A number of studies have shown that psilocybin is safe and effective for treating substance abuse disorders. But a new analysis, released on Monday, offers novel insights into exactly how psychotherapy with psychedelics works.
Researchers from NYU, UC San Francisco, and Fluence (a provider of mental health practitioner training) set out to examine the therapeutic mechanisms which led a group of people with alcohol abuse disorders to reduce their negative drinking behaviors after taking part in a landmark psilocybin trial.
The investigators contacted 13 volunteers who had received psilocybin months after their treatment. They asked them qualitative questions in depth about the experiences they had during and following the trial.
The study published by the American Psychological Association, in the journal Psychology of Addictive Behaviors revealed that participants shared several themes. These themes could be used to inform future research, and even therapeutic applications, as more states promote psychedelic studies, and regulate access.
The authors reported: “Participants said that the psilocybin treatments helped them process painful memories and promoted states of self compassion, self awareness, and feelings interconnectedness.” The acute states experienced during psilocybin treatments were described as providing the basis for self-compassionate regulation negative affect. The participants also reported a newfound sense of belonging, and an improvement in the quality of their relationships after treatment.
Our results confirm that psilocybin improves affect regulation, alcohol cravings and reduces shame-based thinking patterns. These findings suggest that psychosocial treatment that incorporates self-compassion with psychedelic therapies may be a useful tool to enhance psychological outcomes in the AUD treatment.
Researchers stressed that the goal of their analysis was not to determine an “objective truth” about the therapeutic mechanisms of psilocybin, but rather to “uncover the lived experiences of individuals through collaborative inquiry.”
The participants described their relationship with alcohol. Most said that they used destructive coping strategies to manage and reduce distressing feelings, and social anxiety.
In the study, almost all of the subjects said they experienced inner narratives consisting of excessive guilt, resentment and blame towards people close to them. This inner voice is often self-critical, and lends intrusive thoughts.
According to the majority of participants, alcohol “inhibited feelings of belonging and connection with others and self,” while psilocybin elicited “a range of intense emotions that were suppressed for a long time.”
The study states that participants described feelings of “catharsis” and an “emotional rollercoaster”[s ],'”. Participants commented that psilocybin had helped them release emotional pain associated with alcohol abuse. Participants reported that psilocybin had helped them gain self-awareness, new understandings of their alcohol use patterns and coping mechanisms.
The subjects also stressed that having therapists present and a controlled setting in which to use psychedelic medicines was important. The paper states that these were “essential components in facilitating psychological safety required to examine and resolve mental stuck points.”
Participants also reported a deeper sense of spiritual understanding, and learned mindfulness techniques which allowed them to “mental disentangle themselves from overwhelming thoughts and emotions, which previously drove them to drink.”
The qualitative analysis also revealed that, while participants in the clinical trials reported reduced drinking days and decreased desire to drink on average, the cravings did not disappear for all and that psilocybin isn’t a panacea.
It is possible that the differences in experience of each individual could guide further research on dosages, settings and supportive therapy, as well as follow-up measures, which are important for effective psilocybin assisted treatment.
The study states that “a highly structured environment along with a supportive therapy and community-based support aftercare may be required to transform rigid coping techniques into vehicles for healing, to manage strong cravings, and to prevent relapse.”
The authors also noted that participants were mainly white and had an average annual income of $144,000.
They wrote: “In psychedelic studies, Blacks, Indigenous Peoples, and People of Color are vastly underrepresented, even though the multigenerational impacts of centuries of racialized policy burden them with high trauma rates and other mental health consequences.” This presents stakeholders with a moral imperative to give priority to those from historically underrepresented groups to ensure generalizability, and to make sure that those who stand to benefit the most aren’t excluded.
The qualitative reports are still useful for “understanding the therapeutic process and considerations for future studies in the nascent area of psychedelic therapy for ASUD, and disorders characterized rumination or emotional avoidance.”
In a press statement, Elizabeth Nielson (a study coauthor and cofounder of Fluence) said that qualitative research gives us a “direct understanding of the lived experiences of psychedelic treatment clinical trial participants from their perspective and their own words.”
Nielson stated that the study “complements existing quantitative clinical studies, adding nuance and detail to the picture of the treatment and what future clinicians may encounter in their work.”
The National Institute on Drug Abuse has recently begun soliciting proposals to fund a series research initiatives that explore the use of psychedelics to treat drug abuse.
This research is timely, as lawmakers and advocates work to promote psychedelics and regulate access to substances such as psilocybin.
Oregon regulators approved the nation’s first licence for a service center that will allow people to experience the psychedelic drug in a controlled and facilitated setting. Officials have now approved at least one license in each of the four categories of business created by the state’s psilocybin laws.
Last month, the Colorado governor signed a bill that would create a framework for psychedelics in accordance with a voter-approved measure.
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Photo by Dick Culbert.
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