Session 480: Introducing Psychedelics Into Therapy

What happens when you combine psychedelics with the therapeutic process? Psychedelic-assisted therapy is gaining attention as more people look beyond more familiar approaches to mental health, but there’s still a lot we’re learning about how it works and what it actually feels like to experience. In this conversation with Dr. Sierra Carter, an Associate Professor of Psychology and Director of the Center for Family Research at the University of Georgia, we’re unpacking the science behind psychedelics in therapy, the ways it may affect the brain and body, and what to consider before deciding whether this approach is right for you. Resources & Announcements Want to reflect on this conversation in community? Join us inside our Patreon https://community.therapyforblackgirls.com/ community where we’re unpacking this episode together. You can now catch episodes of the Therapy for Black Girls podcast on YouTube https://www.youtube.com/@therapyforblackgirls. Be sure to subscribe to get new episodes every week. Did you know you can leave us a voice note with your questions for the podcast? If you have a question you'd like some feedback on, topics you'd like to hear covered, or want to suggest movies or books for us to review, drop us a message at memo.fm/therapyforblackgirls https://memo.fm/therapyforblackgirls and let us know what’s on your mind. We just might share it on the podcast. Grab your copy of Sisterhood Heals. https://www.sisterhoodheals.com/ Where to Find Our Guest LinkedIn: www.linkedin.com/in/sierra-carter-751b0224 https://www.linkedin.com/in/sierra-carter-751b0224/ Website: www.drsierracarter.com https://www.drsierracarter.com/ UGA Profile: psychology.uga.edu/directory/people/sierra-carter https://psychology.uga.edu/directory/people/sierra-carter Stay Connected​https://click.convertkit-mail.com/27uv20p9mpioh8edr34s8ug63w344hg/58hvh8ug08p6wzc6/dGhlcmFweWZvcmJsYWNrZ2lybHMuY29tb3JibGFja2dpcmxzLmNvbS9wYXRyZW9u Is there a topic you'd like covered on the podcast? Submit it at therapyforblackgirls.com/mailbox https://www.therapyforblackgirls.com/mailbox. If you're looking for a therapist in your area, check out the directory at https://www.therapyforblackgirls.com/directory. Grab your copy of our guided affirmation and other TBG Merch at therapyforblackgirls.com/shop https://therapyforblackgirls.com/shop. The hashtag for the podcast is #TBGinSession. Make sure to follow us on social media: Instagram: @therapyforblackgirls https://www.instagram.com/therapyforblackgirls Facebook: @therapyforblackgirls https://www.facebook.com/therapyforblackgirls Our Production Team Executive Producers: Dennison Bradford & Gabrielle Collins Director of Podcast & Digital Content: Ellice Ellis Producer: Ndeye Thioubou Production Assistant: Bria Mosley See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

• 0:10Speaker 00

  Welcome to the Therapy for Black Girls Podcast, a weekly conversation about mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves. I'm your host, Dr. Joy Harden Bradford, a licensed psychologist in Atlanta, Georgia. For more information or to find a therapist in your area, visit our website at therapyforblackgirls.com. While I hope you love listening to and learning from the podcast, it is not meant to be a substitute for a relationship with a licensed mental health professional.

• 0:55Speaker 00

  Hey y'all. Thanks so much for joining me for session 480 of the Therapy for Black Girls Podcast. Today, I'm sitting down with Dr. Ciara Carter to talk about psychedelic assisted therapy. We'll get right into our conversation after a word from our sponsors.

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• 3:37Speaker 00

  It's no secret that therapy is not a one-size-fits-all tool. For some, talk therapy resonates the most. For others, it's EMDR or somatic work. And now, a fast-growing community is introducing psychedelics into their therapeutic healing. This may not sound completely new if you listened to a recent episode when we sent our own director of podcasts, Elise Ellis, to a psilocybin retreat in Jamaica to report firsthand on what the experience was actually like. But there's a lot more to unpack beyond the retreat itself. Today, I wanted to take a closer look at what psychedelic assisted therapy actually involves, what we know about the therapeutic mechanisms psilocybin may unlock in the brain and body,

• 4:19Speaker 00

  and why these experiences can be so different from other mental health practices. We'll also talk about what you should understand before considering psychedelics as part of your own healing journey. So, if you've ever wondered what's really happening during a psychedelic experience, or why so many people are turning to these substances as a therapeutic tool, this one's for you. Here's our conversation.

• 4:45Speaker 00

  Hi, Dr. Carter. Thank you so much for joining us.

• 4:48Speaker 05

  Thank you so much for having me. It's so nice to meet you.

• 4:51Speaker 00

  Likewise. So, can you start by telling us a little bit about your background and what drew you to actually study psychedelic assisted therapy?

• 5:00Speaker 05

  Yes, I'm happy to. So, I am an associate professor in clinical psychology at the University of Georgia, and that's where I did my graduate studies work at as well, in clinical psychology. And I'm the director for the Center for Family Research there currently. And my background has always been in the area of racism as a chronic stressor that can affect the mind and body for Black people, and how we work on ways to make sure Black people live the lives, the functional longevity, I would call it, that they deserve. And so, my work has gone, in many ways, in service of that purpose of focusing on making sure that we

• 5:42Speaker 05

  acknowledge the chronic stress that has been happening to Black people across generations that are related to intergenerational racial trauma and its effects, while also acknowledging the ancestral wisdom that we have had all this time all along as well, and ways that we can use those types of practices and healing practices for our own wellness. And so, I come to that space, in the space that we're going to talk about today, kind of in the roots of like, if we're thinking about ways in which Black people deserve to live long and thriving lives, then what are the treatments that we have that support that? And I think I've come to many areas, including in the psychedelic renaissance, we like

• 6:24Speaker 05

  to call it, of understanding like, if Black people are interested in something, I want to make sure they have all the information. I want to make sure that these things are accessible in the ways that they deserve, and that they are culturally responsive. So, I tend to think about my holistic journey of kind of Black longevity in a focus of like, what do we have that has been Eurocentric and Westernized? What ways can we infuse the healing practices that we use to make them the most efficacious treatments? And then also, how do we connect the mind and body in ways that serve us to optimal wellness for Black people? So, that's kind of overview of the ways that I think about the work that I do.

