Yale Psychiatry Grand Rounds: "Clinical Implications of Neuroscience Research for Treating PTSD"

April 12, 2024

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00:00It is good to be here and to be
00:04reminded of the origin of PTSD
00:08because several relationships here,
00:10including with Robert J Lyfton back
00:12then and with Henry Crystal, John's dad,
00:17sort of got this whole thing to go in a way.
00:21And I really long back for the old days
00:25before people thought they knew anything.
00:27Today people think they know something.
00:30I don't think we say often enough.
00:32I don't know, I don't know.
00:36And so there was a time that we
00:37really could say, I don't know,
00:39and had a very active exploration.
00:43And just some examples is
00:46when I was working at the VA,
00:48I saw these overwhelmed, out of control guys.
00:54And I went to the library and
00:55I asked the librarian,
00:57give me all your books that you
00:59have on shell, shock, war, neurosis,
01:01whatever you call it back then.
01:04And nothing happened.
01:05So I went back to the library.
01:07What the Hell's happening?
01:08Give me your books,
01:09He said there are no books and
01:14there were actually some books.
01:15So part of the excitement of discovering
01:18PTSD is to see that there were people
01:21way before us who has seen stuff,
01:24notably Abraham Cartner,
01:25who worked in New York treating
01:28first world poor veterans,
01:30who published a book in 1941 as
01:33the war was breaking out and says
01:36this trauma is a physio neurosis
01:38and it causes people to visit,
01:41enduring vigilance to threat.
01:43And that's really the first thing I read.
01:46And the second thing I read
01:48was Henry Crystal,
01:49who had been that survived the Holocaust
01:52himself and who knew about elixocymia.
01:56And I'm going to actually,
01:57I wish that Henry were with us so I
01:59could tell him the amazing results we
02:02found in Elixocymia in our recent research.
02:05And then you come across all these great
02:08people who have been before Ivan Pavlov,
02:10whose dogs got traumatized in 1924
02:13and who were totally messed up
02:16after there was a flood in the lab,
02:18and instead of getting new dogs,
02:20she said what is going on with their dogs,
02:23who sort of messed up?
02:25And he found out they had lost
02:29their instinct of purpose,
02:31something very few people know about.
02:33But certainly Pavlov was a great guy.
02:35This is WHR Rivers,
02:37and this is my real ancestor Pierre Janelle,
02:40who wrote a very first book about drama
02:44in 1889 called Lotematism Psychologic,
02:46in which he says that trauma
02:50causes repetitive behaviours to
02:52occur over and over again,
02:55not as memories, but as sensations,
02:59actions, movements and emotions.
03:01And then he Janelle also said
03:05a very important thing that I
03:07think we should study much more.
03:09He says once you get traumatized,
03:11you get stuck.
03:12He gets stuck at the level of mental
03:15developments at which the trauma occurs.
03:18And then later on,
03:19Judy,
03:20Herman and I did the first research on
03:24Borderlands personality disorder and trauma,
03:26and it turns out that they all had been
03:30abused or severely neglected before age 7.
03:33And for me, part of my
03:35interest in trauma came.
03:36But I said I was a young dad.
03:38I had very small kids at home who
03:41behave just like the Vietnam Veterans.
03:43And I thought,
03:44I'm not so worried about my kids,
03:46they'll probably outgrow it.
03:47But what is it about these veterans that I
03:50feel pessimistic that they were ever grow up?
03:53What has happened in their brain?
03:55And so this is also the time that
03:58we did learned about neuroimaging.
04:01And so my little team at Harvard did,
04:05as far as I know the 1st and maybe the
04:08only study in which people actually
04:10relive their trauma in a computer.
04:12We induce flashbacks today.
04:14Your RRB would not approve that
04:16because it is very traumatizing
04:18to lie in a scanner feeling like
04:21you're getting vaped all over again.
04:23But boy did you learn a lot about the brain
04:27changes that occur secondary to trauma.
04:29And I just want to mention
04:33right here Steven Southwick,
04:38your late beloved teacher here.
04:40And there was a particular piece
04:42of research that Steve Southwick
04:44did that was very important to me.
04:46You guys did the yohimbine study
04:47as he done was part of that also.
04:50And as people gave veterans yohimbine,
04:53they started to relive their trauma
04:56and say I saw it just like it was.
05:00I smelt it just like it was now.
05:04When we see each other a year from now,
05:06none of us will have an imprint
05:08in our minds of just how it was.
05:11The mind is a constructive organ,
05:13but what goes wrong in trauma
05:15is that your brain cannot do its
05:18function and you actually register
05:20the sensory input on integrated with
05:23yourself and you continue to act and
05:26behave as if the trauma pursue life.
05:28Right now the goal of treatment is
05:31to make the trauma into a memory
05:34and say yes it happened but it
05:36happened a long time ago and and
05:40so we get PTSD on the map.
05:43And how does this happen?
05:45It happens all in a political context.
05:47We are living in a political
05:50culture and even your scientific
05:52funding is all dependent depends
05:54on the politics of the day.
06:00I was the first person who
06:02studied EMDR on an NIH grant,
06:05and I was the last person who
06:08got started to get EMDRI was the
06:11first person to get yoga done.
06:13It was very hard to get the money
06:15and now everybody does yoga.
06:17I went to NIH six times to get a
06:21neurofeedback study funded and the
06:23time wasn't ripe for neurofeedback,
06:25All of the psychedelic research,
06:27until you guys started to do it here,
06:29but never funded by defence.
06:31There's always other funding.
06:33So everything is political.
06:35And So what happens back then is that
06:39the wars just ended, the Vietnam War.
06:42A bunch of us had managed to get out of
06:46the draft doing alternative service,
06:49and then we met these guys who were our age.
06:54The chief complaint was I have become
06:57a monster. Nobody is safe with me.
07:00I meet a new girlfriend who's
07:04being spends nights with me and
07:06the moment she moves in the bed,
07:08I attack her and I find myself strangling
07:11this woman and I wake up and go,
07:13what the hell are you doing?
