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Pagni BA, Petridis PD, Podrebarac SK, Grinband J, Claus ED, Bogenschutz MP. Psilocybin-induced changes in neural reactivity to alcohol and emotional cues in patients with alcohol use disorder: an fMRI pilot study. Sci Rep 2024; 14:3159. [PMID: 38326432 PMCID: PMC10850478 DOI: 10.1038/s41598-024-52967-8] [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: 10/23/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
This pilot study investigated psilocybin-induced changes in neural reactivity to alcohol and emotional cues in patients with alcohol use disorder (AUD). Participants were recruited from a phase II, randomized, double-blind, placebo-controlled clinical trial investigating psilocybin-assisted therapy (PAT) for the treatment of AUD (NCT02061293). Eleven adult patients completed task-based blood oxygen dependent functional magnetic resonance imaging (fMRI) approximately 3 days before and 2 days after receiving 25 mg of psilocybin (n = 5) or 50 mg of diphenhydramine (n = 6). Visual alcohol and emotionally valanced (positive, negative, or neutral) stimuli were presented in block design. Across both alcohol and emotional cues, psilocybin increased activity in the medial and lateral prefrontal cortex (PFC) and left caudate, and decreased activity in the insular, motor, temporal, parietal, and occipital cortices, and cerebellum. Unique to negative cues, psilocybin increased supramarginal gyrus activity; unique to positive cues, psilocybin increased right hippocampus activity and decreased left hippocampus activity. Greater PFC and caudate engagement and concomitant insula, motor, and cerebellar disengagement suggests enhanced goal-directed action, improved emotional regulation, and diminished craving. The robust changes in brain activity observed in this pilot study warrant larger neuroimaging studies to elucidate neural mechanisms of PAT.Trial registration: NCT02061293.
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Affiliation(s)
- B A Pagni
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - P D Petridis
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - S K Podrebarac
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - J Grinband
- Departments of Psychiatry and Radiology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - E D Claus
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - M P Bogenschutz
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA.
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2
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Rodgers A, Bahceci D, Davey CG, Chatterton ML, Glozier N, Hopwood M, Loo C. Ensuring the affordable becomes accessible-lessons from ketamine, a new treatment for severe depression. Aust N Z J Psychiatry 2024; 58:109-116. [PMID: 37830221 DOI: 10.1177/00048674231203898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
In this paper, the case study of ketamine as a new treatment for severe depression is used to outline the challenges of repurposing established medicines and we suggest potential solutions. The antidepressant effects of generic racemic ketamine were identified over 20 years ago, but there were insufficient incentives for commercial entities to pursue its registration, or support for non-commercial entities to fill this gap. As a result, the evaluation of generic ketamine was delayed, piecemeal, uncoordinated, and insufficient to gain approval. Meanwhile, substantial commercial investment enabled the widespread registration of a patented, intranasal s-enantiomeric ketamine formulation (Spravato®) for depression. However, Spravato is priced at $600-$900/dose compared to ~$5/dose for generic ketamine, and the ~AUD$100 million annual government investment requested in Australia (to cover drug costs alone) has been rejected twice, leaving this treatment largely inaccessible for Australian patients 2 years after Therapeutic Goods Administration approval. Moreover, emerging evidence indicates that generic racemic ketamine is at least as effective as Spravato, but no comparative trials were required for regulatory approval and have not been conducted. Without action, this story will repeat regularly in the next decade with a new wave of psychedelic-assisted psychotherapy treatments, for which the original off-patent molecules could be available at low-cost and reduce the overall cost of treatment. Several systemic reforms are required to ensure that affordable, effective options become accessible; these include commercial incentives, public and public-private funding schemes, reduced regulatory barriers and more coordinated international public funding schemes to support translational research.
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Affiliation(s)
- Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Dilara Bahceci
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Mary Lou Chatterton
- Health Economics Group, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Colleen Loo
- School of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Randwick, NSW, Australia
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Yaden DB, Berghella AP, Hendricks PS, Yaden ME, Levine M, Rohde JS, Nayak S, Johnson MW, Garcia-Romeu A. IUPHAR-review: The integration of classic psychedelics into current substance use disorder treatment models. Pharmacol Res 2024; 199:106998. [PMID: 38029805 DOI: 10.1016/j.phrs.2023.106998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
Substance use disorders (SUDs) have an enormous impact on public health. With classic psychedelic-assisted therapies showing initial promise in treating multiple SUDs, it is possible that these treatments will become legally available options for patients with SUDs in the future. This article highlights how classic psychedelic-assisted therapies might be integrated into current clinical practice. We first describe contemporary evidence-based treatments for SUDs and highlight how classic psychedelic-assisted therapies might fit within each treatment. We suggest that classic psychedelic-assisted therapies can be integrated into most mainstream evidence-based SUD treatments that are currently used in clinical settings, indicating broad compatibility of classic psychedelics with contemporary SUD treatment paradigms.
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Affiliation(s)
- David B Yaden
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Andrea P Berghella
- Thomas Jefferson University MD/PhD Program, Sidney Kimmel Medical College and Jefferson College of Life Sciences, Philadelphia, USA
| | - Peter S Hendricks
- School of Public Health, The University of Alabama at Birmingham, Birmingham, USA
| | - Mary E Yaden
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Michael Levine
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Julia S Rohde
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sandeep Nayak
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Matthew W Johnson
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Albert Garcia-Romeu
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
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4
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Affiliation(s)
- Guy M Goodwin
- COMPASS Pathways Plc, London (Goodwin, Malievskaia); Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin (Fonzo, Nemeroff)
| | - Ekaterina Malievskaia
- COMPASS Pathways Plc, London (Goodwin, Malievskaia); Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin (Fonzo, Nemeroff)
| | - Gregory A Fonzo
- COMPASS Pathways Plc, London (Goodwin, Malievskaia); Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin (Fonzo, Nemeroff)
| | - Charles B Nemeroff
- COMPASS Pathways Plc, London (Goodwin, Malievskaia); Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin (Fonzo, Nemeroff)
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5
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Thal SB, Baker P, Marinis J, Wieberneit M, Sharbanee JM, Bruno R, Skeffington PM, Bright SJ. Therapeutic frameworks in integration sessions in substance-assisted psychotherapy: A systematised review. Clin Psychol Psychother 2023. [PMID: 38148518 DOI: 10.1002/cpp.2945] [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: 06/30/2023] [Revised: 11/07/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023]
Abstract
Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance-assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integration sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematised review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed-methods investigations, treatment manuals, study protocols, quasi-experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until 11 November 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcomes have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic-experiential tradition. While integration is regarded as crucial for the safe application of SAPT, there is currently an insufficient evidence base to suggest that any type of therapy is effective for guiding integration sessions. A systematic investigation of different therapeutic frameworks for integration and additional therapy-related factors is needed.
