Educational Materials and Image Induction Increase Treatment Credibility.

Patient-perceived treatment credibility is linked to important outcome measures including symptom reduction, therapeutic alliance, patient satisfaction, and attrition rates. However, few studies have tested strategies to enhance treatment credibility. The present study investigates the effect of brief, written educational materials and the use of an image induction prime on perceptions of credibility for cognitive behavioral therapy and psilocybin-assisted therapy for depression. Participants (N = 493) rated the perceived credibility of depression treatments before and after reading brief educational materials. Half of the participants were asked an image induction question containing the construct of open-mindedness. Results indicate that brief educational materials of about 300 words significantly increased perceived treatment credibility for both therapies, with a large effect size (Cohen's d = .91). The use of an image induction prime further increased perceived credibility for psilocybin-assisted therapy for depression (Cohen's d = .38). These strategies offer an efficient and cost-effective way to enhance treatment credibility. Future studies testing variations of the image induction prime might prove fruitful for optimizing the technique.

Development of the Protective Strategies for Psychedelics Scale: A novel inventory to assess safety strategies in the context of psychedelics.

BACKGROUND: Individuals who use psychedelics take efforts to mitigate unintended consequences. Despite the demonstrated utility of analogous protective behavioral strategies (PBS) assessments for other substances, no standardized scale exists to capture these protective strategies for psychedelic use. OBJECTIVE: The present study addresses a notable gap concerning the assessment of psychedelic use, specifically by developing a scale measuring the protective strategies employed around use, called the Protective Strategies for Psychedelics Scale (PSPS). METHODS: A sample (Mage = 36.85 years old, standard deviation = 10.3; male = 61.9%; White = 85.2%) of 434 adults with lifetime use of psychedelics reported on initial qualitatively developed items for the PSPS, PBS scales for cannabis and alcohol, and use of alcohol, cannabis, and psychedelics. RESULTS: Iterative principal components analyses began with 37 items and yielded a 32-item two-factor solution demonstrating excellent internal reliability (Cronbach's α = .95) and accounted for 51.3% of the variance. Nineteen items loaded on PSPS factor 1, which focused on long-term preparation, emphasizing strategies focused on mood/intentions, preparing the substance, environment, and scheduling episode of use; 13 items loaded on factor 2, which focused on short-term preparation, highlighting strategies surrounding social context, health, and other substances. The PSPS demonstrated convergent validity with validated PBS scales for cannabis and alcohol (r = 0.71-0.79, p < 0.001), and was moderately associated with lifetime psychedelic use (r = 0.28, p < 0.001). CONCLUSION: The PSPS demonstrates promising psychometric properties, and future work validating the scale for diverse samples across research and clinical settings is warranted.

Psychedelic Experiences After Bereavement Improve Symptoms of Grief: The Influence of Emotional Breakthroughs and Challenging Experiences.

Grief, a common reaction to loss, can frequently become problematic or impairing. Available treatments for prolonged grief disorder are promising but leave room for considerable improvement. Qualitative accounts of psychedelic experiences after bereavement reveal themes that parallel core components of prolonged grief disorder therapy. However, few studies have investigated the therapeutic potential of psychedelics for symptoms of grief. The present study surveyed recreational psychedelic users (N = 363) who had suffered a bereavement event. They reported retrospective grief symptoms before and after the psychedelic experience as well as subjective reactions to the psychedelic, including emotional breakthroughs and challenging experiences. Results indicate improvements in grief symptoms after a psychedelic experience, with a large effect size (Cohen's d = 0.83). The occurrence of emotional breakthroughs was positively associated with improvements in symptoms of grief, while the converse relation was observed for challenging experiences. Findings provide preliminary evidence that support the development of a psychedelic-assisted therapy protocol to target symptoms of grief. Psychedelic-assisted therapy might offer an alternative to current grief treatment options.

Undergraduate student perceptions of cognitive behavioral therapy, aerobic exercise, and their combination for depression.

OBJECTIVE: Both aerobic exercise and Cognitive Behavioral Therapy (CBT) improve depression, but perceptions of their credibility and efficacy are underexplored. These perceptions can contribute to treatment seeking and outcome. A previous online sample ranging in age and education rated a combined treatment higher than individual components and underestimated their efficacy. The current study is a replication exclusively focused on college students. PARTICIPANTS: Undergraduates (N = 260) participated during the 2021-2022 school year. METHODS: Students reported impressions of each treatment's credibility, efficacy, difficulty, and recovery rate. RESULTS: Students viewed combined therapy as potentially better, but also more difficult, and underestimated recovery rates, replicating previous work. Their efficacy ratings significantly underestimated both meta-analytic estimates and the previous sample's perceptions. CONCLUSIONS: Consistent underestimation of treatment effectiveness suggests that realistic education could prove especially beneficial. Students might be more willing than the broader population to accept exercise as a treatment or adjunct for depression.

