Virtual Reality + Psychedelic Therapy

human brain


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Rena Sherbill: Welcome to the show, Prash and Agnieszka. It’s great to have you on the show. Thanks for taking the time and making it out here.

Agnieszka Sekula: Hello.

Dr. Prashanth Puspanathan: Thank you very much for having us.

RS: Yeah, it’s great to have you. So, share with us your journey to psychedelics and how you started Enosis?

PP: I’m a psychiatrist who did psychiatry training purely to work with psychedelics. I’m a surgical trainee who discovered psychedelics and didn’t want to operate in the body anymore because you wanted to operate in the mind, and I’ve been a psychedelic purist for a very, very long time. And then I met Agnieszka, who introduced me to this world of virtual reality and completely turned on its head where I thought my direction was heading.

AS: My background is completely different. I’m a scientist. I’ve worked with VR for a decade before I met Prash. I use it in whole range of different projects in medicine and got increasingly more interested in how to use it therapeutically. And started to look at it as a method of inducing an altered state of consciousness and approaching mental health treatment from that perspective.

And that’s when I met Prash who introduced me to psychedelics, and jointly, we started to work together on research and all that state of consciousness and eventually realize that we might take the most benefit from combining different state altering methods, and that’s how we looked into combining virtual reality with psychedelics.

RS: That was going to be, that’s where I cut myself off, how you decided to focus on that, so thanks for answering. Did you meet through the psychedelics connection? Was that how you met, or was it totally outside and then you…?

PP: I’d say it was outside. We were working on a paper on altered states of consciousness more broadly. And as part of that, we were looking at a couple of different altered states inducing mechanisms, hypnotherapy, transcendental meditation, psychedelic therapy. That was obviously my focus. And it was looking at that and recognizing that a lot of the data pointed to the fact that synergistic effects worked better than each of them individually on their own that led us to thinking about this.

RS: Like the entourage effect?

PP: Yes.

RS: What was your experience with psychedelics that led you to devote your life to it, I suppose?

PP: I mean, I suppose it was, yeah, it was personal experience and exploration. And – but it wasn’t my first psychedelic experience, possibly my second experience, and then the world was never the same again, and I could not believe in objective reality ever again. And when I looked at the rest of psychiatry and the way medicine treated mental health, we had not had a significant innovation since lithium, really, at that point.

And the treatment modalities that were available to treat human suffering were largely abysmal, full of side effects. And it’s not to say that psychedelics does not come at all range of risks and potential consequences, but it is a completely different paradigm in which to approach healing.

RS: Yeah. Paradigm shifting has been, I think, the term of the past couple days for me. It’s just talking to everybody who is shifting paradigms. And something that we’ve talked – I’ve been doing a Cannabis Podcast for a few years, but we just started focusing on the psychedelics space and something that has been there since the beginning for me and my discussions around psychedelics has been the mental health issues that are facing the entire world, I would say, the number one issue.

And now since I’ve been at South By [Southwest], I have said, and on these talks about mental health professionals suffering or just health professionals suffering, doctors, and I was just at a talk about first responders and police officers and how they can really benefit from psychedelics, although it’s typically not available, like, to a police officer, it’s a whole thing. But, yeah, I guess, I’m just putting it out there, like, the extent of the need for this treatment and what it can bring. Is the VR aspect, is that particular to a certain type of client? Or can you explain how that, kind of fits into the whole picture?

AS: It really does depend on the VR itself. VR is a very broad term, and it is about how you design the software and what you do with the software, which directs how it’s actually going to be used. There’s a number of ways in which you can use that. And most popular ones in mental health are either meditation or relaxation focused. We’ve just attended a talk on pain relief, which is also increasingly more adopted. The way we are using the VR is to allow patients to build their own mental model of their experience.

So, they’re building a mind map by projecting onto the VR space, everything that either happens to them during the psychedelic experience or during the therapy process. So, they’re building the model inside out. And in that sense, there is no specific indication that that’s better for. There’s no specific therapeutic framework that is better suited for. It is up to the patient what they create.

And the second thing that you mentioned is that there is a large number of people that require either mental health professionals or just mental health support, which might really struggle with access to it. And that’s where VR can really help. It can help with scalability where we just have huge demand, and we don’t have enough professionals to catch that demand. And technology has always been best at just increasing the scale and access to support.

RS: But what’s been great about South By is, I feel like each conversation leads to the next and what you’re saying now about the tech aspect of it, strikes me as really true, and this is how you kind of progress is with the innovation and kind of helping the human aspect of it and the limitations around just what humans can bring. Yeah. So, what does it look like exactly the VR treatment?