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Affiliation(s)
- Sascha B Thal
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
- School of Psychology, College of Health & Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Paris Baker
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Jonathon Marinis
- Orygen Youth Health, University of Melbourne, Parkville, Victoria, Australia
| | - Michelle Wieberneit
- Law School, University of Western Australia, Crawley, Western Australia, Australia
| | - Jason M Sharbanee
- Enable Institute, Discipline of Psychology, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Raimundo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Petra M Skeffington
- School of Psychology, College of Health & Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Stephen J Bright
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Psychedelic Research in Science and Medicine (PRISM), Balwyn North, Victoria, Australia
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Inserra A, Piot A, De Gregorio D, Gobbi G. Lysergic Acid Diethylamide (LSD) for the Treatment of Anxiety Disorders: Preclinical and Clinical Evidence. CNS Drugs 2023; 37:733-754. [PMID: 37603260 DOI: 10.1007/s40263-023-01008-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 08/22/2023]
Abstract
Anxiety disorders (ADs) represent the sixth leading cause of disability worldwide, resulting in a significant global economic burden. Over 50% of individuals with ADs do not respond to standard therapies, making the identification of more effective anxiolytic drugs an ongoing research priority. In this work, we review the preclinical literature concerning the effects of lysergic acid diethylamide (LSD) on anxiety-like behaviors in preclinical models, and the clinical literature on anxiolytic effects of LSD in healthy volunteers and patients with ADs. Preclinical and clinical findings show that even if LSD may exacerbate anxiety acutely (both in "microdoses" and "full doses"), it induces long-lasting anxiolytic effects. Only two randomized controlled trials combining LSD and psychotherapy have been performed in patients with ADs with and without life-threatening conditions, showing a good safety profile and persisting decreases in anxiety outcomes. The effect of LSD on anxiety may be mediated by serotonin receptors (5-HT1A/1B, 5-HT2A/2C, and 5-HT7) and/or transporter in brain networks and circuits (default mode network, cortico-striato-thalamo-cortical circuit, and prefrontal cortex-amygdala circuit), involved in the modulation of anxiety. It remains unclear whether LSD can be an efficacious treatment alone or only when combined with psychotherapy, and if "microdosing" may elicit the same sustained anxiolytic effects as the "full doses". Further randomized controlled trials with larger sample size cohorts of patients with ADs are required to clearly define the effective regimens, safety profile, efficacy, and feasibility of LSD for the treatment of ADs.
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Affiliation(s)
- Antonio Inserra
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Avenue des Pins Ouest, Montreal, QC, H3A 1A1, Canada
| | - Alexandre Piot
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Danilo De Gregorio
- Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriella Gobbi
- Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Avenue des Pins Ouest, Montreal, QC, H3A 1A1, Canada.
- McGill University Health Center, Montreal, QC, Canada.
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7
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Dawood Hristova JJ, Pérez-Jover V. Psychotherapy with Psilocybin for Depression: Systematic Review. Behav Sci (Basel) 2023; 13:bs13040297. [PMID: 37102811 PMCID: PMC10135952 DOI: 10.3390/bs13040297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Depression is a common mental health issue that affects 280 million people in the world with a high mortality rate, as well as being a leading cause of disability. Psychopharmacological therapies with psychedelics, particularly those with psilocybin, are showing promising potential for the treatment of depression, among other conditions. Some of their benefits include a rapid and exponential improvement in depressive symptoms and an increased sense of well-being that can last for months after the treatment, as well as a greater development of introspective capacity. The aim of this project was to provide experimental evidence about therapeutic procedures along with psilocybin for the treatment of major depressive disorder. The project highlights eight studies that examined this condition. Some of them dealt with treatment-resistant depression while others dealt with depression due to a life-threatening disease such as cancer. These publications affirm the efficiency of the psilocybin therapy for depression, with only one or two doses in conjunction with psychological support during the process.
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Feduccia A, Agin-Liebes G, Price CM, Grinsell N, Paradise S, Rabin DM. The need for establishing best practices and gold standards in psychedelic medicine. J Affect Disord 2023; 332:47-54. [PMID: 37003433 DOI: 10.1016/j.jad.2023.03.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 03/17/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
Psychedelic substances are under investigation in several drug development programs. Controlled clinical trials are providing evidence for safe and effective use of psychedelic therapies for treating mental health conditions. With the anticipated FDA approval of MDMA-assisted therapy for posttraumatic stress disorder in 2023 and psilocybin therapy for depression disorders soon after, now is the time for the medical community to become informed on best practices and to actively participate in developing standards of care for these new treatments. Given the emergence of numerous drug sponsors and other companies developing therapeutic modalities for combination with psychedelic medications, it is essential that the medical professional field is at the forefront of communicating unbiased information related to safety and effectiveness. Gold standards have long been a part of medicine and serve to distinguish treatments and assessments as the highest quality by which all others can be compared to. For a treatment to be established as a gold standard, several factors are considered including the quantity and quality of the supporting data, the rigor of trials, and the safety and efficacy compared to other treatments. In this article, we review the origins of psychedelic-assisted therapy (PAT), minimum requirements for safe use of psychedelics, criteria for gold standards in mental health, and the nuances regarding how to establish gold standards in psychedelic medicine and guide clinical decision making.
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Affiliation(s)
| | - Gabby Agin-Liebes
- Department of Psychiatry, Weill Institute for Neurosciences, Neuroscape, University of California, San Francisco, CA, USA.
| | - Collin M Price
- Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, CA, USA.
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9
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Psilocybin for alcohol use disorder: Rationale and design considerations for a randomized controlled trial. Contemp Clin Trials 2022; 123:106976. [PMID: 36332827 DOI: 10.1016/j.cct.2022.106976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
Several lines of evidence suggest that classic psychedelics (5-HT2A receptor agonists or partial agonists) such as psilocybin might facilitate behavior change in individuals with substance use disorders. We conducted a multi-site, double-blind, randomized controlled trial (RCT) to assess the effects of psilocybin-assisted psychotherapy in alcohol-dependent volunteers. In addition to a structured 12-week psychotherapy platform, participants (n = 96) were randomly assigned (1:1) to receive either oral psilocybin or an active placebo (oral diphenhydramine) in each of two dosing sessions (at weeks 4 and 8). Initial doses were 25 mg/70 kg psilocybin or 50 mg diphenhydramine, which could be increased in the second session depending on initial response. The psychotherapy platform combined evidence-based, manualized therapy for alcohol dependence with a supportive context for the dosing sessions. All participants were followed in the RCT through week 36. At the end of the RCT, participants who still met safety criteria were offered an open-label psilocybin session. Data collected at screening, baseline and throughout the study included: demographics, measures of alcohol use, subjective response to psilocybin and diphenhydramine, and safety measures. The primary outcome was the proportion of heavy drinking days during the 32 weeks after the first dosing session (i.e., between week 4 and week 36). Secondary outcomes included safety, additional measures of drinking (e.g., abstinence, drinking days, etc.), craving, self-efficacy, and acute effects. We will also explore moderators and mediators of the primary outcome. The primary outcomes will be published elsewhere. In this paper, we describe the protocol and rationale for our design decisions.
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Calleja‐Conde J, Morales‐García JA, Echeverry‐Alzate V, Bühler KM, Giné E, López‐Moreno JA. Classic psychedelics and alcohol use disorders: A systematic review of human and animal studies. Addict Biol 2022; 27:e13229. [PMID: 36301215 PMCID: PMC9541961 DOI: 10.1111/adb.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/20/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023]
Abstract
Classic psychedelics refer to substances such as lysergic acid diethylamide (LSD), psilocybin, ayahuasca, and mescaline, which induce altered states of consciousness by acting mainly on 5-HT2A receptors. Recently, the interest of psychedelics as pharmacological treatment for psychiatric disorders has increased significantly, including their use on problematic use of alcohol. This systematic review is aimed to analyse the last two decades of studies examining the relationship between classic psychedelics and alcohol consumption. We searched PubMed and PsycInfo for human and preclinical studies published between January 2000 to December 2021. The search identified 639 publications. After selection, 27 studies were included. Human studies (n = 20) generally show promising data and seem to indicate that classic psychedelics could help reduce alcohol consumption. Nevertheless, some of these studies present methodological concerns such as low number of participants, lack of control group or difficulty in determining the effect of classic psychedelics in isolation. On the other hand, preclinical studies (n = 7) investigating the effect of these compounds on voluntary alcohol consumption are scarce and show some conflicting data. Among these compounds, psilocybin seems to show the most consistent data indicating that this compound could be a potential candidate to treat alcohol use disorders. In the absence of understanding the biological and/or psychological mechanisms, more studies including methodological quality parameters are needed to finally determine the effects of classic psychedelics on alcohol consumption.
