Meaning-Centered Psychotherapy for Psilocybin-Assisted Therapy Among Patients with Advanced Cancer and Depression: Rationale and Preliminary Evaluation of MCP-PSIL.

Meaning-centered psychotherapy (MCP) is a manualized, brief intervention that enhances meaning and purpose and appears to be a natural therapeutic partner for psilocybin-assisted therapy (PAT) in patients with cancer and major depressive disorder. In a phase 2 open-label trial, seven patients (ages 53-80) and six therapists (with 9-44 years of experience) participated in surveys and focus groups to adapt MCP for psilocybin. Focus groups highlighted the value of psilocybin experiences, group support, and MCP both separately and together. A 5-session model called MCP-PSIL was developed. The group format was emphasized, though individual MCP may be appropriate in some cases.

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Abstract

Psilocybin shows encouraging outcomes for patients with cancer and major depressive disorder (MDD). However, there is insufficient evidence on the use of evidence-based psychotherapeutic interventions to consistently guide and standardize psilocybin preparation, dosing, and integration. Meaning-centered psychotherapy (MCP) is a manualized, brief psychotherapeutic intervention that enhances meaning and purpose among recipients. This article substantiates the rationale for using MCP as a psychotherapeutic intervention to accompany psychedelic-assisted therapy (PAT) with psilocybin for patients with cancer and MDD. We sampled seven patients with cancer and MDD who previously received PAT with psilocybin followed by group MCP in a phase 2 open-label trial, as well as six therapists who delivered the interventions. First, electronic open-ended response surveys were distributed to explore participant experiences during the phase 2 trial and elicit recommendations to adapt MCP for psilocybin. Second, the research team developed a 5-session model of MCP and psilocybin therapy (MCP-PSIL) based on survey responses. Finally, four focus groups were conducted (two with patients and two with therapists) to expand on patient experiences during the phase 2 trial and gather feedback on MCP-PSIL. Seven patients (ages 53-80 years) and six therapists (mental health professional experience ranging 9-44 years) participated in both surveys and focus groups. Focus groups underscored the value of experiences related to psilocybin, the group, and MCP, as distinct elements and in conjunction. Participants shared key recommendations to enhance combined psilocybin and MCP experiences and the 5-session MCP-PSIL model. The importance of the group format was also emphasized while noting that individual MCP may be indicated in certain circumstances. Findings suggest that MCP is a natural therapeutic partner to guide patients throughout the PAT continuum. As MCP-PSIL is tested in the future, we anticipate MCP will leverage the PAT experience by building therapist capacity to optimize care while reducing avoidable distress for patients and maximizing their meaning-making opportunities.