1
|
Pais ML, Teixeira M, Soares C, Lima G, Rijo P, Cabral C, Castelo-Branco M. Rapid effects of tryptamine psychedelics on perceptual distortions and early visual cortical population receptive fields. Neuroimage 2024; 297:120718. [PMID: 38964563 DOI: 10.1016/j.neuroimage.2024.120718] [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: 04/27/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024] Open
Abstract
N, N-dimethyltryptamine (DMT) is a psychedelic tryptamine acting on 5-HT2A serotonin receptors, which is associated with intense visual hallucinatory phenomena and perceptual changes such as distortions in visual space. The neural underpinnings of these effects remain unknown. We hypothesised that changes in population receptive field (pRF) properties in the primary visual cortex (V1) might underlie visual perceptual experience. We tested this hypothesis using magnetic resonance imaging (MRI) in a within-subject design. We used a technique called pRF mapping, which measures neural population visual response properties and retinotopic maps in early visual areas. We show that in the presence of visual effects, as documented by the Hallucinogen Rating Scale (HRS), the mean pRF sizes in V1 significantly increase in the peripheral visual field for active condition (inhaled DMT) compared to the control. Eye and head movement differences were absent across conditions. This evidence for short-term effects of DMT in pRF may explain perceptual distortions induced by psychedelics such as field blurring, tunnel vision (peripheral vision becoming blurred while central vision remains sharp) and the enlargement of nearby visual space, particularly at the visual locations surrounding the fovea. Our findings are also consistent with a mechanistic framework whereby gain control of ongoing and evoked activity in the visual cortex is controlled by activation of 5-HT2A receptors.
Collapse
Affiliation(s)
- Marta Lapo Pais
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Portugal; Institute of Nuclear Sciences Applied to Health (ICNAS), Portugal
| | - Marta Teixeira
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Portugal; Institute of Nuclear Sciences Applied to Health (ICNAS), Portugal
| | - Carla Soares
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Portugal; Institute of Nuclear Sciences Applied to Health (ICNAS), Portugal
| | - Gisela Lima
- Institute of Nuclear Sciences Applied to Health (ICNAS), Portugal; University of Maastricht, the Netherlands; Faculty of Medicine (FMUC), University of Coimbra, Portugal
| | - Patrícia Rijo
- CBIOS-Universidade Lusófona's Research Center for Biosciences & Health Technologies, Portugal; iMed.ULisboa, Faculty of Pharmacy, University of Lisbon, Portugal
| | - Célia Cabral
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Clinic Academic Center of Coimbra (CACC), University of Coimbra, FMUC, Portugal; Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; Centre for Functional Ecology, Department of Life Sciences, University of Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Portugal; Institute of Nuclear Sciences Applied to Health (ICNAS), Portugal; University of Maastricht, the Netherlands; Faculty of Medicine (FMUC), University of Coimbra, Portugal.
| |
Collapse
|
2
|
Golafshani M, Buchman DZ, Husain MI. Disability rights and experiential use of psychedelics in clinical research and practice. NPJ MENTAL HEALTH RESEARCH 2024; 3:34. [PMID: 38956331 PMCID: PMC11219775 DOI: 10.1038/s44184-024-00065-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/01/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Maryam Golafshani
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Daniel Z Buchman
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - M Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
3
|
Korthuis PT, Hoffman K, Wilson-Poe AR, Luoma JB, Bazinet A, Pertl K, Morgan DL, Cook RR, Bielavitz S, Myers R, Wolf RC, McCarty D, Stauffer CS. Developing the Open Psychedelic Evaluation Nexus consensus measures for assessment of supervised psilocybin services: An e-Delphi study. J Psychopharmacol 2024:2698811241257839. [PMID: 38888164 DOI: 10.1177/02698811241257839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Voter initiatives in Oregon and Colorado authorize legal frameworks for supervised psilocybin services, but no measures monitor safety or outcomes. AIMS To develop core measures of best practices. METHODS A three-phase e-Delphi process recruited 36 experts with 5 or more years' experience facilitating psilocybin experiences in various contexts (e.g., ceremonial settings, indigenous practices, clinical trials), or other pertinent psilocybin expertise. Phase I, an on-line survey with qualitative, open-ended text responses, generated potential measures to assess processes, outcomes, and structure reflecting high quality psilocybin services. In Phase II, experts used seven-point Likert scales to rate the importance and feasibility of the Phase I measures. Measures were priority ranked. Qualitative interviews and analysis in Phase III refined top-rated measures. RESULTS Experts (n = 36; 53% female; 71% white; 56% heterosexual) reported currently providing psilocybin services (64%) for a mean of 15.2 [SD 13.1] years, experience with indigenous psychedelic practices (67%), and/or conducting clinical trials (36%). Thematic analysis of Phase I responses yielded 55 candidate process measures (e.g., preparatory hours with client, total dose of psilocybin administered, documentation of touch/sexual boundaries), outcome measures (e.g., adverse events, well-being, anxiety/depression symptoms), and structure measures (e.g., facilitator training in trauma informed care, referral capacity for medical/psychiatric issues). In Phase II and III, experts prioritized a core set of 11 process, 11 outcome, and 17 structure measures that balanced importance and feasibility. CONCLUSION Service providers and policy makers should consider standardizing core measures developed in this study to monitor the safety, quality, and outcomes of community-based psilocybin services.
Collapse
Affiliation(s)
- Philip Todd Korthuis
- Oregon Health & Science University, Portland, OR, USA
- The Open Psychedelic Evaluation Nexus (OPEN), Portland, OR, USA
| | - Kim Hoffman
- Oregon Health & Science University, Portland, OR, USA
- The Open Psychedelic Evaluation Nexus (OPEN), Portland, OR, USA
| | - Adrianne R Wilson-Poe
- The Open Psychedelic Evaluation Nexus (OPEN), Portland, OR, USA
- Legacy Research Institute, Legacy Health, Portland, OR, USA
| | - Jason B Luoma
- The Open Psychedelic Evaluation Nexus (OPEN), Portland, OR, USA
- Portland Psychotherapy Clinic, Research, & Training Center, Portland, OR, USA
| | - Alissa Bazinet
- The Open Psychedelic Evaluation Nexus (OPEN), Portland, OR, USA
- Sequoia Center, Portland, OR, USA
| | - Kellie Pertl
- Oregon Health & Science University, Portland, OR, USA
- The Open Psychedelic Evaluation Nexus (OPEN), Portland, OR, USA
| | - David L Morgan
- Department of Sociology, Portland State University, Portland, OR, USA
| | - Ryan R Cook
- Oregon Health & Science University, Portland, OR, USA
- The Open Psychedelic Evaluation Nexus (OPEN), Portland, OR, USA
| | - Sarann Bielavitz
- Oregon Health & Science University, Portland, OR, USA
- The Open Psychedelic Evaluation Nexus (OPEN), Portland, OR, USA
| | - Renae Myers
- Oregon Health & Science University, Portland, OR, USA
| | - Robert Cameron Wolf
- Subtance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention, Rockville, MD, USA
| | - Dennis McCarty
- Oregon Health & Science University, Portland, OR, USA
- The Open Psychedelic Evaluation Nexus (OPEN), Portland, OR, USA
| | - Christopher S Stauffer
- Oregon Health & Science University, Portland, OR, USA
- The Open Psychedelic Evaluation Nexus (OPEN), Portland, OR, USA
- Portland VA Medical Center, Portland, OR, USA
| |
Collapse
|
4
|
Bornemann J, Close JB, Ahmad K, Barba T, Godfrey K, Macdonald L, Erritzoe D, Nutt D, Carhart-Harris R. Study protocol for "Psilocybin in patients with fibromyalgia: brain biomarkers of action". Front Psychiatry 2024; 15:1320780. [PMID: 38983371 PMCID: PMC11232672 DOI: 10.3389/fpsyt.2024.1320780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/04/2024] [Indexed: 07/11/2024] Open
Abstract
Background Chronic pain is a leading cause of disability worldwide. Fibromyalgia is a particularly debilitating form of widespread chronic pain. Fibromyalgia remains poorly understood, and treatment options are limited or moderately effective at best. Here, we present a protocol for a mechanistic study investigating the effects of psychedelic-assisted-therapy in a fibromyalgia population. The principal focus of this trial is the central mechanism(s) of psilocybin-therapy i.e., in the brain and on associated mental schemata, primarily captured by electroencephalography (EEG) recordings of the acute psychedelic state, plus pre and post Magnetic Resonance Imaging (MRI). Methods Twenty participants with fibromyalgia will complete 8 study visits over 8 weeks. This will include two dosing sessions where participants will receive psilocybin at least once, with doses varying up to 25mg. Our primary outcomes are 1) Lempel-Ziv complexity (LZc) recorded acutely using EEG, and the 2) the (Brief Experiential Avoidance Questionnaire (BEAQ) measured at baseline and primary endpoint. Secondary outcomes will aim to capture broad aspects of the pain experience and related features through neuroimaging, self-report measures, behavioural paradigms, and qualitative interviews. Pain Symptomatology will be measured using the Brief Pain Inventory Interference Subscale (BPI-IS), physical and mental health-related function will be measured using the 36-Item Short Form Health Survey (SF-36). Further neurobiological investigations will include functional MRI (fMRI) and diffusion tensor imaging (changes from baseline to primary endpoint), and acute changes in pre- vs post-acute spontaneous brain activity - plus event-related potential functional plasticity markers, captured via EEG. Discussion The results of this study will provide valuable insight into the brain mechanisms involved in the action of psilocybin-therapy for fibromyalgia with potential implications for the therapeutic action of psychedelic-therapy more broadly. It will also deliver essential data to inform the design of a potential subsequent RCT.
Collapse
Affiliation(s)
- Julia Bornemann
- Centre for Psychedelic Research, Department of Brain Science, Imperial College London, London, United Kingdom
| | - James B. Close
- Centre for Psychedelic Research, Department of Brain Science, Imperial College London, London, United Kingdom
| | - Kirran Ahmad
- Centre for Psychedelic Research, Department of Brain Science, Imperial College London, London, United Kingdom
| | - Tommaso Barba
- Centre for Psychedelic Research, Department of Brain Science, Imperial College London, London, United Kingdom
| | - Kate Godfrey
- Centre for Psychedelic Research, Department of Brain Science, Imperial College London, London, United Kingdom
| | - Lauren Macdonald
- Centre for Psychedelic Research, Department of Brain Science, Imperial College London, London, United Kingdom
| | - David Erritzoe
- Centre for Psychedelic Research, Department of Brain Science, Imperial College London, London, United Kingdom
| | - David Nutt
- Centre for Psychedelic Research, Department of Brain Science, Imperial College London, London, United Kingdom
| | - Robin Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Science, Imperial College London, London, United Kingdom
- Psychedelics Division, Neurology, Psychiatry and Behavioural Sciences Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
5
|
Garcia ACM, Maia LO, Reed PG. Exploring Psychedelics for Alleviating Existential and Spiritual Suffering in People With Serious Illnesses: Links to the Theory of Self-Transcendence. J Holist Nurs 2024:8980101241257836. [PMID: 38809663 DOI: 10.1177/08980101241257836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
The fields of palliative and holistic Nursing are dedicated to providing comprehensive care for the person, emphasizing special attention to the existential and spiritual aspects of care. Psychedelic-assisted therapy has emerged as a promising approach for symptom management in individuals with serious illnesses, particularly those of existential and spiritual origin. People who undergo challenging experiences, as is the case with serious illnesses, often undergo an identity crisis and question the purpose of their lives. Psychedelic therapy, when conducted properly by trained professionals, can facilitate self-exploration and self-transcendence, opening doors to states of expanded consciousness and fostering a profound connection with oneself. This experience can help patients develop a greater sense of self-awareness and a deeper understanding of their existential and spiritual issues, enabling them to find meaning and inner peace. The Theory of Self-Transcendence theory provides a Nursing framework for understanding how psychedelic-assisted therapy can facilitate, through self-transcendence, the journey of spiritual and existential healing, offering the possibility of achieving wellbecoming from a state of vulnerability.
