How Important Is a Guide Who Has Taken Psilocybin in Psilocybin-Assisted Therapy for Depression?

Promising outcomes of Psilocybin-Assisted Therapy (PAT) for depression have generated concerted efforts to replicate, extend, and refine protocols to maximize efficacy. Psychotherapy research reveals that clients benefit most when important components of treatment align with their personal preferences. One open question related to PAT concerns the importance of the psilocybin experience of the guides (trained professionals present during acute effects). We sought to assess the importance of a guide who had used psilocybin to potential clients with depressive symptoms. Over 800 MTurk respondents with depressive symptoms rated the import of a guide who had used psilocybin relative to alternative characteristics in guides and cognitive behavioral (CBT) therapists. Importance ratings for guides who had used psilocybin significantly exceeded the "somewhat important" level (50 on a 0-100 scale), other guide-related qualities, and comparable ratings for a cognitive behavioral therapist who shared demographics, had experience with depression and received cognitive therapy personally. People of color (those who are not Caucasian) and those who had previous therapy gave significantly higher importance ratings for guides who had used psilocybin. Participants who chose to list other qualities important for guides listed very similar ones for CBT therapists, often emphasizing proper training and an empathic demeanor. Guides who have used psilocybin, who inform clients of the fact, might have advantages for facilitating PAT's antidepressant effects, as least in a subset of clients.

Scoping Review of Experiential Measures from Psychedelic Research and Clinical Trials.

Subjective responses to psychoactive drugs have served as intriguing windows into consciousness as well as useful predictors. Subjective reactions to psychedelic molecules are particularly interesting given how they covary with subsequent improvements associated with psychedelic-assisted treatments. Although links between subjective reactions and decreases in treatment-resistant clinical depression, end-of-life anxiety, and maladaptive consumption of alcohol and nicotine appear in the empirical literature, the measurement of these subjective responses has proven difficult. Several scales developed over many decades show reasonable internal consistency. Studies suggest that many have a replicable factor structure and other good psychometric properties, but samples are often small and self-selected. We review the psychometric properties of some of the most widely used scales and detail their links to improvement in response to psychedelic-assisted treatments. Generally, assessments of mystical experiences or oceanic boundlessness correlate with improvements. Challenging subjective experiences, psychological insight, and emotional breakthroughs also show considerable promise, though replication would strengthen conclusions. We suggest a collaborative approach where investigators can focus on key responses to ensure that the field will eventually have data from many participants who report their subjective reactions to psychedelic molecules in a therapeutic setting. This may aid in predicting improvement amongst targeted conditions and wellbeing.

Exploring the Credibility of Psilocybin-assisted Therapy and Cognitive-behavioral Therapy for Depression.

Depression treatments succeed with many but leave others unimproved, and they can generate concerns about side effects, time, and cost. Psilocybin has generated media attention and empirical support for antidepressant effects, but lay impressions of its effectiveness are unclear. Although perceptions of treatment credibility contribute to outcome, beliefs about the credibility of psilocybin-assisted therapy (PAT) among potential patients remain uninvestigated, especially relative to cognitive-behavioral therapy (CBT), a common, empirically-validated approach. The present study examined credibility ratings for CBT and PAT among individuals reporting depressive symptoms. Participants (N = 803) from Amazon's MTurk platform reported demographics, depressive symptoms, and psychotherapy experience, then read data-based vignettes describing each therapy and rated their credibility. Individuals rated CBT as more credible than PAT. Those with therapy experience rated CBT as more credible than those without. Men and lifetime hallucinogen users rated PAT more credible than women and non-users, but few other predictors accounted for much variance in credibility. Results suggest that potential clients appear cautious about PAT. As continued work examines the effectiveness of psychedelic-assisted interventions, researchers and clinicians must consider patients' beliefs about treatments as potential predictors of outcomes. Additionally, the paradigm used here might have potential for examining credibility of many interventions.

Expectancies for Cannabis- Induced Emotional Breakthrough, Mystical Experiences and Changes in Dysfunctional Attitudes: Perceptions of the Potential for Cannabis-Assisted Psychotherapy for Depression.

Psychedelic-assisted psychotherapy has established antidepressant effects. Cannabis users appear to expect high doses administered in a session much like psychedelic-assisted psychotherapy to create comparable subjective effects. The current studies explored expectations of antidepressant effects of such cannabis-assisted sessions to replicate and extend previous work. Users not only expected a cannabis-assisted psychotherapy session to decrease depression, but also to alter some of the same mediators of psychedelic or psychological treatments. Over 500 participants in Study I envisioned a cannabis-assisted therapy session akin to those used in psychedelic therapies and reported the effects that they expected on depression as well as relevant subjective reactions. A second sample of over 500 participants responded to identical measures and an index of dysfunctional attitudes that appears to mediate antidepressant effects of psychotherapy. Expectancies of cannabis-induced antidepressant effects covaried with expected psychedelic effects. Participants also envisioned that cannabis-assisted therapy would alter dysfunctional attitudes, which served as a separate, unique path to expected antidepressant effects unrelated to the subjective effects of psychedelics. These results add support to arguments for relevant clinical trials of cannabis-assisted psychotherapy and suggest that cannabis users would expect it to work in ways similar to psychedelics as well as cognitive therapy.

Cognitive Behavioral Therapy, Ketamine, and Combination Treatment for Depression: Impressions of Credibility in Participants with Self-Reported Depressive Symptoms.

