VR for Psychedelics-assisted Therapy–an Interview with Agnieszka Sekula, Enosis Therapeutics
Exploring the intersection of non-ordinary states, sensory stimulation, and the therapeutic potential of psychedelics opens up a fascinating realm of inquiry. However, applying Virtual Reality (VR) in psychedelic-assisted therapy presents a compelling question: What possibilities does VR offer in this therapeutic context?
By Alexandra Plesner
With psychedelic-assisted therapy gaining traction and showing promise in treating conditions such as PTSD, anxieties, addictions, depression, and more, these substances have captured public attention and sparked discussions in the media. It is widely recognised that the environmental and psychological context plays a crucial role in shaping the psychedelic experience and its outcomes. Indigenous cultures have long understood this, incorporating psychedelics into carefully crafted ceremonial rituals. The transformative potential of a psychedelic journey can be profound, but it also comes with the risk of feeling disoriented or overwhelmed.
In this exploration of VR's potential in psychedelic-assisted therapy, we delve into the possibilities and challenges presented by this emerging technology, aiming to shed light on how it can enhance the therapeutic experience, provide a controlled environment for healing, and navigate the intricate nuances of psychedelic states within a digital realm.
We spoke with Agnieszka Sekula, PhD candidate and a Co-founder of Enosis Therapeutics, about the potential use of Virtual Reality (VR) in psychedelic psychotherapy.
“It may be beneficial for clinical programs to adopt a structure that ensures continuity across all phases of treatment. This approach is expected to minimise psychological side effects and maintain long-term positive outcomes. A more congruent design is also expected to encourage an overlooked phase of the psychedelic journey”
How did you arrive at a space where you decided to explore VR for psychedelics further?
I have spent many years using Virtual Reality within different fields of medicine and was always fascinated with its immersive, psychologically beneficial impact. But it wasn’t until I decided to focus my medical research career on neuroscience and psychology that I truly began to understand its state-altering properties. In this process, I became more familiar with the potential of psychedelics as the new wave studies were conducted at Imperial and more robust data began to pour in.
Given the lack of reliable alternatives in psychiatry, the outcomes of those studies and the level of impact that preliminary results suggested seemed groundbreaking to me. Soon after, my research partner and I began to dive into the concept of maximising the benefits of therapies that utilise an altered state of consciousness and came to the conclusion that marrying different modalities could lead to augmented treatment outcomes. We explored it at a theoretical level for a long time, analysing existing evidence and doing mental exercises with the different properties and mechanisms of action of VR and psychedelics- something that became the foundation for the paper we published earlier this year. It wasn’t until I finalised my proposal for my PhD research that we began to recognise the commercial value of our ideas and decided to found Enosis.
Ideally, therapy in a natural setting with preparation and follow-up sessions in the same environment would be optimal. However, the practicality and scalability of such an approach pose challenges.
Considering the duration of a psilocybin mushroom trip, which typically lasts around 4-8 hours–along with the extended comedown and potential "afterglow" that can persist for hours to weeks–it is important to examine the existing protocols and their inherent limitations. Could you provide insights into the current protocols and their constraints?
Psychedelic psychotherapy study designs show more favourable outcomes in traditional settings than clinical ones, even when the methodology is closely matched. In contrast to clinical models, traditional psychedelic retreats adopted nature-immersion models promoted by early researchers in the field. They aimed to maintain a continuous, relaxed, multi-sensory engagement throughout all phases, from preparation through dosing to integration.
Moving psychedelics from traditional settings, which facilitated peaceful, relaxed immersion in nature throughout all treatment phases, into clinical programs, led to substantial changes in treatment structure. There is a high degree of incoherence in protocol design across the three phases of PP treatment, which include (i) preparation, (ii) dosing and (ii) integration. The preparation and integration phases within the same trial may be based on diverse psycho-therapeutic frameworks, involve different therapists, and occur in different environments.
