Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety

Abstract

Prior research has shown that acute subjective psychedelic effects are associated with both spontaneous and intended changes in depression and anxiety. Psychedelics are also theorized to produce increases in psychological flexibility, which could explain decreases in depression and anxiety following a psychedelic experience. Therefore, the present cross-sectional survey study sought to examine whether psychological flexibility mediated the relationship between acute psychedelic experiences and spontaneous or intended changes in depression and anxiety among a large international sample of people who reported having used a psychedelic (n=985; male=71.6%; Caucasian/white=84.1%; M age =32.2, SD=12.6). A regression analysis showed that acute effects (i.e., mystical and insightful effects) were significantly associated with decreases in depression/anxiety following a psychedelic experience. A path analysis revealed that, while controlling for age and sex, increases in psychological flexibility fully mediated the effect of mystical and insightful experiences on decreases in depression and anxiety following a psychedelic experience. This suggests that psychological flexibility may be an important mediator of the therapeutic effects of psychedelic drugs. Future prospective experimental studies should examine the effect of psychedelic drug administration on psychological flexibility in order to gain a better understanding of the psychological processes that predict therapeutic effects of psychedelics.

Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

“…The observation that blissful ego-dissolution is followed by long-term reductions in psychopathology, greater well-being, and increased openness may thus, at least in part, be explained in terms of reduced avoidance. In line with this idea, a recent survey study (91) found that the impact of acute mysticaltype effects on decreases in depression and anxiety after naturalistic psychedelic use was entirely mediated by increases in psychological flexibility (a construct that is closely related to acceptance). Some positive effects of ego-dissolution could nonetheless be relatively unrelated to acceptance [e.g., see (92)].…”

Post-Psychedelic Reductions in Experiential Avoidance Are Associated With Decreases in Depression Severity and Suicidal Ideation

“…More recently, two studies (18,32) examined the relationship between improved mental health following psychedelic use and decreases on the revised Acceptance and Action Questionnaire [AAQ-II; (33)], a frequently used measure of both experiential avoidance and psychological flexibility. Both studies found that psychedelic use was associated with post-psychedelic decreases in AAQ-II scores (18,32). Furthermore, Close et al (32) found that, following psychedelic use, decreased AAQ-II scores were associated with decreases in depression severity.…”

“…Furthermore, Close et al (32) found that, following psychedelic use, decreased AAQ-II scores were associated with decreases in depression severity. Additionally, Davis et al (18) found that decreased AAQ-II scores indirectly affected the relationship between acute psychedelic experiences (mystical-type experiences and psychological insight) and decreases in anxiety and depression severity. Importantly, however, extant research suggests that the AAQ-II shows poor discriminant validity from psychological distress (34)(35)(36)(37)(38).…”

“…Given the wide range of mental health concerns for which psychedelic therapy has shown promise, it has been suggested that this treatment approach may target underlying transdiagnostic mechanisms (16)(17)(18)(19)(20)(21). Recent research has indicated that the intensity of "mystical-type" (4,6,7,9,22) or "peak" experiences engendered by psychedelics (23) is predictive of positive therapeutic outcomes; however, it remains unclear how (i.e., via what fundamental psychological and neurobiological mechanisms) psychedelic therapy brings about lasting therapeutic changes.…”

Psilocybin occasioned mystical‐type experiences

“…Mystical‐type and insight experiences as measured using validated questionnaires were found to be highly correlated with one another while only indirectly correlated with improved psychological well‐being. Regression analyses showed mystical‐type and insight experiences to be highly correlated with improved psychological flexibility and feelings of personal meaningfulness which in turn were highly correlated with improved psychological outlook (Davis, Barrett, & Griffiths, 2020; Garcia‐Romeu et al, 2019; Garcia‐Romeu et al, 2020). Therefore, these studies suggest that it is the improved psychological flexibility and personal meaningfulness associated with mystical‐type and insight experiences which enables depressed and anxious individuals and people with substance use disorders to reframe how they view their medical conditions, themselves, their lives and relationships with others (Belser et al, 2017; Davis et al, 2020; Garcia‐Romeu et al, 2019, 2020; Spiegel, 2016; Watts, Day, Krzanowski, Nutt, & Carhart‐Harris, 2017).…”