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Back from the Abyss

How do we find a way out of the darkest depths of despair? Psychiatrist Dr. Craig Heacock hosts a deep dive into powerfully moving stories of hope and healing, as well as topical explorations of psychopharmacology, psychotherapy, and psychedelics.

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Healing trauma with psychedelics— Part 1

This is the first of a two part very special interview with Saj Razvi, the Director of Education at Innate Path in Denver, CO. Saj weaves together his three fascinating perspectives— that of a nationally recognized trauma expert, his own personal story of early childhood neglect and how this shaped everything else to come, and finally his long journey of healing the deepest wound a person can have, eventually coming to MDMA and then psilocybin at the latter part of his therapy journey.The episode starts with some foundational concepts in understanding trauma and its long term effects, then shifts to compare and contrast psychotherapy vs somatic therapies vs psychedelic assisted therapies (cannabis vs ketamine vs MDMA vs psilocybin).  Part 1 ends with Saj's life-changing MDMA therapy session and beautifully describes how MDMA might help people break through the dissociative legacy of complex PTSD and attachment trauma. MDMA-assisted psychotherapy for PTSD https://maps.orgInnate Path (ketamine and cannabis assisted therapy)https://www.innatepath.orgDissociation and traumahttps://www.innatepath.org/post/dissociation-psychedelic-therapyhttps://www.innatepath.org/post/why-mdma-psychedelic-therapy-may-not-work-for-youDr. Hhttps://www.craigheacockmd.comOn Twitter @bftapod

1hr 5mins

5 Nov 2019

Rank #1

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Can marijuana be medicine? A psychiatric perspective

Is marijuana a medicine or a coping strategy?  Is it safer than alcohol, or in some people, much more risky? Does it help anxiety or does it trigger panic symptoms? This mini-episode explores the complex landscape of "medical" marijuana and what this looks like in Colorado.LinksMJ and psychosishttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033190/MJ as mania triggerhttps://www.ncbi.nlm.nih.gov/pubmed/25285897Adolescents and MJ-- increasing risk of developing psychosishttps://www.ncbi.nlm.nih.gov/pubmed/25774457https://www.psychiatryadvisor.com/home/topics/addiction/cannabis-use-disorder/cannabis-induced-psychosis-in-teenagers-and-young-adults-risk-factors-detection-management/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931552/CBDhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326553/Dr. Hhttps://www.craigheacockmd.com

8mins

21 Aug 2019

Rank #2

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How to think about anxiety

Anxiety and pain are the primary drivers of medical visits, as well as two of the more complicated symptoms to break down in a meaningful way. In this mini-episode, Dr. H presents the metaphor of "below the neck" vs "above the neck" anxiety to help us think about anxiety in a way that might better guide diagnosis and treatment. "Above the neck" anxiety emanates from the ruminating/imagining/obsessing/spin-cycle brain, while "below the neck" anxiety is the body's fight/flight response, with adrenaline coursing through the body to send the blaring smoke alarm signal of impending danger...even where there is no apparent immediate threat. It matters greatly whether anxiety initially sparks from above or below, and the failure to pinpoint the source can lead to treatment failure and prolonged suffering.  Obsessional/ruminative anxiety responds best to mindfulness meditation, cognitive therapy, and SSRIs; somatic/adrenaline anxiety requires interventions such as biofeedback, (intensive) aerobic exercise, meditation, beta blockers, and the various somatic trauma therapies (EMDR, somatic experiencing, Hakomi). Benzodiazepines address both types, but at significant potential cost. Dr. Hhttps://www.craigheacockmd.com

7mins

23 Oct 2019

Rank #3

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When the past haunts the present: An EMDR story

Sometimes trauma settles deeply in the mind and body and wreaks a kind of clandestine subterranean warfare, turning the body against itself and manifesting strange, frightening, disabling, and even life-threatening symptoms. Sophie's trauma simmered for 16 years, making her life difficult but still mostly manageable. Suddenly, however, she was waylaid as her trauma metastasized into something infinitely more dangerous.  A long torturous course through emergency rooms and various specialists eventually ended up on a therapist's couch, holding an oscillating paddle in each hand, walking directly into the mindscape of her mother's death.LinksEMDR (Eye movement desensitization and reprocessing)https://www.emdr.com/what-is-emdr/https://www.scientificamerican.com/article/emdr-taking-a-closer-look/Video explaining fight/flight (sympathetic nervous system) vs freeze (parasympathetic nervous system) and their roles in PTSDhttps://www.youtube.com/watch?v=q6M1FumqeyMThe parasympathetic (freeze) response is tied to allergic and asthmatic reactionshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039300/Dr. Hhttps://www.craigheacockmd.comOn Twitter @bftapod

