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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] [What about the content of this article? (0)] [Affiliation(s)] [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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