Episode 5.5 - Trevor Silvester. Turn on, Tune in, (Don’t) Drop Out - Psychedelics & Cognitive Hypnotherapy

Aural Apothecary Series 5: Episode 5

Jamie: Welcome to the Aural Apothecary podcast. My name is Jamie Hayes. For this episode, we are joined by Trevor Sylvester. Trevor is a therapist, author, and trainer who is best known for developing cognitive hypnotherapy. We will welcome Trevor in a moment as he shares a drug for our formulary, his career anthem, and recommends a book for the aural apothecary library.

For our micro discussion, we continue our look at an article in the The Times earlier in the year: "the NHS is flatlining, here's how to save it right now" by health editor Shaun Lintern. Before any of that, let me welcome my two fellow Apothecaries, STC is in Bournemouth and Gimmo is in Cardiff. Welcome both.

STC: Good evening.

Gimmo: Good evening.

Jamie: What you been up to?

Gimmo: Um, it's actually not that long since we recorded the last podcast. Is it? So,  I've been off this week, so not much to talk about really, cuz I've been gardening and clearing out the shed, as you do when you've got holiday. And I went today to see, I've been to Bristol today, over the water, to watch a pantomime of all things.

STC: Oh no you didn't!

Gimmo: I did. Mother Goose. It was supposed to be John Bishop, but I think he had some family issues. But it was Ian McKellen, so it was quite weird watching...

STC: Oh what!?

Gimmo: ...a pantomime with a thesp in it.

STC: That is, yeah. That is weird.

Jamie: That's some substitution.

Gimmo: It was at Easter. No, he wasn't the sub. He was the main man. But, maybe it's a new thing, Easter pantomimes. So, yeah, so sorry, not much.

Jamie: Did you say you'd been to the tip though, as part of your shed clear out?

Gimmo:  I did. Yes, I did. I was there, Easter day, I was in the tip.

Jamie: And how was your tip operating?

STC: Hang on a minute. Surely, surely the tip is closed on Easter Sunday.

Gimmo: No

Jamie: Are you still having to book the tip?

Gimmo: It was a recycling centre, Steve. They're not tips anymore. Oh yeah.

STC: You don't have bin men either, do you, in Wales?

Gimmo: Yeah, I had to book in advance.

STC: So, Gimmo, you know, you said you did a lot of gardening. We know that lots of people like to listen to podcasts when they're gardening. So, shall we assume that you listened to some podcasts?

Gimmo: Well, I'm still on "the rest is history" back catalog, so yeah, I was listening to the rest is history.

STC: Oh, okay. Fair enough. Well, actually I've got a terminology actually that my sister-in-law, who is the reason why today's guest is on, her name is Tracy, and she's an avid listener of the podcast and she says she never listened to a podcast until I introduced her to our podcast and she was round on Easter Sunday and she said to me, Steve “I'm podcast pissed”.

She said, I've listened to so many podcasts. And I said, I like that phrase, Trace. I'm going to use that on the podcast. So well done, Tracy. Not only did you deliver us today's guest, but you came up with the term “podcast pissed”.

Gimmo: Well, hold on, Steve, on that term, then you're, you are more than pissed. You're a pod-aholic.

Jamie: He's gone to the next, he's gone to the next level, Gimmo.

STC: Yeah. Is that like when you start listening to podcasts as soon as you get up in the morning, you do it when you're on your own, that kind of stuff.

Jamie: You can give up. You just don't want to.

STC: That's true.Yeah. Okay, I'll take that.

The other phrase I heard this week, which I think is genius, you know, we were talking last week about the NHS, Armageddon, was the word that we couldn't remember. Now of course, it's been bad again this week as the NHS junior doctors are on strike. So, I'm in a meeting with a lot of senior people and somebody was describing just how bad the situation was at the hospital and, I don't think they meant to say it and I still don't, I didn't actually pick them up on it. I just thought I'm having that cuz I'm absolutely sure he is talking about how bad it was. And he said it's a real, I thought he said 'shituation', but I think he just said situation. But I quite like that. So, it's a bit of a 'shituation' going on in England.

Jamie: Oh, very good. I caught up with an Aural Apothecary Alumni earlier today. I caught up with Dr. Sally Lewis, our National clinical director for value-based healthcare.

STC: Was she listening to rock music?

Jamie: She wasn't on this occasion, but it was just a reminder. We could have met on Zoom or on teams, but we didn't. We met up in a coffee shop, had a great catch up, got a few things sorted, and then as we walked out to the coffee shop still chatting, we got a couple of other things sorted too, and that just wouldn't have happened if we'd been online.

And then I had about a 40 minute drive home, which gave me some time to process what we'd just been discussing. So, it was a real reminder to push for, when possible, some face-to-face contact and rather than being on teams or online, cuz it's a completely different experience.

STC: Yeah, you mean so go human. Yeah, I'm like that. You know when you go in Tesco or Sainbury's and you've got all those automatic things. Sometimes they look over to you and they look, they look lost, don't they? The people that are behind the counter. So, I always smile at them and say, yeah, I'll go human anytime.

Jamie: And they say “he's in again”

Okay, before I introduce our guest, thanks to all our listeners, we have a truly global audience wherever you're listening from across the world. Thanks, from everyone involved with the Aural Apothecary, and please don't forget to visit our new website, www.theauralapothecary.com.

 Let's move on, it's our great pleasure to welcome Trevor to the Aural Apothecary. Trevor's, a therapist, author, and trainer who's best known, as I said, for developing cognitive hypnotherapy, a model of therapy that combines a modern use of trance states with techniques from a wide variety of approaches based on the needs of each client. He is co-founder of the Quest Institute, a training organization offers courses in cognitive hypnotherapy.

