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Science
Therapy — The psychedelic substance psilocybin can have a healing effect on people with psychiatric disorders. At the Copenhagen University Clinic for Psychedelic Research, they treat patients with therapy and a psilocybin trip, and the results are promising.
People became strange to look at.
They weren’t ugly, creepy, or unpleasant, just … strange. Distorted.
And they were tiny. Søren Malthe Pedersen had just taken a pill with the psychedelic substance psilocybin as part of a scientific experiment, and even though the people were sitting right next to him, it was as if they were suddenly very far away.
The little weird people asked Søren if he was okay, and he was. He was, also, when the plants in the room suddenly grew, and when his sense of time and place began to dissolve.
Now a boat came sailing through the room that had turned itself into a kind of parallel reality, where Søren was no longer himself, but neither was he someone else. He wanted to get on the boat, but he was denied entry every time he tried.
On the other hand, birds – or perhaps they were some kind of spirits – began to squeak at him. They wanted to lure him into a Street of Sin which had materialized in the transcendent space that he now found himself in. But Søren resisted the temptation.
And then he was allowed on board anyway, and here he got a boat trip that has changed his life today.
Søren Malthe-Pedersen was one of the first patients on the Quantum Trip Trial, a research project investigating the effect of psilocybin as a treatment for alcohol dependency in combination with therapy. He participated as a test subject in a course of treatment that stretched from October 2023 to the summer of 2024.
The project took place at the Copenhagen University Clinic for Psychedelic Research (NOESIS), which opened at the Department of Psychology in January 2023. The clinic currently has seven different research projects that in different ways examine how psychedelics work on the brain and whether they can be used in the treatment of psychiatric disorders.
NOESIS was founded and headed by associate professor in psychology Dea Siggaard Stenbæk. She gives the University Post a tour of the clinic in August, because we want to learn more about how the University of Copenhagen (UCPH) is involved in the blossoming scientific interest in the potential of psychedelics.
The interview takes place in the clinic’s so-called intervention room. This is where Søren Malte-Pedersen and the other patients go when they need to consume psilocybin and are guided through a trip by the clinic’s therapists.
The room has black-out curtains and a soundproof door. In the middle is a bed surrounded by speakers that play music during the trip.
The wall behind the bed is painted in a light, grey colour with beige-coloured mushrooms dancing around among each other. And in front of the bed is a wooden wall decoration with shapes in a multitude of circles, twists and bright colours.
»We have just hung it up there,« says Dea Siggard Stenbæk, and explains that many patients like to look at something visually fascinating when they’re under the influence of psilocybin.
There are always two therapists present during a session – a lead therapist and an assistant therapist. Their job is to support patients through the experience if they become overwhelmed or frightened while it happens.
And even though several of the patients receive psilocybin as part of a trial treatment of a psychiatric disorder such as depression or alcohol dependency, the researchers cannot steer the experience in a specific direction, according to Dea Siggaard Stenbæk.
»Some people will have a certain kind of control. They may have feelings or things popping up that they’d rather steer clear of. It can be compared to someone being able to control their dreams – lucid dreaming – but very few people can do that,« says the associate professor and adds: »Dreaming while you are awake is the best analogy to what happens when you take psilocybin. And here you just have to go with the flow.«
There are no strict rules for whether you want to talk or go inside yourself when taking the trip, even though the therapists do invite you to turn your attention inwards, says Dea Siggaard Stenbæk.
»Sometimes we can feel that people talk a lot, because the effects of the drug are right here …« she says, bringing both hands up behind her head.
»… like a giant wave building up. Then they talk because they may start feeling insecure and want to maintain a connection to reality. And in those situations, we support them to turn inward and try to indulge themselves in the effect.«
Research into psychedelics is now flourishing again after decades in which it was banned.
There were horror stories of experiments from the 60s and 70s in Copenhagen’s Frederiksberg Hospital basement, where people were injected with the psychedelic drug LSD and left strapped to beds.
