Can Experiential Avoidance Be Treated With Psychedelics? Can They Be Useful In Treating Depression?
There have been several studies o the effects of psychedelic drugs and potential benefits in alieving depression in relation to experiential avoidance. There has also been a lot of new research and it provides preliminary evidence that psychedelic drugs can improve mental health by making individuals more accepting of distressing experiences.
Frontiers in Psychiatry, adds to a growing body of literature and research that indicates using substances like psilocybin can result in sustainable improvements in depressive symptoms.
Psychedelic therapy refers to therapeutic practices involving psychedelic drugs, oftentimes utilizing serotonergic psychedelics such as LSD, psilocybin, DMT, MDMA, mescaline, and 2C-B.Wikipedia
“Psychedelic therapy has shown promise as a novel treatment for a range of mental health concerns, including major depressive disorder, distress associated with a life-threatening illness, and substance use disorders,” said study author Richard Zeifman, a PhD student at Ryerson University and research intern at the Centre for Psychedelic Research at Imperial College London.
“In contrast with the traditional pharmacological interventions, the effects of psychedelic therapy appear to last months and even years after treatment has ended. Understanding how psychedelic therapy leads to long-lasting mental health improvements across a range of conditions is not yet fully understood but is important for enhancing and delivering psychedelic therapy to individuals that may benefit from it.”
Researchers were particularly interested in the transdiagnostic construct known as experiential avoidance, meaning the tendency to avoid unpleasant thoughts and feelings.
When unpleasant thoughts are experienced such as our, emotions, or sensations, there is often a natural tendency to want to avoid these uncomfortable experiences – sometimes, at all costs.
People who score high on a measure of experiential avoidance agree with statements such as “I would sacrifice a lot not to feel bad” and “I will go out of my way to avoid uncomfortable situations.”
Experiential avoidance often occurs without us ever taking notice. The following are examples of this occurrence:
- Compulsive buying
- Obsessive-compulsive disorder
“Attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences even when doing so creates harm in the long-run“. Hayes, Strosahl, Wilson, 1999.
Experiential avoidance (a component of the acceptance and commitment therapy [ACT] model of psychological flexibility/inflexibility) is defined as behavior that attempts to ‘alter the frequency or form of unwanted private events, including thoughts, memories, and bodily sensations, even when doing so causes personal harm’ (Hayes, Pistorello, & Levin, 2012, p. 981).
We all have a natural survival instinct embedded within our DNA that creates our aversive reaction to unpleasant or uncomfortable events. This instinct is hard-wired and tells us to avoid things that are unpleasant because they are likely to put us in danger or hams way. However, this same instinct affects our internal processes as well, disconnecting the self from thoughts, emotions, and physical sensations.
For this study, the researchers used online advertisements to recruit a sample of 104 individuals who planned to use a psychedelic substance and a second sample of 254 individuals who planned to attend psychedelic ceremonies. Both samples were used to measure depression severity, experiential avoidance, and suicidal ideation one week before and 4 weeks after using their psychedelic substance of choice.
What was found by Zeifman and his colleagues was that the use of psychedelics in both ceremonial and non-ceremonial settings was associated with decreases in experiential avoidance, which in turn was associated with decreases in depression severity and suicidal ideation 4-weeks after psychedelic use. Psilocybin/magic mushrooms, LSD, and ayahuasca were the most commonly used substances in the study.
“Our findings suggest that one of the reasons that psychedelic therapy has positive therapeutic effects is that it helps individuals to be less avoidant and more accepting of their emotions, thoughts, and memories (even though such experiences may be distressing in the short-term),” Zeifman told PsyPost.
“More broadly, our results provide further support for the negative mental health effects associated with avoidance. This can be summed up with a saying that is often used in the context of psychedelic therapy, that ‘The only way out is through.’”
The study does provide some caveats like most-all studies.
“There were important limitations to our study, including that our study was not conducted in the context of a controlled clinical trial or within a clinical sample. Accordingly, we are currently conducting research where we are comparing the effects of psychedelic therapy versus a traditional antidepressant (called escitalopram) on experiential avoidance. This research will help to further examine the possibility that psychedelic therapy leads to change through different mechanisms than do traditional pharmacological interventions for depression,” Zeifman said.
