Dr. Anne Wagner on Relational Healing - MDMA, PTSD, and the Power of Two

What if healing didn’t have to be a solo journey?

In this episode of Divergent States, host 3L1T3 sits down with Dr. Anne Wagner, clinical psychologist, researcher, and founder of the Remedy Centre in Toronto, to explore how MDMA-assisted psychotherapy is transforming PTSD treatment by working with couples, not just individuals. From groundbreaking clinical trials to the lived reality of dyadic integration, Anne shares what she’s learning at the cutting edge of relational healing.

This conversation goes deep: into trauma, intimacy, conflict, neurodivergence, and how thinking "psychedelically" may just change everything, even outside the medicine space.

🎧 Plus: updates from Psychedelic Science 2025, upcoming guests like Leonard Pickard and Reggie Watts, and why the future of therapy might come in pairs.

🔑 Key Takeaways:

• Couples Therapy with MDMA is groundbreaking: 5 of 6 couples in the pilot no longer met PTSD criteria.
• Dyadic healing is multidimensional: it's not just about one partner’s trauma but transforming the relationship itself.
• Integration as a couple is complex, but powerful: shared experiences provide a unique scaffolding for long-term growth.
• CPT + MDMA shows promise: combining established PTSD therapies with psychedelic medicine could reshape treatment models.
• Ethical training is non-negotiable: Anne cautions against unqualified practitioners marketing “psychedelic couples therapy.”
• Neurodivergence and CPTSD are viable focuses: MDMA appears uniquely helpful for communication and emotional access.

⏱️ Chapters:

00:00 – Intro: Live from Denver, Psychedelic Science 2025
02:45 – Meet Dr. Anne Wagner: Psychedelics, Trauma, and Relational Healing
04:30 – Why Work with Couples? MDMA as a Relational Catalyst
10:10 – Pilot Study Insights: Communication, Intimacy, and Outcomes
15:00 – Surprising Session Dynamics & Therapist Lessons
17:50 – CPT vs. CBCT: Comparing Therapeutic Models
23:30 – Behind the Science: Building Independent MDMA Trials
26:00 – Previewing Anne’s Talks at PS25
29:05 – Debating Evidence-Based Therapy in Psychedelic Work
30:57 – Defining Dyadic Integration
35:00 – Neurodivergence, CPTSD & the Double Empathy Problem
41:45 – Future of MDMA for Relationships Beyond PTSD
45:50 – Guardrails & Ethical Concerns in Dyadic Psychedelic Work
49:30 – Training Needs for Future Couples Practitioners
51:15 – What Still Stands in the Way?
54:00 – Anne’s “Cosmic Red Carpet” into the Field
55:53 – Most Unexpected Lesson from the Work
58:00 – How to Get Involved or Learn More
01:03:42 – Outro + What's Next: Pickard, Strauss, Austin & More

Music by Flintwick

Special Thanks to our Macrodosers and Heroic Dosers on Patreon, Super D and Lucy! 

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Transcript

3L1T3 (00:18.84)
What happens when a clinical psychologist steps into the psychedelic space? Not just as a researcher, but as someone transformed by the work. Dr. Anne Wagner isn't just studying MDMA, the assisted therapy for PTSD. She's living the principles she teaches. In this conversation, we get personal about healing, relational depth, and about what it really means to think psychedelically. Welcome back to Divergent States. I'm Elite, host, back with Brian. Hey, what's up, man? How you doing? I'm doing pretty good. How are you doing? You're out there at the Psychedelic

Science conference. How's that going so far? I was gonna say I'm in Denver this week. We, uh, you know, I'm dropping this and Wagner is doing her keynote. Um, we're dropping this on Patreon on the same night. It's been great. Like, uh, Grady, uh, one of the people from the subreddit, he decided to help me out. Let me stay here. He's been also taking notes out there. He's been going to like all the, uh, Oh, going to some of the workshops. I can't make it to, or some of this has been taking notes. He's coming for your job, Brian. I'm telling you.

So yeah, we're, yeah, we're just, just kicking it. got some, we got, locked down a, interview with, Amber Capone. We're gonna be doing that next week. that'll be coming out soon, but you know, next episode after this is, William Leonard Pickard, like the, "The Acid King. So that's going to be a good one. I met him, talked to him. I got his autograph. He's good. He's cool. Real cool guy.

Just been talking with him a little bit met, you know Alex and Allison Grey talking to them about bringing them on the show Met Reggie Watts. He He said he was super interested said he wanted to come on so maybe we'll have that in the store and like maybe do that something for like a season finale or something so Yeah, it would be pretty awesome, right? It's exciting. We're just meeting people and talking to different people

pretty much met almost everybody we've interviewed so far. Like, uh, just saw Josh white today, you know, talk to him and, uh, Brad has been helping us with the interviews and getting us set up. Just saw him and he was hanging out with, uh, Wendy Tucker, who was on a few episodes ago. So, know, uh, Valerie seen her a few times. She was on the seven principles of the second out with us. Um, and the Zendo project. Yeah, she, she's been out there seeing her several times, just kind of hung out.

3L1T3 (02:44.242)
You know, we just, it's been a lot of fun just meeting everybody in 3D instead of just 2D like we have been doing, you know? So yeah, tonight we're going to be talking with Dr. Anne Wagner, clinical psychologist, a research and one of the few people actually testing how psychedelics work between people, not just within them. Dr. Wagner has been breaking new ground in this space for years. She's the founder of the Remedy Centre in Toronto and adjunct professor at the Toronto Metropolitan University.

and a lead researcher in some of the most advanced, MDMA assisted psychotherapy studies out there, particularly with couples where one partner has PTSD. She's presenting at Psychedelic Science 2025 tonight, and we're going to talk all about it. We're going to talk with her about her research, what she's learned, where the field is going, and why healing doesn't have to be a solo act. So we're going to take a listen to this, and then we're going to do, we're going to take a little,

outro, we'll wrap it up, talk about a little bit more and we'll talk to you soon.

