Increased nature relatedness and decreased... — Research Summary & Context

Increased nature relatedness and decreased... — Research Summary & Context | Blossom

Abstract

Rationale

Previous research suggests that classical psychedelic compounds can induce lasting changes in personality traits, attitudes and beliefs in both healthy subjects and patient populations.

Aim

Here we sought to investigate the effects of psilocybin on nature relatedness and libertarian–authoritarian political perspective in patients with treatment-resistant depression (TRD).

Methods

This open-label pilot study with a mixed-model design studied the effects of psilocybin on measures of nature relatedness and libertarian–authoritarian political perspective in patients with moderate to severe TRD ( n=7) versus age-matched non-treated healthy control subjects ( n=7). Psilocybin was administered in two oral dosing sessions (10 mg and 25 mg) 1 week apart. Main outcome measures were collected 1 week and 7–12 months after the second dosing session. Nature relatedness and libertarian–authoritarian political perspective were assessed using the Nature Relatedness Scale (NR-6) and Political Perspective Questionnaire (PPQ-5), respectively.

Results

Nature relatedness significantly increased ( t(6)=−4.242, p=0.003) and authoritarianism significantly decreased ( t(6)=2.120, p=0.039) for the patients 1 week after the dosing sessions. At 7–12 months post-dosing, nature relatedness remained significantly increased ( t(5)=−2.707, p=0.021) and authoritarianism remained decreased at trend level ( t(5)=−1.811, p=0.065). No differences were found on either measure for the non-treated healthy control subjects.

Conclusions

This pilot study suggests that psilocybin with psychological support might produce lasting changes in attitudes and beliefs. Although it would be premature to infer causality from this small study, the possibility of drug-induced changes in belief systems seems sufficiently intriguing and timely to deserve further investigation.

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Research Summary of 'Increased nature relatedness and decreased authoritarian political views after psilocybin for treatment-resistant depression'

Introduction

Earlier research indicates that classical psychedelics such as LSD, psilocybin and DMT can produce enduring changes in personality, attitudes and beliefs, and some studies have linked lifetime psychedelic use with greater concern for others and the environment. Psilocybin in particular has been associated with persistent increases in openness and wellbeing in healthy volunteers, and with therapeutic effects in addiction, anxiety and depression when given with psychological support. Nature relatedness—the subjective sense of connection to the natural environment—is associated with lower anxiety and better wellbeing, and prior correlational work by the authors suggested that lifetime psychedelic use positively predicts nature relatedness and negatively predicts authoritarian political views, potentially mediated by acute experiences of ego-dissolution. This study set out to examine whether psilocybin administered with psychological support alters nature relatedness and libertarian–authoritarian political perspective in patients with treatment-resistant depression (TRD). Measures were collected at screening (baseline), 1 week and 7–12 months after dosing. An age-matched, untreated healthy control group was assessed over the same intervals to provide test–retest comparison and help address order effects. The investigation was framed as a pilot, open-label study exploring whether changes in these attitudes accompany the antidepressant effects previously reported in this cohort.