• 7:06Speaker 00

  Thank you. I appreciate that. Now, you mentioned the term psychedelic renaissance, and I want to hear more about that. What does that mean?

• 7:13Speaker 05

  Yeah, I feel like a lot of people are hearing those terms now in the public media. And I think even more relevant now is this pending, what we call FDA approval for these types of psychedelic substances. So, there has been a renewed interest in the ways in which psychedelic substances from MDMA to psilocybin, particularly when it comes to depression and PTSD and anxiety, how these psychedelic assisted therapies can help with reducing symptoms and ameliorating symptoms to help people who are living in difficult situations because of them. And so, I think the psychedelic renaissance has taken a new frame of thinking about these mind-altering drugs and substances that can

• 7:58Speaker 05

  change how we deal with our emotions and our cognitions. And sometimes, we see it more in recreational use, but there is a renewed interest, particularly when we think about the psychedelic renaissance, from clinicians, psychologists, medical researchers, in its actual potential to aid in mental health disorders. And there have been a number of clinical trials over the years during the psychedelic renaissance that have promoted and have found some interesting and very novel findings about the ways in which it can help people, even more so than some of our traditional clinical treatments. And I think that has been really interesting because the sad part about that is there

• 8:40Speaker 05

  lacks a lot of diversity in these clinical trials during our psychedelic renaissance. So, 80% of a lot of these clinical trials only include white males, cisgender people, and we have an issue with that. And I think one of the things, as we think about how this renaissance of people being interested, wanting to know more about it, pending federal regulations changing, it's like, who are these treatments for and why? Who gets access to them? Who is this renaissance for? Is it for us, or is it not? And so, I have a lot of questions around that as things move forward, because I do think there has been, you see it on TV shows, you see it in the media, and when you look at the clinical

• 9:24Speaker 05

  trials as a clinical researcher, I'm like, well, where are our people at in this renaissance discovery, particularly when we know the history of psychedelics, particularly when we understand the roots of it being in indigenous history, right? We know that psychedelics truly came from indigenous medicines, and Black people were a part of this discovery as well. And then, we saw in the 60s and 70s where things became illegal to use, recreational, particularly when we started seeing increased upticks and stop at risk laws for Black people, increased criminalization of drug laws. And now, all of a sudden, we have this renaissance that seems to benefit a number of white individuals, but is seeming to dismiss Black

• 10:09Speaker 05

  people and other indigenous people who may have started this movement a long time ago.

• 10:14Speaker 00

  Hmm. So, so many places I want to go there, but I want to make sure we get some kind of foundational definitions kind of on the books first. So, psilocybin, you already mentioned, and we talked about in a previous episode here, but that medication is at the heart of a lot of what's happening with psychedelic assisted therapy right now. What is psilocybin? How does it work? And why do you think it is kind of the drug that is at the center of a lot of what's happening right now?

• 10:41Speaker 05

  Yeah, I mean, I think at the heart of these psychedelic medicines, plant-based medicines that we tend to think of them, psilocybin fits within how we think about serotonin reuptake inhibitors, similar to how we think about depression medication, but it's still a mind-altering state of consciousness drug. And so, one of the key things I think about when I think about psilocybin and a lot of the work I do is MDMA, is these Schedule I drugs, which often are, well, are considered illegal, are substances that are intended to open our mind up to discovery and increase our vulnerability. So it can lead to mind alterations and where we see things, have experiences that could

• 11:24Speaker 05

  be mystical, we might have cognitions that kind of challenge us. We also have seen people, particularly in the racial trauma world, who do this work. Sometimes you perhaps noted that people in the trials have seen their ancestors. So these kind of mind-altering processes where you're in a very vulnerable state. And so psilocybin is one of them, MDMA is another, that can really influence kind of how our body is opening up, but with assistance from a therapist. I always tend to think that the medicine is a part of the discovery. Psilocybin is one step to kind of opening our mind up to this mind-altering experience. But truly, the participant is doing a lot of the work once the mind is open.

• 12:07Speaker 00

  And how is it reacting in the brain, right? So I love that you gave the analogy of serotonin reuptake inhibitors. So is it acting in the brain in a similar way, or what's actually happening in the brain when somebody takes psilocybin?

