How does psilocybin therapy work? An exploration of experiential avoidance as a putative mechanism of change

This re-analysis of the psilocybin (25mg) versus escitalopram (antidepressant, 6 weeks) RCT finds that in the psilocybin arm, experiential avoidance reductions led to improvements in mental health outcomes (e.g. depression severity). Note: the trial itself was insignificant on the primary measure of depression.

Abstract of How does psilocybin therapy work? An exploration of experiential avoidance

“Background Psilocybin therapy is receiving attention as a mental health intervention with transdiagnostic potential. In line with psychotherapeutic research, qualitative research has highlighted the role of reductions in experiential avoidance (and increases in connectedness) within psilocybin therapy. However, no quantitative research has examined experiential avoidance as a mechanism underlying psilocybin therapy’s therapeutic effects.

Method Data was used from a double-blind randomized controlled trial that compared psilocybin therapy (two 25 mg psilocybin session plus daily placebo for six weeks) with escitalopram (two 1 mg psilocybin sessions plus 10–20 mg daily escitalopram for six weeks) among individuals with major depressive disorder (N = 59). All participants received psychological support. Experiential avoidance, connectedness, and treatment outcomes were measured at pre-treatment and at a 6 week primary endpoint. Acute psilocybin experiences and psychological insight were also measured.

Results With psilocybin therapy, but not escitalopram, improvements in mental health outcomes (i.e., well-being, depression severity, suicidal ideation, and trait anxiety) occurred via reductions in experiential avoidance. Exploratory analyses suggested that improvements in mental health (except for suicidal ideation) via reduction in experiential avoidance were serially mediated through increases in connectedness. Additionally, experiences of ego dissolution and psychological insight predicted reductions in experiential avoidance following psilocybin therapy.

Limitations Difficulties inferring temporal causality, maintaining blindness to condition, and reliance upon self-report.

Conclusions These results provide support for the role of reduced experiential avoidance as a putative mechanism underlying psilocybin therapy’s positive therapeutic outcomes. The present findings may help to tailor, refine, and optimize psilocybin therapy and its delivery.“

Authors: Richard J. Zeifman, Anne C. Wagner, Candice M. Monson & Robin L. Carhart-Harris

Summary of How does psilocybin therapy work? An exploration of experiential avoidance