In recent years, interest in psychedelic-assisted therapy has grown due to its potential to treat various psychological disorders such as depression, anxiety, and post-traumatic stress disorder. However, a new study published in the Journal of Psychedelic Studies raises important concerns. It suggests that while there may be benefits, there are also significant risks.
The study focuses on the negative effects reported by therapists who facilitate such treatments, highlighting that the impacts of psilocybin are not universally beneficial and can vary widely from one individual to another.
Psilocybin is a naturally occurring psychedelic compound produced by over 200 species of mushrooms, commonly known as “magic mushrooms.” When ingested, psilocybin is converted into psilocin, which primarily affects the serotonin receptors in the brain, leading to altered perceptions, emotions, and thoughts. This can result in profound changes in consciousness, often described as spiritual or transcendental experiences.
Psilocybin-assisted therapy combines the controlled use of psilocybin with psychotherapy sessions. The typical protocol involves a preparatory session where therapists establish rapport with clients and set intentions for the treatment. This is followed by one or more dosing sessions, where clients consume psilocybin in a controlled, supportive environment, allowing them to explore their thoughts and emotions with professional guidance.
Integration sessions then help clients make sense of their experiences, facilitating psychological healing and personal growth. Research has shown promising results, particularly in treating depression, anxiety, and post-traumatic stress disorder, offering relief where traditional treatments have failed.
Previous research has suggested that psychedelic substances like psilocybin are generally safe from a physiological standpoint and can be beneficial when used in controlled, therapeutic settings. However, the psychological risks associated with these substances, which can profoundly alter perception and emotional states, are less understood.
These substances increase suggestibility, emotional sensitivity, and can dramatically alter one’s perceptual framework, which can sometimes lead to persistent psychological disturbances. The new study was undertaken to explore the less-discussed potential negative impacts of psilocybin.
“The potential benefits of psychedelic-assisted therapy have been a popular discussion point recently. I was invited to join a research group that had begun evaluating the potential drawbacks and negative impacts of psilocybin in psychotherapy,” explained study author Jón Ingi Hlynsson, a clinical graduate student at the University of Iceland.
“What intrigued me the most was the chance to map out psilocybin’s negative effects and identify potential drawbacks of psychedelic-assisted therapy. However, much credit is due for my co-authors, especially Moa Nordin, who conducted the interviews and conceptualized the study, but also Per Carlbring and Jakob Håkansson without whom the project would not have materialized.”
The researchers employed a qualitative research design, using semi-structured interviews to gather in-depth data from eight therapists who have facilitated psilocybin-assisted treatments. These therapists, based in Scandinavia, varied in their professional backgrounds and included psychologists, therapists, and even individuals without formal psychological training but with experience in psychedelic therapies. The qualitative data from these interviews were then thematically analyzed to identify common patterns and themes in the negative effects reported.
The researchers identified three main themes of short-term negative effects. First, some clients experienced direct negative reactions during the psilocybin dosing sessions, including physical symptoms like nausea and headaches, cognitive disturbances such as disorientation and paranoia, and emotional challenges characterized by fear and intense distress. These reactions can significantly impact the immediate therapeutic experience and require careful management.
Second, the study reported undesirable processes in the therapeutic relationship. The altered state induced by psilocybin sometimes complicated interactions between therapists and clients. Issues such as communication barriers, misunderstandings, and a shift in the power dynamics were noted. These could lead to breaches in the therapeutic alliance, potentially diminishing the therapy’s effectiveness and affecting the client’s overall treatment experience.
Third, difficult self-experiences were common, where clients encountered painful and sometimes traumatic realizations about themselves. While these experiences could potentially lead to therapeutic breakthroughs, they were often overwhelming in the short term and could contribute to emotional distress during and immediately after the session.
In terms of long-term effects, the researchers outlined four main themes. Firstly, destabilization was a significant concern, with clients sometimes experiencing ongoing cognitive and emotional instability after the treatment sessions. This included a prolonged sense of confusion, changes in personal identity, and altered life perspectives, which could disrupt daily functioning and overall well-being.
Secondly, adaptation difficulties were frequently observed. Clients often struggled to integrate the insights gained during therapy into their lives. This could lead to prolonged periods of adjustment, characterized by dissatisfaction with life and difficulties in returning to normalcy, which could exacerbate feelings of isolation or depression.
Thirdly, complications in the treatment relationship were noted as a long-term issue. Emotional dependencies, continued attachments, and even romantic feelings towards the therapist could emerge, complicating the conclusion of the therapeutic relationship and potentially leading to additional psychological strain for clients.
“We conducted interviews with individuals who have been and are currently providing psychedelic-assisted therapy,” Hlynsson told PsyPost. “Surprisingly, many treatment providers reported issues with romantic transference and blurred professional boundaries. Even for experienced therapists, managing romantic transference proved to be a challenge.”
Lastly, the study highlighted several undesirable outcomes of treatment, such as the emergence or worsening of psychological symptoms, including existential anxiety and depressive states. Some clients also faced difficulties with sleep, increased anxiety, and a persistent sense of disillusionment about their lives or the treatment.
“Be cautious of unverified claims that psilocybin is a cure-all for psychological disorders,” Hlynsson said. “Psilocybin induces a potent altered state of mind, and it’s not self-evident that consuming psychedelic mushrooms is beneficial for everyone.”
“Our study suggests that potential negative effects of these substances, especially for vulnerable individuals seeking psychotherapy, are not yet fully understood. While existing research presents promising findings, we need to exercise caution before endorsing psilocybin as a viable treatment for mental disorders. The potential adverse effects of these treatments are still understudied.”
The study provides important insights into the potential negative effects of psilocybin-assisted therapy. But the study, like all research, includes some limitations. “Our study focuses on the treatment provider perspective; we did not interview people that had received psychedelic-assisted therapy,” Hlynsson noted. “Therefore, the results must be interpreted with consideration for the absence of the treatment receiver’s perspective.”
Future research could include larger, more diverse populations and incorporate clients’ perspectives to provide a more balanced view of the risks associated with psychedelic-assisted therapy. Additionally, further studies could explore the mechanisms behind the negative effects observed and develop strategies to mitigate these risks.
“We hope our study encourages researchers and clinicians to consider potential adverse effects more thoroughly before adopting this form of treatment,” Hlynsson said. “It’s important to note that the full impact is not yet clear.”
“To quote Carl Jung: Beware of unearned wisdom,” he added.
The study, “A double-edged sword: Insights from practitioners on the short and long-term negative effects of psilocybin-assisted psychological interventions,” Moa Nordin, Jón Ingi Hlynsson, Jakob Håkansson, and Per Carlbring.