Psychedelic Therapy Research Articles

Psychologists' and psychotherapists' knowledge, attitudes, and clinical practices regarding the therapeutic use of psychedelics.

This study explored the current knowledge, attitudes, and clinical practices regarding psychedelics among mental health professionals in California, where state legislation to decriminalize psychedelics has been proposed. Two hundred thirty-seven mental health providers (74% female; mean age 54; 83% White; 46% psychologists) completed a 37-item online survey between November 2021 and February 2022, disseminated through local and state-wide professional organizations in California. Providers endorsed limited knowledge about the risks and benefits of psychedelic use (M = 4.7 and 5.4, respectively, with 10 = high knowledge) and inadequate knowledge to counsel patients on use (45%). Gaps in knowledge related to psychedelic drug scheduling and current use in clinical research were identified. Providers expressed support for additional psychedelic research (97%), approval of recreational (66%) and medical (91%) psychedelic use, belief in the potential therapeutic benefits of psychedelics (89%), and concerns about safety (33%) and potential psychiatric risks (27%). Results indicated that most providers discuss psychedelic use with patients (73%), yet many do not feel comfortable addressing the effects of use (49%). There were significant correlations between knowledge and attitudes towards psychedelics (r = 0.2, p = .006; r = 0.31, p < .001) and attitudes and clinical practices (r = 0.34, p < .001). Findings suggest that providers are interested in psychedelic-assisted treatments and hold favourable attitudes towards the therapeutic use of psychedelics yet lack the knowledge to appropriately counsel patients, highlighting the need for additional provider education about psychedelics.

Acid feminism: Gender, psychonautics and the politics of consciousness

Psychedelic substances have undergone a transformation in the public consciousness over the last 15 years. However, the most influential first-person narratives of psychonauts and ‘scientist-shamans’ navigating the frontiers of consciousness have tended to entirely exclude women’s experiences and voices. Psychedelic feminism, has emerged to signify the role consciousness expansion and experimentation might play in rejuvenating feminism’s collective imagination, and undoing the historical silencing of women’s voices in psychedelic culture and research. Drawing on Mark Fisher’s work on acid communism, the feminist psychedelic humanities, narcofeminism and autobiographical life-writing by women on experimental psychedelic substance use, this article investigates the promise of acid feminism for the wider narcofeminist movement, and its implications for undoing some key precepts endemic in psychedelic culture and research.

On Redescribing the Indescribable: Trauma, Psychoanalysis and Psychedelic Therapy

The psychedelic state can be thought about as an interdependent intrapsychic, somatic, interpersonal and spiritual happening which encourages, perhaps both to the relief and dismay of those participating in the experience, the shocking and impressive emergence of one's unconscious desires and traumata's; a state which may be experienced as cathartic or healing, and as anxiety‐provoking and confusing. Often, in clinical trials investigating psychedelics in mental health conditions, these go hand in hand. Amid a renewed, at times hyperbolic, interest in psychedelics as a potential treatment for mental ill health, significant gaps of knowledge remain. Additional studies exploring the impact of the extra‐pharmacological factors and adjunct therapeutic models on treatment outcomes are needed. Drawing from psychoanalytic perspectives, this paper explores points of intersectionality between psychedelic therapy under investigation and psychoanalysis in the context of traumatic stress. To that end, the psychedelic state will be considered an attempt to make the unconscious conscious by immersing self in a bewildering waking‐dream to better tolerate reality; immersing self in a wilful state of vulnerability, to develop trust in one's agency and capacity to trust others; immersing self in an indescribable experience to learn how to redescribe, to self and to others the traumatic past.

FDA issues first draft guidance on psychedelic research

Observing that designing clinical studies to evaluate the safety and effectiveness of psychedelic substances presents a number of unique challenges that require careful consideration to the industry, the U.S. Food and Drug Administration (FDA) last month issued, for the first time, draft guidance for conducting clinical trials with psychedelic drugs such as psilocybin and MDMA (ecstasy).

