Research into the therapeutic potential of psychedelic (serotonergic) substances is experiencing a resurgence after lying dormant in North America for more than 50 years. Early research suggests these once-vilified substances show great promise in treating depression, anxiety, alcohol addiction, and potentially many other challenging conditions. This emerging area is ripe for the use of dreamwork techniques to help with the integration of psychedelic visionary experiences that have much in common with dreams.
Psychedelic visions and dreams: Vehicles for attenuating fear memories
From a neurobiological perspective, dreams and psychedelic visions (PVs) share similar forms of perception, mental imagery, fear memory extinction, emotional activation and distorted senses of self and body. This is according to a comprehensive review of the literature on the neurophenomenology of both dreams and psychedelic experiences (Kraehenmann, 2017). A major difference the author noted is that there is greater clarity of consciousness and meta-cognition in PVs, suggesting these experiences are closer to lucid dreaming (the ability to become aware of the dream state while still in it).
One of the areas of overlap that has significant therapeutic potential is the attenuation of fear memories. During dreaming, the brain’s limbic emotion processing network is more active than in wakefulness; in dreams, fear memories are often revisited, but broken into more isolated units, and associated with novel contexts. These are also the steps that lead to fear memory extinction, with a final step being emotional expression of the new experience, which consolidates the updated version. Even better, Kraehenmann states that “Dreaming might also directly rewrite fear memories via memory reconsolidation.” This process involves activation of an emotional memory, followed by a new, less fearful experiencing of it within the ‘reconsolidation window’ which permanently updates old fear memories.
In my decades of work as a trauma therapist, I have found that dreams provide excellent fodder for further therapeutic effects when reactivated while awake. In those who suffer from frequent nightmares, the dreams are remain fear-laden over time because the memory reconsolidation process is often interrupted as the emotion is so strong it wakes the dreamer up mid-process. But in a dream therapy session, the fear memory can be opened up again via dream re-experiencing. Then, in a supportive environment where fear is significantly reduced, the dream story can be metabolized and rewritten, permanently updating the original fear memory. When I have worked with nightmares in this way, the most common reported effect the removal of the emotional charge from the dream/memory. The memory is still accessible, but no longer activates a fear response, and this changes the dream itself.
The same kinds of mechanisms may be at work in psychedelic journeys – the activation and recombination of fear memories in a way that has the potential to remove the element of fear from the experience. As with experiential therapy for dreams, a similar process can be used for PVs to integrate the visions and hallucinations that have arisen, and to help reduce the emotional charge from the experience if there is residual fear present.
Optimism and Caution
Although psychedelic substances are still illegal in most countries (as was the case with cannabis before widespread legalization), there is an underground community already using these substances for therapeutic benefit. Legal permission is being granted for use in research in limited, but rapidly-expanding ways as early results show both promise and acceptable safety.
There is a dark side, however, to this mostly good news story. Recent studies are mainly small and many of them not well-designed. Within the community already using psychedelics, often in group therapy sessions, there are varying degrees of safety and levels of appropriate supervision. From those pioneering psychedelic journeyers, we mainly hear about the successes, and less about the frightening and disorienting experiences that can also result.
What the community of psychedelic pathfinders are discovering is that preparation, setting and post-treatment integration are key elements of success. Best practices, although still a work in progress, are emerging. A scoping review by Golden and colleagues (2022) found that the main aspects of setting that can positively impact the experience include music/sound, religious or ritual contexts, group versus individual sessions, socio-cultural norms/expectations, and physical environment. Unfortunately, researchers found the existing data is too patchy, sparse or observational to establish evidence-based practices. Adding to the complexity, responses vary across individuals.
Despite the lack of empirical evidence about the factors that lead to success, early research into use of psychedelics for specific clinical conditions is quite promising. A recent meta-analysis of current research shows that psychedelics (psilocybin, LSD, ayahuasca) can be a part of safe, effective treatment protocol for depression, even in treatment-resistant, life-threatening cases (Ko et al., 2023). Another systematic review of 16 studies conducted between 2000 and 2020 showed that psychedelic substances were safe and effective for depression, anxiety, OCD, and tobacco and alcohol use disorders. They noted that the effects appeared to last weeks or even months after just 1-3 sessions, with no severe adverse effects reported (Andersen et al., 2021).
As someone who works with dream material and teaches therapists how to help clients navigate these rich imaginative realms, I believe these same methods can help with the integration of the dream-like aspects of psychedelic journeys. This feels like a rich potential extension of methods developed for experiential dream therapy and in particular, a way to continue the process of taking the charge out of frightening memories and images.
Andersen, K. A., Carhart‐Harris, R., Nutt, D. J., & Erritzoe, D. (2021). Therapeutic effects of classic serotonergic psychedelics: A systematic review of modern‐era clinical studies. Acta Psychiatrica Scandinavica, 143(2), 101-118.
Golden, T. L., Magsamen, S., Sandu, C. C., Lin, S., Roebuck, G. M., Shi, K. M., & Barrett, F. S. (2022). Effects of setting on psychedelic experiences, therapies, and outcomes: A rapid scoping review of the literature. Disruptive Psychopharmacology, 35-70.
Ko, K., Kopra, E. I., Cleare, A. J., & Rucker, J. J. (2023). Psychedelic therapy for depressive symptoms: A systematic review and meta-analysis. Journal of Affective Disorders, 322, 194-204.
Kraehenmann, R. (2017). Dreams and psychedelics: neurophenomenological comparison and therapeutic implications. Current neuropharmacology, 15(7), 1032-1042.
