The centrality of sense of self in psychological flexibility processes: What the neurobiological and psychological correlates of psychedelics suggest

Acceptance as a possible link between past psychedelic experiences and psychological flexibility

Increased psychological flexibility (PF) may underlie the lasting positive effects of psychedelic experiences on mental well-being. The associations between different components of PF, psychological inflexibility (PI), and well-being with psychedelic use are not well understood. We conducted a cross-sectional internet survey of participants (N = 629) with experience of classical psychedelics. Using network analysis, we examined how aspects of a single psychedelic experience (mystical-type features and psychological insights) and the frequency of past psychedelic use, were associated with current PF and PI components, as well as with mental well-being and ill-being. Mediation analyses explored whether PF mediated the relationship between past psychedelic use and well-being or ill-being. The network analysis linked psychological insight to the PF component Acceptance, with no association found between the frequency of past use and PF. Mediation analyses showed PF mediates the association between past psychedelic use and well-being and ill-being. These results suggest that the quality and depth of the psychedelic experience, rather than the frequency of use, are primarily linked to psychological flexibility, particularly Acceptance, and overall well-being. This underscores the importance of treating PF as a multidimensional construct to better understand the long-term mental health benefits of psychedelics.

Brain Networks, Neurotransmitters and Psychedelics: Towards a Neurochemistry of Self-Awareness

PURPOSE OF REVIEW

Self-awareness can be defined as the capacity of becoming the object of one's own awareness and, increasingly, it has been the target of scientific inquiry. Self-awareness has important clinical implications, and a better understanding of the neurochemical basis of self-awareness may help clarifying causes and developing interventions for different psychopathological conditions. The current article explores the relationship between neurochemistry and self-awareness, with special attention to the effects of psychedelics.

RECENT FINDINGS

The functioning of self-related networks, such as the default-mode network and the salience network, and how these are influenced by different neurotransmitters is discussed. The impact of psychedelics on self-awareness is reviewed in relation to specific processes, such as interoception, body ownership, agency, metacognition, emotional regulation and autobiographical memory, within a framework based on predictive coding. Improved outcomes in emotional regulation and autobiographical memory have been observed in association with the use of psychedelics, suggesting higher-order self-awareness changes, which can be modulated by relaxation of priors and improved coping mechanisms linked to cognitive flexibility. Alterations in bodily self-awareness are less consistent, being potentially impacted by doses employed, differences in acute/long-term effects and the presence of clinical conditions. Future studies investigating the effects of different molecules in rebalancing connectivity between resting-state networks may lead to novel therapeutic approaches and the refinement of existing treatments.

The experimental study of consciousness: Is psychology travelling back to the future?

It was with the promise of rendering an experimental approach to consciousness that psychology started its trajectory as an independent science more than 150 years ago. Here, we will posit that the neurosciences were instrumental in leading psychology to resume the study of consciousness by projecting an empirical agenda for the future. First, we will start by showing how scientists were able to venture into the consciousness of supposedly unconscious patients, opening the door for the identification of important neural correlates of distinct consciousness states. Then, we will describe how different technological advances and elegant experimental paradigms helped in establishing important neuronal correlates of global consciousness (i.e., being conscious at all), perceptual consciousness (i.e., being conscious of something), and self-consciousness (i.e., being conscious of itself). Finally, we will illustrate how the study of complex consciousness experiences may contribute to the clarification of the mechanisms associated with global consciousness, the relationship between perceptual and self-consciousness, and the interface among distinct self-consciousness domains. In closing, we will elaborate on the road ahead of us for re-establishing psychology as a science of consciousness.

Measuring psychotherapeutic processes in the context of psychedelic experiences: Validation of the General Change Mechanisms Questionnaire (GCMQ)

BACKGROUND

Therapeutic and salutogenic effects of psychedelic drugs have been attributed to psychotherapeutic or psychotherapy-like processes that can unfold during the acute psychedelic experience and beyond. Currently, there are no psychometric instruments available to comprehensively assess psychotherapeutic processes (as conceptualized by empirical psychotherapy research) in the context of psychedelic experiences.

AIMS

We report the initial validation of the General Change Mechanisms Questionnaire (GCMQ), a self-report instrument designed to measure five empirically established general change mechanisms (GCMs) of psychotherapy-(1) resource activation, (2) therapeutic relationship, (3) problem actuation, (4) clarification, and (5) mastery-in the context of psychedelic experiences.