The researchers concluded their study with the following summary:
In sum, despite research suggesting that psychedelics lead to improvements in mental health outcomes, there is currently little understanding of whether psychedelics lead to decreases in depression severity and suicidal ideation within non-clinical samples.
Furthermore, while preliminary research suggests that reductions in experiential avoidance may play a key role in psychedelic therapy, there is currently limited research that has examined the association between decreases in experiential avoidance and positive therapeutic outcomes following psychedelic use.
To address these knowledge gaps, the aims of the present study were: (a) to examine the impact of psychedelic use on experiential avoidance, depression severity, and suicidal ideation; (b) to examine whether reductions in experiential avoidance would be associated with reductions in depression severity and suicidal ideation following psychedelic use. We hypothesized that:
1. Psychedelic use will be associated with decreases in (a) experiential avoidance, (b) depression severity, and (c) suicidal ideation.
2. Decreases in experiential avoidance after psychedelic use will be associated with decreases in (a) depression severity and (b) suicidal ideation.
The intention of this article is not to promote this particular treatment. The primary goal is to provide information, research, and facts so one can make an informed decision. Make sure to view Intel Mindz past and future articles on alternative treatments and what may work best for you.
1. Watts R, Day C, Krzanowski J, Nutt D, Carhart-Harris R. Patients’ accounts of increased “connectedness” and “acceptance” after psilocybin for treatment-resistant depression. J Humanist Psychol (2017) 57(5):520–64. doi: 10.1177/0022167817709585
3. Johnson MW, Hendricks PS, Barrett FS, Griffiths RR. Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function. Pharmacol Therapeut. (2019) 197:83–102. doi: 10.1016/j.pharmthera.2018.11.010
4. Griffiths RR, Johnson MW, Carducci MA, Umbricht A, Richards WA, Richards BD, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol (2016) 30(12):1181–97. doi: 10.1177/0269881116675513
5. Grob CS, Danforth AL, Chopra GS, Hagerty M, McKay CR, Halberstadt AL, et al. Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer. Arch Gen Psychiatry (2011) 68(1):71–8. doi: 10.1001/archgenpsychiatry.2010.116
6. Ross S, Bossis A, Guss J, Agin-Liebes G, Malone T, Cohen B, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: A randomized controlled trial. J Psychopharmacol (2016) 30(12):1165–80. doi: 10.1177/0269881116675512
7. Bogenschutz MP, Forcehimes AA, Pommy JA, Wilcox CE, Barbosa PC, Strassman RJ. Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study. J Psychopharmacol (2015) 29:289–99. doi: 10.1177/0269881114565144
8. Garcia-Romeu A, Davis AK, Erowid F, Erowid E, Griffiths RR, Johnson MW. Cessation and reduction in alcohol consumption and misuse after psychedelic use. J Psychophamacol. (2019) 33(9):1088–101. doi: 10.1177/0269881119845793
11. Moreno FA, Wiegand CB, Taitano EK, Delgado PL. Safety, tolerability, and efficacy of psilocybin in 9 patients with obsessive-compulsive disorder. J Clin Psychiat. (2006) 67(11):1735–40. doi: 10.4088/JCP.v67n1110
12. Carhart-Harris RL, Bolstridge M, Rucker J, Day CM, Erritzoe D, Kaelen M, et al. Psilocybin with psychological support for treatment-resistant depression: An open-label feasibility study. Lancet Psychiat. (2016) 3(7):619–27. doi: 10.1016/S2215-0366(16)30065-7
13. Carhart-Harris RL, Bolstridge M, Day CM, Rucker J, Watts R, Erritzoe DE, et al. Psilocybin with psychological support for treatment-resistant depression: Six-month follow-up. Psychopharmacol (2018) 235(2):399–408. doi: 10.1007/s00213-017-4771-xup
14. Palhano-Fontes F, Barreto D, Onias H, Andrade KC, Novaes MM, Pessoa JA, et al. Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: A randomized placebo-controlled trial. Psychol Med (2019) 49(4):655–63. doi: 10.1017/S0033291718001356
15. Zeifman RJ, Palhano-Fontes F, Arcoverde E, Maia-Oliveira JP, Hallak J, de Araujo DB. The impact of ayahuasca on suicidality: Results from a randomized controlled trial. Front Pharmacol (2019) 10:1325. doi: 10.3389/fphar.2019.01325
18. Davis AK, Barrett FS, Griffiths RR. Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. J Contextual Behav Sci (2020) 15:39–45. doi: 10.1016/j.jcbs.2019.11.004
