and strong and you know, kind of irrefutable evidence to suggest that specific personality traits and even biological predispositions are overrepresented. And people have anorexia so that means that they probably play a role or, you know, contribute to the onset or development or maintenance of this and those include, like perfectionism high obsession ality high trait like personality anxiety, so not state anxiety, but this like, you know, kind of temperament or personality of being like a worrywart or thinking about things advance worrying about calm sequences and, you know, being a bit inhibited. Those are all personality factors that we see really, really highly over represented, which kind of indicates that somehow they play a role in the development of anorexia. And it might just be that if someone is to engage in a diet, right, like if someone says, I'm going to eat healthier, which is commonly what we hear, when we ask people, like, how did this happen for you, I wanted to eat healthier, I decided I was going to lose a few pounds that somehow those personality traits allow someone to, like, persist through something that is otherwise like biologically. So inverse of what of like mechanisms as humans, right? Like we have all these deep mechanisms to protect us against starvation. And somehow this specific subset of people are able to override those and actually, like, you know, engage in really significant starvation sometimes. And is it because of these personality features that that happens? That's that's one hypothesis there. But we do I mean, I think that most people would agree that there's some sort of interaction between a biology biological predisposition, like I was just noting, and some sort of societal influences, because often you do hear people say, you know, I started because I felt like I needed to change my body, or I wanted to lose weight, because X, Y, and Z, right, so that that's also kind of irrefutable, when you hear that story over and over again. Alex 11:23 Yeah, and it doesn't help that, you know, I feel like having Instagram and Facebook makes it a whole lot worse, you know, it was once with magazines and TV, but I feel like you're, you have way more overload with a phone in your pocket? percent. And, yeah, it's that doesn't help. And I'm also curious as well, if, you know, say, a family has, do you know, is anxiety genetic? Speaker 2 11:54 Is that it is Yep. If Alex 11:58 anxiety runs in your family? Would would you have a higher chance? Like, what are the I don't know if it's studied at all, but if there's any genetic precursors, towards anorexia nervosa. And then also, like, if there's any connections between certain like at home traumas, say you have like an abusive parent or, you know, like, are there certain themes that create an environment to to create anorexia nervosa? And typically kids, but I guess it could happen? Right, at any age. Right. Speaker 2 12:40 Right. Yeah. I mean, just to, like, speak to that is a great question and speak to that, like, very briefly, as you know, when does anorexia usually, or I mean, and we're talking about anorexia, some of it, there is a crossover. So like, many people who have anorexia will crossover into a different type of eating disorder. And but anyway, the onset is usually in adolescence or young adulthood, those are the most common times for people to present or struggle with an with anorexia. And, and yeah, I mean, you really just said it. I mean, we know that roughly two thirds of people who develop anorexia will have a lifetime comorbid or CO occurring anxiety disorder. So and usually that predates the eating disorder. So someone will have OCD, and then they'll develop anorexia later in life, or there'll be generalized anxiety disorder, social anxiety disorder, and then develop anorexia. So clearly, there's an overlap. And functionally even we know people will say, and, you know, there's studies that kind of, you know, I think, demonstrate that people will use their eating disorder behaviors to control and mitigate anxiety, they will say, I feel better when I don't eat, you know, I feel more anxious when I eat right. And so, but yeah, you know, in terms of genetic pre loading, you know, it is more common for someone to have a history of family history of an eating disorder, but also just anxiety, we see these temperament features run in families, and even if it's not an anxiety disorder, it's similar features that people have used, actually, productively in their life. So like, you know, we talk about perfectionism as though it's this terrible thing. But often people with perfectionism or who are highly obsessional, go on to do amazing things if they can kind of channel that trait appropriately. And so we see those things run in families. And actually, one of the things that we want to do is not pathologize those traits is actually to teach people that these are really positive characteristics, like in some ways 1% of people will develop anorexia, you are the 1%, who has this, like beautiful menu of traits that if you learn how to channel you can use in a different way. So So yes, and then related to trauma? That's a really interesting question. And I, I mean, so I'll start with the facts that are based on the data and so there there is data that suggests that in bulimia trauma is more prevalent than in other populations than in like, you know, healthy. So that suggests that that maybe there's some interaction there. That is not true for anorexia, though, I think one of the things that we do know do know is that when we understand from a neurobiological level, like some of the neuro NERT, basically, like learning differences or neuro diversity