Using Psychedelics With Therapeutic Intent Is Associated With Lower Shame and Complex Trauma Symptoms in Adults With Histories of Child Maltreatment

This survey study (n=166) investigates whether psychedelic use moderates the relationships between child maltreatment, self-concept, social cognition, and posttraumatic stress symptoms. Results indicate that using psychedelic drugs with therapeutic intent is associated with lower levels of complex posttraumatic stress symptoms and internalized shame in individuals with histories of child maltreatment.

Abstract

“Background: Child maltreatment negatively affects the formation of internal schemata of self and other during development, leading to negative adaptations in self-concept and social cognition. Clinical reports suggest the efficacy of psychedelics in treating the psychopathological sequelae of child maltreatment. Altering maladaptive schemata of self and other implicated in negative self-concept and impaired social cognition may be a central mechanism for reducing posttraumatic stress symptoms.

Aims: This study aims to assess whether psychedelic use moderates the relationships between child maltreatment and self-concept, social cognition, and posttraumatic stress symptoms.

Method: An online survey was completed by 166 participants and included measures of maltreatment exposure and severity, history of intentional therapeutic psychedelic use, posttraumatic stress symptoms, internalized shame, and facial emotion recognition.

Results: Child maltreatment significantly correlated with posttraumatic stress symptoms (r = .26 and r = .20, p < .01) and internalized shame (r = .18, p < .05). Of all maltreatment subtypes, emotional abuse and neglect most strongly correlated with complex trauma symptoms (r = .32, p < .001) and internalized shame (r = .31, p < .001). Participants with a history of intentional therapeutic psychedelic use reported significantly lower complex trauma symptoms (d = 0.33, p < .05) and internalized shame (d = 0.35, p < .05) despite similar histories of maltreatment. Differences in complex trauma symptoms (d = 0.66, p < .01) and internalized shame (d = 0.80, p < .001) were largest for participants with a history of more than 5 occasions of intentional therapeutic psychedelic use. A history of more than 5 occasions of intentional therapeutic psychedelic use significantly moderated the relationship between emotional abuse and neglect and complex trauma symptoms (p < .01). No associations were found between maltreatment or psychedelic use and facial emotion recognition.

Conclusion: These findings demonstrate that using psychedelic drugs with therapeutic intent is associated with lower levels of complex trauma symptoms and internalized shame in individuals with histories of child maltreatment. Psychedelic use may have therapeutic benefit in treating the posttraumatic sequelae of child maltreatment.”

Authors: Colson J. Healy, Kellie Ann Lee & Wendy D’Andrea

Summary

Child maltreatment negatively affects self-concept and social cognition. Psychedelic use may moderate the effects of child maltreatment on self-concept and social cognition.

Introduction

Child maltreatment (CM) includes physical abuse and neglect, emotional abuse and neglect, and sexual abuse. Psychedelic substances are singularly effective in treating the psychopathological sequelae of CM, but their mechanisms of action are still being investigated.

Schemata of self and other form in early relationships and are likely to prove maladaptive in adulthood if they are formed within and functionally adapt to an interpersonally traumatic environment.

CM has consistently been associated with negative self-concept, low self-esteem, and impaired facial emotion recognition, though the nature of these alterations remain inconclusive.

Psychedelic drugs may be used to treat traumatic stress disorders by altering the schemata that underlie these symptoms. This can be done by decreasing within-network functional connectivity and increasing between-network, global connectivity, thereby disrupting reified neural patterns of cognition and behavior and facilitating new learning.

Psychedelics have been shown to profoundly compromise the normal subjective sense of self and occasion “mystical” states of selflessness, self-transcendence, or “ego dissolution”, frequently leading to enduring positive changes in mood, personality, and self-concept.

Psychedelics have been shown to alter the recognition of negative faces and reduce amygdala reactivity to negative faces, but the nature of these alterations and their relationship to positive outcomes remain unclear.

Though most research on the use of psychedelics to treat mental disorders has been conducted in controlled, clinical settings, preliminary survey-based research suggests that naturalistic psychedelic use may have therapeutic benefits as well.

This study examines the impact of intentional therapeutic psychedelic use on maladaptive schemata of self and others among adults with histories of CM.