Collapse
Affiliation(s)
| | - Lucas Oliveira Maia
- Federal University of Alfenas University of Campinas Federal University of Rio Grande do Norte
| | | |
Collapse
|
6
|
Rodgers A, Bahceci D, Davey CG, Chatterton ML, Glozier N, Hopwood M, Loo C. Ensuring the affordable becomes accessible-lessons from ketamine, a new treatment for severe depression. Aust N Z J Psychiatry 2024; 58:109-116. [PMID: 37830221 DOI: 10.1177/00048674231203898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
In this paper, the case study of ketamine as a new treatment for severe depression is used to outline the challenges of repurposing established medicines and we suggest potential solutions. The antidepressant effects of generic racemic ketamine were identified over 20 years ago, but there were insufficient incentives for commercial entities to pursue its registration, or support for non-commercial entities to fill this gap. As a result, the evaluation of generic ketamine was delayed, piecemeal, uncoordinated, and insufficient to gain approval. Meanwhile, substantial commercial investment enabled the widespread registration of a patented, intranasal s-enantiomeric ketamine formulation (Spravato®) for depression. However, Spravato is priced at $600-$900/dose compared to ~$5/dose for generic ketamine, and the ~AUD$100 million annual government investment requested in Australia (to cover drug costs alone) has been rejected twice, leaving this treatment largely inaccessible for Australian patients 2 years after Therapeutic Goods Administration approval. Moreover, emerging evidence indicates that generic racemic ketamine is at least as effective as Spravato, but no comparative trials were required for regulatory approval and have not been conducted. Without action, this story will repeat regularly in the next decade with a new wave of psychedelic-assisted psychotherapy treatments, for which the original off-patent molecules could be available at low-cost and reduce the overall cost of treatment. Several systemic reforms are required to ensure that affordable, effective options become accessible; these include commercial incentives, public and public-private funding schemes, reduced regulatory barriers and more coordinated international public funding schemes to support translational research.
Collapse
Affiliation(s)
- Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Dilara Bahceci
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Mary Lou Chatterton
- Health Economics Group, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Colleen Loo
- School of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Randwick, NSW, Australia
| |
Collapse
|
7
|
Spotswood CJ. Psychedelics in Psychiatry, the Nursing Influence, and the Future of Psychedelic Therapies. J Am Psychiatr Nurses Assoc 2024:10783903231222930. [PMID: 38284395 DOI: 10.1177/10783903231222930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Psychedelics and psychedelic-assisted therapies (PATs) are on the cusp of becoming medicalized treatment modalities within the United States, both as potential U.S. Food and Drug Administration (FDA)-approved treatment and therapeutic options outside the medical model, through decriminalization efforts within individual states. Bringing with it a paradigm shift in the delivery of health care for both physical and mental health treatment. A workforce of highly trained facilitators will be needed to meet the anticipated demand for this type of treatment and nurses can play a key role in meeting this demand. This article serves to introduce psychedelic-assisted therapies to psychiatric-mental health nurses as we start to see this new field emerge. METHOD Review of published literature and other media. RESULTS Results based on historical data, modern applications, and future considerations. CONCLUSIONS Nurses have been involved with psychedelic-assisted therapies in the past and are fully capable of providing a wide range of roles upon the anticipated approval as a treatment modality.
Collapse
Affiliation(s)
- Carlton J Spotswood
- Carlton J. Spotswood, MSN, APRN, PMHNP-BC, MaineGeneral Medical Center, Augusta, ME, USA
| |
Collapse
|
8
|
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.
Collapse
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
| | | |
Collapse
|
9
|
Greń J, Tylš F, Lasocik M, Kiraly C. Back from the rabbit hole. Theoretical considerations and practical guidelines on psychedelic integration for mental health specialists. Front Psychol 2023; 14:1054692. [PMID: 37904908 PMCID: PMC10613493 DOI: 10.3389/fpsyg.2023.1054692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 08/25/2023] [Indexed: 11/01/2023] Open
Abstract
The growing interest in and prevalence of the use of psychedelics, as well as the potential benefits and negative consequences associated with psychedelic experiences, create a need for mental health specialists to be able to provide adequate and effective intervention regarding the content and consequences of these experiences, that is, psychedelic integration. At the same time, current graduate training in psychiatry, psychology, psychotherapy, counseling, etc., fails to adequately prepare professionals for such interventions. In order to fill this gap, an international, bottom-up project was established to attempt developing guidelines. This project was conducted by means of literature reviews as well as roundtable discussions among project participants, leading to a consensus on the guidelines' final scope and content. Drawing from the outcomes of this project, this article presents proposed comprehensive guidelines covering both theoretical and practical aspects of psychedelic integration, that are intended to serve as a resource for various mental health specialists who may encounter individuals in need of support considering their psychedelic experiences. These guidelines encompass clinician-friendly information on the effects of psychedelics, a definition of psychedelic integration, the general theoretical considerations linked to utilization of psychedelic experiences in clinical practice, a simple model organizing the course of psychedelic integration practice, as well as an overview of the current models of psychedelic integration, along with a selective presentation of basic and specific interventions derived from various psychotherapeutic approaches that can be employed in the practice of psychedelic integration.
Collapse
Affiliation(s)
- Jakub Greń
- Public Health Department, Institute of Psychiatry and Neurology, Warsaw, Poland
- Polish Psychedelic Society, Warsaw, Poland
| | - Filip Tylš
- Psyon - Psychedelic Clinic, Prague, Czechia
- 3rd Medical Faculty, Charles University in Prague, Prague, Czechia
- National Institute of Mental Health, Klecany, Czechia
- Czech Psychedelic Society, Prague, Czechia
| | - Michał Lasocik
- Polish Psychedelic Society, Warsaw, Poland
- Polish Society of Process Psychology, Warsaw, Poland
| | - Csaba Kiraly
- Multidiszciplináris Társaság a Pszichedelikumok Kutatásáért, Budapest, Hungary
| |
Collapse
|
10
|
Osterhold HM, Fernandes-Osterhold G. Chasing the Numinous: Hungry Ghosts in the Shadow of the Psychedelic Renaissance. THE JOURNAL OF ANALYTICAL PSYCHOLOGY 2023; 68:638-664. [PMID: 37553849 DOI: 10.1111/1468-5922.12949] [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] [Received: 02/27/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
In recent years a renewed scientific, public and commercial interest in psychedelic medicines can be observed across the globe. As research findings have been generally promising, there is hope for new treatment possibilities for a number of difficult-to-treat mental health concerns. While honouring positive developments and therapeutic promise in relation to the medical use of psychedelics, this paper aims to shine a light on some underlying psycho-cultural shadow dynamics in the unfolding psychedelic renaissance. This paper explores whether and how the multi-layered collective fascination with psychedelics may yet be another symptom pointing towards a deeper psychological and spiritual malaise in the modern Western psyche as diagnosed by C. G. Jung. The question is posed whether the West's feverish pursuit of psychedelic medicines-from individual consumption to entheogenic tourism, from capitalist commodification of medicines and treatments to the increasing number of ethical scandals and abuse through clinicians and self-proclaimed shamans-is related to a Western cultural complex. As part of the discussion, the archetypal image of the Hungry Ghost, known across Asian cultural and religious traditions, is explored to better understand the aforementioned shadow phenomena and point towards mitigating possibilities.
Collapse
|
11
|
Ijaz N, Carrie H. Governing therapeutic pluralism: An environmental scan of the statutory regulation and government reimbursement of traditional and complementary medicine practitioners in the United States. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001996. [PMID: 37556455 PMCID: PMC10411782 DOI: 10.1371/journal.pgph.0001996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/18/2023] [Indexed: 08/11/2023]
Abstract
The World Health Organization has called on nation-states to statutorily govern, and integrate into state-funded healthcare systems, practitioners of traditional and complementary medicine (T&CM) (whose therapeutic approaches that fall outside the boundaries of conventional biomedicine). To date, however, there exist few rigorous reports of the degree to which individual nations have responded to this call. This study, an environmental scan, comprehensively documents the statutory governance and government reimbursement of T&CM practitioners in the United States (US). Across the US, where health practitioner governance falls within state and territorial (rather than federal) jurisdiction, over 300 laws have been enacted to statutorily regulate a wide range of T&CM practitioners. Nurse-midwives and chiropractors are universally licensed across all 56 US regulatory jurisdictions (50 states, 5 territories and the District of Columbia); other major T&CM practitioner groups are regulated in fewer jurisdictions (acupuncturists, n = 52; massage therapists, n = 50; direct-entry [non-nurse] midwives, n = 36; naturopaths, n = 24). Additional statutory stipulations exist to govern chiropractic assistants (n = 30), auricular (ear) acupuncture practitioners (n = 24), homeopathic practitioners (n = 3), and psychedelic facilitators (n = 1), as well as biomedical professionals who practice acupuncture and related techniques, e.g., 'dry needling' (n = 44). While professional entry requirements for licensed T&CM practitioners are substantially harmonized across jurisdictions, restricted titles and statutory scopes of practice vary. Ten states have furthermore implemented 'safe harbor' ('negative licensing') exemption laws enabling otherwise-unregulated T&CM practitioners to legally practice. Limited government reimbursement for T&CM care is available across several federal and state programs, including Medicare, Tricare, Veterans Health Authority, and Medicaid. Nurse-midwifery and chiropractic care is most frequently reimbursed; acupuncturists, naturopaths and massage therapists are eligible for much more limited coverage. Medicaid programs for low-income people in ten states furthermore cover the services of (unlicensed but statutorily-recognized) birth doulas. Additional research is needed to assess the impact of these regulations on US health care.
