Cancer at the dinner table: experiences of psilocybin-assisted psychotherapy for the treatment of cancer-related distress

This interview study (n=13) analyzed the phenomenological themes associated with psilocybin therapy for anxiety and depression associated with cancer. Participants reported a felt reconnection to life, reconciliation with death, and other powerful subjective effects.

Abstract

“Recent randomized controlled trials of psilocybin-assisted psychotherapy for patients with cancer suggest that this treatment results in large-magnitude reductions in anxiety and depression as well as improvements in attitudes toward disease progression and death, quality of life, and spirituality. To better understand these findings, we sought to identify psychological mechanisms of action using qualitative methods to study patient experiences in psilocybin-assisted psychotherapy. Semistructured interviews were conducted with 13 adult participants with clinically elevated anxiety associated with a cancer diagnosis who received a single dose of psilocybin under close clinical supervision. Transcribed interviews were analyzed using interpretative phenomenological analysis, which resulted in 10 themes, focused specifically on cancer, death and dying, and healing narratives. Participants spoke to the anxiety and trauma related to cancer, and perceived lack of available emotional support. Participants described the immersive and distressing effects of the psilocybin session, which led to reconciliations with death, an acknowledgment of cancer’s place in life, and emotional uncoupling from cancer. Participants made spiritual or religious interpretations of their experience, and the psilocybin therapy helped facilitate a felt reconnection to life, a reclaiming of presence, and greater confidence in the face of cancer recurrence. Implications for theory and clinical treatment are discussed.”

Authors: Thomas C. Swift, Alexander B. Belser, Gabrielle Agin-Liebes, Neşe Devenot, Sara Terrana, Harris L. Friedman, Jeffrey Guss, Anthony P. Bossis & Stephen Ross

Summary

We conducted semistructured interviews with 13 patients who underwent psilocybin-assisted psychotherapy and found that this treatment resulted in large-magnitude reductions in anxiety and depression.

—Erin, study participant.

Two recent randomized, double-blind, placebo-controlled trials found that psilocybin, a naturally occurring serotonergic compound found in over 180 species of mushrooms, had large clinical benefits for patients with cancer, including robust anxiolytic and antidepressant effects, improvements in physical, psychological, and psychosocial well-being, and an increased sense of meaning and peace.

Three randomized controlled trials of single-dose psilocybin administration in a supportive milieu for cancer-related psychological and existential distress demonstrated substantial effect sizes on primary outcome measures of anxiety and depression. Qualitative research methods may complement existing quantitative research on psychedelic-assisted treatments.

Psilocybin induces a profound shift in consciousness and is known to activate a subtype of serotonin receptor (5-HT2A). This receptor mediates perception, attention, and emotion regulation, and may be responsible for the long-term, durable changes frequently seen after a single, therapeutically supported experience.

A recent review of the literature on psilocybin-assisted psychotherapy found that the psychedelic-occasioned mystical experience partially mediated the clinical benefit of sustained anxiolytic and antidepressant effects. However, no rigorously conducted qualitative studies of first-person narratives regarding the cancer-related experiences of psilocybin-assisted psychotherapy have yet to be evaluated.

Two separate articles were created to document the extensive experiences of participants with psilocybin therapy, one of which focused on a wide range of phenomena, and the other which focused on experiences directly related to cancer and death.

Method

13 participants who completed a Phase 2 RCT clinical trial of psilocybin treatment for cancer-related psychological and existential distress were recruited to enroll in a subsequent interview study of their experiences. The study employed a double-blind, crossover, placebo-controlled design and consisted of two drug administration sessions spaced 7 weeks apart.

In this crossover design study, participants received either psilocybin or niacin first and were encouraged to listen to music during their sessions. The same two study psychotherapists worked with them throughout the study and were present during the drug administration sessions.

Participants

13 participants from the original study were interviewed about their experiences with psilocybin, and 8 participants were interviewed approximately 1 year following their psilocybin dosing session. All participants provided written informed consent prior to enrolling, and all participants were still alive at the time of publication.

