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Exploring the placebo effect in psychedelic studies

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Exploring the placebo effect in psychedelic studies
Photo by Diana Polekhina on Unsplash

The placebo effect is the mysterious power our minds have to make us feel better, even when we are taking just a sugar pill instead of real medicine. 

Several studies have shown that this effect is a legitimate biopsychosocial phenomenon that is an integral part of the overall treatment response.

Research has found that the placebo effects can be as strong as the effect of the actual medicine in randomized controlled trials (RCTs).

When scientists want to test a new drug, they use what’s called a double-blind RCT.

In this trial design, two groups of people are tested, one gets the real medicine and the other gets a fake one (the placebo).

The twist? Neither the people taking the medicine nor the ones giving it know which is which. This helps to make sure that the results are trustworthy and not biased.

Even with this careful setup, it’s tough to uphold the true integrity of the double blind information and sometimes the secret of who got the drug and who didn’t gets out.

This is especially true in psychedelic studies.

The RCT design assumes that the effects of a drug being studied can be isolated, added, and/or subtracted from the “nonspecific effect” of context and person, studied by the placebo.

However, despite the goal of blinding, it is rare for trials to uphold blinding integrity and incorporate this information into the results.

While these trials are great for assessing the added benefit of novel drugs, they don’t always show us the full power of the placebo effect.

It’s a hidden superpower we are still trying to understand.

The History of placebo in the clinic

In 1772, a Scottish doctor named William Cullen reported prescribing a remedy to a patient despite believing it to be inefficacious. He explains that sometimes “it is necessary to give a medicine and [this is] what I call a placebo.”

The role of the placebo was to give patients hope and to make doctors’ work easier in difficult or desperate cases.

Placebos were considered as inert substances with “fake” psychological but benign effects. They were believed that they cannot cause harm, but may relieve symptoms.

See also  Integrating psychedelics into all fields of medicine 

It was only in the 1950s, with the rise of informed consent and autonomy as pillars of medical ethics, that the practice of deceiving patients “for their own good” was put into question. Today, the deceptive use of placebos is seen as a relic of an older era.

However, despite this change in mindset, 46-95% of doctors prescribed placebos in 2018.

Placebos in research

In the 20th century, placebos began to be used in research to assess the added benefit of drugs and to discard harmful or ineffective treatments. By 1946 the comparative experimental framework was advocated for in clinical trials.

The placebo effect

In 1955  Dr. Henry Beecher wrote an article called The Powerful Placebo, which catapulted the ideas on the placebo into popularity and changed the way researchers thought about the placebo effect.

He found that about one-third of participants in clinical trials were experiencing relief from their symptoms.

Before, placebos were often just given to patients to make them feel better, and many brushed them off as just “all in the mind.”

However, in research, the placebo effect led to discerning between useful and non-useful treatments. This insight from Dr. Beecher helped scientists figure out which treatments really worked and which didn’t.

In 1962, the RCT design comparing the effects of treatment and placebo groups became the gold standard for pharmaceutical manufacturers to demonstrate efficacy and safety to regulators.

Placebo in Psychedelic Studies

Using a placebo in psychedelic studies is a challenge. It is very obvious to the recipient who receives a placebo versus a psychedelic.

And placebo effects have been shown to be enhanced by the setting of the psychedelic study.

A recent study looked at placebo psychedelics alone in the context of a psychedelic party. Researchers threw a party for 33 students. They gave them placebo, telling them it was similar to psilocybin, the hallucinogenic molecule found in psychedelic mushrooms.

The party had music, colorful lights, mesmerizing paintings and visual projections.

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Some of the people at the party were in on the secret. They were there to act like they were feeling the effects of “the drug” and to make the study participants believe that there was no placebo control group.

The results indicated that context and expectations can promote psychedelic-like effects.

The party vibes and expectations made the participants feel like they had a psychedelic trip, even without taking any real drugs.

The individual variability within the placebo effects was considerable.

Some felt nothing, while others felt like they’d taken a strong dose of psilocybin.

In psychedelic studies, it is much more difficult to use the traditional framework for assessing the effectiveness of a drug against a placebo. The environment and mindset, often referred to as “set and setting” can play a huge role in the effects of the drug.

The effects can be synergetic. The drug influences the “set and setting” and the “set and setting” influences the drug effect. Since the party setting can itself be a game changer on the effects of the drug, these elements should be seen as factors central to psychedelic science, and cannot be disregarded as noise.

