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Currently, we are going through a silent epidemic of mental diseases. According to The Lancet Global Health journal 2020 estimation, mental diseases might affect one billion people worldwide. And among these diseases, depression is the highest contributor on the list. Approximately 250 million people are struggling with these conditions globally. And this number is increasing every year.
The failure of modern psychiatry and science in providing a biomedical explanation of depression adequately making this epidemic widespread. Though some typical pharmaceutical medications are based on the Serotonin Hypothesis, they are not effective and most time-consuming, with a lot of unavoidable side effects. Besides these, the number of typical treatment-resistant patients is increasing, which is forcing researchers to find alternative modalities.
In search of alternative modalities, the researchers discovered ancient Holistic modalities which involve consumption of Psychoactive Holy Plant-based Medicine to heal mentally, physically, and improve spiritually. Psychedelic compounds can be found in these Psychoactive Plant-based Medicines, which are also being researched to be synthesized in the lab. These Psychedelic compounds and their ancient ways of ingesting are changing the whole concept of mental diseases in the field of psychopharmacology. The ritual-based Sacred Ceremonial healing modalities have inspired researchers to look at mental diseases differently, helping them come up with different methods like Psychedelic-Assisted Psychotherapy (PAP), to treat depression with a deeper understanding.
In a recent article Post Doctoral Researcher of Technische Universität Dresden, Dresden, Germany, Max Wolf, and his colleagues suggested a cognitive-behavioral model of how Psychedelic-assisted psychotherapy promotes acceptance. To understand the mechanism of this method, we have to understand first what experiential avoidance is? And why acceptance is important.
What is Experiential Avoidance, and why is Acceptance important
Experiential avoidance plays an important role in the onset and maintenance of various psychopathologies. It can be shortly conceptualized as an unwillingness to encounter inner distress in the form of memories, emotions, thoughts, and body sensations. People usually attempt to control or ignore the distress in whatever form despite long-term and negative symptomatic outcomes. According to psychiatrists, in most cases, Experiential Avoidance is the root of addiction, eating disorders, and depression too.
Psychedelic-Assisted Psychotherapy is a novel treatment for mental diseases that involves the supervised and therapeutic consumption of Psychedelic substances in the continuous course of psychotherapy. The researchers explained that one of its key therapeutic mechanisms of action is lessening experiential avoidance and cultivating an acceptance toward inner experience.
According to the researcher, acceptance is an adaptive attitude towards inner experience in contrast to experiential avoidance. The process of acceptance involves allowing distressful memories, emotions, thoughts, and body sensations to occur and evolve without attempting to escape from them or to control them. Many contemporary cognitive-behavioural psychotherapies consider the patient’s acquisition of acceptance as crucial driving action in promoting long-lasting behaviour change.
What the Research says about Psychedelic-Assisted Psychotherapy
Psychedelic therapy, also known as Psychedelic-Assisted Psychotherapy or PAP, is a type of novel psychiatric practice which involves ingesting a Psychedelic substance or Holy Plant-based Medicine, as a part of a psychotherapeutic process. In Psychedelic assisted therapy, the use of Psychedelics is typically combined with usual therapy.
In 2017, Max Watts and his colleagues explored the idea of whether the minimization of experiential avoidance and promotion of acceptance support therapeutic changes in participating patients treated with Psychedelic-Assisted Psychotherapy (PAP). In this study, the researchers, at a 6-month follow-up, conducted a qualitative thematic analysis of semi-structured interviews. The researchers observed that patients also transitioned from an avoiding attitude to accepting inner distressful experiences in addition to a movement from disconnection to connection with emotions.
More specifically, the researchers demonstrated that the patients who were experiencing inner distress but willingly adopted an avoiding attitude towards these experiences, coupled with attempts to evade and exert control over the distressful experiences, did not find relief. Rather, the patients reported that when adopting an attitude of acceptance toward the distressing inner experiences, the experience tends to change qualitatively into a more positive nature. This ended up yielding therapeutic insights and emotional breakthroughs.
In short, the researchers found that a patient’s attitudes toward inner experience qualitatively changed the experience itself. But how does the PAP model facilitate a change from experiential avoidance to acceptance? To answer this question, the researchers explained the whole mechanism of the PAP model through the lens of Cognitive-Behavioural therapy.
