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Aday JS, Horton D, Fernandes-Osterhold G, O'Donovan A, Bradley ER, Rosen RC, Woolley JD. Psychedelic-assisted psychotherapy: where is the psychotherapy research? Psychopharmacology (Berl) 2024:10.1007/s00213-024-06620-x. [PMID: 38782821 DOI: 10.1007/s00213-024-06620-x] [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: 10/27/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
RATIONALE Psychedelic-assisted psychotherapy (PAP) has emerged as a potential treatment for a variety of mental health conditions, including substance use disorders and depression. Current models of PAP emphasize the importance of psychotherapeutic support before, during, and after ingestion of a psychedelic to maximize safety and clinical benefit. Despite this ubiquitous assumption, there has been surprisingly little empirical investigation of the "psychotherapy" in PAP, leaving critical questions about the necessary and sufficient components of PAP unanswered. OBJECTIVES As clinical trials for psychedelic compounds continue the transition from safety- and feasibility-testing to evaluating efficacy, the role of the accompanying psychotherapy must be better understood to enhance scientific understanding of the mechanisms underlying therapeutic change, optimize clinical outcomes, and inform cost-effectiveness. RESULTS The present paper first reviews the current status of psychotherapy in the PAP literature, starting with recent debates regarding "psychotherapy" versus "psychological support" and then overviewing published clinical trial psychotherapy models and putative models informed by theory. We then delineate lessons that PAP researchers can leverage from traditional psychotherapy research regarding standardizing treatments (e.g., publish treatment manuals, establish eligibility criteria for providers), identifying mechanisms of change (e.g., measure established mechanisms in psychotherapy), and optimizing clinical trial designs (e.g., consider dismantling studies, comparative efficacy trials, and cross-lagged panel designs). Throughout this review, the need for increased research into the psychotherapeutic components of treatment in PAP is underscored. CONCLUSIONS PAP is a distinct, integrative, and transdisciplinary intervention. Future research designs should consider transdisciplinary research methodologies to identify best practices and inform federal guidelines for PAP administration.
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Affiliation(s)
- Jacob S Aday
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
| | - David Horton
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, Madison, WI, USA
| | | | - Aoife O'Donovan
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Ellen R Bradley
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Raymond C Rosen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Joshua D Woolley
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
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McAlpine RG, Blackburne G, Kamboj SK. Development and psychometric validation of a novel scale for measuring 'psychedelic preparedness'. Sci Rep 2024; 14:3280. [PMID: 38332334 PMCID: PMC10853197 DOI: 10.1038/s41598-024-53829-z] [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: 05/18/2023] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
Preparing participants for psychedelic experiences is crucial for ensuring these experiences are safe and, potentially beneficial. However, there is currently no validated measure to assess the extent to which participants are well-prepared for such experiences. Our study aimed to address this gap by developing, validating, and testing the Psychedelic Preparedness Scale (PPS). Using a novel iterative Delphi-focus group methodology ('DelFo'), followed by qualitative pre-test interviews, we incorporated the perspectives of expert clinicians/researchers and of psychedelic users to generate items for the scale. Psychometric validation of the PPS was carried out in two large online samples of psychedelic users (N = 516; N = 716), and the scale was also administered to a group of participants before and after a 5-7-day psilocybin retreat (N = 46). Exploratory and confirmatory factor analysis identified four factors from the 20-item PPS: Knowledge-Expectations, Intention-Preparation, Psychophysical-Readiness, and Support-Planning. The PPS demonstrated excellent reliability (ω = 0.954) and evidence supporting convergent, divergent and discriminant validity was also obtained. Significant differences between those scoring high and low (on psychedelic preparedness) before the psychedelic experience were found on measures of mental health/wellbeing outcomes assessed after the experience, suggesting that the scale has predictive utility. By prospectively measuring modifiable pre-treatment preparatory behaviours and attitudes using the PPS, it may be possible to determine whether a participant has generated the appropriate mental 'set' and is therefore likely to benefit from a psychedelic experience, or at least, less likely to be harmed.
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Affiliation(s)
- Rosalind G McAlpine
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK.