METHODS

An online survey in a sample of 1153 English-speaking and 714 German-speaking psychedelic users was conducted to evaluate simultaneously developed English- and German-language versions of the GCMQ.

RESULTS

The theory-based factor structure was confirmed. The five GCMQ scales showed good internal consistency. Evidence for convergent validity with external measures was obtained. Significant associations with different settings and with therapeutic, hedonic, and escapist use motives confirmed the hypothesized context dependence of GCM-related psychedelic experiences. Indicating potential therapeutic effects, the association between cumulative stressful life events and well-being was significantly moderated by resource activation, clarification, and mastery. Factor mixture modeling revealed five distinct profiles of GCM-related psychedelic experiences.

CONCLUSION

Initial testing indicates that the GCMQ is a valid and reliable instrument that can be used in future clinical and nonclinical psychedelic research. The five identified profiles of GCM-related experiences may be relevant to clinical uses of psychedelics and psychedelic harm reduction.

Trauma-Informed Care in Psychedelic Therapy Research: A Qualitative Literature Review of Evidence-Based Psychotherapy Interventions in PTSD and Psychedelic Therapy Across Conditions

Introduction

Post-traumatic stress disorder (PTSD) is associated with significant patient burden. While pharmacotherapies and evidence-based psychotherapy interventions (EBPI) are effective, studies consistently highlight inadequate outcomes and high treatment dropout. Psychedelic therapy (PT) has shown preliminary promise across difficult-to-treat conditions, including MDMA-assisted therapy for PTSD, however trials of classical psychedelics in PTSD are lacking. Understanding patients' experiences of EBPI could help promote safety in PT.

Aim

To systematically review qualitative research on patients' subjective experience of EBPI for PTSD, and of PT, and examine areas of overlap and divergence between them.

Methods

Systematic literature searches for studies published between 2010 and 2023 were conducted on OVID, PubMed, Web of Science, and PsycInfo. Included were original studies in English that presented qualitative data of patient experiences of EBPI in PTSD, or PT for any indication. Extracted data from included studies were analysed using thematic synthesis. Syntheses were completed separately for EBPI and PT, before similarities and differences between the therapies were identified.

Results

40 research articles were included for review: 26 studies on EBPI for PTSD, and 14 studies on PT. EBPI studied were CBT, EMDR, CPT and PE. Psychedelic compounds studied were psilocybin, ibogaine, LSD, MDMA and ketamine, for treatment of substance use disorders, anxiety relating to physical illness, depression, and PTSD. Core themes from patient experiences of EBPI: 1) patient burden in PTSD treatment; 2) readiness; 3) key mechanisms of change; 4) psychological safety and trust. Themes identified in the review of PT: 1) indirect trauma processing; 2) reorganisation of self-narratives via processes of relatedness and identification; 3) key treatment characteristics.

Conclusion

This study suggests overlap between patients' experience of EBPI and PT in terms of key mechanisms of change, the importance of psychological safety and readiness to engage in treatment. Trauma-informed care paradigms and practices may improve safety and acceptability of PT research.

The ego in psychedelic drug action - ego defenses, ego boundaries, and the therapeutic role of regression

The ego is one of the most central psychological constructs in psychedelic research and a key factor in psychotherapy, including psychedelic-assisted forms of psychotherapy. Despite its centrality, the ego-construct remains ambiguous in the psychedelic literature. Therefore, we here review the theoretical background of the ego-construct with focus on its psychodynamic conceptualization. We discuss major functions of the ego including ego boundaries, defenses, and synthesis, and evaluate the role of the ego in psychedelic drug action. According to the psycholytic paradigm, psychedelics are capable of inducing regressed states of the ego that are less protected by the ego's usual defensive apparatus. In such states, core early life conflicts may emerge that have led to maladaptive ego patterns. We use the psychodynamic term character in this paper as a potential site of change and rearrangement; character being the chronic and habitual patterns the ego utilizes to adapt to the everyday challenges of life, including a preferred set of defenses. We argue that in order for psychedelic-assisted therapy to successfully induce lasting changes to the ego's habitual patterns, it must psycholytically permeate the characterological core of the habits. The primary working principle of psycholytic therapy therefore is not the state of transient ego regression alone, but rather the regressively favored emotional integration of those early life events that have shaped the foundation, development, and/or rigidification of a person's character - including his or her defense apparatus. Aiming for increased flexibility of habitual ego patterns, the psycholytic approach is generally compatible with other forms of psychedelic-assisted therapy, such as third wave cognitive behavioral approaches.

