This perspective article proposes various synergies between mindfulness practice and psychedelics. The authors argue that psychedelics can form the compass (direction setting) and mindfulness the vehicle (integration).

Abstract

“Psychedelic and mindfulness interventions have been shown to improve mental ill-health and wellbeing, with a range of clinical processes and effects in common. However, each appear to contain specific challenges in the context of mental health treatment. In this Perspective, we focus on a set of distinct affordances, “useful differences”, within psychedelic and mindfulness interventions that might address common challenges within the other intervention. Accordingly, we propose a set of applied synergies, indicating specific ways in which these two promising interventions might be combined for greater benefit. Metaphorically, on the journey toward mental health and wellbeing, we propose that psychedelic treatments may serve the role of Compass (initiating, motivating, and steering the course of mindfulness practice), with mindfulness interventions serving the role of Vehicle (integrating, deepening, generalizing, and maintaining the novel perspectives and motivation instigated by psychedelic experience). We outline a set of testable hypotheses and future research associated with the synergistic action of psychedelic and mindfulness interventions toward improved clinical outcomes.“

Authors: Jake E. Payne, Richard Chambers & Paul Liknaitzky

Notes

Mindfulness is defined as the “awareness that emerges when deliberately paying attention to the experience of the present moment with curiosity and without judgment.” Mindfulness meditation (MM) as the practice to cultivate this skill.

Earlier studies (see Goldberg et al., 2018 for a meta-analysis) found that MM was comparable, and sometimes even better, than other evidence-based treatments. This most consistent evidence was found for depression, pain, smoking, and addictions. Effect sizes are generally small to medium (d = 0.23 to 0.52).

MM also has shown to change measures of brain activity (e.g. EEG; Langopolous et al., 2009), something that a high dose of psychedelics also reliably does.

Synergies

Psychedelics have been shown to increase measures of mindfulness (Soler et al., 2016). And giving psychedelics to experienced meditators, also led to an increase in the depth of their practice (Smigielski et al., 2019).

The authors propose that psychedelics can be the ‘compass’ and MM the ‘vehicle’. By this they mean that psychedelics can be the initial boost, showing what is possible. But that sustainable work on the problems facing someone is needed through MM. An earlier meta-analysis by Piet & Hougaard (2011) found that MM, in combination with cognitive-behavioral therapy (CBT), led to a reduction of relapse risk of 34%.

Mindful State Recognition: A psychedelic experience may serve as a reference point for novice meditators, to show what is possible (e.g. non-dual experiences, decreased self-referential thinking, interpersonal connectedness)
Motivation for Mindfulness Practice: A psychedelic experience can motivate the novice meditator to continue on the path and possibly also help by raising general motivation to act in line with your values
Depth of Mindfulness: A psychedelic experience may show (by force) how to lower psychological defenses. Studies on experiential avoidance (Zeifman et al., 2020) and increased Openness (e.g. Erritzoe et al., 2018) after psychedelics highlight this possibility
Mindful Compassion: Self-compassion is sometimes difficult to cultivate with MM and psychedelics may help with this too
Psychedelic Non-avoidance: MM during a psychedelic experience may help participants stop avoiding challenging thoughts and feelings
Sustained Psychedelic Proximity and Generalization: MM may extend the afterglow effect of a psychedelic experience and retain a sense of proximity/likeness through meditation

Summary

PSYCHEDELIC AND MINDFULNESS-BASED INTERVENTIONS AND EFFECTS

Psychedelic and mindfulness-based interventions have been shown to improve mental health and psychological wellbeing, and can be combined to address key challenges faced by each intervention.

Mindfulness refers to the awareness that emerges when paying attention to the present moment without judgment. It can be enhanced through systematic training known as mindfulness meditation.

The term mindfulness has been used to refer to a state of awareness, a psychological trait, or a mental activity. Mindfulness-based interventions have been shown to reduce clinical symptoms of psychiatric disorders.

MM training can lead to positive and challenging experiences, including relaxation, nonreactivity, attentiveness, gratitude, love, and joy. Long-term meditators report heightened mindful awareness, reductions in automatic behavior, increased gratitude, and reduced stress reactivity.

The “classical” psychedelics are serotonergic tryptamines that produce nonordinary states of consciousness with subjective changes that entail dramatic changes in sensory perception, distortions of time, reduced cognitive control, awe experience, novel perspectives on familiar phenomena, labile emotions, heightened empathy, and compassion.

Psychedelic-assisted psychotherapy involves ingestion of a psychedelic substance alongside professional support or psychotherapy. It can be used to treat depression, tobacco addiction, alcohol dependence, and anxiety and depressive symptoms within terminal cancer patients.

Patients in modern clinical psychedelic trials report mystical-type experiences that are devoid of space, time, and destinction between self and nonself, and convey noetic qualities. These experiences are also rated among the most personally meaningful.

Previous research has shown that mindfulness meditation and psychedelics have some interesting effects together. For example, administration of psychedelics to experienced mindfulness practitioners increased meditation depth, higher post-intervention trait mindfulness, and improved psychosocial functioning.

