Ego-Dissolution and Psychedelics: Validation of the Ego-Dissolution Inventory (EDI)

Exploring serotonergic psychedelics as a treatment for personality disorders

Both psychotherapeutic interventions and pharmacological agents have demonstrated limited efficacy in the treatment of personality disorders (PDs). Emerging evidence suggests that psychedelic therapy, already showing promise in treating various psychiatric conditions commonly comorbid with PDs, may exert therapeutic effects by promoting adaptive changes in personality. Thus, psychedelic therapy could hold potential for addressing core features of PDs through shared mechanisms of personality modulation. Although historical literature and observational studies suggest the potential clinical utility of psychedelics in treating PDs, rigorous research is lacking, and individuals with PDs are often excluded from modern psychedelic therapy trials. In the present review, we first discuss research on the effects of psychedelics in individuals with a PD through the conventional lens of the Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR) categorical model. Next, using the dimensional DSM Alternative Model of Personality Disorders (DSM-AMPD) as a framework, we examine how psychedelics may affect self-functioning, interpersonal functioning, and pathological personality traits. We conclude by discussing the clinical relevance of psychedelic therapy as a treatment for personality pathology, including safety considerations, gaps and limitations, and recommendations for approaching psychedelic therapy within these more complex clinical populations.

Probing the functional magnetic resonance imaging response to psilocybin in functional neurological disorder (PsiFUND): study protocol

Background

Functional neurological disorder (FND) is a common cause of neurological symptoms including seizures and movement disorders. It can be debilitating, is associated with high health and social care costs, and can have a poor prognosis. Functional magnetic resonance imaging (fMRI) has suggested FND is a multi-network disorder. Converging evidence suggests that other mechanisms including dissociation, interoception, and motor agency may be abnormal in people with FND. Psychedelics are currently under investigation for numerous neuropsychiatric disorders and have been shown to disrupt functional brain networks. Administering psychedelics to people with FND will help us to probe mechanistic theories of the disorder.

Protocol

In this open-label neuroimaging study, we will administer 25mg oral psilocybin with psychological support to people with chronic FND (target n = 24). Participants will undergo resting-state and task-based (Libet's clock, a measure of motor agency) fMRI sequences which will be compared in a pre-post manner. Additional mechanistic outcomes including measures of interoception (heartbeat tracking task), somatisation, illness perceptions, suggestibility, and dissociation will be collected. Data on expectancy, preparedness, and subjective experience of the psychedelic experience will also be gathered. Participants will be followed up for three months following psilocybin administration. fMRI changes in networks will be analysed using seed-based approaches, and additional exploratory analysis of resting-state imaging will take place.

Discussion

The study will help us to probe the mechanisms thought to potentially underpin FND. As the first modern study of psychedelics in FND, it will also help us to understand whether psychedelic administration alongside psychological support might be safe and feasible in this patient population.

A scoping review of the effects of serotonergic psychedelics on attitudes towards death

RATIONALE

Emerging evidence suggests that psychedelic experiences have the potential to change attitudes towards death and reduce death anxiety. Improved attitudes towards death, specifically reduced death anxiety, are of psychological significance for clinical and non-clinical populations alike. Despite this emerging evidence, little is known about the phenomenology of this potential outcome.

OBJECTIVES

To provide a systematic overview of studies reporting effects of psychedelics on attitudes towards death and death anxiety, thereby identifying any gaps in the current literature and informing suggestions for future research.

METHODS

MEDLINE, Scopus, PsycINFO, and Web of Science were systematically searched for empirical studies that measured attitudes towards death and death anxiety as an outcomes of classical psychedelic use. There were no limits on the date or design of the study.

RESULTS

The thirty-one studies included in the review all reported changes in attitudes towards death and/or changes in death anxiety. Despite finding evidence for psychedelics improving death anxiety, we found significant gaps in the existing research relating to the role of set and setting, potential differences across substances, the underlying psychological mechanisms involved, the potential for worsening of death anxiety, and the role of expectancy and placebo effects.

CONCLUSIONS

There is largely consistent evidence that psychedelics can often change attitudes towards death and reduce death anxiety. However, less is known about the reliability and strength of these effects, the conditions under which they are likely to emerge and aspects of the experience that best predict them.

Ayahuasca Retreats: The Role of Awe and Mystical Experiences in Well-Being

Research on the positive psychological effects of psychedelics has surged since the early 2000s, particularly regarding increased well-being. Studies have demonstrated how psychedelic-occasioned mystical experiences play a key role in their positive effects, which has prompted an interest in the emotion of awe in the psychedelic context due to its similar phenomenology and associated benefits. This study examined 60 individuals following their visitation to at least one ayahuasca retreat in a country where ayahuasca use was legal or retreats are approved to use ayahuasca, hypothesizing that not only high levels of awe but mystical experiences characterized by high levels of awe would be significantly associated with higher well-being. Neither hypothesis was supported: higher levels of mystical experience with lower perceived vastness, a facet of awe, was significantly associated with higher well-being, possibly highlighting the synergistic relationship between mystical experiences and perceived vastness on well-being. The study has implications for future research, particularly in terms of understanding how the perceived vastness of a person's psychedelic experience may be modulated to mitigate distress and foster well-being.

Acute subjective effects of psychedelics in naturalistic group settings prospectively predict longitudinal improvements in trauma symptoms, trait shame, and connectedness among adults with childhood maltreatment histories

Studies of psychedelic use in naturalistic and clinical settings have suggested safety and mental health benefits for adults with histories of childhood maltreatment. Acute psychological mechanisms that predict therapeutic benefits in this population, however, have yet to be determined. Two common group settings of naturalistic psychedelic use - organized ceremonies and raves or other electronic dance music events - might facilitate therapeutic psychedelic effects because of the unique psychosocial environments they comprise. This prospective, longitudinal study sought to investigate 2 primary questions: first, whether adults with maltreatment histories planning to use psychedelic drugs with therapeutic intent at ceremonies or raves would see enduring psychological benefits after their experiences; and second, whether subjective dimensions of the acute psychedelic experience would be associated with lasting psychological benefits. Eighty-five participants completed self-report measures in the month before, within 2 days after, and approximately 2 months after a planned psychedelic experience with therapeutic intent at a ceremony or rave assessing childhood maltreatment history; trauma symptoms, internalized (trait) shame, and connectedness at baseline and follow-up; and various dimensions of the acute subjective psychedelic experience. Mean scores in posttraumatic stress disorder (PTSD) symptoms, complex PTSD symptoms, trait shame, social connectedness, and general connectedness significantly improved from baseline to 2-month follow-up (ds = 0.73-1.12). Longitudinal changes in outcomes significantly correlated with acute subjective effects of the psychedelic experience. These findings have implications regarding both the potential clinical benefit of psychedelic use among adults with childhood maltreatment histories as well as the psychological mechanisms of therapeutic action of psychedelics.

Contextual and experiential aspects of the psychedelic experience predicting improvement in subjective wellbeing: results from a Norwegian internet convenience sample

Background

Interest in the therapeutic effects of classical psychedelics has risen recently. However, little epidemiological knowledge exists about the use of classical psychedelics in Scandinavian countries. Additionally, there is a limited understanding of what factors drive self-reported improvement in wellbeing. The aim of this study was to investigate the relationship between the use of classical psychedelics and outcomes related to subjective wellbeing in an adult, Norwegian-speaking sample. We examined how contextual and phenomenological variables were associated with self-reported subjective wellbeing.

