Top Ten Tips Palliative Care Clinicians Should Know About Psychedelic-Assisted Therapy in the Context of Serious Illness
Psychedelic-assisted therapy (PAT) is a burgeoning treatment with growing interest across a variety of settings and disciplines. Empirical evidence supports PAT as a novel therapeutic approach that provides safe and effective treatment for people suffering from a variety of diagnoses, including treatment-resistant depression, substance use disorder, and post-traumatic stress disorder. Within the palliative care (PC) field, one-time PAT dosing may lead to sustained reductions in anxiety, depression, and demoralization-symptoms that diminish the quality of life in both seriously ill patients and those at end of life. Despite a well-noted psychedelic renaissance in scholarship and a renewed public interest in the utilization of these medicines, serious illness-specific content to guide PAT applications in hospice and PC clinical settings has been limited. This article offers 10 evidence-informed tips for PC clinicians synthesized through consultation with interdisciplinary and international leading experts in the field with aims to: (1) familiarize PC clinicians and teams with PAT; (2) identify the unique challenges pertaining to this intervention given the current legalities and logistical barriers; (3) discuss therapeutic competencies and considerations for current and future PAT use in PC; and (4) highlight critical approaches to optimize the safety and potential benefits of PAT among patients with serious illness and their caregivers.
Guidelines and standards for the study of death and recalled experiences of death--a multidisciplinary consensus statement and proposed future directions
An inadvertent consequence of advances in stem cell research, neuroscience, and resuscitation science has been to enable scientific insights regarding what happens to the human brain in relation to death. The scientific exploration of death is in large part possible due to the recognition that brain cells are more resilient to the effects of anoxia than assumed. Hence, brain cells become irreversibly damaged and "die" over hours to days postmortem. Resuscitation science has enabled life to be restored to millions of people after their hearts had stopped. These survivors have described a unique set of recollections in relation to death that appear universal. We review the literature, with a focus on death, the recalled experiences in relation to cardiac arrest, post-intensive care syndrome, and related phenomena that provide insights into potential mechanisms, ethical implications, and methodologic considerations for systematic investigation. We also identify issues and controversies related to the study of consciousness and the recalled experience of cardiac arrest and death in subjects who have been in a coma, with a view to standardize and facilitate future research.
Use of the classic hallucinogen psilocybin for treatment of existential distress associated with cancer
Cham, Switzerland: Springer Nature Switzerland AG; Switzerland, 2022
Acute and Sustained Reductions in Loss of Meaning and Suicidal Ideation Following Psilocybin-Assisted Psychotherapy for Psychiatric and Existential Distress in Life-Threatening Cancer
People with advanced cancer are at heightened risk of desire for hastened death (DHD), suicidal ideation (SI), and completed suicide. Loss of Meaning (LoM), a component of demoralization, can be elevated by a cancer diagnosis and predicts DHD and SI in this population. We completed a randomized controlled trial in which psilocybin-assisted psychotherapy (PAP) produced rapid and sustained improvements in depression, demoralization, and hopelessness in people with cancer. Converging epidemiologic and clinical trial findings suggests a potential antisuicidal effect of this treatment. To probe our hypothesis that PAP relieves SI through its beneficial impacts on depression and demoralization (LoM in particular), we performed secondary analyses assessing within- and between-group differences with regard to LoM and an SI composite score. Among participants with elevated SI at baseline, PAP was associated with within-group reductions in SI that were apparent as early as 8 h and persisted for 6.5 months postdosing. PAP also produced large reductions in LoM from baseline that were apparent 2 weeks after treatment and remained significant and robust at the 6.5 month and 3.2 and 4.5 year follow-ups. Exploratory analyses support our hypothesis and suggest that PAP may be an effective antisuicidal intervention following a cancer diagnosis due to its positive impact on hopelessness and demoralization and its effects on meaning-making in particular. These preliminary results implicate psilocybin treatment as a potentially effective alternative to existing antidepressant medications in patients with cancer that are also suicidal, and warrant further investigation in participants with elevated levels of depression and suicidality.
Psilocybin, spirituality, and palliative care: Research and implications
Utility of psychedelics in the treatment of psycho-spiritual and existential distress in palliative care: A Promising new paradigm
New York, NY : The Guilford Press, 
Defining the Roles and Research Priorities for Psychedelic-Assisted Therapies in Patients with Serious Illness: Expert Clinicians' and Investigators' Perspectives
Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer
BACKGROUND/UNASSIGNED:A recently published randomized controlled trial compared single-dose psilocybin with single-dose niacin in conjunction with psychotherapy in participants with cancer-related psychiatric distress. Results suggested that psilocybin-assisted psychotherapy facilitated improvements in psychiatric and existential distress, quality of life, and spiritual well-being up to seven weeks prior to the crossover. At the 6.5-month follow-up, after the crossover, 60-80% of participants continued to meet criteria for clinically significant antidepressant or anxiolytic responses. METHODS/UNASSIGNED:The present study is a long-term within-subjects follow-up analysis of self-reported symptomatology involving a subset of participants that completed the parent trial. All 16 participants who were still alive were contacted, and 15 participants agreed to participate at an average of 3.2 and 4.5 years following psilocybin administration. RESULTS/UNASSIGNED:Reductions in anxiety, depression, hopelessness, demoralization, and death anxiety were sustained at the first and second follow-ups. Within-group effect sizes were large. At the second (4.5 year) follow-up approximately 60-80% of participants met criteria for clinically significant antidepressant or anxiolytic responses. Participants overwhelmingly (71-100%) attributed positive life changes to the psilocybin-assisted therapy experience and rated it among the most personally meaningful and spiritually significant experiences of their lives. CONCLUSION/UNASSIGNED:These findings suggest that psilocybin-assisted psychotherapy holds promise in promoting long-term relief from cancer-related psychiatric distress. Limited conclusions, however, can be drawn regarding the efficacy of this therapy due to the crossover design of the parent study. Nonetheless, the present study adds to the emerging literature base suggesting that psilocybin-facilitated therapy may enhance the psychological, emotional, and spiritual well-being of patients with life-threatening cancer.
