Trauma Needs a Rebrand
Trauma Needs a Rebrand
Trauma, Psychedelics, Limitations of Our Existing Models, and Exciting Alternatives
This article by therapist and psychedelic guide Liam Farquhar first appeared in Psychedelic Press XXXVII. You can subscribe to the final 3 issues of our print journal here.
The four main intentions for this essay are:
Clarify what trauma is and is not, and how various ‘disorders’, including depression and anxiety, might sometimes be symptoms of unresolved trauma responses.
Discuss the limitations of how we ‘get well’ in the West: we take pills and ‘talk it through’ in talking therapies, when overcoming trauma is primarily a physiological process (we can’t think our way out of it)[1].
Present three revolutionary, trauma-informed interventions that address the root: Somatic Experiencing, Internal Family Systems, and MDMA.
Offer a compelling research opportunity to study a trauma-informed, transdiagnostic therapeutic protocol that combines Somatic Experiencing, Internal Family Systems, and MDMA in order to treat a range of disorders, including depression and anxiety.
‘Trauma is a fact of life, but it doesn’t need to be a life sentence’ - Dr Peter Levine
Trauma is certainly in the zeitgeist at the moment. There appears to be a bottomless well of conferences on trauma, and endless Instagram accounts discussing it. The Body Keeps the Score, an academic book about trauma by psychiatrist Bessel van der Kolk, has spent almost three years at the top of the New York Times best-seller list, selling almost two million copies globally.
As a legal psychedelic guide, whose training includes Somatic Experiencing and Internal Family Systems—two increasingly popular, trauma-informed therapeutic modalities—what has become clear to me over the years is that trauma is not well understood at all. In many respects it needs a rebrand. Instagram therapists often describe trauma as being at the root of all our issues, which isn’t true. But the response, ‘Of course trauma doesn’t explain everything. Only PTSD is real trauma’, also isn’t true. Whilst the DSM-5 defines ‘trauma’ as requiring ‘actual or threatened death, serious injury, or sexual violence’,[2] this is an outdated definition, as I’ll explain.
It’s also worth mentioning that using the DSM definition, I wouldn’t have been diagnosed with PTSD. However, once I started to take an embodied, trauma-informed approach to my own healing process, I finally started to thrive. Many of my clients, like me, tried antidepressants and conventional talk therapy, and it didn’t work for them either. They tell me antidepressants numbed them or created more unwanted symptoms, and talk therapy either helped them to a certain point, or didn’t help much at all. There is clearly a distinction to be made between understanding and healing, where the former often doesn’t lead to the latter. The mind is a wonderful tool, but we are an organism of interconnected and interdependent systems, of which the mind is simply one element, and certainly not the whole picture. Taking a trauma-informed approach returns us home to this broader, embodied truth.
We can think of trauma as existing on a continuum. The simplest way I’ve come to frame trauma is as the protective response to overwhelm/adversity (an event or period of time that is too much, too fast, or too soon) in which we breach our unique window of tolerance and get stuck in protect-mode. Unique, because what overwhelms one person might not another. This is somewhat in line with the Freudian definition, where Freud defined trauma as a breach in the protective barrier against stimulation.[3] Although, as I shall describe more fully below, given what we now know about the nervous system, I believe it’s more accurate to say ‘overstimulation’.
In the simplest terms, we can say that the ‘body keeps the score’, and the ‘mind hides the score’ of trauma. But what does that mean exactly?
The Body Keeps the Score
Peter Levine, leading trauma expert and creator of Somatic Experiencing, a radical and exciting approach to healing trauma, says ‘trauma originates as a response in the nervous system, and does not originate in an event’.[4] Therefore, in order to understand trauma, we first need to understand the nervous system, and more specifically, the Autonomic Nervous System (ANS).
The ANS has two branches, the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS), which run from the brainstem all the way down to the genitals, connecting to most of our major organs along the way. The SNS is like an accelerator pedal, and is commonly described as controlling our ‘fight or flight’ systems. It’s designed to protect us—when there’s a threat (or, the perception of a threat) it mobilises our organism to take action. Survival energy (adrenaline, noradrenaline, cortisol) is generated and we enter protect-mode in order to fight our way out of danger, or flee. Whereas the PNS, also oriented towards protection, is like the brake pedal, and is commonly noted as controlling our ‘rest and digest’ systems. The PNS in turn has two branches of its own—the Ventral Vagal Complex (VVC) and the Dorsal Vagal Complex (DVC). The VVC is where we want to be hanging out most of the time. When this system is engaged we’re social, connected, compassionate, grounded, present, curious, and we feel safe. Essentially, we’re in a heart-centred (the nerve literally ends at the heart) state of Self, a concept I’ll explain later.
When the DVC is engaged we’re in ‘freeze’, and might feel numb, helpless, shameful, trapped, or dissociated. It’s designed to conserve energy and protect us in the event where we can’t fight or run away to safety.
We’re constantly oscillating between these systems. We feel safe, connected, and curious in the VVC, then we get activated by something which brings us into the SNS, and if the activation goes on for long enough we might even enter the DVC, but eventually we return home to the VVC. This is normal. Getting activated is normal. Indeed, stress can be healthy.[5] And importantly, stress isn’t trauma.
Trauma is when we breach our unique window of tolerance—again, an event or period of time that is too much, too fast, or too soon for us to handle—and we get stuck in protect-mode, where either the acceleration pedal of the SNS remains pressed, or the PNS does. If we’re stuck in the SNS (called hyperarousal) we might experience anxiety, hyperactivity, an inability to relax, hyper-vigilance, digestive problems, chronic pain, emotional flooding, insomnia, or hostility/rage. If we’re stuck in the PNS (called hypoarousal) we may experience depression, lethargy, exhaustion, chronic fatigue, disorientation, disconnection, dissociation, also digestive problems, complex syndromes, pain, or low blood pressure. Or we can get stuck in both, which is what Peter Levine calls tonic immobility, a state where we remain consciously or unconsciously activated, while feeling powerless to do anything about it. Frozen.
