The readiness of psychiatrists to implement psychedelic-assisted psychotherapy

In this survey study (n=83) psychiatrists working for the NHS in the UK were asked about providing psychedelic-assisted therapy in their practice. The majority of respondents (77.2%) felt that psychedelics do hold important therapeutic potential but they feel unprepared to deliver psychedelic-assisted therapy. The psychiatrists identified a number of significant training needs.

Abstract

“Introduction: Psychedelic-assisted psychotherapy is a promising approach in psychiatry; evidence is growing and it may not be long before mainstream services are expected to offer it to selected patients. This pilot study examined the attitudes and knowledge of NHS psychiatrists of all levels towards psychedelic-assisted psychotherapy and explored potential barriers and facilitators to its implementation.

Methods: A mixed-methods approach was adopted, using a cross-sectional survey and focus groups. All psychiatrists in one NHS mental health trust were approached by email to participate. The survey was analysed using a simple descriptive approach and thematic analysis was used for the focus groups.

Results: 83 (25.7%) psychiatrists participated in the survey. All psychiatrists were familiar with one or more psychedelic substances. Although 77.2% felt that there should be a role for controlled or therapeutic use of psychedelics, trainees appeared better informed than non-training grade psychiatrists. Psychiatrists of all grades did not feel prepared to participate in the delivery of psychedelic-assisted psychotherapy. Thematic analysis of the focus groups identified three main themes in relation to psychedelic-assisted psychotherapy: ‘need for knowledge’, ‘openness to change’ and ‘uncertainty’.

Discussion: NHS psychiatrists are positive about the potential for psychedelic-assisted therapy to advance psychiatric practice. However, psychiatrists are lacking in confidence or preparedness to implement this treatment should it become a mainstream option and significant training needs were identified. Thematic analysis highlighted the need for societal shifts as well as professional ones.”

Authors: Lisa A. Page, Ahmad Rehman, Habib Syed, Kathryn Forcer & Graham Campbell

Summary

INTRODUCTION

Psychedelic-Assisted Psychotherapy (PAP) is a potentially promising and novel therapeutic approach in psychiatry. It has been designated a “breakthrough therapy” by the US Food and Drug Administration (FDA) in 2019.

Psychedelics are potent serotonergic hallucinogens that induce perceptual changes and elicit altered states of consciousness.

What Is Psychedelic-Assisted Psychotherapy?

PAP typically consists of induction, psychedelic and integrative phases, with the psychedelic session involving the patient ingesting a psychedelic substance in the presence of therapist guides. The therapist guides help facilitate the patient’s understanding and interpretation of the psychedelic experience.

Why Might PAP Be Offered Within Mainstream Services?

PAP offers an alternative and novel approach to existing pharmacological or psychological approaches to mental disorders. It may soon be routinely expected to be offered in health services.

Are Psychiatrists Ready for PAP?

In 2018, Barnett et al. surveyed members of the American Psychiatric Association about their views on the use of hallucinogens. They found that 80.5% felt there should be more research in this area.

Since 2018, the evidence for PAP has strengthened, and we wanted to find out whether British psychiatrists held similar attitudes to US psychiatrists.

Cross-Sectional Survey

A survey was sent to all Psychiatrists in one NHS mental health trust in England in January 2021 to examine their awareness, knowledge, attitudes and opinions towards PAP and how confident they would feel to refer patients for PAP.

To include a representative sample of psychiatrists from different sub-specialties, all psychiatrists from one NHS mental health trust were invited to participate.

Basic descriptive statistics were used to analyse the survey data, and a chi-squared test was used to compare responses between age groups.

Focus Groups

We convened two focus groups for psychiatrists from the same NHS trust and used a virtual platform to facilitate the focus groups. The facilitators spent a short period at the beginning of each focus group describing PAP.

The focus groups were audio-recorded and transcribed, and the analytic approach was based on Braun and Clarke (17).

Cross-Sectional Survey

A questionnaire was sent out to 323 psychiatrists, of whom 83 (25.7%) responded. A greater proportion of trainees responded to the survey than non-training grade doctors (41.7 vs. 22.9%).

Most participants were from White British/White other ethnic backgrounds, with 7.2% from Asian backgrounds and 3.6% from Black African/Caribbean or Black British backgrounds.

Views on Existing Treatments for Non-psychotic Mental Illness

Participants felt that existing psychotherapeutic and pharmacological treatments for anxiety, depression, and substance use disorders were extremely or moderately effective.

Familiarity With Psychedelics and PAP

All psychiatrists had heard of at least one psychedelic substance, and most believed that there was a role for controlled or therapeutic use of psychedelics in society. Only two respondents, who were both trainees, had direct experience of participating in PAP.

Involvement With PAP

Most psychiatrists felt unprepared to participate in the practise of PAP, and little difference was found between trainees and non-training grade psychiatrists in terms of preparedness.

Psychiatrists’ Age Did Not Predict Preparedness or Confidence to Deliver PAP

There was no difference in the proportion of older vs. middle-aged vs. younger psychiatrists who felt confident to discuss or refer patients for PAP.

Focus Groups

Thematic analysis of focus group transcripts led to the development of codes and sub-codes, which were then reviewed and revised until an agreed theme definition was arrived at. Three overarching themes were identified, which are described in more detail below.

Theme 1: Need for Knowledge

Psychiatrists felt there was a need for better knowledge amongst the general public about psychedelic substances and psychoactive drugs more generally.

Theme 2: Openness to Change

Psychiatrists felt optimistic that PAP could help patients for whom little else had worked, and wondered about the openness of society to accept PAP.

Theme 3: Uncertainty

Psychiatrists were uncertain how their specific skills might be used in the provision of PAP, and were unsure whether the structures that support psychiatric practise were ready to support PAP.

DISCUSSION

This mixed-methods study explored knowledge and preparedness amongst practising NHS Psychiatrists about the potential for them to deliver Psychedelic-assisted Psychotherapy.

A large cross-sectional survey of NHS Psychiatrists of all grades from one large provider mental health trust demonstrated that most psychiatrists are familiar with psychedelic substances and, to some extent, PAP. However, psychiatrists in training appeared to be better informed about PAP than non-training grade colleagues.

A survey of NHS psychiatrists showed that a substantial minority felt confident to discuss PAP with their patients, but few felt confident to actually deliver or participate in PAP themselves.

Thematic analysis of focus groups revealed that psychiatrists are uncertain about the role of PAP within NHS settings, and are concerned about the uncertain risks and benefits for patients. However, there is excitement about PAP’s potential to benefit patients for whom existing treatments have failed.

Study Strengths and Weaknesses

The study was conducted across an entire NHS mental health trust and involved all sub-specialties and levels of experience. It is possible that there was response bias, such that psychiatrists who were already more knowledgeable about PAP differentially responded to the survey and were more likely to participate in the focus groups.

This pilot study suggests that in order for psychiatrists to develop the necessary expertise and confidence in PAP, they will need support to train and accredit in this new approach, and public education about PAP will also be needed.

AUTHOR CONTRIBUTIONS

LP conceived and designed the study, AR co-designed, conducted, and analysed the cross-sectional survey, and HS, KF, LP, and GC contributed to the write up. All authors approved the submitted version.