This survey study (n=200) examined the views of people with eating disorders (EDs) with regards to psychedelic therapy. Over half of the respondents said they would take part in psychedelic research while 60% believed it is worthwhile continuing research in this area. Respondents agreed that education is needed surrounding psychedelics and that therapy should take place in a professional setting.
Abstract
“Approximately 1.25 million people in the UK suffer from an eating disorder, yet the treatment options show limited efficacy, warranting the need for novel approaches. This study aimed to investigate the perspectives of people with eating disorders on the use of complementary therapies and psychedelic research and treatment. Two hundred participants with eating disorders took part in this web survey study. The majority of participants (70%) had used a complementary treatment to manage their eating disorder. Participants believed that psychedelic research was worthwhile in the context of a moderate level of concern. The most popular solutions to meet these concerns included providing education around psychedelics and their effects and use in psychiatry and experiencing endorsement from professionals in the area. Moreover, participant responses emphasized the need for a safe, monitored environment and the patient-therapist rapport in the context of psychedelic treatment. The findings are explored concerning future trials of psychedelics as a treatment for eating disorders.”
Authors: Fiona Harding, Mathieu Seynaeve, Johana Keeler, Hubertus Himmerich, Janet Treasure & Carol Kan
Notes
Whether or not psychedelic-assisted therapies can be used to treat eating disorders remains to be seen. Research into this particular area of psychedelic science is a relatively novel phenomenon. Nonetheless, pilot studies exploring the safety and efficacy of psychedelics for treating eating disorders are underway in institutions such as Johns Hopkins and Imperial College. As research in this field progresses, it is important that the thoughts of the people living with eating disorders are taken into account. Therefore, this survey study asked 200 people living with eating disorders in the UK for their thoughts and opinions on psychedelic-assisted therapies as potential treatment options.
The main findings:
- 70% of respondents had used a complementary therapy such as yoga to help manage their eating disorder.
- Half of the respondents said they would be willing to partake in psychedelic research, while 60% said it is worth pursuing research in this area.
- The majority emphasized the need for a safe, controlled and professional setting during psychedelic treatments.
- Respondents agreed that education regarding psychedelic’s and their use in psychiatry is needed.
This study is the first study to date examining the views of people with eating disorders with regards to psychedelics. While the results are mostly positive, similar studies are needed in order to gain the patients perspective on psychedelic’s therapies. With pilot studies nearing completion, the findings of survey studies can be hugely beneficial when designing Phase II trials.
Summary
- Introduction
Approximately 1.25 million people in the UK suffer from an eating disorder, and a third of those develop a chronic course of the illness. Psychological treatments and pharmacotherapy have limited efficacy for eating disorders, warranting a need for novel approaches.
Patients with AN tend to be reluctant to take medications that lead to weight gain, and do not perceive the low body weight as their core problem. Therefore, recruitment into clinical trials for AN has been a challenge, and patient-reported outcome measures may help to increase compliance.
Strategies for managing treatment-resistant AN show limited efficacy, and the mortality rate is 20%. This patient group is the most challenging amongst the psychiatric disorders to treat, and psychedelic drugs are now considered in treating such psychiatric disorders. Psychedelics have been used in tribal and religious ceremonies for over 1000 years, and have been used in research since the 1970s, but have been limited due to cultural stigma and legislation.
Ketamine is an atypical psychedelic with NMDA receptor antagonist properties, which is used to treat major depressive disorder and bipolar depression.
There is a lack of evidence for psychedelics in treating eating disorders, and no RCTs. However, retrospective interview studies into the experiences of individuals with eating disorders during an ayahuasca ritual have suggested that psychedelics may help them heal painful memories and generate self-love and acceptance.
A web survey was conducted to examine the views of people with eating disorders on complementary and emerging treatments, focusing on the use of psychedelics.
2.1 Study design and participants
332 participants from the general population were included if they self-reported having an eating disorder and living in the UK.
Participants were recruited through social media channels of BEAT and The Psychedelic Society, and completed an online web survey that took up to 15 minutes to complete.
2.2 Measures and procedure
The questionnaire was co-developed with professionals working in eating disorders and patients with eating disorders, and 3 patients with eating disorders were recruited to participate in the survey.
2.2.2 Use of complementary treatments for eating disorders
Participants’ experience of using complementary treatments was explored, and responses were recorded on Likert scales ranging from “effective” to “ineffective” and “unsure”.
The survey asked participants about their perspectives on psychedelic treatments for eating disorders and their likelihood to take part in psychedelic research. They were also asked about their level of concern regarding safety, side effects, stigma, long term psychological/physical effects, negative psychedelic experiences, weight gain, addiction and loss of control. Participants were asked whether a safe monitored environment, temporary psychological relief, long term psychological benefit, confidentiality, trying something new, trust in the research team, regular follow-up from the research team, and monetary reimbursement would make participating more appealing.
