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Carrithers BM, Roberts DE, Weiss BM, King JD, Carhart-Harris RL, Gordon AR, Pagni BA, Moreau M, Ross S, Zeifman RJ. Exploring serotonergic psychedelics as a treatment for personality disorders. Neuropharmacology 2025; 272:110413. [PMID: 40081794 DOI: 10.1016/j.neuropharm.2025.110413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 02/27/2025] [Accepted: 03/10/2025] [Indexed: 03/16/2025]
Abstract
Both psychotherapeutic interventions and pharmacological agents have demonstrated limited efficacy in the treatment of personality disorders (PDs). Emerging evidence suggests that psychedelic therapy, already showing promise in treating various psychiatric conditions commonly comorbid with PDs, may exert therapeutic effects by promoting adaptive changes in personality. Thus, psychedelic therapy could hold potential for addressing core features of PDs through shared mechanisms of personality modulation. Although historical literature and observational studies suggest the potential clinical utility of psychedelics in treating PDs, rigorous research is lacking, and individuals with PDs are often excluded from modern psychedelic therapy trials. In the present review, we first discuss research on the effects of psychedelics in individuals with a PD through the conventional lens of the Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR) categorical model. Next, using the dimensional DSM Alternative Model of Personality Disorders (DSM-AMPD) as a framework, we examine how psychedelics may affect self-functioning, interpersonal functioning, and pathological personality traits. We conclude by discussing the clinical relevance of psychedelic therapy as a treatment for personality pathology, including safety considerations, gaps and limitations, and recommendations for approaching psychedelic therapy within these more complex clinical populations.
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Affiliation(s)
- Brennan M Carrithers
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA.
| | - Daniel E Roberts
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Brandon M Weiss
- Center for Psychedelic & Consciousness Research, Johns Hopkins, Baltimore, MD, USA
| | - Jacob D King
- Division of Psychiatry, Imperial College London, UK
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK; Psychedelics Division, Neuroscape, University of California, San Francisco, USA
| | - Alexandra R Gordon
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Broc A Pagni
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Miltiadis Moreau
- Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Stephen Ross
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Richard J Zeifman
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, NY, USA; Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
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Agnorelli C, Spriggs M, Godfrey K, Sawicka G, Bohl B, Douglass H, Fagiolini A, Parastoo H, Carhart-Harris R, Nutt D, Erritzoe D. Neuroplasticity and psychedelics: A comprehensive examination of classic and non-classic compounds in pre and clinical models. Neurosci Biobehav Rev 2025; 172:106132. [PMID: 40185376 DOI: 10.1016/j.neubiorev.2025.106132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 03/24/2025] [Accepted: 03/29/2025] [Indexed: 04/07/2025]
Abstract
Neuroplasticity, the ability of the nervous system to adapt throughout an organism's lifespan, offers potential as both a biomarker and treatment target for neuropsychiatric conditions. Psychedelics, a burgeoning category of drugs, are increasingly prominent in psychiatric research, prompting inquiries into their mechanisms of action. Distinguishing themselves from traditional medications, psychedelics demonstrate rapid and enduring therapeutic effects after a single or few administrations, believed to stem from their neuroplasticity-enhancing properties. This review examines how classic psychedelics (e.g., LSD, psilocybin, N,N-DMT) and non-classic psychedelics (e.g., ketamine, MDMA) influence neuroplasticity. Drawing from preclinical and clinical studies, we explore the molecular, structural, and functional changes triggered by these agents. Animal studies suggest psychedelics induce heightened sensitivity of the nervous system to environmental stimuli (meta-plasticity), re-opening developmental windows for long-term structural changes (hyper-plasticity), with implications for mood and behavior. Translating these findings to humans faces challenges due to limitations in current imaging techniques. Nonetheless, promising new directions for human research are emerging, including the employment of novel positron-emission tomography (PET) radioligands, non-invasive brain stimulation methods, and multimodal approaches. By elucidating the interplay between psychedelics and neuroplasticity, this review informs the development of targeted interventions for neuropsychiatric disorders and advances understanding of psychedelics' therapeutic potential.
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Affiliation(s)
- Claudio Agnorelli
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Science, Imperial College of London, UK; Unit of Psychiatry, Department of Molecular and Developmental Medicine, University of Siena, Italy.
| | - Meg Spriggs
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Science, Imperial College of London, UK
| | - Kate Godfrey
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Science, Imperial College of London, UK
| | - Gabriela Sawicka
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Science, Imperial College of London, UK
| | - Bettina Bohl
- Department of Bioengineering, Imperial College of London, UK
| | - Hannah Douglass
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Science, Imperial College of London, UK
| | - Andrea Fagiolini
- Unit of Psychiatry, Department of Molecular and Developmental Medicine, University of Siena, Italy
| | | | - Robin Carhart-Harris
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Science, Imperial College of London, UK; Departments of Neurology and Psychiatry, Carhart-Harris Lab, University of California San Francisco, San Francisco, CA, USA
| | - David Nutt
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Science, Imperial College of London, UK
| | - David Erritzoe
- Centre for Psychedelic Research, Division of Psychiatry, Department of Brain Science, Imperial College of London, UK
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Healy CJ, Frazier A, Kirsch S, Sanford A, Garcia-Romeu A, Todman M, Varon J, D'Andrea W. Acute subjective effects of psychedelics in naturalistic group settings prospectively predict longitudinal improvements in trauma symptoms, trait shame, and connectedness among adults with childhood maltreatment histories. Prog Neuropsychopharmacol Biol Psychiatry 2025:111361. [PMID: 40222645 DOI: 10.1016/j.pnpbp.2025.111361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 04/04/2025] [Accepted: 04/05/2025] [Indexed: 04/15/2025]
Abstract
Studies of psychedelic use in naturalistic and clinical settings have suggested safety and mental health benefits for adults with histories of childhood maltreatment. Acute psychological mechanisms that predict therapeutic benefits in this population, however, have yet to be determined. Two common group settings of naturalistic psychedelic use - organized ceremonies and raves or other electronic dance music events - might facilitate therapeutic psychedelic effects because of the unique psychosocial environments they comprise. This prospective, longitudinal study sought to investigate 2 primary questions: first, whether adults with maltreatment histories planning to use psychedelic drugs with therapeutic intent at ceremonies or raves would see enduring psychological benefits after their experiences; and second, whether subjective dimensions of the acute psychedelic experience would be associated with lasting psychological benefits. Eighty-five participants completed self-report measures in the month before, within 2 days after, and approximately 2 months after a planned psychedelic experience with therapeutic intent at a ceremony or rave assessing childhood maltreatment history; trauma symptoms, internalized (trait) shame, and connectedness at baseline and follow-up; and various dimensions of the acute subjective psychedelic experience. Mean scores in posttraumatic stress disorder (PTSD) symptoms, complex PTSD symptoms, trait shame, social connectedness, and general connectedness significantly improved from baseline to 2-month follow-up (ds = 0.73-1.12). Longitudinal changes in outcomes significantly correlated with acute subjective effects of the psychedelic experience. These findings have implications regarding both the potential clinical benefit of psychedelic use among adults with childhood maltreatment histories as well as the psychological mechanisms of therapeutic action of psychedelics.
