..Tänkte att de kunde utgöra underlag för diskussion/reflektion kring vad vi anser nödvändigt/användbart vid ibogainpsykolys.
Nu råkar det iofs handla om PTSD och inte missbruk, men det verkar vara väldigt liknande metodik.
Först: VAD är PTSD?:
PTSD: Background and Significance of Expected Results
Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder arising after a personally threatening life-event. PTSD severely reduces quality of life and may directly or indirectly lead to or exacerbate other psychiatric and medical problems. The DSM IV (APA 1994) criteria for PTSD include:
A. Exposure to a significant traumatic event accompanied by an intense acute emotional response.
B. Persistent reexperiencing of the event or aspects of the experience.
C. Persistent avoidance of stimuli associated with the event, and/or withdrawal from some aspects of life.
D. Persistent symptoms of increased arousal.
E. The above symptoms must last for more than one month for Acute PTSD and more than three months for Chronic PTSD.
In the National Comorbidity Study, the median time to remission for PTSD was 36 months with treatment and 64 months without treatment. In either subgroup, more than one-third of the patients still had symptoms several times per week after 10 years (Kessler et al., 1995).
Generally, the number of people who do not improve after treatment can be high, between 40% and 60%. In a 2002 comparison of two types of psychotherapy for women with PTSD after sexual assault, 47% of each treatment group still were diagnosed with PTSD with high enough CAPS scores (Resick et al. 2002) and another study by Foa et al. (1999) reported similar figures.
PTSD severely reduces quality of life and may directly or indirectly lead to or exacerbate other psychiatric and medical problems. Cultural and language barriers make psychotherapeutic treatment of traumatized migrants even more difficult. PTSD is clearly a public health problem that causes a great deal of suffering and accounts for a significant portion of health care costs. The search for novel and more effective treatments is therefore of major public health and econonomic significance.
Sen följer de mer intressanta bitarna..
Nature of MDMA-assisted Psychotherapy
MDMA-assisted psychotherapy consists of the following phases and therapeutic elements described in detail in the treatment manual for MDMA-assisted psychotherapy in patients with PTSD (Ruse et al. 2005, unpublished).
The manual bases on principles and procedures similar to those developed by Stanislav Grof, MD for LSD psychotherapy (Grof, 1980, pp. 123 -147) and for Holotropic Breathwork (Grof, 2000: pp. 178-183) and adapted for MDMA-assisted psychotherapy by Metzner and by Greer and Tolbert (Metzner and Adamson 2001; Greer & Tolbert 1998).
Phase 1 : Establishing therapeutic alliance, gathering of information, patient orientation and creating a safe psychological and physical space:
Two introductory 90 minute sessions will be used to establish a positive therapeutic alliance and to create an atmosphere and a space of complete safety and trust permitting the patient to let the MDMAexperience unfold and to confront himself or herself with the traumatic experiences that are the basis of his or her PTSD. Information about the traumatic experiences, previous treatments, previous use of drugs and psychedelics, expectations, motivations, fears and concerns about the MDMA sessions are gathered to get as much relevant information as possible in order to create a sufficient unde rstanding of the patient and his problems. The patient is informed about the setting, how the MDMA-assisted sessions proceed, how psychological difficulties are dealt with, how the participant will be supported and what safety measures will be provided. Goals and intentions for the session are discussed.
Phase 2 : MDMA-Sessions:
Before ingestion of the MDMA the goals, intentions and concerns are reviewed. The participant is reminded of the effects of MDMA which include enhanced positive mood, changed thoughts of meaning, increased access to distressing thoughts and memories, reduced anxiety, reduced self-blame and judgement, as well as increased feelings of closeness to others.
Onset of MDMA-effects is after 30 to 60 minutes after ingestion.
The main psychotherapeutic effective elements induced by MDMA are:
prolonged spontaneous reliving of and confrontation with traumatic memories and emotions; cognitive restructuring, processing of difficult emotions, release of tension and somatic symptoms, increased awareness of past and present positive experiences, new perspectives and changes of meaning. The therapeutic approach is non directive, following and encouraging the MDMA-induced process.