How to control for the placebo effect in psychedelic studies?

A group of drug experts including Prof. David Nutt, Robin Carhartt-Harris, Balázs Szigeti and David Erritzoe, recently wrote a preprint (an article shared prior to peer-review) on the fallibility of placebo control.

When people think they are getting the true drug but aren’t, their expectations can mess with the results of the trial.

They call this combination of weak blinding and positive treatment expectancy, activated expectancy bias (AEB).

The effect of AEB is an uneven distribution of expectancy effects between placebo and drug due to patients recognizing what they received in psychedelic randomized controlled trials.

To counteract the bias, the researchers proposed the Correct Guess Rate Curve (CGRC), a computational model and novel analytical tool that can estimate what the results of the trial would look like if everyone was completely in the dark about whether they got the real drug or a placebo.

See also  Christie’s and MAPS to host NFT fundraiser for psychedelic legalisation

Results from the CGRC suggest that placebo-controlled studies are more fallible than conventionally assumed leading to researchers thinking a drug works when in fact it does not.

The CGRC can help fix this bias, and it is cost effective and less resource intensive.

Most solutions to improve blinding are difficult to implement and resource intensive. Thanks to these experts, we now have a useful tool to make drug research more reliable.

With the resurgence of psychedelic research in randomized controlled trials, it has highlighted the antiquated system we have used for the last century to evaluate drug effectiveness.

The idea of “set and setting” should not stand alone for use in psychedelic research. Perhaps more treatments could benefit from improved set and setting.

Furthermore, in psychedelic studies the psychedelics are given in a treatment regime that involves psychotherapy, resulting in the name psychedelic-assisted therapy.

The idea is not to give the treatment to the patient and send them on their way. The psychotherapist will prepare the patient for treatment, be with them during treatment, and help them integrate in follow-up sessions.

It would be interesting if more treatments used the structure as described above. Most treatments are given after a very brief talk with a doctor, and then usually results in a “give me a call if you don’t improve.”

What if the doctor said: “call me if you improve or if you don’t.” Perhaps it could strengthen the doctor-patient relationship. Even “the placebo effect” could be integrated into a person’s recovery.

The holistic approach of psychedelic-assisted therapy, where the journey is as important as the treatment itself, offers a promising blueprint for future medical practices.

By fostering deeper doctor-patient relationships and harnessing the power of the placebo effect, we could revolutionize the way we heal and care.

This article was first published on Nina’s Notes and is republished on Psychedelic Health with permission.

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Psychedelic-assisted therapy for treating PTSD in Ukraine brings hope

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Photo by Karollyne Videira Hubert on Unsplash

The war in Ukraine brings suffering and trauma, which naturally leads to cases of post-traumatic stress disorder (PTSD) among soldiers and civilians. The Ministry of Health of Ukraine predicts that about 4 million Ukrainian civilians are suffering from PTSD.

According to the WHO, about a quarter of the Ukrainian population may be affected by disorders of mental health. In order to deal with this challenge, Ukraine must ensure access to safe, effective and adequately regulated therapy.

That is also why Ukraine is trying to support the idea that mental health will become an integral part of Ukraine’s “reconstruction.” Czech Republic can in this regard offer a helping hand in the sphere of innovative therapy. That is also one of the reasons why a Ukrainian delegation took part in the international conference Novel Mental Health Treatments and Sustainability of Healthcare Systems: Czechia as a Leader of the EU? which took place in Prague.

Psychedelic-assisted therapy is being increasingly discussed in Ukraine as a way of treating PTSD. Although the use of ketamine as part of mental illness treatment has been legal since 2017, substances such as MDMA and psilocybin are still banned. With a view to global development, which has been inching towards supporting the medical use of psychedelics, Ukrainian institutions are supporting clinical studies for psychedelic-assisted therapy as an innovative way of treating PTSD.

Medical use of psychedelics in PTSD treatment in Ukraine

The potential of psychedelic-assisted therapy in the context of the war in Ukraine was also the focus of one of the conference panels. The panel was attended by Ukrainian MPs Mykhailo Radutskyi, Dmytro Gurin, Rostyslav Tistyk and State Secretary of the Ministry of Internal Affairs Inna Yashchuk.

