Psychedelic drug assisted psychotherapy in patients with terminal cancer

This early study (1972) describes the use of LSD-assisted psychotherapy for patients with terminal cancer. Results suggest significant improvements on various clinical assessments.

Abstract

“Describes the use of psychedelic drug therapy to alleviate the emotional and physical suffering of 50 23-81 yr old terminal cancer patients. In 43 patients, 200-500 mcg of LSD was orally administered as an adjunct to brief intensive psychotherapy. In 7 patients, 60-105 mg of dipropyltryptamine [DPT] was administered. Results were assessed using a clinical rating scale reflecting (a) the degree of depression and psychological isolation; (b) difficulty in management; and (c) acceptance or fear of death and pain. Pre- and posttreatment ratings indicate significant improvement on most of the clinical assessments and a trend toward a reduction in narcotic medication. Brief case histories are presented.”

Authors: Albert A. Kurland, Stanislav Grof, Walter N. Pahnke & Louis E. Goodman

Summary

In 1955, a study with LSD was undertaken to investigate its possible chemotherapeutic properties in a small group of chronically ill, regressed schizophrenic patients. The study was unrewarding, but a few years later, interest was rekindled in the compound.

These studies used the unique subjective effects of the hallucinogenic drug experience as an adjunct to psychotherapy. They found that this experience can help people change their attitude and behavior toward themselves, others, and their life situation.

Kurland, Gro I, Pahnke end Goodman 87

Kast had investigated LSD as an analgesic agent in the very late phases of terminal cancer, and Cohen had also described a lessening of depression and apprehension con- limenting their approaching death. We decided to proceed with the treatment of Mrs. G., but differed from Kast’s approach in that the LSD was administered as an adjunct to psychotherapy.

The patient was fearful and anxious before the LSD session, but by the end of the preparatory gram session she understood everything and felt clear about the procedure. The next morning she was given the first dose of LSD and felt awkward.

In 1966, I was alone in a timeless world with no boundaries. I became poignantly aware that the core of life is love, and I began to emerge, feeling joy, not only for myself but for having been able to use the experience of these people.

The patient was administered MMPI’s one week prior to her LSD session and returned to work two weeks later. She died three days later.

The encouraging outcome of this experience was followed by a continuing series of studies over the inter-report on her vening years that have continued up to the present time. Forty-three of these patients were treated with LSD, and ten with DPT.

90 Psychopharmacolog’_al Agents–Dying Patients, Bereaved DPT was introduced as a possible alternate to LSD in the treatment of the cancer patient after preliminary investigative use in a series of alcoholic patients.

Stanislav Grof took over the work of Dr. Pahnke, and an extensive review of the investigative course was carried out. It was concluded that the significance and meaningfulness of this therapeutic approach might be enhanced by its earlier application in patients who had already been diagnosed with cancer.

Clinical studies reflecting the efficacy and relative lack of physical hazards associated with this procedure have increased in number, and the research endeavors in an area where relief is so desperately needed have accelerated. Nevertheless, a rather difficult task remains, namely the necessity of carrying out controlled studies in this highly sensitive area.

The final months of life for a person dying of cancer are marked by increasing physical and emotional suffering, anxiety and psychological isolation. Heroic efforts are frequently undertaken in attempt to lengthen the quantity of days in the patient’s life, but little is done to enhance the quality of intrapersonal and interpersonal life.

The initial selection criteria were the presence of some degree of physical pain, depression, anxiety and psychological observations isolation associated with malignancy, and a reasonable survival expectancy of at least three months.

The presence of brain metastases, organic brain damage, genc epilepsy, severe cardiovascula_ disorders, or overt psychotic disturbances were considered contraindications for psychedelic psychotherapy. The Minnesota Multiphasic Personality Inventory and the Personal Orientation Inventory were used to screen patients for potential treatment.

The basic demographic characteristics of the sample are shown in Table I, and Table II shows the average consumption of narcotics per day before psychedelic treatment.

