Trauma exposure is associated with an increased risk for psychopathology including post-traumatic stress disorder (PTSD), major depressive disorder (MDD) and dissociative disorders. PTSD, characterized by debilitating comorbid symptomatology and psychosocial dysfunction, is associated with significant individual and societal burden.
Pharmacotherapies (eg, paroxetine and sertraline) and evidence-based psychotherapy interventions (EBPI) for PTSD, such as prolonged exposure (PE) or trauma focused cognitive behavioral therapy (TF-CBT), are considered effective. Despite EBPIs effectiveness, studies consistently highlight difficulties, including inadequate treatment outcomes and poor patient retention.
Psychological treatment of PTSD may be challenging and complex, potentially due to the significant symptomatic and psychosocial burden patients endure (eg, perceived negative experiences related to the treatment across different domains, including emotional, relational, physical, systemic, and practical aspects).
Further, patients who find treatment ineffective and seek additional care are also at increased risk of re-traumatization due to the need to repeatedly recount their traumatic experiences to providers. In response to the unmet clinical need in PTSD15, and difficult-to-treat mental-health conditions, studies investigating psychedelic forms of therapy have shown promise in so-called “treatment-resistant” patients. Psychedelic therapy (PT) is an umbrella term for interventions administering serotonergic hallucinogens such as phosphoryloxy-N,N-dimethyltryptamine (psilocybin) and lysergic acid diethylamide (LSD) or entactogens such as Methyl enedioxy methamphetamine (MDMA) alongside manualized psychological interventions.
Despite PT’s favorable safety profile in research settings and advances in understanding of its neurobiological, psychological, and behavioral effects, significant gaps of knowledge remain. Clinically, it is not well understood how PT supports positive outcomes across conditions and compounds. Positive results are often associated with patient reports of increased insightfulness, emotional breakthrough and mystical-type experiences, however, experimental studies are needed to establish causality.
Importantly, qualitative research has highlighted the significance of the intervention’s nonpharmacological factors, including interpersonal rapport and music listening to positive outcomes. In PTSD, MDMA-assisted therapy appears highly efficacious in clinical trials, reducing symptoms and improving quality of-life in patients with chronic PTSD.
However, completed trials of classical psychedelics in PTSD are lacking, with several early phase studies recruiting as of October 2023. Correspondingly, there is an absence of trauma-focused clinical practice guidelines in PT. Despite considerable advances in treatments for PTSD in recent years, there remain significant challenges associated with standard PTSD treatment, including disruptions to the patient’s linguistic capacities and biological stress dysregulation. Therefore, considering patients’ experience of EBPI may help personalize care and promote safety outcomes for traumatized participants in PT trials.
Further, as the number of psychedelic trials grow and with Australia approving the therapeutic use of MDMA and psilocybin in mental-health, it is vital that regulators, healthcare systems and clinicians have access to a repository of in-depth knowledge of patient experiences to inform operational, clinical, and training protocols that support patient safety. As most PT trial participants must be unsuccessfully treated by first-line interventions, understanding the positive and negative experiences of EBPI patients could help optimize PT protocols. Qualitative research is well-placed to provide an in-depth understanding of patients’ subjective experience of trauma and treatment.
Therefore, this research aims to review qualitative studies in EBPI for PTSD and PT, examining areas of intersectionality and divergence to promote a multidisciplinary dialogue. A synthesis of the themes in the selected studies will be conducted to provide a broad understanding of patients’ experience of the treatments. Based on the data, areas of clinical interest will be discussed to promote patient outcomes and safety in PT.
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