2.3 Statistical analysis
The questionnaire yielded both qualitative and quantitative data, which was analyzed separately. Themes were identified and discussed with the broader research team, and direct patient quotes were utilized to illustrate the content of themes.
3.1 Demographics and clinical information
Two hundred participants completed the survey, with the majority being females (94.5%, n = 189), with a mean age of 28.9 (SD = 8.9). Over half completed tertiary education and were in full-time/part-time employment, with AN being the most common diagnosis.
Over 80% of respondents received psychological therapy for their eating disorders, with cognitive-behavioral therapy being the most commonly endorsed. Antidepressants were the most commonly prescribed medication.
3.2 Brief illness perception scale
Respondents were ambivalent about their current treatment for eating disorders and reported a high level of hopelessness and impact of their eating disorder symptoms. They also reported moderate control over their symptoms and a high level of concern about their eating disorder symptoms.
Nearly 70% of respondents had used complementary treatment to manage their eating disorders. Only 6.5% had ever obtained medication that had not been prescribed to them to manage their eating disorder symptoms.
52% of respondents had used legal psychoactive substances to help with their eating disorders, and 13.5% had used illegal substances. Cannabis was the most commonly used illegal substance, followed by cocaine.
Participants considered psychedelic research for eating disorders moderately valuable, albeit moderately worried about participating. Nearly three-quarters chose weight gain as a concern that would stop them from participating, followed by addiction, long term psychological effects, negative psychedelics experiences, long term physical health effects and side effects.
Most participants chose a safe monitored environment, regular follow-up and support from the research team, long-term psychological benefit, and trust in the research team to improve participation.
3.5 Qualitative results
Participants’ responses could be categorized into several broad themes: those that perpetuated their eating disorder symptoms or those that improved them. Psychological therapy was the most frequently mentioned existing treatment, but many participants were open to trying a new treatment.
Participants were asked about their general concerns about research into psychedelic drugs in eating disorders. The most common concerns were fear of the drug effects, stigma, skepticism regarding medication, and insufficient information on psychedelics.
- Discussion
This is the first study to examine the views of people with eating disorders on psychedelic drugs as a potential treatment option. The study found that over 60% of participants would take part in psychedelic research, with moderate level of concerns.
Empirical findings can alleviate many of the concerns stated by respondents in this survey, including the concern that weight gain is a concern in the context of psychedelic treatment, and that psychedelics may produce little, if any, dependence and have effectively treated substance use disorder in many cases.
Participants reported concern regarding adverse side effects and negative psychedelic experiences. However, there is an overrepresentation of people with prior experience of psychedelic drugs in clinical trials.
The population of previous psychedelic use is comparable to the general population, and the group’s reflections may be closer to the general population’s views on psychedelics. However, adverse reactions such as nausea, vomiting and diarrhea are common, but considered integral to the therapeutic process.
Some solutions to reducing concerns about experimental medication included education regarding the effects of psychedelics and how they are used within psychiatry. Moreover, highlighting the possible benefits of psychedelics over conventional treatment may help patients make a more balanced decision about participation. The research team should co-develop information packs with patients who have previously received psychedelic treatment, and build rapport and trust with participants. This will help to increase recruitment and retention.
Participants expressed a high level of perceived difficulties associated with eating disorders, and a third stated that they would never participate in psychedelic research. This highlights the importance of the “set” of participants taking part in psychedelic research.
4.1 Future directions
PROMs and PREMs should be included in the outcome criteria for RCTs of psychedelic substances. These tools have already been developed within the UK NHS for specific elective procedures, but there are currently no PROMs or PREMs for the psychopharmacological treatment of eating disorders.
Psychedelic drugs may be used to treat eating disorders in combination with psychotherapy, diet counseling and physical health monitoring. Additionally, music may be used to enhance the effects of psychedelic drugs.
The present survey study has several limitations, such as bias due to recruitment methods, the survey being online and involving visual analog scales, and the term “esketamine” being misinterpreted. However, the results are still important and should be further studied.
The demographic and diagnostic variation achieved reflects the patient group well, but most respondents were female and had a high level of education. An eating disorder was the most common diagnosis, with a high level of comorbidity with anxiety and depression.
- Conclusions
This study provided evidence that the eating disorder community supports research into psychedelics. It is important to provide comprehensive information about psychedelics before enrollment.
Abbreviations
Anorexia nervosa, BEAT, the UK eating disorder charity, BIPS, COMET, DMT, FPT, eating-disorder-focused focal psychodynamic therapy, MANTRA, NHS, National Health Service, PREMs, patient-reported experience measures, PROMs, randomized controlled trials.