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Gramling R, Bennett E, Curtis K, Richards W, Rizzo DM, Arnoldy F, Hegg L, Porter J, Honstein H, Pratt S, Tarbi E, Reblin M, Thambi P, Agrawal M. Developing a Direct Observation Measure of Therapeutic Connection in Psilocybin-Assisted Therapy: A Feasibility Study. J Palliat Med 2023; 26:1702-1708. [PMID: 37590474 DOI: 10.1089/jpm.2023.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Context: Measuring therapeutic connection during psilocybin-assisted therapy is essential to understand underlying mechanisms, inform training, and guide quality improvement. Purpose: To evaluate the feasibility of directly observing indicators of therapeutic connection during psilocybin administration encounters. Methods: We evaluated audio and video data from a recent clinical trial for observable expressions of therapeutic connection as defined in proposed best-practice competencies (i.e., empathic abiding presence and interpersonal grounding). We selected the first four 8-hour encounters involving unique participants, therapists, and gender pairs. Each video was independently coded by three members of an interprofessional six-person team. Using a structured checklist, coders recorded start-stop times, the audible (i.e., speech prosody or words) and visible (i.e., body movements, eye gaze, and touch) cues marking the event, and the qualities of the interaction (e.g., expression of awe, trust, distress, and calmness). We assessed feasibility by observing the frequency, distribution, and overlap of cues and qualities coders used to identify and define moments of therapeutic connection. Results: Among the 2074 minutes of video, coders recorded 372 moments of therapeutic connection. Eighty-three percent were identified by at least two coders and 41% by all three. Coders used a combination of audible and visual cues to identify therapeutic connection in 51% of observed events (190/372). Both the cues and qualities of therapeutic connection expressions varied over the course of psilocybin temporal effects on states of consciousness. Conclusion: Direct observation of therapeutic human connection is feasible, sensitive to changes in states of consciousness and requires evaluation of audible and visual data.
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Affiliation(s)
- Robert Gramling
- Department of Family Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Emily Bennett
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Keith Curtis
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Emergency Medicine, University of Vermont, Burlington, Vermont, USA
| | - William Richards
- Sunstone Therapies, Rockville, Maryland, USA
- Center for Psychedelic and Consciousness Research, John's Hopkins University, Baltimore, Maryland, USA
| | - Donna M Rizzo
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
- Department of Civil and Environmental Engineering, University of Vermont, Burlington, Vermont, USA
| | - Francesca Arnoldy
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
| | - Logan Hegg
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
| | - Jon Porter
- Department of Family Medicine, University of Vermont, Burlington, Vermont, USA
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- Osher Center for Integrative Health, University of Vermont, Burlington, Vermont, USA
| | | | - Susanna Pratt
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Elise Tarbi
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
- Department of Nursing, University of Vermont, Burlington, Vermont, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, Burlington, Vermont, USA
- Department of Family Medicine, Vermont Conversation Lab, University of Vermont, Burlington, Vermont, USA
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Paul Thambi
- Sunstone Therapies, Rockville, Maryland, USA
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Gold ND, Mallard AJ, Hermann JC, Zeifman RJ, Pagni BA, Bogenschutz MP, Ross S. Exploring the Potential Utility of Psychedelic Therapy for Patients With Amyotrophic Lateral Sclerosis. J Palliat Med 2023; 26:1408-1418. [PMID: 37167080 DOI: 10.1089/jpm.2022.0604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is an aggressive, terminal neurodegenerative disease that causes death of motor neurons and has an average survival time of 3-4 years. ALS is the most common motor neuron degenerative disease and is increasing in prevalence. There is a pressing need for more effective ALS treatments as available pharmacotherapies do not reverse disease progression or provide substantial clinical benefit. Furthermore, despite psychological distress being highly prevalent in ALS patients, psychological treatments remain understudied. Psychedelics (i.e., serotonergic psychedelics and related compounds like ketamine) have seen a resurgence of research into therapeutic applications for treating a multitude of neuropsychiatric conditions, including psychiatric and existential distress in life-threatening illnesses. Methods: We conducted a narrative review to examine the potential of psychedelic assisted-psychotherapy (PAP) to alleviate psychiatric and psychospiritual distress in ALS. We also discussed the safety of using psychedelics in this population and proposed putative neurobiological mechanisms that may therapeutically intervene on ALS neuropathology. Results: PAP has the potential to treat psychological dimensions and may also intervene on neuropathological dimensions of ALS. Robust improvements in psychiatric and psychospiritual distress from PAP in other populations provide a strong rationale for utilizing this therapy to treat ALS-related psychiatric and existential distress. Furthermore, relevant neuroprotective properties of psychedelics warrant future preclinical trials to investigate this area in ALS models. Conclusion: PAP has the potential to serve as an effective treatment in ALS. Given the lack of effective treatment options, researchers should rigorously explore this therapy for ALS in future trials.
