Psychotherapists’ openness to engage their patients in Psilocybin-Assisted Therapy for mental health treatment

In the 1940–60s the medical field pivoted its attention towards the clinical indications of psychedelic drugs in discovering that LSD held psychoactive effects (Grinspoon and Bakalar, 1979). With the desire to help patients for which effective therapies were unavailable, psychedelics were identified in psychologically-supportive environments to potentially improve outcomes for depression or anxiety (e.g., Cohen, 1968; Eisner and Cohen, 1958), substance use (e.g., Jensen, 1962; Maclean et al., 1961; Savage and McCabe, 1973), and other mental health disorders (e.g., Chandler and Hartman, 1960). Despite this, several factors, including the countercultural revolution of the 1960s, the use of psychedelics in uncontrolled settings, and publicized reports of ‘bad trips’ heightened public fear of psychedelics (Belouin and Henningfield, 2018). Eventually, the Drug Enforcement Administration categorized psychedelics as Schedule I drugs (Chi and Gold, 2020; Rucker et al., 2018), and psychedelic research ceased in the 1970–80s. While this early research is best seen as inconclusive by professionals in the field (Bonson, 2018; Nutt et al., 2013; Nichols and Hendricks, 2020; Rucker et al., 2018), they provide promising pilot data.

This pilot data encouraged researchers to re-examine the safety and efficacy of psychedelics for mental health (e.g., Gasser et al., 2014; Griffiths et al., 2008). Of particular focus in contemporary psychedelic research is psilocybin, which has been found to significantly aid in six-month abstinence of smoking cessation (Garcia-Romeu et al., 2014), increase self-efficacy and decrease alcohol cravings in individuals with alcohol dependence (Bogenschutz et al., 2015), and predict sustained, clinically-significant reductions in depressive and anxious symptoms in end-of-life patients with cancer (Ross et al., 2016). While some of these studies have small sample sizes, the positive results provide support for the potential of using psilocybin for mental health in appropriate psychotherapeutic settings.

In fact, psilocybin has also been found to improve therapy outcomes in depression (e.g., Carhart-Harris et al., 2018; Davis et al., 2021; Davis et al., 2021; Roseman et al., 2018) through Psilocybin-Assisted Therapy (PAT) in which patients are provided with psychological preparation for the psilocybin experience, support during the experience, and integration work following the psilocybin experience, after having consumed at least one dosage of psilocybin. PAT has evidenced such clinical utility that the U.S. Food & Drug Administration provided psilocybin with “breakthrough therapy” status for the treatment of depression (Rahhal, 2019). Furthermore, meta-analyses of PAT have noted both consistent positive implications across these trials (e.g., psilocybin is effective in reducing anxiety and depressive symptoms, psilocybin is safe in controlled, therapeutic settings) and limitations to these trials (e.g., small sample sizes, stringent inclusion/exclusion criteria, small number of studies meeting design quality; Goldberg et al., 2020; Li et al., 2022; Vargas et al., 2020). These overall results provide preliminary support for psilocybin as a successful treatment option for mental health.

Rucker et al. (2018) predict that psilocybin may be one of the first classic psychedelics to be legally rescheduled and licensed; however, they note that the deliverability and cost-effectiveness of psilocybin must be demonstrated before PAT can be an accepted treatment option. This could impede the likelihood of licensing psilocybin as integrating psychedelics with psychotherapy is resource- and labor-intensive which may seem unfeasible for most mental health professionals (Garcia-Romeu and Richards, 2018; Greenway et al., 2020; Walsh and Thiessen, 2018). For example, maintaining a supportive environment in psychedelic-assisted therapy requires treatment providers to accompany the patient for the duration of their psychedelic experience, which could be multiple hours (Rucker et al., 2018).

Distinct from other drugs which are generally assumed to provide pharmacological effects irrespective of context, it is hypothesized that the clinical effectiveness of psychedelics is highly influenced by the setting and patient mindset, necessitating appropriate psychological preparation, careful construction of the therapeutic environment, and consecutive access to compassionate treatment providers (e.g., integration sessions; Carhart-Harris et al., 2018; Erritzoe et al., 2017; Erritzoe and Richards, 2017; Garcia-Romeu and Richards, 2018). Thus, the efficacy of psilocybin to treat mental health is predicted to be most admissible if delivered by the patient’s psychotherapist (e.g., therapeutic alliance; Kazdin, 2007) and those well-informed of psychedelics with appropriate training (Phelps, 2017; Rucker et al., 2018).