Over the course of the day, Mykhailo Radutskyi, Member of the Verkhovna Rada of the Parliament of Ukraine and Chairman of the Committee on National Health, Health Care and Health Insurance praised the Czech Republic and said that the country is at the forefront of psychedelic research in Europe.

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“We have a large population suffering from mental health problems, but we will most likely never have enough experts. In Ukraine, we have an information campaign on how to treat soldiers who have returned from the front, and we are proposing a law which would ensure mental health,” Radutskyi stated.

“About 3.5 million people in Ukraine, and not only soldiers and veterans, currently have mental health problems because of the war, over a million war veterans will need psychotherapeutic help, and currently about half of the veterans suffer from PTSD,” said Dmytro Gurin, Ukrainian MP and member of the Committee on National Health, Health Care and Health Insurance.

“Mental health must become an issue and must play a part in the reconstruction of Ukraine. Winning the war is one thing, but we must also win the war on mental health. One way to win this war is through psychedelic-assisted therapy, and our Parliament and the Ministry of Health will support clinical trials.

“I hope that we will soon approve a study researching the potential for treating PTSD through psychedelic-assisted therapy. Our task is to create fitting conditions for future clinical trials.”

State Secretary of the Ministry of Internal Affairs Inna Yashchuk said: “The Ministry of Internal Affairs is setting up mental health centers all over Ukraine, and I estimate that when we win, 80 % of the people will come to their doctors in need of psychological and psychiatric help. So mental health is not a problem today, but it will be a problem for the future.”

Czech Republic wants to help Ukraine with mental health issues

The event also featured a speech by the Governmental Envoy for the Reconstruction of Ukraine, Tomáš Kopečný, who said: “Ukraine’s reconstruction is not only about physical reconstruction, but also about the mental health of Ukrainian civilians and war veterans, it is about increasing capacities on site, so that the support reach is as effective as possible.”

Other experts also believe that one of the outcomes of the panel discussion should consist in the establishment of a structural relationship between the Czech Republic and Ukraine in the field of mental health, which would include scientific cooperation, exchange of know-how and joint research projects.

Scientific supervision of the ongoing exchange between Czechia and Ukraine in the field of mental health is primarily provided by Professor Jiří Horáček of the Faculty of Medicine at Charles University and director of the Centre for Advanced Studies of Brain and Consciousness at the National Institute of Mental Health, who has prepared an innovative clinical study of using ketamine for the treatment of PTSD in Ukrainian veterans.

In Czech Republic, the topic is also addressed by the Psychedelic Research Foundation (PSYRES). Its director, Jana Bednářová, has said that: “Research about psychedelics is crucial for the future of Ukraine and the Czech Republic. While such research will put Czech Republic on the cutting edge of the field in Europe, without breakthrough solutions for Ukraine, it can take an entire generation to regenerate mental health – in comparison, the physical recovery of the country can be a matter of mere years. Our mission is to enlist visionaries, philanthropists, organizations and the general public to support our research projects and activities and help us make treatment available to everyone who may need it.”

The issue has been resonating in Brussels, Czechia among EU leaders in mental health

The Czech Republic was the first country to put mental health back on the EU’s agenda. The Czech trial in Brussels also leads to the topic of psychedelic-assisted therapy in the treatment of PTSD in Ukraine. The topic was first addressed last year by PsychedelicsEUROPE, a platform focussing on the European regulation of psychedelics. The platform has long been working towards the approval of a new regulatory framework for the medical use of psychedelics on the European single market.

“Mental health is becoming a central issue for the EU. We are a little behind the US, the UK and Australia, but the necessary debate about the regulation of psychedelic substances is coming to Europe. In the same way that psychedelic-assisted therapy can help Ukraine, Ukraine can help the EU in this field by providing data from new research which may help with drafting good legislation. This is one of the reasons why mental health ought to be an implicit part of Ukraine’s reconstruction,” said Viktor Chvátal, founder of PsychedelicsEUROPE.

The event was organised by:

PSYRES
The mission of PSYRES, the Psychedelic Research Endowment Fund, is to provide funding to scientific projects and facilities that focus on innovative treatment procedures in the field of mental illnesses. Our task is to support research and study of the potential of psychedelics and their therapeutic use in psychiatry, neurology and addictology. Our activities help with the preparation and implementation of clinical studies and analyses and with the education of the public. We collaborate with doctors, therapists and researchers who deal in depth with altered states of human consciousness.

