When someone embarks on a psychedelic trip, they have little control over what they'll experience. A person could find themselves floating through the universe, or face-to-face with terrors that haunt them — or some wild combination of both.
What happens at the end, though, is often less intense. The consciousness-altering drug begins to wear off, but the visceral effects of the trip haven't completely faded. This is actually a critical period, particularly for those undergoing psychedelic-assisted psychotherapy. It's during these liminal minutes or hours that the profound insights and emotions a person experienced on their trip can start to slip away. Sometimes what they feel deeply in their heart or bones can't be expressed in words. For some, the ineffable nature of a trip makes it difficult to use the experience as a catalyst for transformational change. Integration, or the therapeutic process by which people make meaning of their trip, is typically designed to help patients recall and interpret their insights, but their recollections aren't always as intuitive the farther they get from dosing.
A few years ago, Dr. Prash Puspanathan, a psychiatrist who's studied psychedelics extensively, and scientist Agnieszka Sekula recognized this challenge, and cofounded Enosis Therapeutics(opens in a new tab), an Australian startup developing virtual reality scenarios to facilitate psychedelic psychotherapy. They not only created a protocol for delivering psychedelic therapy with VR but also a proprietary software called AnchoringVR, which creates an immersive scenario that patients explore once they begin emerging from their trip.
Using any commercially available VR set, a patient starts the AnchoringVR scenario at the tail end of their psychedelic session, which can be four to five hours following psilocybin treatment or shortly after an intravenous infusion of ketamine.
The patient can then construct their own VR world, using audio and visual elements. They might chose to sit seaside, then virtually interact with a large rock, label it with an emotional burden, like a specific trauma, and throw it into the waves. A star can be plucked from the sky, then paired with an audio recording of a memory or feeling that emerged during the trip. That object then becomes a symbolic representation of a key insight and is symbolically turned into the patient's North Star. The handful of patients who've tried AnchoringVR did so for 45 minutes at the end of their psychedelic experience, then replayed those recordings in the company of their therapist during each integration session.
"Patients feel emboldened to speak freely and comfortably when they're encased within a cocoon which is a manifestation of their own mind," says Puspanathan, who is the company's sole funder. (Prior to founding Enosis Therapeutics, Puspanathan was the CEO of a successful boutique cryptocurrency brokerage.)
Amid the billion-dollar rush(opens in a new tab) to identify effective psychedelic compounds, Enosis has carved out an unexpected niche. While VR is used to achieve or enhance consciousness-altering states, pairing the technology with psychedelic-assisted psychotherapy is uncharted territory. Enosis hopes to harness the wonder and awe produced by VR to fine-tune integration. While this treatment phase doesn't capture the popular imagination in the same way as the hunt for new psychedelic drugs or the wonder of a psychedelic trip itself, experts say it's fundamental to successful treatment. In trying to build technology that aids integration, Puspanathan and Sekula are raising important questions about why that aspect of the psychedelic experience matters so much — and how VR could play a pivotal role in improving it.
What is psychedelic integration?
Once Dr. Sergio Pérez Rosal, CEO, cofounder, and medical director of OVID Clinic in Germany, personally tested AnchoringVR, he says it was a "no brainer" to bring Enosis into the psychiatric and psychotherapeutic clinic. Pérez Rosal says that the two patients who've undergone four integration sessions using AnchoringVR have been immersed in the experience. They've interacted with and labeled stars, using them to record insights. Some stars were converted into plants for tending. Others were turned into stones, or brought to a fire for burning. They've also created their own meaningful symbols, which have included drawings of hearts, partners, pets, and birds. (Enosis and OVID declined to make patients available to speak with media, but Mashable did see a demo of AnchoringVR.)
This style of engagement aligns with OVID's approach to psychedelic-assisted psychotherapy, which combines pharmacological and psychotherapeutic treatment with a well-integrated psychedelic experience.
"We shift the focus away from this idea that [the psychedelic] substance is going to make the change," says Pérez Rosal.
While some scientific research suggests that psychedelics(opens in a new tab) may have a powerful effect on neurons in the brain(opens in a new tab), possibly creating new pathways or repairing damaged or dysfunctional ones, high-quality integration is key to helping patients draw conclusions from their insights and make new or different choices in their lives. At OVID Clinic, patients are treated with ketamine, an anesthetic that induces a psychedelic experience. Patients undergo both preparatory and integration sessions with the aim of making their treatment as effective as possible.
Dr. Margaret Ross, a senior clinical psychologist at St. Vincent's Hospital in Melbourne, Australia, and the chief principal investigator for the country's first psilocybin-assisted psychotherapy study, knew Puspanathan for years prior to joining Enosis' clinical advisory board. One of her primary concerns as a psychologist who treats end-of-life patients is ensuring that their integration process is as successful as possible. In this regard, she believes Enosis' technology is "quite extraordinary."
Ross describes its design as nonverbal and symbolic, which can help patients "bridge the conceptual and real without making it too concrete or reducing it all to words." Ross says she often hears from patients desperate for psychedelic-assisted therapy to cure their severe anxiety or treatment-resistant depression, who assume that the substance will seamlessly lead to a life-changing transformation. What they don't understand is how much emotional work it takes to make those changes long after a psychedelic has worn off.
