As More People Turn To Psychedelics, Integration Proves A Crucial Factor For Breakthroughs

Nick Watchorn had suffered for most of his adult life from severe post-traumatic stress disorder (PTSD) before he sought psychedelic treatments to deal with his chronic condition. He credits those psychoactive sessions, and particularly the work he did afterwards in a process known as integration — a way of gleaning insights from the experience — with saving his life. “I thought I was too far gone,” he says of himself before receiving therapeutic treatments using MDMA-assisted therapy (aka ecstasy). 

At 54 years old, Watchorn had suffered for 22 years from the terror of a mass shooting he experienced as a young cop. The year was 1996, in Port Arthur, Tasmania, after a gunman had gone on a deadly shooting spree that left 35 people killed and 23 wounded. It was, and still is to this day, the worst single gunman massacre in Australia’s history. For more than two decades after the terrible event, Watchorn was plagued by visions of the mass killing. His grief led to the classic PTSD symptoms of anxiety, depression, social isolation and destructive behavior. Repeatedly playing back the awful carnage of the crime scene in his mind, he continued to re-experience his trauma on an endless loop. In the years following Port Arthur, Watchorn would eventually quit the police force, saying in MDMA: From The Club To The Clinic, a book I wrote this year about his experience, “I couldn't make decisions anymore. I just didn't trust my own thoughts.”

Watchorn says he tamped down the brutal, recurring mental images for 22 long years, aided by alcohol, pain pills, and a revolving door of psychotherapists. Then one day he heard about a breakthrough clinical study being conducted to treat PTSD using MDMA. The trials, which combined the drug with psychotherapy sessions, were proving to be incredibly effective at treating the symptoms of emotional trauma. Trials were (and still are) steadily progressing through important phases with the U.S. Food and Drug Administration (FDA) to potentially become a legal, prescriptive medicine. Watchorn would eventually qualify to take part in the trials in 2018 through the Multidisciplinary Association for Psychedelic Studies (MAPS), having experienced symptoms of treatment-resistant PTSD for over two decades. Before his trials with MDMA, he had never in his life experienced a psychoactive drug. Not so much as a puff of marijuana, he laughs. He was making a brave choice to face his demons through a relatively new scientific experiment.

While under the influence of MDMA, which took place in three 8-hour clinical sessions with trained therapists, Watchorn assumed he would first confront memories of the horrible scenes he faced at Port Arthur. All the gore of dozens of people killed and wounded by a madman with a high-powered rifle. He was bracing himself to experience those raw emotions up close and personal, to finally deal with the sad and terrible memories. Instead, he would be surprised by what first appeared in his mind’s eye: a vision of himself at eight years old shivering alone by a poolside. Before tackling the events that he believed would be foremost in his wounded psyche — the death and destruction he witnessed in 1996 — he would first reel through a series of early, relatively benign childhood encounters. A place where he felt rejected, abandoned and at the mercy of his parents’ needs. Watchorn was starting at the beginning, where his trauma first rooted — an uncomfortable place many people avoid. The place where he received the initial injuries of his life that later affected his ability to cope through the aftermath of the killings. He would not fully understand the meaning of all those buried mental images that came flooding back from his childhood until after his experience under the influence of MDMA. During integration therapy sessions, he would reflect on what emerged during his time on the drug and slowly patch together the meaning of it all. Only then would he have the true tools to begin healing himself of his PTSD.

Integration is an often-overlooked aspect of the psychedelic experience, yet it is one of the most important factors for success. Generally speaking, it is the wild and mystical moments that take center stage. Once a person returns to ordinary states of consciousness, the psychedelic trip — whether perceived as positive or negative — is often left in the rearview mirror to fade like a dream. One of the key points of integration is to not let significant parts of the experience fade out, but to examine the mental deep dive and mine it for valuable insights. This can also have the effect of reducing subsequent harm in the event of a challenging experience. 

Because the majority of people who use psychedelics will not use them in controlled clinical settings like Watchorn — his case and condition were so extreme that he qualified for the FDA trial over roughly 900 applicants who applied in his area — a group of researchers and clinicians have recently laid out a framework defining integration and its importance in patient care. It is the first peer-reviewed paper of its kind, published in Frontiers in Psychology, and outlines how mental health providers may benefit from understanding the unique motivations, experiences and needs of people who use psychedelics. Still largely illegal in the U.S. and much of the world, psychedelic drugs can be a tricky topic for mental health professionals to come together and agree on standards and practices.

Dr. Ingmar Gorman, co-author of the paper on harm reduction and integration and co-founder of Fluence — an organization focusing on psychedelic education and training mental health providers in psychedelic treatments — saw the necessity to begin a dialogue around offering healthcare providers clinical skills and knowledge to provide effective, compassionate, evidence-based psychedelic therapy and integration services to patients. “Many psychotherapists and other providers have encountered clients who use psychedelics already, but there hasn’t been a consistent approach to working with these individuals,” says Gorman. “We’re hoping that this publication will start a conversation that’s been missing in the field, so that we can be most helpful to those who need us.”

Gorman is in a unique position to discuss concepts around psychedelic integration and harm reduction, having served on Phase 3 clinical trial teams that employ MDMA for PTSD (the same FDA trials participated in by Watchorn), as well as serving as a therapist on FDA-approved clinical trials using psilocybin-assisted treatment for alcohol use disorder and treatment-resistant depression. 

Co-author Dr. Elizabeth Nielson, who is also a co-founder of Fluence and has related FDA-approved clinical trial experience, underscores the need for honest and unbiased discussions around these stigmatized drugs. “Our clinical experience and review of the literature offer a way forward for the field of psychotherapy to engage psychedelics, even when patients’ psychedelic experiences occur outside of psychotherapy,” says Nielson. “By learning how to have honest, respectful, and non-judgmental conversations with patients about psychedelics, clinicians can counter the harms of years of prohibition, misinformation and stigma associated with these experiences.” 

As the public’s interest in psychedelic use continues to expand, ongoing studies in the field and peer-reviewed papers by informed researchers may provide therapists with another instrument in the clinician toolkit when working with patients who use, have ever used or are considering using psychedelics. 

Checking in with Watchorn this week, now three years since his MDMA treatments have concluded, he shares his perspective on integration. “My integration sessions were so confronting and profound, the feelings of relief and optimism were overwhelming for a long time,” he says. “Experiencing such radically different perspectives, feeling more universally connected than disconnected, noticing clarity in thoughts, colors, textures, smells. I’d find myself in tears, often daily, over the next eighteen months. Some of it was sadness — mourning the past. There was also the incredible sense of relief and strong unfamiliar feelings of freedom and optimism.” 

Watchorn says while he has frequently thought back on his experience through the MDMA treatments, he has not felt it necessary to have another MDMA treatment — integration is enough. He is echoing a sentiment by MAPS founder Rick Doblin, who said, “It’s not just about the MDMA experience itself, it’s about what you do with it. The whole point is not to need any MDMA.” 

Watchorn can attest to that. “In a nutshell, the treatment got me to a place where I could appreciate healthier perspectives and make conscious decisions,” he says. “The MDMA treatment wasn't a ‘cure switch,’ although it initially felt like one. It was a window of opportunity. Integration has been a whole new challenge. These days my focus is on being more present, curious and authentic — and it's making a world of difference.”

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This article was originally published on Forbes and appears here with permission.