Psychological variables implied in the therapeutic effect of ayahuasca : a contextual approach.

Alba Franquesa, Alberto Sainz-Cort, Sam Gandy, Joaquim Soler, Miguel Ángel Alcázar-Córcoles, José Carlos Bouso

Psychiatry Research, 2017

PII: S0165-1781(17)31377-X
DOI: 10.1016/j.psychres.2018.04.012

Abstract
Ayahuasca is a psychedelic decoction originating from Amazonia. The ayahuasca-induced introspective experience has been shown to have potential benefits in the treatment of several pathologies, to protect mental health and to improve neuropsychological functions and creativity, and boost mindfulness. The underlying psychological processes related to the use of ayahuasca in a psychotherapeutic context are not yet well described in the scientific literature, but there is some evidence to suggest that psychological variables described in psychotherapies could be useful in explaining the therapeutic effects of the brew. In this study we explore the link between ayahuasca use and Decentering, Values and Self, comparing subjects without experience of ayahuasca (n=41) with subjects with experience (n=81). Results confirm that ayahuasca users scored higher than non-users in Decentering and Positive self, but not in Valued living, Life fulfilment, Self in social relations, Self in close relations and General self. Scores in Decentering were higher in the more experienced subjects (more than 15 occasions) than in those with less experience (less than 15 occasions). Our results show that psychological process variables may explain the outcomes in ayahuasca psychotherapy. The introduction of these variables is warranted in future ayahuasca therapeutic studies.

Key words : Ayahuasca; Psychedelics; Decentering; Values; Self; Psychotherapy; Contextual therapy

1. Introduction

Ayahuasca is the name assigned to both the Amazonian liana Banisteriopsis caapi and any type of decoction containing it (Sánchez and Bouso, 2015). In some Amazonian regions where the use of ayahuasca is considered a tradition, decoctions also include leaves from Psychotrotria viridis (Rubiaceae) or from Diplopterys cabrerana (Malpighiaceae). B. caapi contains harmala alkaloids (harmine, harmaline and tetrahydroharmine), which act as MAOI‟s (monoamine oxidase inhibitors) and P. viridis and D. cabrerana contain the alkaloid DMT (N,N-Dimethyltryptamine) associated with visionary effects. The combination of both plants results in MAO inhibition due to beta-carboline activity, blocking
DMT degradation in the gastrointestinal tract, which allows for uptake by the brain (Riba et al., 2015)

Ayahuasca is used by indigenous Amazonians for ritualistic, religious and ethnomedical purposes (Schultes and Farnsworth, 1980). In recent decades its use has reached an international sphere, it being use for religious, therapeutic and personal growth purposes (Labate and Feeney, 2012). Ayahuasca induces an altered state of consciousness with introspective effects and oneiric-like visions including autobiographic and emotional memories and transpersonal experiences (Bouso and Riba, 2011).

The ayahuasca-induced introspective experience has been shown to have potential benefits for the improvement of several pathologies such as addiction (Nunes et al., 2016; Thomas et al., 2013; Fernández et al., 2014), treatmentresistant depression (Osório et al., 2015; Sanches et al., 2016) and suicidal and aggressive behavior (Frecska, 2008; Grob et al., 1996). Ayahuasca also displays potential mental health protection (Bouso et al., 2012; Grob et al., 1996; Halpern et al., 2008), improved neuro-psychological functions (Bouso et al., 2012, 2015; Bouso et al., 2013) and improved creativity (Frecska et al., 2012; Kuypers et al., 2016). Also, cortical thickness in long-term ayahuasca users has been correlated with cognitive capacities and personality traits (Bouso et al., 2015). Potential risks or negative side effects of ayahuasca use when it is used in a safe and supportive setting appear to be negligible. In fact, in none of the studies comparing long-term ritual ayahuasca users with ayahuasca-abstaining controls have worse scores in either psychopathological status or in neuropsychological functioning in ayahuasca users (for a review see dos Santos et al, 2016a) been observed. However there is some anecdotal evidence linking ayahuasca use to negative effects. A recent report described several deaths that occurred in retreat centers in South America, but none of them seem to be directly related to physiological effects of ayahuasca but with physical accidents or crime (Bauer, 2018). A recent systematic review published by our group found three case series and two case reports describing psychotic episodes associated with ayahuasca intake (dos Santos et al., 2017). The incidence of observed psychosis related to ayahuasca use is within the estimate for the general population (Lima et al., 2002).

The underlying psychological processes related to the use of ayahuasca are not well described yet in the scientific literature, but there is some evidence suggesting that variables such as Decentering, Values and those related to the Self could be useful to explain the therapeutic effects of the decoction (Fernández et al., 2014; Soler et al., 2016; Thomas et al., 2013). Stories about subjective perception of ayahuasca benefits usually include references to “ego dissolution”, “higher consciousness of important things”, “contact with oneself”, “improved ability to understand others”, “greater acceptance of oneself and life
events”, “capacity of self-observation”, and other similar processes related to personal growth (Bresnick and Levin, 2006).

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10.1016j.psychres.2018.04.012