Psychological variables implied in the therapeutic effect of ayahuasca: A contextual approach

This retrospective survey study (n=122) compared non-ayahuasca users with ayahuasca users in decentering, values, and public control of the experience of self, and found that although participants who had taken ayahuasca on more than 15 occasions scored higher on decentering than all other participants, there was no direct correlation between the number of ayahuasca sessions and any of the psychological variables.

Abstract

“Introduction: Ayahuasca is a psychedelic decoction originating from Amazonia. The ayahuasca-induced introspective experience has been shown to have potential benefits in the treatment of several pathologies, to protect mental health and improve neuropsychological functions and creativity, and boost mindfulness. The underlying psychological processes related to the use of ayahuasca in a psychotherapeutic context are not yet well described in the scientific literature, but there is some evidence to suggest that psychological variables described in psychotherapies could be useful in explaining the therapeutic effects of the brew.

Methods: In this study we explore the link between ayahuasca use and Decentering, Values and Self, comparing subjects without experience of ayahuasca (n = 41) with subjects with experience (n = 81). Results confirm that ayahuasca users scored higher than non-users in Decentering and Positive self, but not in Valued living, Life fulfilment, Self in social relations, Self in close relations and General self. Scores in Decentering were higher in the more experienced subjects (more than 15 occasions) than in those with less experience (less than 15 occasions).

Discussion: Our results show that psychological process variables may explain the outcomes in ayahuasca psychotherapy. The introduction of these variables is warranted in future ayahuasca therapeutic studies.“

Authors: Alba Franquesa, Alberto Sainz-Cort, Sam Gandy, Joaquim Soler, Miguel A. Alcázar-Córcoles & José C. Bouso 

Summary

The authors of this article are from several different hospitals and universities in Spain and the UK. They are also from the International Center for Ethnobotanical Education, Research & Service.

Ayahuasca is a psychedelic decoction originating from Amazonia, which has been shown to have potential benefits in the treatment of several pathologies. The underlying psychological processes related to the use of ayahuasca in a psychotherapeutic context are not yet well described in the scientific literature.

Ayahuasca is the name assigned to the Amazonian liana Banisteriopsis caapi and any type of decoction containing it. It also contains leaves from Psychotrotria viridis and Diplopterys cabrerana, which contain the alkaloid DMT.

Ayahuasca is used by indigenous Amazonians for ritualistic, religious and ethnomedical purposes. It induces an altered state of consciousness with introspective effects and oneiric-like visions.

Ayahuasca may improve several pathologies including addiction, treatment-resistant depression, suicidal and aggressive behavior, and has been shown to improve neuropsychological functions, creativity, and cortical thickness in long-term users. Ayahuasca use is not associated with increased risk of psychosis or neuropsychological impairment in studies comparing long-term ritual ayahuasca users with ayahuasca-abstaining controls, but there is some anecdotal evidence linking ayahuasca use to negative effects.

Ayahuasca use is related to psychological processes such as Decentering, Values and the Self, which may be useful to explain the therapeutic effects of the decoction.

Decentering is a construct that has been pointed out as necessary for healthy cognitive, psychological, and social functioning. It has also been observed as a transdiagnostic vulnerability factor shared among several mental disorders.

Ayahuasca users report higher scores for spiritual orientation and purpose in life and positive changes in life attitudes and values, which could be considered as chosen life directions in this sense giving life meaning and purpose and guiding some behaviors.

Contextual psychotherapies define the self as a private experience of the individual that is witness to all events, internal or external. In invalidating environments, the self can be associated with external stimulus or to a public control.

Ayahuasca intake increases self-consciousness, changes in the locus of consciousness, in the perceived boundaries of the self and in personal identity. Positive self, referred to positive concepts about one’s self, is also related to wellbeing and is reflected in lower scores in a clinical sample than a non clinical sample.

We explored the link between ayahuasca use and Decentering, Values, Positive self and Public control of the self, and hypothesized higher scores in ayahuasca users and lower scores in non-users.

122 participants completed the assessment scales, 41 of which had never used ayahuasca and 81 of which had used ayahuasca between 1 and over a 100 times. All the contextual settings consisted of group ceremonies or sessions, and all the subjects took ayahuasca for therapeutic, religious or personal growth purposes.

The Brief Symptom Inventory 18 (BSI-18) is a self-report scale that measures psychological distress. It has three subscales: somatization, depression and anxiety.

The SA-45-psychoticism scale has five items measuring last seven days experience and the Experiences Questionnaire has 11 items measuring Decentering and rumination.

The Engaged Living Scale (ELS) is a self-report measure with 16 items scoring from 1 to 5. It has two subscales: Valued Living (10 items) and Life Fulfilment (6 items).

The Experiencing of Self Scale measures how much other people influence the experience of the self. It has 37 items rated in a Likert -type scale rating from 1 to 7.

We compared sociodemographic and descriptive variables between non-ayahuasca using group and ayahuasca using group, and between groups with low and high ayahuasca use experience. We also made a correlation analysis between the number of ayahuasca experiences and process variables.

