https://orcid.org/0000-0002-3900-4354
![Sample our Behavioral Sciences journals, sign in here to start your access, latest two full volumes FREE to you for 14 days]({"type":"image" , "src" : "/sda/110801/TOC-Subject-Sample-2021-Behavioral-Sciences.jpg"})
Abstract
Introduction
Post-traumatic stress disorder (PTSD) is associated with significant patient burden. While pharmacotherapies and evidence-based psychotherapy interventions (EBPI) are effective, studies consistently highlight inadequate outcomes and high treatment dropout. Psychedelic therapy (PT) has shown preliminary promise across difficult-to-treat conditions, including MDMA-assisted therapy for PTSD, however trials of classical psychedelics in PTSD are lacking. Understanding patients’ experiences of EBPI could help promote safety in PT.
Aim
To systematically review qualitative research on patients’ subjective experience of EBPI for PTSD, and of PT, and examine areas of overlap and divergence between them.
Methods
Systematic literature searches for studies published between 2010 and 2023 were conducted on OVID, PubMed, Web of Science, and PsycInfo. Included were original studies in English that presented qualitative data of patient experiences of EBPI in PTSD, or PT for any indication. Extracted data from included studies were analysed using thematic synthesis. Syntheses were completed separately for EBPI and PT, before similarities and differences between the therapies were identified.
Results
40 research articles were included for review: 26 studies on EBPI for PTSD, and 14 studies on PT. EBPI studied were CBT, EMDR, CPT and PE. Psychedelic compounds studied were psilocybin, ibogaine, LSD, MDMA and ketamine, for treatment of substance use disorders, anxiety relating to physical illness, depression, and PTSD. Core themes from patient experiences of EBPI: 1) patient burden in PTSD treatment; 2) readiness; 3) key mechanisms of change; 4) psychological safety and trust. Themes identified in the review of PT: 1) indirect trauma processing; 2) reorganisation of self-narratives via processes of relatedness and identification; 3) key treatment characteristics.
Conclusion
This study suggests overlap between patients’ experience of EBPI and PT in terms of key mechanisms of change, the importance of psychological safety and readiness to engage in treatment. Trauma-informed care paradigms and practices may improve safety and acceptability of PT research.
Ethical Approval
Ethical approval was not required for this study.
Acknowledgments
Authors thank Ekaterina Malievskaia, Rachel Yehuda, Chantelle Thomas, Scott Aaronson, Jeffrey Guss, Joanne Stubley, Amy Durden, Jan Mars, Mark Burton, and Marc B. Aixalà for sharing their expertise in psychedelic therapy and the treatment of psychological trauma. Special thanks to Tyler McPhee for supporting this work with his extensive knowledge of psychedelic therapy research literature.
Author Contributions
NLM, MC, VW and JR designed the study, in consultation with CM and MS. The first draft of the manuscript was written by NLM. All authors contributed to the execution of the study including search strategy, data extraction, data analysis, writing and critically reviewing the manuscript. NLM, MC and MS contributed to the preparation of the supplementary material. All authors have approved the final manuscript.
Disclosure
All authors declare:
No shareholdings in pharmaceutical companies
No shareholdings in companies developing psychedelics
Dr Rucker, Mr. Nadav Liam Modlin and Ms. Carolina Maggio provide services for the psychoactive trials group at King’s College London. The psychoactive trials group at King’s College London receives grant funding (received and managed by King’s College London) from Compass Pathways, Supporting Wounded Veterans, Multidisciplinary Association for Psychedelic Studies, Beckley PsyTech and National Institute for Health Research.
Dr Rucker is supported by the UK National Institute for Health Research (NIHR) via Clinician Scientist Fellowship Awards to Dr. Rucker (CS-2017-17-007) and by the NIHR Biomedical Research Centre at South London, Maudsley National Health Service Foundation Trust, and King’s College London. Dr. Rucker has attended trial-related meetings paid for by Compass Pathways, Ltd.; he has consulted for Beckley PsyTech and Clerkenwell Health; and he is employed by Sapphire Medical Clinics, a private medical clinic.
Nadav Liam Modlin has received consulting fees from Compass Pathways PLC, Small Pharma Ltd and Beckley Psytech Ltd. Carolina Maggio has received consulting fees from Beckley Academy, Entheon Biomedical and Compass Pathways.