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Affiliation(s)
| | | | - Víctor Echeverry‐Alzate
- School of Life and Nature SciencesNebrija UniversityMadridSpain,Department of Psychobiology and Methodology in Behavioral Sciences, Faculty of Psychology, Somosaguas CampusComplutense University of MadridMadridSpain
| | - Kora Mareen Bühler
- Department of Psychobiology and Methodology in Behavioral Sciences, Faculty of Psychology, Somosaguas CampusComplutense University of MadridMadridSpain
| | - Elena Giné
- Department of Cell Biology, Faculty of MedicineComplutense University of MadridMadridSpain
| | - Jose Antonio López‐Moreno
- Department of Psychobiology and Methodology in Behavioral Sciences, Faculty of Psychology, Somosaguas CampusComplutense University of MadridMadridSpain
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Thal SB, Wieberneit M, Sharbanee JM, Skeffington PM, Baker P, Bruno R, Wenge T, Bright SJ. Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy-A systematized review. J Psychopharmacol 2022; 36:1191-1207. [PMID: 36263882 DOI: 10.1177/02698811221127954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical trials are currently investigating the potential of substance-assisted psychotherapy (SAPT) as treatment for several psychiatric conditions. The potential therapeutic effects of SAPT may be influenced by contextual factors including preparation prior to and integration after the substance-assisted therapy sessions. AIMS This systematized review outlines recommendations for current practice in preparatory sessions in SAPT including safety measures and screening procedures, preparation of set and setting, session contents, methods, and roles, prerequisites, and appropriate conduct of therapists. METHODS A systematized review of the literature was conducted based on PRISMA guidelines. MEDLINE (OVID), PsycINFO (OVID), and Cochrane Library were searched and clinical trials, treatment manuals, study protocols, case studies, qualitative studies, descriptive studies, theoretical papers, reviews, book chapters, and conference proceedings published until February 1, 2022 were retrieved. RESULTS The final synthesis included k = 83 sources. Information about safety measures including screening of participants, set and setting, contextual-, physiological-, and psychological preparation, roles, competencies, prerequisites, and characteristics of the therapists, and the establishment of a therapeutic relationship were summarized and discussed. CONCLUSION It is concluded that there is a consensus in the literature about the importance of adequate preparation before the administration of psychoactive substances in SAPT. However, the extent and approaches for these sessions vary across different models and there is a need for timelier and more rigorous qualitative and quantitative investigations assessing different approaches and techniques for the optimal preparation of clients in SAPT.
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Affiliation(s)
- Sascha B Thal
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia.,Physical Activity and Well-Being Group, Curtin University, Perth, WA, Australia.,Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Michelle Wieberneit
- Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn, Bonn, Germany.,Law School, University of Western Australia, Perth, WA, Australia
| | - Jason M Sharbanee
- Enable Institute, Discipline of Psychology, Curtin School of Population Health, Curtin University, Perth, WA, Australia.,Psychology and Criminology, School of Arts and Humanities, Edith Cowan University, Perth, WA, Australia
| | - Petra M Skeffington
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
| | - Paris Baker
- School of Medicine (Psychology), University of Tasmania, Hobart, TAS, Australia
| | - Raimondo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, TAS, Australia
| | - Tobias Wenge
- International Society for Bonding Psychotherapy, Friedrichshafen, Germany
| | - Stephen J Bright
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Psychedelic Research in Science and Medicine, Balwyn North, VIC, Australia
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Wolfson E. Psychedelic-supportive psychotherapy: A psychotherapeutic model for, before and beyond the medicine experience. JOURNAL OF PSYCHEDELIC STUDIES 2022. [DOI: 10.1556/2054.2022.00192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
A renaissance is underway as research studies are substantiating psychotherapeutic and physiological benefits of psychedelic medicines, along with advancements towards legalization, expansion of professional training programs and a renewed cultural recognition of the healing qualities of the medicines. Pending legislation, a cadre of trained psychotherapists are poised to apply their expertise for those who might benefit however, they are currently largely blocked from doing so. There are also ranks of competent psychedelically informed psychotherapists who might provide support to clients engaging with the medicines but are lacking guidelines to do so.
‘Psychedelic-Supportive Psychotherapy’ is a proposed model which might be immediately implemented by qualified practitioners for working with clients adjacent to but not during a medicine experience without compromising ethical or legal risk. This model aimed at psychotherapists who are increasingly challenged to help clients already engaging with or considering psychedelics, draws from the current field of knowledge to respond to a moral imperative for practitioners to act in the service of client's best interests and expand access for diverse communities. It balances psychedelic harm reduction perspectives with support for the emotional, psychological, and spiritual gains to be had when clients use psychedelics outside of therapy and can process the experience within their therapy. The model of psychedelic-supportive psychotherapy,’ is transtheoretical, its core premise being centrality of the therapeutic relationship as a change agent even as the therapist is not physically present in the client's medicine journey. Here a foundational structure is presented along with criteria, parameters, and recommendations for practitioners in its application.
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13
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Jensen ME, Stenbæk DS, Juul TS, Fisher PM, Ekstrøm CT, Knudsen GM, Fink-Jensen A. Psilocybin-assisted therapy for reducing alcohol intake in patients with alcohol use disorder: protocol for a randomised, double-blinded, placebo-controlled 12-week clinical trial (The QUANTUM Trip Trial). BMJ Open 2022; 12:e066019. [PMID: 36241352 PMCID: PMC9577917 DOI: 10.1136/bmjopen-2022-066019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/30/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Alcohol use disorder is a difficult-to-treat psychiatric disorder and a major burden on public health. Existing treatment efficacy is moderate, and relapse rates are high. Preliminary findings suggest that psilocybin, a psychedelic compound, can safely and reliably occasion highly meaningful experiences that may spur a positive change in drinking behaviour when administered in a therapeutic context. However, the efficacy of a single psilocybin administration and its potential neurobiological underpinnings still remain unknown. METHODS AND ANALYSIS To establish efficacy, we will investigate the effects of psilocybin-assisted therapy versus placebo in a randomised, double-blinded, placebo-controlled 12-week clinical trial. Ninety treatment-seeking patients, aged 20-70 years, diagnosed with alcohol use disorder will be recruited from the community via advertisement and referrals from general practitioners or specialised treatment units. The psilocybin or placebo will be administered in accordance with a protocol for psychological support before, during and after the dosing. Outcome assessments will be carried out 1, 4, 8 and 12 weeks postdosing. The primary outcome is reduction in the percentage of heavy drinking days from baseline to follow-up at 12 weeks. Key secondary outcomes are as follows: (1) total alcohol consumption, (2) phosphatidyl-ethanol, an objective biomarker for alcohol, (3) plasma psilocin, the active metabolite, to establish a possible therapeutic range, (4) the acute subjective drug experience as a possible predictor of treatment outcome and (5) neuronal response to alcohol cues and cognitive flexibility within corticostriatal pathways by use of functional MR brain imaging 1-week postdosing. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Committee on Health Research Ethics of the Capital Region of Denmark (H-20043832). All patients will be provided oral and written information about the trial before screening. The study results will be disseminated by peer-review publications and conference presentations. TRIAL REGISTRATION NUMBER EudraCT 2020-000829-55 and NCT05416229.
