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This isn’t a trip, it’s the most challenging therapy session of your life

April 10, 2026 • 5 min read • views
This isn’t a trip, it’s the most challenging therapy session of your life
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Become a member Login Full Interview This isn’t a trip, it’s the most challenging therapy session of your life Rachel Yehuda, a leading PTSD researcher, has spent her career uncovering the way that trauma can leave impressions on our genes, sometimes passing biological echoes of those events to the next generation. This isn’t a trip, it’s the most challenging therapy session of your life Rachel Yehuda Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience, is the Director of the Traumatic Stress Studies Division at Icahn School of Medicine, and the Mental Health Patient Care Center Director[…] Overview Transcript Related Episodes This isn’t a trip, it’s the most challenging therapy session of your life Rachel Yehuda Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience, is the Director of the Traumatic Stress Studies Division at Icahn School of Medicine, and the Mental Health Patient Care Center Director[…] Up Next A man sits on a chair in front of a white backdrop in a library with brick walls, wooden floor, shelves of books, and large windows. 1hr 26mins Full Interview The strongest arguments for and against the existence of God Instead of treating belief as a private preference, philosopher Alex O’Connor examines how our moral positions shape institutions, obligations, and the ways we justify our choices.  Alex O'Connor A man sits on a chair in front of a white backdrop in a modern room with brick walls, large windows, bookshelves, and minimal decor. 52mins Members Full Interview Over-optimizing your life is making you fragile, not better Brad Stulberg An older man with a beard sits on a chair in front of a white backdrop, with yellow neuron-like patterns on a black background surrounding the scene. 1hr 7mins Members Full Interview The science behind the strangest biological phenomena David J. 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Trauma doesn't end when the danger does, and for decades, science couldn’t explain why.

Rachel Yehuda, a leading PTSD researcher, has spent her career inside that question, uncovering the way that trauma can leave impressions on our genes, sometimes passing biological echoes of those events to the next generation.

Now, she’s focused on MDMA therapy, which could actually break the chain.

RACHEL YEHUDA: Hi, I'm Rachel Yehuda and I study post-traumatic stress disorder and the effects of trauma, including intergenerational trauma. [MUSIC] Chapter one, why trauma sticks? >> In graduate school, I studied the neuroscience of stress. Many people were studying that at the time, and post-traumatic stress disorder was a relatively new disorder. It was a very provocative and challenging concept because what the concept of post-traumatic stress disorder wanted you to understand was that the effects of stress were enduring. Stress theory at that time basically suggested that stress effects were temporary. They could be quite severe and serious at the time that you were undergoing a stressor. >> But that the natural way that the body had of dealing with stress was to recalibrate and achieve a kind of a homeostasis, kind of come back to itself. Whereas there was a lot to look at in terms of neuroscience in an organism that was under threat or that was undergoing stress. The idea that there was still something to see weeks, months, years, and even decades later was really interesting from the perspective of the neuroscience of stress. My current research is really about understanding long-term effects of stress and really entertaining the question of why we are so transformed when we undergo traumatic experiences and why the effects can linger for so long. We are looking at a variety of hormonal and molecular mechanisms to try to help us understand that. I'm also interested in treatment of PTSD and really what to do about the fact that so many people have effects of traumatic experiences that trouble them. They feel haunted by their traumatic experiences or they feel really stuck because of things that have happened to them in the past. So what's the best way to get unstuck and what's the best way to move forward following trauma exposure? So those are the things that my colleagues and I are studying. Why I've dedicated my career to studying the effects of trauma is because trauma exposure seems to be everywhere and increasingly the more we seem to be learning about the effects of trauma. In some ways the more stuck we're getting as a society. We see it as sort of an insurmountable burden or barrier when in fact there's always been stress and there's always been trauma. And truly there must also be a way to go forward in the face of trauma and use the lessons of trauma to really achieve resilience and post-traumatic growth. I think what's really helpful is to make the distinction between the experience of stress and the experience of trauma. So maybe what's useful is to talk about the difference between stress and trauma. We experience both. I'm pretty much a regular basis according to statistics. Many people see it as a kind of continuum with stress being maybe a less serious version of trauma and trauma sort of at the other end of the spectrum and that's not entirely wrong. A stressful event is something that is challenging to you in the moment. It could be a trouble at work, trouble in interpersonal relationships. It could be an illness or coping with really any of a number of things. When most people talk about a traumatic experience they're talking more in the order of life threat, interpersonal violence, childhood abuse, combat, being in a natural disaster. So clearly there is a range of challenging events with trauma being at the other end of the spectrum. But the differences go even deeper than that because when we talk about a stressful situation, once you remove the stressor or the thing that is giving you the symptoms and the angst or the challenge, usually you don't feel under the influence of the stressor anymore. You can relax and say things like, "Well that was stressful. I'm glad that's over now." I mean in fact when you used to go to a physician who used to tell you you were under too much stress, the solution to that problem was removing the stressor. But I think with trauma it's different because the effects of trauma can remain with you even after the event is in the rear view mirror. Even if there's no active threat, the person who perpetrated the violence is in prison, the war is over. You've fully recovered and rebuilt your house from the natural disaster. You can still feel the effects of that experience because it comes back to you. So the way that I like to think about a traumatic experience is an event that really divides your life. It's a watershed. And it's a event that will continue to be experienced by you in some way or continue to have some major presence in your life even though it is in the past. And that is just not true of stress when the solution to being under stress is to remove the threat. With trauma it's not quite as simple because some events really have a bigger power to transform us. I think what's also very important to understand when we're talking about traumatic events, I like to refer to them as potentially traumatic events, the kind of events that are capable of eliciting a post-traumatic stress disorder is that these events are way more common than we think. About 70% of people really around the world, but certainly in the United States, have experienced at least one of these potentially traumatic experiences in their lives and about 25% have experienced multiple life threatening or potentially life threatening events. When you look at the prevalence of PTSD compared to the prevalence of trauma exposure, what you begin to understand is that most people don't develop post-traumatic stress disorder when they're exposed to trauma. What's important about that is that trauma itself doesn't have the power to transform people. It's our responses to the trauma. But when you look at the statistics, you see that compared to the prevalence of trauma, which is quite high, the prevalence of post-traumatic stress disorder is quite a bit lower. The important thing about a traumatic event is really how you process it, what you think about it, why you think it happened. And you know what's really interesting about the prevalence of post-traumatic stress disorder is that it varies from nation to nation. They've done studies on this. And so sometimes that's linked to the fact that there are more trauma exposures in one country and war-torn countries versus other countries. But it's not simply that. Culture has a very important role in teaching us how we respond to traumatic events. We've done such a good job of validating the experience of trauma exposure and of letting people know that traumatic experiences can result in mental health symptoms, that it's not stigmatizing to develop symptoms of anxiety or depression or just to feel very incapacitated. Perhaps we've done too good a job on this concept because I think people automatically assume that if they're exposed to trauma, they're going to develop a mental health problem. And so what we need to do is really underscore the idea that trauma is something that is survivable and that we have tools to help people who have been exposed to trauma recalibrate and really work with what has happened so that they don't remain permanently stuck. Chapter two. How MDMA assisted therapy can break the loop. What's the thing about trauma is a prison, we're all kind of doomed because traumatic experiences are here to stay and we shouldn't view them as a prison. We should view them as simply an occurrence because that's what they are. And of course traumatic experiences are going to be very challenging and they have the power to be extremely disruptive and they have the power to produce a lot of mental health symptoms. But there are ways to also be resilient. There are ways to cope with trauma and there are ways to do amazing things not only despite the trauma but because of the trauma. When we talk about using psychedelic assisted psychotherapy to heal from trauma and to heal from post-traumatic stress disorder, what we're really trying to do is use the power of psychedelics to induce kind of an altered state to help people do the work of trauma-focused therapy that is often very hard to do when you're in an ordinary state of consciousness. The reason that it's so hard for people in the aftermath of a trauma is not only because something terrible has just happened but because they construct a narrative about why it happened and what they did wrong as a result of it happening. But a woman who's been exposed to interpersonal violence can get the impression that maybe if she would have fought harder or worked harder or didn't send certain signals into the stratosphere that she could have prevented this or that she was maybe too passive