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To understand a little more about how psychedelics like MDMA can assist in psychotherapy, I spoke with Saj Razvi, a clinical investigator in MAPS’ MDMA trials and Director of Education at PSI.
“One of the key points to understand about stress and trauma is that they are fundamentally non-cognitive phenomena,” Razvi shares. “This is somewhat of a controversial statement because most models in psychotherapy are cognitive in nature, but what we’re learning from the field of neuroscience is that stressful, and traumatic experiences in particular, and their symptoms, are primarily housed in the more primitive, non-conscious, non-cognitive, and especially the non-verbal area of the mind, mainly in the autonomic nervous system.” The autonomic nervous system is the part of every animal’s nervous system that controls the things they don’t think about. The ANS regulates your heartbeat, balances your body temperate, digests your food and even adjusts your eyes to the light. Anything automatic, below the level of thought, is governed by the ANS.
Normally, when an animal is threatened, the ANS activates the nervous system to respond properly. When the threat subsides, the animal can relax again. But researchers like Razvi are finding the ANS can remain activated in certain situations even after the threat has passed. He uses the example of a zebra grazing. If a zebra catches a glimpse of a lion, it will immediately become more nervous. However, as the zebra realizes the lion is far away, stalking, but not an immediate threat, the zebra will relax slightly, while still staying on-guard. Being “on-guard” is an ANS trough.
“There’s a really good, adaptive, survival-based reason these troughs exist in the nervous system in the first place,” Razvi says. “When something happens, it’s much easier to react to a life or death situation. Calmness is a great state to be in, but it won’t serve you if you’re about to be attacked.”
However, it’s possible for the ANS to get stuck in an activated, on-guard state. “These troughs are adaptive, and they are the source of the problem,” Razvi explains. When the ANS settles in an on-guard state, it can only leave the trough via “a rise in anxiety symptoms. This is the key point. There is going to be a rise in anxiety before there’s a much deeper calming that takes place. Things get worse before they get better. Keep this pattern in mind—it’s the key to how and why stress and trauma patterns can get locked inside of us for years.”
Trauma makes its entrance at the point of nervous system activation where fight or flight just won’t cut it.
Saj Razvi's trauma dynamics map. Courtesy image
“We hit an overwhelm point, we have a sense that we’re not going to make it [and] your body begins to shut down,” Razvi says. “In a traumatic experience, the ANS plummets into a kind of negative activation, and if the hopelessness is severe enough, into complete disassociation. Figure one maps the ANS as it moves through these various states, where zero is calm, one is being “on-guard,” two is flying or fighting, three is moderate trauma and four is complete, blank disassociation.”
Symptoms of PTSD can be understood as one’s nervous system stuck in one of these states. Thus, psychotherapists like Razvi aim to help people work backwards to zero.
“This is an organic process, but we tend to interrupt it because it can be uncomfortable,” he says. “If you’re starting from state four it means going to state three which is a movement out of blankness into feelings of hopelessness…its counter-intuitive, but moving from blankness to depression is actually a positive movement.”
Psychedelics apparently have the capacity to stir up the nervous system so that it can get unstuck. Razvi has worked extensively with MDMA and cannabis to this end, but he says it doesn’t make that much difference what you use.
“MDMA has its own chemical profile, its own experience. Psilocybin, same thing,” Razvi explains. “All these medicines have their unique things they do, and then there’s some overlap in what they do, which is to say that they all generate non-ordinary states in consciousness, and we think that that is the key thing we are making use of in mental health.”