| | - George Blackburne
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK
- Experimental Psychology, University College London, London, UK
| | - Sunjeev K Kamboj
- Clinical Psychopharmacology Unit, Clinical, Educational and Health Psychology, University College London, London, UK
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Modlin NL, Creed M, Sarang M, Maggio C, Rucker JJ, Williamson V. Trauma-Informed Care in Psychedelic Therapy Research: A Qualitative Literature Review of Evidence-Based Psychotherapy Interventions in PTSD and Psychedelic Therapy Across Conditions. Neuropsychiatr Dis Treat 2024; 20:109-135. [PMID: 38268571 PMCID: PMC10807282 DOI: 10.2147/ndt.s432537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/10/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) is associated with significant patient burden. While pharmacotherapies and evidence-based psychotherapy interventions (EBPI) are effective, studies consistently highlight inadequate outcomes and high treatment dropout. Psychedelic therapy (PT) has shown preliminary promise across difficult-to-treat conditions, including MDMA-assisted therapy for PTSD, however trials of classical psychedelics in PTSD are lacking. Understanding patients' experiences of EBPI could help promote safety in PT. Aim To systematically review qualitative research on patients' subjective experience of EBPI for PTSD, and of PT, and examine areas of overlap and divergence between them. Methods Systematic literature searches for studies published between 2010 and 2023 were conducted on OVID, PubMed, Web of Science, and PsycInfo. Included were original studies in English that presented qualitative data of patient experiences of EBPI in PTSD, or PT for any indication. Extracted data from included studies were analysed using thematic synthesis. Syntheses were completed separately for EBPI and PT, before similarities and differences between the therapies were identified. Results 40 research articles were included for review: 26 studies on EBPI for PTSD, and 14 studies on PT. EBPI studied were CBT, EMDR, CPT and PE. Psychedelic compounds studied were psilocybin, ibogaine, LSD, MDMA and ketamine, for treatment of substance use disorders, anxiety relating to physical illness, depression, and PTSD. Core themes from patient experiences of EBPI: 1) patient burden in PTSD treatment; 2) readiness; 3) key mechanisms of change; 4) psychological safety and trust. Themes identified in the review of PT: 1) indirect trauma processing; 2) reorganisation of self-narratives via processes of relatedness and identification; 3) key treatment characteristics. Conclusion This study suggests overlap between patients' experience of EBPI and PT in terms of key mechanisms of change, the importance of psychological safety and readiness to engage in treatment. Trauma-informed care paradigms and practices may improve safety and acceptability of PT research.
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Affiliation(s)
- Nadav Liam Modlin
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Michael Creed
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Maria Sarang
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Carolina Maggio
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - James J Rucker
- The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Victoria Williamson
- King’s Centre for Military Health Research, King’s College London, London, SE5 9RJ, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, OX2 6 GG, UK
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Miller DR, Jacobs JT, Rockefeller A, Singer H, Bollinger IM, Conway J, Slot JC, Cliffel DE. Cultivation, chemistry, and genome of Psilocybe zapotecorum. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.01.564784. [PMID: 37961470 PMCID: PMC10635036 DOI: 10.1101/2023.11.01.564784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Psilocybe zapotecorum is a strongly blue-bruising psilocybin mushroom used by indigenous groups in southeastern Mexico and beyond. While this species has a rich history of ceremonial use, research into its chemistry and genetics have been limited. Herein, we detail mushroom morphology and report on cultivation parameters, chemical profile, and the full genome sequence of P. zapotecorum . First, growth and cloning methods are detailed that are simple, and reproducible. In combination with high resolution microscopic analysis, the strain was barcoded, confirming species-level identification. Full genome sequencing reveals the architecture of the psilocybin gene cluster in P. zapotecorum, and can serve as a reference genome for Psilocybe Clade I. Characterization of the tryptamine profile revealed a psilocybin concentration of 17.9±1.7 mg/g, with a range of 10.6-25.7 mg/g (n=7), and similar tryptamines (psilocin, baeocystin, norbaeocystin, norpsilocin, aeruginascin, 4-HO-tryptamine, and tryptamine) in lesser concentrations for a combined tryptamine concentration of 22.5±3.2 mg/g. These results show P. zapotecorum to be a potent - and variable - Psilocybe mushroom. Chemical profiling, genetic analysis, and cultivation assist in demystifying these mushrooms. As clinical studies with psilocybin gain traction, understanding the diversity of psilocybin mushrooms will assure that psilocybin therapy does not become synonymous with psilocybin mushrooms.
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Kucsera A, Suppes T, Haug NA. Psychologists' and psychotherapists' knowledge, attitudes, and clinical practices regarding the therapeutic use of psychedelics. Clin Psychol Psychother 2023; 30:1369-1379. [PMID: 37394242 DOI: 10.1002/cpp.2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/19/2023] [Accepted: 06/14/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION This study explored the current knowledge, attitudes, and clinical practices regarding psychedelics among mental health professionals in California, where state legislation to decriminalize psychedelics has been proposed. METHOD Two hundred thirty-seven mental health providers (74% female; mean age 54; 83% White; 46% psychologists) completed a 37-item online survey between November 2021 and February 2022, disseminated through local and state-wide professional organizations in California. RESULTS Providers endorsed limited knowledge about the risks and benefits of psychedelic use (M = 4.7 and 5.4, respectively, with 10 = high knowledge) and inadequate knowledge to counsel patients on use (45%). Gaps in knowledge related to psychedelic drug scheduling and current use in clinical research were identified. Providers expressed support for additional psychedelic research (97%), approval of recreational (66%) and medical (91%) psychedelic use, belief in the potential therapeutic benefits of psychedelics (89%), and concerns about safety (33%) and potential psychiatric risks (27%). Results indicated that most providers discuss psychedelic use with patients (73%), yet many do not feel comfortable addressing the effects of use (49%). There were significant correlations between knowledge and attitudes towards psychedelics (r = 0.2, p = .006; r = 0.31, p < .001) and attitudes and clinical practices (r = 0.34, p < .001). CONCLUSIONS Findings suggest that providers are interested in psychedelic-assisted treatments and hold favourable attitudes towards the therapeutic use of psychedelics yet lack the knowledge to appropriately counsel patients, highlighting the need for additional provider education about psychedelics.