Trevor was editor of the Hypnotherapy Journal for nine years and served on the committee of the National Council for Hypnotherapy for a further five years. As Director of Supervision and Ethics. He's written six books including 'cognitive hypnotherapy: what's that about and how can I use it?' and interestingly, for our audience, 'grow: personal development for parents'.

Hi Trevor, welcome to the podcast.

Trevor: Hi, very glad to be here. Thank you.

Jamie: Thanks for joining us. Let me start off, Trevor, if we bumped into you in a pub, a bar, or a coffee house, how would you tell your story?

Trevor: Oh, well, yes, it’s a bit unusual in a way, having begun as a police officer and then segwayed into becoming a therapist.

But I think the common denominator is both sets of people tend to be nosy, especially about other people. It just became a natural thing. I'd been a police officer for 18 years and a lot of the latter years were in training school where we would talk workplace counselling and things like that, and it just felt like I'd found my thing.

I did a course in psychotherapy and hypnosis and got really excited about the possibilities of that. And then stumbled again across this wacky American thing called neurolinguistic programming, or NLP, which was phenomenal because I was in a unit at Hendon at the time that was dealing with students who were failing the course. So we had a month to turn them around or else they got the sack. So, we would teach them how to learn how to study better and I'd done a certificate in education at Greenwich University, took two years, learned next to nothing about educating people. I did a seven-day course in NLP and learned more about how the mind works from them, that I could then translate into helping these students than I could ever have believed.

We went to a point where we could coach them for two and a half hours and their exam results averagely improved somewhere in a range of 15 to 30% and maintained afterwards. So, I was kind of hooked on how quickly the mind could be changed. I set up a private practice where I worked in the evenings after Hendon and then just realized I didn't wanna go back to doing patrol work.

So I left and went into private practice and because I'd been a trainer for a number of years, it seemed an obvious thing to do to set up a training school after a few years. In hypnotherapy, there's a lot of traditional ways of looking at things. You know, the deeper the trance, it seems a special state that you put someone into, you know, the whole kind of stage hypnosis thing, which I was never very attracted to and didn't really fit. And also, within therapy, within psychotherapy, there seemed a great predilection for giving people labels. And then the treatment came from the label.

So if you saw six people for anxiety, they'd all got treated the same way. And that seemed crazy, given the individuality of the brain and people's experiences. So, I began to develop my own kind of ideas. And so, when my wife and I launched the Quest Institute, we called it cognitive hypnotherapy to differentiate it from traditional hypnotherapy and as a separate kind of psychotherapy, and it went from there.

And so we don't do labels. We look at each person's individual experience and one of the key things is we look at how supposing if we do something, you know, common like, a phobia. When you see somebody in the midst of having a phobia, they're in a child state, they've been hijacked in a way by their unconscious, which is causing them to behave in a way they wouldn't choose to, but over which they have no control and it's for their own benefit.

And so, what we do as cognitive therapists is to help the client to understand that trance-state and then de-hypnotize them so they no longer go into it, when they are in their trigger situation, they continue to act as they would always want to, and it seems to work really well.

STC: Trevor, fascinating stuff. Do you get fed up with, or do you like it when people talk to you about their own hypnotherapy examples?

Trevor: It's frustrating. You know, the first thing, if you say you're a hypnotherapist, which I generally don't, you'll get, "Oh, don't look into their eyes". Classically, and this happened at a wedding only two weeks ago, they say, oh, does it work? And I say no, my whole life is based on a lie, it's classic.

STC: So I'm gonna give you two examples.

Trevor: Good one!

STC: The first one, is your friend Tracy, my sister-in-law, who you worked with at Hendon with. Her dad, bless him, he's dead now Ray, but he smoked for a long, smoked like 40 a day for like 20/30 years. He gave up overnight when him and a load of guys from the bus company went to hypnotherapy. And the second one is my own personal one , Jamie, I think you were there, we were students in Cardiff students union , for the stage hypnotherapist. And I decided that I wanted to go on, cuz I'm really fascinated about the mind.

I know we're gonna talk a lot more about this, so I thought, right. And I didn't drink. Okay, so I didn't drink. I went up, got through the first bit where they get rid of a few people who are clearly, you know, either pissed or are not able to be put under. And I would say that I kind of went along with it.

I knew what I was doing most of the time, but there were two really, really weird things. One was another friend of Jamie and I's called Sam Patel, whose wife is also an avid listener of the podcast ,was also doing it. Now, I'm not sure if he was pissed, but he was asked to march like a sergeant major and he marched headlong off the stage in into the crowd and it was quite a high stage and there's no way he would've done that, you know, so he may have been pissed?

But my weird one was we were asked to be, pretend we were seven years of age. And so up until this point I felt I was playing along with it, but, there we go, I start speaking and I go, "hello, my name is Steven' and I am seven", and I had a slight lisp when I was young and I didn't plan on doing that, and that's what freaked me out. And that's why I think there's definitely something about the mind that we're not, something there's loads about the mind that we just don't get.

Trevor: Yeah, I completely agree.

Gimmo: That's hypnotism isn’t  it as opposed to hypnotherapy, I suppose that's where the annoyance comes is when the two, cuz there's obviously similarities, but they are different, aren't they?

Trevor: There's a continuum of trance, really. And you find that there's various scales that experimental hypnotists have demonstrated and people who go up on stage, usually they're screened by the stage hypnotist to be highly suggestible. About 10% of people are somnambulists, so they'll go into a deep trance, and be highly suggestible in a very rapid time with no training. And that's very little use to me as a therapist because I can't depend on my client being good at trance for me to be worth them spending time with me.

So what you find is that everyone goes into trance every day. You know, when you're daydreaming, when you miss a turning on the motorway, cuz you're deep in thought when you're bored in meeting, all that stuff is trance. Anytime when you're not in the moment. And we can utilize that because that's the state you're in when you're having a problem.

