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Senter M, Clifford AM, Bhriain ON. Using theory knitting to conceptualize social phenomena in the design and evaluation of dance programs for people living with Parkinson's disease. EVALUATION AND PROGRAM PLANNING 2024; 104:102430. [PMID: 38581972 DOI: 10.1016/j.evalprogplan.2024.102430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
Dance programs for people living with Parkinson's disease (PwPD) offer participants an opportunity to exercise, engage in artistic self-expression, and form new relationships. While it is understood that the social dimension of dance programs for PwPD contributes to dancer satisfaction and program sustainability, the social mechanisms instrumental to program success are under-examined. Engaging with theory from wider disciplines, or "theory knitting" can help program designers and evaluators examine the mechanisms and contextual factors that make classes socially meaningful with greater detail and specificity. This study identified and examined three theoretical frameworks that program planners and evaluators could use to conceptualize social engagement in dance for PwPD contexts and inform practice. Each theory was assessed for fit using the T-CaST theory comparison and selection tool developed by Birken et al. (2018). As an example, we used anthropologist Victor Turner's (1970; 1977) theory of liminality and communitas to identify five key areas for fostering a sense of social connection in dance for PwPD contexts: (1) selecting a meaningful dance space (2) creating a joyous atmosphere (3) marking entrance into the liminal time and space with rituals (4) embodying liminality and anti-structure and (5) inverting power relations and embracing fluid roles.
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Affiliation(s)
- Morgan Senter
- Irish World Academy of Music and Dance, Faculty of Arts, Humanities, and Social Sciences, University of Limerick, Co. Limerick, Ireland.
| | - Amanda M Clifford
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Co. Limerick, Ireland; Health Research Institute, University of Limerick, Co. Limerick, Ireland; Ageing Research Centre, University of Limerick, Co. Limerick, Ireland
| | - Orfhlaith Ni Bhriain
- Irish World Academy of Music and Dance, Faculty of Arts, Humanities, and Social Sciences, University of Limerick, Co. Limerick, Ireland; Health Research Institute, University of Limerick, Co. Limerick, Ireland
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Kettner H, Roseman L, Gazzaley A, Carhart-Harris RL, Pasquini L. Effects of Psychedelics in Older Adults: A Prospective Cohort Study. Am J Geriatr Psychiatry 2024:S1064-7481(24)00336-1. [PMID: 38849218 DOI: 10.1016/j.jagp.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE Affective symptoms such as anxiety, low mood, and loneliness are prevalent and highly debilitating symptoms among older adults (OA). Serotonergic psychedelics are currently investigated as novel interventions for affective disorders, yet little is known regarding their effects in OA. We investigated the mental health effects and psychological mechanisms of guided psychedelic group experiences in OA and a matched sample of younger adults (YA). METHODS Using a prospective observational cohort design, we identified 62 OA (age ≥60 years) and 62 matched YA who completed surveys two weeks before, a day, two weeks, four weeks, and six months after a psychedelic group session. Mixed linear regression analyses were used to investigate longitudinal well-being changes, as well as baseline, acute, and post-acute predictors of change. RESULTS OA showed post-psychedelic well-being improvements similar to matched YA. Among baseline predictors, presence of a lifetime psychiatric diagnosis was associated with greater well-being increases in OA (B = 6.72, p = .016 at the four-week key-endpoint). Compared to YA, acute subjective psychedelic effects were less intense in OA and did not significantly predict prospective well-being changes. However, relational experiences before and after psychedelic sessions emerged as predictors in OA (r(36) = .37,p = 0.025). CONCLUSIONS Guided psychedelic group sessions enhance well-being in OA in line with prior naturalistic and controlled studies in YA. Interestingly, acute psychedelic effects in OA are attenuated and less predictive of well-being improvements, with relational experiences related to the group setting playing a more prominent role. Our present findings call for further research on the effects of psychedelics in OA.
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Affiliation(s)
- Hannes Kettner
- Department of Neurology, Neuroscape, University of California, San Francisco, CA; Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College, London, UK.
| | - Leor Roseman
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College, London, UK; Department of Psychology, University of Exeter, Exeter, UK
| | - Adam Gazzaley
- Department of Neurology, Neuroscape, University of California, San Francisco, CA; Department of Psychiatry, University of California-San Francisco, San Francisco, CA
| | - Robin L Carhart-Harris
- Department of Neurology, Neuroscape, University of California, San Francisco, CA; Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College, London, UK; Department of Psychiatry, University of California-San Francisco, San Francisco, CA
| | - Lorenzo Pasquini
- Department of Neurology, Neuroscape, University of California, San Francisco, CA.
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3
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Wolff M, Evens R, Mertens LJ, Schmidt C, Beck J, Rutrecht H, Cherniak AD, Gründer G, Jungaberle H. Measuring psychotherapeutic processes in the context of psychedelic experiences: Validation of the General Change Mechanisms Questionnaire (GCMQ). J Psychopharmacol 2024; 38:432-457. [PMID: 38742761 PMCID: PMC11102652 DOI: 10.1177/02698811241249698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Therapeutic and salutogenic effects of psychedelic drugs have been attributed to psychotherapeutic or psychotherapy-like processes that can unfold during the acute psychedelic experience and beyond. Currently, there are no psychometric instruments available to comprehensively assess psychotherapeutic processes (as conceptualized by empirical psychotherapy research) in the context of psychedelic experiences. AIMS We report the initial validation of the General Change Mechanisms Questionnaire (GCMQ), a self-report instrument designed to measure five empirically established general change mechanisms (GCMs) of psychotherapy-(1) resource activation, (2) therapeutic relationship, (3) problem actuation, (4) clarification, and (5) mastery-in the context of psychedelic experiences. METHODS An online survey in a sample of 1153 English-speaking and 714 German-speaking psychedelic users was conducted to evaluate simultaneously developed English- and German-language versions of the GCMQ. RESULTS The theory-based factor structure was confirmed. The five GCMQ scales showed good internal consistency. Evidence for convergent validity with external measures was obtained. Significant associations with different settings and with therapeutic, hedonic, and escapist use motives confirmed the hypothesized context dependence of GCM-related psychedelic experiences. Indicating potential therapeutic effects, the association between cumulative stressful life events and well-being was significantly moderated by resource activation, clarification, and mastery. Factor mixture modeling revealed five distinct profiles of GCM-related psychedelic experiences. CONCLUSION Initial testing indicates that the GCMQ is a valid and reliable instrument that can be used in future clinical and nonclinical psychedelic research. The five identified profiles of GCM-related experiences may be relevant to clinical uses of psychedelics and psychedelic harm reduction.
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Affiliation(s)
- Max Wolff
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- MIND Foundation, Berlin, Germany
| | - Ricarda Evens
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lea J Mertens
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Jessica Beck
- MIND Foundation, Berlin, Germany
- Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | | | - Aaron D Cherniak
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Psychology, Reichman University, Herzliya, Israel
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Lowe MX, Kettner H, Jolly DRP, Carhart-Harris RL, Jackson H. Long-term benefits to psychological health and well-being after ceremonial use of Ayahuasca in Middle Eastern and North African immigrants and refugees. Front Psychiatry 2024; 15:1279887. [PMID: 38666090 PMCID: PMC11044680 DOI: 10.3389/fpsyt.2024.1279887] [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: 08/18/2023] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
Background Refugees and immigrants can experience complex stressors from the process of immigration that can have lasting and severe long-term mental health consequences. Experiences after ayahuasca ingestion are shown to produce positive effects on psychological wellbeing and mental health, including anecdotal reports of improved symptoms of trauma and related disorders. However, data on the longitudinal health impact of naturalistic ayahuasca use in Middle Eastern and North African (MENA) immigrant and refugee populations is limited. Aims The current longitudinal online survey study was conducted to gather prospective data on ceremonial ayahuasca use in a group (N = 15) of primarily female MENA immigrants and refugees and to provide further insight into the patterns and outcomes surrounding that use. The study sought to assess self-reported changes in physical and mental health, well-being, and psychological functioning, examine relationships between aspects of individual mindset (e.g., psychedelic preparedness) prior to ayahuasca use and observed outcomes during (e.g., subjective drug effects) and afterwards (i.e., persisting effects), characterize risks and negative experiences, and describe trauma exposure and personal history. Results/Outcomes Our findings revealed ceremonial use of ayahuasca is associated with significant improvements in mental health, well-being, and psychological functioning, including reductions in depression, anxiety, and shame, and increases in cognitive reappraisal and self-compassion. Most participants reported no lasting adverse effects and experienced notable positive behavioral changes persisting months after ingestion. Conclusion/Interpretation While preliminary, results suggest naturalistic ayahuasca use might hold therapeutic potential for MENA populations exposed to trauma prior to and during the process of migration.
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Affiliation(s)
| | - Hannes Kettner
- Psychedelics Division, Neuroscape, University of California, San Francisco, San Francisco, CA, United States
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | | | - Robin L. Carhart-Harris
- Psychedelics Division, Neuroscape, University of California, San Francisco, San Francisco, CA, United States
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
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Levin AW, Lancelotta R, Sepeda ND, Gukasyan N, Nayak S, Wagener TL, Barrett FS, Griffiths RR, Davis AK. The therapeutic alliance between study participants and intervention facilitators is associated with acute effects and clinical outcomes in a psilocybin-assisted therapy trial for major depressive disorder. PLoS One 2024; 19:e0300501. [PMID: 38483940 PMCID: PMC10939230 DOI: 10.1371/journal.pone.0300501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
We examined if the therapeutic alliance between study participants and intervention facilitators in a psilocybin-assisted therapy (PAT) trial changed over time and whether there were relationships between alliance, acute psilocybin experiences, and depression outcomes. In a randomized, waiting list-controlled clinical trial for major depressive disorder in adults (N = 24), participants were randomized to an immediate (N = 13) or delayed (N = 11) condition with two oral doses of psilocybin (20mg/70kg and 30mg/70kg). Ratings of therapeutic alliance significantly increased from the final preparation session to one-week post-intervention (p = .03, d = .43). A stronger total alliance at the final preparation session predicted depression scores at 4 weeks (r = -.65, p = .002), 6 months (r = -.47, p = .036), and 12 months (r = -.54, p = .014) post-intervention. A stronger total alliance in the final preparation session was correlated with higher peak ratings of mystical experiences (r = .49, p = .027) and psychological insight (r = .52, p = .040), and peak ratings of mystical experience and psychological insight were correlated with depression scores at 4 weeks (r = -.45, p = .030 for mystical; r = -.75, p < .001 for insight). Stronger total alliance one week after the final psilocybin session predicted depression scores at 4 weeks (r = -.85, p < .001), 3 months (r = -.52, p = .010), 6 months (r = -.77, p < .001), and 12 months (r = -.61, p = .001) post-intervention. These findings highlight the importance of the therapeutic relationship in PAT. Future research should explore therapist and participant characteristics which maximize the therapeutic alliance and evaluate its relationship to treatment outcomes. Trial registration: Registration: Clinicaltrials.gov NCT03181529. https://classic.clinicaltrials.gov/ct2/show/NCT03181529.