Ketamine, a novel treatment for depression, has generated considerable interest and research. Few experiments address lay impressions of the credibility of ketamine treatment relative to another popular intervention for depression, CBT. Over 500 participants with depressive symptoms read descriptions of CBT, ketamine, and a treatment that combined the two. Descriptions included pros and cons of each approach. Participants found the combination treatment more credible than ketamine but no better than CBT alone. They rated the credibility of CBT alone significantly higher than ketamine alone. Participants with psychotherapy experience tended to view ketamine as less credible than those who did not report previous psychotherapy. Depression scores did not covary with credibility ratings for any treatment. Despite media coverage and Internet claims, potential clients are cautious about ketamine. These results suggest that providing descriptions of treatments might help reveal important information about their credibility to potential clients. Extended work assessing impressions of many approaches to the treatment of psychopathology and other problems appears justifiable. Given established links between credibility and treatment outcome, additional research on individual differences in perceptions of ketamine and varied treatments for depression seems warranted.

The effects of perceived quality on behavioral economic demand for marijuana: A web-based experiment.

BACKGROUND: Given the growing legalization of recreational marijuana use and related increase in its prevalence in the United States, it is important to understand marijuana's appeal. We used a behavioral economic (BE) approach to examine whether the reinforcing properties of marijuana, including "demand" for marijuana, varied as a function of its perceived quality. METHODS: Using an innovative, Web-based marijuana purchase task (MPT), a sample of 683 young-adult recreational marijuana users made hypothetical purchases of marijuana across three qualities (low, mid and high grade) at nine escalating prices per joint, ranging from $0/free to $20. RESULTS: We used nonlinear mixed effects modeling to conduct demand curve analyses, which produced separate demand indices (e.g., Pmax, elasticity) for each grade of marijuana. Consistent with previous research, as the price of marijuana increased, marijuana users reduced their purchasing. Demand also was sensitive to quality, with users willing to pay more for higher quality/grade marijuana. In regression analyses, demand indices accounted for significant variance in typical marijuana use. CONCLUSIONS: This study illustrates the value of applying BE theory to young adult marijuana use. It extends past research by examining how perceived quality affects demand for marijuana and provides support for the validity of a Web-based MPT to examine the appeal of marijuana. Our results have implications for policies to regulate marijuana use, including taxation based on the quality of different marijuana products.

Psychometric validation of the BDI-II among HIV-positive CHARTER study participants.

Rates of depression are high among individuals living with HIV. Accurate assessment of depressive symptoms among this population is important for ensuring proper diagnosis and treatment. The Beck Depression Inventory-II (BDI-II) is a widely used measure for assessing depression, however its psychometric properties have not yet been investigated for use with HIV-positive populations in the United States. The current study was the first to assess the psychometric properties of the BDI-II among a large cohort of HIV-positive participants sampled at multiple sites across the United States as part of the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study. The BDI-II test scores showed good internal consistency (α = .93) and adequate test-retest reliability (internal consistency coefficient = 0.83) over a 6-mo period. Using a "gold standard" of major depressive disorder determined by the Composite International Diagnostic Interview, sensitivity and specificity were maximized at a total cut-off score of 17 and a receiver operating characteristic analysis confirmed that the BDI-II is an adequate diagnostic measure for the sample (area under the curve = 0.83). The sensitivity and specificity of each score are provided graphically. Confirmatory factor analyses confirmed the best fit for a three-factor model over one-factor and two-factor models and models with a higher-order factor included. The results suggest that the BDI-II is an adequate measure for assessing depressive symptoms among U.S. HIV-positive patients. Cut-off scores should be adjusted to enhance sensitivity or specificity as needed and the measure can be differentiated into cognitive, affective, and somatic depressive symptoms.

Subtypes of attention deficit-hyperactivity disorder (ADHD) and cannabis use.

The current study examined the association between subtypes of attention-deficit/hyperactivity disorder (ADHD) and cannabis use within a sample of 2811 current users. Data were collected in 2012 from a national U.S. survey of cannabis users. A series of logistic regression equations and chi-squares were assessed for proportional differences between users. When asked about the ADHD symptoms they have experienced when not using cannabis, a higher proportion of daily users met symptom criteria for an ADHD diagnoses of the subtypes that include hyperactive-impulsive symptoms than the inattentive subtype. For nondaily users, the proportions of users meeting symptom criteria did not differ by subtype. These results have implications for identifying which individuals with ADHD might be more likely to self-medicate using cannabis. Furthermore, these findings indirectly support research linking relevant cannabinoid receptors to regulatory control.

Problematic Internet use and other risky behaviors in college students: an application of problem-behavior theory.

Given the widespread use of the Internet, researchers have begun to examine the personal and social consequences associated with excessive online involvement. The present study examined college students' problematic Internet use (PIU) behaviors within the framework of Jessor and Jessor's (1977) problem-behavior theory. Its specific aim was to investigate the links between PIU with both internalizing (depression, social anxiety) and externalizing (substance use and other risky behaviors) problems. Relevant variables from the perceived environmental system, the personality system, and the behavioral system were entered in a canonical correlation analysis. The analysis yielded two distinct functions: the first function, titled traditional problem-behavior syndrome, characterized students who are impulsive, hold socially deviant attitudes and show a propensity to use tobacco and illicit drugs. The second function, titled problematic Internet-behavior syndrome, characterized students who are socially anxious, depressed, report conflictive family relations, and show a propensity toward PIU. Thus, PIU did not share the characteristics typically associated with the traditional problem-behavior syndrome consistent with problem-behavior theory, but showed correlates more consistent with internalizing rather than externalizing problems.