Griffiths and colleagues5 found that administering psilocybin alongside supported “spiritual practice” led to greater improvements across many key outcomes, including positive mood and attitudes, life satisfaction, and meaning in life.

MM and PP may be associated with neurobiological changes in the Default Mode Network and the dorsolateral prefrontal cortex.

Psychedelics and mindfulness may produce complementary effects, but it remains unclear how to combine these interventions.

Psychedelics may act as a compass and mindfulness meditation as a vehicle on a journey toward mental health and wellbeing. However, psychedelics may be limited in their longer-term use.

While some studies suggest that psychedelic interventions can have sustained effects, others have found declining clinical effects in the longer term. It may be unreasonable to expect that one or a few doses of a psychedelic alongside brief psychotherapy will produce clinically significant effects that endure for many months.

Psychedelics may be particularly effective for sustaining therapeutic change through integrating, deepening, generalizing, and maintaining the often-temporary changes to belief, attitude, affect, behavior, and relationship following psychedelic dosing.

Psychedelics may aid mindfulness practice in lowering anxiety and psychological defenses, and in sustaining the changes in the longer-term following psychedelics.

While mindfulness may initially appear to be a simple practice, novice meditators may not know the specific target mental processes that reflect progress along a path of deepening meditation practice. Psychedelics may provide a point of reference to orient MM practice, particularly for novice meditators.

Qualitative accounts from both meditative and psychedelic experience suggest that these experiences may be similar, and that psychedelics may provide a reliable, albeit transient, subjective experience that appears to substantially overlap with deep meditative states.

Psychedelics may motivate people to sustain their mindfulness practice over time by transiently inducing a peak experience and “afterglow” that resemble aspects of deep meditative states and the results of effective and prolonged practice.

Psychedelics may improve the quality of the meditative state and therefore its long-term benefits by lowering psychological defenses, provoking insights and new perspectives, and compelling the individual to face their fears, difficult memories, or insights.

Mindfulness without kindness and self-compassion can take on a “cold, critical quality” that can paradoxically lead to maladaptive emotional regulation strategies such as repression. Psychedelics may enhance the therapeutic utility of mindfulness practice by increasing self-compassion, prosocial attitudes, and emotional empathy.

Psychedelic experiences often include challenging experiences such as grief, panic, physical distress, paranoia, and fear of insanity, isolation, or death. However, working through such experiences during the acute effects can facilitate positive therapeutic outcomes.

MM may help reduce negative reactivity and avoidant responding, which may decrease the chance of a therapeutically ineffective or even harmful “bad trip”. MM explicitly trains a nonreactive and accepting attitude, but close supervision by experienced therapists may be warranted.

Psychedelics are associated with a short period of “afterglow”, which tends to dissipate over a period of days or weeks. Mindfulness practice may help maintain such positive changes in thoughts and behaviors following administration of psychedelics by strengthening insights, defusing from maladaptive thoughts and behaviors, and generalizing these changes into more aspects of one’s life.

Well-supported psychedelic experiences are often psychotherapeutically dense, efficient, and useful, but are difficult to describe. MM may assist in better sustaining the effects of psychedelics through its ability to occasion nonordinary state experiences with overlapping qualities.

Psychedelic experiences are rated among life’s most personally meaningful and profound experiences by a large majority of participants. Mindfulness practice may help integrate and generalize these insights into relationships, attitudes, affect, and behaviors.

FUTURE RESEARCH: COMBINING MINDFULNESS AND PSYCHEDELICS

Here we propose a set of research hypotheses for combining mindfulness and psychedelics, including scales and other tools that could be employed to explore these.

Mindfulness practice increases confidence in the methods and benefits of practice, decreases confusion about how to practice mindfulness, increases the depth of meditation practice and subsequent mindful awareness, increases motivation to practice mindfulness, and increases compassion for self and others.

Psychedelic dosing and PP can reduce anxiety and avoidant responding, lead to a more generalized influence of psychedelic perspectives in daily attitudes, feelings, relationships, and behaviors, and sustain a range of mental health benefits.

COMMON GROUND, USEFUL DIFFERENCES

In summary, this Perspective outlined a number of ways in which mindfulness and psychedelics may work clinically in complementary, synergistic ways to address key limitations in each intervention.

Psychedelics may contribute to mindfulness by reducing confusion, increasing the depth and psychotherapeutic utility of mindfulness experiences, and enhancing compassion for self and others. Mindfulness may also aid in the dosing of psychedelics by reducing anxiety and maintaining proximity to nonordinary psychedelic perspectives.

Psychedelics and mindfulness are clearly aligned in terms of their contextual, methodological, experiential, neurobiological, and clinical outcomes, yet their key limitations appear diametrically opposed.

Further research into combining psychedelics and mindfulness is warranted, with implications for clinical practice. New measures would aid in detecting synergistic effects between psychedelic and mindfulness interventions.