AS: So, it’s mostly a space where the patient creates their own experience for themselves. We provide the basic building blocks for that, which are very simple and very abstract to begin with, so that we don’t inform too much of what is being portrayed onto this space initially. We provide little audio recording devices for patients that we call anchors, and that’s why the scenario is called Anchoring VR. And in those anchors, patients record little voice messages for themselves or for their loved ones depending who’s using the model.

These are voice messages that either represent what happened during their psychedelic experience and that can be used immediately after the psychedelic experience or any voice messages that emerge during their therapy. So, basically, it’s the most important information from the therapy that emerges that is being distilled down to those specific anchors. Then those anchors can be labeled, can be explored further, can be grouped, different themes are found, patients work with patterns that emerge during the conversation. They find links and connections between different themes that emerge.

So, it’s supposed to be representing a way of processing your thoughts and feelings in a more organic way. That’s more representative of how you actually think and how you actually process things emotionally, rather than trying to squeeze it for that funnel of linear narrative making that, basically telling your story to a therapist in this, sort of cognitive analytical process usually allows us to do.

So that’s how it emerges. The whole model is being built from those basic building blocks and using symbolism as well to represent certain behavioral change. For example, you can – if you have a thought that represents something that you want to nourish in your life, you can plant that thought and then tend to it and water that plant and watch it grow. So, that’s what the content of it is.

RS: Is there like a service provider helping? Is there training involved?

PP: Yeah. This is delivered with a therapist. The whole point of this is to be a container for the entire psychotherapy process. So, it’s not in any way divorced from having a therapy provider there. I think what makes it often hard to understand is that people have a misconception when they think about VR, which is of an intense stimuli that is being projected inward onto the individual, and that’s what we know of VR.

And so, when we describe what we describe, it does make it hard to make sense of, but we like to describe what we’re doing as being quite the other way around of a complex set of tools that equips the patient with the capacity to project onto the canvas.

YouTube projects onto you. Microsoft PowerPoint allows you to project outward onto a canvas, and you can build some – well, maybe not fantastical things with Microsoft PowerPoint, but you get the analogy and way it drives. And in psychotherapy, what you’re essentially trying to do is, if the process of psychotherapy is to make the unconscious conscious, even then, it sits sort of within this ethereal space, it’s non-tangible space.

If we can now take that, which has been made conscious and make it tangible in the frame of a projection of your whole mental model as it evolves in psychotherapy on this internal space, which the VR scenario is, then you have something that you can work with in real time that is dynamic that you can keep recording to – returning to and that is a permanent record of your psychotherapy experience.

RS: It’s like leaving crumbs for yourself.

PP: That are organized into mind maps. Yeah.

RS: And it’s all psychedelics or which psychedelics are being used?

PP: Well, it’s a psychotherapy tool, so it’s really any process that involves psychotherapy, it could be any psychedelic experience. It needn’t even be. It could be a breathwork session that produces a remarkable number of insights. It could be a traumatic event that produces these insights. Anything that is a strong enough psycho-emotional stimulus that produces insights is enough to seed that session, and then it’s about coming back to it repeatedly in psychotherapy to develop that further.

So, we really need to think about this as a psychotherapy tool, that works beautifully in tandem with psychedelics, but it’s not exclusive. I mean, this came from learnings that we took from the psychedelic experience. I’m a MAPS trained psychedelic therapist. This is where all of our thinking came from.

And I think for us, this is one of the great learnings that psychedelic – working with psychedelics can bring to the rest of mental health care delivery because there’s not many schemes of mental health care that uses this modality of generation of insights and then working with that. And that’s an interesting way of working with altered states of consciousness that psychedelics have taught us.

RS: And who do you partner with? Who are you working with?

AS: At the moment, we are working with the OVID Clinics in Berlin. They are a ketamine provider that have an established ketamine protocol and we have licensed our VR scenario to them, so that they added it on to their protocol. And everything else within the protocol said exactly the same. The only thing is that addition of the VR scenario, which is an extension of the psychotherapy session.

So, it doesn’t exist in silo. It doesn’t exist as an additional replacement of the psychotherapy. It’s a three-dimensional immersive, multisensory extension of the therapy as if it would have happened without it. And we are running a study with them comparing their standard protocol with the protocol that has the VR added on.

RS: Is there data that you’ve compiled yet or it’s being compiled now?

AS: Not yet. In about a year, we should have our data complete.

RS: Really interesting. All ages?

AS: All ages. There’s – any exclusions are predominantly related to the substance itself. The only exclusion criteria that are relevant to VR is seizures or any risk factors, procedures, or migraines, or strong headaches.