Preferences and Support for Psychedelic Policies and Practices Among Those Using Psychedelics

ABSTRACTLegal, scientific, and social landscapes for psychedelics are changing rapidly. Differences of opinion exist among key stakeholders regarding regulatory control, models of provisioning psychedelic therapy, and medicalization, decriminalization, and/or legalization policies. We assessed the policy preferences of people using psychedelics naturalistically (N = 1221) to understand how they aligned and differed with institutional entities and existing psychedelic policies. Three quarters of participants would support decriminalization and legalization. On average, participants strongly supported individuals being legally able to grow and possess psychedelic plants and/or fungi for personal consumption. Trends included more support for natural over synthetic substances, self-production and consumption over gifting, gifting over sales, and administration of psychedelics with therapeutic support than without therapeutic support. Participants were concerned about pharmaceutical-like policy models, including patents of natural and synthetic psychedelic compounds. Participants were mostly from the State of Michigan, though geographical differences were minor. Those who identified as a psychedelic guide, educator, or therapist had small yet extensive differences from those who did not. As psychedelic liberalization continues to advance, it is critical for policymakers to consider these preferences to ensure laws provide safe and equitable access to these substances and appropriate medical support for their use.

Phytochemical interventions for post-traumatic stress disorder: A cluster co-occurrence network analysis using CiteSpace

ObjectiveThis study investigated trends in the study of phytochemical treatment of post-traumatic stress disorder (PTSD). MethodsThe Web of Science database (2007–2022) was searched using the search terms “phytochemicals” and “PTSD,” and relevant literature was compiled. Network clustering co-occurrence analysis and qualitative narrative review were conducted. ResultsThree hundred and one articles were included in the analysis of published research, which has surged since 2015 with nearly half of all relevant articles coming from North America. The category is dominated by neuroscience and neurology, with two journals, Addictive Behaviors and Drug and Alcohol Dependence, publishing the greatest number of papers on these topics. Most studies focused on psychedelic intervention for PTSD. Three timelines show an “ebb and flow” phenomenon between “substance use/marijuana abuse” and “psychedelic medicine/medicinal cannabis.” Other phytochemicals account for a small proportion of the research and focus on topics like neurosteroid turnover, serotonin levels, and brain-derived neurotrophic factor expression. ConclusionResearch on phytochemicals and PTSD is unevenly distributed across countries/regions, disciplines, and journals. Since 2015, the research paradigm shifted to constitute the mainstream of psychedelic research thus far, leading to the exploration of botanical active ingredients and molecular mechanisms. Other studies focus on anti-oxidative stress and anti-inflammation.Please cite this article as: Gao B, Qu YC, Cai MY, Zhang YY, Lu HT, Li HX, Tang YX, Shen H. Phytochemical interventions for post-traumatic stress disorder: A cluster co-occurrence network analysis using CiteSpace. J Integr Med. 2023; 21(4):385–396.

Life after Ayahuasca: A Qualitative Analysis of the Psychedelic Integration Experiences of 1630 Ayahuasca Drinkers from a Global Survey

Ayahuasca is an Amazonian psychoactive plant medicine being explored for its potential therapeutic uses in Western contexts. Preliminary studies link ayahuasca use with improvements across a range of mental health indicators, but studies have not yet explored qualitative aspects of the post-treatment process known in the psychedelic literature as “integration”. This includes how participants make sense of their ayahuasca experiences and minimise harm/maximise benefits after ayahuasca use. A global online survey, conducted between 2017 and 2019, collected responses from 1630 ayahuasca drinkers (50.4% male, mean age = 43 years) to an open-ended question about their integration experiences after consuming ayahuasca. Inductive codebook thematic analysis was used to identify themes in participants’ integration experiences. Participants described integration experiences in three main ways. First, was an overall appraisal of the integration experience (e.g., as easy, challenging, or long-term/ongoing). Second, was describing beneficial tools which facilitated integration (e.g., connecting with a like-minded community and ongoing practice of yoga, meditation, journaling, etc.). Third, was describing integration challenges (e.g., feeling disconnected, going back to “old life” with new understandings, etc.). These findings suggest that integrating ayahuasca experiences can be challenging and take considerable time, though working through integration challenges may facilitate positive growth. Findings also challenge the role of individual psychotherapy as the primary integration tool in Western psychedelic therapy, suggesting that communal and somatic elements may also be useful. An expanded definition of psychedelic integration is proposed which includes working with integration challenges and adjusting to life changes.

