Psychedelic medicines for existential distress associated with life-threatening illnesses

This presentation will review the history of scientific research into the use of psychedelic medicines for the treatment of existential distress due to life-threatening illnesses, it will then outline the current state of affairs in North America, and conclude with exploring the implications it will have on the future of palliative care. Despite the significant advances in the field of palliative care with regards to symptom management, and pain control in particular, we have yet to devise an effective treatment strategy for individuals facing the existential distress associated with the inevitable reality of facing death. Psychedelic-assisted therapy, which involves the use of various psychoactive substances in the right set and setting to experience an altered state of consciousness, could serve as a powerful tool to alleviate the anxiety that many face after receiving a life-threatening diagnosis.

Palliative care provider attitudes toward existential distress and treatment with psychedelic-assisted therapies

Background Existential distress is a significant source of suffering for patients facing life-threatening illness. Psychedelic-Assisted Therapies (PAT) are novel treatments that have shown promise in treating existential distress, but openness to providing PAT may be limited by stigma surrounding psychedelics and the paucity of education regarding their medical use. How PAT might be integrated into existing treatments for existential distress within palliative care remains underexplored. Methods The present study aimed to elucidate the attitudes of palliative care clinicians regarding treatments for existential distress, including PAT. We recruited palliative care physicians, advanced practice nurses, and spiritual and psychological care providers from multiple US sites using purposive and snowball sampling methods. Attitudes toward PAT were unknown prior to study involvement. Semi-structured interviews targeted at current approaches to existential distress and attitudes toward PAT were analyzed for thematic content. Results Nineteen respondents (seven physicians, four advanced practice nurses, four chaplains, three social workers, and one psychologist) were interviewed. Identified themes were 1) Existential distress is a common experience that is frequently insufficiently treated within the current treatment framework; 2) Palliative care providers ultimately see existential distress as a psychosocial-spiritual problem that evades medicalized approaches; 3) Palliative care providers believe PAT hold promise for treating existential distress but that a stronger evidence base is needed; 4) Because PAT do not currently fit existing models of existential distress treatment, barriers remain. Conclusions PAT is seen as a potentially powerful tool to treat refractory existential distress. Larger clinical trials and educational outreach are needed to clarify treatment targets and address safety concerns. Further work to adapt PAT to palliative care settings should emphasize collaboration with spiritual care as well as mental health providers and seek to address unresolved concerns about equitable access.

Carl Jung and the Psychedelic Brain

In this essay, I outline an approach to analytical psychology based on the emerging disciplines of psychedelic neuroscience and psychedelic assisted therapies. During the 1950s Jung made brief comments on the use of psychedelics in traditional cultures and therapeutic contexts. I analyse these comments in the light of consequent research in the field. Contemporary psychedelic researchers are achieving impressive results in the treatment of mental illness and various forms of existential distress. A number of theories have been proposed to explain these results. In this essay, I will explore the idea that psychedelics facilitate a transition from our recently evolved secondary consciousness associated with the default mode network, to a more affect-based form of primary consciousness. I will also apply these findings to ethnographic accounts of traditional psychedelic use in Africa and Latin America, highlighting the usefulness of a Jungian approach to this material informed by psychedelic and evolutionary neuroscience.

Existential distress in patients with advanced cancer and their caregivers: study protocol of a longitudinal cohort study

IntroductionAt the end of life, patients with advanced cancer and their informal caregivers may confront multiple existential concerns. Despite the strong potential to alleviate existential distress through psychosocial interventions, existential distress and its impact on healthcare outcomes have not yet been studied systematically. We aim to investigate the frequency, longitudinal trajectory and predictive impact of existential distress on end-of-life outcomes. We further aim to determine patients’ and caregivers’ specific need for and utilisation of psychosocial support for existential distress.MethodsThis longitudinal cohort study will consecutively recruit 500 patients with advanced cancer and 500 caregivers from oncological outpatient and inpatient clinics. Participants will complete self-report questionnaires (sociodemographic and disease-related characteristics, existential distress, end-of-life outcomes, resources and support needs) at five points of assessment (at baseline and after 3, 6, 9 and 12 months). At baseline and 6-month follow-up, we will conduct structured diagnostic interviews to assess mental disorders. Statistical analyses will include descriptive statistics to determine the prevalence of existential distress, mental disorders and end-of-life outcomes; multiple linear and logistic regression analyses to calculate the predictive impact of existential distress on end-of-life outcomes; and growth mixture models to analyse longitudinal trajectories of existential distress.DiscussionThis study will provide comprehensive knowledge about patients’ and caregivers’ existential concerns. The longitudinal empirical data will allow for conclusions concerning the frequency and course of existential distress throughout 1 year. This important extension of existing cross-sectional research will contribute to further develop targeted psychosocial interventions. Profiles of existential distress may be applied by clinicians from multiple professions and help to address existential concerns effectively.Ethics and disseminationThe study was approved by the institutional research ethics committee (reference number LPEK-0177). Results will be presented at scientific conferences and published in peer-reviewed journals. Other forms of dissemination will include sharing results on the psychometric properties of the structured demoralisation interview with international research groups and communication with healthcare professionals providing psychosocial treatment for patients and caregivers. Following scientific standards, our progress will be regularly updated on ClinicalTrials.gov.Trial registration numberNCT04600206.