This meta-synthesis (s=8) of qualitative studies explored experiences of psychedelic treatment for eating disorders from the perspectives of people with eating disorders and providers. It found that perceived benefits centred on emotional processing and a stronger sense of connection with the body and self, while also highlighting the need for careful support because low weight and other physical vulnerabilities may increase risks.
Background
Eating disorders (EDs) have complex presentations with high rates of comorbidities and low recovery rates. Current treatment options often lack sufficiency in improving ED symptoms. Psychedelic-assisted therapies represent a novel treatment approach for the treatment of EDs, with research documenting preliminary positive evidence. However, psychedelics have their own challenges and risks which need to be considered within an ED population to inform study design and future clinical application. The primary aim of this meta-synthesis was to integrate existing qualitative data on the experience of using psychedelics in ED treatment from the perspectives of both individuals with EDs and providers (e.g. clinicians, ceremony leaders), using meta-ethnography to generate new interpretative insights.
Methods
The methods followed the seven steps of a meta ethnographic approach. An electronic search of three databases (PubMed, Medline, and PsycINFO) was conducted. Papers were included if they were qualitative studies exploring the use of typical or atypical psychedelics, from the perspective of either a provider or individual experiencing an ED.
Results
A total of eight studies were included. From the data we identified five meta-themes that together depict how psychedelic experiences may act as catalysts for transformation. Our interpretive narrative posits that core transformative processes (Mind-Body-Spirit, Emotional Processing), unfold within specific contextual conditions (Navigating Challenges and Risks, Enabling Safe and Supportive Experiences), and lead to meaningful outcomes (Therapeutic Improvements). Meta- and sub-themes reflect ED-specific elements, highlighting that psychedelics may improve emotion processing and enhance perception of and connection with the body and the self, which is pertinent to ED recovery. Themes also indicate the increased risk for adverse side effects with low weight and other physical vulnerabilities associated with EDs.
Conclusions
The themes and interpretive narratives identified in this meta-synthesis suggest that to achieve therapeutic outcomes, ED-specific contextual conditions are required to facilitate internal processes during psychedelic therapy for EDs. This includes minimising the uncertainty that typifies EDs through exploration of expectations and autonomy in selection of setting elements (e.g. lighting, music, eye-mask) or collaboratively agreeing strategies for if anxiety spikes. Further, facilitators should require dual competency in psychedelic treatment and ED psychopathology and treatment.
Papers cited by this study that are also in Blossom
Gukasyan, N., Schreyer, C. C., Griffiths, R. R. et al. · Current Psychiatry Reports (2022)
Ledwos, N., Rodas, J. D., Husain, M. I. et al. · Journal of Psychopharmacology (2022)
Berman, R. M., Cappiello, A., Anand, A. et al. · Biological Psychiatry (2000)
Spriggs, M. J., Kettner, •. H., Carhart-Harris, •. R. L. · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity (2020)
Eating disorders are described as complex psychiatric conditions with substantial psychological and physical burden, high comorbidity, low recovery rates, and limited success with current first-line treatments. The paper notes that psychological therapies and the few approved medications often produce only modest or inconsistent benefits, leaving a need for more acceptable and effective options. The authors also frame psychedelics as promising but not straightforward, because their acute effects, risks, and the specific vulnerabilities seen in eating disorders may shape both safety and therapeutic value. Against this background, Morris and colleagues set out to synthesise qualitative evidence on how people with eating disorders and treatment providers experience psychedelic-assisted treatment. Their aim was to generate higher-order interpretative insights about how psychedelic experiences may contribute to recovery, and to identify eating-disorder-specific risks and contextual conditions that should inform future study design and clinical protocols. The paper uses meta-ethnography to go beyond description and develop an integrated account of the experience of psychedelic treatment in this population.
The study was a pre-registered qualitative meta-synthesis using a meta-ethnographic approach informed by Noblit and Hare. The authors searched three databases - PubMed, Medline, and PsycINFO - and also carried out additional searching via Google Scholar. The extracted text does not clearly report the full search dates. Studies were eligible if they were qualitative and explored the use of typical or atypical psychedelics in the context of eating disorders, from the perspective of either people with eating disorders or providers such as clinicians and ceremony leaders. The review ultimately included eight studies. Five explored the experiences of people with eating disorders, and three examined provider perspectives. Two reviewers independently appraised the studies using the Critical Appraisal Skills Programme checklist for qualitative studies. The authors used an inclusive approach and did not exclude studies on the basis of quality score; the scores were used to indicate trustworthiness. They extracted first-order constructs (verbatim participant material) and second-order constructs (original study authors’ themes and descriptions), then used reciprocal translation across studies to generate new third-order meta-themes and sub-themes. Senior reviewers were consulted during synthesis, and one team member with lived experience of anorexia nervosa contributed to refinement of the themes. The synthesis was interpretivist and explicitly reflexive. The authors state that the included studies were all conducted in Western settings, that participants were self-selected, and that this may limit generalisability. The extracted text does not clearly specify a formal statistical analysis, which is expected for this type of qualitative synthesis.
The search identified 1,211 records in total, including 925 after deduplication. After screening and full-text assessment, eight studies met inclusion criteria and were appraised. Across the included studies, participants with lived eating-disorder experience were mostly women, with ages ranging from 21 to 55 and samples of six to 16. Provider samples ranged from 30 to 60 years in the studies that reported age, and were also mainly female or mixed. Five studies focused on ayahuasca, two on psilocybin, and one on psychedelics more generally. The quality appraisal judged all eight studies to be high quality, with CASP scores reported as falling between 70% and 90%. The authors synthesised the findings into five meta-themes: spirituality, reuniting and reconnecting with the self, emotional processing, navigating challenges and risks, and enabling safe and supportive experiences. These themes together were presented as depicting psychedelic experiences as potential catalysts for transformation. In the results narrative, psychedelics were described as facilitating spiritual insight, existential reflection, and renewed meaning. Participants sometimes reported reconnecting with religion or experiencing a sense of oneness and connection to the natural world. The therapies were also associated with separating the person from the eating disorder, greater self-compassion, and a stronger sense of wholeness. Several accounts described a changed relationship with the body, including seeing it as something to respect and nourish rather than criticise or control. Emotional processing was another major theme. Participants described being able to sit with fear, sadness, and traumatic memories rather than avoiding them, and some reported insight into the origins or function of their eating disorder. Under risks and challenges, the synthesis highlighted that people with eating disorders may face added vulnerability because of low weight, cardiac or electrolyte complications, psychiatric comorbidity, anxiety, and a strong need for control and predictability. The ritual and purging elements of ayahuasca were reported as potentially reinforcing eating-disorder behaviours for some, even though others experienced them as different from pathological purging. Safe and supportive experiences were linked to careful preparation, trustworthy facilitators, a controlled setting, and integration with conventional treatment. The authors also noted barriers such as narrow trial eligibility, the intensity and duration of some psychedelic rituals, and the need for provider training. In the final outcome theme, participants reported subjective improvements in psychological wellbeing, including reductions in depression and anxiety, as well as eating-disorder-specific changes such as better awareness of hunger cues, less obsessive thinking, greater mindfulness around meals, and reduced compulsive symptoms. Some also described improved relationships with family and other close contacts.