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Affiliation(s)
| | - Dea Siggaard Stenbæk
- Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Tobias Søgaard Juul
- Psychiatry Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Patrick MacDonald Fisher
- Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Fink-Jensen
- Psychiatry Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Bogenschutz MP, Ross S, Bhatt S, Baron T, Forcehimes AA, Laska E, Mennenga SE, O’Donnell K, Owens LT, Podrebarac S, Rotrosen J, Tonigan JS, Worth L. Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:953-962. [PMID: 36001306 PMCID: PMC9403854 DOI: 10.1001/jamapsychiatry.2022.2096] [Citation(s) in RCA: 164] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Although classic psychedelic medications have shown promise in the treatment of alcohol use disorder (AUD), the efficacy of psilocybin remains unknown. OBJECTIVE To evaluate whether 2 administrations of high-dose psilocybin improve the percentage of heavy drinking days in patients with AUD undergoing psychotherapy relative to outcomes observed with active placebo medication and psychotherapy. DESIGN, SETTING, AND PARTICIPANTS In this double-blind randomized clinical trial, participants were offered 12 weeks of manualized psychotherapy and were randomly assigned to receive psilocybin vs diphenhydramine during 2 day-long medication sessions at weeks 4 and 8. Outcomes were assessed over the 32-week double-blind period following the first dose of study medication. The study was conducted at 2 academic centers in the US. Participants were recruited from the community between March 12, 2014, and March 19, 2020. Adults aged 25 to 65 years with a DSM-IV diagnosis of alcohol dependence and at least 4 heavy drinking days during the 30 days prior to screening were included. Exclusion criteria included major psychiatric and drug use disorders, hallucinogen use, medical conditions that contraindicated the study medications, use of exclusionary medications, and current treatment for AUD. INTERVENTIONS Study medications were psilocybin, 25 mg/70 kg, vs diphenhydramine, 50 mg (first session), and psilocybin, 25-40 mg/70 kg, vs diphenhydramine, 50-100 mg (second session). Psychotherapy included motivational enhancement therapy and cognitive behavioral therapy. MAIN OUTCOMES AND MEASURES The primary outcome was percentage of heavy drinking days, assessed using a timeline followback interview, contrasted between groups over the 32-week period following the first administration of study medication using multivariate repeated-measures analysis of variance. RESULTS A total of 95 participants (mean [SD] age, 46 [12] years; 42 [44.2%] female) were randomized (49 to psilocybin and 46 to diphenhydramine). One participant (1.1%) was American Indian/Alaska Native, 3 (3.2%) were Asian, 4 (4.2%) were Black, 14 (14.7%) were Hispanic, and 75 (78.9%) were non-Hispanic White. Of the 95 randomized participants, 93 received at least 1 dose of study medication and were included in the primary outcome analysis. Percentage of heavy drinking days during the 32-week double-blind period was 9.7% for the psilocybin group and 23.6% for the diphenhydramine group, a mean difference of 13.9%; (95% CI, 3.0-24.7; F1,86 = 6.43; P = .01). Mean daily alcohol consumption (number of standard drinks per day) was also lower in the psilocybin group. There were no serious adverse events among participants who received psilocybin. CONCLUSIONS AND RELEVANCE Psilocybin administered in combination with psychotherapy produced robust decreases in percentage of heavy drinking days over and above those produced by active placebo and psychotherapy. These results provide support for further study of psilocybin-assisted treatment for AUD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02061293.
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Affiliation(s)
- Michael P. Bogenschutz
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | - Stephen Ross
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | - Snehal Bhatt
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque
| | - Tara Baron
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | | | - Eugene Laska
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York,Department of Population Health, Division of Biostatistics, New York University Grossman School of Medicine, New York
| | - Sarah E. Mennenga
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | - Kelley O’Donnell
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | - Lindsey T. Owens
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York,Department of Psychology, University of Alabama at Birmingham
| | - Samantha Podrebarac
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | - John Rotrosen
- Department of Psychiatry, New York University Langone Center for Psychedelic Medicine, New York University Grossman School of Medicine, New York
| | - J. Scott Tonigan
- University of New Mexico Center on Alcohol, Substance Use and Addictions, Albuquerque
| | - Lindsay Worth
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque
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15
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Brennan W, Belser AB. Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model. Front Psychol 2022; 13:866018. [PMID: 35719571 PMCID: PMC9201428 DOI: 10.3389/fpsyg.2022.866018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
The current standard of care in most uses of psychedelic medicines for the treatment of psychiatric indications includes the provision of a supportive therapeutic context before, during, and after drug administration. A diversity of psychedelic-assisted psychotherapy (PAP) models has been created to meet this need. The current article briefly reviews the strengths and limitations of these models, which are divided into basic support models and EBT-inclusive therapy models. It then discusses several shortcomings both types of models share, including a lack of adequate attention to embodied and relational elements of treatment, and insufficient attention to ethical concerns. The article then introduces the EMBARK model, a transdiagnostic, trans-drug framework for the provision of supportive psychotherapy in PAP clinical trials and the training of study therapists. EMBARK was designed to overcome challenges that prior models have had in conceptualizing therapeutic change in psychedelic treatment, incorporating elements of non-psychedelic evidence-based therapies, incorporating therapists' prior skills and clinical orientations, delimiting therapist interventions for research standardization, and determining specific factors that contribute to treatment outcomes. The article explains EMBARK's six clinical domains, which represent parallel conceptualizations of how therapists may support therapeutic benefit in PAP treatment, and its four care cornerstones, which reflect therapists' broad ethical responsibility to participants. The article describes how these elements of the model come together to structure and inform therapeutic interventions during preparation, medicine, and integration sessions. Additionally, the article will discuss how EMBARK therapist training is organized and conducted. Finally, it will demonstrate the broad applicability of EMBARK by describing several current and upcoming PAP clinical trials that have adopted it as the therapeutic frame.
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Affiliation(s)
- William Brennan
- Cybin, Inc., Toronto, ON, Canada.,Fordham University, New York City, NY, United States
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16
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Rodrigues LS, Rossi GN, Rocha JM, L Osório F, Bouso JC, Hallak JEC, Dos Santos RG. Effects of ayahuasca and its alkaloids on substance use disorders: an updated (2016-2020) systematic review of preclinical and human studies. Eur Arch Psychiatry Clin Neurosci 2022; 272:541-556. [PMID: 33914164 DOI: 10.1007/s00406-021-01267-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/22/2021] [Indexed: 12/09/2022]
Abstract
Ayahuasca is a hallucinogenic/psychedelic traditionally used for ritual and therapeutic purposes. One such therapeutic use is related to Substance Use Disorders (SUDs). A previous systematic review of preclinical and human studies published until 2016 suggested that ayahuasca and its alkaloids have therapeutic effects in the treatment of SUDs. To conduct an update of this previous review. A systematic review of quantitative studies which analyzed the effects of ayahuasca and its alkaloids on drug use (primary outcome) and other measures (secondary outcomes) related to SUDs was conducted, including articles from 2016 to 2020. Nine studies (four preclinical, five observational) were included in the review. Preclinical studies in rodents reported reductions in amphetamine self-administration and anxiety, and in alcohol- and methylphenidate-induced conditioned place preference. Observational studies among healthy ritual ayahuasca users and patients with SUDs reported reductions in drug use, anxiety, and depression, and increases in quality of life and well-being. We replicated the findings of the previous review suggesting that ayahuasca and its alkaloids have therapeutic effects in the treatment of SUDs. However, translation of preclinical data to humans is limited, observational studies do not allow us to infer causality, and there is a lack of standardization on ayahuasca doses. Although promising, randomized, controlled trials are needed to better elucidate these results. The PROSPERO ID for this study is CRD42020192046.
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Affiliation(s)
- Lucas Silva Rodrigues
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Giordano Novak Rossi
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Juliana Mendes Rocha
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Flávia L Osório
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil
| | - José Carlos Bouso
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- ICEERS Foundation, International Center for Ethnobotanical Education, Research and Services, Barcelona, Spain
- Medical Anthopology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | - Jaime E Cecílio Hallak
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil
| | - Rafael G Dos Santos
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
- National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil.
- ICEERS Foundation, International Center for Ethnobotanical Education, Research and Services, Barcelona, Spain.
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17
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The psychological processes of classic psychedelics in the treatment of depression: a systematic review protocol. Syst Rev 2022; 11:85. [PMID: 35513876 PMCID: PMC9074259 DOI: 10.1186/s13643-022-01930-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is currently renewed interest in the use of psychedelic therapy in the treatment of psychiatric disorders, including depression. The proposed systematic review will aim to identify, evaluate and summarise the psychological processes of change underlying psychedelic therapy for depression in the current literature and consider the implications these processes may have on the psychotherapy component of treatment. METHODS Scopus, PsycINFO, PubMed and Web of Science databases will be searched using relevant terms. Studies will be included if they discuss the use of a classic psychedelic to treat depression symptomology in an adult population and report or propose psychological processes responsible for depression symptom change. Two authors will independently screen articles, complete quality assessment tools and conduct data extraction. Empirical and non-empirical research will be extracted and synthesised separately. A narrative synthesis approach will be used to report psychological processes identified in the literature. DISCUSSION This systematic review will be the first to collate available evidence on the psychological processes associated with psychedelic therapy for depression. The preliminary nature of this research field is expected to result in the review having several limitations, namely heterogeneity between studies and the inclusion of limited empirical research. We intend for this review to present the current state of the literature, identify gaps and generate candidate variables that warrant further investigation. SYSTEMATIC REVIEW PROSPERO CRD42020197202.