So they don't need any special training or be particularly skilled at it. But for someone like Steve, usually they mistake suggestibility with gullibility and it's not usually, and I hate to say this Steve, cuz this is gonna sound nice. But it's above average intelligence and highly creative. They're two of the common denominators of people who go into that kind of trance.

Gimmo: Well, yeah. Let's move on from complimenting Steve. So what you're saying, Trevor, I think is fascinating cuz I've done a bit of the NLP courses myself and I know there's a sort of, there's a mixed evidence base around NLP on its own, but the principles are about, as you're saying about human behavior and how we, how we look at human behavior, one of the things we talk about a lot in behavior change is about heuristics and things like system one and system two and this idea that a lot of decision making in healthcare is automatic. You know, the idea that, we think, when we've made a decision or we've picked a drug up off a shelf or we've made a prescribing decision, it's a conscious decision, but it's not, it's an unconscious decision. So just really interested when you started to talk about trance state, cause that in a way, I suppose, is again, talked about continuums, is the same sort of thing as heuristics, isn't it?

Trevor: It absolutely is. You know, I've read somewhere, and I can't, don't quote me, but something like 90% of our behaviour is driven by the unconscious and it hasn't got the time to work everything out, so it uses a series of rules of thumb or heuristics to guide it. And once you understand what they are, you can short circuit them because they can really help you.

You know, a lot of our positive behaviors are heuristically based as well, but the negative ones are too. And if you can understand what that is, what that rule of thumb that's being used, then we can get inside the programming if you like, and help them to change it. And it's not me doing it as a therapist, it's me helping them to where they need to go in their own minds to do the changing.

That's something I like about this approach rather than the traditional thing, which is very Svengali-like, you know, whenever somebody says they put someone into hypnosis, I just get this kind of itchy feeling. It just doesn't feel right. It feels a bit coercive and there's a power dynamic I don't like. If somebody comes to see me, then it's a meeting of two people on equal ground. And nothing is happening without their permission.

STC: So, Trevor, as you know, this is a medicines podcast and when we were looking at for guests and when I was talking to Tracy and she suggested you and cuz it is a really fascinating story, and I think we might come back to this later on in the podcast about the power of using complimentary therapies. Because, I guess it is a complimentary therapy, isn't it? And all those- I've also had Reiki therapy for example, for chronic intractable headache. I don't get, I don't get it. I'm a scientist, right? It shouldn't make sense, but it helped.

But in conversation, obviously what you said was that you were also happy to talk about was, if you like, partly through, I guess, how you learned about the subject that you now teach and that you help people with, is that, from a personal point of view, you were also interested in what the mind has got and whether the use of psychedelics may actually enhance or help. And so that was one thing that you said you'd be happy to talk about, cause obviously with us being medicines podcast we are particularly interested in that kind of element.

And most of us, I'm sure most of the listeners, and I'm sure the three of us here, haven't used any, what you would describe as a psychedelic drug, legally or otherwise. So, would you be prepared to talk to us a little bit about that?

[00:15:29] Trevor: Yeah, very happily. It came about, I think 2016, we did a research project where we were comparing cognitive therapy against other talking therapies being used within the NHS.

And we were using the same outcome measures as was used within the NHS, GAD 7, PHQ 9, those kind of things for anxiety and depression. And the results that we got from our pilot study showed that 71% of our clients were reporting themselves recovered from anxiety and depression. On an average of six sessions, which we were really pleased about. And that, compared to, I think CBT had a, had an average of about 42%. So, there's a lot of flag waving going on about that, but what bugs me is what about the 29% who aren't helped by it? You know, they're still out there. And so, I'm always looking for, you know, we've gotta be humble about the fact that in a hundred years time, people will look back on what we think is cutting edge and laugh at us like we do, really about Freud, well, most of us do, about Freud. Yeah. And so, I'm always looking for what's new and just several of my students were coming along talking about these experiences they'd had with Ayahuasca, which had been very beneficial. And it knocked on the door often enough that I decided to take it as a sign.

So, being someone who's never even smoked, let alone taken any kind of drug, the idea of suddenly taking psychedelic was quite scary because I've been indoctrinated into this idea, especially as a police officer, you know that drugs are bad. But anyway, I found a place where I could go off and do it legally, and I had a three day or a three night really, experience with Ayahuasca, which was absolutely transformative to a degree, which I would say I had never experienced from therapy alone.

And I went in as an Atheist, and I came out not an Atheist. That was how transformative it was. I'd spent 20 years teaching cognitive therapy as a non-spiritually based, scientifically driven approach. And suddenly, you know, I'm meeting alternative spirits from alternative realms who are giving me these insights, which absolutely helped me move to a different level of wellness, mentally.

So I thought, well, you know, this has gotta be something that should be offered. And I read it, I got deeply interested in it. I came across a book by Michael Pollen called How to Change Your Mind, the New Signs of Psychedelics. And he went round, there's a Netflix series on it now, and he went around all the different offerings in psychedelics therapies in America: ecstasy, psilocybin, LSD, and reported back what his experiences were.

 And I saw that he was being helped by people with psychedelic guides and I didn't even know they existed. So I did some research and within two weeks I was in Colorado learning how to be a psychedelic guide. And I went back a month later to take the advanced training and they were using psychedelic cannabis.

And I didn't even know cannabis could be psychedelic. And honestly, three puffs of this in the beginning, I took more later, but three puffs kept me completely cataleptic for three hours in the most amazingly sematic healing environment. With no talking going on at all. It was all like the cannabis was doing it to me kind of thing.

STC: I assume you must have inhaled?