07:15I cannot control myself now.
07:17I have a bunch of kids to make
07:20a little noise. I blow up.
07:22I cannot control myself,
07:23I cannot control myself and I do
07:26not cannot have loving feelings.
07:28Those were the chief complaints.
07:30But we at the VA and so we have
07:33to say this is about the war.
07:35Well,
07:36the obvious thing it was about
07:37the war were nightmares.
07:39And I happened to study nightmares
07:41at the time.
07:41And so the PTSD definition became a
07:45definition focused on flashbacks.
07:47But that's only a very small part of PTSD.
07:51What we didn't know at that part
07:53is that PTSD changes the brain and
07:56changes your perception of current reality.
08:00Right now, you're being traumatized.
08:02In fact, the trauma is over,
08:04a defendant's over.
08:05It's not about the memory of the past.
08:08It's about the degree to which
08:10the reactions to trauma continue
08:12to live in your body and the way
08:15to which today you'll continue to
08:17feel as if you're being raped,
08:19right, Or assaulted right now.
08:21So there is something about the
08:23time sense of the brain and
08:25the capacity for memories.
08:27And then we did our EMDR research
08:29and we saw that EMDR makes these
08:32traumatic flashbacks into a story
08:34of what happened in the past.
08:37Same thing with psychedelic research.
08:39People see their images,
08:40they feel their feelings.
08:42And after, we should say,
08:43has happened to me,
08:44but it happened a long time ago.
08:46I said it's something that good
08:49therapy makes it possible for the
08:52brain to put it in a time perspective.
08:56And so we create this diagnosis.
08:59How did the diagnosis get created?
09:01DSM three. Why did we have a DSM 3?
09:04Because in the 1970s we learned
09:08about brain chemicals and Pfizer
09:10and other people started to make
09:12some drugs that had the promise
09:14to cure mental illness.
09:15I was certainly one of those
09:17people who thought, boy,
09:19we're going to have the answer with
09:21drugs and we can abolish mental illness.
09:23Didn't quite work that way.
09:26But in order to create
09:28some science behind it,
09:30we had to create a a system used to be
09:33called the Research Diagnostic System.
09:36So people at Yale and Harvard and in
09:38London and Australia could all talk
09:41to each other about some things.
09:43The preamble for DSM is says this
09:47is just a bunch of symptoms,
09:50This is very inaccurate.
09:52This is not scientifically established.
09:54We're just taking a stab at trying to
09:57put some syndromes together to get a
10:00general idea of mental functioning,
10:02but it's too inaccurate to ever be used
10:06for forensic or for insurance purposes.
10:09That preamble disappears from
10:11DSM four and DSM 5,
10:13and now people actually believe
10:15that these diagnosis exists.
10:17Now these diagnosis are figments
10:19of our imagination and they
10:22are extremely inadequate.
10:24Like for example, John Kerry,
10:27whose name ES PTSD1 of the
10:31most functional people around,
10:33the guy down in the overpass
10:36homeless also has PTSD.
10:38They may have the same PTSD scores.
10:40It doesn't tell you very much
10:41about who is doing what,
10:42though.
10:43So we start off naively and
10:45first of all we say this is an
10:49extraordinary event outside of the
10:51realm of usual human experience.
10:53That tells you something
10:55about how ignorant we were.
10:57We didn't know that one third of all
11:00couples engaged in domestic violence.
11:02We had didn't know that at least
11:05one of our five girls get molested,
11:08usually started before age 11.
11:11We didn't know how pervasive drama is.
11:14When they talk to people like you,
11:16I always assume that most of you
11:19have had traumatic experiences
11:20in your life because we do.
11:23So it is not extraordinary and
11:26we focused on memory and the
11:29memory part is important,
11:30but but that's even more important
11:31to my mind is the fact that your
11:34current reality is destroyed and
11:36you cannot connect with people.
11:38You cannot feel alive,
11:43you cannot feel pleasure, enjoyment,
11:46that's a a whole bunch of mental
11:49functioning gets wiped out.
11:51The other big thing is that
11:55depending on where you live,
11:56is when you start really studying in trauma,
11:59you find that most people have
12:01been traumatized with traumatized
12:02early on in their lives at the
12:04hands of their own caregivers.
12:06And what we'd never acknowledge in
12:08the PTSD diagnosis is the role,
12:10the attachment system.
12:11And basically as long as you securely
12:14attach the people around you,
12:16you tend not to get PTSD in
12:19response to terrible environments.
12:21And that's showed up very clearly after 911.
12:23For example,
12:25getting assaulted as a one year old is
12:28very different from being assaulted
12:30as a 50 year old because you have a
12:33different brain and work of mighty
12:35Tiger and other people have shown how
12:38trauma at the different ages causes
12:40different impacts on the brain.
12:42That is something that we did
12:44study much more,
12:45and what we also aren't studying how
12:50certain mental processes don't develop.
12:53After early PTSDI grew up on Piaget,
12:56I grew up on how people think.
12:59These days I hardly ever talk
13:02people about mental functioning.
13:04What is this person able to imagine?
13:06What other people feel like?
13:08Is this a person able to distinguish
13:11what's relevant from this?
13:12Irrelevant.
13:13How much does this person feel like
13:18they're discussing and loathsome
13:20because what happened to them
13:22early on in their lives?
13:23So Tom has a very different impact
13:27on different levels of development.
13:30As long as you feel safely attached,
13:32you probably don't get PTSD.
13:34And the other huge thing is that most
13:37recent research shows that even if
13:40your mental symptoms of PTSD get better,
13:43oftentimes your core neurobiological
13:45functions don't get better.
13:48The fibromyalgia has they're
13:50autoimmune diseases.
13:51All the body parts of PTSD seem
13:54to be the most vulnerable to
13:57stay online and if we get as we
14:00get into psychedelic research,
14:02I think one of our great jobs is to
14:05study to what degree psychedelic
14:08research can change core
14:10neurobiological functions in the body.
14:12A psychiatrist, psychologist.
14:14We keep focusing on behaviour and external,
14:17but underneath it all is this Organism
14:21that no longer functions properly.