Below are the first symptoms that begin to show up at the same time or shortly after the trauma occurred:
Hypervigilance (being ‘on guard’ at all times)
Intrusive imagery or flashbacks
Extreme sensitivity to light and sound
Hyperactivity
Exaggerated emotional responses and startled responses
Nightmares and night terrors
Abrupt mood swings (rage reactions or temper tantrums, frequent anger, crying)
Shame and lack of self-worth
Reduced ability to deal with stress (easily and frequently stressed-out)
Difficulty sleeping
Several of these symptoms can also show up at a later time, even years later. Keep in mind that this list is not for diagnostic purposes. It’s simply a guide to help us get a feel for how trauma symptoms behave.
The next symptoms that may appear are:
Panic attacks, anxiety, and phobias
Mental ‘blankness’ or spaced-out feelings
Avoidance behaviour (avoiding places, activities, movements, memories, or people)
Attraction to dangerous situations
Addictive behaviours (overeating, drinking, smoking, etc.)
Exaggerated or diminished sexual activity
Amnesia and forgetfulness
Inability to love, nurture, or bond with other individuals
Fear of dying or having a shortened life
Self-mutilation (severe abuse, self-inflicted cutting, etc.)
Loss of sustaining beliefs (spiritual, religious, interpersonal)
The final group of symptoms generally takes longer to develop. In most cases, they may have been preceded by some of the earlier symptoms. However, there is no fixed rule that dictates when and if a symptom will appear. This group includes:
Excessive shyness
Diminished emotional responses
Inability to make commitments
Chronic fatigue or very low physical energy
Immune system problems and certain endocrine problems, such as thyroid malfunction and environmental sensitivities
Psychosomatic illnesses, particularly headaches, migraines, neck and back problems
Chronic pain
Fibromyalgia
Asthma
Skin disorders
Digestive problems (spastic colon)
Severe premenstrual syndrome
Depression and feelings of impending doom
Feelings of detachment, alienation, and isolation
Reduced ability to formulate plans
Any of the above sound familiar? The symptoms of trauma can be stable, meaning ever-present. They can also be unstable, meaning they come and go, and are triggered by stress. Or they might remain hidden for decades and suddenly surface. Usually symptoms do not occur individually, but come in groups, and they often grow increasingly complex over time, becoming less and less connected with the original trauma experience.
When stuck in protect-mode, the amygdala in our limbic system (part of our brain that controls the fear response) can remain switched on, meaning that people, places, situations, or even ideas might feel unsafe, even though rationally there is no threat present. Further, our muscles may remain contracted, where we might habitually raise our shoulders, or mindlessly clench our jaw or grind our teeth, sometimes for years. All of that chronic tension gets stuck in the muscles and tissue. And because the ANS connects to most of our major organs, it can impact these, too, leading to a whole host of diseases.[6] Therefore, we need to reduce arousal in the autonomic nervous system as a much higher order priority than is common in most therapeutic processes, as this has a direct impact on both our stories and our physical health.
Mammals have evolved over millions of years to know how to instinctively discharge survival energy soon after a traumatising event—often real life or death situations—in order to return to a Ventral Vagal Complex state, and to a felt sense of safety. Their very survival depends on their ability to do this—if they are stuck in protect-mode then they won’t be able to look for food, or socialise and play. How do they do this? Well, first they need to complete the fight or flight response. If they can’t fight their way out to safety, they flee. And if they can’t do that, then their systems will shut down and they enter freeze—the Dorsal Vagal Complex—where they disconnect from the event because it’s too overwhelming. As long as they don’t get eaten or mauled to death, they leg it as soon as the opportunity presents itself, thus discharging the fight/flight survival energy that was generated when the Sympathetic Nervous System was activated. Once safe, they then shake or tremor, further discharging any excess survival energy. Or they shake first, and then leg it. This is how mammals heal. They don’t think about it, they just do it.
This can be seen in videos showing two animals—an impala[7] and a polar bear[8]—automatically discharging the survival energy that was generated when they were overwhelmed.
Sometimes we forget that we’re mammals. But we are, so this is how we heal, too. And by healing, I mean releasing the unwanted symptoms that I mentioned above. I’ll use myself as an example of this. I had several years of conventional talk therapy, and although one could argue that it helped me to understand some things, it didn’t help me to heal. For example, my chronic insomnia, something that I suffered through for 17 years, remained. It was only once I started to understand trauma, and work somatically, that my unwanted symptoms (including my insomnia), went away. I can’t begin to tell you how life changing this has been for me. Further, as I released the trauma from my body and my nervous system settled, my mental and emotional states changed dramatically; I softened, things became clearer for me, my narratives organically updated, and I felt much more resourced to meet challenges.
Keep in mind that most of our physiological systems are very similar to those of other mammals, and we too have evolved over millions of years to know instinctively how to heal. Often, our need is also to complete the fight/flight response and discharge the survival energy that was generated when we were overwhelmed. For example, if our boundaries were crossed in any way—physically, mentally, or emotionally—we will have generated survival energy needed to fight off the aggressor. Or if we grew up in an environment (whether domestic or societal) that was oppressive, exhaustive, confusing, hurtful, shaming, neglectful, or overwhelming in any way, our organisms will have generated survival energy necessary to flee. This is simply how we’re wired as mammals.
I recorded two videos, showing me automatically discharging the survival energy that had been frozen in my body since my teen years and throughout adulthood. The first video demonstrates the shakes/tremors,[9] and the second video demonstrates me completing the flight response.[10] Both were completely painless, non-rational, automatic, and instinctual processes. I didn’t need to think about it, and there was no story attached to it.
Which begs the question: if our organisms have evolved over millions of years to know instinctively how to heal, then why don’t we just do it? In short, often the rational mind gets in the way. Most of us don’t understand trauma responses, so if we start shaking or tremoring then we might want to stop. We may consider it being out of control (a state much feared). Perhaps we connect shaking to cowardice, again thwarting the automatic process from completing. Or we might be fearful of feeling into the activation that lies beneath the frozen state.
