Acceptability of Psilocybin-Assisted Group Therapy in Patients with Cancer and Major Depressive Disorder: Qualitative Analysis

Authors

Yvan Beaussant, Elise Tarbi, Kabir Nigam, Skye Miner, Zachary Sager, Justin J Sanders, Michael Ljuslin, Benjamin Guérin, Paul Thambi, James A Tulsky, Manish Agrawal 

Originally published in Cancer as Acceptability of psilocybin-assisted group therapy in patients with cancer and major depressive disorder: Qualitative analysis.

Published Date: December 18, 2023

Abstract

Background

The present study explored the acceptability of psilocybin-assisted group therapy from the perspective of patients with cancer and depression who participated in a clinical trial assessing the safety and efficacy of this novel intervention.

Methods

Guided by the conceptual framework of acceptability, the authors conducted semi-structured interviews with participants of the psilocybin trial. Data were analyzed using template and thematic analyses.

Results

Participants’ (n = 28) perspectives on the acceptability of the group and simultaneous sessions was generally positive, both in terms of safety and efficacy: first, the groups contributed to increase participants’ sense of safety and preparedness as they were engaging in the therapy; and second, the groups fostered a sense of connection and of belonging, which served to enrich and deepen the meaning of participants’ experience, ultimately opening a dimension of self-transcendence and compassion. Other subthemes related to factors influencing the acceptability of the group approach included: 1) the importance of the therapeutic framework, 2) the complementary value of individual sessions, 3) disruptive factors related to the group and/or simultaneous setting, and 4) opportunities and challenges related to group size and how to structure interactions.

Conclusions

This study enhances understanding of what promotes acceptability of the psilocybin-assisted therapy group model for the treatment of MDD in cancer patients.

Plain language summary: We conducted exit interviews with participants of a phase 2 trial of psilocybin-assisted therapy (PAT) conducted in a community cancer center, to assess the acceptability of a novel psilocybin delivery model combining simultaneous individual therapy and group sessions. Our findings support the acceptability of this intervention and suggest that in addition to being feasible, it might also enhance participants’ perceived safety and efficacy compared to uniquely individual or group delivery models of PAT. Our analysis highlights critical factors conditioning acceptability and suggests new ways PAT may be scaled and integrated into cancer care.

References

References

SEER data, 2020. Cancer of Any Site – Cancer Stat Facts. Accessed January 2, 2020. https://seer.cancer.gov/statfacts/html/all.html

Krebber AMH, Buffart LM, Kleijn G, et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psycho Oncol. 2014;23(2):121-130. doi:10.1002/pon.3409

Colleoni M, Mandala M, Peruzzotti G, Robertson C, Bredart A, Goldhirsch A. Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet. 2000;356(9238):1326-1327. doi:10.1016/s0140-6736(00)02821-x

Wilson KG, Chochinov HM, Graham Skirko M, et al. Depression and anxiety disorders in palliative cancer care. J Pain Symptom Manag. 2007;33(2):118-129. doi:10.1016/j.jpainsymman.2006.07.016

Breitbart W, Rosenfeld B, Pessin H, et al. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA. 2000;284(22):2907-2911. doi:10.1001/jama.284.22.2907

Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychol Med. 2010;40(11):1797-1810. doi:10.1017/s0033291709992285

Fujisawa D, Temel JS, Traeger L, et al. Psychological factors at early stage of treatment as predictors of receiving chemotherapy at the end of life. Psycho Oncol. 2015;24(12):1731-1737. doi:10.1002/pon.3840

Forsythe LP, Kent EE, Weaver KE, et al. Receipt of psychosocial care among cancer survivors in the United States. J Clin Oncol. 2013;31(16):1961-1969. doi:10.1200/jco.2012.46.2101

Rayner L, Price A, Evans A, Valsraj K, Higginson IJ, Hotopf M. Antidepressants for depression in physically ill people. Cochrane Database Syst Rev. 2010:CD007503. doi:10.1002/14651858.cd007503.pub2

Rayner L, Price A, Evans A, Valsraj K, Hotopf M, Higginson IJ. Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis. Palliat Med. 2011;25(1):36-51. doi:10.1177/0269216310380764

Walker J, Hansen CH, Martin P, et al. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatr. 2014;1(5):343-350. doi:10.1016/s2215-0366(14)70313-x

Grob CS, Danforth AL, Chopra GS, et al. Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer. Arch Gen Psychiatr. 2011;68(1):71-78. doi:10.1001/archgenpsychiatry.2010.116

Ross S, Bossis A, Guss J, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol. 2016;30(12):1165-1180. doi:10.1177/0269881116675512

Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. doi:10.1177/0269881116675513

Maia LO, Beaussant Y, Garcia ACM. The therapeutic potential of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness: a systematic review. J Pain Symptom Manag. 2022:S0885392422000604.