3L1T3 (04:30.796)
Dr. Wagner, thank you for being here today.

thanks so much for having me. Glad to be here.

Thank you. Let's kick this off a little bit broad. What do you think people most misunderstand about MDMA assisted therapy, especially compared to how we usually frame psychedelic healing as a solo journey?

Yeah, well, I think working with two people or more than two people, but in this case, couples or close relationships is an incredible opportunity. And I think the way that we think of psychedelic work, if we're working with just one person or just ourselves, is that we have an ability.

to go really deeply within ourselves and to explore our own psyches, our own minds, our hearts. But when we're working with somebody else and the focus there is on perhaps the relationship or perhaps one person's healing or both people's healing, then you have not just the opportunity for the person, but also for the relationship and the other person. So you're really working with kind of three different fields.

Anne Wagner (05:44.66)
at the same time. And my experience with that has been that it is an incredibly powerful tool to be able to heal different aspects of yourself that you wouldn't actually get the opportunity to do without having the other person present because you're, you know, you've got resonance with that other person's experience, you're able to connect with them, maybe feel empathy, feel

their emotions in a different way. And I think a really important factor is that you can stay with any emotion that's present. And I think that's a really difficult thing when we think about, for example, you know, let's say you're in conflict with somebody or conflict with someone you're in a relationship with. It's so hard to stay present in that moment. It's so hard to be there and to actually listen and to actually fully immerse in that moment.

because we're often thinking about the next thing we want to say or we're hurting and so we're trying to protect ourselves in some way or we're aiming at an outcome that we really want. We want them to say this. We want them to go in that direction. And with MDMA, what can happen is that it keeps you in this zone where you're able to be present with whatever is there. And that means that you can actually hear what someone else is saying, even if it's really hard.

or if it's really beautiful, both of those things can stay and be present. And so to have that experience with somebody else is, well, A, it can be incredibly healing, but also can be incredibly generative. So you can get that sense of feeling like someone else is understanding, someone else is hearing me, someone else is here with me, even if what you're communicating is something really hard or difficult.

Yeah, I really feel like the synchronicity you can almost get from MDMA too within all that kind of can help, I guess, facilitate that side of mindset where you can kind of sync with your partner. And that probably makes it a lot easier for, I guess, couples to empathize with each other a little bit, kind of connect on a level.

Anne Wagner (07:58.702)
Absolutely. think that, yeah, the empathizing is massive. And I think the ability to, yeah, be to see and feel what's present for them and like what's in their heart is incredible. I often feel that or see that with folks that they're experiencing this, like, I really see you, I really can feel you in that moment. And that's so

potent for both people, right, to be to feel that and to be seen in that way, which is beautiful and lovely. And it's also interesting if it brings up things like the other person feeling really far away, right, if it feels like their heart is really distant from the other and you can feel into the grief of that or the disconnection, and also be able to name it and speak to it, which I think sometimes without the assistance of MDMA, or without kind of walking through that door.

it's a lot harder to do that or a lot harder to name what you're feeling or feel self conscious about it or feel concerned that you're going to be misinterpreted or judged or something will happen with that. So there's I think there's also a real opportunity to be truthful and to be very much in alignment with what it is you think and feel and what's true for you. And to be able to do that in a way that is

very, it's kind as well, which I think can sometimes be a hard thing when people are feeling anxious or shy or scared or fears taking over. They're able to do that in a way that is present and grounded and available.

Yeah, it's really, yeah, being present, I think, is a huge thing too that I find with MDMA is it really can just ground you to the moment. And if you're doing that with a partner or whatever, I mean, that's so much so that's going to just help facilitate that a little further. Yeah, I agree. So what could you tell me about the pilot studies he ran with MDMA and CVCT? What kind of changes did you see in couples communications or emotional intimacy there?

Anne Wagner (10:10.944)
Yeah, well, that was the real eye opener for me running that site. That was my first psychedelic trial that I worked on. And it was really beautiful to witness that also as someone who'd worked with couples and trauma for several years before that, and without using MDMA, then being able to add MDMA into the picture really added for me something exciting and inspiring, but also really effective. So

That was really good.

I was going to say you'd really be in a good position to kind look at that critically that way too, to kind of see the real juxtaposition between the two. So that's, yeah, I really like that. That's awesome.

Yeah, and the cool thing too, I think going into that study was that I was really kind of agnostic about psychedelics. Like I wasn't at that point, convinced that like, oh, yeah, this will for sure be a useful tool. I didn't know. And I was curious and interested. I'd been reading, I'd been learning, but I also wasn't I didn't know at that point. And getting to

witness that and see it in action. That's what helped convince me. And I think also the other thing that really helped convince me earlier was I process of developing the study with my colleagues. And a big nod of gratitude to my mentors within this Annie and Michael Mithofer and Candace Monson. And the four of us got to work together on this, the study and bringing it to

Bryan (11:28.897)
in the head.

Anne Wagner (11:48.152)
fruition. But one of the one wonderful things that happened in that lead up was I got to participate as a therapist and a trial for therapists to have my own MDMA therapy session. And yeah, it really at that point, I was psychedelic naive, which was cool to go into it going like, I have no idea. And here I go get to have medical grade MDMA and the whole setup everything set and setting. And I went into that and our team went into that.

the piece.