Despite psychedelics often being negatively stigmatized, clinicians would need to be open to receive training on this innovative treatment otherwise PAT would be largely inaccessible in practice and may not be implemented (Belouin and Henningfield, 2018). Should psilocybin be FDA approved, the success of PAT may largely rely on psychotherapists’ openness to engage their patients with PAT. Thus, assessing psychotherapists’ opinions of PAT is imperative to identify potential barriers and facilitators towards informing their patients. This would also aid in determining what resources should be made available to psychotherapists’ in this clinical decision making.

In looking at healthcare professionals’ (HCPs) opinions of similar substances and how it affects their willingness to inform patients, medical cannabis (MC) has been more widely investigated. Across multiple systematic reviews it has been evidenced that HCPs disclose their knowledge of MC (e.g., prescribing, regulations) to be low (e.g., Gardiner et al., 2019; Hordowicz et al., 2021; Weisman and Rodriguez, 2021), desire more education on MC to inform their clinical decision making, and note this lack of knowledge to contribute to unwillingness to recommend use of MC to their patients (e.g., Gardiner et al., 2019; Hordowicz et al., 2021). Furthermore, 86 % of HCPs were considered as having poor knowledge of MC and 60 % endorsed receiving inquiries for its use from their patients; however, <30 % felt comfortable discussing this potential treatment option with patients (Karanges et al., 2018). Additionally, in areas where MC has been legalized, professionals in the field note significant barriers to making this treatment option available to their eligible patients and provide recommendations to policymakers in addressing these barriers (e.g., Nutt et al., 2020). As HCPs’ attitudes towards MC are significantly associated with their intention to recommend MC to their patients (Melnikov et al., 2021), gathering similar data from HCPs in the context of classic psychedelics seems timely.

Beaussant et al. (2020) conducted interviews with a small sample of clinicians (n = 17) that revealed highly polarizing views on most aspects related to psychedelic-assisted therapy. It was also found that clinicians’ experiences with psychedelics influenced their opinions. The authors posit that larger sample sizes would be necessary to address the limitations of their research, such as how demographics and prior personal experience with psychedelics influences clinicians (Beaussant et al., 2020). Research on 323 psychiatrists’ attitudes towards classic hallucinogens revealed that 80.5 % felt that hallucinogens deserve further research for treatment of psychiatric disorders and 52.5 % disagreed that the use of hallucinogens is unsafe under medical supervision (Barnett et al., 2018). Similarly, research on psychologists’ attitudes and beliefs about psychedelic-assisted therapies evidenced that 84.7 % felt that psychedelics deserves further scientific inquiry, 55.4 % agreed that medically supervised use of psychedelics is not unsafe, and 29.4 % endorsed having personal experience with psychedelics which they predominantly rated to be somewhat or very positive (Davis, Agin-Liebes, et al., 2021).

More recently, Meyer et al. (2022) found that in a sample of mental health professionals (1) attitudes and beliefs of psilocybin were neutral while self-reported knowledge was low, (2) attitudes, beliefs, and knowledge of psilocybin were all significantly positively associated, and (3) some sociodemographic variables (i.e., history of psychedelic usage, attitudes towards medical cannabis, gender, terminology used) were associated with opinions on psilocybin while other variables (i.e., age, number of years licensed) were not. In looking at patients’ attitudes, 55 % agreed they would try psilocybin therapy if their doctor recommended it (Corrigan et al., 2022). Furthermore, patients who had previously tried psychedelics or held no religious beliefs were more likely to agree that psilocybin therapy would benefit their own mental health conditions, and patients with depression/anxiety were more likely to agree that the government should fund psilocybin research (Corrigan et al., 2022).

The primary objectives of this study are to (1) examine psychotherapists’ openness to engaging their patients with PAT and explore factors which may influence this openness; and (2) identify barriers and facilitators to informing patients about PAT as well as resources that providers would like made available to them should psilocybin be FDA approved. Furthermore, with the literature indicating that personal experiences with substances positively influences HCPs’ attitudes towards those substances (Hordowicz et al., 2021; James and Omoaregba, 2013; Meyer et al., 2022), we assessed whether psychotherapists’ personal experiences with psychedelics would be related to their openness to PAT.