The authors interpret the findings as showing that psychedelic experiences may support eating-disorder recovery through a set of interconnected transformative processes, particularly spiritual insight, reconnecting with the self, emotional processing, and changed body perception. They argue that these processes are not sufficient on their own; they must occur within conditions that manage eating-disorder-specific uncertainty, vulnerability, and risk. In their view, the therapeutic potential of psychedelics depends heavily on the surrounding context. They position the findings as broadly consistent with earlier psychedelic and eating-disorder research suggesting that improvements in emotion regulation, self-concept, and body image may be part of the mechanism of change. The discussion emphasises that providers brought an additional interpretative layer, including theories about spirituality and illness, which contrasts with more biomedical accounts of eating-disorder aetiology. The authors also link their themes to the set-and-setting framework, arguing that expectations, preparation, setting, and trust in the facilitator are central to outcomes. The paper highlights several limitations. The included studies were self-selected, which may over-represent positive or interested participants and under-represent adverse experiences. All studies were from Western cultures, so the authors caution that the synthesis may not generalise to other cultural contexts. They also note that the review itself is influenced by its interpretive stance and by the team’s positionality, including experience in psychedelic research. In addition, the authors state that qualitative findings around ayahuasca are often framed through a Western biomedical lens, even though ayahuasca has Indigenous roots and meanings. In terms of implications, the authors call for eating-disorder-specific psychedelic manuals and protocols, co-designed with people with lived experience and, where relevant, Indigenous collaborators. They suggest that future work should include larger samples and empirically test the proposed processes and mechanisms. They also recommend that facilitators have dual competence in psychedelic treatment and eating-disorder psychopathology, and that psychedelic interventions be integrated with conventional eating-disorder treatment rather than treated as standalone solutions.
Eating disorders (EDs) are complex psychiatric disorders characterised by disturbances in eating-and weight-related perceptions, thoughts, emotions and behaviour, and severe psychological and physical complications, with a biopsychosocial pathogenesis. The 11 th edition of the International
Classification of Diseases (ICD-11;recognises several EDs, such as anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant restrictive food intake disorder (ARFID), pica, ruminationregurgitation disorder, as well as unspecified and other specified feeding and eating disorders (UFED, OSFED). AN can be further classified by sub-type according to the presence or absence of binge eating and compensatory behaviours; termed the binge-purging and restrictive subtypes, respectively. EDs are associated with rigid thought and behavioural patterns and deficient cognitive functioning and flexibility. There may be difficulty naming, regulating, and experiencing bodily feelings and emotions. EDs are often described as coping mechanisms to help control and deal with underlying unmanageable emotions (e.g. depression, anxiety;). Moreover, individuals with EDs often report previous challenging interpersonal or traumatic experiences. Yet, EDs are more complex than the characterisations and symptoms listed here; these are complex psychiatric disorders with severe comorbid psychopathology, impairment across various domains, and high mortality rates.
The National Institute for Health and Care Excellence (NICE) recommends psychological therapies as first line interventions for EDs.These include eating-disorder-focused cognitive behavioural therapy (CBT-ED), Maudsley anorexia nervosa treatment for adults (MANTRA;), specialist supporting clinical management (SSCM), and family therapy. Compared with treatment as usual (TAU), psychological treatments are associated with modest improvements on clinical outcomes. However, a meta-analysis reported no significant differences between psychological treatment (e.g. cognitive behavioural therapy, MANTRA) and control (e.g. TAU or SSCM) on weight gain, ED pathology, or quality of life. Regarding pharmacological treatments, fluoxetine for BN and lisdexamfetamine for BED are the only approved medications for EDs.
There is no approved pharmacological intervention for AN, although individuals are frequently prescribed medicationto target comorbid disorders, such as depressionor anxiety or to help with weight recovery. However, the evidence remains inconsistent. The limited number of evidence-based medications for EDs is a severe limitation for their clinical management. While some do recover with treatment, less than half will achieve recovery status (defined as weight restoration and no binge or compensatory behaviour for the prior 12 weeks) at long-term follow-up. ED patients have expressed ambivalence around recovery, and dissatisfaction with treatment, pertaining to high levels of discontinuation and negative clinical outcomesthat are influenced by psychological, social, behavioural, and environmental factors at the individual and service level. This underlines the urgent need for innovative and acceptable treatments and treatment escalation strategies. Building and implementing a treatment algorithm to escalate therapeutic intensity across ED staging, and incorporating psychedelics into later stages of this strategy, could help to create a progressive pathway of treatment for people who do not respond to first-line options.
Psychedelics are a subset of drugs that are characterised by their ability to induce altered states of consciousness, and produce profound acute effects on perception, cognition, and emotions. The classification of psychedelics into classic and atypical is one driven by pharmacology; to align with the literature that will be drawn on in this paper, we will refer to these substances under the broader umbrella of psychedelics. Classic psychedelics include psilocybin, lysergic acid diethylamide (LSD), and N,Ndimethyltryptamine (DMT). These compounds primarily act as agonists or partial agonists of the serotonin 5-hydroxtryptamine type 2a receptors. Classic psychedelics, specifically Ayahuasca (an Amazonian brew with the
A R T I C L E I N P R E S S active ingredient DMT), have been traditionally used for decades in ritualistic and religious practices in Central and South America. Prior clinical studies investigating their effects and use were quickly prohibited due to increased recreational use, government regulations, and lapses in research ethics. There has since been a resurgence in clinical interest of the therapeutic potential of psychedelics as novel treatments for psychiatric disorders, including EDs. As serotonin disturbances contributes to dysregulation of mood and appetite in EDs, classic psychedelics can enhance cognitive and neural flexibility, and modulate mood, appetite and perception. Atypical psychedelics can be further divided into dissociative psychedelics (e.g. ketamine), cannabinoid agonists (e.g. Δ9tetrahydrocannabinol [Δ9-THC]), and entactogens (e.g. 3,4methylenedioxymethamphetamine [MDMA]). Ketamine exerts effects primarily via N-methyl-D-aspartate receptor antagonismand MDMA's primary action is as a monoamine releaser. MDMA promotes the release of oxytocin, which is implicated in social bonding and emotional regulation; this can encourage processing of unmanageable emotions, which is often central to EDs. .
