Patient Experiences of Psilocybin-Assisted Psychotherapy: An Interpretative Phenomenological Analysis

Abstract

The psychological mechanisms of action involved in psilocybin-assisted psychotherapy are not yet well understood. Despite a resurgence of quantitative research regarding psilocybin, the current study is the first qualitative study of participant experiences in psilocybin-assisted psychotherapy. Semistructured interviews were carried out with 13 adult participants aged 22 to 69 years (M = 50 years) with clinically elevated anxiety associated with a cancer diagnosis. Participants received a moderate

Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

“…There is mounting evidence that the positive long-term effects of psychedelic therapy are mediated by the quality of the acute psychedelic experience (44)(45)(46)(47). Qualitative interviews with patients have shown that avoidance and acceptance are often central themes of their psychedelic experiences (13,(48)(49)(50)(51), and patients commonly report transient episodes of struggle with intense aversion. These challenging experiences 1 (42,52,53) are often characterized by extreme fear or panic, and can involve frightening imagery, unsettling body sensations, and the apprehension of immediate threat.…”

“…The associated experience of an emotional breakthrough is commonly described as insightful and rewarding, and has been proposed to constitute a key component of psychedelic therapy (13,54). Patients often experience episodes of unique openness to greatly intensified emotions during dosing sessions, and commonly describe the sensation that previously "hidden" or "suppressed" feelings became "accessible" or were "released" (13,48,49). Many patients report increases in emotional openness that last long after acute drug effects subside (13), and symptom reductions after psychedelic therapy are associated with enhanced neural measures of emotional responsiveness (55,56).…”

“…Patient #3 (13) Such reports of exceptional openness to previously "hidden" or "suppressed" feelings during dosing sessions (13,48,49) suggest that conditioned acceptance may yield unique opportunities for exposure to private events that are otherwise avoided. Apart from the necessity to desist from avoidant responses, successful exposure treatment requires that suitable exposure targets (i.e., avoidance-related private events that are meaningfully related to the patient's psychopathology) are elicited and experienced with sufficient intensity.…”

“…Applied to our model, long-term increases in acceptance and corresponding reductions in psychopathology should be especially pronounced following psychedelic experiences where operant processes engender episodes of relatively avoidance-free exposure to otherwise avoided private events, thereby enabling the revision of avoidance-related beliefs. Whereas qualitative analyses of patient interviews (13,48,49,51) are compatible with this view, quantitative studies are needed to test and further develop the proposed model. This requires that relevant aspects of the acute psychedelic experience are adequately measured.…”

Can Psychedelics be the Treatment for the Crisis in Psychopharmacology?

“…43 For a complete review of the pharmacological mechanisms of psychedelic drugs, see Kyzar et al 2017. 36 Regarding the enhancement of psychotherapeutic interventions, psychedelic drugs could trigger meaningful personal concerns, 44,45 facilitate introspective insights 33 and enhance the relationship between the therapist and the patient, 46 among other effects. Additionally, there are some idiosyncrasies of this kind of assisted psychotherapy that deserve mention.…”