14:24So what this is about trauma,
14:27it's tummy,
14:28it's a terrible event that
14:30you cannot tolerate feeling.
14:32It is overwhelming.
14:34And so the body lives on and you
14:37continue to feel like it's happening
14:41and many people's room have been there.
14:44And you try to get away from it.
14:46You try to suppress it.
14:48You try not to think about it.
14:51If I'd asked one of you,
14:52have you ever been raped, you'd go like,
14:56that's a totally inappropriate question.
14:58I'm not going to answer it.
15:00Not only that,
15:01I don't want to answer it because
15:03the moment I start telling you
15:05about the fact that I was raped,
15:06my body starts feeling as if
15:08it's being raped again.
15:09So I don't want to go there.
15:12And so,
15:13as Darwin already pointed out back in
15:161872, trauma is lived out in gut
15:20experiences in the course of the
15:22vagus nerve and heartbreaking
15:24and gut wrenching sensations.
15:27I could, I could talk for hours about it.
15:30And because you have these
15:32sensations that you cannot carry,
15:34you try to manage the the life of your body.
15:38As many of us know,
15:41if today has been a review of time,
15:43you go home and say, boy,
15:45I want a gin and tonic,
15:47I want to do a little drinking,
15:48I want to go smoke a little dope because
15:51I can no longer stand how I feel.
15:53And indeed when you're traumatized,
15:55you're very likely to indulge in
15:57drugs and to become much more likely
16:00to become a drug and alcohol person.
16:03That starts off as trying to
16:06manage that internal world.
16:08And so it's not the memory of the trauma,
16:11but all the behaviours that persist.
16:14And I think nobody ever comes to
16:16my office to for the first time
16:19saying I suffer from child abuse.
16:21No, I can't, cannot connect to my kids.
16:24I blow up at people,
16:26I cannot get along with people.
16:27I come angry, I hate myself,
16:31just lived inside.
16:33So this is an important slide
16:36as far as I'm concerned.
16:37In 1990, eighty and eighty,
16:41we knew nothing about trauma.
16:44We were sort of of, you know,
16:46by Pluto back then,
16:47and then slowly we're beginning to
16:50learn something. And today is 2024.
16:53I started to learn about psychedelics
16:57probably less than 10 years ago.
16:59I'm 80 years old.
17:00I have learned new stuff every year and
17:04anybody who says I found the answer,
17:08I said have a good life because we
17:11are very much still on a journey
17:14of discovery and to really to
17:16prematurely say I have the answer
17:19is not a trustworthy thing to do.
17:22The other thing is,
17:24but it's left out and it keeps being
17:27left out in our scientific endeavours,
17:30is the role of the attachment system.
17:33We are monkeys. We are wired to be together.
17:37Most of our brain is wired in
17:39order to get along with each other
17:41and do things together.
17:43Attachment system is critically
17:45important for drama,
17:47and there actually is a very
17:50vast literature on attachment
17:52and trauma and child abuse,
17:54but most psychologists and psychiatrists
17:56don't know that literature.
17:58How many people in this room
18:00know the work of Dante Ciccheri?
18:06Or you would,
18:08But to my mind, don't just get
18:11one of the heroes of her field.
18:13How many of you know the
18:14work of Carlin Lions Ruth?
18:18I don't know any more important
18:20scientific work than the
18:21work of Carlin Lions Ruth.
18:22But we don't learn about
18:24the attachment issues.
18:25We don't learn about children.
18:27And so we don't have much time.
18:30But I'm just going to skip over some things.
18:33But here's a good example of how
18:37we are deeply imitative creatures.
18:40This is an attachment researcher
18:42at University of Washington and
18:47the amounts of going into a nursery
18:50room with a 5 hour old baby and he
18:55sticks out his tongue and his baby
18:57and the baby sticks out his tongue.
18:59He frowns and the baby frowns.
19:01That is five hours after this baby is born.
19:04We are so wired to be social creatures
19:07and to take up our relationship to our
19:10environment and that shapes our brain.
19:15Colonized Ruth started to do a prospective
19:19study about 340 years ago now,
19:23and she studied about 125 kids and
19:27videotaped the interactions between these
19:30kids and their single teenage mothers.
19:3515 years later, she doesn't follow
19:37up of what happened to these kids.
19:39And she is able to show that if in the
19:44videotapes of the interaction between
19:46this kid and their mothers age 2,
19:48you can predict later Borderlands features
19:51of suicidality in late adolescence.
19:54And so that early attachment system
19:56is terribly important and that her
19:59calculations show is that once your
20:01attachment relationship is disturbed,
20:03you're much more likely to get abused.
20:05But the abuse is the secondary issue.
20:08The attachment is the primary
20:10issue that gives destroyed.
20:11So there's some There's Marty Tiger.
20:14We spent his whole life trying
20:16to see what parts of the brain
20:18development gets affected by trauma,
20:20at what age.
20:21And so we get different symptoms
20:24and different challenges depending
20:26on different ages of development.
20:30So let me see what's the time
20:36We got to 11:15. Now
20:42they're better. Skip this.
20:46No, I'm going to go to the
20:49heart just about anyway.
20:51As, as Maura has mentioned, we have been.
20:54We set up a National Child Traumatic
20:57Assessment of Work consists of 150 sites
21:00around the country because of a lack of
21:04knowledge about trauma and child development.
21:06And out of that research came our notion
21:10of developmental trauma disorder.
21:13That trauma has a very pervasive
21:15effect on your identity,
21:16your effect regulation,
21:18your learning styles.
21:19And we put that into a proposal for
21:23the American Psychiatric Association
21:25on the basis of studies of 20,000 kids.
21:29And this supposure we rejected
21:32Following says the consensus was that
21:34it was just too little evidence at
21:37this point to include developmental
21:39trauma disorder in DSM 5.
21:41The notion that early childhood as
21:43various experiences lead to substantial
21:45development disruptions is more clinical
21:48intuition than a research based fact.
21:50The statement is commonly made,
21:52but cannot be backed up
21:54by prospective studies.