Interviews

Twelve semistructured interviews were conducted with participants, one via video teleconference. The interviews lasted 1 hour and 33 minutes on average, and were transcribed verbatim and deidentified to protect the identity of study participants.

Data Analysis

We used an interpretative phenomenological analysis to explore and interpret the interview data. A consensus decision-making process was used, and a computer-assisted qualitative data analysis software package with collaborative capabilities was used.

Result

Cancer-Related Anxiety and Trauma (Prior to the Psilocybin Treatment)

In the beginning of the interview, participants described their lives before their participation in the psilocybin study. Eight participants described the prospect of death moving from a distant abstraction to a close and imminent reality, one that could not be escaped.

All participants experienced some level of anxiety after completing their cancer treatments, and some even reported an increase in anxiety and despair following the completion of their cancer treatments.

Five participants described symptoms consistent with posttraumatic stress disorder, including hypervigilance, sleeplessness, and paralyzing anxiety.

Lack of Available Emotional Support

Eight participants reported maladaptive coping strategies in response to their emotional distress, including going to work immediately after the completion of their medical treatments, gaining 70 pounds, and developing an addiction to alcohol and antianxiety medications.

Participants expressed the limitations of their medical care to support their emotional needs, and sought a different approach to treating their psychological existential distress through the psilocybin study at New York University.

Immersive and Distressing Effects of Psilocybin

Psilocybin effects were described in complex and multifaceted ways, but all 13 participants spoke of the highly immersive nature of their session. Nine participants described a loosening or even dissolving sense of self, often merging with different elements of their experience such as the music, emotions, or images.

The immersive quality of the psilocybin experience was felt as overwhelming, challenging, or fearful for many participants, particularly in the early stages of the session.

Participants reported feeling taken to the brink of what they could tolerate, but then experiencing a shift or resolution that led to feelings of calmness, peace, happiness, and a sense of connection to their family and friends.

Four participants reported that the difficulty of their psilocybin session was a productive “struggle” or “work”, and that this struggle helped them to gain a greater sense of confidence and resilience.

Reconciliations With Death

Nearly all participants spoke of significant new understandings of death and dying after their psilocybin session, with many feeling relieved and comforted after experiencing a state of being or a realm that was felt to exist at the time of or after death.

Participants’ revelations of death and dying were related to a sense of interconnectedness, which they felt was a transcendent state of belonging. This sense of belonging helped them to cope with their cancer diagnoses.

Participants described vivid visions of reconnection with the earth after death that positively influenced their views on dying. One participant experienced floating toward a brick crematorium and concluding that she must have died, before finding herself under the ground in rich soil.

Cancer’s Place in Life

Six participants described confronting and transforming their relationship to cancer. They moved from a place of denial or avoidance of their cancer toward a clearer acknowledgement and acceptance of its place in their lives.

Five participants reported visions and realizations that helped them accept their cancer as part of their lives. As a result, they felt their lives to be more authentic, more whole, and less fragmented.

Erin felt a greater sense of integration and wholeness in her own life after seeing her cancer as part of the story.

Six participants who had experienced body trauma and cancer treatments came to new acceptance of their bodies. One participant experienced himself as a disembodied form and had to choose a body.

Adam, who initially described his “crazy anxiety” and debilitating fear of cancer recurrence, came to accept the effects of cancer on his body and come to embrace his remission.

Emotional Uncoupling From Cancer

All 13 participants experienced a wide variety of emotions during their psilocybin session, including feelings of release, expanded positive emotions, and new understandings.

Six participants noted that they had not felt the cancer to be a primary or significant focus of their emotional process during their session. Instead, they felt they had been able to face, transform, or release their emotional distress.

Psilocybin helped Edna, who had a traumatic family history with cancer, feel her fear manifest as a physical form near her ribcage.

Spiritual or Religious Interpretations

Seven of the participants described experiencing spiritual or religious experiences during their psilocybin session. Some participants had never been religious or spiritual prior to their session, while others reclaimed a spiritual connection.

Victor felt a connection to a spiritual side of himself during his psilocybin session, while Edna said that she immediately after “started just feeling love on the level of a religious experience”.

