Dr Rosalind Watts is a clinical psychologist working with psychedelics as a tool to treat depression. She has pioneered the recognition and study of connectedness as a key aspect of psychedelic integration. Her ACE model – ‘Accept, Connect, Embody’ – has been used in clinical trials of both psilocybin and DMT and the Watts Connectedness Scale is a psychometric tool for measuring outcomes of psychedelic therapy. Dr Watts is the former clinical lead on the Psilocybin for Depression trial at Imperial College London. She is the founder of ACER Integration.
In the first of a two-part interview, she tells Frank why she believes psilocybin, when used in a truly integrated way, can be a transformative therapy for depression.
Dr Watts, can you tell us about your career background as a psychologist and what led you to work with psilocybin for depression rather than conventional talk therapy?
Dr Rosalind Watts: I trained as a clinical psychologist in the NHS and I really enjoyed being part of those teams. The NHS attracts a wonderful workforce of people who are very committed to offering support ‘in the trenches’. However, the waiting lists were so long that we could only offer people a small number of talk therapy sessions, and it wasn’t enough. The NHS was underfunded and under-resourced; I am a huge believer in good therapy but it is usually expensive.
When I went on maternity leave, I was able to have a breather from my job and I started working as a volunteer ‘guide’ in a psychedelic clinical trial looking at psilocybin assisted therapy as a treatment for depression. I suddenly saw that psychedelics, when offered as part of talk therapy, could be a powerful tool to help deepen and catalyse the therapeutic process; that one day psychedelics could help get effective, transformative therapy to more people.
What is psilocybin? What does it do to the brain?
Dr Rosalind Watts: Psilocybin works by activating serotonin receptors in the brain and increases global connectivity in the brain, which means that the different parts of the brain become more connected and communicative with each other. It takes the brain out of rigid patterns of thinking into a more flexible, connected state.
We see this ‘plasticity’ as a window of opportunity for behavioural change. From my work over the last six years, I don’t think psilocybin’s effect on the brain is long-lasting; it is certainly not a permanent reset for most people. Rather, it provides a few weeks or possibly months of a new kind of neural plasticity. New habits can be formed and old habits can be dropped, but this requires support and guidance from an integration therapist (a therapist who works with people in the months after a psychedelic experience, to help optimise the outcomes) or an integration community (others who are working through a similar process who can offer peer support).
It’s not so much the psychedelic experience itself, but what comes after it that makes a difference to long term improvements in mood, cognition and behaviour. With good integration, a burst of global connectivity in the brain can translate into a deeper sense of connectedness to self, others and the wider world.
One of the themes I have found in my research quite consistently is that psychedelic experiences can open people up to a strong connectedness with nature. People describe feeling a sudden realisation that nature is not a thing to be consumed, but a beautiful web of life that they are part of. This can be life-changing.
You say the psychedelic is not the cure itself but rather acts as a gateway to our unconscious. Can you explain a bit more?
Dr Rosalind Watts: The psychedelic itself temporarily deactivates ‘ego consciousness’. The default mode network (the formal term for the brain system which regulates our day to day thinking and ruminating) is stopped for a while. That allows us to access deeper layers: the body, feelings and things that our minds have suppressed through years of numbing and avoidance. We are forced to really feel our feelings.
The psychedelic does not fix anything; it allows our inner healing intelligence to speak to us, to show us our pain. When we cut our finger, the body heals it. The body knows how to bring balance, but we have to silence our minds and dive down into our bodies, and all the feelings and sensations stored there, for our system to find this homeostatic healing.
People often cry and shake a lot in sessions: this is the body releasing. When the thinking mind shuts up for a little while, the deeper layers of ourselves have a chance to express what they need to, process all the things we have been through in our lives and move on.
Sometimes people access something that feels very sacred: we go beyond the standard day to day thinking routines to much deeper and sometimes much higher levels.
If day-to-day consciousness is a grass lawn, psychedelics can help us access the deep earth underground, the roots, and also the sky.
In 2016, you became a volunteer psychedelic trip sitter and guide at Imperial College London’s psilocybin for depression trial. What were the most enlightening results of that trial?
Dr Rosalind Watts: The trial found that 17 of the 20 people in that first study responded to psilocybin, and their depression went into remission or was dramatically reduced for a few months. The main finding was that psilocybin was helping people move from ‘avoidance of emotion to acceptance of emotion’ and from ‘disconnectedness to self, others and world’ to ‘connectedness to self, others and world’. However, the positive changes were temporary. For most participants, depression returned fully after a few months.
How did you adapt the second trial to take that onboard?
Dr Rosalind Watts: After the first trial, a colleague and I started a community integration group, for all those who required a lot more support than is offered by clinical trials or psychedelic retreats. We particularly wanted it to be a safety net for the participants in the second trial. I also developed a therapy model for use in the second trial itself, called Accept Connect Embody. This included music and guided visualisation to help people prepare for and integrate psychedelic experiences. The model has been adapted and used in many different settings.
In a recent article, you said the greatest threat to a healthy psychedelic future is the ‘fetishising of just the drug alone’. Are people looking for a quick fix – and are more people and pharma companies willing to offer that?
Dr Rosalind Watts: Yes, the pharma adoption of psychedelics is in full swing and seems to be entirely missing the point. I feel that these profit-driven approaches, by people with very little real understanding of these methods and too much focus on brain mechanisms of the drug itself, and not enough focus on the all-important therapy and integration aspects, may do more harm than good. Ultimately when offered in such disconnected and profit-driven containers, psychedelics may be ineffective as treatments. People will choose community-based healing centres instead, where the long-term therapeutic aspects can be more solidly supported.
My focus now is on how we can bring in fair legal access to psychedelic healing methods that are offered by the community for the community. Local, regenerative, caring and warm, with long-term circles of support and accountability. Bennet Zelner’s Pollination Approach and the Transformative Capital Institute are both inspiring projects in this regard. The psychedelic healing revolution will happen in community, not within the mainstream toxic systems of extraction and competition that have caused so many of the mental health problems in Western society in the first place.