and didn't fight as hard as she could have. And this is really what's sustaining the post-traumatic stress disorder. It's not just that she was violated but that she disappointed herself in her own actions. Even something like 9/11 which was 20 years ago, had a lot of people who were murdered whether trying to run and save themselves was the best course of action, maybe they should have gone back and maybe they should have helped other people struggling to get out of the burning building. So there's a lot of room after a traumatic exposure to kind of second-guess yourself. And what happens is that this narrative can be perpetuated every time you think about the traumatic event which can be very often. And you start to believe that the problem isn't only what happened but it's you. When you use conventional therapies to try to get at these, we call them "altered cognitive schemas" or "altered cognitions". When you try to use cognitive behavioral therapies to get people to look at some of these ideas, what happens is that they can get very, very distressed. And so many times they give up on the therapy and right now we have cognitive behavioral therapies for PTSD that can work quite well for people but also equally many people find that these therapies are just too emotionally draining or too distressing for them. A lot of trauma survivors with PTSD feel really alienated. They feel different. They try to avoid people. Sometimes it's because they don't want to hurt the ones that they love because they feel inside that they're very aggressive or they don't want to get really too close to someone that they were once close to because that person might start asking questions and the trauma survivor doesn't want to give them horrific details about what happened to them. Mostly out of protecting the person or out of this feeling that once a person understands what happened to them, they may not want to see them the same way. It's distancing and all the partner experiences is that they've lost their loved one in some fundamental way that sometimes they can't even name. MDMA is now undergoing kind of the last stage before FDA approval. And in phase two and phase three studies, MDMA has shown remarkable efficacy for reducing symptoms of PTSD and about two thirds of people that are treated report no longer having PTSD and also report feeling changed in a very positive direction. That's a very, very high rate of recovery for any kind of a treatment and that's why it's exciting. MDMA is not a classic psychedelic. It works very differently than say, psilocybin, which is commonly referred to as magic mushrooms or LSD or ayahuasca. Those experiences produce a much more dramatic out of body experience or mystical experience or even a sense that you might even have an ego dissolution, your sense of self and maybe blending into a larger cosmos. Those experiences can be very, very powerful. I think those kinds of psychedelics can and should be tried in PTSD. They might be very interesting. But they're different because while you're having those kind of experiences, it's hard to do psychotherapy. It's hard to be coherent in a sentence. A lot of the healing work with those kind of classic psychedelics are occurring really after in integration, which is usually very short in clinical trials, but ideally the material that is brought up in that kind of a session can be talked about for a long time in therapy. With MDMA, this is just psychotherapy. A lot of the therapeutic work is being done in the session while you're in the altered state because you can be coherent because you are not having an ego dissolution experience. Those people, but not all, experience a sense of pleasure. It's called ecstasy. It gives your body a good feeling sometimes. Some people during the session can also report feeling not so good. Sometimes people say, "I don't know why they call this ecstasy," but that's because they're also re-experiencing very difficult memories. But being in a situation where you feel calm and serene can have different effects in different people, but being in a state where you're not so worried about getting agitated can be very helpful for processing traumatic memories. So for example, a woman who's been exposed to interpersonal violence as an adult or even a child may be able to look past the self-flame and the disappointment that she feels in herself to really seeing that really she was always with really the responses that she made at the time with the ones that were most conducive to keeping her alive. But instead of just understanding this intellectually, which is what happens in cognitive behavioral therapy, she feels it as a truth. She sees it in a different and more powerful way and she sees it in a way that is also infused with compassion for herself and similarly a combat veteran might also be able to understand that the monster that he feels that is now inside of him is actually a monster he can let go of because that part of him that was aggressive saved him in a situation where it was life or death and also was brought about by the need to provide service to keep others alive, which is an extraordinary thing that combat veterans certainly in the United States and also around the world often do voluntarily. Being in a state that is induced by a psychedelic such as MDMA may enhance your empathy for yourself, your introspection, your ability to see things differently and also make you feel part of the world. The idea of the cognitive behavioral therapies has always been really correct. The idea is to kind of go back there and correct some of the faulty assumptions that you have about yourself in the world as a result of the traumatic experiences. Why they didn't work as well as we had hoped they would work for as many people as we had hoped they would work for is because some of the things that happened to people are really horrible. And so going back and trying to discuss this in an ordinary state of consciousness is just too much for people. So a lot of times I'm certainly aware of this people engage in cognitive behavioral therapy and they talk about a trauma but it isn't the trauma because they just can't bear to go into something so deeply distressing and so many people have had aspects of a traumatic experience that they can talk about but that they hold something back. In our society unfortunately we have given some people the message. Perhaps unintentionally or unwittingly that if they would have only done something different during a traumatic experience it wouldn't have happened. They might have been able to prevent it. I remember my mother telling me that when the Holocaust survivors came from Europe to Israel after the war a lot of people asked them why they went like lamps to the slaughter. And there were so many of you that were so few of the Nazis like how did you let this happen? Obviously that's really not the right thing to say to a trauma survivor. What it does though is it makes you wonder well why did I go to a lamp to slaughter? The influence of a psychedelic you may really understand that you had absolutely no choice with all those machine guns firing at you and aimed at your loved one and if you didn't march they would die. So we create a lot of narratives in our society sometimes that suggest to people that they have choices during a trauma that they may not have. Plus which we don't often understand that the biologic reality of the fight or flight response is really to try to preserve one's life. You're not really stepping through this cognitive process at the time of a trauma you're just trying to survive. I think part of the reason that we sometimes do second-guess trauma survivors is because of our own difficulty hearing traumatic material and in fact the reason it's important for people with severe PTSD to go and seek therapy is because you do have to be trained to kind of not have these reactions to somebody's trauma to listen non-judgmentally and with extraordinary empathy and compassion for someone as they're telling their tale. What most people find when they really go into a deep state where they have empathy and when they are in the presence of therapists that can help them process the traumatic experience is that they actually were heroes. That they survived something that was designed to kill them or hurt them. And that they did so as best as could be expected in the time and that the reason they did so is because life is worth living. And that now they can kind of take some of that and try to regain that will to live without worrying that they may be horribly defective not only because of what the trauma did but because of the because of who they were that they weren't able to overcome the experience of adversity. So in part there's a cultural message and a societal message here that we need to really let trauma survivors know that we understand how difficult it was and really embrace their survival and adaptation. But sometimes we live in a society that's pretty judgmental and so that can add fuel to the fire when combat veterans returned home from the Vietnam War. I think one of the biggest contributors to their ongoing symptoms and their subsequent readjustment was being called baby killers. That is a great example of how to not help somebody get over combat trauma. So thinking people for their service and understanding the absolutely impossible situation that somebody is in is more appropriate to helping combat survivors heal because it reminds them that they were doing a mission perhaps in an extraordinary cost. One of the ways that I like to think about how a psychedelic assists the psychotherapy process is really based on a quote from Stan Groff which says that psychedelic is to the brain what the telescope is to astronomy or the microscope is to biology just allows you to go deeper and see things that perhaps you couldn't ordinarily see. And I think that's exactly why these compounds have so much potential and particularly MDMA for PTSD because it allows you to get past this initial layer that you can't see which is how did I let this happen or how could this have happened to me and go to that next layer that perhaps is more microscopic which is because I couldn't do anything else because I had no other options and it also developed that sense of self-compassion that allows you to understand that you don't need to be punished or punish yourself because you didn't live up to your own expectations for how you should have behaved. I think the most important thing to let people know about psychedelic assisted psychotherapy if you're using it for the purpose of healing for mental health symptoms is that intention is very important. It's not only intention it's the desire to go deeper than you've been able to go. On some level you have to have this sense that I know I need to be going deeper I just can't it's too upsetting it's too traumatic it's too difficult and really using the medicine for what it is there to do which is help you see that thing that you can't see with your naked eye and really wanting to see it. The MDMA or any psychedelic really won't have healing properties if you're afraid