of anorexia, that I think that people are highly sensitive, right. And so if you think about a, like acute trauma, perhaps that's not it, but highly sensitive to things that are like little T trauma that might impact the way they move around their life and how they navigate, that could potentially be something that is true for people with anorexia, that they tend to kind of hold on to experiences and experience them as traumatic in a way that might influence their sense of self, you know, because of these. Yeah, just like, neuro divergences, I should say. Alex 16:00 I don't know if you have an answer to this question. And I don't know if anyone has done research about this. But it is. It is interesting how societal views on beauty changes throughout time, but also space. And you know, it's interesting when you go in different cultures of the world, like, what, what different cultures view on weight, and beauty is, you know, and here in, I'd say, pretty much all North America, specifically United States and Canada, I'd say that the ideal beauty is a lot lower weight than other parts of the world. You know, I remember I went to South Africa, and we were with a vocal guy, and some other guy came up, and he was like, Hey, you look fat today. And we were like, what? And the guy was like, oh, like, it's a compliment, like, you know, like, that's, that's something you say that, you know, it's like, your welfare, you know, and are like babies in China, you bet all your baby looks so fat, or like, you know, round is like welfare. And that's like, a compliment, you know? And but if you said that in the United States, you'd be like, Oh, my God, I can't believe so. I'm curious that like, you know, or if you were from from a place that had that feudi standard, and then you move to the United States, and you're an immigrant or something like that, and then all your, your childhood peers, you know, really, you know, so I'm guessing is different culturally, and that has an impact on the rates of anorexia and, or what eating disorder, you're probably pushed towards, right. I don't know if anyone has done that research, or Yeah, it's Speaker 2 18:02 really interesting to think about cultural influence right around beauty standards. And if we think that beauty standards play a role in the development or onset of anorexia, then that's really interesting. I mean, even just like food scarcity issues, food deprivation, right, the value of right of how that's expressed in the way that you look all the things that you're talking about. But it's really interesting, because there is data. So the prevalence rate of anorexia is about 1%. So it's actually quite, it's not that prevalent, right. And it might just be because it's this conglomeration of things that are needed to meet full criteria for anorexia, the prevalence rates for other eating disorders are, are larger or greater. But you know, the definition of anorexia is narrower, because you're requiring like this underweight status in some ways. And what I was gonna say about that is that the prevalence rates of 1% have kind of remained consistent over time. And the earliest case of anorexia was kind of recorded in like the 1800s 1700s. I don't exactly remember and but early, you know, and so I think people who see things things through a biological lens exclusively would argue that that indicates that this is a biological disorder. Right. And I think that's hard to say, because and, you know, there is a tendency to, I think there's some data pointing to the fact that anorexia is more prevalent in global Western populations, Asian populations. And so then that's another argument that somehow this is biological, although you could also just say that those are, you know, maybe cultural conglomerations, that have been more impacted by global West traditional beauty standards. So it's all very complicated. You can see it through many lenses, you know, my hypothesis is that there is a kind of a pretty significant interaction between the two things and that might present differently for different people. But like I said, if you if I was to kind of tell you a story about someone that I that maybe like a classic case that shows up and how they present. Normally it would be something like, the story is I'm here for treatment. And if I asked how did this start, it's, well, I wanted to eat cleaner, I wanted to eat healthier, which indicates that there was some need to control body weight shape, right? That might be cultural in nature. But and then when you learn about the person, you learn that they are usually high achievement oriented, super perfectionistic highly anxious. So like, that classic representation to me is like an expression of two things coming together a biology and a societal influence. Alex 20:37 You know, it's interesting, I, I never knew the full name anorexia nervosa, just, you know, everyone just referred to it as anorexia. Yeah. And same with bulimia, bulimia. Bulimia nervosa. I never heard that full term before. And I never knew that anxiety was such a huge component. I mean, it makes sense now that I think about it, but I never knew that. Yeah, it was as crucial as it it seems to be. And so I'm curious for the current treatments out there. I did some research. It's it sounds like there's no current pharmaceutical drugs out there. Now, for anorexia specifically. But for, like, psychological treatment, I don't know if that's the right term. But are they similar to treating general anxiety? Do they have kind of some crossovers? Speaker 2 21:42 Yeah, you know, again, great question. It's like, you know, that's actually some of the endeavors that are at UCSD, we have a large Eating Disorder