Psychedelics are partly characterised by their acute subjective effects and intense emotional states which are understood to be an important part of the therapeutic process. These idiosyncratic effects occur in an altered state that is malleable and flexible, leading to personal insight by promoting cognitive flexibility, confronting challenging emotions, and enabling detachment from internal dialogue. The introspective quality of psychedelics may facilitate an embodied experience, enabling attunement with internal aspects of the self by increasing openness to new perspectivesand reconstituting a new-self model that improves identity and selfpercept. The benefits of using psychedelics for ED treatment are illustrated in several reviews pertaining to potential neurobiological and psychological mechanisms, which are hypothesised to work symbiotically with "set" (expectation, psychopathology, and assumptions that the user has) and "setting" (the environment in which the psychedelic substance is taken) in shaping therapeutic outcomes. There is positive preliminary clinical evidence for the benefits of psychedelics in ED populations(Additional File 1: Table 1). However, there is a need for specifying protocols that mitigate risks associated with psychedelic use specific to those with EDs. 1.2.1.1 Unique needs and challenges of using psychedelics in people with
Challenges and needs unique to people with EDs include a heightened intolerance for uncertainty, difficulties with impulsive control and emotion regulation, substance abuse in binge-purge presentations of EDs, and low body weight in AN. It is important to consider how these characteristics interact with risks and characteristics of psychedelics. Given the idiosyncratic acute effects of psychedelics and the complex heterogenous presentations of EDs, understanding the unique needs of the ED population is necessary to help to navigate potential challenges, maintain patient safety, and maximise the therapeutic potential of psychedelic treatments in those with EDs.
Whilst symptom overlap is observed, there are also features that differentiate EDs from other psychiatric conditions, necessitating a tailored approach rather than solely drawing on the experience and data of other psychiatric disorders. Psychedelics may offer therapeutic potential; however, their use introduces challenges that interact with the complex features of EDs, (e.g. physical vulnerabilities, uncertainty, and need for control) that need to be understood to minimise harm.
Qualitative research can improve understanding of phenomenological effects of psychedelics that are not accurately captured with quantitative measures, by generating valuable insight into acceptance, attitudes, subjective effectiveness, and how individuals experience psychedelic treatments. Such insights may highlight facilitators and barriers to their use, inform study design, and optimise clinical application and outcomes. To our knowledge, there has been one previous review of qualitative data of psychedelics in EDs, which summarised perspectives on psychedelic therapies among people with a current or past diagnosis of ED, who did or did not have direct experience of psychedelics. A conceptual understanding of the experiential and contextual factors associated with psychedelic use in the ED population remains lacking. Using a meta-ethnographic approach, the present study aims to generate new, interpretative, higher order insights into the experiences of using psychedelics in ED treatment from the point of view of people receiving psychedelic treatment for EDs and providers that facilitate it. We aim to understand how acute psychedelic effects are experienced and how they contribute to therapeutic outcomes, and to understand ED-specific risks that should be considered in protocols for psychedelic treatment.
This meta-synthesis was pre-registered on PROSPERO (). A metaethnographic approach to synthesising the literature was undertaken, informed by Noblit and Hare. The methods section is laid out according to the steps of meta-ethnography (see Table). Meta-ethnography was used to produce something that is "greater than the sum of its parts". This framework has been used in other meta-syntheses of qualitative ED research.
The Critical Appraisal Skills Programme (CASP;) checklist for qualitative studies was used by the two independent reviewers (RM and AG) to appraise included studies. Disagreements were resolved between the two reviewers. This study used an inclusive approach that did not exclude studies on the basis of CASP scores; scores are presented for context as an indication of the trustworthiness of the findings in the individual studies.
Both Both reviewers (RM and AG) independently familiarised themselves with each included study. The reviewers identified themes, concepts, and metaphors from each study. The headline, descriptor, exemplar methodwas used, where the theme name, detailed description of the theme in the original authors words (second order constructs), and one verbatim "exemplar" of the theme from the perspective of the experiencing person (first order construct) was extracted. The studies included two participant groups: individuals with EDs, and providers (e.g., clinicians, ceremony leaders, etc). While these groups differed in perspective and background, the accounts often addressed overlapping concepts. Given the limited number of provider studies and the conceptual overlap between groups, all papers were synthesised together in a single interpretive process. However, there is also a distinction between epistemic knowledge produced by the individuals with EDs and providers. We have endeavoured to identify patterns that emerge across both individuals with EDs and provider perspectives, whilst also identifying and reflecting differences. Therefore, we have distinguished between the interpretations of individuals with EDs experiences and the interpretations of providers where relevant (e.g. spirituality sub-theme). As concepts were largely comparable, reciprocal translation was performed. This involved an iterative process of translating concepts from one study into another by arranging the papers chronologically and comparing paper one with paper two, and so on until all papers had been synthesised. The translations were then synthesised to form new interpretive meta-themes and sub-themes (third order constructs). This was an iterative process until no new themes emerged. Senior reviewers (JK, HH, JT, VL) were consulted at this stage to offer additional insights and ensure clarity of the new themes, encompassing multiple perspectives here to reflect on bias. This discussion facilitated refinement of themes; one reviewer with lived experience of AN offered insights that informed revisions to meta-theme and sub-theme titles and merging or separating of themes. These refinements ensured that interpretations and the analysis were shaped by lived experience. After developing meta-themes and sub-themes, an integrative narrative was constructed to illustrate how these themes relate to one another. This drew on the content of the themes and the researcher's (RM) conceptual understanding and interpretations to develop a coherent account of how the meta-themes come together to collectively explain perspectives and experiences of psychedelics in EDs. This aligns with a line-of-argument synthesis, in that it aimed to explain how meta-themes fit together to form a broader, higher-order understanding of the phenomenon. The first author (RM) then drafted the synthesis (results and discussion sections), which was refined after discussion with the other reviewers (AG, JK, HH, JT, VL).