Anne Wagner (12:17.908)
with the idea of exploring like, would this be a good combination with CDCT, you so I'm going in with my researcher lens, and then getting to have a very personal experience of it and getting to go like, Wow, alright, this is very impactful for me. And very meaningful. And I could really feel in myself the different kind of mechanisms that I could imagine would be useful and couples therapy with it. So that

that felt sense experience helped in so many ways that when we actually got to running the pilot study, we were able to remember that those are some of the mechanisms that could be useful, but also that knowing of what it feels like in that state. And so that can be helpful to, for example, support people when they're stuck somewhere or where they feel like they can't move through or they notice that

you know, you're talking a lot and maybe it would be useful to go inwards into your experience because there's something bubbling. But yeah, what we found with that study was so we ran six couples through that. And that study was all romantic couples. And we found that the vast majority so five out of six didn't meet criteria for PTSD at the end of the study, which was awesome. Yeah, it was really, really wonderful. And also that

That's huge,

Anne Wagner (13:44.998)
Well, the interesting thing was when people came into the study, some of them were quite satisfied in their relationship, but some weren't. So there wasn't, you know, a criteria that you had to be distressed, you could be anywhere. But we found overall, the group moved up, they improved in their relationship satisfaction. And that for the partners, that actually continued to improve over time. And so it didn't just

get better and stay better, continue got better and then improve later. So can see the ongoing impact and effects over time, which was, that to me was one of the most exciting things about the findings was to see it over time, but also to see the breadth of impact that it had. So normally when you do a PTSD trial, you're like, great, PTSD is down. Awesome. But here we had multiple aims, and then we found outcomes well beyond that too. So in terms of

function, like just general functioning in life in terms of feeling people saying like they're can feel their feelings differently. They are have better relationships with other people in their lives as well. Certain things I found really fascinating were like improved creativity, improved spirituality, things that you know, we weren't explicitly targeting, but definitely saw changes and, you know, lots of people in the study.

What would you say would be the most surprising dynamic, positive or challenging, that emerged during the sessions?

Anne Wagner (15:18.35)
That's an interesting one. one of the interesting things that came up where it was when one person would have a really big experience. So let's say challenging or in this case, I'm thinking of like a very physical experience. So really having a lot of

bodily sensations and moving through and making noise and needing to experience that. And then staying present with that person and also the partner at the same time, because I that's one of the main focuses of the treatment that we do in the therapy is that both people are equally involved, important, the focus. And so it's not, for example, just the person who has PTSD with people. And so

these.

that initially as the therapist felt like, okay, we got to be really mindful about not just focusing on this person's experience, because this the other person is still going through their MDMA journey and wanting to connect and these different things. So we Yeah, it's the dance of needing to support and pay attention to the quote unquote big experiences happening, but also really be present with

the what looks like a gentler experience, but is also very meaningful and deep and intense, and then helping facilitate between the two of them. Because you could see in the partner that there was some fear that was coming up, like going, what is going on? Or I don't understand. So it's helping normalize and support through that. And then us modeling that this is okay, and we can navigate this. And that

Anne Wagner (17:07.87)
Yeah, was one of the more interesting ones, I think, to navigate, but also was a really good learning.

Yeah, can obviously be, I can imagine be very, be a very delicate like kind of line, don't walk. Because yeah, just because they're quiet too, doesn't mean that the quiet partner is having, not having an intense experience or something challenging. They're just not being vocal about it. So you have to kind of, yeah, you have to kind of gauge two people, just twice as hard as doing just one person.

In the MAPS trials, solo format seemed to be emphasized a lot. Why did you choose couples therapy and how do you see that addressing trauma differently?

So.

Anne Wagner (17:54.734)
So I love relational healing. I think like that is my jam, if you will. Like I think the possibilities for that are huge. I think therapies tends to be done in an individual format. tends to be that's what we're to tends to be the most convenient. But the impact that doing something in a couple or in a close relationship can have

Use.

Anne Wagner (18:23.712)
is that it actually ends up treating not just the person, but really the system and creates change. And also the other thing we notice a lot in individual treatments for PTSD, especially if people make a lot of very quick change or really drastic change is they can go back to their home environment and that environment isn't really supportive of that change or they can't wrap their heads around it. So you can imagine that.

Let's say someone's had PTSD for 15 years, right? And their spouse has really worked to make that home environment okay for them. And it's done in such a loving and well-meaning way. And that's what's made that family be able to tick, right? It's made it be able to function, people to be quote unquote okay. And the person reenters and suddenly...

things have changed and that the spouse ends up going like, wait, what is going on? What has happened? And also their experience as the spouse who's had to work with this and the challenges that come with it haven't really been addressed. And so they're kind of left feeling, wait, what about me? And like, this has been hard on me too. And what do we do now? And how do we function? How do we navigate this? So that's a risk when you're working with one person, especially with

quick change or big change. But when you work with both, then both people are along for the journey and the ride and getting to both get to heal as well because it's no small thing being the partner of someone who has PTSD. And so there's that and I think also, often, often, our traumas are interpersonal, right? They are either occur interpersonally like something has happened with another person.

or the impact of it has impacted our relationships with the people around us, be it that like, we didn't feel supported afterwards, or we've had challenging comments, or it's made it hard to connect with other people. And one of the symptoms of PTSD is emotional numbing. And so it can feel very difficult to feel connected. And so that can really be a barrier to relationships. So to have the different experience and the

Bryan (20:29.005)
years.

Anne Wagner (20:43.594)
healing experience of getting to feel seen, heard, be in that moment, feel your feelings, feel emotions, go into difficult story, and be witnessed and be present with somebody else, I think adds another layer on to the potential healing within it.

Yeah. I would say just probably the feeling of intimacy too, of just sharing something like that with your partner can be really healing on its own. that, you know, being able to go through something and talk about these things and actually work through these things with someone that's so close to you. Yeah, that'd be really, I can see that being really, really healing. So you've since shifted towards exploring CPT.

What informed that transition? Do you see CPT addressing something CBCT didn't quite hit?

Great question. So there's been a sequence in these studies. So CBCT, which is the couples treatment, is a standalone treatment for PTSD that has been tested amongst different groups of people. CPT, so cognitive processing therapy, is the same. It is a standalone treatment for PTSD that's been tested amongst many different people.

their

Bryan (21:43.47)
of a strategic.