Center, which is also a research program and neuro imaging lab. And, and so I should acknowledge my bias that I do tend to see things through a biological lens, quite a bit like coming from UCSD. But I yeah, I mean, one of the things that we've thought a lot about is like, Well, if there's this mechanistic thing happening, which is anxiety, can we target anxiety? Right? And will that lead to change, and that's proven a lot of groups who are in this field are doing that, but it's proven difficult to do. And, you know, you think about sort of applying treatments that work really well, for anxiety disorders, like have the best behavioral therapies out there, the best outcomes, like exposure therapy, I don't know if you've ever heard of that. But if you have a phobia, you do kind of like a graded or a flooded exposure to the SphereD stimulus. And over time, people have an ability to kind of like correct any fear expectancies, they have and have maybe habituate, even. And without getting too much into that applying those treatments to anorexia like food exposures actually hasn't really yielded a lot of difference. So there might be some learning differences once again, that make it more difficult to do that. And but yeah, I think you bring up a really good point is like, and that's something that we that was a question that we hypothesize, for psilocybin treatments is, is anxiety, sort of a mechanistic or a mediator of outcome like, because there are other studies demonstrating psilocybin therapy studies demonstrating that there is reductions in anxiety and have that happen. And so one of the things we're interested in knowing is, is that one of the mechanisms that might support and like recovery when we're doing psilocybin treatment. Alex 23:33 So can you talk about your study, and pairing psilocybin with specifically treating anorexia? Speaker 2 23:40 Yeah, definitely would love to. So we're very excited because this was the first study of its kind. So we feel really enthusiastic that we were able to engage in such an endeavor. And there's a lot of reasons that people others, not just us have kind of pose theoretical reasons for why anorexia is a good fit or psilocybin treatment might be a good fit, or may help with symptoms of anorexia, right. One of which is what I just said, like there's they're potentially like a mechanism of action is a reduction in anxiety. And other studies have demonstrated that when people come out of psilocybin experiences or treatment, they often will say, like, I feel a distancing, you know, like, I feel an opening up, like I feel less attached to my thoughts. And so, again, with all that we've already said about anorexia that could potentially be helpful in mitigating behaviors like restriction. And there's a whole bunch of other reasons that I'm happy to talk about, but in our study, because it was the first of its kind, I really do want to state like, as scientists, that this was a really small first phase one study. So we basically studied 10 People who met either full or partial criteria for anorexia nervosa, and we were mostly interested in kind of determining whether this treatment was safe and tall. herbal right and looking at signals for whether or not it was effective. And so yeah, to speak first about our results, like, you know, in our study, we, there was no serious adverse events. And that might seem obvious at this point along the way with psilocybin treatments, because we've learned that in other healthy populations and mental illness, like it's a highly safe, drug medicine, whatever you want to call it, and, but there's a lot of physiological complications and anorexia so that that needed that needs to be proven right. Anorexia and underweight status affects all systems in the body. So we really wanted to ensure that this was safe. And you know, lots of people refuse treatment with anorexia because it is so ego syntonic in nature, like people are benefiting, they perceive to be benefiting from their illness. And so dropout rates tend to be high and treatment, relapse rates tend to be high. Sometimes treatment is like a little bit prescriptive. I don't want to say coercive, but like slightly coercive in nature, people are engaging in treatment, because others are expecting them to or because they know that if they don't, they're going to lose their job, but there's not like an intrinsic drive. So we were really interested to know if whether people that are, so we're going to be willing and able and we found that they were and so those are really important findings. And yeah, on top of that very, very small sample. So more research is definitely needed to kind of substantiate how and if this works, but there was a subset of people who had significant and precipitous drops and their eating disorder symptoms after treatment. So that's really cool to see, too. Alex 26:38 I I'm not a neuroscientist at all. So I have a very rudimentary understanding of how psilocybin works in the body, especially when treating addiction and things like that, it seems to do a lot, everything we seem to throw at it, it seems to be pretty good. With, with a few exceptions, but we brought on some people in the past that were looking into using psilocybin for to actually to lose weight. So kind of the opposite. And there was a study with rats. Again, it's it's rats, so you can't say much, but the rats actually ended up losing weight, and, and body fat. And so but the the thought it had to do something with, you know, h five HT to see receptors and the serotonin system and things like that, which goes beyond my understanding. But do you feel? Yeah, I'm just curious on what your take on that is. And if you feel like