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Affiliation(s)
- Adam W. Levin
- The Ohio State University, Center for Psychedelic Drug Research and Education, Columbus, Ohio, United States of America
- Department of Psychiatry, The Ohio State University, Columbus, Ohio, United States of America
| | - Rafaelle Lancelotta
- The Ohio State University, Center for Psychedelic Drug Research and Education, Columbus, Ohio, United States of America
| | - Nathan D. Sepeda
- The Ohio State University, Center for Psychedelic Drug Research and Education, Columbus, Ohio, United States of America
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Natalie Gukasyan
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Sandeep Nayak
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Theodore L. Wagener
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, United States of America
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Frederick S. Barrett
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Roland R. Griffiths
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
| | - Alan K. Davis
- The Ohio State University, Center for Psychedelic Drug Research and Education, Columbus, Ohio, United States of America
- Johns Hopkins University, Center for Psychedelic and Consciousness Research, Baltimore, Maryland, United States of America
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6
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Kettner H, Roseman L, Gazzaley A, Carhart-Harris R, Pasquini L. Improvements in well-being following naturalistic psychedelic use and underlying mechanisms of change in older adults: A prospective cohort study. RESEARCH SQUARE 2024:rs.3.rs-3977169. [PMID: 38496492 PMCID: PMC10942571 DOI: 10.21203/rs.3.rs-3977169/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Affective symptoms such as anxiety, low mood, and loneliness are prevalent and highly debilitating symptoms among older adults (OA). Serotonergic psychedelics are novel experimental interventions for affective disorders, yet little is known regarding their effects in OA. Using a prospective cohort design, we identified 62 OA (age ≥ 60 years) and 62 matched younger adults (YA) who completed surveys two weeks before, and one day, two weeks, four weeks, and six months after a guided psychedelic group session in a retreat setting. Mixed linear regression analyses revealed significant well-being improvements in OA and YA, amplified in OA with a history of a psychiatric diagnosis. Compared to YA, acute subjective psychedelic effects were attenuated in OA and did not significantly predict well-being changes. However, a psychosocial measure of Communitas emerged as a predictor in OA, suggesting that the relational components in psychedelic group settings may hold particular value for OA.
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7
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Marrocu A, Kettner H, Weiss B, Zeifman RJ, Erritzoe D, Carhart-Harris RL. Psychiatric risks for worsened mental health after psychedelic use. J Psychopharmacol 2024; 38:225-235. [PMID: 38491857 PMCID: PMC10944581 DOI: 10.1177/02698811241232548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND Resurgent psychedelic research has largely supported the safety and efficacy of psychedelic therapy for the treatment of various psychiatric disorders. As psychedelic use and therapy increase in prevalence, so does the importance of understanding associated risks. Cases of prolonged negative psychological responses to psychedelic therapy seem to be rare; however, studies are limited by biases and small sample sizes. The current analytical approach was motivated by the question of whether rare but significant adverse effects have been under-sampled in psychedelic research studies. METHODS A "bottom margin analysis" approach was taken to focus on negative responders to psychedelic use in a pool of naturalistic, observational prospective studies (N = 807). We define "negative response" by a clinically meaningful decline in a generic index of mental health, that is, one standard error from the mean decrease in psychological well-being 4 weeks post-psychedelic use (vs pre-use baseline). We then assessed whether a history of diagnosed mental illness can predict negative responses. RESULTS We find that 16% of the cohort falls into the "negative responder" subset. Parsing the sample by self-reported history of psychiatric diagnoses, results revealed a disproportionate prevalence of negative responses among those reporting a prior personality disorder diagnosis (31%). One multivariate regression model indicated a greater than four-fold elevated risk of adverse psychological responses to psychedelics in the personality disorder subsample (b = 1.425, p < 0.05). CONCLUSION We infer that the presence of a personality disorder may represent an elevated risk for psychedelic use and hypothesize that the importance of psychological support and good therapeutic alliance may be increased in this population.
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Affiliation(s)
- Alessia Marrocu
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Hannes Kettner
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Brandon Weiss
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Richard J Zeifman
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - David Erritzoe
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Carhart-Harris Lab, Departments of Neurology and Psychiatry, University of California San Francisco, San Francisco, CA, USA
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8
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Glynos NG, Aday JS, Kruger D, Boehnke KF, Lake S, Lucas P. Psychedelic substitution: altered substance use patterns following psychedelic use in a global survey. Front Psychiatry 2024; 15:1349565. [PMID: 38455520 PMCID: PMC10917882 DOI: 10.3389/fpsyt.2024.1349565] [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: 12/04/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Recent research suggests that psychedelics may have potential for the treatment of various substance use disorders. However, most studies to date have been limited by small sample sizes and neglecting to include non-North American and European populations. Methods We conducted a global, cross-sectional online survey of adults (n = 5,268, 47.2% women) self-reporting past or current psychedelic use and investigated whether psychedelic use was associated with changes in use of other substances. Results Nearly three-quarters (70.9%; n = 3,737/5,268) reported ceasing or decreasing use of one or more non-psychedelic substances after naturalistic psychedelic use. Among those with previous use, 60.6% (n = 2,634/4,344) decreased alcohol use, 55.7% (n = 1,223/2,197) decreased antidepressant use, and 54.2% (n = 767/1,415) decreased use of cocaine/crack. Over a quarter of the sample indicated that their decrease in substance use persisted for 26 weeks or more following use of a psychedelic. Factors associated with decreased use included a motivation to either decrease one's substance use or self-treat a medical condition. Importantly, 19.8% of respondents also reported increased or initiated use of one or more other substances after psychedelic use, with illicit opioids (14.7%; n = 86/584) and cannabis (13.3%; n = 540/4,064) having the highest proportions. Factors associated with increased substance use included having a higher income and residing in Canada or the US. Discussion Although limited by cross-sectional study design, this large observational study will help inform future studies aiming to investigate the relationship between substance use patterns and psychedelic use.
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Affiliation(s)
- Nicolas G. Glynos
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Abor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Jacob S. Aday
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Abor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Daniel Kruger
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Kevin F. Boehnke
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Abor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Stephanie Lake
- University of California Los Angeles (UCLA) Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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9
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Barba T, Kettner H, Radu C, Peill JM, Roseman L, Nutt DJ, Erritzoe D, Carhart-Harris R, Giribaldi B. Psychedelics and sexual functioning: a mixed-methods study. Sci Rep 2024; 14:2181. [PMID: 38326446 PMCID: PMC10850066 DOI: 10.1038/s41598-023-49817-4] [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: 05/16/2023] [Accepted: 12/12/2023] [Indexed: 02/09/2024] Open
Abstract
Do psychedelics affect sexual functioning postacutely? Anecdotal and qualitative evidence suggests they do, but this has never been formally tested. While sexual functioning and satisfaction are generally regarded as an important aspect of human wellbeing, sexual dysfunction is a common symptom of mental health disorders. It is also a common side effect of selective serotonin reuptake inhibitors (SSRIs), a first line treatment for depression. The aim of the present paper was to investigate the post-acute effects of psychedelics on self-reported sexual functioning, combining data from two independent studies, one large and naturalistic and the other a smaller but controlled clinical trial. Naturalistic use of psychedelics was associated with improvements in several facets of sexual functioning and satisfaction, including improved pleasure and communication during sex, satisfaction with one's partner and physical appearance. Convergent results were found in a controlled trial of psilocybin therapy versus an SSRI, escitalopram, for depression. In this trial, patients treated with psilocybin reported positive changes in sexual functioning after treatment, while patients treated with escitalopram did not. Despite focusing on different populations and settings, this is the first research study to quantitively investigate the effects of psychedelics on sexual functioning. Results imply a potential positive effect on post-acute sexual functioning and highlight the need for more research on this.
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Affiliation(s)
- Tommaso Barba
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, UK.
| | - Hannes Kettner
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, Department of Neurology, University of California San Francisco, San Francisco, United States
| | - Caterina Radu
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, UK
| | - Joseph M Peill
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, UK
| | - Leor Roseman
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, UK
| | - David J Nutt
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, UK
| | - David Erritzoe
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, UK
| | - Robin Carhart-Harris
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, Department of Neurology, University of California San Francisco, San Francisco, United States
| | - Bruna Giribaldi
- Department of Medicine, Centre for Psychedelic Research, Imperial College London, London, UK
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10
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Mediano PAM, Rosas FE, Timmermann C, Roseman L, Nutt DJ, Feilding A, Kaelen M, Kringelbach ML, Barrett AB, Seth AK, Muthukumaraswamy S, Bor D, Carhart-Harris RL. Effects of External Stimulation on Psychedelic State Neurodynamics. ACS Chem Neurosci 2024; 15:462-471. [PMID: 38214686 PMCID: PMC10853937 DOI: 10.1021/acschemneuro.3c00289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/26/2023] [Indexed: 01/13/2024] Open
Abstract
Recent findings have shown that psychedelics reliably enhance brain entropy (understood as neural signal diversity), and this effect has been associated with both acute and long-term psychological outcomes, such as personality changes. These findings are particularly intriguing, given that a decrease of brain entropy is a robust indicator of loss of consciousness (e.g., from wakefulness to sleep). However, little is known about how context impacts the entropy-enhancing effect of psychedelics, which carries important implications for how it can be exploited in, for example, psychedelic psychotherapy. This article investigates how brain entropy is modulated by stimulus manipulation during a psychedelic experience by studying participants under the effects of lysergic acid diethylamide (LSD) or placebo, either with gross state changes (eyes closed vs open) or different stimuli (no stimulus vs music vs video). Results show that while brain entropy increases with LSD under all of the experimental conditions, it exhibits the largest changes when subjects have their eyes closed. Furthermore, brain entropy changes are consistently associated with subjective ratings of the psychedelic experience, but this relationship is disrupted when participants are viewing a video─potentially due to a "competition" between external stimuli and endogenous LSD-induced imagery. Taken together, our findings provide strong quantitative evidence of the role of context in modulating neural dynamics during a psychedelic experience, underlining the importance of performing psychedelic psychotherapy in a suitable environment.
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Affiliation(s)
- Pedro A. M. Mediano
- Department
of Computing, Imperial College London, London SW7 2AZ, U.K.
- Department
of Psychology, University of Cambridge, Cambridge CB2 3EB, U.K.
| | - Fernando E. Rosas
- Department
of Informatics, University of Sussex, Brighton BN1 9RH, U.K.
- Centre
for Psychedelic Research, Department of Brain Sciences, Imperial College London, London SW7 2AZ, U.K.
- Centre
for Complexity Science, Imperial College
London, London SW7 2AZ, U.K.
- Centre for
Eudaimonia and Human Flourishing, University
of Oxford, Oxford OX1 2JD, U.K.
| | - Christopher Timmermann
- Centre
for Psychedelic Research, Department of Brain Sciences, Imperial College London, London SW7 2AZ, U.K.
| | - Leor Roseman
- Centre
for Psychedelic Research, Department of Brain Sciences, Imperial College London, London SW7 2AZ, U.K.
| | - David J. Nutt
- Centre
for Psychedelic Research, Department of Brain Sciences, Imperial College London, London SW7 2AZ, U.K.
| | | | | | - Morten L. Kringelbach
- Centre for
Eudaimonia and Human Flourishing, University
of Oxford, Oxford OX1 2JD, U.K.
- Department
of Psychiatry, University of Oxford, Oxford OX1 2JD, U.K.
- Center
for Music in the Brain, Department of Clinical Medicine, Aarhus University, Aarhus 8000, Denmark
| | - Adam B. Barrett
- Sussex
Center for Consciousness Science and Department of Informatics, University of Sussex, Brighton BN1 9RH, U.K.
| | - Anil K. Seth
- Sussex
Center for Consciousness Science and Department of Informatics, University of Sussex, Brighton BN1 9RH, U.K.