INSTITUTE FOR RATIONAL ADDICTION POLICIES
Institute for Rational Addiction Policies is a multidisciplinary association of independent and prominent experts who address the issue of addiction from all angles – public and individual health, legislation and other legal implications, including security challenges, and economics including market modeling, tax, economic impacts on public budgets, the field of education and prevention, and finally also the fields of social and sociological and political science.

PSYCHEDELICS EUROPE
PsychedelicsEUROPE (PE) is an innovative public affairs mental health platform based in Brussels that brings together leading research centres, NGOs, investors, philanthropists and private companies. Based on the latest scientific evidence, PE advocate in the EU for a regulatory environment that promotes modern therapies, cutting-edge research, and innovative industry.

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Psychedelic therapist training programmes are not fit for purpose

We must learn from our mistakes when conducting Psychedelic Assisted Therapy.

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Groundbreaking trial to assess real-world efficacy of MDMA therapy for PTSD

Psychologists, therapists and counsellors play a fundamental role in treating common mental health disorders such as anxiety and depression. With little advancement in treatments for common mental health issues for over half a century, reliance on therapy to support people with such conditions is extremely high in the UK.

However, most training programmes for these professionals do not focus enough on skills acquisition and we are simply not training enough therapists to meet the growing demand. This will not fix the nation’s mental health crisis.

Don’t believe me? Look at the variance in outcomes between therapists. Look at the sheer number of people in England who are prescribed antidepressants by their GP. The figure now stands at more than 8 million people, with over 2 million having been taking them for five years. Look at the number of people on waiting lists to start therapy. It all points to a fundamental problem where many people, with a common mental health problem, are unable to access therapy that works.

One of the reasons lies in the way we train therapists. On most training programmes, students are assessed as competent to practice through their academic writing and the submission of one or two, self-selected, recordings of therapy sessions. They typically have a placement to apply their new skills. However, unlike other healthcare professionals, these sessions occur behind closed doors, without direct observation. Imagine training a nurse, a surgeon or a dentist like this.

See also  Where can I find training for psychedelic therapy?

This lack of direction observation makes it difficult to know what the trainee is doing with their patients, whether they can consistently deliver therapy with fidelity to the therapy model, and how they interact with patients/clients. It makes it difficult to give the trainee meaningful feedback that will enable them to become better at what they do.

The system encourages higher and higher academic qualifications. However, in my own experience of teaching and supervising mental health professionals, there is no association between competence and the level of academic qualification. Dare I say it, but it is not necessary to have a degree in order to be a highly effective therapist.

This is why Clerkenwell Health has recently launched their Foundations Programme – a practitioner programme for healthcare professionals interested in Psychedelic Assisted Therapy (PAT). Programme participants will be provided with the knowledge required to prepare to safely, ethically and effectively deliver psychedelic treatments.

As we move towards a future where Psychedelic Assisted Therapy (PAT) becomes more mainstream in treating metal health disorders, we must ensure all training programmes robustly assess whether a trainee can consistently deliver high quality therapy that makes measurable difference to patients’ lives. This is what really matters.

Clerkenwell Health’s Foundations Programme leaves no stone unturned. The course explores both the ethical and practical aspects surrounding psychedelic treatments within a regulated healthcare setting, with the teaching delivered by practitioners at the forefront of psychedelic research in the UK, including Dr Sara Tai, Professor of Clinical Psychology at the University of Manchester; Dr David Luke, Associate Professor of Psychology; and Dr Jules Evans, the writer, philosopher and award-winning author of Philosophy for Life.

I asked one organisation, that provides training in PAT, how they selected their trainees, and I was told that it was done “with the gut”. The current approach runs the risk of training a new workforce who are not fit for purpose.

What’s more, all of the existing programmes use ‘psychedelic-psychobabble’. Trainees are taught to ‘trust the medicine’, ‘trust your instinct’ or ‘trust that the participant has the power to heal themselves’. These terms are not widely understood within mainstream healthcare and have, in some cases, led to acts of gross misconduct.

We need a more sober, science-led and evidence-based approach to training. Clerkenwell Health’s Foundations Programme tries to achieve this by providing learners with a thorough background in the history, current state of evidence, treatment modalities, putative mechanisms of actions, and future of psychedelics.