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Affiliation(s)
- C J Healy
- Department of Psychology, The New School for Social Research, New York, NY, USA.
| | - Aaron Frazier
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Stephen Kirsch
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Anna Sanford
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Albert Garcia-Romeu
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - McWelling Todman
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Jeremy Varon
- Department of History, 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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Forstmann M, Sagioglou C. Psychedelics and connectedness to natural and social worlds: An examination of the evidence and a proposed conceptual framework. Curr Opin Psychol 2025; 62:101992. [PMID: 39862684 DOI: 10.1016/j.copsyc.2025.101992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 01/06/2025] [Accepted: 01/10/2025] [Indexed: 01/27/2025]
Abstract
Recent research suggests that serotonergic psychedelics may simultaneously enhance connectedness to both social and natural worlds. This article synthesizes current evidence regarding psychedelics' effects on nature relatedness and social connectedness, examining underlying mechanisms through the framework of self-other overlap. Psychedelics appear to facilitate self-expansion through two complementary mechanisms: ego dissolution, which temporarily alters self-boundaries, and enhanced emotional processing, which increases empathic concern. While studies demonstrate promising effects, interpretation is complicated by methodological challenges including functional unblinding, reliance on self-reports, and small sample sizes. We propose a multidimensional model of connectedness that distinguishes between perceptual, emotional, and epistemic domains, each showing distinct patterns in acute and enduring effects. Future research would benefit from behavioral measures, active placebos, and careful consideration of contextual factors.
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Zhou K, de Wied D, Carhart-Harris RL, Kettner H. Prediction of hallucinogen persisting perception disorder and thought disturbance symptoms following psychedelic use. PNAS NEXUS 2025; 4:pgae560. [PMID: 40264850 PMCID: PMC12012689 DOI: 10.1093/pnasnexus/pgae560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 09/21/2024] [Indexed: 04/24/2025]
Abstract
Interest in using psychedelic drugs to treat psychiatric disorders is growing rapidly. While modern controlled clinical trials show a favorable safety and efficacy profile, it remains unclear if the risk of side effects would increase with broader use in more heterogeneous populations. To address this, we investigated the frequency and baseline predictors of delusional ideation, magical thinking, and "hallucinogen persisting perception disorder" (HPPD)-related symptoms following psychedelic use in a self-selected naturalistic sample. Using a prospective cohort study, symptoms were assessed in ( N = 654 ) participants at one week before a planned psychedelic experience, and at two and four weeks afterward. Across the sample, delusional ideation was found to be reduced one month after psychedelic use ( P < 0.001 ) with no changes detected in magical thinking. These findings were in seeming opposition to positive correlations between lifetime psychedelic use at baseline with magical thinking ( r s = 0.12 , P = 0.003 ) and delusional ideation ( r s = 0.11 , P = 0.01 ), suggesting that schizotypal traits, instead of being caused by, may merely correlate with psychedelic use. Importantly, over 30% of the sample reported HPPD-type effects at the 4-week endpoint, although rarely perceived as distressing (< 1% of the population). Younger age, female gender, history of a psychiatric diagnosis and baseline trait absorption predicted the occurrence of HPPD-like effects. This is in line with prior studies showing a high prevalence of HPPD-like symptoms in psychedelic users, which, however, appear to remain at a subclinical severity in most cases, explaining the comparatively lower prevalence of HPPD diagnoses.