19. Garcia-Romeu A, Davis AK, Erowid E, Griffiths RR, Johnson MW. Persisting reductions in cannabis, opioid, and stimulant misuse after naturalistic psychedelic use: An online survey. Front Psychiat. (2020) 10:955. doi: 10.3389/fpsyt.2019.00955
20. Luoma JB, Sabucedo P, Eriksson J, Gates N, Pilecki BC. Toward a contextual psychedelic-assisted therapy: Perspectives from Acceptance and Commitment Therapy and contextual behavioral science. J Contextual Behav Sci (2020) 14:136–45. doi: 10.1016/j.jcbs.2019.10.003
21. Zeifman RJ, Wagner AC. Exploring the case for research on incorporating psychedelics within interventions for borderline personality disorder. J Contextual Behav Sci (2020) 15:1–11. doi: 10.1016/j.jcbs.2019.11.001
22. Garcia-Romeu A, Griffiths RR, Johnson MW. Psilocybin-occasioned mystical experiences in the treatment of tobacco addiction. Curr Drug Abuse Rev (2014) 7(3):157–64. doi: 10.2174/1874473708666150107121331
23. Roseman L, Nutt DJ, Carhart-Harris RL. Quality of acute psychedelic experience predicts therapeutic efficacy of psilocybin for treatment-resistant depression. Front Pharmacol (2018) 8:974. doi: 10.3389/fphar.2017.00974
24. Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, et al. Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. Am J Psychiat. (2010) 167(7):748–51. doi: 10.1176/appi.ajp.2010.09091379
27. Domínguez-Clavé E, Soler J, Pascual JC, Elices M, Franquesa A, Valle M. Ayahuasca improves emotion dysregulation in a community sample and in individuals with borderline-like traits. Psychopharmacol (2019) 236(2):573–80. doi: 10.1007/s00213-018-5085-33
28. Sampedro F, de la Fuente Revenga M, Valle M, Roberto N, Domínguez-Clavé E, Elices M, et al. Assessing the psychedelic “after-glow” in ayahuasca users: Post-acute neurometabolic and functional connectivity changes are associated with enhanced mindfulness capacities. Int J Neuropsychopharmacol (2017) 20(9):698–711. doi: 10.1093/ijnp/pyx036
29. Soler J, Elices M, Franquesa A, Barker S, Friedlander P, Feilding A, et al. Exploring the therapeutic potential of ayahuasca: Acute intake increases mindfulness-related capacities. Psychopharmacol (2016) 233(5):823–9. doi: 10.1007/s00213-015-4162-0
30. Soler J, Elices M, Dominguez-Clavé E, Pascual JC, Feilding A, Navarro-Gil M, et al. Four weekly ayahuasca sessions lead to increases in “acceptance” capacities: A comparison study with a standard 8-week mindfulness training program. Front Pharmacol (2018) 9:224. doi: 10.3389/fphar.2018.00224
31. Hayes SC. Content, context, and the types of psychological acceptance. In: Hayes SC, Jacobson NS, Follette VM, Dougher MJ, editors. Acceptance and change: Content and context in psychotherapy. Reno, Nevada: Context Press (1994). p. 13–32.
32. Close JB, Hajien EC, Watts R, Roseman L, Carhart-Harris RL. Psychedelics and psychological flexibility–Results of a prospective web-survey using the Acceptance in Action Questionnaire II. J Contextual Behav Sci (2020) 16:37–44. doi: 10.1016/j.jcbs.2020.01.005
33. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behav Ther (2011) 42(4):676–88. doi: 10.1016/j.beth.2011.03.007
34. Gámez W, Chmielewski M, Kotov R, Ruggero C, Watson D. Development of a measure of experiential avoidance: The Multidimensional Experiential Avoidance Questionnaire. Psychol Assess (2011) 23(3):692–713. doi: 10.1037/a0023242
36. Tyndall I, Waldeck D, Pancani L, Whelan R, Roche B, Dawson DL. The Acceptance and Action Questionnaire-II (AAQ-II) as a measure of experiential avoidance: Concerns over discriminant validity. J Contextual Behav Sci (2018) 22:278–84. doi: 10.1016/j.jcbs.2018.09.005
37. Vaughan-Johnston TI, Quickert RE, MacDonald TK. Psychological flexibility under fire: Testing the incremental validity of experiential avoidance. Pers Individ Differ (2017) 105:335–49. doi: 10.1016/j.paid.2016.10.011
39. Hayes SC, Strosahl K, Wilson KG, Bissett RT, Pistorello J, Toarmino D, et al. Measuring experiential avoidance: A preliminary test of a working model. Psychol Rec. (2004) 54(4):553–78. doi: 10.1007/BF03395492
40. World Health Organization. Depression and other common mental disorders: Global health estimates. (Geneva: World Health Organization) (2017), http://hesp-news.org/2017/02/23/depression-andother-common-mental-disorders-global-health-estimates/.
