New Training for Physicians in Augmented Psychotherapy

Interview with Henrik Jungaberle about psychedelic augmented psychotherapy (APT), new training programs for physicians and treatment outcomes that ought to be obtained.

Article translated from the original German version

Dr. sc. hum. Henrik Jungaberle is the Director of the MIND Foundation and one of two CEOs of OVID Health Systems, that has open the OVID Clinic Berlin, a practice for augmented psychotherapy. He researches psychedelics and their evidence-based use. He is a science entrepreneur and book author. In 2016, he co-founded the MIND Foundation. He is also involved in the psilocybin study EPIsoDE, which the Central Institute of Mental Health in Mannheim (ZI) conducts in collaboration with the MIND Foundation and Charité Universitätsmedizin Berlin.

esanum: Henrik Jungaberle, you are Director of the MIND Foundation and CEO of OVID Health Systems. In these organizations, you are all about psychedelic experiences. Can you briefly introduce yourself and your work?

Henrik Jungaberle: Yes, with pleasure. We started the MIND Foundation 5 years ago as an organization engaged in science communication, training for physicians and psychotherapists, and research. And OVID Clinics then joined two years ago as our clinical partner organization that actually treats patients. We are perhaps the first organization in the world to adopt a completely evidence-based view of our work in this field. We see psychedelic treatments as right at the intersection of medicine and psychotherapy. And we really want to bring this form of therapy to the center of German and international medicine.

What is augmented psychotherapy?

esanum: In recent years, you have been very active with the MIND Foundation, and, as I have observed, you have also grown a lot. Every two years, you have the INSIGHT Conference with international participants, you offer a lot of workshops and seminars, and recently also training in augmented psychotherapy. What is that exactly?

Henrik Jungaberle: We have a particular concept of psychedelic therapy, and it differs from the one that Stan Grof, for example, advocated in the 1960s and -70s. We believe that psychedelic therapy is psychotherapy, in fact, an extraordinary form of psychotherapy. This is where the medical and psychotherapeutic perspectives come together. The pharmaceutical that is used is undoubtedly unique because it produces profound experiences in patients, and that needs a framework. And the framework, which we think is trustworthy, suitable for the patients, and ethical, is called psychotherapy. What does augmentation mean? Psychiatrists are familiar with the term. It is when certain drugs are augmented - typically with another substance. However, in our case, this means that psychotherapy and psychedelics interact in their effects. This is perhaps not so easy to imagine for someone who otherwise only works in internal medicine. Still, it is actually easy to explain: the effect of psychedelics depends on the environment and the inner mindset of the person who takes this psychedelic. It means that there is an augmentation in this direction: the effect of the substance depends on the set and setting.

Conversely, it also means that the effect of the therapy depends on the psychedelic. For example, this influences the relationship between therapist and patient enormously. It can strengthen the relationship or accelerate relationship building. That is augmentation. There is also research on this. For example, we have developed a questionnaire that is used in the EPIsoDE study.

esanum: What does augmented psychotherapy offer that other forms of therapy do not?

Henrik Jungaberle: First of all, this form of therapy reaches people who have already given up hope. We can see this now with the more than 40 patients we have already treated in the EPIsoDE study. There are impressive processes here. People who have been frozen in their depression for 20 years now see new chances in life. In some patients, the symptoms change dramatically, dropping from 30 to 3 on the Hamilton scale. These are results that you don't usually see even after electroconvulsive therapy. In other words, we have a new way to treat patients. What else can augmented psychotherapy do? It has the potential to create a more profound feeling of connectedness that is otherwise unattainable. This means connectedness, particularly in patients who have difficulties in interaction. And thirdly, I would say that there are special effective factors in psychedelic therapy. The relationships, the philosophy of life, and patients' values will usually change or be questioned after such a psychedelic treatment. Often very, very positively. People ask themselves what their goals have been over the last few years or decades and if this is really what they want. That is the extraordinary thing about psychedelic therapy. You could also call it a change in the patient's spirituality.

