By Mark Bates | Psychology Today | Nov 16, 2023
Published by the Modern Medicine Group
KEY POINTS
- With an average of 16.8 veteran suicides per day, veteran mental health is in crisis.
- Psychedelic-assisted therapy promises several advantages over traditional therapy for treating veterans.
- Safe and effective psychedelic therapy needs to be supported by trained, trauma-informed therapists.
- Collective effort is needed to reduce barriers to treatment and make it accessible to all who may benefit.
As a former U.S. military pilot and, later, military psychologist, I have witnessed first-hand the mental health crisis amongst veterans. Last year, the U.S. Department of Veterans Affairs reported that in 2020 there were a staggering 6,146 veteran suicide deaths—an average of 16.8 per day—with suicide being the second leading cause of death among veterans under 45.[1] This alarming reality highlights the urgent need for innovative approaches to veteran mental health treatment. It was during my nine-year tenure overseeing resilience and suicide prevention programs at the Department of Defense Psychological Health Center of Excellence that I first encountered the growing and compelling research supporting psychedelic-assisted therapy.
Understanding psychedelic-assisted therapy
Psychedelic-assisted therapy combines therapy with the administration of psychedelic substances, particularly psilocybin and MDMA, for the treatment of various mental health conditions, including PTSD, which is of particular relevance to veterans. It is the subject of a fast-growing field of research, with a number of studies underway. The Multidisciplinary Association for Psychedelic Studies (MAPS) has completed two Phase 3 studies on the treatment of moderate to severe PTSD with MDMA-assisted therapy and is expected to file for FDA approval next year.[2]
In addition to symptom reduction, psychedelic-assisted therapy offers potential advantages over traditional therapy for the treatment of veterans. In particular, it incorporates a holistic approach to participant outcomes, which involves fostering an improved connection to, and meaning in, life—an important issue faced by those readjusting to civilian living.
Psychedelic-assisted therapy for veterans
There is a wide range of veteran interest in healing with psychedelics. Many veterans have come forward in news stories and podcasts describing their unique healing experiences with psychedelic-assisted therapy after first trying many other therapeutic modalities. There are also numerous veteran advocacy groups working hard to ensure that psychedelic-assisted therapy can be studied and adequately researched. The Breakthrough Therapies Act is a bipartisan bill that would streamline the approval process for psychedelic-assisted therapy, and the Veterans Administration is participating in multiple psychedelic-assisted therapy trials.
Psychedelic-assisted therapy also fits well within the veteran culture. The self-directed nature of psychedelic-assisted therapy, as well as preparation and empowerment of participants to “go inside” and explore their own inner terrain, aligns well with veteran practices of mission preparation and self-reliance. Likewise, a medication that is taken only one to three times, compared with standard prescriptions, aligns with general wariness surrounding medication dependency amongst veterans.
The Veterans Administration is also studying group administration of psychedelic-assisted therapy. A four-member “fire team” consisting of service members who deployed together and fought together may find synergy and traction in healing together. By making such alignments clear, therapists can connect veteran culture and language to therapy sessions in a way that leans into the familiarity and shared points of reference—thereby building a comfortable and trusting treatment environment.
There are compelling reasons to leverage group treatment and peer support models, given the collectivistic and service-centered orientation of many veterans. Two common and important holistic outcomes of psychedelic therapy are a sense of restored connection both within a person and with others, which goes beyond symptom reduction. These outcomes are especially valuable for the internal connection, often in the form of a renewed sense of meaning and purpose in living.
Barriers to safe and effective treatment
As an emerging field of treatment, psychedelic-assisted therapy faces barriers to becoming an accessible option beyond the regulatory step of receiving FDA approval. First, amongst a participant population in which trauma is an occupational hazard, it is critical that therapists are properly trained in key issues such as military-specific trauma and moral injury. Moral injury refers to a multifaceted trauma response arising from being perpetrator, party, or witness to behaviors that go against one’s own values or ethical beliefs. In the context of military service, this might include veterans who were participants in the use of deadly force, who were unable to provide adequate military or medical aid, or who followed orders for which they now doubt the justification. MDMA’s profound empathogenic qualities enable people to compassionately connect with themselves and others, which is fundamental to forgiveness and moving forward. Because the development of the therapeutic relationship is both sacrosanct and paramount, therapists must be highly trauma-informed and trauma-sensitive. Moreover, therapists must be adequately informed to integrate the significance of a variety of military-specific factors, including the fog and friction of war, law of armed conflict, ambiguity, split-second decision-making, chain of command, military customs and courtesies and many other culture-specific elements.
A further barrier is the high burden of proof facing psychedelic-assisted therapy to combat natural and expected institutional skepticism and stigmatization of psychedelics within a military context. Given the association of psychedelics with recreational use, extensive clinical evidence from highly rigorous trials will be needed for broad access to treatment.
Considerations must also be made for the important social contexts surrounding the trials of psychedelic-assisted therapy, such as who is included in therapy. For instance, just as veterans themselves experience social and civil dysregulation as they re-enter life after the military, so do their peers and family members, and their inclusion is often overlooked in treatment.
In particular, peer support groups provide veterans with important networks of care and socialization, while reconnecting them with team-oriented camaraderie. Ensuring that veterans have a healthy environment to return to, and the capacity to connect and re-integrate into that environment, is a crucial part of after-duty care—and only by integrating families and peers into treatment can this be effectively reinforced.
Collective effort and more research needed
Despite the challenges, psychedelic-assisted therapy holds much promise in addressing trauma recovery, treatment-resistant depression, and suicide-prevention in veterans. As we continue to build our research and understanding, the government, military, experts in psychedelic-assisted therapy and its delivery, and the broader mental health community must join forces and work synergistically in unlocking the potential of this treatment as a lifeline to those who have sacrificed so much for the nation.
Mark Bates is a clinical psychologist at Sunstone Therapies who provides psychedelic-assisted therapy with a focus on whole-person healing. He has led the Department of Defense’s mission for over nine years, co-authored the first DoD policy on holistic health and fitness, and supports and works with veterans and their family members. Bates is also interested in how people in dyads and groups can support each other in healing. Bates received his clinical psychology degree from the military’s medical school and completed the Center for Psychedelic Therapies and Research certificate program at the California Institute of Integral Studies. He has also received training in multiple psychedelic-assisted psychotherapies and participated in ethnobotany studies in Ecuador and Brazil.
References
[1] (2022) 2022 National Veteran Suicide Prevention Annual Report. Available at: https://www.mentalhealth.va.gov/docs/data-sheets/2022/2022-National-Vet… (Accessed: 02 October 2023).
[2] Mitchell, J.M. et al. (2023) ‘MDMA-assisted therapy for moderate to severe PTSD: A randomized, placebo-controlled phase 3 trial’, Nature Medicine [Preprint]. doi:10.1038/s41591-023-02565-4; Mithoefer, M.C. et al. (2018) ‘3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: A randomised, double-blind, dose-response, phase 2 clinical trial’, The Lancet Psychiatry, 5(6), pp. 486–497. doi:10.1016/s2215-0366(18)30135-4.
