Hallucinogen-Assisted Psychotherapy for Trauma Disorders: A Bionian Lens

There has been an increasing interest in the use of classic psychedelics (such as psilocybin) and 3,4-methylenedioxymethamphetamine (MDMA) for treating mental health conditions. Individuals often describe psychedelic sessions as among the most significant experiences in their lives, emphasizing the sense of awe, connectedness, and spiritual transformation taking place. While the psychedelic literature from the past two decades has mostly focused on using these drugs in the treatment of major depressive, anxiety, and substance use disorders, researchers have also investigated the utility of classic psychedelics and MDMA for other conditions, including trauma- and stressor-related disorders. Trauma can profoundly affect biological systems, including stress hormone pathways and neural circuitry, often leading to hyperarousal and rigid cognitions. In this article, we discuss how some of the concepts posited by Wilfred Bion can be applied to neurobiological models of the mind and to the effects of these drugs. Relevant concepts from neurodevelopment are presented first, including how key areas can be significantly affected by early adversity. This is followed by a discussion of Bion's theory of containment and of how the K link (K denoting knowledge) is developed or disrupted, depending on one's experience. Finally, we present extant literature on the use of MDMA and classic psychedelics in trauma disorders, reflecting on how a Bionian lens can enrich our understanding of their therapeutic action.