21:55That is a complete lie.
21:58There's at least five 3035 year
22:01long prospective studies on
22:03which we base this diagnosis.
22:05So as a result the majority of the
22:08people we see in our practices have
22:11no appropriate psychiatric label.
22:13And you can call your patients PTSD
22:17or disruptive dismigration disorder,
22:19reactive testimony disorder,
22:22you can tell call them any of these
22:24things depending what the insurance
22:26companies will be in pursue for.
22:28But these are not real diagnosis
22:30because all these things occur
22:32Co occur in the same person.
22:35So that's the preamble.
22:38Now I'm going to talk about two
22:40treatments that I think need
22:42some elucidation.
22:43The first one is neurofeedback.
22:45And my interest in neurofeedback starts
22:48when the man who I call my best friend,
22:52Alexander McFarland,
22:53does a study in Australia that
22:56is very simple.
22:58You see 38 normal Australians
23:00if you've ever been there.
23:02I just came back three days ago from there.
23:05Lots of normal people there.
23:07And he's 38.
23:09Traumatic Australians And he
23:11plays the sound of the ear,
23:13something like and your sounds like that.
23:16Your brain needs to figure out what happens.
23:19Now you can put electrodes all over the
23:21skull and harvest the underlying brain maves.
23:25And what you see is that when you
23:27put these people in a scanner and
23:29you play sound like in the normal people,
23:33the left brain does all the work,
23:35the cognitive,
23:36verbal commutative part of the brain,
23:39the right brain barely gets activated.
23:42That's the emotional brain gives
23:45you feelings and sensations.
23:47The traumatized people,
23:48when the US are like,
23:50they don't use their left brain,
23:51they use their right brain.
23:53When you're traumatized,
23:55your feelings are the only thing that counts.
23:58There is no cognition.
24:01Then you look at,
24:02you put his little electrodes over
24:04the skull and you look at how
24:06the different parts of the brain
24:07are talking to each other.
24:09And like you see in non charmatist people,
24:12there's internal coherence in
24:13the brain in terms of engaging
24:16in disasters and ERP
24:19traumatist people, there's different
24:20parts of the brain are not talking
24:24to each other specifically.
24:30When you hear a sound like the
24:33first maybe developers is N 200 to
24:35say now focus and pay attention.
24:38It's a salience network of the
24:40brain and get you to focus
24:43and to ignore everything else.
24:45Trauma test people? No.
24:48N 200 traumatized people have
24:50a very hard time filtering out
24:53what's relevant from relevant.
24:55This is a not a cognitive issue,
24:58it's a deeper brain issue of a system
25:00in your brain that's not working
25:03to help you to figure out what is
25:06relevant and what's not relevant.
25:08The next wave is the P300,
25:11the learning wave of the brain.
25:13How you learn stuff, how you grab things.
25:16Traumatized People Lousy piece 300.
25:20When you're traumatized,
25:21it's very,
25:21very hard to learn from experience.
25:26All of you who work for traumatized
25:28people keeping astounded how people do
25:30the same dancing over and over again
25:32and do not learn from experience.
25:34So my friend does his study and I go like,
25:39we'll never figure this one out.
25:41And then I meet some people who say,
25:44have you ever heard about neurofeedback?
25:46And I say, what is it?
25:48You can put electrodes on people's skulls.
25:50You can harvest the brain waves,
25:54put it on a computer.
25:56And then you can set the computer in
25:58such a way that whenever your brain
26:01makes waves that help you to pay
26:03attention or to be calm or to be focused,
26:06you get a little reward.
26:07Some deer jumps out of the
26:09forest or hear some music.
26:11And whenever you don't make
26:13the right combination,
26:15your brain don't get feedback.
26:17And they say, that sounds really interesting,
26:19Send me to research.
26:21And the research never came because our
26:24field is a field of anecdotes and of stories,
26:28but very few people do research
26:30in these innovative methods.
26:34And so I mean this woman at some point,
26:36even Fisher, who says,
26:39you know,
26:40let me show you what neurofeedback can do.
26:42He's an 8 year old boy and we asked
26:46him to make a family drawing and I
26:48said that's a pretty sucky family
26:50drawing for an 8 year old because we've
26:52seen a lot of kids in our clinic.
26:54I said I do 20 sessions of neurofeedback
26:56and that's his family drawing and I
26:59do 20 more sessions of neurofeedback.
27:01That's his family drawing.
27:04Like holy **** I don't know anything
27:07else that can change this into
27:10this in a three months period.
27:12There is something there and so I
27:15start studying in your feedback
27:17and this is I just mainly wanted
27:19to show this to you.
27:20Do you
27:20think he used to kick me and punch me and
27:23kick me and bite me with hyperactivity
27:26disorder or ADHD without of the control?
27:33Older sisters, what are
27:38you right now? I'm happier.
27:40And they will concentrate, Yeah.
27:44Get along with people better.
27:46Yeah. Get along with my mum.
27:47Well, OK, Kane,
27:49I want you to get the Green Rock fire up.
27:52After years of violent outbursts,
27:54finally relief in what looks
27:57to be a simple computer game.
27:59It works.
28:00Flushing works for mood disturbances.
28:03It works for panic.
28:05I've I've used it successfully
28:07with chronic pain
28:10headaches. It's called neurofeedback,
28:12a system where clinical psychologist Dr.
28:16Moshe Kane's brain waves are represented
28:20as different coloured spaceships,
28:22purple and the yellow rock. Doctor
28:26Pearl says electrodes on Kane's head since
28:28when he's relaxed and focused and as a
28:31result the green spaceship speeds up,
28:33overtaking the other spaceships
28:35that show when he's tired or tense.
28:38What he wants to do is get
28:39the Rockets to go fast.
28:40So he teaches his self really to slow
28:44down absolutely excellent results.
28:46And it's been long term.
28:48And he's lost, like I would say,
28:51all his violence.
28:52Yes, I have a little point there,
28:54you know, and it's fabulous.
28:57That's badly looking back.