it's, it's it's treating, like, a bad habit, like rewiring the brain. And and that's how it works. And it's, yeah, I'm just I'm phrasing this question horribly. But yeah, I'm just curious what your take on that is Speaker 2 28:22 definitely following you. And it's fascinating. And I mean, again, first, as you know, a clinical researcher, I'll say, like, we don't know, and those are amazing questions, but I can certainly talk my ideas based on spending a lot of time with participants and my current knowledge of how this illness works, and how the way that people were talking about how they were potentially improving from this and yeah, so it is on a neurological level. Absolutely. Like, you know, if we're this is a serotonergic agonist and, you know, serotonin is a neurochemical that works on mood, behavior. And so And actually, serotonin has been heavily implicated in anorexia, that there's alterations and so to think about, you know, a drug that acts on these receptors for anorexia already makes sense, actually, but kind of on a psychological more like phenomenological level, like what is happening, right, that might help someone recover? And I mean, that's a question that I will continue to ask myself probably for years until someone looks at mechanisms of action or, you know, more work is done there. But I think that what I one theme that I saw pop up a lot was sort of reorganization of value systems like which makes sense when you have a psilocybin experience, you have the opportunity to think about things differently, gain new perspective, new insights, right, like, you know, I connect with other parts of yourself. And so, you know, to have a reorganization of values of or the relative value of weight and shape in accordance or relative to other things in your life. If I saw a lot of that happen where people were like, I don't, I don't want this to define me anymore. This is not as important as other life endeavors. Right. And so that's kind of an indirect way of treating anorexia. And yeah, I mean, it is interesting to think about, you know, like I said before, because I think one of the challenges here is that, that's great, that phenomenological shift of wanting to not identify with your eating disorder, as much for me is huge. And if that ends up panning out, that's a huge contribution to the treatment fields for eating disorders, because we don't have any treatments that do that right now, we really, really don't So, but then there's this next step of like, executing that in your life, right, like integrating that. And something that's really difficult about anorexia specifically, like let's say OCD is it requires like, pretty significant behavior change, right? It's not like you just walk out and decide, okay, I don't care about my body anymore. That's a stereotypical example. But I'll just give it so I'm better like, no, now I actually have to go change some pretty like rigid and ritualistic behaviors, and just psilocybin opened up an opportunity to make that easier, possibly, we'll have to see, I didn't have anyone walk out and do that with ease, I had people connect to the desire to do that more than they did before and feel like they could and knew the pathway. But it was still work, you know, and I mean, that's something that I know you and I know about. So it's not just like this button, then suddenly your life is perfect, like there is work to be done with the experience. And I think that's actually even more important with this illness, because there's actually a lot of work to be done after in kind of undoing some really rigid, ingrained behavioral patterns. And it brings up questions for me around how to navigate that with people after a psilocybin experience that, you know, that I think will come in the future as we continue this work. Alex 31:54 And do you do you have more trials in the in the pipeline? Speaker 2 31:58 Yeah, so we are doing the phase two trial right now, which is a, so phase two is more about kind of examining efficacy. So this is a much larger multi site trial. And we're currently recruiting and running people in that study. And that is a randomized study. So it's a randomized, double blinded study, where people will either get randomized to either a therapeutic dose, or what we consider to be a therapeutic dose dose of what I should let you know, is synthetic psilocybin, not you know, fruit body mushrooms, synthesized in a lab, and or a one milligram, which is like really, technically supposed to act as a placebo dose, so that we can evaluate whether it's, there's a difference, right, and we can really say that, like, it's the drug that is actually impacting change, not the full therapy that we're doing around the drug to, because everyone will receive the same type of kind of treatment around that, that looks like traditional models of psilocybin treatment, which includes preparation and support during the experience and integration. Alex 33:01 Right. And so, right now, in Oregon, the the minimum age to get psilocybin therapy is 21. And I'm sure you have the same age restrictions for your trial. However, anorexia, as we're talking about, typically develops at younger years, which, you know, becomes an issue of, you know, kind of sucks that, you know, these kids probably wouldn't be able to get the treatment, if it's very successful in these trials. Is that something that you've thought about? And you know, is it just kind of like, Yeah, well, we'll, we'll work with other forms of therapy, and until they turn 21. And then that's just what it is. Yeah. And even if even if it was legal, I don't know if there's much studies on this of, you know, pre pre full brain development. I don't know