A diagnosis of advanced cancer is devastating and most people experience waves of distress, depression and fear as they process it. Researchers are hoping to support people going through this in new clinical trials that use psychotherapy in combination with psychedelics.
Lisa Reynolds, a health psychologist at the University of Auckland, has worked with cancer patients and their families for many years and found therapies available here to cope with the psychological impacts of a terminal cancer diagnosis are limited. “Most of what’s on offer is supportive counselling, which can be very helpful but it’s a limited toolkit.”
The team is now recruiting 70 cancer patients for two clinical trials. One, in Auckland and Dunedin, is to assess the usefulness of psychotherapy augmented with MDMA (also known as ecstasy) in treating depression and anxiety experienced by patients with advanced-stage cancer. The other, in Auckland, uses meaning-centred psychotherapy in combination with microdosed LSD.
MDMA works by temporarily suppressing activity in the amygdala, the brain’s fear centre. Psychiatrist David Menkes says this may account for its usefulness in helping people process traumatic memories and address underlying emotions linked to regrets and unresolved issues as they approach the end of their life. A full dose also causes a surge of serotonin and dopamine in the brain, which results in euphoria and strong feelings of connection with others and the natural environment.
Like other classical psychedelics, LSD stimulates serotonin receptors in the brain. This enables communication between parts of the brain that aren’t normally in contact, possibly explaining hallucinations, synaesthesia and mystical experiences. It also increases neuroplasticity, the building of new neuronal connections, which may underlie longer-lasting changes in mood.
Although the two medicines work differently, they both help people to delve deeper to explore issues that are confronting them.
The MDMA trial offers two 90-minute therapy sessions the week before participants receive a carefully controlled dose of the medicine or an active placebo. The dose is high enough to lead to a significant alteration of consciousness that can last for about eight hours. This is followed by debrief therapy and follow-up sessions.
The study uses an active placebo to preserve the “blinding” of the trial. “It can be pretty obvious if you’re having a psychedelic experience,” Reynolds says. “If you know, you can guess which arm of the trial you’re in and then your expectations could influence the outcome.”
The LSD trial provides seven sessions of meaning-centred psychotherapy, delivered by specifically trained therapists. Participants are given a micro-dose or an active placebo before each therapy session and then take another dose at home later in the week.
Meaning-centred psychotherapy is not widely available in New Zealand, Reynolds says, but international studies show benefits for people with cancer. She says the research team hopes everyone will benefit from the micro-dosing LSD trial because all participants receive this specific therapy.
People in the full-dose MDMA trial will also benefit from the associated therapy sessions, but Reynolds says some may be put off by the prospect of receiving a placebo. The team offers what’s called an “open label extension” – one month later, they can opt to repeat the session under the same conditions, except that they know they’ll receive MDMA.
Reynolds says the trials will also add to the number of trained therapists, including Māori, who are able to deliver meaning-centred psychotherapy, which could result in new treatments being more widely available. The team is recruiting Māori and non-Māori late-stage cancer patients. Anyone interested can contact wellbeingtrials@auckland.ac.nz