29:01Kane hardly recognizes himself.
29:03Can't believe I was like that.
29:05Could you ever be like that again?
29:09Yeah, I think so. And even if I tried,
29:12I don't think I'd be able to do it.
29:13Click the button anytime you
29:15see the white square Doctor
29:17Bill Tip Kane's attention span.
29:19After 60 neurofeedback sessions,
29:22his scores have doubled.
29:24Maybe one in 10,000 children would
29:26have scored as poorly as he did and
29:28now he's completely average.
29:32So interesting, isn't it?
29:34So we start doing research on neurofeedback
29:37and I won't spend too much time on it,
29:40but here's an example.
29:41What can it can do?
29:43So you can do a quantitative EEG,
29:45which I'm amazed that not more
29:47people are into that and you can
29:50measure what part of the brain is
29:52getting active in responsive task.
29:54And this is the QEG of a 12 year
29:56old Somali refugee in Sydney.
30:02It's just a clinical virus there.
30:05This kid was a very charmed this kid
30:08completely unbullied in the classroom.
30:10He gets kicked out,
30:12he's too disturbed and he
30:14has the good luck to that.
30:16In his neighbourhood is this refugee
30:19program that does neurofeedback.
30:20And what they discover when
30:22they do a quantity of EG on him
30:25is that the predominant rhythm
30:28in the frontal lobe is delta.
30:31For if you know anything about EEG,
30:32delta is the waves that
30:35people create in deep sleep.
30:37That means the frontal lobe is not there.
30:40This kid is just a limbic creature who
30:43has no frontal lobe functioning at all.
30:46If he had gone to anybody else,
30:47they would have put him on
30:49a psychotic medication.
30:49We would have had disastrous consequences.
30:52But they do neurofeedback and
30:54with 20 sessions of neurofeedback,
30:56they'd normalize this frontal lobe
30:58and the kids start behaving well.
31:01So we have been,
31:02we have done three studies ourselves
31:04and what you see is indeed that with
31:08neurofeedback you can change the Erps
31:10and to increase the filtering wave
31:13for the brain and you can increase
31:15the learning wave for the brain.
31:17And so you're actually able to
31:21change people's mental functioning.
31:23And we published this data in the Plus one.
31:26And what we see that this is
31:28not a trauma treatment.
31:30There's a treatment to make
31:32the brain more relaxed,
31:33more calm and more functional.
31:36It's an optimal functioning treatment.
31:39The Italian soccer team,
31:41the Azuros,
31:43use neurofeedback for optimal performance,
31:47and they will keep winning
31:49the world championship.
31:50So John Cruzlier in London gives
31:54neurofeedback to violinists and
31:56finds out that with neurofeedback
31:59you can increase the performance
32:02by 10% if any of your musicians.
32:05You know what the difference is.
32:06I once played in the same orchestra
32:09as yo-yo Ma. I'm a jealous.
32:11I was a jealous.
32:13He probably pays more than 20% better
32:16than I do, but it makes a lot.
32:18That 10% can make all the difference
32:21between being really good at something,
32:23being sorry for guys.
32:25OK,
32:25I've heard enough.
32:27And so the issue of focusing on
32:30optimal functioning to my mind is a
32:32really nice approach to our work.
32:35Rather than pathologizing everything,
32:37it's just thinking about how can
32:39we help people to function better.
32:41And what we see is that all
32:44after neurofeedback,
32:45all these variables have to
32:47do with self organization,
32:49effects, regulation,
32:51negotiating interpersonal conflicts,
32:53all dramatically changed,
32:56including executive functioning.
32:59So becoming flexible,
33:01having a brain that works.
33:04Neurofeedback can help you with all that.
33:07So if you want to know more about it,
33:09come to our 35th Annual meeting
33:12at the beginning of May.
33:15Last piece, like you many of you guys are,
33:19is I'm interested in psychedelics.
33:21And my own psychedelic story starts about 15
33:26years ago when two guys came to talk to me.
33:29Their names were Michael Mishoffer
33:32and Big Dublin and they say Bessel,
33:35you know something about trauma.
33:36What do you think about possibility
33:40of psychedelic ages for trauma?
33:43And I go, wow, that's really interesting.
33:46Of course you're talking to the right guy.
33:48I'm a child in the 60s and of course I
33:51dabbled to the LSD just like everybody else.
33:54Not only that,
33:55but they had Timothy Leary's
33:56office at Harvard at some point.
34:01I also have a number of friends who
34:03are very successful scientists.
34:05And as we hang out, I've asked my friends,
34:08did you take LSD while you were in college?
34:10And my friends say, duh, of course I did.
34:13And I say, So what effect do you
34:16think it has on you all your life?
34:18And they say, I think it has a lot to
34:21do with my becoming such an eminent
34:23scientist because in LSDI got to see
34:26that the real world is so much larger
34:28than the little mental construct
34:30that I have formed for myself.
34:33And it really opened up my mind.
34:35I have a confession to make.
34:37Four years ago I was in the White
34:41House talking to Trump's healthcare
34:43advisor and I come to her office
34:46and she said Doctor Vaniko,
34:47I've tried to write your book,
34:49read your book, but it's pretty complicated.
34:51And is there a simplified version?
34:55And I said this is the simplified
34:59version and if you're the the premier
35:02advisers to to the president and
35:04you don't know how to read it.
35:05But I didn't.
35:06I I've messed up again, you know,
35:08like I should've flattered her
35:10but but I didn't.
35:11So I walk out of that meeting, waste of time,
35:15and I walks gate of White House.
35:18I said I blew it.
35:20I could have smuggled A blotter
35:22with ***** into the White House.
35:24I could have adopted the drinking water.
35:26And for four days the whole White House
35:29would have been a psychedelic state.
35:30And Can you imagine our previous
35:32president go like, Oh my God,
35:35the universe is so large and
35:37I'm just such a small,
35:39insignificant part of it.
35:41I'm a precious part of that part.
35:43But boy, the world said I could
35:45have changed history and I blew it.
35:47So, so you stupid.
