Psychedelics and health behaviour change

This theory-building paper (2021) argues for the positive impact that psychedelic use can have on health behaviors. Current trials are using psychedelics for mental health disorders, but future studies could look further to improvements in diet, exercise, nature exposure and other behaviours that promote physical and psychological well-being.

Abstract

“Healthful behaviours such as maintaining a balanced diet, being physically active and refraining from smoking have major impacts on the risk of developing cancer, diabetes, cardiovascular diseases and other serious conditions. The burden of the so-called ‘lifestyle diseases’—in personal suffering, premature mortality and public health costs—is considerable. Consequently, interventions designed to promote healthy behaviours are increasingly being studied, e.g., using psychobiological models of behavioural regulation and change. In this article, we explore the notion that psychedelic substances such as psilocybin could be used to assist in promoting positive lifestyle change conducive to good overall health. Psilocybin has a low toxicity, is non-addictive and has been shown to predict favourable changes in patients with depression, anxiety and other conditions marked by rigid behavioural patterns, including substance (mis)use. While it is still early days for modern psychedelic science, research is advancing fast and results are promising. Here we describe psychedelics’ proposed mechanisms of action and research findings pertinent to health behaviour change science, hoping to generate discussion and new research hypotheses linking the two areas. Therapeutic models including psychedelic experiences and common behaviour change methods (e.g., Cognitive Behaviour Therapy, Motivational Interviewing) are already being tested for addiction and eating disorders. We believe this research may soon be extended to help promote improved diet, exercise, nature exposure and also mindfulness or stress reduction practices, all of which can contribute to physical and psychological health and well-being.“

Authors: Pedro J. Teixeira, Matthew W. Johnson, Christopher Timmermann, Rosalind Watts, David Erritzoe, Hannah Douglass, Hannes Ketner & Robin L. Carhart-Harris

Summary

Abstract

Psychobiological models of behavior change are being used to promote healthy behaviors such as improved diet, exercise, nature exposure, and also mindfulness or stress reduction practices. Psilocybin is a non-addictive psychedelic that has been shown to predict favorable changes in patients with depression, anxiety, and other conditions marked by rigid behavioral patterns.

Introduction

Psychedelic compounds such as LSD, psilocybin and DMT may be used to promote healthier lifestyles, such as diet, physical activity, smoking and drinking. This is important because unhealthy behaviors increase the probability of manifest disorders such as obesity, diabetes, depression, cancer, and cardiovascular disease.

Psychedelic plants and fungi have been used by humans for centuries to promote holistic ‘healing’ of body and mind. In the mid 20th century, scientists began to systematically test the effects of psychedelics on traditional psychotherapy, with positive results claimed in the treatment of mood disorders and addictions. The 21st century has witnessed a renaissance in human research with psychedelic compounds, with published research on psychedelic-assisted psychotherapy for a range of psychiatric conditions including cancer-related distress, depression, anxiety, substance use disorders, and obsessive compulsive disorder.

Despite mostly small-sample studies, published results are largely promising for psilocybin therapy for depression and eating disorders. Ketamine and MDMA are also being studied for treating depression, posttraumatic stress disorder and substance abuse.

Classic psychedelics are direct agonists at the serotonin (5-HT) 2A receptor (5-HT2A-R), and have a favorable toxicity profile and therapeutic index. They produce an intense altered state of consciousness and require professional supervision.

Psychedelics have been found to promote cortical synaptogenesis, which is an important marker of neuroplasticity. This increase in synaptic gain is associated with an increase in the complexity, unpredictability or entropy of field potentials, which correlates closely with the intensity of subjective effects in humans. Psychedelics decrease the prediction-weighting of priors at high levels of the brain’s functional hierarchy, and this results in a felt relaxation of beliefs or assumptions.

Psychedelics offer a respite from weighty beliefs and can be used to change habits of mind and behavior if combined with a commitment to therapeutic development. Psychedelics may facilitate behavioral change by revising high-order mechanisms, which can result in an increase in exploration of new behaviors. This is consistent with an increase in the personality domain called “openness to experience”, which has been shown to be increased by psilocybin.

