Patient Experiences of Psilocybin-Assisted Psychotherapy: An Interpretative Phenomenological Analysis
Abstract
The psychological mechanisms of action involved in psilocybin-assisted psychotherapy are not yet well understood. Despite a resurgence of quantitative research regarding psilocybin, the current study is the first qualitative study of participant experiences in psilocybin-assisted psychotherapy. Semistructured interviews were carried out with 13 adult participants aged 22 to 69 years (M = 50 years) with clinically elevated anxiety associated with a cancer diagnosis. Participants received a moderate dose of psilocybin and adjunctive psychotherapy with an emphasis on the process of meaning-making. Verbatim transcribed interviews were analyzed by a five-member research team using interpretative phenomenological analysis. General themes found in all or nearly all transcripts included relational embeddedness, emotional range, the role of music as conveyor of experience, meaningful visual phenomena, wisdom lessons, revised life priorities, and a desire to repeat the psilocybin experience. Typical themes found in the majority of transcripts included the following: exalted feelings of joy, bliss, and love; embodiment; ineffability; alterations to identity; a movement from feelings of separateness to interconnectedness; experiences of transient psychological distress; the appearance of loved ones as guiding spirits; and sharing the experience with loved ones posttreatment. Variant themes found in a minority of participant transcripts include lasting changes to sense of identity, synesthesia experiences, catharsis of powerful emotion, improved relationships after treatment, surrender or “letting go,” forgiveness, and a continued struggle to integrate experience. The findings support the conclusion that psilocybin-assisted psychotherapy may provide an effective treatment for psychological distress in cancer patients. Implications for theory and treatment are discussed.
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Biographies
Alexander B. Belser, MPhil, is a fellow and adjunct instructor in the Department of Applied Psychology at New York University (NYU). He cofounded the NYU Psychedelic Research Group in 2006. He is an investigator of a qualitative study exploring how patients with cancer experience psilocybin-assisted psychotherapy. He serves as a scientific collaborator for the NYU Psilocybin Alcohol Dependence Qualitative Study, a study investigating psilocybin treatment for alcohol addiction. He is also helping conduct a qualitative study of religious leaders who are administered psilocybin. He graduated from Georgetown University, and pursued graduate studies at Cambridge University, NYU, and Columbia University. He is a member of the Research Advisory Board of Compass Pathways, a medical research foundation that supports innovation in mental health through translational research. He currently works at Mount Sinai Beth Israel Hospital, and lives in Brooklyn, New York. His website is http://alexbelser.com.
Gabrielle Agin-Liebes is completing her training toward a PhD in clinical psychology at Palo Alto University (PAU) under the joint mentorship of Matthew J. Cordova, PhD, and Josef Ruzek, PhD. She is a member of the PAU Early Intervention Clinic lab, which provides and evaluates evidence-based treatments to prevent trauma-related problems in recently traumatized individuals. As part of this research laboratory, she is examining the effects of self-compassion on trauma-related guilt cognitions and shame. She is also a practicum therapist at the Gronowski Center, a community mental health clinic, and coleads an empirically supported meditation group at Kara Grief Support Center in Palo Alto.
T. Cody Swift, MA, MFTI, received his degree in existential–phenomenological psychology from Seattle University and is currently perusing clinical licensure in California. He has worked as a guide at Johns Hopkins University in the psilocybin cancer–anxiety study, and is currently conducting qualitative research into the nature of healing with psychedelics in a clinical context, with MDMA and psilocybin. He is also a current director of the Riverstyx Foundation which has been dedicated to advancing opportunities for psychological growth and healing in the areas of end-of-life care, addiction recovery, and the criminal justice system.
Sara Terrana is a doctoral student at UCLA–Luskin, School of Public Affairs in the Department of Social Welfare. Her research interests are in nonprofit human service organizations, founders of such organizations, and neighborhoods of concentrated disadvantage; she also specializes in qualitative methodology and advanced CAQDAS (computer-assisted qualitative data analysis software) technologies.
