Although depression and anxiety affect millions of people worldwide, and are the most common forms of mental illness, current treatments show limited success in relieving the symptoms. This has led to increased investigation into alternative approaches, including the use of psychedelic experiences combined with psychotherapy. This approach has yielded significant reductions in depression and anxiety symptoms.
Published research on this approach mostly reflects the use of a top-down approach in analyzing the relationship between psychedelic effects and mental health outcomes, meaning that researchers have developed their own hypotheses before the study starts. A drawback of this approach is that it does not provide an understanding of the different types of subjective experiences brought on by the use of psychedelic substances. In addition, it does not allow analysis of the relationship between subjective experience and beneficial mental health outcomes.
A new study, published in the Journal of Affective Disorders, has now taken an alternative, bottom-up approach using data collected from users of psychedelic substances and a machine learning analytic procedure involving cluster analysis. This has enabled the researchers to elucidate specific subtypes of the psychedelic experience and how these subtypes might be related to different mental health outcomes.
Data were collected from nearly 1,000 respondents who answered questions about their previous, non-clinical experiences with psychedelic drugs. They included users of psilocybin (magic mushrooms), LSD, Ayahuasca, mescaline, peyote cactus and 5-MeO-DMT, the natural psychedelic substance in the venom of the Colorado River toad. The survey was anonymous, and included people who reported having a moderate to strong psychedelic experience in the past, associated with subsequent changes to their symptoms of anxiety and depression.
The participants completed online questionnaires and evaluated the extent to which their psychedelic experience was mystical (evoking a sense of pure awareness, positive mood and/or transcendence of time and space that is difficult to describe in words), psychologically insightful (eliciting acute insight into memories, emotions, relationships, behaviors or beliefs), or challenging.
Outcomes assessed in the survey included depression and anxiety symptom levels and ratings of satisfaction with life and psychological flexibility – one’s capacity to act in ways that are consistent with one’s values regardless of whatever might be experienced, internally or externally – before and after using the psychedelic.
Analysis of the results shows that individuals who rated their experiences as highly mystical and insightful consistently reported improvements in the symptoms of their anxiety and depression. It also suggests that a challenging experience while on these substances, one that feels frightening or destabilizing, can have beneficial results, especially in the context of mystical and insightful experiences. This could be helpful for practitioners to know as they guide patients through clinical trials testing the therapeutic potential of psychedelics.
“Sometimes the challenge arises because it’s an intensely mystical and insightful experience that can, in and of itself, be challenging,” said senior author Alan Davis, assistant professor and director of the Center for Psychedelic Drug Research and Education in The Ohio State University College of Social Work.
“In the clinical research setting, folks are doing everything they can to create a safe and supportive environment. But when challenges do come up, it’s important to better understand that challenging experiences can actually be related to positive outcomes.”
The data analysis suggested three distinct subtypes of psychedelic experiences:
“The group that had the highest insightful and mystical experiences and low challenging experiences showed the most benefit in terms of remission of anxiety and depression symptoms and other longer lasting benefits to their life,” said first author Aki Nikolaidis, an affiliate of Ohio State’s Center for Psychedelic Drug Research and Education (CPDRE) and a research scientist in the Center for the Developing Brain at the Child Mind Institute.
When the researchers included only data from participants who had used psilocybin and LSD, the same patterns emerged: three distinct subtypes that were associated with the same outcomes, including benefits to mental health even after a challenging experience. That replication speaks to the importance of the subjective experience for psychedelics users, Nikolaidis said.
“Identifying subtypes that exist regardless of which psychedelic you take answers an interesting question,” he said. “But the fact that we found that they’re associated with specific outcomes, and replicated that finding, really shows why it’s important to understand the powerful nature of what is happening subjectively and its potential to yield a beneficial outcome.”
Davis said he will be watching to see if these subtypes of experiences apply in the clinical setting, where psilocybin-assisted therapy is being studied at Ohio State for the treatment of post-traumatic stress disorder among military veterans.
“Finding the variety of other outcomes that these subtypes might be related to is an interesting next step,” he said. “These could include adaptive or functional outcomes in people’s quality of life or wellbeing, or a better understanding of their life’s purpose or relationships.”
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