Methods

This was an open-label pilot study with a mixed-model design comparing seven patients with TRD to seven age-matched healthy control subjects. All participants provided informed consent and the study received ethical and regulatory approvals; it was sponsored by Imperial College London and reviewed by the MHRA. TRD patients were required to have major depressive disorder of at least moderate severity (HAM-D score 16+), and to have failed two adequate antidepressant courses during the current episode. Exclusion criteria included current or past psychotic disorder, a first-degree relative with psychosis, serious suicide attempts requiring hospitalisation, prior manic episodes, pregnancy, current substance dependence and medically significant conditions. Controls were physically and mentally healthy and subjected to the same exclusion criteria; however, they did not undergo the psilocybin treatment procedures. Psilocybin (sourced from THC Pharm GmbH and formulated locally) was administered to patients in two oral sessions separated by 1 week: an initial safety dose of 10 mg followed by a treatment dose of 25 mg. Before dosing, patients attended preparatory sessions with two allocated psychiatrists to build rapport and set expectations. During dosing, patients were supervised in a dimly lit, music-accompanied room with psychiatrists providing a non-directive supportive presence; vital signs and urine/breathalyser screens were obtained prior to dosing, and discharge assessments occurred about 6 hours post-administration. A close contact accompanied patients to and from the research facility. Primary psychometric outcomes were the 6-item Nature Relatedness Scale (NR-6) to measure connection with nature, and a 5-item subset of the Libertarian–Authoritarian Questionnaire termed the Political Perspective Questionnaire (PPQ-5) to assess libertarian–authoritarian orientation. Self-rated depressive symptoms were assessed with the Quick Inventory of Depressive Symptoms (QIDS) at baseline, 1 week and 7–12 months post-dosing. Statistical analyses were conducted in SPSS v23. Within-group tests used one-tailed paired t-tests or Wilcoxon signed ranks tests as appropriate; between-group comparisons used two-tailed independent t-tests or Mann–Whitney U tests. Ninety-five percent confidence intervals were reported for mean differences, and Hedges' g was calculated for effect sizes to account for the small sample. The authors note that the NR-6 and PPQ-5 were introduced late in the trial, and that this reduced the available sample for those measures, though exact reduced counts are not clearly reported in the extracted text.

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RESULTS

To assess political views on the dimension of libertarianism to authoritarianism, a recently validatedsubset of questions (five items) from the Libertarian-Authoritarian Questionnairewere used as a short version and termed the Political Perspective Questionnaire (PPQ-5). The validated 6-item Nature Relatedness Scale (NR-6)was used to measure the subjective sense of connectedness to nature. Self-rated depressive symptoms were measured at baseline and two followup time points (1 week and 7-12 months) in all study participants using the Quick Inventory of Depressive Symptoms (QIDS). The above measures were assessed at baseline and then again at the 1 week and 7-12-months follow-ups for all study participants.

