Patient selection for psilocybin-assisted therapy rests upon psychologist opinion

Healthcare practitioner beliefs and attitudes concerning psilocybin-assisted therapy (PAT) primarily influence their willingness to offer PAT as a treatment option for eligible patients, according to researchers from the University of Texas Health Science Center’s McGovern Medical School.  Practitioner predisposition to embrace or avoid PAT varies as inclination is often predicated upon personal perception of psychedelics as a viable clinical option, personal recreational experiences using psychedelics, and degree of clinically up-to-date psilocybin knowledge. Researchers explored factors influencing and curtailing psychotherapist impartiality to PAT as reports chronicling psilocybin’s therapeutic benefits accumulate alongside a growing number of patients willing to try PAT if recommended by their doctor.

Highlights of the study include:

  • Most psychologists would choose to inform eligible patients of PAT as a viable treatment option, however only 50% would choose to actually refer patients for PAT.
  • Psychologist attitudes, beliefs, and knowledge strongly influence their intention to refer patients for PAT.
  • Most psychiatrists indicate that a greater level of knowledge would impact their openness to inform eligible patients of PAT.
  • Barriers preventing psychologists from informing and referring patients for PAT include perceptions concerning liability, therapeutic value, and potential negative interactions of PAT with other medications.

Modern psychedelic research dates back to the 1940s where focus on the therapeutic effects of lysergic acid diethylamide (LSD) for mental health conditions including depression, anxiety, substance abuse and addiction, personality disorders, and more crescendoed into the 1980s, kickstarting investigations of other psychedelic substances as viable medical options.  Burgeoning momentum was curbed by a budding countercultural revolution spurring misinformation of psychedelic effects, public fear, and Schedule I classification by the Drug Enforcement Administration (DEA), a categorization preventing any further psychedelic use in medical research.  As the collective cacophony of scientific interest decreased to a murmur, fragments of promising pilot data indicating the potential benefits of psychedelics for mental health were archived beside the cultural and political dogma that colored the period.  When unearthed for reexamination decades later, so too did the negative stigmatization of the past reemerge to color healthcare practitioner opinions and reinforce barriers of psychedelic exclusion from the clinical cannon.

Taking the center stage of modern clinical research interest is psilocybin, a substance found to improve outcomes in mental health-related conditions like depression, smoking and alcohol dependency, and anxiety when administered in controlled settings, i.e., PAT, where patients are given psychological preparation prior to consuming at least one dose of psilocybin, support during the psilocybin session, and integrative work after, i.e., discussion between patient and therapist guiding patients to form insights from their experience that may be used to change unhealthy emotional or behavioral patterns. PAT has been granted “breakthrough therapy” status for the treatment of depression by the FDA, an acknowledgement of its potential for improving outcomes in patients with serious conditions who have not responded to traditional therapy.  The distinction opens the potential for psilocybin to be officially rescheduled and licenced for clinical use, which would make it the first of the four “classic” psychedelics, i.e. LSD, DMT, mescaline, and psilocybin, with such status.  However, though official FDA approval and reclassification would place PAT as a viable choice alongside other traditional treatment options for depression, the decision to inform eligible patients of PAT still rests upon the clinician.

Researchers surveyed 119 psychologists to gather information on factors that may influence their decision to inform or refer patients for PAT.  Psychotherapists rated how different factors would affect their likelihood including concerns of personal liability, personal knowledge regarding psilocybin, side effects and uncertainty of possible psilocybin interactions with other medications, opinions of professional peers on PAT, patient intent when asking for PAT, e.g., seeking psilocybin for recreational purposes, and more. Psychotherapists were asked how they would react if PAT were FDA approved, given options to either disagree, agree, or remain neutral on stances such as remaining in opposition to psilocybin decriminalization, supporting psilocybin reclassification, informing and recommending PAT to eligible patients, attempting all other treatment options prior to recommending PAT, and more.  Factors such as access to resources, knowledge, attitudes, and beliefs surrounding psilocybin, and history of personal psychedelic usage were assessed.  Researchers also asked those surveyed of their attitudes toward medical cannabis to see if responses would act as a predictor for openness to PAT, with results strongly indicating a positive correlation.

Results demonstrated that PAT administration would mainly depend upon therapists’ acceptance of PAT as a viable treatment option and their willingness to educate themselves and receive training on PAT, despite FDA-approval.  The majority of psychotherapists surveyed indicated they would be willing to inform their patients of PAT, however only slightly over half agreed they would refer patients for PTA or view PAT as a viable treatment option in comparison to current treatments for depression.  Of those willing to view PAT as a viable treatment option, the majority agreed they would only refer patients for PAT after exhausting all other treatment options including medication.  Barriers to PAT referral included perceptions regarding uncertainty of therapeutic value and effectiveness, potential interactions with other medications, and liability.  However, the majority of therapists surveyed also indicated that greater knowledge of PAT would increase their likelihood to inform and refer patients for treatment.

Clinical decisions are often influenced by a multitude of unique factors including factors unique to patients and their circumstances.  Among the most important for consideration are the attitudes, beliefs, and opinions of patients regarding their course of treatment.  Any biases or misinformation expressed by patients should be met with unbiased knowledge rather than non-evidence based attitudes and opinions.  Autonomy is a sacred principle of healthcare ethics instilling power in patients to make well-informed, self-determined decisions for their care.  To give patients the power to make rational, knowledgeable decisions, practitioners must abscond from unfounded opinions and embrace education of all viable treatment options so that they may uphold their duty to inform.