The deeper I went into my work, and the more I directly experienced the healing effects of working somatically, the more I realised that healing mostly happens beyond the rational mind. Beyond the stories and the narratives. And don’t get me wrong, telling ourselves better stories and updating our life scripts is an essential part of any healing process, but it won’t help us to overcome our unwanted symptoms alone. It’s also important to point out that our stories are influenced by the state of our nervous system. Indeed, Peter Levine says that healing is primarily a physiological process, where the story of what happened is secondary to the release of the stuck survival energy and resulting nervous system regulation, which in turn updates our stories.
‘I remain awestruck by how much somatic trauma was released. I feel like a new person. I can breathe fluidly and the anxious stories have diminished substantially.’[11]
Also, we exalt the rational mind in our culture. We mostly incentivise and reward a certain type of intelligence—logical-mathematical intelligence—which is of course immensely useful, whilst being highly disembodied. But there are many types of intelligence, all worthy, including somatic intelligence (also known as bodily-kinesthetic intelligence).[12] And although trauma can disconnect us from our bodies, many of us are already disconnected, relating to our bodies merely as a way of getting our minds to meetings.[13]
This disconnect between mind and body goes way back. In his book Intelligence in the Flesh: Why Your Mind Needs Your Body Much More Than it Thinks, Guy Claxton, a cognitive scientist, suggests that the misguided split between body and mind originated in ancient Greece and was made worse when early Christians started framing the body as a source of distraction, in need of taming. This separation continued into the scientific age, and was concretised by the work of 17th-century philosopher René Descartes and his theory of mind-body dualism.
However, this view, still widely believed today, and which continues to underpin many of our therapeutic models, is wrong. The fact we call it ‘mental health’ rather than ‘organism health’ is indicative of this. We simply can’t resolve everything in the mind alone. Claxton explains how, instead, our organisms are a ‘massive, seething, streaming collection of interconnected communication systems that bind the muscles, the stomach, the heart, the senses and the brain so tightly together that no part—especially the brain—can be seen as functionally separate from, or senior to, any other part’.[14]
Indeed, research into embodied cognition has shown that memory, language comprehension, problem-solving, and decision-making all depend on the quality of the relationship that mind and body have.[15] As such, the cardiovascular system, the digestive system, the somatosensory system, the immune system, the endocrine system, and the nervous system (including the brain) is an information exchange, constantly talking to, and being informed and modified by, all of the others. Because the whole person has to act as one unit, each of these is a sub-system, responsive to the wider context of the whole. In other words, the body doesn’t just have a brain, it is a brain.
Because trauma mostly impacts the body and the deeper reaches of our brain in the limbic system, we often can’t access it via the rational mind. This has implications for conventional talking therapies, because here we’re trying to access and process the trauma via the rational mind through narrativizing and story-telling techniques. This is a bit like trying to see into the basement by turning on the lights at the top floor. No matter how hard we try, the trauma remains inaccessible.
What has become clear to me over the years is that the best way to access and discharge trauma is to create a deeply felt sense of safety, becoming embodied and tuning down the rational mind, breathing into the belly, and then letting our organism do what it has evolved over millions of years to know how to instinctively do. The story of what happened to us is secondary to this process, and quite often we can get stuck in obsessively trying to uncover all the details (which can in itself be another trauma-response, especially if people were hurtful and confusing for us growing up). Not to mention that every time we recall a memory, we change that memory,[16] meaning it’s pretty much impossible to know exactly what really happened. The most important thing is to unfreeze ourselves from the past, and feel safe in the here and now.
Trauma-informed, body-based modalities like Somatic Experiencing offer a revolutionary way for us to access the trauma, and importantly, discharge it. Most talking therapies largely involve ‘moving beyond’ rather than removing our issues. This still stands. However, Somatic Experiencing offers us a way to actually release our unwanted symptoms, and return to a regulated Ventral Vagal nervous system state. Somatic Experiencing also shows us that the root of many of our unwanted symptoms lies in the nervous system.
Indeed, the chemical imbalance theory of certain mental disorders like depression (i.e. viewing the cause of depression as a lack of serotonin in the brain) remains unproven,[17] and has been a narrative pushed by pharmaceutical companies to sell drugs that require daily intake within the flawed biomedical model.[18] In short, although conventional talking therapies and psychopharmacology might help to a point—indeed, they can be a lifeline in some cases—they won’t resolve trauma. I believe that the current research on MDMA for trauma offers many opportunities to combine trauma release with this substance.
The Mind Hides the Score
As well as Somatic Experiencing, my training also includes Internal Family Systems (IFS), which is an increasingly popular, non-pathologizing, evidence-based, and trauma-informed therapeutic model. Often confused with family constellations therapy, rather than being about our actual family (although that of course comes into play), IFS relates to our inner family. Allow me to explain. Central to IFS is the idea that we’re not a singular entity, but rather, we consist of multiple parts, a bit like an inner family of subpersonalities. Multiplicity of mind (although our parts live in the body too, and indeed can control our physiology). These parts have their own roles, needs, and fears, and are grouped into two categories: Exiles and Protectors.
Exiles are often, although not always, young parts of us that carry the memories, sensations, and emotions from times when we’ve been shamed, hurt, abused, humiliated, scared, neglected, abandoned, or overwhelmed in any way. Because they are too painful to face, they are exiled from conscious awareness. These parts are often young because it is when we’re young that we’re more likely to be overwhelmed—we haven’t fully developed or built many resources yet, and often we have nowhere to go.
And then we have the Protectors—which include the roles of Managers and Firefighters—ensuring we don’t access the Exiles because this would bring back states of hurt and overwhelm. Their motto is ‘do and say whatever it takes’, and they can sometimes be quite extreme in their effects.
Managers are proactive parts of us that try to keep us safe and functional. If we’ve been overwhelmed in the past, Managers can keep us from getting too close or dependent on others. They might deflect the pain by being overly critical or judgemental of others, or they may focus on others’ needs before their own. They can also present as an inner critic, ensuring that we remain small and safe.
