Psilocybin-assisted group therapy: A new hope for demoralization

Anderson et al.’s [[1]Anderson B.T. Danforth A. Daroff R. Stauffer C. Ekman E. Agin-Liebes G. et al.Psilocybin-facilitated group therapy for demoralized older long-term AIDS survivor men: an open-label safety and feasibility pilot study.Eclinical Med. 2020; https://doi.org/10.1016/j.eclinm.2020.100538Summary Full Text Full Text PDF Scopus (74) Google Scholar] open-label pilot study of psilocybin-assisted group therapy for demoralization among older long-term AIDS survivor (OLTAS) men is innovative and courageous. It is innovative in applying a group therapy paradigm not previously used in contemporary clinical studies of classic psychedelics. This is important because psilocybin- and other classic psychedelic-assisted treatments are typically time-intensive, involving several lengthy individual pre-drug preparatory sessions and post-drug integration sessions, raising concerns about scalability in real-world settings. The use of group therapy with classic psychedelics, though uncommon, is consistent with the anthropology of these compounds [[2]Schultes R.E. Hallucinogens of plant origin.Science. 1969; 163: 245-254Crossref PubMed Google Scholar], and may well increase the likelihood of implementing such interventions in clinical practice should they continue to prove safe and effective. Furthermore, considering the unique and ineffable nature of transcendent experiences occasioned by classic psychedelics [[3]Hendricks P.S. Awe: a putative mechanism underlying the effects of classic psychedelic-assisted psychotherapy.Int Rev Psychiatry. 2018; 30: 331-342Crossref PubMed Scopus (63) Google Scholar,[4]Johnson M.W. Hendricks P.S. Barrett F.S. Griffiths R.R. Classic psychedelics: an integrative review of epidemiology, therapeutics, mystical experience, and brain network function.Pharmacol Ther. 2019; 197: 83-102Crossref PubMed Scopus (189) Google Scholar], group therapy may provide an optimal outlet for making meaning of such experiences, and critically, translating them to adaptive changes in behavior. Though comparing the effectiveness of group vs. individual therapy in this context is an objective for future research, it is nonetheless made possible by Anderson et al.’s [[1]Anderson B.T. Danforth A. Daroff R. Stauffer C. Ekman E. Agin-Liebes G. et al.Psilocybin-facilitated group therapy for demoralized older long-term AIDS survivor men: an open-label safety and feasibility pilot study.Eclinical Med. 2020; https://doi.org/10.1016/j.eclinm.2020.100538Summary Full Text Full Text PDF Scopus (74) Google Scholar] trailblazing work. Anderson et al.’s [[1]Anderson B.T. Danforth A. Daroff R. Stauffer C. Ekman E. Agin-Liebes G. et al.Psilocybin-facilitated group therapy for demoralized older long-term AIDS survivor men: an open-label safety and feasibility pilot study.Eclinical Med. 2020; https://doi.org/10.1016/j.eclinm.2020.100538Summary Full Text Full Text PDF Scopus (74) Google Scholar] study is courageous in its focus on OLTAS men, a marginalized population diagnosed with HIV/AIDS at a time when HIV/AIDS was considered a terminal diagnosis. OLTAS men endured unprecedented and devastating loss of loved ones, and consequently, demoralization-a sense of helplessness, hopelessness, and a loss of meaning in life-is a pervasive clinical concern. Anderson et al. [[1]Anderson B.T. Danforth A. Daroff R. Stauffer C. Ekman E. Agin-Liebes G. et al.Psilocybin-facilitated group therapy for demoralized older long-term AIDS survivor men: an open-label safety and feasibility pilot study.Eclinical Med. 2020; https://doi.org/10.1016/j.eclinm.2020.100538Summary Full Text Full Text PDF Scopus (74) Google Scholar] thus targeted a significant and difficult-to-treat problem with current demoralization-focused psychotherapies demonstrating limited effectiveness. Moreover, 