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Journal ArticleDOI

Considerations in the Application of Psychedelic-Augmented Psychotherapy: A Commentary on Clinical Mechanisms

12 May 2023-Vol. 2, Iss: 2, pp 162-173
TL;DR: In this article , the role of psychotherapy in the augmentation, follow-up, and support mechanisms relevant to psychedelic administration has been examined, with the intention of opening a broader conversation to those situated in medical and medical-adjacent fields.
Abstract: Psychedelics have been studied extensively in their broad treatment potential for a variety of mental health disorders. Recently, scholars have turned their attention to the role of psychotherapy in the augmentation, follow-up, and support mechanisms relevant to psychedelic administration. While it is tempting to position psychedelic substances as standalone medicines akin to SSRIs or SNRIs, their unique neurochemical action and potential for psychological transformation calls for a broader examination of the role of counseling and psychotherapy, within the context of a bio-psychosocial model. I outline well-established and emerging therapeutic modalities that are well-placed in complementary and augmented psychedelic treatment. I do so with the intention of opening a broader conversation to those situated in medical and medical-adjacent fields, including psychoanalysts, counselors, support workers, and other allied professionals. Ultimately, practitioners working in medical-aligned fields hold diversly vested interests in understanding the place of psychedelic therapies in mental health, and more attention should be given to a balanced consideration of treatment and support mechanisms.

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Journal ArticleDOI
TL;DR: Ketamine rapidly reduced suicidal thoughts, within 1 day and for up to 1 week in depressed patients with suicidal ideation, although subsequent trials in transdiagnostic samples are required to confirm that ketamine exerts a specific effect on suicidal Ideation.
Abstract: Objective:Suicide is a public health crisis with limited treatment options. The authors conducted a systematic review and individual participant data meta-analysis examining the effects of a single dose of ketamine on suicidal ideation.Method:Individual participant data were obtained from 10 of 11 identified comparison intervention studies that used either saline or midazolam as a control treatment. The analysis included only participants who had suicidal ideation at baseline (N=167). A one-stage, individual participant data, meta-analytic procedure was employed using a mixed-effects, multilevel, general linear model. The primary outcome measures were the suicide items from clinician-administered (the Montgomery-Asberg Depression Rating Scale [MADRS] or the Hamilton Depression Rating Scale [HAM-D]) and self-report scales (the Quick Inventory of Depressive Symptomatology–Self Report [QIDS-SR] or the Beck Depression Inventory [BDI]), obtained for up to 1 week after ketamine administration.Results:Ketamine r...

414 citations

Journal ArticleDOI
TL;DR: A leading model of global brain function, hierarchical predictive coding, is integrated with an often-cited model of the acute action of psychedelics, the entropic brain hypothesis, which states that psychedelics work to relax high-level priors, sensitising them to liberated bottom-up information flow, which can help guide and cultivate the revision of entrenched pathological priors.
Abstract: This paper formulates the action of psychedelics by integrating the free-energy principle and entropic brain hypothesis. We call this formulation relaxed beliefs under psychedelics (REBUS) and the anarchic brain, founded on the principle that—via their entropic effect on spontaneous cortical activity—psychedelics work to relax the precision of high-level priors or beliefs, thereby liberating bottom-up information flow, particularly via intrinsic sources such as the limbic system. We assemble evidence for this model and show how it can explain a broad range of phenomena associated with the psychedelic experience. With regard to their potential therapeutic use, we propose that psychedelics work to relax the precision weighting of pathologically overweighted priors underpinning various expressions of mental illness. We propose that this process entails an increased sensitization of high-level priors to bottom-up signaling (stemming from intrinsic sources), and that this heightened sensitivity enables the potential revision and deweighting of overweighted priors. We end by discussing further implications of the model, such as that psychedelics can bring about the revision of other heavily weighted high-level priors, not directly related to mental health, such as those underlying partisan and/or overly-confident political, religious, and/or philosophical perspectives. Significance Statement Psychedelics are capturing interest, with efforts underway to bring psilocybin therapy to marketing authorisation and legal access within a decade, spearheaded by the findings of a series of phase 2 trials. In this climate, a compelling unified model of how psychedelics alter brain function to alter consciousness would have appeal. Towards this end, we have sought to integrate a leading model of global brain function, hierarchical predictive coding, with an often-cited model of the acute action of psychedelics, the entropic brain hypothesis. The resulting synthesis states that psychedelics work to relax high-level priors, sensitising them to liberated bottom-up information flow, which, with the right intention, care provision and context, can help guide and cultivate the revision of entrenched pathological priors.