What does the APT training consist of?

esanum: Thinking of our doctors now - can you perhaps briefly outline how the APT continuing education is structured and how this could subsequently also be integrated into the normal day-to-day practice?

Henrik Jungaberle: The training has a pretty unique format. It is a two-year, intensive training of 400 hours. The first year is entirely dedicated to the topic of integration. The second year is dedicated to the application of psychedelics. Why did we do it this way? Integration means transforming experiences into supportive behaviors. In such a way that they change the patients' lives and that they do not just have a good experience - the latter could perhaps be called "taking drugs." Integration is all about making something out of that experience.

Then the whole APT training teaches how to use this form of therapy right now. Even before the first psychedelic substances are available on the pharmaceutical market, we're not expecting that until 2024 to 2026. We teach physicians and psychotherapists how to conduct psychedelic treatments with ketamine and breathwork when it comes to psychedelic substances. That's something special about this treatment. It's not limited to the use of pharmacological substances but defines itself by the use of psychedelics or the psychedelic experience in psychiatric treatment or psychotherapeutic process.

About two-thirds to three-quarters of our participants are physicians, and the rest are psychotherapists. So what can a psychiatrist do after the training? They can use the atypical psychedelic ketamine in their practice with colleagues or alone or deepen a psychotherapeutic process through immersive breathing techniques. And this augmentation requires knowledge because the patients behave differently in this therapy than in psychoanalytic talk therapy. They immerse into an inner journey. They also have very intense, cathartic bodily experiences, particularly with immersive breathing. You learn to deal with that therapeutically. You also learn to do proper screening of patients suitable for such therapies in the first place. Some patients should not be treated with breathwork or psychedelics because, for example, there is a risk that they will become psychotic.

esanum: What are the contraindications?

Henrik Jungaberle: Manic-depressive patients, bipolar disorders, patients with previous psychosis experience. We do not include patients who have a family history of psychosis, including first and second-degree relatives. It is mainly this group. This may change in the future, but caution is essential with this form of therapy. Some personality disorders would also not be suitable at the moment because there is no evidence of this being an effective treatment for these patients yet. On the contrary, there are many case reports that people with personality disorders often experience an intensification or accentuation of symptoms. They have to be supported over a much more extended period, and doctors in regular practice often cannot provide that at all.

Working in multi-professional teams

esanum: What about CME points for the training?

Henrik Jungaberle: Yes, it will be fully equipped with CME points. There are at least 50, probably more, every year, which means you can complete your entire annual quota with the training. It is also the case that a particular focus of the training is on working in multiprofessional teams. We believe that the future of psychedelic therapy is that different professional groups come together and conduct improved treatments through these structured collaborations. And not only physicians and psychotherapists but also physicians and psychiatric staff or specially trained medical personnel. We also have a cost problem with psychedelic therapy. Because patients often have to be supported over hours during the sessions, we have to think about handling this. In regular psychiatric practice, it will hardly be possible for the physician to supervise a patient for a whole day, lasting six or eight hours. So you have to learn how to manage and co-ordinate with other mental health professionals. We also have some anesthesiologists, particularly general practitioners, who are very interested in the APT training. This could also be part of the future of the health care system if psychedelic therapies prove to be as effective as they look now. Then it might not just be psychiatrists who do it, but possibly primary care physicians who partner with a psychiatrist and psychological psychotherapist. Our long-term goal is to use the APT training to establish an additional official certification in the German health care system for psychedelic-augmented therapy. General practitioners or representatives of other groups of physicians would also be able to conduct such a form of treatment, possibly together with colleagues.

esanum: What do you expect related to health insurance companies? Could augmented psychotherapy eventually be covered by health insurance?