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Affiliation(s)
- Katie Zhou
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London SW7 2AZ, United Kingdom
| | - David de Wied
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London SW7 2AZ, United Kingdom
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London SW7 2AZ, United Kingdom
- Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Hannes Kettner
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London SW7 2AZ, United Kingdom
- Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
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Jiwani Z, Goldberg SB, Stroud J, Young J, Curtin J, Dunne JD, Simonsson O, Webb CA, Carhart-Harris R, Schlosser M. Can psychedelic use benefit meditation practice? Examining individual, psychedelic, and meditation-related factors. PLoS One 2025; 20:e0310160. [PMID: 39937729 PMCID: PMC11819602 DOI: 10.1371/journal.pone.0310160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Accepted: 11/29/2024] [Indexed: 02/14/2025] Open
Abstract
INTRODUCTION Meditation practice and psychedelic use have attracted increasing attention in the public sphere and scientific research. Both methods induce non-ordinary states of consciousness that may have significant therapeutic benefits. Thus, there is growing scientific interest in potential synergies between psychedelic use and meditation practice with some research suggesting that psychedelics may benefit meditation practice. The present study examined individual, psychedelic-related, and meditation-related factors to determine under what conditions meditators perceive psychedelic use as beneficial for their meditation practice. METHOD Participants (N = 863) who had reported psychedelic use and a regular meditation practice (at least 3 times per week during the last 12 months) were included in the study. To accommodate a large number of variables, machine learning (i.e., elastic net, random forest) was used to analyze the data. RESULTS Most participants (n = 634, 73.5%) found psychedelic use to have a positive influence on their quality of meditation. Twenty-eight variables showed significant zero-order associations with perceived benefits even following a correction. Elastic net had the best performance (R2 = .266) and was used to identify the most important features. Across 53 variables, the model found that greater use of psychedelics, intention setting during psychedelic use, agreeableness, and exposure to N,N-Dimethyltryptamine (N,N-DMT) were most likely to be associated with the perception that psychedelics benefit meditation practice. The results were consistent across several different approaches used to identify the most important variables (i.e., Shapley values, feature ablation). DISCUSSION Results suggest that most meditators found psychedelic use to have a positive influence on their meditation practice, with: 1) regularity of psychedelic use, 2) the setting of intentions for psychedelic use, 3) having an agreeable personality, and 4) reported use of N,N-DMT being the most likely predictors of perceiving psychedelic use as beneficial. Longitudinal designs and randomized trials manipulating psychedelic use are needed to establish causality.
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Affiliation(s)
- Zishan Jiwani
- Department of Counseling Psychology, University of Wisconsin, Madison, Wisconsin, United States of America
- Center for Healthy Minds, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin, Madison, Wisconsin, United States of America
- Center for Healthy Minds, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Jack Stroud
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Jacob Young
- Department of Counseling Psychology, University of Wisconsin, Madison, Wisconsin, United States of America
| | - John Curtin
- Center for Healthy Minds, University of Wisconsin, Madison, Wisconsin, United States of America
- Department of Psychology, University of Wisconsin, Madison, Wisconsin, United States of America
| | - John D. Dunne
- Center for Healthy Minds, University of Wisconsin, Madison, Wisconsin, United States of America
- Department of Asian Languages and Cultures, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Otto Simonsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Christian A. Webb
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts, United States of America
| | - Robin Carhart-Harris
- Department of Neurology, University of California-San Francisco, San Francisco, California, United States of America
| | - Marco Schlosser
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
- Institut für Psychotherapie Potsdam, Potsdam, Germany
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Pagni BA, Zeifman RJ, Mennenga SE, Carrithers BM, Goldway N, Bhatt S, O'Donnell KC, Ross S, Bogenschutz MP. Multidimensional Personality Changes Following Psilocybin-Assisted Therapy in Patients With Alcohol Use Disorder: Results From a Double-Blind, Placebo-Controlled Clinical Trial. Am J Psychiatry 2025; 182:114-125. [PMID: 39741446 DOI: 10.1176/appi.ajp.20230887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
OBJECTIVE Evidence suggests that psilocybin-assisted therapy (PAT) leads to durable shifts in personality structure. However, such changes have yet to be characterized in disorders of addiction. In this secondary analysis from a randomized controlled trial, the authors examined the effect of PAT on personality dimensions in patients with alcohol use disorder (AUD), hypothesizing that PAT would attenuate personality abnormalities in AUD and that reductions in trait impulsiveness would be associated with lower drinking. METHODS Eighty-four adults with AUD were randomized to two medication sessions of either psilocybin (N=44) or active placebo (diphenhydramine; N=40), received 12 weekly psychotherapy sessions, and completed follow-up for an additional 24 weeks. Changes in personality traits (week 36 vs. baseline) were assessed with the revised NEO Personality Inventory; daily alcohol consumption was quantified using the timeline followback. RESULTS Relative to the placebo group, the psilocybin group showed significant reductions in neuroticism and increases in extraversion and openness. Secondary analyses showed that reductions in neuroticism were driven by decreases in the facets depression, impulsiveness, and vulnerability; increases in openness were driven by increases in the facets openness toward feelings and fantasy. Across all participants, decreases in impulsiveness were associated with lower posttreatment alcohol consumption, and an exploratory analysis revealed that these associations were strongest among psilocybin-treated participants who continued moderate- or high-risk drinking prior to the first medication session. CONCLUSIONS PAT elicited durable shifts in personality, suggesting normalization of abnormal personality trait expression in AUD. Further study is needed to clarify whether PAT exerts its beneficial effects by reducing impulsiveness or whether impulsive individuals inherently respond better to PAT.