Collapse
Affiliation(s)
- Nadine Ijaz
- Department of Law and Legal Studies, Faculty of Public Affairs, Carleton University, Ottawa, Canada
| | - Heather Carrie
- Heather Carrie Research Associates, Vashon Island, Vashon, Washington, United States of America
| |
Collapse
|
12
|
Spriggs MJ, Murphy-Beiner A, Murphy R, Bornemann J, Thurgur H, Schlag AK. ARC: a framework for access, reciprocity and conduct in psychedelic therapies. Front Psychol 2023; 14:1119115. [PMID: 37251069 PMCID: PMC10211333 DOI: 10.3389/fpsyg.2023.1119115] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/31/2023] [Indexed: 05/31/2023] Open
Abstract
The field of psychedelic assisted therapy (PAT) is growing at an unprecedented pace. The immense pressures this places on those working in this burgeoning field have already begun to raise important questions about risk and responsibility. It is imperative that the development of an ethical and equitable infrastructure for psychedelic care is prioritized to support this rapid expansion of PAT in research and clinical settings. Here we present Access, Reciprocity and Conduct (ARC); a framework for a culturally informed ethical infrastructure for ARC in psychedelic therapies. These three parallel yet interdependent pillars of ARC provide the bedrock for a sustainable psychedelic infrastructure which prioritized equal access to PAT for those in need of mental health treatment (Access), promotes the safety of those delivering and receiving PAT in clinical contexts (Conduct), and respects the traditional and spiritual uses of psychedelic medicines which often precede their clinical use (Reciprocity). In the development of ARC, we are taking a novel dual-phase co-design approach. The first phase involves co-development of an ethics statement for each arm with stakeholders from research, industry, therapy, community, and indigenous settings. A second phase will further disseminate the statements for collaborative review to a wider audience from these different stakeholder communities within the psychedelic therapy field to invite feedback and further refinement. By presenting ARC at this early stage, we hope to draw upon the collective wisdom of the wider psychedelic community and inspire the open dialogue and collaboration upon which the process of co-design depends. We aim to offer a framework through which psychedelic researchers, therapists and other stakeholders, may begin tackling the complex ethical questions arising within their own organizations and individual practice of PAT.
Collapse
Affiliation(s)
- Meg J. Spriggs
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
- Drug Science, London, United Kingdom
| | - Ashleigh Murphy-Beiner
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
- Department of Psychology, Royal Holloway University of London, London, United Kingdom
| | - Roberta Murphy
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
- South West London and St George’s Mental Health NHS Trust, London, United Kingdom
| | - Julia Bornemann
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
- Drug Science, London, United Kingdom
| | | | - Anne K. Schlag
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
- Drug Science, London, United Kingdom
| |
Collapse
|
13
|
Peterson A, Largent EA, Lynch HF, Karlawish J, Sisti D. Journeying to Ixtlan: Ethics of Psychedelic Medicine and Research for Alzheimer's Disease and Related Dementias. AJOB Neurosci 2023; 14:107-123. [PMID: 36476106 DOI: 10.1080/21507740.2022.2148771] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
In this paper, we examine the case of psychedelic medicine for Alzheimer's disease and related dementias (AD/ADRD). These "mind-altering" drugs are not currently offered as treatments to persons with AD/ADRD, though there is growing interest in their use to treat underlying causes and associated psychiatric symptoms. We present a research agenda for examining the ethics of psychedelic medicine and research involving persons living with AD/ADRD, and offer preliminary analyses of six ethical issues: the impact of psychedelics on autonomy and consent; the impact of "ego dissolution" on persons experiencing a pathology of self; how psychedelics might impact caregiving; the potential exploitation of patient desperation; institutional review boards' orientation to psychedelic research; and methods to mitigate inequity. These ethical issues are magnified for AD/ADRD but bear broader relevance to psychedelic medicine and research in other clinical populations.
Collapse
Affiliation(s)
| | | | | | | | - Dominic Sisti
- University of Pennsylvania Perelman School of Medicine
| |
Collapse
|
14
|
Dawood Hristova JJ, Pérez-Jover V. Psychotherapy with Psilocybin for Depression: Systematic Review. Behav Sci (Basel) 2023; 13:bs13040297. [PMID: 37102811 PMCID: PMC10135952 DOI: 10.3390/bs13040297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Depression is a common mental health issue that affects 280 million people in the world with a high mortality rate, as well as being a leading cause of disability. Psychopharmacological therapies with psychedelics, particularly those with psilocybin, are showing promising potential for the treatment of depression, among other conditions. Some of their benefits include a rapid and exponential improvement in depressive symptoms and an increased sense of well-being that can last for months after the treatment, as well as a greater development of introspective capacity. The aim of this project was to provide experimental evidence about therapeutic procedures along with psilocybin for the treatment of major depressive disorder. The project highlights eight studies that examined this condition. Some of them dealt with treatment-resistant depression while others dealt with depression due to a life-threatening disease such as cancer. These publications affirm the efficiency of the psilocybin therapy for depression, with only one or two doses in conjunction with psychological support during the process.
Collapse
|
15
|
Emmerich N, Humphries B. Is the Requirement for First-Person Experience of Psychedelic Drugs a Justified Component of a Psychedelic Therapist's Training? Camb Q Healthc Ethics 2023:1-10. [PMID: 36861394 DOI: 10.1017/s0963180123000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Recent research offers good reason to think that various psychedelic drugs-including psilocybin, ayahuasca, ketamine, MDMA, and LSD-may have significant therapeutic potential in the treatment of various mental health conditions, including post-traumatic stress disorder, depression, existential distress, and addiction. Although the use of psychoactive drugs, such as Diazepam or Ritalin, is well established, psychedelics arguably represent a therapeutic step change. As experiential therapies, their value would seem to lie in the subjective experiences they induce. As it is the only way for trainee psychedelic therapists to fully understand their subjective effects, some have suggested that firsthand experience of psychedelics should form part of training programs. We question this notion. First, we consider whether the epistemic benefits offered by drug-induced psychedelic experience are as unique as is supposed. We then reflect on the value it might have in regard to the training of psychedelic therapists. We conclude that, absent stronger evidence of the contribution drug-induced experiences make to the training of psychedelic therapists, requiring trainees to take psychedelic drugs does not seem ethically legitimate. However, given the potential for epistemic benefit cannot be entirely ruled out, permitting trainees who wish to gain first-hand experience of psychedelics may be permissible.
Collapse
Affiliation(s)
- Nathan Emmerich
- School of Medicine and Psychology, Australian National University, Florey Building, Acton, Australian Capital Territory, Australia
| | - Bryce Humphries
- School of Medicine and Psychology, Australian National University, Florey Building, Acton, Australian Capital Territory, Australia
| |
Collapse
|
16
|
Ponomarenko P, Seragnoli F, Calder A, Oehen P, Hasler G. Can psychedelics enhance group psychotherapy? A discussion on the therapeutic factors. J Psychopharmacol 2023:2698811231155117. [PMID: 36855289 DOI: 10.1177/02698811231155117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Despite the growth of psychedelic research, psychedelic-assisted group psychotherapy (PAGP) has received little attention in comparison to individual psychedelic-assisted psychotherapy models. METHODS In this article, we aim to discuss the therapeutic potential of PAGP, as well as outline existing models and the challenges of this approach. Using Irvin Yalom's 11 therapeutic factors of group therapy as a basic framework, we analyse current literature from clinical studies and neurobiological research relative to the topic of PAGP. RESULTS We argue that combining psychedelic substances and group psychotherapy may prove beneficial for increasing group connectedness and interpersonal learning, potentially enhancing prosocial behaviour with direct opportunities to practice newly acquired knowledge about previously maladaptive behavioural patterns. Challenges regarding this approach include a more rigid therapy structure and potential loss of openness from patients, which may be ameliorated by adequate therapeutic training. CONCLUSION We hope for this article to support clinical research on PAGP by presenting a therapeutic framework and outlining its mechanisms and challenges.
Collapse
Affiliation(s)
| | | | - Abigail Calder
- Department of Medicine, University of Freiburg, Villars-sur-Glâne, Switzerland
| | - Peter Oehen
- Private Practice for Psychiatry and Psychotherapy, Biberist, Switzerland
| | - Gregor Hasler
- Department of Medicine, University of Freiburg, Villars-sur-Glâne, Switzerland
| |
Collapse
|
17
|
Torrado Pacheco A, Olson RJ, Garza G, Moghaddam B. Acute psilocybin enhances cognitive flexibility in rats. Neuropsychopharmacology 2023; 48:1011-1020. [PMID: 36807609 PMCID: PMC10209151 DOI: 10.1038/s41386-023-01545-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023]
Abstract
Psilocybin has been shown to improve symptoms of depression and anxiety when combined with psychotherapy or other clinician-guided interventions. To understand the neural basis for this pattern of clinical efficacy, experimental and conceptual approaches that are different than traditional laboratory models of anxiety and depression are needed. A potential novel mechanism is that acute psilocybin improves cognitive flexibility, which then enhances the impact of clinician-assisted interventions. Consistent with this idea, we find that acute psilocybin robustly improves cognitive flexibility in male and female rats using a task where animals switched between previously learned strategies in response to uncued changes in the environment. Psilocybin did not influence Pavlovian reversal learning, suggesting that its cognitive effects are selective to enhanced switching between previously learned behavioral strategies. The serotonin (5HT) 2 A receptor antagonist ketanserin blocked psilocybin's effect on set-shifting, while a 5HT2C-selective antagonist did not. Ketanserin alone also improved set-shifting performance, suggesting a complex relationship between psilocybin's pharmacology and its impact on flexibility. Further, the psychedelic drug 2,5-Dimethoxy-4-iodoamphetamine (DOI) impaired cognitive flexibility in the same task, suggesting that this effect of psilocybin does not generalize to all other serotonergic psychedelics. We conclude that the acute impact of psilocybin on cognitive flexibility provides a useful behavioral model to investigate its neuronal effects relevant to its positive clinical outcome.
Collapse
Affiliation(s)
- Alejandro Torrado Pacheco
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, 97239, USA.
| | - Randall J Olson
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Gabriela Garza
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, 97239, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Bita Moghaddam
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, 97239, USA.
| |
Collapse
|
18
|
Meir P, Taylor L, Soares JC, Meyer TD. Psychotherapists' openness to engage their patients in Psilocybin-Assisted Therapy for mental health treatment. J Affect Disord 2023; 323:748-754. [PMID: 36535547 DOI: 10.1016/j.jad.2022.12.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/04/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Despite psychedelic research initially ceasing in the 1970-80s, the findings documented encouraged researchers to re-examine the safety and efficacy of treating mental health with psychedelics. Of particular focus, psilocybin has shown to have therapeutic potential for a variety of mental health problems and was granted breakthrough therapy status by the FDA. Should psilocybin eventually become legally licensed, the success of Psilocybin-Assisted Therapy (PAT) may largely rely on clinicians' openness to engage their eligible patients with PAT. We therefore assessed 119 psychologists' openness to recommend PAT, perceived barriers/facilitators to informing patients about PAT, and factors affecting their openness to involve patients with PAT if FDA approved. While 77.4 % of psychologists agreed they would inform eligible patients about PAT, 91.6 % stated they would still recommend psychotherapies that do not involve psilocybin first. 76.5 % endorsed that knowledge on psilocybin would increase their likelihood to inform patients about PAT. More positive attitudes and beliefs about psilocybin, greater self-reported knowledge of psilocybin, personal history of psychedelic usage, and more positive attitudes towards medical cannabis (MC) was associated with greater openness to engage patients with PAT. Our regression analysis revealed that attitudes towards MC and beliefs about psilocybin were the only significant predictors of psychotherapists' openness towards PAT. These findings provide relevant information to institutions planning educational programs for mental health professionals about psilocybin and Psychedelic-Assisted Therapies.
