A new study suggests that psilocybin-assisted group therapy is a promising approach for cancer patients dealing with depressive symptoms. The research, which appears in the Journal of Pain and Symptom Management, provides initial evidence of the safety, feasibility, and possible efficacy of psilocybin-assisted group therapy.
Psilocybin is a compound found in certain types of mushrooms, often referred to as “magic mushrooms.” It belongs to a class of compounds known as classic psychedelics, which also includes LSD, DMT, and mescaline. Researchers have been interested in studying psilocybin because it has shown potential in improving depressive and anxiety symptoms associated with a cancer diagnosis.
Previous studies have demonstrated that a single high-dose administration of psilocybin can lead to rapid and significant improvement in symptoms, with some effects lasting up to several years. However, these studies have mostly been conducted on an individual basis with one or two therapists present during the sessions, making it resource-intensive and challenging to scale up the treatment.
The researchers wanted to explore whether a group format of psilocybin-assisted therapy could be safe, feasible, and effective. They hypothesized that combining the effects of psilocybin with group psychotherapeutic processes could enhance the therapeutic outcomes. The group format seemed particularly suitable for cancer patients, as the experience of illness can be isolating and emotionally challenging.
“There are currently limited treatment options for symptoms of anxiety and depression associated with a cancer diagnosis, serious illness, or end of life,” explained study author Ben Lewis (@BenLewisMD), an assistant professor of psychiatry at the Huntsman Mental Health Institute at the University of Utah.
“There have been promising early results with psilocybin for this indication however these studies have employed individual format sessions, which presents significant challenges for scalability and access. This study employed a full group model to investigate feasibility, safety, and efficacy. There is also a robust precedent of group therapy with cancer support groups and so the group model is a natural fit and a promising extension of an emerging set of treatments. ”
The study, called the HOPE trial, was a single-arm, open-label pilot study. It involved 12 participants with symptoms of depression and anxiety associated with a cancer diagnosis. The participants were predominantly female, with an average age of 48.2.
The study included three 120-minute group preparatory sessions, one high-dose psilocybin administration session (25mg) in a group setting, and three 120-minute group integration sessions. The therapist-to-participant ratio was 1:1, with an additional therapist serving in a lead role.
Before the psilocybin session, the participants went through preparatory sessions that included group discussions, individual time with therapists, and psychoeducation about the effects of psilocybin. The psilocybin administration session took place in a controlled environment with reclining chairs and a communal music playlist. Therapists provided non-directive and supportive interventions during the session.
After the psilocybin session, there were three integration sessions focused on participant sharing of experiences, exploring personal narratives, and techniques for integrating the psychedelic experience into their lives. The study also assessed the feasibility, safety, and efficacy of the group format, including recruitment and retention rates, adverse events, and changes in clinical outcomes measured by scales for depression, spiritual well-being, and death transcendence.
The group therapy intervention appeared to be well tolerated and safe.
No serious adverse events attributed to psilocybin were reported. During the psilocybin dosing day, none of the participants required a private room or emergent medications for psychiatric concerns. However, four participants did require medication for general medical issues such as nausea, headache, and hypertension.
One participant experienced nausea and sustained hypotension during the session and had ongoing symptoms the following day, but it was later determined that these symptoms were due to a viral gastroenteritis rather than the effects of psilocybin.
There were no significant changes in suicidal ideation or suicidal behavior reported or observed throughout the monitoring period. No adverse events related to medical or psychiatric issues were recorded following the psilocybin session.
Symptoms of depression showed a significant decrease in scores at both the 2-week and 26-week follow-up points compared to baseline. Six out of 12 participants met the criteria for remission at 2 weeks, and most participants showed clinically significant or substantial improvements in their depressive symptoms.
“Group format psilocybin-assisted psychotherapy may be a safe and effective intervention for this population,” Lewis told PsyPost. “There may be good reasons to hypothesize that the group model has unique strengths with this kind of treatment.”
Six out of 12 participants reported having a complete mystical experience during the psilocybin session, as measured by the MEQ-30 (Mystical Experience Questionnaire). Participants who had a complete mystical experience reported greater decreases in depression scores compared to those who did not have such an experience.
“I was surprised at the magnitude of scores on the Mystical Experience Questionnaire, which were higher than typically seen with psilocybin studies using this dose range,” Lewis noted. “It is unclear to what extent the group model amplified these effects however that is an interesting question for further investigation.”
The researchers also observed significant improvements in measures of quality of life, spiritual well-being, and death transcendence, which aligns with previous studies using psilocybin therapy for cancer patients.
The therapy involved a total of 20 hours per participant, with a reduced number of therapists compared to individual sessions. The researchers said that this reduction in therapist hours could make this form of therapy more accessible and cost-effective for patients with limited resources.
While the results are promising, it is important to note that the study was focused on establishing the safety and feasibility of psilocybin-assisted group therapy. Additional placebo-controlled research is needed to assess the effectiveness of the therapy.
“This was a small study that was single-arm and without a control group,” Lewis explained. “As such there was limited ability to control for expectancy effects, which are pronounced for studies with psychedelics. This limits interpretation of our results and in certain ways represents a larger set of challenges for the field as a whole.”
“Being involved with this study has been one of the most meaningful experiences of my life,” the researcher added. “I have so much gratitude for our participants who trusted our team and the process we designed.”
The study, “HOPE: A Pilot Study of Psilocybin Enhanced Group Psychotherapy in Patients with Cancer“, was authored by Benjamin R. Lewis, Eric L. Garland, Kevin Byrne, Tyler Durns, John Hendrick, Anna Beck, and Paul Thielking.
