Recommended Readings

Psychedelic-Assisted Therapy

 

This list was made by Jagoda Mackowiak in cooperation, and co-published, with Blossom

Recreational users have long recognized the positive effects of serotonergic hallucinogens, however, the history of academic research on the therapeutic potential of psychedelics has been turbulent, to say the least.

For more than a decade, we have been observing a Psychedelic Renaissance – a growing interest in exploring the potential of psychedelics in the treatment of mental health disorders. Substances such as psilocybin, LSD, and ayahuasca are being investigated the world over, from university research groups to forward-looking therapists’ offices—all with the hope of establishing effective methods for society at large to improve global mental health.

In this list, we will introduce the history and current state of the research on psychedelic-assisted therapy, as well as its challenges and future perspectives.

A straight-forward and down-to-earth briefing on some of the problems involved in psychedelic research was published by Ben Sessa in 2014. In ‘Why Psychiatry Needs Psychedelics and Psychedelics Need Psychiatry’ the UK-based psychotherapist argues that we have to reject the enthusiastic, yet naïve notion of creating a utopian society thanks to the use of psychedelics. Instead, researchers and healthcare professionals should focus on realistic and non-biased views of psychedelics as novel players in the pharmaceutical market.

Sessa, B. (2014). Why Psychiatry Needs Psychedelics and Psychedelics Need Psychiatry. Journal of Psychoactive Drugs, 46(1):57-62.

The historical context of research on psychedelics is extensively discussed in ‘Psychedelics: Where we are now, why we got here, what we must do.’ In their 2018 commentary, Belouin & Henningfield travel through the rise, the fall, and the current renaissance of psychedelics as medical agents. Drawing conclusions from the historical context and paying close attention to health policymakers and their influence on science, the authors set a trajectory for the immediate future of clinical advances in the field of psychedelic research.

Belouin, S. J. and Henningfeld, J. E. (2018). Psychedelics: Where we are now, why we got here, what we must do. Neuropharmacology, 142:7-19.

A strictly medical perspective is offered by David Nichols, Matthew Johnson, and Charles Nichols in their state-of-the-art review from 2016. ‘Psychedelics as Medicines: An emerging new paradigm’ compares various clinical trials with patients suffering from several psychiatric disorders and presents the psychedelic mechanisms of action on a cellular level.

Nichols, D. E., Johnson, M. W., and Nichols, C. D. (2017). Psychedelics as Medicines: An Emerging New Paradigm. Clinical Pharmacology and Therapeutics, 101(2):209-219.

Four years later, two pioneers of psychedelic research in Brazil teamed up and published a detailed review of the therapeutic potential of LSD, psilocybin, and ayahuasca. ‘Therapeutic use of serotoninergic hallucinogens: A review of the evidence and of the biological and psychological mechanisms‘ (2020) scrutinizes the effects of psychedelics in substance use disorders, as well as in anxiety and depression related to cancer and other life-threatening diseases.

dos Santos, R. G. and Hallak, J. E. C. (2019). Therapeutic use of serotoninergic hallucinogens: a review of the evidence and of the biological and psychological mechanisms. Neuroscience & Biobehavioral Reviews, 108:423-434.

Living with a life-threatening disease can lead to many mental health problems. General anxiety, loneliness, the anguish about unresolved personal relationships, and managing pain are but a few of these problems. In 2014 a joint effort of researchers from Switzerland and the US had led to a detailed investigation of the ‘Safety and Efficacy of Lysergic Acid Diethylamide-Assisted Psychotherapy for Anxiety Associated With Life-threatening Diseases.’ The study, partially funded by MAPS, resulted in a positive trend in reducing anxiety after only two LSD-assisted therapy sessions. In a follow-up study, they found that the effects persisted 12 months later.

Gasser, P., Holstein, D., Michel, Y., Doblin, R., Yazar-Klosinski, B., Passie, T., and Brenneisen, R. (2014). Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety associated with life-threatening diseases. Journal of Nervous and Mental Disease, 202(7):513-520.

