Trends in Psychiatry and Psychotherapy
May 1, 2023
Elena Koning, Elisa Brietzke
13 citations
Eating disorders involve abnormal energy balance, cognitive inflexibility, and emotional distress, with few effective treatments and low long-term remission. Psilocybin, a serotonergic psychedelic, shows therapeutic potential for disorders marked by rigid thinking and treatment resistance. This narrative review examines the hypothesis that psilocybin-assisted psychotherapy could be an effective adjunctive treatment for eating disorders, drawing on biological plausibility, transdiagnostic evidence, and preliminary results. The authors conclude that current literature does not yet support clinical use, but preliminary evidence warrants more rigorous clinical trials.
CNS spectrums
November 21, 2024
Elena Koning, Elvina M Chu, Elisa Brietzke
5 citations
Psychedelics alter consciousness and have been used for centuries by indigenous communities, but only recently studied as therapeutic tools in psychotherapy. Since the early twentieth century, psychedelic-assisted psychotherapy has been explored for neuropsychiatric conditions with rigid thought patterns and treatment resistance. This emerging field has faced opposition from mid-twentieth century counterculture associations, media sensationalism, legislative restrictions, and scientific criticisms like 'breaking the blind' and 'excessive enthusiasm.' This perspective article examines that historical opposition and its implications for the field's credibility. Drawing lessons from history can aid clinical research in psychiatry amid drug policy reform.
Trends in psychiatry and psychotherapy
January 1, 2025
Elena Koning, Marco Solmi, Elisa Brietzke
4 citations
As psychedelics gain acceptance for mental health treatment, corporate funding of clinical trials raises concerns about conflicts of interest and biased reporting. The evidence for safety and efficacy of psychedelic-assisted psychotherapy remains early. This paper examines safety concerns associated with psychedelics, how financial stakeholders may influence the reporting of safety outcomes, and why balanced science communication is critical for public health and safety during ongoing drug reform.
Journal of Eating Disorders
December 27, 2024
Elena Koning, Cristiano Chaves, Elisa Brietzke et al.
2 citations
Eating disorders affect 1-3% of the population, and standard treatments fail for about one third of cases. Psilocybin-assisted psychotherapy shows emerging evidence for improving outcomes, but limited knowledge of its neurobiological mechanisms restricts confirmation of clinical utility. This narrative review surveys methodologies—including magnetic resonance imaging, molecular neuroimaging, electrophysiology, and neuroplasticity markers—that could probe the neurobiological correlates of psilocybin-assisted psychotherapy in eating disorders. It describes implications of these methods for psychedelic study design, challenges, limitations, and future directions, serving as a resource for scientists designing studies to identify effective therapeutic interventions.
Behavioral sciences (Basel, Switzerland)
March 6, 2026
Elena Koning, Susan Gamberg, Aaron Keshen
1 citation
Eating disorders remain difficult to treat, with high dropout and low remission rates in cognitive-behavioral therapy for eating disorders (CBT-ED). Psilocybin treatment may enhance CBT-ED by producing antidepressant, neuroplasticity, and emotional openness effects that could increase therapeutic engagement and improve outcomes. This narrative review consolidates theoretical evidence for combining psilocybin treatment with CBT-ED, proposes considerations for a concurrent intervention protocol, and outlines clinical and research considerations for testing its feasibility, safety, and efficacy. The authors expect this work to advance treatments for eating disorders and the study of psychedelics as tools to enhance evidence-based psychotherapy.
International Journal of Eating Disorders
July 2, 2026
Elena Koning, Jérémie Richard, Aaron Keshen
Psilocybin treatment shows promise as a transdiagnostic intervention for eating disorders and their common psychiatric comorbidities. Preliminary clinical evidence supports its feasibility, safety, and therapeutic effects, with robust transdiagnostic effects observed across comorbid conditions. Proposed mechanisms include serotonergic receptor agonism, psychoplastogenic effects, and neural network desynchronization that target shared vulnerabilities. These vulnerabilities map onto dimensional constructs in the Hierarchical Taxonomy of Psychopathology (Emotional Dysfunction superspectrum, Internalizing spectrum) and Research Domain Criteria (negative/positive valence, cognitive, and social process domains). Future research should explore pragmatic trial designs and dimensional outcome measures to capture real-world complexities.
Preprints.org
December 19, 2025
Elena Koning, Susan Gamberg, Aaron Keshen
preprint
Eating disorders remain difficult to treat, with high dropout and low remission rates in cognitive-behavioral therapy. Psilocybin treatment may enhance this therapy by producing neurobiological, psychological, and experiential effects such as antidepressant action, increased neuroplasticity, and emotional openness, which are hypothesized to improve engagement, reduce dropout, and boost clinical outcomes. This article consolidates existing theoretical evidence for combining psilocybin with cognitive-behavioral therapy for eating disorders, proposes considerations for a concurrent intervention protocol, and presents clinical and research considerations for testing its feasibility, safety, and efficacy. This line of inquiry aims to advance approaches that improve eating disorder treatment outcomes and the study of psychedelics as tools to enhance evidence-based psychotherapy.
Trends in Psychiatry and Psychotherapy
January 1, 2025
Elena Koning, Pedro Starzynski Bacchi, Cristiano Chaves et al.
Both models of psychological intervention in psilocybin-assisted therapy (PAP) may have clinical relevance for treating depression. Future research should standardize reporting of psychological interventions in PAP and use comparative study designs to better evaluate non-specific and specific treatment models, which could inform clinical guidelines.