The treatment procedure consisted of three mutually interrelated phases: a series of drug-free interviews, a psychedelic session, and several subsequent drug-free interviews to integrate the session. A close therapeutic relationship and atmosphere of basic trust seemed to be the single most important variable in successful psychedelic therapy.

RI) and the procedure with alcoholics, narcotic drug addicts and neurotic patients. The family was encouraged to increase their interaction on as many levels as possible in order to decrease the psychological isolation usually positive experience by such patients. The therapist should not confront the patient indiscriminately with the fatal outcome of his illness, but should be willing to discuss issues of diagnosis and prognosis when the patient was ready for such discussions.

After the major issues had been explored and a good therapeutic relationship established, the patient received specific and comprehensive instructions concerning the actual psychedelic session. There were several exceptions to these instructions, however, dictated by the specific conditions of the patient.

The actual psychedelic session was conducted in a private zoom at Sinai Hospital. Flowers were brought into the patient’s room, and portable stereophonic to music equipment was set up.

The therapist invites relevant persons from the patient’s life to share the termination period of the session with the patient, and this often facilitates new, open and honest ways of communication.

The therapeutic design of the study allowed for repeated drug sessions, if they were considered necessary and useful. The duration of the sessions depended on the therapist’s judgment and the patient’s clinical condition.

A detailed account of the patient’s psychedelic session was written before the patient’s exposure to the psychedelic drug questionnaire. The questionnaire measured the intensity of the patient’s psychedelic peak experiences on a 0-5 scale.

All reasonable effort was exerted to gather psychological test data for the Minnesota Multiple Personality Inventory (MMPI) and the Personal Orientation Inventory (POI), but only for a small fraction of patients could this be done. Therefore, the emotional condition of the patients was assessed primarily on the basis of independent ratings.

The effect of psychedelic therapy on cancer patients was observed in the initial stages of the study. A month after the sessions, an independent rating was introduced into the research design.

The effectiveness of the psychedelic treatment program was estimated by performing statistical tests of significance on the pre- and post-psychedelic session assessments of the clinical condition of the patient, and by the consumption of narcotics.

For each patient, a Global Index was developed by pooling the ratings of all the raters. The improvement of the patient was assessed by comparing the Global Indexes from pre- to post-treatment.

In patients who took LSD, the presence of a psychedelic peak experience was compared to the presence of distress.

In a separate methodological study performed by J. Lenox, the reliability of Global rating scales and correlations with several measures were investigated.

The results of ratings showed that psychedelic therapy improved the emotional condition of cancer patients, and that many of the differences were significant at the 0.001 level.

In evaluating the data, it is necessary to take into consideration that this research was a pilot experiment, that there was no concomitant control group, and that different combinations of raters, physicians, and constellations during various stages of research account for the differences in the results.

The difference in the means of the pre- and post-treatment Global Indexes was significant at the 0.001 level, and can be used as a gross indicator of the over-all improvement of the patients.

The Global Index makes it possible to estimate the percentage of therapeutic success, and 13 patients showed dramatic improvement following psychedelic therapy, 36.1% were moderately improved and 7.4% were unchanged. Only 3 patients had a lower Global Index in the post-treatment period.

A 58-year-old Jewish, married female was referred for LSD treatment after suffering from cancer of the breast for 12 years. She had a few moments of intense positive psychedelic reactivity, but a complete psychedelic experience was not obtained.

The patient was told that it was very unlikely that she would be able to walk again, but she expressed her determination to try her best in physiotherapy and was supported in her decision. Her family visited her after she had emerged from the effects of the drug. The patient made remarkable, quite un- expected progress after her “‘rter-acting LSD treatment” and was able to use a waller within four months.

The patient, who had impressive accomplishments, became depressed and difficult to manage at home. She requested another LSD treatment and improved her interpersonal relations, her self-concept and some realistic expectations.