- CIFAR Program on Brain, Mind, and Consciousness, Toronto M5G 1M1, Canada
| | - Suresh Muthukumaraswamy
- School
of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand
| | - Daniel Bor
- Department
of Psychology, University of Cambridge, Cambridge CB2 3EB, U.K.
- Department
of Psychology, Queen Mary University of
London, London E1 4NS, U.K.
| | - Robin L. Carhart-Harris
- Centre
for Psychedelic Research, Department of Brain Sciences, Imperial College London, London SW7 2AZ, U.K.
- Psychedelics
Division, Neuroscape, University of California
San Francisco, San Francisco, California 94117-1080, United States
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11
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Wolfson P, Vaid G. Ketamine-assisted psychotherapy, psychedelic methodologies, and the impregnable value of the subjective-a new and evolving approach. Front Psychiatry 2024; 15:1209419. [PMID: 38362026 PMCID: PMC10867319 DOI: 10.3389/fpsyt.2024.1209419] [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] [Received: 04/20/2023] [Accepted: 01/05/2024] [Indexed: 02/17/2024] Open
Abstract
Psychiatry is in a growth phase in which several psychedelic medicines have entered its arena with great promise. Of these, presently, ketamine is the only medicine that may be legally prescribed. We hypothesize that at subanesthetic doses, ketamine produces a unique spectrum of altered states, ranging from psychoactive to deep ego-dissolving experiences, that are intrinsic to ketamine's therapeutic effects. When these experiences are embedded in a therapeutic relationship-a setting-that fosters an amplification of the recipient's subjective consciousness, personal growth, inner healing, greater clarity, and better relationships may well ensue. While much of the literature on ketamine labels its dissociative effects as 'side effects', alteration of consciousness is a component and unavoidable 'effect' of its therapeutic impact. From its inception in the clinical trials of the 1960s, ketamine was recognized for producing dissociative, psychedelic effects on consciousness in subjects as they emerged from ketamine-induced anesthesia. Unanticipated and unintegrated, these experiences of 'emergence phenomena' were felt to be disturbing. Accordingly, such experiences have been typically labeled as dissociative side effects. However, in a conducive set and settings, these experiences have been demonstrated to be of positive use in psychiatry and psychotherapy, providing a time-out from usual states of mind to facilitate a reshaping of self-experience along with symptomatic relief. In this way, ketamine-assisted psychotherapy (KAP) offers a new potential in psychiatry and psychotherapy that is powerfully valanced toward recognizing experience, individuality, and imagination. Essential to a successful therapeutic experience and outcome with KAP is close attention to the subjective experience, its expression by the recipient and integration of the ketamine experience as a healing opportunity.
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12
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Barbut Siva J, Barba T, Kettner H, Kuc J, Nutt DJ, Carhart-Harris R, Erritzoe D. Interactions between classic psychedelics and serotonergic antidepressants: Effects on the acute psychedelic subjective experience, well-being and depressive symptoms from a prospective survey study. J Psychopharmacol 2024; 38:145-155. [PMID: 38281075 PMCID: PMC10863370 DOI: 10.1177/02698811231224217] [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: 01/29/2024]
Abstract
BACKGROUND There is growing evidence for the therapeutic effects of psychedelics. However, it is still uncertain how these drugs interact with serotonergic antidepressants (serotonin reuptake inhibitors (SRIs)). OBJECTIVE This study explores the interaction between psychedelics and SRIs in terms of therapeutic effects. The objective is to compare acute psychedelic effects and subsequent changes in well-being and depressive symptoms among 'SRI -' individuals (not on psychiatric medication) and 'SRI +' individuals (undergoing SRI treatment). METHODS Using prospective survey data, the study employs multivariate analysis of covariance (MANCOVA) and linear mixed effect models to analyse subjective differences and changes in well-being and depressive symptoms pre- and post-psychedelic experiences. RESULTS Results indicate that 'SRI -' participants experience significantly more intense subjective effects compared to 'SRI +' participants (F = 3.200, p = 0.016) in MANCOVA analysis. Further analysis reveals 'SRI -' individuals report stronger mystical (18.2% higher, p = 0.048), challenging (50.9% higher, p = 0.001) and emotional breakthrough experiences (31.9% higher, p = 0.02) than 'SRI +' individuals. No differences are observed in drug-induced visual effects (p = 0.19). Both groups exhibited similar improvements in well-being and depressive symptoms after the psychedelic experience. CONCLUSION Individuals presumed to be on serotonergic antidepressants during psychedelic use display reduced subjective effects but similar antidepressant effects compared to those not undergoing SRI treatment. Further controlled research is needed to comprehend the interplay between serotonergic antidepressants and psychedelics, illuminating potential therapeutic benefits and limitations in clinical contexts.
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Affiliation(s)
- Jessica Barbut Siva
- Centre for Psychedelic Research, Department of Medicine, Imperial College London, London, UK
| | - Tommaso Barba
- Centre for Psychedelic Research, Department of Medicine, Imperial College London, London, UK
| | - Hannes Kettner
- Centre for Psychedelic Research, Department of Medicine, Imperial College London, London, UK
| | - Joanna Kuc
- Experimental Psychology, University College London, London, UK
| | - David J Nutt
- Centre for Psychedelic Research, Department of Medicine, Imperial College London, London, UK
| | - Robin Carhart-Harris
- Centre for Psychedelic Research, Department of Medicine, Imperial College London, London, UK
- Psychedelics Division – Neuroscape, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - David Erritzoe
- Centre for Psychedelic Research, Department of Medicine, Imperial College London, London, UK
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13
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Zeifman RJ, Kettner H, Ross S, Weiss B, Mithoefer MC, Mithoefer AT, Wagner AC. Preliminary evidence for the importance of therapeutic alliance in MDMA-assisted psychotherapy for posttraumatic stress disorder. Eur J Psychotraumatol 2024; 15:2297536. [PMID: 38174611 PMCID: PMC10769553 DOI: 10.1080/20008066.2023.2297536] [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] [Received: 06/19/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Background: MDMA-assisted psychotherapy (MDMA-AP) is a combined psychotherapeutic and pharmacologic intervention that shows promise in the treatment of posttraumatic stress disorder (PTSD). Although therapeutic alliance has been established as a key predictor across psychotherapies and is emphasised within MDMA-AP treatment manuals, research has not yet examined the relationship between therapeutic alliance and MDMA-AP treatment outcomes.Objective: Examine whether therapeutic alliance predicts changes in PTSD symptoms following MDMA-AP.Method: Twenty-three individuals with chronic PTSD participated in a MDMA-AP clinical trial that included a randomised (MDMA vs. placebo) and open-label phase. The present analyses focused on participants who were administered MDMA over the course of the randomised and open-label phases (n = 22). Therapeutic alliance was assessed using the Working Alliance Inventory at sessions baseline (pre-session 3) and sessions 4 and 9. PTSD symptoms were assessed using the Clinician Administered PTSD Scale and the Impact of Events Scale-Revised.Results: Controlling for baseline clinician-assessed PTSD severity, therapeutic alliance at sessions 4 and 9 (but not baseline) significantly predicted post-MDMA-AP clinician-assessed PTSD severity. Controlling for baseline self-reported PTSD severity, therapeutic alliance at baseline (although this did not survive correction for multiple comparisons) and sessions 4 and 9 predicted post-MDMA-AP self-reported PTSD severity.Conclusions: The present results provide the first preliminary evidence for the relationship between the therapeutic alliance and treatment outcomes within MDMA-AP for PTSD. These findings highlight the important role of psychotherapy, and common psychotherapeutic factors, within MDMA-AP. Replication in studies with larger and more diverse clinical samples remain necessary.Trial registration: ClinicalTrials.gov identifier: NCT00090064.
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Affiliation(s)
- Richard J. Zeifman
- Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Centre for Psychedelic Medicine, New York, NY, USA
| | - Hannes Kettner
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Stephen Ross
- Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Centre for Psychedelic Medicine, New York, NY, USA
| | - Brandon Weiss
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | | | | | - Anne C. Wagner
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
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14
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Maddock JE, Johnson SS. Spending Time in Nature: The Overlooked Health Behavior. Am J Health Promot 2024; 38:124-148. [PMID: 38126319 DOI: 10.1177/08901171231210806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Jay E Maddock
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, Center for Health and Nature, College Station, TX, USA
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15
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Borkel LF, Rojas-Hernández J, Henríquez-Hernández LA, Santana Del Pino Á, Quintana-Hernández DJ. Set and setting predict psychopathology, wellbeing and meaningfulness of psychedelic experiences: a correlational study. Expert Rev Clin Pharmacol 2024; 17:165-176. [PMID: 38108102 DOI: 10.1080/17512433.2023.2295997] [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: 09/20/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND In psychedelic therapy, the importance of set and setting is a fundamental but under-researched assumption. The aim of this study is to correlate variables of set (psychedelic use motivation) and setting (psychedelic use location and type of companion) with psychopathology, wellbeing and personality variables. RESEARCH DESIGN AND METHODS A sample of 1022 participants of the Spanish-speaking population was collected through an online survey. A novel instrument, the Psychedelic Use Scale (PUS), was developed to measure substance use variables of LSD, mescaline, psilocybin, DMT, 5-Meo-DMT, ketamine, Salvia divinorum, ibogaine and MDMA. Various personality, well-being and psychopathology instruments were implemented to measure outcome variables. RESULTS Growth motivations, natural settings and presence of significant others predicted less psychopathology, greater wellbeing and meaningfulness of psychedelic experiences, whereas problematic motivations predicted greater psychopathology, lower wellbeing and did not predict meaningfulness of psychedelic experiences. CONCLUSIONS Based on these results, we suggest experimental hypotheses for future clinical trials and longitudinal studies with potential clinical implications.
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Affiliation(s)
- Lucas F Borkel
- Asociación Científica Psicodélica, Canary Islands, Spain
| | - Jaime Rojas-Hernández
- Asociación Científica Psicodélica, Canary Islands, Spain
- Asociación Canaria para el Desarrollo de la Salud a través de la Atención, Canary Islands, Spain
| | - Luis Alberto Henríquez-Hernández
- Asociación Científica Psicodélica, Canary Islands, Spain
- Unidad de Toxicología, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Ángelo Santana Del Pino
- Departmento de Matemáticas, Universidad de Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Domingo J Quintana-Hernández
- Asociación Científica Psicodélica, Canary Islands, Spain
- Facultad de Ciencias de la Salud, Universidad del Atlántico Medio, Canary Islands, Spain
- Instituto-AS, Cabildo de Gran Canaria, Canary Islands, Spain
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16
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McCrone P, Fisher H, Knight C, Harding R, Schlag AK, Nutt DJ, Neill JC. Cost-effectiveness of psilocybin-assisted therapy for severe depression: exploratory findings from a decision analytic model. Psychol Med 2023; 53:7619-7626. [PMID: 37264950 PMCID: PMC10755218 DOI: 10.1017/s0033291723001411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND There is growing evidence to support the use of the psychedelic drug psilocybin for difficult-to-treat depression. This paper compares the cost-effectiveness of psilocybin-assisted psychotherapy (PAP) with conventional medication, cognitive behavioural therapy (CBT), and the combination of conventional medication and CBT. METHODS A decision model simulated patient events (response, remission, and relapse) following treatment. Data on probabilities, costs and quality-adjusted life years (QALYs) were derived from previous studies or from best estimates. Expected healthcare and societal costs and QALYs over a 6-month time period were calculated. Sensitivity analyses were used to address uncertainty in parameter estimates. RESULTS The expected healthcare cost of PAP varied from £6132 to £7652 depending on the price of psilocybin. This compares to £3528 for conventional medication alone, £4250 for CBT alone, and £4197 for their combination. QALYs were highest for psilocybin (0.310), followed by CBT alone (0.283), conventional medication alone (0.278), and their combination (0.287). Psilocybin was shown to be cost-effective compared to the other therapies when the cost of therapist support was reduced by 50% and the psilocybin price was reduced from its initial value to £400 to £800 per person. From a societal perspective, psilocybin had improved cost-effectiveness compared to a healthcare perspective. CONCLUSIONS Psilocybin has the potential to be a cost-effective therapy for severe depression. This depends on the level of psychological support that is given to patients receiving psilocybin and the price of the drug itself. Further data on long-term outcomes are required to improve the evidence base.
