Optimizing outcomes in psilocybin therapy: Considerations in participant evaluation and preparation
This theory-building article (2023) proposes that a patient's 'readiness' (eligibility & capacity) is taken into account to optimise the outcomes of psilocybin/psychedelic-assisted therapies (PAT). Factors discussed include intrapersonal (e.g. openness & motivation) and interpersonal (e.g. therapeutic alliance) factors.
Authors
- James Rucker
- Nadav Liam Modlin
- Scott Tyler Aaronson
Published
Abstract
Recent studies have demonstrated the promise of psilocybin therapies in creating positive changes for those with poor mental health across multiple diagnostic categories, including major depressive disorder (MDD), end-of-life anxiety, and obsessive-compulsive disorder (OCD). While there may be a large population that is eligible to participate in psilocybin therapy based on psychiatric diagnosis and medical clearance, little attention has been given to intrapersonal and interpersonal factors that might influence patient's readiness (i.e., eligibility and capacity) for psychedelic interventions. This paper proposes that readiness assessment includes both intrapersonal and interpersonal factors in order to improve safety, patient care, and treatment outcomes. While at the present time a reliable and valid instrument has not been developed, we propose that three specific areas of focus - patient presentation, therapeutic alliance, and patient safety - may be used to establish a patient's readiness for psilocybin therapy, thus increasing therapy optimization and personalization.
Research Summary of 'Optimizing outcomes in psilocybin therapy: Considerations in participant evaluation and preparation'
Introduction
Contemporary research has revived interest in psychedelic-assisted therapies, notably psilocybin therapy (PT), following earlier mid-20th century work. The introduction summarises biological and psychological mechanisms proposed to underlie psilocybin's effects: psilocybin acts as a selective partial agonist at cortical 5-HT2A receptors, is thought to modulate the default mode network (DMN), and may promote neuroplasticity. Clinically, small randomised controlled trials (RCTs) and longitudinal studies provide preliminary evidence of safety, tolerability, and efficacy in conditions such as treatment-resistant major depressive disorder (TRD), end-of-life anxiety, and obsessive-compulsive disorder. The extracted text reports specific trial findings, including a 59-participant RCT by Carhart‑Harris et al. that found no significant difference on the primary depression outcome but secondary analyses favouring 25 mg psilocybin, a 233-participant RCT where 37% of the 25 mg group showed a clinically significant response and 26% met remission criteria, and a longitudinal study reporting 58% in remission at 12 months after two doses (20 mg/30 mg). Common acute adverse effects noted include headache, nausea, fatigue and insomnia. Modlin and colleagues argue that psilocybin therapy is not solely a pharmacological intervention but a package intervention combining drug administration with psychological support and contextual factors such as mindset and setting. They identify a gap in current practice and research: although many patients may be medically eligible for PT, little attention has been paid to intrapersonal and interpersonal factors that determine a patient's readiness or capacity to engage with the psychological elements of treatment. The paper therefore sets out to conceptualise "readiness for PT" and to propose a framework—focusing on patient presentation, therapeutic alliance, and patient safety—that could be used to assess readiness and guide personalised preparation to optimise clinical outcomes.
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Study Details
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- APA Citation
Modlin, N. L., Miller, T. M., Rucker, J. J., Kirlic, N., Lennard-Jones, M., Schlosser, D., & Aaronson, S. T. (2023). Optimizing outcomes in psilocybin therapy: Considerations in participant evaluation and preparation. Journal of Affective Disorders, 326, 18-25. https://doi.org/10.1016/j.jad.2023.01.077
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