In this episode of the Psychedelic Medicine Podcast, Dr. Max Wolff joins to discuss his 2020 study exploring how psychedelics can facilitate the healing process of “letting go.” Dr. Wolff is a psychologist, psychotherapist and head of psychotherapy training and research at the MIND Foundation. He is also therapist and researcher in the EPIsoDE Study, a government funded clinical trial investigating psilocybin-augmented psychotherapy for treatment resistant depression at CIMH Mannheim and Charité Universitätsmedizin Berlin.
In this conversation, Dr. Wolff shares insights from his study, “Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance,” which appeared in Frontiers in Psychiatry in February 2020. In this paper Dr. Wolff and colleagues explore how psychedelic assisted therapies can help patients work through maladaptive avoidant behaviors at the root of many mental health conditions.
Dr. Wolff explains that there are two fundamental motivations systems at work in human beings—the approach system and the avoidance system. In healthy individuals, both of these have important and adaptive roles to play as people work towards goals and seek balance in life. However, adverse experiences in unsafe environments can cause individuals to develop unhealthy avoidance, often leading to mood disorders such as anxiety and depression in more severe cases.
One of the goals of psychotherapy—psychedelic or otherwise—is to facilitate a safe container where an individual can work through avoidance, says Dr. Wolff. Psychedelic assisted therapy may be especially effective to this end, as the introspective nature of the experience precludes avoidant thought patterns or behaviors and there is nothing to use as a distraction in the therapeutic context. However, this isn’t the only way psychedelics facilitate the process of letting go.
Dr. Wolff also discusses the effect of psychedelics on relaxing the beliefs of the patient. This recent theory, called “relaxed beliefs under psychedelics” (REBUS), considers how psychedelics encourage an open mindedness and curiosity around perceptions and ideas that would often be dismissed or ignored in sober states due to rigid structures of beliefs and assumptions. This is important in the context of avoidance, Dr. Wolff explains, as it means that the patient is primed to explore issues where typically an avoidant response would be triggered due to a fixed belief about the stressfulness of the topic at hand.
As a result, psychedelic assisted psychotherapy can be particularly effective in empowering patients to revise avoidance-related beliefs at the root of many mental health conditions. By helping patients work through fear and let go of traumas and stress around tender topics, Dr. Wolff thinks psychedelic therapy can make an important contribution to the broader field of psychotherapy.
In this episode:
The approach and avoidance systems of human motivation How avoidant behaviors can develop into mental illnesses How working through avoidance is crucial for both conventional and psychedelic therapies The experience of avoidance in psychedelic therapy and how this can be conducive to acceptance How the idea of relaxed beliefs under psychedelics intersects with avoidance Different mechanisms for MDMA and classic psychedelics for facilitating letting go
“The less favorable the environment is, or the conditions in which we develop are, the more likely we are to have interactions with our environment that are threatening to our psychological needs, or even perhaps violating to our psychological needs—that is where a lot of avoidance behaviors or avoidance schemas can develop.” [5:43]
“Only by withstanding the urge to run away, and only by breaking this vicious circle of avoidance, you get the chance of revising the assumptions that underlie the anxiety.” [27:42]
“In psychedelic experiences, one fac