35:50So,
35:51so I also talked Vic and Michael that
35:56in 1994 I put a symposium together
35:59at the APA to sort of review what
36:03we had learned about psychedelics.
36:04And it was.
36:07A lot of research had been done already,
36:09and it was the most depressing
36:11meeting I've ever gone to,
36:12because all these guys said I came
36:15up with amazing data that really
36:17looks very promising for trip to drug
36:20addiction and colonic depression.
36:22And we got kicked out of our departments.
36:24Our funding stopped.
36:26I wasted my life and I said to wicked,
36:29Michael, I wouldn't do it if I were you,
36:31because you're not never going to get
36:34a ******* past the FDA to do the study.
36:37And they say thank you very
36:39much for your opinion.
36:40And of course, nobody ever takes my advice.
36:43So they go and do the psychedelic research.
36:46They sued the FDA.
36:47These are two very nice people,
36:49but boy, they're Bulldogs.
36:51And they get permission for one little study,
36:54little study does quite well tonight,
36:57permission to do second study.
36:58They sue again.
36:59They fight for it,
37:01do third study,
37:01and then they do the third study
37:03and they come to me and say we could
37:05like to be involved with it and
37:07become the Pi of the Boston arm.
37:10So I became the Pi of the Boston team.
37:12That's my little team that
37:16does MDMA research. Let me see.
37:20I'm just going to show you a
37:22picture of this for a moment
37:23because this is what it looks like.
37:34Think about it now. I got blown up myself.
37:44Oh yeah, I
37:47don't know. I see it
37:49completely different now. Like
37:54thinking about it, I really
37:58that moment that I got
38:02blown up when I was happy and
38:06everything was moving so slow.
38:12My mind was just racing
38:14at the speed of light.
38:15It was I can go go back to the movement
38:20and never visualize it so hard.
38:23It was like and I was just, it's
38:29like I feel like more in my body.
38:30My heartbeat started beating up fast, but
38:34I didn't get at at
38:37first. I started feeling a little
38:39afraid, but then once I started
38:43breathing, I never felt before.
38:46Like I really felt hard to slow
38:48down and everything when I
38:50started breathing, just relax and like,
38:52it's amazing how not quickly
38:55it went away, but just howl in control I
38:58felt making it go away.
39:00So usually I've had those feelings.
39:04In a way. It kind of felt like I
39:06want a panic attack and it comes
39:08on and my heartbeat started and
39:10my whole body flush really hot.
39:13And then I was just amazed how I was able to.
39:17I don't really fight it, but
39:20relax, that's good. I just let
39:23y'all you might want to know. Yeah,
39:32so that's Michael Mitt's offering and
39:34his wife, Annie, always 2 therapists.
39:49It's hard to put in words
39:55show things that would don't come
39:59up every time there's there's just
40:03blow away like sand just and I even
40:07purposely tried to think of things.
40:10Bothersome like money issues
40:13or something. And this
40:17voice, this
40:20part of me just like so
40:22wise and so intelligent,
40:25just like brought this piece over me,
40:28just said, you know,
40:30you've always been taken care of.
40:32You always will be taken care of.
40:33It's it's nothing to worry about.
40:35And then it just flows away,
40:36like saying And then I tried
40:41thinking about that aspect of me.
40:46That's just really graceful.
40:48And also besides that image I
40:51told you all about, you know,
40:54the fighting with them, I had this
40:57image of it like kind of jail cell.
40:59Yeah, like I had that part of me is
41:02locked up in jail and it's just,
41:04you know, got it's dark,
41:06but it's got, you know,
41:11bright red eyes, just really evil.
41:15And I thought that and I felt like, so
41:21I felt like I put that person there.
41:24I went to it, just open the door,
41:31hug that person. And then the eyes
41:35just faded away no longer had kind
41:38of an evil look to itself and like
41:42we like I visualize both of
41:45us just taking apart the gym.
41:46So and just you know like really become
41:51our friends And then I visualized.
41:55So this is what we see all the time is
41:57people spontaneously got in touch with parts
42:00of themselves that have been disavowed.
42:03We are all trained in IFS
42:06internal family system therapy.
42:08We don't use it a lot because the
42:11MDMA trials are usually very quiet
42:14and 80% of our patients spontaneously
42:16start talking about different parts of
42:18themselves having to do with trauma.
42:20What's also interesting is that, you know,
42:23MDMA is was a very popular party drug.
42:26I had never taken MDMA and I thought,
42:30boy, it's called ecstasy.
42:31Is this great?
42:32And as API had to go through
42:35my own MDMA experiences,
42:38it does no fun and games at all.
42:40Actually, we have hardly ever seen
42:43somebody who had just a blissful experience.
42:46A lot of pain came up.
42:47Let me tell you about one of my
42:49own experience, my first one.
42:52People had often asked me
42:54about vicarious trauma.
42:56And you've seen all this trauma,
42:57now you're practicing.
42:58Your life doesn't get to you.
43:01And I always said, you know,
43:03if you have good friends,
43:04you have a good team,
43:05and you have a good a good marriage
43:07and you get to talk about your results,
43:10it doesn't really get to you.
43:13I was wrong.
43:15In my own first MDMA experience,
43:17all the traumatist people I've seen
43:20over the years came to visit me.
43:22Like with that trauma.
43:24I lied there for 8 hours going
43:26oh **** Oh my God, Oh my God,
43:31this is so terrible.
43:33Are you sure this is a party drug?
43:35There was nothing fun about it,
43:37but boy did I get in touch with all the
43:40stuff that I'd taken in over the years.
43:43My second MDMA experience.
43:45I was part of that generation in the
43:48Netherlands that almost starved to death.
43:50Half of the kids my generation did.
43:53I obviously didn't,
43:55and it was also very sickly child
43:57and I had the experience of being
43:59a one year old starving child.
44:04I checked out with my brothers for
44:06the experience and he both said,
44:07yeah, that sounds very reasonable.
44:09So stuff comes up that you
44:12ordinarily don't have access to.
44:14And I think the mental processes on
44:16psychedelics are the most interesting
44:18ones because people really change
44:20the way they look at things.
