Insight Mind Body Talk

Psychedelic Assisted Therapy with guest Dr. Travis Fox

• Jessica Warpula Schultz, LMFT • Season 2 • Episode 12

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The use of psychedelics to assist in the improvement of mental health symptoms is a cutting-edge practice happening in psychotherapy clinics, and doctor offices, across the world.
 
In this episode of Insight Mind Body Talk, Dr. Travis Fox, of Winding Path Psychotherapy, talks about the current psychedelic therapy research for PTSD, Major Depressive Disorder, addiction, and other mental health disorders. Dr. Fox explains how he implements the use of psychedelics to assist in the therapy process and shares his thoughts on what is ahead in this emerging, highly promising mental health treatment. 


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Produced by Jessica Warpula Schultz
Music by Jason A. Schultz

Insight Mind Body Talk. Also, check out our e-courses!

Welcome to Insight Mind Body Talk, a body-based mental health podcast. We're your hosts, Jessica Warpula Schultz and Jeanne Kolker Whether you've tried everything to feel better and something is still missing or you've already discovered the wisdom of the body. This podcast will encourage and support you in healing old wounds, strengthening relationships, and developing your inner potential all by accessing the mind body connection. Please know while we're excited to share and grow together. This podcast is not intended to be a substitute for mental health treatment. It doesn't replace the one-on-one relationship you have with a qualified healthcare professional and is not considered psychotherapy. 

Thanks Jess. And thank you for listening. Now, let's begin a conversation about what happens when we take an integrative approach to improving our wellbeing. Welcome to Insight Mind, body Talk. My name is Jeff. I'm a licensed clinical social worker from Insight Counseling and Wellness, and today I'm your host. Don't worry, Jess is here as well. Hi, Jess. Hello. Hey, Jeff. Hi everyone. I am still here. Excited to listen, but we thought it would be pretty cool to let Jeff take the lead.

So without further ado, why don't you introduce our topic and our guest? Thanks so much, Jess, and I'm really glad to have you here riding shotgun for, uh, for my first, uh, attempt at this. Me too. So, today's episode is one that, I, I brought forward as, uh, near and dear to me for several reasons. And one of them is that there's a trend in mental health right now that, and we want to cover this particular topic for our clients and other therapists in our office.

And the second one is many of our clients have, have actually brought up this topic and have wanted. To know more about it, and I want to mm-hmm. , you know, be able to speak to it in a, in a way that, that makes sense to clients, but is also, you know, accurate. And so I have a personal and a professional relationship with our guests today to talk about this cutting edge therapy.

and we are of course talking about psychedelic assisted therapy and there's a, there's been a lot, um, of talk about this right now in the Madison community and all over the country and even the world, and it's a modality that is, is really just. Rising. And so we feel fortunate and grateful to have with us today, uh, Dr.

Travis Fox, and I'll tell you a little bit about Dr. Fox before we let him, uh, join us here. So Travis Fox is a psychologist in private practice here in Madison, Wisconsin, and he works with individuals, groups and provides seminars, workshops, and super. Specialty areas of interest are working with men's issues, healthcare professionals in the ME medical and mental health field groups, and psychedelic assisted therapy.

He's also a researcher with the University of Wisconsin Madison, where he's a therapist and assessor of a variety of F D A approved clinical trials. Investigating the potential for psychedelic assisted therapy for the treatment of trauma and addiction. He has received training from MAPS and us to work on clinical on these clinical trials at UW Madison, and also from the Polaris Institute to offer Ketamine assisted therapy.

Which offers, which he offers in his private practice that we'll talk a little more about today. Travis is also trained at the Gestalt Institute and practiced for almost 20 years, most notably at the Gestalt Institute of Cleveland, where he's now a member of the teaching and training faculty. Thank you so much for being here, Travis.

Thank you. We appreciate you lending your expertise and experience to us. It's great to be here. Thanks for having me. I appreciate the invitation, Jeff, and um, to be joining you, Jess, well, 

thank you for being here. We really appreciate. My pleasure. And in that spirit of what I mentioned earlier of providing accurate and, um, up to date information to our, our clients and, and really anyone, um, directly part of the insight family or, or affiliated, uh, we really wanted to get, um, some info right from someone who's doing this work.

You know, we, Jess and I talk a lot about, we did a recent episode on social media and really, Age where we can get as much information as we can possibly hold. Oh yeah. The question becomes, right, is this accurate? Is it up to date? Is it. Is it presented in a, uh, neutral way for clients and people to, to be able to consume and, and search and seek this out.

So in that vein, we really would love you, Travis, if you would start and give us some of the, the nuts and bolts of what is psychedelic assisted therapy. Yeah, thanks Jeff. That's a, uh, it's a big question and I'll start kind of in a more general way. You know, I. Um, when I think of what is psychedelic assisted therapy, I think of it first as therapy.