Collapse
Affiliation(s)
- Priel Meir
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Science Center at Houston, Houston, TX, United States
| | - Leslie Taylor
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Science Center at Houston, Houston, TX, United States
| | - Jair C Soares
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Science Center at Houston, Houston, TX, United States
| | - Thomas D Meyer
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Science Center at Houston, Houston, TX, United States.
| |
Collapse
|
19
|
Torrado Pacheco A, Olson RJ, Garza G, Moghaddam B. Acute psilocybin enhances cognitive flexibility in rats. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.09.523291. [PMID: 36712091 PMCID: PMC9881983 DOI: 10.1101/2023.01.09.523291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Psilocybin has been shown to improve symptoms of depression and anxiety when combined with psychotherapy or other clinician-guided interventions. To understand the neural basis for this pattern of clinical efficacy, experimental and conceptual approaches that are different than traditional laboratory models of anxiety and depression are needed. A potential novel mechanism is that acute psilocybin improves cognitive flexibility, which then enhances the impact of clinician-assisted interventions. Consistent with this idea, we find that acute psilocybin robustly improves cognitive flexibility in male and female rats using a task where animals switched between previously learned strategies in response to uncued changes in the environment. Psilocybin did not influence Pavlovian reversal learning, suggesting that its cognitive effects are selective to enhanced switching between previously learned behavioral strategies. The serotonin (5HT) 2A receptor antagonist ketanserin blocked psilocybin's effect on set-shifting, while a 5HT2C-selective antagonist did not. Ketanserin alone also improved set-shifting performance, suggesting a complex relationship between psilocybin's pharmacology and its impact on flexibility. Further, the psychedelic drug 2,5-Dimethoxy-4-iodoamphetamine (DOI) impaired cognitive flexibility in the same task, suggesting that this effect of psilocybin does not generalize to all other serotonergic psychedelics. We conclude that the acute impact of psilocybin on cognitive flexibility provides a useful behavioral model to investigate its neuronal effects relevant to its positive clinical outcome.
Collapse
Affiliation(s)
- Alejandro Torrado Pacheco
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR 97239,Corresponding author:;
| | - Randall J. Olson
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR 97239
| | - Gabriela Garza
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR 97239,Current address: Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Bita Moghaddam
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR 97239,Corresponding author:;
| |
Collapse
|
20
|
Earleywine M, Low F, Altman BR, De Leo J. How Important Is a Guide Who Has Taken Psilocybin in Psilocybin-Assisted Therapy for Depression? J Psychoactive Drugs 2023; 55:51-61. [PMID: 35318904 DOI: 10.1080/02791072.2022.2047842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Promising outcomes of Psilocybin-Assisted Therapy (PAT) for depression have generated concerted efforts to replicate, extend, and refine protocols to maximize efficacy. Psychotherapy research reveals that clients benefit most when important components of treatment align with their personal preferences. One open question related to PAT concerns the importance of the psilocybin experience of the guides (trained professionals present during acute effects). We sought to assess the importance of a guide who had used psilocybin to potential clients with depressive symptoms. Over 800 MTurk respondents with depressive symptoms rated the import of a guide who had used psilocybin relative to alternative characteristics in guides and cognitive behavioral (CBT) therapists. Importance ratings for guides who had used psilocybin significantly exceeded the "somewhat important" level (50 on a 0-100 scale), other guide-related qualities, and comparable ratings for a cognitive behavioral therapist who shared demographics, had experience with depression and received cognitive therapy personally. People of color (those who are not Caucasian) and those who had previous therapy gave significantly higher importance ratings for guides who had used psilocybin. Participants who chose to list other qualities important for guides listed very similar ones for CBT therapists, often emphasizing proper training and an empathic demeanor. Guides who have used psilocybin, who inform clients of the fact, might have advantages for facilitating PAT's antidepressant effects, as least in a subset of clients.
Collapse
Affiliation(s)
- Mitch Earleywine
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Fiona Low
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Brianna R Altman
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | | |
Collapse
|
21
|
Abstract
Importance Psychedelic drugs are becoming accessible in the US through a patchwork of state legislative reforms. This shift necessitates consensus on treatment models, education and guidance for health care professionals, and planning for implementation and regulation. Objective To assess trends in psychedelics legislative reform and legalization in the US to provide guidance to health care professionals, policy makers, and the public. Evidence Review Data were compiled from legislative databases (BillTrack50, LexisNexis, and Ballotpedia) from January 1, 2019, to September 28, 2022. Legislation was identified by searching for terms related to psychedelics (eg, psilocybin, MDMA, peyote, mescaline, ibogaine, LSD, ayahuasca, and DMT). Bills were coded by an attorney along 2 axes: which psychedelic drugs would be affected and in what ways (eg, decriminalization, funding for medical research, and right to try). To explore drivers and rates of legislative reform, data were compared with other state indices including 2020 presidential voting margins and marijuana legislative reform. Findings Twenty-five states have considered 74 bills (69 legislative initiatives, 5 ballot measures); 10 bills were enacted, and 32 were still active. The number of psychedelic reform bills introduced during each calendar year increased steadily from 5 in 2019 to 6 in 2020, 27 in 2021, and 36 in 2022. Nearly all bills specified psilocybin (67 [90%]), and many also included MDMA (3,4-methylenedioxy-methamphetamine; 27 [36%]). While bills varied in their framework, most (43 [58%]) proposed decriminalization, of which few delineated medical oversight (10 of 43 [23%]) or training and/or licensure requirements (15 of 43 [35%]). In general, bills contained less regulatory guidance than the enacted Oregon Measure 109. While early legislative efforts occurred in liberal states, the margin between liberal and conservative states has decreased over time (although the difference was not significant), suggesting that psychedelic drug reform is becoming a bipartisan issue. In addition, an analytic model based on marijuana legalization projected that a majority of states will legalize psychedelics by 2034 to 2037. Conclusions and Relevance Legislative reform for psychedelic drugs has been proceeding in a rapid, patchwork fashion in the US. Further consideration should be given to key health care issues such as establishing (1) standards for drugs procured outside the medical establishment, (2) licensure criteria for prescribers and therapists, (3) clinical and billing infrastructure, (4) potential contraindications, and (5) use in special populations like youths, older adults, and pregnant individuals.
Collapse
Affiliation(s)
- Joshua S Siegel
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - James E Daily
- Center for Empirical Research in the Law, Washington University in St Louis, St Louis, Missouri
| | - Demetrius A Perry
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Ginger E Nicol
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| |
Collapse
|
22
|
Celidwen Y, Redvers N, Githaiga C, Calambás J, Añaños K, Chindoy ME, Vitale R, Rojas JN, Mondragón D, Rosalío YV, Sacbajá A. Ethical principles of traditional Indigenous medicine to guide western psychedelic research and practice. LANCET REGIONAL HEALTH. AMERICAS 2022; 18:100410. [PMID: 36844020 PMCID: PMC9950658 DOI: 10.1016/j.lana.2022.100410] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/31/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
The resurgence of Western psychedelic research and practice has led to increasing concerns from many Indigenous Nations regarding cultural appropriation, lack of recognition of the sacred cultural positioning of these medicines, exclusionary practices in research and praxis, and patenting of traditional medicines. Indigenous voices and leadership have been notably absent from the Western psychedelic field currently widely represented by Westerners. An Indigenous-led globally represented group of practitioners, activists, scholars, lawyers, and human rights defenders came together with the purpose of formulating a set of ethical guidelines concerning traditional Indigenous medicines current use in Western psychedelic research and practice. A global Indigenous consensus process of knowledge-gathering was engaged which identified eight interconnected ethical principles, including: Reverence, Respect, Responsibility, Relevance, Regulation, Reparation, Restoration, and Reconciliation. A summary of the work is presented here with suggested ethical actions for moving forward within Western psychedelic research and practice spaces.
Collapse
Affiliation(s)
- Yuria Celidwen
- University of California, Berkeley, CA, USA,Corresponding author. 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA.
| | - Nicole Redvers
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada,Arctic Indigenous Wellness Foundation, Yellowknife, NT, Canada
| | | | - Janeth Calambás
- Universidad Distrital Francisco José de Caldas, Bogotá, Colombia
| | | | | | - Riccardo Vitale
- Unión de Médicos Indígenas Yageceros de La Amazonía Colombiana, Colombia
| | - Juan Nelson Rojas
- Pull Together Now, USA,Pipil Kakawira Indigenous Council of Firekeepers and Healers, El Salvador
| | | | - Yuniur Vázquez Rosalío
- Wixárika Ceremonial Center “Kuruxi Manuwe” of the Wixárika Regional Council in Defense of Wirikuta, Mexico
| | | |
Collapse
|
23
|
George DR, Hanson R, Wilkinson D, Garcia-Romeu A. Ancient Roots of Today's Emerging Renaissance in Psychedelic Medicine. Cult Med Psychiatry 2022; 46:890-903. [PMID: 34476719 PMCID: PMC8412860 DOI: 10.1007/s11013-021-09749-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 01/30/2023]
Abstract
An international ban on psychedelics initiated by the United Nations' Convention on Psychotropic Substances in 1971 restricted the clinical use of these ancient psychoactive substances. Yet, in an era marked by rising mental health concerns and a growing "Deaths of Despair" epidemic (i.e., excess mortality and morbidity from suicide, drug overdose, and alcoholism), the structured psychedelic use that has long been a part of ritual healing experiences for human societies is slowly regaining credibility in Western medicine for its potential to treat various mental health conditions. We use a historical lens to examine the use of psychedelic therapies over time, translate ancient lessons to contemporary clinical and research practice, and interrogate the practical and ethical questions researchers must grapple with before they can enter mainstream medicine. Given the COVID-19 pandemic and its contributions to the global mental health burden, we also reflect on how psychedelic therapy might serve as a tool for medicine in the aftermath of collective trauma. Ultimately, it is argued that a "psychedelic renaissance" anchored in the lessons of antiquity can potentially help shift healthcare systems-and perhaps the broader society-towards practices that are more humane, attentive to underlying causes of distress, and supportive of human flourishing.
Collapse
Affiliation(s)
- Daniel R George
- Department of Humanities, Penn State Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA, 17033, USA.
| | - Ryan Hanson
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Albert Garcia-Romeu
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
24
|
Mocanu V, Mackay L, Christie D, Argento E. Safety considerations in the evolving legal landscape of psychedelic-assisted psychotherapy. Subst Abuse Treat Prev Policy 2022; 17:37. [PMID: 35568884 PMCID: PMC9107659 DOI: 10.1186/s13011-022-00468-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractInternational drug policy is rapidly evolving in tandem with promising evidence for psychedelic-assisted psychotherapy (PAP) in treating a range of mental health conditions. Canada is among the countries increasingly expanding access to psychedelic substances for therapeutic purposes. The 8-year ban on medical exemptions through the Canadian Special Access Programme was recently reversed in January 2022 and the first exemptions for legal possession and personal use of psilocybin mushrooms were granted in 2020, nearly 50 years since their criminalization. In view of the evolving evidence base and regulatory landscape for PAP illustrated by recent shifts in Canadian and international drug policy, this piece seeks to clarify the special range of factors which ought to be considered to safely expand access to psychedelics. Streamlining access to safe and evidence-based compassionate use of PAP will provide a timely treatment option to those currently in need while encouraging further research and outcome surveillance to refine best practices.
