Anxiety DisordersDepressive DisordersSuicidality

Post-Psychedelic Reductions in Experiential Avoidance Are Associated With Decreases in Depression Severity and Suicidal Ideation

This prospective survey study (n=358) investigated the relationship between psychedelic use, experiential avoidance, and mental health outcomes in naturalistic settings. It finds significant decreases in experiential avoidance, depression severity, and suicidal ideation, suggesting that reduced experiential avoidance may be a key mechanism in psychedelic therapy.

Authors

  • Richard Zeifman
  • Robin Carhart-Harris
  • Hannes Kettner

Published

Frontiers in Psychiatry
individual Study

Abstract

Psychedelic therapy shows promise as a novel intervention for a wide range of mental health concerns but its therapeutic action is incompletely understood. In line with acceptance and commitment therapy’s (ACT’s) transdiagnostic model, qualitative research has suggested that reductions in experiential avoidance are an important component of therapeutic outcomes associated with psychedelics. However, limited research has quantitatively explored the association between decreases in experiential avoidance and therapeutic outcomes associated with psychedelics. Therefore, in two prospective studies, using convenience samples of individuals with plans to use a psychedelic, we explored the impact of psychedelic use on experiential avoidance, depression severity, and suicidal ideation, as well as relationships between changes in these outcomes. Participants (Study 1, N=104; Study 2, N=254) completed self-report questionnaires of depression severity, suicidal ideation, and experiential avoidance: 1) before using a psychedelic (in ceremonial and non-ceremonial contexts), as well as 2) 2-weeks and 3) 4-weeks after psychedelic use. Across both studies, repeated measures ANOVAs indicated significant decreases in experiential avoidance, depression severity, and suicidal ideation after psychedelic use. Furthermore, decreases in experiential avoidance were significantly associated with decreases in depression severity and suicidal ideation. These results suggest that psychedelics may lead to significant decreases in experiential avoidance, depression severity, and suicidal ideation. Additionally, these findings imply that reduced experiential avoidance may be a transdiagnostic mechanism mediating treatment success within psychedelic therapy. We conclude that integrating psychedelics with psychotherapeutic interventions that target experiential avoidance (e.g. ACT) may enhance therapeutic outcomes.

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Research Summary of 'Post-Psychedelic Reductions in Experiential Avoidance Are Associated With Decreases in Depression Severity and Suicidal Ideation'

Introduction

Zeifman and colleagues frame the study within growing interest in serotonergic psychedelics (e.g. psilocybin, LSD, DMT/ayahuasca) as treatments for a range of mental health conditions. Randomised and open-label trials have reported promising reductions in anxiety, depression, substance misuse and suicidal ideation, and prior work suggests that intensity of so-called mystical or peak experiences predicts therapeutic benefit. However, the psychological and neurobiological mechanisms that mediate durable change after psychedelic use remain incompletely understood, and identifying transdiagnostic mechanisms could aid optimisation and targeting of treatments. One candidate transdiagnostic mechanism is reduced experiential avoidance, a process targeted by acceptance and commitment therapy (ACT) and conceptually distinct from general psychological distress. The authors note that prior psychedelic studies using the AAQ-II have shown post‑use reductions but that the AAQ-II may lack discriminant validity from distress. Thus, there is a need to examine changes in the process of experiential avoidance itself and whether such changes relate to decreases in depression severity and suicidal ideation. To address these gaps, the paper reports two prospective cohort studies of individuals planning to use a psychedelic, with the aims of (a) assessing changes in experiential avoidance, depression severity and suicidal ideation after psychedelic use, and (b) testing whether reductions in experiential avoidance are associated with reductions in depression and suicidal ideation. The primary hypotheses were that psychedelic use would be followed by decreases in experiential avoidance, depression severity and suicidal ideation, and that decreases in experiential avoidance would be associated with decreases in the other outcomes.

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Study Details

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