Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety

This survey study (n=985) finds that psychological flexibility fully mediated the effects of mystical/peak experiences on depression/anxiety.

Abstract

“Prior research has shown that acute subjective psychedelic effects are associated with both spontaneous and intended changes in depression and anxiety. Psychedelics are also theorized to produce increases in psychological flexibility, which could explain decreases in depression and anxiety following a psychedelic experience. Therefore, the present cross-sectional survey study sought to examine whether psychological flexibility mediated the relationship between acute psychedelic experiences and spontaneous or intended changes in depression and anxiety among a large international sample of people who reported having used a psychedelic (n = 985; male = 71.6%; Caucasian/white = 84.1%; M_age = 32.2, SD = 12.6). Regression analysis showed that acute effects (i.e., mystical and insightful effects) were significantly associated with decreases in depression/anxiety following a psychedelic experience. A path analysis revealed that, while controlling for age and sex, increases in psychological flexibility fully mediated the effect of mystical and insightful experiences on decreases in depression and anxiety following a psychedelic experience. This suggests that psychological flexibility may be an important mediator of the therapeutic effects of psychedelic drugs. Future prospective experimental studies should examine the effect of psychedelic drug administration on psychological flexibility in order to gain a better understanding of the psychological processes that predict therapeutic effects of psychedelics.”

Authors: Alan K. Davis, Frederick S. Barrett & Roland R. Griffiths

Notes

This paper is included in our ‘Top 10 Articles on Psychedelics in the Treatment of Depression‘

This paper offers extra insights into other studies that investigate psychedelics through the lens of the mystical experience (e.g. Griffiths et al., 2008). It offers a (survey-based) new way of interpreting the effect of a mystical experience.

“Further, when mystical and psychological insight effects were included simultaneously as predictors of changes in our models, results showed that psychological insight stands out as a more robust predictor of change, as evidenced by the larger direct (Insight: β = 0.46 versus Mystical: β = 0.09) and indirect (Insight: β = 0.29 versus Mystical: β = 0.06) coefficients in the path analysis.”

This part of the discussion argues that psychological insight is more important than the mystical experience. And that therapies that improve psychological insight (e.g. ACT therapy) can be important in improving the efficacy of psychedelic therapy.

Summary

A cross-sectional survey study showed that acute subjective psychedelic effects were associated with both spontaneous and intended changes in depression and anxiety. Increases in psychological flexibility fully mediated the effect of acute effects on depression and anxiety.

Financial support

The authors thank the NIH for funding and the Steven and Alexandra Cohen Foundation for support.

1. Introduction

Depression and anxiety disorders are common mental health problems. Despite evidence supporting the use of psychotherapy and pharmacotherapy, many people do not have access to these treatments, and many people who do have access do not experience symptom relief despite intervention.

Psychedelic compounds such as psilocybin, LSD, ayahuasca, 5-MeO-DMT have been shown to produce profound changes in sensory perceptions, mood, cognitions, and behavior when administered in clinical trials and used in naturalistic settings.

Recent studies have demonstrated that psychedelics can be used as an adjunct to psychotherapy to decrease symptoms of anxiety and depression. These effects may be due to changes in brain network connectivity, awe/ego dissolution, and psychological flexibility.

Psychological flexibility is the capacity to adapt to various contexts, maintain balance across important life domains, and engage in values-driven action. It is the opposite of psychological inflexibility, which is the cause of depression and anxiety disorders.

Psychological interventions have been developed using this theoretical framework, such as Acceptance and Commitment Therapy (ACT), which attempt to increase psychological flexibility via six interconnected processes. If psychedelic experiences promote increases in psychological flexibility, then this could explain the effects observed in clinical trials.

A cross-sectional survey study was conducted to examine whether psychological flexibility is a potential mediator of acute psychedelic experiences on changes in anxiety/depression. The study found that psychological flexibility was associated with reductions in depression and anxiety.

2.1. Procedure

A large anonymous internet-based cross-sectional survey of individuals who reported having a moderate to strong psychedelic experience in the past was conducted. The survey was conducted by using electronic message postings and advertisements on several internet websites, electronic mail announcements, and via an article published by Motherboard/VICE.

2.2. Study recruitment flow

Respondents were recruited from June 2018 through January 2019. Of the 3080 who consented, 985 reported experiencing a change in anxiety or depression as a result of a psychedelic experience.