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Affiliation(s)
- Broc A Pagni
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York (Pagni, Zeifman, Mennenga, Carrithers, Goldway, O'Donnell, Ross, Bogenschutz); School of Life Sciences, Arizona State University, Tempe (Mennenga); Department of Psychology, New York University, New York (Goldway); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Bhatt)
| | - Richard J Zeifman
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York (Pagni, Zeifman, Mennenga, Carrithers, Goldway, O'Donnell, Ross, Bogenschutz); School of Life Sciences, Arizona State University, Tempe (Mennenga); Department of Psychology, New York University, New York (Goldway); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Bhatt)
| | - Sarah E Mennenga
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York (Pagni, Zeifman, Mennenga, Carrithers, Goldway, O'Donnell, Ross, Bogenschutz); School of Life Sciences, Arizona State University, Tempe (Mennenga); Department of Psychology, New York University, New York (Goldway); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Bhatt)
| | - Brennan M Carrithers
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York (Pagni, Zeifman, Mennenga, Carrithers, Goldway, O'Donnell, Ross, Bogenschutz); School of Life Sciences, Arizona State University, Tempe (Mennenga); Department of Psychology, New York University, New York (Goldway); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Bhatt)
| | - Noam Goldway
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York (Pagni, Zeifman, Mennenga, Carrithers, Goldway, O'Donnell, Ross, Bogenschutz); School of Life Sciences, Arizona State University, Tempe (Mennenga); Department of Psychology, New York University, New York (Goldway); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Bhatt)
| | - Snehal Bhatt
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York (Pagni, Zeifman, Mennenga, Carrithers, Goldway, O'Donnell, Ross, Bogenschutz); School of Life Sciences, Arizona State University, Tempe (Mennenga); Department of Psychology, New York University, New York (Goldway); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Bhatt)
| | - Kelley C O'Donnell
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York (Pagni, Zeifman, Mennenga, Carrithers, Goldway, O'Donnell, Ross, Bogenschutz); School of Life Sciences, Arizona State University, Tempe (Mennenga); Department of Psychology, New York University, New York (Goldway); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Bhatt)
| | - Stephen Ross
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York (Pagni, Zeifman, Mennenga, Carrithers, Goldway, O'Donnell, Ross, Bogenschutz); School of Life Sciences, Arizona State University, Tempe (Mennenga); Department of Psychology, New York University, New York (Goldway); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Bhatt)
| | - Michael P Bogenschutz
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York (Pagni, Zeifman, Mennenga, Carrithers, Goldway, O'Donnell, Ross, Bogenschutz); School of Life Sciences, Arizona State University, Tempe (Mennenga); Department of Psychology, New York University, New York (Goldway); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Bhatt)
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Weleff J, Nunes JC, Costa GPA, Sofuoglu M, MacLean RR, De Aquino JP. From taboo to treatment: The emergence of psychedelics in the management of pain and opioid use disorder. Br J Clin Pharmacol 2024; 90:3036-3053. [PMID: 38627909 PMCID: PMC11480258 DOI: 10.1111/bcp.16045] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/17/2024] [Accepted: 02/08/2024] [Indexed: 10/17/2024] Open
Abstract
The rise of psychedelics in contemporary medicine has sparked interest in their potential therapeutic applications. While traditionally associated with countercultural movements and recreational use, recent research has shed light on the potential benefits of psychedelics in various mental health conditions. In this review, we explore the possible role of psychedelics in the management of chronic pain and opioid use disorder (OUD), 2 critical areas in need of innovative treatment options. Pain control remains a significant clinical challenge, particularly for individuals with OUD and those who receive long-term opioid therapy who develop marked tolerance to opioid-induced analgesia. Despite the magnitude of this problem, there is a scarcity of controlled studies investigating pain management alternatives for these populations. Drawing from preclinical and human evidence, we highlight the potential of psychedelics to act on shared neurobiological substrates of chronic pain and OUD, potentially reversing pain- and opioid-induced neuroadaptations, such as central sensitization. We elaborate on the multifaceted dimensions of the pain experience (sensory, affective and cognitive) and their intersections that overlap with opioid-related phenomena (opioid craving and withdrawal), hypothesizing how these processes can be modulated by psychedelics. After summarizing the available clinical research, we propose mechanistic insights and methodological considerations for the design of future translational studies and clinical trials, building on a shared clinical and neurobiological understanding of chronic pain and OUD. Our intention is to provide timely perspectives that accelerate the development and exploration of novel therapeutics for chronic pain and OUD amidst the escalating opioid crisis.
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Affiliation(s)
- Jeremy Weleff
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
| | - Julio C. Nunes
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
| | - Gabriel P. A. Costa
- Faculty of Medicine, University of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Mehmet Sofuoglu
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
| | - R. Ross MacLean
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
| | - Joao P. De Aquino
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, 3rd Floor, New Haven, CT, 06519
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9
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Jiwani Z, Goldberg SB, Stroud J, Young J, Curtin J, Dunne JD, Simonsson O, Webb CA, Carhart-Harris R, Schlosser M. Can Psychedelic Use Benefit Meditation Practice? Examining Individual, Psychedelic, and Meditation-Related Factors. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.27.24312677. [PMID: 39252913 PMCID: PMC11383514 DOI: 10.1101/2024.08.27.24312677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Introduction Meditation practice and psychedelic use have attracted increasing attention in the public sphere and scientific research. Both methods induce non-ordinary states of consciousness that may have significant therapeutic benefits. Thus, there is growing scientific interest in potential synergies between psychedelic use and meditation practice with some research suggesting that psychedelics may benefit meditation practice. The present study examined individual, psychedelic-related, and meditation-related factors to determine under what conditions meditators perceive psychedelic use as beneficial for their meditation practice. Method Participants (N = 863) who had reported psychedelic use and a regular meditation practice (at least 3 times per week during the last 12 months) were included in the study. To accommodate a large number of variables, machine learning (i.e., elastic net, random forest) was used to analyze the data. Results Most participants (n = 634, 73.5%) found psychedelic use to have a positive influence on their quality of meditation. Twenty-eight variables showed significant zero-order associations with perceived benefits even following a correction. Elastic net had the best performance (R2 = .266) and was used to identify the most important features. Across 53 variables, the model found that greater use of psychedelics, intention setting during psychedelic use, agreeableness, and exposure to N,N-Dimethyltryptamine (N,N-DMT) were most likely to be associated with the perception that psychedelics benefit meditation practice. The results were consistent across several different approaches used to identify the most important variables (i.e., Shapley values, feature ablation). Discussion Results suggest that most meditators found psychedelic use to have a positive influence on their meditation practice, with: 1) regularity of psychedelic use, 2) the setting of intentions for psychedelic use, 3) having an agreeable personality, and 4) reported use of N,N-DMT being the most likely predictors of perceiving psychedelic use as beneficial. Longitudinal designs and randomized trials manipulating psychedelic use are needed to establish causality.