Bryan (22:06.254)
So the.

The rationale, the reason for doing those two pilot studies was to have some evidence that you could combine a couples treatment and an individual treatment. And I think one of the things that is different about that is that for the other individual PTSD interventions with MDMA, which have wonderful results, is that the therapy that's used is

but the things with those.

generally not a standalone therapy that you would use without MDMA. And so for me, was really a scientific question of going, hey, could you combine something that's pretty widely used as a treatment for PTSD with MDMA? Would it work in a similar way and as effective as this other model that we've been using combining MDMA with an inter-directed therapy?

this.

Bryan (22:54.734)
way.

Bryan (23:02.52)
So that was.

the rationale behind it, the thought behind it. And the other, the other idea was to pilot study and run it for CPT while we were getting ready to run the large randomized trial of the couples therapy trial. So it was always meant to be kind of the stepping stone. And the CPT plus MDMA pilot trial was the first study that we ran out of Remedy, which is here in Toronto. And that was

was to develop.

Bryan (23:23.298)
So.

Anne Wagner (23:33.058)
to demonstrate that we were able to run an independent and independently sponsored MDMA trial. so being philanthropically funded and it's an academic study, so not a drug development study here. So that was the plan was to have the CPT1 be basically the test case that can we do it here? Yes, we can. And to see about this combination. And then now being in the place where we're running this larger couple study.

when it comes to CPT itself.

I actually think it's a really lovely combination with MDMA. so CBT is a therapy that focuses on meaning making around the traumatic experience. And it really works with our thoughts can get very stuck. it's the theory behind it is that when we have different beliefs about ourselves, the world, other people, how we've made sense of why the trauma happened and what happened afterwards.

When that gets stuck or it is not feeling good in some way, that's what keeps PTSD present. And so if you can change those beliefs, you can loosen the knot on those difficult experiences and therefore the PTSD can lessen. We really thought that because within MDMA sessions, what you can often see is people naturally going back into traumatic memories and making different sense of them.

So.

Anne Wagner (25:02.53)
So using it with a therapy that explicitly targets that explicitly talks about meaning making and what do you think about, you know, responsibility and control and power, esteem, intimacy, asking those questions and then being able to use the MDMA strategically to help deepen the experience when you're at these points in the therapy was the reason why we decided to try that combination.

I like it. I'm taking, you know, just empirical studies like your processes, guess, like CBT, combining that with the MDMA therapy. makes a lot of sense because the neuroplasticity with the MDMA is really, I mean, I can really see how that would help with, you know, CBT or CBCT.

So can you give us a preview a little bit of what you'll be sharing at Psychedelic Science this year? Any new data or insights you're especially excited about?

Yeah, so I'm.

I'm actually going to be on four panels and giving a workshop on So it's going to be lots of opportunities.

Bryan (26:08.59)
It's like Alex with your

You're gonna be busy.

about some of this work. So, so the work.

Okay, let's say workshop and then two of the panels are going to be talking about the couples therapy. And so is, I'm really gonna be outlining in, especially in the workshop, how we do this work, right? I think there's a hunger to know what we're doing and how we're doing it. And I think people are excited about the possibility. It's a little tricky, of course, because we don't know when this is going to be able to be used in clinical practice.

So that's.

Anne Wagner (26:44.942)
But I think having people start to learn the theory, learn the mechanisms, learn how to start thinking about it, and especially thinking about it in this dyadic way, in this two-person way, because it's a very different approach than with one person. And I think people get excited about the idea. They can see, oh, yes, MDMA is going to be awesome for relationships, it's going be awesome for couples. And in my experience, part of

the really important part of it is really good couples therapy. like needing to be attuned to some of these relational pieces and how to work with two people and then how to work with two people in a non-ordinary state and who are interacting in that. it's like many layers of these different things and how to like really hold an effective container for two people while they're doing that. That's one thing I'm really excited to be talking about. I'm really excited to be

So.

Bryan (27:39.309)
And also.

in this idea of talking about the couples therapy because at the moment we don't have data from the large trial. We're running it right now, actively recruiting and also if people are in the Toronto area and are wanting to participate, we are actively recruiting right now. So, I want to be talking about though is more of the principles around it and what I'm starting to think about as being

kind of like brave relational choices and brave relationships. And being able to see that going into these MDMA sessions, taking that leap together, and being brave in terms of sharing whatever is present on people's hearts and in their minds is we see as being the things that help shift and change for people and help them grow and help them heal. So that's going to be a big component of it. And then

really.

Two of the other two panels I'm on are going to be one talking about these, but also the questions or perils of using evidence-based therapies with psychedelics. So I'll be on a panel with several talking all the different angles about it, because what we're doing with CBCT and CPT is out of quote unquote the norm for what people are often combining with psychedelics and

Bryan (28:41.646)
possibility.

Bryan (28:51.37)
colleagues.

Anne Wagner (29:05.314)
there's questions about if that would be too reductionist or limiting in some way and not allowing to follow. And my perspective is I don't think so, given what I've seen. And of course, everything's a question and it's one possibility or one option of being, how to be able to work with it. And I think I'm really going to want to emphasize and emphasizing now that

to

Anne Wagner (29:31.63)
I don't think there's one best way. think that there's many possible ways and I think it'll be based on the provider in terms of what they feel drawn to work with and then the clients in terms of what they feel drawn to work with. So like now you can choose your therapist and you can choose what approach you use. The same would be true with this. And then the other thing I find that is helpful and that I'll be speaking to and on this panel.

is this idea that having some structure, especially when we're working with PTSD and we're working with MDMA in the preparation and in the integration can be really helpful for people. And we've gotten spontaneous reports and thank yous about that saying that I found that really useful to have this language or to have the structure to be able to work with. And then the way we work with it is in the MDMA sessions, it's open. And so we're, it's similar to the non direct or inter directed model.

where we're not saying you need to go this direction. We don't have an agenda, but we will check in to see if people, for example, haven't talked about their trauma. We'll prime and see is there, has that come up or what's been coming up about that. So there's that panel. And then the final panel, which will be on the Friday, the last day, we'll be sharing the results from the CPT MDMA trial there. So that will be the first time that that's going to be presented.