It may be beneficial for clinical programs to adopt a structure that ensures continuity across all phases of treatment. This approach is expected to minimise psychological side effects and maintain long-term positive outcomes. A more congruent design is also expected to encourage an overlooked phase of the psychedelic journey, which may continue after the integration phase: self-practice. Following a clear, uninterrupted structure may make it easier for participants to continue integration privately, outside the clinic and at their own pace, for as long as they see fit.
The importance of context and preparation has gained recognition in determining the benefits of therapeutic outcomes. How do you see the application of VR in therapy for better and more controllable journeying and outcome?
VR is a full-spectrum tool for a targeted approach that enables capitalising on exceptional aspects of the psychedelic journey, particularly the associated experiences of awe, the unique mindset characteristic of the afterglow phase, and the unexplored opportunity for anchoring peak experiences. All of these constructs can augment therapy’s efficacy, especially relevant during the most challenging moments in therapy.
Conceptually, there are many potential methods of utilising those properties of VR to improve PP. However, we can only evaluate their appropriateness once they are tested and validated through robust scientific research.
Despite the growing interest in combining VR and psychedelics, which is emerging predominantly within the commercial industry, we have conducted the only experimental study investigating this combined approach.
This study has been based on a large body of research on VR and the growing research on the therapeutic application of psychedelics. This theoretical investigation, combined with extensive consultation with top scientists and clinicians who work with both approaches, led to the developing of a unique protocol for incorporating virtual reality into psychedelic-assisted psychotherapy.
The Anchoring VR™ scenario we tested in our recent case studies is a transition zone out of an altered state of consciousness that enables recording insights that emerge during ‘the first narrative’ process, improving access, comfort and ease of addressing those insights during integration sessions. This increases the opportunity for the consolidation and the meaning-making process to be revisited over and over and, hopefully, expansion of the afterglow mindset to maximise the benefits of integration.
A unique feature of VR is that it is adaptive to the user's preferences. Patients can create their own world with VR, much like choosing a playlist. Does this help to return to a safe space that feels familiar during the integration process and can give the patient a sense of ownership?
Repeated use of the same VR environment can create a sense of cohesion and familiarity throughout the treatment process. The capacity to influence that world could increase self-efficacy in treatment, hence a stronger sense of ownership over the healing pathway.
Just as importantly, following the completion of the integration, returning to the same VR scenario can also support continuing the therapeutic process through self-improvement. VR is a multifunctional platform that can ease the transition into self-practice of meditation, gratitude, relaxation or further behavioural training to maintain healthy habits initiated during therapist-led integration. The comfortable, enjoyable nature of the VR experience also makes it an adherence booster for accompanying treatments.
Please tell us more about your current or previous trials or research studies.
We have completed the world’s first study on the synergistic application of VR and psychedelics, conducted in the Netherlands and in collaboration with Swinburne University and the Psychedelic Society Belgium.
The primary results showed that Anchoring VR™, combined with a guided psychedelic experience within a supportive psychotherapeutic framework, generated high levels of acceptance and satisfaction, as well as reduced pre-session anxiety during the preparation session and increased the recall of psychedelic insights in the integration session.
Face-to-face interviews with participants indicate that through the application of Anchoring VR™ on the day after the dosing session, participants were reminded of their psychedelic-induced insights, which they had started to forget even one day after the dosing session. Given that one of the main challenges faced by therapists and patients engaged in psychedelic-based treatments is the elusive nature of psychedelic insights, offering patients a tool that can reconnect them with those insights augments the therapist's capacity to support and guide the process of integrating them into tangible, real-life outcomes.
Where do you see the development going for VR in psychedelic-assisted therapy?
VR is used to explore alternative approaches to therapy which are not cognitively heavy and pushes the boundaries of what current frameworks allow. We would like to see VR inspire a more robust exploration of therapeutic approaches and constantly allow us to keep reiterating things as we learn more about mental health, human nature and consciousness. We can’t be completely limited by the methods developed decades ago. VR can allow for exploration, even if the best final optimised model does not use VR. To us at Enosis, the main focus is the experience design of therapy, which complements the clinical approach, and the main tool we focus on as a mode of experience design is VR.
