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“ To be uncertain is to be uncomfortable. To be certain is to be merely ridiculous. ” - Goethe

Psychedelics: a group retreat - lessons: ceremonies, duration & organisation

"And now let us believe in a long year that is given to us, new, untouched, full of things that have never been."   Rainer Maria Rilke 

This is the fourth in a series of five posts triggered by a recent psychedelic retreat I went on.  The first three posts are 'Psychedelics: a group retreat - initial thoughts', 'Psychedelics: a group retreat - meeting up, orientation & the ceremony"Psychedelics: a group retreat - the ceremony, integration & follow-up' and the fifth is 'Psychedelics: a group retreat - lessons: playlists, nature & integration'.  In this fourth post I want to discuss how many 'ceremonies' - how many doses of psilocybin - it might be best to take during a retreat, how long the retreat might last, and other organisational issues.  But before I do, I would like to say a bit about my own journey with psychedelics over these last several months - partly because it shows 'where I'm coming from' in my discussion about structuring retreats.  It's less than a year ago that I read Michael Pollan's rather wonderful book 'How to change your mindand then embarked on something of a mission to read as much of the emerging research on psychedelics as I could lay my hands on.  I now - November '19 - have 274 articles on psychedelics in my personal database, with well over 50 of them having been published in the 11 months since I read Michael's book.  I also attended this summer's 'Breaking conventionconference where I listened to the main researchers in the UK (and elsewhere) presenting on their recent work.  I've written fairly extensively too and also initiated discussions about forming a support network of Scottish health professionals who are interested in the therapeutic potential of psychedelics. 

I took a dozen or so LSD trips - first as a philosophy & then as a medical student - about 45-50 years ago.  In the last year, I've reacquainted myself with these psychedelic mountains, taking eight psilocybin trips - one low dose, three moderate, three high, and (on this recent group retreat) one very high.  These have ranged from 5 to nearly 60 gm of truffles (approximately equivalent to 5 to 60mg of psilocybin).  This is a more concentrated set of trips than I would have wanted (or recommended) just on a personal basis, but the quite extensive experience has helped me be of more use to others interested in these areas.  The trips have mostly been on my own (with an accompanying 'tripsitter' - in the Netherlands - for the higher dose journeys).  The most recent however was this 4-day group retreat linked to the UK Psychedelic Society, run by a group of maybe the most experienced providers of psilocybin retreats in Europe.  Overall this recent refreshing of knowledge & experience about the therapeutic possibilities of psychedelics sits on my longer term personal background of decades working as a medical doctor, psychotherapist and group facilitator.  In this blog post - and the next - I'd like to think a bit about how I would design a psychedelic retreat, building on what I've learned.  This includes comments about one- or two-ceremony retreats, truffle dose, duration, numbers & organisation - while, in the next post, I'll discuss playlists, time in nature, and integration. 

One- or two-ceremony retreats?  I would definitely go for two.  I have written a good deal on variation both in the strength of different batches of truffles and in how different individuals metabolise them.  So someone with little experience of psychedelics flying into the Netherlands and taking a fixed, fairly high dose of psilocybin truffles is swimming out into particularly unpredictable waters.  This is likely to be OK ... psilocybin, taken responsibly is a pretty safe substance.  It is however even safer and kinder to start with a moderate dose and then decide what subsequent dose to take ... now having a better idea of the strength of the particular batch of truffles one is using (there's probably about a threefold variation in how much psilocybin a gram of truffles might contain) ... and a better idea of one's individual metabolic & psychological response (here again there's considerable variation between different people).  It's certainly not essential to go for a two-ceremony retreat, but it does seem safer and kinder.  The downside is that it will be more expensive.  The fact that it will also take a longer commitment of time could be seen as a downside or an upside.  Psychedelics aren't really a fast food, they are more rewarding viewed as a banquet! 

