Emerging Themes in Psychedelic-Assisted Therapy for Anxiety

Psychedelic-assisted therapy for anxiety is an emerging field that has garnered significant attention in recent years due to its potential to provide a novel and effective approach to treating anxiety disorders (Pollan, 2019). Pollan (2019) delved into the history of psychedelics, legitimizing and emphasizing their use by indigenous cultures for centuries, with the drugs themselves around for over 5,000 years. He highlighted the West’s initial fascination with psychedelics in the mid-20th century when researchers like Albert Hofmann discovered compounds like LSD. Pollan (2019) outlined the extensive research that took place during this era, exploring the therapeutic potential of psychedelics for various mental health conditions. He also discusses the subsequent backlash against these substances, driven by concerns about their misuse and the counter-culture movement with the eventual FDA shutdown of psychedelic research in the mid 1970s. Despite this, psychedelics have influenced and continue to influence the fields of psychology, spirituality, and the understanding of the mind (Walsh & Grob, 2005).

According to the Anxiety & Depression Association of America (2023), anxiety disorders are the most common mental health issue in the U.S., affecting 40 million adults aged 18 and older every year. Anxiety disorders emerge as a result of a multifaceted interplay of risk factors, encompassing genetics, brain chemistry, personality traits, and life experiences.         

The psychedelic-assisted therapeutic approach involves the controlled and supervised use of psychedelic substances, such as psilocybin, MDMA, or LSD, in combination with psychotherapy to address and alleviate anxiety symptoms (Lea et al., 2020, Lowe et al, 2022, Rootman et al., 2021, Walsh & Grob, 2005). The therapy revolves around several key themes, which together contribute to its effectiveness. This paper will explore the main themes in psychedelic-assisted therapy for anxiety and end-of-life existential anxiety providing an overview of its principles, current research findings, and potential future developments.

Generalized Anxiety

Altered States of Consciousness and Psychological Insights

One of the central themes in psychedelic-assisted therapy for anxiety is the induction of altered states of consciousness through the use of psychedelic substances (Metzner, 2017). These altered states, often characterized by changes in perception, thought patterns, and emotions, can lead to profound psychological insights and experiences. The altered state facilitates a unique opportunity for individuals to explore their anxieties from a different perspective, often allowing them to access repressed memories, emotions, and thought processes.

In a therapeutic context, the role of the therapist is to guide and support the individual during the psychedelic experience (Modlin et al., 2023). This support is crucial as it can help the patient process intense emotions and navigate potentially challenging aspects of the experience. With the therapist’s guidance, patients may be better equipped to confront the root causes of their anxiety and work through unresolved issues.

Psychedelic substances, when administered in a controlled and supportive environment, have been shown to promote introspection and self-reflection (Metzner, 2017, Moreton, 2023, Wheeler & Dyer, 2020), which can lead to a greater understanding of the sources of anxiety. This increased self-awareness can be a catalyst for change, as individuals may gain fresh perspectives on their anxieties and develop strategies for managing them.

Neuroplasticity and Brain Connectivity

Another significant theme in psychedelic-assisted therapy for anxiety is the potential impact on neuroplasticity and brain connectivity (Nichols et al., 2017, Pollan, 2019). Recent neuroimaging studies have demonstrated that psychedelics can lead to increased connectivity within the brain, particularly in areas associated with emotional processing and self-reflection and the amygdala which can suppress the fear expression (Pędzich et al., 2022). This increased connectivity is believed to facilitate the processing of emotional and traumatic experiences, which can be particularly beneficial for individuals with anxiety disorders.

The default mode network (DMN), a brain network implicated in self-referential thoughts and the rumination often associated with anxiety, is of particular interest (Pollan, 2019). Psychedelics have been shown to disrupt the typical functioning of the DMN, leading to decreased activity in this network. This disruption can reduce the incessant self-criticism and rumination that often underlie anxiety disorders. It allows individuals to disengage from their habitual thought patterns and potentially reevaluate their self-concept and past experiences.