Discussions between therapist and participant are only intermittent. The therapists may employ other techniques, including focused body work and anxiety management techniques. Focused body work employs nurturing touch (hand-holding or hugging) and touch aimed at intensifying and thereby releasing body tension and pain by giving resistance for the participant to push against. Focused body work is always performed with explicit consent from the participant and respecting boundaries and vulnerabilities of the patients. Transference is not a main focus and is addressed openly in early stages if necessary. Subsequent MDMA-assisted sessions lead to deeper emotional experiences, building on the experiences and results from the previous sessions.
Phase 3 : Follow -up and Integration Sessions:
A 90-minute non-drug follow-up talk session the day after the MDMA experience and 2-4 sessions one week apart ensure the understanding, acceptance and integration of the insights and experiences from the MDMA-sessions. Goals and intentions are evaluated and reconsidered for the following MDMA sessions. The MDMA-induced shift of self- and other related cognition and emotion helps the patient gain a new perspective and meaning of his symptoms and life with a new sense of safety and control. Expressive techniques such as writing or drawing are encouraged. Therapist also encourage the transfer of states of acceptance, feelings of intimacy, closeness and reduced fear experienced on MDMA sessions to emotionally threatening everyday situations. Therapist attitude is supportive, validating the MDMA experience and facilitating understanding and emotional clearing. Therapists are accessible any time the participant needs support outside the scheduled integration sessions.
Details of MDMA-assisted Experimental Sessions
The protocols will be exactly the same for each experimental session. All treatment sessions will begin at 10:00 AM and will take place at the office of Dr. Oehen in Biberist, Switzerland. There will be sufficient equipment for assessing blood pressure, pulse and body temperature, and for dealing with potential adverse events, such as hypertension. In case of a hypertensive crisis the next hospital with emergency room and ICU is 5 minutes away from the office (Bürgerspital Solothurn).
Ambient temperature will be kept comfortably cool to decrease the likelihood of hyperthermia. Participants will have had nothing by mouth except alcohol-free liquids since 12 AM on the evening before each experimental session. They will be asked to arrive at 9:00 AM for collection of a urine specimen for drug screening and, for females, a pregnancy test.
These results must be negative for the subject to continue in the study.
At the beginning of the session, the therapists will discuss with the participant his or her intentions for the session, including intentions regarding working with psychological issues related to their PTSD. Participants will complete the SUD just prior to initial dose administration (25 mg for Low Dose participants and 125 mg for Fully Active Dose participants). After the session begins, participants will lie or recline in a comfortable position with eyes closed or wearing eyeshades if preferred. They will listen to a program of music designed to support their experience by initially aiding relaxation and later evoking and supporting deep emotions and the emergence of unconscious material (Bonny and Savary 1990; Grof 2000: pp.186 -191; Grof 1980; Unkefer 1990).
After the first hour, if the participant has not spoken spontaneously, the therapist- investigators will check in with him/her about the nature of the experience. For the rest of the experience, as appropriate, the therapist investigators will support and encourage the participant in emotional processing and resolution of whatever psychological material is emerging. The therapist-investigators will also encourage periods of time in which the participant remains silent with eyes closed and with attention focused inward in order to allow for the further unfolding of their i nner experience. Electrolyte containing fluids will be available ad lib throughout the session within the limits described under "Monitoring for Toxicity."
Food will be available during the latter part of the session.
Blood pressure, pulse and temperature will be measured according to Table 3.The exact timing will be at the discretion of the therapists so that testing will not interfere unnecessarily with the therapeutic process.
Table 3. Schedule of Procedures and Measures for Experimental Sessions
TIME Procedure or Action
09:00 Urine drug screen and pregnancy test. Participant acclimated to environment
09:45 Baseline BP, Pulse, Temp, Subjective Units of Distress Rating (SUDS)
09:55 2nd Baseline BP, Pulse, SUDS
10:00 Drug Administration, begin audiotaping
10:30 BP, Pulse.