Psychedelic therapy in the treatment of addiction: the past, present and future.

Psychedelic therapy has witnessed a resurgence in interest in the last decade from the scientific and medical communities with evidence now building for its safety and efficacy in treating a range of psychiatric disorders including addiction. In this review we will chart the research investigating the role of these interventions in individuals with addiction beginning with an overview of the current socioeconomic impact of addiction, treatment options, and outcomes. We will start by examining historical studies from the first psychedelic research era of the mid-late 1900s, followed by an overview of the available real-world evidence gathered from naturalistic, observational, and survey-based studies. We will then cover modern-day clinical trials of psychedelic therapies in addiction from first-in-human to phase II clinical trials. Finally, we will provide an overview of the different translational human neuropsychopharmacology techniques, including functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), that can be applied to foster a mechanistic understanding of therapeutic mechanisms. A more granular understanding of the treatment effects of psychedelics will facilitate the optimisation of the psychedelic therapy drug development landscape, and ultimately improve patient outcomes.

Learned Helplessness As a Potential Transdiagnostic Therapeutic Mechanism of Classic Psychedelics

Background: Emerging literature suggests that classic psychedelics may have efficacy in treating mood and substance use disorders in humans. This has raised questions regarding the primary therapeutic mechanism of these compounds. Here, we hypothesize that the reversal of and resilience against learned helplessness may be an important driver of the therapeutic mechanisms of classic psychedelics. Furthermore, we argue that the learned helplessness paradigm can provide a robust model to investigate the behavioral and mechanistic effects of classic psychedelics in both clinical and preclinical experiments. Opinion: We highlight the learned helplessness model and its potential utility in the psychedelic sphere for several reasons. First, learned helplessness is a robust phenomenon observed across multiple mammalian species including humans, and has been well described in terms of its neurobiology, behavioral effects, and clinical implications; current efforts in psychedelic research and theories of psychedelic mechanisms have yet to achieve this level of integration. Interestingly, there is substantial overlap in the neural circuits governing resilience against learned helplessness and psychedelic actions—such as those involving the dorsal raphe nucleus. Furthermore, our hypothesis that classic psychedelics can reverse helplessness behavior fits with much of the current preclinical data, which has shown that psychedelics improve performance in behavioral despair tasks in rodents. Here we make the case for bringing attention to these congruencies in an effort to advance toward mechanistic, behavioral, and transdiagnostic insights into the therapeutic effects of classic psychedelics, with the potential for learned helplessness to help explain some positive effects across levels of analysis.

Ethical considerations for psychedelic-assisted therapy in military clinical settings

Psychedelic treatments, particularly 3,4-methylenedioxymethamphetamine (MDMA)-assisted and psilocybin-assisted therapies, have recently seen renewed interest in their clinical potential to treat various mental health conditions. Clinical trials for both MDMA-assisted and psilocybin-assisted...

Commentary: Access to Psychedelics for Psychological Suffering at the End of Life - Prioritizing Our Priorities.

We agree with Kratina et al. (2023) that the problem of psychological suffering at the end of life deserves attention from a policy standpoint and that psychedelic therapies show promise in this clinical context. However, we argue the following in this rejoinder: (1) disproportionate attention to psychedelics may overstate the current evidence base, potentially diverting resources away from existing evidence-based programs; (2) a more pressing policy priority related to this public health problem is to address population-level inequities in accessing high-quality, early and holistic palliative care, including psychosocial care; and (3) discussions about expanded access to psychedelics must also foreground equity issues.

