Participant Reports of Mindfulness, Posttraumatic Growth, and Social Connectedness in Psilocybin-Assisted Group Therapy : An Interpretive Phenomenological Analysis

Gabrielle Agin-Liebes, Eve Ekman, Brian Anderson, Maxx Malloy, Alexandra Haas, and Josh Woolley

Abstract

The primary objective of this qualitative study was to explore the therapeutic trajectories of individuals undergoing psilocybin-assisted group therapy. This interpretive phenomenological analysis focused on an enriched study sample of gay-identified cisgender men (n = 9) with human immunodeficiency virus diagnosed before 1996 and clinically significant trauma symptoms. Microphenomenological interviews were carried out 1 day after participants’ individual psilocybin sessions to elicit fine-grained descriptions of the psilocybin-assisted treatment. Two major thematic change processes were identified using Interpretive Phenomenological Analysis. During their psilocybin sessions, participants reported transitioning out of habitual,

evaluative modes of processing and into mindful, experiential modes of processing (from “autopilot” to “meta-aware”). Freed from their emotionally avoidant tendencies, participants were able to process and release previously disowned feelings (grief, shame) and access relational and self-transcendent feelings and prosocial attitudes (joy, gratitude, love, care, compassion). The treatment also supported processes of meaning-making and the realization of posttraumatic growth (in psychological, relational, spiritual dimensions) as participants integrated past traumas into their life narratives and identities (from “trauma-dominant” to “growth-dominant”). These findings suggest that administering adjunctive group therapy with psilocybin may enhance the effectiveness of trauma processing by reinforcing social cohesion, safety, trust, and belonging. These data provide the first empirical suggestion of psilocybin’s efficacy in alleviating trauma symptoms in a group-facilitated format and provide a deeper understanding of the potential psychological change processes involved in this novel treatment approach.

Keywords : HIV/AIDS, psychedelic, qualitative, trauma, mindfulness

Introduction

Over the last two decades, there has been a steady resurgence in human labo- ratory research with classic psychedelics such as psilocybin, ayahuasca, and lysergic acid diethylamide (LSD). Current research indicates that classic psy- chedelics are effective in the treatment of a variety of psychiatric conditions including depression, existential distress related to life-threatening illnesses, and addiction (Luoma et al., 2020). These substances provoke a range of acute perceptual, cognitive, and affective changes (Rickli et al., 2016). Their neural and psychological effects are mediated by agonist activity at the serotonin-2A (5HT-2A) receptor, which lead to functional changes in brain regions associ- ated with emotional regulation and self-related processing (Carhart-Harris et al., 2017; Madsen et al., 2019). Symptom improvement following psyche- delic administration (e.g., psilocybin) has been linked with psychological fac- tors including the strength of acute mystical-type (Johnson et al., 2019) and insight experiences (Davis et al., 2020). While some researchers have chal- lenged the notion that the subjective, psychological effects are key drivers of clinical improvements (Olson, 2021), an accumulating number of studies indicate their importance (Yaden & Griffiths, 2021). Theories continue to remain underdeveloped, and, thus, additional qualitative and quantitative research are needed to refine mechanistic models.

The present analysis draws from a subsample of participants from a recently completed study of psilocybin-assisted group therapy (Anderson et al., 2020). Despite a rich history of ceremonial, group-based psychedelic use and several published studies from the 1960s and early 1970s involving psychedelic-facilitated group models (Trope et al., 2019), our parent study represented the first contemporary clinical trial of group-based psilocybin- assisted therapy. The study enrolled 18 older gay-identified cisgender men with human immunodeficiency virus (HIV) diagnosed prior to 1996 and clinically significant levels of demoralization. The clinical needs of this pop- ulation are well documented and include high rates of depression, anxiety, posttraumatic stress disorder (PTSD), and chronic social isolation (John et al., 2016). Most participants in the study carried complex trauma histories, including childhood abuse and severe stigma, and presented with lingering trauma-related symptoms at enrollment. Participants had also confronted multiple life-threatening illnesses and struggled with complicated grief reac- tions in response to repeated traumatic losses during the AIDS epidemic.

In addition to clinically significant reductions in demoralization, there were significant reductions on secondary measures of self-reported PTSD and complicated grief (Anderson et al., 2020). While there is growing support for the use of methylenedioxymethamphetamine-assisted therapy for the treatment of PTSD (Mithoefer et al., 2019), these data are the first docu- mented improvements in PTSD symptomatology following the administra- tion of a classic 5HT-2A agonist psychedelic. The primary aim of the present study was to enrich our understanding of these quantitative findings and to generate hypotheses regarding psychological mechanisms of change for test- ing in future trials.

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