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Affiliation(s)
- Noah D Gold
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Austin J Mallard
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Jacob C Hermann
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard J Zeifman
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Broc A Pagni
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Michael P Bogenschutz
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Stephen Ross
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
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van Elk M, Fried EI. History repeating: guidelines to address common problems in psychedelic science. Ther Adv Psychopharmacol 2023; 13:20451253231198466. [PMID: 37766730 PMCID: PMC10521293 DOI: 10.1177/20451253231198466] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/11/2023] [Indexed: 09/29/2023] Open
Abstract
Research in the last decade has expressed considerable optimism about the clinical potential of psychedelics for the treatment of mental disorders. This optimism is reflected in an increase in research papers, investments by pharmaceutical companies, patents, media coverage, as well as political and legislative changes. However, psychedelic science is facing serious challenges that threaten the validity of core findings and raise doubt regarding clinical efficacy and safety. In this paper, we introduce the 10 most pressing challenges, grouped into easy, moderate, and hard problems. We show how these problems threaten internal validity (treatment effects are due to factors unrelated to the treatment), external validity (lack of generalizability), construct validity (unclear working mechanism), or statistical conclusion validity (conclusions do not follow from the data and methods). These problems tend to co-occur in psychedelic studies, limiting conclusions that can be drawn about the safety and efficacy of psychedelic therapy. We provide a roadmap for tackling these challenges and share a checklist that researchers, journalists, funders, policymakers, and other stakeholders can use to assess the quality of psychedelic science. Addressing today's problems is necessary to find out whether the optimism regarding the therapeutic potential of psychedelics has been warranted and to avoid history repeating itself.
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Affiliation(s)
- Michiel van Elk
- Cognitive Psychology Unit, Institute of Psychology, Leiden University, PO Box 9555, Leiden 2300 RB, The Netherlands
| | - Eiko I. Fried
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
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Masel EK, Antunes B, Schulz-Quach C. Palliative care in severe mental illnesses. BMC Palliat Care 2023; 22:31. [PMID: 36991479 DOI: 10.1186/s12904-023-01152-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
In this editorial, we highlight the interaction between patients who are diagnosed with severe mental illness and their treatment within palliative care, a clinical area of specialized focus which has a multitude of complex impacts on affected patients, their (chosen) family members and caregivers, as well as the healthcare professionals who are caring for them.
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Affiliation(s)
- Eva Katharina Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
| | - Bárbara Antunes
- Primary Care Unit, Department of Public Health and Primary care, Palliative and End of Life Care Research Group, University of Cambridge, Cambridge, UK
| | - Christian Schulz-Quach
- Centre for Mental Health, University Health Network, Toronto, Canada
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Division of Consultation and Liaison Psychiatry, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Plazas E, Faraone N. Indole Alkaloids from Psychoactive Mushrooms: Chemical and Pharmacological Potential as Psychotherapeutic Agents. Biomedicines 2023; 11:461. [PMID: 36830997 PMCID: PMC9953455 DOI: 10.3390/biomedicines11020461] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Neuropsychiatric diseases such as depression, anxiety, and post-traumatic stress represent a substantial long-term challenge for the global health systems because of their rising prevalence, uncertain neuropathology, and lack of effective pharmacological treatments. The approved existing studies constitute a piece of strong evidence whereby psychiatric drugs have shown to have unpleasant side effects and reduction of sustained tolerability, impacting patients' quality of life. Thus, the implementation of innovative strategies and alternative sources of bioactive molecules for the search for neuropsychiatric agents are required to guarantee the success of more effective drug candidates. Psychotherapeutic use of indole alkaloids derived from magic mushrooms has shown great interest and potential as an alternative to the synthetic drugs currently used on the market. The focus on indole alkaloids is linked to their rich history, their use as pharmaceuticals, and their broad range of biological properties, collectively underscoring the indole heterocycle as significant in drug discovery. In this review, we aim to report the physicochemical and pharmacological characteristics of indole alkaloids, particularly those derived from magic mushrooms, highlighting the promising application of such active ingredients as safe and effective therapeutic agents for the treatment of neuropsychiatric disorders.
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Affiliation(s)
| | - Nicoletta Faraone
- Department of Chemistry, Acadia University, Wolfville, NS B4P 2R6, Canada
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Frymann T, Whitney S, Yaden DB, Lipson J. The Psychedelic Integration Scales: Tools for Measuring Psychedelic Integration Behaviors and Experiences. Front Psychol 2022; 13:863247. [PMID: 35677137 PMCID: PMC9168432 DOI: 10.3389/fpsyg.2022.863247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
In this study, we describe the development and initial validation of two psychometric scales for measuring psychedelic integration. Psychedelic integration refers to the post-acute period of time following psychedelic drug administration. We created the Integration Engagement Scale (IES) to capture positive behavioral engagement with integration and the Experienced Integration Scale (EIS) to capture internal aspects of feeling integrated. These scales were developed to measure post-acute psychedelic administration dynamics in order to inform the creation of enhanced integration support and to help refine a general conceptual understanding of the construct of psychedelic integration. The scales are brief and face valid instruments designed for practical use in applied and research settings. Scale items were generated and refined using the Iterative Process Model of scale development, with input from psychedelics experts and clinicians. Content validity, internal structure, and reliability were assessed via expert surveys, content validity analysis, cognitive interviewing, convergent validity analysis, exploratory factor analysis, and confirmatory factor analysis. The data indicates the scales are valid and reliable measurements of the behavioral and experiential forms of Psychedelic Integration.
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Affiliation(s)
- Tomas Frymann
- Psychology and Spirituality Lab, Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Sophie Whitney
- Depth and Clinical Psychology, Pacifica Graduate University, Carpinteria, CA, United States
| | - David B Yaden
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joshua Lipson
- Psychology and Spirituality Lab, Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
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