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Affiliation(s)
- Zishan Jiwani
- Department of Counseling Psychology, University of Wisconsin – Madison
- Center for Healthy Minds, University of Wisconsin – Madison
| | - Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin – Madison
- Center for Healthy Minds, University of Wisconsin – Madison
| | - Jack Stroud
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Jacob Young
- Department of Counseling Psychology, University of Wisconsin – Madison
| | - John Curtin
- Center for Healthy Minds, University of Wisconsin – Madison
- Department of Psychology, University of Wisconsin – Madison
| | - John D. Dunne
- Center for Healthy Minds, University of Wisconsin – Madison
- Department of Asian Languages and Cultures, University of Wisconsin – Madison
| | - Otto Simonsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Christian A. Webb
- Department of Psyciatry, Harvard Medical School, Boston, MA, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | | | - Marco Schlosser
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
- Institut für Psychotherapie Potsdam, Potsdam, Germany
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10
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Schmid Y, Bershad AK. Altered States and Social Bonds: Effects of MDMA and Serotonergic Psychedelics on Social Behavior as a Mechanism Underlying Substance-Assisted Therapy. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:490-499. [PMID: 38341085 PMCID: PMC11378972 DOI: 10.1016/j.bpsc.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/14/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
There has been renewed interest in the use of 3,4-methylenedioxy-methamphetamine (MDMA) and serotonergic psychedelics in the treatment of multiple psychiatric disorders. Many of these compounds are known to produce prosocial effects, but how these effects relate to therapeutic efficacy and the extent to which prosocial effects are unique to a particular drug class is unknown. In this article, we present a narrative overview and compare evidence for the prosocial effects of MDMA and serotonergic psychedelics to elucidate shared mechanisms that may underlie the therapeutic process. We discuss 4 categories of prosocial effects: altered self-image, responses to social reward, responses to negative social input, and social neuroplasticity. While both categories of drugs alter self-perception, MDMA may do so in a way that is less related to the experience of mystical-type states than serotonergic psychedelics. In the case of social reward, evidence supports the ability of MDMA to enhance responses and suggests that serotonergic psychedelics may also do so, but more research is needed in this area. Both drug classes consistently dampen reactivity to negative social stimuli. Finally, preclinical evidence supports the ability of both drug classes to induce social neuroplasticity, promoting adaptive rewiring of neural circuits, which may be helpful in trauma processing. While both MDMA and serotonergic psychedelics produce prosocial effects, they differ in the mechanisms through which they do this. These differences affect the types of psychosocial interventions that may work best with each compound.
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Affiliation(s)
- Yasmin Schmid
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel and University of Basel, Switzerland; Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Anya K Bershad
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California.
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11
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Solaja I, Haldane K, Mason N, Weiss B, Xu X, Xu M, Nikolin S, Jayasena T, Millard M, Brett J, Bayes A, Loo CK, Martin DM. Who are you after psychedelics? A systematic review and a meta-analysis of the magnitude of long-term effects of serotonergic psychedelics on cognition/creativity, emotional processing and personality. Neurosci Biobehav Rev 2024; 158:105570. [PMID: 38311046 DOI: 10.1016/j.neubiorev.2024.105570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/06/2024]
Abstract
This systematic review and a meta-analysis synthesised the results from contemporary, randomized and non-randomized controlled studies to assess lasting (one week minimum) changes on cognition/creativity, emotional processing and personality from serotonergic psychedelics. PubMed, Embase and PsycInfo were searched in July 2022. Risk of bias was assessed using Rob 2.0 and ROBINS-I. Ten studies met the eligibility criteria which involved 304 participants. No statistically significant effects were found for the majority outcome measures across the three constructs. A meta-analysis of emotional recognition outcomes found an overall significant effect for faster reaction times in the active treatment groups for disgust (SMD=-0.63, 95% CI=[-1.01 to -0.25], I2 = 65%) and sadness (SMD=-0.45, 95% CI=[-0.85 to -0.06], I2 = 60%). Future research should include larger samples, better control conditions, standardized doses and longer follow-up periods to confirm these preliminary findings.
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Affiliation(s)
- Ivana Solaja
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | | | - Natasha Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Brandon Weiss
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, UK
| | - Xiaomin Xu
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mei Xu
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Stevan Nikolin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Tharusha Jayasena
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | | | - Adam Bayes
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Colleen K Loo
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Donel M Martin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
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12
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Zaretsky TG, Jagodnik KM, Barsic R, Antonio JH, Bonanno PA, MacLeod C, Pierce C, Carney H, Morrison MT, Saylor C, Danias G, Lepow L, Yehuda R. The Psychedelic Future of Post-Traumatic Stress Disorder Treatment. Curr Neuropharmacol 2024; 22:636-735. [PMID: 38284341 PMCID: PMC10845102 DOI: 10.2174/1570159x22666231027111147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 01/30/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) is a mental health condition that can occur following exposure to a traumatic experience. An estimated 12 million U.S. adults are presently affected by this disorder. Current treatments include psychological therapies (e.g., exposure-based interventions) and pharmacological treatments (e.g., selective serotonin reuptake inhibitors (SSRIs)). However, a significant proportion of patients receiving standard-of-care therapies for PTSD remain symptomatic, and new approaches for this and other trauma-related mental health conditions are greatly needed. Psychedelic compounds that alter cognition, perception, and mood are currently being examined for their efficacy in treating PTSD despite their current status as Drug Enforcement Administration (DEA)- scheduled substances. Initial clinical trials have demonstrated the potential value of psychedelicassisted therapy to treat PTSD and other psychiatric disorders. In this comprehensive review, we summarize the state of the science of PTSD clinical care, including current treatments and their shortcomings. We review clinical studies of psychedelic interventions to treat PTSD, trauma-related disorders, and common comorbidities. The classic psychedelics psilocybin, lysergic acid diethylamide (LSD), and N,N-dimethyltryptamine (DMT) and DMT-containing ayahuasca, as well as the entactogen 3,4-methylenedioxymethamphetamine (MDMA) and the dissociative anesthetic ketamine, are reviewed. For each drug, we present the history of use, psychological and somatic effects, pharmacology, and safety profile. The rationale and proposed mechanisms for use in treating PTSD and traumarelated disorders are discussed. This review concludes with an in-depth consideration of future directions for the psychiatric applications of psychedelics to maximize therapeutic benefit and minimize risk in individuals and communities impacted by trauma-related conditions.
