Journal of Psychoactive Drugs
September 30, 2019
Maha N. Mian, Brianna R. Altman, Mitch Earleywine
47 citations
Ayahuasca, a plant-based hallucinogen used as a spiritual medicine in South America, has shown antidepressant effects in at least one placebo-controlled trial, but the mechanisms remain unclear. A survey of 152 individuals examined changes in depressive symptoms, behavioral activation, and mindfulness after an Ayahuasca experience. Mindfulness was strongly linked to reduced depression severity, but behavioral activation—engaging in rewarding activities—was a stronger predictor of improvement. Changes in behavioral activation likely serve as a mechanism underlying Ayahuasca's antidepressant effects, suggesting future clinical trials could benefit from tracking behavioral activation.
Journal of Psychopharmacology
March 28, 2021
Mitch Earleywine, Luna F. Ueno, Maha N. Mian et al.
36 citations
High doses of cannabis can produce subjective effects similar to those of the psychedelic psilocybin, but at a lower rate. In a survey, 17–19% of cannabis users reported a “breakthrough” experience, compared to 59% in psilocybin clinical trials. Heavier cannabis users reported lower scores. These effects may parallel the therapeutic benefits seen with psilocybin, suggesting potential for cannabis-assisted psychotherapy.
Journal of Psychoactive Drugs
March 23, 2022
Mitch Earleywine, Fiona Low, Brianna R. Altman et al.
31 citations
People with depressive symptoms consider it somewhat important that guides in psilocybin-assisted therapy have personally used psilocybin. In a survey of over 800 MTurk respondents with depressive symptoms, ratings for the importance of a guide who had used psilocybin exceeded the "somewhat important" level (50 on a 0–100 scale) and were higher than ratings for other guide qualities and for a cognitive behavioral therapist who shared demographics, had depression experience, or received personal therapy. People of color and those with prior therapy gave even higher importance ratings. Participants listed similar desired qualities—proper training and empathy—for both psilocybin guides and CBT therapists. The findings suggest that guides who have used psilocybin and inform clients might enhance therapy's antidepressant effects for some clients.
American Journal of Psychiatry
January 1, 2024
Mitch Earleywine, Joseph de Leo, Dinesh Bhayana et al.
23 citations
No Summary
Journal of psychoactive drugs
January 1, 2023
Zachary Herrmann, Mitch Earleywine, Joseph De Leo et al.
19 citations
Subjective responses to psychedelic drugs, such as mystical experiences and oceanic boundlessness, often correlate with therapeutic improvements in conditions like treatment-resistant depression, end-of-life anxiety, and substance use disorders. Measuring these responses is challenging; several scales show good reliability and factor structure, but samples are often small and self-selected. This review examines the psychometric properties of widely used scales and their links to treatment outcomes. Challenging experiences, psychological insight, and emotional breakthroughs also show promise, though replication is needed. A collaborative approach to data collection on subjective reactions in therapeutic settings could help predict improvement across conditions.
Psychedelic medicine (New Rochelle, N.Y.)
June 1, 2024
Ryan Yermus, John Bottos, Nathan Bryson et al.
13 citations
Ketamine-assisted psychotherapy (KAP) produces sustained reductions in anxiety, depression, and PTSD symptoms lasting up to 5 months after the last session. In a retrospective study of adults with treatment-resistant major depressive disorder, generalized anxiety disorder, or PTSD who received KAP across 11 North American clinics, large treatment effects were detected at 3 months (Cohen's d = 0.75-0.86) and sustained at 6 months (d = 0.61-0.73). Case reductions ranged from 39% to 41% at 3 months and 29% to 37% at 6 months. However, high attrition rates (82% at 3 months, 95% at 6 months) may limit validity of the results.
Journal of Psychedelic Studies
June 1, 2020
Mitch Earleywine, Joseph De Leo
12 citations
Antidepressant medications alone help only one in four patients and rarely outperform placebos, while psychotherapies yield better outcomes and combining both helps only 65% of clients who complete treatment. Psychedelics may improve depression through mechanisms overlapping with psychotherapy and some novel ones, suggesting their combination could work very well. Subjective experiences during psychedelic sessions correlate with improvement, so guiding clients to focus on targeted thoughts and feelings could enhance outcomes. Clinical trials of psychedelic-assisted, empirically supported treatment with guided sessions are needed, including preparatory, administration, integration, and follow-up components for maximum impact.
Cannabis
July 11, 2022
Mitch Earleywine, Maha N Mian, Brianna R Altman et al.
11 citations
People who use cannabis expect that a cannabis-assisted psychotherapy session, modeled on psychedelic-assisted psychotherapy, would reduce depression. Over 500 participants in each of two studies imagined such a session and reported expected antidepressant effects. Expected reductions in depression were linked to anticipated psychedelic-like subjective experiences, such as mystical-type feelings, and also to expected changes in dysfunctional attitudes—a separate pathway that resembles how cognitive therapy works. These findings support calls for clinical trials of cannabis-assisted psychotherapy and indicate that users anticipate it would work through mechanisms similar to both psychedelics and cognitive therapy.