what our current understanding of that is. But, you know, what, what are the effects of psychedelics on on younger? Humans? I don't know if there's any trials on that. I know a lot of people have kind of said, maybe stay away from it. Until we fully know, but yeah, what are your thoughts around around those two things? So many thoughts? Speaker 2 34:28 Such a great question. Thank you. Because that is, well, okay. So I'm also a child and adolescent psychologist by training. And so, again, like many days of my life I've spent with teens with eating disorders, but also just other psychological, mental illnesses, depression, who are already chronic, like, again, we're talking about, you know, applying these treatments to treatment resistant populations, or you know, better treatments because other people haven't responded to the traditional ones. And yet, somehow, if you're are under 18. In our study, it's 18. Or I guess, a legal adult, kind of Yeah, that you can't access these. And there's good reason for that, we need to study that. But it is really unfortunate because that means that you can have someone who has been chronically ill already since they were 12. You know, and we know that that, you know, in mental illness, I mean, we know many things. One is that the earlier the onset, sometimes the more, the worse, the prognosis. And the longer the duration of illness, the worse the prognosis. So the fact that people have to wait around when clearly they haven't been responding to things is, to me, a super travesty. And I will say that, we need to do those studies, like all for all the reasons you said, we don't understand yet how to adapt models of psychedelic assisted therapies, psychedelic treatments, that so they're appropriate for adolescents who are embedded in a family system, who have, yeah, just other pressures around them in terms of treatment different like locus of control around wanting to recover. And so we need to do those adaptations in those studies. And I think that those will come like in, you know, in the approval processes for pharmaceutical drugs, which is this, this is one in the standard approval processes, outside of, you know, places where it's legal to access psychedelic treatments with plant medicine, there's usually an age de escalation protocol. So essentially, you again, in different phases of treatment, you will then kind of study whether this can be an application for younger populations, and that is 100%. necessary, we have a crisis, and child and adolescent and young adult mental health, actually, the rates are skyrocketing, and our treatments are limited, right? And so there's a lot of kids who are suffering and a lot of families who don't have any access to doing different things, unless they're seeking out help in alternative formats, or the underground. So. Alex 37:02 Yeah, I'm just thinking through how many kids are on handfuls of like, SSRIs at such a young age, and it's like, well, what is that doing to their brain? You know, pre fall development. Right. And, and also, it's like, well, if you don't get treatment, what does nine years of having anorexia untreated, do to your development? Right? Like, know that Speaker 2 37:27 that's really bad? For right, like, yeah, Alex 37:30 yeah. And like, if I, I'm sure, if you have clinical, rigid set and setting with trained professionals, I think the worry, like, I would be worried of a kid taking psychedelics without that rigid set and setting when they don't have a full grasp on themselves and the world. And they're having these very crazy realizations, but they don't have a framework to fully integrate or work around it or have anyone to talk to about it. Because their whole, all their friends and colleagues are just at a dip. They're not having those, you know, and, yeah, they don't have a good foundation to bounce those things around. And it could be, it could be a lot. Right. And and, yeah, so yeah, I feel like I'm on the fence. Right. And I would love to see more studies around that. But my gut is telling me that, you know, if it's done in the right way, it's better than not. Yeah, right. Speaker 2 38:46 Exactly. Because it's really is all a risk benefit calculation. At the end of the day, it's like if you have not responded to other treatments, and you are now going into your fifth year of being ill, what effect is that having on your life, right and worsening your prognosis mean, even if there was some potential risks associated? That's it's a risk benefit calculation, you know, for people who are chronically mentally ill. And I totally agree. I mean, I think, as a child and adolescent psychologist, I've thought a lot about what are the adaptations that would be needed? And eventually will, you know, I think I think those studies will be done and, and I think, again, significant and thorough preparation, significant and thorough preparation and kind of containment within the family system, right? All of those things are really, really important and could really mitigate some of those potentially negative outcomes. And I very much look forward to those studies happening for the same reasons I was describing and working with people with anorexia like it's just not fair that we cannot provide adequate treatments for kids who are really suffering, you know, and struggling for extended periods of time in a way that's really going to affect their life long term. Alex 39:59 Yeah, I A, I used to be prescribed anti anxiety medications as a teenager and it made me feel awful. Like just, it was all a blur. Like I, I think back to those the the few years I was on it, and it it's just a blur like I, I felt like a zombie. It helped mask the the surface