Attitudes and Beliefs about the Therapeutic Use of Psychedelic Drugs among Psychologists in the United States

This survey study (n=366) among clinical psychologists finds cautious optimistic attitudes towards psychedelics as medicines. Most psychologists indicate that they lack education or knowledge of effectiveness surrounding treatments with psychedelics.

Abstract

“Psychologists are a vital component of mental health treatment and their perceptions of psychedelic-assisted therapy are critical for future implementation. This cross-sectional quasi-experimental electronic survey study explored the attitudes about psychedelics used in treatment among 366 clinical psychologists in the United States. Participants expressed cautiously favorable attitudes toward therapeutic psychedelic experiences but indicated concern about possible psychiatric and neurocognitive risks. Most participants indicated that they lack an understanding of the full range of effects of psychedelics, would need to seek out additional consultation, and endorsed positive beliefs in the potential of psychedelic treatment and the need for further research. Overall, this research identified the need to increase education and training about psychedelics for psychologists in order to help increase knowledge and reduce stigma about psychedelic therapies.”

Authors: Alan K. Davis, Gabrielle I. Agin-Liebes, Megan España, Brian Pilecki & Jason B. Luoma

Summary

This cross-sectional quasi-experimental electronic survey study explored the attitudes toward psychedelics used in treatment among 366 clinical psychologists in the United States. The study found that most participants held cautiously favorable attitudes toward therapeutic psychedelic experiences.

Introduction

Psychedelics, such as magic mushrooms, LSD, and ayahuasca, have a long history of stigma in the US, but recent research has demonstrated a societal shift in the acceptability of the use of psychedelics. However, stigma may still exist and negatively affect the treatment of clients who use psychedelics.

Psilocybin therapy has been shown to improve mental health functioning in several areas, including cancer-related anxiety and depression, treatment-resistant depression, major depressive disorder, and substance misuse.

Although the US Food and Drug Administration has granted breakthrough therapy status to two organizations conducting large multi-site trials with psilocybin, this drug remains a schedule I drug.

Little research has been published on the acceptability of psilocybin and psychedelics among clinicians, and thus it is unknown how acceptable this approach is among social workers. Furthermore, no study has assessed the attitudes and beliefs about psychedelics among clinical and counseling psychologists.

This paper reports on the results of a survey designed to assess psychologists’ attitudes toward psychedelics generally, and psilocybin specifically. The survey explored whether psychologists’ beliefs about working with a client who had a recent spiritual/mystical experience varied as a function of whether the experience was occasioned by psilocybin or a meditation retreat.

Participants and procedure

This is a cross-sectional online survey study of psychologists conducted between July and August 2020. A total of 447 participants were recruited from a database of 27,866 e-mail addresses, and 82% of those who opened the recruitment e-mail and viewed the informed consent document were included in the final sample.

Participants were randomized to one of two conditions and then completed a series of questionnaires. They were also given the option to enter a raffle for a chance to win one of ten $50 or one of five $100 electronic gift cards.

Vignettes and follow-up questions

Participants were randomized to one of two conditions and were presented with a series of vignettes (provided in supplemental appendix 1). The vignettes depicted clients with major depressive disorder, a client with major depressive disorder who had a recent experience with psilocybin mushrooms, and a client who had read about psychedelic assisted treatment.

After being randomized to vignette conditions, participants were asked to respond to 7 questions about vignettes 1a/2a and 7 questions about vignettes 2a/2b. The questions ranged from how likely they were to explore the pros and cons of engaging in this new behavior to seeking additional consultation.

Acceptability of medication/psychedelic assisted therapy

A modified version of the Treatment Acceptability Rating Form-Revised (TARF-R) was used to measure participants’ level of acceptability of psychedelic or medication-assisted therapies.

Safety and therapeutic potential of psychoactive drugs

We created 10 items to assess the safety and therapeutic potential of five different types of psychoactive drugs.

Psychedelic-related beliefs, attitudes, and experiences were assessed using seven items from a prior study on attitudes of psychiatrists. Seven additional items were created to assess background characteristics related to perceptions and experiences related to psychedelics. Questionnaire: How knowledgeable are you about the risks and benefits associated with psychedelic use?, Have you ever used psychedelics in the past, Have you had a positive experience with psychedelics, Have you worked with patients that talked about a psychedelic experience during treatment?

Data analysis

We conducted descriptive statistics, chi-square and t-test analyses, independent t-test analyses, repeated measures ANOVAs, and post-hoc tests of mean pairwise comparisons to examine whether there were any significant differences in demographic characteristics, responses to questions following each of the vignette conditions, and perceived therapeutic value between groups.

Results

Participants were primarily middle-aged female psychologists with a PsyD or PhD degree, most practicing Cognitive Behavioral Therapy, and most working in a private practice setting in various regions of the US.

A hypothetical client with major depression reported having a recent experience with psilocybin mushrooms or a spiritual/religious activity. A large proportion of respondents indicated they would be likely to warn their client about the risks associated with psilocybin use, but an approximately equal proportion also reported they would consider the experience psychologically beneficial.

There were several between-group differences in response to vignettes 2a/2b, including twice as many participants warning their client about potential risks of psilocybin use, and four to eight times as many participants referring their client to another clinician.

Participants were less open to and less favorably disposed toward psychedelic-assisted treatment than medication-assisted treatment for substance use disorders, PTSD, depression, or anxiety. They were also less confident in the effectiveness of psychedelic-assisted treatment than medication-assisted treatment.

Participants perceived psychedelics and alcohol to be comparable in safety, followed by opioids and cocaine. Cannabis was perceived to be the safest of all drugs, and opioids and cocaine were rated to be the least therapeutic of all drugs.

A large proportion of participants believed psychedelics increase the risk of subsequent psychiatric or neurocognitive impairment and should remain illegal for recreational use. However, a large percentage believed medically supervised use was not unsafe.

Participants reported having personal experiences with psychedelics, and most rated the experience as somewhat (40.6%) or very (39.6%) positive. Approximately one-half of participants reported having worked with a client who had experiences with psychedelics.

Discussion

A quasi-experimental internet survey study among 366 psychologists was conducted to assess attitudes and beliefs about psychedelics and more specifically the use of psilocybin among clients with depression. The majority of psychologists believed psychedelic-assisted interventions deserve further research, but less than half agreed it “shows promise in treating psychiatric disorders”.

Participants in this study were twice as likely to warn a potential client about risks associated with psilocybin than they would regarding a meditation retreat. This is likely reflective of the stigma associated with psychedelics.

Although rare, psychiatric harms have been reported following controlled administration of psychedelics in the 1950s and 1960s. These harms are likely to have been caused by inadequate screening procedures, intentional neglect of contextual variables, or mistreatment by investigators.

The results of this study indicate that psychologists need to be better educated on the relative safety of psychedelics compared to traditional pharmaceutical agents and other consciousness-altering substances. Epidemiological data indicate that psilocybin use is associated with very low rates of adverse effects compared to other psychoactive drugs. Additionally, psilocybin and LSD use have been associated with significantly reduced odds of mental health problems.

This study suffers from a number of limitations, including sampling bias, self-report, and possible issues of social desirability and stigma relating to psychedelics. However, the sample size was adequate to detect between group differences and result in relatively stable parameter estimates.

Clinical trials of psychedelic-assisted psychotherapy are on the rise, and psychologists are uniquely qualified to support clients in processing or integrating psychedelic experiences, as well as to encourage vital harm reduction practices.