So the way that, um, we practice, for example, at Winding Path in our use of ketamine is that it's, it's the use of the medicine embedded in a therapeutic relationship. And so whereas, you know, some might think, um, take this medication and the improvement comes because of the medication. Our belief is it's in conjunction with the therapy relationship.

And right now there's kind of only two routes in the United States to get psychedelic assisted therapy. Uh, one is, uh, through Ketamine assisted psychotherapy, which we'll be talking about in detail as we go on, um, that is currently accessible to folks. Uh, it's legal to. And then the other route would be through clinical trials.

So right now, um, there are trials going on all over the country, in other countries as well, focusing on a variety of, of these substances. Um, and so there's research happening looking at different indications for psilocybin, L S D M D M A, um, five M E O D m T. Um, so there's, there's quite a bit happening now.

Um, and so, but in terms of what your listeners could access now, it's more like ketamine space. Um, and so what does the psychotherapy entail? I kind of think of it in three stages. So you have the initial preparatory phase, so that is where you are meeting with your clinician. So I would meet with folks, spending time, getting to know them, getting to know what's bringing them.

Starting to formulate a sense of goals and intentions for the medicine sessions, um, and just doing a lot of education during that preparatory phase. What are some things to expect? How best can we support you? And then there's the actual medicine session, or the dosing session is what we often call it, and that mm-hmm.

uh, the length of that varies depending on the, the substance being used, the psychedelic that that's being onboarded. And during that time, you would have. In our clinic, we use a two clinician model as well as in the research. So you'd have two providers there with you for the duration of the experience to provide support, um, to help you through any challenges you're experiencing.

And then that third phase is the integration phase. And this is where I really think the work really starts to happen. And the change is really possible is during that integration phase. And so there's kind of a, yeah, that three stage process of what is psychedelic assisted. . Does that make sense? Yeah.

You know, I'm, at least, at least for me, I didn't realize there was, you know, different stages to what's happening. But it really, I feel, I mean, Just actually a lot of relief to know that, you know, clients are supported in such, you know, an extensive way. And that it, you know, I thought, again, speaking to the fact that I don't know much about this area, I just assumed it was like they're going to maybe a treatment center.

Receiving the treatment almost like, you know, receiving, you know, saline solution or something in the ER so that they feel better and then leaving again. And so I really appreciate hearing, you know, the different levels of support that are provided for the client throughout the process and that most importantly throughout it, that there is that relationship as you.

Right. And now that being said, there are a variety of models, um, that are out there that are being experimented with or used. So when you said, you know, like, so I'm talking about the way that I think about like psychedelic assisted psychotherapy. . Mm-hmm. . Um, however, there are different models depending on the medicine, right?

So Ketamine, for example, can be offered in an IV infusion clinic where you wouldn't have that kind of relationship pre and post experience, where it would be a little bit more in a medical model. Um, and so I just wanted to clarify that. I'm talking about a particular way of thinking about, um, the therapy embedded in a, in a therapy relationship, but there are.

models out there that we can talk about more in detail as well, just so for listeners can kind of have a sense of what might be a good fit for them as these things start to become offered more publicly. Mm-hmm. . Sure, definitely. So can I ask another question? So for the, do you know, and again, so you're talking about kinda like what happens at the, the model that you work in right now with the different phases.

Are there other expectations for someone if they do go to, let's say an infusion clinic, that they have an outpatient psychotherapist or that they're in that they do have a team of support somewhere, or there's some people. Or just receiving the services, you know, maybe just with their PCP as a support ju, you know, just kind of so that I can imagine like all the different options for, for possible listeners or clients.

Right. And, and I'm not completely aware of what, say an infusion clinic may ask a person to, to have who they would have as part of their care team. . Um, and I know there are a few different, so this is ketamine we're talking about here, right? Which is, is accessible now. And, um, maybe be helpful to talk a bit more about there's different roots of administration, which would then include, would have a different sort of way of working with the medicine.

So what you're asking about right now, what we're talking about is the IV infusion model. . So, um, there are IV infusion clinics here in Madison already operating, and I do believe that UW Health also offers, um, IV ketamine. Um, and for, uh, some folks insurance will actually cover portions of interesting treatment.

Right. And so my under, I'm, I'm less versed in the IV infusion model, like what it looks like on the ground, but my understanding is, you know, it's about a 45 minute infusion. So you would go to the hospital, you'd be in a hospital room, they would hook you up to the iv, a nurse would be there to, to support you with getting set up, getting comfortable, and then they run the infusion.

And often you're alone in the. And then when the time is up, um, they stop the infusion, there may be a period of kind of, uh, giving you a chance to just kind of come back into your body, come back into the present, and then in that model, someone would drive you home. So there wouldn't be like, a post-integration support mm-hmm.

and that comes from the medical model belief that it's the medicine interacting with your brain, creating the, the relief, the change. And one of the advantages of, of that model is it, it has been shown to be really effective and rapidly effective for chronic suicidality. and treatment resistant depression.

