Psilocybin-assisted cognitive behavioral therapy for major depressive disorder: A pilot trial.

Abstract

<h4>Background</h4>Psilocybin-assisted therapy has emerged as a promising treatment for major depressive disorder, but little attention has been paid to the psychotherapy that adjoins psilocybin. Providing an adjunctive psychotherapy that is manualized and evidence-based may make psilocybin treatment more acceptable, effective, and disseminable. We examined the acceptability, feasibility, and clinical outcomes of psilocybin paired with cognitive behavioral therapy (CBT) for major depressive disorder.<h4>Methods</h4>Participants were adults with major depressive disorder who presented with at least moderately severe depressive symptoms. All participants underwent psilocybin-assisted CBT (PA-CBT), which consisted of two psilocybin doses (10 mg and 25 mg separated by one month) interspersed with 12 psychotherapy sessions over four months. Participants' depressive symptoms, psychosocial functioning, and cognitive-affective responses were collected at the study's baseline, at the completion of PA-CBT, and three months post-treatment.<h4>Results</h4>Sixteen participants were enrolled, and all were retained through the 7-month study. PA-CBT was rated as highly acceptable by participants and study clinicians, with no serious adverse events reported. Based on independent assessments, 13 of 16 participants showed at least moderate (≥ 25%) improvement in depressive symptoms by the end of treatment, and 9 had fully remitted. Pre-to-post treatment improvements in depressive symptoms and psychosocial functioning were sustained at the 3-month follow-up (Hedges' gs = 1.9-2.7). Changes in depressive severity during the treatment were associated with improvements in emotion regulation and positive and negative cognitive schemas.<h4>Conclusions</h4>CBT appears to be a feasible, well-accepted, and beneficial adjunct to psilocybin treatment. Future randomized trials are needed to compare the efficacy of PA-CBT with other psilocybin-assisted therapy modalities.

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