Frontiers in Human Neuroscience, Journal Year: 2024, Volume and Issue: 18
Published: Dec. 11, 2024
Introduction We are experiencing a mental health crisis of unprecedented proportions. Over the last two decades this grew from perfect storm rising insurance deductibles, escalating social stressors, COVID-19 pandemic, and critical workforce deficiency. Perhaps no arena has greater shortfall effective treatment options than Post-traumatic Stress Disorder (PTSD) as new was approved by FDA 24 years ago (Hamner Davis, 2024). Inadequate funding for research efforts public resources available to expandservices may in part stem inordinate prevalence PTSD among women anddisadvantaged populations. Women experience at three times rate found inmen (US Department Veterans Affairs, 2023), these rates also significantly higheramong African Americans, Latinos, Native homeless (Tortella-Feliu et al.,2019; Kwon al., 2024; Armoon 2019; Reyes, 2019). Neighborhood poverty alsopredicts development following traumatic event (Ravi, al, 2023). Our traumaburden is unevenly distributed across society.Trauma unfortunately quite common. The National Center estimates that over 13 million people US suffer with 5% our population diagnosed any given year annual cost been estimated $232 billion (per person/year $19,630) 2018 (Davis 2022). group report high levels trauma. According PTSD, 23% veterans accessing Administration services (USDepartment Suicide, often linked trauma nowbecome leading cause death those serving Armed Forces (Kaplansky andToussaint, For society, human suffering immense undeniable. Yet, current treatments inadequate (Smith Trauma-focused psychological therapies (TFPT) best-evidenced interventions they typically first line (Schrader Ross, 2021). However, only about 50% patients complete course treatment, response who do roughly (Schottenbauer 2008). TFPTs not used clinicians (Kline 2001) due fear retraumatizing, dislike manualized, rigid concern symptom exacerbation (Finch 2020). Even when high-quality TFPT offered, refuse even consider option because facing way extremely painful indicated medications, such sertraline paroxetine which were early 1990s, minimally evidenced small effect size (0.28 0.23, respectively) (Hoskins 2015; Hoskins 2021) burdened side effects. need innovation care feels critical. MDMA Psychedelic Framework represents best hope generation. application MDMA-assisted psychotherapy (MDMA-AP) time considered linkage medication (DeBattista Schatzberg, This combination serves core psychedelic framework. framework components: container, catalyst carrier (Shannon, container psychotherapeutic model support, safety rapport well attention set setting. creates atmosphere trust work traumatized patients. itself. agent alters consciousness flow information within it. improves access memories feelings including material. Mechanistically, MDMA, psilocybin, ketamine all different, their distinctive neurochemical properties continue be elaborated. ultimately induce an altered awareness enhanced processing contents held psyche. Finally, there carrier. includes use curated music delivered headphones, eyeshades designed drive inward therapeutic benefit. Without carrier, externally focused, little consequence other amusement or distraction. While commonly setting, it can tool (along eye shades headphones) support focus attention. Music does contribute context, but plays larger role nature reducing cognitive hierarchy. synergistic psychedelics allows flexibility thought perception characteristic insight (Lebedev, 2016). Together, basic components comprise psychotherapy. ties disparate arms conventional together time. Both psychopharmacology finally share unified goals common process. Thus, groundbreaking true paradigm shift (Zaretsky 2024).MDMA Psychotherapy evolved enormously since Sigmund Freud popularized psychoanalysis, its remains talk therapy. Transcranial Magnetic Stimulation (TMS) more modern less invasive variation on shock Electroconvulsive Therapy (ECT) introduced 1930s. Psychopharmacology, 1950s, care. specific medications prescribed evolve, format much same: daily dosing agents reduce load. catalysts durably improve psychiatric disorders through alteration innovative core. It generally accepted principle magnitude success flows quality relationship therapist. When history trauma, creating context becomes imperative. supports alignment process modulating range physiological These include increase monoamines accompanied significant oxytocin release. appears occasion sense deep safety: relaxed, compassionate prosocial, fearful state. With level emotional safety, easily accessed reconsolidated (Feduccia Mithoefer, 2018; Molla There network changes induced implicated empathogenic effects, modulation sensory information, extinction (Gamma 2000; Yu A study carried out Singleton colleagues (2022) exploring brain activity connectivity post-MDMA-AP resting-state amygdala-hippocampal connectivity, addition shifts. induces limited enhancement neuroplasticity (Ly 2018), enhance learning trauma-related reappraisal both during after session. allow body digest move without sequelae PTSD.Perhaps most importantly, facilitates something takes develop (and some, never does): decrease defensiveness/avoidance. Theoretically, necessary healing take place. potential accelerate forms offers. challenges Western idea driven external expertise intervention, rather internal wisdom innate capacity heal. we would argue many modes psychotherapy, majority currently US, mechanism mysterious. must remain humble face complexity consciousness. Phase III studies published recently MDMA-AP demonstrate sizes evidence serious adverse effects (Mitchell 2021; Mitchell Concerns functional unblinding challenge medicine whole (Goodwin assessment tools, Diagnostic Statistical Manual (DSM) exhibit disappointing low interrater reliability actual practice. They create formidable desire brain-based science diagnostic categories inclusive based superficial phenomenology. In opinion, created calls methods honor centrality psyche personal experience. Given exposure (three doses) compared dosing, multiple pharmaceuticals, biochemical considerably reduced. have some risks, manageable. almost exclusively time-limited responses day ingestion: muscle tightness, nausea loss appetite. benefit durable improvement combined large 0.91, benefits likely far outweigh risks. Furthermore, emphasizes power each individual heal thus carries optimism too lacking psychiatry emphasis pathology. Potential To fully grasp care, outline confers via observed relaxation defenses, augmentation compassion oneself others. real reevaluation one's values, behaviors, beliefs. perspective, span domains psychopathology beyond If one learn regulate nervous system work, increased tolerability clinical issues, hard assess promise transdiagnostic capacity. Clearly, broad facets developmental, attachment, repeated traumas. utility several categories, especially roots (addiction, anxiety, depression, personality difficulties) could useful eating where self-compassion acceptance won. therapy adults, sponsors will compelled investigate effectiveness adolescents children (Kangaslampi Zijlmans, believe another deserves completely change trajectory lives. Taking reasoning step further, perhaps parents treated prior generational carryover untreated burden (Narayan pernicious defined Adverse Childhood Experiences (ACEs) literature (Gilgoff 2020), dramatically pain, illness lifetime. relational speed couples, families, groups. see invaluable fractured groups communities, infusion facilitation clear, communication. Additionally, place various demographic groups, disenfranchised whom meaningful historically limited. Often, faced enormous pain structural factors deserve potentially profound modality. encourage ongoing investigation into veterans, additional justice-involved, color, LGBTQ communities. Does carry justice agenda? engagement broader issues around shared humanity interconnection. manner, might patients, delivery itself.Discussion At juncture, understand effectively evaluate transformative novel modality, reimagine fabric healthcare country. industry increasingly controlled rapid symptomatic management (Goldman 2018). frustrated attempts implement parity provisions (https://www.kff.org/mental-health/issue-brief/mental-health-parity-at-a-crossroads/). Prevention ignored on-going (Kamra underlies intensive prevention needed innovation. By emphasizing heal, bring humanistic needs approach. reimagining programs preventative nature, help mitigate vast sooner. Can demand complex expensive unlike hip replacement placement stent? Economic evaluation outlines severe save $100,000 per case consequences impairment entire positive trials assessing represent type demands what is, be.
Language: Английский