Henrik Jungaberle: We are sure that it can be reimbursed by public health insurance in the future. Our goal is to include this form of psychotherapy in standard mental health treatment. What is necessary for this to happen? For this, research such as the EPIsoDE study must be carried out successfully. Then there must be a phase 3 study, and after the phase 3 study, what needs to take place is what has lately happened for esketamine, namely a so-called HTA study (Health Technology Assessment). Such a study compares the standard treatment, the first-line treatment, with the new treatment, and we must then perform better. Based on our preliminary calculations, we are very optimistic that it is possible to become a first-line treatment in the area of depression, but potentially also for other indications. And then we are in the public health insurance. But there are still a lot of possibilities even before reimbursement by public health insurance, for example, establishing treatment contracts with private health insurance companies or for self-payers.

esanum: That means that you also have to deal with a lot of bureaucratic work added to the therapeutic and research work.

Henrik Jungaberle: That is a vast understatement. It is an incredible amount of work with public organizations, strategically and bureaucratically. Drug development is, after all, a pharma business and pharma is highly complex; every step has to be GMP-certified (Good Manufacturing Practice), is highly structured, and very expensive.

esanum: Again, briefly about the EPIsoDE study: psilocybin is being tested there.

Henrik Jungaberle: Yes, exactly, and this should also be mentioned in the context of APT. In the second year, we will not only learn how to apply ketamine in a psychotherapeutic setting, but we will also teach the use of psilocybin, already anticipating what is supposed to be coming in the future. We are submitting an application to the BfArM to make selfexperience with psilocybin possible for physicians within this training context. That is a step in getting to know this substance. As with any psychotherapy, we believe that self-experience is part of it. But of course, legally, like everything we do. There is a lot of training going on underground, but we think that is unethical and it doesn't do any good. It also doesn't lead to these therapies making their way into the medical field. From my point of view, what we need is for physicians and therapists to become familiar with this substance, for myths to be dispelled, and for people to learn how to deal with the specifics of this substance and not describe everything with New Age terminologies and philosophies. After all, not every time a patient feels they are being reborn, they are being reborn. It is a subjective experience. This does not mean that we all have to become followers of the doctrine of reincarnation.

esanum: That would also be problematic to carry out the cultural appropriation of practices repeatedly.

Henrik Jungaberle: Yes, that is precisely it. But many people believe that psychedelic therapies are that kind of therapy: an esoteric, spiritual, or religious therapy. Of course, patient spirituality plays a role, but you also must understand what this means. Helpful patient spirituality can be described as a practical philosophy of life, reorientation, and a new understanding of the world, which (re)connect with nature and the cosmos. These are all things that can also be described in Western philosophical terms.

esanum: That leads me to my next question, about resistance. Have you also had the experience of being met with rejection within the medical profession?

Henrik Jungaberle: Well, by being an evidence-based, science-oriented organization, we have experienced very little resistance. Little means that when we opened the OVID Clinic, there was the voice of a clinic director in Berlin who didn't take the treatment form seriously at all and thought she had to use 1970s stereotypes, asking: "What are they doing there? Is that a place to "get high"?" Interestingly, we experienced almost no resistance beyond this. Of course, it could be that psychedelic-assisted therapy is still so unknown in the medical profession that, on the one hand, we are perhaps not taken seriously, and, on the other hand, the topic has not yet reached a large number of doctors. But that's why we are involved in research like the EPIsoDE study by Prof. Gerhard Gründer. There is now also the first scientific paper on the subject in German in "Nervenarzt," which is called "Are psychedelics fast-acting antidepressants?" So far, we have published a lot in English, which is not easily accessible to some of the German medical community. And the answer is yes, psychedelics are fast-acting antidepressants, but now we are trying to make a treatment with sustainable effects out of it. After all, what good is it for a depressed person if they are perhaps symptomfree for a week and then relapse again? So a lot of the training and therapy is about stabilizing that effect so that it lasts for six months or a year or even longer. We want to train people in conducting psychedelic-augmented psychotherapy in a way that changes the course of the disease. That is our goal. And we try to do that with science and proper training for the medical and psychotherapeutic community.