to have the experience or if you're reluctant about it it's like saying well look through the telescope but I'm also going to put my hand on the back of the telescope because I'm really kind of afraid of what I might see. There are ways to be avoidant even using a psychedelic assisted psychotherapy. It's very important to not give people the impression that there's a passive cure. You lie down there on the bed you take MDMA you swallow it with some water and magical things start to happen in terms of processing trauma. That isn't what the therapy is about. Ideally therapists who really know how to work with trauma in an ordinary state can use those tools and techniques to help you do the work of pushing forward while you are in the state induced by MDMA and really kind of help you supercharge the psychotherapy. The way that this is being rolled out for PTSD is more medicalized. It is that's not to say that people won't have good experiences with psychedelics that are taken outside of their context. People really show a range of different experiences ranging from this saved my life to I'm not doing that again that was pretty bad. Psychedelics are really interesting that way so much of how they're going to work has to do with where you are, who you're with, what your intention is and also probably your internal biochemistry so there's no way to really predict it. Even though this treatment has been found to work in two thirds of people with PTSD there's this other third. So everyone that tries this treatment has to understand that people respond very differently to different kind of medications and to make sure that you're working with somebody really ethical and can respect your boundaries. Anyone that is in an altered state of consciousness is more vulnerable and so you really want to make sure you're working with people of the highest not only therapeutic skill but ethical standards. What's fascinating about psychedelics is that the same person can have remarkably different responses in different settings. When we talk about MDMA assisted psychotherapy for PTSD we're talking about a process where there's readiness where we prepare people to work with the medicine. We talk a lot about what the experience will be like and what they want to get out of it and what some of the stuck points have been. What their hopes are for getting past those stuck points. There are 390 minute sessions to do that. Not to mention that these are patients you might have known and have tried to work with for a long time before the MDMA assisted psychotherapy and they need work during the session, any work after the session and the way that the MDMA assisted psychotherapy is structured right now there are going to be three medicine sessions. So you have three very long days to kind of get where you need to go and hopefully you can make great strides with it but for anyone that thinks this is a quick fix. That's a perception that needs to be corrected because the way that it's being rolled out right now with clinical trials with the FDA is a three month experience with 12 psychotherapy sessions in addition to the medication sessions. It's a commitment that somebody is making towards their own healing and working in a very non passive way to try to really understand what it is they saw so that they can make something out of it and tackle their lives in a different way. When people hear this kind of stuff about how great MDMA assisted psychotherapy is or psychedelics, there are psychedelic experiences in general and they have a natural curiosity to want to try it or they want to see if they can learn more about themselves. I mean that's a very natural reaction. It's important to understand that not everybody responds the same way. It's important to adjust one's expectations of this and really be in the hands of somebody that is very trusted. Different states in the United States are experimenting with different levels of decriminalization and legalization. So I suspect that we will have a lot more information about the effects of psychedelics in the general population. When you think about psychotherapy, that was initially meant for people that had serious mental health issues and a lot of people go for psychotherapy even if they don't have a mental health disorder. We may see after we have enough experience with psychedelic assisted psychotherapy in clinical populations. That might be a very natural transition that it might be particularly helpful and maybe easier in some ways for people that don't have as intransigent mental health symptoms. Obviously want to understand themselves better. So it's an exciting time to see what the future brings. Chapter 3, healing can echo across generations. One of the dilemmas that people had when they first heard about the diagnosis of PTSD or thought about the enduring effects of trauma is how can an event in the past continue to exert symptoms, continue to exert biologic effects? Why can we measure the blood or the brain in people that have post-traumatic stress disorder and see differences even though the event is passed? When we look at some of the hormonal changes that we see in people that have post-traumatic stress disorder, you don't really see the kind of things that you would see in someone that is undergoing stress. And one of the biggest examples of that is that people with post-traumatic stress disorder have lower cortisol levels. Cortisol is a hormone that is released by the adrenals during stress. It is designed to help you cope with the fight or flight challenge. We think that lower levels of cortisol are part of why the stress response doesn't fully shut off and continues to live on in some ways. But it wasn't until we began looking at epigenetic mechanisms or molecular mechanisms for the stress hormone receptors that we began to understand that perhaps one of the things that are allowing kind of the enduring effects of trauma are changes that are actually made into how those receptors work in the long run. So that in response to a very big traumatic event earlier on, there can actually be molecular changes and epigenetic changes that can change the way that the stress receptor genes function and really in some way keep alive a stress response. Many people have misconceptions about epigenetics. Epigenetics refers to the study of how genes are regulated. A lot of epigenetic mechanisms occur during development and help really with the complex choreography of which genes are firing at any given time. It explains something very real about why things just don't go back to normal. When epigenetic mark, once it's on the DNA, it survives cell division so that the daughter cells that are formed when the cell replicates itself through the process of mitosis and also meiosis, which is the process of making sperm and egg. The epigenetic mark is robust and it can survive cell division. A lot of excitement occurred a few decades ago when people began to understand that experience can also influence epigenetics. Now people talk a lot about how trauma influences epigenetics, but trauma is just another example of an environmental influence that can have a profound effect. The experience of treatment is also an environmental experience that can have profound effects and some of the work that we have done in the last decade has really demonstrated an improved response to treatment even to psychotherapy. When it comes to understanding issues like, well, how does psychedelics work? Why do they produce, if they do, a long lasting, enduring and transformative response? Many people who are treated with MDMA-assisted psychotherapy for PTSD actually say, "I feel really different now about my PTSD symptoms." First of all, they have far fewer PTSD symptoms. They also feel more self-compassionate and they also feel ready to kind of take the next step in life. They feel transformed. The word "transformed" could have also been used to describe how they felt when they had their traumatic experience to begin with. I'm not the same person that I used to be. And probably epigenetic mechanisms will be very important in helping us understand both the kind of transformative and enduring changes that occurred following trauma exposure and the ones that are associated with deep healing. It's not about a good event or a bad event. It's just about experience and the impact that experience can potentially have in regulating stress-responsive genes. Well, one of the really interesting things about epigenetics of PTSD and the epigenetics of recovery from trauma is that we found changes in the same region of the same stress-related gene in both situations. That there are epigenetic changes that on stress-related genes that might explain enduring effects and might also explain why we're more sensitized to our environments. And that somehow when people are successfully treated with PTSD, that you see some of those epigenetic changes again on those same genes, but in a reverse direction. So it's important to understand about epigenetics, and this is that you're not stuck just because there's an epigenetic change. If a certain region of a certain gene is responsive to the environment, then make healing environments so that we can transform in positive directions and I think to me that's really the message. I think it's really important to not take the epigenetics too literally and try to tie little regions on little marks on genes to specific behaviors. Certainly when people start talking about intergenerational epigenetic effects, we're not carrying trauma with us. These changes are not necessarily responsible for all the behaviors, but they're present. And their presence is probably a way to really allow the experience to stick with us for some reason. I'd like to think that epigenetics provides a mechanism for adaptation. Traumatic experiences really in essence provide a way of learning. Sometimes we don't like the lesson, but a traumatic event may teach us that certain situations are dangerous. And we want to have a way of really recollecting that and really acting on that so that we don't find ourselves in harm's way as often, or if we do, we can mount a response. When people talk about intergenerational transmission of trauma, which I'd really like to correct, it's not intergenerational transmission of trauma, it's the idea that people in a subsequent generation may feel the effects of a trauma in a first generation. Maybe that is a way of kind of transmitting a lesson to the next generation about how to cope or about a potential dangerous situation or scenario. So the idea is that really it's a type of wisdom. I just want to correct this idea that trauma is inherited or trauma sticks with us for generations. That's not what the science says. What the science says is that there are epigenetic marks in the adult children of trauma survivors in the same location as in the trauma survivors. And so there are a lot of questions that we could ask about why that might be so and how did those marks get there. But what's inescapable is that many people feel that it's not just the genes that they inherited, it's the experiences that the parents have