Classic Psychedelic Use and Mechanisms of Mental Health: Exploring the Mediating Roles of Spirituality and Emotion Processing on Symptoms of Anxiety, Depressed Mood, and Disordered Eating in a Community Sample

This survey study (n=159) tested a model examining the associations between frequency of psychedelic use, self-reported spirituality, and difficulties with emotion regulation. It was found that classic psychedelic use predicted greater spirituality, which predicted better emotion regulation, ultimately leading to lower levels of anxiety, depressed mood and disordered eating. Several limitations exist including a lack of causality and a diverse sample.

Abstract

“A resurgence of research has begun to systematically examine the relationship between psychedelic use and mental health and well-being. Although preliminary findings examining the therapeutic value of these substances show promise, the mechanisms through which psychedelic use may predict reduced mental distress remain poorly understood. To this end, we surveyed a community sample of individuals (n = 159) who endorsed lifetime psychedelic use to examine relationships among psychedelic use and self-reported spirituality, difficulties in emotion regulation, and symptoms of mental health issues. Results revealed a pathway through which classic psychedelic use predicted greater spirituality, which in turn predicted better emotion regulation, ultimately predicting lower levels of anxiety, depressed mood, and disordered eating. These results contribute to our understanding of potential mechanisms of change with respect to psychedelics and mental health. They also add to the growing body of literature pointing to the healing effects of the cultivation of spirituality and emotion regulation as separate and related constructs.”

Authors: Adele Lafrance, Erin Strahan, Brian M. Bird, Michelle St. Pierre & Zach Walsh

Summary

Researchers surveyed a community sample of individuals who endorsed lifetime psychedelic use to examine relationships among psychedelic use and mental health and well-being.

LSD, psilocybin, mescaline, and DMT are serotonin (5-HT2A) agonists and have been used for spiritual and healing purposes for millennia. Recently, interest in psychedelics has increased due to Western medicine’s curiosity in long-standing Indigenous technologies. Despite substantial obstacles, preliminary studies indicate that psychedelics may have therapeutic potential in the treatment of mental health conditions. For example, two double-blind, randomized active placebo studies reported long-term decreases in anxiety following a course of psychedelic psychotherapy.

Several studies have shown that psychedelics can be used to treat depression, including a small open-label study of psilocybin for treatment-resistant depression and a double-blind randomized placebo-controlled trial of ayahuasca for treatment-resistant depression.

Mechanisms of Change

Psychedelic substances have been reported to induce increases in overall levels of spirituality, as well as profoundly life-changing mystical experiences. These substances are used in traditional spiritual and healing ceremonies in some indigenous cultures of the Americas.

Studies have found that individuals with treatment-resistant depression who took psilocybin had increased capacity for emotion processing, including regulation, and that this capacity was correlated with decreased anhedonia.

A qualitative study conducted among cancer patients with treatment-resistant depression who participated in psilocybin-assisted psychotherapy revealed that participants experienced a shift from feeling disconnected to connected to self, others, and the world, including a deeper connection to spirituality.

Although spirituality and emotion regulation have been identified as potential mechanisms between psychedelic use and mental health, no research to date has examined the extent to which these two variables together account for this relationship.

The Current Study

We tested a model whereby psychedelic use was linked to greater spirituality, which was linked to a higher capacity for emotion regulation, which was linked to lower levels of depressed mood, anxiety, and disordered eating.

Participants

A total of 461 participants were recruited from undergraduate psychology classes at two Canadian universities, from Reddit forums, and from Amazon’s Mechanical Turk. They completed an online questionnaire relating to their history of psychedelic use, as well as self-reported ratings of spirituality, difficulties in emotion regulation, and symptoms of mental health issues.

World Health Organization Spirituality, Religiousness, and Personal Beliefs (WHOQOL-SRPB)

The WHOQOL-SRPB is a 32-item questionnaire that measures various aspects of quality of life, with a focus on spirituality, religiousness, and personal beliefs.

