The Psychedelic Debriefing in Alcohol Dependence Treatment: Illustrating Key Change Phenomena through Qualitative Content Analysis of Clinical Sessions

Abstract

Research on the clinical applications of psychedelic-assisted psychotherapy has demonstrated promising early results for treatment of alcohol dependence. Detailed description of the content and methods of psychedelic-assisted psychotherapy, as it is conducted in clinical settings, is scarce.Methods: An open-label pilot (proof-of-concept) study of psilocybin-assisted treatment of alcohol dependence (NCT01534494) was conducted to generate data for a phase 2 RCT (NCT02061293) of a similar treatment in a larger population. The present paper presents a qualitative content analysis of the 17 debriefing sessions conducted in the pilot study, which occurred the day after corresponding psilocybin medication sessions.Results: Participants articulated a series of key phenomena related to change in drinking outcomes and acute subjective effects of psilocybin.Discussion: The data illuminate change processes in patients' own words during clinical sessions, shedding light on potential therapeutic mechanisms of change and how participants express effects of psilocybin. This study is unique in analyzing actual clinical sessions, as opposed to interviews of patients conducted separately from treatment.

Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies

“…In many studies, participants experienced significant relief from the disorder they were treated for, including reductions in eating disorder-related thoughts and symptoms, PTSD symptoms, anxiety, depression, and substance use. Reductions in withdrawal and reduced (in some cases completely vanished) craving were mentioned by participants in all studies on SUDs [77,78,83,86,89,90]. Remarkably, decreased drug, alcohol, and medication use were also reported in studies with MDMA, ayahuasca and psilocybin that did not deal directly with substance use [53,80,87].…”

“…All articles were published between 2014 and 2019. Where reported, respondents' ages ranged from 21 to 67 years, and the number of included subjects ranged from 4 [77] to 22 [78,79]. Studies were heterogeneous in terms of substances, population/mental disorders, contexts, and qualitative research methodologies.…”

“…Several respondents, especially in studies with psilocybin [77,81,82], and also with other substances, remarked on the ineffable nature of the experience, their inability to adequately put it into words, leading some to mention that it was easier to describe the emotional impact of the experience than the specific content.…”

“…These emotionally difficult experiences were often considered therapeutically useful, especially when participants managed to transform negative into positive emotions, which often had a lasting impact [53,78,81,82,85,88]. Closely related was the therapeutic importance of emotional catharsis, or the release of often painful emotions or memories [53,77,79,82,85]. This tied in closely with participants' ability to accept, and surrender to, the difficult emotions they experienced [53,81,82,85,88].…”

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

“…There is mounting evidence that the positive long-term effects of psychedelic therapy are mediated by the quality of the acute psychedelic experience (44)(45)(46)(47). Qualitative interviews with patients have shown that avoidance and acceptance are often central themes of their psychedelic experiences (13,(48)(49)(50)(51), and patients commonly report transient episodes of struggle with intense aversion. These challenging experiences 1 (42,52,53) are often characterized by extreme fear or panic, and can involve frightening imagery, unsettling body sensations, and the apprehension of immediate threat.…”