People who have used psilocybin hold strong expectations about its antidepressant effects, with those experiencing higher levels of mystical experiences, emotional breakthroughs, and ego dissolution holding greater expectations, according to new research published in the Journal of Humanistic Psychology. Specifically, these individuals tend to believe that psilocybin-assisted therapy would most impact symptoms related to hope and happiness, but less so for symptoms like motivation and sleep disturbances.
Depression is a widespread and growing concern, affecting millions of people globally. But traditional treatments, such as antidepressant medications and psychotherapy, sometimes fall short in providing relief to all sufferers. This has led researchers to explore alternative approaches, including psychedelics like psilocybin, which has shown promise in recent clinical trials.
Previous studies have indicated that psilocybin-assisted therapy, when administered in a controlled environment with the guidance of trained professionals, can lead to profound, transformative experiences. The researchers behind the current study recognized the importance of expectancies (beliefs about the effects of a substance) in influencing treatment outcomes. They aimed to examine how expectations regarding the effects of psilocybin-assisted therapy might contribute to its effectiveness.
“I have been flummoxed by the challenges associated with treating depression since my first depressive episode in my late teens. The thought that psychedelics might be involved in an efficacious treatment made absolutely no sense to me at first. The idea actually sounded more than a little dangerous and potentially horrifying for someone in the midst of a depressive episode,” said study author Mitch Earleywine, a psychology professor at the University at Albany and director of the Habits and Lifestyles Laboratory (HALL).
The research team recruited 551 participants through Amazon’s work platform, MTurk. These individuals, who ranged in age from 18 to 73, voluntarily participated in the study and provided informed consent. To ensure data quality, participants needed to have used psilocybin at least once, pass attention checks, and have unique IP addresses.
The survey, conducted on Qualtrics, aimed to understand the participants’ depression symptoms, lifetime use of psychedelics, and their expectations regarding the antidepressant effects of psilocybin-assisted therapy. Participants were asked to respond to a vignette describing the process of psilocybin-assisted therapy and then rate how much impact they thought this approach would have on various symptoms of depression. They also reported their own experiences with psilocybin, including mystical experiences, ego dissolution, and emotional breakthroughs.
The researchers found that the participants held strong expectations regarding the antidepressant effects of psilocybin-assisted therapy. On average, they expected this therapy to have a substantial impact on reducing depressive symptoms.
The study demonstrated a significant connection between subjective effects (such as mystical experiences, emotional breakthroughs, and ego dissolution) and participants’ expectations of the therapy’s antidepressant effects. Those who reported higher levels of mystical experiences, emotional breakthroughs, and ego dissolution also had greater expectations regarding psilocybin’s antidepressant effects.
The researchers also delved into the specific symptoms of depression that participants expected psilocybin-assisted therapy to impact. Results showed that expectations varied for different symptoms. For instance, participants anticipated that psilocybin-assisted therapy would have the most significant impact on symptoms related to hope, happiness, and fear. Conversely, they expected fewer benefits for symptoms like feeling bothered, getting motivated, focusing, loneliness, and sleep disturbances.
A regression analysis was performed to identify the factors predicting expected antidepressant effects. After controlling for age and lifetime hallucinogen use, the results indicated that only emotional breakthrough and ego dissolution remained significant predictors of expected antidepressant effects.
“A subset of folks believe that psilocybin can decrease depressive symptoms, especially the cognitive and emotional ones (hope, fear, sadness) rather than the vegetative ones (getting your ass out of bed, insomnia),” Earleywine explained. “They think that the more your ego dissolves and the more you are emotionally moved during the trip, the more you will improve.”
The findings are strikingly similar to a previous study, which examined expectancies regarding cannabis-assisted psychotherapy. “I was stunned that the symptom specificity replicated an effect we found with cannabis, as people report comparable effects of a big, therapeutic dose of weed used in an appropriately therapeutic way,” Earleywine told PsyPost.
The new study also found that age and lifetime hallucinogen involvement were associated with expectations. Older participants tended to have higher expectations, while those with more experience using hallucinogens had lower expectations. However, these correlations were relatively small.
Despite the valuable insights gained from this study, there are some limitations to consider. The study sample was not very diverse, with the majority of participants identifying as White. This limitation highlights the need for future research to include more diverse populations to better understand the expectations of psilocybin-assisted therapy across different demographic groups.
Moreover, the study relied on self-reported data, which can be subject to biases and inaccuracies. Future research could benefit from combining self-report measures with objective assessments to provide a more comprehensive understanding of the relationship between subjective experiences and antidepressant expectations.
“The big caveat is that we did NOT do a randomized clinical trial here,” Earleywine noted. “We only have these retrospective reports. I DO NOT RECOMMEND THE HOME GAME, but in an outstandingly supportive environment after developing a stellar alliance with a therapist, this approach might be worthy of consideration if 12 sessions of an empirically supported approach like cognitive behavioral treatment hasn’t done the trick.”
“We just finished analyses on a sample that is 2,000 people discussing their responses to any of the serotonergic psychedelics, and the symptom specificity is replicating again. Psychedelics are likely not as helpful for vegetative symptoms as for cognitive and emotional ones, but people sure seem to think that they can help the other ones.”
The study, “Expectancies for Subjective and Antidepressant Effects in Psilocybin Users“, was authored by Mitch Earleywine, Maha N. Mian, and Joseph A. De Leo.