44:23And So what happened in our data
44:25collection is that I joined the
44:27study and I wanted to have a
44:30whole bunch of measures in there.
44:33They didn't adopted only three of
44:35them of what they wanted because
44:38they wanted to have approval for MDMA
44:40as by the FDA as a legitimate drug.
44:43So I was put in charge of the secondary data.
44:47And the secondary data,
44:48to my mind, are the real data.
44:51So what you do,
44:52you get 36 hours of psychotherapy.
44:56Half of you get 3 sessions,
45:00three whole days of doing MDMA.
45:03The other half get three
45:05whole days of a placebo pill.
45:07Always in the presence of good therapist,
45:10very good,
45:11very well trained therapy
45:12does a lot of stuff,
45:15good stuff happens and all of
45:17our subjects say I couldn't
45:19have done this without you.
45:21The relationship and the safety
45:24and the context was terribly
45:26important in helping people to go
45:31to restart places. And indeed,
45:35I saw that my chemotherapist,
45:38who I trained but beat MDMAI, was wrong.
45:45Therapy alone did pretty well,
45:48but the therapy plus MDMA did
45:51dramatically better and a two-month
45:54follow up the there's no need to improve.
45:58So it's a nice differentiation.
46:01But you know, if you know about PTSD,
46:04you know there's many other ways
46:06in which people can treat PTSDI
46:09do neurofeedback, I do Emdi,
46:11do yoga, I do all kind of stuff.
46:18But it's one form of PTSD that's
46:21extremely hard to treat and
46:23that's the dissociative subtype.
46:25If you are basically numbed out
46:28and you don't feel yourself,
46:30there's nothing to work with.
46:32And at this point,
46:34nobody has done very well with
46:37dissociative subtype of PTSD.
46:39In our study,
46:40the people with dissociative subtype
46:43did slightly better than the
46:45people who had pure classic PTSD.
46:48Very surprising.
46:49Something got stirred up
46:53when I joined the study.
46:55I done various studies in other
46:58subjects and what I found was a very
47:02dramatic difference between let's say
47:04EMDR or CBT or any of these methods
47:08depending on the context of your trauma.
47:10If you're an adult onset trauma person
47:13you gently you generally fight quite well.
47:16But if you have a history of long
47:18term child abuse and neglect,
47:20of being an unwanted child,
47:24these treatments don't seem
47:25to work very well.
47:26So as we're doing this trial,
47:29which at the end cost $62 million,
47:33I said don't stack the deck against
47:37you and get people who have only
47:40post traumatic stress disorder,
47:42IE there was a time in life and
47:45they were not traumatized and this
47:47happens on top of stuff that happened.
47:50Well, I was overruled and boy am
47:52I glad I was overruled because
47:55the vast majority of our subjects
47:57had developed alter trauma.
47:5988% of them could not remember feeling
48:02safe with their own parents growing up.
48:05That's the worst possible thing
48:07that can happen to you.
48:09And then we looked at what
48:11happened to this population.
48:16Self compassion. Well, as you know,
48:20hating yourself, loathing yourself,
48:22basically feel like you're terrible,
48:24disgusting person is a very common
48:26thing for people with colic trauma.
48:29You would expect that being the 36
48:31hours of two very sweet, loving,
48:34nice therapist would make a big difference.
48:38That's the therapy and that's the therapy
48:41plus the MDMA dramatic difference.
48:44I'm a psychotherapist also,
48:47and I was really appalled by how poorly the
48:52psychotherapy actually did self judgments.
48:55Our patients filled the self judgments.
48:58Or somebody said to me yesterday,
49:00every day is judgment day and that's what
49:02it's like to be a traumatized person.
49:04Every day is judgment day.
49:05You think if you've been a good therapist,
49:08they will help you be less judgmental.
49:10Traumatized people and they made much
49:13better feeling part of the common humanity.
49:17Feeling isolated.
49:18A very important part of trauma
49:21is feeling God forsaken.
49:23There's nobody there you'd expect to.
49:25Psychotherapy would help a lot of that.
49:28It didn't, but the MDMA helped a lot.
49:31Becoming mindful being able to
49:33observe yourself being over
49:34identified with your trauma.
49:36Huge thing at the VA for
49:38example I'm a combat veteran.
49:40I'm a Vietnam veteran and
49:41that's all they have.
49:43And after the MDMA is off we say
49:45yeah I was in combat and I had
49:47kids and I was also working as a
49:49Carpenter and I have a life that is
49:51much more than just my drama.
49:54So huge difference in how
49:57you feel about yourself.
49:59Alexis I medium huge issue.
50:02I imagine that because of John,
50:04people still talk about Alexis and Yale,
50:08but in most people places,
50:09people don't pay enough attention
50:11that when you're traumatized,
50:13you're living in a mind where the
50:15lights are oftentimes turned off.
50:18You don't know what you're feeling,
50:19you don't know why you're reacting.
50:21There's very little sense
50:23of self observation.
50:24You would expect that psychotherapy
50:26would really help people to really find
50:29language for their internal experience.
50:31Not so much.
50:32MDMA allowed people to go
50:34deep inside and do so
50:38describing feelings.
50:40There's much more talking going
50:42on in the placebo condition.
50:45But on MDMA, which is largely silent,
50:48people come up with being able to
50:51formulate what goes inside of themselves.
50:53I wish your dad were alive.
50:54I could show him this data.
50:55Let's say John, we can like to try
50:57some MDMA to see what it's like.
51:02And then this is a measure I
51:04always use self capacities,
51:06interpersonal conflicts.
51:08We noted during the pandemic incidents
51:12of domestic violence went way up.
51:16I'm not surprised.
51:18We all drive each other crazy before too
51:20long and it's important to get out of there.
51:23And honey, I'm off to work.
51:24I'm doing something where you're
51:26locked up in a little room.
51:28You need dealing with all that.
51:29It's a personal conflict.
51:31It's very hard.
