Psychedelics for Psychological and Existential Distress in Palliative and Cancer Care

Rosenbaum, Daniel; Boyle, A. B.; Rosenblum, Amanda M.; Ziai, Setareh; Chasen, Martin

doi:10.3747/co.26.5009

Cited by 15 publications

(8 citation statements)

References 18 publications

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“…Pilot trials with ketamine [ 17 – 19 ] and MDMA [ 20 ] suggest similar reductions in distress associated with LTI. While the evidence base still awaits larger confirmatory trials, these encouraging phase 2 results have brought discussions of psychedelic medicine into mainstream circles [ 21 , 22 ] and generated proponents within palliative care [ 23 , 24 ]. At the same time, stigma around psychedelics persists [ 25 ] despite their benign safety profile compared to similarly classified controlled substances [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Palliative care provider attitudes toward existential distress and treatment with psychedelic-assisted therapies

et al. 2021

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Background Existential distress is a significant source of suffering for patients facing life-threatening illness. Psychedelic-Assisted Therapies (PAT) are novel treatments that have shown promise in treating existential distress, but openness to providing PAT may be limited by stigma surrounding psychedelics and the paucity of education regarding their medical use. How PAT might be integrated into existing treatments for existential distress within palliative care remains underexplored. Methods The present study aimed to elucidate the attitudes of palliative care clinicians regarding treatments for existential distress, including PAT. We recruited palliative care physicians, advanced practice nurses, and spiritual and psychological care providers from multiple US sites using purposive and snowball sampling methods. Attitudes toward PAT were unknown prior to study involvement. Semi-structured interviews targeted at current approaches to existential distress and attitudes toward PAT were analyzed for thematic content. Results Nineteen respondents (seven physicians, four advanced practice nurses, four chaplains, three social workers, and one psychologist) were interviewed. Identified themes were 1) Existential distress is a common experience that is frequently insufficiently treated within the current treatment framework; 2) Palliative care providers ultimately see existential distress as a psychosocial-spiritual problem that evades medicalized approaches; 3) Palliative care providers believe PAT hold promise for treating existential distress but that a stronger evidence base is needed; 4) Because PAT do not currently fit existing models of existential distress treatment, barriers remain. Conclusions PAT is seen as a potentially powerful tool to treat refractory existential distress. Larger clinical trials and educational outreach are needed to clarify treatment targets and address safety concerns. Further work to adapt PAT to palliative care settings should emphasize collaboration with spiritual care as well as mental health providers and seek to address unresolved concerns about equitable access.

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Section: Introductionmentioning

confidence: 99%

Palliative care provider attitudes toward existential distress and treatment with psychedelic-assisted therapies

et al. 2021

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“…However, they do not address important existential domains of distress, such as lack of meaning and dignity, death anxiety, and coping with overwhelming changes. Since all psychedelics exert effects rapidly and are known to induce mystical-type, peak, or transcendental effects that are correlated with therapeutic outcomes (Dore et al, 2019;Johnson et al, 2019;Barrett and Griffiths, 2018), these treatments may be especially helpful in the context of existential distress (Rosenbaum et al, 2019). Furthermore, psychedelic treatment may be a suitable option in palliative care given the importance that is placed upon existential and spiritual themes.…”

Section: Discussionmentioning

confidence: 99%

“…These therapies yield significant but time-limited (up to 3 months) positive effects on existential well-being, hope, and self-reliance, but no effects on depression and anxiety. Hence, there is a serious need for effective interventions with a sustained effect on existential distress, depression, and anxiety in patients with an incurable illness (Rosenbaum et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: a systematic review

Schimmel¹,

Breeksema²,

Smith-Apeldoorn³

et al. 2021

Psychopharmacology

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Background Terminally ill patients may experience existential distress, depression, or anxiety, limiting quality of life in the final stage. Existing psychotherapeutic or pharmacological interventions have (time) limited efficacy. Psychedelic treatment may be a safe and effective alternative treatment option. Aim Systematically review studies on psychedelic treatment with and without psychotherapy for existential distress, depression, and anxiety in terminally ill patients. Methods Medline, PsycINFO, and Embase were searched for original-data studies on the treatment of depression, anxiety, and existential distress with classical or a-typical psychedelics in patients with a terminal illness, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results A total of 1850 records were screened, and 33 articles were included in this review: 14 studies on classical psychedelics (DPT, LSD, and psilocybin) and 19 studies on atypical psychedelics (MDMA and ketamine). Results of early pre-post studies are promising but have serious methodological flaws. Recent (controlled) trials with LSD, psilocybin, ketamine, and MDMA are of higher methodological quality and indicate positive effects on existential and spiritual well-being, quality of life, acceptance, and reduction of anxiety and depression with few adverse and no serious adverse effects. Conclusions Both classical and a-typical psychedelics are promising treatment options in patients with terminal illness. To draw final conclusions on effectiveness and safety of psychedelics, we need larger high-quality studies for classical psychedelics and MDMA. Ketamine studies should pay more attention to existential dimensions of well-being and the psychotherapeutic context of the treatment.

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“…The pharmacological approaches used to manage dying persons' ES are considered controversial. Although the use of psilocybin has been shown to mitigate dying persons' ES and produce salutary effects that persist after the patient has stopped taking the therapy, the research is still in its early stages, and researchers have noted that a historical stigma remains with psychedelic-assisted therapy [25]. Moreover, study participants from the Ross et al [17] study also received psychotherapy, and it is therefore not possible to separate the effects of psilocybin from those of the psychotherapeutic sessions.…”

Section: Around Them Heidary Et Al [4 ▪mentioning

confidence: 99%

Current practices in managing end-of-life existential suffering

Risio

Thompson

2023

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review Within the context of palliative care, existential suffering (ES) can be an exclusive source of suffering or intertwined with physical pain and/or psychological and spiritual suffering. With newly emerging modalities for addressing this phenomenon and its increasing salience given that many patients cite ES as a significant contributing factor to requests for hastened death, a review of recent interventions for addressing ES at the end of life is timely. Recent findings This review of newer approaches to dealing with ES in the palliative context suggests some promising new modalities and pharmacological interventions, such as brain stimulation and the use of psychedelics. The use of other pharmacological interventions, such as palliative sedation and lethal injections, solely for the alleviation of existential distress remains ethically controversial and difficult to disentangle from other forms of suffering, not least because a clear clinical definition of ES has yet to emerge in the literature. Summary The evaluation of end-of-life (EOL) ES mitigating tools should also consider how broader contexts, such as institutional arrangements and barriers, and cultural factors may influence the optimal management of dying persons’ ES in the palliative care setting.

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Psychedelics for Psychological and Existential Distress in Palliative and Cancer Care

Abstract: -

Cited by 15 publications

References 18 publications

Palliative care provider attitudes toward existential distress and treatment with psychedelic-assisted therapies

Palliative care provider attitudes toward existential distress and treatment with psychedelic-assisted therapies

Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: a systematic review

Current practices in managing end-of-life existential suffering

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