DERS

The DERS is a 36-item self-report measure that evaluates patterns of emotion regulation, including lack of emotional awareness and clarity, nonacceptance of emotional responses, and difficulty with impulse control.

Beck Anxiety Inventory (BAI)

The Beck Anxiety Inventory (BAI) is a self-report measure of current generalized anxiety symptoms.

Center for Epidemiologic Studies Depression Scale Revised (CESD-R)

The CESD-R is a 20-item screening test for depression and major depressive disorder that asks participants to rate 20 items on a 5-point Likert-type scale.

Eating Disorders Examination Questionnaire (EDE-Q)

The EDE-Q is a 30-item questionnaire that requests that participants rate the frequency of engagement with eating disorder thoughts and behaviors within the past 28 days.

Descriptive Statistics

Approximately 96% of participants reported past use of psilocybin, and a third reported using more than one type of classic psychedelic.

Links Between Psychedelic Use and Spirituality

We predicted that higher levels of psychedelic use would be linked to higher levels of spirituality, and we found support for this hypothesis.

Link Between Spirituality and Emotion regulation

We hypothesized that higher levels of spirituality would be related to fewer difficulties with emotion regulation. We found that participants who reported higher levels of spirituality reported an increased capacity for emotion regulation.

Links Between Emotion Regulation and Anxiety, Depressed Mood, and Disordered Eating

We conducted regression analyses to test whether DERS predicted self-reported anxiety, depressed mood, and disordered eating. We found that DERS positively predicted all three dependent variables in our model.

Test of Mediation Model

The distribution of psychedelic use scores was highly positively skewed, so the variable was log-transformed and mean centered prior to running the main model. We predicted that psychedelic use would predict spirituality, which in turn would predict capacities for emotion regulation, which in turn would predict anxiety, depressed mood, and disordered eating. Our model showed that spirituality and emotion regulation together accounted for a portion of the relationship between psychedelic use and anxiety, depressed mood, and disordered eating.

Discussion

More frequent psychedelic use is associated with higher reported spirituality, which predicts higher emotion regulation, ultimately predicting better mental health across different domains.

Previous research has found that higher estimated psychedelic doses were associated with greater changes in mystical experience and emotional breakthrough, leading to greater well-being. It could be hypothesized that higher doses could also lead to greater changes in one’s ability to regulate emotions.

Psychotherapy provides psychological support, and therefore using psychedelics at various doses with different forms of psychotherapy will likely be a key research area for future work.

Despite promising results from early work in the 1960s, experimental research on psychedelics was halted in 1970. However, research has increased over the past decade and has shown promising results in reducing symptoms of depression, anxiety, and substance use.

Although psychedelic psychotherapy is a relatively young area of scientific inquiry, Indigenous communities have been facilitating spiritual connection via nonordinary states of consciousness for millennia.

The results of this study suggest that a focus on spirituality may improve mental health functioning and that it may help with emotion processing difficulties that underlie most emotion-based disorders. Although more research is needed to determine the effect of increasing the focus on spirituality in psychotherapy on mental health outcomes, clinicians may find it useful to support their clients in cultivating a greater connection with self, others, the natural world or with spirit.

Limitations

This study is not without limitations, and it is possible that an unmeasured factor explains the reported findings. Future research should employ longitudinal and experimental designs to attempt to replicate the current findings, rule out third variables, and confirm the causal direction of the proposed relationships.

Although effort was made to recruit a diverse sample of individuals, the majority of psychedelic users came from the university sample, and psilocybin mushrooms were the most frequently endorsed psychedelic. Furthermore, the frequency of use was relatively low for most participants.

Despite several limitations, this study provides preliminary evidence that spirituality and emotion regulation may be mechanisms through which psychedelic use relates to improved mental health variables, including anxiety, depressed mood, and disordered eating behavior.