This research briefing is co-published with the excellent Report on Psychedelics.

July 8th, 2021

In The Research Briefing:

• Sustained improvements in well-being after psychedelic experiences
• Psychedelic shift metaphysical beliefs away from materialistic
• Treating anorexia with psychedelics looks promising

SURVEY

Well-being improved up to two years after psychedelic use

If we step outside of the lab for a moment, can we find the same improvement in well-being? Can we find the sustained positive impact on mental well-being that many studies have reported on? That is what the current study tries to grapple with.

A survey among those who took psychedelics questioned the participants on fourteen aspects of well-being. They measured this a week before the experience, two and four weeks after, and two years later. At the first moment, 654 participants answered the questions, after two years they were able to gather results from 64 people.

This is what changed in their well-being

• The themes ‘being well’ and ‘staying well’ improved and stayed elevated throughout the study
• The theme ‘spirituality’ didn’t change from the baseline measure
• Changes in well-being negatively correlated with psychological inflexibility and depressive symptoms

A survey study like this is able to answer the question of what happens in real life for those who use psychedelics. The current study was done with those who had already done psychedelics before (90%) and a future study could possibly see if the same results (or better results) can be found for those who haven’t used psychedelics before. And finding out what specifically, for those without mental illness, during the psychedelic experience leads to these positive outcomes.

As the authors say in the introduction and conclusion, understanding how psychedelics can help those who are ‘well’ could help strengthen them against adversity (e.g. lockdowns, grief). And in turn, this could lead to fewer people falling into the ‘unwell’ category. And who doesn’t want their well-being to improve?

METAPHYSICS

Psychedelics change our beliefs about reality

Metaphysics as a topic of study is something most of us are completely unaware of. Yet, at the same time, we all engage in metaphysics in our daily lives. We hold implicit beliefs about the nature of reality. Some believe that there is no more to the world than just the matter it consists of (materialism) and others believe that a God or gods are the foundation that started it all. Still others, half-jokingly, say that it’s ‘turtles all the way down.’

Psychedelics reliably alter consciousness. A recent paper discussed that all that used DMT had the lived experience of meeting other entities. So, the current pre-print paper, asks if psychedelics can causally change our beliefs about the nature of reality, consciousness, and free will? The researchers also wanted to know if there was a relationship with mental health. And finally, what the underlying psychological mechanisms are that underlie a belief shift.

The study found that people indeed changed their beliefs after the use of psychedelics. The 866 participants in the study were those participating in a prospective survey study, and the data was confirmed with data from the SSRI vs psilocybin for depression study participants.

Who changed their mind?

• On average participants moved away from physicalism and towards mind-body dualism and panpsychism (all things have a mind)
• This was most pronounced for those who were more impressionable and for whom it was their first psychedelic experience
• Participants who felt emotional syncronicity with others during the experience also shifted their beliefs more

Further analyses of the data show that those who come from a ‘hard-materialistic’ view reliably shifted towards ‘hard-dualism.’ This also correlated with an improvement in well-being, answering the second question the researchers had. When they compared the data from this large survey with the clinical trial, they found similar results, confirming these findings.

What the study also found is that contextual factors (such as feeling emotionally close to others during the experience) can greatly influence the outcomes afterwards. This doesn’t only apply to metaphysical beliefs, but also to mental health outcomes, personality, and political beliefs. If, in the near future, psychedelics become more widely available in medical (and recreational) use, it should be done so whilst keeping this in mind.

ANOREXIA

Using psychedelics in the treatment of eating disorders

Eating disorders (EDs), of which anorexia nervosa is one, affect more than 8% of women during their lifetime and 2.2% of women each year. The number is lower for men, but still there more than 2% will be affected by an eating disorder during their lifetime. Those with EDs have severe pathological fear and anxiety around food, food, intake, and body weight. It’s common for those with EDs to also have symptoms of depression and anxiety disorders. Most worrying is that EDs are the category of mental health disorders with the highest mortality of any psychiatric illness.

It’s also so that many will live with an eating disorder for a long period of time. Of those suffering from an ED, 30% will live with it for more than 15 years. This is partly so because the current treatments don’t work. One way current treatments often break down is at the moment of success. If there is (much needed) weight gain, it’s in direct opposition to the deeply held belief or fear of those with EDs. The current paper discusses how psychedelic-assisted therapy, specifically with psilocybin, may help this patient population.

Three take-home messages

• Psilocybin has been shown to be safe when used in a carefully controlled clinical setting
• And it has been used successfully, in combination with talk therapy, in other refractory (treatment-resistant) mental health disorders such as PTSD and depression (TRD)
• The unique long-term effects could indicate that it can help long-term and also reduce the burden on the healthcare system

At this time there are three research groups investigating psilocybin for EDs in phase I clinical trials. The studies will answer if, for this population, psychedelics can be a tool for improving mental health. The studies will also need to answer if they can assist in restoring weight to ‘normal’ levels and so also improving physical health.

Research Report Readout

LSD (200 µg) improves emotional empathy, and moderately increases plasma oxytocin levels. Ketanserin pre-treatment reduced the elevation of oxytocin but not the increase in emotional empathy (arguing that the latter isn’t dependent on the 5HT-2a receptor pathway).

Doing Cognitive Behavioral Therapy (CBT) after ketamine treatment can extend the benefits. In comparison to standard treatment, there was a significant (moderate effect) on a score of depression (QIDS) that favored the CBT group at the end of the study (14 weeks).

A further examination of the secondary outcomes (up to 6 months later) of Cognitive Behavioral Conjoint Therapy (CBCT) where one partner was suffering from PTSD, find that there were improvements for both partners on post-traumatic growth, relational support, social intimacy, empathic concern, and less conflict.

A study in mice brain cells, specifically the layer five pyramidal neurons, finds they grew by 10% after the introduction of psilocybin. The effects were still present 30 days later, providing more evidence for brain plasticity as an underlying mechanism of psychedelic-assisted therapies’ long-lasting effects.