Research into the healing potential of psychedelic-assisted therapies have largely focused on the treatment of a single client by a single therapist. But the costs associated with that kind of one-to-one therapy can be prohibitively high for many people, while the small number of therapists trained in using psychedelics further limits who will be able to receive treatment.
Now a recent study suggests that psychedelic-assisted group therapy using psilocybin, the psychoactive ingredient in magic mushrooms, offers a cost effective alternative for delivering psychotherapy, pre- and post-psilocybin, to patients.
Published in The Lancet’s EClinicalMedicine, the study was conducted by a team of researchers from the University of California at San Francisco. It investigates the benefits for pallative care patients by selecting 18 gay-identifying males in the San Francisco Bay area, aged 50 to 66, diagnosed with HIV/AIDS and suffering from “demoralization,” to receive treatment in two separate cohorts. Each subject completed three hours of individual psychotherapy at the onset, followed by 90-minute group therapy sessions occurring twice a week for three weeks, in preparation for one eight-hour psilocybin administration. Afterwards subjects took part in an additional two or three weeks of group therapy sessions, and then were assessed after three months.
At the end of treatment, 88.9% and 66.7% of participants of the two respective cohorts saw a “clinically meaningful change in demoralization.” There was also significant improvement of symptoms relating to post-traumatic stress disorder (PTSD) and complicated grief. The group sessions included mindfulness practices at the opening and closing of meetings.
Funding for the program came from Heffter Research Institute, River Styx Foundation, Usona Institute, and the U.S. Department of Veterans Affairs, among other sources.
What they found to be essential to successful outcomes in treating chronic depression with psilocybin was the ability to build trust, rapport, and pathways to connection for patients within a group environment.
For clinicians, healers, or those otherwise familiar with plant medicines, this might not seem like a news flash. People have been taking mind altering substances in group settings for millennia. In ayahuasca ceremonies a shaman typically hosts eight to twenty people on a journey, with one to two helpers for support throughout the experience.
Yet today in clinical trials, MDMA and psilocybin are administered almost exclusively in 1:1 or 1:2 sessions. So how is it that clinical studies of psilocybin-assisted therapies have not integrated or mimicked a group therapeutic setting?
Brian Anderson, lead author of the study, says that psychedelic studies in the 1960s and 1970s suggested the importance of patients spending time within a group, but that approach had not attracted interest until now. Following on previous research into group therapy for those in palliative care or with life threatening conditions, the UCSF team of researchers sought to apply psilocybin-assisted treatments to patients they saw on a daily basis.
“As we spoke to more HIV/AIDS survivors we identified a real desire to find new treatments. The isolation, lack of meaning, and chronic coping is something that this community has been struggling with for a long time,” says Anderson.
The study’s findings support the conclusion that psilocybin’s therapeutic ability is enhanced by people connecting to each other as part of the process, and specifically connecting with others who experience a similar treatment or condition.
Julie Holland, psychotherapist and author of Good Chemistry and the Science of Connection, offers an explanation for the value of psilocybin as part of therapy. “Used in the right setting, psychedelics seem to be lighting a path out of chronic loneliness and towards connectedness. Psychedelics can enable not just a connection with the self, they can also offer us a glimpse of the bigger picture, how we are part of the cosmos, and how we are all interconnected and reliant on one another for survival.”
According to Holland, when we are able to shift from a state of isolation and disconnection to a shared experience, we are actually taking steps to combat depressive tendencies. When we facilitate a state of human connection with an experience that feels larger than ourselves, we have the ability to create new behavioral patterns and generate greater cognitive flexibility. The difference between psychedelics and existing pharmaceutical options for reducing pain and depression – such as SRRIs or opioids, for example – is that “these drugs aren’t intended to help people connect; they’re designed to help you not mind that you’re disconnected. Opiates mimic the body’s response to feeling cared for,” says Holland.
Initially, a number of participants in the study had reservations about participating in the clinical trial because they didn’t want to share intimate personal information with people they didn’t know. But Anderson and the team of researchers found that the same participants who first expressed hesitation, later credited the positive emotional support they received from the group. A number of participants struggling with longstanding issues of shame, trauma and abuse found relief and support through speaking with their peers and experienced major positive shifts in perspective.
Anderson explains, “It’s so important to build trust and rapport before patients undergo treatment, it can help facilitate the medicine and allow them to open up. It seems that working with our population that there is a common issue with trust around provider care. This is particularly important to remember when working with long term survivors and to be aware of their needs to adjust [treatments] to be patient centered.”
Holland notes the parallels between chronic depression as seen in palliative care and the growing mental health crisis in response to Covid-19. The symptoms are eerily similar – a lack of connection, isolation, lack of life purpose or meaning, feelings of grief or loss – and lessons can be drawn from studies that explore modernized approaches to mental care which offer cost-saving alternatives to long-term prescription medications.
As Holland puts it, psychedelic-assisted therapy is a paradigm shift; it’s the new “disruptive technology” in the field of psychiatry. While trials and further research are underway, initial results suggest cost-savings and unique opportunities to address the heightened need for human connection and community support through group psilocybin-assisted psychotherapy.