Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca

Abstract

Background: Evidence suggests that psychedelic-assisted therapy carries transdiagnostic efficacy in the treatment of mental health conditions characterized by low mood and the use of avoidance coping strategies. Aims: While preliminary evidence suggests that psychological flexibility and emotion regulation processes play an important role within psychedelic therapy, this prospective study addressed methodological gaps in the literature and examined the ability of ayahuasca to stimulate acute states of cognitive reappraisal and long-term changes in psychological flexibility and mood. The study also explored whether moderating factors predisposed participants to experience therapeutic changes. Methods: Participants ( N = 261) were recruited from three Shipibo ayahuasca retreat centers in Central and South America and completed assessments on mood, psychological flexibility, and acute ceremonial factors. Expectancy, demand characteristics, and invalid responding were controlled for with several validity scales. Results/Outcomes: Participants reported significant reductions in negative mood after three months, as well as increases in positive mood and psychological flexibility. Acute experiences of reappraisal during the ayahuasca ceremony exerted the strongest moderating effects on increases in positive mood and psychological flexibility. Increases in psychological flexibility statistically mediated the effects of acute psychological factors, including reappraisal, on changes in positive mood. Conclusions/Interpretation: These results highlight the role of acute psychological processes, such as reappraisal, and post-acute increases in psychological flexibility as putative mechanisms underlying positive outcomes associated with psychedelics. These results also provide support for the integration of third-wave and mindfulness-based therapy approaches with psychedelic-assisted interventions.

Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model

“…This inattention may reflect the ongoing effort to characterize PAP within the institutional bounds of Western psychiatry and psychology, which attend more exclusively to cognitive and neural phenomena. As such, beneficial outcomes of PAP treatment have been conceptualized in neuropsychological terms that omit participants’ experiences of embodiment ( Kelly et al, 2021 ; Thal et al, 2021 ), such as the “reset” of a maladaptive neural status quo ( Carhart-Harris et al, 2017 ; Carhart-Harris and Friston, 2019 ), increased psychological flexibility ( Watts and Luoma, 2020 ; Agin-Liebes et al, 2022 ), cognitive reappraisal ( Agin-Liebes et al, 2022 ), altered neural responses to affect ( Barrett et al, 2020 ), or increased neuronal and mental plasticity ( Kočárová et al, 2021 ). This centering of the brain-mind may seem unremarkable, given the prevalence of neuropsychological explanations offered by most psychotherapies.…”

From Relaxed Beliefs Under Psychedelics (REBUS) to Revised Beliefs After Psychedelics (REBAS): Preliminary Development of the RElaxed Beliefs Questionnaire (REB-Q)

“…Although our sample was comprised of healthy individuals, these finding suggest that psilocybin therapy may be especially promising for the treatment of psychiatric disorders characterized by especially rigid and inflexible negative self-beliefs, such as depression (Dozois & Rnic, 2015) and anorexia (see Spriggs et al, 2021aSpriggs et al, , 2021b. Moreover, integrating psychedelic therapy within therapies that challenge and increase distance from such beliefs (e.g., cognitive behavioural therapies) may help to enhance the efficacy of psychedelic therapy (see Agin-Liebes et al, 2022;Sloshower et al, 2020;Wolff et al, 2020;Watts & Luoma, 2020;Zeifman et al, 2020). Relatedly, identifying and examining confidence associated with salient maladaptive beliefs within the context of psychedelic therapy may help to more effectively target such maladaptive beliefs.…”

Prevalence and therapeutic impact of adverse life event reexperiencing under ceremonial ayahuasca

“…Other scientists have observed the role of psychological flexibility in psychedelic-mediated healing 34 – 36 . Psychological flexibility is defined as the ability to flexibly alternate between and manage challenging thoughts, emotions, or mental sets in the service of carrying out valued actions 37 .…”