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18
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Earleywine M, Low F, Lau C, De Leo J. Integration in Psychedelic-Assisted Treatments: Recurring Themes in Current Providers’ Definitions, Challenges, and Concerns. JOURNAL OF HUMANISTIC PSYCHOLOGY 2022. [DOI: 10.1177/00221678221085800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Integration therapy, an integral part of psychedelic-assisted treatment, usually includes sessions devoted to making meaning of relevant psychedelic experiences after subjective effects have subsided. As the psychedelic renaissance continues, offers for this integration therapy have proliferated. In the present project, semi-structured interviews with 30 integration therapists focused on definitions of integration as well as challenges and concerns that they associated with the practice. A mixed-methods approach revealed 19 themes that coders identified reliably. Prevalent themes included expressing concern about nonresponsive clients, defining integration as a bridge between the psychedelic experience and daily life, and apprehensions about the commercialization of psychedelic psychotherapy. Interviewees viewed integration as a process that begins prior to the administration of substances, never ends, makes sense of the psychoactive experience, creates behavioral change, is personalized, and makes the individual whole. Most participants also discussed issues related to client resistance, unrealistic expectations of psychedelic psychotherapy, problems associated with power differentials, the importance of an integration therapist’s connection to other service providers, and the need for self-care. These data might help the standardization of integration therapy, inform lay impressions of the process, and help generate hypotheses for continued research on this aspect of psychedelic-assisted treatment. These data also suggest that psychedelic integration practitioners would appreciate regular support from a community of like-minded colleagues.
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Affiliation(s)
| | - Fiona Low
- University at Albany, State University of New York, NY, USA
| | - Carmen Lau
- MindCure Health Inc., Vancouver, British Columbia, Canada
| | - Joseph De Leo
- Centre for Compassionate Care, Hamilton, Ontario, Canada
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19
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Thal S, Engel LB, Bright SJ. Presence, Trust, and Empathy: Preferred Characteristics of Psychedelic Carers. JOURNAL OF HUMANISTIC PSYCHOLOGY 2022. [DOI: 10.1177/00221678221081380] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research into psychedelic-assisted psychotherapy (PAP) is rapidly increasing with best practice guidelines being continuously updated. Yet the key principals of such guidelines are based on evidence accumulated during earlier research into these treatments and trans-disciplinary psychotherapeutic knowledge. One area of practice-based evidence that has not been considered is that accumulated by people who use psychedelics (PWUP) outside of clinical contexts. We conducted a thematic analysis of 403 posts on two online discussion forums with the aim of gathering information regarding the preferences of PWUP for characteristics they value in their carers in nonclinical contexts. We found three key distinct characteristics that PWUP preferred among their carers: presence, trust, and empathy. The characteristics were often consistent with the existing literature on PAP, though at times extended current understandings of key characteristics of PAP therapists, with the notion of carers being able to “hold space” during the psychedelic experience seen as an integral component of effective therapeutic outcomes that deserves more attention. Data obtained from PWUP in nonclinical contexts can be used to triangulate existing principles contained within PAP treatment guidelines and identify areas for further investigation.
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20
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Smith DT, Faber SC, Buchanan NT, Foster D, Green L. The Need for Psychedelic-Assisted Therapy in the Black Community and the Burdens of Its Provision. Front Psychiatry 2022; 12:774736. [PMID: 35126196 PMCID: PMC8811257 DOI: 10.3389/fpsyt.2021.774736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022] Open
Abstract
Psychedelic medicine is an emerging field that examines entheogens, psychoactive substances that produce non-ordinary states of consciousness (NOSC). 3,4-methylenedioxymethamphetamine (MDMA) is currently in phase-3 FDA clinical trials in the United States (US) and Canada to treat the symptoms of posttraumatic stress disorder (PTSD). MDMA is used in conjunction with manualized therapy, because of its effectiveness in reducing fear-driven stimuli that contribute to trauma and anxiety symptoms. In 2017, the FDA designated MDMA as a "breakthrough therapy," signaling that it has advantages in safety, efficacy, and compliance over available medication for the treatment of trauma-, stress-, and anxiety-related disorders such as PTSD. In the US and Canada, historical and contemporary racial mistreatment is frequently experienced by Black people via a variety of macro and micro insults. Such experiences trigger physiological responses of anxiety and fear, which are associated with chronically elevated stress hormone levels (e.g., cortisol and epinephrine), similar to levels documented among those diagnosed with an anxiety disorder. This paper will explore the benefits of entheogens within psychedelic assisted-therapy and their potential benefits in addressing the sequelae of pervasive and frequent negative race-based experiences and promoting healing and thriving among Black, Indigenous and other People of Color (BIPOC). The author(s) discuss the ethical responsibility for providing psychedelic-assisted therapy within a culturally competent provider framework and the importance of psychedelic researchers to recruit and retain BIPOC populations in research and clinical training.
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Affiliation(s)
- Darron T. Smith
- Department of Sociology, The University of Memphis, Memphis, TN, United States
| | | | - NiCole T. Buchanan
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | | | - Lilith Green
- Department of Sociology, The University of Memphis, Memphis, TN, United States
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21
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Spriggs MJ, Douglass HM, Park RJ, Read T, Danby JL, de Magalhães FJC, Alderton KL, Williams TM, Blemings A, Lafrance A, Nicholls DE, Erritzoe D, Nutt DJ, Carhart-Harris RL. Study Protocol for "Psilocybin as a Treatment for Anorexia Nervosa: A Pilot Study". Front Psychiatry 2021; 12:735523. [PMID: 34744825 PMCID: PMC8563607 DOI: 10.3389/fpsyt.2021.735523] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/15/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Anorexia nervosa (AN) is a serious and life-threatening psychiatric condition. With a paucity of approved treatments, there is a desperate need for novel treatment avenues to be explored. Here, we present (1) an overview of the ways through which Public Patient Involvement (PPI) has informed a trial of psilocybin-assisted therapy for AN and (2) a protocol for a pilot study of psilocybin-assisted therapy in AN currently underway at Imperial College London. The study aims to assess the feasibility, brain mechanisms and preliminary outcomes of treating anorexia nervosa with psilocybin. Methods: (1) PPI: Across two online focus groups, eleven individuals with lived experience of AN were presented with an overview of the protocol. Their feedback not only identified solutions to possible barriers for future participants, but also helped the research team to better understand the concept of "recovery" from the perspective of those with lived experience. (2) Protocol: Twenty female participants [21-65 years old, body mass index (BMI) 15 kg/m2 or above] will receive three oral doses of psilocybin (up to 25 mg) over a 6-week period delivered in a therapeutic environment and enveloped by psychological preparation and integration. We will work with participant support networks (care teams and an identified support person) throughout and there will be an extended remote follow-up period of 12 months. Our two-fold primary outcomes are (1) psychopathology (Eating Disorder Examination) across the 6-month follow-up and (2) readiness and motivation to engage in recovery (Readiness and Motivation Questionnaire) across the 6-week trial period. Neurophysiological outcome measures will be: (1) functional magnetic resonance imaging (fMRI) brain changes from baseline to 6-week endpoint and (2) post-acute changes in electroencephalography (EEG) activity, including an electrophysiological marker of neuronal plasticity. Discussion: The results of this pilot study will not only shed light on the acceptability, brain mechanisms, and impression of the potential efficacy of psilocybin as an adjunct treatment for AN but will be essential in shaping a subsequent Randomised Control Trial (RCT) that would test this treatment against a suitable control condition. Clinical Trial Registration: identifier: NCT04505189.