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Affiliation(s)
- Tamar Glatman Zaretsky
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathleen M. Jagodnik
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Barsic
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josimar Hernandez Antonio
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip A. Bonanno
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carolyn MacLeod
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charlotte Pierce
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hunter Carney
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Morgan T. Morrison
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles Saylor
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Danias
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren Lepow
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Zeifman RJ, Kettner H, Pagni BA, Mallard A, Roberts DE, Erritzoe D, Ross S, Carhart-Harris RL. Co-use of MDMA with psilocybin/LSD may buffer against challenging experiences and enhance positive experiences. Sci Rep 2023; 13:13645. [PMID: 37608057 PMCID: PMC10444769 DOI: 10.1038/s41598-023-40856-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023] Open
Abstract
Psilocybin and lysergic acid diethylamide (LSD) experiences can range from very positive to highly challenging (e.g., fear, grief, and paranoia). These challenging experiences contribute to hesitancy toward psychedelic-assisted psychotherapy among health care providers and patients. Co-use of 3,4-Methylenedioxy methamphetamine (MDMA) with psilocybin/LSD anecdotally reduces challenging experiences and enhances positive experiences associated with psilocybin/LSD. However, limited research has investigated the acute effects of co-use of MDMA and psilocybin/LSD. In a prospective convenience sample (N = 698) of individuals with plans to use psilocybin/LSD, we examined whether co-use of MDMA with psilocybin/LSD (n = 27) is associated with differences in challenging or positive experiences. Challenging experiences were measured using the Challenging Experiences Questionnaire and positive experiences were measured using the Mystical Experience Questionnaire and single-item measures of self-compassion, compassion, love, and gratitude. Potentially confounding variables were identified and included as covariates. Relative to psilocybin/LSD alone, co-use of psilocybin/LSD with a self-reported low (but not medium-high) dose of MDMA was associated with significantly less intense total challenging experiences, grief, and fear, as well as increased self-compassion, love and gratitude. Co-use of psilocybin/LSD and MDMA was not associated with differences in mystical-type experiences or compassion. Findings suggest co-use of MDMA with psilocybin/LSD may buffer against some aspects of challenging experiences and enhance certain positive experiences. Limitations include use of a convenience sample, small sample size, and non-experimental design. Additional studies (including controlled dose-response studies) that examine the effects and safety of co-administering MDMA with psilocybin/LSD (in healthy controls and clinical samples) are warranted and may assist the development of personalized treatments.
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Affiliation(s)
- Richard J Zeifman
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA.
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.
| | - Hannes Kettner
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, University of California, San Francisco, USA
| | - Broc A Pagni
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - Austin Mallard
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - Daniel E Roberts
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - David Erritzoe
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Stephen Ross
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, University of California, San Francisco, USA
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Plesa P, Petranker R. Psychedelics and neonihilism: connectedness in a meaningless world. Front Psychol 2023; 14:1125780. [PMID: 37621941 PMCID: PMC10445489 DOI: 10.3389/fpsyg.2023.1125780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/24/2023] [Indexed: 08/26/2023] Open
Abstract
The resurgence of psychedelic research explicitly targets treating mental health conditions largely through psychedelics-assisted psychotherapy. Current theories about mechanisms of change in psychedelics-assisted psychotherapy focus on mystical experiences as the main driver of symptom improvement. During these mystical experiences, participants report an enhanced sense of salience, connectedness, and meaning. Simultaneously, a growing psychedelic culture is also cultivating the use of psychedelics as medicine for relieving symptoms of anxiety and depression and promoting cognitive functions. We argue that an integral part of the excitement around the resurgence in psychedelics is in response to a meaning and alienation crisis that correlates with rising rates of anxiety and depression. Framing the absence of meaning as neonihilism, a contemporary correlate to the 19th-century phenomenon with unique features present in a neoliberal cultural context, we explore whether psychedelics combined with group therapy can provide answers to modern experiences of meaninglessness. Based on this exploration, we suggest concrete next steps both in the theory and practice of psychedelic psychotherapy toward what we are calling neonihilistic psychedelic group psychotherapy.
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Affiliation(s)
- Patric Plesa
- Department of Psychology, Slippery Rock University of Pennsylvania, Slippery Rock, PA, United States
| | - Rotem Petranker
- Department of Psychology, McMaster University, Hamilton, ON, Canada
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15
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Weiss B, Erritzoe D, Giribaldi B, Nutt DJ, Carhart-Harris RL. A critical evaluation of QIDS-SR-16 using data from a trial of psilocybin therapy versus escitalopram treatment for depression. J Psychopharmacol 2023; 37:717-732. [PMID: 37122239 PMCID: PMC10350722 DOI: 10.1177/02698811231167848] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND In a recent clinical trial examining the comparative efficacy of psilocybin therapy (PT) versus escitalopram treatment (ET) for major depressive disorder, 14 of 16 major efficacy outcome measures yielded results that favored PT, but the Quick Inventory of Depressive Symptomatology, Self-Report, 16 items (QIDS-SR16) did not. AIMS The present study aims to (1) rationally and psychometrically account for discrepant results between outcome measures and (2) to overcome psychometric problems particular to individual measures by re-examining between-condition differences in depressive response using all outcome measures at item-, facet-, and factor-levels of analysis. METHOD Four depression measures were compared on the basis of their validity for examining differences in depressive response between PT and ET conditions. RESULTS/OUTCOMES Possible reasons for discrepant findings on the QIDS-SR16 include its higher variance, imprecision due to compound items and whole-scale and unidimensional sum-scoring, vagueness in the phrasing of scoring options for items, and its lack of focus on a core depression factor. Reanalyzing the trial data at item-, facet-, and factor-levels yielded results suggestive of PT's superior efficacy in reducing depressed mood, anhedonia, and a core depression factor, along with specific symptoms such as sexual dysfunction. CONCLUSION/INTERPRETATION Our results raise concerns about the adequacy of the QIDS-SR16 for measuring depression, as well as the practice of relying on individual scales that tend not to capture the multidimensional structure or core of depression. Using an alternative approach that captures depression more granularly and comprehensively yielded specific insight into areas where PT therapy may be particularly useful to patients and clinicians.
