The Healing Potential of Psychedelic-Assisted Therapy for Eating Disorders

Eating disorders affect millions of people worldwide, presenting complex challenges that often require comprehensive and innovative approaches to treatment. In recent years, there has been growing interest in the potential of psychedelic-assisted therapy as a transformative tool in the realm of mental health. This blog post explores the emerging field of psychedelic-assisted therapy for eating disorders, shedding light on its promising benefits and the implications it may have for the future of treatment.

Introduction

Eating disorders affect at least 9% of the population, or 70 million people, worldwide[8], and this number is increasing. A review of worldwide data found that eating disorder diagnoses more than doubled from 2000-2018, with the trend was consistent across regions, age groups, and genders.[10]

These conditions are also serious, falling among the deadliest mental illnesses, second only to opioid overdose.[8] Every year, 10,200 deaths occur as the direct result of an eating disorder—that’s one death every 52 minutes.[9]

 

Understanding Eating Disorders

“Eating disorders are a window into the struggle of the soul.”

People don’t choose eating disorders. Nobody wakes up one day and says “I’d like to have anorexia”—If they do, they’re seriously misinformed. Eating disorders aren’t choices, but rather serious multi-faceted and biologically influenced illnesses. An individual may consciously decide to purge or over-exercise at first, but before long, this disordered relationship with food and one’s body can become a deeply-ingrained subconscious pattern that takes on a life of its own. When left untreated, eating disorders can lead to serious, and sometimes life-threatening, physical and psychological consequences, underscoring the urgent need for effective therapeutic interventions.

Thankfully, eating disorder behaviors are learned behaviors and can be unlearned—but it takes time. Everyone has the capacity for full recovery. Part of the work in recovery is to uncover the meaning or purpose behind the symptoms.

 

The Limitations of Traditional Treatments

Conventional treatment approaches, including cognitive-behavioral therapy and medication, have demonstrated some effectiveness in managing eating disorders. However, there are currently no FDA-approved treatment options for anorexia nervosa and only one for bulimia nervosa and binge-eating disorder respectively. While depression commonly occurs with most eating disorders, traditional antidepressants (i.e. SSRIs) often lack efficacy in patients with anorexia. Even when patients are able to take advantage of available treatments, many continue to struggle with symptoms, and relapse rates remain high.

Studies have found that over a third of all patients treated for anorexia or bulimia end up relapsing within the first few years of completing treatment. The highest risk for relapse from anorexia occurs in the first 18 months (about 1 and a half years) after treatment, with 35% falling back into eating disordered behaviors.[1]

While the onset of bulimia usually occurs during adolescence or early adulthood, it tends to persist for several years, either chronically or intermittently. Treatment does help most people with bulimia achieve long-lasting recovery, but relapse still is a significant concern, with rates of up to 41% of former patients resuming bulimic behaviors within 2 years.[2]

Recognizing these challenges, researchers and clinicians have continued to search for new and improved ways to help individuals with eating disorders find more long-lasting and complete healing, including the use of psychedelic-assisted therapy as a potential alternative or complementary treatment modality.

 

The Role of Psychedelics in Healing

Psychedelic substances like psilocybin, MDMA, and LSD have shown promise in facilitating profound psychological healing in individuals dealing with depression, PTSD, substance abuse, eating disorders, and other mental health conditions. Though theoretical mechanisms of action of psychedelic medicines are still being investigated, a growing body of research points suggest that psychedelics create desirable brain states that can accelerate therapeutic processes and make eating disorder interventions easier to receive. The desirable brain states in

 

Research Studies

Group Ketamine-Assisted Therapy for Eating Disorders [3]

This pilot study, led by Dr. Reid Robison, Chief Clinical Officer of Numinus, explored the use of group ketamine-assisted psychotherapy (KAP) in a residential eating disorder treatment facility. 5 individuals with eating disorder diagnoses and comorbid mood and anxiety disorders received weekly intramuscular ketamine injections in a group setting followed by non-drug psychotherapy over 4 weeks.

