back to indexClinical Psychedelic Journey (Set & Setting) Explained | Dr. Andrew Huberman
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from the subjective side and from the structural side. 00:00:08.680 |
what I mean is what does a psychedelic journey 00:00:16.480 |
Some of you may have heard that set and setting 00:00:23.520 |
or even therapeutically beneficial psychedelic journey. 00:00:27.400 |
And all of that really hinges on safety and outcomes. 00:00:32.240 |
the mindset of the person taking the psychedelic. 00:00:52.720 |
That means no streets of moving cars they can run out into. 00:00:59.240 |
That means no opportunity for getting into bodies of water. 00:01:02.420 |
In other words, it requires that there be at least one 00:01:06.200 |
and perhaps even two or more other individuals 00:01:14.160 |
present in that setting to ensure that the person 00:01:18.080 |
taking the psilocybin is not going to harm themselves 00:01:21.840 |
I say this not to sound like a school teacher, 00:01:23.920 |
even though technically I'm a school teacher, 00:01:26.640 |
but because of course I don't want anyone to get harmed. 00:01:29.480 |
And I'm also aware that there's a lot of interest nowadays 00:01:33.560 |
in psychedelics such as psilocybin becoming legal 00:01:37.200 |
or decriminalized for their therapeutic applications. 00:01:40.560 |
And if we look back to the late 1960s and early 1970s, 00:01:44.160 |
when the Controlled Substances Act was invoked 00:01:46.700 |
to make psychedelics like psilocybin illegal, 00:01:51.600 |
was not just the geopolitical unrest at the time 00:02:03.760 |
took things like LSD, stared at the sun, went blind, 00:02:07.040 |
or took psilocybin, went out and harmed somebody else. 00:02:10.880 |
Again, these are very, very isolated instances, 00:02:19.160 |
or the fact that things like psilocybin and LSD 00:02:21.700 |
and MDMA for that matter are considered illegal. 00:02:31.160 |
We talk about the drug trade, the war on drugs, 00:02:33.220 |
but right now is such a critical time in the history 00:02:43.480 |
meaning making it absolutely as safe as possible 00:02:46.080 |
for the person taking the psychedelic is absolutely key. 00:02:48.560 |
And one of the best ways to ensure that it's safe 00:02:53.220 |
who are not under the influence of psychedelics 00:02:58.080 |
The other component of setting that we talked about earlier, 00:03:05.680 |
toward the person on the psychedelic being seated 00:03:08.880 |
or ideally lying down and being in the eye mask, 00:03:14.720 |
any spontaneous visual hallucinations that occur 00:03:17.840 |
with the various thought processes that are occurring 00:03:23.020 |
This is far in a way different than quote unquote, 00:03:29.680 |
What we're talking about today is the use of psychedelics 00:03:32.640 |
for particular brain rewiring outcomes that yes, 00:03:36.120 |
can involve things like changing one's relationship 00:03:38.980 |
to nature or changing one's relationship to somebody else 00:03:44.040 |
And while I'm not trying to diminish the potential value 00:03:50.860 |
the vast majority of it, not just in the clinical setting, 00:03:54.680 |
but in terms of understanding the safety and efficacy 00:04:03.400 |
and to interact with life in more adaptive ways 00:04:06.160 |
going forward out of the psychedelic journey, 00:04:08.400 |
involve these very, let's say, subdued settings 00:04:14.080 |
that are typically in one room, a closed environment 00:04:18.160 |
with one or two other individuals acting as sort of guides 00:04:24.880 |
from time to time if they feel like they have to sort 00:04:27.020 |
through a particular aspect of the psychedelic journey 00:04:30.560 |
And we'll talk about the contour of the psychedelic journey 00:04:35.080 |
at somewhere between 20 and 30 milligram dosages 00:04:39.600 |
But the setting that I'm describing is not just a list 00:04:44.720 |
but they're really the list of things that also ensure 00:04:51.720 |
Now, other things included in setting that are known, 00:04:54.520 |
again, from scientific literature, to be very influential 00:04:59.520 |
and to bias things towards a positive experience 00:05:09.040 |
from one of the premier researchers on psilocybin 00:05:12.280 |
and other psychedelics, which is Robin Cardart-Harris, 00:05:14.360 |
he's a professor at University of California, San Francisco, 00:05:20.760 |
And when he first started telling me about the critical role 00:05:22.820 |
that music plays, I thought, okay, that makes sense. 00:05:26.160 |
Music can impact our emotion, impact the way that we think, 00:05:31.160 |