361 citations

Journal ArticleDOI
TL;DR: This updated version of the original entropic brain hypothesis now offers more concrete information on specific measures of brain entropy and suggests new studies to scrutinise it further, as well as examining its utility for describing and informing the treatment of psychiatric and neurological conditions such as depression and disorders of consciousness.

236 citations

Journal ArticleDOI
TL;DR: Compared with placebo, kava extract is an effective symptomatic treatment for anxiety although, at present, the size of the effect seems small and the effect lacks robustness and is based on a relatively small sample.
Abstract: Background Constraints on resources and time often render treatments for anxiety such as psychological interventions impracticable. While synthetic anxiolytic drugs are effective, they are often burdened with adverse events. Other options which are effective and safe are of considerable interest and a welcome addition to the therapeutic repertoire. Objectives To assess the effectiveness and safety as reported in rigorous clinical trials of kava extract compared with placebo for treating anxiety. Search methods All publications describing (or which might describe) randomised, double-blind, placebo-controlled trials of kava extract for anxiety were sought through electronic searches on EMBASE (1974 to January 2005), MEDLINE (1951 to January 2005), AMED (1985 to January 2005)), CISCOM (inception until August 2002) and Central/CCTR and CCDANCTR (issue 1, 2005). The search terms that were used were kava, kawa, kavain, Piper methysticum and Rauschpfeffer (German common name for Piper methysticum). Additionally, manufacturers of kava preparations and experts on the subject were contacted and asked to contribute published and unpublished material. Hand-searches of a sample of relevant medical journals (Erfahrungsheilkunde 1996 - 2005, Forsch Komplementarmed Klass Naturheilkd 1994 - 2005, Phytomed 1994 - 2005, Alt Comp Ther 1995 - 2005), conference proceedings (e.g. FACT - Focus on Alternative and Complementary Therapies 1996 - 2005) and our own collection of papers were conducted. No restrictions regarding the language of publication were imposed. Selection criteria To be included studies were required to be randomised, controlled trials (RCTs), i.e. trials with a randomised generation of allocation sequences, and conducted placebo-controlled and double-blind, i.e. trials with blinding of patients and care providers. Trials using oral preparations containing kava extract as the only component (mono-preparation) were considered. Trials using single constituents of kava extract alone, assessing kava extract as one of several active components in a combination preparation or as a part of a combination therapy were excluded. Data collection and analysis Data were extracted systematically according to patient characteristics, interventions and results. Methodological quality of all trials was evaluated using the standard scoring system developed by Jadad and colleagues. The screening of studies, selection, data extraction, validation and the assessment of methodological quality were performed independently by the two reviewers. Disagreements in the evaluation of individual trials were largely due to reading errors and were resolved through discussion. Main results Twelve double-blind RCTs (n=700) met the inclusion criteria. The meta-analysis was done on seven studies using the total score on the Hamilton Anxiety (HAM-A) scale as a common outcome measure. The result suggests a significant effect towards a reduction of the HAM-A total score in patients receiving kava extract compared with patients receiving placebo (weighted mean difference: 3.9, 95% confidence interval: 0.1 to 7.7; p = 0.05; n = 380). The results of the five studies that were not submitted to meta-analysis largely support these findings. Adverse events as reported in the reviewed trials were mild, transient and infrequent. Authors' conclusions Compared with placebo, kava extract is an effective symptomatic treatment for anxiety although, at present, the size of the effect seems small. The effect lacks robustness and is based on a relatively small sample. The data available from the reviewed studies suggest that kava is relatively safe for short-term treatment (1 to 24 weeks), although more information is required. Rigorous trials with large sample sizes are needed to clarify the existing uncertainties. Also, long-term safety studies of kava are required.

180 citations

Journal ArticleDOI
02 Apr 2020-Cell
TL;DR: Outcomes of neuroscience and clinical research into 5-Hydroxytryptamine 2A (5-HT2A) receptor agonists, such as psilocybin, show promise for addressing a range of serious disorders, including depression and addiction.

134 citations

Trending Questions (2)
What are the different ways that psychedelics are being used in psychotherapy?

Psychedelics are being used in psychotherapy through the application of well-established and emerging therapeutic modalities that complement and augment psychedelic treatment.

What are the most relevant topics in psychedelic therapy?

The paper discusses the role of counseling and psychotherapy in psychedelic therapy, including well-established and emerging therapeutic modalities.