Moreover, psychedelics may enhance neuroplasticity, enabling the brain to form new neural connections and pathways. This could be instrumental in breaking free from the well-established anxiety loops. By promoting the creation of new, healthier mental patterns and perspectives, individuals may experience lasting relief from their anxiety symptoms.

Integration and Long-Term Healing

A third key theme in psychedelic-assisted therapy for anxiety is the importance of integration and long-term healing (Andersen et al., 2021, Raison et al., 2022). The psychedelic experience itself is just one part of the therapeutic process. Integration refers to the post-session phase where the individual works with their therapist to make sense of the insights gained during the psychedelic experience and apply them to their daily life.

This theme emphasizes that the true benefits of psychedelic therapy extend beyond the immediate experience. It is not just about having a mystical or insightful moment during the session; it is about how those insights are incorporated into one’s life and lead to long-term healing.

The integration process may involve cognitive restructuring, behavioral changes, and the development of new coping strategies (Pollan, 2019). It often requires ongoing psychotherapy sessions to support the individual in applying the insights gained from the psychedelic experience to real-world situations. This integration phase is essential to ensure that the therapeutic benefits are sustained over time and that the individual can effectively manage their anxiety in the long run.

Additionally, long-term healing emphasizes the potential for enduring positive changes in mental health and well-being. Some studies have suggested that even a single psychedelic session, when properly integrated, can have lasting positive effects on anxiety and mood (Andersen, 2021, Raison et al., 2022). However, the long-term impacts and optimal treatment protocols are still being investigated.

End-of-Life Existential Anxiety

The main challenge for those with terminal illness anxiety is end-of-life existential distress and the pursuit of meaning and acceptance (Schimmers et al., 2021). This therapeutic approach focuses on addressing the profound emotional and psychological challenges that individuals facing a terminal illness often experience. Terminal illness anxiety often encompasses existential distress, which includes fears, anxieties, and questions related to the meaning of life, death, and the individual’s place in the universe. Patients facing the end of their lives may grapple with feelings of hopelessness, regret, and unresolved issues. Psychedelic-assisted therapy aims to confront and alleviate these distressing existential concerns (Vargas et al., 2005).

Exploration of Psychedelic Experience

Psychedelics like psilocybin or LSD, when administered under controlled and supportive conditions, can induce altered states of consciousness that provide individuals with a unique opportunity to explore their thoughts, emotions, and beliefs (Metzner, 2017, Pollan, 2019). These altered states can lead to profound insights and experiences that allow patients to confront and make sense of their existential distress in ways that may not be possible with conventional therapy alone.

Transcendence and Mystical Experiences

Many individuals undergoing psychedelic-assisted therapy report experiencing transcendental or mystical states (Moreton, 2023, Wheeler & Dyer, 2020). These experiences often involve a profound sense of interconnectedness, unity, and a feeling of being part of something greater than themselves. Such experiences can provide individuals with a deeper understanding of life, death, and the nature of existence, helping them find acceptance and peace.

Meaning-Making and Acceptance

A central goal of psychedelic-assisted therapy for terminal illness anxiety is to help patients make sense of their lives and find meaning, even in the face of mortality (Moreton, 2023, Wheeler & Dyer, 2020). It encourages individuals to confront their fears, regrets, and unresolved issues, allowing for a process of acceptance and resolution. This can lead to reduced anxiety and an improved quality of life during their remaining time.

Integration and Support

Therapy does not end with the psychedelic experience. It includes a crucial phase of integration, where patients work with therapists to make sense of the insights gained during the session and apply them to their daily lives. This ongoing support helps individuals maintain and build upon the positive changes in their mental and emotional well-being.

Conclusion

In summary, psychedelic-assisted therapy for anxiety incorporates the induction of altered states of consciousness to gain psychological insights, the promotion of neuroplasticity and altered brain connectivity to address the root causes of anxiety, and the focus on integration and long-term healing to ensure enduring therapeutic benefits. This emerging field holds promise for individuals suffering from anxiety disorders, but it also raises important questions about safety, ethics, and the need for further research to establish best practices and standards of care. As ongoing research continues to shed light on the potential benefits and risks, psychedelic-assisted therapy for anxiety may become a valuable addition to the toolbox of mental health treatments particularly for those facing a terminal illness.