Induced negative affect's impact on self-reported cannabis use, expectancies, and problems.

Substance use disorders and affective disturbances often covary. Even momentary experiences of negative affect (NA) appear linked with substance use. While strong evidence of these relations exists, NA might bias endorsements of substance use due to hindered recall and reporting processes. This hypothesis warrants further research, as accurate assessment of substance-related variables is crucial in both research and treatment settings. The present study examined the influence of NA on reporting of cannabis variables using an affect-induction paradigm. Over 700 individuals recruited from Amazon's MTurk participated. After reporting demographics and baseline affect, participants were randomly assigned to either a NA induction or control condition. Follow-up measures assessed post-induction affect and cannabis-related variables. Results revealed that the NA induction task significantly increased NA and decreased positive affect relative to the control condition. Participants assigned to the NA induction reported greater negative cannabis expectancies and more cannabis problems, even after controlling for age and educational attainment. Cannabis use and cannabis problems appeared positively related. Future research should continue to assess for the influence of NA in reporting of cannabis variables. Should subsequent work find differences in reporting of substance use that appear to covary with negative affect, clinicians and researchers alike should be mindful of the implications of potentially biased reporting on assessment, intervention, and research outcomes.

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.

Cannabis's Link to Schizotypy: Phenomenon, Measurement Bias, or Delusion?

Links between cannabis use and psychosis generate research and media attention. Cannabis users have outscored non-users on the Schizotypal Personality Questionnaire-Brief (SPQ-B) in multiple studies, but previous work suggests that groups do not differ if biased items are removed. The present study examined links between schizotypal personality and cannabis use in a large sample recruited from Amazon's MTurk platform (N = 705). Over 500 participants reported lifetime cannabis exposure. Of those, 259 participants reported current cannabis use, and on average, used 4.53 days per week. Users and non-users failed to differ significantly on total SPQ-B scores or any of the three established subscales. The null results inspired a re-examination of the SPQ-B's factor structure, which identified a novel 3-factor solution (difficulty opening up to others, hyperawareness, and odd or unusual behavior). Only the "odd or unusual behavior" factor showed cannabis-related differences, but a differential item functioning test revealed that one subscale item showed potential bias against users. Removing this item diminished group differences. These results suggest that links between schizotypy and cannabis use require cautious interpretation with careful attention to potential measurement bias. In addition, the SPQ-B might have an alternative factor structure that could help answer important questions in psychopathology.

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.

Policing Pot: State-Level Cannabis Arrests Increase Perceived Risks and Costs but Not Use.

Legal sanctions are purported to play a role in cannabis use and related consequences. General models of deterrence suggest that increases in arrests should decrease consumption by heightening perceptions of the negative consequences of use as well as the likelihood and severity of penalties. The present study examined if arrests resulting from cannabis possession relate to cannabis consumption, perceptions of use, and likelihood and severity of related penalties. Combining data from the National Survey on Drug Use and Health with the FBI Uniform Crime Report (2002-2013) allowed for the estimation of a series of fixed- effects models that compare rates of arrests and perceived risks of aggregate rates of self-reported use at the state-level over time. Forty-nine states reported data (N = 592 state-years). Cannabis-related arrest rates (ratio of possession arrests for state/state population times 1,000) ranged from 0.04 - 5.63. Increases in cannabis-related arrests were associated with heightened perceptions of risk from use (b = .80 [-.16, 1.8], p < .05); but this association was non-significant in the model omitting states that legalized recreational cannabis in 2012. Arrests related to greater perceptions of the severity of potential penalties, including community service (b = .54 [.24, .85], p < .05), probation (b = .85 [.44, 1.3], p < .001), and prison sentences (b = .25 [.02, .5], p < .05). Arrest rates were not associated with cannabis use (b = -.25 [-.52, .05], p > .05) or the proportion of new initiates (b = -.02 [-.08, .05], p > .05). We conclude that increased arrests are associated with perceptions of negative consequences and penalty but appear unrelated to actual use. This study highlights the need to re-examine the utility of punitive approaches to reduce the public health burden posed by substance use.

