Neuroimaging & Brain Measures

The Subjective Effects of Psychedelics Are Necessary for Their Enduring Therapeutic Effects

This perspective paper (2020) argues that the subjective experience of psychedelics is necessary for enduring therapeutic outcomes.

Authors

  • Roland Griffiths
  • David Yaden

Published

ACS Pharmacology and Translational Science
meta Study

Abstract

Classic psychedelics produce altered states of consciousness that individuals often interpret as meaningful experiences. Across a number of human studies, when the participant-rated intensity of the overall drug effects are statistically controlled for, certain subjective effects predict therapeutic and other desirable outcomes. Underlying neurobiological mechanisms are likely necessary but not sufficient to confer full and enduring beneficial effects. We propose that the subjective effects of psychedelics are necessary for their enduring beneficial effects and that these subjective effects account for the majority of their benefit.

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Research Summary of 'The Subjective Effects of Psychedelics Are Necessary for Their Enduring Therapeutic Effects'

Introduction

Classic psychedelics are a chemically diverse group of compounds that act as partial agonists at 5-HT2A serotonin receptors and elicit distinctive subjective effects. The authors note that substances such as psilocybin, DMT (as in ayahuasca), mescaline and LSD have low toxicity and limited abuse liability, and that several recent clinical studies have reported favourable outcomes when these drugs are given under supportive conditions. A central unresolved question is the mechanism of therapeutic action: whether underlying neurobiological changes (for example, enhanced neural plasticity or brain network reorganisation) are sufficient, or whether the first-person subjective experiences engendered by moderate-to-high doses are necessary to produce enduring benefit in humans. Yaden and colleagues set out to argue that certain acute subjective effects are necessary for the full and lasting therapeutic and otherwise beneficial outcomes of psychedelics in humans. They frame this position against an alternative view that regards subjective effects as epiphenomena, summarise psychometric and clinical evidence bearing on the question, and propose a critical experimental test (a thought experiment involving administration under deep anaesthesia) to adjudicate whether subjective experience is essential for durable therapeutic benefit.

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Study Details

References (23)

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Vollenweider, F. X., Vollenweider-Scherpenhuyzen, M. F. I., Bäbler, A. et al. · NeuroReport (1998)

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Show all 23 references
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Noorani, T., Garcia-Romeu, A., Swift, T. C. et al. · Journal of Psychopharmacology (2018)

Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance

Griffiths, R. R., Richards, W. A., Mccann, U. et al. · Journal of Psychopharmacology (2006)

Psilocybin occasioned mystical-type experiences: immediate and persisting dose-related effects

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Roseman, L., Nutt, D. J., Carhart-Harris, R. L. · Frontiers in Pharmacology (2018)

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