Psilocybin-Assisted Therapy Increases Self-Compassion in Patients with Alcohol Use Disorder

In a trial where adults with alcohol use disorder received either psilocybin or an active placebo alongside psychotherapy, psilocybin-assisted therapy robustly increased compassionate self-responding and decreased uncompassionate self-responding, with the largest effects on reducing self-judgment, isolation, and over-identification. Across all participants, small but significant correlations linked improvements in self-compassion to reduced drinking. However, in the psilocybin group alone, no significant association emerged between self-compassion gains and drinking reductions, while the control group showed moderate associations. These between-group differences were not statistically significant. Self-compassion appears clinically relevant for alcohol use disorder treatment but may not mediate outcomes when psilocybin is part of therapy.

Study at a glance

Abstract

A recent randomized, double-blind, placebo-controlled, parallel-group trial (NCT02061293) found that psilocybin-assisted therapy significantly improved drinking outcomes compared to an active placebo in adults with alcohol use disorder (AUD). In this secondary analysis, we assessed whether psilocybin-assisted therapy improved self-compassion and whether these changes predicted drinking outcomes. Of the 95 participants enrolled, 86 had self-compassion and drinking outcome data. Forty-four participants were randomized to 2 medication sessions with psilocybin and forty-two to active-placebo control (diphenhydramine); all participants received 12 sessions of manualized psychotherapy. Psilocybin-assisted therapy robustly increased compassionate self-responding (CS) and decreased uncompassionate self-responding (UCS), with the largest effect sizes observed in reducing UCS components (Self-Judgment, Isolation, Over-Identification). Across the full sample, small but significant correlations emerged between improvements in self-compassion and reductions in drinking. However, group-specific analyses revealed that participants in the control group exhibited moderate associations between gains in self-compassion and decreased drinking, whereas no significant association was observed in the psilocybin group. In both groups, these associations were stronger among participants who maintained moderate-to-high-risk drinking during the first four weeks of therapy prior to medication administration. Although the control group consistently exhibited significant correlations and the psilocybin group did not, the between-group differences in correlation strength were not statistically significant. These findings underscore the clinical relevance of self-compassion in AUD treatment but suggest that self-compassion may not mediate outcomes when psilocybin is administered as part of therapy. Larger studies with additional mechanistic analyses are needed to further clarify how self-compassion interacts with psychological processes and pharmacological interventions in shaping treatment response, ultimately informing improvements to psilocybin-assisted therapy for AUD.