Participants spoke to how their psilocybin experience provided a sense of resilience in the face of death, and how this experience may have influenced their relationship to death.

Reconnection to Life

During their psilocybin experience, 13 participants expressed reconnecting to feelings of aliveness and belonging, which had been forgotten in the face of cancer and adulthood. They also described a quality of transcendence in their perspective, which led to a greater sense of well-being and emotional fortitude.

Other participants spoke of remembering simple and positive feelings from their childhoods, which gave them an abiding sense of freedom.

Vandana and Dan reported feeling contentment and freedom during their psilocybin sessions.

Reclaiming of Presence

Seven participants described changes in their lives inspired by their psilocybin experiences, such as slowing down a little bit, not going right to the stress, and not being so organized around time.

Some participants reported that their experiences in the psilocybin session gave them greater confidence to put up boundaries against various stressors and overcome barriers that were impeding life goals.

Augusta described the ways in which her aliveness had withdrawn during her cancer treatments and how her session helped her regain a connection to her sense of joy and abundance in the world.

Confidence in the Face of Cancer Recurrence

Psilocybin treatment resulted in a positive shift in participants’ perspectives toward cancer recurrence, with the majority reporting a less preoccupied feeling, a reduction in thinking or obsessive worrying about cancer, and an expressed confidence in facing cancer were it to return.

Participants who took psilocybin described feeling less overwhelmed by reminders of their cancer, such as follow-up visits to the doctor.

Participants reported a newfound confidence regarding cancer and its recurrence, but were not in denial of its reality. Instead, they were less preoccupied by an unknown future.

Chrissy, who has cancer, said she feels relieved from having to think about it all the time and has more faith that the discomfort will eventually pass.

This qualitative analysis of narrative accounts from participants in a RCT of psilocybin-assisted psychotherapy for cancer-related emotional distress revealed 10 distinct themes focusing on the therapeutic effects of psilocybin administration on cancer-related psychological and existential distress.

The present study revealed that psilocybin therapy sessions were generally described as immersive and experiential in nature, with insights and visions felt as lived experiences for the participants. This may help explain the immediate and enduring positive changes in participants’ lives after a single session.

The felt quality of immersion and “intense struggle” of psilocybin led to transient forms of fear or distress in many participants, but all participants experienced resolution of these manifest difficulties either spontaneously or with the support of study therapists.

Psychological Mechanisms of Action: Reconciliation and Transcendence

The therapeutic process with psilocybin involved a powerful reconciliation of the discordant realities of cancer and death in participants’ lives. This process was consistent with classical mystical-type experiences, in which cancer and death were no longer seen as separate from life but were now a living process within it.

Trauma processing allows the release of complicated emotions, which allows participants to more clearly consider reality.

A significant pathway that could explain improvements in anxiety and depression relates to the more positive, transcendent, and life-affirming aspects of the psilocybin experience. These positive aspects can lead to expanded life priorities and fortitude in the face of future difficulties.

Following their psilocybin session, participants experienced a greater sense of meaning and perspective in their lives, as well as a greater openness and presence with their surroundings. This kind of growth may help explain the enduring effects of the psilocybin treatment.

Limitations and Future Directions

We report on qualitative phenomena from participants’ involvement in a psilocybin treatment for cancer-related psychological and existential distress. The current article focuses on those inquiries related specifically to cancer and death and the healing from emotional distress.

This study was limited by its homogeneous sample, focus on cancer, timing of the interviews, and possible issues with participant recall. It should also be noted that the visions and revelations participants described emerged during their psilocybin session without verbal prompting from their study therapists.

Although legal barriers restrict the use of psilocybin in clinical trials, this article explains how caregivers can help cancer patients explore meaning in cancer and death and release difficult emotions.

Conclusion

This study used qualitative methods to describe the subjective experiences of those who underwent psilocybin treatment for cancer-related emotional distress. It concluded that psilocybin-assisted psychotherapy may be a powerful intervention for cancer patients.

Notes

The participants in this study previously participated in the psilocybin for cancer-related anxiety by Ross and colleagues (2016).

The themes from during and after the experience were also analysed (from the same dataset) in Belser and colleagues (2017).