Mm-hmm. . And so it, I actually have, um, some folks I work with that do go to IV clinics for their ketamine and then do psychotherapy with me, but they've chosen kind of to go that route in part, I think because insurance might cover it or just the ease and the, the shorter time requirement there where it's 45 minutes.

Whereas in our model, it's about a three hour session for the medicine session. It sounds to me, Travis, like, um, in the IV route, it is looking, being looked at as almost like a last re resort. Maybe not a last resort, but a, um, a treatment once folks have tried other things. Um, the chronic depression, I think is what made me think of that or the suicidality.

is that accurate? And is that, I would guess it's not the same, uh, for the integration type therapy that you've been talking about. Do you, can you say much about those differences and um, how you view those?

I have heard folks, you know, who, especially when you start talking about treatment resistant depression, you know, folks have tried a lot of different things mm-hmm. and so. This has be for some, it is a last resort option, likely because they just weren't aware of that option. I think the awareness is building around this being a potential treatment.

Um, you know, ketamine was originally approved as an anesthetic. . And so any, uh, subjective effects of the medicine we're off, we're just seen as sort of a, a, a side effect . Um, and it wasn't until later where, uh, dosages started getting discovered around, um, you know, there's psychodelic properties to ketamine and so, so, yes.

Um, Folks may come to that, you know, feeling like I've tried everything. This is my last resort. And I think that's that for me as a clinician, really, it just makes me wanna make sure those people do have therapeutic support because it doesn't work for everybody. And I think that's the thing that doesn't get said enough is it's, it's not a silver bullet.

It's not a cure-all. And so, um, while many people are helped and helped rapidly with that relief, um, not everybody is, and everybody who is helped, it doesn't necessarily linger, right? Mm-hmm. . And so that's the other piece that we're still trying to figure out through the research is. Not only does this help folks, but then what is gonna help maintain those gains, right?

Mm-hmm. , that's where I think the integration process is really valuable and why I really have gone more toward the psychotherapeutic models out there, um, to support people post medicine experience to make those behavioral changes. and to hopefully have that relief stick around longer. Right now, the infusion model, I mean, people are going for multiple infusions, right?

So depending on, um, what the recommendation of their prescriber is, they may go in for a couple infusions a week, sometimes weekly, right? For a period of time. Um, and then in our model, , uh, we tell folks, you know, if possible to have one to three medicine sessions right within our treatment approach. That would be the dosing session.

That would be the dosing session, yeah. Thank you. Yeah. And so, so where we're at different is, um, you know, we're really. I guess I should back up a little bit like what is Ketamine used for? Right? So we've talked about chronic suicidality, we've talked about treatment resistant depression. There's some good evidence out there now that it can help in the depressive phase of a bipolar illness.

Mm-hmm. , um, there's some research being done and that, and people are using this to support folks to manage anxiety, O C D and PTSD and trauma symptom. And so that's another reason we prefer the psychotherapeutic model because as you know, a lot of trauma occurs in relationships and a lot of the healing needs to occur in relationship.

Most definitely. So part of the process, right, is getting that relationship with the psychotherapist as well as the psychiatrist prescribing the medication. who can then be there to support you during the medicine session. So the healing can happen in relationship this way, in this model too. And then you have that kind of post-integration process.

And part of our thinking around that integration piece is, um, you may have heard the term like neuroplasticity. So one of the ways we think that ketamine and other psychedelics, um, help people who have psychiatric issues is it creates this sort of like window in the brain where there's new neural connections are are available, right?

Old fixed patterns, old fixed pathways in the brain get broken up a little. and there's opportunities to sort of, in a way rewire your own brain, but to do that right, you have the window open and that window sometimes is referred to as the alo period lasts often just one to two weeks. And so we really think that getting in there and doing some of those, that behavioral and emotional work on the integration side, maybe utilizing insights that happen during this session and how to apply them in your life is really where those, that reforming of those connections can happen.

And so that's our belief is that the integration process is really essential and having a safe, therapeutic space to explore what comes up is primary, you know? Um, and so we think of, it's kind of, you know, the approach really generally is the set and setting approach, which you may be familiar with, right?

So a big part of that prep part is getting the mindset that that optimizes healing and growth. , right? So that's what we mean by set. So that's what we're doing with preparing them not only for euphoric experiences, but also it often includes very challenging experiences. And so, um, sort of managing expectations is part of developing the mindset, going in, having an intention and a focus to hold lightly in the session.

and then as therapists, we're part of the setting, right? And so there's a healing setting that we try to create just from the decorations in the room to the way that we carry ourself, right? So that setting is a really big part of, um, the psychedelic experience. And it's why we, you know, that like people take psychedelics recreationally all the time and don't find healing.

And a big part of that, It's not in the context of a therapeutic setting. And so we really try to leverage all of that toward healing. I, the, the term intentional and intentionality kind of came up for me as you were talking, uh, about. Related to this, this type of treatment and being open and receptive, um, to the potential of growth and healing.

