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Psychological instruments that assess an individual’s symptoms of depression or anxiety are obviously necessary for providing quantitative data on the effectiveness of a particular therapeutic approach. But when evaluating a therapeutic modality that involves the administration of a psychedelic drug like psilocybin, information about the patient’s subjective experiences during the therapeutic session is equally important. Malone and colleagues (2018) published just such an account of four different cancer patients who participated in a randomized controlled trial of psilocybin-assisted psychotherapy to treat symptoms of depression and anxiety that are at least partly related to their diagnosis. After briefly describing the study design, we present the quantitative symptom changes from before the treatment to 26 weeks later for each patient. We then recount some of the descriptions provided by the four patients of their subjective experience during the drug-assisted therapeutic session.
The overall study involved 29 patients, 13 of which gave in-depth interviews about their psilocybin experience. The four participants discussed here were drawn from that group of 13. The basic study design is shown in Figure 1. Participants initially received three preparatory psychotherapy sessions designed to familiarize them with the two psychotherapists with whom they would be working, along with the therapeutic environment (study room). The study room, in which all sessions were conducted, was set up to resemble a living-room environment complete with oriental rug, books, plants, and soft lighting. Preparatory sessions were additionally used to educate the participants about the effects of psilocybin and the interventions that might be applied by the therapists. Drug treatments were administered using a double-blind crossover design in which either psilocybin (0.3 mg/kg) or niacin placebo (250 mg) was given in the first session and the other drug was given in the second session. Participants were randomly assigned with respect to whether they would receive psilocybin or placebo first. After taking the pill at the beginning of the dosing session, the participant laid down, put on eyeshades, and listened to preselected music through headphones. They were invited by the therapists to “go on an inner journey” while experiencing the effects of the drug. Dosing sessions were followed over the next 7 weeks by three integrative psychotherapy sessions designed to assist the participants in identifying and verbalizing the personal meaning of their experience and to relate that experience to the cancer-associated symptoms for which they had sought help. Several quantitative measures of depression and anxiety were obtained at baseline, 1 day before each dosing day, 6 weeks after each dosing day, and 26 weeks after the second drug dose. Readers interested in learning more about the details of the therapeutic methodology used in this study are encouraged to access the on-line Supplementary Material from Malone et al. (2018) (https://www.frontiersin.org/articles/10.3389/fphar.2018.00256/full#supplementary-material).
Figure 1 Overview of the study design. (After Malone et al., 2018.)
The four participants discussed in the present paper are referred to as Victor, Tom, Chrissy, and Brenda. Victor was a male in his 20s, never married, reported prior psychedelic drug use, had a diagnosis of non-Hodgkins lymphoma, and received psilocybin in his first dosing session. Tom was a male in his 50s, currently married, reported no prior psychedelic drug use, had a diagnosis of chronic myeloid leukemia, and received psilocybin in his second dosing session. Chrissy was a female in her 50s, never married, reported prior psychedelic drug use, had a diagnosis of breast cancer, and received psilocybin in her second dosing session. Brenda was a female in her 60s, divorced but currently cohabiting with a partner, reported no prior psychedelic drug use, had a diagnosis of colon cancer, and received psilocybin in her first dosing session. Tom self-identified as a Christian, whereas the other three participants self-identified as atheist/agnostic.
Figure 2 shows each participant’s scores across sessions on the Anxiety and Depression subscales of the Hospitalized Anxiety and Depression Scale (HADS). Both sets of scores decreased over time; however, the effect was most marked for anxiety symptoms. It is
interesting to note the results for Chrissy, who showed a clear reduction in anxiety 6 weeks after the first dosing session even though she received placebo during that session. Although
this result could reflect a placebo effect, it could also be interpreted as a positive influence of the psychotherapeutic regimen even without the psilocybin.
Figure 2 Changes in anxiety and depression over time for each participant. Anxiety and depression were assessed using the Hospitalized Anxiety and Depression Scale (HADS). (After Malone et al., 2018.)
A few of each participant’s comments about their psilocybin experience are presented to provide deeper insight into the therapeutic process. Victor was in remission at the time of the study but continued to be plagued by anxiety over the possible return of his cancer. He described going on a journey with a “spirit guide” during his psilocybin session. Later he felt like he no longer inhabited his body but needed to “shop” for a new one. In the process of choosing his body, he said “I saw everything that has happened to my body, all the food I have eaten, the drugs I have taken, the alcohol [I have drunk], the people I have had sex with, the chemo, the exercise, everything that has happened to my body. I took it in at once, then I made this decision. Like okay, I need a body to go on, so I will choose this body. So I kind of accepted this body, and at this point I was no longer this soul spirit entity. It became me, integrated my mind into my body.” (Malone et al., 2018, p. 2).
For Tom, the music being played during the session played a significant role in his experience. He said “I started not just hearing but playing the music. My entire body was the musical instrument for every sound which was coming through my head.”. Later he felt a kind of all-knowingness that he expressed this way: “There is nothing to fear after you stop being in
your body …. it’s absolutely no hell or heaven, it’s just nothing to be afraid of.” (Malone et al., 2018, p. 4).
Chrissy was seriously ill when she entered the study, having been diagnosed with stage 4 breast cancer that had metastasized to her lungs. Her descriptions of her psilocybin experience emphasized feelings of unity and connectedness to others. “I felt like I could reach out to anybody and connect with them.” When asked during a follow-up session about whether the psilocybin experience had altered her spiritual beliefs, she said that the experience “brought my beliefs to life, made them real, something tangible and true – it made my beliefs more than something to think about, really something to lean on and look forward to.” (Malone et al., 2018, p. 4).
Lastly, Brenda’s particular challenge related to the fact that she had been in remission from an earlier uterine cancer when she received the diagnosis of stage 1 colon cancer. She described her psilocybin experience as a “roller-coaster kind” of train ride. During part of the drug session, she seemed to be comfortably lying on a damp cloud, which caused her to think
“If this is the way it’s going to be, it’s going to be really interesting. This is going to be really amazing. And I’m ready to go.” This feeling transitioned into an experience Brenda described
as being outside of space and time, but also interconnected with everything else. “I was the cloud, I was everything, and that was the theme throughout the whole [experience], that I was all this – this was me. And it was so wonderful …. to believe that. And I still do – that is me.” (Malone et al., 2018, p. 5).
The quotes above illustrate that each participant’s psilocybin experience was unique; however, we can see that certain common themes were present such as feelings of connectedness, acceptance, and loss of fear. The authors of the study emphasize that the drug session gave each participant insight into their specific psychological needs and helped them meet those needs. They further argue that the benefits realized by the participants depended neither on the drug nor the psychotherapy alone, but on an interaction between the two. The present results along with those of other psychedelic-assisted therapy studies suggest that this approach may be beneficial for many patients dealing with profound depression and anxiety because of a cancer diagnosis or other equally distressing life event.
Reference
Malone, T.C., Mennenga, S.E., Guss, J., Podrebarac, S.K., Owens, L.T., Bossis, A.P., Belser, A.B., et al. (2018). Individual experiences in four cancer patients following psilocybin-assisted psychotherapy. Front. Pharmacol., 9:256. doi: 10.3389/fphar.2018.00256.