Collapse
|
25
|
Belouin SJ, Averill LA, Henningfield JE, Xenakis SN, Donato I, Grob CS, Berger A, Magar V, Danforth AL, Anderson BT. Policy considerations that support equitable access to responsible, accountable, safe, and ethical uses of psychedelic medicines. Neuropharmacology 2022; 219:109214. [PMID: 35973601 PMCID: PMC9536012 DOI: 10.1016/j.neuropharm.2022.109214] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022]
Abstract
There is mounting evidence suggesting psychedelic and entactogen medicines (namely psilocybin and 3,4-methylenedioxymethamphetamine [MDMA]), in conjunction with proper psychosocial support, hold the potential to provide safe, rapid acting, and robust clinical improvements with durable effects. In the US, both psilocybin and MDMA have been granted Breakthrough Therapy designations by the US Food and Drug Administration and may potentially receive full FDA approval with similar regulatory considerations occurring in multiple countries. At the same time, regulatory changes are poised to increase access to legal or decriminalized psychedelic use in various non-medical settings. This review provides a brief discussion on the historical use of psychedelic medicines, the status of the empirical evidence, and numerous significant policy considerations that must be thoughtfully addressed regarding standards-of-practice, consumer protection, engagement of communities, safeguarding access for all, and developing data standards, which supports the responsible, accountable, safe, and ethical uses of these medicines in clinical, faith-based, and other contexts. We provide suggestions for how public health and harm reduction can be supported through a public-private partnership that engages a community of stakeholders from various disciplines in the co-creation and dissemination of best practices and public policies.
Collapse
Affiliation(s)
- Sean J Belouin
- United States Public Health Service, Germantown, MD, USA; Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, MD, USA; Pain and Palliative Care, NIH Clinical Research Center, Bethesda, MD, USA.
| | - Lynnette A Averill
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; US Department of Veterans Affairs, Michael E. DeBakey Veterans Administration Medical Center, Houston, TX, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; US Department of Veterans Affairs, National Center for PTSD - Clinical Neurosciences Division, Orange, CT, USA; Reason for Hope, New York, NY, USA
| | - Jack E Henningfield
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Research, Health Policy and Abuse Liability, Pinney Associates, Bethesda, MD, USA
| | - Stephen N Xenakis
- Reason for Hope, New York, NY, USA; United States Army, Hallandale Beach, FL, USA; Uniformed Services University of the Health Sciences (UHSUS), Bethesda, MD, USA
| | - Ingrid Donato
- Office of Prevention Innovation, Center for Substance Abuse Prevention, SAMHSA, Rockville, MD, USA
| | - Charles S Grob
- David Geffen School of Medicine at University of California (UCLA), Los Angeles, CA, USA; Division of Child and Adolescent Psychiatry, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ann Berger
- Pain and Palliative Care, NIH Clinical Research Center, Bethesda, MD, USA
| | - Veronica Magar
- Gender, Equity and Human Rights, World Health Organization (WHO), Geneva, Switzerland
| | - Alicia L Danforth
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Brian T Anderson
- University of California San Francisco (UCSF) Department of Psychiatry & Behavioral Sciences, San Francisco, CA, USA; University of California Berkeley Center for the Science of Psychedelics, Berkeley, CA, USA
| |
Collapse
|
26
|
Thal SB, Wieberneit M, Sharbanee JM, Skeffington PM, Baker P, Bruno R, Wenge T, Bright SJ. Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy-A systematized review. J Psychopharmacol 2022; 36:1191-1207. [PMID: 36263882 DOI: 10.1177/02698811221127954] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical trials are currently investigating the potential of substance-assisted psychotherapy (SAPT) as treatment for several psychiatric conditions. The potential therapeutic effects of SAPT may be influenced by contextual factors including preparation prior to and integration after the substance-assisted therapy sessions. AIMS This systematized review outlines recommendations for current practice in preparatory sessions in SAPT including safety measures and screening procedures, preparation of set and setting, session contents, methods, and roles, prerequisites, and appropriate conduct of therapists. METHODS A systematized review of the literature was conducted based on PRISMA guidelines. MEDLINE (OVID), PsycINFO (OVID), and Cochrane Library were searched and clinical trials, treatment manuals, study protocols, case studies, qualitative studies, descriptive studies, theoretical papers, reviews, book chapters, and conference proceedings published until February 1, 2022 were retrieved. RESULTS The final synthesis included k = 83 sources. Information about safety measures including screening of participants, set and setting, contextual-, physiological-, and psychological preparation, roles, competencies, prerequisites, and characteristics of the therapists, and the establishment of a therapeutic relationship were summarized and discussed. CONCLUSION It is concluded that there is a consensus in the literature about the importance of adequate preparation before the administration of psychoactive substances in SAPT. However, the extent and approaches for these sessions vary across different models and there is a need for timelier and more rigorous qualitative and quantitative investigations assessing different approaches and techniques for the optimal preparation of clients in SAPT.
Collapse
Affiliation(s)
- Sascha B Thal
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia.,Physical Activity and Well-Being Group, Curtin University, Perth, WA, Australia.,Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Michelle Wieberneit
- Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn, Bonn, Germany.,Law School, University of Western Australia, Perth, WA, Australia
| | - Jason M Sharbanee
- Enable Institute, Discipline of Psychology, Curtin School of Population Health, Curtin University, Perth, WA, Australia.,Psychology and Criminology, School of Arts and Humanities, Edith Cowan University, Perth, WA, Australia
| | - Petra M Skeffington
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
| | - Paris Baker
- School of Medicine (Psychology), University of Tasmania, Hobart, TAS, Australia
| | - Raimondo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, TAS, Australia
| | - Tobias Wenge
- International Society for Bonding Psychotherapy, Friedrichshafen, Germany
| | - Stephen J Bright
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Psychedelic Research in Science and Medicine, Balwyn North, VIC, Australia
| |
Collapse
|
27
|
Gobbi G, Inserra A, Greenway KT, Lifshitz M, Kirmayer LJ. Psychedelic medicine at a crossroads: Advancing an integrative approach to research and practice. Transcult Psychiatry 2022; 59:718-724. [PMID: 36263521 PMCID: PMC9663823 DOI: 10.1177/13634615221119388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psychedelics have been already used by human societies for more than 3000 years, mostly in religious and healing context. The renewed interest in the potential application of psychedelic compounds as novel therapeutics has led to promising preliminary evidence of clinical benefit in some psychiatric disorders. Despite these promising results, the potential for large-scale clinical application of these profoundly consciousness-altering substances, in isolation from the sociocultural contexts in which they were traditionally used, raises important concerns. These concerns stem from the recognition that the mechanisms of therapeutic action of psychedelics are not entirely dependent on neurobiology, but also on the psychological, social and spiritual processes for their efficacy. For these reasons, physicians or psychotherapists involved in psychedelic-assisted psychotherapy need training in ways to accompany patients through this experience to promote positive outcomes and address potential side effects. Psychedelic therapies may foster the emergence of a novel paradigm in psychiatry that integrates psychopharmacological, psychotherapeutic, and cultural interventions for patients with mental health issues.
Collapse
Affiliation(s)
- Gabriella Gobbi
- Neurobiological Psychiatry Unit, Department of Psychiatry, 5620McGill University, Montreal, QC, Canada
| | - Antonio Inserra
- Neurobiological Psychiatry Unit, Department of Psychiatry, 5620McGill University, Montreal, QC, Canada
| | - Kyle T Greenway
- Geri-PARTy Research Group, 113635Lady Davis Institute for Medical Research, Jewish General Hospital, 5620McGill University, Montreal, QC, Canada
| | - Michael Lifshitz
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, 5620McGill University, Montreal, QC, Canada.,Culture and Mental Health Research Unit, Institute of Community & Family Psychiatry and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, 5620McGill University, Montreal, QC, Canada.,Culture and Mental Health Research Unit, Institute of Community & Family Psychiatry and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| |
Collapse
|
28
|
Breeksema JJ, Kuin BW, Kamphuis J, van den Brink W, Vermetten E, Schoevers RA. Adverse events in clinical treatments with serotonergic psychedelics and MDMA: A mixed-methods systematic review. J Psychopharmacol 2022; 36:1100-1117. [PMID: 36017784 PMCID: PMC9548934 DOI: 10.1177/02698811221116926] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Small-scale clinical studies with psychedelic drugs have shown promising results for the treatment of several mental disorders. Before psychedelics become registered medicines, it is important to know the full range of adverse events (AEs) for making balanced treatment decisions. OBJECTIVE To systematically review the presence of AEs during and after administration of serotonergic psychedelics and 3,4-methyenedioxymethamphetamine (MDMA) in clinical studies. METHODS We systematically searched PubMed, PsycINFO, Embase, and ClinicalTrials.gov for clinical trials with psychedelics since 2000 describing the results of quantitative and qualitative studies. RESULTS We included 44 articles (34 quantitative + 10 qualitative), describing treatments with MDMA and serotonergic psychedelics (psilocybin, lysergic acid diethylamide, and ayahuasca) in 598 unique patients. In many studies, AEs were not systematically assessed. Despite this limitation, treatments seemed to be overall well tolerated. Nausea, headaches, and anxiety were commonly reported acute AEs across diagnoses and compounds. Late AEs included headaches (psilocybin, MDMA), fatigue, low mood, and anxiety (MDMA). One serious AE occurred during MDMA administration (increase in premature ventricular contractions requiring brief hospitalization); no other AEs required medical intervention. Qualitative studies suggested that psychologically challenging experiences may also be therapeutically beneficial. Except for ayahuasca, a large proportion of patients had prior experience with psychedelic drugs before entering studies. CONCLUSIONS AEs are poorly defined in the context of psychedelic treatments and are probably underreported in the literature due to study design (lack of systematic assessment of AEs) and sample selection. Acute challenging experiences may be therapeutically meaningful, but a better understanding of AEs in the context of psychedelic treatments requires systematic and detailed reporting.
Collapse
Affiliation(s)
- Joost J Breeksema
- Department of Psychiatry, University of
Groningen, University Medical Center Groningen, Groningen, The Netherlands,Department of Psychiatry, Leiden
University Medical Center, Leiden, The Netherlands,OPEN Foundation, Amsterdam, The
Netherlands,Joost J Breeksema, University Center of
Psychiatry, University Medical Center Groningen, Hanzeplein 1, Groningen 9700
RB, The Netherlands.
| | - Bouwe W Kuin
- Department of Psychiatry, University of
Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jeanine Kamphuis
- Department of Psychiatry, University of
Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam
University Medical Center, Amsterdam, The Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden
University Medical Center, Leiden, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University of
Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
29
|
Meyer TD, Meir P, Lex C, Soares JC. Magic Mushrooms - an exploratory look at how mental health professionals feel and think about Psilocybin. Psychiatry Res 2022; 316:114727. [PMID: 35878481 DOI: 10.1016/j.psychres.2022.114727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
Psilocybin recently received breakthrough status by the FDA for its use in treatment of depression. We therefore investigated mental health professionals' (MHPs) opinions on Psilocybin (n = 155). Overall, attitudes were neutral but self-rated knowledge of Psilocybin was low. The term used in the survey, 'Psilocybin' or 'Magic Mushrooms', did not significantly affect their responses. Some variables (i.e., gender, attitudes towards medical cannabis, and personal history of psychedelic usage) were associated with ratings of Psilocybin. These results provide a baseline of MHPs' thoughts on Psilocybin and what should be considered in the future if it is FDA-approved.