[00:18:45] Trevor: Oh yeah. Yes, probably too much to begin with. So, since then, I've used psilocybin through magic mushrooms. I've used DMT once, which I wouldn't use again for, because I couldn't see how it could be used therapeutically.

It was too much kind of a 'wham bam' experience.

[00:19:05] STC: Yeah. So just to clarify for the listener in relation to, I still go to, is it called 'Ask Frank', you know, the website about illicit drugs and psychedelics. Are you familiar with that, guys? Its set up by the government and Ayahuasca, although it comes from an Amazonian plant, if I'm right, but it's thought to contain DMT, isn't it? Which, for the listener, is dimethyl tryptamine. And it's claimed quite a lot of interest recently because Prince Harry, in his book, I quote, "it cleared the windshield of the trauma" of his mother's death. And I believe that Elon Musk may also be an Ayahuasca user and fan.

Trevor: I can quite believe it. I think the research that I've seen done on it for trauma-based stuff, there are some incredible results, and we've gotta be really careful here because when you read Michael Pollin's book, you realise how we've had 60 years of misinformation about it.

You know, back in the fifties and sixties in America, LSD was being used on an ongoing basis with biomedical professionals in therapy as a standard thing. Carrie Grant had over a hundred LSD sessions and said it was the most effective therapy he'd ever gone. I don't know why he needed a hundred sessions, mind you, but nevertheless, and then Richard Nixon, he jumped the fence at Stanford with Timothy Leary and, you know, the kids started taking it, Richard Nixon got scared that they wouldn't allow themselves to be drafted to Vietnam, and so began the war on drugs. So I've been part of the generation that's been raised with all the scare stories about psychedelics, and there's no doubt we've gotta be very careful and responsible and how they're introduced into use.

Because, what I found was that while the Ayahuasca was a really transformative experience, it was almost too overwhelming. And if I hadn't known what I know about how the mind works, it could have been quite dark for me afterwards. So I think it needs, Timothy Leary talked about “the set and the setting” being really important, and that is the mindset of the person going into the experience and the setting within which it's delivered.

And I would add that it also needs a careful period of integration after the experience so that you can fit whatever revelations you've had from the experience into your world back into your world. Otherwise it could be really discombobulating.

Gimmo: I think that's an important point, isn't it? Cuz you described something that's very attractive to you is almost a spiritual experience that can cure your depression. And in that way, if we're not careful, it becomes like a magic bean, doesn't it? Cause I looked at the evidence base, we shared some papers between ourselves and so there's a growing evidence base, but we still do need to tread very carefully because, I think, we're in the realms of some emerging evidence, some very positive experiences, like you described, some celebrity endorsements and I suppose it's just treading carefully, but actually, when I've read the evidence base, it does, you know, I am quite optimistic about where it might take us.

[00:22:00] Trevor: Yeah. I am too. And I think there needs to be a balance because, you know, it does need to be done responsibly and we know that the minute it would become available, there would be all kinds of charlatans peddling it as the latest quick fix. And while it could be a quick fix, only within the right usage, the right parameters of its use, but what I wouldn't like it to become, I'm saying this because I'm not, I would fall outside the fence within which it would be allowed. I don't want the psychiatry profession or even the psychotherapy profession to “own it”. Because, I think we need to be humble because people in a spiritual field, indigenous tribes have been using it for hundreds and hundreds of years. There's an expertise there and a knowledge of how to place it in a setting, which might not transcribe into a clinical setting.

So, for example, a friend of mine has just taken part in a ketamine clinical trial and has had a short term benefit from it, but nothing long, he reverted quite quickly afterwards and listening to the protocol, I guess because it's a trial, it was done really to measure the effect in the moment, but it didn't prepare him beforehand and it didn't help him integrate the experience afterwards.

And so if it's just gonna be like, come into my normal office, but today I'm gonna give you some psilocybin, that might not really fit. You've gotta meet the client in their model of the world in its use.

[00:23:26] Gimmo: And that applies to psychotherapy now, doesn't it? In terms of we give people a drug and it doesn't work because we know they should be having the therapy alongside it, hypnotherapy or otherwise.

Trevor: Yeah, it should absolutely be a mixed bag of approach, shouldn't it? There's always been this thing in psychotherapy that the school that your approach comes from is the best school. And so instead of everybody sharing new ideas, people tend to put fences up. So there's lots of these little churches in therapy that don't talk to each other.

And so I've always wanted, for cognitive therapy is to be 'fenceless'. And so we go in and we borrow from everything. And we would be the same way. If ever we were allowed to use psychedelics, it would be sitting in front of each client, finding out how they work, what is their spiritual model, if they have one, and if they haven't, How else could we introduce this in a way that would be the most profound experience for them to have? Because in every experience there is some placebo, but let's maximise the placebo by making it what they wanted it to be, not what I wanted it to be for them. Does that make sense?

[00:24:27] Jamie: Yeah. Trevor, what we do though is we put something in a medical journal. So there's a trial of psilocybin appears in the New England Journal of Medicine, one of the biggest journals in the world. It appears in the journal, and then from there….. And so that's a phase two study of a couple of hundred patients. And from there, the media frenzy that happens does it a disservice really doesn't it? It deflects. And so I've, before, we didn't know you were coming on, so I've been collecting this stuff for months and months.

STC: Of course we did! It's not just thrown together.

Jamie: The Sunday papers...

Trevor: You can't see, Jamie is showing us literature, not actual pills.

STC: Plants that he's been growing in the garden.

Jamie: The Sunday papers: "psychedelic drugs are being heralded by a growing number of medics as the answer to the mental health crisis."

Somebody probes, "Turn on, tune in, take your Ketamine prescription". Yeah, and so with the psilocybin study that came out in November, it just feels as though and again, I think in 10, 15 years time, we may look back and think, "oh, that was just the PR machine crunching into action as these articles were planted or released to let's get people talking about psilocybin".