Regarding the outcomes, the study found promising results. Group KAP was feasible and well-tolerated, with high patient satisfaction and treatment adherence rates. Participants experienced reduced symptoms of depression, anxiety and showed significant improvements in eating eating symptoms and quality of life, with effects persisting at a 6-month follow-up.

Participant quote:

“Trying ketamine allowed me to see the possibility of a life I could have. While the effects did not last, my very first experience snapped me out of a state of life-long, deep disconnection that I didn't even know I had been experiencing. Suddenly, I was able to live in the world in the way people had always described it. Though I am still trying to figure out how to attain that level of connection after catching a glimpse, that one experience was so essential. I could finally feel hunger and fullness cues. I felt what it's like to live in a body, instead of living a short distance from it. I felt connected to others and genuinely cared about their well-being. I felt human for the first time in a long time.”

 

Psilocybin-Assisted Therapy for Anorexia [4]

This study being conducted by Compass Pathways in collaboration with University of California San Diego,  is exploring the safety, tolerability, and efficacy of psilocybin-assisted therapy for patients with anorexia. Preliminary results from 10 participants who received a single 25 mg dose of synthetic psilocybin (~3.5 grams of dried psilocybin) shows:

 

Psilocybin-Assisted Therapy for Binge-Eating Disorder [5]

This Phase II study is currently underway at the University of Florida in collaboration with Tryp Therapeutics and happens to be the first ever psilocybin-assisted therapy study addressing binge-eating disorder. Interim analysis of five early participants has found:

MDMA-Assisted Therapy for Eating Disorder Symptoms [6]

This study investigated the effects of MDMA-assisted therapy on adults with severe PTSD, specifically exploring its impact on eating disorder symptoms. A total of 90 participants with severe PTSD received treatment in a double-blind, placebo-controlled trial. At baseline, 13 participants had EAT-26 scores in the clinical range, and 28 had scores in the high-risk range, despite the absence of active purging or low weight. After finishing the study, there was a significant reduction in total EAT-26 scores in the entire PTSD group following MDMA-assisted therapy compared to placebo. Moreover, significant reductions in total EAT-26 scores were observed in women with high EAT-26 scores (≥11 and ≥20) following the study protocol.

 

Other studies:

 

GROUP PHASE INDICATION STATUS
MAPS Phase II MDMA for anorexia and BED Anticipated start date in 2023
Johns Hopkins Phase I Psilocybin for anorexia Enrollment complete
Imperial College Phase I/II Psilocybin for anorexia Enrollment complete
TRYP Phase II Psilocybin for BED Enrolling
XPIRA Phase II Psilocybin for Anorexia Anticipated start date in 2023
COMPASS Phase II Psilocybin for Anorexia Enrolling

 

 

Integrating Psychedelics with Conventional Models

Integration of psychedelic-assisted therapy with conventional eating disorder treatment requires careful consideration of medical and safety factors, as well as the crucial involvement of specialized eating disorder clinicians. These clinicians have the expertise to navigate the unique challenges and triggers associated with eating disorders, helping patients access and integrate psychedelics in a safe and therapeutic manner. Their involvement ensures a comprehensive treatment approach that combines the benefits of psychedelic therapy with the tailored support required for individuals with eating disorders, leading to more effective and sustainable outcomes. We view the role of psychedelics as an adjunctive to traditional treatments, not a “replacement.”

 

Conclusion

Psychedelic-assisted therapy represents a promising frontier in the treatment of eating disorders, offering new possibilities for deep healing and transformation. While further research is needed to fully understand its effectiveness and establish appropriate guidelines, preliminary studies and anecdotal evidence suggest that this approach holds tremendous potential. As the field progresses, it is essential to strike a balance between innovation and responsible practice, ultimately providing individuals with hope and a path toward recovery from their eating disorders.