The patient was readmitted to the hospital for her second LSD treatment ten months after her first session. She faced the fact that she had tended to deny that she was really sick. After confronting her unpleasant feelings and experiences, the patient experienced passing through blue curtains, soaring through the air, and being on a high mountain top in a small cabin alone with the snow falling. She experienced wonderful feelings of peace and harmony and visions of beautiful colors. The patient’s family arrived after supper and she had a serene smile on her face, but was reluctant to talk about her therapy experience too much.

The patient was able to walk down the aisle without a cane and dance with her husband at her daughter’s wedding.

The patient requested a third LSD treatment, and experienced positive ego transcendence, where she felt free of her body and was in the presence of God. She was quiet during the session and emerged from it with a deep feeling of peace and joy. The patient was discharged from the hospital in good spirits, and could push the pain from her mind by remembering her out-of-body LSD experience.

The patient did very well for about one month, but then slipped on the stairs and injured her back again, and became sick with influenza. She again became depressed and had another LSD bout her treatment.

The patient asked a direct question about her diagnosis for the first time in the almost two years she had been in the LSD-treatment program, and the meaning and emotional impact were discussed with her. The family members reacted by becoming quite upset and angry, but they eventually resolved their feelings.

The fourth session went smoothly, except for the reliving of nausea. Much psy-chodynamie material emerged concerning her feelings about various members of her family, especially her two daughters, and the patient felt relaxed and in good spirits in the days after the session.

A 56-year-old, white, married Protestant female was diagnosed with cancer of the uterine cervix, and was treated with radium implantation and cobalt irradiation. Four years after her discharge, she developed increasingly severe suprapubie pain, which was at first controlled with Darvon a were able compound.

The patient was in a terminal state, was severely debilitated, had severe pain, and was receiving chemotherapy via an intra-arterial catheter. She also had diarrhea and uncontrolled nausea, which led the surgeon to suggest LSD therapy.

The patient attempted to read the LSD descriptive literature, but was not strong enough to do so. Despite many misgivings and the desperate nature of the situation, the doctor proceeded with the LSD intervention.

The patient was given 100 mg of LSD by mouth, followed by 100 mg one hour later, but suffered from uncontrollable diarrhea and intense gas pains. She was unable to enter into the LSD experience, and the therapist shut down the drug effects at 6:30 in the evening.

The patient’s psychological condition improved in the days following the treatment, but her physical condition steadily worsened. Twenty-two days after the LSD experience, the patient sank into a stupor and expired.

This case emphasizes the difficulty of initiating psychedelic psychotherapy when the patient is in an advanced stage of terminal illness.

Many pone cancer patients experienced dramatic changes in their clinical condition following psychedelic therapy, including relief of pain, changes in their attitude toward impending and inevitable death, and dramatic shifts in their hierarchy of values.

LSD has a limited therapeutic value when used predominately as a psychopharmacolo_cal agent within the framework of chemotherapy, but its use as an adjunct to a complex program of psychedelic psychoherapist by therapy can yield important clinical results. Kast’s results appear rather surprising, since he approached the procedure from a purely chemotherapeutic point of view, and administered a drug without even attempting to forewarn them. However, in later studies, when he became aware of the psychological, philosophical, and religious aspects of the LSD procedure, his results improved.

Kast’s study was limited by the use of DPT and was unable to separate the real analgesic effect of this compound from a change in experiencing the pain, due to psychological factors.

Kast (1964) discussed the pain-relieving properties of LSD, and believed that it has rather penetrating psychic effects that influence the psychological component of the pain experience. This allows the patient to escape the pain that before seemed unbearable by virtue of its inevitability.

Cohen (1965) stated that LSD does not act directly on the part of the brain that receives pain impulses, but rather alters the meaning of the pain and, in doing so, diminishes it. The data concerning the effect of LSD on pain in terminally independent patients presented an interesting problem.

The ratings of four out of six raters were significant at the 0.001 level, and the nurse’s rating was the only one that reached this level. The consumption of narcotics did not change significantly, but there was a positive trend toward a decrease.