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Affiliation(s)
- Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | | | | | - Rebecca Harding
- Clerkenwell Health, London, UK
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Anne K. Schlag
- Drug Science, London, UK
- Psychedelic Research Group, Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - David J. Nutt
- Drug Science, London, UK
- Psychedelic Research Group, Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Joanna C. Neill
- Drug Science, London, UK
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
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17
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Nutt DJ, Peill JM, Weiss B, Godfrey K, Carhart-Harris RL, Erritzoe D. Psilocybin and Other Classic Psychedelics in Depression. Curr Top Behav Neurosci 2023. [PMID: 37955822 DOI: 10.1007/7854_2023_451] [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: 11/14/2023]
Abstract
Psychedelic drugs such as psilocybin and ketamine are returning to clinical research and intervention across several disorders including the treatment of depression. This chapter focusses on psychedelics that specifically target the 5-HT2A receptor such as psilocybin and DMT. These produce plasma-concentration related psychological effects such as hallucinations and out of body experiences, insightful and emotional breakthroughs as well as mystical-type experiences. When coupled with psychological support, effects can produce a rapid improvement in mood among people with depression that can last for months. In this chapter, we summarise the scientific studies to date that explore the use of psychedelics in depressed individuals, highlighting key clinical, psychological and neuroimaging features of psychedelics that may account for their therapeutic effects. These include alterations in brain entropy that disrupt fixed negative ruminations, a period of post-treatment increased cognitive flexibility, and changes in self-referential psychological processes. Finally, we propose that the brain mechanisms underlying the therapeutic effect of serotonergic psychedelics might be distinct from those underlying classical serotonin reuptake-blocking antidepressants.
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Affiliation(s)
- D J Nutt
- Centres for Neuropsychopharmacology & Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK.
| | - J M Peill
- Centres for Neuropsychopharmacology & Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - B Weiss
- Centres for Neuropsychopharmacology & Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - K Godfrey
- Centres for Neuropsychopharmacology & Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - R L Carhart-Harris
- Centres for Neuropsychopharmacology & Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, University of California San Francisco, San Francisco, CA, USA
| | - D Erritzoe
- Centres for Neuropsychopharmacology & Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
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18
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Urrutia J, Anderson BT, Belouin SJ, Berger A, Griffiths RR, Grob CS, Henningfield JE, Labate BC, Maier LJ, Maternowska MC, Weichold F, Yaden DB, Magar V. Psychedelic Science, Contemplative Practices, and Indigenous and Other Traditional Knowledge Systems: Towards Integrative Community-Based Approaches in Global Health. J Psychoactive Drugs 2023; 55:523-538. [PMID: 37747281 DOI: 10.1080/02791072.2023.2258367] [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: 03/21/2023] [Accepted: 09/09/2023] [Indexed: 09/26/2023]
Abstract
As individuals and communities around the world confront mounting physical, psychological, and social threats, three complimentary mind-body-spirit pathways toward health, wellbeing, and human flourishing remain underappreciated within conventional practice among the biomedical, public health, and policy communities. This paper reviews literature on psychedelic science, contemplative practices, and Indigenous and other traditional knowledge systems to make the case that combining them in integrative models of care delivered through community-based approaches backed by strong and accountable health systems could prove transformative for global health. Both contemplative practices and certain psychedelic substances reliably induce self-transcendent experiences that can generate positive effects on health, well-being, and prosocial behavior, and combining them appears to have synergistic effects. Traditional knowledge systems can be rich sources of ethnobotanical expertise and repertoires of time-tested practices. A decolonized agenda for psychedelic research and practice involves engaging with the stewards of such traditional knowledges in collaborative ways to codevelop evidence-based models of integrative care accessible to the members of these very same communities. Going forward, health systems could consider Indigenous and other traditional healers or spiritual guides as stakeholders in the design, implementation, and evaluation of community-based approaches for safely scaling up access to effective psychedelic treatments.
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Affiliation(s)
- Julian Urrutia
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Prisons Group Legal Clinic, Universidad de los Andes Medical School, Bogotá, Colombia
| | - Brian T Anderson
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Sean J Belouin
- United States Public Health Service, Department of Health and Human Services (DHHS), Rockville, MD, USA
- Substance Abuse and Mental Health Services Administration (SAMHSA), DHHS, Rockville, MD, USA
- Office of Science and Medicine, DHHS, Washington, DC, USA
- Office of the Assistant Secretary, DHHS, Washington, DC, USA
- Pain and Palliative Care, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Ann Berger
- Pain and Palliative Care, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Roland R Griffiths
- Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles S Grob
- David Geffen School of Medicine, University of California (UCLA), Los Angeles, CA, USA
- Division of Child and Adolescent Psychiatry, Harbor-UCLA Medical Center, Torrance, CA, 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
| | | | | | - M Catherine Maternowska
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Frank Weichold
- Office of the Chief Scientist, Office of the Commissioner, US Food and Drug Administration, Silver Spring, MD, USA
| | - David B Yaden
- Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Veronica Magar
- (formerly) Office of the Director General, World Health Organization, Geneva, Switzerland
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19
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Noorani T, Bedi G, Muthukumaraswamy S. Dark loops: contagion effects, consistency and chemosocial matrices in psychedelic-assisted therapy trials. Psychol Med 2023; 53:5892-5901. [PMID: 37466178 PMCID: PMC10520581 DOI: 10.1017/s0033291723001289] [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] [Received: 12/19/2022] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 07/20/2023]
Abstract
What happens when an emerging programme of medical research overlaps with a surging social movement? In this article we draw on the anthropological term 'chemosociality' to describe forms of sociality born of shared chemical exposure. Psychedelic administration in the context of recent clinical trials appears to have been particularly chemosocial in nature. We argue that one consequence is that psychedelic-assisted therapy (PAT) clinical research trials tend to breach key assumptions underlying the logic of causal inference used to establish efficacy. We propose the concept of dark loops to describe forms of sociality variously emerging from, and impacting participant experiences in, PAT trials. These dark loops are not recorded, let alone incorporated into the causal pathways in the interpretation of psychedelic trial data to date. We end with three positions which researchers might adopt in response to these issues: chemosocial minimisation where research is designed to attenuate or eliminate the effects of dark loops in trials; chemosocial description where dark loops (and their impacts) are openly and candidly documented and chemosocial valorisation where dark loops are hypothesised to contribute to trial outcomes and actively drawn upon for positive effect. Our goal is to fold in an appreciation of how the increasingly-discussed hype surrounding psychedelic research and therapeutics continues to shape the phenomena under study in complex ways, even as trials become larger and more rigorous in their design.
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Affiliation(s)
| | - Gillinder Bedi
- Orygen, Parkville, VIC, Australia
- Center for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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20
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Pronovost-Morgan C, Hartogsohn I, Ramaekers JG. Harnessing placebo: Lessons from psychedelic science. J Psychopharmacol 2023; 37:866-875. [PMID: 37392012 PMCID: PMC10481630 DOI: 10.1177/02698811231182602] [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: 07/02/2023]
Abstract
The randomized controlled trial (RCT) research design assumes that a drug's "specific" effect can be isolated, added, and subtracted from the "nonspecific" effect of context and person. While RCTs are helpful in assessing the added benefit of a novel drug, they tend to obscure the curative potential of extra-pharmacological variables, known as "the placebo effect." Ample empirical evidence suggests that person/context-dependent physical, social, and cultural variables not only add to, but also shape drug effects, making them worth harnessing for patient benefits. Nevertheless, utilizing placebo effects in medicine is challenging due to conceptual and normative obstacles. In this article, we propose a new framework inspired by the field of psychedelic science and its employment of the "set and setting" concept. This framework acknowledges that drug and nondrug factors have an interactive and synergistic relationship. From it, we suggest ways to reintegrate nondrug variables into the biomedical toolbox, to ethically harness the placebo effect for improved clinical care.
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Affiliation(s)
- Chloé Pronovost-Morgan
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ido Hartogsohn
- The Program for Science, Technology and Society Studies, Bar-Ilan University, Ramat Gan, Israel
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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21
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Zeifman RJ, Kettner H, Pagni BA, Mallard A, Roberts DE, Erritzoe D, Ross S, Carhart-Harris RL. Co-use of MDMA with psilocybin/LSD may buffer against challenging experiences and enhance positive experiences. Sci Rep 2023; 13:13645. [PMID: 37608057 PMCID: PMC10444769 DOI: 10.1038/s41598-023-40856-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023] Open
Abstract
Psilocybin and lysergic acid diethylamide (LSD) experiences can range from very positive to highly challenging (e.g., fear, grief, and paranoia). These challenging experiences contribute to hesitancy toward psychedelic-assisted psychotherapy among health care providers and patients. Co-use of 3,4-Methylenedioxy methamphetamine (MDMA) with psilocybin/LSD anecdotally reduces challenging experiences and enhances positive experiences associated with psilocybin/LSD. However, limited research has investigated the acute effects of co-use of MDMA and psilocybin/LSD. In a prospective convenience sample (N = 698) of individuals with plans to use psilocybin/LSD, we examined whether co-use of MDMA with psilocybin/LSD (n = 27) is associated with differences in challenging or positive experiences. Challenging experiences were measured using the Challenging Experiences Questionnaire and positive experiences were measured using the Mystical Experience Questionnaire and single-item measures of self-compassion, compassion, love, and gratitude. Potentially confounding variables were identified and included as covariates. Relative to psilocybin/LSD alone, co-use of psilocybin/LSD with a self-reported low (but not medium-high) dose of MDMA was associated with significantly less intense total challenging experiences, grief, and fear, as well as increased self-compassion, love and gratitude. Co-use of psilocybin/LSD and MDMA was not associated with differences in mystical-type experiences or compassion. Findings suggest co-use of MDMA with psilocybin/LSD may buffer against some aspects of challenging experiences and enhance certain positive experiences. Limitations include use of a convenience sample, small sample size, and non-experimental design. Additional studies (including controlled dose-response studies) that examine the effects and safety of co-administering MDMA with psilocybin/LSD (in healthy controls and clinical samples) are warranted and may assist the development of personalized treatments.
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Affiliation(s)
- Richard J Zeifman
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA.