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.

Associations between Cannabis Use and Sexual Risk Behavior among Women under Community Supervision: A Brief Report.

OBJECTIVES: Cannabis use and sexual risk behavior have been found to co-occur, but more research on these associations is needed among criminal justice-involved women (i.e., courts, jails, or prisons). METHODS: Regression models examined past 90-day cannabis use on unprotected sex, multiple sexual partners, and STIs/HIV among 306 women under NYC community supervision, adjusting for alcohol, other illicit substances, and socio-demographics. RESULTS: Cannabis use, but not alcohol or other illicit substance use, was positively associated with having unprotected sex and multiple sexual partners, but not STIs or HIV. CONCLUSIONS: Criminal justice-involved women may benefit from sexual risk reduction interventions incorporating cannabis content.

Alcohol use, cannabis use, and psychopathology symptoms among college students before and after COVID-19.

College students have experienced significant disruptions related to COVID-19, and limited international data suggest they may be at elevated risk for mental health symptom increases related to COVID. Given their potentially elevated risk, our aim was to evaluate differences from pre-college closures to post-closure in mental health symptoms, alcohol, and cannabis use. Participants (N = 4749) were from seven U.S. public universities/colleges. They were 70.1 % female and 48.5 % white, non-Hispanic/Latino, with 48.1 % in their first college/university year. 30-day retrospective assessments of alcohol and cannabis use, and past 2-week retrospective assessments of anxiety, depression, anger, and insomnia were captured at the time of the survey. We examined differences between those providing data pre- and post-university closure via linear and negative binomial regressions. Alcohol and cannabis use days were 13 % and 24 % higher, respectively, from pre-to post-university closure; also, prevalence of any 30-day alcohol use and alcohol use consequences were both higher in the post-closure sample (odds ratios = 1.34 and 1.31, respectively). In contrast, days of binge alcohol use were 4 % lower in the post-closing sample. Depressive symptoms and anger were both modestly higher in post-closing participants (d < 0.1), with no differences in anxiety symptoms or insomnia. The modest differences in substance use and mental health from pre-closure through two months post-college closure suggest unexpected resilience in a large and diverse sample of students. College health providers will need to identify those students experiencing the greatest increases in mental health symptoms and substance use, using innovative outreach and treatment.

Packing cannabis, pouring alcohol: Validating a free-pack assessment among college students using cannabis.

Objective: Long-standing challenges in quantifying cannabis use make assessment difficult, potentially complicating attempts to minimize harm. Our study investigated how accurately undergraduates who use substances estimate amounts of alcohol through a behavioral pouring task. We also aimed to validate a free pack assessment in which participants similarly estimated amounts of cannabis. We further examined how estimations related to consequences and protective behavioral strategies (PBS). Methods: Participants completed a free pour task and a modified free "pack" task to measure out and estimate quantities of alcohol and cannabis, and self-reported use, problems, PBS, and social context (N = 264; Mage = 19.2, 67.10% Female, 46.20% White). Results: Both tasks indicated high rates of misestimating amounts. Over 80% of the sample misestimated alcohol and cannabis amounts by more than 10%. Students typically underestimated the actual amount of alcohol that they poured, but the trend was opposite for cannabis. Discrepancies in packing joints decreased as quantity-specific cannabis PBS increased, but increased with more frequent cannabis use. Both alcohol and cannabis PBS decreased their respective consumption and negative consequences. Conclusions: A considerable proportion of young adults inaccurately estimate quantities, which is related to negative outcomes. Discrepancies are associated with problems, and interventions may benefit from targeting improvements in accuracy to prevent future harms and enhance protective strategies for specific substance use methods. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cannabis-induced oceanic boundlessness.

BACKGROUND: Despite tetrahydrocannabinol (THC)'s reputation for creating dramatic effects at high doses, empirical work rarely addresses cannabis's impact on subjective responses common to the tryptamine psychedelics. We focused on these effects because they have preceded and covaried with the therapeutic impact of psilocybin in previous work. AIMS: The current study examined if self-reported responses to cannabis products might parallel those found in clinical trials of psilocybin administration. We also investigated if measures of demographics and cannabis use might correlate with these responses. METHODS: Participants reported the subjective effect of their highest THC experience using 27 items that assess oceanic boundlessness, a correlate of mystical experiences. They also answered infrequency items and questions on demographics and cannabis consumption. RESULTS: In an effort to address concerns about replication, we divided respondents who passed infrequency items into two random samples. Self-reported "breakthrough" experiences were significantly greater than zero but significantly lower than those reported in randomized clinical trials of psilocybin (17-19% vs. 59%). Total scores covaried with perceived dosages of THC, but only in one sample. Heavier users of cannabis reported lower scores. CONCLUSIONS: Self-report data suggest that high doses of cannabis can create subjective effects comparable to those identified in trials of psilocybin that precede relief from cancer-related distress, treatment-resistant depression, alcohol problems, and cigarette dependence. Given the disparate mechanisms of action, comparing THC-induced to psilocybin-induced effects might improve our understanding of the mechanisms underlying subjective experiences. This work might also support the development of a cannabis-assisted psychotherapy comparable to psilocybin-assisted psychotherapy.