This meta-ethnography is situated in an interpretivist paradigm, adopting a relativist ontology and constructivist epistemology. Here, multiple realities can co-exist. Knowledge is viewed as co-constructed through interaction of the synthesis researcher and the first-and second-order constructs of the original papers. We acknowledge that the researcher is inseparable from the research and acts as an active interpreter who produces a contextual interpretation of the data. The process of the synthesis may be informed by collective personal and professional experiences of the researchers. The research team have reflected on their positionality related to the topic of this review, to identify and reflect on assumptions that may influence the review process. The authors identify as white female (RM, AG, JK, JT, VL) or male (HH) researchers It is important for us to reflect on how these positions shaped the interpretive work presented. Considering the team's involvement in psychedelic research, we acknowledge that expectations regarding the therapeutic potential of psychedelics are likely to have shaped the emphasis on "therapeutic improvements" as the endpoint of our interpretive narrative; however, this was also reflected in some of the primary studies where outcome-oriented findings were prominent. Further, our experience of developing protocols for a ketamine study in AN within a Western setting may have shaped the interpretations and narratives around ED-specific protocols, including aspects related to set and setting, and safety management within Western treatment settings, particularly for ketamine studies.
The search process yielded a total of 1205 studies through database searching, supplemented by 6 studies from additional searching on Google Scholar, resulting in a total of 1211 studies (n=925 after deduplication). A total of 852 articles were excluded after title and abstract screening, one full- text article was not retrieved, and a further 64 articles were excluded at the full-text stage. Overall, eight studies met the inclusion criteria and underwent quality appraisal; see Figure. The characteristics of the included studies are outlined in Tablesand. All five studies exploring individuals with EDs encompassed a range of EDs: two studies had a complete AN sample, two consisted of AN and BN, and the final encompassed AN, BN, BED, eating disorder not otherwise specified (EDNOS), and OSFED among others. Three studies required diagnosis of ED by a qualified professional, one recruited individuals with current or past AN and associated body image disturbance (BID), and the other recruited individuals both with and without professional diagnosis of an ED. In two studies investigating ceremony leader perspectives, nine of the 15 participants disclosed self-reported ED history, including AN, BN, or disordered eating. Two studies recruited individuals with direct experience of being ayahuasca ceremony leaders, in which some of their participants had had EDs. In one study, topics explored included the utility of ayahuasca for EDs, perspectives on conventional ED treatment, and diet restriction and purging with ayahuasca in relation to EDs.The other asked questions pertaining to the utility of ayahuasca and its application for EDs. The remaining study recruited individuals providing medical or psychotherapeutic care to patients with EDs, where three participants had completed psychedelic-or ketamine-assisted therapy training, but direct experience in providing this was not required. In this study, clinicians were asked about their knowledge and attitudes towards using psilocybin in AN, education and training, and referring for psilocybin therapy. Across all studies exploring people with lived ED experience, age ranged from 21 to 55, with sample size between six and 16, and majority female samples. In the studies exploring provider perspectives, age of providers ranged from 30 to 60 (although two did not report range (), with sample size ranging between. Gender was majority female in oneand more evenly split in the remaining two. Five studies looked solely at ayahuasca, two at psilocybin, and one at any psychedelic. Of the five studies exploring people with lived ED experience, three documented ayahuasca use in ceremonies and multi-day retreats. One reported use in clinical trials, psychedelic rehabs, personal and social use, and in one case of ketamine, prescription for chronic pain. The other did not report whether participants had prior psilocybin experience. Regarding the number of uses, ayahuasca studies ranged from once to 30 times, one reported frequencies ranging from less than five times, to microdosing and lifetime recreational use, and one did not report.
Quality appraisal of the included studies utilised the CASP tool. Each paper was given a score out of ten representing high, medium, or low quality by the two reviewers (RM and AG). All eight papers were allocated a high-quality score of between 70-90% (Additional File 1: Table).
This meta-synthesis generated five meta-themes with a series of sub-themes (see Table; Figure) that together depict how psychedelic experiences may act as catalysts for transformation. To provide an overview of how these meta-themes interrelate, the following narrative is proposed: core
Psychedelics fostered profound spiritual insights, enabling individuals to explore the meaning of life and their role within it. This appears to manifest as a renewed perspective on life. Spirituality as accessed through psychedelics, provides an opportunity for self-reflection, existential understanding, and new approaches to healing that go beyond conventional ED treatment approaches. Authors highlighted the intense spiritual experiences in psychedelics, including "connecting to a higher power or oneness". For some individuals with EDs, experiences pertaining to spirituality enabled reconnection with their religion, and encouraged "religious, spiritual or contemplative practices post-Ayahuasca drinking". "The soil was blanketing me and the branches were wrapping themselves around me… it's a life force… I'm connected and I'm part of the earth and when I die my roots and my energy will become some other life force and I just feel like everything is so much more special" Renelli"The Ayahuasca worked with my body and my soul, my spirit... It offers a form of spiritual and existential introspection and a form of physical healing that is unlike anything else" Renelli et alNotably, some Ayahuasca ceremony leaders offered insights into possible aetiological theories about EDs. They explored the idea that EDs function to fill the void following a lack of spiritual connection, commenting that spirituality is under-emphasised in biomedical approaches. "Most diseases like this I can trace back to a kind of forgetting of one's nature as spiritual, as Sprit". "Why we get to that place is very complex. The missing piece in allopathic medicine is the spiritual component"ACCEPTED MANUSCRIPT
Psychedelics provided the opportunity for separation from the ED, highlighting the distinction between the individual and the ED and making space to observe the individuals' internal thoughts and feelings. The psychedelic experience encourages a deeper connection with the self by recognising and accepting all parts of themselves with self-love and compassion, which results in a wholeness of self. The study authors reported that the relaxed state enables individuals with EDs to "realise faulty thinking…separate from and challenge the oppressive harsh or anxious inner critic dictating their reality linked to their ED", enabling them to "reorient away from self-blame and self-hatred, towards self-love, self-care and self-compassion". "You might call that soul retrieval: bring back all of the parts of themselves theyin order to not feel pain" Williams et al
Loh and Luke"Ayahuasca helped me deeply connect with myself so that self-love has been the prevalent priority over self-criticism that […] self-love became more important and more prevalent" Lafrance et alNewfound perception of the body Reconfiguration of the perception of the body may facilitate a reconnection with and acceptance of the physical form of the self, by fostering a compassionate and embodied self-awareness. The experiential effects of psychedelics may enable reframing the body as a valued and relational entity. For some individuals, this may lessen thoughts and behaviours linked to weight. Authors of primary studies exploring ayahuasca explored an increased "respect for one's body", where the physical form was experienced as a gift and something to be cherished and honoured.