Journal of Psychopharmacology
December 4, 2023
Maha N. Mian, Brianna R. Altman, Fiona Low et al.
8 citations
A new 32-item scale, the Protective Strategies for Psychedelics Scale (PSPS), measures strategies people use to reduce harm when taking psychedelics. Two factors emerged: long-term preparation (mood, setting, scheduling) and short-term preparation (social context, health, other substances). The scale showed excellent reliability and was strongly correlated with existing protective behavior scales for cannabis and alcohol, and moderately with lifetime psychedelic use. The authors call for further validation in diverse samples.
Journal of Psychedelic Studies
March 5, 2024
Mitch Earleywine, Alyssa B. Oliva, Joseph A. de Leo et al.
6 citations
Internal Family Systems (IFS) therapy, which views the mind as composed of multiple subpersonalities or 'parts' shaped by trauma, has gained popularity, particularly in psychedelic-assisted treatments. However, outcome data for applying IFS to post-traumatic stress disorder are limited, and its theoretical assumptions are difficult to test. The model's appeal highlights a problem with how empirically supported treatments are perceived. Ethical recommendations for presenting IFS include providing detailed psychoeducation about evidence-based treatments, being candid about the experimental nature of alternatives, monitoring progress, and watching for harm. Drawing on IFS's appealing features to improve perceptions of validated treatments may attract more clients and reduce dropout while awaiting empirical evidence.
Journal of psychopharmacology (Oxford, England)
January 1, 2025
Henry A MacConnel, Mitch Earleywine, Steven Radowitz
5 citations
Intravenous ketamine administered in a supportive environment with preparation, intention-setting, integration sessions, eye shades, and evocative music—paralleling psychedelic therapy—was associated with large reductions in PTSD symptoms. In a retrospective sample of 117 outpatients, mean PCL-5 scores dropped from 52.54 to 28.78, with 75% showing clinically meaningful improvement and 62% suggesting remission. No serious adverse events occurred, and concomitant psychotherapy was a significant moderator. The findings suggest that environmental factors may account for variation in previous ketamine studies and that this approach may be a promising option for PTSD unresponsive to other treatments.
Journal of Humanistic Psychology
September 22, 2023
Mitch Earleywine, Maha N. Mian, Joseph A. de Leo
5 citations
Expectations about psychedelics are understudied despite their powerful subjective effects. In over 500 people who have used psilocybin, expectancies about antidepressant effects correlated with specific subjective experiences—mystical experiences, ego dissolution, and emotional breakthrough—that previous work linked to depression improvement. Current depressive symptoms, ego dissolution, and emotional breakthrough each predicted unique variance in expected antidepressant effects, but mystical experience expectancies did not. Demographic factors and general hallucinogen involvement showed only weak correlations. These findings suggest that psilocybin users hold relevant expectancies about subjective and antidepressant effects, which could influence treatment outcomes and deserve monitoring in clinical trials.
Psychiatric Annals
September 1, 2022
Mitch Earleywine, Zachary Herrmann
5 citations
Serotonergic psychedelics such as psilocybin, LSD, and ayahuasca, when paired with supportive therapy, have reduced end-of-life anxiety in cancer patients, treatment-resistant depression, alcohol dependence, social anxiety in autistic adults, and nicotine dependence. MDMA-assisted therapy improves PTSD symptoms. Meta-analyses show promising effect sizes, but concerns remain about brief follow-ups, small samples, and poorly understood mechanisms. Generalization to the public is premature, and the proliferation of specialized clinics is not yet justified. Continued coordinated trials and judicious application are recommended, with realistic expectations that replication may yield smaller effects.
Journal of Psychoactive Drugs
January 3, 2022
Brianna R. Altman, Mitch Earleywine, Joseph De Leo
4 citations
People with depressive symptoms view cognitive-behavioral therapy (CBT) as more credible than psilocybin-assisted therapy (PAT). In a study of 803 adults recruited from Amazon's MTurk, participants read descriptions of each therapy and rated their credibility. Those with prior therapy experience rated CBT higher than those without. Men and individuals who had used hallucinogens rated PAT more favorably than women and non-users. Other demographic and clinical factors explained little of the variation in credibility ratings. The findings suggest that potential clients are cautious about PAT, and researchers and clinicians should consider patients' treatment beliefs as possible predictors of outcomes.
Journal of Psychedelic Studies
March 12, 2020
Brianna R. Altman, Maha N. Mian, Mitch Earleywine
4 citations
Ayahuasca users expect its effects to differ from those of other hallucinogens like LSD or psilocybin in several ways, including stronger positive connections to nature and other people, more dramatic or terrifying thoughts, greater variability of effects, and distinct physical reactions. Among 139 experienced users surveyed online, intentions to use ayahuasca again increased when they expected positive connections but decreased when they expected physical reactions. One version of a scale measuring the novelty of ayahuasca effects predicted a preference for ayahuasca over other hallucinogens, while another version did not, indicating a need for further research. Understanding these expectancies may help guide choices among hallucinogens for therapeutic use.