CONCLUSION

The present study sought to investigate the effects of psilocybin with psychological support on nature relatedness and authoritarianism in patients with TRD. Patients reported a greater connection with nature 1 week after treatment. This increase in nature relatedness was sustained at the 7-12-months follow-up. One week post-treatment a significant decrease in authoritarianism was also observed, and at the 7-12-month follow-up the decrease was at trend level. No significant differences in nature relatedness, authoritarianism or depressive symptoms were found in an age and education-matched group of control subjects measured over an equivalent time period, thus supporting the inference that the changes were not due to order effects. Taken together, these findings indicate that the psychologically supportive administration of psilocybin might induce sustained changes in attitudes and beliefs, including feeling closer to nature and less allied to authoritarian views. The reduction of depressive symptoms following psilocybin treatment found here is consistent with previous studies demonstrating the therapeutic potential of psychedelic compounds. Long-term improvements in psychological wellbeingand trait openness and optimismhave been observed in healthy volunteers following a single exposure to a psychedelic drug. A single dose of psilocybin has also been shown to induce enduring reductions in anxiety and depression as well as increases in quality of life, life meaning, and optimism in patients with anxiety reactive to advanced-stage cancer. Furthermore, rapid and sustained antidepressant effects were found in patients with recurrent MDD that were treated with a single dose of the plant-based psychedelic brew, ayahuasca. Evidence suggests that greater nature relatedness is associated with lower anxietyand greater personal wellbeing, and that exposure to awe-inspiring nature may increase pro-social behaviour-perhaps through a related mechanism of seeing oneself as small in relation to the vastness of nature. Here, we show that the TRD patients felt more connected to nature up to 7-12 months after psilocybin treatment. This is consistent with a previous study in healthy participants in which 38% of the sample reported enduring positive changes in their relationship to nature and the environment 8-16 months post-psilocybin. Psychedelic use in a large sample of web-survey respondents was found to positively predict nature relatedness; moreover, as with nature-inspiring experiences of awe, this relationship was strongest in people who experienced the greatest ego-dissolution during their most intense psychedelic experience. Psychedelic users have been found to rate themselves as more concerned with the environment than users of other illicit substances. Interacting with nature has been shown to have cognitive and affective benefits in healthy individualsand patients with MDD. Although we found no correlation between the changes in nature relatedness or authoritarianism and changes in depression in the patients, this may simply have been due to the small sample size (n=7), or it is possible that a measure of mental wellbeing may have been more sensitive to such a relationship than the presently used measure of depression. There is, however, evidence to suggest that nature exposure decreases rumination as well as activity in brain regions implicated in depression, namely the subgenual prefrontal cortex (sgPFC) and regions of the default mode network (DMN). Interestingly, the administration of psilocybin has also been shown to acutely decrease sgPFC and DMN blood flow and within-network functional integrityand to increase global connectivity in the brain. Further work is required to test the hypotheses that a renewed sense of 'connectedness', including feeling connected to nature, is a key factor determining therapeutic outcomes in psychedelic therapyand to better elucidate its basis in the brain. A working hypothesis is that increased global connectivity in the brain and its relationship to ego-dissolutionand associated 'connectedness') is a key mediating factor. Psychedelic drug use in the 1960s and 1970s was strongly associated with anti-establishment and egalitarian counter-culture movements), yet very little controlled research has investigated the link between psychedelic use and political perspectives. Here we show for the first time, in a controlled study, lasting changes in political values after exposure to a psychedelic drug. This is in line with early research showing that recreational LSD users score higher on attitudes of 'personal liberty' and 'foreign policy liberalism' than control subjects. Psychedelic users have also been shown to score higher on 'concern for others' and place lower value on 'financial prosperity' than non-users of illicit substances as well as users of amphetamine, cannabis or heroin. Given that psychedelics act through the serotonin system, it is interesting that serotonin has been implicated in the assessment of harm in moral decision-making, altruistic punishment and fairness. Moreover, psychedelics have been shown to increase trait openness, and a substantial body of evidence demonstrates a positive association between openness and liberalism within individuals. Relatedly, the role of the serotonin 2A receptor, the key site of action of psychedelics, in mediating 'conversion-type' or 'quantum change'experiences has recently been discussed. There are a number of important limitations to this study that must be considered when interpreting the results. The study formed part of an open-label clinical trial with a small sample size. The sample was smaller still for the NR-6 and PPQ-5, as these measures were introduced late in the trial due to inspiration from a separate project of ours. Also, although we recruited a control group to examine test-retest reliability on these measures, the controls were healthy subjects and were not exposed to the same