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.
| | - Hannes Kettner
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, University of California, San Francisco, USA
| | - Broc A Pagni
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - Austin Mallard
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - Daniel E Roberts
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - David Erritzoe
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Stephen Ross
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, University of California, San Francisco, USA
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Davis AK, Timmermann C, Ortiz Bernal AM, Lancelotta R, Nayak S, Sepeda ND, Nikolaidis A, Griffiths RR. Translation and Initial Psychometric Evaluation of Spanish Versions of Three Psychedelic Acute Effects Measures: Mystical, Challenging, and Insight Experiences. J Psychoactive Drugs 2023:1-11. [PMID: 37449499 DOI: 10.1080/02791072.2023.2232379] [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: 12/27/2022] [Revised: 04/10/2023] [Accepted: 05/04/2023] [Indexed: 07/18/2023]
Abstract
This study translated and tested the psychometric properties of acute psychedelic effects measures among Spanish-speaking people. The Psychological Insight Questionnaire (PIQ), Challenging Experiences Questionnaire (CEQ), and Mystical Experiences Questionnaire (MEQ) were translated before being incorporated into a web-based survey. We recruited native Spanish-speakers (N = 442; Mage = 30.8, SD = 10.9; Latino/Latina = 62%; Hispanic = 91.4%; male = 71.5%) to assess their previous experience with one of two psychedelics (LSD = 58.4%; Psilocybin = 41.6%) and their acute and enduring effects. Confirmatory factor analysis (confirming factor structure based on the English version) revealed a good fit for the MEQ, PIQ and the CEQ. Repeating our analysis in each drug subsample revealed consistency in factor structure for each assessment tool. Construct validity was supported by significant positive associations between the PIQ and MEQ, and between the PIQ and MEQ and changes in cognitive fusion and negative associations between changes in prosocial behaviors. As a signal of predictive validity, persisting effects (PEQ) were strongly related to scores on the MEQ and PIQ. Findings demonstrate that the Spanish versions of these measures can be reliably employed in studies of psychedelic use or administration in Spanish-speaking populations.
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Affiliation(s)
- Alan K Davis
- College of Social Work, The Ohio State University - Center for Psychedelic Drug Research and Education, Columbus, Ohio, USA
- Johns Hopkins University School of Medicine - Center for Psychedelic and Consciousness Research, Baltimore, Maryland, USA
| | | | - Ana Maria Ortiz Bernal
- Department of Human Development and Family Studies, University of Wisconsin-Madison - School of Human Ecology, Madison, Wisconsin, USA
| | - Rafaelle Lancelotta
- College of Social Work, The Ohio State University - Center for Psychedelic Drug Research and Education, Columbus, Ohio, USA
| | - Sandeep Nayak
- Johns Hopkins University School of Medicine - Center for Psychedelic and Consciousness Research, Baltimore, Maryland, USA
| | - Nathan D Sepeda
- College of Social Work, The Ohio State University - Center for Psychedelic Drug Research and Education, Columbus, Ohio, USA
- Johns Hopkins University School of Medicine - Center for Psychedelic and Consciousness Research, Baltimore, Maryland, USA
| | - Aki Nikolaidis
- Center for the Developing Brain, Child Mind Institute, New York, NY, USA
| | - Roland R Griffiths
- Johns Hopkins University School of Medicine - Center for Psychedelic and Consciousness Research, Baltimore, Maryland, USA
- Johns Hopkins University - Department of Neuroscience
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Weiss B, Erritzoe D, Giribaldi B, Nutt DJ, Carhart-Harris RL. A critical evaluation of QIDS-SR-16 using data from a trial of psilocybin therapy versus escitalopram treatment for depression. J Psychopharmacol 2023; 37:717-732. [PMID: 37122239 PMCID: PMC10350722 DOI: 10.1177/02698811231167848] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND In a recent clinical trial examining the comparative efficacy of psilocybin therapy (PT) versus escitalopram treatment (ET) for major depressive disorder, 14 of 16 major efficacy outcome measures yielded results that favored PT, but the Quick Inventory of Depressive Symptomatology, Self-Report, 16 items (QIDS-SR16) did not. AIMS The present study aims to (1) rationally and psychometrically account for discrepant results between outcome measures and (2) to overcome psychometric problems particular to individual measures by re-examining between-condition differences in depressive response using all outcome measures at item-, facet-, and factor-levels of analysis. METHOD Four depression measures were compared on the basis of their validity for examining differences in depressive response between PT and ET conditions. RESULTS/OUTCOMES Possible reasons for discrepant findings on the QIDS-SR16 include its higher variance, imprecision due to compound items and whole-scale and unidimensional sum-scoring, vagueness in the phrasing of scoring options for items, and its lack of focus on a core depression factor. Reanalyzing the trial data at item-, facet-, and factor-levels yielded results suggestive of PT's superior efficacy in reducing depressed mood, anhedonia, and a core depression factor, along with specific symptoms such as sexual dysfunction. CONCLUSION/INTERPRETATION Our results raise concerns about the adequacy of the QIDS-SR16 for measuring depression, as well as the practice of relying on individual scales that tend not to capture the multidimensional structure or core of depression. Using an alternative approach that captures depression more granularly and comprehensively yielded specific insight into areas where PT therapy may be particularly useful to patients and clinicians.
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Affiliation(s)
- Brandon Weiss
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, UK
| | - David Erritzoe
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, UK
| | - Bruna Giribaldi
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, UK
| | - David J Nutt
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, UK
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, Department of Neurology, University of California, San Francisco, CA, USA
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Kähönen J. Psychedelic unselfing: self-transcendence and change of values in psychedelic experiences. Front Psychol 2023; 14:1104627. [PMID: 37388660 PMCID: PMC10300451 DOI: 10.3389/fpsyg.2023.1104627] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/31/2023] [Indexed: 07/01/2023] Open
Abstract
Psychedelic experiences have been shown to both facilitate (re)connection to one's values and change values, including enhancing aesthetic appreciation, promoting pro-environmental attitudes, and encouraging prosocial behavior. This article presents an empirically informed framework of philosophical psychology to understand how self-transcendence relates to psychedelic value changes. Most of the observed psychedelic value changes are toward the self-transcendent values of Schwartz's value theory. As psychedelics also reliably cause various self-transcendent experiences (STEs), a parsimonious hypothesis is that STEs change values toward self-transcendent values. I argue that STEs indeed can lead to value changes, and discuss the morally relevant process of self-transcendence through Iris Murdoch's concept of "unselfing". I argue that overt egocentric concerns easily bias one's valuations. Unselfing reduces egocentric attributions of salience and enhances non-egocentric attention to the world, widening one's perspective and shifting evaluation toward self-transcendent modes. Values are inherently tied to various evaluative contexts, and unselfing can attune the individual to evaluative contexts and accompanying values beyond the self. Understood this way, psychedelics can provide temporarily enhanced access to self-transcendent values and function as sources of aspiration and value change. However, contextual factors can complicate whether STEs lead to long-term changes in values. The framework is supported by various research strands establishing empirical and conceptual connections between long-term differences in egocentricity, STEs, and self-transcendent values. Furthermore, the link between unselfing and value changes is supported by phenomenological and theoretical analysis of psychedelic experiences, as well as empirical findings on their long-term effects. This article furthers understanding of psychedelic value changes and contributes to discussions on whether value changes are justified, whether they result from cultural context, and whether psychedelics could function as tools of moral neuroenhancement.
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Apud I, Scuro J, Carrera I, Oliveri A. Ayahuasca Ritual, Personality and Sociality: Observational Research Conducted in a Substance Use Disorder Rehabilitation Center in Uruguay. J Psychoactive Drugs 2023; 55:141-150. [PMID: 35506737 DOI: 10.1080/02791072.2022.2053004] [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: 09/07/2021] [Revised: 12/13/2021] [Accepted: 01/10/2022] [Indexed: 10/18/2022]
Abstract
The current article presents a mixed qualitative-quantitative observational study of the effect of ayahuasca ritual on subjective experiences and personality traits on participants of a center specialized in the treatment of substance use disorder in Uruguay. When comparing the psychological traits of ayahuasca participants to a control group, quantitative results using the Zuckerman-Kuhlman-Aluja Personality Questionnaire showed statistically significant higher scores in Impulsive Sensation Seeking, Boredom Susceptibility, and Social Warmth scales. Qualitative analysis of ayahuasca experiences resulted in five main categories: emotional experiences (including social emotions such as love and empathy), corporal experiences, spiritual/transcendental experiences, personal experiences, and visions. Last, qualitative descriptions provide support for the importance of social interactions in the phenomenological manifestations of the psychedelic experience. Both quantitative and qualitative results suggest that the combination of social interactions and the pharmacological action of ayahuasca could facilitate the manifestation of social emotions during the ritual, and may contribute to the long-term increase of empathic and social aspects of personality.
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Affiliation(s)
- Ismael Apud
- Institute of Foundations and Methods in Psychology, Faculty of Psychology, Universidad de la República, Montevideo, Uruguay
| | - Juan Scuro
- Department of Social Anthropology, Faculty of Humanities and Educational Sciences, Universidad de la República, Montevideo, Uruguay
| | - Ignacio Carrera
- Department of Organic Chemistry, Faculty of Chemistry, Universidad de la República, Montevideo, Uruguay
| | - Andrés Oliveri
- Institute of Foundations and Methods in Psychology, Faculty of Psychology, Universidad de la República, Montevideo, Uruguay
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Michael P, Luke D, Robinson O. An encounter with the self: A thematic and content analysis of the DMT experience from a naturalistic field study. Front Psychol 2023; 14:1083356. [PMID: 37051610 PMCID: PMC10083325 DOI: 10.3389/fpsyg.2023.1083356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/22/2023] [Indexed: 03/28/2023] Open
Abstract
IntroductionN,N-Dimethyltryptamine (DMT) is an endogenous serotonergic psychedelic capable of producing radical shifts in an experience that have significant implications for consciousness and its neural correlates, especially given the “disconnected consciousness” suggested by the “breakthrough” DMT state. Its increasing usage and clinical trial indicate the growing importance of a thorough elucidation of the experience's qualitative content, over and above the phenomenological structure. This is particularly in light of the intensely pervasive effects of DMT occasions in all dimensions of the self, which are often ontologically challenging yet potentially transformative.MethodsThis is the second report on the first naturalistic field study of DMT use exploring its qualitative analysis. Screened, healthy, anonymized, and experienced DMT users were observed during their non-clinical use of the drug at home (40–75-mg inhaled). In-depth semi-structured interviews, inspired by the micro-phenomenological technique, were employed immediately after their experience. This study reports on the thematic and content analysis of one major domain of the breakthrough experiences elicited, the “self”; where analyses of the “other” were previously reported. A total of 36 post-DMT experience interviews with mostly Caucasian (83%) men (eight women) of a mean of 37 years were predominantly inductively coded.ResultsInvariably, profound and highly intense experiences occurred. The first overarching category comprised the onset of effects, encompassing super-ordinate themes including sensory, emotion and body, and space-time shifts; the second category comprised bodily effects, encompassing themes including pleasurable, neutral/both, and uncomfortable; the third category comprised the sensorial effects, encompassing open-eye, visual, and cross-modal and other; the fourth comprised the psychological effects, encompassing memory and language, awareness and sense of self, and time distortions; and the fifth comprised the emotional effects, encompassing positive, neither/both, and challenging experiences. Many further subthemes also illuminate the rich content of the DMT experience.DiscussionThe present study provides a systematic and nuanced analysis of the content of the breakthrough DMT state pertaining to one's personal and self-referential experiences of the body, senses, psychology, and emotions. The resonances both with previous DMT studies and other types of extraordinary experiences, such as the alien abduction, shamanic and near-death experiences, are also elaborated upon. Putative neural mechanisms and their promise as a psychotherapeutic agent, especially owing to deep emotional impact, are discussed.