Journal of Psychoactive Drugs
January 22, 2023
Fiona Low, Mitch Earleywine
3 citations
Brief written educational materials of about 300 words significantly increased how credible people found both cognitive behavioral therapy and psilocybin-assisted therapy for depression, with a large effect size. Asking participants to imagine open-mindedness before reading further boosted credibility ratings for psilocybin-assisted therapy, with a medium effect. These simple, low-cost strategies could help improve how patients view treatments. The findings suggest that even short informational texts can shape treatment perceptions, and that priming open-mindedness may be especially useful for newer or less familiar therapies.
Journal of Psychedelic Studies
April 19, 2021
Cody Gilbert, Mitch Earleywine, Maha N. Mian et al.
3 citations
Ayahuasca affects some depressive symptoms more than others. In a retrospective survey of over 120 participants who used ayahuasca, affective symptoms such as hope, depressed mood, and happiness improved more than cognitive, interpersonal, and somatic symptoms like restless sleep, loneliness, and difficulty focusing. This pattern of symptom specificity resembles that of serotonergic antidepressant medications. People seeking relief from affective symptoms may find ayahuasca more helpful, while those targeting sleep, loneliness, or concentration problems may benefit less. The rapid onset of relief could also be useful for jumpstarting psychotherapy.
Journal of Psychoactive Drugs
January 1, 2026
Philip Kamilar-Britt, Alyssa B. Oliva, Mitch Earleywine
Familiarity with treatment options predicts how credible nicotine users find both standard cessation methods and psilocybin-assisted psychotherapy. In a survey of 534 daily nicotine users, those more familiar with a treatment rated it as more credible. Credibility, in turn, predicted interest in trying that treatment. Younger age, lower education, and prior psychedelic use were associated with greater interest in psilocybin-assisted therapy. Tailoring educational materials to increase familiarity may improve treatment engagement and outcomes.
Journal of Psychoactive Drugs
October 10, 2025
Mitch Earleywine, Caitlin Holley, Henry A. Macconnel et al.
Veterans receiving care from the Veterans Affairs system hold a mix of hope, curiosity, and concerns about MDMA-assisted therapy for PTSD. In a story completion task, at least one third of 30 participants mentioned shortcomings of existing treatments, curiosity about the treatment's rationale, hope, and concerns about side effects, subjective effects, and addictive potential. Clear misunderstandings about the molecule, treatment, or its implications appeared in at least 10% of narratives. Allusions to therapist abuse, microdosing, and the role of sitters were rare. These findings can guide development of surveys and psychoeducation materials to address attitudes in larger veteran samples.
Psychoactives
June 25, 2025
Mitch Earleywine, Alyssa B. Oliva
Supervision in psychedelic-assisted therapy currently accounts for very little variance in treatment outcome, despite enthusiasm from trainees and supervisors. A proposed model, Motivational-Interviewing-Enhanced Integration Supervision (MIE-IS), aims to improve outcomes by having supervisors model Motivational Interviewing (MI) principles with trainees. Trainees then apply those same MI technical and relational skills to support clients in integrating psychedelic-induced insights into behavioral change. This approach is expected to enhance therapeutic alliances, improve self-care for clients, trainees, and supervisors, reduce burnout, and foster a culture of continuous learning and reflective practice, ultimately benefiting clients through more effective integration of psychedelic experiences.
Journal of psychoactive drugs
October 15, 2024
Jamie E Parnes, Mitch Earleywine
People who inhale DMT often start because of curiosity, general interest in psychedelics, and hope for spiritual benefits. Those who have used other psychoactive substances, especially ayahuasca, and who extract DMT themselves tend to use it more frequently. Most users obtain DMT from a friend and find it slightly difficult to get. They typically inhale it from a glass pipe in private homes, alone or in small groups. Positive experiences include psychological cleansing or catharsis, while challenges involve difficult integration, aversive experiences, or bad trips. Users generally rate DMT as very or slightly safe. The findings highlight the need for education and harm reduction as media coverage of DMT's potential benefits grows.
Journal of Psychedelic Studies
July 11, 2024
Alyssa B. Oliva, Mitch Earleywine, Fiona Low et al.
In a survey of 635 adults in the United States, the importance people place on having a therapist of the same gender or same race differs by the type of therapy and by the participant's own race and gender. For both cognitive behavioral therapy (CBT) and psychedelic-assisted therapy (PAT), racial and ethnic minority participants and female participants rated a same-gender practitioner as more important than did White or male participants. A same-gender CBT therapist was rated as more important than a same-gender PAT guide.
April 2, 2024
Henry A. Macconnel, Mitch Earleywine, Steven Radowitz
preprint
Intravenous ketamine given in a supportive environment with preparation, intention-setting, and integration sessions—similar to psychedelic therapy—led to large reductions in PTSD symptoms. In 117 outpatients with elevated PTSD Checklist scores, the mean score dropped from 52.54 to 28.78, a large effect size of 1.64. No serious adverse events occurred. Concomitant psychotherapy also contributed to improvement. Of the patients, 75% showed clinically meaningful improvement and 62% showed remission of symptoms. The results suggest that environmental factors may account for variation in previous ketamine studies.