level symptoms, but it didn't help the route. Or at least, you know, potentially did help a little bit. But it really wasn't until I started taking mushrooms that it was like, oh, okay, because I you know, it was it was putting the spotlight on the root of those things. And I was, you know, even the most powerful microdosing experiences have been when I quote unquote, took too much, which happened to be the perfect dose. And it was when I was really feeling it. And I was in a social situation. And I was really feeling like a lot of social anxiety coming up. But I was able to work through it real time, and integrate it real time and feel it and be like, Oh, okay, this is what I'm feeling. And I'm not running away from it. I'm not, I'm the kind of exposure therapy really, I mean, it was. And those have been the most powerful experiences of me of like, All right, see, this is the feelings that are coming up, this is the route and I'm, I'm here let's work through it. Because there's, there's no other way, you know, can't turn this off. So, um, so yeah, I'm excited for your research. And I think this is really crucial. And I hope more adolescent kids beyond anorexia, I feel like, you know, most, I feel like a lot of things develop in your, in your childhood, and a lot of these traumas develop in your childhood. So the faster that we can get at them, the better. And it's really just establishing protocol and, and a system in which we can help kids not suffer as much and develop into good humans. Speaker 2 42:15 So much, and it's you just sort of gave such an example of how I think some of the ways that you know, SSRIs do well SSRIs pharmaceutical drugs do work for a subset of people, but it's even interesting, the route at which they work, right, like people will describe feeling like, not more numb or more dulled. Right. And so then maybe there's like, less big emotions, and okay, so I could see how that could be a pathway to feeling better. And yet, with psilocybin or psychedelics, there's like this encountering what's happening, right, there's like, a facing and going towards, and that's a really different route of treatment, you know, and maybe, in some ways, feels more salient and powerful in the long run. So, yeah, I totally understand what you're saying, Alex 43:00 which I can also see being counterproductive if you don't know what's happening, and you don't have that, yeah, set and setting and people around you that can if you don't know what's happening, right, and you'd be like, Oh, everything's in you can go in a spiral. But if you if you know what's happening, and you could be at ease and kind of work through it, then it can be really powerful. But yeah, you know, it's all about setting setting and having the right network and people around you, but Speaker 2 43:32 really important part of this, it's like, you know, we're talking about psilocybin treatment, which isn't just administering psilocybin it's this whole kind of appropriate preparation education, practice with sitting with internal experiences, like all of that is like really kind of tangled within the treatment right alongside the medicine so Alex 43:55 so you you work with a lot of different eating disorders, and you have a whole you have bright mind therapy and seemed to work with a lot of kids doing a lot of different things including your work with anorexia and mushrooms what has been the hardest part of of your your work? Speaker 2 44:19 Oh my goodness wow, you know, I'm so privileged like this, I don't want to be caught bowtie but I feel so lucky. Like I get to be in a place through my work where I'm feeling like I'm doing something like being of service to others, which is like a value of mine. Right? And so it feels so values aligned that I just love my work. And you just said I mean I do a lot and that that's not a surprise to me when I think about it because I'm a novelty seeker. I just do better with like, navigating many things at once versus one thing and and I think that This is the hardest part of my work is the the administrative parts that are not the work, you know what I mean? So, so finally, when I finished the paper that was published for nature, on this study, people asked me like, What was the hardest part and I was like, honestly, the hardest part was like the formatting and the editing, the writing was the easy part, like the telling the story and writing up the results was the passion part and the parts that come alongside. And that's probably true for many and all of us, right, it's like, all the things that you have to do, that surrounds the work to get the work done. And that's probably the most difficult part. And you know, I think holding, I mean, in the work that I do, that I'm passionate about, the hardest part is Holding, holding people in places where they are not improving. So like I can think of, you know, a teenager that I've been seeing for with her family for five years. So I think I started her when she I started seeing her when she was a freshman in high school, and now she's off to college. And she's actually going to college, which at some point, we didn't know, she could make it. And, you know, there was periods of time where it was just nothing was working. And my job was to, like, be out, like to hold the family in that right. And, and, in some ways, just hold them and walk through that with them. And that's really difficult, you know, because I wish that I could do more. Right. And I wish that week there was something out there. And yeah, but I'm a therapist, I'm not like a messiah, you know. So I think that that can be a really difficult part, but also a part that's really rewarding, as well as just, you know, knowing