Psychedelics and the essential importance of context

Psychedelic drugs are making waves as modern trials support their therapeutic potential and various media continue to pique public interest. In this opinion piece, we draw attention to a long-recognised component of the psychedelic treatment model, namely ‘set’ and ‘setting’ – subsumed here under the umbrella term ‘context’. We highlight: (a) the pharmacological mechanisms of classic psychedelics (5-HT2A receptor agonism and associated plasticity) that we believe render their effects exceptionally sensitive to context, (b) a study design for testing assumptions regarding positive interactions between psychedelics and context, and (c) new findings from our group regarding contextual determinants of the quality of a psychedelic experience and how acute experience predicts subsequent long-term mental health outcomes. We hope that this article can: (a) inform on good practice in psychedelic research, (b) provide a roadmap for optimising treatment models, and (c) help tackle unhelpful stigma still surrounding these compounds, while developing an evidence base for long-held assumptions about the critical importance of context in relation to psychedelic use that can help minimise harms and maximise potential benefits.

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Consensus for the General Use of Equine Water Treadmills for Healthy Horses

Animals ◽

10.3390/ani11020305 ◽

2021 ◽

Vol 11 (2) ◽

pp. 305

Author(s):

Kathryn Nankervis ◽

Carolyne Tranquille ◽

Persephone McCrae ◽

Jessica York ◽

Morgan Lashley ◽

...

Keyword(s):

Working Group ◽

Best Practice ◽

Treadmill Exercise ◽

Good Practice ◽

Belt Speed ◽

Research Programmes ◽

Potential Benefits ◽

Water Treadmill ◽

Selection Of

Water treadmill exercise has become popular in recent years for the training and rehabilitation of equine athletes. In 2019, an equine hydrotherapy working group was formed to establish what was commonly considered to be best practice in the use of the modality. This article describes the process by which general guidelines for the application of water treadmill exercise in training and rehabilitation programmes were produced by the working group. The guidelines describe the consensus reached to date on (1) the potential benefits of water treadmill exercise, (2) general good practice in water treadmill exercise, (3) introduction of horses to the exercise, (4) factors influencing selection of belt speed, water depth and duration of exercise, and (5) monitoring movement on the water treadmill. The long-term goal is to reach a consensus on the optimal use of the modality within a training or rehabilitation programme. Collaboration between clinicians, researchers and experienced users is needed to develop research programmes and further guidelines regarding the most appropriate application of the modality for specific veterinary conditions.

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Psychedelic treatment of functional neurological disorder: a systematic review

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125320912125 ◽

2020 ◽

Vol 10 ◽

pp. 204512532091212 ◽

Cited By ~ 2

Author(s):

Matthew Butler ◽

Mathieu Seynaeve ◽

Timothy R. Nicholson ◽

Susannah Pick ◽

Richard A. Kanaan ◽

...

Keyword(s):

Neurological Disorder ◽

Neural Circuits ◽

Therapeutic Potential ◽

Conversion Disorder ◽

Evidence Base ◽

Control Groups ◽

Recent Interest ◽

Psychedelic Drugs ◽

Neuropsychiatric Conditions ◽

Functional Neurological Disorder

Functional neurological disorder (FND), formerly known as conversion disorder, causes a high burden of disability and distress, and is amongst the most commonly encountered conditions in neurology clinics and neuropsychiatric services, yet the therapeutic evidence base is somewhat limited. There has been recent interest in the therapeutic potential of psychedelics such as psilocybin and lysergic acid diethylamide (LSD), and in recent studies psychedelics have shown promise in treating a range of neuropsychiatric conditions. Modification of neural circuits associated with self-representation is thought to underlie some of this effect, and as some contemporary theories of FND focus on aberrant somatic self-representation, psychedelics may therefore represent an unexplored treatment option for FND. We systematically reviewed studies involving the use of psychedelics in FND. Nine studies published between 1954 and 1967, with a total of 26 patients, were identified. Due to restriction of licencing of psychedelic drugs since this period, no modern studies were identified. In most cases, patients received a course of psychotherapy with variable adjunctive administration of psychedelics (in a combination known as ‘psycholytic therapy’), with protocols varying between studies. Of those treated, 69% ( n = 18) were found to have made at least some recovery on heterogeneous and subjective clinician-rated criteria. Adverse events were mostly mild and transient; however, at least one patient terminated the study due to distressing effects. All included studies were of low quality, often lacking control groups and valid outcome measures. Although no conclusions on efficacy may be drawn from these data, further research may help to determine whether psychedelics offer a feasible, safe and effective treatment for FND.