also had, whether they be personal or cultural experiences that are very shaping and determine much of who they are. We have to start thinking about epigenetics also in terms of what it tells us about adaptation and resilience. What lessons do we take forward that can help us cope with adversity should we have to experience something the way our prior generation did. Our work was done primarily in the adult children of Holocaust survivors, and many of them feel very hyper vigilant as if somebody is trying to hurt them or chasing after them for no reason other than who they are. That's a trauma they're parent-experienced. And so this hyper vigilance may not serve them in a world where nobody is chasing after them. But once there's anti-Semitism, again, and they notice it, they might be more attuned to it. And being more attuned to anti-Semitism might end up being something that is adaptive if that is indeed what is happening in society. There are biologic mechanisms to keep the effects of experience alive from one generation to the next. We don't know if they're memories, we don't really know what form they take, but we know that it is kind of a biologic possibility, and this has opened up a lot of questions and a lot of potential excitement. For many people, it just means that what I feel is real, and that's good too. We really are very affected by cultural and societal and personal experiences of previous generation or generations. Really does form a tremendous amount of our identity, and it forms the basis of how we do respond to adversity when it occurs from a cultural and societal perspective. But what it might also mean is that responding to mass casualty and mass trauma and big traumas in our society may not be only a mental health problem, but it might be a problem of creating resilient and healing societies so that we have a mechanism for positive transformation and change, and we can use the power of culture and society to help each other cope from adversity rather than kind of use it to make us feel more isolated and stigmatized like we let people down by the fact that trauma occurred or how we responded to it. The legacy that we have most often from our parents and prior generations is that whatever they went through, they survived, and that's why we exist. We're here because someone survived trauma. And then the question is what's the next step beyond survival? It's restoring, repairing, achieving resilience, achieving growth and really understanding how to go forward despite being exposed to trauma. It's beyond just surviving to living. How do we then do that? One of the benefits of having a complete healing, which I think is possible with psychedelic assisted psychotherapy because it's not about just dampening symptoms. It's not about just giving a medication so that you can sleep better or that you no longer feel depressed or anxious or hyper-vigilant. It's really about going deep and correcting and changing this narrative that you got stuck in that is some version of how bad you are and how deserving you were of this trauma. But now you're having a different narrative about how you actually survived, did the best you could, and you have not only a more compassion for yourself, but you feel that you can take your rightful place in society, that you are part of the world, you are part of the earth. And having that legacy can be profound from animal research is that, and this is not our work, this is work that was done at Emory University, if you subject a male mouse to a cherry blossom and then shock the mouth, that mouse can develop a fear of that cherry blossom. That fear of the cherry blossom is associated with epigenetic changes in brain and sperm, and if that mouse is mated, that mouse's male offspring will also have the same changes in the epigenetic, in brain and sperm, but will also, inexplicably, be afraid of cherry blossoms, even though you didn't have to shock that offspring in order to be afraid. And that is a really powerful demonstration of what we're talking about, when we're talking about behavioral epigenetics and the kind of things that can be passed. But if you use fear extinction on that male mouse, that you continue to expose the cherry blossom to that mouse that is now afraid of the cherry blossom, such that he now becomes sensitized and says, "Okay, I guess a cherry blossom doesn't mean I'm going to be shocked," and then make the mouse. That offspring doesn't have the epigenetic changes in the brain and sperm. So this is a very profound example of what we're trying to achieve here. By trying to understand the epigenetics of what occurs in healing, generally and also in response to psychedelic assisted psychotherapy, we're just wondering whether that can kind of restore a certain biological equilibrium. The real beneficiaries of successful PTSD treatment are the next generation in some very real way. Not necessarily only because of epigenetic changes, but because a change in their parent is going to make a gigantic difference in their lives. So many people think that one of the mechanisms of how psychedelic assisted psychotherapy can help us process trauma is that it reduces the fear involved in approaching traumatic memories. And that can allow, once you don't have the fear of talking about the trauma, that can allow for new mechanisms in a way that this can facilitate a fear extinction if you think the problem is the fear. And there are studies that have also shown that MDMA specifically can dampen down some of the activity in the amygdala that occurs when a trauma survivor is exposed to a traumatic reminder or a script of their trauma. That is definitely one of the mechanisms that might be at play here. But it's really important to understand that fear is only one component of why people have enduring post-traumatic stress symptoms and overemphasizing the link between fear and PTSD is, I think, leads us to focus really on things like extinguishing a fear response without delving into why there is such an over-consolidated fear response to begin with and why there might be such an over-consolidated fear response might have to do with guilt and might have to do with shame and self-blame and all of the other kinds of narratives. One of the things I really like about the MDMA-assisted psychotherapy approach is that it's not directed. That the therapists are trained to follow the patient's process, to go where the patient goes. The patient might not go to "I'm scared." The patient might go to "I'm bad and always have been" and then go leapfrog straight over the event that was discussed in preparation to something that happened in childhood. We don't fully understand why we respond to events the way we do. When a person is exposed to a traumatic event in adulthood, they've already lived a life and there might be a lot of events from their past that are contributing to why they think that something that happened was their fault. And they may identify one of those early events and that has to be corrected in some profound way or a person needs to develop a large sense of empathy for that five-year-old, for example, or that six-year-old that maybe didn't get something that they should have gotten or maybe has been harboring some sort of a secret inside. Again, we don't all respond to trauma with PTSD. That's very important. It means that it's not just the exposure alone that put us here. The kind of the beauty of the psychedelic assisted psychotherapy experience is that it keeps it open. And I think some of the limitations of the current cognitive behavioral approaches have been this narrowing on. We're going to talk about this trauma. We're going to focus on what happened to you that you believe is the focus of your symptoms. Without understanding that, you know what? It could be something before. It could also be something that happened after the trauma. Someone spoke to a veteran who told me anything that happened to him in war paled by comparison to the systemic racism that he experienced when he came back from war. It pales in comparison to the sense that even after I served my country dispensable, I am not worthy and I am lesser. And so I think that what we have to understand is that there are factors before that contributed to how you're going to respond to a trauma in the moment. There are factors after the traumatic event that are equally as important and they have to do with how we're treated by our loved ones, by society at large, and how we treat ourselves. So it's just this whole long chain. And when you have an experience with psychedelics, the whole thing is open. If you're with trained people, they're not going to shift your focus and call it avoidance if you don't stick with the traumatic experience that we've agreed is the source of your problem. You may be open to identifying the kind of things that are really impeding your recovery or the kind of things that you really can't get past. And so a lot of the time, if we're in abusive or traumatic environments after we sustain a trauma, that just makes it a lot harder. And so sometimes with a psychedelic assisted psychotherapy, you're more able to broadly understand what in the here and now needs to be changed, even though it doesn't have to do with a then and there. And so what kind of change can I make to improve my here and now so that I can recover from the trauma. And the other aspect is really that we're not just looking to neutralize something negative. We're trying to learn from a traumatic experience. And for many people that heal successfully, what that looks like is them taking everything that they learned about what it is to be exposed to trauma and helping the next person who is exposed to trauma. This is what I should have gotten. This is what I want to give you. This is what I wish somebody would have taught me and to teach them to be self-compassionate so that we create a more healing society. What I hope viewers take away from this is that there's hope. I've talked to so many trauma survivors with PTSD or maybe even other mental health conditions who really feel that because the trauma happened and because we can't erase the fact that the trauma happened, they're just going to be stuck and unless somehow we can go back in the past and change the course of history, they're going to be in the state that they're in forever. And I think what this kind of public education message is all about is letting people know that there are so many ways to begin to deal with even the most severe PTSD cases and that if you're watching this and you or someone that you know or love is struggling because a traumatic experience occurred to them, trauma and PTSD are things that the mental health community has made great advances in. And psychedelic medicine in particular really offers a lot of hope for people who have not benefited from more traditional forms of psychotherapy or medicine. [music] Want to support the channel? Join the Big Think Members community where you get access to videos early, add free. [MUSIC PLAYING]

Overview Transcript

Trauma doesn't end when the danger does, and for decades, science couldn’t explain why.

