Psilocybin-Assisted Group Therapy and Attachment: Observed Reduction in Attachment Anxiety and Influences of Attachment Insecurity on the Psilocybin Experience

Abstract

Attachment insecurity is determined early in life, is a risk factor for psychopathology, and can be measured on two separate continuous dimensions: attachment anxiety and attachment avoidance. Therapeutic changes toward more secure attachment correlate with reduction in psychiatric symptoms. Psilocybin-assisted psychotherapy has demonstrated promise in the treatment of psychopathology, such as treatment-resistant depression and substance use disorders. We hypothesized that psilocybin-assisted psychotherapy would reduce attachment anxiety and attachment avoidance, thus increasing attachment security. We also hypothesized that baseline measures of attachment insecurity, which can reflect a diminished capacity for trust and exploration, would inform the quality of the psilocybin session. Participants were male long-term AIDS survivors with moderate-severe demoralization (n = 18). Using the Experiences in Close Relationships scale, we measured attachment insecurity at baseline as well as immediately, and 3 months, after completion of a brief group therapy course, which included a single midtreatment open-label psilocybin session conducted individually. Clinically important aspects of the psilocybin session were assessed using the revised Mystical Experience Questionnaire and the Challenging Experience Questionnaire the day following psilocybin administration. Self-reported ratings of attachment anxiety decreased significantly from baseline to 3-months post-intervention, t(16) = −2.2; p = 0.045; d rm = 0.45; 95% CI 0.01, 0.87. Attachment avoidance did not change significantly. Baseline attachment anxiety was strongly correlated with psilocybin-occasioned mystical-type experiences, r(15) = 0.53, p = 0.029, and baseline attachment avoidance was strongly correlated with psilocybin-related challenging experiences, r(16) = 0.62, p = 0.006. These findings have important implications for the general treatment of psychopathology as well as optimizing psilocybin-assisted psychotherapy as a broadly applicable treatment modality.

Therapeutic Alliance and Rapport Modulate Responses to Psilocybin Assisted Therapy for Depression

“…A link between early relational experiences and depression is well established, with attachment difficulties suggested to partially mediate the relationship between early interpersonal trauma and depression ( Fowler et al, 2013 ). Recent research examining the relationship between insecure attachment styles and responses to individual psilocybin therapy sessions with group preparation and integrative group therapy sessions ( Stauffer et al, 2021 ), found that high attachment avoidance was associated with more intensely challenging psychedelic experiences, whereas high attachment anxiety was associated with higher levels of mystical experience in the psilocybin sessions. Furthermore, attachment anxiety was significantly reduced by the trial endpoint.…”

“…What might look like a participant resisting the experience or not responding to psychedelics might just be a different kind of psychedelic experience. Further research is needed to better understand the quality of the psychedelic experience in cases of a weaker therapeutic alliance, e.g., is it associated with more challenging experiences ( Stauffer et al, 2021 ), amplified psychological defences or intensified transference ( Grof, 2008 )? Moreover, how might these experiences be best supported and worked with therapeutically?…”

Psychedelic Therapy's Transdiagnostic Effects: A Research Domain Criteria (RDoC) Perspective

“…Some of the potential therapeutic subjective experiences induced by psychedelics involve the transition from experiential (151,152) and emotional (88) avoidance to acceptance. Interestingly, attachment avoidance at baseline may be linked with psilocybin-related challenging experiences (153). Similarly, high neuroticism has been associated with unpleasant/anxious reactions in 3,4ethylenedioxymethamphetamine (MDMA) therapy (154).…”

Psychedelic experience dose-dependently modulated by cannabis: results of a prospective online survey

“…The total MEQ score was calculated as the average of all 30 items and multiplied by 20 to provide a value in a 0-100 range (MacLean et al 2012). The MEQ was previously used in both non-clinical (Haijen et al 2018;Roseman et al 2019;Kettner et al 2021) and clinical work (Barrett et al 2015;Liechti et al 2017;Schmid et al 2021;Stenbaek et al 2021;Stauffer et al 2021).…”