and could therefore impact what one experiences 00:05:38.480 |
to which music is not just a sort of incidental feature 00:05:50.520 |
of the actual cognitive and emotional experience 00:05:53.880 |
that somebody has on something like psilocybin 00:05:57.740 |
that allows the psilocybin journey to be looked at 00:06:02.880 |
and this is quoted in the scientific literature, 00:06:12.780 |
that have been used in these clinical studies. 00:06:17.440 |
how long the psilocybin journey itself is going to be. 00:06:20.840 |
And the typical duration of the psilocybin journey 00:06:41.440 |
it was advised that people not have any food in their gut 00:06:50.840 |
if people are going to be taking psilocybin mushrooms 00:07:00.400 |
Again, that's converted to psilocin in the gut 00:07:03.920 |
And the acidity of the gut is going to be impacted 00:07:09.460 |
why people are advised to not eat for at least four hours 00:07:15.160 |
So here we've got this six-hour, what we're calling journey, 00:07:18.460 |
'cause that's what everyone calls it, or trip, 00:07:21.180 |
that people start experiencing about 30 to 45 minutes 00:07:26.000 |
after ingesting psilocybin or taking psilocybin. 00:07:31.560 |
in which there's a maximal intensity of emotion, 00:07:34.980 |
and often that's also associated with anxiety. 00:07:49.360 |
and I think most people would probably hear peak experience 00:07:55.240 |
But no, we're referring to a peak experience in anxiety 00:08:00.400 |
that people stay with and then come down from gradually 00:08:09.920 |
and that tapers off slowly toward the six-hour mark, 00:08:14.480 |
what sometimes people refer to as parachuting back in. 00:08:23.200 |
while on psilocybin, but I think you get the idea. 00:08:27.180 |
The music that's typically played in the clinical studies 00:08:30.940 |
using psilocybin for the treatment of depression 00:08:36.180 |
tends to have a particular contour that matches with 00:08:39.740 |
and can also drive that contour of the psilocybin journey 00:08:45.700 |
Again, we're talking about people wearing an eye mask 00:08:50.240 |
so people who are not taking psilocybin there as well 00:08:53.600 |
to ensure that the person feels supported and is safe. 00:09:00.360 |
but more often than not lying down, wearing an eye mask, 00:09:08.100 |
tends to be music that doesn't have a lot of vocalizations. 00:09:18.860 |
that has a lot of percussion, so often drums, 00:09:25.100 |
that has a lot of intensity at about the time 00:09:29.100 |
that one would be experiencing the peak in emotion 00:09:32.780 |
and in perception, the so-called peak of the journey. 00:09:44.580 |
and then tends to transition into softer music again, 00:09:58.620 |
the outside natural world and less so synthetic things 00:10:06.860 |
So why would it be so important that music match 00:10:10.020 |
and even contribute to the subjective experience 00:10:14.260 |
And here we should probably take a couple of moments 00:10:16.660 |
and just talk about what those subjective experiences 00:10:21.540 |
or any psychedelics, it's a little hard to describe, 00:10:25.160 |
but one way to describe it is that there's a lot 00:10:32.380 |
will report seeing some geometric shapes and colors, 00:10:40.400 |
or the movement of whatever it is that they're seeing, 00:10:52.840 |
In addition, people under the influence of psilocybin 00:10:57.540 |
often will report that their pattern of breathing 00:11:06.140 |
So for instance, if they take a big deep breath in 00:11:10.180 |
they may find that during the long exhale out 00:11:20.820 |
at least what they perceive as control over the music, 00:11:24.200 |
which of course they are not actually controlling 00:11:36.500 |
can occur while under the influence of psilocybin. 00:11:49.100 |
that they happen to be lying down or sitting on, 00:11:51.300 |
that they will experience a change in the music. 00:12:00.740 |
and that all of this is linked to their emotional state 00:12:05.460 |
Okay, so we're talking about a lot of perceptual 00:12:08.220 |
and emotional blending and some sense of control 00:12:15.220 |
in a way that's very unordinary, even extraordinary. 00:12:22.140 |
very subjective description of the psychedelic journey 00:12:26.980 |
that would allow these sorts of things to occur? 00:12:30.980 |
with an understanding of the cell biology and the chemistry 00:12:40.260 |
and it's the psilocin that crosses the blood-brain barrier, 00:12:42.820 |
and then even though psilocin looks a lot like serotonin, 00:12:47.700 |