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Affiliation(s)
- Brandon Weiss
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, UK
| | - David Erritzoe
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, UK
| | - Bruna Giribaldi
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, UK
| | - David J Nutt
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, UK
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, Department of Neurology, University of California, San Francisco, CA, USA
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16
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Kähönen J. Psychedelic unselfing: self-transcendence and change of values in psychedelic experiences. Front Psychol 2023; 14:1104627. [PMID: 37388660 PMCID: PMC10300451 DOI: 10.3389/fpsyg.2023.1104627] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/31/2023] [Indexed: 07/01/2023] Open
Abstract
Psychedelic experiences have been shown to both facilitate (re)connection to one's values and change values, including enhancing aesthetic appreciation, promoting pro-environmental attitudes, and encouraging prosocial behavior. This article presents an empirically informed framework of philosophical psychology to understand how self-transcendence relates to psychedelic value changes. Most of the observed psychedelic value changes are toward the self-transcendent values of Schwartz's value theory. As psychedelics also reliably cause various self-transcendent experiences (STEs), a parsimonious hypothesis is that STEs change values toward self-transcendent values. I argue that STEs indeed can lead to value changes, and discuss the morally relevant process of self-transcendence through Iris Murdoch's concept of "unselfing". I argue that overt egocentric concerns easily bias one's valuations. Unselfing reduces egocentric attributions of salience and enhances non-egocentric attention to the world, widening one's perspective and shifting evaluation toward self-transcendent modes. Values are inherently tied to various evaluative contexts, and unselfing can attune the individual to evaluative contexts and accompanying values beyond the self. Understood this way, psychedelics can provide temporarily enhanced access to self-transcendent values and function as sources of aspiration and value change. However, contextual factors can complicate whether STEs lead to long-term changes in values. The framework is supported by various research strands establishing empirical and conceptual connections between long-term differences in egocentricity, STEs, and self-transcendent values. Furthermore, the link between unselfing and value changes is supported by phenomenological and theoretical analysis of psychedelic experiences, as well as empirical findings on their long-term effects. This article furthers understanding of psychedelic value changes and contributes to discussions on whether value changes are justified, whether they result from cultural context, and whether psychedelics could function as tools of moral neuroenhancement.
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Weiss B, Sleep C, Miller JD, Campbell WK. Examining the Therapeutic Effect of Ceremonial Ayahuasca on Narcissistic Personality and Antagonistic Externalizing in Adults. J Pers Disord 2023; 37:131-155. [PMID: 37002934 PMCID: PMC10508917 DOI: 10.1521/pedi.2023.37.2.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Changes in narcissistic traits (e.g., entitlement) following the ceremonial use of ayahuasca were examined across three timepoints (baseline, postretreat, 3-month follow-up) in a sample of 314 adults using self- and informant-report (N = 110) measures. Following ceremonial use of ayahuasca, self-reported changes in narcissism were observed (i.e., decreases in Narcissistic Personality Inventory [NPI] Entitlement-Exploitativeness, increases in NPI Leadership Authority, decreases in a proxy measure of narcissistic personality disorder [NPD]). However, effect size changes were small, results were somewhat mixed across convergent measures, and no significant changes were observed by informants. The present study provides modest and qualified support for adaptive change in narcissistic antagonism up to 3 months following ceremony experiences, suggesting some potential for treatment efficacy. However, meaningful changes in narcissism were not observed. More research would be needed to adequately evaluate the relevance of psychedelic-assisted therapy for narcissistic traits, particularly studies examining individuals with higher antagonism and involving antagonism-focused therapeutic approaches.
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Affiliation(s)
- Brandon Weiss
- Imperial College London, Division of Psychiatry, London, United Kingdom
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Carhart-Harris RL, Chandaria S, Erritzoe DE, Gazzaley A, Girn M, Kettner H, Mediano PAM, Nutt DJ, Rosas FE, Roseman L, Timmermann C, Weiss B, Zeifman RJ, Friston KJ. Canalization and plasticity in psychopathology. Neuropharmacology 2023; 226:109398. [PMID: 36584883 DOI: 10.1016/j.neuropharm.2022.109398] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/01/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
This theoretical article revives a classical bridging construct, canalization, to describe a new model of a general factor of psychopathology. To achieve this, we have distinguished between two types of plasticity, an early one that we call 'TEMP' for 'Temperature or Entropy Mediated Plasticity', and another, we call 'canalization', which is close to Hebbian plasticity. These two forms of plasticity can be most easily distinguished by their relationship to 'precision' or inverse variance; TEMP relates to increased model variance or decreased precision, whereas the opposite is true for canalization. TEMP also subsumes increased learning rate, (Ising) temperature and entropy. Dictionary definitions of 'plasticity' describe it as the property of being easily shaped or molded; TEMP is the better match for this. Importantly, we propose that 'pathological' phenotypes develop via mechanisms of canalization or increased model precision, as a defensive response to adversity and associated distress or dysphoria. Our model states that canalization entrenches in psychopathology, narrowing the phenotypic state-space as the agent develops expertise in their pathology. We suggest that TEMP - combined with gently guiding psychological support - can counter canalization. We address questions of whether and when canalization is adaptive versus maladaptive, furnish our model with references to basic and human neuroscience, and offer concrete experiments and measures to test its main hypotheses and implications. This article is part of the Special Issue on "National Institutes of Health Psilocybin Research Speaker Series".