• 12:21Speaker 05

  So, I mean, I think there is still research on, I think a lot of what is actually happening to our brain when people are taking psilocybin, similar to a lot of these medical mind-altering drugs that we see in, like LSD, and how we think about them as, the reason why they're illegal is because we think they do too much, right? But the reason why we have a specific dose that is given, we hear phrases like microdosing. Even in the clinical trials, we give a full dose. So it's not in the sense of like, this is causing necessarily harm to the brain in a way that it's causing our neurotransmitters to be on fire, but it's allowing a space where we think about the ways in which our neurotransmitters turn on and off to a drug,

• 13:05Speaker 05

  right? It's an important component of the opening up process of allowing space for cognitions to change, to think about emotions potentially altering, to allow that space. So it's more hitting the brain components that are important to thinking about mind alteration. So what components of our brain that we often see, where that's the frontal lobe, that's allowing space for those things to open up, but not necessarily causing any type of damage necessarily. And so I think there's still a lot of thoughts on like, what can be happening to the brain, similar to other drugs that we take for our medications for like severe depression, that are causing also a lot of mind alterations as well, particularly in the serotonin space.

• 13:48Speaker 05

  And so I think when serotonin is entering our brain, we can see how that's causing us to maybe feel calm, right? So in the brain, making us feel more open to discovery, what parts of that are opening our brain processes up. So I tend to think of it as similar to thinking about other medications that we might be taking, particularly in the SSRIs space, but an expansion of that, right? It's allowing additional component to parts of our brain that are allowing space, not necessarily like the amygdala where our fear responses are really important, but it allows the space for our amygdala maybe to not be as forceful in our fear response, to allow the space for us to open up to discovery.

• 14:31Speaker 05

  Because often, particularly in the PTSD space, we have a lot of parts of our brain that have learned as humans that fears danger, valuably slipped, so it's an adaptive process. And I think a lot of these drugs are saying, hey, let's allow space for those spaces to be a little calmer in our brain, so that we can be open to discovery. I know that there's a lot of research in this area, it's like, what parts of the brain, particularly for me as PTSD, like what happens to the amygdala in our brain, which is particularly related to fear circuitry, when they're taking this MDMA drug? Some of it's talking through like, what it's allowing space for, like I was mentioning before, and then also like what it's not, right?

• 15:12Speaker 05

  So if it is affecting, opening us up, how vulnerable is it making us? And sometimes I think the danger of psychedelic, because people have different experiences on these drugs, human to human. And so, in thinking of that, what different experiences of vulnerability can happen when you take a drug, means that it could lead to more opening up than you might want it to be for your brain processes. Hey, whoa, that was too fast, that was too much, I wasn't ready, what's happening? Or it can also potentially not do much. And so, some people might have sustained processes in their brain over time, that's not necessarily leading to this kind of renaissance discovery.

• 15:57Speaker 05

  Since we know that there are differences in humans, I tend not to generalize about what can be happening in the brain, because I know that we're still trying to discover what are these differences from, why are some people having these reactions, why are some people not? So I think we still have more work to do.

• 16:12Speaker 00

  You've already referred to the fact that it sounds like some research has been being done related to psychedelics and PTSD, you've mentioned depression. Are there other mental health concerns that are being tested as responses to, or how they're responding to psychedelics?

• 16:29Speaker 05

  Yeah, there has been some research done on anxiety, particularly, I do a lot of work in maternal health, so there has been a little bit of work on postpartum depression, which I find really interesting. Even in some kind of like couple relationship discussions, I haven't been a part of that at all, but I find it interesting how far it can go. And also in drug addiction research as well, so there have been different subsets. The biggest ones I have seen have been PTSD and depression, but I think it is expanding of how far reaching it can go.

• 17:02Speaker 00

  You already talked about this kind of renaissance, how these medicines have been around for a while, people tried them, then they became illegal, and then now we are seeing regulation and like science actually entering the space. What would you say are your observations of like how psychedelics are being received, maybe in comparison to traditional medicines, like your SSRIs?

• 17:25Speaker 05

  I think it's an interesting space for researchers. I think in some ways, it provides researchers in particular, a novel opportunity for discovery. Just like how we think about things that are new and shiny, right? It's like, oh, we never have tried this out. So we get to obviously see what happens to the brain, right? In comparison to other drugs, even when you have a placebo drug, what's happening, right? And I also think there is also the history of the illegal components of these medicines and plant-based products of, oh, we have to make sure we're doing this in a safe way, we have to make sure that there are safety precautions, this hasn't been FDA approved,

• 18:10Speaker 05

  this is a Schedule I drug for a reason. And so we have to be very cautious about who is allowed to engage in the psychedelic assisted therapy, what are our restrictions on that? So one of the things that I found really interesting, as I kind of dove a little bit more into the space, is the amount of evaluation that goes into who would be a good candidate for clinical trials for these psychedelic assisted therapies. And they're very stringent, to the point like they have EKGs that has to be done, where you have to do a thorough psychological assessment, if you have some medical ailments that tend to affect Black people, you might not qualify.

• 18:52Speaker 05

  So I tend to see like, there is a pretty stringent, and most clinical trials can be stringent, but I think particularly with a Schedule I drug, like psychedelic medications, the assessment period phase of, before you become eligible for a clinical trial for this, can be pretty intense. And I think there's a reason and a history to that, to be. Thought through.

• 19:14Speaker 00

  Mm hmm. Can you say more about what kinds of qualifications? So you mentioned like EKG and maybe previous medical history. What kinds of concerns that you mentioned, like that maybe predominantly impact black people would maybe kind of disqualify people for a clinical trial for this?

• 19:29Speaker 05

  So for example, I think about cardiovascular issues of inflammation, high blood pressure, components of diabetes, metabolic disorders, highly can disqualify us from being able to be a part of this study, depending on where your blood pressure is. So maybe as a blood pressure cuff, my colleague, Dr. Justin McMillan has been working to reduce some restrictions in that area, but they are pretty stringent in what level of blood pressure you have. But you can think about the reasons why, right? Because you are taking this mind altering drug that can be in ways, stimulates you in different ways. Your body can cause your blood pressure potentially to rise.