Neşe Devenot, PhD, graduated from the University of Pennsylvania in 2015 with a doctorate in comparative literature, and she currently serves as Andrew W. Mellon Postdoctoral Fellow in Digital Humanities at the University of Puget Sound in Tacoma, WA. She was a 2015-2016 Research Fellow at the New York Public Library’s Timothy Leary Papers, and she was awarded Best Humanities Publication in Psychedelic Studies from Breaking Convention in 2016. Her research explores the function of metaphor and other literary devices in verbal accounts of psychedelic experiences.
Harris L. Friedman, PhD, is retired research professor of psychology at University of Florida, and is professor emeritus of Humanistic and Transpersonal Psychology at Saybrook University and Distinguished Professor of Integral and Transpersonal Psychology at the California Institute of Integral Studies. He now teaches at Goddard College, supervises dissertations at several universities, and also practices as a clinical psychologist and organizational consultant. He has written extensively on transpersonal assessment and psychotherapy, as well as on culture and change. He is a prolific author with over 200 professional publications, and his recent books, with other authors/editors, include Transcultural Competence (American Psychological Association, 2015), The Praeger Handbook of Social Justice and Psychology (three volumes; 2014), and The Wiley-Blackwell Handbook of Transpersonal Psychology (2013). He serves as the associate editor of Humanistic Psychologist and the senior editor of the International Journal of Transpersonal Studies.
Jeffrey Guss, MD, is a psychiatrist, psychoanalyst, and researcher with specializations in psychoanalytic therapy and the treatment of substance use disorders. He is coprincipal investigator and director of Therapist Training for the NYU School of Medicine’s study on psilocybin-assisted psychotherapy in the treatment of cancer-related existential distress. He is interested in the integration of psychedelic therapies with contemporary psychoanalytic theory and has published in Studies in Gender and Sexuality and Psychoanalysis, Culture & Society. He is an instructor and mentor with the California Institute of Integral Studies’ Center for Psychedelic Therapies and maintains a full-time private practice.
Anthony Bossis, PhD, is a clinical assistant professor of psychiatry at New York University School of Medicine and a founding member of the NYU Psilocybin Research Group, which in 2009 began FDA-approved scientific research into the therapeutic efficacy of psilocybin, a naturally occurring psychedelic compound found in specific species of mushrooms. He was director of Palliative Care Research, coprincipal investigator, and psilocybin session guide for the NYU clinical trial investigating the efficacy of a psilocybin-generated mystical experience on the existential and psychospiritual distress in persons with cancer. Subjective features of a mystical experience include unity, sacredness, transcendence, and a greater connection to deeply felt positive emotions including that of love. The study results were published in the Journal of Psychopharmacology in December 2016. He is a clinical supervisor of psychotherapy training and cofounder and former codirector of the Palliative Care Service at Bellevue Hospital. He has a long-standing interest in comparative religion, consciousness research, and the interface of psychology and spirituality. He maintains a private consulting and psychotherapy practice in New York City.
Stephen Ross, MD, is associate professor of Psychiatry and Child and Adolescent Psychiatry at the New York University (NYU) School of Medicine and associate professor of oral and maxillofacial pathology, radiology, and medicine at the NYU College of Dentistry. He is the director of the Division of Alcoholism and Drug Abuse in the Psychiatry Department at Bellevue Hospital Center, director of Addiction Psychiatry at NYU Langone Medical Center/Tisch Hospital, and the director of the NYU Addiction Fellowship. He directs an NIH-funded Addictive Disorders Laboratory at Bellevue Hospital Center and is the director of the NYU Psychedelic Research Group. He researches the therapeutic application of hallucinogen treatment models to treat psychiatric and addictive disorders. He is an expert in psycho-oncology and is studying novel pharmacologic–psychosocial approaches to treating psychological distress associated with advanced or terminal cancer. He is the principal investigator (PI) of the NYU Psilocybin Cancer Project (a recently completed FDA phase II RCT studying the efficacy of psilocybin-assisted psychotherapy in patients with life-threatening cancer and psychological/existential distress), PI of a controlled trial administering psilocybin to religious professionals, and co-PI of a controlled trial assessing psilocybin-assisted psychotherapy in patients with alcoholism. He receives his research funding from the National Institute on Drug Abuse (NIDA), the NYU School of Medicine and the Heffter Research Institute.
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Article first published online: April 28, 2017
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