In just a few short years, psychedelic-assisted therapy involving controlled substances like ketamine, MDMA, and psilocybin (the psychoactive compound found in “magic mushrooms”) have evolved from relative obscurity to the far edges of mainstream medical acceptance. Clinical studies have shown that their medical use can have positive effects for patients living with depression and post-traumatic stress disorder. Sometimes, these treatments prove effective where other, more widely-prescribed medications fall short. But new research suggests close bonds with a trained therapist is a key element contributing to effective psychedelic-assisted treatment, specifically psilocybin.
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A surge in interest in therapeutic use of psychedelics has fostered a burgeoning industry of startups specializing in treatments. As of today, according to the psychedelics industry tracker Psilocybin Alpha, more than 50 publicly traded companies currently offer psychedelic therapy (mostly ketamine) and psychedelic retreats. Yet, the exact ways these companies administer psychedelics can vary widely. While some require patients to consume or inject the substance in the presence of a trained clinician, others lean on loose, pandemic-era health regulations to let patients take the medication at home, typically as pills and lozenges. The latter method can carry risks. In some cases, the Federal Drug Administration, which has yet to approve psychedelic drugs for therapy, claims it has received reports of patients experiencing adverse health effects after they’ve taken medically prescribed ketamine at home without a clinician’s supervision. There are currently no legal at-home psilocybin treatments available however individuals in Oregon were able to begin accessing the compound without a prescription last year.
A new study published in the journal PLOS ONE this week suggests that strong relationships between patients and their therapists could play a crucial role determining whether or not psychedelic-assisted therapy can prove useful as treatments for depression. The study, which analyzed a 2021 clinical study involving 24 patients using psilocybin-assisted therapy to treat severe depression, found that participants with stronger self-reported connections with their therapist were more likely to report a decrease in depression over time.
In other words, the efficacy of psilocybin treatment increases over the long-term when a patient feels more connected to their clinician. The clinician provides hours or preparation and also guides the patient through the experience and dissects it days and weeks later. Findings like these could help influence treatment standards for psychedelic-assisted therapy treatments, especially as the practice gains more widespread clinical acceptance and adoption.
Patients with stronger connections to their therapists reported better results
Researchers from Ohio State University examined data from a 2021 clinical trial where 24 adults seeking treatment for severe depression received two doses of psilocybin paired with 11 hours of psychotherapy. Patients completed survey questionnaires where they assessed the strength of the relationship with their therapists, which the researchers refer to as their “therapeutic alliance.” The patients also noted down any mystical or insightful psychological experience they had during the treatment. Researchers say at times these experiences tend to yield positive therapeutic outcomes, particularly in the short and medium term. In this case, these experiences led to positive outcomes around four-weeks after introducing the psilocybin into treatment.
Having higher alliance scores, or stronger relationships with therapists, was linked to longer-term psychological insights. A year after the treatments, patients who reported strong connections with their therapist also significantly had lower self-reported depression scores one year after treatment compared to those with weaker relationships. The research is based on previous studies showing that a strong therapeutic alliance between a therapist and a patient often leads to a more effective outcome following therapy. This new study suggests that those same basic findings similarly apply to psychedelic-assisted therapy.
“This idea is not new. What is new is that very few people have explored this idea as part of psychedelic-assisted therapy,” stated paper senior author and Center for Psychedelic Drug Research and Education associate professor Alan Davis. “This data suggests that psychedelic-assisted therapy depends heavily on the therapeutic alliance, just like any other treatment.”
The findings also confirm the impact of a patient’s environment and mindset, known as “set and setting,” on influencing positive experiences. In this case, hours of preparatory psychotherapy before giving psilocybin, along with “supportive, no direct” therapy during the actual psychedelic experience, were significant factors contributing to the drug’s overall effectiveness. Patients who were more at ease with their clinician may be more open to the therapy.
“That’s why I believe the relationship has been shown to be influential in this analysis–because, really, the whole intervention is designed for us to establish the trust and rapport needed for someone to enter an alternative consciousness safely,” added Davis.
The study’s findings come at a pivotal time for psychedelic-assisted therapy research and treatment in the US. Despite still being classified as a Schedule 1 drug nationally, various cities including Denver, Oakland, and Washington have decriminalized psilocybin. On the medical front, the FDA in 2019 approved the use of a nasal spray called Spravato, which utilizes a derivative of ketamine, for treating depression. Just last year, the FDA released its first-ever draft guidance outlining considerations for researchers wishing to conduct clinical trials for psychedelic treatments. An MDMA therapy from the MAPS Public Benefit Corporation could reportedly receive FDA approval by the end of the year.
Ohio State University College of Medicine resident and paper lead author Adam Levin notes that his and his fellow researchers’ findings could emphasize the importance of maintaining strong connections between patients and physicians, especially with treatments poised to gain wider adoption in the coming years. Levin, and others critical of attempts to rush out access to psychedelic drugs without proper therapeutic support, caution that such an approach could lead to unintended consequences and even set back efforts to make psychedelic-assisted therapy more widely available.
“We are worried that reducing therapeutic support could cause safety issues or negative effects,” Levin said. “What we demonstrated in this research provides proof of how important the connection between the patient and the therapist is not only for preventing such incidents, but also for improving treatment results.”