Considerations in the Application of Psychedelic-Augmented Psychotherapy: A Commentary on Clinical Mechanisms

Psychedelics have been studied extensively in their broad treatment potential for a variety of mental health disorders. Recently, scholars have turned their attention to the role of psychotherapy in the augmentation, follow-up, and support mechanisms relevant to psychedelic administration. While it is tempting to position psychedelic substances as standalone medicines akin to SSRIs or SNRIs, their unique neurochemical action and potential for psychological transformation calls for a broader examination of the role of counseling and psychotherapy, within the context of a bio-psychosocial model. I outline well-established and emerging therapeutic modalities that are well-placed in complementary and augmented psychedelic treatment. I do so with the intention of opening a broader conversation to those situated in medical and medical-adjacent fields, including psychoanalysts, counselors, support workers, and other allied professionals. Ultimately, practitioners working in medical-aligned fields hold diversly vested interests in understanding the place of psychedelic therapies in mental health, and more attention should be given to a balanced consideration of treatment and support mechanisms.

ARC: a framework for access, reciprocity and conduct in psychedelic therapies.

The field of psychedelic assisted therapy (PAT) is growing at an unprecedented pace. The immense pressures this places on those working in this burgeoning field have already begun to raise important questions about risk and responsibility. It is imperative that the development of an ethical and equitable infrastructure for psychedelic care is prioritized to support this rapid expansion of PAT in research and clinical settings. Here we present Access, Reciprocity and Conduct (ARC); a framework for a culturally informed ethical infrastructure for ARC in psychedelic therapies. These three parallel yet interdependent pillars of ARC provide the bedrock for a sustainable psychedelic infrastructure which prioritized equal access to PAT for those in need of mental health treatment (Access), promotes the safety of those delivering and receiving PAT in clinical contexts (Conduct), and respects the traditional and spiritual uses of psychedelic medicines which often precede their clinical use (Reciprocity). In the development of ARC, we are taking a novel dual-phase co-design approach. The first phase involves co-development of an ethics statement for each arm with stakeholders from research, industry, therapy, community, and indigenous settings. A second phase will further disseminate the statements for collaborative review to a wider audience from these different stakeholder communities within the psychedelic therapy field to invite feedback and further refinement. By presenting ARC at this early stage, we hope to draw upon the collective wisdom of the wider psychedelic community and inspire the open dialogue and collaboration upon which the process of co-design depends. We aim to offer a framework through which psychedelic researchers, therapists and other stakeholders, may begin tackling the complex ethical questions arising within their own organizations and individual practice of PAT.

Exploring the Potential Utility of Psychedelic Therapy for Patients With Amyotrophic Lateral Sclerosis.

Background: Amyotrophic lateral sclerosis (ALS) is an aggressive, terminal neurodegenerative disease that causes death of motor neurons and has an average survival time of 3-4 years. ALS is the most common motor neuron degenerative disease and is increasing in prevalence. There is a pressing need for more effective ALS treatments as available pharmacotherapies do not reverse disease progression or provide substantial clinical benefit. Furthermore, despite psychological distress being highly prevalent in ALS patients, psychological treatments remain understudied. Psychedelics (i.e., serotonergic psychedelics and related compounds like ketamine) have seen a resurgence of research into therapeutic applications for treating a multitude of neuropsychiatric conditions, including psychiatric and existential distress in life-threatening illnesses. Methods: We conducted a narrative review to examine the potential of psychedelic assisted-psychotherapy (PAP) to alleviate psychiatric and psychospiritual distress in ALS. We also discussed the safety of using psychedelics in this population and proposed putative neurobiological mechanisms that may therapeutically intervene on ALS neuropathology. Results: PAP has the potential to treat psychological dimensions and may also intervene on neuropathological dimensions of ALS. Robust improvements in psychiatric and psychospiritual distress from PAP in other populations provide a strong rationale for utilizing this therapy to treat ALS-related psychiatric and existential distress. Furthermore, relevant neuroprotective properties of psychedelics warrant future preclinical trials to investigate this area in ALS models. Conclusion: PAP has the potential to serve as an effective treatment in ALS. Given the lack of effective treatment options, researchers should rigorously explore this therapy for ALS in future trials.