Rachel Yehuda, a leading PTSD researcher, has spent her career inside that question, uncovering the way that trauma can leave impressions on our genes, sometimes passing biological echoes of those events to the next generation.

Now, she’s focused on MDMA therapy, which could actually break the chain.

RACHEL YEHUDA: Hi, I'm Rachel Yehuda and I study post-traumatic stress disorder and the effects of trauma, including intergenerational trauma. [MUSIC] Chapter one, why trauma sticks? >> In graduate school, I studied the neuroscience of stress. Many people were studying that at the time, and post-traumatic stress disorder was a relatively new disorder. It was a very provocative and challenging concept because what the concept of post-traumatic stress disorder wanted you to understand was that the effects of stress were enduring. Stress theory at that time basically suggested that stress effects were temporary. They could be quite severe and serious at the time that you were undergoing a stressor. >> But that the natural way that the body had of dealing with stress was to recalibrate and achieve a kind of a homeostasis, kind of come back to itself. Whereas there was a lot to look at in terms of neuroscience in an organism that was under threat or that was undergoing stress. The idea that there was still something to see weeks, months, years, and even decades later was really interesting from the perspective of the neuroscience of stress. My current research is really about understanding long-term effects of stress and really entertaining the question of why we are so transformed when we undergo traumatic experiences and why the effects can linger for so long. We are looking at a variety of hormonal and molecular mechanisms to try to help us understand that. I'm also interested in treatment of PTSD and really what to do about the fact that so many people have effects of traumatic experiences that trouble them. They feel haunted by their traumatic experiences or they feel really stuck because of things that have happened to them in the past. So what's the best way to get unstuck and what's the best way to move forward following trauma exposure? So those are the things that my colleagues and I are studying. Why I've dedicated my career to studying the effects of trauma is because trauma exposure seems to be everywhere and increasingly the more we seem to be learning about the effects of trauma. In some ways the more stuck we're getting as a society. We see it as sort of an insurmountable burden or barrier when in fact there's always been stress and there's always been trauma. And truly there must also be a way to go forward in the face of trauma and use the lessons of trauma to really achieve resilience and post-traumatic growth. I think what's really helpful is to make the distinction between the experience of stress and the experience of trauma. So maybe what's useful is to talk about the difference between stress and trauma. We experience both. I'm pretty much a regular basis according to statistics. Many people see it as a kind of continuum with stress being maybe a less serious version of trauma and trauma sort of at the other end of the spectrum and that's not entirely wrong. A stressful event is something that is challenging to you in the moment. It could be a trouble at work, trouble in interpersonal relationships. It could be an illness or coping with really any of a number of things. When most people talk about a traumatic experience they're talking more in the order of life threat, interpersonal violence, childhood abuse, combat, being in a natural disaster. So clearly there is a range of challenging events with trauma being at the other end of the spectrum. But the differences go even deeper than that because when we talk about a stressful situation, once you remove the stressor or the thing that is giving you the symptoms and the angst or the challenge, usually you don't feel under the influence of the stressor anymore. You can relax and say things like, "Well that was stressful. I'm glad that's over now." I mean in fact when you used to go to a physician who used to tell you you were under too much stress, the solution to that problem was removing the stressor. But I think with trauma it's different because the effects of trauma can remain with you even after the event is in the rear view mirror. Even if there's no active threat, the person who perpetrated the violence is in prison, the war is over. You've fully recovered and rebuilt your house from the natural disaster. You can still feel the effects of that experience because it comes back to you. So the way that I like to think about a traumatic experience is an event that really divides your life. It's a watershed. And it's a event that will continue to be experienced by you in some way or continue to have some major presence in your life even though it is in the past. And that is just not true of stress when the solution to being under stress is to remove the threat. With trauma it's not quite as simple because some events really have a bigger power to transform us. I think what's also very important to understand when we're talking about traumatic events, I like to refer to them as potentially traumatic events, the kind of events that are capable of eliciting a post-traumatic stress disorder is that these events are way more common than we think. About 70% of people really around the world, but certainly in the United States, have experienced at least one of these potentially traumatic experiences in their lives and about 25% have experienced multiple life threatening or potentially life threatening events. When you look at the prevalence of PTSD compared to the prevalence of trauma exposure, what you begin to understand is that most people don't develop post-traumatic stress disorder when they're exposed to trauma. What's important about that is that trauma itself doesn't have the power to transform people. It's our responses to the trauma. But when you look at the statistics, you see that compared to the prevalence of trauma, which is quite high, the prevalence of post-traumatic stress disorder is quite a bit lower. The important thing about a traumatic event is really how you process it, what you think about it, why you think it happened. And you know what's really interesting about the prevalence of post-traumatic stress disorder is that it varies from nation to nation. They've done studies on this. And so sometimes that's linked to the fact that there are more trauma exposures in one country and war-torn countries versus other countries. But it's not simply that. Culture has a very important role in teaching us how we respond to traumatic events. We've done such a good job of validating the experience of trauma exposure and of letting people know that traumatic experiences can result in mental health symptoms, that it's not stigmatizing to develop symptoms of anxiety or depression or just to feel very incapacitated. Perhaps we've done too good a job on this concept because I think people automatically assume that if they're exposed to trauma, they're going to develop a mental health problem. And so what we need to do is really underscore the idea that trauma is something that is survivable and that we have tools to help people who have been exposed to trauma recalibrate and really work with what has happened so that they don't remain permanently stuck. Chapter two. How MDMA assisted therapy can break the loop. What's the thing about trauma is a prison, we're all kind of doomed because traumatic experiences are here to stay and we shouldn't view them as a prison. We should view them as simply an occurrence because that's what they are. And of course traumatic experiences are going to be very challenging and they have the power to be extremely disruptive and they have the power to produce a lot of mental health symptoms. But there are ways to also be resilient. There are ways to cope with trauma and there are ways to do amazing things not only despite the trauma but because of the trauma. When we talk about using psychedelic assisted psychotherapy to heal from trauma and to heal from post-traumatic stress disorder, what we're really trying to do is use the power of psychedelics to induce kind of an altered state to help people do the work of trauma-focused therapy that is often very hard to do when you're in an ordinary state of consciousness. The reason that it's so hard for people in the aftermath of a trauma is not only because something terrible has just happened but because they construct a narrative about why it happened and what they did wrong as a result of it happening. But a woman who's been exposed to interpersonal violence can get the impression that maybe if she would have fought harder or worked harder or didn't send certain signals into the stratosphere that she could have prevented this or that she was maybe too passive and didn't fight as hard as she could have. And this is really what's sustaining the post-traumatic stress disorder. It's not just that she was violated but that she disappointed herself in her own actions. Even something like 9/11 which was 20 years ago, had a lot of people who were murdered whether trying to run and save themselves was the best course of action, maybe they should have gone back and maybe they should have helped other people struggling to get out of the burning building. So there's a lot of room after a traumatic exposure to kind of second-guess yourself. And what happens is that this narrative can be perpetuated every time you think about the traumatic event which can be very often. And you start to believe that the problem isn't only what happened but it's you. When you use conventional therapies to try to get at these, we call them "altered cognitive schemas" or "altered cognitions". When you try to use cognitive behavioral therapies to get people to look at some of these ideas, what happens is that they can get very, very distressed. And so many times they give up on the therapy and right now we have cognitive behavioral therapies for PTSD that can work quite well for people but also equally many people find that these therapies are just too emotionally draining or too distressing for them. A lot of trauma survivors with PTSD feel really alienated. They feel different. They try to avoid people. Sometimes it's because they don't want to hurt the ones that they love because they feel inside that they're very aggressive or they don't want to get really too close to someone that they were once close to because that person might start asking