Many patients had a broad spectrum of psychotropic drugs, including narcotics, barbiturates, chloral hydrate and other hypnotics, phenothiazine preparations, minor tranquilizers, and analgesics.

The medication was compared for the same periods of time before and after psychedelic therapy, but the decrease in pain was followed by decreased medication only in patients who were expt i dramatically improved and could be discharged from the hospital able shortly after treatment.

Maslow suggested that spontaneously occurring peak experiences can change a person’s behavior and attitude towards himself, others, and his life anticipate situation, and that they are correlated with the psycho- life, as tt logieal characteristics of self-actualization.

In psychedelic therapy, subjects often report feeling a radical change in their attitude towards death. These statements reflect much more than a momentary self-deception due to altered brain function.

Kast (1966) suggested that the terror experienced from the contemplation of death in preterminal patients as well as in normals consists of fear of the loss of control of internal and environmental influences. In addition, Kast (1964) emphasized the attenuation of anticipation as an important factor in relieving both the experience of pain and fear of death.

A person who has lost all his worldly possessions begins to appreciate life and its simple pleasures, and attempts to resolve conflicts in present relationships. A distinct increase in spirituality of a cosmic nature rather than one of d , related to specific church affiliation occurs.

A method that is able to produce such profound emotion_ apy changes in cancer patients offers the possibility of s_dying and offers interesting and important problems for the pursuit of which we did not have provisions in the research described. If this is true, then successful api_ psychedelic sessions could prolong the time of surw_’val, and this prolongation would be substantially different from a me- 1_ ehaneal prolongation of suffering as it is practiced at the present.

Psychedelic therapy in terminal patients that includes the family members thus dying other J offers a unique opportunity to practice preventive psychiatry by easing the agony of death for the one who dies and at the same time helping those who stay absorb this deep trauma in a health) way.

In conclusion, psychedelic therapy for terminal cancer patients is not simple chemotherapy, and the optimism of the therapist is an important factor in many forms of psychotherapy. The dramatic positive changes in attitudes and behavior when therapy is successful are more than enough to keep the therapist’s enthusiasm at an effective level.

Given adequate training, skilled use of the psychedelic procedure can be a relatively safe and promising approach.

This paper describes the results of a clinical study in which 50 cancer patients received psychedelic therapy as an adjunct to intensive psychotherapy. LSD and DPT were administered to the patients on different occasions.

The therapeutic results were assessed by assessing the degree of the patient’s depression, psycho- logical isolation, anxiety, difficulty in management, acceptance of imminent death, fear of death and pain.

The comparison of pre- to post-treatment ratings showed significant improvement in all measured la parameters for most of the raters. There was a definite trend toward reduction of the narcotic medication, but it did not reach statistical significance.

We thank Mrs. G., our first patient, the members of the research staff, Dr. Charles Savage, Mr. William Richards, Mrs. Helen Bonny, Mrs. Nancy Jewell and Mrs. Ilse Richards for their dedication, support and sensitive participation in this unexplored and highly sensitive experimental venture.

This research endeavor was made possible by the agencies providing the necessary funding, by the Mary Reynolds Babcock Foundation, and by Friends Medical Science Research Center.

LSD-25 was used to treat an early J.R. deprivation syndrome in alcoholics and was also used to treat chronic schizophrenia. LSD-25 was also used to treat pain and was included in the book LSD: The Consciousness Expanding Drug.

A controlled study of the use of LSD in the treatment of alcoholism was conducted.

Study details

Compounds studied
LSD

Topics studied
Pain Anxiety Depression Palliative Care

Study characteristics

Participants
43

Authors

Authors associated with this publication with profiles on Blossom

Stanislav Grof
Stanislav (Stan) Grof, M.D. has over sixty years of experience as a psychiatrist and researcher. He is one of the founders of transpersonal psychology. Holotropic breathwork also originated with him.