Psychedelic therapy as reality transformation: A phenomenological approach

AbstractCoinciding with and responding to a growing crisis in the diagnostic, explanatory and treatment systems of psychiatry, the last couple of decades have seen a growing amount of evidence regarding the therapeutic potential of psychedelic drugs to treat a variety of mental health conditions. Broadly, this crisis can be construed as that of “indivi/dualist” approaches which aim to treat patients who are construed as separated from their social and material contexts, which are taken as given. The implicit premise: the self, but not the world, is the site of therapeutic intervention. By contrast, researchers insist that psychedelic therapy functions by on producing an experience of “connectedness” to self, world, and others, which is heavily influenced by context. However, by remaining in an indivi/dualist thoughtspace, neurological and psychological perspectives betray these recurring themes. In this essay, I approach psychedelic therapy for depression through the lens of phenomenological psychiatry to take these themes seriously–a task which passes by considering experience as embodied, and therefore embedded. Starting off from an analysis of depression as a bodily detunement (disconnection), I argue that, through a process of “immersive reflection”, psychedelic therapy transforms not only the self, but patients’ sense of reality. This will allow me to answer several questions pertaining to psychedelic therapy regarding its therapeutic mechanism, why it transforms reality and not only the self, why it transforms and not merely amplifies experience, why its effects last beyond the drugs’ psychoactive duration, and in what their paradigm-shifting potential for mental health consists of.

View, meditation, action: A Tibetan framework to inform psychedelic-assisted therapy

AbstractWhether occasioned through careful, consistent meditative practice or through quicker means like the ritual ingestion of psilocybin or ayahuasca, global contemplative practices have established effective systems of implementing, directing, and integrating the very kinds of non-ordinary experiences central to psychedelic use. However, contemplative traditions are largely absent from the present discourse on psychedelic therapy. This paper addresses this gap and offers a novel analysis of psychedelic-assisted therapy through the lens of the Tibetan Buddhist contemplative tradition. It first establishes a baseline for comparing the non-ordinary experience occasioned by Tibetan Buddhist meditation and the psychedelic experience by referencing the phenomenological literature of both. It then articulates the Tibetan contemplative framework of view, meditation, action (Tib. lta sgom spyod gsum) as the way Tibetan Buddhism directs its non-ordinary meditative experience towards its desired ends and suggests how this framework may be applied to psychedelic-assisted therapy. Finally, this paper uses this Tibetan Buddhist lens of analysis to compare and assess two protocols for psychedelic-assisted therapy and to make recommendations for future clinical protocols. Given the phenomenological similarity of Tibetan Buddhist meditative experience and the psychedelic experience, this article suggests that a more intensive preparatory session where maladaptive conceptual narratives are worked through and beneficial ones are introduced, repeated dosing sessions, and a more directed psychedelic experience may increase the efficacy of psychedelic-assisted therapy. It thus argues that the insights of the Tibetan framework of view, meditation, action can improve future protocols and allow for psychedelic-assisted therapy to be of even greater benefit.

Group format psychedelic-assisted therapy interventions: Observations and impressions from the HOPE trial

