Can we predict who will benefit from psychedelic therapy?
With research and the number of clinical trials speeding up, strengthening the evidence that psychedelics have a beneficial role in treating mental health conditions, some thought will need to be considered in identifying who will best benefit from this treatment.
Whilst precision medicine has become a focus in other fields of medicine, particularly with cancer treatments, precision psychiatry is still in its nascent. This may be linked with still an incomplete understanding and appreciation of the complexity surrounding why certain individuals
develop mental health challenges. For example, as it stands with regards to treatments for depression, research to date does not identify any biologic or genetic predictors of sufficient clinical utility to inform the choice between medication and psychotherapy, the selection of specific medication, or the selection of specific psychotherapy. While individuals vary widely in response to specific depression treatments, unfortunately, this variability remains largely unpredictable
But for psychiatry to progress, and to improve the response rate to different treatments ( for example 1 in 3 individuals remain resistant to treatment with 2 different types of anti-depressants) we do need to focus on who will best benefit from the treatments. In the case of psychedelics, as different drug compounds are being developed, we may need to consider who will benefit from which treatment paradigm.
What we know so far
So far, the most prominent study exploring personality traits and other factors ( outside those related to human physiology) that may affect the psychedelic experience was conducted by Robin Carhaart Harris’ team at Imperial College London(1).
What did they do
Their study collected data from individuals who planned to take psychedelics on their own initiative. These individuals agreed to participate in an online survey ( psychedelic survey.com) at 5 different time periods before and after the experience. They were able to collect data from 212-654 participants across different time points before and up to 4 weeks after a dose.
What they found
Participants experiencing a ‘mystical type' experience was predictive of positive long term outcomes on wellbeing.
Those reporting the experience as ‘challenging’ appeared to have in general a negative impact on their wellbeing after the experience ( previous research has suggested contradictory findings) (2)
It is unclear whether challenging experiences have a negative or positive effect on supporting an emotional breakthrough or simply causing the emotional struggle.
Baseline personality traits overall appeared to have the biggest influence on the change in wellbeing after the experience.
Openness to experience before dosing was more likely to have improved wellbeing scores post dose.
Individuals who intended on having a psychedelic experience to connect with nature, have a spiritual experience and for health-related benefits tended to have an overall improvement in wellbeing
Baseline trait Predictors of a mystical experience
‘Absorption’ defined as being able to immerse in certain experiences
Clear intentions prior to the experience
Baseline Trait predictors for a increasing/decreasing chance of a Challenging Experience
Feeling well prepared and ready for the experience had a protective effect against having a challenging experience
Feeling comfortable with the environment and people present during the session were associated with less challenging experiences.
Absorption also appears to also intensify the challenging experience
Why is this important
Identifying key factors that influence the response to psychedelic therapy will allow us in the future to identify:
Who to recommend psychedelic therapy treatment
When to deliver treatment
How to dose to deliver a therapeutically beneficial psychedelic experience
The next steps
Here are a few things to think about in terms of where future research on psychedelic therapy should consider exploring:
Are there other factors/ combination of factors that may predict acute and long term responses of individuals to psychedelics
Do the factors above relate to psychedelic assisted therapy ( where setting and set can be better controlled for)
How do factors such as sleep, caffeine, and state of relaxation prior to administration affect response?
Are there other markers that may play a stronger role in influencing long term effects of the treatments? Blood based markers? Genetic markers?
How do we incorporate the findings above in the clinical setting? What adaptations can be made to clinical environment to enhance chance of mystical experience ( e.g. scope of music)
Are the factors different for different psychedelic compounds?
References
(1) Predicting Responses to Psychedelics: A Prospective Study Front. Pharmacol., 02 November 2018 https://doi.org/10.3389/fphar.2018.00897
(2)Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S., MacLean, K. A., Jesse, R., Johnson, M. W., et al. (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: acute and enduring positive and negative consequences. J. Psychopharmacol. 30, 1268–1278. doi: 10.1177/0269881116662634