COMPASS Pathways. COMPASS Pathways Receives FDA Breakthrough Therapy 

Designation for Psilocybin Therapy for Treatment-resistant Depression. PR Newswire; 2018. Accessed August 14, 2019. https://www.prnewswire.com/news-releases/compass-pathways-receives-fda-b…

Businesswire. FDA grants Breakthrough Therapy Designation to Usona Institute’s psilocybin program for major depressive disorder. 2019. Accessed August 8, 2021. https://www.businesswire.com/news/home/20191122005452/en/FDA-grants-Brea…

Beaussant Y, Sanders J, Sager Z, et al. Defining the roles and research priorities for psychedelic-assisted therapies in patients with serious illness: expert clinicians’ and investigators’ perspectives. J Palliat Med. 2020;23(10):1323-1334. doi:10.1089/jpm.2019.0603

Beaussant Y, Richards W, Byock IR, et al. An agenda of psychedelic-assisted therapy research in seriously ill patients: highlights from the Harvard Radcliffe Institute Exploratory Seminar (FR405). J Pain Symptom Manag. 2020;59(2):446-447. doi:10.1016/j.jpainsymman.2019.12.112

Anderson BT, Danforth A, Daroff PR, et al. Psilocybin-assisted group therapy for demoralized older long-term AIDS survivor men: an open-label safety and feasibility pilot study. EClinicalMedicine. 2020;27:100538. doi:10.1016/j.eclinm.2020.100538

Rucker JJ, Marwood L, Ajantaival R-LJ, et al. The effects of psilocybin on cognitive and emotional functions in healthy participants: results from a phase 1, randomised, placebo-controlled trial involving simultaneous psilocybin administration and preparation. J Psychopharmacol. 2022;36(1):114-125. doi:10.1177/02698811211064720

Agrawal M, Thambi PM, Shnayder S. The safety and efficacy of psilocybin therapy in patients with cancer and major depressive disorder. J Clin Orthod. 2022;40(16_Suppl l):12097. doi:10.1200/jco.2022.40.16_suppl.12097

Agrawal M, Emanuel E, Richards B, et al. Assessment of psilocybin therapy for patients with cancer and major depression disorder. JAMA Oncol. 2023:e230351.

Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):88. doi:10.1186/s12913-017-2031-8

Brooks J, McCluskey S, Turley E, King N. The utility of template analysis in qualitative psychology research. Qual Res Psychol. 2015;12(2):202-222. doi:10.1080/14780887.2014.955224

Miller WL, Crabtree BF. Qualitative analysis: how to begin making sense. Fam Pract Res J. 1994;14:289-297.

Leary T, Litwin GH, Metzner R. Reactions to psilocybin administered in a supportive environment. J Nerv Ment Dis. 1963;137(6):561-573. doi:10.1097/00005053-196312000-00007

Hartogsohn I. Constructing drug effects: a history of set and setting. Drug Sci Policy and Law. 2017;3:2050324516683325. doi:10.1177/2050324516683325

Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753-1760.