 

References

  1. Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74
  2. BMC Psychiatry. 2019; 19: 134. Published online 2019 May 6. doi: 10.1186/s12888-019-2112-9
  3. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00588-9
  4. https://compasspathways.com/comp360-psilocybin-therapy-shows-potential-in-exploratory-open-label-studies-for-anorexia-nervosa-and-severe-treatment-resistant-depression/
  5. https://tryptherapeutics.com/updates/tryp-therapeutics-announces-interim-results-for-its-phase-ii-clinical-trial-for-the-treatment-of-binge-eating-disorder-with-psilocybin-assisted-psychotherapy
  6. https://www.sciencedirect.com/science/article/pii/S0022395622001303
  7. https://pubmed.ncbi.nlm.nih.gov/9797933/
  8. (Ghaderi et al., 2018, Ward et al., 2019)
  9. Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
  10. Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. Am J Clin Nutr. 2019;109(5):1402-1413. doi:10.1093/ajcn/nqy342

We’re Heading Into Pivotal Years for Psychedelics – Here’s Why

By Dr. Reid Robison, Chief Medical Officer

I had the good fortune of attending the Horizons Conference in NYC in December, one of the more scientifically rigorous (and longest running) psychedelic medicine conferences. With both MDMA and psilocybin moving through the drug development process and a steady stream of new and exciting developments from stakeholders in space, I’m convinced that the next couple of years will be pivotal for psychedelics. It’s inspiring to see the progress being made in this field.

Progress in MDMA research

I really appreciated the openness, transparency and thoughtfulness of MAPS and their update on the path toward MDMA approval for PTSD. After nearly two decades of tireless work led by Rick Doblin, including clinical trials, therapy training programs, and several high impact publications, the phase III MDMA study is well underway. After incredibly promising results from the first part of the phase III study (announced last year), MDMA-assisted psychotherapy is poised for approval by the FDA as a potential treatment for PTSD by the end of 2023. Equally exciting were the goals that MAPS shared of training 30,000 therapists by 2031 and treating 1 million people with PTSD by 2031.

Psilocybin for anorexia

It was great to get a sneak preview from Dr. Natalie Gukasyan about their preliminary impressions from the study for anorexia at Johns Hopkins. I often point out when I speak about eating disorders that anorexia nervosa has the highest mortality of any psychiatric illness, and there's an urgent need for new treatment options. Dr. Gukasyan noted that many individuals with anorexia experience lower-than-expected subjective effects of psilocybin. She mentioned that optimal psychedelic study design for anorexia may need more than the typical two or three dosing sessions that are written into most protocols. Not surprisingly, some individuals with anorexia may need more psychological support than is needed for other conditions—an important reminder that change takes time. These observations and ongoing studies are a great addition to our growing understanding of how psychedelics might help treat anorexia. More research to come.

Can we use psychedelics to reopen critical periods?

Another fascinating topic was Dr. Gul Dolen’s talk on psychedelics and metaplasticity. In their study, Dr. Dolen and her team set out to answer the question: “Can we use psychedelics to reopen critical periods?” A critical period—also called neuroplasticity—is a duration in which a person’s brain is more receptive to the influence of experience and external stimuli. And the answer, for both the classic psychedelics and other compounds like MDMA and ketamine, was not only fascinating, but has relevance for how we approach psychedelic therapy clinically. Different psychedelics vary dramatically in their acute subjective effects, and there’s evidence that the duration of these effects is proportional to the duration of therapeutic effects and the window of neuroplasticity.

For example, ibogaine's subjective effects last 26-72 hours, and ibogaine opens the social reward learning critical period (a period of increased brain plasticity, sensitivity to environmental stimuli, and adaptability) for >4 weeks. Compare this to other drugs, such as ketamine, and you can see a proportionality. Ketamine acts rapidly, but the effects don’t last as long. The acute subjective effects of ketamine last only .5-2 hours, and the social reward learning critical period is open for much shorter, at 48 hours. The critical period of psilocybin and MDMA is two weeks, and for LSD, it’s about three weeks.