Methods

Using an anonymous internet survey, we recruited Norwegian speaking subjects who have had a memorable experience after taking a classic psychedelic substance. Data are presented by using descriptive statistics about the sample and two hierarchical regression analyses. The first regression analysis examined contextual variables, and the second examined variables related to acute phenomena during the experience.

Results

The survey showed that 85% of the sample reported a small to large positive change in subjective wellbeing after their experience with classical psychedelics. Integration, ego dissolution, and emotional breakthrough had a clear, positive predictive effect on the participants' self-reported subjective wellbeing. Variables with lower but significant effects were the degree of challenging experiences, settings associated with nature or ceremony, and a therapeutic or seeking intention.

Conclusion

The use of classical psychedelics leads to an increase in subjective wellbeing for the majority of the participants. This relationship seems dependent upon various experiential aspects of acute subjective drug effects. These findings should be viewed as hypothesis-generating rather than confirmatory due to the study's limitations.

From Efficacy to Effectiveness: Evaluating Psychedelic Randomized Controlled Trials for Trustworthy Evidence-Based Policy and Practice

The recent review of a new drug application for MDMA-assisted therapy for posttraumatic stress disorder by the United States' Food and Drug Administration (FDA) highlighted epistemological and methodological challenges for evidence assessments. Similar challenges will also be faced in reviews of other compounds in early- and late-stage development, like psilocybin for depression. The regulatory demand for two successful phase 3 randomized controlled trials (RCTs) seems problematic, given a current lack of agreement on what constitutes "success", particularly when psychoactive drug administration is concomitant with (psycho)therapy. These complex arrangements challenge the internal validity of estimated average treatment effect through comparison with conventional control conditions. This paper reviews the assumptions behind RCTs' current "gold-standard" status in the hierarchy of evidence-based medicine (EBM). Recapitulating known epistemic limits of randomization and blinding, it emphasizes the urgent need to avoid the extrapolation fallacy. The resulting argument is that the degree of trustworthiness that efficacy-reported in RCTs-will reliably predict effectiveness-in target populations outside RCTs-depends on what type of psychedelic treatments will be regulated. If "stand-alone" drugs for large-scale prescription and consumption, trustworthiness should be graded low. On the other hand, for regulation of drug-assisted (psycho) therapies, the degree of trustworthiness can be considered high. The reason being that these two treatment approaches are based on different causal claims with distinct external validities. Therefore, careful assessment of support factors in each is recommended to prevent detrimental consequences, from potential rejection of effective therapies up to medical reversal of eventually approved drugs.

Moderating factors in psilocybin-assisted treatment affecting mood and personality: A naturalistic, open-label investigation

RATIONALE

Psychedelic-assisted therapy is increasingly applied within mental health treatment.

OBJECTIVES

This study focused on factors moderating changes in the acute and long-term effects of an individual psilocybin-assisted program on depression, anxiety, PTSD and personality structures by including demographic factors, subjective experience and degree of mystical type experiences during the dosing, as well as emotional breakthrough and personal growth after the program.

METHODS

At baseline, 1 week and 3 months after the psilocybin program participants completed the Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), PTSD Checklist for DSM-5 (PCL-5) and NEO Five-Factor Inventory-3 (NEO-FFI-3). In addition, after the dosing the Mystical Experiences Questionnaire (MEQ-30), Posttraumatic Growth Inventory (PTGI) and Emotional Breakthrough Inventory (EBI) were administered. Moderation effects were established using linear mixed-model analysis.

RESULTS

A single high dose of psilocybin in combination with therapy was found to lower symptoms of anxiety, depression, PTSD and neuroticism over a period of 3-months. Scores on openness and conscientiousness increased after the treatment only. Participants reported mystical type experiences, emotional breakthrough and personal growth. These subjective experiences together with demographic factors were moderating the observed positive changes.

CONCLUSIONS

Findings indicate that individual psilocybin-assisted therapy has the potential for beneficial effects on mood and personality characteristics. Moreover, the study highlights the importance of subjective experiences and demographic factors in moderating this effect. This study adds to the ongoing research on psilocybin-assisted therapy by investigating contributing factors for optimizing this evolving type of therapy.

Insights on psychedelics: A systematic review of therapeutic effects

BACKGROUND

Insight - a sudden change in understanding or perspective that feels true or reliable - is a common occurrence during psychedelic experiences, and often considered by clinicians and patients to be central to their therapeutic value. However, their occurrence and role has not been systematically assessed.

OBJECTIVES

We reviewed all peer-reviewed studies that published data on insight catalysed by a classic psychedelic at psychoactive levels to elucidate several aspects of psychedelic-catalysed insight, including its prevalence, relationship to dose, time-course, and relationship to therapeutic outcomes. Risk of bias was assessed regarding selection, reliability, causality, and transparency. PROSPERO registration: CRD42023405854 FINDINGS: The final database and key bibliography searches were completed on July 13, 2024. We screened 741 abstracts and included 98 studies (40 survey, 58 interventional). Insight was positively correlated with psychedelic dose, and was significantly higher following psychedelics in 43 of 46 (93 %) studies that presented a comparison to a placebo condition. Crucially, 25 of 29 studies (86 %) found that insight was associated with therapeutic improvement, and this relationship was often stronger than mystical-type experience, which has received more research attention.

INTERPRETATION

This review indicates that psychedelic-catalysed insight is associated with therapeutic improvement, suggesting its importance for clinical practice and for understanding the mechanisms of psychedelic therapy.

LIMITATIONS

Heterogeneous study designs and operationalisations of insight precluded a meta-analytic summary. Publication bias and selective reporting is possible, given insight was typically not a primary outcome of the included studies.

A prospective ecological momentary assessment study of an ayahuasca retreat: exploring the salutary impact of acute psychedelic experiences on subacute affect and mindfulness skills in daily life

RATIONALE

To examine the acute effects of ayahuasca use and their relationship to sub-acute changes in affect and mindfulness in a non-clinical sample, addressing the need for a better understanding of ayahuasca's immediate and short-term impacts as interest in its use grows.

OBJECTIVES

Using prospective ecological assessment, this study investigates how ayahuasca used at a 4-day retreat affects positive/negative affect and mindfulness skills in daily living compared to pre-retreat. Additionally, we explore acute psychedelic experiences during the ayahuasca retreat, assessed retrospectively 1-2 days post-retreat, as potential mechanisms for theorized effects in daily living post-retreat.

METHODS

Thirty-six participants reported positive/negative affect and mindfulness skills three times daily for 5 days before and after the retreat. Baseline assessments included lifetime psychedelic experience, and post-retreat assessments covered acute ayahuasca experiences. Mixed-effect linear models were used to analyze the data.

RESULTS

Post-retreat, we observed reduced negative affect, increased positive affect, and enhanced mindfulness skills in daily living. Ayahuasca-induced acute experiences, such as time/space transcendence, emotional breakthrough and challenging experiences predicted greater subacute positive affect. Notably, none of these experiences were linked to subacute improvements in negative affect or mindfulness. No participants showed clinically significant adverse responses post-retreat, and only 5.5% exhibited some degree of potentially clinically significant deterioration in affect.

CONCLUSIONS

Ayahuasca use may lead to improvement in mood and mindfulness skills, and key acute psychedelic experiences induced by ayahuasca may be important to some of these salutary effects, positive affect in particular.