Ayahuasca users had a higher ratio of MDMA use in the last 12 months than non-users, but no differences were found in other substance use, somatisation, depression, anxiety, or psychoticism.

After separating subjects who had experience with ayahuasca into two groups, the two groups were compared again with the non-using group. There were no differences in gender, education level, Somatisation, Anxiety, Depression or Psychoticism between groups.

We observed significant differences in Decentering between non-users and AYA>15, and between AYA 1-15 and AYA>15. AYA 1-15 scored higher in Self in social relations and Positive self than both non-users and AYA>15.

Although ayahuasca has been popularized as a personal growth enhancing spiritual tool, little research has been conducted in attempting to understand the psychological processes, or factors, that may explain its outcome effects.

Ayahuasca users scored higher in Decentering than nonusers, but when ayahuasca users were separated into two subsamples, only the users with more than 15 experiences scored higher than non-users and subjects with less experience.

Increases in Decentering have been suggested as an underlying mechanism in therapies such as Mindfulness Based Cognitive Therapy (MBCT) or Cognitive Behavioral Therapy (CBT), and may be particularly useful in preventing relapse on those receiving MBCT.

There are many personal reports from ayahuasca users referring to the ayahuasca experiences as transformative ones. We did not observe differences between ayahuasca users and non-users in Valued living and Life fulfilment.

Lastly, differences between ayahuasca users and non-users were not confirmed in „Public control of the experience of self”. Only scores in Positive self showed differences between ayahuasca users and non-users.

Ayahuasca users have higher scores in the positive self sub-index, which is formed by items that refer to creativity and spontaneity of the individual. This result is similar to previous studies that describe enhancement of creativity after ayahuasca consumption.

The lower values reported by less experienced ayahuasca users in Valued living and Public control of self can reflect a state that motivates the search for solutions to issues via the consumption of ayahuasca, and the higher scores in Decentering in experienced subjects would support this long-term therapeutic effect.

This study used self-report questionnaires to evaluate changes in consciousness in daily life and behavioural regulation through values in people who took ayahuasca. It is difficult to assign the results observed specifically to ayahuasca use because of the lack of information about the context, dosage and acute effects of ayahuasca use.

Ayahuasca use is related to a basic process linked to therapeutic change: Decentering. However, there is no correlation between the number of sessions and measurements of Decentering, Values or Self, suggesting that variables such as individual differences, context of use, and post session integration work are important.

This study was not funded and acknowledges the volunteers for their participation. It also considers the medical anthropology perspective on ayahuasca networks.

L.T.,et al. (2012) found that mindfulness-based cognitive therapy was more effective than antidepressant medication or placebo for prevention of depressive relapse. Ayahuasca use is associated with changes in brain structure and personality, including differences in executive function between experienced and occasional users, as well as differences in life attitudes and personality among ritual users of ayahuasca. Carhart-Harris, Bolstridge, Kaelen, M., Williams, T.M., Williams, L.T., Underwood, R., et al. (2016) investigated the paradoxical psychological effects of lysergic acid diethylamide (LSD). De Fruyt, Van De Wiele, Van Heeringen, 2000, Derogatis, L.R., 2001, BSI-18, 2014, BSI-18: administration, scoring and procedures manual, Pearson Educación S.A., Madrid.

A systematic review of human studies on the effects of ayahuasca on psychiatric symptoms, neuropsychological functioning, and neuroimaging was conducted by Dos Santos, Balthazar, F.M., Bouso, J.C., Hallak, J.E., 2016a, 2016b, and 2017 respectively.

Ayahuasca and violence: a case report. Frecska, E., Móré, C.E., Vargha, A., Luna, L.E., Fresco, D.M., van Dulmen, M.H.M., Segal, Z.V., Ma, S.H., Teasdale, J.D., et al., 2007.

Ayahuasca, a plant hallucinogen used in ritual context in Brazil, enhances creative divergent thinking while decreasing conventional convergent thinking, according to a study by Kuypers, Riba, J., de la Fuente Revenga, M., Barker, S., Theunissen, E.L., Ramaekers, J.G.

Labate, Feeney, Lebedev, A.V., Lövdén, M., Rosenthal, G., Feilding, A., Nutt, D. J., Carhart-Harris, R. L., 2002. Ayahuasca and the process of regulation in Brazil and internationally: implications and challenges.

Ayahuasca and psychedelics: validation of the ego-dissolution inventory (EDI) and a systematic review of quantitative studies in animals and humans. Riba, J., McIlhenny, E.H., Bouso, J.C., Barker, S.A., 2015.

Ayahuasca is a natural hallucinogen that increases mindfulness-related capacities. The Engaged Living Scale (ELS) is a measure of values and committed action that has been validated in several studies.

A study used the Experiencing of Self Scale to evaluate a nonclinical sample and a chronic pain sample, and a study used the Valued Living Questionnaire to define and measure valued action within a behavioral framework.