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Affiliation(s)
- Meg J. Spriggs
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Hannah M. Douglass
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Rebecca J. Park
- OxBREaD Research Group, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Tim Read
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Jennifer L. Danby
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Kirsty L. Alderton
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Tim M. Williams
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Allan Blemings
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Adele Lafrance
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
| | - Dasha E. Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - David Erritzoe
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - David J. Nutt
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Robin L. Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
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22
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Perkins D, Opaleye ES, Simonova H, Bouso JC, Tófoli LF, GalvÃo-Coelho NL, Schubert V, Sarris J. Associations between ayahuasca consumption in naturalistic settings and current alcohol and drug use: Results of a large international cross-sectional survey. Drug Alcohol Rev 2021; 41:265-274. [PMID: 34308566 DOI: 10.1111/dar.13348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Emerging evidence suggests that psychedelic compounds, including the Amazonian botanical decoction ayahuasca, may provide clinical benefit in the treatment of alcohol or other drug use disorders. This study investigates associations between ayahuasca consumption in naturalistic settings and current alcohol and other drug use. METHODS Online cross-sectional study of people who have consumed ayahuasca in religious, traditional and non-traditional settings in over 40 countries. A total of 8629 participants (53% male, average age 40 years) were included in the analysis. Logistic regressions were used to explore associations between ayahuasca drinking variables and the current use of alcohol and other drugs, as well as the influence of confounding factors, such as church or community membership. RESULTS The number of times ayahuasca had been consumed was strongly associated with increased odds of never or rarely drinking alcohol, never or rarely engaging in 'risky drinking' and having not consumed a range of drugs in the past month, with these effects greater for those with a prior substance use disorder compared to those without. The strength of ayahuasca drinkers subjective spiritual experience, number of personal self-insights obtained and drinking ayahuasca with an ayahuasca church were also associated with lower substance use in some models. DISCUSSION AND CONCLUSIONS Consumption of ayahuasca in naturalistic settings is associated with lower self-reported current consumption of alcohol and other drugs for those with and without prior substance use disorders, with such effects present after adjusting for religious or social group effects.
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Affiliation(s)
- Daniel Perkins
- School of Social and Political Science, University of Melbourne, Melbourne, Australia
| | - Emerita S Opaleye
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - José C Bouso
- International Center for Ethnobotanic Education, Research and Service, Barcelona, Spain.,Medical Anthropology Research Center, University of Rovira I Virgili, Tarragona, Spain.,Department of Neurosciences and Behavior, Ribeião Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Luís F Tófoli
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Nicole L GalvÃo-Coelho
- Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Violeta Schubert
- School of Social and Political Science, University of Melbourne, Melbourne, Australia
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Sydney, Australia.,Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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23
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Horton DM, Morrison B, Schmidt J. Systematized Review of Psychotherapeutic Components of Psilocybin-Assisted Psychotherapy. Am J Psychother 2021; 74:140-149. [PMID: 34293927 DOI: 10.1176/appi.psychotherapy.20200055] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This systematized review sought to fill a gap in psilocybin research by investigating the structure and format of psilocybin-assisted psychotherapy (PAP), with a focus on the counseling components of the treatment. METHODS A systematized review of PAP was conducted by using the PubMed and PsycInfo databases to search for peer-reviewed studies of human clinical trials, published within the past 25 years, in which psilocybin was administered with psychological support in a clinical setting. RESULTS Eleven articles matched the criteria necessary for inclusion in this review. PAP was found to consist of three stages: pretreatment sessions to prepare participants for psilocybin, treatment sessions in which psilocybin was administered, and posttreatment sessions to integrate the experience with daily life. Conventional psychotherapy was primarily seen in the pre- and posttreatment sessions. Psychotherapies included in PAP differed among studies, but most often included music therapy and a nondirective supportive approach to treatment. CONCLUSIONS This systematized review found important commonalities among clinical trials of PAP published within the past 25 years and revealed key differences among studies in psychotherapy's incorporation into PAP. Additional research is needed to identify the unique effect of psychotherapy in PAP.
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Affiliation(s)
- David M Horton
- Department of Allied Health Sciences, University of North Carolina, Chapel Hill
| | - Blaise Morrison
- Department of Allied Health Sciences, University of North Carolina, Chapel Hill
| | - Judy Schmidt
- Department of Allied Health Sciences, University of North Carolina, Chapel Hill
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Thal SB, Bright SJ, Sharbanee JM, Wenge T, Skeffington PM. Current Perspective on the Therapeutic Preset for Substance-Assisted Psychotherapy. Front Psychol 2021; 12:617224. [PMID: 34326789 PMCID: PMC8313735 DOI: 10.3389/fpsyg.2021.617224] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/31/2021] [Indexed: 01/07/2023] Open
Abstract
The present narrative review is the first in a series of reviews about the appropriate conduct in substance-assisted psychotherapy (SAPT). It outlines a current perspective onpreconditions and theoretical knowledge that have been identified as valuable in the literaturefor appropriate therapeutic conduct in SAPT. In this context, considerations regarding ethics and the spiritual emphasis of the therapeutic approaches are discussed. Further, current methods, models, and concepts of psychological mechanism of action and therapeutic effects of SAPT are summarized, and similarities between models, approaches, and potential mediators for therapeutic effects are outlined. It is argued that a critical assessment of the literature might indicate that the therapeutic effect of SAPT may be mediated by intra- and interpersonal variables within the therapeutic context rather than specific therapeutic models per se. The review provides a basis for the development and adaptation of future investigations, therapeutic models, training programs for therapists, and those interested in the therapeutic potential of SAPT. Limitations and future directions for research are discussed.
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Affiliation(s)
- Sascha B. Thal
- College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
| | - Stephen J. Bright
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Psychedelic Research in Science and Medicine Pty Ltd (PRISM), Balwyn North, VIC, Australia
| | - Jason M. Sharbanee
- Department of Psychology and Criminology, School of Arts and Humanities, Edith Cowan University, Joondalup, WA, Australia
| | - Tobias Wenge
- International Society for Bonding Psychotherapy, Friedrichshafen, Germany
| | - Petra M. Skeffington
- College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
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Pilecki B, Luoma JB, Bathje GJ, Rhea J, Narloch VF. Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduct J 2021; 18:40. [PMID: 33827588 PMCID: PMC8028769 DOI: 10.1186/s12954-021-00489-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/29/2021] [Indexed: 12/21/2022] Open
Abstract
Psychedelic-assisted therapy may represent an upcoming paradigm shift in the treatment of mental health problems as recent clinical trials have demonstrated strong evidence of their therapeutic benefits. While psychedelics are currently prohibited substances in most countries, the growing popularity of their therapeutic potential is leading many people to use psychedelics on their own rather than waiting for legal medical access. Therapists therefore have an ethical duty to meet this need by providing support for clients using psychedelics. However, incorporating psychedelics into traditional psychotherapy poses some risk given their prohibited status and many therapists are unsure of how they might practice in this area. This paper explicates such risks and describes ways in which therapists can mitigate them and strive to practice within legal and ethical boundaries. A harm reduction approach will be emphasized as a useful framework for conducting therapy around clients' use of psychedelics. It is argued that therapists can meet with clients before and after their own personal psychedelic experiences in order to help clients minimize risk and maximize benefit. Common clinical scenarios in this growing clinical area will also be discussed.