What truffle doses would I recommend?  It's helpful to remember here that dose is only one of a number of factors affecting the depth (and helpfulness) of a trip.  So, for example, I went 'deeper' - scoring 89% on the Mystical Experiences Questionnaire (MEQ) - on 30gm of truffles (taken on my own, with a tripsitter I trusted & using my own playlist) than I achieved on nearly 60gm - scoring 85% on the MEQ - on this recent retreat (again with tripsitters I trusted, but taken in a group & with a playlist I wasn't that keen on).  More formal research has also demonstrated that trip depth and psychedelic dose are only moderately linked.  So I would encourage all retreat participants to buy 3 packets - 66gm - of High Hawaians.  Why the High Hawaians brand?  I strongly suspect that there's often more variation in psilocybin content between different packets of the same truffle brand than between similar weight packets of different truffle brands.  I would choose High Hawaians because their unusual 22gm packet size would fit better into the dosing schedule I'd recommend than the more typical 15gm packet size of several other brands.  So, for the first ceremony, I would suggest participants start with half a packet (about 11gm of truffles) and then have the option of taking part or all of the rest of the packet (a further 5-11gm) about 60-75 minutes into the trip.  See more details of the research literature on the effects of different psilocybin doses (and whether one increases doses in steps) further down the post 'Psychedelics: again the pilgrimage - current experience, low/moderate dose'.  Suggested doses for the second ceremony a couple of days later (see overall retreat length suggestions in the paragraph below) would be affected by people's experience during the first ceremony when they took 11-22gm.  There is going to be some desensitization to truffles taken for the second ceremony due to brain receptor down regulation from the truffles taken at the first ceremony.  The recent 2018 paper by Geiger & colleagues on the metabolism & pharmacology of psilocybin gives more information on this.  My own personal experience is that taking two trips - each involving a full 44gm of High Hawaians - three days apart (so a gap of two clear days before taking a second dose on the third day) was that there seemed to be a reduction in strength of about 20-25%.  With the two-ceremony retreat schedule I'm currently discussing, we would probably only have a day between trips - but the first trip would be at 11-22gm and so would tend to down regulate receptors less than with the initial 44gm I used for my pair of High Hawaian trips taken earlier this year (although the gap between trips isn't the same in the two comparisons). 

I can imagine a two-ceremony retreat running for anything from six to eight days, depending on how much initial preparation and between ceremonies time one allows for.  The timetable for a shorter six-day (five-night) version would look something like - 1st day: arrive, eat, meet; 2nd day: orientate & moderate-dose trip; 3rd day: integrate; 4th day: high-dose trip; 5th day: integrate; 6th day: further integration & farewells.  I think I'd aim for a dozen participants, three facilitators & a cook - although over a fairly long residential like this, sixteen participants with four facilitators plus cook would also probably work well - and just eight participants with two facilitators & cook could be fun too.  I'm remembering here that stronger group cohesion is associated with better long-term outcomes, and that, in my group experience - the longer the retreat duration - the greater the numbers that can really bond over the course of the retreat.  So, for example, I think that sixteen participants over just three nights is likely to be too many/too short for more optimal bonding.  As usual, one can 'get away with' these shortcuts, but they probably detract a bit from best outcomes.  

Pre-retreat I'd link small groups of four participants to a specific facilitator.  The facilitator would have video-calls with each member of their small group both before and after the retreat.  If appropriate they might provide or encourage more extensive follow-up as well.  During the retreat these small five-person support groups (facilitator plus four) would meet each day (probably after breakfast) for an hour & a half or so to check-in and process what's going on for each member.  I would be thoughtful too about the balance of structured exercises and unstructured discussions in the group as a whole.  As Irvin Yalom highlighted, structured exercises are often welcomed by participants and tend to move things forward faster, however they may somewhat disempower people and can lead to a decreased ability to take learnings out into the world.  

I realise that the lessons from a psychedelic experience can at times be an unexpected, surprising gift ... and that it's important to stay humble and open to what the experiences may teach us.  However there are also advantages to coming to trips with clear intentions.  And one way of clarifying these intentions is by linking to the research finding - see 'Psychedelics and connectedness' - that psychedelics can be seen to act by connecting us more fully to self, others and the world.  I would be interested to see how helpful it seemed to be using these ideas more in the orientation & integration phases of the retreat.  So how might one explore connection to self, others and the world?  This, in part, is the kind of territory looked at in the ten session course (freely avaiable online) - 'How to live well - a shared exploration'.  And the questionnaires linked to the course, could be used to highlight areas that might benefit from more focus - and provide a way of tracking changes.  And too, the Mystical experience questionnaire, the Emotional breakthrough inventory and a Measure of positive/welcomed emotions could all also be useful for tracking experiences during the ceremonies themselves ... and for suggesting areas to look at in post-ceremony integration.

And even more recent research (published in January '20) - "Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety" - shows scores on a new scale, the Psychological Insights Questionnaire, seem to be more strongly associated than MEQ scores with decreases in depression/anxiety via improvements in Psychological Flexibility.  Note however that although this seems a genuinely important new set of findings, once again the focus here is on decrease in 'ill-being' rather than increases in 'well-being' or 'self-transcendence'.  So the authors comment "The sample used for our primary analyses (described above) was a group of individuals who reported a spontaneous or intended change in anxiety or depression following a psychedelic experience."

For the fifth & last post in this sequence of five about a group retreat, see 'Psychedelics: a group retreat - lessons: playlists, nature & integration'.


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