• 20:10Speaker 05

  And so they want to make sure that you don't already have a lot of complications necessarily going on. And they also have a tapering off of current SSRIs. So, and I think that also can be very difficult for people who have a number of chronic illnesses, particularly I used to work at Grady, right? So one of the things that I said, oh, they got a taper off of their SSRIs, like,

• 20:37Speaker 05

  that's not my favorite component to this, to be able to engage in the clinical trial. And that I think further makes me think about who is this for, right? For people who are already in some ways somewhat well. And so I tend to think like, some of these stringent things are barriers to engaging in the treatment. And I think those are things that people are wrestling with currently of like, how much stringent things do we need to implement? How could we appease that and still be safe? Because the safety is still the most important thing. And so I think because it's new and novel, there's a lot to discover. But at the same time, I think there's still a lot to like wrestle with, right? We haven't done all the research and like, how stringent do we need to be?

• 21:22Speaker 05

  How lenient could we be while including safety? So I think there's still some of that going on.

• 21:27Speaker 00

  Yeah, I appreciate you sharing that. And I do think that that's interesting in thinking about like what you've already outlined as the conditions where we might see the most benefit. So something like drug resistant depression, like people who tried like multiple different SSRIs and things like just not working or PTSD, right? Like people who may be experiencing significant impairment, which indicates that they probably are already taking something, but then maybe would be excluded from the clinical trial because they're already taking something. So I wonder, like, what kinds of results are we seeing for the people who might benefit from this most if they're actually excluded from the clinical trial?

• 22:03Speaker 05

  Exactly. And I think that's where a lot of push needs to continue to happen. That's kind of the work that me and some colleagues have done around thinking through like, who is this for? And how do you want to get people in the door, particularly those who are the most chronically ill? And I think that part of the conversation has always been about safety and a consideration about that. But also, I think clinical trials generally, in my experience, have often been very stringent. And I think that's a part of the reason why it's been very like, we have this control group, we have this trial group that's pretty clean. And I think when we're thinking about these

• 22:45Speaker 05

  accessible treatments or the accessibility of treatments, I think people kind of get stuck in like, how far can we go? That's making it objectively a good clinical trial. Now, I think what's going to happen with this psychedelic movement, which is different from other things, I think, particularly medicines, is this FDA approval, which is potentially rapidly happening in the next year, which could mean that this could be accessible in many different ways, not just necessarily in a clinical trial. Now, do we need these clinical trials to be able to understand, like, who is this benefiting? How is it affecting our brain? Who is this for? Yes.

• 23:25Speaker 05

  I think to be able to understand this from multiple populations, multiple diverse populations, I think is a struggle. But I will not say that this clinical trial is necessarily a lot different from other clinical trials that have focused on making things clean for a clinical trial to be able to happen.

• 23:44Speaker 00

  More from our conversation after the break.

• 23:52Speaker 00

  A rare disease diagnosis can change your life, but it doesn't have to define your future. Tune in for season seven of Untold Stories: Life with a Severe Autoimmune Condition, a Ruby Studio production in partnership with Argenx. Hosted by public health and policy expert Dr. Martine Hackett, Untold Stories: Life with a Severe Autoimmune Condition pushes the conversation within the rare disease community forward. Featuring guests living with MG, CIDP, myositis, SMA, and other rare autoimmune conditions, each episode explores hope, progress, and connection. How does research create new opportunities? How do shared experiences help light the way forward? How do we best show up for each other? Tune in to find out. Listen on the iHeartRadio app,

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• 27:27Speaker 00

  So, Dr. Carter, this may be a very rudimentary question I'm about to ask, but I really have no clue, which means the community probably needs these answers too. So when I hear about clinical trial research, does clinical trial only refer to like the research that needs to happen for something to be FDA approved? Or, for example, since we are seeing kind of psilocybin, it seems like rapidly moving quickly towards FDA approval, could it be that it is FDA approved and then there's research done on the other side of FDA approval that then allows us to maybe be more experimental with who is in the like trial group? Is that still a clinical trial or is that some other form of research?

• 28:08Speaker 05

  So there, it's both, right? So you can have clinical trials after FDA approval, right? We have so many clinical trials related to depression treatments, both for medications and those for not. But I think a lot of these from different industries, from like Compass Pathways, this one I've worked with before, just focused on psychedelic clinical trials, has focus on like, we need to do these clinical trials to see how efficacious it is for FDA approval. So some of them are specific for like, we got to do these phase trials in order to show that this is efficacious. Now, after FDA approval, there will still be clinical trials that are going

• 28:50Speaker 05

  on that are specific to different populations. You can think about who you're trying to serve, rural, urban, like there are different sorts of clinical trials that happen every day. That have nothing to do with FDA approval. But I do think particularly in the psychedelic movement, because it is a Schedule I drug, a lot of the beginning of the clinical trials had to be under federal regulations. So you had to have a certain hospital that could do a clinical trial. And I think what's happening now is I think there is a scary because of the current presidential administration's announcement that there needs to be an uptick in research for approval of psychedelics for FDA approval.

• 29:33Speaker 05

  So what the difference is, I think the root of it was we didn't have FDA approval ever before. So a lot of this had to be clinical trials, but I think you're going to rapidly see things might be coming into the orifice that aren't clinical trial related, that are things that have been clinical trials tested, but are rapidly being sent out. But I think what a lot of these companies that have engaged in the clinical trials want to show is that we have done enough to prove to you that once FDA approval has happened, that this is something that is meant for you. Now, I don't think they may reach that goal yet, but I think it's an interesting thought.