I

3L1T3 (30:57.006)
That's exciting.

Yeah.

Mm-hmm.

So yeah, I mean, going right into that, the theme this year is the integration. How would you define integration when it's happening with two people and not just one in mind?

yeah. Well, yeah, it's rich. It's rich, and it can be complex. And I think that that's beautiful, and also hard. So it can be that there's each person, obviously, is going to be having their individual process. And then there's also what's impacting the relationship and how each process is impacting the relationship and what they want to do with it. so often in integration, we think about

Bryan (31:40.366)
Thanks.

with individuals, for example, we think about not having people make large decisions right away after a psychedelic session and waiting a little bit, letting it all settle. And the same would hold for couples like to have them not necessarily jump into another country or something like that or and at the same time when people kind of join forces and understand that something, for example, hasn't been working well for them or

They want to change a dynamic or they can really see something has changed. Those are the things we want to say. Absolutely. Let's move in that direction and we can definitely practice that. it's more about like big, life changes. No, but process changes a hundred percent. Like those are great. And we try to emphasize in the integration too, for, couples is the sense of you've had this felt sense experience in the MDMA session.

Thanks.

Bryan (32:29.24)
we really

Anne Wagner (32:39.862)
You know what it was like to be present and empathic and really connected with each other, no matter what it is you're sharing, that that doesn't leave you. don't get to, you don't unknow what you've known. You don't unring the bell once it's been rung. even if they're feeling disconnected as they go forward, especially I'm thinking, you know, they're like a month out from the session when the worn off, when, you know, life is coming back into focus.

that.

Bryan (33:04.61)
the afterglow.

Anne Wagner (33:09.506)
that in that moment.

they always have the opportunity to go.

to back, remember, and tap into what they've experienced before. And the fact that that's been a shared experience, that there, we encourage them to be in conversation about that and bringing that forward. And also the communication that's possible, understanding that they, what that felt like to be openly communicative with each other and sharing that that's so useful and important to help guide people and remind people of going forward.

So just.

Anne Wagner (33:44.174)
I think one risk that can happen after psychedelic sessions and MDMA in particular is that people can feel very, like they can be very vulnerable and very open in the MDMA sessions, which usually feels good in the moment. But then afterwards they can have a question mark of going, was that okay? Like, was it all right that I shared that much or like that felt vulnerable now that I don't have the MDMA present.

And a lot of it is working with the, yes, it is still safe and OK that that was shared. And how do we continue to make that safe and OK? And how can you continue to share going forward? Yeah.

Yeah, I guess that's important. And I guess that that could be a real benefit to integration in that sense of having someone with that shared experience who is there with you that you can immediately empathize with and just be like, remember, we were there. We had this experience together. Really kind of helps it fall back into place. You can be like, yeah, yeah, I remember that. Let's Remember and do this. So yeah, I like that.

Do you think that couples or dyadic integration will become its own subfield as psychedelic therapy expands?

Thank

Bryan (35:00.302)
I'm sure everything will become its own.

Yeah, and I think for me, it's interesting because I've been actually doing this work now and like, I mean, not always actively seeing cases because there's big gaps between studies. you know, we first started designing the study in 2014 and the conversations about it in 2013. So I've been thinking, thinking about it for a long time and reading and writing and working on it. And, and what coming up the

Bryan (35:32.302)
Keep.

registering for me is that it's not unique to MDMA at all. It's just, it's these experiences that people can have without MDMA that are sometimes just feel more accessible or are kind of given the opportunity to happen when people are in an MDMA session. so

That to me has been interesting in thinking of like, we've kind of, you know, when you think about narrowing in to MDMA-assisted couples therapy, but really the takeaway is like, I think it's actually we need to funnel it back out and go like, what are the principles that we're learning from this that are applicable to everybody and applicable to all relationships or all romantic relationships or even other relationships too. And so I think it will be, it could be its own subfield. I'm sure people will want to specialize in it, but at the same time, I think

too.

Anne Wagner (36:29.55)
especially when I think about it for me, I think about taking more of the lessons and bringing that out into a broader spectrum. So it's like almost having like psychedelically informed broader therapies or ways of thinking, which may not have anything to do with the medicine itself, but.

It's good practice that, know, I think Valerie Beltran from the Sendoh Project was, she's working on something about bringing how non psychedelic therapists can deal with psychedelic therapy. Something like that. You know, that's a good, probably a good thing people need to work on too, because there's going to be as it grows and grows more, you just never know. So.

kind of in theory meets practice. You're dealing with couples, you know, they're sometimes volatile, sometimes avoidant. How does MDMA shift power dynamics or communication patterns in ways talk therapy can't?

Yeah, I think one of the important things that we do in our work before people go into the MDMA sessions is work on giving them communication skills. And so that they have something already worked with and talked about and an agreement around. So for example, if they're getting escalated in conflict,

that's.

Anne Wagner (37:56.544)
that there's an agreement that a we're going to target not doing that we're going to target deescalation, but that also they would have some tools to be able to deescalate. things like for example, being able to stop a conversation, but then also return back to it to have safety that they would have some tools about how to share in a way that is

for example, like paraphrasing what the other person is saying so that they're able to slow down their communication and understand when they're getting activated. And that's really important, I think beforehand. And so I, for myself, wouldn't do an MDMA session without giving some skills and tools first around how to deal with conflict and how to converse together. And then in the sessions themselves, it's

it's interesting that people are in a balance between going inwards into their own experience and then being in conversation either with the other person or with the room and meaning that also the therapist and we find there is that as of yet we haven't had a couple go really into conflict in those moments which is interesting and not to say it won't happen but

there is.

something with the set and setting and at times the internal focus that helps from those conflicts from not sparking off of each other. Once we're done the next trial, I might have a different answer to that question because we will have seen a bunch more more dyads to see what happens. But naturally with MDMA, those alarm bells are going on, they're less

Bryan (39:28.28)
So I feel like.