Single-dose psilocybin therapy for alcohol use disorder: Pharmacokinetics, feasibility, safety and efficacy in an open-label study

BACKGROUND

Psilocybin, a serotonin 2A receptor agonist with psychedelic properties, shows promise as a novel treatment for alcohol use disorder (AUD). While current studies involve two dosing sessions, the effects of a single dose have not been investigated.

AIMS

To investigate the pharmacokinetics, feasibility, safety and efficacy of single-dose psilocybin therapy in AUD.

METHODS

This open-label, single-group study investigated single-dose psilocybin therapy in 10 treatment-seeking adults (8 men and 2 women; median age 44 years) with severe AUD. The treatment involved two preparation sessions, a high-dose psilocybin session (25 mg) and two integration sessions. Pharmacokinetics were determined by noncompartmental analysis, and changes in alcohol consumption, craving and self-efficacy, were assessed using a linear mixed model.

RESULTS

Notable between-participant pharmacokinetic variations were observed, with peak plasma psilocin concentrations ranging from 14 to 59 µg/L. Alcohol consumption significantly decreased over the 12 weeks following psilocybin administration. Heavy drinking days were reduced by 37.5 percentage points (95% CI: -61.1 to -13.9, p = 0.005), and drinks per day decreased by 3.4 drinks (95% CI: -6.5 to -0.3, p = 0.03). This was corroborated by reports of rapid and sustained reductions in craving and increases in self-efficacy.

CONCLUSIONS

Despite pharmacokinetic variations, a single 25 mg psilocybin dose was safe and effective in reducing alcohol consumption in AUD patients. Larger randomised, placebo-controlled, single-dose AUD trials are warranted.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/study/NCT04718792.

Processing of self-related thoughts in experienced users of classic psychedelics: A source localisation EEG study

BACKGROUND

Psychedelics have gained increasing interest in scientific research due to their ability to induce profound alterations in perception, emotional processing and self-consciousness. However, the research regarding the functioning of individuals who use psychedelics in naturalistic contexts remains limited.

AIMS

Here we aim to explore psychological and neurophysiological differences between naturalistic psychedelics users and non-users in terms of processing of self-related thoughts.

METHODS

We use behavioural testing combined with electroencephalography (EEG) with source localisation. To mitigate potential confounding effects of personality traits and personal history which makes one willing to take psychedelics, we compared users to individuals who did not take psychedelics, but are intending to do so in the future. To ensure robustness of our results, we included two datasets collected at two different laboratories.

RESULTS

The results from Dataset I (N = 70) suggest that during self-related thoughts psychedelics users exhibit weaker increases in alpha and beta power in comparison to non-users, primarily in brain regions linked to processing of self-related information and memory (such as posterior cingulate cortex). However, analysis of Dataset II (N = 38) did not replicate the between-group effects, possibly due to the smaller sample size and spatial resolution limitations.

CONCLUSIONS

While non-replicability restricts interpretation of our findings, our research expands the ongoing discussion on strength and duration of the psychedelic effects, specifically in brain circuits associated with self-related processing, and its relationship to well-being. Our results fit into growing scepticism about the specificity of the role of default-mode network hubs in changes associated with psychedelics experience.

Benefits and Challenges of Ultra-Fast, Short-Acting Psychedelics in the Treatment of Depression

Unlike classical antidepressants, psychedelics such as psilocybin have been shown to induce a rapid antidepressant response. In the wake of this development, interest has emerged in ultra-fast, short-acting psychedelics such as 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) and N,N-dimethyltryptamine (DMT) with the expectation that these can produce rapid antidepressant effects following an intense but brief psychedelic intervention. The current paper reviews the clinical pharmacology of 5-MeO-DMT and DMT and their potential benefits and challenges in the treatment of depression. Both compounds display affinities for a variety of monoamine receptors and transporters, but mostly so for serotonergic (5HT) receptors, including 5HT1A and 5HT2A. Early clinical trials in small samples have shown that short interventions (15-30 min) with 5-MeO-DMT and DMT are safe and well tolerated and can induce marked improvement in symptoms of depression within 24 hours that sustain for at least 1 week. Data on long-term efficacy are currently scarce but do suggest a prolongation of the treatment response. Potential benefits of these treatments include flexible, single day dosing regimens, achievement of treatment efficacy independent from integrative therapy, and ease of clinical implementation. Future challenges include establishing the duration of the antidepressant effect and strategies on how to sustain the antidepressant response, optimization of treatment delivery parameters, and a mechanistic understanding of the clinical response. Acceptance of ultra-fast, short-acting psychedelics will depend on future randomized, placebo-controlled trials with a focus on replication, duration and maintenance of antidepressant efficacy in large patient samples.

Measuring transformative virtual reality experiences in children's drawings

Transformative experiences in an individual's life have a lasting impact on identity, belief system, and values. At the core of these experiences is the complex emotion of awe that promotes learning, making it worthwhile to study from an educational point of view. Drawing studies may provide a useful measure of awe in children-one that is more intuitive and attractive than questionnaires alone. Previous studies conducted with adults indicated that the diminished self, associated with transformative experiences, manifests in an actual decrease in size for figures representing the self in drawings. In the current study, self-representation was investigated in drawings of 10- to 12-year-old primary school children within the context of an immersive virtual reality (VR) experience that elicits the overview effect, known to lead to an intense apperception of awe. We did not replicate the adult findings regarding self-size in this younger age group. However, details and complexity in children's drawings appeared to be impacted by the awe-elicitation procedure in VR. These elements subsequently correlated to learning gains instead of the overview effect, indicating that this measure could be linked to cognitive ability. The findings of the current study contribute to a better understanding of how drawings reflect self-transcendental experiences; however, they also reveal that in younger age groups, they are not necessarily reflected in decreased self-size.

Phenomenology of Psychedelic Experiences and Psychedelic-Associated Distressing Effects: Quantifying Subjective Experiences

The range of phenomena that can be induced by psychedelic substances is broad and variable, including effects on perception, cognition, and emotion. The umbrella term "psychedelic phenomenology" is used to refer to a combination of altered experiential features, such as hallucinations or ego dissolution, which together constitute a psychedelic experience. However, there is no consensus on the set of alterations of consciousness that qualifies an altered state to be a "psychedelic state." In this chapter we summarize the most commonly discussed changes in subjective experiences which could be seen as "core features" of psychedelic experiences. While acknowledging the rich history of pioneering phenomenological work of the last century, this chapter focuses on more recent developments in the quantitative work on the assessment of these phenomena. We also address the under-researched phenomenology of distressing effects, often referred to as "challenging experiences" or "bad trips," and point to their importance in understanding the therapeutic potential and risks associated with psychedelic phenomenology. Historically, one can find many links between psychedelic phenomenology and the phenomenology of psychopathology. We stress the importance to refine the assessment and description also of distressing effects, to identify factors that promote acute experiences which are beneficial and limit those which can have potentially harmful long-term effects.