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Affiliation(s)
- Brian Pilecki
- Portland Psychotherapy Clinic, Research, & Training Center, 3700 N Williams Ave, Portland, OR, 97227, USA.
| | - Jason B Luoma
- Portland Psychotherapy Clinic, Research, & Training Center, 3700 N Williams Ave, Portland, OR, 97227, USA
| | - Geoff J Bathje
- Department of Counseling and Integrated Programs, Adler University, 17 N Dearborn, Chicago, IL, 60602, USA
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Gorman I, Nielson EM, Molinar A, Cassidy K, Sabbagh J. Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice. Front Psychol 2021; 12:645246. [PMID: 33796055 PMCID: PMC8008322 DOI: 10.3389/fpsyg.2021.645246] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
Psychedelic Harm Reduction and Integration (PHRI) is a transtheoretical and transdiagnostic clinical approach to working with patients who are using or considering using psychedelics in any context. The ongoing discussion of psychedelics in academic research and mainstream media, coupled with recent law enforcement deprioritization of psychedelics and compassionate use approvals for psychedelic-assisted therapy, make this model exceedingly timely. Given the prevalence of psychedelic use, the therapeutic potential of psychedelics, and the unique cultural and historical context in which psychedelics are placed, it is important that mental health providers have an understanding of the unique motivations, experiences, and needs of people who use them. PHRI incorporates elements of harm reduction psychotherapy and psychedelic-assisted psychotherapy, and can be applied in both brief and ongoing psychotherapy interactions. PHRI represents a shift away from assessment limited to untoward outcomes of psychedelic use and abstinence-based addiction treatment paradigms and toward a stance of compassionate, destigmatizing acceptance of patients' choices. Considerations for assessment, preparation, and working with difficult experiences are presented.
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Affiliation(s)
- Ingmar Gorman
- MAPS Public Benefit Corp, Santa Cruz, CA, United States
- Fluence, Woodstock, NY, United States
- Depression Evaluation Services, New York State Psychiatric Institute, New York, NY, United States
- Journey Clinical, Inc. Dover, DE, United States
| | - Elizabeth M. Nielson
- MAPS Public Benefit Corp, Santa Cruz, CA, United States
- Fluence, Woodstock, NY, United States
- Depression Evaluation Services, New York State Psychiatric Institute, New York, NY, United States
| | - Aja Molinar
- Todman Psychopathology Lab, Psychology Department, New School for Social Research, New York, NY, United States
| | - Ksenia Cassidy
- Todman Psychopathology Lab, Psychology Department, New School for Social Research, New York, NY, United States
- The Center for Attachment Research, Psychology Department, New School for Social Research, Attachment Lab, New York, NY, United States
| | - Jonathan Sabbagh
- Journey Clinical, Inc. Dover, DE, United States
- Todman Psychopathology Lab, Psychology Department, New School for Social Research, New York, NY, United States
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Healy CJ. The acute effects of classic psychedelics on memory in humans. Psychopharmacology (Berl) 2021; 238:639-653. [PMID: 33420592 DOI: 10.1007/s00213-020-05756-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022]
Abstract
RATIONALE Memory plays a central role in the psychedelic experience. The spontaneous recall and immersive reliving of autobiographical memories has frequently been noted by researchers and clinicians as a salient phenomenon in the profile of subjective effects of classic psychedelic drugs such as psilocybin, LSD, and ayahuasca. The ability for psychedelics to provoke vivid memories has been considered important to their clinical efficacy. OBJECTIVE This review aims to examine and aggregate the findings from experimental, observational, and qualitative studies on the acute modulation of memory by classic psychedelics in humans. METHOD A literature search was conducted using PubMed and PsycInfo as well as manual review of references from eligible studies. Publications reporting quantitative and/or qualitative findings were included; animal studies and case reports were excluded. RESULTS Classic psychedelics produce dose-dependently increasing impairments in memory task performance, such that low doses produce no impairment and higher doses produce increasing levels of impairment. This pattern has been observed in tasks assessing spatial and verbal working memory, semantic memory, and non-autobiographical episodic memory. Such impairments may be less pronounced among experienced psychedelic users. Classic psychedelics also increase the vividness of autobiographical memories and frequently stimulate the recall and/or re-experiencing of autobiographical memories, often memories that are affectively intense (positively or negatively valenced) and that had been avoided and/or forgotten prior to the experience. CONCLUSIONS Classic psychedelics dose-dependently impair memory task performance but may enhance autobiographical memory. These findings are relevant to the understanding of psychological mechanisms of action of psychedelic-assisted psychotherapy.
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Affiliation(s)
- C J Healy
- Department of Psychology, The New School for Social Research, 80 5th Ave, 6th Floor, New York, NY, USA.
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Williams MT, Reed S, George J. Culture and psychedelic psychotherapy: Ethnic and racial themes from three Black women therapists. JOURNAL OF PSYCHEDELIC STUDIES 2021. [DOI: 10.1556/2054.2020.00137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractPsychedelic medicine is an emerging field of research and practice that examines the psychotherapeutic effects of substances classified as hallucinogens on the human mind, body, and spirit. Current research explores the safety and efficacy of these substances for mental health disorders including anxiety, depression, and posttraumatic stress disorder (PTSD). Although current studies explore psychotherapeutic effects from a biomedical perspective, gaps in awareness around cultural issues in the therapeutic process are prominent. African Americans have been absent from psychedelic research as both participants and researchers, and little attention has been paid to the potential of psychedelics to address traumas caused by racialization. This paper examines cultural themes and clinical applications from the one-time use of 3,4-methylenedioxymethamphetamine (MDMA) as part of an US Food and Drug Administration (FDA)-approved clinical trial and training exercise for three African American female therapists. The primary themes that emerged across the varied experiences centered on strength, safety, connection, and managing oppression/racialization. The participants' experiences were found to be personally meaningful and instructive for how Western models of psychedelic-assisted psychotherapy could be more effective and accessible to the Black community. Included is a discussion of the importance of facilitator training to make best use of emerging material when it includes cultural, racial, and spiritual themes. A lack of knowledge and epistemic humility can create barriers to treatment for underserved populations. Implications for future research and practice for marginalized cultural groups are also discussed, including consideration of Functional Analytic Psychotherapy (FAP) as an adjunct to the psychedelic-therapy approaches currently advanced. As women of color are among the most stigmatized groups of people, it is essential to incorporate their perspectives into the literature to expand conversations about health equity.
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Affiliation(s)
- Monnica T. Williams
- 1Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- 2Behavioral Wellness Clinic, LLC, Tolland, CT, USA
- 3School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Sara Reed
- 1Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- 2Behavioral Wellness Clinic, LLC, Tolland, CT, USA
| | - Jamilah George
- 1Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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Lepow L, Morishita H, Yehuda R. Critical Period Plasticity as a Framework for Psychedelic-Assisted Psychotherapy. Front Neurosci 2021; 15:710004. [PMID: 34616272 PMCID: PMC8488335 DOI: 10.3389/fnins.2021.710004] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/17/2021] [Indexed: 12/28/2022] Open
Abstract
As psychedelic compounds gain traction in psychiatry, there is a need to consider the active mechanism to explain the effect observed in randomized clinical trials. Traditionally, biological psychiatry has asked how compounds affect the causal pathways of illness to reduce symptoms and therefore focus on analysis of the pharmacologic properties. In psychedelic-assisted psychotherapy (PAP), there is debate about whether ingestion of the psychedelic alone is thought to be responsible for the clinical outcome. A question arises how the medication and psychotherapeutic intervention together might lead to neurobiological changes that underlie recovery from illness such as post-traumatic stress disorder (PTSD). This paper offers a framework for investigating the neurobiological basis of PAP by extrapolating from models used to explain how a pharmacologic intervention might create an optimal brain state during which environmental input has enduring effects. Specifically, there are developmental "critical" periods (CP) with exquisite sensitivity to environmental input; the biological characteristics are largely unknown. We discuss a hypothesis that psychedelics may remove the brakes on adult neuroplasticity, inducing a state similar to that of neurodevelopment. In the visual system, progress has been made both in identifying the biological conditions which distinguishes the CP and in manipulating the active ingredients with the idea that we might pharmacologically reopen a critical period in adulthood. We highlight ocular dominance plasticity (ODP) in the visual system as a model for characterizing CP in limbic systems relevant to psychiatry. A CP framework may help to integrate the neuroscientific inquiry with the influence of the environment both in development and in PAP.