that you can be side by side with people, even when they're struggling. Alex 46:41 If you had unlimited resources Time Team, what would you do? Yeah. Speaker 2 46:50 Right now, not in the future. But right now, I think, you know, applying for and evaluating, which like, could be in the future, other psychedelic compounds and how they work for and the two main indications right now that I have my mind set on that you've kind of named for me, our younger populations within that are embedded within systems as a child and adolescent psychologist, I'm also a family systems therapist. So that work is important to me is like how do we navigate and help people like move back into their own systems in a way that's supportive for integration and their work? And, and yeah, and, you know, basically evaluating other psychedelic compounds for eating disorders, as well. So those are the two kind of main lines that I find myself gravitating towards right now. And also just like continuing to, I am a Clint, I always say I'm a clinician first. And I'm a researcher second. So for me, it's really important to be connected to the actual work, like I really like to see people and be in therapy. And that's how I think that I can do my best work and kind of thinking about better ideas. So but yeah, those would be the two things that I'd be interested in, I don't think are totally out of scope, actually, either. So we'll see in a few years. Alex 48:06 And where do you see the space in say, like, 510 years? Oh, my could be it could be two part. Where do you see it realistically? And where do you see it? Hopefully? Speaker 2 48:15 Yeah, such a good question. Oh, my gosh, I don't know, I noticed for myself when that question is asked, like, I feel nervous and anxious. Because I think that it's hard to kind of, hopefully in the right direction. And, you know, I think places I'm really, really happy to see decriminalization and access to just on deep prohibitionist around medicines. Right. And, and I think it's really important that that we proceed safely. And you know, recognize that, like you said, there's a lot of measures that need to be in place. And there is some, I think, some regulatory oversight that needs to be in place to really reduce harm, and make sure that these treatments are being delivered safely and effectively. And, like deliberately, right, and so I hope that there is a way for two pathways to emerge. One is approvals for pharmaceutical indications, right for mental illnesses. And I think that will happen over time in five to 10 years. And then I also think that there's another pathway, which is again, decriminalization and legalization, and I hope that that can be done really consciously, in a way that treatments being provided without kind of with like mitigating negative outcomes to and that's happening in other states, it's likely going to happen eventually in California, I imagine as well. So, yeah, so my hope is actually that people actually have access to treatments without having to be in a study, right that they can actually go and get a different treatment and that it feels accessible and it feels non stigmatized, right and five years. Alex 49:54 Looking forward to it. And in the meantime, where can people follow you your work your future studies Speaker 2 50:00 Yeah, I'm a terrible social media person. And part I have like I have neuroses about that part of me. It's like, that's because I'm doing work. I don't have time to be on Twitter about it. But the other part of me is like, Well, no, but that is a platform that people use. I can I have, I'm on Twitter, I'm on Instagram. And my Twitter handle is Dr. natspec. My LinkedIn is Dr. Stephanie natspec. So my full name and same with my Instagram, actually, so you can follow my work there, to the extent that I will keep up with posting about it. UCSD will be soon kind of releasing and launching, we have a psychedelic Health Research Consortium and that page, or that kind of platform is about to go live. So work will be published there as well. And then of course, hopefully in research articles as well. So yeah, Alex 50:51 amazing. Well, thanks for coming on. Is there anything else you want to leave the audience before we break? Speaker 2 50:57 No, I mean, thank you so much for your really intelligent questions. I feel like we've covered most of it today. Alex 51:03 Amazing. And thank you everyone for tuning in and tuning in for another episode. Wherever you are at listening around the world. We can do this without you. So thanks for listening. And if you want to support the show, we don't have a Patreon or any way that you could donate directly but we do have a brand mushroom revival where we sell a bunch of functional mushroom products. So check it out mushroom revival.com. We have gummies capsules, powders, tinctures, and a bunch of free resources as well. We have a bunch of free ebooks and blogs, all of our podcasts, podcasts with show notes are on there as well. And if you want to try your products and you don't want to spend money we have a giveaway going on. The link is in the bio and you can sign up to win some goodies. If you want to try it out with a discount code we have a special VIP code. It's pod treat for a special discount only for podcast listeners. And apart from that just tell your friends tell your family if you learned something in this episode. Tell someone if you learn something in a different episode just spread it around like the mycelial network that we're a part of get more people into mental health advocacy and mushrooms and fungi as a whole. So thank you again everyone. As always much love me the spores be with you Transcribed by https://otter.ai