Synergistic, multi-level understanding of psychedelics: three systematic reviews and meta-analyses of their pharmacology, neuroimaging and phenomenology

Serotonergic psychedelics induce altered states of consciousness and have shown potential for treating a variety of neuropsychiatric disorders, including depression and addiction. Yet their modes of action are not fully understood. Here, we provide a novel, synergistic understanding of psychedelics arising from systematic reviews and meta-analyses of three hierarchical levels of analysis: (1) subjective experience (phenomenology), (2) neuroimaging and (3) molecular pharmacology. Phenomenologically, medium and high doses of LSD yield significantly higher ratings of visionary restructuralisation than psilocybin on the 5-dimensional Altered States of Consciousness Scale. Our neuroimaging results reveal that, in general, psychedelics significantly strengthen between-network functional connectivity (FC) while significantly diminishing within-network FC. Pharmacologically, LSD induces significantly more inositol phosphate formation at the 5-HT2A receptor than DMT and psilocin, yet there are no significant between-drug differences in the selectivity of psychedelics for the 5-HT2A, 5-HT2C, or D2 receptors, relative to the 5-HT1A receptor. Our meta-analyses link DMT, LSD, and psilocybin to specific neural fingerprints at each level of analysis. The results show a highly non-linear relationship between these fingerprints. Overall, our analysis highlighted the high heterogeneity and risk of bias in the literature. This suggests an urgent need for standardising experimental procedures and analysis techniques, as well as for more research on the emergence between different levels of psychedelic effects.

Personal psychedelic experience of psychedelic therapists during training: should it be required, optional, or prohibited?

Personal psychedelic experience is common among psychedelic therapists and often considered to be a necessary aspect of training: only personal psychedelic experience allows psychedelic therapists to properly guide patients through their own psychedelic experience, to truly understand that experience, and to help them integrate it into their lives. But is this really true? The present paper examines the value of therapists' personal psychedelic experience, why this value may be higher than that of personal experience with other psychotropic drugs, and whether it justifies a requirement of personal psychedelic experience for psychedelic therapists. The analysis, which also considers the literature on therapists' personal experience with the mental disorder being treated or with psychotherapy, concludes that the current evidence does not justify making personal psychedelic(-like) experience a requirement for psychedelic therapists. However, because therapists' personal psychedelic experience can be valuable to both therapists and patients, and because the likelihood of harm is very low, psychedelic therapists should be given the opportunity to have a psychedelic experience during their training.

Effects of classical psychedelics on implicit and explicit emotional empathy and cognitive empathy: a meta-analysis of MET task

This meta-analysis investigates the effect of classic psychedelic drugs on empathy and focuses on cognitive and emotional empathy measured using the Multifaceted Empathy Test (MET). Empathy entails the ability to understand and share the feelings of another and is a significant component of social interaction. Several studies have examined the effects of psychedelic drugs such as LSD, psilocybin and ayahuasca on empathy, yet their overall effect has not been studied so far. In this meta-analysis, we reviewed data from studies up to November 2023 with the aim of examining the effects of various psychedelic drugs on empathic abilities broadly. Our findings suggest that classical psychedelics significantly enhance explicit and implicit emotional empathy without affecting measures of cognitive empathy. The results emphasize the need to continue testing the therapeutic potential of classic psychedelic drugs.

From antidepressants and psychotherapy to oxytocin, vagus nerve stimulation, ketamine and psychedelics: how established and novel treatments can improve social functioning in major depression

Social cognitive deficits and social behavior impairments are common in major depressive disorder (MDD) and affect the quality of life and recovery of patients. This review summarizes the impact of standard and novel treatments on social functioning in MDD and highlights the potential of combining different approaches to enhance their effectiveness. Standard treatments, such as antidepressants, psychotherapies, and brain stimulation, have shown mixed results in improving social functioning, with some limitations and side effects. Newer treatments, such as intranasal oxytocin, mindfulness-based cognitive therapy, and psychedelic-assisted psychotherapy, have demonstrated positive effects on social cognition and behavior by modulating self-referential processing, empathy, and emotion regulation and through enhancement of neuroplasticity. Animal models have provided insights into the neurobiological mechanisms underlying these treatments, such as the role of neuroplasticity. Future research should explore the synergistic effects of combining different treatments and investigate the long-term outcomes and individual differences in response to these promising interventions.

Naturalistic psychedelic therapy: The role of relaxation and subjective drug effects in antidepressant response

BACKGROUND

Psychedelic-assisted therapy (PAT) is permitted in Switzerland under its limited medical use program. Data from patients in this program represent a unique opportunity to analyze the real-world practice of PAT.

AIMS

This study compared the subjective effects of lysergic acid diethylamide (LSD) and psilocybin between patients undergoing PAT and healthy volunteers. For the patients, it also investigated the relationship between antidepressant effects and six measures of acute drug effects.

METHODS

We compared data on acute psychedelic drug effects between 28 PAT patients with data from 28 healthy participants who participated in a randomized, double-blind crossover trial. All participants received varying doses of psilocybin and LSD. Subjective effects were assessed on an hourly basis during the acute drug effects, and the Mystical Experience Questionnaire (MEQ) was completed retrospectively. For patients, depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS).

RESULTS

Ratings of overall drug effect and mystical experience were similar across groups. Compared with healthy controls, patients reported lower ratings of ego dissolution. Patients showed a significant decrease in MADRS scores, and the greatest predictor of antidepressant outcome was relaxation during the PAT session. We did not observe a relationship between mystical-type experiences and antidepressant effects. Most patients experienced mild adverse effects which resolved within 48 h.

CONCLUSION

PAT reduced depressive symptoms in this heterogeneous patient group. Patients may experience more challenging psychedelic effects and reduced ego dissolution. Hourly assessment of drug effects may predict clinical outcomes better than retrospectively assessed mystical experiences, and the impact of relaxation during PAT should be investigated further.

Neurophenomenological Investigation of Mindfulness Meditation "Cessation" Experiences Using EEG Network Analysis in an Intensively Sampled Adept Meditator

Mindfulness meditation is a contemplative practice that is informed by Buddhism. It has been proven effective for improving mental and physical health in clinical and non-clinical contexts. To date, mainstream dialogue and scientific research on mindfulness has focused primarily on short-term mindfulness training and applications of mindfulness for reducing stress. Understanding advanced mindfulness practice has important implications for mental health and general wellbeing. According to Theravada Buddhist meditation, a "cessation" event is a dramatic experience of profound clarity and equanimity that involves a complete discontinuation in experience, and is evidence of mastery of mindfulness meditation. Thirty-seven cessation events were captured in a single intensively sampled advanced meditator (over 6,000 h of retreat mindfulness meditation training) while recording electroencephalography (EEG) in 29 sessions between November 12, 2019 and March 11, 2020. Functional connectivity and network integration were assessed from 40 s prior to cessations to 40 s after cessations. From 21 s prior to cessations there was a linear decrease in large-scale functional interactions at the whole-brain level in the alpha band. In the 40 s following cessations these interactions linearly returned to prior levels. No modulation of network integration was observed. The decrease in whole-brain functional connectivity was underlain by frontal to left temporal and to more posterior decreases in connectivity, while the increase was underlain by wide-spread increases in connectivity. These results provide neuroscientific evidence of large-scale modulation of brain activity related to cessation events that provides a foundation for future studies of advanced meditation.

Translation and Initial Psychometric Evaluation of Spanish Versions of Three Psychedelic Acute Effects Measures: Mystical, Challenging, and Insight Experiences

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.

Development of the Japanese version of the Challenging Experience Questionnaire

INTRODUCTION

The therapeutic potential of psychedelics for various mental disorders has gained significant interest. Previous studies have highlighted that psychedelics induce psychoactive effects, including challenging aspects of experiences. These experiences are assessed using the Challenging Experience Questionnaire (CEQ), yet its Japanese version has been unavailable. This study aimed to create a Japanese version of the CEQ.