treatment procedures. Critically, since treatment with psilocybin involved more than just drug administration (e.g. psychological support before and after the psilocybin dosing sessions), it is quite possible that drug-unrelated factors contributed to the changes in NR-6 and PPQ-5 scores observed here. The caring therapeutic model may have been one such factor. A large doubleblind randomised control trial, ideally with an active control condition (to try and maintain the study blind), is required to more rigorously test the possible causal association between psilocybin and changes in nature relatedness and political perspective reported here. It would be hasty, therefore, to attempt any strong claims about a causal influence due specifically to psilocybin at this stage, and we should also be aware of anomalies in the relationship between psychedelic use and left-wing politics; however, intriguing questions relating to psychedelics and political/philosophical perspectives remain. A further limitation concerns the gender matching of control subjects and TRD patients; all TRD patients were male, whereas there were more females (71%) than males (29%) in the control condition. Thus, our findings in the TRD group cannot necessarily be extrapolated to females and the possibility of a gender effect cannot be discounted, and neither can we directly extrapolate the present findings to non-depressed populations. The specificity of our main results also requires careful consideration. The question remains to be addressed whether the reported changes in nature relatedness and authoritarianism observed here post-treatment with psilocybin were selective for these outcomes, or rather an epiphenomenon of the treatment's core effects on depressive symptoms. The question of causality is of central relevance here, and only further research can elucidate this. In this context, we would like to propose that there is a common mediating factor at play, driving both the improvements in mental health and changes in belief systems seen here -as well as elsewhere with psilocybin and other psychedelics. Such a common factor could be seen as a mental health equivalent of the general intelligence factor (e.g. Spearman's g) in cognitive science. More specifically, in line with a recent commentary from our teamwe propose that connectedness is this factor (see;), and that psychedelics positively and potently modulate this. Connectedness is a construct in need of development, but related concepts can be found in the literature. In brief, connectedness can be defined as a sense of feeling connected to one's self (i.e. a sense of feeling emotionally and somatically integrated and at peace) as well as others (e.g. one's partner, family, friends, colleagues and community) and the world more generally (e.g. feeling connected to nature and a guiding ethical and/or philosophical principle), as described in our recent work. Thus, a remediating effect on feelings of disconnectedness, characteristic of a broad swathe of mental illness, may underlie both the improvements in depressive symptoms and the relevant changes in political perspective reported here. What of the association between mental health and political perspective? There is some support for a link between lower authoritarianism and better mental health, although there are also some contradictory findings. The idea that drugs, including legal ones such as alcoholand caffeine, and medications such as stimulantsand selective serotonin reuptake inhibitorscan modulate belief systems, including political perspective, is relatively new -but one that may be fundamentally important, with potentially profound implications. If, for example, it was found that excessive alcohol use promotes a detachment from nature, chronic stimulant use promotes an aggressive industriousness and hubris -and potential for paranoia-and psychedelic experiences promote a generalised sense of connectedness, including greater altruism, what implications would this have for societies and their policies on such drugs? This and related topics may be seen as part of a new branch of political science, focused on the psychology and neurobiology of political perspective. Finally, we are keen to avoid a value judgement about the political changes that may (or may not) be attributable to psychedelic use. For some, ecological considerations (e.g. captured by nature relatedness) may be assigned the greatest importance, particularly when considering the scale and seriousness of the problem posed by climate change, for example, whereas others may recognise 'order' (e.g. captured in part by our authoritarianism scale) as an essential and functional counterweight to lawlessness. Testing whether psychedelic use is 'beneficial for society' would be a complex project, not least because opinions will differ on how to define 'beneficial' (although seefor a thought-provoking discussion on this matter). Even so, exploring the potential of psychedelics to moderate extremist views, and/or facilitate reconciliation, might be worth exploring, given the present results and wider supporting literature. In conclusion, this study sought to investigate the effects of psilocybin with psychological support on nature relatedness and authoritarian attitudes in patients with TRD. With significant caveats clearly highlighted, our findings tentatively raise the possibility that given in this way, psilocybin may produce sustained changes in outlook and political perspective, here in the direction of increased nature relatedness and decreased authoritarianism. These findings motivate further controlled studies to better determine the causality, reliability, specificity and durability of this relationship, as well as potential applications. Before I enjoyed nature, now I feel part of it. Before I was looking at it as a thing, like TV or a painting… [But now I see] there's no separation or distinction, you are it. (Patient from this trial)

