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We examined if the therapeutic alliance between study participants and intervention facilitators in a psilocybin-assisted therapy (PAT) trial changed over time and whether there were relationships between alliance, acute psilocybin experiences, and depression outcomes. In a randomized, waiting list-controlled clinical trial for major depressive disorder in adults (N = 24), participants were randomized to an immediate (N = 13) or delayed (N = 11) condition with two oral doses of psilocybin (20mg/70kg and 30mg/70kg). Ratings of therapeutic alliance significantly increased from the final preparation session to one-week post-intervention (p =.03, d =.43). A stronger total alliance at the final preparation session predicted depression scores at 4 weeks (r = -.65, p =.002), 6 months (r = -.47, p =.036), and 12 months (r = -.54, p =.014) post-intervention. A stronger total alliance in the final preparation session was correlated with higher peak ratings of mystical experiences (r =.49, p =.027) and psychological insight (r =.52, p =.040), and peak ratings of mystical experience and psychological insight were correlated with depression scores at 4 weeks (r = -.45, p =.030 for mystical; r = -.75, p <.001 for insight). Stronger total alliance one week after the final psilocybin session predicted depression scores at 4 weeks (r = -.85, p <.001), 3 months (r = -.52, p =.010), 6 months (r = -.77, p <.001), and 12 months (r = -.61, p =.001) post-intervention. These findings highlight the importance of the therapeutic relationship in PAT. Future research should explore therapist and participant characteristics which maximize the therapeutic alliance and evaluate its relationship to treatment outcomes. Trial registration: Registration: Clinicaltrials.govNCT03181529. https://classic.clinicaltrials.gov/ct2/show/NCT03181529. [ABSTRACT FROM AUTHOR]

There has been little research on the effects of psychedelics on menstrual and reproductive function, though anecdotal evidence suggests that these compounds may have striking effects on menstrual function in at least a subset of users. Social media and word of mouth were used to seek out individuals who had a history of changes in menstrual function following psychedelic use. Case histories were elicited from three respondents following informed consent. A literature search on the effects of classic psychedelics and related compounds was completed. Three women ranging from 27 to 34 years of age were interviewed and reported three distinct phenomena following the use of classic psychedelics: 1) resumption of menses following amenorrhea, 2) early onset of menses, in particular when psychedelics were used in the mid to late luteal period, and 3) improved menstrual regularity in a woman with irregular cycles who was eventually diagnosed with polycystic ovarian syndrome. The mechanisms behind these effects remain unclear, though they may be mediated via direct or indirect effects of 5-HT2A agonism on the hypothalamic-pituitary-gonadal axis. Although phenomena related to menstrual and reproductive function have been largely overlooked in the psychedelic literature to date, these effects may have therapeutic utility and warrant further study. [ABSTRACT FROM AUTHOR]

A recent study published in JAMA Psychiatry explores the potential use of psilocybin, a compound found in certain mushrooms, for the treatment of bipolar II depression. The study involved 15 participants with bipolar II depression who were given a high dose of psilocybin alongside psychological support. The results showed significant improvements in depression symptoms, with 80% of participants meeting criteria for response and remission. Importantly, there were no significant adverse events reported. While the study has limitations, such as a small sample size and lack of a control group, it provides preliminary evidence for the safety and potential efficacy of psilocybin in treating bipolar II depression. However, caution should be exercised in generalizing these findings to bipolar I disorder, which is characterized by more severe manic episodes. Further research is needed to explore the long-term effects and risks associated with psilocybin treatment. [Extracted from the article]

Psychedelic-assisted treatment is at first glance markedly different in structure and approach from mainstream forms of psychotherapy in the West. A major criticism of clinical psychedelic research rests on the difficulty of executing placebo-controlled studies and distinguishing drug effects from those of the psychotherapeutic container in which psychedelics are typically presented. Detractors also tend to find fault in spiritual or mystical themes that often arise in the context of psychedelic use. Common factors theory of psychotherapy is a useful and extensively studied framework that can help make sense of these issues, and has much to contribute to our understanding of contextual effects that are often discussed in psychedelic literature as "set and setting." In this article, we examine four major contextual "common factors" shared by various healing traditions: 1) the therapeutic relationship; 2) the healing setting; 3) the rationale, conceptual scheme, or myth; and 4) the ritual. We explain how these factors show up in psychedelic-assisted treatment and how they may contribute to therapeutic effects. Lastly, we discuss the implications of these factors for the concept of placebo, and for future research. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionThe growth of psychedelic medicine creates new challenges in psychiatric education as physicians may soon be responsible for prescribing a number of psychedelic interventions. Despite this growing need for educated providers, very little is known about the training psychiatry residents receive in psychedelic medicine. We conducted a survey to determine the current educational opportunities as well as the priorities and concerns held by training directors about this emerging field.We emailed an online survey to US psychiatry residency training directors. Respondents answered questions about current offerings in psychedelic medicine, as well as their interest, priorities, and concerns about curricular materials and their delivery.Sixty-one programs responded to our survey. The majority of respondents (64%) favored devoting additional time to psychedelic education, but many endorsed concerns about the dearth of educational materials (54%) and limited availability of faculty to deliver content (46%). The majority of programs (94%) expressed some interest in implementing a standardized curriculum in psychedelic medicine.Training directors recognized that their current curricular materials are limited, and they appeared interested in additional support to meet the upcoming demand in psychedelic education. Further research can inform curriculum development and implementation of psychedelic education in residency training. [ABSTRACT FROM AUTHOR]