questions and the trauma survivor doesn't want to give them horrific details about what happened to them. Mostly out of protecting the person or out of this feeling that once a person understands what happened to them, they may not want to see them the same way. It's distancing and all the partner experiences is that they've lost their loved one in some fundamental way that sometimes they can't even name. MDMA is now undergoing kind of the last stage before FDA approval. And in phase two and phase three studies, MDMA has shown remarkable efficacy for reducing symptoms of PTSD and about two thirds of people that are treated report no longer having PTSD and also report feeling changed in a very positive direction. That's a very, very high rate of recovery for any kind of a treatment and that's why it's exciting. MDMA is not a classic psychedelic. It works very differently than say, psilocybin, which is commonly referred to as magic mushrooms or LSD or ayahuasca. Those experiences produce a much more dramatic out of body experience or mystical experience or even a sense that you might even have an ego dissolution, your sense of self and maybe blending into a larger cosmos. Those experiences can be very, very powerful. I think those kinds of psychedelics can and should be tried in PTSD. They might be very interesting. But they're different because while you're having those kind of experiences, it's hard to do psychotherapy. It's hard to be coherent in a sentence. A lot of the healing work with those kind of classic psychedelics are occurring really after in integration, which is usually very short in clinical trials, but ideally the material that is brought up in that kind of a session can be talked about for a long time in therapy. With MDMA, this is just psychotherapy. A lot of the therapeutic work is being done in the session while you're in the altered state because you can be coherent because you are not having an ego dissolution experience. Those people, but not all, experience a sense of pleasure. It's called ecstasy. It gives your body a good feeling sometimes. Some people during the session can also report feeling not so good. Sometimes people say, "I don't know why they call this ecstasy," but that's because they're also re-experiencing very difficult memories. But being in a situation where you feel calm and serene can have different effects in different people, but being in a state where you're not so worried about getting agitated can be very helpful for processing traumatic memories. So for example, a woman who's been exposed to interpersonal violence as an adult or even a child may be able to look past the self-flame and the disappointment that she feels in herself to really seeing that really she was always with really the responses that she made at the time with the ones that were most conducive to keeping her alive. But instead of just understanding this intellectually, which is what happens in cognitive behavioral therapy, she feels it as a truth. She sees it in a different and more powerful way and she sees it in a way that is also infused with compassion for herself and similarly a combat veteran might also be able to understand that the monster that he feels that is now inside of him is actually a monster he can let go of because that part of him that was aggressive saved him in a situation where it was life or death and also was brought about by the need to provide service to keep others alive, which is an extraordinary thing that combat veterans certainly in the United States and also around the world often do voluntarily. Being in a state that is induced by a psychedelic such as MDMA may enhance your empathy for yourself, your introspection, your ability to see things differently and also make you feel part of the world. The idea of the cognitive behavioral therapies has always been really correct. The idea is to kind of go back there and correct some of the faulty assumptions that you have about yourself in the world as a result of the traumatic experiences. Why they didn't work as well as we had hoped they would work for as many people as we had hoped they would work for is because some of the things that happened to people are really horrible. And so going back and trying to discuss this in an ordinary state of consciousness is just too much for people. So a lot of times I'm certainly aware of this people engage in cognitive behavioral therapy and they talk about a trauma but it isn't the trauma because they just can't bear to go into something so deeply distressing and so many people have had aspects of a traumatic experience that they can talk about but that they hold something back. In our society unfortunately we have given some people the message. Perhaps unintentionally or unwittingly that if they would have only done something different during a traumatic experience it wouldn't have happened. They might have been able to prevent it. I remember my mother telling me that when the Holocaust survivors came from Europe to Israel after the war a lot of people asked them why they went like lamps to the slaughter. And there were so many of you that were so few of the Nazis like how did you let this happen? Obviously that's really not the right thing to say to a trauma survivor. What it does though is it makes you wonder well why did I go to a lamp to slaughter? The influence of a psychedelic you may really understand that you had absolutely no choice with all those machine guns firing at you and aimed at your loved one and if you didn't march they would die. So we create a lot of narratives in our society sometimes that suggest to people that they have choices during a trauma that they may not have. Plus which we don't often understand that the biologic reality of the fight or flight response is really to try to preserve one's life. You're not really stepping through this cognitive process at the time of a trauma you're just trying to survive. I think part of the reason that we sometimes do second-guess trauma survivors is because of our own difficulty hearing traumatic material and in fact the reason it's important for people with severe PTSD to go and seek therapy is because you do have to be trained to kind of not have these reactions to somebody's trauma to listen non-judgmentally and with extraordinary empathy and compassion for someone as they're telling their tale. What most people find when they really go into a deep state where they have empathy and when they are in the presence of therapists that can help them process the traumatic experience is that they actually were heroes. That they survived something that was designed to kill them or hurt them. And that they did so as best as could be expected in the time and that the reason they did so is because life is worth living. And that now they can kind of take some of that and try to regain that will to live without worrying that they may be horribly defective not only because of what the trauma did but because of the because of who they were that they weren't able to overcome the experience of adversity. So in part there's a cultural message and a societal message here that we need to really let trauma survivors know that we understand how difficult it was and really embrace their survival and adaptation. But sometimes we live in a society that's pretty judgmental and so that can add fuel to the fire when combat veterans returned home from the Vietnam War. I think one of the biggest contributors to their ongoing symptoms and their subsequent readjustment was being called baby killers. That is a great example of how to not help somebody get over combat trauma. So thinking people for their service and understanding the absolutely impossible situation that somebody is in is more appropriate to helping combat survivors heal because it reminds them that they were doing a mission perhaps in an extraordinary cost. One of the ways that I like to think about how a psychedelic assists the psychotherapy process is really based on a quote from Stan Groff which says that psychedelic is to the brain what the telescope is to astronomy or the microscope is to biology just allows you to go deeper and see things that perhaps you couldn't ordinarily see. And I think that's exactly why these compounds have so much potential and particularly MDMA for PTSD because it allows you to get past this initial layer that you can't see which is how did I let this happen or how could this have happened to me and go to that next layer that perhaps is more microscopic which is because I couldn't do anything else because I had no other options and it also developed that sense of self-compassion that allows you to understand that you don't need to be punished or punish yourself because you didn't live up to your own expectations for how you should have behaved. I think the most important thing to let people know about psychedelic assisted psychotherapy if you're using it for the purpose of healing for mental health symptoms is that intention is very important. It's not only intention it's the desire to go deeper than you've been able to go. On some level you have to have this sense that I know I need to be going deeper I just can't it's too upsetting it's too traumatic it's too difficult and really using the medicine for what it is there to do which is help you see that thing that you can't see with your naked eye and really wanting to see it. The MDMA or any psychedelic really won't have healing properties if you're afraid to have the experience or if you're reluctant about it it's like saying well look through the telescope but I'm also going to put my hand on the back of the telescope because I'm really kind of afraid of what I might see. There are ways to be avoidant even using a psychedelic assisted psychotherapy. It's very important to not give people the impression that there's a passive cure. You lie down there on the bed you take MDMA you swallow it with some water and magical things start to happen in terms of processing trauma. That isn't what the therapy is about. Ideally therapists who really know how to work with trauma in an ordinary state can use those tools and techniques to help you do the work of pushing forward while you are in the state induced by MDMA and really kind of help you supercharge the psychotherapy. The way that this is being rolled out for PTSD is more medicalized. It is that's not to say that people won't have good experiences with psychedelics that are taken outside of their context. People really show a range of different experiences ranging from this saved my life to