01 Nov 2018

Patient experiences of psilocybin-assisted psychotherapy

by Psillow

Most of the existing research on the therapeutic use of psilocybin among humans has focused on measuring their effects using numbers. Recognizing the limitations of these numbers-based methods, NYU researcher Alexander Besler and his team sought to gather first-hand accounts about the effects of psilocybin-assisted psychotherapy among cancer patients with anxiety.

Research on Psilocybin and Psychotherapy

In this study, the researchers interviewed 13 adult cancer patients with anxiety (ranging in age between 22 to 69 years old) about their experiences during the study, during which they received doses of psilocybin along with psychotherapy. The dual treatment method primarily aimed to help participants make meaning of their anxiety and health-related circumstances. Each interview lasted 1-1.5 hours and was audio recorded and transcribed. Research team members then analyzed the transcriptions and found several “general themes,” which nearly all of study participants (i.e., 12 or 13 participants) discussed experiencing during and after their psilocybin-assisted psychotherapy sessions:

Relational embeddedness: Participants described arriving at remarkable insights or transformations involving a significant personal relationship, including seeing loved ones (e.g., parents, romantic partner, children) in a new way. Emotional range: Participants described experiencing a wide range of complex and quickly moving emotions that were “beyond what they were able to access in their daily lives.” For instance, they described experiencing intense positive feelings of joy, bliss and falling in love, as well as intense negative and/or repressed emotions such as despair, fear, sadness, and grief. One participant shared that he had “experienced all the emotions I know how to experience,” and another said she felt, “all of them, all of them. Every possible emotion.” The role of music as conveyor of experience: A playlist of prerecorded music that matched the intensity of the psilocybin experience was played during participants’ sessions. Participants characterized the music as having been the “conduit, vehicle, or carrier” of their emotions during the psilocybin experience. Meaningful visual phenomena: Participants reported seeing colorful, complex and fantastical visions, even when their eyes were closed. For instance, some described seeing animals, such as a gorilla’s face or a two-headed cow, as well as vivid scenery, such as riding a rollercoaster in colored carts. Many ascribed deep meaning to the visual scenery they experienced. Wisdom lessons: Participants described gaining new levels of insight that transcended him/herself. Many described their revelations as an “inner” experience, and found it challenging to find the right words to explain their experiences. Revised life priorities: All participants described some degree of improvement in their lifestyles and quality of life following the psilocybin sessions. The experience led some to feel more connected with their authentic selves, while others were better able to identify and pursue the most important parts of their life (e.g., love ones, authentic existence) with greater clarity and resolve. Desire to repeat the psilocybin experience: The vast majority of participants in the study (12/13 people) said that they would participate in a psilocybin session again, either immediately or in the near future. They described their desire to participate again, even in spite of their fears or initial reservations about using psilocybin.

The researchers also identified several “typical themes,” which the majority of study participants (i.e., 7 to 11 of the participants) discussed experiencing during and after their psilocybin-assisted psychotherapy sessions:

Feelings of joy, bliss, and love

Embodiment: Participants reported seeing abstract thoughts and ideas take on physical forms during their psilocybin experience. For example, several of the cancer patients described watching the cancer physically eject from, or assimilate into, their bodies. Ineffability: Generally, participants had a hard time finding the right words to describe their experiences while on psilocybin. Many noted that their experiences could not be explained by mere words. Alterations to identity: Participants shared that they had experienced alterations to their sense of self following their psilocybin experiences. For example, one patient who struggled with emotional eating and over eating following her cancer diagnosis reported gaining the confidence to adhere to a strict diet and attend the gym regularly after her psilocybin experience, resulting in the loss of 30 lbs at follow-up. Movement from feelings of separateness to interconnectedness: Participants described feeling of sense of interconnection with other people, the entire planet, and in some cases even the universe at large. At the same time, participants acknowledged feeling like empowered individuals who had found a sense of belonging within the collective. Experiences of transient psychological distress: A few participants reported experiences of fleeting psychological or emotional struggle, such as sudden reactions of fear, confusion, panic, or paranoia. Although these feelings were described as extreme, they often went away quickly and participants were provided with support for managing these emotions. No adverse effects as a result of this study were reported. The appearance of loved ones as guiding spirits: Participants described being visited by guiding spirits – often taking the form of loved ones – who provided guidance and reassurance, and who helped them through their psilocybin experiences and existing challenges. Sharing the experience with loved ones post-treatment: Participants described how sharing aspects of their experience with loved ones allowed their relationships to become closer.

The researchers also noted a number of “variant themes,” which a few study participants (i.e., 2 to 6 of the participants) discussed experiencing during and after their psilocybin-assisted psychotherapy sessions. These themes were less commonly mentioned than the “general” and “typical themes,” but nonetheless worthy to mention as they served as significant parts of these participants’ experiences:

Catharsis of powerful emotion

Lasting changes to sense of identity: Participants noted that their experiences with psilocybin had given them greater confidence to buffer against day-to-day challenges, while also helping them to overcome personal barriers to their life goals. For example, participants mentioned “remembering” parts of themselves that they had forgotten. Synesthesia experiences: Participants described having experiences where input from one sense (e.g., visual) led to sensations in another (e.g., auditory). For example, some reported that they were able to see and taste music, or that they could physically feel sensations of the things they saw and heard. Improved relationships after treatment: Participants described how their ways of relating to other people changed after treatment, for instance: by prompting participants to make greater efforts to stay in touch with friends, by showing others how much they care, by becoming more emotionally “open,” and by gaining newfound appreciation for the time spent with loved ones. Surrender or “letting go”: Participants described feelings of “surrender” or a “letting go” of their circumstances following the psilocybin sessions. They described moving from feelings of resistance towards feelings of relief, wholeness, freedom and affirmation. Forgiveness: Therapy allowed some participants to see their loved ones in an entirely new way and with deeper clarity. In doing so, some described having transformed their negative emotions (e.g., frustration, anger, disappointment) toward important people in their lives into positive ones (e.g., acceptance, forgiveness). A continued struggle to integrate: While the vast majority of participants characterized the psilocybin experience as positive, some shared that they needed some more time to process their experiences in light of their previous histories (e.g., of past trauma).

Besler’s study provides novel, qualitative data to uncover the nature of psilocybin experiences within a group of cancer patients who had anxiety. Generally, the participants characterized their therapeutic experiences as highly positive, and most indicated that they would participate in the psilocybin sessions again either immediately or in the near future. Nonetheless, the study features a few main limitations, including the emphasis on interviewing patients about their experiences during and after the psilocybin sessions (rather than discussing the important preparatory work they may have engaged in beforehand), as well as the long 1 year follow-up interview time for some participants (during this time participants could have mixed-up or forgotten key details about their experiences).

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