In one clinical trial sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS)(opens in a new tab), which is unrelated to Enosis' research, investigators are researching the efficacy of methylenedioxymethamphetamine (MDMA)-assisted therapy for the treatment of PTSD. Following each dose, participants have three integration sessions with a therapist, says Sara Gael, a psychedelic therapist and one of the trial investigators. Participants may meditate, journal, create art, or use movement or other activities to support the integration process. Importantly, analyzing insights with language isn't always necessary or possible.
Gael, harm reduction officer for MAPS, says that when a client concludes psychedelic-assisted therapy, it's as if they're walking away with a handful of seeds that may be new insights, awareness, changes to their self-concept, or even mystical spiritual experiences, which can contribute to healing and growth. If planted in nurtured soil, under the right conditions, those seeds will eventually blossom. Integration can similarly create the right environment for change, says Gael.
"If proper integration doesn't happen, the best-case scenario is those seeds just never get planted and change doesn't really stick."
"If proper integration doesn't happen, the best-case scenario is those seeds just never get planted and change doesn't really stick," she says of her experience working with private practice clients. In the worst cases, people are further "destabilized" and may feel lost or confused after treatment.
Avoiding an over-the-top VR experience
While Gael is unfamiliar with Enosis, she said its technology could hold promise if used in "client-centered" ways. This means avoiding overstimulation. VR has the potential to flood a person with stimuli like light, noise, color, and movement, which can undermine a patient's natural ability to interpret the sensations of their trip. An over-the-top VR experience could also trigger cybersickness, or worsen anxiety and trauma for those with a history of both conditions, particularly if their psychedelic journey brought up difficult or painful emotions and memories.
Sekula says AnchoringVR has been designed with these risks in mind, even if some might expect the software to come with every bell and whistle.
"Everyone has an idea based on their own private, probably single experience [with psychedelics] at one time..." says Sekula. "They want angels, or someone wants tarot cards, or someone wants to have little humans they can play with."
But while one person might find an angel comforting, for example, the next person might find it terrifying, which is why Enosis has built nature-based environments with imagery that mimics the traditional setting for psychedelic use, before human beings started using those substances in medical clinics.
"We really need to systematically test and check how does that work, when does it not work, how risky is it," says Sekula of design elements that could be more overwhelming than helpful for most patients.
Earlier this year, Sekula and Puspanathan laid out these considerations, among others, in a paper published in Frontiers in Psychology(opens in a new tab). They also tested AnchoringVR on four volunteers at a psychedelic retreat in the Netherlands. The participants received therapeutic doses of truffles that contained psilocybin.
While their findings haven't been published in a peer-reviewed journal, Sekula and Puspanathan found that AnchoringVR helped recreate similar emotions to those the participants experienced while on psychedelics while also increasing their ability to remember insights during an integration session. The same results weren't true for participants who were only exposed to an "awe-evoking" VR scenario, not Enosis' proprietary technology. Enosis plans to launch a large clinical trial early next year.
The future of VR and psychedelics
Sekula and Puspanathan are both concerned that VR companies will try to tap the psychedelics market with experiences optimized for gaming and entertainment. While a recreational psychedelics user might seek spiritual or psychological growth by tripping while using VR, Puspanathan says commercial, off-the-shelf VR scenarios haven't been designed with this purpose in mind.
"We do maintain our stance that an evidence-based, science-first approach is very important because of the risks that are involved," he says. "The deeper worry for us is that while uptake is good but then the wrong scenarios start to be used, then the entire industry starts to be tarred with that brush, which isn't actually reflective of the science that's behind what will be the optimal approach..."
"We do maintain our stance that an evidence-based, science-first approach is very important because of the risks that are involved."
So far, Pérez Rosal has been impressed by Enosis' technical support and pace of innovation. When he personally tried AnchoringVR prior to bringing it to OVID Clinic, Pérez Rosal found it created a calm environment that allowed the user to follow their own thoughts, without immersing them in a stereotypical '60s-style version of a psychedelic trip. Enosis' team trained his clinic's staff to use the technology. The implementation was easy, with no software or hardware failures to slow it down.
Still, Enosis has a monumental challenge ahead. Its clinical trial must show convincing evidence that AnchoringVR is equivalent or superior to standard integration practices like meditation and journaling. Then there's the question of who pays for VR sets and licenses. Puspanathan and Sekula say that AnchoringVR is intended for clinics and research institutions, which will need to purchase licenses. Any VR headset is compatible with AnchoringVR, and Enosis' licenses can be used for an unlimited number of patients.
Puspanathan acknowledges that developing a business model for what Enosis is doing won't be easy, but he and Sekula are driven by their belief that psychedelic-assisted psychotherapy patients who use their VR technology will benefit in unique ways.
"Being in control gives you a sense of empowerment," says Sekula, "and also means you're far more likely to continue with the therapy and stick to the therapy, and come up with solutions that are personally relevant to you."