METHODS

We followed the "Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation." Initially, two Japanese psychiatrists independently conducted the forward translations. These were then reconciled into a single version, which was back-translated into English. The original authors reviewed this back-translation for accuracy, leading to revisions through continuous dialogue until the original authors approved the final version.

RESULTS

The final, approved back-translated version of the CEQ is presented in the figure.

CONCLUSIONS

This study developed a Japanese version of the CEQ, enabling the assessment of challenging experiences during psychedelic-assisted therapy for Japanese speakers. Further studies are needed to assess the reliability and validity of this newly translated version.

Effects of Psychedelics in Older Adults: A Prospective Cohort Study

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.

On the mushrooming reports of "quiet quitting": Employees' lifetime psilocybin use predicts their overtime hours worked

Despite the recent and sharp rise in psychedelic research, few studies have investigated how classic psychedelic use relates to employees' work-related outcomes. This is surprising given that the increased use, decriminalization, and legalization of classic psychedelics in the United States (U.S.) has the potential to impact both employees and their organizations. Addressing this gap, the current study explores how employees' lifetime psilocybin use relates to the amount of overtime they work, thereby offering insight into what current trends in psilocybin use could mean for businesses. Using pooled, cross-sectional data from the National Survey on Drug Use and Health (2002-2014) on 217,963 adults employed in the U.S. full-time, this study tests whether lifetime psilocybin use is associated with employees' number of overtime hours worked in the past week. After adjusting for sociodemographics and other substance use, a significant negative association is found between employees' lifetime psilocybin use and the amount of overtime they reported working. Specifically, the findings suggest that lifetime psilocybin use in the U.S. full-time working population is associated with an estimated 44,348,400 fewer overtime hours worked per year and may help explain recent findings linking employees' lifetime psilocybin use to a reduction in sick leave taken.

N, N-Dimethyltryptamine (DMT)-Occasioned Familiarity and the Sense of Familiarity Questionnaire (SOF-Q)

This study investigated the sense of familiarity attributed to N, N-dimethyltryptamine (DMT) experiences. 227 naturalistic inhaled-DMT experiences reporting a sense of familiarity were included. No experiences referenced a previous DMT or psychedelic experience as the source of the familiarity. A high prevalence of concomitant features discordant from ordinary consciousness were identified: features of a mystical experience (97.4%), ego-dissolution (16.3%), and a "profound experience of death" (11.0%). The Sense of Familiarity Questionnaire (SOF-Q) was developed assessing 19 features of familiarity across 5 themes: (1) Familiarity with the Feeling, Emotion, or Knowledge Gained; (2) Familiarity with the Place, Space, State, or Environment; (3) Familiarity with the Act of Going Through the Experience; (4) Familiarity with Transcendent Features; and (5) Familiarity Imparted by an Entity Encounter. Bayesian latent class modeling yielded two stable classes of participants who shared similar SOF-Q responses. Class 1 participants responded, "yes" more often for items within "Familiarity Imparted by an Entity Encounter" and "Familiarity with the Feeling, Emotion, or Knowledge Gained." Results catalogued features of the sense of familiarity imparted by DMT, which appears to be non-referential to a previous psychedelic experience. Findings provide insights into the unique and enigmatic familiarity reported during DMT experiences and offer a foundation for further exploration into this intriguing phenomenon.

Within-subject comparison of near-death and psychedelic experiences: acute and enduring effects

Mystical-like states of consciousness may arise through means such as psychedelic substances, but may also occur unexpectedly during near-death experiences (NDEs). So far, research studies comparing experiences induced by serotonergic psychedelics and NDEs, along with their enduring effects, have employed between-subject designs, limiting direct comparisons. We present results from an online survey exploring the phenomenology, attribution of reality, psychological insights, and enduring effects of NDEs and psychedelic experiences (PEs) in individuals who have experienced both at some point during their lifetime. We used frequentist and Bayesian analyses to determine significant differences and overlaps (evidence for null hypotheses) between the two. Thirty-one adults reported having experienced both an NDE (i.e. NDE-C scale total score ≥27/80) and a PE (intake of lysergic acid diethylamide, psilocybin/mushrooms, ayahuasca, N,N-dimethyltryptamine, or mescaline). Results revealed areas of overlap between both experiences for phenomenology, attribution of reality, psychological insights, and enduring effects. A finer-grained analysis of the phenomenology revealed a significant overlap in mystical-like effects, while low-level phenomena (sensory effects) were significantly different, with NDEs displaying higher scores of disembodiment and PEs higher scores of visual imagery. This suggests psychedelics as a useful model for studying mystical-like effects induced by NDEs, while highlighting distinctions in sensory experiences.

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

Out-of-body experiences in relation to lucid dreaming and sleep paralysis: A theoretical review and conceptual model

Out-of-body experiences (OBEs) are characterized by the subjective experience of being located outside the physical body. Little is known about the neurophysiology of spontaneous OBEs, which are often reported by healthy individuals as occurring during states of reduced vigilance, particularly in proximity to or during sleep (sleep-related OBEs). In this paper, we review the current state of research on sleep-related OBEs and hypothesize that maintaining consciousness during transitions from wakefulness to REM sleep (sleep-onset REM periods) may facilitate sleep-related OBEs. Based on this hypothesis, we propose a new conceptual model that potentially describes the relationship between OBEs and sleep states. The model sheds light on the phenomenological differences between sleep-related OBEs and similar states of consciousness, such as lucid dreaming (the realization of being in a dream state) and sleep paralysis (feeling paralyzed while falling asleep or waking up), and explores the potential polysomnographic features underlying sleep-related OBEs. Additionally, we apply the predictive coding framework and suggest a connecting link between sleep-related OBEs and OBEs reported during wakefulness.

A framework for assessment of adverse events occurring in psychedelic-assisted therapies

OBJECTIVE

Despite considerable research examining the efficacy of psychedelic-assisted therapies (PATs) for treating psychiatric disorders, assessment of adverse events (AEs) in PAT research has lagged. Current AE reporting standards in PAT trials are poorly calibrated to features of PAT that distinguish it from other treatments, leaving many potential AEs unassessed.

METHODS

A multidisciplinary working group of experts involved in PAT pooled formally and informally documented AEs observed through research experience and published literature. This information was integrated with (a) current standards and practices for AE reporting in pharmacotherapy and psychotherapy trials and (b) published findings documenting post-acute dosing impacts of psychedelics on subjective states, meaning, and psychosocial health variables, to produce a set of AE constructs important to evaluate in PAT as well as recommended methods and time frames for their assessment and monitoring. Correspondence between identified potential AEs and current standards for AE assessment was examined, including the extent of coverage of identified AE constructs by 25 existing measures used in relevant research.

RESULTS

Fifty-four potential AE terms warranting systematized assessment in PAT were identified, defined, and categorized. Existing measures demonstrated substantial gaps in their coverage of identified AE constructs. Recommendations were developed for how to assess PAT AEs (including patient, clinician, and informant reports), and when to assess over preparation, dosing session, integration, and follow-up. Application of this framework is demonstrated in a preliminary assessment protocol (available in the supplement).

CONCLUSIONS

This assessment framework addresses the need to capture post-acute dosing AEs in PAT, accounting for its pharmacotherapy and psychotherapy components, as well as documented impacts of psychedelics on worldviews and spirituality.

