Individual Experiences in Four Cancer Patients Following Psilocybin-Assisted Psychotherapy

This case study describes patients (n=4) from a randomized, double-blind, placebo-controlled trial investigating single-dose psilocybin (21mg/70kg) psychotherapy to treat cancer-related anxiety and depression. These four participants’ personal narratives extended beyond the cancer diagnosis itself, frequently revolving around themes of self-compassion and love, acceptance of death, and memories of past trauma.

Abstract

“A growing body of evidence shows that existential and spiritual well-being in cancer patients is associated with better medical outcomes, improved quality of life, and serves as a buffer against depression, hopelessness, and desire for hastened death. Historical and recent research suggests a role for psilocybin-assisted psychotherapy in treating cancer-related anxiety and depression. A double-blind controlled trial was performed, where 29 patients with cancer-related anxiety and depression were randomly assigned to treatment with single-dose psilocybin (0.3 mg/kg) or niacin in conjunction with psychotherapy. Previously published results of this trial demonstrated that, in conjunction with psychotherapy, moderate-dose psilocybin produced rapid, robust, and enduring anxiolytic, and anti-depressant effects. Here, we illustrate unique clinical courses described by four participants using quantitative measures of acute and persisting effects of psilocybin, anxiety, depression, quality of life, and spiritual well-being, as well as qualitative interviews, written narratives, and clinician notes. Although the content of each psilocybin-assisted experience was unique to each participant, several thematic similarities and differences across the various sessions stood out. These four participants’ personal narratives extended beyond the cancer diagnosis itself, frequently revolving around themes of self-compassion and love, acceptance of death, and memories of past trauma, though the specific details or narrative content differ substantially. The results presented here demonstrate the personalized nature of the subjective experiences elicited through treatment with psilocybin, particularly with respect to the spiritual and/or psychological needs of each patient.”

Authors: Tara C. Malone, Sarah E. Mennenga, Jeffrey Guss, Samantha K. Podrebarac, Lindsey T. Owens, Anthony P. Bossis, Alexander B. Belser, Gabrielle Agin-Liebes, Michael P. Bogenschutz & Stephen Ross

Notes

This paper describes the experience of patients that were enrolled in the psilocybin trial for anxiety and depression in patients with life-threatening cancer by Ross and colleagues (2016).

Another analysis of all 13 patients’ experiences was carried out by Belser and colleagues (2017).

Summary

Introduction

From the early 1960s to the 1970s, psychedelic drug-assisted psychotherapy was researched in the United States as a treatment for cancer-related psychological and existential distress.

In-depth interviews were conducted with 13 participants treated in the Ross et al. (2016) trial, revealing several common themes related to the psilocybin experience. Four participants were selected to represent the rich complexity and personalized nature of patient responses to psilocybin-assisted psychotherapy.

Methods

This report presents data from a double-blind randomized controlled trial of psilocybin-assisted psychotherapy of anxiety and depression in cancer patients, as well as two studies utilizing qualitative analysis of interviews from a subset of participants.

Various demographic data have been obscured to preserve anonymity. The participants provided written informed consent for publication.

Results

Each participant demonstrated improvement on multiple measures of anxiety and depression following their cancer experience.

Victor

Victor was a male in his 20s, employed as a full-time graduate student, who had used LSD previously. He was diagnosed with Adjustment Disorder with Anxiety, Chronic, and was in remission at the time of enrollment.

Victor reported seeing geometric patterns with his eyes closed, being led on a journey by a felt presence, and experiencing different emotions in each part of the experience. He later said he didn’t have a body and was shopping for a new one.

Victor had a spiritual experience where he chose his body, met with a spirit guide, and encountered several people who had passed away. His data showed decreased anxiety, increased purpose in life, spirituality and death transcendence, and he had a new attitude toward his cancer.

Tom, a Christian male in his 50s, had been diagnosed with Chronic Myeloid Leukemia and had never used hallucinogens.

Tom reported seeing an inhuman, aggressive female face that transformed into a less-threatening male figure. He experienced visual-auditory synesthesia and felt that he gained a greater appreciation for life and simultaneously lost his fear of death.

Tom showed moderately decreased anxiety and depression, hopelessness, demoralization, and death anxiety after taking psilocybin, but was underwhelmed and disappointed with the psilocybin experience, its short-term effects, and its impact on his life.

Chrissy

Chrissy was diagnosed with stage 4 breast cancer and received a diagnosis of Generalized Anxiety Disorder upon screening.

Chrissy said she began to experience psilocybin effects when she could “see music” and heard words inside her head saying “we are here all together”.

Chrissy experienced strong themes of unity and connection during this session, and felt her own birth and her cancer as her “umbilical cord to the universe”. She chose to live, and explained the experience helped her reach this decision.

Chrissy’s anxiety, depression, death anxiety, hopelessness, demoralization, and purpose in life significantly decreased after her psilocybin session, and her religious and spiritual beliefs significantly increased.

Brenda

Brenda was a female in her 60s with stage I colon cancer who identified as hallucinogen-naive and met criteria for Adjustment Disorder with Anxiety, Chronic.

Brenda’s psilocybin experience was a “roller-coaster kind” of train ride, and she felt she was outside of time and space. She believed she was the cloud, and she was everything, and she still does.

Brenda felt as if she experienced her own death on two separate occasions during the experience and emerged both unafraid of death and viewing it as a beautiful component of existence.

Brenda’s experience revealed childhood memories of sexual assault that remained unhealed, and her data depicted decreased anxiety and death anxiety. She also experienced an increase in spirituality, and began seeking out opportunities to recollect and re-experience elements of the experience through meditation.

Conclusion

The four cases presented here represent several themes identified in published qualitative studies from this trial. They were rich in multiple thematic areas, while still retaining personal, meaningful, and tangible content.

Participants often had difficulty describing the episodic content of their medication sessions, and instead described the emotional and cognitive impact of the experience. This impact may be more important for persisting benefit than any specific content.

Several questions remain unanswered regarding the use of psychedelics in cancer treatment, including whether one has to be imminently facing death to gain benefit from such treatment.

The current trial of psilocybin versus niacin demonstrated that the clinical benefit following treatment with psilocybin was a result of the drug-therapy interaction, and that future trials will be needed to evaluate the comparative efficacy of the various psychotherapeutic models that have historically been used.