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Exploring inner depths

A qualitative investigation of patients’ lived experiences with psychedelic treatments of depression
PhD ceremony:J.J. (Joost) Breeksema, MA
When:March 14, 2024
Start:16:15
Supervisors:prof. dr. R.A. (Robert) Schoevers, prof. dr. H.G.J.M. Vermetten, prof. dr. W. van den Brink
Co-supervisor:dr. A. Niemeijer
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
Exploring inner depths

Exploring inner depths

Psychedelics are remarkable substances that produce a wide range of effects and can cause both harm and healing. Clinical research into psychedelic treatments is booming. This thesis first reviews the quantitative effects of psychedelic treatment in patients with mental disorders. However, relatively little is known about how patients experience these treatments. In the second part of this dissertation, we report about patients’ experiences with psychedelic treatments (either ketamine or psilocybin). The aim was to better understand how these treatments might work therapeutically, and, at least as importantly, how to improve how these treatments are offered in the future.  

Many patients with treatment-resistant depression reported intense and overwhelming experiences that sometimes made them feel (quite) anxious, although this was often temporary. While anxiety is frequently reported as an adverse reaction, in psychedelic treatments this can also be therapeutically meaningful. Patients who felt ill prepared or insufficiently supported often struggled to let go of control and surrender to the experience, which increased their discomfort. On the other hand, trust in therapists, realistic expectations, and feeling emotionally supported actually made it easier to surrender to the experience and reduce anxiety. On ketamine, patients had experiences hinting at a psychotherapeutic potential, such as increased openness, more detachment from negative thoughts and ruminations, and even mystical-type experiences. Patients who received psilocybin wished for multiple sessions, longer-term therapeutic support. Across studies, patients’ experiences yielded concrete, relatively easy-to-implement recommendations - including thorough training of clinical staff – which may have a positive impact on the experience and comfort of participants, and possibly help improve treatment outcomes.