Patient safety, robust standards and clinical effectiveness are of utmost importance in our work at Clerkenwell Health. It’s for these reasons that we’ve launched the Foundations Programme, a course which carefully selects its trainees, assesses their competence and efficacy and is scientifically and theoretically robust. This is not the place where you can try out some psychedelics and suddenly feel qualified to be a psychedelic assisted therapist. This is the place where healthcare professionals come to train in evidence-based practices that are proven and safe. PAT must grasp the golden opportunity to set the standard for a new paradigm in mental healthcare.

If you’re interested in learning more about Clerkenwell Health’s Foundations Programme, you can find out more here: https://training.clerkenwellhealth.com/foundations

This article was written by Dr Sarah Bateup, Scientific Advisor at Clerkenwell Health. Sarah has delivered over 30,000 hours of therapy and taught at Kings College London and Exeter University before joining ieso digital health where she helped scale the company from 10 therapists to 1000.

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Psilocybin therapy for end-of-life care supported by 79% of Canadians

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The Entourage Effect in Mushrooms: Natural psilocybin may outperform synthetic

A new survey has revealed that over 79% of Canadians support psychedelic-assisted therapy for existential distress at the end of life.

People facing a terminal diagnosis often experience significant distress. Depression, anxiety, existential distress and loss of meaning or purpose can make this type of diagnosis difficult to deal with.

Current treatments consist of counselling of cognitive behaviour therapy (CBT), but these are not always effective for everyone, creating a need for innovative new approaches to end-of-life care.

Increasing research is now showing that psychedelic therapy may be beneficial for treating existential distress in patients diagnosed with incurable diseases.

For example, a review published in 2018 in Neuropsychopharmacol Biol Psychiatry found that patients with life-threatening diseases associated with symptoms of depression and anxiety benefitted from the anti-anxiety and anti-depressant properties of psychedelics.

The studies reviewed anecdotally reported that patients experienced quality of life improvements along with a reduced fear of death.

A randomized double-blind trial carried out by John Hopkins University also revealed that high-dose psilocybin produced significant decreases in depression, anxiety and death anxiety, and improvements in quality of life, life meaning, and optimism.

A further clinical trial from New York University found that 60% to 80% of participants experienced anti-anxiety and anti-depressive effects from the treatment, along with benefits for existential distress, quality of life, and attitudes towards death, noting that “the psilocybin-induced mystical experience mediated the therapeutic effect of psilocybin on anxiety and depression.”

Supporting psychedelics for end-of-life care

In light of psychedelic therapy’s inclusion in Canada’s Special Access Programme in 2022, which enables authorised patients to receive access to these therapies if other treatments have been unsuccessful, a team of researchers set out to understand the public’s opinion on the potential easing of rules surrounding the medical use of psilocybin.

The survey, published in Palliative Medicine and carried out by Michel Dorval and Louis Plourde at Université Laval’s Faculty of Pharmacy and researchers from McGill University, Université de Montréal and UQAR, revealed that nearly four out of five Canadians support the use of psilocybin as a treatment for end of life existential distress.

In a statement, Dorval commented: “Studies have already shown that psilocybin, combined with psychotherapy, produces rapid, robust and lasting anxiolytic and antidepressant effects in patients suffering from advanced cancer.

“This substance can bring about a profound awareness that leads the patient to view existence from a different perspective. Treatment with psilocybin, combined with psychotherapy, can produce relief for up to six months.

“Our results seem to indicate that the social acceptability of this intervention is high in the Canadian population. If we consider only Québec respondents, the acceptability rate is similar to the national average.”

The findings also revealed that public support for psilocybin is higher among respondents who have already been exposed to palliative care, as well as higher in respondents who have already used psilocybin.

“Having been close to loved ones at the end of life, or having witnessed their distress, could explain this openness to new approaches designed to help people at this stage of their life,” added Dorval.

“There are still many prejudices against psychedelic substances. Familiarity with these substances probably helps to better understand their true effects as well as their therapeutic potential.”

The authors write: “The social acceptability of psilocybin-assisted therapy for existential distress at the end of life is rather high in Canada. These findings may contribute to efforts to mobilise resources and improve access to this emerging therapy in palliative and end-of-life care settings.”

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Psychedelic Health is a journalist-led news site. Any views expressed by interviewees or commentators do not reflect our own. We do not provide medical advice or promote the personal use of psychedelic compounds. Please seek professional medical advice if you are concerned about any of the issues raised.

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