36mins

4 Sep 2019

Rank #4

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Healing trauma with psychedelics— Part 2

In this second part of Saj's story, he continues to explore the transformative healing of his MDMA session. Initially believing his therapy journey to be complete,  his mother later develops terminal cancer and his attachment wounds reactivate. This impending loss leads him to seek even more advanced and difficult work with psilocybin and the support of two experienced guides in the Netherlands.Saj further develops the idea that while psilocybin may well have major therapeutic potential, it is definitely not a starter psychedelic medicine, but rather one that requires significant psychological preparation and scaffolding in order to harness its power.Psilocybin as an advanced medicinehttps://www.innatepath.org/post/psilocybin-mushroom-therapy-part-2Multidisciplinary Association for Psychedelic Studies (MAPS)https://maps.orgDr. Hhttps://www.craigheacockmd.comOn Twitter @bftapod

36mins

19 Nov 2019

Rank #5

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MDMA and the Inner Healer

After a nightmarish sexual assault at age 15, Mitch's life felt over. Wracked by daily dread, panic, and a desperate longing to die, he eventually found his way 22 years later to the MAPS trial of MDMA-assisted psychotherapy for severe PTSD. In this astonishing account, Mitch describes how MDMA was able to reactivate his innate healing intelligence to allow him to go directly into the hottest fires of his trauma with a powerful shield of openness, safety, self-compassion, and trust. Mitch describes the actual "how" behind MDMA-assisted therapy and why it shows such promise for the future of trauma treatment.MAPS (Multidisciplinary Association for Psychedelic Studies)https://maps.orgDr. H interview on Therapy Chat podcast about working with MDMAhttps://baltimoreannapolispsychotherapypodcast.libsyn.com/218-understanding-the-research-on-psychedelics-with-trauma-survivors-with-dr-craig-heacockBFTA in the top psychedelic podcasts of 2020!!https://blog.feedspot.com/psychedelic_podcasts/MDMA and inner healing intelligence https://maps.org/news/bulletin/articles/383-bulletin-winter-2014/5427-a-conversation-with-mdma-assisted-psychotherapy-researchers-winter-2014https://maps.org/news/bulletin/articles/435-maps-bulletin-winter-2018-vol-28-no-3/7515-cultivating-inner-growth-the-inner-healing-intelligence-in-mdma-assisted-psychotherapy-winter-2018Dr. Hhttps://www.craigheacockmd.comOn Twitter @bftapod

1hr 18mins

1 Mar 2020

Rank #6

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Why it's so hard to find (or be) a good therapist

A wise psychotherapy supervisor once said:  "There are only two things a therapist can do...hold...or poke...lots of therapists are good at holding...not so many are confident enough to poke...the good therapist has mastered the art of both."Actually, there are at LEAST 4-5 other crucial mental processes that an effective therapist should be doing more or less simultaneously...and that's no easy task.This mini-episode explores the hold vs poke dilemma, why this matters so much to anyone who has come to a therapist for meaningful change, and some tangible markers for whether your therapist is up for the challenge of you.Dr. Hhttps://www.craigheacockmd.com

8mins

25 Jun 2019

Rank #7

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A power wash of the brain

Chris successfully hid his increasingly severe depression throughout middle and high school, but by his first year of college he could no longer ignore the horrifying signs that his brain was losing touch with reality. Inanimate objects began to radiate into his thoughts, and suicide seemed the only way to escape. Fortunately Chris took the scariest leap of all and began to open up to a therapist about what was happening in his mind, leading to an exploration of shame, a reformulation of the self, and finally the unexpectedly powerful healing of ketamine. Dr. H interview-- "Recognizing psychosis", on Rural Emergency Med podcasthttps://www.ruralem.org/2019/03/31/episode-18-recognizing-psychosis/Ketamine resources/informationhttps://www.kriyainstitute.comLinks-- Delaying treatment leads to worsening and more difficult to treat depressive, bipolar, and psychotic illnesshttps://www.nature.com/articles/mp201233https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608308/https://eurekalert.org/pub_releases/2018-02/cfaa-oyd022318.phphttps://www.nationalelfservice.net/treatment/systems/early-intervention-in-psychosis/outcomes-in-first-episode-manic-psychosis/https://www.sciencedirect.com/science/article/abs/pii/S0920996412004987Dr. H and Back from the Abysshttps://www.craigheacockmd.com