Collapse
Affiliation(s)
- Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Science Center at Houston, 1941 East Road (BBSB), Houston, TX 77054, United States.
| | - Priel Meir
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Science Center at Houston, 1941 East Road (BBSB), Houston, TX 77054, United States
| | - Claudia Lex
- Department of Psychiatry, General Hospital Villach & Alpen-Adria University of Klagenfurt, Austria
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Science Center at Houston, 1941 East Road (BBSB), Houston, TX 77054, United States
| |
Collapse
|
30
|
Mathai DS, Lee SM, Mora V, O'Donnell KC, Garcia-Romeu A, Storch EA. Mapping consent practices for outpatient psychiatric use of ketamine. J Affect Disord 2022; 312:113-121. [PMID: 35753499 DOI: 10.1016/j.jad.2022.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Given increasing community-based and off-label use of ketamine for psychiatric indications, we examined current informed consent processes from a convenience sample of outpatient ketamine clinics to identify areas of congruence with current evidence and opportunities for growth. METHODS Using a rubric developed from existing practice guidelines, we conducted an exploratory analysis of informed consent documents (IC-Docs) from 23 American clinics offering ketamine as a psychiatric treatment. Domains assessed included clinical content, procedures, and syntax. RESULTS Participating clinics (23/288) varied widely in their constitution, training, and services provided. We found that IC-Docs addressed a majority of consent elements, though did so variably on an item-level. Areas for improvement included communication around long-term adverse effects, treatment alternatives, medical/psychiatric evaluation prior to treatment, medical/psychological support during treatment, adjunctive psychological interventions, and subjective/dissociative-type effects. All forms were limited by poor readability. LIMITATIONS Our study was limited by convenience sampling along with possible underestimation of verbal consent processes. CONCLUSIONS As ketamine continues to emerge as a psychiatric intervention, both patients and providers will benefit from a deliberate consent process informed by scientific, ethical, and pragmatic factors toward the goal of shared decision-making regarding treatment.
Collapse
Affiliation(s)
- David S Mathai
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States of America.
| | - Scott M Lee
- Veteran Affairs Boston Healthcare System/Harvard Medical School, Department of Psychiatry, Brockton, MA, United States of America
| | - Victoria Mora
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, TX, United States of America
| | - Kelley C O'Donnell
- New York University Grossman School of Medicine, Department of Psychiatry, New York, NY, United States of America
| | - Albert Garcia-Romeu
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States of America
| | - Eric A Storch
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, TX, United States of America
| |
Collapse
|
31
|
Agin-Liebes G, Davis AK. Psilocybin for the Treatment of Depression: A Promising New Pharmacotherapy Approach. Curr Top Behav Neurosci 2022; 56:125-140. [PMID: 34811715 PMCID: PMC10072288 DOI: 10.1007/7854_2021_282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Depression is highly prevalent and represents the leading cause of global disability and primary contributor to overall global burden of disease. Several lines of evidence from early-phase experimental trials suggest that serotonergic psychedelics, particularly psilocybin, with therapeutic support show great promise in the treatment of depression with large effect sizes. Neuroimaging data have also revealed the dynamic effects of psilocybin on functional activity within and between neural regions. This chapter reviews the methods and findings from three small human laboratory clinical trials examining the effects of psilocybin therapy for patients with major depressive disorder and treatment-resistant depression. Insights from functional magnetic resonance imaging and qualitative analyses are also presented, as well as a discussion of study limitations and future directions for the research.
Collapse
Affiliation(s)
- Gabrielle Agin-Liebes
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA. .,Neuroscape, Sandler Neurosciences Center, San Francisco, CA, USA.
| | - Alan K Davis
- Department of Psychiatry, College of Social Work, The Ohio State University, Columbus, OH, USA.,Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
32
|
Brennan W, Belser AB. Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model. Front Psychol 2022; 13:866018. [PMID: 35719571 PMCID: PMC9201428 DOI: 10.3389/fpsyg.2022.866018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
The current standard of care in most uses of psychedelic medicines for the treatment of psychiatric indications includes the provision of a supportive therapeutic context before, during, and after drug administration. A diversity of psychedelic-assisted psychotherapy (PAP) models has been created to meet this need. The current article briefly reviews the strengths and limitations of these models, which are divided into basic support models and EBT-inclusive therapy models. It then discusses several shortcomings both types of models share, including a lack of adequate attention to embodied and relational elements of treatment, and insufficient attention to ethical concerns. The article then introduces the EMBARK model, a transdiagnostic, trans-drug framework for the provision of supportive psychotherapy in PAP clinical trials and the training of study therapists. EMBARK was designed to overcome challenges that prior models have had in conceptualizing therapeutic change in psychedelic treatment, incorporating elements of non-psychedelic evidence-based therapies, incorporating therapists' prior skills and clinical orientations, delimiting therapist interventions for research standardization, and determining specific factors that contribute to treatment outcomes. The article explains EMBARK's six clinical domains, which represent parallel conceptualizations of how therapists may support therapeutic benefit in PAP treatment, and its four care cornerstones, which reflect therapists' broad ethical responsibility to participants. The article describes how these elements of the model come together to structure and inform therapeutic interventions during preparation, medicine, and integration sessions. Additionally, the article will discuss how EMBARK therapist training is organized and conducted. Finally, it will demonstrate the broad applicability of EMBARK by describing several current and upcoming PAP clinical trials that have adopted it as the therapeutic frame.
Collapse
Affiliation(s)
- William Brennan
- Cybin, Inc., Toronto, ON, Canada.,Fordham University, New York City, NY, United States
| | | |
Collapse
|
33
|
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.
Collapse
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
| |
Collapse
|
34
|
McCartney AM, McGovern HT, De Foe A. Psychedelic assisted therapy for major depressive disorder: Recent work and clinical directions. JOURNAL OF PSYCHEDELIC STUDIES 2022. [DOI: 10.1556/2054.2022.00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
Psychedelic substances such as psilocybin and ketamine may represent the future of antidepressant treatment, due to their rapid and prolonged effects on mood and cognition. The current body of psychedelic research has focused on administration and treatment within a psychiatric context. Here, instead, we put to the test the contention that it is necessary to evaluate the current state of this literature from a broader biopsychosocial perspective. Examining these arguably neglected social and psychological aspects of psychedelic treatment can provide a more holistic understanding of the interplay between the interconnected domains. This review of six major clinical trials applies a biopsychosocial model to evaluate the antidepressant effects of psilocybin and ketamine assisted therapy. We conclude that combination psychedelic treatment and psychotherapy facilitate more enduring and profound antidepressant effects than produced by ketamine or psilocybin alone. Emphasising the advantages of therapeutic intervention will encourage those who may attempt to self-medicate with psychedelics to instead seek a framework of psychological support, minimising associated risks of unregulated use.
Collapse
Affiliation(s)
| | | | - Alexander De Foe
- The Royal Melbourne Institute of Technology, Melbourne, Australia
| |
Collapse
|
35
|
Maia LO, Beaussant Y, Garcia ACM. The Therapeutic Potential of Psychedelic-assisted Therapies for Symptom Control in Patients Diagnosed With Serious Illness: A Systematic Review. J Pain Symptom Manage 2022; 63:e725-e738. [PMID: 35157985 DOI: 10.1016/j.jpainsymman.2022.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/20/2022]
Abstract
CONTEXT People affected by serious illness usually experience suffering in its various dimensions, not only in the physical but also in the psychosocial and spiritual aspects. The interest in psychedelic-assisted therapies as a potential new therapeutic modality has increased since evidence suggests a significant impact of their use on the outcomes of patients with serious illness. OBJECTIVES To systematically review the available evidence on the effects of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness. METHODS The protocol of this systematic review has been prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. This review included randomized and non-randomized controlled trials published in peer-reviewed scientific journals. A comprehensive search for studies was carried out in the main scientific databases, including Web of Science, Scopus, Cochrane Library, PsycINFO, PubMed, CINAHL, and EMBASE. There were no limitations regarding the year or language of publication. RESULTS The sample was composed of 20 studies. The results suggest positive effects of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness, with considerable safety of use. Most studies have been conducted with lysergic acid diethylamide, psilocybin, and N,N-dipropyltryptamine in cancer patients. The adverse effects reported were of physical and/or psychological nature and of mild to moderate intensity, transient, and self-resolutive. CONCLUSION The evaluated evidence suggests positive effects of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness, especially regarding symptoms of psychological and spiritual nature.
Collapse
Affiliation(s)
- Lucas Oliveira Maia
- Interdisciplinary Center for Studies in Palliative Care (L.O.M., A.C.M.G.), School of Nursing, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil; Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO) (L.O.M.), School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Yvan Beaussant
- Department of Psychosocial Oncology and Palliative Care (Y.B.), Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Ana Cláudia Mesquita Garcia
- Interdisciplinary Center for Studies in Palliative Care (L.O.M., A.C.M.G.), School of Nursing, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.
| |
Collapse
|
36
|
Stein CA, Penn A, Van Hope S, Dorsen CG, Mangini M. The Pharmacology and Clinical Applications of Psychedelic Medicines Within Midwifery Practice. J Midwifery Womens Health 2022; 67:373-383. [PMID: 35522087 PMCID: PMC9322528 DOI: 10.1111/jmwh.13371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Abstract
The research and use of psychedelic medicines to treat common mental health disorders has increased substantially in the past 2 decades. At the same time, knowledge is relatively uncommon among midwives regarding (1) the relative benefits of psychedelic-assisted therapy, (2) best practices associated with the delivery of psychedelic-assisted therapy, and (3) responsible integration of this potentially useful intervention into mental health treatment plans. The purpose of this review is to describe current applications of psychedelic medicines to treat common mental health disorders, to describe the current legal status of these medicines used in this context, and to explore the potential for midwifery practice in this area with further training. This article also addresses the disparities regarding LGBTQIA+ and BIPOC populations in relation to this topic and their historical exclusion from research and treatment access in this field.
