A pair of unassuming Australian psychedelic researchers are proposing a radical paradigm shift to the way psychotherapy is conducted. The pair have developed a unique protocol for incorporating virtual reality into the still experimental mode of psychedelic-assisted psychotherapy, and it promises to shatter 20th century ideas of therapy. Psychedelic-assisted psychotherapy is still a deeply experimental concept.
While MDMA-therapy for PTSD has advanced to late-stage clinical trials and looming FDA authorization, other more classical psychedelics such as psilocybin and LSD are still in relatively early stages of research. Agnieszka Sekula and Prash Puspanathan founded Enosis Therapeutics to explore ways of integrating virtual reality into psychedelic therapy.
Underpinning the pair’s philosophy behind Enosis is the idea virtual reality technology can help people connect more directly with the visceral nature of a psychedelic experience. The psychedelic experience, according to Prash, is an embodied and emotional experience. Yet modern psychotherapy frameworks often work within protocols of cognitive therapy. It’s this chasm between the ineffable nature of a psychedelic experience and the pragmatic, analytical structure of talk therapy that Enosis is trying bridge.
“Anything that we can do to return things back to being more emotional, more embodied, or anchored to the true tenets of that [psychedelic] experience would be incredibly beneficial towards sustaining those insights,” Prash said to New Atlas.
Most current psychedelic psychotherapy follows a conventional structure involving a few preparatory therapy visits, before one or more active drug sessions, which are then followed up with a handful of therapy sessions designed to help patients integrate the insights gained from their psychedelic experiences. A complete psychedelic-assisted psychotherapy protocol can span anywhere from eight to 12 weeks.
The protocol proposed by Enosis is both simple and radical. Agnieszka and Prash envision virtual reality being used across all stages of psychedelic therapy, serving as a kind of adjunct to help patients stay connected to those deeply resonant altered state experiences as the weeks and months pass.
“The way we are working is injecting VR in a targeted manner in different parts of therapy,” Agnieszka explained. “We’re using it for the entire process, from preparation for dosing, to integration, in every session if possible. In a way that maintains a cohesion of treatment so there’s an environment that you keep returning back to that helps with the transition between therapeutic space.”
Enosis proposes a number of different VR scenarios deployed at different stages of the therapeutic process. Early on, before any drug experiences, there are preparatory sessions designed to help acquaint patients with the VR space and frame certain intentions for the future psychedelic sessions.
Perhaps the most conventional part of the Enosis VR protocol is a kind of meditative 15-to-20-minute scenario dubbed "SurrenderVR," designed to be played on a dose day, soon after a patient has consumed their psychedelic. The goal of this VR engagement is to help reduce a patient’s anxieties while they wait for the drug to take effect.
Both Agnieszka and Prash are very keen to stress VR is not used at all during the active psychedelic drug experience. This is not about tripping within a VR environment, so the introductory dose-day scenario is short and finishes at the point where a psychedelic experience is likely coming on.
The more interesting part of the Enosis protocol comes at the end of the psychedelic experience. At some point, four or five hours after taking the drug, another VR scenario is engaged. This one is dubbed “AnchoringVR,” and involves placing the patient into a calm beachside VR environment.
The patient is presented with a series of floating jewels. As each jewel is held the patient is prompted to describe an insight they garnered from the preceding psychedelic experience. Their own words are recorded and then attached to the jewels. The patients can record as many insights as they see fit, each connecting to a unique shape in this virtual beach environment.
When the patient returns to meet their therapist in the days and weeks after the psychedelic drug experience they re-enter that beach VR scenario. Every time a jewel-connected insight is touched they hear their own voice recounting how they felt in the moments immediately following the psychedelic experience.
Across multiple follow-up therapy sessions these insights begin to connect with each other in the VR scenario, creating a kind of three-dimensional visual map filled with interconnected ideas. Sometimes those ideas take the form of seeds, planted on the beach, and growing larger from session to session, other times disparate insights can join together to form larger clouds of realization.
This VR-driven mode of therapy feels unconventional, futuristic, and strangely apt in its relationship with a family of psychedelic drugs that are themselves known for destroying preconceived notions. It's certainly a fun, interesting and unusual way of framing a psychotherapy experience, but does it actually help improve therapeutic outcomes or is it merely a shiny tech-gimmick?
Establishing the clinical efficacy of this kind of VR-assisted protocol will be a challenge considering psychedelic therapy itself is still in preclinical stages. But Agnieszka and Prash are certainly doing their best to try, with clinical trials in the pipeline.
The first real-world testing for the tech took place recently in the Netherlands. In collaboration with Swinburne University and the Psychedelic Society Belgium the Enosis VR system was trialed with four volunteers as part of a two-day psychedelic retreat.
Two main measures were investigated in this preliminary study, whether pre-session anxiety could be reduced using the early VR scenarios, and whether the post-session anchoring scenarios increased recall of psychedelic insights the following day.
The data has yet to be published in a peer-reviewed journal, however, according to Agnieszka and Prash these early tests were incredibly promising. Qualitatively and quantitatively the emotional state of the psychedelic experience could be measurably rekindled during the later integrative session with the VR scenarios.
“There were more memories than I thought,” reported one participant in this preliminary study. “I thought I didn’t need to start to record this but then I actually said more than I remember.”
Building on those findings Enosis is planning to commence a more robust clinical trial next year. That will directly face off the VR psychedelic therapy protocol against a more traditional psychedelic therapy protocol.
To be conducted in healthy volunteers and using the traditional psychedelic therapy framework as control, the trial will compare the effects of VR on reducing pre-session anxiety and more rigorously measure how well VR anchors the psychedelic experience and helps subjects reconnect with those insights in the following therapy sessions.
Ultimately, what Agnieszka and Prash are proposing is a relatively radical re-imagining of how psychotherapy can incorporate psychedelics in the 21st century. If, as researcher Rick Doblin envisions, there could be thousands of psychedelic therapy clinics around the world within the next decade, then Enosis sees no reason why VR can’t be one new tool amongst many designed to increase the benefits of this treatment.
Underpinning all of this talk around VR and psychedelic therapy is the idea that psychedelics are maybe not that well suited to our current medical models. So at its core the goal of using VR as an adjunct to psychedelic therapy is more about getting closer to a clinical framework better suited to the intrinsic effects of psychedelics.
Prash frankly points out it’s probably not ideal to try and jam psychedelics into whitewashed clinical spaces. Taking these substances in more natural outdoor environments would be a much better model, he suggests.
“While that would be optimal, that’s not scalable,” Prash said. “We understand that the Trojan horse to getting this into the mainstream is for it to be fit into the medical model, however, we recognize that that model isn't optimal. So what can we do to approximate the unfortunate necessity of the one that we need to fit into, into something that is perhaps more closely related to what will be an optimal model? These are some of the tools that we can we can use to help us get there.”
While the first iteration of psychedelic psychotherapy has yet to reach mainstream clinics, researchers like Agnieszka and Prash are already trying to envision ways of making it work better. It's a little like psychedelic therapy version 2.0.