A biphasic relational approach to the evolution of human consciousness: Un enfoque relacional bifásico para la evolución de la conciencia humana

Background/objective

Human consciousness is arguably unique, and its features are hard to explain. Continuous and discrete accounts of consciousness are commonly viewed as incompatible, but both have limitations. Continuous accounts cannot readily account for what appears to be unique about human consciousness; discrete accounts have a hard time explaining how human consciousness could have evolved. The present position paper shows how both continuous and discontinuously elements can be combined.

Method

A biphasic model is constructed by unifying complex systems theory, the evolution of symbolic reasoning as a relational extension of human cooperation, and evolutionary science. The application of this approach to modern views of consciousness is then explored.

Results

Our analysis suggests that human consciousness may be viewed as a discontinuous event, that emerged from continuous foundations. This biphasic account contains processes that can be targeted clinically. For example, developmentally delayed children with problems in consciousness may be helped by targeting the processes the present account suggests are important at different levels of complexity.

Conclusions

This biphasic relational approach fits with the evolutionary record and with data on human cognitive development. It may be useful in guiding clinical intervention.

Psychedelic unselfing: self-transcendence and change of values in psychedelic experiences

Psychedelic experiences have been shown to both facilitate (re)connection to one's values and change values, including enhancing aesthetic appreciation, promoting pro-environmental attitudes, and encouraging prosocial behavior. This article presents an empirically informed framework of philosophical psychology to understand how self-transcendence relates to psychedelic value changes. Most of the observed psychedelic value changes are toward the self-transcendent values of Schwartz's value theory. As psychedelics also reliably cause various self-transcendent experiences (STEs), a parsimonious hypothesis is that STEs change values toward self-transcendent values. I argue that STEs indeed can lead to value changes, and discuss the morally relevant process of self-transcendence through Iris Murdoch's concept of "unselfing". I argue that overt egocentric concerns easily bias one's valuations. Unselfing reduces egocentric attributions of salience and enhances non-egocentric attention to the world, widening one's perspective and shifting evaluation toward self-transcendent modes. Values are inherently tied to various evaluative contexts, and unselfing can attune the individual to evaluative contexts and accompanying values beyond the self. Understood this way, psychedelics can provide temporarily enhanced access to self-transcendent values and function as sources of aspiration and value change. However, contextual factors can complicate whether STEs lead to long-term changes in values. The framework is supported by various research strands establishing empirical and conceptual connections between long-term differences in egocentricity, STEs, and self-transcendent values. Furthermore, the link between unselfing and value changes is supported by phenomenological and theoretical analysis of psychedelic experiences, as well as empirical findings on their long-term effects. This article furthers understanding of psychedelic value changes and contributes to discussions on whether value changes are justified, whether they result from cultural context, and whether psychedelics could function as tools of moral neuroenhancement.

Being no one, being One: The role of ego-dissolution and connectedness in the therapeutic effects of psychedelic experience

Background and aims

Despite promising findings indicating the therapeutic potential of psychedelic experience across a variety of domains, the mechanisms and factors affecting its efficacy remain unclear. The present paper explores this by focusing on two psychedelic states which have been suggested as therapeutically significant in past literature: ego-dissolution and connectedness. The aim of the study is to investigate the impact of ego-dissolution and connectedness on the therapeutic effects of the psychedelic experience.

Methods

The investigation was carried out as a mixed methods systematic review, with the data from four databases analysed thematically and results presented through narrative synthesis.

Results

The analysis and synthesis of findings from 15 unique studies (n = 2,182) indicated that both ego-dissolution and connectedness are associated with a higher chance of improvement following a psychedelic experience. However, there seem to be differences in the way the two experiences affect individuals psychologically. Ego-dissolution appears to trigger psychological change but does not typically exceed the psychedelic experience in its duration, while connectedness can be more sustained and is associated with several positive, potentially therapeutic feelings.

Conclusions

Moreover, the findings of this review have implications for further theory-building about the mechanisms which enable therapeutic effects in psychedelic experience. This in turn might lead to improved models for psychedelic therapy practice. Emphasis on ego-dissolution during the preparation phase and on connectedness during integration is one suggestion presented here, alongside overarching implications for the mental health debate and general practice.

