Psilocybin for PTSD with Stacey Armstrong, PhD
In this episode of the Psychedelic Medicine Podcast, Stacey Armstrong, PhD joins to discuss the latest research on psilocybin treatments for PTSD. Dr. Armstrong is Associate Director and Senior Researcher at The Ohio State University’s Center for Psychedelic Drug Research and Education, and a clinical psychologist with advanced training in treating PTSD in veterans. She is the first author on a recent pilot study of psilocybin-assisted therapy for veterans with severe, treatment-resistant PTSD.
In this conversation, Dr. Armstrong discusses her team’s pilot study of psilocybin-assisted therapy for veterans with severe, treatment-resistant PTSD, explaining why this population urgently needs new treatment options and how trauma, repeated exposure, military culture, and difficulties with reintegration may contribute to the severity and persistence of PTSD among veterans. Dr. Armstrong emphasizes that the potential benefits of psilocybin cannot be separated from the therapeutic context, including extensive preparation, trust-building, supportive care during dosing, and integration focused on psychological flexibility and personal values. The conversation explores how psilocybin may create a window for new ways of thinking and behaving, why preparation itself appeared to contribute to symptom improvement, and what larger, controlled and more diverse studies will need to investigate before psilocybin-assisted therapy can become a more established treatment for PTSD.
In this episode, you'll hear:
Why veterans with PTSD may experience particularly severe, chronic, and treatment-resistant symptoms
How trauma, military culture, and difficulties transitioning back to civilian life can complicate PTSD treatment
The preliminary findings from Dr. Armstrong’s pilot study of psilocybin-assisted therapy in 12 veterans
How the study used four extended preparation sessions and two ascending-dose psilocybin sessions to build trust and gradually introduce participants to the psychedelic experience
How acceptance and commitment therapy themes, psychological flexibility, and values informed the preparation and integration process
What future research should investigate, including larger controlled trials, longer-term outcomes, more diverse participants, and the potential therapeutic effects of preparation alone
Quotes:
“[Dr. Morski] What do you think the mechanism of action of why psilocybin might be effective in treating PTSD?
[Dr. Armstrong] That's a great question. You know we don't know for sure. That's the straightforward short answer. But there are some hypotheses right. So there seems to be some impacts at the mechanistic biological level, some some changes in brain functioning from what we can tell that perhaps it opens up an opportunity, psilocybin itself, to be able to think in new ways or or perhaps not foreclose on a coping strategy that maybe before I would have been like, no way. I'm absolutely not going to go into that triggering, you know, grocery store at the busiest time on Saturday. So it might create a window of opportunity to basically try out and create new pathways in the brain of ways to think. And, and maybe we feel a little bit different when we're doing things because of these new ways our brain is functioning. But at the same time, you know, there seems to be something important—or at least I feel pretty compelled—that there's something happening psychologically as well. So a lot of the hype and the excitement—of course, and understandably—goes towards the psychedelic itself: like what's happening with the psychedelic and why is it creating better outcomes for some people. But I think there's a really important piece of the story too, which is: it's a therapy and it's a therapy around what we're doing to prepare somebody for a psychedelic experience and how we're showing up for them during a psychedelic dosing session. So, you know, we don't just put them in a room and walk away and we're there. We're with them for the whole day, making sure they don't need anything. If they're feeling anxious, they're having a hard time. You know, we're there to help support them throughout that process, but then also to kind of put the pieces together on the other side, which is this integration piece. And there seems to be something perhaps quite compelling about this complete picture.” [12:14 - 14:47]
“Psilocybin when taken at high enough doses can create an experience that can change drastically one's perception of themselves, other people in the world. And so there often are experiences that people are having during a dosing session that can be leveraged in integration, for instance, to help somebody take advantage of that biological window of opportunity. So they're saying like, ‘man, I had this really, really significant insight about my trauma,’ right? ‘I essentially felt a profound sense of forgiveness that I've never felt before. And now I know what that feels like.’ And so then we go into the integration session, having had that experience and say, ‘what does that sense of forgiveness now allow you to do to get you back into your life in a way that is really important to who you are and your values and who you want to be?’ And so it seems, at least for me, that if we're not looking at the whole picture, then we're going to be missing some answers to that question that you've asked, which is why is [psilocybin for PTSD] working?” [14:50 - 16:10]
“If we think about somebody having this profound experience—they're feeling better, they're doing things different, they're living their life in a different way, and now they're engaging in their world different—it's going to take a bit of time for all of those different layers and systems around them to really get used to and understand and start to react to the new way that this person is engaging in their life. And it can take some time to practice those new skills and figure out what works and what doesn't and hone them. And so this idea that it would take a little bit of time before we see full improvement [after psilocybin treatments] does make quite a bit of sense. [25:37 - 26:21]
Links:
Center for Psychedelic Drug Research & Education website
Center for Psychedelic Drug Research & Education on LinkedIn