That sounds like a pretty important part, right? Right. Yeah. That openness is, is pretty essential. At the same time, some people come in nervous and afraid, right? And that that's okay as well. And. , that's part of having that time before the medicine session to really develop that relationship, that trust that if really difficult emotions or material emerges, I'm, I'm held in this safe container.

Mm-hmm. . Mm-hmm. . So I think that's the advantage of the psychotherapeutic model. . And as we're talking with you, you know, the, the listeners can't see, but we can see, you know, and I've been in your lovely office at, at, um, Winding Path. Is that where, um, is that the setting in which you all are doing this work?

Or where would that be? Great question. Um, this office has been used for ketamine sessions, and then we're in the process of a. getting a dedicated dosing room set up upstairs in the clinic. And so our clinic is kind of a home setting. Um, it's a smaller clinic right now. There's five, I think five clinicians here.

Um, and so we're trying to create, yeah, just a nice homey vibe where people feel comfortable and kick off their shoes. Um, we've got pullout pouches for folks, you know, during the dosing session to lay down, um, eye shades. music, some snacks, things like that. Very cool. Wow. Wow. You know, earlier you mentioned Travis, that, or Jeff, it might have been you too, that this is, this has kind of come back more in the last few years.

You know, um, I think I first heard of Ketamine myself in 2018 approximately. So let. You know, where is this coming from? Has this been on? It just feels like it's suddenly a thing, which is wonderful, but what is, what is the history of this use? Because I can't imagine it just started now. I mean, people have probably been talking or thinking about this for quite a while.

Absolutely. Um, and there's really, uh, depending on the culture we're talking about these, you know, in thes, psychedelics, plant medicines have been around for centuries, if not millennial, right? So cultures throughout the world have been using plant medicines. as long as there's been recorded history and, and have used them as part of ritual, as a part of healing and as a part of gaining knowledge.

And so there's a long history of the use of these medicines. Um, it's only been, I think it was in the. thirties or forties when these things started showing up in kind of the western model of, of treatment and medicine, you know, with the synthesis of L S D 25 by Albert Hoffman, kind of by accident. Mm-hmm.

And, and so, you know, once he realized what this compound could do and um, people got interested in how could it. with psychiatric issues. Right. So originally, like LSD was considered what they call a psycho mimetic, which is something that can mimic the symptoms of psychosis. Hmm. So originally we just thought that this could really help model.

um, for researchers and psychiatrists, just the, you know, how to help people with psychosis and what does that experience feel like? So you could have an experience of psychosis, I guess was kind of the idea, but then it would go away when the compound wore off. So that was one original use of these, of these medicines in a, in, I guess a research context or in a medical, you know, western kind of context.

Um, There's a lot more great detailed, you know, information there about, you know, folks who went down to Mexico and got introduced to the psilocybin mushrooms down there and kind of brought that back. And again, it was Albert Hoffman who, um, synthesized psilocybin in a lab. And that was being used then in clinical trials, really trying to see, um, what this could help with, you know?

Mm-hmm. , in fact, LSD really was an early treatment for alcohol. . Mm. And in fact, um, bill Wilson, the founder of a, had an l s D experience that kind of led to his spiritual awakening and eventually the creation of aa. So psych, so psychedelics have been around a long time. Um, and, and then as, as you may be aware, you know, as the drug war started coming of age in the seventies, All that research got shut down.

So there were thousands of studies happening in the forties, fifties, and sixties and early seventies, with lots of promising results, and that just all ended one day. Mm-hmm. , I mean, I remember listening to a podcast, I think it was Bill Richards or someone was saying, that they had dosed people and then got the letter they needed to shut it down.

And they all just kind of agreed to say, Hey, I think we got the letter tomorrow. ? Mm-hmm. . Yeah. Yeah. Thank goodness. Thank goodness they did it just shut down and then, wow. Research kind of had stopped until the nineties, uh, the above ground research. Right. But a lot of this kind of went underground and has been continued on, you know, in an unbroken chain since that.

Mm-hmm. , where is, go ahead. Where is the research right now for the, you know, we've talked a lot about ketamine, but what is the, the current, what, what else are they studying? I know they're looking at P T S D and, and you know, like you said, major depressive disorder. But, um, are there any like, bigger up and coming, you know, concepts that are being researched like at the UW right now, or, or other?

Yeah, uw, um, has been a part of the MAPS research program. So MAPS is the multidisciplinary Association for Psychedelic studies. Um, that's a great resource for folks who want to, you know, see a nice curated list of studies or books or, you know, want information. maps.org is a great website. Um, and they've been looking at M D M A for the treatment of p t s.

And one of the unique things about that research paradigm is they actually chose to try to work with folks with the most severe forms of PTSDs, including folks who have active suicidal ideation, which often in a clinical trial that might be a, you know, something that they might be less interested in bringing people in and they would said, Hey, let's try to help the people in most in.