51:32After MDMA people feel much a were able
51:35to tolerate their own feelings and how
51:39it different from other people and
51:41sit back and not react immediately.
51:44Immunization.
51:46I imagine some of you also have the
51:48experience I have quite a bit of people say,
51:50Oh my God, you're the first person.
51:52Whoever understands me,
51:54you're amazing.
51:55I could not live without you and the
51:58next moment you'd make this comeback.
52:00Whoever lived, the harder they come,
52:03the harder they fall.
52:04Idealization and denigration is
52:05very much part of doing travel work.
52:08And again MDMA much more successful.
52:11Abandonment concerns,
52:13huge issue of course impairment
52:16of self regulation measures.
52:18So what we really come up with
52:21is that the relationship through
52:24the self get changed.
52:26But the research shows is
52:27that if you're electrozymic,
52:29you have a hard time doing psychotherapy.
52:33If you have long left of effect tolerance,
52:37you cannot go back in your trauma because
52:39you get freaked out if you hate yourself.
52:42Very bad prognostic issue for
52:44PTSD and when our calculation
52:46showed is if you come into the
52:48treatment with good self compassion,
52:51lack of Alexa Thermia and and
52:54good self regulation,
52:55then the placebo group does
52:58just as well as the MDMA group.
53:01But what MDMA does,
53:03it's those those capacities
53:05for treatment to come online.
53:07That brings us to the last piece
53:09is the work of Gil Dolan.
53:13Imagine you'll have a
53:14grand voucher these days.
53:15Very important work showing that all
53:19of the psychedelics have various
53:22windows of being able to open up
53:25critical periods of brain development.
53:27I've I've been long
53:29interested in critical periods
53:33because it has said to PF feed
53:35a lot of adoptive kids who kids
53:38who the critical period that they
53:41needed to develop the capacity to
53:43drink the milk of human kindness.
53:46There was no human kindness came
53:48in and they cannot benefit from
53:51human kindness. My accent.
53:53If you know anything about accents,
53:56it's very clear that this guy must
53:58have come to America after age 13,
54:00because anybody who speaks and
54:02learn new language before age
54:0513 gets the accent perfectly.
54:07But by the time you're 13 or 14 years old,
54:09your mouth and your brain is
54:11formed in such a way it's almost
54:13impossible to get rid of your accent.
54:15Your dad still has his actions,
54:18even though he came quite early and so,
54:21but you see, and it's a big issue for me,
54:24it's a country always had been there.
54:26I will sometimes say if I'd
54:28ever been head of NIH.
54:30That's the thing I've focused on.
54:32How can you open up critical
54:34periods and allow new experiences
54:36to come into the brain that they
54:38did not get at the right time,
54:40at the right place.
54:42And so goals researched in
54:44animals up to now shows that these
54:47drugs open up critical periods.
54:49And that raises a very important
54:52question for all of us going on.
54:54Our psychedelic research is not
54:56only what drug do we give people,
54:59but what do we put into people while
55:02they're in the secondary experience.
55:04This is an opportunity to really
55:07give people something that they
55:09might be able to take in, take in.
55:12I'll give you an example yesterday morning.
55:15I know a guy physician actually,
55:18who had multiple football accidents
55:20in college for a long time and who
55:24always has a dysautonomia and it's
55:28very much it's his nervous system,
55:30malfunctioning adult and my
55:32psychotherapy didn't go very far.
55:35My wife is a body worker and yesterday
55:38we did the psychedelic session ketamine
55:41and my wife worked on his body and
55:44help this body to relax and I think
55:47that's just the right input they give
55:50at this vulnerable time so your mind
55:52can open itself up to new experiences.
55:56And so but for to my mind is the challenge
55:59is not only do we give people psychedelics,
56:02but what do we open up in people and
56:05what do we put into people at the time
56:08that they're in the psychedelics?
56:10We have a momentary window
56:12of opening something up.
56:13This may be the most exciting thing
56:16that's happened in psychiatry in my
56:19lifetime that actually you're able to.
56:22We've always tried to do that,
56:23like most therapists like,
56:25to give their patients a
56:28corrective emotional experience.
56:30But as one of my teachers pointed out to me,
56:33I,
56:34as an 80 year old guy,
56:36cannot give you a 45 year old woman.
56:39The feeling of what would have felt
56:41like if your mum would have loved you
56:43at three years old as a mismatch.
56:45And so we really cannot.
56:47We can be kind to people and thoughtful
56:49with people, but we cannot give
56:51people what they needed back then.
56:54And so the question is what can we,
56:56if these, these, these clinical PAS
56:59get opened up from neuroplasticity,
57:02then the question for us is what
57:04is the best thing to put into
57:06people at that particular point?
57:08Of course, psychiatry has,
57:10I did the first studies in Prozac and so on.
57:13After psychiatry,
57:14we didn't think about context,
57:16but maybe maybe the context should be the
57:20critical issue that we pay attention to.
57:22Let me give you an example, my final word.
57:25So I did the first study on on project
57:27and I had at the point just left the VA.
57:31So half of our sample was combat veterans,
57:34the other half were people
57:36in came to our clinic.
57:37The people in our clinic did very well.
57:40They got the 30 percent,
57:425% improvement.
57:43The veterans did not budget absolutely flat.
57:49Why is that?
57:52Is it the identity?
57:54Is it getting compensated for for being I'll?
57:58This is a very tough population.
58:00And so as people are beginning to
58:03give psychedelic agents for veterans,
58:06it's very important to really think
58:08about what you do you put into that
58:11at particular time so they can have
58:13new experiences that are contradictory
58:15to where their life has been.
58:17So it's not just giving people a pill,
58:20but it's what is the context
58:22of the pill is given in have.
58:24For example,
58:25when I had my own experience where all
58:27my time and people came to visit me,
58:30I felt really horrible, actually horrified.
58:34But somebody was with me who was a body
58:38worker and she helped my body to feel health.
58:41Well, well,
58:42I relived it and processed it.
58:45So the issue of how do we process
58:48information in what context is
58:50the challenge as I see it here
58:52and this the lesson for today.
58:54Thank you.