Psychedelic-Assisted Psychotherapy Model through the Lens of Cognitive-Behavioural Therapy
How does the PAP model help patients adopt an accepting rather than avoiding stance toward inner distress? To answer this, the researchers explored the qualitative patient reports and synthesized them within a framework of cognitive-behavioral theory and the theory of belief relaxation. Wolff and colleagues proposed that the PAP model may facilitate the change from avoidance to acceptance through three primary mechanisms which operate synergistically:
- Operant conditioning of acceptance.
- Elicitation and excitation of the private event.
- Relaxation of avoidance-related beliefs.
Operant Conditioning of Acceptance
Generally, as a usual feature of numerous psychopathologies, avoidance is maintained by negative reinforcement. For example, avoidance of a distressing internal emotion may be perpetuated because the distress associated with the emotion is removed temporarily when avoidance strategies are executed. According to the researchers’ observation, the PAP model has the unique quality of promoting acceptance of distressing private inner experiences, which then become conditioned through the same mechanism of negative reinforcement.
For example, the researchers further explained that in the process of the PAP model, patients often report a curious sensation of being drawn to encounter a distressing inner experience rather than avoid it; it can be a thought, emotion, an image of experience or bodily sensation. Being drawn to discover the distressing inner experience in a new light changes the state of the private event into a more positive valence. The change in that state’s quality then elicits a positive emotional response, and acceptance and avoidance become negatively reinforced.
Elicitation and Excitation of Private Events
In addition, to induce operant conditioning of acceptance, the researchers also observed that the PAP model elicits or brings out the suppressed private events through excitation, which facilitates change. Typically a person avoids these events in daily life, but during the PAP therapy session, the deepest suppressed traumatic events from early childhood may come back to the awareness of the patients. These typically warded-off inner experiences then become open and responsive to discussion to alteration not only through operant conditioning of acceptance as mentioned above but also through relaxation of avoidance-related beliefs.
Relaxation of Avoidance Related Beliefs
Facilitated by elicitation and excitation of private events in the context of a PAP session, the researchers hypothesized that acceptance becomes conditioned through negative reinforcement. Concurrently, beliefs about avoidance become agreeable to change. This ability to change due to negative expectancies are proven false by new experiences with the context of encountering distressing inner experiences in the new light of the Psychedelic induced state of mind during the PAP sessions.
Finally, the researchers summarized that Psychedelic experiences involve breakthrough experiences and episodes of relatively avoidance-free exposure. Usually, people avoid such private events. But PAP sessions enabled the participants to see those suppressed events as the constitution of unique learning conditions where relaxed avoidance-related beliefs can be revised with beneficial results. Corresponding changes in explicit attitudes, preconscious assumptions, and more implicit expectancies may profoundly transform the patient’s way of relating to private events.
Conclusion
Using the cognitive-behavioural model, Wolff and his research team formulated a model that sheds light on potential mechanisms of change involved in the current PAP model, including the synergistic interaction among these three stages.
This proposed model appears to provide a starting point for further research on cognitive-behavioural change mechanisms. The model also welcomes a need to develop specific measurement instruments and techniques to facilitate a further clear and deep understanding of these change mechanisms.
References
- Carhart-Harris, L. R. & Friston, J. K. (2019). REBUS and the Anarchic Brain: Toward a Unified Model of the Brain Action of Psychedelics. Pharmacological Reviews, [online] Volume, 71(3), p. 316-344. Available at: https://pharmrev.aspetjournals.org/content/71/3/316 [Accessed 11th August 2021].
- Hayes-Skelton, S. A., & Eustis, E. H. (2020). Experiential avoidance. In J. S. Abramowitz & S. M. Blakey (Eds.), Clinical handbook of fear and anxiety: Maintenance processes and treatment mechanisms. American Psychological Association, [online] Volume, 1, p. 115-131. Available at: https://doi.org/10.1037/0000150-007 [Accessed 11th August 2021].
- Schenberg E. E. (2018). Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development. Frontiers in pharmacology, [online] Volume, 9, p. 733. https://doi.org/10.3389/fphar.2018.00733 [Accessed 11th August 2021].
- The Lancet Global Health. (2020). Mental health matters. The Lancet Global Health, [online] Volume 8(11), Available at: https://doi.org/10.1016/S2214-109X(20)30432-0 [Accessed 10th August 2021].
- Wolff, M., et al. (2020). Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance. Frontiers in Psychiatry, [online] Available at: https://doi.org/10.3389/fpsyt.2020.00005 [Accessed 11th August 2021].
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