I'm not doing that again that was pretty bad. Psychedelics are really interesting that way so much of how they're going to work has to do with where you are, who you're with, what your intention is and also probably your internal biochemistry so there's no way to really predict it. Even though this treatment has been found to work in two thirds of people with PTSD there's this other third. So everyone that tries this treatment has to understand that people respond very differently to different kind of medications and to make sure that you're working with somebody really ethical and can respect your boundaries. Anyone that is in an altered state of consciousness is more vulnerable and so you really want to make sure you're working with people of the highest not only therapeutic skill but ethical standards. What's fascinating about psychedelics is that the same person can have remarkably different responses in different settings. When we talk about MDMA assisted psychotherapy for PTSD we're talking about a process where there's readiness where we prepare people to work with the medicine. We talk a lot about what the experience will be like and what they want to get out of it and what some of the stuck points have been. What their hopes are for getting past those stuck points. There are 390 minute sessions to do that. Not to mention that these are patients you might have known and have tried to work with for a long time before the MDMA assisted psychotherapy and they need work during the session, any work after the session and the way that the MDMA assisted psychotherapy is structured right now there are going to be three medicine sessions. So you have three very long days to kind of get where you need to go and hopefully you can make great strides with it but for anyone that thinks this is a quick fix. That's a perception that needs to be corrected because the way that it's being rolled out right now with clinical trials with the FDA is a three month experience with 12 psychotherapy sessions in addition to the medication sessions. It's a commitment that somebody is making towards their own healing and working in a very non passive way to try to really understand what it is they saw so that they can make something out of it and tackle their lives in a different way. When people hear this kind of stuff about how great MDMA assisted psychotherapy is or psychedelics, there are psychedelic experiences in general and they have a natural curiosity to want to try it or they want to see if they can learn more about themselves. I mean that's a very natural reaction. It's important to understand that not everybody responds the same way. It's important to adjust one's expectations of this and really be in the hands of somebody that is very trusted. Different states in the United States are experimenting with different levels of decriminalization and legalization. So I suspect that we will have a lot more information about the effects of psychedelics in the general population. When you think about psychotherapy, that was initially meant for people that had serious mental health issues and a lot of people go for psychotherapy even if they don't have a mental health disorder. We may see after we have enough experience with psychedelic assisted psychotherapy in clinical populations. That might be a very natural transition that it might be particularly helpful and maybe easier in some ways for people that don't have as intransigent mental health symptoms. Obviously want to understand themselves better. So it's an exciting time to see what the future brings. Chapter 3, healing can echo across generations. One of the dilemmas that people had when they first heard about the diagnosis of PTSD or thought about the enduring effects of trauma is how can an event in the past continue to exert symptoms, continue to exert biologic effects? Why can we measure the blood or the brain in people that have post-traumatic stress disorder and see differences even though the event is passed? When we look at some of the hormonal changes that we see in people that have post-traumatic stress disorder, you don't really see the kind of things that you would see in someone that is undergoing stress. And one of the biggest examples of that is that people with post-traumatic stress disorder have lower cortisol levels. Cortisol is a hormone that is released by the adrenals during stress. It is designed to help you cope with the fight or flight challenge. We think that lower levels of cortisol are part of why the stress response doesn't fully shut off and continues to live on in some ways. But it wasn't until we began looking at epigenetic mechanisms or molecular mechanisms for the stress hormone receptors that we began to understand that perhaps one of the things that are allowing kind of the enduring effects of trauma are changes that are actually made into how those receptors work in the long run. So that in response to a very big traumatic event earlier on, there can actually be molecular changes and epigenetic changes that can change the way that the stress receptor genes function and really in some way keep alive a stress response. Many people have misconceptions about epigenetics. Epigenetics refers to the study of how genes are regulated. A lot of epigenetic mechanisms occur during development and help really with the complex choreography of which genes are firing at any given time. It explains something very real about why things just don't go back to normal. When epigenetic mark, once it's on the DNA, it survives cell division so that the daughter cells that are formed when the cell replicates itself through the process of mitosis and also meiosis, which is the process of making sperm and egg. The epigenetic mark is robust and it can survive cell division. A lot of excitement occurred a few decades ago when people began to understand that experience can also influence epigenetics. Now people talk a lot about how trauma influences epigenetics, but trauma is just another example of an environmental influence that can have a profound effect. The experience of treatment is also an environmental experience that can have profound effects and some of the work that we have done in the last decade has really demonstrated an improved response to treatment even to psychotherapy. When it comes to understanding issues like, well, how does psychedelics work? Why do they produce, if they do, a long lasting, enduring and transformative response? Many people who are treated with MDMA-assisted psychotherapy for PTSD actually say, "I feel really different now about my PTSD symptoms." First of all, they have far fewer PTSD symptoms. They also feel more self-compassionate and they also feel ready to kind of take the next step in life. They feel transformed. The word "transformed" could have also been used to describe how they felt when they had their traumatic experience to begin with. I'm not the same person that I used to be. And probably epigenetic mechanisms will be very important in helping us understand both the kind of transformative and enduring changes that occurred following trauma exposure and the ones that are associated with deep healing. It's not about a good event or a bad event. It's just about experience and the impact that experience can potentially have in regulating stress-responsive genes. Well, one of the really interesting things about epigenetics of PTSD and the epigenetics of recovery from trauma is that we found changes in the same region of the same stress-related gene in both situations. That there are epigenetic changes that on stress-related genes that might explain enduring effects and might also explain why we're more sensitized to our environments. And that somehow when people are successfully treated with PTSD, that you see some of those epigenetic changes again on those same genes, but in a reverse direction. So it's important to understand about epigenetics, and this is that you're not stuck just because there's an epigenetic change. If a certain region of a certain gene is responsive to the environment, then make healing environments so that we can transform in positive directions and I think to me that's really the message. I think it's really important to not take the epigenetics too literally and try to tie little regions on little marks on genes to specific behaviors. Certainly when people start talking about intergenerational epigenetic effects, we're not carrying trauma with us. These changes are not necessarily responsible for all the behaviors, but they're present. And their presence is probably a way to really allow the experience to stick with us for some reason. I'd like to think that epigenetics provides a mechanism for adaptation. Traumatic experiences really in essence provide a way of learning. Sometimes we don't like the lesson, but a traumatic event may teach us that certain situations are dangerous. And we want to have a way of really recollecting that and really acting on that so that we don't find ourselves in harm's way as often, or if we do, we can mount a response. When people talk about intergenerational transmission of trauma, which I'd really like to correct, it's not intergenerational transmission of trauma, it's the idea that people in a subsequent generation may feel the effects of a trauma in a first generation. Maybe that is a way of kind of transmitting a lesson to the next generation about how to cope or about a potential dangerous situation or scenario. So the idea is that really it's a type of wisdom. I just want to correct this idea that trauma is inherited or trauma sticks with us for generations. That's not what the science says. What the science says is that there are epigenetic marks in the adult children of trauma survivors in the same location as in the trauma survivors. And so there are a lot of questions that we could ask about why that might be so and how did those marks get there. But what's inescapable is that many people feel that it's not just the genes that they inherited, it's the experiences that the parents have also had, whether they be personal or cultural experiences that are very shaping and determine much of who they are. We have to start thinking about epigenetics also in terms of what it tells us about adaptation and resilience. What lessons do we take forward that can help us cope with adversity should we have to experience something the way our prior generation did. Our work was done primarily in the adult children of Holocaust survivors, and many of them feel very hyper vigilant as if somebody is trying to hurt them