42. Nock MK, Hwang I, Sampson NA, Kessler RC. Mental disorders, comorbidity and suicidal behavior: Results from the National Comorbidity Survey Replication. Mol Psychiatry (2010) 15(8):868. doi: 10.1038/mp.2009.29
43. Dutta R, Ball HA, Siribaddana SH, Sumathipala A, Samaraweera S, McGuffin P, et al. Genetic and other risk factors for suicidal ideation and the relationship with depression. Psychol Med (2017) 47(14):2438–49. doi: 10.1017/S0033291717000940
46. Hengartner MP, Plöderl M. Statistically significant antidepressant-placebo differences on subjective symptom-rating scales do not prove that antidepressants work: Effect size and method bias matter! Front Psychiatry (2018) 9:517. doi: 10.3389/fpsyt.2018.00517
47. Cuijpers P, Karyotaki E, Weitz E, Andersson G, Hollon SD, van Straten A. The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis. J Affect Disord (2014) 159:118–26. doi: 10.1016/j.jad.2014.02.026
48. Cuijpers P, de Beurs DP, van Spijker BA, Berking M, Andersson G, Kerkhof AJ. The effects of psychotherapy for adult depression on suicidality and hopelessness: A systematic review and meta-analysis. J Affect Disord (2013) 144(3):183–90. doi: 10.1016/j.jad.2012.06.025
49. Cuijpers P, Karyotaki E, Reijnders M, Ebert DD. Was Eysenck right after all? A reassessment of the effects of psychotherapy for adult depression. Epidemiol Psych Sci (2019) 28(1):21–30. doi: 10.1017/S2045796018000057
50. Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. Lancet Psychiat (2018) 391:1357–66. doi: 10.1016/S0140-6736(17)32802-7
51. Näslund J, Hieronymus F, Lisinski A, Nilsson S, Eriksson E. Effects of selective serotonin reuptake inhibitors on rating-scale-assessed suicidality in adults with depression. Br J Psychiatr (2018) 212(3):148–54. doi: 10.1192/bjp.2017.24
52. Braillon A, Lexchin J, Noble JH, Menkes D, M’Sahli L, Fierlbeck K, et al. Challenging the promotion of antidepressants for non-severe depression. Acta Psychiatr Scand (2019) 139(3):294–5. doi: 10.1111/acps.13010
53. Hegerl U, Allgaier AK, Henkel V, Mergl R. Can effects of antidepressants in patients with mild depression be considered as clinically significant? J Affect Disord (2012) 138(3):183–91. doi: 10.1016/j.jad.2011.05.015
54. Lewis G, Duffy L, Ades A, Amos R, Araya R, Brabyn S. The clinical effectiveness of sertraline in primary care and the role of depression severity and duration: A pragmatic randomised controlled trial. Lancet Psychiat (2019) 6(11):903–14. doi: 10.1016/S2215-0366(19)30366-9
56. Hengartner MP, Plöderl M. Newer-generation antidepressants and suicide risk in randomized controlled trials: A re-analysis of the FDA database. Psychother Psychosom (2019) 24:1–2. doi: 10.1159/000501215
58. Fava GA, Benasi G, Lucente M, Offidani E, Cosci F, Guidi J. Withdrawal symptoms after serotonin-noradrenaline reuptake inhibitor discontinuation: Systematic review. Psychother Psychosom (2018) 87(4):195–203. doi: 10.1159/000491524
60. Machado-Vieira R, Baumann J, Wheeler-Castillo C, Latov D, Henter ID, Salvadore G, et al. The timing of antidepressant effects: A comparison of diverse pharmacological and somatic treatments. Pharmaceuticals (2010) 3(1):19–41. doi: 10.3390/ph3010019
62. National Action Alliance for Suicide Prevention: Research Prioritization Task Force. A prioritized research agenda for suicide prevention: an action plan to save lives. National Institute of Mental Health Research Prioritization Task Force: Rockville (2014).