"I just really experienced my body as a gift… I could sense that I was not honouring the gift" Lafrance et al"I saw myself as a rotting, decaying skeleton and then I saw myself as this beautiful full-bodied, just beautiful with this long hair, and I like, I wanted to be that woman" Lafrance et alThe vivid symbolic imagery conjured during the psychedelic experience reflects transformations of self-image and renewal of life. This is specifically pertinent in the ED population, due to characteristic distortion of body image and self-perception, where a decaying skeleton represents the once idealised pursuit of thinness, and the beautiful full-bodied… woman symbolises healing and shifting toward self-acceptance of the physical form. For some, this renewed perception of the body incorporated a new understanding of weight. Authors highlighted that these experiences reflected a newfound understanding that the body should be "cherished and honoured through nourishment", providing insight into how "body weight had meaning beyond simply being a consequence of restrictive or binge-eating symptomatology"following ayahuasca use. "I felt my ribs and I could feel them, they were so hollow… I can't wait to get back and just start gaining some weight" Lafrance et al"Weight had something to do with protecting myself and because of ayahuasca I don't have to protect myself anymore" Renelli
The second meta-theme explores the ability to regulate and experience emotions that had previously been unresolved or avoided, including accessing painful memories that were difficult to engage with and manage. Here, we highlight how, through emotional processing, individuals may be able to realise the "root cause" of their ED.
Psychedelic experiences facilitated deep emotional processing, enabling individuals to access and work through previously unregulated or unresolved emotions. For some, this included confronting and processing painful memories. Ayahuasca provided a unique window of opportunity to reprocess difficult emotions and memories whilst in an altered state, without the need to hide from them: "… you can't go anywhere, you can't hide from it, and I think that is, I mean for me, it was like one of the first times where I just sat in fear or sat in sadness or sat in memories that I was trying to hide from" Renelli et al"I feel more capable of experiencing my emotions" Lafrance et al
The acute effects of ayahuasca helped individuals with EDs and providers to recognise the root cause of the ED, gaining new insights into its origins, which may be pivotal to moving towards healing and ED recovery. Further, individuals were able to gain insight into the function that their ED severs. "By pulling the weed out by the roots, the top of the plant just falls naturally" Williams et al"I really saw at the time bingeing and purging and restricting were actually adaptive coping mechanisms; at the time, they were the only coping mechanisms that I actually knew how to use to deal with the difficulty that I was experiencing that I had no words for and that no one was asking about" Lafrance et al"I couldn't look in the mirror and validate what I saw, and so I tried to externally validate it by, like, engaging in all these, all these eating disorder behaviours"ACCEPTED MANUSCRIPT
The third meta-theme explores the typical challenges and risks (e.g. unpredictability, expectations) that are inherent to using psychedelics within the ED population, a group who have their own specific challenges and risks (e.g. physical and mental contraindications) inherent to their disorder. These factors need to be well understood to mitigate potential harm to individuals with EDs.
EDs present with complex and multifaceted clinical profiles, which may complicate the safe use of psychedelics. Physical health vulnerabilities and high rates of psychiatric comorbidity common in individuals with EDs may introduce additional risks that require monitoring or further consideration when using psychedelics, due to side effects of psychedelics possibly exacerbating the ED. Providers highlighted how these factors may render psychedelic treatment unsuitable for patients with EDs. "It might not be safe for them, because physiologically, they're already in a very, very delicate disposition""I had a client with ARFID who went and tried ketamine… more nauseous and then really exacerbated the ARFID"Unpredictability as a central risk of psychedelic treatment Individuals with EDs reported that traits that typify EDs, such as the drive for control and high rates of anxiety, may introduce risks for using psilocybin that require thorough preparation and mitigation strategies, and ED-specific guidance to offset these potential challenges. Authors highlighted that there is likely to be some anxiety around the lack of "predictability around content that may emerge" during psychedelic experiences.
"Eating disorders are characterised by such an intolerance for uncertainty and high levels of anxiety""It could be very off-putting and could really derail the whole process if it's not known and if it comes up as a surprise and they're not prepared for that"Balancing expectations of a "miracle" with reality Both individuals with EDs and providers highlighted the importance of understanding and managing expectations. There is a need for education, personalised preparation sessions, and understanding of "set" when considering using psychedelics, as individuals may be disappointed with certain outcomes or experience something unexpected. This is pertinent in the ED population, due to fluctuating motivation and ambivalence around treatment and recovery, in addition to inherent characteristics explored in the previous sub-theme (e.g. anxiety, drive for control). Authors highlighted that "expectations of psychedelic therapy [are] related to the influence of the media on patients or providers", promoting the necessity of education for both groups before using psychedelics in this population. "I think there's a danger of putting all our hopes and dreams in the basket of life, like if I eat this mushroom then my life is going to be like sorted and im gonna have no problems every again… I'd try not to put it on a pedestal""If people take a psychedelic and think oh im gonna be cured then they're in for a very rude awakening, because that's not the way it works. You have to be determined to commitment to work hard"
The ritualistic elements of Ayahuasca, including restriction and purging through vomiting, mirror behaviours familiar to those with EDs. For most, "The eating disorder symptoms of bingeing and purging, it was like going numb, eating… feeling the shame… in ceremonial context… absolutely no shame, there wasn't a feeling of fullness, it was more just a feeling of my body recalibrating and just being able to release something that had been held for a long time""Intentions and purposes of the purging in context of Ayahuasca ceremonies were wholly different from purging in the context of an ED. In-ceremony purging was viewed as energetic in nature, a clearing, a clearing of blockages, or trauma, a release of the root problem, and a complete reframe of the behaviour"Notably, for some, this experience may not be conceptually different. Authors highlighted that these elements "mimic or mask ED symptoms", meaning that participants with EDs may use Ayahuasca ceremonies as an "opportunity to engage in ED behaviours". Whilst this theme is derived from ayahuasca primary studies, these findings highlight a likely challenge in implementing psychedelic treatment in an ED population, underscoring the need to consider ED-specific risk and assessment of who may be more at-risk than others, or what classification of psychedelics may be better suited (e.g. no restriction with ketamine). "I've seen someone use ayahuasca as an excuse for food restriction""[the preparatory food restriction] was a struggle for me"
The fourth meta-theme explores the importance of having safe and supportive psychedelic experiences for individuals with EDs. This includes access to psychedelics in a safe, controlled environment, with trust in welltrained and expert providers, to support preparation, dosing, and integration.