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Affiliation(s)
- Pascal Michael
- Centre for Mental Health, School of Human Sciences, Old Royal Naval College, University of Greenwich, London, United Kingdom
| | - David Luke
- Centre for Mental Health, School of Human Sciences, Old Royal Naval College, University of Greenwich, London, United Kingdom
- Department of Brain Sciences, Faculty of Medicine, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | - Oliver Robinson
- Centre for Mental Health, School of Human Sciences, Old Royal Naval College, University of Greenwich, London, United Kingdom
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Nikolaidis A, Lancelotta R, Gukasyan N, Griffiths RR, Barrett FS, Davis AK. Subtypes of the psychedelic experience have reproducible and predictable effects on depression and anxiety symptoms. J Affect Disord 2023; 324:239-249. [PMID: 36584715 PMCID: PMC9887654 DOI: 10.1016/j.jad.2022.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/24/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Subjective experiences seem to play an important role in the enduring effects of psychedelic experiences. Although the importance of the subjective experience on the impact of psychedelics is frequently discussed, a more detailed understanding of the subtypes of psychedelic experiences and their associated impacts on mental health has not been well documented. METHODS In the current study, machine learning cluster analysis was used to derive three subtypes of psychedelic experience in a large (n = 985) cross sectional sample. RESULTS These subtypes are not only associated with reductions in anxiety and depression symptoms and other markers of psychological wellbeing, but the structure of these subtypes and their subsequent impact on mental health are highly reproducible across multiple psychedelic substances. LIMITATIONS Data were obtained via retrospective self-report, which does not allow for definitive conclusions about the direction of causation between baseline characteristics of respondents, qualities of subjective experience, and outcomes. CONCLUSIONS The present analysis suggests that psychedelic experiences, in particular those that are associated with enduring improvements in mental health, may be characterized by reproducible and predictable subtypes of the subjective psychedelic effects. These subtypes appear to be significantly different with respect to the baseline demographic characteristics, baseline measures of mental health, and drug type and dose. These findings also suggest that efforts to increase psychedelic associated personal and mystical insight experiences may be key to maximizing beneficial impact of clinical approaches using this treatment in their patients.
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Affiliation(s)
- Aki Nikolaidis
- Child Mind Institute, Center for the Developing Brain, United States of America
| | - Rafaelle Lancelotta
- College of Social Work, The Ohio State University, Columbus, United States of America
| | - Natalie Gukasyan
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Roland R Griffiths
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Frederick S Barrett
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Alan K Davis
- College of Social Work, The Ohio State University, Columbus, United States of America; Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
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28
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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.
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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
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Apud I. Ayahuasca and personality. A systematic review and meta-analysis of cross-sectional studies with long-term participants ( Ayahuasca y personalidad. Revisión sistemática y metaanálisis de estudios transversales con participantes de larga trayectoria). STUDIES IN PSYCHOLOGY 2023. [DOI: 10.1080/02109395.2022.2163776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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30
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Beaussant Y, Nigam K. Expending Perspectives on the Potential for Psychedelic-Assisted Therapies to Improve the Experience of Aging. Am J Geriatr Psychiatry 2023; 31:54-57. [PMID: 36307304 DOI: 10.1016/j.jagp.2022.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Yvan Beaussant
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (YB), Boston, MA; Harvard Medical School (YB, KN), Boston, MA.
| | - Kabir Nigam
- Harvard Medical School (YB, KN), Boston, MA; Department of Psychiatry, Brigham and Women's Hospital (KN), Boston, MA
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Sustained effects of single doses of classical psychedelics in humans. Neuropsychopharmacology 2023; 48:145-150. [PMID: 35729252 PMCID: PMC9700827 DOI: 10.1038/s41386-022-01361-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 02/08/2023]
Abstract
The serotonergic classical psychedelics include compounds that primarily activate the brain's serotonin 2 A receptor (5-HT2AR), such as LSD, psilocybin, and DMT (ayahuasca). The acute effects of these compounds are well-known as are their ability to increase the emotional state both in healthy people and in those with neuropsychiatric disorders. In particular psilocybin, the psychoactive constituent in "magic mushrooms", has shown great potential for treatment of anxiety and depression. A unique and compelling feature of psychedelics is that intake of just a single psychedelic dose is associated with long-lasting effects. This includes effects on personality, e.g., higher openness, and amelioration of depressive symptoms. This review focuses on these stunning effects and summarizes our current knowledge on which behavioral, biochemical, neuroimaging, and electrophysiological data support that the intriguing effects of psychedelics on the human brain and mind are based on neural plasticity. The review also points to so far understudied areas and suggests research questions to be addressed in future studies which potentially can help to understand the intriguing long-term effects after intake of a single (or a few) psychedelic doses.
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Spriggs MJ, Giribaldi B, Lyons T, Rosas FE, Kärtner LS, Buchborn T, Douglass HM, Roseman L, Timmermann C, Erritzoe D, Nutt DJ, Carhart-Harris RL. Body mass index (BMI) does not predict responses to psilocybin. J Psychopharmacol 2023; 37:107-116. [PMID: 36373934 PMCID: PMC9834321 DOI: 10.1177/02698811221131994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psilocybin is a serotonin type 2A (5-HT2A) receptor agonist and naturally occurring psychedelic. 5-HT2A receptor density is known to be associated with body mass index (BMI), however, the impact of this on psilocybin therapy has not been explored. While body weight-adjusted dosing is widely used, this imposes a practical and financial strain on the scalability of psychedelic therapy. This gap between evidence and practice is caused by the absence of studies clarifying the relationship between BMI, the acute psychedelic experience and long-term psychological outcomes. METHOD Data were pooled across three studies using a fixed 25 mg dose of psilocybin delivered in a therapeutic context to assess whether BMI predicts characteristics of the acute experience and changes in well-being 2 weeks later. Supplementing frequentist analysis with Bayes Factors has enabled for conclusions to be drawn regarding the null hypothesis. RESULTS Results support the null hypothesis that BMI does not predict overall intensity of the altered state, mystical experiences, perceptual changes or emotional breakthroughs during the acute experience. There was weak evidence for greater 'dread of ego dissolution' in participants with lower BMI, however, further analysis suggested BMI did not meaningfully add to the combination of the other covariates (age, sex and study). While mystical-type experiences and emotional breakthroughs were strong predictors of improvements in well-being, BMI was not. CONCLUSIONS These findings have important implications for our understanding of pharmacological and extra-pharmacological contributors to psychedelic-assisted therapy and for the standardization of a fixed therapeutic dose in psychedelic-assisted therapy.
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Affiliation(s)
- Meg J Spriggs
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK,Meg J Spriggs, Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, 2nd floor, Commonwealth Building, Hammersmith Campus 160 Du Cane Road, London, London W12 0NN, UK.
| | - Bruna Giribaldi
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Taylor Lyons
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Fernando E Rosas
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK,Centre for Complexity Science, Imperial College London, UK
| | - Laura S Kärtner
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK,Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tobias Buchborn
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK,Institute for Psychopharmacology, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Hannah M Douglass
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Leor Roseman
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Christopher Timmermann
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - David Erritzoe
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK,CNWL-Imperial Psychopharmacology & Psychedelic Research Clinic, St. Charles Hospital, CNWL NHS Foundation Trust, London, UK
| | - David J Nutt
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK,Psychedelics Division, Neuroscape, University of California San Francisco, USA
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St Arnaud KO, Sharpe D. Contextual Parameters Associated with Positive and Negative Mental Health in Recreational Psychedelic Users. J Psychoactive Drugs 2023; 55:30-39. [PMID: 35156542 DOI: 10.1080/02791072.2022.2039815] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Growing research exploring the utility of psychedelic substances suggests that they not only hold promise for clinical practice but may enhance mental health through recreational use as well. However, given the importance of set and setting for maximizing benefits and minimizing harms of drug use, it is important to develop a foundational understanding of the contextual factors associated with positive and negative mental health in psychedelic users. Accordingly, data were collected using an internet-based survey of psychedelic drug users (n = 511). Hierarchical regression analyses were used to explore to what degree life-time use, frequency of use, dose size, group use, intentions for use, and post-use integration predict mental health in psychedelic users. In particular, using psychedelics with high frequency and to cope with negative affect were found to predict negative mental health. Conversely, using psychedelics in a group setting, with self-expansive intentions, and integrating post-use were found to predict positive mental health. Findings suggest that recreational psychedelic use may either enhance or diminish mental health depending on the contextual parameters of use. Limitations and areas for further research are discussed.
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Affiliation(s)
- Kevin O St Arnaud
- Department of Psychology, Concordia University of Edmonton, Edmonton, Canada
| | - Donald Sharpe
- Department of Psychology, University of Regina, Regina, Canada
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Hartogsohn I, Petranker R. Set and setting in microdosing: an oft-overlooked principle. Psychopharmacology (Berl) 2022; 239:3771-3777. [PMID: 36289109 DOI: 10.1007/s00213-022-06249-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/24/2022] [Indexed: 11/24/2022]
Abstract
RATIONALE The use of psychedelics for medical and recreational purposes is rising. Contextual factors such as expectancy, intention, and sensory and social environment (set and setting) are widely recognized as moderating the effects of these substances. Nevertheless, clinical trials of microdosing - the ingestion of small, sub-hallucinogenic doses of psychedelics - rarely report their set and setting. This fact suggests that such factors are not considered important in the context of microdosing. OBJECTIVE This paper challenges this assumption and makes the case for the crucial relevance of set and setting in microdosing practice. Building on set and setting theory and placebo theory, we explain why set and setting are of crucial importance in the case of microdosing. RESULTS This reasoning helps elucidate the role of set and setting in determining the outcomes of microdosing and helps explain some of the contradictory results that have emerged in microdosing research in recent years. CONCLUSION Set and setting are important constructs to be considered especially in the context of microdosing psychedelics. By reporting set and setting, the results of microdosing research can be made more reliable and consistent.
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Affiliation(s)
- Ido Hartogsohn
- The Program for Science, Technology and Society Studies, Bar Ilan University, Ramat Gan, Israel
| | - Rotem Petranker
- Department of Psychology, McMaster University, Hamilton, ON, Canada.
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Tvorun-Dunn M. Acid liberalism: Silicon Valley's enlightened technocrats, and the legalization of psychedelics. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103890. [PMID: 36279734 DOI: 10.1016/j.drugpo.2022.103890] [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: 07/30/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 12/12/2022]
Abstract
The history of psychedelia within the New Left counterculture often implies a cultural alignment between psychedelics and progressive values or the promise of radical communitarian social reform. In contrast to these potentials, this paper examines Silicon Valley's engagement with psychedelics, a community which has demonstrated considerable financial and personal interests in these drugs despite promoting and advancing consistently neoliberal ends. This article studies Silicon Valley's culture of psychedelic drug use through extensive analysis of published interviews by tech industrialists, news reports, and recent studies on the tech industry's proliferation of mystical and utopian rhetoric. This work finds that psychedelics and their associated practices are given unconventional mystical meanings by some high-profile tech entrepreneurs, and that these meanings are integrated into belief systems and philosophies which are explicitly anti-democratic, individualist, and essentialist. It is argued that these mystical ideas are supported by a venture capital community which profits from the expression of disruptive utopian beliefs. These beliefs, when held by the extremely wealthy, have effects on legalization policy and the ways which psychedelics are commercialized within a legal marketplace. As Silicon Valley has put considerable resources into funding research and advocacy for psychedelics, I argue that the legalization of psychedelics will likely be operationalized to generate a near-monopoly on the market and promote further inequality in the United States that is reflective of both neoliberalism, and the essentialist beliefs of Silicon Valley functionaries.