AbstractBackgroundPsilocybin-assisted psychotherapy has demonstrated significant promise as a treatment for depression, anxiety, and existential distress associated with serious medical illness and has generally been employed on an individual basis, which presents challenges for scaling and resource availability. There are also compelling theoretical reasons to suggest that group-based formats-if utilized in a thoughtful fashion-might offer unique or enhanced therapeutic benefits for certain conditions or populations. The HOPE trial is an IRB-approved open-label feasibility and safety pilot study of psilocybin enhanced group therapy in patients with a DSM-5 depressive disorder associated with a cancer diagnosis completed at the Huntsman Cancer Institute (HCI) in Salt Lake City, Utah (HOPE: A Pilot Study of Psilocybin Enhanced Group Psychotherapy in Patients with Cancer). We report here qualitative survey-based data, impressions, and suggestions for group-based psychedelic-assisted therapy interventions based on our observations to inform future studies.MethodsPatients with a DSM-5 depressive disorder with an underlying cancer diagnosis were recruited from HCI by referral from oncology providers, palliative care, and social work. Following screening and consenting, 4-6 participants per cohort (with three total cohorts) were enrolled in a protocol involving 3 120 min group preparatory sessions, a single high-dose (25 mg) group psilocybin session, and 3 subsequent group integration sessions. Primary clinical outcomes are still in process of data collection and analysis. Qualitative data was gathered from patient written reports and a survey administered at 2 weeks post intervention. Qualitative reports were also gathered from the therapist team at a post-study group process session.FindingsWe report here results from a qualitative survey of participant experiences with group format study design, as well as impressions and guidelines for group format and group psychotherapeutic process to inform other studies pursuing group-based interventions in psychedelic therapy. Suggestions are provided for protocol design, screening processes, space considerations, therapist team structure, group process, music, timeline, as well as potential issues and challenges.

Increased low-frequency brain responses to music after psilocybin therapy for depression

BackgroundPsychedelic-assisted psychotherapy with psilocybin is an emerging therapy with great promise for depression, and modern psychedelic therapy (PT) methods incorporate music as a key element. Music is an effective emotional/hedonic stimulus that could also be useful in assessing changes in emotional responsiveness following PT. MethodsBrain responses to music were assessed before and after PT using functional Magnetic Resonance Imaging (fMRI) and ALFF (Amplitude of Low Frequency Fluctuations) analysis methods. Nineteen patients with treatment-resistant depression underwent two treatment sessions involving administration of psilocybin, with MRI data acquired one week prior and the day after completion of psilocybin dosing sessions. ResultsComparison of music-listening and resting-state scans revealed significantly greater ALFF in bilateral superior temporal cortex for the post-treatment music scan, and in the right ventral occipital lobe for the post-treatment resting-state scan. ROI analyses of these clusters revealed a significant effect of treatment in the superior temporal lobe for the music scan only. Voxelwise comparison of treatment effects showed relative increases for the music scan in the bilateral superior temporal lobes and supramarginal gyrus, and relative decreases in the medial frontal lobes for the resting-state scan. ALFF in these music-related clusters was significantly correlated with intensity of subjective effects felt during the dosing sessions. LimitationsOpen-label trial. Relatively small sample size. ConclusionsThese data suggest an effect of PT on the brain's response to music, implying an elevated responsiveness to music after psilocybin therapy that was related to subjective drug effects felt during dosing.

Emerging Challenges for Psychedelic Therapy

This Viewpoint examines the benefits and challenges of psychedelic therapy using 4 fundamental questions.

Psychedelic therapies are returning to psychiatry

Psychedelic therapies are returning to psychiatry Professor Erika Dyck, Canada Research Chair in History of Health &amp; Social Justice at the University of Saskatchewan argues that psychedelic drugs and therapies, whether conducted in ceremonial settings or clinical ones, are being touted as life-changing moments for their capacity to efficiently transform an individual's perspective on themselves. The number of people who suffer from mental illness has grown steadily, with the WHO now reporting that 1 in 5 people in the world lives with mental illness. Due to this, numerous psychedelic therapies have also emerged on this landscape as a potential treatment that may improve individual lives while also transforming the way we diagnose and treat mental illness around the world – labelled a "psychedelic renaissance". Initiatives to legalize, decriminalize, and/or regulate psychedelics have taken different legal forms – as the legal landscape is changing quickly – but there are undeniable and unprecedented successes in treating alcoholism and trauma-based disorders with psychedelic therapies, which Professor Dyck recommends to be explored in more depth.