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Affiliation(s)
- R L Carhart-Harris
- Psychedelics Division - Neuroscape, Department of Neurology, University of California, San Francisco, USA; Centre for Psychedelic Research, Imperial College London, UK.
| | - S Chandaria
- Centre for Psychedelic Research, Imperial College London, UK; Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, UK; Institute of Philosophy, School of Advanced Study, University of London, UK
| | - D E Erritzoe
- Centre for Psychedelic Research, Imperial College London, UK; CNWL-Imperial Psychopharmacology and Psychedelic Research Clinic (CIPPRS), UK
| | - A Gazzaley
- Psychedelics Division - Neuroscape, Department of Neurology, University of California, San Francisco, USA
| | - M Girn
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - H Kettner
- Psychedelics Division - Neuroscape, Department of Neurology, University of California, San Francisco, USA; Centre for Psychedelic Research, Imperial College London, UK
| | - P A M Mediano
- Department of Computing, Imperial College London, London, UK; Department of Psychology, University of Cambridge, UK
| | - D J Nutt
- Centre for Psychedelic Research, Imperial College London, UK
| | - F E Rosas
- Centre for Psychedelic Research, Imperial College London, UK; Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, UK; Department of Informatics, University of Sussex, UK; Centre for Complexity Science, Imperial College London, UK
| | - L Roseman
- Centre for Psychedelic Research, Imperial College London, UK; CNWL-Imperial Psychopharmacology and Psychedelic Research Clinic (CIPPRS), UK
| | - C Timmermann
- Centre for Psychedelic Research, Imperial College London, UK; CNWL-Imperial Psychopharmacology and Psychedelic Research Clinic (CIPPRS), UK
| | - B Weiss
- Centre for Psychedelic Research, Imperial College London, UK; CNWL-Imperial Psychopharmacology and Psychedelic Research Clinic (CIPPRS), UK
| | - R J Zeifman
- Centre for Psychedelic Research, Imperial College London, UK; NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, USA
| | - K J Friston
- Wellcome Centre for Human Neuroimaging, University College London, UK
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Kiraga MK, Kuypers KPC, Uthaug MV, Ramaekers JG, Mason NL. Decreases in State and Trait Anxiety Post-psilocybin: A Naturalistic, Observational Study Among Retreat Attendees. Front Psychiatry 2022; 13:883869. [PMID: 35873251 PMCID: PMC9300865 DOI: 10.3389/fpsyt.2022.883869] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/01/2022] [Indexed: 12/02/2022] Open
Abstract
Anxiety disorders are the most common type of psychiatric disorders among Western countries. Evidence-based treatment modalities including pharmacological and cognitive-behavioral therapy result in deficient treatment responses. Historical and recent research suggests psychedelic drugs may be efficacious in alleviating anxiety-related symptoms among healthy and clinical populations. The main aim of the present study was investigation of the effects of psilocybin-containing truffles, when taken in a supportive group setting, on ratings of state and trait anxiety across self-reported healthy volunteers. Attendees of psilocybin ceremonies were asked to complete a test battery at three separate occasions: before the ceremony (baseline), the morning after, and 1 week after the ceremony. The test battery included questionnaires assessing state and trait anxiety (State-Trait Anxiety Inventory), mindfulness capacities (Five Facet Mindfulness Questionnaire), and personality (Big Five Inventory). Additionally, the psychedelic experience was quantified with the Persisting Effects Questionnaire and the Ego Dissolution Inventory. The total amount of psilocybin-containing truffles consumed by each participant was recorded, and a sample of the truffles was analyzed to determine psilocin concentrations. Fifty-two attendees (males = 25; females = 25; others = 2) completed parts of the baseline assessment, 46 (males = 21; females = 24; others = 1) completed assessments the morning after the ceremony, and 23 (males = 10; females = 13) completed assessments at the 1-week follow-up. Average psilocin consumption across individuals was 27.1 mg. The morning after the ceremony, we observed medium reductions in anxiety measures (both state and trait) compared to baseline ( d ¯ = 6.4; p < 0.001 and d ¯ = 6; p = 0.014, respectively), which persisted over a 1-week period post-ceremony ( d ¯ = 6.7; p = 0.001 and d ¯ = 8.6; p = 0.004, respectively). At 1 week post-ceremony, the non-judging facet of the mindfulness scale was increased ( d ¯ = 1.5; p = 0.03), while the personality trait neuroticism decreased ( d ¯ = 5.2; p = 0.005), when compared to baseline. Additionally, we found ratings of ego dissolution (mean: 59.7, SD: 28.3) and changes in neuroticism to be the strongest predictors of reductions in state and trait anxiety, respectively. In sum, results suggest rapid and persisting (up to 1 week) anxiolytic effects in individuals with sub-clinical anxiety symptoms, which are related to the acute experience of ego dissolution, as well as lasting changes in trait neuroticism. Results also add support to the feasibility and potential efficacy of group sessions with psychedelics. To understand whether these effects extend to wider populations suffering from heightened anxiety, and the mechanisms involved, further experimental research is needed.
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Affiliation(s)
- Maggie Kamila Kiraga
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Kim P C Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Malin Vedoy Uthaug
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Natasha Leigh Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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