63. Davis AK, So S, Lancelotta R, Barsuglia JP, Griffiths RR. 5-methoxy-N, N-dimethyltryptamine (5-MeO-DMT) used in a naturalistic group setting is associated with unintended improvements in depression and anxiety. Am J Drug Alcohol Abuse (2019) 45(2):161–9. doi: 10.1080/00952990.2018.1545024
64. Uthaug MV, van Oorsouw K, Kuypers KPC. Sub-acute and long-term effects of ayahuasca on affect and cognitive thinking style and their association with ego dissolution. Psychopharmacol (2018) 235(10):2979–89. doi: 10.1007/s00213-018-4988-3
65. Uthaug MV, Lancelotta R, van Oorsouw K, Kuypers KP, Mason N, Rak J, et al. A single inhalation of vapor from dried toad secretion containing 5-methoxy-N, N-dimethyltryptamine (5-MeO-DMT) in a naturalistic setting is related to sustained enhancement of satisfaction with life, mindfulness-related capacities, and a decrement of psychopathological symptoms. Psychopharmacol (2019) 236(9):2653–66. doi: 10.1007/s00213-019-05236-w
69. Moroz M, Dunkley DM. Self-critical perfectionism, experiential avoidance, and depressive and anxious symptoms over two years: A three-wave longitudinal study. Behav Res Ther (2019) 112:18–27. doi: 10.1016/j.brat.2018.11.006
70. Shallcross AJ, Troy AS, Boland M, Mauss IB. Let it be: Accepting negative emotional experiences predicts decreased negative affect and depressive symptoms. Behav Res Ther (2010) 48(9):921–9. doi: 10.1016/j.brat.2010.05.025
72. Rufino KA, Ellis TE. Contributions of cognitions, psychological flexibility, and therapeutic alliance to suicidal ideation in psychiatric inpatients. Suicide Life Threat Behav (2018) 48(3):271–80. doi: 10.1111/sltb.12353
73. Berking M, Neacsiu A, Comtois KA, Linehan MM. The impact of experiential avoidance on the reduction of depression in treatment for borderline personality disorder. Behav Res Ther (2009) 47(8):663–70. doi: 10.1016/j.brat.2009.04.011
74. Walser RD, Garvert DW, Karlin BE, Trockel M, Ryu DM, Taylor CB. Effectiveness of acceptance and commitment therapy in treating depression and suicidal ideation in Veterans. Behav Res Ther (2015) 74:25–31. doi: 10.1016/j.brat.2015.08.012
75. Ellis TE, Rufino KA. Change in experiential avoidance is associated with reduced suicidal ideation over the course of psychiatric hospitalization. Arch Suicide Res (2016) 20(3):426–37. doi: 10.1080/13811118.2015.1093983
76. Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, et al. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): A psychometric evaluation in patients with chronic major depression. Biol Psychiatry (2003) 54(5):573–83. doi: 10.1016/S0006-3223(02)01866-8
78. Gámez W, Chmielewski M, Kotov R, Ruggero C, Suzuki N, Watson D. The Brief Experiential Avoidance Questionnaire: Development and initial validation. Psychol Assess (2014) 26(1):35–45. doi: 10.1037/a0034473
79. Rush AJ, Carmody TJ, Ibrahim HM, Trivedi MH, Biggs MM, Shores-Wilson K, et al. Comparison of self-report and clinician ratings on two inventories of depressive symptomatology. Psychiat Serv (2006) 57(6):829–37. doi: 10.1176/ps.2006.57.6.829
80. Van Spijker BA, Batterham PJ, Calear AL, Farrer L, Christensen H, Reynolds J, et al. The Suicidal Ideation Attributes Scale (SIDAS): Community-based validation study of a new scale for the measurement of suicidal ideation. Suicide Life Threat Behav (2014) 44(4):408–19. doi: 10.1111/sltb.12084