And if Managers let anything slip through the net (because life happens), our Firefighters kick in. These are reactive parts that spring into action whenever an Exile part becomes so activated that the person risks being hurt or overwhelmed again. Their role is to distract or numb from the Exile’s feelings. Addictions to, or excessive consumption of, drugs, alcohol, food, sex, internet, social media, porn, comics or books, exercise, and work are all common firefighter behaviours.
Another central concept of IFS is that, beyond our wounded and protective parts, which can come and go, at the core of our Being is the unwavering Self. Our essential Self. In IFS, the Self embodies several characteristics known as the 8 Cs—Calmness, Curiosity, Clarity, Compassion, Confidence, Creativity, Courage, and Connectedness. The Self is deeply wise, and moves us towards wholeness (i.e. making our unconscious parts conscious) and wellbeing.
Although the relationship between the IFS practitioner and client is important, the most important relationship to build in IFS is between the client and their Self. Because it’s the Self that heals, and is what is always with them. Once they’ve accessed their Self, they can then turn their ‘Self-energy’ (the qualities of the aforementioned 8 Cs) towards the protective parts, who now trust that the client is open, curious, and able to hold their experience. Once the Protectors’ roles, needs, and fears are witnessed, they learn to lower their weapons and grant access to the Exiles they’re protecting, who can then be healed.
As you can see, there are parts of us that we might not want to be there, or that we may feel are getting in the way of our happiness. But these parts are on our side—they’re trying to protect us from being overwhelmed again.
Often, we need to update our Protectors about our actual age. Just as in trauma, these parts are locked in protect-mode, frozen in time to the event or period when we were overwhelmed. Such parts are usually surprised to know that we’re adults now, with resources we didn’t have back then. The things that overwhelm us as children are manageable for us to face as adults, especially with support and if we’re coming from a place of Self. According to Richard Schwartz, creator of IFS, nothing can overwhelm the Self (one might even say it’s infinite), which becomes deeply reassuring for our parts to experience.
As with Somatic Experiencing, IFS also isn’t a rational ‘talking it through’ process. It’s more like a shamanic guided inner voyage, one that works directly with our parts, as opposed to around them, or even past them (think CBT, which entirely bypasses our parts).
For me, one of the most powerful aspects of IFS—and Somatic Experiencing for that matter—is that 100% of the healing, potential, and wisdom comes from within the client. In IFS sessions, I simply have the client ask their parts what they need, and then those parts tell the client. It’s a symmetrical power dynamic that invokes the Ram Dass quote, ‘We’re just walking each other home’. The therapist/practitioner is never the expert of or for the client, and doesn’t need to be too clever—rather they simply create a space for the process to happen.
Being a non-pathologizing model, there is no need to diagnose the client; whether directly, as in labelling them with a ‘disorder’, or indirectly, by using theoretical frameworks to know how to approach the client. Because what if the psychiatrist or therapist gets it wrong? What if the client can’t fit neatly into a diagnostic box? All too commonly, this approach often doesn’t work.[19] Increasingly, we’re waking up to the idea that disorders might not be disorders at all, and instead are protective responses to overwhelm and adversity.[20]
In this way, our protective parts hide the score of the trauma. Which, alongside Somatic Experiencing, also has implications for conventional talking therapies. In hindsight, when I was in talk therapy myself, I spent most of my time obsessively trying to understand what the hell happened. Although I believe it’s important to broadly understand our issues and traumas, attempting to uncover all the details is at best of limited value, and at worst impossible. Further, I now realise that I spent much of my time in therapy selling and buying my own BS, which is to say that I was caught up in the convincing stories of my Protectors. They will say and do whatever it takes to block access to the wounded parts that were overwhelmed.
It was only once I started to access Self and work with my Protectors directly that they learned to soften their defences and grant access to the parts of me that needed healing. And I’m not saying that it’s impossible to access our parts or Self in traditional talk therapy. But in my view, IFS offers us a more reliable and direct way in, that doesn’t take as long. Plus it’s a natural ally to an intentional psychedelic process, which I’ll explain in a bit.
What Causes Trauma?
Hopefully I’ve made it clear how and why trauma can be framed as the protective response to overwhelm, in which our unique window of tolerance is breached, locking us into protect-mode, where the body keeps the score, and the mind hides the score of trauma.
But what causes trauma? Well, lots of things can overwhelm us. As Peter Levine says, ‘trauma is a fact of life. But it doesn’t need to be a life sentence’.[21] Remember, we’re especially prone to being overwhelmed when we’re young.
Obvious causes of trauma include:
War
Emotional, physical, or sexual abuse during childhood
Neglect, betrayal, or abandonment during childhood
Experiencing or witnessing violence
Rape
Catastrophic injuries and illnesses
Less obvious causes of trauma include a wide variety of seemingly ordinary events. Many of these events prove traumatising far more frequently than we might expect, and could cause overwhelm to both the mind and body.
These can include:
Minor automobile accidents, especially those that result in whiplash
Invasive medical and dental procedures, particularly when performed on children who are restrained or anaesthetised. (The use of ether increases the chance of trauma. For adults, many medical procedures, such as a pelvic exam, can be experienced as an attack, even if rationally we know they are necessary and helpful)
Falls and other so-called minor injuries, especially when children or elderly people are involved (for example, a child falling off a bicycle)
Natural disasters, including earthquakes, hurricanes, tornadoes, fires, and floods
Illness, especially when a high fever or accidental poisoning is involved
Being left alone, especially for young children and babies
Children having their reality denied consistently
Parents vicariously living through their children
A consistently confusing and turbulent home environment growing up, especially where parents don’t regulate their emotions.
Prolonged immobilisation, especially in children (casting or splinting for long periods, such as for scoliosis or turned-in feet)
Exposure to extreme heat or cold, especially in children and babies
Sudden loud noises, especially in children and babies
Birth stress, for both mother and infant
Many things can push us outside our window of tolerance. This is especially true if we’ve experienced many cumulative unresolved stresses over our lives. The final straw could be a divorce, losing a loved one, being fired. The list is endless.