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Study Details

Study Type
individual
Population
humans
Characteristics
re analysisopen label
Journal
Journal of Psychopharmacology
Compound
Psilocybin
Topics
Depressive Disorders Healthy Volunteers Treatment-Resistant Depression (TRD)Anxiety Disorders

Results

Fourteen participants were enrolled (7 patients with TRD, 7 controls). Demographically, most participants were Caucasian (78.6%), 64.3% were male, and 85.7% had post-secondary education. In the patient group baseline clinician-rated severity confirmed TRD: HAM-D scores ranged 24–36 (M=28.6, SD=3.7) and MADRS scores ranged 28–40 (M=35.9, SD=5). No serious adverse events were reported and acute drug effects were described as well tolerated. Nature relatedness (NR-6): Patients showed a statistically significant increase in NR-6 scores at 1 week post-treatment compared with baseline (baseline M=3.67, SD=1.00; 1 week M=4.14, SD=0.75; t(6)=-4.242, p=0.003, 95% CI [-0.75, 0.2]; Hedges' g=2.5). This increase was sustained at the 7–12-month follow-up (M=4.12, SD=0.60; t(5)=-2.707, p=0.021, 95% CI [-1.15, -0.03]; g=1.2). Non-treated controls showed no significant change between screening and either follow-up (screening M=4.02, SD=0.79; first follow-up M=4.02, SD=0.94; t(6)=0.008, p=0.994; second follow-up M=4.05, SD=0.62; t(5)=-1.228, p=0.274). Between-group differences at baseline and follow-ups were not significant, indicating that the within-patient increase was not mirrored by change in controls over the same period. Authoritarianism (PPQ-5): Patients exhibited a significant reduction in authoritarian political perspective at 1 week post-treatment; the extracted text reports a significant change at 1 week and a trend-level decrease at 7–12 months. The authors report a Hedges' g of 0.7 for the relevant contrast, described as a medium-to-large effect, and indicate that the study was underpowered to detect statistical significance on some comparisons. Controls showed no significant changes on PPQ-5 between screening and either follow-up. No significant between-group differences were observed at baseline or follow-ups. Depressive symptoms (QIDS): At baseline, patients had substantially higher self-rated depressive symptoms than controls (patients M=19.43, SD=4.04; controls M=3.86, SD=2.41; U=0.0E0, p=0.001; Hedges' g=4.7). Patients' QIDS scores decreased significantly 1 week after psilocybin (M=12.29, SD=9.18 vs baseline M=19.43; Z=-2.04, p=0.025; g=1.3), and remained significantly reduced at 7–12 months (M=13.00, SD=6.39 vs baseline; Z=-1.782, p=0.038; g=0.7). Controls showed no significant change in QIDS across the study period. Between-group comparison at 1 week approached but did not reach significance (U=10.000, p=0.062), whereas a between-group difference was reported at 7–12 months (U=3.500, p=0.020).

Discussion

Lyons and colleagues interpret their findings as preliminary evidence that psilocybin administered with psychological support may produce sustained increases in nature relatedness and reductions in authoritarian attitudes in patients with TRD, alongside rapid and durable antidepressant effects. The pattern—significant increases in NR-6 at 1 week sustained to 7–12 months, and a significant decrease in authoritarianism at 1 week with a trend at long-term follow-up—was not observed in the untreated control group, which the authors argue reduces the likelihood that results reflect simple order or retest effects. The authors situate these results within prior literature showing enduring personality and wellbeing changes after psychedelic exposure, and note converging findings from surveys linking lifetime psychedelic use to higher nature relatedness and lower authoritarianism, often mediated by ego-dissolution experiences. They also discuss mechanistic hypotheses: increased connectedness (a construct the authors define broadly as feeling integrated with self, others and the world) may underlie both therapeutic improvements and shifts in belief systems. Neurobiological observations cited include acute psilocybin-induced decreases in subgenual prefrontal cortex and default mode network activity and increases in global brain connectivity, which the authors suggest could relate to ego-dissolution and connectedness. Several important limitations are acknowledged. The study was open-label with a very small sample, and the NR-6 and PPQ-5 were added late in the trial so the effective sample for those measures was reduced (the extracted text does not clearly report the exact reduced counts). Controls were healthy and did not undergo the same preparatory or therapeutic procedures, so non-drug factors—particularly the psychological support and caring therapeutic context—could have contributed to the observed changes. Gender imbalance is another concern: all TRD patients were male, whereas the control group was majority female, limiting generalisability and leaving open the possibility of sex effects. The authors also recognise that changes in nature relatedness and authoritarianism could be epiphenomena of improvements in depression rather than specific outcomes caused by psilocybin; no correlations between those attitude changes and depression change were found in this small sample. Lyons and colleagues therefore call for larger, double-blind randomised controlled trials with active control conditions to test causality, specificity and durability more rigorously. They also flag broader questions about how psychoactive drugs might influence belief systems at a societal level, while emphasising neutrality about the value of any particular political change. A short patient quote is included to illustrate the phenomenological shift reported by at least one participant: "Before I enjoyed nature, now I feel part of it. Before I was looking at it as a thing, like TV or a painting… [But now I see] there's no separation or distinction, you are it."

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Increased nature relatedness and decreased authoritarian political views after psilocybin for treatment-resistant depression

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