The neurobiology of aesthetic chills: How bodily sensations shape emotional experiences

The phenomenon of aesthetic chills-shivers and goosebumps associated with either rewarding or threatening stimuli-offers a unique window into the brain basis of conscious reward because of their universal nature and simultaneous subjective and physical counterparts. Elucidating the neural mechanisms underlying aesthetic chills can reveal fundamental insights about emotion, consciousness, and the embodied mind. What is the precise timing and mechanism of bodily feedback in emotional experience? How are conscious feelings and motivations generated from interoceptive predictions? What is the role of uncertainty and precision signaling in shaping emotions? How does the brain distinguish and balance processing of rewards versus threats? We review neuroimaging evidence and highlight key questions for understanding how bodily sensations shape conscious feelings. This research stands to advance models of brain-body interactions shaping affect and may lead to novel nonpharmacological interventions for disorders of motivation and pleasure.

Neurophysiological evidence for the overview effect: a virtual reality journey into space

The Overview Effect is a complex experience reported by astronauts after viewing Earth from space. Numerous accounts suggest that it leads to increased interconnectedness to other human beings and environmental awareness, comparable to self-transcendence. It can cause fundamental changes in mental models of the world, improved well-being, and stronger appreciation of, and responsibility for Earth. From a cognitive perspective, it is closely linked to the emotion of awe, possibly triggered by the overwhelming perceived vastness of the universe. Given that most research in the domain focuses on self-reports, little is known about potential neurophysiological markers of the Overview Effect. In the experiment reported here, participants viewed an immersive Virtual Reality simulation of a space journey while their brain activity was recorded using electroencephalography (EEG). Post-experimental self-reports confirmed they were able to experience the Overview Effect in the simulated environment. EEG recordings revealed lower spectral power in beta and gamma frequency bands during the defining moments of the Overview Effect. The decrease in spectral power can be associated with reduced mental processing, and a disruption of known mental structures in this context, thereby providing more evidence for the cognitive effects of the experience.

Psilocybin and Motor Function: A Triple-Blind, Dose-Finding Study in Healthy Participants

Background

There has been a resurgence of research into the potential therapeutic benefits of psychedelics for neuropsychiatric disorders. Classic psychedelics, such as psilocybin, exert complex effects on higher cognitive functions such as perception and awareness, but their impact on motor function remains unexplored. Moreover, there is a theoretical rationale for using psychedelics to promote motor retraining in certain neuropsychiatric conditions associated with motor dysfunction. This protocol paper outlines the first study to investigate the feasibility and safety of performing movement tasks during the acute effects of psilocybin in healthy participants. The findings from this study will further our understanding of the impact of psychedelics on motor function, and inform future studies that combine classic psychedelics with motor retraining in clinical populations.

Methods

12 healthy participants will each receive three doses of psilocybin (between 5 and 20 mg) in a randomized order, with each dose administered at least 1 week apart. Participants, the trial physiotherapists, and statisticians will remain blinded to the psilocybin dose. A battery of measures assessing motor function will be completed during the acute drug effects. In addition, measures of safety, pre- and post-dose resting-state brain activity via functional magnetic resonance imaging, and participants' subjective experience will be assessed.

Health Benefits and Positive Acute Effects of Psilocybin Consumption: A Quantitative Textual Analysis of User Self-Reported Data

There has been growth in the use of psychedelics by the global population in recent years. In addition to recreational and ritualistic use, recent research into psychedelics has brought advances for treating mental disorders. Understanding the specific circumstances in which psilocybin leads to positive outcomes may have important implications for the future of its clinical use and for harm reduction initiatives. This study aimed to investigate the positive effects from the consumption of psilocybin through public online self-reports. We sought to investigate health benefits promoted by the consumption of the substance, positive acute effects, and contextual details of these experiences. We analyzed 846 reports with the assistance of the IRaMuTeQ textual analysis software, adopting the procedures of Descending Hierarchical Classification, Correspondence Factor Analysis, and Specificities Analysis. The texts were grouped in 5 clusters, describing the content of mental experiences, cognitive processes, somatic experiences, perceptual alterations, and context of administration. The findings of this study reinforce central axes of the psychedelic experience, such as the presence of somatic and visual alterations, connectedness and feeling one with the world and effects of setting, as well as the beneficial character of mystical experiences this substance promotes, and the importance of the ego-dissolution phenomenon.

Psychedelic therapy in depression and substance use disorders

Psychoactive substances obtained from botanicals have been applied for a wide variety of purposes in the rituals of different cultures for thousands of years. Classical psychedelics from N,N'-dimethyltryptamine, psilocybin, mescaline and various lysergamides cause specific alterations in perception, emotion and cognition by acting through serotonin 5-HT2A receptor activation. Lysergic acid diethylamide, the first famous breakthrough in the field, was discovered by chance by Albert Hoffman in the Zurich Sandoz laboratory in 1943, and studies on its psychoactive effects began to take place in the literature. Studies in this area were blocked after the legislation controlling the use and research of psychedelic drugs came into force in 1967, but since the 1990s, it has started to be a matter of scientific curiosity again by various research groups. In particular, with the crucial reports of psychotherapy-assisted psilocybin applications for life-threatening cancer-related anxiety and depression, a new avenues have been opened in the treatment of psychiatric diseases such as treatment-resistant depression and substance addictions. An increasing number of studies show that psychedelics have a very promising potential in the treatment of neuropsychiatric diseases where the desired efficiency cannot be achieved with conventional treatment methods. In this context, we discuss psychedelic therapy, encompassing its historical development, therapeutic applications and potential treatment effects-especially in depression, trauma disorders and substance use disorders-within the framework of ethical considerations.

Psychedelics in developmental stuttering to modulate brain functioning: a new therapeutic perspective?

Developmental stuttering (DS) is a neurodevelopmental speech-motor disorder characterized by symptoms such as blocks, repetitions, and prolongations. Persistent DS often has a significant negative impact on quality of life, and interventions for it have limited efficacy. Herein, we briefly review existing research on the neurophysiological underpinnings of DS -specifically, brain metabolic and default mode/social-cognitive networks (DMN/SCN) anomalies- arguing that psychedelic compounds might be considered and investigated (e.g., in randomized clinical trials) for treatment of DS. The neural background of DS is likely to be heterogeneous, and some contribution from genetically determinants of metabolic deficiencies in the basal ganglia and speech-motor cortical regions are thought to play a role in appearance of DS symptoms, which possibly results in a cascade of events contributing to impairments in speech-motor execution. In persistent DS, the difficulties of speech are often linked to a series of associated aspects such as social anxiety and social avoidance. In this context, the SCN and DMN (also influencing a series of fronto-parietal, somato-motor, and attentional networks) may have a role in worsening dysfluencies. Interestingly, brain metabolism and SCN/DMN connectivity can be modified by psychedelics, which have been shown to improve clinical evidence of some psychiatric conditions (e.g., depression, post-traumatic stress disorder, etc.) associated with psychological constructs such as rumination and social anxiety, which also tend to be present in persistent DS. To date, while there have been no controlled trials on the effects of psychedelics in DS, anecdotal evidence suggests that these agents may have beneficial effects on stuttering and its associated characteristics. We suggest that psychedelics warrant investigation in DS.