11:00 BP, Pulse, Temp, SUDS
11:30 BP, Pulse
12:00 BP, Pulse, Temp
12:30 BP, Pulse, SUDS
13:00 BP, Pulse, Temp
13:30 BP, Pulse,
14:00 BP, Pulse, Temp, SUDS
Every hour, and as needed BP, Pulse,
Every 60-90 minutes SUDS, Temp
Approximately 2.5 hours later, the therapist-investigators will offer the participant the supplemental dose of MDMA. They will only do so if, in their judgment, the participant does not show any signs or symptoms suggesting that an additional dose of MDMA could produce a serious adverse event. If the participant agrees to take the supplemental dose, then it will be administered with 250 to 300 mL electrolyte-containing beverage. All experimental sessions will be audiotaped in their entirety.
Sessions will last from six to eight hours, depending on when the participant feels that he or she has arrived at a point of completeness with the process and on dependent the therapists' determination of the mental and physical state of the participant. Participants will receive a copy of the experimental session recording as soon as one is available.
After approximately eight hours, if all medical parameters are acceptable and the subject is alert, ambulatory and emotionally stable, the session will end. During the last 30 - 60 minutes of the session a designated support person (a spouse, partner, relative or friend) may join in this meeting. After the researchers leave (when they have judged the participant to be emotionally and medically stable), the participant will spend the rest of the evening and night at Dr.Oehen’s office where the MDMAassisted therapy session will take place. The office is located right next to the house of Dr. Oehen. He will check on the participant before he leaves for the night. He is available on all times during the night following the experimental session if requested to do so by the participant or the designated support person. He will evaluate whether the participant is in need of any further medical intervention and will assist the participant in coping with increased psychological distress if necessary. Throughout the study, Dr. Oehen will remain available to participants via 24-hour cellular phone.
Participants will be encouraged to use much of the time for rest and for a period of reflection and integration in a quiet atmosphere. The participant may request that their designated support person, described above remain with them during the night, pending approval from Dr. Oehen after he has met this support person and has discussed the possible advantages and pitfalls with the study subject.
Details of Non-Drug Psychotherapy 24 Hours Post-Experimental Session
The scheduled sixty to ninety-minute therapy session will take place in the morning after the experimental session. After this psychotherapy session, a person previously selected by the subject will provide a ride home. If the participant is unable to locate an individual willing or able to take him or her home, or if the designated person is unable to assist the participant due to unforeseen events, the investigators will assist the participant in finding an alternative means of returning home.
The therapist-investigators and the participant will discuss the experimental session and any material that arose during the session and will seek to integrate this material. The therapist-investigators will assist the participant in addressing any residual psychological distress he or she is experiencing. The participant and both investigators will complete measures of their beliefs concerning the participant’s condition assignment. The non-drug psychotherapy session can also serve as an opportunity for the therapist-investigators to gather information about the effects of MDMA on the participant in an unstructured manner.
Starting on the day of the non-drug psychotherapy session following each experimental session, one of the investigators will contact the participant via telephone on a daily basis for one week. The investigators will use clinical judgment to assess the participant’s psychological well-being during this period of time. If there are any indications of continuing anxiety or distress, the investigators may arrange to work on reducing the distress at a specially scheduled non-drug therapy session, through continuing contact, or at the next regularly scheduled non-drug therapy session. The participant may also initiate contact with the investigators at any time throughout the study.
Följer upp med lite kommentarer så småningom... hinner inte idag.
men... psykolytisk terapi fungerar med MDMA och t.ex. psilocybin... men Ibogain ? Är det praktiskt möjligt? Effekten av Ibogain tycker jag verkar så otroligt annorlunda mot de klassiska psykedelierna och MDMA så det går nog inte att direkt använda metoder utvecklade för de senare substanserna. Om du har tagit ibogain så förstår du nog.... men jag kan ju ha fel. Frågan är i så fall hur metoden kan modifieras för att passa IBOGAIN?
Ibogainbehandlingen är ju annars ganska välutvecklad verkar det som. Kanske man kan / bör införa mer "psykoterapi" före och efter behandlingen som komplement och för att effektivare bearbeta upplevelserna?
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