Materials

The Childhood Trauma Questionnaire is a 28-item retrospective self-report scale that assesses exposure to and severity of childhood maltreatment across five subscales.

The International Trauma Questionnaire (ITQ) is a 12-item measure designed to assess PTSD and complex PTSD symptomatology. It has three core symptom clusters and three additional symptom clusters that collectively represent “Disturbances in Self-Organization”.

The reading the mind in the eyes test (RMET) is a widely used and reliable measure of FER. Participants must select the word that best matches what emotion the person in the picture is expressing.

The Internalized Shame Scale is a 30-item self-report measure that assesses internalized shame.

Procedure

Participants completed the study online via Qualtrics, provided informed consent, completed the CTQ and ITQ, and then completed the RMET. Time spent on each page was recorded to collect reaction time data, and the final page thanked the participants for volunteering to participate.

Data Analysis

Data were analyzed using descriptive statistics, independent-samples t-tests, chi-square tests, and one-way analysis of variance (ANOVA) tests. Only participants who completed the entire survey were included in analyses.

Bivariate correlation analyses were used to assess the relationships between CM exposure and severity, PTSD, internalized shame, and FER accuracy.

Independent-samples t-tests, one-way ANOVA, Tukey post hoc tests, and further independent-samples t-tests were used to assess differences between the ITPU and non-ITPU groups in outcome variables.

Participant Characteristics

283 people began the survey, 167 completed it entirely, and one participant was excluded for entering a birth date indicating they were less than 18 years of age.

Participants were mostly White, cisgender, cissexual, woman, and heterosexual, with a large proportion of LGBTQ participants. Most participants endorsed at least one self-reported psychiatric condition, most commonly anxiety and/or depression.

Approximately one third of the sample endorsed a history of ITPU, and three quarters rated their experiences as exclusively healing/helpful/positive change.

The sample reported high levels of CM and PTSS, and 61.4% met diagnostic criteria for PTSD and 45.8% for CPTSD. Non-heterosexual participants had significantly higher CTQ scores and ITQ PTSD scores, and were more likely to meet diagnostic criteria for PTSD and CPTSD.

Hypotheses

Our first hypothesis was partially confirmed, and CTQ scores showed weak, positive correlations with ITQ PTSD, DSO, and ISS sores.

No significant relationship was found between CTQ scores and RMET scores, and no CTQ subtype scores significantly correlated with RMET accuracy.

Post Hoc Analyses

Due to the stronger relationships between emotional abuse and neglect and outcome variables than other CTQ subscale scores, a composite score of emotional abuse and neglect (EAN) was used in post hoc analyses. A multiple regression analysis found no significant effect of the interaction between EAN and ITPU5 on variance in ISS scores.

Discussion

This study found that ITPU was associated with lower PTSS, lower internalized shame, and better FER compared to non-ITPU.

Participants who had used psychedelics with therapeutic intentions more than 5 times had a moderate relationship between emotional abuse and CPTSD symptoms.

The partial confirmation of H2a and confirmation of H2b lend themselves to multiple interpretations, but the significant moderation analysis may indicate a beneficial influence of repeated occasions of ITPU on the relationship between CM and posttraumatic sequelae.

The failure to confirm H1c or H2c may be due to a number of factors, including alexithymia, a condition marked by difficulties with identifying and labeling emotional experiences, and high levels of CM exposure and severity across the entire sample.

Limitations, Implications, and Future Directions

This study has some limitations, such as its cross-sectional design and reliance on retrospective reporting, and it has a predominantly White sample. Future studies should attempt to recruit a sample with higher racial diversity.

The results of this study indicate that intentional psychedelic use in naturalistic settings has therapeutic benefits, and may be used in addition to structured psychedelic-assisted psychotherapy.

ITPU, and especially ITPU5, were associated with decreased complex PTSD symptoms, but not with decreased simple PTSD symptoms. Emotional abuse and neglect showed the strongest associations with DSO, and psychedelics may be particularly well-suited as therapeutic agents in complex PTSD. Participants’ experiences with ITPU illustrate how psychedelics can help them embody a more adaptive self-schema, and how this can help them leave the darkness of trauma induced dissociation.

Conclusion

Using psychedelic drugs with therapeutic intent may be helpful in treating mental disorders associated with child maltreatment.