Can expressed interpersonal distress reverse the effects of early interpersonal adversity on somatoform/centralized pain? on neuropsychophysiologic mechanisms of symptom formation and implications for treatment [Meeting Abstract]
Background: Research based Developmental Theory of Somatoform/Centralized Pain (S/CP) (Landa et al., 2012) suggests that early interpersonal adversity(EIA) interacts with multigenerational factors leading to neural predisposition to S/CP. Interpersonal affect regulation between infant and caregiver is crucial for optimal maturation of nervous system; EIA may impede development of capacities for emotion-somatic sensation differentiation, awareness, expression and regulation of emotions, leading to experiencing distress in somaticaly. These mechanisms of symptom formation suggest that psychotherapies targeting development of these capacities can help treat S/CP; studies show that psychotherapies that focus on emotion expression and working through interpersonal traumas can alleviate S/CP. However, the exact neurophysiologic mechanisms underlying these effects are not yet fully understood. In our previous study, 90% of S/CP patients (vs 10% of controls) presented with the Unmet Need for Closeness with Others (UNCO) as main representation of relationships. We now present the data on autonomic regulation (HRV) and verbally expressed emotions/alexithymia during patient's interviews on interpersonal relationships.
Method(s): Twenty patients with S/CP from Pain, Neurology, and Primary Care clinics, and 20 age-, sex-, ethnicity-, and level of education-matched healthy controls completed the Relationship Anecdotes Paradigm (RAP)-a semi-structured interview coded for representations of relationships (Core Conflictual Relationship Theme method). HRV was measured continuously during RAP. RAP narratives were coded for Verbally Expressed Emotion using coding method adapted from Levels of Emotional Awareness Scale.
Result(s): S/CP patients had higher levels of UNCO and RAP alexithymia, and significant increase in HRV during RAP vs controls. Relationship between these dimensions and history of interpersonal traumas will be explored.
Discussion(s): Talking about interpersonal relationships and expressing UNCO to others was associated with HRV increase among S/CP patients, which has direct implications for psychophysiologic mechanisms underlying change in psychotherapeutic interventions for S/CP, therefore helping reverse effects of EIA suggested by the Developmental Theory of S/CP. Implications for diagnosis and treatment of S/CP will be discussed
Psychedelic-Assisted Therapies-Palliative Care Clinical & Research Priorities (TH317) [Meeting Abstract]
Objectives: *Identify types of suffering of psychological, emotional, social, spiritual, or existential nature that are potential indications for supervised therapy involving psychedelic medications, as well as important contraindications to this class of drugs.*Critically evaluate published findings from the expanding evidence base of clinical research into psychedelic-assisted treatment of patients with depression, anxiety, demoralization, and existential and spiritual suffering. People with advanced medical illness often experience anxiety, feelings of hopelessness and loss of meaning and value of life. Some conclude that their life is not worth living and desire to hasten their deaths. Currently available treatments for depression, anxiety, and spiritual distress often fail to alleviate suffering among people who are seriously ill. Research involving psilocybin and related compounds have shown significant benefit suggesting that this class of drugs may offer therapeutic potential in treating persistent, non-physical suffering. During the 2018 AAHPM-HPNA Assembly Meeting a concurrent session on psychedelic therapy drew approximately 600 participants, indicating substantial interest among palliative care providers in the research, cautions, and potential clinical application of these medications. The 2019 session will build on this interest and the content of the previous session to begin defining priorities for research and clinical use of psychedelics within palliative care practice. Recent and ongoing clinical studies pertaining to psychedelic-assisted therapies in care of seriously ill patients will be reviewed. Session faculty will present results of key informant interviews conducted with palliative care clinicians and researchers regarding their priorities for future studies and therapeutic application of these medications. Survey items will include considerations of: a) patient selection and screening, b) frequency and duration of treatment sessions with specific drugs, c) selection of medications (entheogens and empathogens) in treating syndromes of depression, anxiety, demoralization and PTSD, d) necessary levels of supervision, e) safety and therapeutic influence of different settings. These results will inform discussion among session participants. A distillation of this interactive discussion will inform priorities for a developing Special Interest Group on Psychedelic Therapies.