And although it’s beyond the scope of this essay, with the emerging science of epigenetics we’re discovering that we might inherit trauma through generations as a modification to our gene expression (and in case that sounds alarming, as this is a modification to the gene expression as opposed to the DNA itself, it can be undone).[22]
It’s also important to point out that the scope of what could breach our window of tolerance extends to socio-economic-cultural factors, too (sometimes the narratives around trauma can be overly focused on the individual). For example, intergenerational structural racism could be overwhelming.[23] Our Neoliberal cultural model that normalises individualism, greed, inequality, exhaustion, depletion, extraction, disconnection, hoarding, lack, and infinite growth on finite resources (both personal and planetary) could lead to overwhelm. And although we can acknowledge the global average is overall healthier, more democratic, less violent, and more educated than it’s ever been,[24] this can create a false confidence. For we are also lonely,[25] depressed,[26] anxious,[27] medicated,[28] and addicted.[29] It is not unreasonable to assume that this could be a response to an overwhelming environment. Our nervous systems are millions of years old and haven’t evolved in a very long time, whereas the constructed environments in which we live have developed extraordinarily rapidly, and our technologies exponentially. It’s perhaps no surprise that many of us feel overwhelmed. Healing trauma therefore needs to address several levels: individual, cultural/societal, and environmental.
The Psychedelic Renaissance
In case you missed it, there’s a psychedelic renaissance happening at the moment.[30] Some of the world’s leading research institutions have been studying the benefits of classic and non-classic psychedelics, such as psilocybin (the active compound in magic mushrooms), ketamine, and MDMA, among others, as part of a wider therapeutic process. Psilocybin has so far dominated this new wave of exciting research, showing promising preliminary results in helping with the alleviation of alcohol and nicotine addictions,[31] depression,[32] end of life anxiety,[33] cluster headaches,[34] and obsessive-compulsive disorder.[35]
The main healing mechanism for psilocybin, or what many of the research teams have been focusing on, is the so-called mystical experience,[36] which is said to include: a sense of unity (i.e. loss of internal boundaries within the self, or external boundaries between self and environment); transcendence of time and/or space; ineffability and paradoxicality (i.e. that the experience is difficult to describe or conceptualise); a sense of sacredness or awe; a noetic quality (i.e. sense of direct knowledge of ultimate or higher reality); and a deeply felt positive mood (e.g. joy, peace, love). Such an experience can quite radically shift the lens through which one views the world.
Participants of clinical studies who have psilocybin experiences in a supportive setting often consider them to be one of the most meaningful experiences of their lives, sometimes the single most meaningful experience, attributing to it substantial personal and spiritual significance[37] and sustained positive changes in attitudes, mood, and behaviour. It should be noted that the positive clinical outcomes appear to be tied to the extent to which a mystical experience was had,[38] suggesting that the therapeutic effects of psilocybin are not a simple product of isolated pharmacological action, but rather are experience dependent.
The quest for a mystical experience is all very well. It quite literally has the potential to open up the entire universe for you. The problem is that not everyone who takes a psychedelic substance has one. Which perhaps has the potential to lead to disappointment, especially if the stated benefits are so dependent on one having it.[39] It’s also important to note that most, if not all, of the current protocols involve lying down with an eye mask on and headphones playing a curated playlist. Participants are encouraged to stay with the experience, and let their inner healing intelligence lead the way,[40] which often involves remaining lying down in stillness. Much of the research has also been focused on the neurological effects of the experience, exploring changes to neuroplasticity,[41] psychological flexibility,[42] cognitive reappraisal,[43] 5-HT2A receptors,[44] the Default Mode Network[45] and the like.
My question is… where is the body in all of this? Don’t get me wrong, much of the research so far has been stellar, as have many of the people behind it (not to mention courageous). Exploring the neurological changes to the brain in the psychedelic state is perhaps especially exciting given its implications in understanding the nature of consciousness (Johns Hopkins’ research facility is named the Centre for Psychedelic & Consciousness Research). However, hopefully I’ve made it clear that trauma is a protective response located largely in the body, and that trauma is a much broader term than many realise. I would argue that undischarged trauma responses are responsible for many of our unwanted symptoms, including depression,[46] where we get stuck in the Dorsal Vagal Complex, or anxiety, where we get stuck in the Sympathetic Nervous System.
It is important to bear in mind that not everyone will be seeking a psychedelic process for healing. Some people will merely be curious, or might want to creatively explore a life issue in a new way, or have a mystical experience, or whatever else the reason may be. There are use cases for which one or two high-dose psilocybin experiences might be better indicated—smoking cessation, end-of-life anxiety, and others. Beyond these, on behalf of all the many people who are seeking such experiences to feel better (which includes those with depression and anxiety), I reiterate: we can’t resolve everything in the mind alone.
My hunch is that this might be one of the reasons behind why some research in the psilocybin for depression trials showed depression returning within a few weeks to months.[47] Even when participants adopt a new story about themselves and their existence (which can be profound and immensely beneficial), because the trauma hasn’t been physiologically discharged and the participant’s underlying maladaptive structures of behaviour and self-identity (in IFS terms, the Protector and Exile parts) haven’t been worked with directly, eventually the new story will unravel enough that participants return to their unwanted symptoms. And although there are many factors implicated in our wellbeing—diet, exercise, a sense of community, connection to nature, the quality of our relationships, our environment, our socio-economic standing, and so on—I believe the impact of undischarged overwhelm plays a major role, as do our parts, who will continue to run the show if bypassed.
We now turn to MDMA. MDMA has been shown to be an extraordinarily effective treatment for PTSD.[48] Researchers found that 67% of PTSD sufferers who had MDMA sessions supported with therapy no longer qualified for a PTSD diagnosis following the trial, compared with 32% of those who received a placebo with therapy. And 88% of subjects in the MDMA group experienced a ‘clinically significant improvement’ in symptoms.
