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Cannabis users expect cannabis-assisted therapy for depression to work as well as psilocybin-assisted therapy

Psilocybin-assisted therapy has shown promise as a treatment for depression. New research published in Cannabis finds that cannabis users expected that cannabis-assisted therapy could produce similar subjective experiences and have similar therapeutic benefits for the treatment of depression as psilocybin-assisted treatment.

Over 300 million people suffer from depression worldwide. Although a combination of antidepressant medication and psychotherapy is an effective therapy for around 65% of people suffering from depression, there are still those who may benefit from alternative empirically based therapies, such as psilocybin, which when administered in a controlled therapeutic setting can help improve depression.

“A great many cannabis users look at the measures included in the Mystical Experiences Questionnaire and emphasize that they have had comparable reactions to the plant. When other labs showed that psilocybin’s impact on depression seemed to stem from these, we couldn’t help but ask people,” said study author Mitch Earleywine, a professor of psychology at the University at Albany.

The research sought to assess expectations of regular cannabis users of the potential effectiveness of cannabis-facilitated psychotherapy on depression in two studies. For Study 1, researchers recruited a sample of 560 lifetime cannabis users from Amazon’s Mechanical Turk (MTurk), an online platform, and gave measures of their level of cannabis consumption. Participants read a brief passage describing the therapeutic effects of psilocybin treatment for depression and asked if the ideal dose of cannabis could also help depression under similar circumstances. Participants answered this on a scale of 0 (not at all) – 100 (a great deal).

Participants then read about subjective experiences that are commonly associated with psilocybin-assisted treatment and asked to indicate how much an ideal dose of cannabis would produce each experience. Of these included experiences of emotional breakthrough (i.e., sudden increase in emotional experiences), oceanic boundlessness (i.e., altered state of consciousness commonly associated with antidepressant effects of psilocybin), and ego dissolution (i.e., sense of connectedness and lowered self-importance).

“The emotional breakthroughs seem to underlie therapeutic effects of psychedelics, and plenty of cannabis users claimed that they thought that they could have an emotional breakthrough with cannabis,” Earleywine told PsyPost. “We had to take a look at dysfunctional attitudes because many psychological models of depression, anxiety, and other disorders suggest that maladaptive attitudes are the key.”

Level of cannabis use and expectations of all subjective experiences were positively correlated with the expected effects of improvement of depression. Results suggest, though, that an emotional breakthrough is particularly important. “The link between expected subjective experiences and expected antidepressant effects was no longer significant when [emotional breakthrough] was present as a predictor,” noted the researchers. “Perhaps an emotional breakthrough is the key source of relevant changes in depression, at least according to what cannabis users expect.” This finding suggests the importance of looking at other underlying mechanisms of cannabis-assisted therapy.

The researchers then conducted Study 2 to address the possibility of the expected effectiveness of cannabis-assisted therapy by changing maladaptive or dysfunctional attitudes. Researchers recruited a total of 568 cannabis users from MTurk for Study 2, which had the same materials and general procedure as Study 1 with the inclusion a measure of expectations of an improvement of dysfunctional attitudes. This was measured by having participants rate how much they would agree with various maladaptive statements both before and after a cannabis-assisted therapy session for depression.

Like in Study 1, all expectations of subjective experiences were positively correlated with expectations of the effectiveness of cannabis-assisted therapy. However, of most importance was emotional breakthrough and expectations of dysfunctional attitude change. These two subjective experiences were the only significant predictors of an expected antidepressant effect of cannabis-assisted therapy when all other variables were entered into their statistical analysis.

“Two samples of cannabis users reported expecting that an ideal dose of cannabis administered in a therapeutic setting could create subjective effects like those linked to psilocybin-related improvements,” reported the researchers. “These new data reveal that users expect that an ideal dose administered in ways that parallel current psilocybin-assisted therapy will alter psychedelic experiences of multiple types, including oceanic boundlessness and emotional breakthroughs. In addition, users report that an ideal dose might alter dysfunctional attitudes—a key contributor to depression in cognitive models of the disorder.”

The authors do recommend some caution interpreting these findings. For example, perhaps the participants’ expectations of the cannabis-facilitated therapy do not align with what their actual experience would be like. Participants were also all asked to think of an ideal dosage, which likely varied in unpredictable ways from person to person.

“These data are only ‘expectations,’” Earleywine explained. “People claim that these effects appear in reaction to cannabis, but we don’t have the actual trials. We are trying to collaborate with other labs to get some cannabis-assisted psychotherapy trials off the ground. As you’d guess, the placebo control is a big challenge, but we are eager to at least document that appropriate cannabis sessions.”

“We aren’t recommending the home game,” he added. “Cannabis is not for everybody, especially at high doses.”

The study, “Expectancies for Cannabis-Induced Emotional Breakthrough, Mystical Experiences and Changes in Dysfunctional Attitudes“, was authored by

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