"What I think we might have actually discovered is that psychedelics might be that master key for reopening critical periods." – Dr. Gul Dolen

IMAGE SOURCE

Concluding thoughts

As a final note, I’ll quote Dr. Matthew Johnson: "One of the reasons psychedelic therapy works so well is people are doing their own healing—there's nothing 'automatic' about it."

These drugs aren’t magic, fix-all solutions. They're powerful tools we can use to do deeper work and to become more aware of ourselves and the world we’re a part of. The process of psychedelic therapy and integration is difficult, but incredibly rewarding work that requires bravery and openness. There truly isn’t anything “automatic” or “easy” about it.

I’m extremely grateful for the contributions that have been made by so many in this field. We’ve come a long way, and I’m excited to see what we can accomplish going forward.

Episode 36: Dr. Rosalind Watts on Psilocybin and Depression

“The real medicine is the therapeutic relationship and psychedelics beautifully amplify that.”

In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Rosalind Watts. Dr. Watts is the clinical lead of the Imperial College of London’s Psilocybin for Depression trials. Most recently, she designed the treatment protocol for and served as a guide for participants in a study comparing psilocybin to an antidepressant at the Centre for Psychedelic Research at Imperial College London. This study was published in the New England Journal of Medicine. And she is also a consultant psychologist for Small Pharma who are investigating DMT as a treatment for depression.

(Image: Imperial College London / Thomas Angus)

She is a clinical psychologist for more than 6 years, and now specializes in psychedelic-assisted psychotherapy. She is the clinical director for the Synthesis Institute, an organization dedicated to “training practitioners to safely, ethically and effectively support people on a journey for healing using truffles containing psilocybin.” She co-hosts a monthly Psychedelic Integration group, alongside Michelle Baker Jones for participants of psilocybin clinical trials. And she will be launching Twelve Trees Integration, a new 12 month psychedelic community integration program for anyone who has experience with psychedelics.

More information on this program will be posted on her site in the near future and you sign up for the waitlist there as well: drrosalindwatts.com

She also developed the psychedelic therapy model ‘Accept, Connect, Embody (ACE)’ and an iteration for group-based integration of psychedelic experiences ‘Accept, Connect, Embody, Restore’ (ACER). It is based on the Hexaflex model in Acceptance and Commitment Therapy (ACT).

Dr. Watts and Dr. Joe spoke about:

 

Connect with Dr. Joe on FacebookTwitter,LinkedIn and Instagram

Connect with Dr. Rosalind Watts on InstagramFacebookTwitter, and LinkedIn.

Follow Numinus on FacebookTwitterInstagramLinkedIn, and YouTube.

 

Here is more information on subjects mentioned in this episode:

 

                                                                                                                                                       ACE Model

                                                                                                                                                    The Hexaflex Model

More quotes from Dr. Watts from the interview:

“The psilocybin experience is kind of a spring or summer opening, and there will inevitably be autumn and winter. You can think of depression as deep rest, and ‘I will allow myself this time of darkness. But I don’t need to get stuck in this winter forever.’

That’s the thing where depression becomes incredibly debilitating when the hope is lost and people feel that they’re not going to be able to move through it. I think that’s where it becomes so painful.”

 

“A lot of people describe antidepressants as numbing them. They’re not going into the depths, and they’re not learning from those places. Psychedelics give us the opportunity for a deep adventure.”

 

“Psilocybin enables people to go to those dark places and go through the cycles. The thing about antidepressants is that people say that it numbs them. It’s cutting off the peaks and the troughs of experience. So they don’t go to the winter. They’re kind of in a limbo land. They’re not going into the depths, and they’re not learning from those places.”

 

Here are some highlights of their conversation:

 

It’s interesting listening to that story because when you said that when the depression comes back, part of me wants to say, ‘well, wait a second. These people did psilocybin and isn’t one session of psilocybin a life-changing mystical experience? Depression is cured. It’s like surgery. Let’s get on with it. Get it into the drinking water so people don’t feel depressed anymore.’ 