RS: There’s also the big part about psychedelics is, we had Payton Nyquvest from Numinus (OTCQX:NUMIF) on who was discussing that calling it even a psychedelic industry is really limiting. He feels like it’s going to transform healthcare, and it’s really just going to be a new – healthcare is going to look really differently. And that’s kind of what I’m thinking as you’re talking and as you’re describing how you use this. It’s really just a widespread approach.

AS: That’s exactly how we feel about it. We recognize that the actual adoption of those – of new method of drug delivery will be quite limited because not – it won’t be available everywhere, not everyone will want it. But what we believe is that we can learn from this enough to actually allow for that phase shift in the mental health care delivery.

And that’s what we are trying to learn from psychedelic is how to approach our consciousness, how to approach the way we process emotions, how we embody emotions, and how can we learn new methods of communicating that and analyzing that, which don’t rely on those analytical cognitive methods that we’ve learned from those previous approaches. So, how can we actually break away from that previous system enough to do justice to what psychedelics have taught us.

RS: How do you see it – you both live in Australia, I’m assuming? Are you – does the recent, kind of legalization around psilocybin, does that push forward kind of your thoughts around the business model and in general how much psychedelics is in the public consciousness at this point?

PP: It certainly puts Australia on the map and with us being placed in Australia does give us a quite unique opportunity to examine. I think what’s going to be most interesting to examine is how this – it gets delivered in real life.

We’ve seen a limitation of clinical trials as being overly utopian, and that the selection criteria is so, so narrow that it is just not reflective of your average patient population or the average methodology of mental health care delivery. So, this is going to really give us real world data on what a rollout actually looks like when you’ll be dealing with real people and not the perfect trial participant.

So, for us, from a data collection perspective and in terms of optimizing what we’re doing outside of the clinical trial frameworks, certainly gives us the opportunity very, very much ahead of the game.

Having said that, most of our clients, I think, will still continue to be outside of Australia just from a scale perspective, it’s a small population, and it’s going to take a while for even this to ramp up, certainly in areas like the ketamine space; Europe, in the United States; and Canada are far ahead of the game, and that’s where our clients will probably continue to come from now. But we are, yeah, we’re definitely going to leverage this opportunity to collect some, really useful data.

RS: If you could design how healthcare kind of shapes itself up over the next couple of years and I know that’s kind of a broad question depending on where you live in the world is, looks a bit different, but I guess, speaking broadly, you can get specific if you want.

How would you kind of ideally think that that’s going to progress and maybe a little bit pragmatically also?

PP: The world is certainly moving towards one of greater decentralization, whether we like it or not, partly because we’re getting lazier and we don’t want to leave our couches and our rooms. As much as we blame COVID, maybe blame is the wrong world, or we put the onus of the incidents on COVID for telehealth proliferation and Zoom Therapy proliferating.

The writing was on the wall well before that, and that was a direction that we were heading in. And that for me as a psychotherapist, at least, is a cause for concern because I think Zoom Therapy is a truly suboptimal form of therapy. It’s better than no therapy, but there’s no therapeutic frame. There is no separation of day-to-day life and then therapy life, which is necessary to maintain presence and attention.

And we would love to see a return to models with greater engagement, but we know that’s not always possible if the world is trending in a decentralized manner.

We’d like to see experiential therapies in the way that we use them to be, yeah, to take on some of that burden away from Zoom Therapy, because we see VR as being incredibly useful in delivering that therapeutic space, that therapeutic frame that Zoom Therapy is unable to offer. And so that’s our personal hope, I guess, in terms of the way where the – what the company is trying to add to the mental health care system.

RS: Are there particular clinical studies that you’re specifically focused on or excited about or think that it’s really going to push the industry forward more kind of seriously?

PP: Yeah. If we’re talking purely about psychedelics, yes, things like stroke. Okay, let’s separate. There has been a move in the psychedelic world to investigate non-hallucinogenic use cases of psychedelics, which a lot of us sort of recoil from. And I understand why.

And the last thing I want is for another purely biological treatment to come out of something which is really and should be as a really psychologically-based treatment modality, but there are studies looking at the use of psychedelics and particularly the non-hallucinogenic component for neuroplasticity for neuroregeneration in stroke victims, as an example, like, that’s pretty interesting.

I do think that the research looking into delivery devices is going to be really interesting in shaping the way psychedelic healthcare ends up being delivered because some of the formulations that we have now are quite limiting and hard to scale.

