Researchers assess if psilocybin reduces anxiety related to metastatic cancer
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Recruitment is underway for a small study focused on the ability of psilocybin to reduce anxiety among individuals with metastatic cancer.
The FDA designated psilocybin — the psychedelic compound found in some species of mushrooms — a breakthrough therapy for depression in November 2019. This has led to a resurgence in research into this compound for this indication and others.
“I hope [the study] will open up more research into how to enable people with cancer to deal with things like existential anxiety, fear of dying and fear of cancer recurrence,” principal investigator Anthony L. Back, MD, professor of medicine/oncology at University of Washington School of Medicine, told Healio. “I hope it will help us find some new ways for people to live better with their cancer.”
Back spoke with Healio about the intervention he and his colleagues plan to evaluate in their pilot study, as well as the potential value of psilocybin for helping patients cope with anxiety and depression associated with metastatic cancer.
Healio: What inspired you to conduct this study?
Back: I am a medical oncologist. I’ve worked with many patients over the years who have had a lot of distress, fear and anxiety about their cancer but couldn’t process it. That anxiety often ends up causing a great deal of suffering and difficulty when it comes to making medical decisions — in many situations, patients ended up dying in the ICU or dying with a great deal of intervention and horrible side effects from treatments.
I was reading the early randomized studies of psilocybin for people with cancer from around 2016. These studies were very rigorously done and showed that there was a rapid and sustained response in anxiety, depression and existential distress.
There is nothing else like psilocybin-assisted therapy in our armamentarium. Most of my patients take benzodiazepines from time to time when they have to but, honestly, that’s just zoning them out. If they take selective serotonin reuptake inhibitors (SSRIs), they end up feeling blunted, and SSRIs don’t really work for existential distress or fear of dying.
Therapy is terrific when someone can afford it and when they can find a therapist who is available and experienced in treating people with cancer. So, I have been wondering: What else do we have to offer?
I became interested in this new research with psilocybin, so I arranged for my own psilocybin experience, which I wrote about in Journal of Palliative Medicine. It was a profound experience that left me thinking, ‘Wow, there is really something to this. It could really change the experience of cancer for patients.’
After I had my personal experience, I got some training in becoming a psychedelic practitioner from California Institute for Integral Studies. I was able to start my first study of psilocybin-assisted therapy for physicians and nurses with depression and burnout from their work during the pandemic, and I am now finishing that study.
I designed this new study as a group intervention because there is something very powerful in groups where people listen to each other’s experiences. My hypothesis is that giving people with cancer a guided experience with psilocybin, combined with the chance to talk to peers about their experiences, could be highly efficacious. Also, if a group model works, it has the potential to be much more accessible to people than an individual model.
Healio: How will the study be conducted?
Back: Study participants will have two preparation Zoom visits. They then will go to a 3-day retreat, where they have more preparation work. On the second retreat day, they’ll have their psilocybin session. The room where the psilocybin session will take place is a big, beautiful room that overlooks the Hood Canal — about 90 minutes from Seattle — and has beautiful trees around it. The third retreat day, they’ll have group integration discussions to allow them to start processing their experiences. Then they’ll go home and have two more Zoom integration follow-up group visits.
Healio: How will you assess the intervention?
Back: The primary outcome is the safety of the group format. We’ll be looking at adverse reactions during the group psilocybin sessions and specifically times when more than four facilitators are needed (for the group size of six patients) and we need to call in backup facilitators. Over time, if the group size of six proves to be safe, we will increase the group size. We will be measuring symptoms of depression, anxiety, demoralization and other symptoms over the course of the intervention. We will compare our results with historical results of studies done using an individual format — one patient with two therapists.
Healio: What are the potential long-term implications of this study?
Back: Our cancer treatments and technology continue to get better, and I am all for that. However, a few people I have met who are applying for the study have said, ‘I know I have more time and I’m grateful for it, but I feel stuck. I’m just waiting for the other shoe to drop.’ I think that happens to a lot of people. They have this time to live and yet they feel they should be living more, or making more of this time they didn’t expect to have. I would like to give those people the gift of being free from that — of helping them get unstuck.
Healio: What is it about psilocybin that seems to help people cope with cancer-related anxiety and depression?
Back: Psilocybin-assisted therapy seems to be able to enable people who are stuck to gain new perspective on their situations. The exact mechanisms are just starting to be understood. But what we can say now is that anxiety and depression symptoms can be generated from mental habits about how we deal with certain problems. For example, there is a lot of emphasis in the lay press about positive thinking when living with cancer, and that might lead people to think that if they allow themselves to ‘go there’ and feel sad, they will get stuck in a doom spiral of negative thinking. In reality, that mental habit to not let yourself feel ends up causing many other issues. What I’ve seen with other psilocybin-assisted therapy studies is that, once people realize they can feel all the sadness and it won’t destroy them, that frees people up to let themselves feel that sadness and know that it won’t last forever.
Healio: Is there anything else you’d like to mention?
Back: The study is open and people who are interested can learn more by visiting this website: http://depts.washington.edu/psilocybin-retreat/.
References:
- Back AL. J Palliative Med. 2019;doi:10.1089/jpm.2018.0561.
- Psilocybin study focuses on patients with metastatic cancer (press release). Available at: https://newsroom.uw.edu/news/psilocybin-study-focuses-patients-metastatic-cancer. Published July 24, 2023. Accessed Aug. 8, 2023.
- University of Washington. A phase 1/2 study of a group model of psilocybin-assisted therapy for cancer-related anxiety in patients with metastatic cancer. Available at: http://depts.washington.edu/psilocybin-retreat/
For more information:
Anthony L. Back, MD, can be reached at tonyback@uw.edu.
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