50% of their sample met criteria for a comorbid mental health condition including generalized anxiety disorder, panic disorder, and borderline personality disorder. As psilocybin can produce acute anxiety/fear/panic, dysphoria, and confusion [[4]Johnson M.W. Hendricks P.S. Barrett F.S. Griffiths R.R. Classic psychedelics: an integrative review of epidemiology, therapeutics, mystical experience, and brain network function.Pharmacol Ther. 2019; 197: 83-102Crossref PubMed Scopus (189) Google Scholar], the administration of psilocybin to a group of individuals predisposed to these difficult experiences undoubtedly presented many challenges. These challenges were unquestionably amplified by the Schedule I status of psilocybin and the heightened political lens surrounding its clinical application. Still, despite these challenges, Anderson et al. [[1]Anderson B.T. Danforth A. Daroff R. Stauffer C. Ekman E. Agin-Liebes G. et al.Psilocybin-facilitated group therapy for demoralized older long-term AIDS survivor men: an open-label safety and feasibility pilot study.Eclinical Med. 2020; https://doi.org/10.1016/j.eclinm.2020.100538Summary Full Text Full Text PDF Scopus (74) Google Scholar] demonstrated the feasibility, safety, and potential efficacy of psilocybin-assisted group therapy for an underserved and vulnerable population. Of course, as with any open-label pilot study, Anderson et al.’s [[1]Anderson B.T. Danforth A. Daroff R. Stauffer C. Ekman E. Agin-Liebes G. et al.Psilocybin-facilitated group therapy for demoralized older long-term AIDS survivor men: an open-label safety and feasibility pilot study.Eclinical Med. 2020; https://doi.org/10.1016/j.eclinm.2020.100538Summary Full Text Full Text PDF Scopus (74) Google Scholar] findings are not conclusive. Future randomized placebo-controlled trials with larger samples are required to more definitively inform the safety and effectiveness of psilocybin-assisted group therapy for OLTAS men. Nevertheless, Anderson et al.’s [[1]Anderson B.T. Danforth A. Daroff R. Stauffer C. Ekman E. Agin-Liebes G. et al.Psilocybin-facilitated group therapy for demoralized older long-term AIDS survivor men: an open-label safety and feasibility pilot study.Eclinical Med. 2020; https://doi.org/10.1016/j.eclinm.2020.100538Summary Full Text Full Text PDF Scopus (74) Google Scholar] findings open the door to future investigations testing psilocybin-assisted group therapy in other populations confronted with demoralization, including those with chronic pain, obesity, substance use disorders, and the elderly, among others [5Robinson S. Kissane D.W. Brooker J. Burney S. A review of the construct of demoralization: history, definitions, and future directions for palliative care.Am J Hosp Palliat Care. 2016; 33: 93-101Crossref PubMed Scopus (62) Google Scholar, 6Tecuta L. Tomba E. Grandi S. Fava G.A. Demoralization: a systematic review on its clinical characterization.Psychol Med. 2015; 45: 673-691Crossref PubMed Scopus (99) Google Scholar, 7Hendricks P.S. Grob C.S. Classic psychedelics and rational suicide in the elderly: exploring the potential utility of a reemerging treatment paradigm.in: McCue R. Balasubramaniam M. Rational suicide in the elderly. Springer International Publishing, Cham, Switzerland2017Crossref Google Scholar]. PSH is on the scientific advisory board of Bright Minds Biosciences Ltd. and Silo Pharma Inc. Psilocybin-assisted group therapy for demoralized older long-term AIDS survivor men: An open-label safety and feasibility pilot studyWe demonstrated the feasibility, relative safety, and potential efficacy of psilocybin-assisted group therapy for demoralization in OLTAS. Groups may be an effective and efficient means of delivering psychotherapy pre- and post-psilocybin to patients with complex medical and psychiatric needs. Full-Text PDF Open Access