That’s not really what happens. Is it?

No. I actually just felt a tear coming to my eye when you said that. I had this real surge of emotion because I remember that narrative and really thinking that was going to be the way forward. The experience of working with people long term showed me that it is absolutely not. We wish it was, but the depression came back for everyone that I was still in touch with. There may be a few people for whom it really, really shifted something and have stayed, but it was just a very small number of people. I’m talking out of like 80 people, maybe three or four. And yeah, for most people, it comes back.

The metaphor that I really started working with and the one that has kind of been the foundation for the work I’ve done since is of the cycles of nature and the seasons in nature and the fact that, you know, starting to think about a psilocybin experience as a kind of spring, summer opening. And then there will inevitably be autumn and there will be winter. And it doesn’t really happen in that linear cycle, but that we all go through the cycles of spring, summer, autumn, and winter.

Trying to hold onto the idea of constant summer is so typical of our culture because we want the never ending sunshine and the kind of consumerist dream of like we can find a way to rig this show and be always happy. But if you think about like the cycle of nature and the course of a day, we go from day to night and the course of the year we go from, you know, well, in the parts of the world where you have seasons.

That cycle of dark and light is so fundamental to nature and to us that rather than lamenting on the fact the psilocybin experience benefits tend to fade, I thought, ‘Well, we can embrace this because there is a time of hibernation. There’s a time of sitting and waiting and resting.’ Thinking about depression as deep rest and allowing that process of ‘I don’t need to get stuck in this winter forever. I can move through this cycle, but I’m going to allow myself this time of darkness. I think it’s just about not getting stuck.

That’s the thing where depression becomes incredibly debilitating, when hope is lost and people feel that they’re not going to be able to move through it. And I think that’s where it becomes so painful.

 

I’m feeling a bit of a need to recalibrate here because if we are just cycling through the seasons in our emotional lives, what the hell is the point of all this? It’s like, maybe, SSRIs are good enough as the New England Journal of Medicine article seems to suggest. Maybe especially if it’s paired with some kind of therapy. There are lots of therapists out there that can provide this work. 

Why do we need the fireworks, the hallucinations, the mystical experiences? Like what’s all the hype about then? What is psilocybin in the context of a therapy actually bringing that’s unique and different and worthy of all the hope and promise?

Very, very good question. And I think it is that it enables people to go to those dark places and go through the cycles because the thing about antidepressants is that what people describe about them is that it’s numbing them. It is cutting off the peaks and troughs of experience, but they didn’t go to the winter. They’re kind of kept in a kind of limbo land and they’re not going into the depths of it and really learning from those places.

And I’d say often with good talking therapy, you can really get down into the shadow. Which is, you know, often the winter, the kind of the underworld, you can get down there. But it’s really hard. And what I’ve learned about depression through this work is that I used to think about depression as like deep grief and sadness, like deep winter. But actually, I think for a lot of people depression is just numbness and stuckness and feeling nothing.

So actually being able to go to grief, being able to go down into that deep, dark cavern of despair that we all have, some people to a much greater degree, and really swim around in those deep dark waters, but also connect. That’s the acceptance: going down into the water. And then there’s the connection to values. So in that cycle of going down and going up, going around, it’s like you can become–you can embrace a cycle of, ‘I will accept my darkest feelings. I’m willing to feel them. I can open up to them. And when I’ve done that, I’m going to connect to the values of what that teaches me. And every time I go through the cycle, I’m learning more. I’m getting more gifts. I’m getting more resilient.’

And as you go through the cycle, you kind of hopefully come out the other side, wise, experienced, able to hold pain, and connect to beauty rather than with other traditional, well, kind of antidepressants. Obviously, for some people, they just work brilliantly, but for a lot of people, antidepressants, you’re not going on these big journeys of acceptance and connection. You’re just kind of staying in numbness.

You’re not going on the adventure. Psychedelics give us the adventure, the opportunity for the deep adventure.