50mins

9 Jul 2019

Rank #8

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Therapists in the abyss: Vicarious trauma

This is the first of an intermittent series of therapists sharing their abyss stories.  Samantha was a newly minted therapist just out of her MSW program, full of hope and excitement for her new career, when she met a client whose horrific trauma story and rapid disappearance from therapy haunted her for years.  Dr. H and Samantha explore how she was able to eventually move from the grief and regret of this vicarious traumatization to a place of acceptance and self-compassion. A heads up— this story contains a description of a sexual assault. Dr. H / Back from the Abysshttps://www.craigheacockmd.comOn Twitter @bftapod

27mins

20 Dec 2019

Rank #9

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One phone call changed everything: EMDR Part 2

As her father descended into years of meth-induced rages and psychosis,  Kate and her family repeatedly tried to flee...but there was no place to hide. And when at last, after finishing college and starting a new life with her husband, she thought she had escaped the demons of her past, a phone call lit her world on fire. Kate eventually found a way to heal through a six year treatment journey with the help of a deeply caring and skilled therapist and the tool of EMDR.This episode is the second in a two part exploration of healing through EMDR.LinksComplex PTSD and EMDRhttps://www.goodtherapy.org/blog/complex-trauma-emdr-can-help-but-its-no-quick-fix-0425165http://www.coping.us/images/Korn_2009_EMDR_with_PTSD.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5904704/Dr. Hhttps://www.craigheacockmd.com

44mins

22 Sep 2019

Rank #10

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The Delta Flight Attendant

In psychotherapy, it’s the relationship itself that heals.  In this episode of BFTA, Dr. H and his patient Jasmine explore their always complicated, often humorous, and at times very painful journey through the minefield of borderline personality disorder. A heads up on this episode— Jasmine and Dr. H discuss self-harm/cutting and suicidality in a very frank and perhaps unsettling manner. BPD overviewhttps://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder/OverviewLifetime course of BPDhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500179/Dr. Hhttps://www.craigheacockmd.comOn Twitter @bftapod

51mins

6 Oct 2019

Rank #11

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Ketamine: Seven questions

This mini-episode explores some of the most frequently asked questions about ketamine: •What is ketamine?•How does it work?•Who responds best to ketamine?•What is the ketamine experience like?•What is the best way to do ketamine treatments?•What are the side effects/risks?•Who definitely shouldn't do ketamine?Interview with Dr. H about ketamine on Rural Emergency Medicine podcasthttps://www.ruralem.org/2019/03/07/episode-17-ketamine-revisited/Dr. H and Back from the Abysshttps://www.craigheacockmd.comOn Twitter @bftapod

16mins

24 Jul 2019

Rank #12

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When a tree falls twice

The root system of a tree is its hidden protection against the harsh realities of wind and drought and disease.  For people, loving and healthy childhood  attachments are our central hidden protection against the inevitable losses and tragedies of life. But what happens when these early attachments aren't safe and secure?Jami's childhood emotional neglect and abuse and profound loneliness left her attachment roots shallow and damaged, yet her inner fire and natural resilience helped her to grow up strong and healthy despite the childhood challenges. When the winds of loss and grief started to blow, she came toppling down, twice. This led to a long list of failed treatments, benzodiazepine dependence and its horrors, and even a brief course of ECT (electroconvulsive therapy) when seemingly all other options had failed. And today, she again stands strong and tall, a testament to her refusal to give up and to relationships that have helped to scaffold her and compensate for those early traumas.Adverse childhood experiences and effects on long-term resilience and risk of chronic illnesshttps://www.acesconnection.com/blog/got-your-ace-resilience-scoresMajor depressive episode vs "nervous breakdown"https://www.psychologytoday.com/us/blog/how-everyone-became-depressed/201309/bring-back-the-nervous-breakdownKetamine vs ECThttps://www.psychiatryadvisor.com/home/topics/mood-disorders/depressive-disorder/short-term-treatments-for-depression-ketamine-vs-ect/Dr. Hhttps://www.craigheacockmd.com

38mins

17 Feb 2020

Rank #13

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What’s the deal with Depression?