or chasing after them for no reason other than who they are. That's a trauma they're parent-experienced. And so this hyper vigilance may not serve them in a world where nobody is chasing after them. But once there's anti-Semitism, again, and they notice it, they might be more attuned to it. And being more attuned to anti-Semitism might end up being something that is adaptive if that is indeed what is happening in society. There are biologic mechanisms to keep the effects of experience alive from one generation to the next. We don't know if they're memories, we don't really know what form they take, but we know that it is kind of a biologic possibility, and this has opened up a lot of questions and a lot of potential excitement. For many people, it just means that what I feel is real, and that's good too. We really are very affected by cultural and societal and personal experiences of previous generation or generations. Really does form a tremendous amount of our identity, and it forms the basis of how we do respond to adversity when it occurs from a cultural and societal perspective. But what it might also mean is that responding to mass casualty and mass trauma and big traumas in our society may not be only a mental health problem, but it might be a problem of creating resilient and healing societies so that we have a mechanism for positive transformation and change, and we can use the power of culture and society to help each other cope from adversity rather than kind of use it to make us feel more isolated and stigmatized like we let people down by the fact that trauma occurred or how we responded to it. The legacy that we have most often from our parents and prior generations is that whatever they went through, they survived, and that's why we exist. We're here because someone survived trauma. And then the question is what's the next step beyond survival? It's restoring, repairing, achieving resilience, achieving growth and really understanding how to go forward despite being exposed to trauma. It's beyond just surviving to living. How do we then do that? One of the benefits of having a complete healing, which I think is possible with psychedelic assisted psychotherapy because it's not about just dampening symptoms. It's not about just giving a medication so that you can sleep better or that you no longer feel depressed or anxious or hyper-vigilant. It's really about going deep and correcting and changing this narrative that you got stuck in that is some version of how bad you are and how deserving you were of this trauma. But now you're having a different narrative about how you actually survived, did the best you could, and you have not only a more compassion for yourself, but you feel that you can take your rightful place in society, that you are part of the world, you are part of the earth. And having that legacy can be profound from animal research is that, and this is not our work, this is work that was done at Emory University, if you subject a male mouse to a cherry blossom and then shock the mouth, that mouse can develop a fear of that cherry blossom. That fear of the cherry blossom is associated with epigenetic changes in brain and sperm, and if that mouse is mated, that mouse's male offspring will also have the same changes in the epigenetic, in brain and sperm, but will also, inexplicably, be afraid of cherry blossoms, even though you didn't have to shock that offspring in order to be afraid. And that is a really powerful demonstration of what we're talking about, when we're talking about behavioral epigenetics and the kind of things that can be passed. But if you use fear extinction on that male mouse, that you continue to expose the cherry blossom to that mouse that is now afraid of the cherry blossom, such that he now becomes sensitized and says, "Okay, I guess a cherry blossom doesn't mean I'm going to be shocked," and then make the mouse. That offspring doesn't have the epigenetic changes in the brain and sperm. So this is a very profound example of what we're trying to achieve here. By trying to understand the epigenetics of what occurs in healing, generally and also in response to psychedelic assisted psychotherapy, we're just wondering whether that can kind of restore a certain biological equilibrium. The real beneficiaries of successful PTSD treatment are the next generation in some very real way. Not necessarily only because of epigenetic changes, but because a change in their parent is going to make a gigantic difference in their lives. So many people think that one of the mechanisms of how psychedelic assisted psychotherapy can help us process trauma is that it reduces the fear involved in approaching traumatic memories. And that can allow, once you don't have the fear of talking about the trauma, that can allow for new mechanisms in a way that this can facilitate a fear extinction if you think the problem is the fear. And there are studies that have also shown that MDMA specifically can dampen down some of the activity in the amygdala that occurs when a trauma survivor is exposed to a traumatic reminder or a script of their trauma. That is definitely one of the mechanisms that might be at play here. But it's really important to understand that fear is only one component of why people have enduring post-traumatic stress symptoms and overemphasizing the link between fear and PTSD is, I think, leads us to focus really on things like extinguishing a fear response without delving into why there is such an over-consolidated fear response to begin with and why there might be such an over-consolidated fear response might have to do with guilt and might have to do with shame and self-blame and all of the other kinds of narratives. One of the things I really like about the MDMA-assisted psychotherapy approach is that it's not directed. That the therapists are trained to follow the patient's process, to go where the patient goes. The patient might not go to "I'm scared." The patient might go to "I'm bad and always have been" and then go leapfrog straight over the event that was discussed in preparation to something that happened in childhood. We don't fully understand why we respond to events the way we do. When a person is exposed to a traumatic event in adulthood, they've already lived a life and there might be a lot of events from their past that are contributing to why they think that something that happened was their fault. And they may identify one of those early events and that has to be corrected in some profound way or a person needs to develop a large sense of empathy for that five-year-old, for example, or that six-year-old that maybe didn't get something that they should have gotten or maybe has been harboring some sort of a secret inside. Again, we don't all respond to trauma with PTSD. That's very important. It means that it's not just the exposure alone that put us here. The kind of the beauty of the psychedelic assisted psychotherapy experience is that it keeps it open. And I think some of the limitations of the current cognitive behavioral approaches have been this narrowing on. We're going to talk about this trauma. We're going to focus on what happened to you that you believe is the focus of your symptoms. Without understanding that, you know what? It could be something before. It could also be something that happened after the trauma. Someone spoke to a veteran who told me anything that happened to him in war paled by comparison to the systemic racism that he experienced when he came back from war. It pales in comparison to the sense that even after I served my country dispensable, I am not worthy and I am lesser. And so I think that what we have to understand is that there are factors before that contributed to how you're going to respond to a trauma in the moment. There are factors after the traumatic event that are equally as important and they have to do with how we're treated by our loved ones, by society at large, and how we treat ourselves. So it's just this whole long chain. And when you have an experience with psychedelics, the whole thing is open. If you're with trained people, they're not going to shift your focus and call it avoidance if you don't stick with the traumatic experience that we've agreed is the source of your problem. You may be open to identifying the kind of things that are really impeding your recovery or the kind of things that you really can't get past. And so a lot of the time, if we're in abusive or traumatic environments after we sustain a trauma, that just makes it a lot harder. And so sometimes with a psychedelic assisted psychotherapy, you're more able to broadly understand what in the here and now needs to be changed, even though it doesn't have to do with a then and there. And so what kind of change can I make to improve my here and now so that I can recover from the trauma. And the other aspect is really that we're not just looking to neutralize something negative. We're trying to learn from a traumatic experience. And for many people that heal successfully, what that looks like is them taking everything that they learned about what it is to be exposed to trauma and helping the next person who is exposed to trauma. This is what I should have gotten. This is what I want to give you. This is what I wish somebody would have taught me and to teach them to be self-compassionate so that we create a more healing society. What I hope viewers take away from this is that there's hope. I've talked to so many trauma survivors with PTSD or maybe even other mental health conditions who really feel that because the trauma happened and because we can't erase the fact that the trauma happened, they're just going to be stuck and unless somehow we can go back in the past and change the course of history, they're going to be in the state that they're in forever. And I think what this kind of public education message is all about is letting people know that there are so many ways to begin to deal with even the most severe PTSD cases and that if you're watching this and you or someone that you know or love is struggling because a traumatic experience occurred to them, trauma and PTSD are things that the mental health community has made great advances in. And psychedelic medicine in particular really offers a lot of hope for people who have not benefited from more traditional forms of psychotherapy or medicine. [music] Want to support the channel? Join the Big Think Members community where you get access to videos early, add free. [MUSIC PLAYING]

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