MDMA works by enhancing the release of monoamines such as serotonin, norepinephrine, and dopamine, and hormones including oxytocin.[49] It also reduces activation in brain regions implicated in the expression of fear, namely the amygdala and insula. Essentially, what this means is that it creates a period of psychological and physiological safety, which, in IFS language, can grant access to Self. With this in place, the experience can soften the defences of the Protectors so that we gain access to the Exiles underneath that require healing. And although Somatic Experiencing teaches us to move very slowly so as not to overwhelm the client, because nothing can overwhelm the Self, it means that we can courageously explore, be with, and heal the most wounded parts of ourselves without risk of being overwhelmed again. MDMA has also been said to unlock deep abdominal breathing,[50] a profound healing tool in itself.[51] With the volume of the rational mind turned down, bodily awareness can increase, enabling the participant to remain present with the unfolding somatic experience in the here and now.
Therefore, in my view MDMA could be the perfect tool to release trauma, and many of the aforementioned symptoms associated with it, including depression and anxiety. Indeed, I believe the healing potential for MDMA reaches far beyond PTSD. I also believe it could be especially powerful when used in conjunction with Somatic Experiencing and IFS approaches. Somatic tools could be utilised to teach the language and vocabulary of sensations, where the participant will know how to track sensations in real-time. Combined with a felt sense of safety and plenty of Self-energy, this has the ability to give the participant’s organism the opportunity to do what it has evolved over millions of years to know how to instinctively do—discharge the survival energy that remains frozen within them. IFS can be used in the preparation period, to give the Protectors a heads up that an MDMA experience is about to take place, working through any of their fears or concerns (another way of framing Protectors is ego defences, which can create resistance. Working directly with the parts that might resist the experience upfront has the potential to allow for a deeper experience to take place).
I also think that more than one psychedelic experience is required, ideally three. We’re often talking about a lifetime’s worth of issues here, so chances are they won’t all be resolved in a single experience. IFS could be used in between the MDMA sessions to work with any parts that emerge throughout the process. I believe IFS could also be used in the MDMA sessions themselves, in the event that the trauma release (which I would prioritise in the MDMA sessions), doesn’t occur. And I understand why so far the non-directive, inner healing intelligence model has been used in the MDMA research.[52] The argument is that an overly active therapist could inadvertently undermine the participant’s own self-healing capacity.
There are ethical concerns, too; taking a directive approach to psychedelic assisted therapy, using conventional therapeutic models, puts far too much power with the therapist. But IFS and Somatic Experiencing are newer, innately inner-healer models. In the IFS, only the participant can heal themselves, by connecting with their Self, and then directing their Self-energy towards their parts that need healing. With a participant’s protective parts relaxed, and with Self-energy generated due to the MDMA effect, this has the potential to allow for some deep work to take place.
Indeed, in a recent conversation on the Psychedelics Today podcast, IFS creator Richard Schwartz said using IFS in MDMA sessions has a lot of potential.[53] And by using Somatic Experiencing-inspired tools, the participant could simply track sensations, discharge the bodily-held trauma, and not get lost in the narratives. Although this is a very different proposal to the ‘lie back with eye mask and headphones on’ model that we’ve seen so far, it would remain entirely led by the participant’s organism—mind and body—and would also serve to build helpful tools for the participant after the process has completed.
I suggest an ideal protocol could include three psychedelic sessions supported with nine preparation/integration sessions—three preparation sessions before the first psychedelic session, two integration sessions in between the three psychedelic sessions, and finally two integration sessions after the third psychedelic session, with community support being offered after the entire process completes, and tools for regulating the nervous system, practising mindfulness, embodiment, connecting with Self, and working with parts are embedded throughout the process.
The first preparation session could focus on drawing a broad map of the participant’s history and, importantly, the current issues they want to work with. The next preparation session could include SE-inspired embodiment tools to help the participant learn what embodiment feels like, and how to track sensations, which would support the entire process. (The therapist/practitioner wouldn’t necessarily need to have done the full three-year Somatic Experiencing training to be able to do this, although some training would be required). Embodiment awareness could be further supported with embodiment meditations and a trauma-informed educational written guide, thus offloading some of the ‘work’ from the therapist/practitioner. As mentioned, IFS could be used in the remaining preparation session to prepare the Protectors and support the work with the parts throughout the process (this would need to be facilitated by a trained IFS practitioner/therapist, but thankfully there are more and more people being trained in this model due to its increasing popularity).
And although I believe MDMA should be used for at least two of the psychedelic sessions, perhaps there could be the option to work with psilocybin for the third psychedelic session, once much of the ‘groundwork’ has been done, i.e., once the participant has a more regulated nervous system and connection with Self. This is beneficial because psilocybin has the potential to surface potentially hurtful or even shameful material from the unconscious. If a person doesn’t have a strong, or any, connection with Self, it has the potential to be quite destabilising. IFS, MDMA, and Ventral Vagal access through trauma release all serve to build the Self connection, meaning that if difficult material does surface in a psilocybin experience, the participant is better equipped to meet it with self-compassion and curiosity, and would of course be supported by the therapist/practitioner throughout the process.
It should be noted that psilocybin works very differently to MDMA—whereas MDMA can be relational and allows the participant to be calmly present with, and safely explore, the unfolding process, a high-dose psilocybin experience is one arguably necessitated by the need to surrender to it without external influence. Therefore, I believe a psilocybin session would need to follow an entirely non-interventional approach, where the psilocybin and the participant’s psyche does the majority of the work within the session, and the therapist/practitioner is there to provide safety, comfort, and reassurance, helping the participant to move through any resistance that might emerge.
In Closing
To summarise, trauma exists on a continuum, and can be defined as the protective response to overwhelm/adversity (an event or period of time that is too much, too fast, or too soon for us to handle), in which the unique window of tolerance in our autonomic nervous system is breached, and we get stuck in protect-mode. When we are overwhelmed, there is a physiological consequence: we generate survival energy (adrenaline, noradrenaline, cortisol) which can then get frozen within us, locking our nervous system into dysregulation, causing chronic muscle tension, and sometimes somatic diseases. And there is a psychological consequence: we can disconnect from Self, and our protective parts, developed as an adaptive response, work hard to protect us from being overwhelmed again. Trauma can be generational, and it can be a result of both our personal histories as well as the environments in which we live. Trauma also relates to a threat, or the perception of a threat.