In this mini-episode Dr. H explores the critical implications of thinking about Depression as a syndrome rather than as a meaningful clinical diagnosis.  The diagnosis of Depression is but the first tiny step in the journey of exploring biological, psychological, and interpersonal causes and factors which might then point toward effective treatment.Dr. Hhttps://www.craigheacockmd.comTwitterhttps://twitter.com/bftapod

7mins

17 Jan 2020

Rank #14

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Bright and Shiny and Exciting!

Life is much better on Adderall, until it's not.In this episode, Dr. H and Dan Ronken, a Boulder-based psychotherapist and addiction specialist, explore the double edged sword of stimulants.  Using Dan's ADHD and addiction story as a launching point, they explore questions including:  Do stimulants make us smarter and more productive? What is the saliency circuit and why is it so relevant here? Are some stimulants safer than others? Can they safely be used by people in active addiction or in recovery? What behavioral strategies are helpful with ADD? Can you ever get that same dopamine rush without drugs? They then transition to the question of whether ketamine therapy is safe for people in recovery.Dan Ronkenhttps://www.inclusionrecovery.comDan's Youtube channelhttps://www.youtube.com/user/danronkenDr. Hhttps://www.craigheacockmd.com

32mins

31 Jan 2020

Rank #15

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Desperately NOT seeking meth

Sobriety can sometimes be a bridge too far. In a last ditch attempt to escape his methamphetamine-drenched life, Larry moved 1000 miles away to live with his father, he threw away his cell phone, gave up all drugs and alcohol, started running, got a good job...and found himself increasingly overwhelmed by the need to put a needle in his arm.His eventual solution wasn't perfect, but it may have saved his life. LinksHarm reductionhttps://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-6-35Marijuana and cognitionhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037578/Suboxone/buprenorphinehttps://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphinehttps://www.vox.com/science-and-health/2017/7/20/15937896/medication-assisted-treatment-methadone-buprenorphine-naltrexone

21mins

7 Aug 2019

Rank #16

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My desert island meds

In this mini-episode Dr. H opens himself up for major audiophile shaming as he (reluctantly) reveals his three desert island albums. With this revelation complete, he then moves on to the challenge at hand-- which three psychiatric medications are at the top of the heap, combining efficacy, safety, and breadth of symptom coverage?A hint-- they all start with the same letter.  And they are all generic.  And psychiatry would be greatly hamstrung without them. Guesses?? Dr. Hhttps://www.craigheacockmd.com

10mins

5 Dec 2019

Rank #17

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Can you take someone where you haven't gone yourself?

In this second installment of therapists in the abyss,  Dr. H sits down with Jungian analyst and master therapist Dr. Michael Daine to explore how facing death catalyzed an exploration of the unconscious and the eventual rebirth both of his career and sense of purpose in the world.  This then leads to a discussion of whether one can be a capable and resilient therapist without having successfully passed through periods of darkness and despair.Dr. Michael Dainehttp://www.dainepsychservices.comDr. Hhttps://www.craigheacockmd.com

29mins

3 Jan 2020

Rank #18

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Bonus Episode-- Conversations with a Wounded Healer

Self-described podcast junkie Dr. H reached out to Sarah Buino, host of the excellent podcast Conversations with a Wounded Healer, and they agreed to do this super nifty episode swap, in which Sarah will feature a favorite BFTA episode on her show, and Dr. H chose a favorite episode to feature here.  In this episode Sarah interviews one of the more thoughtful and compelling people in the podcast universe, Dr. Hillary McBride (of both The Liturgists and Other People's Problems). They explore Hillary's journey of healing and how this informs her current work as a therapist and researcher. Dr. H interviewed on Conversations with a Wounded Healerhttps://headhearttherapy.com/114-craig-heacock-back-from-the-abyss-with-psychedelic-assisted-psychotherapy/Subscribe to Conversations with a Wounded Healer!https://podcasts.apple.com/us/podcast/conversations-with-a-wounded-healer/id1356225272Conversations with a Wounded Healer home pagehttps://headhearttherapy.com/podcast/IG: @headhearttherapyFB: @woundedhealr and @headhearttherapyTwitter: @woundedhealr and @HeadHeart_Chi

45mins

26 May 2020

Rank #19

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Chris and Craig in the fishbowl

BFTA's two co-conspirators sit down together for a look back at the first year-- the origin story, highlights, points of gratitude, mistakes made, Craig's most poignant/painful moment, the Enneagram, and Chris' desert island albums (no Meat Loaf!)Back from the Abysshttps://www.craigheacockmd.com

45mins

12 May 2020

Rank #20