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Affiliation(s)
- Maxim Tvorun-Dunn
- University of Tokyo, Department of Interdisciplinary Cultural Studies, Tokyo, Japan.
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Bonnelle V, Smith WJ, Mason NL, Cavarra M, Kryskow P, Kuypers KPC, Ramaekers JG, Feilding A. Analgesic potential of macrodoses and microdoses of classical psychedelics in chronic pain sufferers: a population survey. Br J Pain 2022; 16:619-631. [PMID: 36452124 PMCID: PMC9703241 DOI: 10.1177/20494637221114962] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Although several studies and reports have shown the potential analgesic use of serotonergic psychedelics in cancer pain, phantom limb pain and cluster headache, evidence supporting their use for chronic pain is still limited. The past years have seen a considerable renewal of interest toward the therapeutic use of these compounds for mood disorders, resulting in a marked increase in the number of people turning to psychedelics in an attempt to self-medicate a health condition or improve their wellbeing. In western countries particularly, this population of users overlaps substantially with chronic pain sufferers, representing a unique opportunity to evaluate the effects these compounds have on pain and wellbeing. Here, we report results from an online survey conducted between August 2020 and July 2021 in a population of 250 chronic pain sufferers who had experience with psychedelics, either in microdoses (small sub-hallucinogenic doses), macrodoses (hallucinogenic doses), or both. Macrodoses, while less often used for analgesic purposes than microdoses, were reported to induce a higher level of pain relief than both microdoses and conventional pain medications (including opioids and cannabis). Although the effects were weaker and potentially more prone to expectation bias than with macrodoses, our results also suggested some benefits of psychedelics in microdoses for pain management. The reported analgesic effect appeared unrelated to mood improvements associated with psychedelic use, or the advocacy of psychedelic use. Taken together, our findings indicate interesting potential analgesic applications for psychedelics that warrant further clinical research.
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Affiliation(s)
| | | | - Natasha L Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Mauro Cavarra
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Pamela Kryskow
- Department of Family Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kim PC Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Hartogsohn I. Modalities of the psychedelic experience: Microclimates of set and setting in hallucinogen research and culture. Transcult Psychiatry 2022; 59:579-591. [PMID: 35818775 DOI: 10.1177/13634615221100385] [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
Mid-20th-century American research on psychedelics evinced a stunning diversity of interpretations of hallucinogenic effects. While some researchers viewed psychedelics as invaluable tools for psychotherapy, others persisted in treating them as psychosis-inducing agents. As some groups considered psychedelics as catalysts for artistic creativity, others investigated their potential use as psychochemical weapons in the battlefield, or conversely as tools for spiritual ecstasy and revelation. This bewildering array of perceptions regarding the nature of hallucinogenic effects led to stark contrasts in the contexts (set and setting) of psychedelic research and experimentation, leading to wildly divergent outcomes and reports on the effects of the drugs, and strident disagreements between the actors in the field. Examining this remarkable historical moment of epistemological unclarity regarding psychedelics and their effects, this article describes how distinct scientific and cultural trends and moments of mid-20th-century America contributed to the creation of diverse microclimates of set and setting that reproduced investigator beliefs and attitudes and brought about a beguiling Pygmalion effect that left researchers befuddled and perplexed. I propose the concept of psychedelic modality to describe how distinct sociocultural microclimates lead to thematic aggregates in which distinct types of expectations, intentions as well as physical, social, and cultural environments all tend to cluster, producing characteristic outcomes and results. By exploring the historical context and consequences of the emergence of seven psychedelic modalities (psychotomimetic, military, psychotherapeutic, spiritual, artistic-creative, tech-innovative, and political) in mid-20th-century America, this article outlines the varieties of psychedelic experiences in their relationship with culture at large, and subcultures in particular.
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Affiliation(s)
- Ido Hartogsohn
- Program in Science, Technology and Society, Bar Ilan University, Ramat Gan, Israel
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Dourron HM, Strauss C, Hendricks PS. Self-Entropic Broadening Theory: Toward a New Understanding of Self and Behavior Change Informed by Psychedelics and Psychosis. Pharmacol Rev 2022; 74:982-1027. [DOI: 10.1124/pharmrev.121.000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/22/2022] Open
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Pizarro JJ, Zumeta LN, Bouchat P, Włodarczyk A, Rimé B, Basabe N, Amutio A, Páez D. Emotional processes, collective behavior, and social movements: A meta-analytic review of collective effervescence outcomes during collective gatherings and demonstrations. Front Psychol 2022; 13:974683. [PMID: 36118463 PMCID: PMC9473704 DOI: 10.3389/fpsyg.2022.974683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
In this article, we review the conceptions of Collective Effervescence (CE) –a state of intense shared emotional activation and sense of unison that emerges during instances of collective behavior, like demonstrations, rituals, ceremonies, celebrations, and others– and empirical approaches oriented at measuring it. The first section starts examining Émile Durkheim's classical conception on CE, and then, the integrative one proposed by the sociologist Randall Collins, leading to a multi-faceted experience of synchronization. Then, we analyze the construct as a process emerging in collective encounters when individuals contact with social ideal and values, referring to the classical work of Serge Moscovici as well as those more recent empirical approaches. Third, we consider CE as a set of intense positive emotions linked to processes of group identification, as proposed by authors of the Social Identity Theory tradition. Finally, we describe CE from the perspective of self-transcendence (e.g., emotions, experiences), and propose a unified description of this construct. The second section shows the results of a meta-analytical integration (k = 50, N = 182,738) aimed at analyzing CE's proximal effects or construct validity (i.e., Individual Emotions and Communal Sharing) as well as its association with more distal variables, such as Collective Emotions, Social Integration, Social Values and Beliefs and Empowerment. Results indicate that CE strongly associates with Individual Emotions –in particular, Self-Transcendent Emotions– and Communal Sharing constructs (e.g., Group Identity, Fusion of Identity), providing construct validity. Among the distal effects of CE, it is associated with Collective Positive Emotions, long-term Social Integration (e.g., Ingroup Commitment), Social Values and Beliefs and Empowerment-related variables (e.g., Wellbeing, Collective Efficacy, Collective Self-Esteem). Among the moderation analyses carried out (e.g., study design, CE scale, type of collective gathering), the effects of CE in demonstrations are noticeable, where this variable is a factor that favors other variables that make collective action possible, such as Group Identity (rpooled = 0.52), Collective Efficacy (rpooled = 0.37), Negative and Self-Transcendent Emotions (rpooled = 0.14 and 0.58), and Morality-related beliefs (rpooled = 0.43).
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Affiliation(s)
- José J. Pizarro
- Faculty of Psychology, University of the Basque Country, San Sebastian, Spain
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
- *Correspondence: José J. Pizarro
| | - Larraitz N. Zumeta
- Faculty of Psychology, University of the Basque Country, San Sebastian, Spain
| | - Pierre Bouchat
- Université de Lorraine, Équipe PerSEUS (EA 7312), Metz, France
| | - Anna Włodarczyk
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Bernard Rimé
- Department of Psychology, Université catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Nekane Basabe
- Faculty of Psychology, University of the Basque Country, San Sebastian, Spain
| | - Alberto Amutio
- Faculty of Psychology, University of the Basque Country, San Sebastian, Spain
- Facultad de Educación y Ciencias Sociales, Universidad Andrés Bello, Santiago, Chile
| | - Darío Páez
- Faculty of Psychology, University of the Basque Country, San Sebastian, Spain
- Facultad de Educación y Ciencias Sociales, Universidad Andrés Bello, Santiago, Chile
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Bathje GJ, Majeski E, Kudowor M. Psychedelic integration: An analysis of the concept and its practice. Front Psychol 2022; 13:824077. [PMID: 35992410 PMCID: PMC9386447 DOI: 10.3389/fpsyg.2022.824077] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
The concept of integration has garnered increased attention in the past few years, despite a long history of only brief mention. Integration services are offered by therapists, coaches, and other practitioners, or may be self-guided. There are many definitions of psychedelic integration, and the term encompasses a range of practices and techniques. This seems to have led to confusion about what integration is and how it is best practiced. The primary focus of this manuscript is the presentation of the first extensive review and concept analysis of definitions, practices, and models of psychedelic integration. We provide a synthesized definition of integration, synthesized model of integration, and comprehensive summary of integration practices to bring clarity to the subject.
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Affiliation(s)
- Geoff J. Bathje
- Department of Counseling and Integrated Programs, Adler University, Chicago, IL, United States
- Sana Healing Collective, Chicago, IL, United States
| | - Eric Majeski
- Department of Counseling and Integrated Programs, Adler University, Chicago, IL, United States
| | - Mesphina Kudowor
- Department of Counseling and Integrated Programs, Adler University, Chicago, IL, United States
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Nygart VA, Pommerencke LM, Haijen E, Kettner H, Kaelen M, Mortensen EL, Nutt DJ, Carhart-Harris RL, Erritzoe D. Antidepressant effects of a psychedelic experience in a large prospective naturalistic sample. J Psychopharmacol 2022; 36:932-942. [PMID: 35924888 PMCID: PMC9353970 DOI: 10.1177/02698811221101061] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Over the last two decades, a number of studies have highlighted the potential of psychedelic therapy. However, questions remain to what extend these results translate to naturalistic samples, and how contextual factors and the acute psychedelic experience relate to improvements in affective symptoms following psychedelic experiences outside labs/clinics. The present study sought to address this knowledge gap. AIM Here, we aimed to investigate changes in anxiety and depression scores before versus after psychedelic experiences in naturalistic contexts, and how various pharmacological, extrapharmacological and experience factors related to outcomes. METHOD Individuals who planned to undergo a psychedelic experience were enrolled in this online survey study. Depressive symptoms were assessed at baseline and 2 and 4 weeks post-psychedelic experience, with self-rated Quick Inventory of Depressive Symptomatology (QIDS-SR-16) as the primary outcome. To facilitate clinical translation, only participants with depressive symptoms at baseline were included. Sample sizes for the four time points were N = 302, N = 182, N = 155 and N = 109, respectively. RESULTS Relative to baseline, reductions in depressive symptoms were observed at 2 and 4 weeks. A medicinal motive, previous psychedelic use, drug dose and the type of acute psychedelic experience (i.e. specifically, having an emotional breakthrough) were all significantly associated with changes in self-rated QIDS-SR-16. CONCLUSION These results lend support to therapeutic potential of psychedelics and highlight the influence of pharmacological and non-pharmacological factors in determining response. Mindful of a potential sample and attrition bias, further controlled and observational longitudinal studies are needed to test the replicability of these findings.