The test subjects were rarely properly informed about the treatment to which they were subjected. In the cold basement they were left alone with hallucinations and delusions, and in many cases this caused severe trauma in the test subjects.
In 1974, the Danish healthcare system stopped using LSD to treat psychiatric disorders, and for several decades research into the use of psychedelics came to a standstill, says Dea
Siggaard Stenbæk.
But a 2006 study set off a new wave of interest in psilocybin. The study with the title ‘Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance’ showed that psilocybin provided subjects with an experience that could lead to sustained positive changes in attitudes and behaviour.
Interest in psilocybin research only really took off ten years later however, when a study from Imperial College London in 2016 indicated that psilocybin could be used to treat people with treatment-resistant depression.
Dreaming while you are awake is the best analogy to what happens when you take psilocybin. And here you just have to go with the flow
»In the study they had used psilocybin for treatment-resistant depressive patients. Their depression symptoms were rapidly reduced. This really kick-started the studies,« says Dea Siggaard Stenbæk, who has been researching psychedelics now for eight or nine years and has been part of the wave from the beginning.
In addition to the research project on alcohol dependency, the clinic is currently running two research projects on healthy subjects: One of them examines how LSD works in the brain – it is the first study of its kind in Northern Europe in the last 50 years. The second examines how music influences the effects of psilocybin.
In addition, the clinic has a project with depressive patients and is part of three international projects, which include examining how psilocybin can treat psychological or existential disorders in patients who have been declared terminally ill.
Does it work? I ask.
»It would be unscientific to conclude anything yet, but there is nothing in our studies that indicates otherwise,« says Dea Siggaard Stenbæk, who after many years in the field sees enormous treatment potential in using psychedelics.
Psilocybin occurs naturally in certain mushrooms, for example, psilocybe semilanceata or liberty cap, popularly known as magic mushrooms. The substance given at the clinic is laboratory-produced however.
But why is it precisely the substance psilocybin that has become the focal point of psychedelic research? Why not LSD?
»LSD and psilocybin work much the same way in the brain, but the difference is that whereas a psilocybin trip lasts five to eight hours, an LSD trip can last up to 20 hours. And it can be very tiring for patients to be affected for so long,« says Dea Siggaard Stenbæk, who adds that they do not exclude LSD from future treatments, which is why the clinic is also in the process of mapping out how exactly the drug works in the brain.
»In addition, LSD can bounce up and down in a completely different way, so the effect fluctuates in strength,« says Dea Siggaard Stenbæk.
When describing how a trip on psilocybin works, she compares it to the three phases of travelling by air: In the first phase, the plane takes off, the effects increase, and you may become overwhelmed and nauseous, until the effects level off to where they can flow naturally. In the second phase, the aircraft has found a fixed altitude, and the effects blossom out. In the third phase, the flight altitude is lowered and the effects gradually begin to reduce. At this stage, you will typically gain more control over the experience.
»In the last phase, patients can typically work more actively with their experience, because in this phase you can better choose which direction to go.«
Physically, the drug intervenes and affects the brain’s serotonin system – a system that is often associated with well-being and happiness, and which antidepressants often target.
The serotonin balance is a large and complex neurotransmission system with many receptors, and one receptor in particular, the serotonin 2a receptor, is significantly affected by psilocybin and is responsible for the psychedelic effects of the substance.
»The influence of precisely this receptor means that there are changes in the brain’s function. Normally, the brain is controlled in a kind of hierarchical order, but when you add a psychedelic drug like psilocybin or LSD, the hierarchy breaks down. You could say that the brain becomes more democratic,« says Dea Siggaard Stenbæk.
A »display of fireworks« emerges, in other words, where input from the sensory and visual areas in particular explodes, explains Dea Siggaard Stenbæk. And then something happens that may be crucial to the drug’s potential for treating psychiatric disorders:
The brain’s so-called default mode is significantly affected. This is the network in your brain that gives you the experience of being you: A person with an identity, a history and an emotional life.
