Advancing elite athlete mental health treatment with psychedelic-assisted psychotherapy

Abstract

Despite a politically vilified past, classical psychedelics, including lysergic acid diethylamide (LSD), psilocybin, and dimethyltryptamine (DMT), are experiencing a revival in scientific and clinical research. When used under the appropriate guidance and setting, these substances show promise for substantially improving well-being and reducing mental ill-health alongside an excellent safety profile. Elite athletes are known to experience mental health disorder symptomatology and psychological distress at similar, if not higher, rates to the general population. Therefore, this promising line of research may be relevant to mental health treatment within elite sport. Psychedelic treatment may reduce the incidence and experience of mental ill-health in athletes, particularly when related to a range of issues commonly seen in elite sport, including therapeutic resistance, challenges to identity and meaning through career transitions and injury, and managing interpersonal stress and conflict. As a number of psychedelic treatments are currently advancing through the drug development pathway in the US and EU, it is timely to develop an understanding of the clinical application of psychedelics within elite sport, and the legislative and sport-specific regulations that will need to be addressed if psychedelics become registered medicines. In this article, we outline the sport-specific relevance of psychedelic treatments, the role of sports psychologists and psychiatrists in delivering and managing prospective psychedelic treatment, the key ethical and regulatory issues this treatment raises, as well as propose initial research questions the field could address. We argue that psychedelic-assisted psychotherapy should be investigated as a novel treatment option for addressing mental ill-health in elite athletes.

Lay summary

Psychedelic-assisted treatments are attracting increased attention and impressive efficacy in early research. We outline the potential for psychedelic therapies to treat the mental health problems seen in athletes. We describe the rationale for their use specifically within elite athletes, the sport-specific considerations and challenges that need to be addressed, the role of sports clinicians, and define the research required to demonstrate their feasibility, safety and efficacy within athletes.

IMPLICATIONS FOR PRACTICE

• With poor mental health a growing concern in elite sport, the clinically-supported application of psychedelics may be well positioned to treat these issues and the sport-specific factors that can contribute to them.

• Various regulatory and sport-specific ethical factors will make research in this context challenging; however, these are tractable, and preliminary research in the application of psychedelic treatments for mental ill-health associated with elite sport is warranted.

• There is no evidence yet to support the safety and efficacy of psychedelic treatment in elite sport, and psychedelic compounds are not currently registered for medical use. Accordingly, the ideas explored within this commentary should not be taken as support for independent self-medication or recreational use of psychedelics.

Acknowledgments

The ideas contained within this manuscript are those of the authors, and do not necessarily reflect those of Orygen, the University of Melbourne, or Deakin University. We would like to thank A/Prof Rosie Purcell, A/Prof Simon Rice, Dr Ruben Laukkonen, and Dr Claire O’Callaghan for providing critical feedback during the preparation of an earlier version of this manuscript.

Disclosure statement

C Walton: None. P Liknaitzky: In accordance with Taylor & Francis policy and my ethical obligation as a researcher, I am reporting that I am a scientific advisor to a company that may be affected by the research reported in the enclosed paper. I have disclosed those interests fully to Taylor & Francis, and I have in place an approved plan for managing any potential conflicts arising from that involvement.

Notes

1 While medicinal MDMA is often loosely referred to as a psychedelic, this paper only addresses the utility of the classical psychedelics listed.

2 See https://www.wada-ama.org/sites/default/files/wada_2020_english_prohibited_list_0.pdf for a full and current list with details regarding ‘Non-Approved’ and ‘Prohibited’ Substances.