Anne Wagner (39:44.782)
less loud in people's brains and so you're less likely to get very angry and so therefore I think that that can help with conflict and help people stay present.

Yeah, that's a really good point. I think maybe the idea that they're in there already probably for, you know, they're helping to get help for that could, you know, put them off guard a little bit too. So yeah. Do you ever see this work benefited neurodivergent couples or those dealing with complex PTSD and overlapping conditions with that?

Yeah, think working with MDMA would be absolutely a great tool for neurodivergent couples, like either if one member or both members are neurodivergent. like, for sure, I think it can help, particularly around comfort in terms of communication. And so, for example, not having both, either or both people trying to...

guess or having like the double empathy problem where both people are trying to understand or accommodate in different ways, but be able to be present and communicate in the way that feels good and feels right for them and is truthful in that moment. We and then also for CPTSD, I would say the vast majority of people in all of the MDMA trials I've worked on would meet criteria for CPTSD. So even though it's like a PTSD trial,

Absolutely.

Anne Wagner (41:15.646)
if we would have assessed them for CPTSD, they would have met criteria for that. So I would say absolutely that that's definitely useful. And I actually think dyadic treatment, relational treatment for CPTSD is maybe even the best fit for it because so much of CPTSD can come from early interpersonal traumatic experiences. And so to have to be able to heal that with

Thank

Anne Wagner (41:44.374)
a relationship can be amazingly potent.

Yeah, that's amazing. That sounds just really helpful. And I know being a neurodivergent myself, can definitely see how MDMA times opens me up a little bit. can become a lot just more open. Have you ever had to, or do you have to tailor your therapeutic approach for specific populations, like neurodivergents?

Well, interesting because we've been operating in trials. We haven't, but that being said, it's, I think, who have PTSD and making sure that everything is really, you know, comfortable and full in terms of folks experiences in some ways really.

as we.

Bryan (42:19.478)
working with folks.

Anne Wagner (42:37.728)
allows for many different people's experiences to be attended to in the room and attended to in that way. And so we've had folks in the trials who've been, who are neurodivergent. And I think the setting and also there's even a set and setting of MDMA sessions is actually, I think, very comfortable for folks who where that's their experience because we're very attentive to all the different stimuli and

tailoring, tailoring it in that way to the person. and so I think sometimes, what people believe around things like CPT and CBCT is because it follows a protocol and it follows a structure that it's rigid. And I would challenge that that's actually not the case that is always populated by whatever the person is bringing in. And so in that way, it's completely tailored to their experience. We're going to.

questions about certain topics, but then how we work with it and is all based on what's brought in around it. So I think in that way we tailor, but then also knowing that this is in clinical trials and so in the future we're going to be able to adjust and change, I think, a lot based on clinical practice.

Do you think that MDMA could have a future in relationship work even without a PTSD diagnosis? Like, could we see this evolve into a general relationship, relational enhancement work?

Yes, definitely. I think that's probably one of the things I'm most excited about of where this could go next. And just given all of the possibilities and also what people talk about, you know, in the sessions, it's definitely not just about PTS, all kinds of different facets, know, facets of life and relationships. I think it was a wonderful tool for that and to help understand and be connected with another person. And

Bryan (44:26.478)
Do you give me a...

Anne Wagner (44:41.332)
One thing I'm really excited about with the current trial that we're running is that in one, so there's two conditions. One condition is they get the couples therapy for PTSD plus MDMA. And the other condition, they just get the couples therapy for PTSD. So our trial is a very much a psychotherapy focused trial as opposed to based on the drug effect. But the group that gets just CBCT when they finish and then they go through their follow-up.

Afterwards, they can cross over and have two MDMA sessions. And those sessions are embedded in a general couples therapy. And so that's actually the first time we're going to get to do legal general couples therapy with MDMA. And so by the end of this trial, we'll have data on that, which I'm really excited about.

Yeah, that is really exciting. Yeah, just to have, I mean, just fresh data because, how long has it been since it really had any kind of real data on this?

It's been a long time. Yeah, for sure.

What ethical guardrails are essential as more therapists and clinics start offering MDMA for relational work?

Anne Wagner (45:48.686)
Great question.

I think.

One of the most important things to know is that if people are offering this as therapy, that it needs to be done as therapy. it's very, it's different than, like if someone's trip sitting or holding space, but if people are actually offering it as an intervention, and then it people need to be couples therapists. And so I think that's key. And I think that may get missed in people's

This is...

Anne Wagner (46:22.24)
excitement about this, that there may be an overemphasis on the MDMA or on the model, but I think really feeling grounded and skilled as couples therapists is primary. I'd suggest that and I'd also suggest that there needs to be a real emphasis on being trauma informed. And I think because regardless of what it is you're working with, with MDMA,

So.

Anne Wagner (46:47.872)
If trauma has occurred in that person's experience, it will likely emerge in some way. And that's very important to know and to be able to work with. because you can't sweep that under the rug. And also the vast majority of people have experienced some type of trauma, whether they have symptoms or not around it. Those are important. This is probably not for every couple. I think this is...

So I think also the.

Anne Wagner (47:14.126)
Certainly, if it's a case where one person really wants to do it and the other person does not, then the person who doesn't should never feel coerced into doing that. And I think that will also be kind of on, in some ways on the providers to check about that and to have conversation. I think that, I mean, as all good couples therapy does, really screening for any abuse or any coercion in relationships is really important.

you for us.