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Affiliation(s)
- Victoria Amalie Nygart
- Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Centers for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, UK
| | - Lis Marie Pommerencke
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Eline Haijen
- Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Centers for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, UK
| | - Hannes Kettner
- Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Centers for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, UK
| | - Mendel Kaelen
- Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Centers for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, UK
| | - Erik Lykke Mortensen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David John Nutt
- Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Centers for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, UK
| | - Robin Lester Carhart-Harris
- Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Centers for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, UK
| | - David Erritzoe
- Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Centers for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, UK
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Roseman L, Preller KH, Fotiou E, Winkelman MJ. Editorial: Psychedelic sociality: Pharmacological and extrapharmacological perspectives. Front Pharmacol 2022; 13:979764. [PMID: 35935854 PMCID: PMC9355415 DOI: 10.3389/fphar.2022.979764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leor Roseman
- Centre for Psychedelic Research, Faculty of Medicine, Imperial College London, London, United Kingdom
- *Correspondence: Leor Roseman,
| | - Katrin H. Preller
- Pharmaco-Neuroimaging and Cognitive-Emotional Processing, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
| | | | - Michael J. Winkelman
- Retired, School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States
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van Elk M, Yaden DB. Pharmacological, neural, and psychological mechanisms underlying psychedelics: A critical review. Neurosci Biobehav Rev 2022; 140:104793. [PMID: 35878791 DOI: 10.1016/j.neubiorev.2022.104793] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 07/08/2022] [Accepted: 07/20/2022] [Indexed: 10/17/2022]
Abstract
This paper provides a critical review of several possible mechanisms at different levels of analysis underlying the effects and therapeutic potential of psychedelics. At the (1) biochemical level, psychedelics primarily affect the 5-HT2A receptor, increase neuroplasticity, offer a critical period for social reward learning, and have anti-inflammatory properties. At the (2) neural level, psychedelics have been associated with reduced efficacy of thalamo-cortical filtering, the loosening of top-down predictive signaling and an increased sensitivity to bottom-up prediction errors, and activation of the claustro-cortical-circuit. At the (3) psychological level, psychedelics have been shown to induce altered and affective states, they affect cognition, induce belief change, exert social effects, and can result in lasting changes in behavior. We outline the potential for a unifying account of the mechanisms underlying psychedelics and contrast this with a model of pluralistic causation. Ultimately, a better understanding of the specific mechanisms underlying the effects of psychedelics could allow for a more targeted therapeutic approach. We highlight current challenges for psychedelic research and provide a research agenda to foster insight in the causal-mechanistic pathways underlying the efficacy of psychedelic research and therapy.
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Affiliation(s)
- Michiel van Elk
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, the Netherlands.
| | - David Bryce Yaden
- The Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
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Pontual AADD, Tófoli LF, Corradi-Webster CM, van Oorsouw K, Delgado ARO, Ramaekers JG. The influence of ceremonial settings on mystical and challenging experiences occasioned by ayahuasca: A survey among ritualistic and religious ayahuasca users. Front Psychol 2022; 13:857372. [PMID: 35911023 PMCID: PMC9335152 DOI: 10.3389/fpsyg.2022.857372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Recent studies have recognized the importance of non-pharmacological factors such as setting to induce or promote mystical experiences or challenging experiences among ayahuasca users. This study aimed to evaluate the association between the setting in which ayahuasca is consumed and the intensity of mystical and challenging experiences considering three ayahuasca using traditions (União do Vegetal, Santo Daime and neo-shamanic groups). A cross-sectional analysis was performed on survey data collected online from 2,751 participants. The Setting Questionnaire for the Ayahuasca Experience (SQAE) was used to evaluate six dimensions of the setting characteristics. The Mystical Experience Questionnaire (MEQ) and the Challenging Experience Questionnaire (CEQ) were used to quantify the psychedelic experience. Ratings on every SQAE setting dimension were negatively correlated with ratings of the CEQ (r values between 0.21 and 0.36) for all ayahuasca using traditions. Regression analysis revealed that ratings on four SQAE dimensions (Social, Comfort, Infrastructure and Decoration) explained 41% of the variance in CEQ ratings. Associations between SQAE and MEQ ratings were relatively weak and confined to the dimensions Leadership and Comfort, explaining 14% of the variance in MEQ ratings. Ratings of Social context were higher among members of União do Vegetal compared to Santo Daime and neo-shamanic members. Ratings of Infrastructure, Comfort and Decoration were more consistently correlated with MEQ in the neoshamanic tradition compared to the other traditions. This study shows that the setting is an important moderator of a challenging experience under ayahuasca. Maximizing the quality of the setting in which ayahuasca is taken will reduce the chance of a challenging experience while contributing positively to a mystical experience. The present findings can be considered when designing rituals and the (social) environment of ayahuasca ceremonies, and indicate that the SQAE questionnaire can be employed to monitor the influence of ceremonial settings on the ayahuasca experience.
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Affiliation(s)
- Alexandre Augusto de Deus Pontual
- Department of Psychology, Faculty of Philosophy, Science and Letters, University of São Paulo, Ribeirão Preto, Brazil
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- *Correspondence: Alexandre Augusto de Deus Pontual,
| | - Luís Fernando Tófoli
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Kim van Oorsouw
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alicia Raquel Osuna Delgado
- Department of Psychology, Faculty of Philosophy, Science and Letters, University of São Paulo, Ribeirão Preto, Brazil
| | - Johannes G. Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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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.
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Affiliation(s)
- William Brennan
- Cybin, Inc., Toronto, ON, Canada.,Fordham University, New York City, NY, United States
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Group VR experiences can produce ego attenuation and connectedness comparable to psychedelics. Sci Rep 2022; 12:8995. [PMID: 35637199 PMCID: PMC9149675 DOI: 10.1038/s41598-022-12637-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/12/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractWith a growing body of research highlighting the therapeutic potential of experiential phenomenology which diminishes egoic identity and increases one’s sense of connectedness, there is significant interest in how to elicit such ‘self-transcendent experiences’ (STEs) in laboratory contexts. Psychedelic drugs (YDs) have proven particularly effective in this respect, producing subjective phenomenology which reliably elicits intense STEs. With virtual reality (VR) emerging as a powerful tool for constructing new perceptual environments, we describe a VR framework called ‘Isness-distributed’ (Isness-D) which harnesses the unique affordances of distributed multi-person VR to blur conventional self-other boundaries. Within Isness-D, groups of participants co-habit a shared virtual space, collectively experiencing their bodies as luminous energetic essences with diffuse spatial boundaries. It enables moments of ‘energetic coalescence’, a new class of embodied intersubjective experience where bodies can fluidly merge, enabling participants to include multiple others within their self-representation. To evaluate Isness-D, we adopted a citizen science approach, coordinating an international network of Isness-D 'nodes'. We analyzed the results (N = 58) using 4 different self-report scales previously applied to analyze subjective YD phenomenology (the inclusion of community in self scale, ego-dissolution inventory, communitas scale, and the MEQ30 mystical experience questionnaire). Despite the complexities associated with a distributed experiment like this, the Isness-D scores on all 4 scales were statistically indistinguishable from recently published YD studies, demonstrating that distributed VR can be used to design intersubjective STEs where people dissolve their sense of self in the connection to others.
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McCulloch DEW, Grzywacz MZ, Madsen MK, Jensen PS, Ozenne B, Armand S, Knudsen GM, Fisher PM, Stenbæk DS. Psilocybin-Induced Mystical-Type Experiences are Related to Persisting Positive Effects: A Quantitative and Qualitative Report. Front Pharmacol 2022; 13:841648. [PMID: 35355714 PMCID: PMC8959755 DOI: 10.3389/fphar.2022.841648] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Psychedelic drugs such as psilocybin have shown substantial promise for the treatment of several psychiatric conditions including mood and addictive disorders. They also have the remarkable property of producing persisting positive psychological changes in healthy volunteers for at least several months. In this study (NCT03289949), 35 medium-high doses of psilocybin were administered to 28 healthy volunteers (12 females). By the end of the dosing day, participants reported the intensity of their acute experience using the 30-item Mystical Experience Questionnaire (MEQ) and an open-form qualitative report from home. Persisting psychological effects attributed to the psilocybin experience were measured using the Persisting Effects Questionnaire (PEQ) 3-months after administration. Using a linear latent-variable model we show that the MEQ total score is positively associated with the later emergence of positive PEQ effects (p = 3 × 10−5). Moreover, the MEQ subscales “Positive Mood” (pcorr = 4.1 × 10−4) and “Mysticality” (pcorr = 2.0 × 10−4) are associated with positive PEQ whereas the subscales “Transcendence of Time and Space” (pcorr = 0.38) and “Ineffability” (pcorr = 0.45) are not. Using natural language pre-processing, we provide the first qualitative descriptions of the “Complete Mystical Experience” induced by orally administered psilocybin in healthy volunteers, revealing themes such as a sense of connection with the Universe, familial love, and the experience of profound beauty. Combining qualitative and quantitative methods, this paper expands understanding of the acute psilocybin induced experience in healthy volunteers and suggests an importance of the type of experience in predicting lasting positive effects.
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Affiliation(s)
- Drummond E-Wen McCulloch
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Maria Zofia Grzywacz
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Martin Korsbak Madsen
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Steen Jensen
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Sophia Armand
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Patrick MacDonald Fisher
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Dea Siggaard Stenbæk
- Neurobiology Research Unit and NeuroPharm, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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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).
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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
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49
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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.
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50
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Sekula AD, Downey L, Puspanathan P. Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy. Front Psychol 2022; 13:813746. [PMID: 35310225 PMCID: PMC8931418 DOI: 10.3389/fpsyg.2022.813746] [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] [Received: 11/12/2021] [Accepted: 02/11/2022] [Indexed: 12/20/2022] Open
Abstract
Psychotherapy with the use of psychedelic substances, including psilocybin, lysergic acid diethylamide (LSD), ketamine, and 3,4-methylenedioxymethamphetamine (MDMA), has demonstrated promise in treatment of post-traumatic stress disorder (PTSD), anxiety, addiction, and treatment-resistant depression. Psychedelic-assisted psychotherapy (PP) represents a unique psychopharmacological model that leverages the profound effects of the psychedelic experience. That experience is characterized by strong dependency on two key factors: participant mindset and the therapeutic environment. As such, therapeutic models that utilize psychedelics reflect the need for careful design that promotes an open, flexible, trusting mindset and a supportive setting. To meet this need, the PP model is increasingly supplemented by auxiliary methods, including meditation, relaxation, visualization or spiritual practices. We suggest virtual reality (VR) as a full-spectrum tool able to capitalize on and catalyze the innately therapeutic aspects of the psychedelic experience, such as detachment from familiar reality, alteration of self-experience, augmentation of sensory perception and induction of mystical-type experiences. This is facilitated by VR’s evidenced capacity to: aid relaxation and reduce anxiety; buffer from external stimuli; promote a mindful presence; train the mind to achieve altered states of consciousness (ASC); evoke mystical states; enhance therapeutic alliance and encourage self-efficacy. While these unique VR features appear promising, VR’s potential role in PP remains speculative due to lack of empirical evidence on the combined use of VR and PP. Given the increased commercial interest in this synergy there is an urgent need to evaluate this approach. We suggest specific VR models and their role within PP protocols to inspire future direction in scientific research, and provide a list of potential disadvantages, side effects and limitations that need to be carefully considered. These include sensory overstimulation, cyber-sickness, triggering memories of past traumatic events as well as distracting from the inner experience or strongly influencing its contents. A balanced, evidence-based approach may provide continuity across all phases of treatment, support transition into and out of an ASC, deepen acute ASC experiences including mystical states and enrich the psychotherapeutic process of integration. We conclude that the potential application of VR in modulating psychedelic-assisted psychotherapy demands further exploration and an evidence-based approach to both design and implementation.
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Affiliation(s)
- Agnieszka D. Sekula
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
- Enosis Therapeutics Pty. Ltd., Melbourne, VIC, Australia
- *Correspondence: Agnieszka D. Sekula,
| | - Luke Downey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, VIC, Australia
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