Increases in Psychological Flexibility Mediate Relationship Between Acute Psychedelic Effects and Decreases in Racial Trauma Symptoms Among People of Color

This survey study (n=313) found that psychological flexibility mediated the relationship between acute psychedelic effects (acute insight & challenging experiences) and decreases in racial trauma among BIPOC.

Abstract

“Background: Previous research showed acute psychedelic effects were associated with decreases in racial trauma (RT) symptoms among black, indigenous, and people of color (BIPOC). Among samples comprised primarily of white participants, positive outcomes of psychedelic experiences have been mediated by increases in psychological flexibility. Therefore, we examined whether changes in psychological flexibility from before to after a psychedelic experience mediated the relationship between acute psychedelic effects and changes in RT symptoms among BIPOC.

Methods: This cross-sectional online survey study included 313 BIPOC (mean age =33.1; SD =11.2; female =57%). A multiple linear regression analysis was used to examine the association between acute psychedelic effects and decreases in RT symptoms in a nonclinical setting; a path analysis was used to explore whether changes in psychological flexibility mediated this relationship.

Results: Acute insight and challenging effects were significantly (p < .001) associated with decreases in RT symptoms following a psychedelic experience. Increases in psychological flexibility partially mediated relationships between greater intensity of psychological insight and less intensity of challenging experiences and decreases in RT symptoms (ps<.001).

Conclusion: This research suggests psychedelics confer potential benefits in decreasing RT symptoms among BIPOC and psychological flexibility may be an important mediator of these effects. Future research should test this hypothesis in a longitudinal clinical trial among BIPOC.“

Authors: Alan K. Davis, Yitong Xin, Nathan D. Sepeda, Albert Garcia-Romeu & Monnica T. Williams

Notes

This paper uses the same participants as Williams and colleagues (2020).

Summary

Previous research showed psychedelic experiences can decrease racial trauma symptoms among black, indigenous, and people of color. This study examined whether psychological flexibility mediates this relationship.

Introduction

Racial trauma is a form of trauma underrepresented in empirical investigations, and the public health burden of racial trauma includes trauma symptoms that are significantly predicted by overt and subtle racial discrimination, and the development of posttraumatic stress disorder due to the cumulative effects of ongoing racial discrimination.

Psychedelic compounds have been used as potential treatments for mental health problems. Clinical studies have demonstrated efficacy in decreasing symptoms of anxiety and depression, and several surveys and observational studies have reported decreases in depression and anxiety following psychedelic use.

Recent clinical trials have found positive effects of psychedelic-assisted therapy on mental health outcomes, but samples are small and have lacked inclusion of POC. POC may also use licit and illicit substances to cope with the sequelae of racial trauma symptoms, including psychedelics.

Evidence suggests that psychedelics can lead to beneficial outcomes when administered in clinical and naturalistic settings. Potential mediators of psychedelic effects on therapeutic outcomes include changes in brain network connectivity.

Psychological flexibility is the capacity to adjust to various contexts, maintain balance across important life domains, and engage in value-driven behaviors, despite negative feelings that may be present for the individual in each moment. Dysfunctions in psychological functioning, including mental health problems such as race-based PTSD, could be the result of reduced psychological flexibility, which is related to maladaptive responses to trauma through avoidance of thoughts and feelings related to the trauma.

A recent study found that psychological flexibility was associated with the intensity of acute psychedelic effects and that this relationship was mediated by increases in psychological flexibility. Furthermore, a recent prospective study found that psychological insight was significantly correlated with increases in psychological flexibility.

This study sought to examine the relationship between psychological flexibility and acute psychedelic effects on racial trauma symptoms among POC. It hypothesized that psychological flexibility would be directly related to acute psychedelic effects on racial trauma symptoms, and that psychological flexibility would mediate these relationships.

Procedure

The present study includes data from a larger cross-sectional, observational study among POC. Eligibility criteria included being at least 18 years old, able to read and understand English, having used a psychedelic that produced psychoactive effects, and experiencing relief from racial discrimination after taking the psychedelic.

Measures

Seventeen questions were taken from the General Ethnic Discrimination Scale58 and rated on a 6-point scale to determine the frequency of racial discrimination experienced before the psychedelic experience.

A 23-item PIQ30,56 was used to assess participants’ insights into their psychedelic experience. The internal consistency reliability was excellent.

The 30-item Mystical Experience Questionnaire was used to measure mystical-type experience. The internal consistency reliability was excellent.

The 26-item CEQ38 was used to assess participants’ feelings of grief, fear, insanity, death, isolation, physical distress, or paranoia after their psychedelic experience.

Psychological flexibility was measured using the Acceptance and Action Questionnaire-II. AAQ-II scores were changed from “before” to “after” the psychedelic experience to aid in the interpretability of the findings.

This study examined participants’ discriminatory distress about symptoms of trauma in the 30 days before and 30 days after the psychedelic experience. The internal consistency reliability for the total scale score was excellent.

Analyses were conducted in SPSS v 2759 and MPlus version 8.0 using maximum likelihood estimators to examine the relationships among all primary study variables, including age, sex, acute insight, mystical-type, and challenging effects, trauma symptom change score, and psychological flexibility change score.

Respondent Characteristics

The sample for this study was recruited intentionally for diversity, with approximately one-half of the participants living in Canada and the other half in the United States. Most participants reported their race as black or African heritage.

Associations Between Acute Psychedelic Effects and Changes in Psychological Flexibility and Changes in Trauma Symptoms

Race subgroup was weakly related to the intensity of acute psychedelic effects, trauma symptom change scores, and psychological flexibility change scores. Additionally, psychological flexibility was negatively correlated with number of trauma symptoms prior to the psychedelic experience and after the psychedelic experience.

Regression Analysis

Table 2 shows that the sum of ethnic discrimination events was significantly associated with decreases in trauma symptoms after the psychedelic experience, as were acute mystical-type, challenging, and insight effects.

Path Analysis

The path analysis revealed that greater mean intensity of acute insight effects and less mean intensity of challenging effects were directly related to mean increases in psychological flexibility, and that mean changes in psychological flexibility were directly related to mean changes in racial trauma symptoms.

Discussion

Psychedelic effects were significant correlates of change in racial trauma symptoms in a sample of POC, but mystical-type effects were not. This may be because one-quarter of the sample reported using MDMA.

Acute psychedelic effects are directly related to psychological flexibility, and the intensity of challenging effects is correlated with insight effects. This relationship may be due to increased negative emotional and physiological arousal that accompany novel insights into past traumatic experiences.

There was a relationship between psychological flexibility and racial trauma symptoms, suggesting that psychological flexibility may be a substantial factor contributing to mental health.

The relationship between acute psychedelic effects and changes in racial trauma symptoms was mediated by psychological flexibility. This finding supports models of psychedelics’ therapeutic efficacy being linked to increases in psychological flexibility.

This study was conducted using a cross-sectional online survey design, and participants were purposively sampled to collect data on individuals reporting benefits in racial trauma symptoms after psychedelic use. However, the study lacks multiple prospective assessments to measure changes in psychological flexibility or mental health symptoms over time.

In addition to the limitations listed above, several concerns have been raised about the validity of the AAQ-II as a measure of psychological flexibility. Nevertheless, the AAQ-II remains a predominant measure of psychological flexibility, but further investigation is warranted.

Conclusion and Implications

POC face substantial health disparities, including unique and often undertreated mental health challenges. Despite the limitations noted above, the present study highlights a much-needed expansion of research efforts to include racial/ethnic and other minoritized populations in assessing psychedelics’ therapeutic potentials for underserved communities.