Psychedelics and Psychotherapy: Cognitive-Behavioral Approaches as Default

The acute subjective effects of psychedelics are responsive to users' expectations and surroundings (i.e., "set and setting"). Accordingly, a great deal of thought has gone into designing the psychosocial context of psychedelic administration in clinical settings. But what theoretical paradigms inform these considerations about set and setting? Here, we describe several historical, sociological influences on current psychedelic administration in mainstream European and American clinical research settings, including: indigenous practices, new age spirituality from the 1960s, psychodynamic/psychoanalytic approaches, and cognitive-behavioral approaches. We consider each of these paradigms and determine that cognitive-behavioral therapies, including newer branches such as acceptance and commitment therapy (ACT), have the strongest rationale for psychedelic-assisted psychotherapy going forward. Our primary reasons for advocating for cognitive-behavioral approaches include, (1) they avoid issues of cultural insensitivity, (2) they make minimal speculative assumptions about the nature of the mind and reality, (3) they have the largest base of empirical support for their safety and effectiveness outside of psychedelic therapy. We then propose several concepts from cognitive-behavioral therapies such as CBT, DBT, and ACT that can usefully inform the preparation, session, and integration phases of psychedelic psychotherapy. Overall, while there are many sources from which psychedelic psychotherapy could draw, we argue that current gold-standard, evidence-based psychotherapeutic paradigms provide the best starting point in terms of safety and efficacy.

Perspective: Can psychedelic-assisted therapy be a promising aid in compulsive sexual behavior disorder treatment?

Recently, there has been an increase in studies yielding evidence for psychedelics' anxiolytic and anti-depressive qualities. Preliminary evidence for treatment in substance addiction is also available. In our manuscript, we present a perspective on the possible effectiveness and mechanisms of action of psychedelics' introduction in the treatment of Compulsive Sexual Behavior Disorder (CSBD) and other p roblematic sexual behaviors, which are considered representative of the so-called "behavioral addiction" category. Evidence for the efficacy of Mindfulness Based Interventions in CSBD treatment is promising. Psychedelics- and mindfulness-induced states share common characteristics on both a subjective and objective level. One of the proposed mechanisms regards reduction of experiential avoidance through the promotion of exposure and acceptance. On the neurophysiological level, a shift from higher- to lower-level association regions and an impact on 5- HT2A receptors is observed. Elaborated mechanisms explain the possible enhancement of therapeutic processes by psychedelics. Psychedelics' relative safety and low addictive potential support their introduction into traditional forms of therapy for CSBD and other out of control behaviors.

Measuring 'self': preliminary validation of a short form of the Self Experiences Questionnaire in people with chronic pain

BACKGROUND

People with chronic pain often struggle with their sense of self and this can adversely impact their functioning and well-being. Acceptance and Commitment Therapy particularly includes a process related to this struggle with self. A measure for this process, the Self Experiences Questionnaire (SEQ), was previously developed in people with chronic pain.

PURPOSE

The aim of the current study was to validate a shorter version of the SEQ in people with chronic pain to reduce respondent burden and facilitate further research.

METHODS

Data from 477 participants attending an interdisciplinary pain management programme were included. Participants completed measures of treatment processes (self-as-context, pain acceptance, cognitive fusion and committed action) and outcomes (pain, pain interference, work and social adjustment and depression) at baseline and post-treatment. Confirmatory factor analysis was used for item reduction. Correlations between scores from the shorter SEQ and other process and outcome variables were calculated to examine validity. Change scores of the shorter SEQ and their correlations with changes in outcome variables were examined for responsiveness.

RESULTS

An eight-item SEQ (SEQ-8) scale including two factors, namely Self-as-Distinction and Self-as-Observer, emerged, demonstrating good reliability (Cronbach's α = .87-.90) and validity (|r| = .14-.52). Scores from SEQ-8 significantly improved after the treatment (d = .15-21), and these improvements correlated with improvements in most outcomes.

CONCLUSIONS

The SEQ-8 appears to be a reliable and valid measure of self. This shorter format may facilitate intensive longitudinal investigation into sense of self and functioning and well-being.