You start thinking about veterans first responders, you know, and part of I think, why that push was so successful to get those things approved, those studies approved is because as you know, there's, there's not a lot of great treatments for, for chronic P T S D available or, you know, or things that can provide.

um, in less than years of therapy, right? Mm-hmm. , mm-hmm. . So they provide relief more rapidly. And so maps, right now, they just completed their phase three trial and phase three. So there's kind of three phases of FDA research. The first phase is a really tiny, you know, s you know, small group of people, maybe at a few different sites.

Just really looking at safety feasibility. making sure that the compounds are safe to give. Sometimes that'll be with healthy volunteers and sometimes that'll be with folks with a particular condition. Phase two is kind of expanding that to see if it can work with P T S D, and so maps their results in phase two show that, um, M D M A assisted psychotherapy is effective in treating P A T S D and it looks like phase three confirmed.

So M Dmma may be the first FDA approved psychedelic, um, a aside from Ketamine, uh, probably within the next couple years I would think. Wow. Um, they're thinking maybe even this year it could get approved for PTSD treatment. So that's really exciting. That is so amazing. Yeah, it really is. We're part of, got to be a part of those studies.

I missed that just a little bit. We were in recruitment, um, and uh, they closed the study right before I could get, get a participant on that study. But, um, so that's really exciting. Um, and then at uw we're also right now actively recruiting for two studies with psilocybin. So our lab really focuses on the treatment of trauma and.

Um, and so we are currently actively recruiting for a study looking at meth use disorder and um, opioid use disorder. Mm-hmm. . And so if for any clinicians or listeners out there who think that they may know of somebody or may feel they qualify for that study, I'd really encourage you to go to the protia website, which will be linked in.

Show notes here to, um, and you can get in touch with our coordinators, see if you might be eligible for that study. And that's an open label study. So everybody in that study, um, once enrolled, they would get the active psilocybin dose. Um, and that's a safety feasibility study to look at the potential for psilocybin in, in treating meth use disorder and opioid use disorder.

So it'd be like a phase one study. Wow. And, and you. Talking a bit about P T S D and trauma, and you know, what the three of us know, and I think a lot of our listeners either know or experiencing is, you know, the, the tracing current, um, diagnoses or issues to traumatic events in our past of various, um, magnitudes.

And, and so I'm just thinking as, as we're doing more and more trauma treatment, Having additional roots to explore and refer, um, just makes me feel like things are coming together at the right time. And, and, um, is that the thing you see most Travis is, is folks looking for, uh, treatment alternative treatments, psychedelic assisted therapy in particular for trauma?

Or, um, what are you seeing there for folks who are seek. This assistance, what are they presenting with in terms of like our outpatient clinic here? Right. Yeah, I would say, um, it's been a variety, you know, trauma, certainly treatment resistant depression, folks, uh, with anxiety. Um, folks who maybe have brain injuries or things where they're curious about the neuroplasticity side.

Um, and if that could kind of help with some of the side effects of those brain injuries. Um, so, so quite a range of, of, of folks are seeking out, uh, ketamine assisted therapy. Uh, it hasn't been really, I haven't noticed anything like, here's a theme like this is, this is the kind of presenting issue we see a lot of, um, Probably, I would say if I had to pick a number one thing, it would be kind of folks who've really tried to get help for depression, su chronic suicidality, and just haven't found that relief.

Hope, I would say in, in my caseload, I see, um, like debilitating anxiety, possibly due to P T S D, but also just really, you know, people struggling to function and, and you know, and also bipolar disorder and, and in those suppressive states. And, and I'm just so glad again that you're here. Talking about this and, and telling, you know, letting even more people know, because for me as a clinician, you know, if I have a client who says, like, Jess, do you think I should go to, you know, some southern country and, and go on this retreat?

I'm like, I, I don't know if you should go there and do that thing. I, I, you know, that is not like a source that to me is reputable or that I can consult with and provide ongoing care. But I do know people are desperate for more options, right. And more solutions. And so I'm just really grateful for, you know, you and, you know, the UW and Winding Path, even bringing it into, you know, a Dane County and a private outpatient setting.

And, uh, yeah. I mean, at least for me it's like, it's the debilitating symptoms that is, is, is really seeking that support, right. And. One of the really rewarding aspects of this work is to see folks who've had those debilitating years long struggles. And again, not everybody has a rapid response, but ketamine, one of its, I guess, prop, you know, one of the ways it works is sometimes really rapid relief, you know?

Um, and even that little bit of a break can be really powerful for people to see, okay, so this is what life could be. . Um, you know, and so with that becomes, you know, also that like the vigilance of providing that safe therapeutic contains, you know, sometimes as those symptoms come back, hopelessness kicks up.

And so that's why, you know, I encourage people, this is a part of a longer therapeutic process rather than a one and done kind of. Treatment. Mm-hmm. , you know, and, and that's why we've really leaned into the, the psychotherapy piece of it, um, is that it's, it's still kind of a, a can be a longer road for folks, but that, that that alternative is possible.