And that's what it feels like to me a little bit is despite the small amount of evidence that is trickling through, we've just, once again, we get way ahead of ourselves.

[00:25:47] Trevor: Yeah. Yeah, we do. And I do think we need to tread cautiously here in doing that. And let's face it, those, all of those drugs are already out there and people are already taking them.

And there are places you can quietly go in the UK and do it. And sometimes it's recreationally and sometimes it is done within a therapeutic background, but not necessarily well. And so I think what we need is to bring it into the open so people have a choice to go to someone that they can have trust in.

Rather than just someone they've heard of down the pub who does it, you know, in their living room.

STC: Yeah.

Jamie: And I'm going full conspiracy here, as well, you know, in terms of asking for declarations of interests, there's lots of little companies mentioned now, aren't there little spin outs of...

Gimmo: Are you talking about Big mushroom?

STC: Very good Gimmo!

Jamie: But yeah, there's lots of spin outs, lots of little companies, little boutique companies starting, and it's a multi-billion pounds segment.

STC: I'll give you another one. McKetamine clinics.

Jamie: So there are the questions I'd like to ask.

Trevor: What was the question?

Jamie: Well, not of you, Trevor, but just when you see these pieces, you see these opinion pieces, you see these pieces in the media, it's following the funding. And we always find out 5, 10, 15 years afterwards that, oh, it turns out there's a junket here or that there's been some money, if you follow the money.

STC: Trevor, just so you can get your thoughts before, let me just add in something for the listener.

So you'll have heard, we've talked about psilocybin before, which is another one of these tryptamine alkaloids like ayahuasca, and it's just about, I think it's just been licensed this very week. There was a piece in the, Paul sent it, it was from The Guardian and it's in Australia and psilocybin has been licensed and it's probably gonna, we're thinking it might get licensed here, but as Trevor has said, it's sort of single dose with psychological support, and it's for treatment-resistant depression.

So it is in a very controlled way. And I know offline, when I've spoken to Trevor, when we planned about him coming on, he did say he really feared exactly what Jamie's asking and that it would get taken out of context, people will be looking to make a quick buck. And actually, when you're not trying to do it properly and holistically, like Trevor's suggesting, that's when we could have a problem on our hands.

But I'll let you answer Jamie's question.

Trevor: Well, I would share what Jamie's saying other than my experience. You know, I'm a fan of it because I felt the effect of it. And it has fascinated me about the doors that it's opened, the things that it's changed in me.

And, of course because I've experienced that, I really want other people to have that benefit too. Especially the people who are not being helped by current chemistry or by current therapy. We've gotta keep moving on, haven't we? And, you know, and there's so much of a need of it.

Depression is going through the roof, and we haven't got the treatments that actually work because in a way, the depression is a response to the toxicity of our society. So, that isn't gonna get better anytime soon. Maybe this would begin to alter it.

[00:28:36] Jamie: The Guardian article is the big idea, 'should doctors be able to prescribe psychedelics?' Which, in itself, is a big question. Would they want to?

STC: Are they the right people?

Trevor: Yeah. They're not. The idea of just them saying, "oh, here's some psilocybin, good luck", it's terrible. But a doctor prescribing it within a multi-agency approach, which could be, you know, somebody who's a shamanic practitioner or a drugs counsellor or a cognitive hypnotherapist. Done in that way, we move the client in the direction that would suit them most with, oversight. That would, I think that would be a great model.

Gimmo: A parallel in my mind is, you know, we've seen schemes where a community group have got together with local doctors and worked out that if people with intractable depression sort of enroll in allotment schemes, then they see a reduction in their depression.

And then what happens is we get a term, “social prescribing” and we suddenly just think all a doctor needs to do is write a prescription to join the local allotment and that will cure depression, completely forgetting that what was around it was the whole community engagement, the multifaceted approach.

So I know it's different, but it's the same, isn't it? That we turn it into a prescription and it becomes a capsule. 25 milligrams of psilocybin is the answer. Whereas actually it's a very small part of the overall answer in the same way that. 20 milligrams of fluoxetine is a small part of the answer, but we don't do the rest, do we?

Trevor: No, I think that's right. The psilocybin is just a catalyst that enables the next level of change, which I think is exactly what you say. It's about greater connection and that greater connection should be either to either people or nature. Those are the two great healers. We've become increasingly disconnected from real relationships. And we've been terribly distanced from nature for way too long, and yet, they're both healing

STC: I'll tell you how I think we're all in agreement, that it's about holistic care, isn't it?

And we talk about a lot on this podcast, and if you just, if you've been an avid listener, you will know when I say this. So, if you remember the Karen Sanky episode, who was the GP who talked about working with homeless people and how she just realized that, just cuz it was easy to prescribe an antidepressant, it wasn't the right thing to do and that it was the need to think about all those things that were around it.

And think about, if you've read the book, Stuart, a Life Backwards, which was introduced to us by Lucy Pollock, such a powerful book. But again, it's all about the situation that that person found themselves in. And so, I think, you know, I'm an evidence-based practitioner. I'm a scientist. I've told you I've tried Reiki. I don't understand it. It did work. There's definitely something, but I think we're all agreed that there needs to be some control, but it does need to be used in the way that it was always used, as I understand it, in that it is, like you said at the beginning about situation, and you need somebody to support that as well. And I think that's very much the thing.

And two other things I just wanted to say for the benefit of the listener, which is that, it's quite clear when I've read around the subject as well that, and I'm sure you would agree with this, Trevor, but there are definitely types of people who are not recommended to use psychedelics, as I understand it, people with a history of psychosis or a family history of psychosis even taking some of these SSRI antidepressants is considered to be a contraindication. And we also know that in too bigger doses you could definitely cause heart arrhythmia and palpitations.