• 30:10Speaker 00

  Mm hmm. So you mentioned that a part of what happens with medication like psilocybin is that it really kind of increases your openness, right? Like can lead to more vulnerability, which sometimes can be a great thing, but also something that you need to monitor. I mean, so we know that an important part of psilocybin and other psychedelics is the integration part, right? Like what happens after you're done with the medicine? How do you kind of reintegrate to your life kind of post taking it? Why is that so important? And can you tell us like what really happens when we're talking about the integration phase?

• 30:42Speaker 05

  Yeah. So like a lot of times, I think when people hear about psychedelic assisted therapy, they forget the assisted part. They think the psychedelic. And it was validly so. Like when I first heard it, I was like psychedelic just spills out for me. But and the integration component, that's after what we call the dosing session. So you've taken the dosing session that can last from six to eight hours. And then you're in an integration phase where you have two therapists who are processing with you what happened in the experiences of the dosing session when you were in the space opening up and were vulnerable. Now, for us in the kind of PTSD world, we're wanting to process through like, what did you discover about your trauma?

• 31:27Speaker 05

  You know, so this can be very vulnerable work that you have maybe never had to process before, and it's kind of hitting you all at once. Right? And so what I do see is, and what I hear is that there are a lot of times where this is like a very emotionally driven space. Like, I didn't know. I saw this when I was in my dosing session and I didn't really process how this hit me in this way all my life. And this is why my relationships are having these types of difficulties. But what I also think is not remiss from this discussion is these mystical experiences can also invite joy, love, right? Like the vulnerability can go both ways, right?

• 32:11Speaker 05

  Like, what does it mean to be able to see your ancestors telling you that you're going to be okay? Like, what do all these processes mean? So I think a key point in the integration is going to be the therapist. And that's one of the ways in which I think also our work has moved and thinking about how these systems engage, particularly with Black folks around being open to discussions, particularly around religion. A lot of religious discussions comes up, right? If you think about all the things that can happen with a mystical experience, who you might see, who you might discover that could be a god, that could be a deity, that could be a someone who might be your savior. That could be a number of different processes happening.

• 32:52Speaker 05

  And so we need clinicians in the room who are open for that type of discussion, open also to discussions of racial injustice, racial trauma. What does that mean for me, being a Black woman in this space? And so where I think that is a critical conversation. I was like, if you want more Black and Brown people to be a part of this, like when you open people up to discovery, all the types of oppression, cultural oppression, traumas that are laden in historical oppression could come up. And I think that is where I think the clinicians are going to be critical at that integration stage, is they're standing in the line, trying to keep you in a space of discovery, keeping

• 33:34Speaker 05

  you exploring, keep you uncovering, keep you processing. And to do that well, you also have to have your own critical consciousness as a therapist and how to do that.

• 33:45Speaker 00

  You know, I would imagine that this is a particular modality, like all of the ways that we practice therapy, right? Like that you are going to be drawn to maybe kind of depending on some of your own stuff, like your own training, your own kind of interest. You and I both know that the field of psychology has not historically done a great job of having conversations around like racism and structural injustice. And so much of our training is about like leaving that part of yourself out of the room, right? Because we want to have a clean space, so to speak, for the client to bring this stuff in. But then if the psychedelics are bringing forth these kinds of conversations, which indicate that the client is interested and needing to have this kind of conversation, what work have you seen done on like the therapeutic side, right? So there's all the research related to is this medicine safe?

• 34:30Speaker 00

  How much is the dose? But to your point, it also feels like there's some research and like movement that needs to be had on the clinician's side of how are you actually facilitating the space for these conversations? Can you speak to any of that work?

• 34:43Speaker 05

  Yeah, I can speak to what we just wrote and just got funded at Emory. So I am the lead on my cultural humility, culturally grounded work side for therapist practice. And I don't think we're the only ones thinking about this. I think Monica Williams, who's a leading racial trauma scholar, is like really focused on this space as well. And Dr. Jamila George, who is coming out of Brown, has done a lot of work in this space as well in the clinical trials, particularly trying to train the therapist on what we need to be open to discovery. Because like, you're right, we traditionally and even currently have not got much training

• 35:23Speaker 05

  at all, what it means to not be this blank slate when it comes to therapeutic practice, particularly when you're asking someone to take a medicine, a drug that is mind altering, and then you're asking me, the therapist, to not be open to what this discovery could be. And I think what we have found, we have done talks on this, is that with other therapists, it's been like, I was never trained to talk about my own religion, for that matter. I was really never trained to talk about like race and gender differences in the realm. But what we find in our focus group, the Black people in Atlanta, has been like, I

• 36:08Speaker 05

  need somebody who understands the vibe if I'm going to be in that type of space. And so I think there is this discordance of our training and what is going to be necessary in this movement, particularly for diverse folks to come into this space to be vulnerable and acknowledge that space and make some changes. I will say that there have been manuals created by the people I mentioned before, like Monica Williams, Jamila George, have said specifically in the integration stage, like, these things have come up. We have been a part of these things, particularly racially traumatic experiences, talking about this and not feeling that we were heard or understood by our therapists, and these are the things that need to change.