Collapse
Affiliation(s)
- Cindy A Stein
- California State University Monterey Bay School of Nursing, Seaside, California
| | - Andrew Penn
- University of California at San Francisco School of Nursing, San Francisco, California
| | | | - Caroline G Dorsen
- Division of Advanced Nursing Practice, Rutgers School of Nursing, Newark, New Jersey
| | - Mariavittoria Mangini
- Integral and Transpersonal Psychology Department, California Institute of Integral Studies, San Francisco, California
| |
Collapse
|
37
|
Earleywine M, Low F, Lau C, De Leo J. Integration in Psychedelic-Assisted Treatments: Recurring Themes in Current Providers’ Definitions, Challenges, and Concerns. JOURNAL OF HUMANISTIC PSYCHOLOGY 2022. [DOI: 10.1177/00221678221085800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Integration therapy, an integral part of psychedelic-assisted treatment, usually includes sessions devoted to making meaning of relevant psychedelic experiences after subjective effects have subsided. As the psychedelic renaissance continues, offers for this integration therapy have proliferated. In the present project, semi-structured interviews with 30 integration therapists focused on definitions of integration as well as challenges and concerns that they associated with the practice. A mixed-methods approach revealed 19 themes that coders identified reliably. Prevalent themes included expressing concern about nonresponsive clients, defining integration as a bridge between the psychedelic experience and daily life, and apprehensions about the commercialization of psychedelic psychotherapy. Interviewees viewed integration as a process that begins prior to the administration of substances, never ends, makes sense of the psychoactive experience, creates behavioral change, is personalized, and makes the individual whole. Most participants also discussed issues related to client resistance, unrealistic expectations of psychedelic psychotherapy, problems associated with power differentials, the importance of an integration therapist’s connection to other service providers, and the need for self-care. These data might help the standardization of integration therapy, inform lay impressions of the process, and help generate hypotheses for continued research on this aspect of psychedelic-assisted treatment. These data also suggest that psychedelic integration practitioners would appreciate regular support from a community of like-minded colleagues.
Collapse
Affiliation(s)
| | - Fiona Low
- University at Albany, State University of New York, NY, USA
| | - Carmen Lau
- MindCure Health Inc., Vancouver, British Columbia, Canada
| | - Joseph De Leo
- Centre for Compassionate Care, Hamilton, Ontario, Canada
| |
Collapse
|
38
|
Murphy R, Kettner H, Zeifman R, Giribaldi B, Kartner L, Martell J, Read T, Murphy-Beiner A, Baker-Jones M, Nutt D, Erritzoe D, Watts R, Carhart-Harris R. Therapeutic Alliance and Rapport Modulate Responses to Psilocybin Assisted Therapy for Depression. Front Pharmacol 2022; 12:788155. [PMID: 35431912 PMCID: PMC9009076 DOI: 10.3389/fphar.2021.788155] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/07/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Across psychotherapeutic frameworks, the strength of the therapeutic alliance has been found to correlate with treatment outcomes; however, its role has never been formally assessed in a trial of psychedelic-assisted therapy. We aimed to investigate the relationships between therapeutic alliance and rapport, the quality of the acute psychedelic experience and treatment outcomes. Methods: This 2-arm double-blind randomized controlled trial compared escitalopram with psychedelic-assisted therapy for moderate-severe depressive disorder (N = 59). This analysis focused on the psilocybin condition (n = 30), who received two oral doses of 25 mg psilocybin, 3-weeks apart, with psychological preparation, in-session support, and integration therapy. A new psychedelic therapy model, called “Accept-Connect-Embody” (ACE), was developed in this trial. The primary outcome was depression severity 6 weeks post treatment (Quick Inventory of Depressive Symptomatology, QIDS-SR-16). Path analyses tested the hypothesis that therapeutic alliance (Scale To Assess the Therapeutic Relationship Patient Version, STAR-P) would predict depression outcomes via its influence on the acute psychedelic experience, specifically emotional-breakthrough (EBI) and mystical-type experiences (MEQ). The same analysis was performed on the escitalopram arm to test specificity. Results: The strength of therapeutic alliance predicted pre-session rapport, greater emotional-breakthrough and mystical-type experience (maximum EBI and MEQ scores across the two psilocybin sessions) and final QIDS scores (β = −0.22, R2 = 0.42 for EBIMax; β = −0.19, R2 = 0.32 for MEQMax). Exploratory path models revealed that final depression outcomes were more strongly affected by emotional breakthrough during the first, and mystical experience during the second session. Emotional breakthrough, but not mystical experience, during the first session had a positive effect on therapeutic alliance ahead of the second session (β = 0.79, p < 0.0001). Therapeutic alliance ahead of the second session had a direct impact on final depression scores, not mediated by the acute experience, with a weaker alliance ahead of the second psilocybin session predicting higher absolute depression scores at endpoint (β = −0.49, p < 0.001) Discussion: Future research could consider therapist training and characteristics; specific participant factors, e.g., attachment style or interpersonal trauma, which may underlie the quality of the therapeutic relationship, the psychedelic experience and clinical outcomes; and consider how therapeutic approaches might adapt in cases of weaker therapeutic alliance. Clinical Trial Registration: This trial is registered at http://clinicaltrials.gov, identifier (NCT03429075).
Collapse
Affiliation(s)
- Roberta Murphy
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Medical Psychotherapy, South West London and St. Georges NHS Trust, London, United Kingdom
- *Correspondence: Roberta Murphy,
| | - Hannes Kettner
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Rick Zeifman
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Bruna Giribaldi
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Laura Kartner
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Jonny Martell
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Medical Psychotherapy and General Adult Psychiatry, Devon Partnership NHS Trust, Exeter, United Kingdom
| | - Tim Read
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Ashleigh Murphy-Beiner
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Department of Psychology, Royal Holloway University, Surrey, United Kingdom
| | - Michelle Baker-Jones
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - David Nutt
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - David Erritzoe
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Rosalind Watts
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
| | - Robin Carhart-Harris
- Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, Faculty of Medicine, London, United Kingdom
- Psychedelics Division Neuroscape, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
39
|
Pots W, Chakhssi F. Psilocybin-Assisted Compassion Focused Therapy for Depression. Front Psychol 2022; 13:812930. [PMID: 35401294 PMCID: PMC8990799 DOI: 10.3389/fpsyg.2022.812930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Psilocybin-assisted psychotherapy, i.e., psilocybin treatment with psychological support, has demonstrated the efficacy of psilocybin to reduce depressive symptoms. However, in clinical trials, the structure of psilocybin-assisted psychotherapy is primarily based on preparation, navigation (support during dosing sessions), and integration. For psychotherapeutic guidance, the application of this structure is favored over the usage of theoretical models. The applied psychotherapeutic models may be of critical importance if the effects are augmented due to the psychologically insightful experiences during the navigation and integration sessions. One of the important next steps is to provide therapists with guidance on how to provide psilocybin-assisted psychotherapy. We present an integrated protocol for psilocybin-assisted psychotherapy for depression based on the theoretical model and psychotherapeutic framework of Compassion Focused Therapy (CFT). We hypothesize that CFT can provide the theoretical model and compassion practices that will reinforce the experiences during the navigation and follow-up therapy sessions. In this paper, we describe the rationale for selecting CFT, the compatibility of CFT and psilocybin-therapy, an overview of the psilocybin-assisted CFT protocol, the study protocol, and limitations to this approach.
Collapse
Affiliation(s)
- Wendy Pots
- Arjuna Labs, Mill Valley, CA, United States
- *Correspondence: Wendy Pots,
| | | |
Collapse
|
40
|
Hearn BG, Brubaker MD, Richardson G. Counselors’ attitudes toward psychedelics and their use in therapy. JOURNAL OF COUNSELING AND DEVELOPMENT 2022. [DOI: 10.1002/jcad.12429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Benjamin G. Hearn
- College of Education, Criminal Justice, and Human Services University of Cincinnati Cincinnati Ohio USA
| | - Michael D. Brubaker
- College of Education, Criminal Justice, and Human Services University of Cincinnati Cincinnati Ohio USA
| | - George Richardson
- College of Education, Criminal Justice, and Human Services University of Cincinnati Cincinnati Ohio USA
| |
Collapse
|
41
|
Bălăeţ M. Psychedelic Cognition—The Unreached Frontier of Psychedelic Science. Front Neurosci 2022; 16:832375. [PMID: 35401088 PMCID: PMC8989050 DOI: 10.3389/fnins.2022.832375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/27/2022] [Indexed: 12/14/2022] Open
Abstract
Psychedelic compounds hold the promise of changing the face of neuroscience and psychiatry as we know it. There have been numerous proposals to use them to treat a range of neuropsychiatric conditions such as depression, anxiety, addiction and PTSD; and trials to date have delivered positive results in favor of the novel therapeutics. Further to the medical use, the wider healthy population is gaining interest in these compounds. We see a surge in personal use of psychedelic drugs for reasons not limited to spiritual enhancement, improved productivity, aiding the management of non-pathological anxiety and depression, and recreational interests. Notably, microdosing—the practice of taking subacute doses of psychedelic compounds—is on the rise. Our knowledge about the effects of psychedelic compounds, however, especially in naturalistic settings, is still fairly limited. In particular, one of the largest gaps concerns the acute effects on cognition caused by psychedelics. Studies carried out to date are riddled with limitations such as having disparate paradigms, small sample sizes, and insufficient breadth of testing on both unhealthy and healthy volunteers. Moreover, the studies are majoritarily limited to laboratory settings and do not assess the effects at multiple dosages within the same paradigm nor at various points throughout the psychedelic experience. This review aims to summarize the studies to date in relation to how psychedelics acutely affect different domains of cognition. In the pursuit of illuminating the current limitations and offering long-term, forward-thinking solutions, this review compares and contrasts findings related to how psychedelics impact memory, attention, reasoning, social cognition, and creativity.
Collapse
|
42
|
Rosa WE, Sager Z, Miller M, Bernstein I, Doerner Rinaldi A, Addicott K, Ljuslin M, Adrian C, Back AL, Beachy J, Bossis AP, Breitbart WS, Cosimano MP, Fischer SM, Guss J, Knighton E, Phelps J, Richards BD, Richards WA, Tulsky JA, Williams MT, Beaussant Y. Top Ten Tips Palliative Care Clinicians Should Know About Psychedelic-Assisted Therapy in the Context of Serious Illness. J Palliat Med 2022; 25:1273-1281. [PMID: 35285721 PMCID: PMC9467634 DOI: 10.1089/jpm.2022.0036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Psychedelic-assisted therapy (PAT) is a burgeoning treatment with growing interest across a variety of settings and disciplines. Empirical evidence supports PAT as a novel therapeutic approach that provides safe and effective treatment for people suffering from a variety of diagnoses, including treatment-resistant depression, substance use disorder, and post-traumatic stress disorder. Within the palliative care (PC) field, one-time PAT dosing may lead to sustained reductions in anxiety, depression, and demoralization-symptoms that diminish the quality of life in both seriously ill patients and those at end of life. Despite a well-noted psychedelic renaissance in scholarship and a renewed public interest in the utilization of these medicines, serious illness-specific content to guide PAT applications in hospice and PC clinical settings has been limited. This article offers 10 evidence-informed tips for PC clinicians synthesized through consultation with interdisciplinary and international leading experts in the field with aims to: (1) familiarize PC clinicians and teams with PAT; (2) identify the unique challenges pertaining to this intervention given the current legalities and logistical barriers; (3) discuss therapeutic competencies and considerations for current and future PAT use in PC; and (4) highlight critical approaches to optimize the safety and potential benefits of PAT among patients with serious illness and their caregivers.