81. Ballard ED, Ionescu DF, Voort JL, Niciu MJ, Richards EM, Luckenbaugh DA, et al. Improvement in suicidal ideation after ketamine infusion: Relationship to reductions in depression and anxiety. J Psychiatr (2014) 58:161–6. doi: 10.1016/j.jpsychires.2014.07.027
82. Ballard ED, Yarrington JS, Farmer CA, Richards E, Machado-Vieira R, Kadriu B, et al. Characterizing the course of suicidal ideation response to ketamine. J Affect Disord (2018) 241:86–93. doi: 10.1016/j.jad.2018.07.077
83. Price RB, Nock MK, Charney DS, Mathew SJ. Effects of intravenous ketamine on explicit and implicit measures of suicidality in treatment-resistant depression. Biol Psychiatry (2009) 66(5):522–6. doi: 10.1016/j.biopsych.2009.04.029
84. Price RB, Iosifescu DV, Murrough JW, Chang LC, Al Jurdi RK, Iqbal SZ, et al. Effects of ketamine on explicit and implicit suicidal cognition: A randomized controlled trial in treatment-resistant depression. Depress Anxiety (2014) 31(4):335–43. doi: 10.1002/da.22253
87. Walsh Z, Thiessen MS. Psychedelics and the new behaviourism: Considering the integration of third-wave behaviour therapies with psychedelic-assisted therapy. Int Rev Psychiatry (2018) 30(4):343–9. doi: 10.1080/09540261.2018.1474088
88. Roseman L, Demetriou L, Wall MB, Nutt DJ, Carhart-Harris RL. Increased amygdala responses to emotional faces after psilocybin for treatment-resistant depression. Neuropharmacol (2018) 142:263–9. doi: 10.1016/j.neuropharm.2017.12.041
89. Stroud JB, Freeman TP, Leech R, Hindocha C, Lawn W, Nutt DJ, et al. Psilocybin with psychological support improves emotional face recognition in treatment-resistant depression. Psychopharmacol (2018) 235(2):459–66. doi: 10.1007/s00213-017-4754-y
92. Puglisi-Allegra S, Andolina D. Serotonin and stress coping. Behav Brain Res (2015) 277:58–67. doi: 10.1016/j.bbr.2014.07.052
93. Spinhoven P, Drost J, de Rooij M, van Hemert AM, Penninx BW. Is experiential avoidance a mediating, moderating, independent, overlapping, or proxy risk factor in the onset, relapse and maintenance of depressive disorders? Cogn Ther Res (2016) 40(2):150–63. doi: 10.1007/s10608-015-9747-8
95. Wolff M, Evens R, Mertens LJ, Koslowski M, Betzler F, Gründer G, et al. Learning to let go: A cognitive-behavioral model of how psychedelic therapy promotes acceptance. Front Psychiatry (2020) 11:5. doi: 10.3389/fpsyt.2020.00005
96. A-tjak JG, Davis ML, Morina N, Powers MB, Smits JA, Emmelkamp PM. A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychother Psychosom (2015) 84(1):30–6. doi: 10.1159/000365764
97. Sloshower J, Guss J, Krause R, Wallace RM, Williams MT, Reed S, et al. Psilocybin-assisted therapy of major depressive disorder using Acceptance and Commitment Therapy as a therapeutic frame. J Contextual Behav Sci (2020) 15:12–9. doi: 10.1016/j.jcbs.2019.11.002
98. Carhart-Harris RL, Roseman L, Haijen E, Erritzoe D, Watts R, Branchi I, et al. Psychedelics and the essential importance of context. J Psychopharmacol (2018) 32(7):725–31. doi: 10.1177/0269881118754710
99. Roseman L, Haijen E, Idialu-Ikato K, Kaelen M, Watts R, Carhart-Harris R. Emotional breakthrough and psychedelics: Validation of the Emotional Breakthrough Inventory. J Psychopharmacol (2019) 33(9):1076–87. doi: 10.1177/0269881119855974
100. Forstmann M, Yudkin DA, Prosser AM, Heller SM, Crockett MJ. Transformative experience and social connectedness mediate the mood-enhancing effects of psychedelic use in naturalistic settings. Proc Natl Acad Sci (2020) 117(5):2338–46. doi: 10.1073/pnas.1918477117