An exploratory study of experiences with conventional eating disorder treatment and ceremonial ayahuasca for the healing of eating disorders

Marika Renelli, Jenna Fletcher, Kenneth W. Tupper, Natasha Files, Anya Loizaga‑Velder,  Adele Lafrance

Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 2018

https://doi.org/10.1007/s40519-018-0619-6

 

Abstract

Purpose : Ayahuasca is a traditional Amazonian medicine that is currently being researched for its potential in treating a variety of mental disorders. This article reports on exploratory qualitative research relating to participant experiences with ceremonial ayahuasca drinking and conventional treatment for eating disorders (EDs). It also explores the potential for ayahuasca as an adjunctive ED treatment.

Methods : Thirteen individuals previously diagnosed with an ED participated in a semi-structured interview contrasting their experiences with conventional ED treatment with experiences from ceremonial ayahuasca. The interviews were analyzed using thematic analysis.

Results : Participant reports were organized with key themes including that ayahuasca: led to rapid reductions in ED thoughts and symptoms; allowed for the healing of the perceived root of the ED; helped to process painful feelings and memories; supported the internalization of greater self-love and self acceptance; and catalyzed spiritual elements of healing.

Conclusions : The results suggest that ayahuasca may have potential as a valuable therapeutic tool, and further research— including carefully controlled clinical trials—is warranted. Level of evidence Level V, qualitative descriptive study.

Keywords : Eating disorder · Psychotherapy · Ayahuasca · Adjunctive treatment · Psychedelics · Traditional medicine

 

Introduction

Eating disorders (EDs) are serious mental disorders that negatively affect individuals at the neurobiological, cognitive, emotional, physical and social level [1]. This class of disorders is often comorbid with mood, anxiety, and substance use disorders, with anorexia nervosa having the highest mortality rates of all the psychiatric disorders [2]. Although there have been significant advances in the field of ED treatment, outcomes are modest, while relapse and treatment drop-out rates remain high [3]. The many obstacles to recovery highlight the continued need for treatment refinement, as well as the consideration and exploration of novel approaches for treating EDs [4]. As EDs are now a global phenomenon, there has also been a call to ED researchers and clinicians to look beyond Western-based therapeutic modalities and explore treatment alternatives from across cultures [5]. In this vein, a preliminary qualitative study [6] reported positive outcomes in individuals with EDs who explored the use of a traditional Amazonian plant medicine commonly known as ayahuasca.

Ayahuasca

Ayahuasca is a psychoactive brew originating from the Amazon basin. It is used in rituals by indigenous leaders and as part of religious ceremonies in a few Brazilian-based syncretic churches. In the last 25 years, there has been a surge of interest in ayahuasca as a psychotherapeutic and spiritual tool. Its use has spread from these traditional South American communities throughout North America, Europe and other parts of the world [7]. Ayahuasca, is prepared by boiling the woody bark of the vine Banisteriopsis caapi in combination most commonly with the leaves of Psychotria viridis. The B. caapi vine contains high concentrations of beta-carboline alkaloids, which function as short-acting reversible monoamine oxidase inhibitors, while the hallucinogenic component N,N-dimethyltryptamine (DMT) is found in the leaves of P. viridis. This combination when ingested orally induces changes in perception and cognition, such as vivid visual and auditory sensations, newfound insights, memory recall, strong emotions, bodily sensations, and spiritual and transpersonal experiences [8]. DMT is Schedule I substance under the 1971 Convention on Psychotropic Substances, which severely limits access to ayahuasca for scientific investigation in most countries, including Canada and the United States. Ayahuasca is traditionally drunk in the context of a shaman-guided group ceremony. Typically, the shaman individually administers the ayahuasca in the form of a tea and once ingested, the individual participants engage in silent meditation for the duration of the ritual. The ceremony lasts approximately 5 hours, during which time the individual may experience nausea, purging (vomiting, diarrhea, crying, yawning, sweating, shaking), and altered states of consciousness [9].

Psychedelics, including LSD, MDMA, psilocybin, and ayahuasca have made a recent resurgence in research as potential therapeutic tools in the field of mental illness [10] including mood, affective and substance use disorders and as of most recently EDs [6, 11–14]. Unlike other categories of illicit drugs, classic psychedelics—which includes DMT, a primary psychoactive component of ayahuasca—do not tend to lead to chronic-dependent patterns of use characteristic of addiction [15]. In terms of physical toxicity, psychedelic drugs, including ayahuasca, are less harmful than many other pharmaceutical medications or street drugs [16], and the overall health risks for typical doses of ayahuasca consumed by healthy individuals have been assessed as negligible [17]. Further, new research suggests that when used with therapeutic or spiritual intention under the guidance of a clinician or experienced ceremonial leader, these types of substances have the potential not only to be used safely, but in some cases to catalyze “quantum change” for patients— i.e., rapid and sustained resolution of symptoms for some mental disorders and addictions [18–20]. While some have suggested a strong element of placebo effect may account for some of the therapeutic effects of psychedelics, this may not necessarily militate against the successes that can be realized through their careful and circumspect use [21].

With respect to EDs, individuals with a history of both the illness and ceremonial ayahuasca drinking reported the reduction or cessation of ED symptomology and other comorbid symptoms, increased emotion processing and regulation, and greater self-love [6]. Some of the particular physical health compromises that individuals with EDs may experience (e.g., cardiovascular or gastrointestinal issues) highlight a need for significant precautions in drinking ayahuasca, which has not been studied clinically to assess safety risks specifically for ED sub-populations. Although some challenges and risks were acknowledged by participants [6]—and hypothetical explanatory mechanisms  for ayahuasca’s potential therapeutic effects are as yet unclear [22]—these preliminary findings suggest a holistic model of healing that warrants further research. In particular, new neuroscience research indicating that alkaloids in ayahuasca and other psychedelic compounds can stimulate neurogenesis and synaptogenesis provides an impetus for this line of inquiry [23, 24]. As such, this exploratory study serves to report on the perspectives of participants with experience with both ceremonial ayahuasca drinking and conventional ED treatments. The results will be utilized to gain a deeper understanding of the potential for ayahuasca as ahealing modality, as well as support the exploration of future investigations.

(…)

Renelli-ConventionalEatingDisorderTreatmentvsAyahuasca-EWD2018