I hope I have explained that trauma is a much broader term than many people realise—it is not limited to PTSD that requires ‘actual or threatened death, serious injury, or sexual violence’. Lots of things could lead to us breaching our unique window of tolerance. We are increasingly waking up to the idea that trauma’s protective response to overwhelm and adversity could very well explain many of our unwanted symptoms, and the tools we’re currently commonly using might not be the optimal ones for the important task of helping people get well.
Indeed, overcoming trauma is largely a physiological process—we can’t talk, think, or even meditate our way through it. Further, I believe it’s of crucial importance that we acknowledge how the state of our nervous system greatly influences our mental and emotional states, and the narratives we hold about ourselves, others, and the world. Rather than solely working at the narrative level, which is a later stage process, we must address the root at the somatic and nervous system levels, while working directly with the parts of ourselves that came into being as a response to overwhelm and adversity, so as not to either disregard them or get too caught up in their protective stories.
We’re constantly evolving and adapting, and the therapeutic tools, methods, and approaches we’ve used thus far have paved the way for others to emerge. For example, there would be no IFS without psychosynthesis, gestalt, Jungian psychology, family systems thinking, humanistic psychology, and indeed many shamanic and spiritual traditions (another way to frame the Self could be Buddha nature, Atman, or Christ consciousness; and parts work has similarities with a shamanic soul retrieval process).
I’m deeply grateful to all the teachers, guides, healers, therapists, clinicians, and researchers who have taken us this far. And although there are other great approaches out there for trauma (EMDR, yoga, etc.) I believe that Somatic Experiencing, Internal Family Systems, and psychedelics—perhaps especially when combined—present us with new, increasingly popular, and most importantly, very effective alternatives to some of the approaches we’ve used to date. Therefore, I believe there is a great research and investment opportunity here to combine these models in a transdiagnostic, trauma-informed MDMA (or MDMA + psilocybin) protocol that connects to Self, processes parts, and importantly, prioritises the release of stuck survival energy and nervous system regulation.
Learn more about Liam’s work here.
[1] Wong A (2000) ‘Why you can’t think your way out of trauma’ in Psychology Today. Online: https://www.psychologytoday.com/us/blog/the-body-knows-the-way-home/202005/why-you-cant-think-your-way-out-trauma
[2] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5.
[3] Freud S (1922). Beyond the Pleasure Principle. The International Psycho-Analytical Library No.4, p22. https://www.libraryofsocialscience.com/assets/pdf/freud_beyond_the_pleasure_principle.pdf
[4] Levine P (2012). Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body. Boulder, CO: Sounds True
[5] Sanders R (2013) ‘ Researchers find out why some stress is good for you’ in Berkeley News. Online: https://news.berkeley.edu/2013/04/16/researchers-find-out-why-some-stress-is-good-for-you/
[6] Maté G (2003) When the Body Says No: Understanding the Stress-disease Connection. Hoboken, NJ: John Wiley & Sons
[7] ‘Impala shaking off his trauma’. Video Online
[8] ‘Polar bear shaking trauma’. Video Online
[9] https://drive.google.com/file/d/1Tap77nuP88rmm7JRGIMJ3Zz5I58txkM0/view
[10] https://drive.google.com/file/d/16ERXac2-lKuVJk15PP7r4gXQGa7NhEVC/view
[11] Client testimonial I received from Jason.
[12] Cherry K (2021) ‘Gardner's Theory of Multiple Intelligences’ in VeryWellMind. Online: https://www.verywellmind.com/gardners-theory-of-multiple-intelligences-2795161
[13] ‘Robinson K: Do schools kill creativity?’ Video Online: https://www.ted.com/talks/sir_ken_robinson_do_schools_kill_creativity
[14] Claxton G (2015). Intelligence in the Flesh. New Haven & London: Yale University Press, p4.
[15] Wilson AD & Golona S (2013) ‘Embodied cognition is not what you think it is’, Frontiers in Psychology. Online: https://doi.org/10.3389/fpsyg.2013.00058
[16] Nash R (2018) ‘Are memories reliable? Expert explains how they change more than we realise’ in The Conversation. Online: https://theconversation.com/are-memories-reliable-expert-explains-how-they-change-more-than-we-realise-106461
[17] Moncrieff J, Cooper RE, Stockmann T et al. (2022) ‘The serotonin theory of depression: systematic umbrella review of the evidence’. Molecular Psychiatry. Online: https://doi.org/10.1038/s41380-022-01661-0
[18] Leo J & Lacasse JR (2008) ‘The Media and the Chemical Imbalance Theory of Depression’, Society, 45:35–45 doi.org/10.1007/s12115-007-9047-3; and Deacon BJ (2013) ‘The biomedical model of mental disorder: a critical analysis of its validity, utility, and effects on psychotherapy research’, Clinical Psychology Review: 33(7):846–61 doi.org/10.1016/j.cpr.2012.09.007
[19] Schwartz R (n.d.) ‘Depathologizing the Borderline Client’, Alternative Healing Trauma Centre. Online: https://alternativehealingtraumacenter.com/depathologizing-the-borderline-client-by-richard-schwartz/
[20] Escalante A (2020) ‘Researchers doubt that certain mental disorders are disorders at all’ in Forbes. Online: https://www.forbes.com/sites/alisonescalante/2020/08/11/researchers-doubt-that-certain-mental-disorders-are-disorders-at-all/
[21] Levine P (2008).