3.1. Psychedelic experience

We asked respondents to report which psychedelic substance they had used, the subjective level of dose, the route of administration, and the length of time since the experience.

3.2. Acute mystical experiences

A questionnaire was used to assess subjective mystical-type phenomena that may have occurred after taking a psychedelic. The total mean score was calculated using a 6-point scale.

3.3. Acute insight experiences

The Psychological Insight Questionnaire was created to assess the degree to which respondents experienced acute insight after taking a psychedelic, and the internal reliability of this total score was excellent (alpha = .93).

3.4. Anxiety and depression

The Depression, Anxiety, and Stress Scale (DASS-21) was used to assess depression and anxiety symptoms during the 3 months before and 3 months after a psychedelic experience. A single measure combining depression and anxiety subscales (depression/anxiety) was analyzed as the dependent measure.

3.5. Psychological flexibility

The Acceptance and Action Questionnaire II (AAQII) was used to assess the degree of psychological flexibility respondents experienced before and after the psychedelic experience. Lower scores indicate greater psychological flexibility.

3.7. Data analyses

Data Quality. Only 3 respondents completed the survey in less than 15 min, and 25% of the sample completed the survey in less than 33 min.

A statistical analysis was conducted to determine the relationships among demographic and background characteristics, acute insight and mystical effects, depression/anxiety change score, and psychological flexibility change score. A regression analysis was then conducted to test the hypothesis that acute insight and mystical effects will be negatively associated with depression/anxiety change score.

4.1. Respondent characteristics

Most participants were male, Caucasian/ white, never married, currently live in the United States, earned $35,000 or more in income, and had a mean age of 32.2 (SD = 12.6). They reported a decrease in depression/anxiety and an increase in psychological flexibility after their psychedelic experience.

A series of point-biserial correlations revealed that the type of psychedelic drug used by respondents was unrelated to all other variables. Additionally, the intensity of mystical effects was moderately correlated with insight effects and depression/anxiety decreases.

4.2. Regression analysis

A multiple linear regression model was used to predict decreases in depression/anxiety. The intensities of both mystical and insight effects were associated with decreases in depression/anxiety.

4.3. Path analysis

The path analysis showed that greater mean intensity of acute mystical and psychological insight effects were directly related to greater mean increases in psychological flexibility, and that greater mean increases in psychological flexibility were directly related to greater mean decreases in depression/anxiety.

4.4. Supplementary analyses

We analyzed 985 individuals who reported a spontaneous or intended change in anxiety or depression following a psychedelic experience. We found that intensity of mystical effects was not significantly associated with decreases in anxiety or depression, nor was there an indirect relationship between intensity of mystical effects and decreases in anxiety via increases in psychological flexibility.

5. Discussion

A retrospective cross-sectional survey study examined the relationship between psychedelic occasioned mystical-type or psychological insight experiences and decreases in depression and anxiety following a psychedelic experience. Results showed that psychological insight stood out as a more robust predictor of change than mystical experiences.

Psychological insight is strongly related to decreases in depression and anxiety, and mystical experiences are also predictive of change. Insight is a subtype of quantum change, which has been implicated in decreases in alcohol use among individuals with alcohol use disorder.

Findings from the present study underscore a potential explanation for how acute psychedelic experiences, including gaining psychological insight and mystical experiences, may exert such changes. Specifically, increases in psychological flexibility may be a mediator of the positive therapeutic effects.

If psychological flexibility emerges as a consistent and robust mediator of effects in prospective clinical trials, then psychedelic-assisted psychotherapy should consider integrating psychedelic administration with contextual behavioral therapies (e.g., ACT) or other therapies designed to target psychological flexibility.

The high rate of biologically verified abstinence at 6 months post-treatment suggests that psychedelics occasion both mindfulness/acceptance processes as well as commitment and behavior change processes.

This study has several limitations, including the use of internet-based recruitment and data collection procedures, the use of retrospective survey methods, and the possibility that participants who specifically reported gaining insight as part of a psychedelic experience account for some of the differential strength in the association.

The lack of diverse representation in psychedelic survey studies may be due to several factors, including the topic of these studies not being interesting to some potential respondents, a perceived risk involved with reporting an illegal behavior, or the internet computer format excluding individuals from differing socio-economic backgrounds.

6. Conclusion

Future research should examine the effect of psychedelic drug administration on psychological flexibility in a laboratory setting using a controlled trial design, and whether changes in these core processes predict enduring effects of psychedelic substances on therapeutic outcomes.