Psychological effects of psychedelics in adolescents

This study aimed to investigate differences in long-term psychological effects, acute subjective effects, and side effects associated with psychedelic use in adolescents (aged 16-24), compared with adults (aged 25+). Data from two observational online survey cohorts was pooled, involving adolescents (average age 20.4 ± 2.2, N = 435) and adults (average age 36.5 ± 9.7, range = 25-71, N = 654) who self-initiated a psychedelic experience and were tracked via online surveys from a pre-experience baseline to four weeks post-use. Self-reported measures of well-being were collected one week before, and two and four weeks after psychedelic use. Acute subjective drug effects, dosage and contextual variables pertaining to the setting of use were measured on the day after the session. Repeated-measures analyses of covariance, t- and z-tests, as well as exploratory correlational and regression analyses tested differences in psychological changes, acute drug effects, and side effects between the two groups. Psychological well-being significantly improved in adolescents two and four weeks following psychedelic use, with a clinically relevant mean change score of 3.3 points (95% CI: 1.1-5.5). on the Warwick-Edinburgh Mental Wellbeing Scale [F(1.8, 172.9) = 13.41, η 2G = .04, p < .001], statistically indistinguishable from changes in adults. Acute subjective effects differed between the age groups; adolescents reported significantly higher challenging experiences and ego-dissolution. In adolescents, visual symptoms related to "hallucinogen persisting perceptual disorder" (HPPD) were reported at a higher prevalence than in adults (73.5% vs. 34.2%, p < .001) but were reported as distressing by only one adolescent participant. To our knowledge, this is the first prospective study to examine the psychological effects of psychedelic use specifically in adolescents. Statistically significant improvements in psychological well-being and other domains of mental health were observed, consistent with effects seen previously in adults, providing tentative evidence for the potential utility of psychedelic interventions in adolescents. However, differences in acute subjective effects, specifically the less positive role of ego-dissolution experiences for long-term changes in adolescents, as well as a higher prevalence of HPPD-related symptoms suggest that special considerations might be required when assessing psychedelic treatment design and risks.

[Psilocybin-Assisted Treatment of Depression, Anxiety and Substance use Disorders: Neurobiological Basis and Clinical Application]

Successful therapy of mental disorders is very important in view of the high level of suffering of those affected. Since established pharmaceutical and psychotherapeutic approaches do not lead to the desired improvement in all cases, complementary or alternative treatment methods are intensively researched. Psilocybin-assisted psychotherapy seems particularly promising, and has been approved in the USA for larger clinical trials. Psilocybin belongs to the group of psychedelics and influences psychological experiences. In assisted therapy, psilocybin is administered in controlled doses under medical supervision to patients with different mental disorders. In the studies conducted so far, longer-term positive effects could be shown after just one or a few doses. In order to provide a better understanding of the potential therapeutic mechanisms, this article will first describe neurobiological and psychological effects of psilocybin. To better assess the potential of psilocybin-assisted psychotherapy for various disorders, clinical studies conducted so far with patients administered psilocybin are reviewed.

Archetype symbols and altered consciousness: a study of shamanic rituals in the context of Jungian psychology

The alteration of consciousness during shamanic rituals is both a physical and mystical phenomenon. It involves psychological and spiritual experiences. Through ritual practices, shamans can connect with archetype within the collective unconscious, utilizing trance-inducing techniques for "hallucinatory exploration". This study surveyed 75 participants to investigate the impact of prototype symbols in Shamanistic rituals on participants' consciousness states focusing on Jungian psychology's concept of archetype. The results indicate that archetype symbols in shamanic rituals can significantly influence participants' conscious state, leading them to experience a conscious dissolution of the self. Furthermore, archetype symbols have different effects at the stages of consciousness change. In particular, during the "Visionary Restructuralization" stage, archetype symbols, such as patterns, masks, totems and music, brought participants' consciousness to a peak and caused significant changes to it. These findings suggest that the metaphoric function of archetype symbols plays a crucial role in rituals. Archetype symbols connect the individual to the collective unconscious through visual images and symbolic imagery. They prompt the participants to experience emotional resonances that transcend individual experiences and affect their state of consciousness.

Psychedelics and the 'inner healer': Myth or mechanism?

BACKGROUND

Reference to an intrinsic healing mechanism or an 'inner healer' is commonplace amongst psychedelic drug-using cultures. The 'inner healer' refers to the belief that psychedelic compounds, plants or concoctions have an intrinsically regenerative action on the mind and brain, analogous to intrinsic healing mechanisms within the physical body, for example, after sickness or injury.

AIMS

Here, we sought to test and critique this idea by devising a single subjective rating item pertaining to perceived 'inner healing' effects.

METHODS

The item was issued to 59 patients after a single high (25 mg, n = 30) or 'placebo' (1 mg, n = 29) dose of psilocybin in a double-blind randomised controlled trial of psilocybin for depression.

RESULTS

Inner healer scores were higher after the high versus placebo dose of psilocybin (t = 3.88, p < 0.001). Within the high-dose sub-sample only, inner healer scores predicted improved depressive symptomatology at 2 weeks post-dosing.

CONCLUSIONS

The principle of activating inner healing mechanisms via psychedelics is scientifically nascent; however, this study takes a positivist and pragmatic step forward, asking whether it warrants further examination.

Effects of discontinuation of serotonergic antidepressants prior to psilocybin therapy versus escitalopram for major depression

BACKGROUND

There is growing evidence for the therapeutic effects of the psychedelic drug psilocybin for major depression. However, due to the lack of safety data on combining psilocybin with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) and concerns that there may be a negative interaction on efficacy, participants enrolling in psychedelic trials are usually required to discontinue SNRI/SNRIs prior to enrolling.

AIMS

Using data from a recent clinical trial examining the comparative efficacy the psychedelic drug psilocybin (P) combined with approximately 20 h of psychological support to a 6-week (daily) course of the SSRI escitalopram plus matched psychological support for major depressive disorder, we explored the effects of discontinuing SSRI/SNRIs prior to study enrolment on study outcomes.

METHODS

Exploratory post hoc analyses using linear mixed effects model were performed to investigate the discontinuation effect on various validated depression symptom severity scales and well-being. The impact of SSRI/SNRIs discontinuation on the acute psychedelic experience was also explored.

RESULTS/OUTCOMES

In the psilocybin group, there was a reduced treatment effect on all outcome measures for SSRI/SNRIs discontinuers compared with unmedicated patients at trial entry. However, no effects of discontinuation on measures of the acute psychedelic experience were found.

CONCLUSION

Discontinuation of SSRI/SNRIs before psilocybin might diminish response to treatment; however, as we did not test SSRI/SNRI continuation in our trial, we cannot infer such causation. Moreover, the exploratory nature of the analyses makes them hypothesis generating, and not confirmatory. A controlled trial of SSRI/SNRI discontinuation versus continuation prior to psilocybin is urgently required.