»When this particular network is released, what we call ego dissolution or ego death occurs,« says Dea Siggaard Stenbæk.
The feeling of being the person you are is dissolved. And even though this may sound uncomfortable – and it can be, the researcher admits – it provides a unique opportunity to see things from new perspectives.
»Your person does not stand in the way of your experience. We have had subjects, for example, who have relived situations with people who have bullied them or things like that. And they have suddenly experienced a sense of forgiveness or reconciliation, because they were no longer fixated on their own perspective,« she says.
Often people cry when going through a session in the clinic. Tears pour out, and they touch their cheeks, feel the tears and are surprised that they are the ones who are crying, says Dea Siggaard Stenbæk.
»There isn’t a person who perceives ‘I’m crying.’ There is just crying,« she says.
»Physiologically speaking, it’s easier to overdose on coffee than on psilocybin,« Dea Siggaard Stenbæk responds when I ask if it can’t be dangerous.
She hastens to emphasize that therapists must be present who can take care of the person – also in the physical sense.
»While the session is ongoing, the therapists act as a kind of substitute person structure,« says Dea Siggaard Stenbæk.
There are people who take mushrooms completely privately. How is it different from a session here at the clinic?
»It’s important to say that there are substances that are physiologically dangerous and where you can die from an overdose – MDMA, for example,« says Dea Siggaard Stenbæk and adds:
»But the dangers of taking a drug like psilocybin are primarily psychological, and we certainly don’t recommend people to experiment with it at home.«
If you are not properly prepared for a psilocybin trip, anxiety and paranoia can take over the experience – you may experience a bad trip.
»When you’re in an experience where time and place don’t exist and you’re feeling good, you’re in paradise. If, on the other hand, you feel bad, you are in hell. And if people don’t know how the drugs work, they can be terrified when they, for example, start to experience ego dissolution. The fear will feel as if it is timeless, and it can be downright traumatic,« says Dea Siggaard Stenbæk.
Have you ever had patients who experienced a bad trip?
»No. We have seen feelings that are challenging, deep and sorrowful. But never a bad trip, where they suddenly become paranoid and think that everyone is after them.«
Dea Siggaard Stenbæk believes that psilocybin will one day be approved as a form of treatment for a number of psychiatric disorders. And it is therefore an important objective for the clinic to disseminate knowledge about the subject area through teaching. Dea Siggaard Stenbæk wants to be allowed to set up a continuing or specialty education programme in psilocybin therapy.
»We hope that at some point some pharmaceutical companies will get psilocybin products approved for treatment, and when that happens, we still need the infrastructure to actually be able to handle these types of treatments. This is a task that we hope that the clinic will be able to help with,« she says.
Assistant Professor Sophia Armand works at the clinic and is involved in several research projects. She also teaches a psilocybin-assisted psychotherapy course for master’s degree students, the only course currently offered to students in the field.
If people don't know how the drugs work, they can be terrified when they, for example, start to experience ego dissolution
The course is hugely popular, according to Sophia Armand.
»There is space for 30 students in the class, and it has been packed every time it has been offered. Last year, there was even a petition to set up another class,« she says.
On the course, the students are trained in preparing for a psychedelic experience, says Sophia Armand. She stresses that there are no real psychedelics in the teaching, as it would be illegal.
Mathias Ebbesen Jensen is a medical doctor and clinical researcher at the psychiatric unit in Copenhagen. He leads and runs the Quantum Trip Trial, which is the clinical project that has had most patients through it.
The project started in 2023 as a pilot project with ten participants, and the majority experienced a large and positive effect on their alcohol dependency from the treatment.
»All the participants went through a three-month course of therapy, they had a psilocybin session, and then we followed them three months later. In seven out of ten participants, we saw a clear effect on how much [alchohol, ed.] they drank after the course compared to before,« says Mathias Ebbesen Jensen.