So, you do have to be careful with this stuff and I think that's really important. The last thing I wanted to say when I read around this subject, and Trevor, I think I sent this to you and I wasn't sure if you were aware of it, but those listeners who might remember the name, Professor David Nutt. He is a neuropsychopharmacologist. He was the head of the advisory council on the misuse of drugs. He was actually dismissed from that job in the UK I think. He now works in Australia or New Zealand, and he is behind a new drink that has come out called S E N T I A - GABA , and it's the idea that it is 'mimicking the conviviality of alcohol' and that it would offer the 'two- drink sweet- spot'. And it's basically him talking about enhancing GABA which is one of these inhibitory neurotransmitters that potentially some of these psychedelics work on. But I just found it fascinating. It's incredibly expensive if you go to look to buy a bottle of it. Cause I did think about buying a bottle for Gimmo and Jamie for Christmas. But had you actually heard of SENTIA ? It's bizarre.

Trevor: It's a bit left field, isn't it, for him to go. Just thinking of the point you made there about the contraindications. Absolutely, those are really important to consider, but not those alone. I would go further to say that it also depends where the person is in their life at that particular moment, and I think a period of therapy before we got to the point of taking psychedelics for many people would be required.

You know, there's a level of balance in your own psyche that you need to be at to get the most from it. It's not to be used to fix the nursery slopes of therapy. It's to push you further over once you are kind of almost there, if you like, just to get you to another level of functioning.

Jamie: Sorry. It is treatment resistant we're talking about as well at the moment in the studies. Can I just say in my notes, Professor David Nutt is head of the psychedelic research group at Imperial College in London.

STC: Ah. He may be that as well, but I thought he'd definitely moved to Australasia. Anyway, interesting, this GAB-SENTIA.

Trevor: I'll try and get hold of some

STC: Gimmo, did you have a last question? It's been fascinating, this, hasn't it. I really think we could talk about this.

Gimmo: No, I could talk all night. I'm musing on the way it works and my simplistic take, and I may be completely wrong, is that the reason that you need to be in a particular sort of state of your, the stage of your therapy is cuz is what you are doing is, through taking a psychedelic, people get an insight into their own condition or their own way of thinking that allows them to address it in a practical way. And that's the spirituality of it, it's your own brain guiding you towards a solution.

Jamie: Completely wrong.

Gimmo: Yeah. I may, might, well be wrong.

Trevor: Can I have permission to talk weirdly for a little while about it?

Jamie: We can cut it out. It's okay.

Trevor: Haha, The experience you have is that, I thought first of all as a therapist, I would, if I was gonna be using it, they would take it and then I would be guiding them through, their experience.

And I actually found that you need to stay out of it because, to use the terminology, the medicine does it for you. And so it does feel as if some kind of sentience outside of you is guiding the process of bringing you to these insights. It's a very weird thing. And here's an interesting thing, with ayahuasca, it's actually two plants, from the Amazon, one is a vine and one is something else. Now, I don't wanna embarrass myself in front of you guys cuz I'm not quite sure of the chemistry, but they have to be mixed together because without the second plant, the DMT wouldn't be available, the gut just breaks it down.

But this other product has an inhibitor which prevents that from happening. Now there are thousands of plants in the Amazon and these two don't even grow in proximity to each other, and they have to be prepared in a very particular way. So how did the indigenous tribes come up with this concoction? And if you ask any of the shaman in the tribes, they will tell you that the plants told them, because they all, because shaman enter an altered state and can speak to the spirit of the plant.

And that sounds absolutely bonkers until you take an ayahuasca, and you kind of feel like you might have met her. And I can't, you know, I like to think of myself as skeptical and scientificy, but you have to leave it at the door cuz you come out of it and you think, well, I can either say, well of course I have these experiences, they're hallucinogenics, or you can say that was real. And I found that by going down, that that was real for me. Has it made the difference to me?

Jamie: You're right, Trevor. It's weird.

STC: Yeah, you're right. I was about to say that, but it's a good point to move on, I think, it's been absolutely fascinating. I really do think we could talk all night about this and I'm so glad that I managed to persuade Gimmo and Jamie, it wasn't difficult to persuade them that you should come on as a guest.

Jamie: Well, 'Trevor, the wild card'.

STC: I never described him as that.

Trevor: like that. That's gonna be a t-shirt.

STC: So Trevor, one of the other things guests get the pleasure of giving us three things, as you know, cuz I know you're prepared for this.

So the first thing is a memory evoking drug that you would like to offer for the aural apothecary formulary. So what would you like to offer us?

Trevor: You know, with all of the things we've already spoken of, I think if you're in the right place, I would say give Ayahuasca. Go and visit when you're ready and do the prep and get somebody good.

I'm a great fan of psilocybin, don't get me wrong. It's very much gentler than ayahuasca and I think different psychedelics suit different people, so, you know, there's no one that would suit everyone.

Jamie: Can I just stop you there? Clarify, we we're not looking for a recommendation for the listener.

STC: It's a personal, it's evoking a memory. I think that's fine, isn't it? Yeah. Let's be clear. Yeah, that's fine. Excellent. Okay.

Trevor: So, yeah, under all of those provisos, I go with Ayahuasca.

STC: Yeah. And am I right in saying that there are certain places, is it Oregon in the USA and Switzerland? Is that right? That you could legally use them?

Trevor: And Holland. Holland used to be the case. Don't know if it still is. I think there are several states in America now where you can.

STC: Yeah, well that's great. Now that we've gone longer, we're into our over 50th guest. We've had alcohol and now we've got our first illicit drug, so that's great.We've got Ayahuasca. If I say illicit drug, is that offensive if I use the term illicit drug?