Shnayder S, Ameli R, Sinaii N, Berger A, Agrawal M. Psilocybin-assisted therapy improves psycho-social-spiritual well-being in cancer patients. J Affect Disord. 2023;323:592-597. doi:10.1016/j.jad.2022.11.046

Agin-Liebes G, Ekman E, Anderson B, Malloy M, Haas A, Woolley J. Participant reports of mindfulness, posttraumatic growth, and social connectedness in psilocybin-assisted group therapy: an interpretive phenomenological analysis. J Humanist Psychol. 2021:00221678211022949. doi:10.1177/00221678211022949

Watts R, Kettner H, Geerts D, et al. The Watts Connectedness Scale: a new scale for measuring a sense of connectedness to self, others, and world. Psychopharmacology. 2022;239(11):3461-3483. doi:10.1007/s00213-022-06187-5

Ross S, Agin-Liebes G, Lo S, et al. Acute and sustained reductions in loss of meaning and suicidal ideation following psilocybin-assisted psychotherapy for psychiatric and existential distress in life-threatening cancer. ACS Pharmacol Transl Sci. 2021;4(2):553-562. doi:10.1021/acsptsci.1c00020

Crowe M, Manuel J, Carlyle D, et al. Experiences of psilocybin treatment for clinical conditions: a qualitative meta-synthesis. Int J Mental Health Nurs. 2023:inm.13127.

Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med. 2014;17(6):642-656. doi:10.1089/jpm.2014.9427

Balboni TA, Fitchett G, Handzo GF, et al. State of the science of spirituality and palliative care research part II: screening, assessment, and interventions. J Pain Symptom Manag. 2017;54(3):441-453. doi:10.1016/j.jpainsymman.2017.07.029

Balboni TA, VanderWeele TJ, Doan-Soares SD, et al. Spirituality in serious illness and health. JAMA. 2022;328(2):184-197. doi:10.1001/jama.2022.11086

Rodin G, Lo C, Rydall A, et al. Managing Cancer and Living Meaningfully (CALM): a randomized controlled trial of a psychological intervention for patients with advanced cancer. J Clin Oncol. 2018;36(23):2422-2432. doi:10.1200/jco.2017.77.1097

Breitbart W, Pessin H, Rosenfeld B, et al. Individual meaning-centered psychotherapy for the treatment of psychological and existential distress: a randomized controlled trial in patients with advanced cancer. Cancer. 2018;124(15):3231-3239. doi:10.1002/cncr.31539

Sloshower J, Guss J, Krause R, et al. Psilocybin-assisted therapy of major depressive disorder using Acceptance and Commitment Therapy as a therapeutic frame. J Context Behav Sci. 2020;15:12-19. doi:10.1016/j.jcbs.2019.11.002

van der Weegen K, Hoondert M, Timmermann M, et al. Ritualization as alternative approach to the spiritual dimension of palliative care: a concept analysis. J Relig Health. 2019.

Beachy J, Petersen R. Chaplaincy and psychedelic-assisted therapy: opportunities and barriers. Reflective Pract. 2022;42.

Smigielski L, Scheidegger M, Kometer M, Vollenweider FX. Psilocybin-assisted mindfulness training modulates self-consciousness and brain default mode network connectivity with lasting effects. Neuroimage. 2019;196:207-215. doi:10.1016/j.neuroimage.2019.04.009

Metzner R, Leary T. On programming psychedelic experiences. Psychedelic Rev. 1967;5-19.

Trope A, Anderson BT, Hooker AR, Glick G, Stauffer C, Woolley JD. Psychedelic-assisted group therapy: a systematic review. J Psychoact Drugs. 2019;51(2):174-188. doi:10.1080/02791072.2019.1593559

Chacruna Institute for Psychedelic Plant Medicines. Guide to RFRA and Best Practices for Psychedelic Plant Medicine Churches 2021. Accessed June 30, 2023. https://chacruna.net/guide_rfra_best_practices_psychedelic_churches/

Schwarz-Plaschg C. Socio-psychedelic imaginaries: envisioning and building legal psychedelic worlds in the United States. Eur J Futures Res. 2022;10(1):10. doi:10.1186/s40309-022-00199-2

Petrelli NJ. A community cancer center program: getting to the next level. J Am Coll Surg. 2010;210(3):261-270. doi:10.1016/j.jamcollsurg.2009.11.015

Pfister DG, Rubin DM, Elkin EB, et al. Risk adjusting survival outcomes in hospitals that treat patients with cancer without information on cancer stage. JAMA Oncol. 2015;1(9):1303-1310. doi:10.1001/jamaoncol.2015.3151

Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160-174. doi:10.1016/s1470-2045(11)70002-x

Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. N Dir Progr Eval. 1986;1986(30):73-84. doi:10.1002/ev.1427