• 36:51Speaker 05

  Us as therapists talking to other therapists, right? After engaging in psychedelic assisted therapy themselves. So they published on this type of work and have talked through like what their process was like as therapists going through the therapeutic experience and where the missteps were happening, particularly in that phase of trying to be open to a therapist that may not even have racial concordance, but trying to say like, hey, can we talk about my religious experience? I just saw this. Like, those are the types of things that I still think there needs to be a lot of training on.

• 37:27Speaker 00

  Are the people who are running a lot of the clinical trials open to this feedback? Is this something that they are taking into consideration?

• 37:35Speaker 05

  Somewhat. I mean, we just got a grant that definitely has that embedded in it. Now, I will say, we did focus groups, we did a number of things, and I do think this current administration may have caused some pause to the type of work that we think is necessary for this to continue. But I do think because particularly in spaces like Atlanta, where you have a large Black population, but your clinical trials do not look anything like the people that you might want to serve with FDA approval, you're starting to see a little bit more openness than before. So we started doing focus groups around 2021, and that was funded by individuals who were doing clinical trials with psychedelic assisted therapy.

• 38:20Speaker 05

  And then we wanted to do more community facing work based on what we found that Black people desire. So a lot of Black people wanted more information. They wanted more discussion within their community, not them coming to us, but us going into community about what was happening, how it would happen. So we proposed funding for that, but we just started to get funding currently. And I think some of that is related to other factors, but I think a part of it is this renewed interest in this FDA approval and the need for the ability to have some sort of diversity representation and understanding what works and for whom. So I do think there is an interest. I do think that people are want to do well.

• 39:05Speaker 05

  I think there still needs to be a push because there are many reasons people could say, for example, that Black people don't want to engage in this. But our research shows that it's not a lack of interest, and we've done some work both at a survey based level, but also at a focus group. If we provide psychoeducation about psychedelic assisted therapy,

• 39:26Speaker 05

  Just to the general public, but particularly black people who have more chronic depression, there is significant interest in the psychedelic assisted therapy, which makes me feel and makes some of the co-authors feel that it's really the onus on these systems to be able to make this more culturally salient, more trustworthy, make it more safe. Not that the interest isn't there, because naturally, I think what we hear often for black people who aren't engaging this treatment is it's something about us, right? That we don't want it because we're not interested. We don't want it because of valid cultural mistrust. But I think there's much more layers to that. And it's not, we found, it's not related to interest across the US.

• 40:09Speaker 00

  I'd love to hear more about the focus groups, Dr. Carter. Is there anything that has surprised you maybe that has come out of the talks and maybe the surveys that you've done with the people you've been in the research with?

• 40:20Speaker 05

  I was not a psychedelic girlie, like probably since 2021. My close friend in graduate school, Dr. Jessica McCallister, we both worked at Grady's because Dr. O'Fellows. And we're just seeing a lot of difficulties with chronic medications, particularly when it came to trauma for the people we love and care about. And my friend came up to me and was like, Sierra, have you ever thought about black people and psychedelics? I was like, black people like do any of that? Like, what are you talking about? And she was like, well, let's just apply for some focus groups. I love doing focus groups. So I was like, of course, like you can hear for yourself of how black people are down for this. So I came in with this like preconceived notion.

• 41:04Speaker 05

  I grew up in a Christian household. Like, I was like, I don't see it. I don't see it at all. And then we started doing these focus groups in Atlanta during COVID, but part on the later end of it. And so it was all virtual. And we would start off by just generally asking everybody in those group sessions, like, would you engage in psychedelic assisted therapy? Straight off, no education or anything. Everybody pretty much was a no. But then we provided psychoeducation. We answered any questions that they had about the psychedelic assisted therapy process at each stage, what would it include, what it didn't include.

• 41:47Speaker 05

  And by the end of the session, just about everybody said they were interested. And so then that was a surprise to me. And the thought that like, I think I had this preconceived notion, but that was just not something that we would do. But I also found, which was somewhat saddening to me, is I think a reason that this psychedelic assisted therapy was so interesting, particularly to people who were getting services at Grady Hospital and sometimes predominantly serving some low-income black individuals, was the problems we already had with our medical system. So what I heard them saying was like, we get two therapists.

• 42:29Speaker 05

  I possibly will not have to take this drug for the rest of my, like, multiple drugs with all these side effects, weight gain. And this is just a one-time thing. And I get to see my therapist for a while. Like, I usually have a session every once in a while. It's so hard for me to be able to see my psychiatrist. I don't even know if I'm on the right dose anymore. I've tried to change my dose, right? And so I was like, there's something also inherently wrong with our current medical system that people can't get the basic services that they need. And this service is showing that this discrepancy doesn't need to be there. Like, there is something that other people are getting that you deserve, even if it wasn't a psychedelic assisted therapy.

• 43:13Speaker 05

  So I think that was also very eye-opening to me of, yes, I'm interested in this, making sure that psychedelic assisted therapy is accessible. But it also highlighted for me that I have a long journey as a service provider of trying to change these medical systems to provide the basic care that every black person deserves.

• 43:32Speaker 00

  More from our conversation after the break.

• 43:39Speaker 00

  A rare disease diagnosis can change your life, but it doesn't have to define your future. Tune in for season seven of Untold Stories: Life with a Severe Autoimmune Condition, a Ruby Studio production in partnership with Argenx. Hosted by public health and policy expert Dr. Martine Hackett, Untold Stories: Life with a Severe Autoimmune Condition pushes the conversation within the rare disease community forward. Featuring guests living with MG, CIDP, myositis, SMA, and other rare autoimmune conditions, each episode explores hope, progress, and connection. How does research create new opportunities? How do shared experiences help light the way forward? How do we best show up for each other? Tune in to find out.