»The first week after the psilocybin session, participants typically stopped drinking altogether. And over time, they found that they had gained a whole new control over their alcohol intake. We have just done an annual follow-up with them, and six out of ten still find that they have better control over their alcohol consumption,« says Mathias Ebbesen Jensen.
The project is now in its second phase, with 90 participants with severe alcohol dependency going through the same course. So far, approximately 40 percent of the 90 participants have been through the process.
I ask if it seems a bit counterintuitive to give a psychedelic drug to people who abuse another drug — a question that Mathias Ebbesen Jensen says he often gets.
»We work with psychoactive substances, and you have to respect them. Some of them are addictive, for example, cannabis, cocaine, MDMA and amphetamines. But this does not seem to be the case with psychedelics like psilocybin and LSD,« says Mathias Ebbesen Jensen, and continues:
»Our hypothesis is that psilocybin can introduce a transformative or transcending perspective to your life. People describe it in many different ways — as a mystical or spiritual experience where you feel very strongly connected to something greater than yourself.«
The psilocybin can introduce a transformative or transcending perspective on your life
The participants in the alcohol project are screened thoroughly as they need to meet a number of requirements. They must not, for example, have previously had a psychosis. Their heart function must be normal, and they must not be on antidepressant medication, because this can reduce the psychedelic effect, according to Mathias Ebbesen Jensen.
»It is not grounds for exclusion in itself that you are psychologically vulnerable. But we don’t want to risk bringing in patients who may have a predisposed low threshold for psychosis, or who have had serious suicidal thoughts,« he says.
The participants in the second phase of the project undergo the same course of treatment as in the pilot project, but a significant difference is that in this phase there is also a placebo control group. Half of the participants get a placebo instead of a pill with psilocybin.
The study is difficult to placebo control because the patients quickly discover whether they have received either one or the other. But it is important if you are to conclude whether it is the therapy or the psilocybin that makes the biggest difference, according to Mathias Ebbesen Jensen.
If we assume that it is the psilocybin that is key, what is it that happens during the trip that makes them drink less afterwards?
»You have to nearly ask all of them, because it’s so individual. You can generally say that they get the opportunity to detach themselves from themselves and see their actions from different perspectives,« says Mathias Ebbesen Jensen.
Many drink because they have an anxiety, or an uneasiness, that they don’t know how they otherwise should reduce. And without being able to explain exactly how, or why, many of the patients find that they can simply better cope with the difficult emotions without alcohol after the project.
But there are, of course, some where the treatment does not work, says Mathias Ebbesen Jensen.
»In our limited studies, there are a few participants who do not experience the desired effect. They get a good experience with the psilocybin and the therapy, but they just don’t take the last step and integrate it into a way to stop drinking,« says Mathias Ebbesen Jensen.
One of the participants who did succeed was Søren Malthe Pedersen. He cannot explain what happened inside him, but when the urge to drink turns up, the image of the boat appears again on his retina. He remembers how great it felt when he was finally offered a seat on board.
»The therapy was very important. I don’t think the trip would have been worth anything without the therapy,« says Søren Malthe Pedersen, who in conversations both before and after got help to connect the psychedelic experience to specific things in his life.
»It gave me a framework to analyze what the hell was really going on. Now I can see that the boat was a symbol of my family that I wanted to be a part of again. I wanted to be the old Søren that they could trust,« he says.
Søren Malthe Pedersen is »enormously grateful« to have been able to participate in the process. One year after and it still »makes it ten times easier« to control his alcohol intake.
»There are still times when I succumb to the urge. But not nearly as much as in the past. Now I can better say: No, stop for goodness sake, when the craving for alcohol hits me,« he says.
»I can’t explain what it is. But I an better able to think: This will pass. And then I can do something else instead. Go for a walk, play the guitar. When we finished the course of treatment, I remember Mathias saying to me: Your eyes have got a completely different life in them, Søren. And I really have.«