Parallel to LSD, psilocybin has also been investigated in order to establish its potential in reducing depression and anxiety in patients suffering from life-threatening cancer. Scientists from Johns Hopkins University School of Medicine established that ‘Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial’ (2016), while producing no adverse effects. The reported improvements in quality of life, life meaning, death acceptance, and optimism persisted for at least 6 months after psilocybin administration.

Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D., Cosimano, M. P., and Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology, 30(12):1181-1197.

Studying the effects of psychedelics in patients in terminal life stages is, however, extremely challenging, not only because of the delicate nature of the subject, but also because of the study design and sample size. ‘Serotonergic hallucinogens in the treatment of anxiety and depression in patients suffering from a life-threatening disease: A systematic review’ (2018) written by Simon Reiche and colleagues (including Henrik Jungaberle – the founder of MIND Foundation) analyzed over 50 years of clinical trials and discussed their significance, safety, and limitations, while also bringing to the reader’s attention that there are still many questions to be answered.

Reiche, S., Hermle, L., Gutwinski, S., Jungaberle, H., Gasser, P., and Majic, T. (2018). Serotonergic hallucinogens in the treatment of anxiety and depression in patients suffering from a life-threatening disease: A systematic review. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 81:1-10.

Psychedelic therapy can involve the use of not only LSD or psilocybin, but often also of ayahuasca. Although originally only found in the Amazon jungle, the plant-based brew has been consumed by users worldwide. In 2017, recent ayahuasca users (527 participants) filled out a survey prepared by an international team of researchers. ‘Well-being, problematic alcohol consumption and acute subjective drug effects in past-year ayahuasca users: a large, international, self-selecting online survey’ shone a light on self-rated contentment, drinking habits, and trip-related experience of those who drank ayahuasca in the recent past.

Lawn, W., Hallak, J. E. C., Crippa, J. A. S., dos Santos, R. G., Pory, L., Barratt, M. J., Ferris, J. A., Winstock, A. R., and Morgan, C. J. (2017). Well-being, problematic alcohol consumption and acute subjective drug effects in past-year ayahuasca users: A large, international, self-selecting online survey. Scientific Reports, 7:15201.

Drawing from the REBUS model proposed by Robin Carhart-Harris, Max Wolff et al., (2020) constructed a cognitive-behavioral model to explain the mechanisms of beneficial effects in psychedelic interventions. ‘Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance’ proposes that the relaxation of avoidance-related beliefs can be achieved during a psychedelic-assisted therapy session. It allows the patient to reach an emotional breakthrough, which is an insightful and rewarding experience able to re-wire the previous avoidance patterns. The relaxed-belief state can potentially induce ego-dissolution, leading to long-term improvements in overcoming anxiety-provoking situations through revision and remodulation of pathological belief systems.

Wolff, M., Evens, R., Mertens, L. J., Koslowski, M., Betzler, F., Grunder, G., and Jungaberle, H. (2020). Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance. Frontiers in Psychiatry, 11:5.

A very pragmatic analysis has been presented in ‘The cost-effectiveness of MDMA-assisted psychotherapy for the treatment of chronic, treatment-resistant PTSD’ (Marseille et al., 2020). The article focuses on the costs of medical care required for patients suffering from PTSD – a disorder affecting almost 12 million Americans, many of which experience it chronically or recurringly, while the response to standard pharmaceuticals is often inadequate. The developed model of medical care cost suggests that MDMA-assisted psychotherapy is highly cost-effective and therefore beneficial not only to the patients, but also to the society and healthcare providers.

Marseille, E., Kahn, J.G., Yazar-Klosinski, B. and Doblin, R. (2020) The cost-effectiveness of MDMA-assisted psychotherapy for the treatment of chronic, treatment-resistant PTSD. PLoS ONE 15(10):e0239997