to predominantly activate the serotonin 2A receptor. 00:12:51.580 |
Well, we can understand much of what's happening 00:12:55.260 |
at a subjective level during the psychedelic journey, 00:13:03.700 |
by understanding where the serotonin 2A receptors 00:13:16.540 |
Pyramidal neurons are found lots of places in the brain, 00:13:22.240 |
They have a cell body, which is the part of the cell 00:13:28.060 |
like the organelles, mitochondria, et cetera. 00:13:30.920 |
And then they also have what are called dendrites. 00:13:32.940 |
Dendrites are the little branches or processes 00:13:36.100 |
that reach out both from the bottom of these cells, 00:13:39.300 |
and then these pyramidal cells are interesting 00:13:42.460 |
because they also grow a branch up, up, up, up, up, up 00:13:49.060 |
and they have what's called an apical branch. 00:13:58.340 |
Okay, so if you're not getting a good picture 00:13:59.780 |
of this in your mind for my description, I apologize, 00:14:02.180 |
but simply think about putting your arms out to the side, 00:14:08.580 |
with things that are some distance from your body, 00:14:13.160 |
These cells are effectively doing the same thing 00:14:15.300 |
by extending little processes out into layers above them 00:14:36.020 |
And so when somebody is under the influence of psilocybin, 00:14:39.500 |
that means that psilocin has bound to the receptors 00:14:52.020 |
well-documented effects of psilocybin and other psychedelics, 00:14:58.060 |
from the brain being more modular, meaning more segmented, 00:15:01.140 |
like auditory neurons are communicating electrically 00:15:03.860 |
and chemically largely with other auditory neurons. 00:15:10.860 |
you know, like a snap of fingers off to the right, 00:15:15.540 |
depends on my auditory neurons being linked up 00:15:17.580 |
with things like my motor system and my visual system. 00:15:23.100 |
when there is psilocybin present in one system, 00:15:26.660 |
that the communication of any of these pyramidal neurons, 00:15:38.980 |
or in the generation of visual hallucinations 00:15:42.620 |
those are all talking to many, many more other neurons 00:15:51.240 |
is that there's a reduction in the modularity, 00:16:01.840 |
what would otherwise be disparate brain regions. 00:16:06.680 |
psilocybin increases communication across the brain. 00:16:29.480 |
up, meaning it propagates up through the eyes, 00:16:32.920 |
through the nose, through the ears, through the skin, 00:16:36.440 |
or the senses in those regions, I should say, 00:16:38.880 |
up into areas of the brain that sit deep to the cortex, 00:16:44.640 |
And then the thalamus is sort of a way station. 00:16:49.320 |
that sends visual stuff to the visual centers, 00:16:57.280 |
off to the memory centers of the brain, et cetera. 00:17:01.400 |
It's hierarchical because it goes from the periphery up 00:17:04.280 |
to the more complex processing regions of the brain 00:17:08.080 |
that link all of that stuff to prior experience, 00:17:16.160 |
there's a broadening of the flow of that information 00:17:22.120 |
Okay, and that has to do with what's called thalamic gating. 00:17:24.520 |
The thalamus is a very interesting structure. 00:17:29.220 |
but it really is like a switchboard and a way station 00:17:31.720 |
saying, hey, pay attention to the visual stuff. 00:17:37.440 |
and ignore touch sensation for the time being, 00:17:51.380 |
of the flow of information up and through the thalamus. 00:17:59.780 |
because they're involved in thinking and decision-making 00:18:03.020 |
but there's also a shift in the flow of sensory information 00:18:07.020 |
into the brain that can generally be described as broader 00:18:11.460 |
and including more blending of the different senses. 00:18:16.540 |
I'm also referring to blending of the sense of interoception 00:18:53.860 |
and less hierarchical activation of brain circuitry. 00:18:58.780 |
what I mean is that normally things go from periphery, 00:19:04.540 |
However, when under the influence of psilocybin, 00:19:09.860 |
the visual cortex is going to be very activated 00:19:14.200 |
So then if one hears a sound, perhaps from music, 00:19:20.740 |
and that's linked to a particular emotional state, 00:19:23.100 |
that is now being blended with visual phenomenon 00:19:26.540 |
occurring within the brain that have no external stimulus. 00:19:29.620 |
And so while the patterns of activation in the brain 00:19:32.700 |
while under the influence of psilocybin aren't random, 00:19:35.520 |
they are far less channeled, far less modular, 00:19:38.740 |
and far less hierarchical than would ever be the case