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Infections and use of antibiotics in residents of long-term care facilities in Hungary

Orvosi Hetilap ◽

10.1556/oh.2014.29876 ◽

2014 ◽

Vol 155 (23) ◽

pp. 911-917 ◽

Cited By ~ 1

Author(s):

Rita Szabó ◽

Karolina Böröcz

Keyword(s):

Urinary Tract ◽

Long Term Care ◽

Soft Tissues ◽

Good Practice ◽

Antibiotic Use ◽

Prevalence Survey ◽

Term Care ◽

Care Facilities ◽

Tract Infections

Introduction: Healthcare associated infections and antimicrobial use are common among residents of long-term care facilities. Faced to the lack of standardized data, the European Centre for Disease Prevention and Control funded a project with the aim of estimating prevalence of infections and antibiotic use in European long-term care facilities. Aim: The aim of the authors was to present the results of the European survey which were obtained in Hungary. Method: In Hungary, 91 long-term care facilities with 11,823 residents participated in the point-prevalence survey in May, 2013. Results: The prevalence of infections was 2.1%. Skin and soft tissues infections were the most frequent (36%), followed by infections of the respiratory (30%) and urinary tract (21%). Antimicrobials were mostly prescribed for urinary tract infections (40.3%), respiratory tract infections (38.4%) and skin and soft tissue infections (13.2%). The most common antimicrobials (97.5%) belonged to the ATC J01 class of “antibacterials for systemic use”. Conclusions: The results emphasise the need for a national guideline and education for good practice in long-term care facilities. Orv. Hetil., 2014, 155(23), 911–917.

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Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

British Journal of General Practice ◽

10.3399/bjgp20x711581 ◽

2020 ◽

Vol 70 (suppl 1) ◽

pp. bjgp20X711581

Author(s):

Charlotte Greene ◽

Alice Pearson

Keyword(s):

Chronic Pain ◽

Back Pain ◽

Practice Guidelines ◽

Best Practice ◽

Evidence Base ◽

High Dose ◽

Opioid Prescription ◽

Opioid Prescribing ◽

Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

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Concussion in sports in children and adolescents – to play or not to play?

Swiss Sports & Exercise Medicine ◽

10.34045/ssem/2017/18 ◽

2017 ◽

Vol 65 (3) ◽

Keyword(s):

Gender Differences ◽

Children And Adolescents ◽

Return To Sport ◽

Consensus Conference ◽

Return To School ◽

The Novel ◽

International Consensus ◽

Persistent Symptoms ◽

New Findings

A lot has been published on the topic concussion in sports during the last years, conscience was sharpened, much was structured and defined more precisely, help tools were developed and rules changed. This article summarizes the fifth edition of the recently published guidelines of the “International Consensus Conference on Concussion in Sport”. In addition, new findings regarding gender differences and recovery will be presented, as well as the modified “return-to-sport” and the novel “return-to-school” protocols. Despite increased knowledge many questions remain such as the therapy of persistent symptoms or long-term sequelae of recurrent concussions.

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Integrating Focusing and Differentiation: A Therapeutic Path for Couples in Intimate Relationships

International Journal of Psychotherapy, Counselling and Psychiatry: Theory Research & Clinical Practice ◽

10.35996/1234/3/focusingdifferentiation ◽

2018 ◽

Vol 3 ◽

Author(s):

Evi Zohar

Keyword(s):

Couples Therapy ◽

Therapeutic Potential ◽

Well Being ◽

Point Of View ◽

The Body ◽

Self Awareness ◽

Emotional Healing ◽

Felt Sense ◽

Inner World

Continuing the workshop I've given in the WPC Paris (2017), this article elaborates my discussion of the way I interlace Focusing with Differentiation Based Couples Therapy (Megged, 2017) under the systemic view, in order to facilitate processes of change and healing in working with intimate couples. This article presents the theory and rationale of integrating Differentiation (Bowen, 1978; Schnarch, 2009; Megged, 2017) and Focusing (Gendlin, 1981) approaches, and its therapeutic potential in couple's therapy. It is written from the point of view of a practicing professional in order to illustrate the experiential nature and dynamics of the suggested therapeutic path. Differentiation is a key to mutuality. It offers a solution to the central struggle of any long term intimate relationship: balancing two basic life forces - the drive for individuality and the drive for togetherness (Schnarch, 2009). Focusing is a body-oriented process of self-awareness and emotional healing, in which one learns to pay attention to the body and the ‘Felt Sense’, in order to unfold the implicit, keep it in motion at the precise pace it needs for carrying the next step forward (Gendlin, 1996). Combining Focusing and Differentiation perspectives can cultivate the kind of relationship where a conflict can be constructively and successfully held in the inner world of each partner, while taking into consideration the others' well-being. This creates the possibility for two people to build a mutual emotional field, open to changes, permeable and resilient.

