“Why would you open someone’s brain up?” Lived experience insights inform a psilocybin-assisted psychotherapy treatment manual for body image disturbance

Abstract Background: Body Image Disturbance (BID) is the distorted experience of one’s body. BID presents a risk for the onset, maintenance and relapse of body dysmorphic disorder and eating disorders, including anorexia nervosa (AN). Current treatments tend to focus on the cognitive and behavioural aspects while overlooking the perceptual symptoms and BID frequently persists beyond physical recovery. Psilocybin-assisted psychotherapy (PAP) may bridge the gap in current BID treatments by addressing perceptual and affective symptoms. This study sought to inform the development of a PAP treatment manual for BID in AN, through a co-design process informed by individuals with lived/living experience of AN. Methods: A Lived Experience Panel (LEAP) comprising six adult women who had a lived or living experience of AN and associated BID were presented with the proposed treatment protocol, including therapeutic interventions, and invited to provide feedback. An experiential, relativist framework informed reflexive thematic analysis of the LEAP data. Results: Reflexive thematic analysis of the LEAP data identified three central themes: enduring uncertainty; managing internal experience, and ambivalence in recovery. The LEAP also proposed strategies to address the challenges they identified and enhance the treatment manual more broadly. Conclusions: The LEAP identified challenges associated with intolerance of uncertainty, harm avoidance, alexithymia, and interoceptive impairment. The LEAP provided feedback that directly informed adaptations to the PAP treatment manual, including graduated interventions, the inclusion of nominated supports, and comprehensive psychoeducation for participants and their supports. Accordingly, a PAP treatment manual to treat BID for individuals with AN has been developed through lived experience co-design.