[22] Henriques M (2019) ‘Can the legacy of trauma be passed down the generations?' in BBC. Online: https://www.bbc.com/future/article/20190326-what-is-epigenetics
[23] Hankerson et al. (2022) ‘The Intergenerational Impact of Structural Racism and Cumulative Trauma on Depression’, American Journal of Psychiatry. Online: https://doi.org/10.1176/appi.ajp.21101000
[24] Roser M & Nagdy M (2014) ‘Optimism and Pessimism’ in OurWorldInData.org. Online: https://ourworldindata.org/optimism-pessimism
[25] ‘Loneliness is a Serious Public Health Problem’ in The Economist. Online: https://www.economist.com/international/2018/09/01/loneliness-is-a-serious-public-health-problem
[26] Hidaka BH (2012) ‘Depression as a disease of modernity: explanations for increasing prevalence’, Journal of Affective Disorders, 140(3):205–14. doi.org/10.1016/j.jad.2011.12.036
[27] Campbell D (2020) ‘UK had experienced ‘explosion in anxiety since 2008, study finds’ in The Guardian. Online: https://www.theguardian.com/society/2020/sep/14/uk-has-experienced-explosion-in-anxiety-since-2008-study-finds
[28] Winerman L (2017) ‘By the Numbers: Antidepressant Use on the Rise’, American Psychology Association. Online: https://www.apa.org/monitor/2017/11/numbers
[29] US Department of Health and Human Science: ‘What is the US Opioid Epidemic?’ Online: https://www.hhs.gov/opioids/about-the-epidemic/index.html
[30] Richert L (2019) ‘The Psychedelic Renaissance’ in Psychology Today. Online: https://www.psychologytoday.com/us/blog/hygieias-workshop/201908/the-psychedelic-renaissance
[31] Bogenschutz MP et al. (2015) ‘Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study’, Journal of Psychopharmacology, 29(3):289–299 doi.org/10.1177/0269881114565144; and Johnson MW, Garcia-Romeu A, Griffiths RR (2017) ‘Long-term follow-up of psilocybin-facilitated smoking cessation’, The American Journal of Drug and Alcohol Abuse, 43(1):55–60 doi.org/10.3109/00952990.2016.1170135
[32] Davis AK et al (2021) ‘Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial’, JAMA Psychiatry, 78(5):481-489. doi:10.1001/jamapsychiatry.2020.3285
[33] Agin-Liebes GI et al (2020) ‘Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer’, Journal of Psychopharmacology, 34(2):155–166. doi:10.1177/0269881119897615
[34] Sewell RA, Halpern JH, Pope HG Jr (2006) ‘Response of cluster headache to psilocybin and LSD’, Neurology, 66(12):1920–2. doi.org/10.1212/01.wnl.0000219761.05466.43
[35] Moreno FA et al (2006) ‘Safety, tolerability, and efficacy of psilocybin in 9 patients with obsessive-compulsive disorder’, Journal of Clinical Psychiatry, 67(11):1735–40. doi.org/10.4088/jcp.v67n1110
[36] Griffiths RR et al. (2006) ‘Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance’, Psychopharmacology, 187(3):268–83 doi.org/10.1007/s00213-006-0457-5
[37] Griffiths RR, Johnson MW, Richards WA, Richards BD, McCann U, Jesse R (2011) ‘Psilocybin occasioned mystical-type experiences: immediate and persisting dose-related effects.’ Psychopharmacology, 218(4):649–65 doi.org/10.1007/s00213-011-2358-5
[38] Roseman L, Nutt D, Carhart-Harris RL (2018) ‘Quality of Acute Psychedelic Experience Predicts Therapeutic Efficacy of Psilocybin for Treatment-Resistant Depression ‘Frontiers in Pharmacology, Section Neuropharmacology. Online: doi.org/10.3389/fphar.2017.00974
[39] Kent J (2022) ‘Psychedelic Clinical Trials and the Michael Pollan Effect’ in Psychedelic Spotlight News. Online: https://psychedelicspotlight.com/psychedelic-clinical-trials-and-the-michael-pollan-effect/
[40] Clare S (2018) ‘Cultivating Inner Growth: The Inner Healing Intelligence in MDMA-Assisted Therapy’, MAPS Bulletin, 28(3). Online: https://maps.org/news/bulletin/cultivating-inner-growth-the-inner-healing-intelligence-in-mdma-assisted-psychotherapy-winter-2018/
[41] Ly et al. (2018) ‘Psychedelics Promote Structural and Functional Neural Plasticity’, Cell Reports, 23(11):3170–3182 doi.org/10.1016/j.celrep.2018.05.022
[42] Escalante A (2020) ‘We’ve got depression all wrong. It’s trying to save us’ in Psychology Today. Online: https://www.psychologytoday.com/us/blog/shouldstorm/202012/we-ve-got-depression-all-wrong-it-s-trying-save-us
[43] Brennan W & Belsar AB (2022) ‘Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model’, Frontiers Psychology. Online: https://doi.org/10.3389/fpsyg.2022.86601
[44] Lee HM, Roth BL (2012) ‘Hallucinogen actions on human brain revealed’, Proceedings of the National Academy of Sciences USA; 109(6):1820–1 doi.org/10.1073/pnas.1121358109
[45] Carhart-Harris RL et al. (2012) ‘Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin’, Proceedings of the National Academy of Sciences; 109(6):2138–43. doi: 10.1073/pnas.1119598109
[46] Escalante A (2020)
[47] Escalante A (2020)
[48] Mitchell JM et al. (2021) ‘MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study’, Natural Medicine: 27, 1025–1033 doi.org/10.1038/s41591-021-01336-3
[49] Allison A et al (2018) ‘MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms?’, Progress in Neuro-Psychopharmacology and Biological Psychiatry: Vol. 84, Part A, 221–228 doi.org/10.1016/j.pnpbp.2018.03.003
[50] Coleman R (2017) Psychedelic Psychotherapy: A User Friendly Guide to Psychedelic Drug Assisted Psychotherapy. Berkeley, CA: Transform Press
[51] Strom M ‘Breathe to Heal’. Video Online
[52] Clare S (2018)
[53] ‘Interview with Dr Richard C Schwartz’, Psychedelics Today. Online: https://psychedelicstoday.com/2022/03/11/pt300/