Trevor: Not to me.

STC: Because that's what I ask my patients. I say, by the way, do you take anything over the counter from Boots and do you take illicit drugs?

Trevor: Well, it's crazy isn't it, psilocynbin is a class A drug. And my understanding is to be Class A, it has no therapeutic use, which clearly proving to not be true.

STC: Yeah, yeah, that's right. Okay. Yes. We should just say again, for the listener, all these drugs we've talked about are technically Class A drugs in this country.

Gimmo: Not technically, actually. They are actually.

STC: Technically that's correct. Yeah. Okay. I thought you might have given us ayahuasca or psilocybin, but that's great. That's what we needed.

Jamie: So predictable. So predictable, Trevor.

STC: Should we put it in the subsection of the formulary, either with alcohol or should we start a subsection?

 Okay. The second thing is a life or career anthem. So what, shoot for the stars in relation to this, which is for the Spotify aural apothecary playlist. Okay.

Trevor: I'm gonna go with not knowing what you guys have had recommended before.

STC: It's very eclectic.

Trevor: Is it? I'm going with Paul Weller.

STC: Oh, nice.

Trevor: Changing man.

STC: Ah, great tune. And is that what you hear when you go, when you use psychedelics or?

Trevor: No, it isn't. I just love the fact that who I am now would've appalled who I was 10 years ago, but that who I was 10 years ago would probably have appalled me 20 years before that. And I love that idea that I'm still changing. And I hope that's always the case.

Jamie: Taking you back to who you used to be and very quickly, your career in the police, any medicines related anecdotes there from...

STC: Medicines podcast!

Trevor: Other than the obvious of arresting people for illicit medicines, let's say, my biggest exposure to medicines within the police came during the prison officers dispute, which I think was late eighties. Cuz obviously, you know, I'm old now and that's experiences going back where I was in charge of a dedicated cell block, looking after prisoners from the local prisons and what I found was that 80% of my day as the custody officer was looking after the medications, prescribing the medications to the prisoners, just about all of them were on it, mainly temazepam and diazepam.

And they were utterly dependent on it as well. And I got a real insight into the psyche of the criminals, you know, of rather than seeing them bad, as often, just being really in need of help. And I think maybe that was part of my transition from wanting to, to lock them up to actually helping them out.

STC: "Stuart, a life backwards" just to remind people about the book recommendation from Lucy Pollock. If you've never read it, incredible book.

Jamie: Well, do you know what, to show you that our reading list is the gift that keeps on giving. I've had a conversation with Sam Quaye (episode 1.10) this week. And Sam has just submitted her MBA and she said, I'm looking forward to a holiday where I'm getting ready to read "Stuart a life backwards" from the reading list.

Trevor: That's the power of the podcast.

Jamie: Enjoy your holiday, Sam.

STC: Yes, and oh, actually, I've got an apology to Tracy again, my sister-in-law because. When I went to Lisbon, I borrowed her a copy of Albert Camu ‘s The Plague, and I realized I left it on the plane on the way home. It was a bit deep for me, if I'm honest. I think I was about a third of the way through and I was like, wow, this is really deep. So I'm gonna say that I read it, but I did lose it. So sorry, Tracy. Right. That will move us on to the book then. This is something for the Aural Apothecary library. Then Trevor, what would you like to offer the listener in relation to a book recommendation?

Trevor: You said I couldn't have two, so I very cleverly inserted one already earlier in the podcast.

So the second, the other one, I thought I'd keep the theme going. And again, this is a little bit out there for you, but I read recently a book called The Immortality Key, and it's by Brian Muraresku. And it's the social history of the religion with no name. And what that basically is, is mapping back the use of psychedelics in, in history as part of an initiatory experience.Going back to the Neolithic when it was used in beer, in, in Europe, and all the way down into the Mediterranean when it was used in the Ellucian mysteries, when it was wine and the suggestion that it might even have been the original Eucharist and that Paul lost his loaf over that a little bit and watered it down to just wine and bread.

But originally it was psychedelic. So how's that?

STC: That sounds pretty, pretty cool. The immortality key by Brian Muraresku, it almost rhymes with Ayahuasca. No, not really. Jamie, have you read that one?

Jamie: No.

STC: Jamie reads everything, so he'll definitely read it because he reads everything.

And Gimmo's a big reader, as well. I'm probably the least well-read.

Trevor: I've always believed in looking opposite to the things you believe in. You know, if you just keep reading what you believe in, then you become very concrete, don't you? So read the things that kind of throw you out. And five years ago, I'd never have read a book like that, and yet it just opens your mind to different ways of thinking.

STC: Well, I think this episode has definitely met the bar of trying to open the mind, and so you've definitely done a great job in relation to that. Jamie?

Jamie: Indeed. Our micro discussion next, did you get chance to have a look at the article from the Sunday Times, the NHS is flatlining, here's how to save it right now.

Trevor: I definitely did. I did, and I felt really kind of under gunned in it being just a lay member of the public compared to you.

Jamie: Oh, not just a lay member of the public.

STC: No, no, not at all.

[00:43:43] Trevor: But, so I'm gonna give it a stab, what came to mind was only yesterday I was down in Boots, we were queuing for prescription and the chemist was down on her knees with a young child looking at something wrong with this girl's foot and talking about the progression of it, what should happen, what they could come back and be prescribed with. And I thought that's really good is that within the chemist's purview of actually beginning to diagnose and treat. And it was, fantastic cuz you know what it's like to get a doctor's appointment. So number two, let pharmacists do more, I think is a really great idea. And I wondered whether it'd be possible, with the NHS haemorrhaging experienced nursing staff, whether there could be funding to actually put some of those nursing staff who might not want to be on ward anymore, but might not mind being in a chemist, doing a bit of triaging as a compliment to the pharmacist as an extra kind of outreach.