Self-determination is a psychological concept that has been explored in studies of health behavior change, and may provide a psychological framework from which psychedelics could assist in lifestyle change. According to self-determination theory, humans are naturally inclined to engage in interesting activities, exercise capacities, pursue connectedness in social groups, and integrate intrapsychic and interpersonal experiences into a relative unity, but only to the extent basic psychological needs are satisfied.

Psychedelics could influence factors such as competence, autonomy, and interpersonal relatedness, which could be explained by increased connection to oneself, increased self-efficacy, and increased autonomy in research trials for depression, alcohol cessation, and smoking cessation.

Noorani and colleagues (2018) noted that participants had lasting impressions of interconnectedness and an increase in prosocial behavior, and that a sense of unity was one of the features of the mystical experience construct that is strongly affected by classic psychedelics.

No study has been conducted specifically to investigate lifestyle behaviors such as over-eating and physical activity in relation to psychedelic use, but some studies have asked participants to report spontaneous changes in various areas of their lives, including in health behaviors. A study of 380 ayahuasca users showed that they had a mean BMI of 22.6 kg/m2, were physically active, consumed a high amount of fruit and vegetables, and had a high rate of yoga/meditation.

13 People who claimed to have stopped or reduced alcohol consumption, cannabis, opioid, or stimulant misuse after a psychedelic experience also reported improved diet and increased exercise. It is unknown whether these individuals were intentionally seeking changes in these specific areas as they embarked on psychedelic use. The Johns Hopkins studies on smoking cessation and depression in cancer patients both report increases in positive behavior changes as people went through the psilocybin-assisted therapy program. Although these changes are not health-related behaviors per se, they are consistent with improved well-being and meaning.

A study with 16 participants who had been previously diagnosed with an eating disorder investigated how having partaken in one or several ayahuasca ceremonies influenced their management of their condition or recovery process. They reported reductions in ED-related negative thoughts, improvements in emotional processing and regulation, and an increased ability to identify root psychological causes.

Early clinical psychedelic research suggested that LSD and psilocybin could help with alcohol misuse and tobacco smoking. More recent studies have confirmed this and extended this to 30 months of smoking abstinence. Psilocybin sessions helped participants in smoking cessation by improving mood and affect, changing life priorities and values, providing motivational insights, and emotional regulation.

For both smoking and alcohol dependence, most recent intervention trials using psychedelics have employed mainstream motivational / behavior change methods to complement the substance-induced psychedelic experience(s). The model of psychedelic therapy which is now emerging in the field usually involves one or two sessions where participants ingest the psychedelic compound (e.g. a psilocybin capsule), with variable amounts of preparation and integration therapeutic sessions. Trained guides / therapists are usually present for the duration of the psychedelic experience.

A therapeutic container for such work could be the ACE model, which is based on Acceptance and Commitment Therapy. Alternatively, Cognitive Behavioral Therapy and Motivational Enhancement Therapy could be used, as they have been supported by robust research as effective in supporting multiple varieties of health behavior change.

Final Considerations

We have reviewed the modern resurgence in psychedelic research with a focus on therapeutic applications, such as the treatment of addictions, and proposed that self-determination theory may be useful in understanding these effects.

Driven motivation upon well-integrated psychedelic experiences may be a useful approach to behavior change, and future research may examine the role of suggestibility and drug-induced enhancements of suggestibility. Some people might worry that psychedelic drugs will cause them to lose motivation, but the data shows that they actually improve people’s behaviors, attitudes, and functioning, and do not cause them to drop out of mainstream society or disengage with their families.

Future research should expand existing research to look at broader ranges of behavioral targets, and should also examine the role of therapy, including whether psychedelic sessions are enhanced when accompanied by explicit frameworks such as Cognitive Behavioral Therapy, Motivational Interviewing, and the ACE model.