Anne Wagner (47:43.934)
and that would go for, that happens in any good couples therapy assessment at the beginning of treatment, is you want to assess for that. And so if that's present and I would not do MDMA assisted therapy at that point, I would want that to be addressed first. Because the last thing I'd want to do is be putting partners in a really emotionally vulnerable.

place when we haven't started to work through some of the dynamics of what is happening when those abusive or coercive dynamics are present. I think that those are some of the key things that come to mind for me.

So, sorry.

3L1T3 (48:23.096)
So would you say we're at risk at all of people marketing psych? I've done like couples therapy without the science or training behind it.

So sorry.

we

Do you see any risk of people marketing psychedelic couples therapy without the science or training behind it?

Yeah, I think so. I think there's risk in general, especially people holding themselves to be able to hold space for something if they maybe don't have experience or if they're just they're really enthusiastic about it. Wonderful. Enthusiasm is great and it needs to be supported by experience and you know or mentorship or guidance but

Bryan (48:40.823)
I mean, I have.

Anne Wagner (49:05.312)
Yeah, I think that there's a risk in that, and especially when people are wanting to focus, if there's a focus on sexuality or a focus on conflict, then there's risk there in terms of not being effective for folks and then also not being able to hold a container in the way that people would need you to.

Well.

3L1T3 (49:28.93)
What would you want to see in future training models for therapists working with dyads?

I would want to see, I think an emphasis on assessment to start off with, right? So getting to know the dyad, getting to know the couple, what their goals are, what their experiences are, and understanding kind of what's present for them. That would be really important. And then I think working both with understanding how to hold a frame for two people, so called the dyadic frame, and

an emphasis on how to work with navigating two people in nonordinary states, and especially if they're either in sync with each other or out of sync and learning how to navigate through that. you know, one of the things that we learned early on in the pilot is what do you do when one person is eager and ready to share and the other person's deeply in an internal experience? And MDMA makes can really facilitate you being

connected and wanting to participate. And so we'd often find Leo one partners, like sitting up, eyeshades off, wanting to share. And it's often, especially for the person with PTSD, the partner would like hear them and like pop up and like, you know, be ready and eager to listen. Lovely. Except it kept pulling the partner out of their own experience. And so that's, you know, and wanting to make sure that the partner is equally having their own journey and experience.

We learned how to better navigate that and kind of conduct that between them. So if one person was ready to talk, then one of the therapists would go over and talk with them and jot down notes and so that they didn't have to remember or hold onto it. And then we could cue them when the other partner was ready to be in conversation.

3L1T3 (51:17.804)
What barriers still stand in the way of this work becoming more mainstream? Would you say it's access, regulation, or stigma?

I think all of the above.

But I think, regulation would be the main thing. given that there, we don't have jurisdictions where we're able to do this yet. I think that that's going to be, that's one of the question marks I have around how we're going to be able to implement this in the future, because. Posting to people, you know, there's the question mark of, for example, if and when MDMA becomes prescribable as a medicine.

for example, for PTSD, one could do a couples PTSD intervention for it. And I think we would have the data from our trials to suggest, hey, this is safe and effective. And so that that might be enough to be able to not, for example, get someone's wrist slapped by a regulatory agency because we'd have data to support that, why you would dose the partner. But then to extend that to say, OK, then how do we make this?

available then for relational enhancement. I'm hoping that the data we're collecting in this crossover arm will go far enough to be able to also offer that information and that data to say, hey, look, safe and effective and impacts relational functioning. That again, that would allow people to be able to do that with that evidence base. But yeah, that's a question to be seen. I anticipate there's going to be

Bryan (52:33.582)
will.

Anne Wagner (52:53.452)
you know, as someone who works exclusively in the above ground, like doing clinical trials and doing the special access program here in Canada, that there's, yeah, I anticipate there being gaps between, for example, the end of this trial and then being able to offer MDMA assist a couples therapy again in the future, it'll depend on regulation. So I am hoping that regulation will come soon or be available for MDMA or who knows if there's

a jurisdiction is able to fully decriminalize, that would be awesome.

Yeah, that would be great. think, I don't know about like Canadian drug policy, but we always grow up with DARE. So it was a very heavy stigma. It's very heavy anti-drug. And obviously it just made us want to do more drugs. So it didn't really work. So what originally drew you to this very specific intersection of psychedelics, trauma, and relational work?

Yeah. Well, I really feel like it applies.

I've used this term before and I, but I feel like I had the cosmic red carpet just kind of rolled out for me in this. was my interests has been in relational stuff. So couples work and in trauma. And then when I was in my grad school and my PhD, I started working with Candace Mountain on her randomized trial of CVCT. So that's the couples therapy for PTSD.

Bryan (54:06.414)
So, had always.

Anne Wagner (54:26.37)
So that was my introduction to that. And then the introduction to psychosis, that felt like the cosmic red carpet. So Candace got approached by maths to see if she might be interested in collaborating, given that she'd developed CBCT. And I was her postdoc at the time. And so I got brought into those conversations and those meetings, and it really captured my interest and attention as someone who had been a meditator.

psychedelics was.

Anne Wagner (54:53.046)
or I'm still a meditator, but I had been introduced to different states of consciousness via that. And was always really curious about the mystical and spirituality and those questions. It felt like a whole new door got to open or going, wow, this could be another way of doing that. And to get to do it relationally and to target PTSD, like it just felt like this really beautiful intersection. And

continues to capture my imagination.

Yeah, I love the feeling. I kind of have a similar way I feel about what this whole podcast. Like, things just fell into place as things, and I was like, my gosh, well, look at this. It's all going, wow. And yeah, just one thing after another has been great. So yeah, you too. That's, mean, what I'm doing, nothing compared to what you did. So yeah. So after all this research and hands-on clinical work, what's the most unexpected lesson you've taken away?

Amazing.