Collapse
Affiliation(s)
- William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Zachary Sager
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Megan Miller
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ilan Bernstein
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | | | - Katie Addicott
- Department of Palliative Medicine, Maine Medical Center, Portland, Maine, USA
| | - Michael Ljuslin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Palliative Medicine Division, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Chris Adrian
- Children's Hospital, Los Angeles, California, USA
| | - Anthony L. Back
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jamie Beachy
- Center for Contemplative Chaplaincy, Naropa University, Boulder, Colorado, USA
| | - Anthony P. Bossis
- NYU Grossman School of Medicine, New York, New York, USA
- NYU Langone Health Center for Psychedelic Medicine, New York, New York, USA
| | - William S. Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mary P. Cosimano
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Stacy M. Fischer
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeffrey Guss
- NYU Grossman School of Medicine, New York, New York, USA
- Fluence International, Inc., Woodstock, New York, USA
| | - Emma Knighton
- American Psychedelic Practitioners Association, Seattle, Washington, USA
| | - Janis Phelps
- Center for Psychedelic Therapies and Research, California Institute of Integral Studies, San Francisco, California, USA
| | - Brian D. Richards
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- The Bill Richards Center for Healing, Sunstone Therapies, Aquilino Cancer Center, Rockville, Maryland, USA
| | - William A. Richards
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- The Bill Richards Center for Healing, Sunstone Therapies, Aquilino Cancer Center, Rockville, Maryland, USA
| | - James A. Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Yvan Beaussant
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| |
Collapse
|
43
|
Thal S, Engel LB, Bright SJ. Presence, Trust, and Empathy: Preferred Characteristics of Psychedelic Carers. JOURNAL OF HUMANISTIC PSYCHOLOGY 2022. [DOI: 10.1177/00221678221081380] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research into psychedelic-assisted psychotherapy (PAP) is rapidly increasing with best practice guidelines being continuously updated. Yet the key principals of such guidelines are based on evidence accumulated during earlier research into these treatments and trans-disciplinary psychotherapeutic knowledge. One area of practice-based evidence that has not been considered is that accumulated by people who use psychedelics (PWUP) outside of clinical contexts. We conducted a thematic analysis of 403 posts on two online discussion forums with the aim of gathering information regarding the preferences of PWUP for characteristics they value in their carers in nonclinical contexts. We found three key distinct characteristics that PWUP preferred among their carers: presence, trust, and empathy. The characteristics were often consistent with the existing literature on PAP, though at times extended current understandings of key characteristics of PAP therapists, with the notion of carers being able to “hold space” during the psychedelic experience seen as an integral component of effective therapeutic outcomes that deserves more attention. Data obtained from PWUP in nonclinical contexts can be used to triangulate existing principles contained within PAP treatment guidelines and identify areas for further investigation.
Collapse
|
44
|
Hendricks PS, Copes H, Family N, Williams LT, Luke D, Raz S. Perceptions of safety, subjective effects, and beliefs about the clinical utility of lysergic acid diethylamide in healthy participants within a novel intervention paradigm: Qualitative results from a proof-of-concept study. J Psychopharmacol 2022; 36:337-347. [PMID: 35253517 DOI: 10.1177/02698811211055855] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Classic psychedelics show promise in the treatment of mental health conditions; however, more scalable intervention protocols are needed to maximize access to these novel therapeutics. In this proof-of-concept study, perceptions of safety, subjective effects, and beliefs about the clinical utility of lysergic acid diethylamide (LSD) were evaluated among healthy participants (N = 31) administered 50 to 100 µg LSD in a treatment paradigm conceptualized as more scalable than traditional approaches to administering classic psychedelics. METHODS Semi-structured interviews assessed participants' expectations, experience, and thoughts on the safety and efficacy of the study design. These interviews were transcribed for thematic analysis relating to perceptions of safety, subjective effects, and beliefs about the clinical utility of LSD. RESULTS Most participants felt safe throughout the study, with a minority reporting concerns related to having a challenging experience that diminished over time. Participants attributed their feelings of safety to the study structure and support of their attendants, which allowed them to "let go" and immerse themselves in the experience without pre-occupation. Furthermore, participants reported transcendent, mystical-type experiences characteristic of classic psychedelics, with almost half highlighting the prominent role played by music during the acute period of drug action. Finally, participants endorsed support for the clinical utility of LSD in controlled environments, expressing the belief that LSD is safe and has the potential to help others. CONCLUSION Findings provide preliminary support for the feasibility of this scalable interventional paradigm and set the stage for future critical research with clinical populations.
Collapse
Affiliation(s)
| | - Heith Copes
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - David Luke
- Centre for Mental Health, School of Human Sciences, Old Royal Naval College, University of Greenwich, Greenwich, UK
| | - Shlomi Raz
- Eleusis Health Solutions US, New York, NY, USA
| |
Collapse
|
45
|
Ziff S, Stern B, Lewis G, Majeed M, Gorantla VR. Analysis of Psilocybin-Assisted Therapy in Medicine: A Narrative Review. Cureus 2022; 14:e21944. [PMID: 35273885 PMCID: PMC8901083 DOI: 10.7759/cureus.21944] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/05/2022] Open
|
46
|
Golden TL, Magsamen S, Sandu CC, Lin S, Roebuck GM, Shi KM, Barrett FS. Effects of Setting on Psychedelic Experiences, Therapies, and Outcomes: A Rapid Scoping Review of the Literature. Curr Top Behav Neurosci 2022; 56:35-70. [PMID: 35138585 DOI: 10.1007/7854_2021_298] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The health and well-being impacts of art and aesthetic experiences have been rigorously studied by a range of disciplines, including cognitive neuroscience, psychiatry, public health, and translational clinical research. These experiences, encompassed in the concepts of set and setting, have long been claimed to be pivotal in determining the acute and enduring effects of psychedelic experiences. Responding to the field's longstanding emphasis on the role and value of setting, a rapid scoping review was undertaken to identify the extent to which effects of setting and aesthetics on psychedelic experiences and therapies have been explicitly studied. It offers an analysis of the strengths and limitations of the extant literature and discusses evidentiary gaps as well as evidentiary opportunities for the field. The 43 included studies indicate apparent consensus regarding the importance of setting in psychedelic therapies, as well as consistent interest in theorizing about these effects. However, this consensus has yet to generate consistent, prospective, rigorous tests of setting and its complexities. As a result, the field continues to lack understanding or agreement regarding the effects of various specific elements of setting, the mechanisms by which they affect outcomes, for whom these effects occur, under what circumstances, given what conditions, and other critical factors. Further studies of setting and aesthetics in the context of psychedelic therapies are likely to not only improve these therapies and their delivery, but also inform considerations of setting and aesthetics for non-psychedelic interventions.
Collapse
Affiliation(s)
- Tasha L Golden
- International Arts + Mind Lab, Center for Applied Neuroaesthetics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Susan Magsamen
- International Arts + Mind Lab, Center for Applied Neuroaesthetics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clara C Sandu
- International Arts + Mind Lab, Center for Applied Neuroaesthetics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shuyang Lin
- International Arts + Mind Lab, Center for Applied Neuroaesthetics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Grace Marie Roebuck
- International Arts + Mind Lab, Center for Applied Neuroaesthetics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathy M Shi
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frederick S Barrett
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
47
|
Hayes C, Wahba M, Watson S. Will psilocybin lose its magic in the clinical setting? Ther Adv Psychopharmacol 2022; 12:20451253221090822. [PMID: 35480296 PMCID: PMC9036342 DOI: 10.1177/20451253221090822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
Psilocybin as a novel treatment for depression is garnering a lot of attention from both the mainstream media and the academic community. Although phase 3 trials are only just beginning, we feel that it is important for clinicians to consider what psilocybin-assisted psychotherapy might look like in the clinical setting. In this narrative review article we have considered the difficulties that may arise as psilocybin emerges from the research setting, which may hamper its progress towards becoming a licenced medication. Psilocybin has its own unique challenges: the expectation patients come to dosing with having read overwhelmingly positive media; patient suggestibility under the influence of psilocybin and requirement for specialised therapists to name a few. We have also made some recommendations for measures that should be taken in both the phase 3 trials and with clinicians to try and minimise some of the issues raised. In doing so our hope is that psilocybin will continue towards becoming a licenced medication that suitable patients are able to access with relative ease. Practicing psychiatrists need to have an awareness of the potential pitfalls of psilocybin as they will be responsible for prescribing it in the future.
Collapse
Affiliation(s)
- Caroline Hayes
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Jubilee Road, Newcastle upon Tyne NE3 3XT, UK
| | - Mourad Wahba
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stuart Watson
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
48
|
Abstract
This chapter presents an integrative model for training psychedelic therapists. It begins with an overview of the psychedelic healing process - remembering the disconnected parts of ourselves and reestablishing fundamental trust. The authors then walk through six therapist competencies that describe the root principles of practice, breadth of knowledge, transpersonal perspective, and therapeutic stance of a psychedelic practitioner. This model includes 12 curricular areas and didactic methods that support the therapist's process of growth. Finally, the authors link their training philosophy to the current needs of society, offering a vision of how to express psychedelic integration through the honoring of diversity and collaboration.
Collapse
Affiliation(s)
- Janis Phelps
- Center for Psychedelic Therapies and Research, California Institute of Integral Studies, San Francisco, CA, USA
| | | |
Collapse
|
49
|
King F, Hammond R. Psychedelics as Reemerging Treatments for Anxiety Disorders: Possibilities and Challenges in a Nascent Field. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:190-196. [PMID: 34690582 DOI: 10.1176/appi.focus.20200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although psychedelics initially showed promise in treating anxiety disorders, psychedelics were criminalized and research halted in the early 1970s. A subsequent resurgence of research into psychiatric benefits of psychedelic-assisted psychotherapy in the last 20 years has led to a potential paradigm shift in the treatment of numerous psychiatric disorders, including anxiety disorders. Despite accumulating evidence and likely U.S. Food and Drug Administration approval in the next 2-3 years, the emerging field of psychedelic medicine faces several challenges. Obstacles include ongoing barriers on the regulatory level, lack of education, stigma among mental health clinicians, cost and scalability, and a dearth of specialized personnel prepared to provide these treatments. Deeper issues of ethical responsibility and inclusivity also exist given the historical discovery and use of psychedelics by indigenous peoples throughout the world as well the ongoing disparities in mental health delivery and access within psychiatry and psychedelic research.
Collapse
Affiliation(s)
- Franklin King
- Department of Psychiatry, Harvard Medical School, Boston (King); Center for Neuroscience of Psychedelics, Massachusetts General Hospital, Boston (King); private practice, Boston (Hammond)
| | - Rebecca Hammond
- Department of Psychiatry, Harvard Medical School, Boston (King); Center for Neuroscience of Psychedelics, Massachusetts General Hospital, Boston (King); private practice, Boston (Hammond)
| |
Collapse
|
50
|
Hearn B. Psychedelics, Mystical Experiences, and Meaning Making: A Renegotiation Process With the Challenges of Existence. THE JOURNAL OF HUMANISTIC COUNSELING 2021. [DOI: 10.1002/johc.12164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Benjamin Hearn
- Department of Counselor Education and Human Services University of Cincinnati
| |
Collapse
|