It is here and, you know, you don't have to go to Jamaica, um, or, or to, you know, somewhere where you don't know anybody. Mm-hmm. . Mm-hmm. . Yeah. And I'm not disparaging those, I don't know those programs, um, but. , but I share your, your thoughts of like, Ooh, it'd be nice to have someone more locally, or somebody I know personally, right.

To suggest. Mm-hmm. . Mm-hmm. . So I'm grateful for the opportunity to come here and talk about what we're offering too. Yeah. Yeah. It's, well let, I know I was curious, let's transition to that. You know, this something you offer in practice in outpatient care. You know, tell us more. What does. that look like, you know, how do, how do people, do they need a referral?

Are there certain fee? Like, what is the fee? What, what does the journey look like? If, if any of our listeners, a, any listeners are interested, but B, any therapists are saying mm-hmm. , okay, I wanna send, you know, someone to you. Like, is this a six week period? Is this ongoing care? You know, can, can you kind of tell us a little bit more?

Yeah, that's a great question. Um, so one of the ways to, to express interest in this treatment is, uh, to go to the Winding Path website and we've got an online consultation form that folks can fill out where they'd have a chance to say, Hey, I'm interested in Ketamine assisted psychotherapy. I'd like to try to work with Travis.

Um, and that's, that's our kind of like one stop. To, to get your name on our list. And then, um, one of us will reach out to the person and kind of set up an initial phone consult just to do a little of the psychoeducation piece. Some of the things like I've talked about today. We'll talk through that. I'll get, you know, just a little bit of information about their situation to see if it seems like, Hey, yeah, let's set up an appointment.

And so if, you know, if we agree to let, let's just start the process, uh, then folks would come in and, and we would start, you know, kind of a, a therapy relationship. Um, folks who have health insurance, we can actually, you know, utilize insurance for the, the preparation and, and the integration sessions, right, as part of the psychotherapy.

So I think that's often helpful for people. Uh, cost is of course a concern for everybody. Um, and you know, I would say we don't have like a fixed number of sessions. We need to meet with somebody before we would determine whether or not let's do a ketamine session. But our process is, you know, around 10 sessions of prep.

right. And then we'd also have a psychiatrist meet with the person and do a medical evaluation. Um, and so we are doing an assessment to determine whether, you know, goodness of fit, to make sure there's no, um, contraindications for this, this medicine work, right? So we're taking great care to try to make sure, um, that we do a thorough assessment with people both medically and psychiatrically.

So, we'll, I'll do a psychological assessment with someone. and then, um, if it seems like we want to continue to progress, that's when we start working on the preparation and really getting into the nuts and bolts of the ketamine experience. . Um, and then once we pick a time to do the dosing day, uh, that's, you know, a three hour session where you would have both the, the medical providers, so a psychiatrist and our staff, and then either myself or one of our other trained therapists, um, who the person has been working with will sit.

And it's usually about a three hour session. Um, here we use what's called a sublingual lo. . So there's several routes of administration for ketamine. We've talked a lot about IV already. Um, the other roots are, there's a nasal spray called s Ketamine, which is f d a, approved for, um, treatment resistant depression.

Um, that's a more expensive medication. Uh, it has, and there's fewer options for, uh, adjusting. . And so our psychiatrist will use what's called emmic Ketamine. It's basically a mere image of the molecule of s ketamine. They're just kind of mere images of each other. Um, emmic ketamine is the one that's been, um, approved as an analgesic, but uh, it's also the one that's being used off-label for treatment resistant depression, anxiety, treatment of trauma.

And so, um, our psychiatrists feel like they can really titrate the dose to try to work specifically with people on an individualized. . Right. So they can really titrate that easier with a lozenge with folks. Mm-hmm. . And they start with a conservative dose. People are still able to communicate with us if they choose to.

So they can either kind of go inward, um, and have their experience inward, but they can also report out things they're experiencing and we'll make sure to write those things down so they don't have to try to remember things. Um, and so there's that three hour session, so that session, unfortunately right now, insurance doesn't.

And so kind of a good baseline for thinking about that is that's $2,000 a session because you have two providers who are there with you for three hours, um, providing that really, you know, solid support. And then after that, then we would do at least a couple, you know, probably at least an integration session or two.

um, definitely offer like a phone support option in between sessions too, because it can be kind of destabilizing for people. Mm-hmm. . Mm-hmm. just want to make sure they feel supported after the process too, and at least doing scheduled phone check-ins and all of that. We kind of work out individually with each person kind of what level of support they might need and then we say, you know, see how that goes.

Do some integration and then look at maybe doing a second session right. . And sometimes then we can adjust the dose and maybe have a deeper experience depending on how they tolerate the first session. And so our psychiatrists are really great at working individually with people just to kind of, um, yeah, just making it really individualized care, you know?

Mm-hmm. , um, because people tolerate these medicines differently. Right. And so, and then the other root of administration I haven't mentioned yet is an intramuscular injection. And right now, that's not something that we. Um, not more reliably, you know, puts people in the psychedelic space. So, another thing, these are kind of heady terms, but there's like the psycholytic model, which is, you know, you're in a, you're in an altered state, but you can still, you can, you're still in contact with the world around you.