The potential of 5-methoxy-N,N-dimethyltryptamine in the treatment of alcohol use disorder: A first look at therapeutic mechanisms of action

Alcohol use disorder (AUD) remains one of the most prevalent psychiatric disorders worldwide with high economic costs. Current treatment options show modest efficacy and relapse rates are high. Furthermore, there are increases in the treatment gap and few new medications have been approved in the past 20 years. Recently, psychedelic-assisted therapy with psilocybin and lysergic acid diethylamide has garnered significant attention in the treatment of AUD. Yet, they require significant amounts of therapist input due to prolonged subjective effects (~4-12 h) leading to high costs and impeding implementation. Accordingly, there is an increasing interest in the rapid and short-acting psychedelic 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT). This paper offers a first look at potential therapeutic mechanisms for AUD by reviewing the current literature on 5-MeO-DMT. Primarily, 5-MeO-DMT is able to induce mystical experiences and ego-dissolution together with increases in psychological flexibility and mindfulness. This could decrease AUD symptoms through the alleviation of psychiatric mood-related comorbidities consistent with the negative reinforcement and self-medication paradigms. In addition, preliminary evidence indicates that 5-MeO-DMT modulates neural oscillations that might subserve ego-dissolution (increases in gamma), psychological flexibility and mindfulness (increases in theta), and the reorganization of executive control networks (increases in coherence across frequencies) that could improve emotion regulation and inhibition. Finally, animal studies show that 5-MeO-DMT is characterized by neuroplasticity, anti-inflammation, 5-HT2A receptor agonism, and downregulation of metabotropic glutamate receptor 5 with clinical implications for AUD and psychiatric mood-related comorbidities. The paper concludes with several recommendations for future research to establish the purported therapeutic mechanisms of action.

Development of the Japanese version of the Ego-Dissolution Inventory (EDI)

AIM

Psychedelics have recently gained attention as potential therapeutic agents for various psychiatric disorders. Previous research has highlighted that a diminished sense of self, commonly termed "ego-dissolution" is a pivotal feature of the psychedelic-induced state. While the Ego-Dissolution Inventory (EDI) is a widely acknowledged instrument for measuring this phenomenon, no Japanese version has been available. This study aimed to develop a Japanese version of the EDI.

METHODS

We adhered to the "Guidelines for Best Practices in the Translation and Cultural Modification Process for Patient-Reported Outcomes Instruments: Document from the ISPOR Committee on Translation and Cultural Modification" during our translation approach. Two Japanese psychiatrists independently conducted initial translations, and a consolidated version was achieved via mutual agreement. This version was then back-translated to English and assessed by the original authors for consistency. The repetitive modification process was conducted in continuous dialogues with the original authors until they accepted the concluding back-translated version.

RESULTS

The finalized, approved back-translated version of the EDI is presented in the accompanying figure. In addition, the authorized Japanese version of the EDI is included in the Appendix.

CONCLUSIONS

In this study, we successfully developed the Japanese version of the EDI. This instrument will assist in assessing ego-dissolution experiences associated with psychedelic-assisted therapy among Japanese speakers. Additional studies are necessary to evaluate the reliability and validity of this newly translated instrument.

Giving Consent to the Ineffable

A psychedelic renaissance is currently taking place in mental healthcare. The number of psychedelic-assisted therapy trials is growing steadily, and some countries already grant psychiatrists special permission to use psychedelics in non-research contexts under certain conditions. These clinical advances must be accompanied by ethical inquiry. One pressing ethical question involves whether patients can even give informed consent to psychedelic-assisted therapy: the treatment's transformative nature seems to block its assessment, suggesting that patients are unable to understand what undergoing psychedelic-assisted therapy actually means for them and whether it aligns with their values. The present paper argues that patients often have sufficient knowledge to give informed consent because they know that they want to change their negative status quo and that psychedelic-assisted therapy offers an effective way to do so. Accordingly, patients can understand what the transformative nature of psychedelic-assisted therapy means for them and a make a value-aligned choice even if they are unable to anticipate the manifestation of a psychedelic experience.

What Predicts Beneficial Outcomes in Psychedelic Use? A Quantitative Content Analysis of Psychedelic Health Outcomes

Interest in psychedelics and their possible therapeutic potential has been growing. Metaphysical belief theory asserts that these benefits stem from the adoption of comforting supernatural beliefs following a mystical experience. By contrast, predictive self-binding theory suggests that the beneficial outcomes of psychedelics are primarily driven by psychological insights. The present study tests these competing models of psychedelic benefits. We conducted a quantitative content analysis on unsolicited self-reports of psychedelic users available on Erowid.org, to examine the potential relations between psychological insight, ego dissolution, therapeutic intent, altered metaphysical belief, and enduring health outcomes. We randomly selected, coded, and analyzed two hundred forty psychedelic experience reports from the website. Path analysis using structural equation modeling showed that psychological insight, not metaphysical beliefs, uniquely predicted beneficial outcomes. Moreover, beneficial outcomes' positive relation to ego dissolution and therapeutic intent was fully mediated by psychological insight. These findings support the predictive self-binding model over the metaphysical belief model.

Keeping the promise: a critique of the current state of microdosing research

Introduction

The practice of taking small, sub-hallucinogenic doses of psychedelics, known as microdosing, has exploded in popularity over the last decade. Users claim benefits ranging from improved mood and enhanced creativity to an increased sense of meaning and connectedness in life. While research on microdosing is still lagging behind the shift in public opinion, several papers have been published in the last five years which attempted to assess the effects of microdosing.

Methods

This review paper aimed to critically analyze the research practices used in the recent wave of microdosing research: We reviewed 15 papers published before the closing date of this review in March 2022.

Results

Our review concludes that it is premature to draw any conclusions about the efficacy or safety of microdosing since the research quality cannot be considered confirmatory.

Discussion

We propose some potential causes for the current state of the literature and some suggestions for how these causes may be ameliorated.

Effects of Ayahuasca on Gratitude and Relationships with Nature: A Prospective, Naturalistic Study

Qualitative studies and anecdotal reports suggest that experiences with ayahuasca, a psychedelic brew found in Central and South America, may be followed by individuals enduringly feeling more grateful and connected to nature. Yet, to date, these changes have been understudied. Here, participants (N = 54) completed validated surveys related to gratitude, nature relatedness, and nature appreciation one-week before, one-week after, and one-month after attending an ayahuasca retreat center. Compared to baseline, there was a significant increase in gratitude, nature relatedness, and nature appreciation at the one-week and one-month follow-ups. Ratings of mystical-type experiences and awe, but not ego dissolution, during participants' ayahuasca sessions were weakly-to-moderately correlated with these increases. The number of ayahuasca ceremonies attended at the retreat was not related to change in outcomes, underscoring the importance of the quality rather than the quantity of the experiences in post-acute change. Lastly, participant age was negatively related to the occurrence of mystical-type experiences and awe, supporting literature indicating blunted psychedelic effects with increased age. In the context of study limitations, the results suggest that mystical-type experiences and awe occasioned by ayahuasca may be linked to prosocial changes in gratitude and relationships with nature that may be beneficial to mental health.

Synthetic surprise as the foundation of the psychedelic experience

Psychedelic agents, such as LSD and psilocybin, induce marked alterations in consciousness via activation of the 5-HT2A receptor (5-HT2ARs). We hypothesize that psychedelics enforce a state of synthetic surprise through the biased activation of the 5-HTRs system. This idea is informed by recent insights into the role of 5-HT in signaling surprise. The effects on consciousness, explained by the cognitive penetrability of perception, can be described within the predictive coding framework where surprise corresponds to prediction error, the mismatch between predictions and actual sensory input. Crucially, the precision afforded to the prediction error determines its effect on priors, enabling a dynamic interaction between top-down expectations and incoming sensory data. By integrating recent findings on predictive coding circuitry and 5-HT2ARs transcriptomic data, we propose a biological implementation with emphasis on the role of inhibitory interneurons. Implications arise for the clinical use of psychedelics, which may rely primarily on their inherent capacity to induce surprise in order to disrupt maladaptive patterns.