Jamie: Great. Trevor, that you witnessed the pharmacist delivering some care. Slightly unhealthy that you were able to observe it all?

 STC: And hear it all, that's what I was thinking. I thought that's where he was gonna come from. I thought that's what he was gonna say.

Jamie: That's a work in progress.

Trevor: It was nothing of any particular privacy, I don't think.

STC: I think we should let our community pharmacist expert talk to this one, Paul.

[00:45:00] Gimmo: Well, firstly, that sort of thing is happening, from community pharmacies, hosting GPs and other types of clinics, but that multidisciplinary approach, interesting, I'm not actually aware if nurses are directly employed in any pharmacies, but I certainly heard similar schemes, but what was interesting in what you said, and you described yourself as a lay person, so I'll use that, is that I think there is a general shift in the general population about the potential of the role of community pharmacists that probably wasn't there 10 years ago.

I think people might have pooh-poohed or thought they were getting a cheaper inferior service if they'd used a community pharmacist. So, in a way it's heartening that, that you said that because I think it's where we want to be, so for you to pick it up as an answer I think is good.

Trevor: Well be honest, as a layperson, I feel so divorced from my doctor's surgery now. It almost seems impossible to get an appointment, and this is only anecdotally cause I haven't needed to, that to see, to think that I could go down to Boots and speak to somebody who could give me the first level of intervention, even if it's only putting my mind at rest is tremendously reassuring. Yeah.

STC: Other community pharmacies are available.

Jamie: They had a few mentions tonight.

STC: Yeah. Although, I'm sure Gimmo knows more about this than anybody, but it's quite interesting actually that you say that, Trevor, because, for example, when we had the Patient Association, not Deborah, what was her name?  Rachel. She was talking a lot about how she spent her life, first of all, talking to her community pharmacist when her children were young. And I got the impression that was, you know, 20 years ago, and my dad's retired now, but he was a community pharmacist, you know, started in the sixties and people would always go to their community pharmacy, whether they could get access to their GP or not for certain things. I think it does depend on the area that you work in, the people that you've got there, how difficult or easy access is and that those people have got the time and the abilities to do that.

Gimmo: But I think people have, even that description of Rachel's is a defined view of what the community pharmacist can do. I took what Trevor to be saying as that more advanced role in the realms of doctors and nurses and other members of the healthcare team, I suppose.

STC: Sure. Yeah. And the answer to that, Trevor, is that certainly in England there is a scheme now so that if you phone up or tried to get hold of the surgery, they would say for a list of things that might involve what you've just described in this child is you can go down to the community pharmacy. So that is, that is definitely happening.

Jamie: They're ready, Trevor, we can no longer describe them as a sleeping giant. Don't write in.

Okay. Thanks all. A big thank you to Trevor for joining us on the Aural Apothecary and for sharing his stories, his Desert Island Drug, his career anthem, and his book for our library.

I knew it. If we had bumped into you in a pub, Trevor, it would've been fascinating. Thank you very much. Coming up next time, we'll be joined by Liz O'Riordan. Liz is an international speaker, broadcaster, and award-winning co-author of the Complete Guide to Breast Cancer, how to Feel Empowered and Take Control. In 2015, she was diagnosed with stage three breast cancer, whilst working as a consultant breast surgeon. In 2020, she launched her podcast, "don't ignore the elephant" that talks about the things that no one else does, like sex, death, and body image. Join us next time on the Aural Apothecary.

You can contact us via Twitter @AuralApothecary.

We're on LinkedIn.

Visit our new website, theauralapothecary.com and you can email us at auralapothecarypod@gmail.com.

Gimmo now with the Final Ingredient.

Gimmo: And I've just realized, I think the final ingredient featured psilocybin about a year or so ago, didn't it? We were way ahead of the curve on the evidence.

STC: Yeah. It's not just thrown together.

Jamie: You can remember these last ingredients?

STC: Of course, I've got it all logged. That's how it's all on the website. Sorry, Gimmo.

[00:48:54] Gimmo: What if I told you that a solution to antimicrobial resistance or high opioid prescribing could simply be to get more sleep or to put it more accurately to help prescribers get some better quality of rest. So, we've talked a lot about the need to reduce the prescribing of antibiotics and opioids, and we've discussed many strategies to do so. But those strategies, while good, are fairly conventional, so sometimes, you need to think left of field and one of my favourite books is called Obliquity by John Kay.

And the book describes how, paradoxical as it may sound, many goals are more likely to be achieved when pursued indirectly. And I was reminded of the book, when reading a recent article in the times that you sent through, I think Jamie, " Tired, GPs Write More Scripts". So the article was based on a study in the University of Manchester who looked at the prescribing patterns of 320 GPs in England, and they found that doctors with a high burnout rating, working over 37 hours a week, were, on average, four times more likely to prescribe opioids and five times more likely to prescribe antibiotics.

Doctors who reported feeling emotionally exhausted were more likely to prescribe these drugs, while those intending to leave their jobs were even more likely to prescribe opioids and antibiotics. So this study produced in the British Journal of General Practice highlights how rising stress levels and exhaustion amongst GPs are actually putting patients at risk of harm and contributing to what we talk about a lot, which is over-prescribing.

So, easier said than done, I realise. But researchers said the new studies highlight the importance of GP surgeries, and I guess we could say the same about any clinical setting. Introducing measures to mitigate burnout, which is being fuelled by workforce shortages.

As I say, not an easy solution, but there we have it. If we are really serious about reducing opioid and antimicrobial prescribing and over-prescribing in general, then maybe we need to listen more to our striking NHS colleagues who aren't just talking about pay, but they're talking about workforce wellbeing.