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Affiliation(s)
- Aileen Kucsera
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Bipolar and Depression Research Program, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Nancy A Haug
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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van Elk M, Fried EI. History repeating: guidelines to address common problems in psychedelic science. Ther Adv Psychopharmacol 2023; 13:20451253231198466. [PMID: 37766730 PMCID: PMC10521293 DOI: 10.1177/20451253231198466] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/11/2023] [Indexed: 09/29/2023] Open
Abstract
Research in the last decade has expressed considerable optimism about the clinical potential of psychedelics for the treatment of mental disorders. This optimism is reflected in an increase in research papers, investments by pharmaceutical companies, patents, media coverage, as well as political and legislative changes. However, psychedelic science is facing serious challenges that threaten the validity of core findings and raise doubt regarding clinical efficacy and safety. In this paper, we introduce the 10 most pressing challenges, grouped into easy, moderate, and hard problems. We show how these problems threaten internal validity (treatment effects are due to factors unrelated to the treatment), external validity (lack of generalizability), construct validity (unclear working mechanism), or statistical conclusion validity (conclusions do not follow from the data and methods). These problems tend to co-occur in psychedelic studies, limiting conclusions that can be drawn about the safety and efficacy of psychedelic therapy. We provide a roadmap for tackling these challenges and share a checklist that researchers, journalists, funders, policymakers, and other stakeholders can use to assess the quality of psychedelic science. Addressing today's problems is necessary to find out whether the optimism regarding the therapeutic potential of psychedelics has been warranted and to avoid history repeating itself.
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Affiliation(s)
- Michiel van Elk
- Cognitive Psychology Unit, Institute of Psychology, Leiden University, PO Box 9555, Leiden 2300 RB, The Netherlands
| | - Eiko I. Fried
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
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Kargbo RB. Unraveling Psychedelic Responses: Targeted Protein Degradation and Genetic Diversity. ACS Med Chem Lett 2023; 14:1017-1020. [PMID: 37583820 PMCID: PMC10424308 DOI: 10.1021/acsmedchemlett.3c00269] [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: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 08/17/2023] Open
Abstract
This Viewpoint discusses the intersection of targeted protein degradation (TPD) technologies and psychedelic research. The resurgence in interest in psychedelics for treating mental disorders and the known genetic variability in responses require new strategies. TPD technologies might address this variability, modulating protein expressions based on genetic profiles. The discussion includes potential challenges in implementing TPD technologies in psychedelic research and potential strategies to address these issues. It considers lessons from COVID-19 research on genetic variability, proposing integration of TPD technologies into psychedelic research as a promising field despite these challenges, possibly leading to personalized treatments and improved patient outcomes.
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Affiliation(s)
- Robert B. Kargbo
- API & DP Development, Usona
Institute, 2780 Woods
Hollow Road, Madison, Wisconsin 53711, United States
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Kargbo RB. Microbiome: The Next Frontier in Psychedelic Renaissance. J Xenobiot 2023; 13:386-401. [PMID: 37606422 PMCID: PMC10443327 DOI: 10.3390/jox13030025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 08/23/2023] Open
Abstract
The psychedelic renaissance has reignited interest in the therapeutic potential of psychedelics for mental health and well-being. An emerging area of interest is the potential modulation of psychedelic effects by the gut microbiome-the ecosystem of microorganisms in our digestive tract. This review explores the intersection of the gut microbiome and psychedelic therapy, underlining potential implications for personalized medicine and mental health. We delve into the current understanding of the gut-brain axis, its influence on mood, cognition, and behavior, and how the microbiome may affect the metabolism and bioavailability of psychedelic substances. We also discuss the role of microbiome variations in shaping individual responses to psychedelics, along with potential risks and benefits. Moreover, we consider the prospect of microbiome-targeted interventions as a fresh approach to boost or modulate psychedelic therapy's effectiveness. By integrating insights from the fields of psychopharmacology, microbiology, and neuroscience, our objective is to advance knowledge about the intricate relationship between the microbiome and psychedelic substances, thereby paving the way for novel strategies to optimize mental health outcomes amid the ongoing psychedelic renaissance.
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Affiliation(s)
- Robert B Kargbo
- Usona Institute, 2800 Woods Hollow Rd., Madison, WI 53711-5300, USA
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