Access to psychedelic treatment for EDs is currently constrained by clinical trial eligibility criteria, which typically focuses on individuals with AN. Moreover, the requirement for multiple ceremonies, each lasting a half or full day, was identified as a potential barrier for individuals with EDs by both patients and providers, where prolonged, intensive interventions that disrupt the daily routine could trigger ED symptoms and exacerbate risk. "All the clinical trials are all focused on low weight anorexia""Often just missing one meal could retrigger ED thoughts for me"Bridging psychedelics and conventional treatment Individuals with EDs and providers highlighted the potential opportunity to integrate psychedelic experiences and conventional ED treatment to support understanding, engagement, and maintain therapeutic outcomes. This points to a possible complementary relationship, in which novel interventions may leverage the strengths of established ED treatments, and vice versa. "I am currently in an eating disorder support group… I can't really talk about my ayahuasca experiences there but it does help to kind of connect it to the eating disorder behaviour and thought process around that""Psychotherapy can be useful if it's done in the right way… it would certainly allow the [participant with an ED] to integrate the experiences of the medicine, allowing them to get in touch with the emotions bought up in the ceremony in a guided… setting that maybe feels safe for them"ACCEPTED MANUSCRIPT
As with conventional ED treatments, new approaches require extensive training accompanied by guidance and frameworks to enable the provider to create a safe environment to use and explore psychedelics with attention paid to specific ED challenges. Authors reported that providers "desire to operate from a framework of data-informed knowledge, harm reduction, and responsible engagement with psilocybin therapy to best advise their patients""
Developing ED-specific guidance and frameworks for providers may also act as a way to bridge psychedelics and conventional treatment, by teaching providers how to assess risk or plan mitigation strategies for high anxiety in psychedelic contexts. This would support the merging of conventional ED and psychedelic treatment.
The trust and relationship between the facilitator and participant are key conditions for the therapeutic potential of psychedelic sessions, reflecting the centrality of this relational context in shaping outcomes for individuals with EDs. As with any ED treatment, it is imperative that a trusting therapeutic alliance is built to support the individual in their ED recovery. Authors highlighted that trust in the provider can be the difference between a negative and positive experience and helps to "maximise potential healing and minimise risks or harm". "Feeling like the people holding space are doing it in a very adept way, yeah, thinking of everything and I don't need to, I can just relax into that and I'm safe"
The fifth meta-theme explores the subjective outcomes associated with use of psychedelics in individuals with EDs, reflecting improvement in a variety of symptom domains.
Individuals with EDs reported that psychedelics subjectively improved symptoms of comorbidities that are common in EDs, such as depression. Targeting comorbid depression in people with EDs is a promising avenue for improving ED symptoms. Here, psychedelics presented new avenues of hope, reflecting a general improvement in psychological wellbeing.
"I feel like it helped … my depression more than it helped my eating disorder, but because they're comorbid, I feel like it helped in turn"ED specific changes Individuals with EDs reported that psychedelics promoted subjective personal shifts which induced improvements in ED symptoms. Considering specific ED symptoms, the use of psychedelics promoted changes in the relationship held with food, greater awareness of hunger cues, appreciation of the body, and reduced compulsive symptoms. Authors highlighted that individuals described "notable improvements in psychological flexibility and reduced cognitive symptoms".
"I sit down and every meal I'm able to stop, to chew, to fully be mindful in my meal… I really enjoy that moment"ACCEPTED MANUSCRIPT
"Some of my compulsive symptoms had dramatically reduced""My thoughts are not obsessive"Changes in social relationships Individuals with EDs who had used ayahuasca reported that the experiential effects promoted understanding and acceptance towards family members, where they were able to perceive previous events and experiences in a different light. This appeared to encourage the repairing and rebuilding of relationships post-psychedelic use. Authors reported that individuals had "improvements in their relationships with friends and loved ones, including parents, siblings, romantic partners, and children".
The medicine was able to show me that -it really re-patterned that for me -I was able to feel that, like absorb that on a cellular level and to feel a lot of compassion for her as well".
The aim of this meta-synthesis was to synthesise previous qualitative literature pertaining to the experiences of using psychedelics for ED treatment. Using a meta-ethnography approach, findings were synthesised and reciprocally translated, to deduce five overarching meta-themes. Within this, an overarching interpretative narrative was founded, which suggests that core transformative processes ("Mind-Body-Spirit", "Emotional Processing") are embedded within specific contextual conditions ("Navigating Challenges and Risks", "Enabling Safe and Support Environments"), and must work synergistically to produce meaningful outcomes ("Therapeutic Improvements").
Spirituality reflected a recognition of the purpose of life and the individual's meaning in it, encompassing existential understanding and self-reflection. For some, this realisation provides a pathway to reconnecting with the self and appreciation of the body. This aligns with psychedelics promoting connection to the world and encouraging a transformed outlook on one's life. In contrast to the phenomenological descriptive accounts of individuals with EDs, providers offered interpretive insights into theoretical aetiological about EDs. Ayahuasca ceremony leaders highlighted the importance of spirituality in ED onset and development, which aligns with recognition of EDs and mental health as inseparable from physical, emotional, and spiritual aspects of the being in Indigenous cultures. This contrasts with biomedical approaches which tend to prioritise empirical evidence about ED aetiology. Emotional dysregulation is a transdiagnostic factor of EDs, where individuals have difficulty in accepting, experiencing, and attending to emotions. Emotional Processing and Discovering Root Causes refers to the process where insights and knowledge otherwise inaccessible or supressed, are revealed and evoke meaning for the user experiencing them. These themes align with psychedelic research in a mixed sample of EDs, felt that psilocybin enabled processing of these emotions. Here, confrontation and acceptance of emotions appeared to be linked with reuniting and reconnecting with the self. Individuals with EDs often experience their disorder as a part of their identity where the ED is integral to the self-concept; thus, reconstructing identity and valuing the authentic self as recognised central features of recovery. Shifts in personal identity and reconstructing the self are features documented in other psychedelic research within ED samples, reflecting an improved sense of connection to self-hood and moving away from the ED as a central part of identity. As the physical entity and representation of the self, body
image disturbance in EDs is often resultant from a difficulty in building the self and experiencing inner states and identity. Newfound perception of the body encompassed a reconfiguration and reconnection with the physical form of the self, where individuals reframed the body as a valued entity that needed nourishment. This aligns with other qualitative work in ED samples, where psychedelics promoted improved relationships with the body, improved perception and acceptance of the body , reduced the importance of the physical appearance, decentralising weight and shape. While definitive mechanisms of action cannot be identified from this meta-synthesis, the interpretation presented in our results suggests that reuniting and reconnecting with the self, newfound perception of the body, and emotional processing may function as psychological processes through which psychedelics exert, or contribute to, therapeutic effects including EDspecific changes, improved psychological wellbeing, and changes in social domains; this hypothesis should be investigated empirically, in larger samples to better capture both homogeneous and heterogeneous experiences across ED diagnoses. Prior research highlighted that improvements in emotion regulation had an indirect effect on improvement in ED psychopathology symptoms through improvements in self-image, highlighting emotion regulation and renewed body perception as mechanisms of change for ED outcomes. Furthermore, increases in self and identity coherence were associated with a decrease in drive for thinness and body dissatisfaction. Recognising these processes and potential mechanisms can guide clinicians in shaping preparation and integration sessions to support shifts in self-concept, body perception, and identity, and to facilitate emotional exploration and processing. The potential of the core transformative processes contributing to therapeutic improvements discussed here is dependent on the containment of the psychedelic experience within a suitable and safe set and setting (also referred to under the umbrella "context").