And then there's the deep psychedelic state where you're much more internal and maybe even disconnected from your body. , perhaps even feel as though you're elsewhere. And people can get into a psychedelic state using lozenges as well. Um, and that's where that dosing titration with the psychiatrist really plays a role.

Wow. And so, yeah, and again, I'm thinking. Who wouldn't want to have a therapeutic relationship with the people that are, um, with somebody that is guiding you or sitting with you through this versus a, uh, you know, a, a single injection or an episode in which you kind of do this by yourself. . Right, right.

Cause you, it's, it's very unpredictable what kind of experience a person will have, and then the same person can have different, very different experiences on the same dosage. It makes me think too, Travis, um, this is not. Microdosing, this is not people, uh, finding somebody to give or give them or finding ways to procure hallucinogenics and deciding that this is the thing that's going to help and going off and doing, doing them on their own.

So, you know, I wonder if you could speak to that a little bit and, and cuz I've had folks say, should I just take these, um, similar to Jess's, Right. That's when I shift into the harm reduction approach. Mm-hmm. and, and, and lean into more of that, that educational piece of talking about the importance of set and setting.

And so thinking about what mindset you're in before you take these substances. You know, Stan Grf is a really, uh, important researcher. He did a lot of L S D work, and then when they shut that down, Him and hi, uh, he, he, I think it was his, it's his wife who they developed holotropic breath work, which is, is a yes, a way to get through an altered state without taking a citizen.

So I also wanna say there's other ways to get into non-ordinary states in a therapeutic way that don't require taking one of these medicines. . And an advantage to that is if you get, if it gets too uncomfortable, you can just stop. Mm. Right. Just a nice advantage where with these medicines, it's kinda like once they're in, you kind of are in until the medicine works its way through your system.

Um, we're kind of coming back to your question. Yeah. Should I just take this, you know, I just talk with folks a lot about. Set and setting, who are you gonna do this with? What would be a safe space to do this? And just really focused on safety and reducing harm, you know, and thinking about dosages and maybe turning them on to some resources.

Like The Psychedelic Explorers Guide is a great book written by James Fatman that a lot of people will use to educate themselves in more detail about, you know, proper set and setting. . Um, and like, and I was saying Stan Graff, one of the things he said is psychedelics or non-specific amplifiers, right? So these amplify whatever's going on in your mind, Mm.

Whatever emotions you're having. And that's why we talk about the value of set and setting. And so mm-hmm. , it's like you got a plan to go, maybe have a mushroom journey with a, a friend that you really trust, but you just had a huge fight with your spouse. It might not be. , right? And so really talking with people, you know, talking through those pieces.

Um, and then you mentioned microdosing, you know, which a lot of people are really interested in, and I, I know there's some research groups that are starting to look at that and some random, I randomized controlled trials, uh, to see if, if it is effective. Um, James Fatman has written about this in his book that I mentioned, um, where he's done citizen research.

So it's a lot of anecdotal research right now. people feel like it does give some relief, um, from like depression, anxiety. And what a microdose is, is what we call sub perceptual dose. The idea there is you're taking such a small amount that you don't really notice it perceptually. Hmm. And so it's using it more like a medicine and there's protocols, you know, like how many days to take it and then take a break because.

Tolerance. There's a tolerance that builds up. Thank you. I was having a word finding issue there. Um, and some things to, to just put out there too, if you're taking an SSRI or some other SSRIs, a thing to be aware of with these classical hallucinogens as they work on the serotonin system. Hmm. So there's always the possibility of a serotonin syndrome that can happen if, which means, you know, basically you have too much serotonin going on in the brain.

So that's something to consider if somebody's in, you know, thinking about using one of these medicines. Um, and then another caution I like to put out there for microdosing is that, um, microdosing, so like psilocybin for example, works on the five H two, A serotonin receptor, but it also works on other receptors, one of which is the five H two B receptor, which, um, that binds in the.

And so there are heart conditions, um, that have something to do with the five H two B system. And so there's been no, there's nothing that I've seen that says, you know, microdosing will cause a valvular issue for you. Um, but it's a caution to be aware of, particularly for folks who already have heart conditions, to just really think through that maybe.

I'm not giving medical advice, I'm not qualified to do that. So maybe talking to a physician you feel comfortable with about that. Um, but from what I read, kind of in getting prepared to talk today too, that, um, if somebody's considering microdosing to think about doing it for shorter periods of time, you know, like, you know, the, the concern really goes up if you're microdosing, say for.

right? Where you're really doing this quite frequently, um, that's just an open-ended question. And so just to, you know, to have people just have all the information, make an informed choice. So that's one piece I would consider. Well, and that's what this is really all about today, is, um, information informed choices.