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Placental Therapy as Panacea: An Insight to Its Therapeutic Potential

Current Traditional Medicine ◽

10.2174/2215083806999201026223652 ◽

2020 ◽

Vol 06 ◽

Author(s):

Sayed Md Mumtaz ◽

Madhu Gupta ◽

Ramesh K. Goyal

Keyword(s):

Tissue Regeneration ◽

Therapeutic Potential ◽

Biologically Active ◽

Bioactive Components ◽

Biochemical Mechanisms ◽

Clinically Significant ◽

Available Information ◽

Clinical Potential ◽

Placental Extract

Abstract:: The placenta that maintains and regulates the growth of fetus, consists of various biological treasures nutrients such as cytomedines, vitamins, trace elements, amino acids, peptides, growth factors and other biologically active constituents. Their therapeutic usefulness can well define in the terms of biochemical mechanisms of various components present in it. Biomedical waste derived extract is also a panacea for treatment of various diseases. Placental therapy has been reported specifically to have potent action on recovery of diseases and tissue regeneration. Placental bioactive components and their multi targeting identity prompted us to compile the précised information on placental extract products. However, some findings are needed to be explored by scientific community to prove their clinical potential with clinically significant statistical conclusions. In the light of available information and the usefulness of the placental extract, it is necessary for the development of various formulations for various unmet meet for the treatment as well as access their adverse effects as well as contradictions and precisely evaluated in the short and in the long-term periods.

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Evidence-Based Treatment for the Eating Disorders

The Oxford Handbook of Eating Disorders ◽

10.1093/oxfordhb/9780195373622.013.0025_update_001 ◽

2010 ◽

pp. 451-451

Author(s):

Phillipa J. Hay ◽

Angélica de M. Claudino

Keyword(s):

Primary Care ◽

Eating Disorders ◽

Evidence Base ◽

Good Evidence ◽

Distinct Advantage ◽

Specialist Care ◽

Feeding And Eating Disorders ◽

Online Therapies ◽

Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

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Evidence-Based Treatment for the Eating Disorders

10.1093/oxfordhb/9780195373622.013.0025 ◽

2012 ◽

Cited By ~ 1

Author(s):

Phillipa J. Hay ◽

Angélica de M. Claudino

Keyword(s):

Primary Care ◽

Eating Disorders ◽

Evidence Base ◽

Good Evidence ◽

Distinct Advantage ◽

Specialist Care ◽

Feeding And Eating Disorders ◽

Online Therapies ◽

Primary Care Practitioners

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A Delphi Study Investigating Clinicians’ Views on Access to, Delivery of, and Adaptations of MBCT in the UK Clinical Settings

Mindfulness ◽

10.1007/s12671-021-01706-5 ◽

2021 ◽

Author(s):

Kate Williams ◽

Samantha Hartley ◽

Peter Taylor

Keyword(s):

Delphi Study ◽

Good Practice ◽

Evidence Base ◽

Clinical Settings ◽

Training Support ◽

Decision Making Processes ◽

Complex Decision Making ◽

Complex Decision ◽

The Uk ◽

Clinical Populations

Abstract Objectives Mindfulness-based cognitive therapy (MBCT) is a well-evidenced relapse-prevention intervention for depression with a growing evidence-base for use in other clinical populations. The UK initiatives have outlined plans for increasing access to MBCT in clinical settings, although evidence suggests that access remains limited. Given the increased popularity and access to MBCT, there may be deviations from the evidence-base and potential risks of harm. We aimed to understand what clinicians believe should be best clinical practice regarding access to, delivery of, and adaptations to MBCT. Methods We employed a two-stage Delphi methodology. First, to develop statements around best practices, we consulted five mindfulness-based experts and reviewed the literature. Second, a total of 59 statements were taken forward into three survey rating rounds. Results Twenty-nine clinicians completed round one, with 25 subsequently completing both rounds two and three. Forty-four statements reached consensus; 15 statements did not. Clinicians agreed with statements regarding sufficient preparation for accessing MBCT, adherence to the evidence-base and good practice guidelines, consideration of risks, sufficient access to training, support, and resources within services, and carefully considered adaptations. The consensus was not reached on statements which reflected a lack of evidence-base for specific clinical populations or the complex decision-making processes involved in delivering and making adaptations to MBCT. Conclusions Our findings highlight the delicate balance of maintaining a client-centred and transparent approach whilst adhering to the evidence-base in clinical decisions around access to, delivery of, and adaptations in MBCT and have important wide-reaching implications.

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