In the book, “Beyond Normal: How the New Science of Enhanced Medicine Elevates Peak Performance & Repairs Brain Injuries” author Shai Efrati, MD presents his journey into the field of hyperbaric oxygen therapy (HBOT). It’s an intriguing book outlining case studies, research, and the effects of HBOT on numerous physiological disorders. Efrati covers various types of conditions including stroke, traumatic brain injury (TBI), age-related cognitive decline, fibromyalgia, and post-traumatic stress disorder (PTSD).
While the neurological damage and impairment associated with stroke, TBI, and age-related decline are rather widely acknowledged by the general public, conditions such as fibromyalgia and PTSD are largely considered to be psychological in nature. Dr. Efrati outlines the fact that classic neuroimaging techniques such as computed tomography (CT) scans and basic magnetic resonance imaging (MRI) can fail to capture impaired and damaged areas of the brain. In his practice, Efrati utilizes a combination of single-photon emission computed tomography (SPECT) and advanced MRI to visualize the damaged areas of the brain that suffer from impaired blood flow, neural microstructure damage, and altered connectivity before and after HBOT treatment. This neuroimaging combination helps to quantify physiological neurological improvement that correlates with the enhancement in cognitive processing, emotions, and mood.
A 2018 study published by Efrati’s research team outlined the results of a randomized controlled trial of the effects of HBOT on female patients suffering from fibromyalgia with a history of sexual abuse. The researchers saw a significant improvement in regional blood flow associated with pain and emotional regulation, increased connectivity in various areas of the cortex, and microstructure gains (synaptic density, axonal packing, myelination). These brain injury reversals correlated with the improvements in pain and emotion related symptoms.
Similarly, Efrati’s group published studies in 2022 and 2024 regarding the neurological injuries of military veterans with PTSD and the effects of 60 HBOT sessions on their condition. Pre-HBOT neuroimaging showed frontal-limbic failure, cortex impairment, reduced hippocampus and insula activity, impaired inter-hemispheric connectivity, and reduced white-matter integrity. These two studies lacked SPECT imaging and therefore had no pre- or post- changes in cerebral blood flow. However, it was reported that there was significant symptom reduction in HBOT treated subjects and an improved connectivity in 3 main networks including the default-mode network, central-executive network, and the salience network. Unconnected research from 2004 reported that impaired blood flow in the prefrontal cortex has been observed in Vietnam veterans with PTSD.
The link between neurological damage and conditions such as addiction, depression, anxiety, and PTSD have not been well publicized (Guo et al., 2025; Ceceli et al., 2022; Liu et al., 2022; Bromis et al., 2018; Goldstein and Volkow, 2011; Woon et al., 2010; Smith et al., 2005; Shin et al., 2004; Bremner et al., 1999). The general public perceives these conditions to be a “weakness of the mind” or written off as purely psychological by nature. This lack of awareness regarding brain injury and these conditions is what we believe to be a key hurdle regarding the “mainstreaming” of psychedelics for therapeutic benefits.
While it is estimated that about 10% of the US population have had psychedelic experiences, that leaves 90% of the country to be psychedelic naive. There is still much stigma surrounding these substances for various reasons including safety concerns, brain harm perceptions, religious beliefs, illegality, and propaganda since the 1980s. Identifying what the gaps in messaging are is essential for the field to progress at the rate that supporters desire it to be at.
The outside perspective from those not immersed in psychedelic scientific research is that a person with a “psychological condition” such as depression or PTSD takes a drug that causes them to hallucinate and somehow there is reported benefits from this treatment.
This all sounds a bit disconnected to the average person. While those that have benefited from or have family that has experienced improvement for their conditions from psychedelic therapy, it is more than obvious that there are therapeutic qualities to these substances. However, psychedelic supporters must be cognizant of the large gap in terms of clean, effective messaging to reach the skeptical public.
It would be very different if these psychological conditions were tightly correlated with neurological injury in which the psychedelics help alleviate through mechanisms such as neurogenesis (the growth of brain cells), neuroplasticity (reorganization and increased connectivity), metabolic recovery (improved cerebral blood flow post- treatment), and improved microstructure (improved myelination). These are all therapeutic aspects emerging in the psychedelic research field over the past decade (Cruz et al., 2024; Grieco et al., 2022; Sanches et al., 2016; Frautschi et al., 2025). These data points can be utilized to ground the messaging of psychedelic therapy for injured brains.
Sometimes it feels as though the neurophenomenology of acute psychedelic experiences has been a primary focus of research efforts. While this is an important endeavor, in order to better understand the therapeutic benefits and changes that take place, pre- and post- neuroimaging that quantifies neurological repair that correlates with enhanced cognitive function and psychological state could be essential for public acceptance. Basically a combination of PET, SPECT, & advanced MRI before and well after psychedelic journeys could provide the data points that are currently missing in this grand psychedelic story.
While physical conditions such as paralysis, arthritis, and cancer are all conceded to have distinct underlying mechanisms in the body, changes in mental status are generally thought to lack these same types of measurable mechanisms. This can change with well designed research and media efforts to educate the public regarding these conditions.
It is not the only method to change the public perception but it could be an essential key towards inspiring the public to alter their perspective of these therapeutic substances.
PS. This is why we believe that Alzheimer’s and Parkinson’s disease are such powerful potential targets for psychedelic therapy being that they are widely and rightfully perceived to have brain damage as the fundamental origin driving them. The fact that small case studies regarding these conditions have generated wide media attention is a testament of the potential impact of utilizing psychedelics for clear neurological reparative effects could have on the public perception of these chemicals.