Psilocybin Treatment as an Adjunct to Cognitive Behavioral Therapy for Eating Disorders: Therapeutic Rationale & Considerations for Protocol Development

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.

Study at a glance

Abstract

Eating disorders (ED) remain challenging to treat, with high dropout and low remission rates in cognitive-behavioral therapy for EDs (CBT-ED). Psilocybin treatment (PT) demonstrates therapeutic potential to enhance CBT-ED by exerting several neurobiological, psychological, and experiential effects (e.g., antidepressant, neuroplasticity, emotional openness) that are hypothesized to increase psychotherapeutic engagement, reduce dropout, and improve clinical outcomes. This article provides the first consolidation of existing theoretical evidence for PT/CBT-ED, proposes considerations for a con-current intervention protocol, and presents clinical and research considerations to empirically test its feasibility, safety, and efficacy. This line of inquiry is expected to advance the development of approaches that improve ED treatment outcomes and, more broadly, advance the study of psychedelics as tools to enhance evidence-based psychotherapy models.