Factor analysis of a short form of the Protective Behavioral Strategies for Marijuana scale.

OBJECTIVE: The Protective Behavioral Strategies for Marijuana Scale (PBSM), a 17-item scale targeting strategies for mitigating the negative consequences of cannabis use, highlights a range of behaviors that can reduce harm beyond straightforward decreases in quantity or frequency. The 17-item scale's factor structure remains under-examined but could reveal meaningful distinctions among strategies. This study aimed to confirm the factor structure of the short form of the PBSM. METHODS: This study recruited cannabis-using undergraduates (N = 454,Mage = 19.6, 68.8% female, 39% White), who reported using cannabis approximately 2.3 days per week with mild cannabis-related consequences (CAPQ; M = 9.74). RESULTS: A confirmatory factor analysis demonstrated poor fit for the one-factor model of the PBSM, prompting an exploratory factor analysis. Analyses revealed two internally reliable factors: a "Quantity" factor, strategies specific to mitigating overuse and limiting amounts consumed and an "Context" factor loosely related to troubles with others. This two-factor model accounted for over half of the total variance; invariance testing indicated reduced fit as models became more restrictive. Though each of the factors covaried negatively with both days of use and problems, Context had a stronger relation to both variables compared to Quantity. Only Context predicted fewer cannabis problems and use. CONCLUSIONS: The two-factor solution suggests further work on the psychometric properties of the scale could provide heuristic information to allow for more nuanced approaches in clinical and research settings. Theoretically, each factor might have novel links to some constructs but not others in ways that could assist harm-reduction strategies and treatment.

Age-Related Differences in Cannabis Product Use.

Cannabis use varies with age and gender, but less is known regarding specific product choices. Previous work suggests that older adults are inclined to stick to the more "classic" and familiar, while "novel" products are more likely to appeal to younger populations. We examined cross-sectional, retrospective data to determine whether the type of cannabis products used varied according to participant age (N = 1406, 71.3% female). The extensive list of products included: loose flower, pre-rolled joints, edibles, concentrates, oil vaporizers (vape pens), dry vaporizers, tinctures, topicals, and ingestible oils. Overall, rates of use for cannabis-infused ingestible oils, topicals, and tinctures are the lowest and show no age or gender-related differences. In contrast, the use of pre-rolled joints, vape pens, and edibles tends to decrease with age. Loose flower and dry vaporizer use also decrease with age, although less consistently. These age-related differences in product choices can facilitate prevention and treatment efforts toward specific populations. While harm-reduction efforts targeting loose flower and edible products would benefit all age groups, those targeting concentrates might focus only on younger users. On the other hand, learning about concentrates might be beneficial for older medical users due to their larger THC doses and rapid onset.

Confirming Savoring's Link to Fewer Cannabis Problems.

Savoring has covaried inversely with cannabis problems and moderated the association between cannabis use and negative consequences related to use. Research has not yet addressed the acceptability of savoring interventions for cannabis users. The present study aimed to replicate the finding of savoring as a protective factor against problems for cannabis users. The second aim of the study was to examine preferences for a savoring intervention among problem-endorsing cannabis users. We sampled 447 (63.3% female) problem users who self-reported cannabis use, cannabis problems, savoring beliefs, and preferences for cannabis use interventions. On average, our sample reported using cannabis 4.7 days per week and 16.03 times per month, with men endorsing significantly more cannabis-related problems than women. Savoring did increase as problems decreased, but the moderator effect did not replicate. Problem cannabis users preferred a savoring intervention to a typical harm reduction intervention across all sampled demographics, with one notable exception: women were 1.73 times more likely to prefer a savoring intervention. Our findings confirmed that cannabis problems decrease as savoring increases and identified a preference for a savoring intervention among problem users.