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  Host Nora McInerney is back for an all-new season of The Head Start, embracing the journey brought to you in partnership with AbbVie. In each episode, Nora has honest conversations with real people living with chronic migraine, people who are figuring out how to adapt, advocate, and stay connected to the things that bring them joy. This season, she's revisiting familiar voices and introducing new ones who will share their stories about what it means to live with this condition, from the missed moments to the strategies that help them keep going when things feel uncertain. As always, she'll be joined by headache specialist Dr. Christopher Rhine, who offers insight into these challenges and the questions many of us have. If you're new to the podcast, check out the three previous seasons, each one offering a different perspective on this condition

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  and the theme of resilience displayed while navigating it. So don't miss season four of The Head Start: Embracing the Journey. Listen on the iHeartRadio app or wherever you get your podcasts.

• 47:07Speaker 00

  So, Dr. Carter, if we just take like treatment-resistant depression, for example, and it sounds like a lot of your work has been in the depression symptoms kind of space. When we think about like a typical maybe treatment plan for this, we're thinking therapy, maybe medication. But to your point, this is something that is ongoing, medication maybe for most of your life, if not all. How does something like psilocybin completely change that, right? Like, how is it that you could do a one-time dosage? How does that work?

• 47:40Speaker 05

  Yeah, I think it is, and this is for depression and also partly some PTSD work too. I think a lot of times as adults, like the malleability of our mind to discovery can shut off, right? Like, we're kind of sustained in our unjust world beliefs, our belief systems of things aren't rosy, things aren't well. It's hard for us to open up to forms of discovery. And I do think like a part of this psychedelic experience is to allow space for people to see many different ways of living, right?

• 48:24Speaker 05

  And that possibly other drugs can't quite hit in the same way of discovery. So I think the processing of that looks differently from how our typical kind of combined medication and therapy for a depression, severe depression, looks because I think possibly what's happening at the root is the openness to discovery just isn't quite there for the current medications we have. And what we do find, and what we're finding, I think, which is fascinating, is like, they're starting to see like a year out sustained cure for depression, right? And cure meaning like just sustain lower symptoms where you're not having a diagnosis of major depression anymore.

• 49:07Speaker 05

  Same for PTSD, and we haven't seen that a lot for a lot of our chronic depression and chronic PTSD, for that matter. And I think that just leads us to like, what is the mechanism drawing that from happening in comparison to other types of treatment? And I feel like the discovery is, again, kind of looking at your question about what's happening to the brain, which we have more work to do. But I also think it's something about being able to have a space for this drug to be working in a space of like, okay, I was struggling to be open to this type of discussion. Like, I have deep pain, deep pain in my life

• 49:52Speaker 05

  that has been hard for me to talk about with a therapist, hard for me to even maybe discover for myself as like the root of what is causing my longstanding depression. And this is, I think, a potential mechanism, just opening up the possibility of discovery for people so they can sit and actually process what's happening. I do think also that having the amount of time And psychedelic assisted therapy, I'm talking, you know, you gotta stay there six, eight hours and you get multiple therapy sessions kind of repeatedly back to back. It's certainly not how our system is set up for people with severe depression either. So I think a part of it is just the practice that they have set up for how the

• 50:36Speaker 05

  therapy is set up that not a lot of people with chronic depression get to have. I wish there was a comparison of that where we could see if it actually is similar if we were to give people the same amount of space and time with our traditional treatments as we do for the psychedelic assisted therapy. Cause I'm not sure, but I do think there is something about that's happening about the way the treatment is going and also potentially what the drug is allowing space for.

• 51:04Speaker 00

  Yeah, it also feels like there's something about the speed, right? Like if you're taking an SSRI, we're talking two to four weeks before you feel anything versus within the hour.

• 51:13Speaker 05

  Within the hour.

• 51:14Speaker 00

  Yeah, yeah.

• 51:15Speaker 05

  Yeah. Which is, I think, completely, that is a completely important point. I think,

• 51:21Speaker 05

  I, I would like to say that, you know, something that is mind altering, you know, wouldn't have such a strong effect so quickly, but it really is a rapid discovery. And I think for some people that might be too fast, but for others, I think it also can be just like this opening up very quickly. Whereas I think for our current treatments, it takes time. When I think about depression treatment, it can be hard to get people to come in. I think about PTSD treatment, it can be hard, particularly when you start bringing up stressors for people to come back to a session, which makes complete sense to me. Like, why would I want to come back and talk about the things I've been struggling with for so long? And

• 52:02Speaker 05

  I think the psychedelics is like, you're already here, right? Like it's time, it's time to do that work now. So it's kind of like the attrition isn't necessarily as possible.

• 52:13Speaker 00

  Yeah.

• 52:14Speaker 05

  So I think it really takes away the attrition rates, the ability to kind of avoid talking to some of those things.

• 52:22Speaker 00

  Mm hmm. And what happens after this first kind of like six to eight hour experience? Are you then still seeing the therapist or the two therapists like every week for some time? What happens afterwards?