The themes discussed in this meta-synthesis broadly align with the set and setting framework. Sub-themes relating to internal psychological factors, such as unpredictability, expectations, and ED thoughts and behaviours map on to set. Several factors, such as unpredictability and trust, intersect both set and setting domains. This section explores these sub-themes and the set setting framework in more detail. The role of the facilitator within psychedelic treatment and the psychotherapeutic intervention they deliver is immersed within the set and setting, thus, they co-define set and setting within psychedelic sessions. As demonstrated in our sub-theme, Trust in facilitator and provider, therapeutic alliance is important for ensuring safety and enhancing treatment outcomes, with research reporting a reciprocal relationship between symptom change and therapeutic alliance. Moreover, trust in the provider of treatment is pertinent to recovery in EDsand is seen as an important characteristic of facilitators of psychedelic sessions. More broadly, the trust in the provider, partly shaped by confidence in their ethical conduct and the supervised training they receive in accordance with specialist guidelines, may also contribute to ensuring safety and mitigating risk to harm. This holds paramount importance within the psychedelic space given recent cases of abuse of patients by therapists during psychedelic therapy, and rates of individuals being or knowing a victim of inappropriate sexual contact by a guide, sitter, or practitioner during a psychedelic experience. These accounts of boundary violations are fundamentally rooted in the abuse of power held by the facilitator. It is important to highlight the complex power dynamics between the client and facilitator, which is typically imbalanced, and differs markedly between medical clinical and ceremonial use. In traditional ceremonial contexts,
ceremony leaders hold considerable authority that is spiritual, physical, and experiential. Power is firstly derived from a spiritual authority wherein the community perceives their connection to plant spirits and sacred knowledge, and their ability to mediate between human and spiritual realms. Experiential authority is derived from the personal knowledge of altered states and the ritual experience. Contrastingly, in clinics, authority and power comes from professional qualifications, ethical guidelines and protocols. Here, therapists facilitate the psychedelic experience rather than direct and participate in it. A first consideration is screening protocols that assess risk, specifically substance-specific challenges and ED-specific contraindications. Ritualistic components of Ayahuasca may further trigger ED symptoms (e.g. restriction and purging) or be particularly challenging for these individuals. In our results, for most individuals, this was experienced in a different way to an ED context, but for some, this may present an opportunity to engage with or reinforce ED behaviours. Likewise, the side effect of nausea that is reported by approximately 8-15%of participants receiving therapeutic ketamine, may contribute to loss of appetite during the dosing period.
Other criteria may include body weight. Low body weight is a physical vulnerability specific to AN, where a dangerously low body weight could increase the risk of adverse side effects of psychedelics. This concern is more pertinent for atypical psychedelic use, as classic psychedelics are not typically weight-dosed; low body weight could translate to intense acute effects in atypical psychedelics like MDMA, and ketamine overdose may result in death. However, there is evidence of preliminary safety for adequately-dosed ketamine in AN patients with low weight and medical instability. Other physical medical complications in EDs include structural and functional cardiac abnormalities, including heart rate and rhythmand in EDs with purging presentations, electrolyte abnormalities. These medical risks can exacerbate the potential for adverse effects with psychedelic use and require consistent and ongoing monitoring throughout treatment, including at dosing, such as electrocardiograms. Given the heterogeneity within individuals with EDs [100], a personalised approach should be adopted. Treatment may begin with low doses and titrate according to clinical response, measured through ongoing physiological and psychological monitoring, and preference of the individual. Additionally, dependency may be included in screening criteria. People with binge-purge type EDs (e.g., BN, BED) often experience difficulties with impulsive control and emotion regulation. Research has demonstrated higher prevalence of substance use in binge-purge presentations of EDs. Models of EDs suggest that individuals may rely on ED behaviours as a coping mechanism for underlying unmanageable emotions. Few . This is paramount given the ideology that EDs are coping mechanisms for prior interpersonal trauma and the rates of high traumatic experiences in individuals with EDs. Moreover, "bad trips" can exacerbate pre-existing, or induce new, symptoms or disorders [109, 110], or can be harnessed for therapeutic benefit. Unpredictability as a central risk of psychedelic treatment reflects how drive for control and high rates of anxiety typify EDs, mapping on to the set domain. Given the unpredictability of the acute psychedelic experience, and heightened intolerance for uncertainty in EDs, being able to prepare for and manage unpredictability, to prevent "bad trips", is pertinent to the ED population. Further, treatment that takes place in medical environments may intersect with iatrogenic harm experienced by individuals with EDs who have had repeated admissions. Giving the individual input over setting features (e.g. whether the room has a chair or a bed, lighting adjustments, volume and type of music) may promote autonomy and reduce uncertainty. These are subjective features of setting that should be adapted accordingly to patient preferences, and this customisation should be documented. The provider and individual should collaboratively agree on mitigation strategies for if, and when, anxiety arises during the acute experience (e.g. consensual therapeutic touch). Further, explaining an approximate timeline and structure of the overall treatment model and of each visit may provide some anxiety relief. Integration sessions provide a unique opportunity for psychedelic experiences to be explored, processed, and linked to the individuals ED. The therapeutic framework of integration sessions in psychedelic clinical trials has varied between studies. Provided there is synergy between the therapeutic intervention and the psychedelic to promote desired outcomes, various forms of intervention could be adapted for use in psychedelic treatment. The Yale manual for psilocybin-assisted