Promoting university students’ well-being and studying with an acceptance and commitment therapy (ACT)-based intervention

Students’ poor well-being is a serious problem in higher education. In part, this problem is related to the problems in studying as poorer study skills are related to poorer well-being. Both students’ study skills and their well-being should be enhanced in higher education, but effective ways to do this are needed. The aim of this study was to explore students’ experiences of an ACT-based online, 8-week course on university students’ well-being and studying. Data were collected in two ways: a) with qualitative data consisting of learning journals (n = 97) and with b) a pre- and post-questionnaire (n = 143) during the course. The students’ scores on well-being, psychological flexibility, and time and effort management skills improved, and stress levels decreased during the course. Qualitative analyses showed that the students benefited from the course in many ways, both in terms of studying and well-being; their studying and time management skills had improved and they had learnt stress management skills and how to cope with their negative thoughts. We argue that supporting students’ well-being, as well as their study skills with ACT-based course in higher education studies, can lead to more effective studying.

Self-Medication for Chronic Pain Using Classic Psychedelics: A Qualitative Investigation to Inform Future Research

Background: Chronic Pain is among the leading causes of disability worldwide with up to 60% of patients suffering from comorbid depression. Psychedelic-assisted therapy has recently been found effective in treating a host of mental health issues including depression and has historically been found to be useful in treating pain. Reports of self-medication for chronic pain using psychedelic drugs have been widely documented, with anecdotal evidence indicating widespread success in a range of pathologies. Aims: In preparation for an upcoming trial, to better understand how those with lived experience of chronic pain self-medicate with psychedelic drugs, and to establish, in detail, their therapeutic protocols and practices for success. Methods: As part of patient-involvement (PI) for an upcoming trial in this population, 11 individuals who reported self-medicating with psychedelic drugs took part in a 1-h semi-structured discussion, which was then transcribed and thematically analyzed. Results: Across a range of psychedelic substances and doses, reported pain scores improved substantially during and after psychedelic experiences. Two processes, Positive Reframing and Somatic Presence, were reliably identified as playing a role in improvements in mental wellbeing, relationship with pain, and physical (dis)comfort. Inclusion of other strategies such as mindfulness, breathwork, and movement were also widely reported. Due to the data's subjective nature, this paper is vulnerable to bias and makes no claims on causality or generalisability. Together, these results have been used to inform study design for a forthcoming trial. Conclusion: This pre-trial PI work gives us confidence to test psychedelic therapy for chronic pain in a forthcoming controlled trial. The results presented here will be instrumental in improving our ability to meet the needs of future study participants.

Does Psychedelic Therapy Have a Transdiagnostic Action and Prophylactic Potential?

Addressing global mental health is a major 21st-century challenge. Current treatments have recognized limitations; in this context, new ones that are prophylactic and effective across diagnostic boundaries would represent a major advance. The view that there exists a core of transdiagnostic overlap between psychiatric disorders has re-emerged in recent years, and evidence that psychedelic therapy holds promise for a range of psychiatric disorders supports the position that it may be transdiagnostically effective. Here, we propose that psychedelic therapy's core, transdiagnostically relevant action lies in its ability to increase neuronal and mental plasticity, thus enhancing the potential for change, which we consider to be a key to its therapeutic benefits. Moreover, we suggest that enhanced plasticity via psychedelics, combined with a psychotherapeutic approach, can aid healthy adaptability and resilience, which are protective factors for long-term well-being. We present candidate neurological and psychological markers of this plasticity and link them with a predictive processing model of the action of psychedelics. We propose that a model of psychedelic-induced plasticity combined with an adequate therapeutic context has prophylactic and transdiagnostic potential, implying that it could have a broad, positive impact on public health.

Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

The efficacy of psychedelic-assisted therapies for mental disorders has been attributed to the lasting change from experiential avoidance to acceptance that these treatments appear to facilitate. This article presents a conceptual model that specifies potential psychological mechanisms underlying such change, and that shows substantial parallels between psychedelic therapy and cognitive behavioral therapy: We propose that in the carefully controlled context of psychedelic therapy as applied in contemporary clinical research, psychedelic-induced belief relaxation can increase motivation for acceptance via operant conditioning, thus engendering episodes of relatively avoidance-free exposure to greatly intensified private events. Under these unique learning conditions, relaxed avoidance-related beliefs can be exposed to corrective information and become revised accordingly, which may explain long-term increases in acceptance and corresponding reductions in psychopathology. Open research questions and implications for clinical practice are discussed.