• 52:33Speaker 05

  Yeah. So you have, the integration is after also the, the dosing phase, which can be like six to eight hours. And then the integration you have, well, some treatment protocols are a little bit different, but in the MDMA ones that I've seen, you have like three to four sessions kind of daily. And then you also have weekly sessions kind of follow up. And so like particularly that full week is almost dedicated to your treatment journey. And you're kind of asked to kind of process things outside of session, maybe not talk too much to family and friends and your process journey, kind of come back in and allow the space before you reintegrate into the world. There is a specific session

• 53:14Speaker 05

  around reintegration into the world, what that's going to look like, a lot of coping processes of reintegrating into the world after this time is based to heal. And like weekly appointments, what I think a lot of the people at our focus groups wanted, they were thinking more communal reintegration phases. That's one of the things we want to support too. But I think it is kind of more kind of collectivistic, not collectivistic, but like in a way, ways we get more sessions than would be typical across time. And then like, you know, you still have like a year follow up, six months follow up, monthly follow up. But at first phase is pretty like consistently a week.

• 54:00Speaker 00

  Got it. So for anybody who's listening to our conversation and thinking this may be something I'm interested in or want to try, what kinds of questions do you think they should ask themselves about whether this might be a good fit for them?

• 54:12Speaker 05

  Oh, I kind of think about this as similar to how I think about figuring out who you want to be your therapist generally is what has or hasn't been working for me and why? And another question is like, what do I think would be helpful for me in trying to heal? That can mean a lot of different things for different people, but if it relies on the fact of like, I've had this long journey where things just haven't been getting better. And I have tried every medication and it just hasn't been getting better. Like, are there other options to explore? And so the question would be like, are you open to another

• 54:57Speaker 05

  form of discovery for myself, for my healing journey? So as you notice, my questions aren't like related to you having to be a part of psychedelic assisted therapy. Mine are just like openness to discovery because I think the job is really on us as therapists and providers to make this system more trustworthy. Like the system needs to be more trustworthy for the people. So I would rather people say, oh, I'm open to discovery because I'm working on making it a better system for you. So if you ever open up to that space. So I think in your journey of discovery, like if the things haven't been working for you, I want to make sure this other option is something that you would be, that will

• 55:41Speaker 05

  be open to being trustworthy for you. So I think it's worth asking for more information, asking for more questions, seeing who is all going to be in the room when you get your therapy journey. And it's okay to say no to that, but I do think it is an option that is readily pending, that I hope black people will give a chance as a part of potentially their healing journey.

• 56:05Speaker 00

  So when you think about the future of psychedelic assisted therapies, what makes you hopeful and what also are you cautious about?

• 56:14Speaker 05

  What makes me hopeful is I'm truly at my heart of hearts, a person who believes that if there is a healing journey that is showing that people are having much better outcomes with their health, that black people deserve to have it. And what makes me hopeful is that this is a potential avenue to that type of accessibility of healing in a way that is both holistic and in a way that is not having people to be not functioning well for a very long time. So that makes me hopeful. I like the ability for something to, has

• 56:57Speaker 05

  shown quick progress and for black people to have accessibility for it, to it. What makes me worry is just like any other thing in our historical legacies of oppression, that this particularly psychedelic assisted therapy is going to follow the same Eurocentric standards that a lot of our other treatments have and will not make any changes towards being more culturally responsive, culturally safe for black people, particularly with this rapidly FDA approval. So I am very worried that the work that we have been doing could be shut down. It could be saying like, you know, we already got FDA approval. We don't need to worry about this no more. I do think there is a possibility for that to happen.

• 57:41Speaker 05

  That does significantly worry me.

• 57:44Speaker 00

  Thank you so much for that, Dr. Carter. I have so enjoyed hearing so much more about this and learning more about your work. Please let us know where we can stay connected with you. What is your website as well as any social media channels you'd like to share?

• 57:56Speaker 05

  Yeah. So I'm at drsierra Carter dot com. You can find me on, I'm at EGA. I'm also at sefar dot EGA dot edu, which is also the C-FAR, Center for Family Research website. So feel free to reach out there. But yeah, we're going to keep the work going. There's a lot of different ways in which I hope this work continues and hopefully we'll be moving in the right ways for black people in the future.

• 58:22Speaker 00

  Thank you so much. We'll be sure to include that in our show notes.

• 58:26Speaker 05

  Thank you.

• 58:30Speaker 00

  I'm so glad Dr. Carter was able to join me for this conversation. To learn more about her and her work, be sure to visit the show notes at therapyforblackgirls.com/session480. And don't forget to text this episode to two of your girls right now and tell them to check it out. Did you know that you could leave us a voicemail with your questions or suggestions for the podcast? If you have movies or books you'd like us to review or have thoughts about topics we should discuss, drop us a message at memo.fm/therapyforblackgirls and let us know what's on your mind. We just might feature it on the podcast. If you're looking for a therapist in your area, visit our therapist directory at therapyforblackgirls.com/directory. Don't forget to follow us on Instagram at therapyforblackgirls and come on over and

• 59:13Speaker 00

  join us in our Patreon community for exclusive updates, behind the scenes content and much more. You can join us at community.therapyforblackgirls.com. This episode was produced by Elise Ellis, Inde Chubu and Bria Mosley. Editing was done by Denison Bradford. Thank y'all so much for joining me again this week. I look forward to continuing this conversation with you all real soon. Take good care.

• 59:41Speaker 00

  A rare disease diagnosis can change your life, but it doesn't have to define your future. In season seven of Untold Stories, Life with a Severe Autoimmune Condition, host Martine Hackett continues the conversation with people living with MG, CIDP, and the broader rare disease community, exploring what comes after diagnosis through stories of hope, progress, and connection. Produced by Ruby Studio in partnership with Argenx. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is Colin Coward from the Colin Coward Podcast. Buy smart, drive for less, and trade for more. That's Toyota affordability. All starts with a great deal on an off-road

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