IV formulations of ketamine, for example, are perfect pharmacodynamic profiles, but it’s really hard to scale because you need – well, you need all the infrastructure for it. Whereas a lot of oral formulations of things like psilocybin cause huge amounts of nausea and vomiting, which again isn’t ideal when you’re trying to create the perfect type of set and setting to lead into the experience. So, I think delivery devices will be a fascinating area to watch.

RS: And given our focus is the investing space in cannabis and psychedelics, what would you say to the investment community is a good way of looking at the space or thinking about the space, like what do you think is going to make it or how they should think about it?

PP: We see a disconnect between the way that capital has been deployed in psychedelics and where we think the efficacy in psychedelic therapy is actually going to head. There’s an L.E.K. Consulting report that $1.7 billion was invested in drug development, psychedelic drug development, up until the end of 2021. And less than $200 million in absolutely everything else. And the psychedelics is only one part of the whole process, which consists of a whole other set of human elements.

In fact, the psychedelic, the $1.7 billion is invested in the one thing we technically already have, which is hysterical in its own right. But we understand why that is necessary from an IP protection perspective.

I think what will be interesting in a couple of years as these products come to market and reach maturity. That is the difference between substance a, substance b, and substance c in terms of the end psychobehavioral outcomes. Is that difference going to be significant, or is it going to be negligible when you compare it to all the other confounding effects such as the therapist training, such as that the set and setting such that the number of sessions that are delivered? And if so, then all that money that’s gone into to drug development has created a disproportionate industry.

I think of a body builder who just has continuously skipped legs day, all right, and the rest of that ecosystem suddenly finds itself underdeveloped and immature. And I think that’s what is missed at the moment. I understand why it’s hard to invest in all these other parts of the industry. It’s not that easy to develop, to capture IP around things like therapist training.

We’ve tried to do that by having a therapeutic tool that is basically a therapeutic framework encapsulated within a device, which allows us to capture IP and we’re patent pending on the method of using VR to anchor psychedelic experiences, but there’s not many ways to really capture that, and that’s why there hasn’t been that much in investment in it. But I think that that day of reckoning will – might come.

RS: Lots to think about. Lots to think about. First of all, I appreciate you both sharing so much insight, a lot of food for thought, or just a lot of thought. What would you, if there’s anything that you think that we missed in the conversation if you’re speaking to the investment community or things that they might – things they may want to pay attention to, and then also if you see any, like, risks to putting capital in the space at this point in time?

PP: I think there are a lot of risk to putting capital into the space in this time if one is putting capital into the space in the same way as capital has been deployed in the space for the last few years because the space is shifting. We are rapidly seeing that some of the old business models are failing. There are a lot of psychedelic companies that are struggling right now, and the sort of financial models that drove those capital raises in the last few years are coming to bear as just not adding up from an economic standpoint.

So, the risk is there if you blindly follow what’s been happening for the last few years. I think there is an opportunity now to invest in new emerging businesses in this space, which are not doing the same, tried, and tested thing. We talked about a bit of some of what we find is interesting from a research perspective. And I think that’s the – these are the parts of the industry to look at. I think the industry has an incredibly long way to go, but I do think it is immature.

And I’d say, looking at the kind of businesses that are being led by scientists, rather than businesses that are being led by capitalists, maybe, or – and there are a huge amount, many businesses that are led by people who’ve come from other industries, sort of catapulting into the bandwagon of the psychedelics of psychedelic renaissance. And, again, we understand why from an economic viewpoint.

But I think it’s hard to have the same depth of foresight into where the industry is going if you’re not a scientist or researcher who’s actually shaping this to science in the space in the direction that it’s going. And I think that’s a distinct – that’s a crucial distinction to look out for when investing in this space.

RS: Do you – is there competitors in the VR space right now, like, doing similar things to what you’re doing?

PP: To what we’re doing? There are a bunch of other companies working on using VR in some way related to the psychedelic space, like there are companies that are trying to recreate elements of the psychedelic system, psychedelic experience to replicate it, to prepare people for it.

There are companies that are trying to use VR to create particular brainwaves that may make them more amenable to the psychedelic state, but there’s no one trying to create a psychotherapy tool, whether in psychedelics or as far as we know outside of psychedelics. It’s just a flip of the way you think about how you use virtual reality to have a, yeah, to build a toolkit, a Batman’s-belt in a way.

RS: Really interesting stuff. Well, we’ll keep an eye out for Enosis. What does the name mean just out of curiosity?

PP: Enosis is an old Greek for union and old world wisdom, new world technology has been the marriage that we’ve always been trying to create.

RS: Thank you both very much. Really appreciate the conversation.

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