therapy of depressionis based on the therapeutic framework of acceptance and commitment therapy (ACT), which has reasonable efficacy for improving ED symptoms. Indeed, there is opportunity for integrated care models that bridge psychedelic treatment with conventional ED treatment frameworks or modules. Our results encompassed how psychedelics and conventional ED treatments could be integrated to maintain long-term positive therapeutic outcomes, by leveraging the strengths of different treatment types. This is already seen within MDMA research, which has thus far been explored mainly for post-traumatic stress disorder (PTSD), whereby there is an addition of structured trauma-focussed psychotherapy interventions with trained psychotherapists. A similar vein should be followed for treatment of EDs, integrating modules from conventional models such as MANTRA and CBT-ED, with specifically trained providers. In addition to differences between clinical and ceremonial settings, the underlying approaches to EDs also diverge. Indigenous approaches to EDs are fundamentally holistic, placing emphasis on relational connections and spirituality. While Western models generally include social, relational, and cultural aetiological aspects of EDs, and consider some environmental influences (e.g. media influence, food insecurity), a key distinction is that Indigenous approaches extend this relational lens to include ancestry, nature, land, and spiritual connections; these are contexts that traditional psychedelic practices are grounded in. Whilst there was considerable variability in key features of the primary studies, all studies were the same in their methodological biases. Participants were self-selected, resulting in a sample that is likely not representative of the spectrum of experiences of psychedelics in the ED population, as those who experienced adverse outcomes are less likely to volunteer to take part in the primary studies. Participant selection of primary studies would also be limited to individuals with EDs who both wanted to participate and had access to psychedelic treatment. Additionally, as all eight studies were conducted in Western cultures; the findings likely fail to generalise to other cultures, where cultural background shapes interpretation and meaning-making of experiences. Qualitative findings pertaining to ayahuasca may be framed through the Western biomedical lens, whereby in turn, this synthesis is approached through the same lens. The inclusion of an Indigenous person in this meta-synthesis may have We recommend that ED-specific psychedelic manuals and protocols for psychedelics adopted from Indigenous cultures, such as ayahuasca, are codesigned with people with lived ED or psychedelic experience and people from Indigenous cultures. These collaborations may also be relevant to optimising the experiences of Western substances, such as ketamine. This The acute non-ordinary states induced by psychedelics are often described as ineffable or indescribable, where language is inadequate to convey experiences; despite this quality, attempts to describe these experiences appear to be for therapeutic benefit and can be meaningful other life force and I just feel like everything is so much more special" RenelliReuniting and reconnecting with the self "You might call that soul retrieval: bring back all of the parts of themselves they [exiled] in order to not feel pain" Williams et al"… leading to incre wholeness within t Williams et alNewfound perception of the body "I just really experienced my body as a gift… I was not honouring the gift" Lafrance et al"Respect for one's something to be ch honoured through nourishment" LafrDeep emotional processing "… you can't go anywhere, you can't hide from it… I just sat in fear or sat in sadness or sat in memories that I was trying to hide from" Renelli et al"… emphasised ab access and reproc blocked intense ne positive emotions" LukeEmotional Processing Discovering root cause "By pulling the weed out by the roots, the top of the plant just falls naturally" Williams et al"Leaders perceive ayahuasca offers i the 'root' of the ED al"Acknowledging th disappointment bu unrealistic expecta magic pill outcome appreciating its ha requires so much m just taking a drug" LukeAspects of psychedelic treatment that reinforces ED behaviours "I've seen someone use ayahuasca as an excuse for food restriction" Williams et al"Preparation for ay involves a restricte the effects of the b include a purge th vomiting, which m ED symptoms." LaWidening access to psychedelics "…often just missing one meal could re trigger ED thoughts for me" Finkelstein et al"From a pragmatic the impact that an intervention like p dosing would have Finkelstein et al [6 Bridging psychedelics and conventional treatment "I am currently in an eating disorder support group once a week… I cant really talk about my ayahuasca experiences there but it does help to kind of connect it to the eating disorder behaviour and thought process around that" Renelli et al"… conventional tr could support the ayahuasca experie or prevent relapse ayahuasca could fa receptivity to conv treatment method alTrust in facilitator and provider "… feeling nurtured and cared for, and that part of their healing came from being able to ask for and receive help in moments of vulnerability" Lafrance et al"…feeling like the holding space are very adept way, ye of everything and to, I can just relax I'm safe" Lafrance
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Andersen, K. A. A., Carhart-Harris, R. L., Nutt, D. J. et al. · Acta Psychiatrica Scandinavica (2020)
Keeler, J. L., Treasure, J., Juruena, M. F. et al. · Nutrients (2021)
Devenot, N., Seale-Feldman, A., Smith, E. et al. · Kennedy Institute of Ethics Journal (2022)
Carhart-Harris, R. L., Roseman, L., Haijen, E. C. H. M. et al. · Journal of Psychopharmacology (2018)
Calabrese, L., Scolnick, B., Zupec-Kania, B. et al. · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity (2022)
Peck, S. K., Shao, S., Grue, T. et al. · Nature Medicine (2023)
Verroust, V., Zafar, R., Spriggs, M. J. · Annales Médico-Psychologiques (2021)
Williams, M., Miller, A. K., Lafrance, A. · Eating Disorders - The Journal of Treatment & Prevention (2023)
Lafrance, A., Loizaga-Velder, A., Fletcher, J. et al. · Journal of Psychoactive Drugs (2017)
Renelli, M., Fletcher, J., Tupper, K. W. et al. · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity (2018)
Roseman, L., Haijen, E. C. H. M., Idialu-Ikato, K. et al. · Journal of Psychopharmacology (2019)
Thal, S., Engels, L. B., Bright, S. J. · Journal of Humanistic Psychology (2022)
Neil, J. C., Nutt, D. J. · Journal of Psychopharmacology (2022)
Bremler, R., Katati, N., Shergill, P. et al. · Scientific Reports (2023)
Sloshower, J., Guss, J., Krause, R. et al. · Journal of Contextual Behavioral Science (2020)