Um, And I think while we were talking about, um, treatment resistant depression and, and suicidality and, and P P T S D hope kept coming up for me, and, and I know you're similar in how you practice without a relationship and without hope and trust. We, we don't get where we ultimately wanted need to be. And, and that's something I'm really taking away from this today is all this wonderful information, but also just about how.

you and Winding Path look at, uh, treatment in a variety of ways. And, and I really appreciate how you've brought this all together for us today. Yeah. Well, I'm, yep, you're welcome. You know, and, and not only here at Winding Path. What I know in the research studies we do at UW as well, we take really seriously that aspect of this, that people are often coming in having tried a lot.

Yeah. And just there is a lot of hope that this can help. And we're aware too that there can also, on the other side of that come a lot of disappointment. And then potentially hopelessness too, which is why I think it's really important to have that relationship in case it doesn't quite go the way one hopes.

Mm-hmm. . Absolutely. Mm-hmm. so, well, you know, and I appreciate that even though you have your model, that you're using it Winding Path, that you're, you are letting us snowball all the options out there. You know, earlier when I expressed like, well, how wonderful that is to have. ability to have a therapeutic relationship.

You know, I have to kind of call myself out too on like my privilege of even saying, Wow. Because when you hear the, you know, the dollar amount and the time that people have to put into it, sometimes one of the best option is to go to a clinic and work with your P C P and, and, you know, this model isn't as accessible to everyone.

So, you know, I just appreciate you even as a researcher and you know, as a mental health professional, letting the listeners know while we're really excited. You know, the model with the three stages, that there are so many options for maybe all sorts of, you know, different people with different resources and different access issues, that this isn't just for one set of people.

You know that there are multiple options for people out there. Right. And I'm glad that you mentioned that because it's also something we're actively discussing thinking through is what are ways. that we can increase accessibility, you know? Yeah. Like uw at our lab prot, we're partnering with another lab where that is their primary focus is how to, um, not only recruit people from a dif different backgrounds, whether that be, you know, race sexual orientation to get folks who maybe traditionally show up to research study to diversify that we're working with, because again, If we can't generalize the results, then it's not as useful as we'd like.

And then in addition to that, there's a lot of recruitment efforts too, to even to recruit people of color as facilitators, as practitioners, and trying to help that side because it's a sacred space. You're entering with people and to really feel safe and seen is of the utmost importance. being a white male, I, it may not be me for everybody, right?

Yeah. And so we gotta justify who offers these services, these treatments, and to speak to the economic piece, that's at the forefront of my mind too, because when I hear $2,000, I go, uh, you know, I think it, I think it's worth it if you can afford it. At the same time, not everybody can. And so one of the things we're looking.

um, you know, there's like, I've been trained at Polaris in San Francisco and so one of the things they're doing is, um, group ketamine sessions where it's a cost share. And so that's something we've been here in the future as we kind of get. Get our own processes, you know, humming along. You know, could we offer something like that as a cost share, you know, um, what that might look like.

I've seen where we may do a dosing session together with the two providers sharing that cost. We're considering possibilities for, say, group preparation and group integration as well. Mm-hmm. . So it's the forefront of our mind too, to try to find out how do we make this more accessible? Yeah. That's wonderful.

That's wonderful. Thank you. Thank you for sharing that. Yeah. I appreciate you bringing that, bringing that up.

Well, this has been a wonderful conversation. I am just, again, so grateful for your time, Travis. Thank you. Oh, you're very welcome. And I, I was hoping to put in a, a shameless plug. Yeah. Not. I've already plugged Winding Path, and Tfw, and there's a new center, the Transdisciplinary Center for Psychoactive Substances.

I might have gotten that name wrong, but at uw and so, mm-hmm. , um, that will be in the show notes too, I think in particular for anybody who's interested in what's going on at uw. Um, and they do an annual symposium, it looks like in November, I believe. So for folks who want to learn more, keep your eye out for.

If you want to support the research at uw, there is an option to donate to the center. Um, and there's a variety. Uh, I'm on the, an advisory board for that, and we're in discussions about how to use those funds, whether that's scholarships for students of color or just, you know, honorariums to bring in speakers to really help educate our community, uh, as well as to fund some of the research.

So, I just wanted to put a plug there if you're interested. No, I love that plug. We'll, definitely that'll be all that information in the show notes because again, we want, you know, that's one of the missions of Insight MINDBODY talk is that we are a community resource. Mm-hmm. , and that our community can use us as a resource to connect.

Them to what they need. And the UW is a huge part of our community and they're doing, you all are doing amazing work over there and we wanna support you too. So thank you. Thank you appreciate it. Welcome. Thanks for being willing to, to support our community and this pa this podcast is a great way to do that.

We really enjoyed having you here. Thanks, Dr. Fox. Thank you. 

Thank you again for joining us on Insight Mind Body Talk, a body-centered mental health podcast. We hope today's episode was empowering and supported you in strengthening your mind-body connection.

We're your hosts, Jeanne and Jess. Please join us again as we continue to explore integrative approaches to wellbeing. Until then, take care.