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Affiliation(s)
- Lauren Lepow
- Department of Psychiatry, Icahn School of Medicine Mount Sinai, New York, NY, United States.,Department of Neuroscience, Icahn School of Medicine Mount Sinai, New York, NY, United States
| | - Hirofumi Morishita
- Department of Psychiatry, Icahn School of Medicine Mount Sinai, New York, NY, United States.,Department of Neuroscience, Icahn School of Medicine Mount Sinai, New York, NY, United States.,Department of Ophthalmology, Icahn School of Medicine Mount Sinai, New York, NY, United States
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine Mount Sinai, New York, NY, United States.,Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States
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Healy CJ, Lee KA, D’Andrea W. Using Psychedelics With Therapeutic Intent Is Associated With Lower Shame and Complex Trauma Symptoms in Adults With Histories of Child Maltreatment. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2021; 5:24705470211029881. [PMID: 34291179 PMCID: PMC8278461 DOI: 10.1177/24705470211029881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Child maltreatment negatively affects the formation of internal schemata of self and other during development, leading to negative adaptations in self-concept and social cognition. Clinical reports suggest the efficacy of psychedelics in treating the psychopathological sequelae of child maltreatment. Altering maladaptive schemata of self and other implicated in negative self-concept and impaired social cognition may be a central mechanism for reducing posttraumatic stress symptoms. AIMS This study aims to assess whether psychedelic use moderates the relationships between child maltreatment and self-concept, social cognition, and posttraumatic stress symptoms. METHOD An online survey was completed by 166 participants and included measures of maltreatment exposure and severity, history of intentional therapeutic psychedelic use, posttraumatic stress symptoms, internalized shame, and facial emotion recognition. RESULTS Child maltreatment significantly correlated with posttraumatic stress symptoms (r = .26 and r = .20, p < .01) and internalized shame (r = .18, p < .05). Of all maltreatment subtypes, emotional abuse and neglect most strongly correlated with complex trauma symptoms (r = .32, p < .001) and internalized shame (r = .31, p < .001). Participants with a history of intentional therapeutic psychedelic use reported significantly lower complex trauma symptoms (d = 0.33, p < .05) and internalized shame (d = 0.35, p < .05) despite similar histories of maltreatment. Differences in complex trauma symptoms (d = 0.66, p < .01) and internalized shame (d = 0.80, p < .001) were largest for participants with a history of more than 5 occasions of intentional therapeutic psychedelic use. A history of more than 5 occasions of intentional therapeutic psychedelic use significantly moderated the relationship between emotional abuse and neglect and complex trauma symptoms (p < .01). No associations were found between maltreatment or psychedelic use and facial emotion recognition. CONCLUSION These findings demonstrate that using psychedelic drugs with therapeutic intent is associated with lower levels of complex trauma symptoms and internalized shame in individuals with histories of child maltreatment. Psychedelic use may have therapeutic benefit in treating the posttraumatic sequelae of child maltreatment.
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Affiliation(s)
- C. J. Healy
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Kellie Ann Lee
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Wendy D’Andrea
- Department of Psychology, The New School for Social Research, New York, NY, USA
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Abstract
Psychedelics have shown great promise in modern clinical trials for treating various psychiatric conditions. As a transdiagnostic treatment that exerts its effects through subjective experiences that leave enduring effects, it is akin to psychotherapy. To date, there has been insufficient discussion of how psychedelic therapy is similar to and different from conventional psychotherapy. In this article, we review the shared features of effective conventional psychotherapies and situate therapeutic psychedelic effects within those. We then discuss how psychedelic drug effects might amplify conventional psychotherapeutic processes-particularly via effects on meaning and relationship-as well as features that make psychedelic treatment unique. Taking into account shared features of conventional psychotherapies and unique psychedelic drug effects, we create a framework for understanding why psychedelics are likely to be effective with very diverse types of psychotherapies. We also review the formal psychotherapies that have been adjunctively included in modern psychedelic trials and extend the understanding of psychedelics as psychotherapy towards implications for clinical ethics and trial design. We aim to provide some common conceptual vocabulary that can be used to frame therapeutic psychedelic effects beyond the confines of any one specific modality.
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Affiliation(s)
- Sandeep Nayak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew W Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Wolff M, Evens R, Mertens LJ, Koslowski M, Betzler F, Gründer G, Jungaberle H. Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance. Front Psychiatry 2020; 11:5. [PMID: 32153433 PMCID: PMC7046795 DOI: 10.3389/fpsyt.2020.00005] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/03/2020] [Indexed: 12/24/2022] Open
Abstract
The efficacy of psychedelic-assisted therapies for mental disorders has been attributed to the lasting change from experiential avoidance to acceptance that these treatments appear to facilitate. This article presents a conceptual model that specifies potential psychological mechanisms underlying such change, and that shows substantial parallels between psychedelic therapy and cognitive behavioral therapy: We propose that in the carefully controlled context of psychedelic therapy as applied in contemporary clinical research, psychedelic-induced belief relaxation can increase motivation for acceptance via operant conditioning, thus engendering episodes of relatively avoidance-free exposure to greatly intensified private events. Under these unique learning conditions, relaxed avoidance-related beliefs can be exposed to corrective information and become revised accordingly, which may explain long-term increases in acceptance and corresponding reductions in psychopathology. Open research questions and implications for clinical practice are discussed.
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Affiliation(s)
- Max Wolff
- Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- MIND Foundation, Berlin, Germany
| | - Ricarda Evens
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lea J. Mertens
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Koslowski
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Betzler
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Sloshower J, Guss J, Krause R, Wallace RM, Williams MT, Reed S, Skinta MD. Psilocybin-assisted therapy of major depressive disorder using Acceptance and Commitment Therapy as a therapeutic frame. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2019.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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5-Methoxy-N,N-dimethyltryptamine: An Ego-Dissolving Endogenous Neurochemical Catalyst of Creativity. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s41470-019-00063-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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35
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Nielson EM, Guss J. The influence of therapists’ first-hand experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training. JOURNAL OF PSYCHEDELIC STUDIES 2018. [DOI: 10.1556/2054.2018.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Jeffrey Guss
- Department of Psychiatry, NYU School of Medicine, New York, NY, USA
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Nielson EM, May DG, Forcehimes AA, Bogenschutz MP. The Psychedelic Debriefing in Alcohol Dependence Treatment: Illustrating Key Change Phenomena through Qualitative Content Analysis of Clinical Sessions. Front Pharmacol 2018. [PMID: 29515449 PMCID: PMC5826346 DOI: 10.3389/fphar.2018.00132] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Research on the clinical applications of psychedelic-assisted psychotherapy has demonstrated promising early results for treatment of alcohol dependence. Detailed description of the content and methods of psychedelic-assisted psychotherapy, as it is conducted in clinical settings, is scarce. Methods: An open-label pilot (proof-of-concept) study of psilocybin-assisted treatment of alcohol dependence (NCT01534494) was conducted to generate data for a phase 2 RCT (NCT02061293) of a similar treatment in a larger population. The present paper presents a qualitative content analysis of the 17 debriefing sessions conducted in the pilot study, which occurred the day after corresponding psilocybin medication sessions. Results: Participants articulated a series of key phenomena related to change in drinking outcomes and acute subjective effects of psilocybin. Discussion: The data illuminate change processes in patients' own words during clinical sessions, shedding light on potential therapeutic mechanisms of change and how participants express effects of psilocybin. This study is unique in analyzing actual clinical sessions, as opposed to interviews of patients conducted separately from treatment.
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Affiliation(s)
- Elizabeth M Nielson
- Department of Psychiatry, NYU School of Medicine, New York University, New York, NY, United States
| | - Darrick G May
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Michael P Bogenschutz
- Department of Psychiatry, NYU School of Medicine, New York University, New York, NY, United States
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