References

Andersen, K., Carhart-Harris, R., Nutt, D., & Erritzoe, D. (2021). Therapeutic effects of classic serotonergic psychedelics: A systematic review of modern-era clinical studies. Acta Psychiatrica Scandinavica, 143(2), 101–118.

Anxiety & Depression Association of America (2023). Anxiety Disorders – Facts & Statistics. https://adaa.org/understanding-anxiety/facts-statistics

Lea, T., Amada, N. & Jungaberle, H. (2020). Psychedelic Microdosing: A Subreddit Analysis, Journal of Psychoactive Drugs, 52:2, 101–112.

Lowe, H., Toyang, N., Steele, B., Grant, J., Amza, A., Gordon, L., & Ngwa, W. (2022). Psychedelics: Alternative and potential therapeutic options for treating mood and anxiety disorders. Molecules 27(2520) p. 1–19.

Metzner, R. (2017). Entheogenesis: Toward an Expanded Worldview for Our Time. Journal of Humanistic Psychology,57, 443–449.

Modlin, N.L., Stubley, J., Maggio, C. and Rucker, J.J. (2023), On Redescribing the Indescribable: Trauma, Psychoanalysis and Psychedelic Therapy. British Journal of Psychotherapy, 39, 551–572.

Moreton, S., Arena, A., Foy, Y. & Menzies, R. (2023). Reduced death anxiety as a mediator of the relationship between acute subjective effects of psychedelics and improved subjective well-being. Death Studies, 47:10, 1115-1126

Nichols, D. E., Johnson, M. W., & Nichols, C. D. (2017). Psychedelics as Medicines: An Emerging New Paradigm. Clinical pharmacology and therapeutics, 101(2), 209–219.

Pędzich, B. D., Rubens, S., Sekssaoui, M., Pierre, A., Van Schuerbeek, A., Marin, P., Bockaert, J., Valjent, E., Bécamel, C., & De Bundel, D. (2022). Effects of a psychedelic 5-HT2A receptor agonist on anxiety-related behavior and fear processing in mice. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 47(7), 1304–1314. 

Pollan, M. (2019). How to Change your mind: What the new science of psychedelics teaches us about consciousness, dying, addiction, depression, and transcendence. Penguin Books.

Raison, C. L., Jain, R., Penn, A. D., Cole, S. P., & Jain, S. (2022). Effects of naturalistic psychedelic use on depression, anxiety, and well-being: Associations with patterns of use, reported harms, and transformative mental states. Frontiers in Psychiatry, 13, 831092. 

Rootman, J., Kryskow, P., Harvey, K., Stamets, P., Santos-Brauly, E., Kuypers, K., Polito, V., Bourzat, F. & Walsh, Z. (2021). Adults who microdose psychedelics report health related motivations and lower levels of anxiety and depression compared to non‑microdosers. Scientific Reports, 11(22479), p. 1-11

Schimmers, N., Breeksema, J., Smith-Apeldoorn, S., Veraart, J., van den Brink, & W., Schoevers, R. (2021). Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: A systematic review. Psychopharmacology 239:15–33

Vargas, A. S., Luís, Â., Barroso, M., Gallardo, E., & Pereira, L. (2020). Psilocybin as a New Approach to Treat Depression and Anxiety in the Context of Life-Threatening Diseases-A Systematic Review and Meta-Analysis of Clinical Trials. Biomedicines, 8(9), 331.

Walsh, R & Grob C. (2005). Higher wisdom: Eminent elders explore continuing impact of psychedelics. State University of New York.

Wheeler, S. W., & Dyer, N. L. (2020). A systematic review of psychedelic-assisted psychotherapy for mental health: An evaluation of the current wave of research and suggestions for the future. Psychology of Consciousness: Theory, Research, and Practice, 7(3), 279–315. https://doi.org/10.1037/cns0000237