Anne Wagner (55:53.438)
the impact it's had on my own personal life. I learned and applied everything I've learned into my own world and then also had my have had my own world impact how I do this work. And I think there's been no greater gift than being able to learn to think psychedelically, like in terms of being open to the mystery and paradox of things and being

So like I would say I have

Bryan (56:13.75)
if you will.

Anne Wagner (56:21.076)
able to sit with emotions in a different way. Like we, we think we talk about that all the time as therapists, but the actual lived experience of doing that in psychedelic work is, to me unparalleled, like you don't get another like direct contact experience like that. And the same in terms of relational healing in terms of, you know, evolving spiritualities and faiths. And like, I think all of those pieces for me,

are probably honestly what keep me so interested in this work is because I then apply it or have it apply, you know, bidirectionally into my own world. And I think that that's a real gift.

Yeah, it is really, it's such a cool like ecosystem, I guess. And it does, it pulls you in and then yeah, it's really beautiful. I really, yeah, it's really, there's not, I can't really put that into words. It just seems magical sometimes at times, the way everything gets pulled together the way it does. So where could listeners learn about you or your research or connect with the Remedy Centre?

Yeah, so.

We have two websites. One is remedycenter.ca and center, spelled the Canadian way, R-E. And then so that's our general clinic. And so there's information about me and our writings and also our clinical work, if you happen to be in Ontario. And then on remedyinstitute.ca, that's our charity and that's where we run our research. so

Anne Wagner (58:00.92)
that's where people can, for example, learn more about the trial that's running and sign up if they're interested. So as I mentioned, we're currently recruiting for the large couples therapy for PTSD trial with MDMA. So if you know someone who has PTSD and they have a loved one that they would want to participate, they're welcome to sign up. And the only requirement is you need to be in the greater Toronto area. So that's, you know,

I know

at some people.

Yeah, and you're going to be speaking at Psychedelic Science 2025 in June. I will. I'll try and Denver. So yeah, I'm excited. I was doing my calendar and I signed up, made sure I was in at least one of your talks. So I'm going through it. So yeah, and hopefully get to meet you there. It's going to be a great time. I'm excited about it.

Yes, I'll be glad to meet

Anne Wagner (58:54.988)
you in person.

Yeah. But yeah, I think that really just kind of wraps most of it up. All the questions I had. It's great having you on. It's great to talk to you. Great. It'll be hopefully. Yeah, we'll meet in person. I'll see you at the conference in Denver.

Wonderful. Thank you so much.

happy.

3L1T3 (01:03:42.584)
So yeah, that was my interview with Ann Wagner. She, it's really interesting stuff. She, she's brought up the, the therapy and types of therapy she's using. And it was, was really interesting. I'm kind of, I'm really excited. she's announced her results now and there's like a, like a 40 % reduction across the board with PTSD, something like that, especially, it's really, really impressive. mean, it's huge for, for like PTSD, like, and I think after so long,

like, no, they wanted, they didn't even qualify to, be, have PTSD anymore. So it's really awesome. Yeah. And so, yeah, she, she presented, she'll be presented her results tonight or she did today. And, you know, we're doing, Leonard Pickard, next month, first to next month. He, those that don't know, he was busted in 1999 with,

think it was enough stuff, technically what they said was enough stuff to make two kilograms of LSD. he spent 20. So that's like a lot. Yeah, that's like, mean, I mean, I'd have to look, I'd have to think about a tooth of math, it's millions of doses. yeah. So he, yeah, he got two life sentences for that and spent 20 years in the federal penitentiary.

A lot of that time in solitary confinement. So, my gosh, dude. Yeah. It was crazy. So yeah, he, was lucky enough to sit down with him. like I said, I've been, I've talked to him a few times. I'll been out here in Denver, you know, got his book. I'm going to read his book. Finally, the Rosa Paracelsus, or yeah, Paracelsus and then, yeah, I'm excited. So

Dude, we've got huge guests coming up. We've got to line up pretty much out through the end of the year. So if you want to get any, yeah, I'm going to have to maybe start doing some like just episodes, you know, just different stuff and do those episodes. Just throw them on exclusively on Patreon. So if you guys want to hear any of that, you know, come on, join the Patreon. time to sign up. Right. patreon.com, slash Divergent States.

3L1T3 (01:05:56.506)
follow us YouTube, Instagram, Tik TOK, all that. I throw a lot of videos, a lot of videos from this conference. I've been thrown up on Tik TOK. So you guys want to check that out, you know, follow me at Divergent States on Tik TOK. So yeah, guys, you know, keep it up. we're, we're doing it. We're laying this down and people are listening. I'm glad I got you here with me, man. we got Amber Capone. That's going to be a, you know, real good one. She's, runs the Vets organization.

Yes. Yeah. For healing for veterans with PTSD. know, we've got, uh, um, Adam Strauss next month, the comedian, um, healed his OCD using mushrooms. It's really interesting. Oh yeah. And he's super funny. Yeah. He's super funny. So that's going to be a great episode. Um, yeah, after that, I think it's, uh, Paul Austin, a microdosing coach. Um, yeah. And then, you know, hopefully.

By that point, you know, we'll be finding out some more names. know we've also got a Joe Moore from psychedelics today. He's coming on. September. He's also going to be doing an ask me anything on the subreddit. Same with Paul Austin. So you guys want to get questions in or talk to those guys, you know, get them in on the subreddit. So, yeah, Brian, I wish you're here, man. I was, you know, too bad didn't work out. Yeah. Yeah, no, just that's the way life is right now. I'm not a.

Right. Super famous podcaster yet. So yeah, right. We're neither of us, but we're, we're working on it. And, right now with my daughter. So it's really exciting, but I appreciate you going out there and taking this on, your own, man. Like it's, it's a lot of work, but you've been out there hustling pretty hard. sounds like I've been trying to, and you know, I appreciate you doing with your kid. mean, that's you family comes first, you know, you know, you guys stay out there, keep exploring. We'll talk to you next time and we'll, do it again. Yes, sir.