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Post-Psychedelic Reductions in Experiential Avoidance Are Associated With Decreases in Depression Severity and Suicidal Ideation
Open accessAbstract
Psychedelic therapy shows promise as a novel intervention for a wide range of mental health concerns but its therapeutic action is incompletely understood. In line with acceptance and commitment therapy’s (ACT’s) transdiagnostic model, qualitative research has suggested that reductions in experiential avoidance are an important component of therapeutic outcomes associated with psychedelics. However, limited research has quantitatively explored the association between decreases in experiential avoidance and therapeutic outcomes associated with psychedelics. Therefore, in two prospective studies, using convenience samples of individuals with plans to use a psychedelic, we explored the impact of psychedelic use on experiential avoidance, depression severity, and suicidal ideation, as well as relationships between changes in these outcomes. Participants (Study 1, N=104; Study 2 N=254) completed self-report questionnaires of depression severity, suicidal ideation, and experiential avoidance: 1) before using a psychedelic (in ceremonial and non-ceremonial contexts), as well as 2) 2-weeks and 3) 4-weeks after psychedelic use. Across both studies, repeated measures ANOVAs indicated significant decreases in experiential avoidance, depression severity, and suicidal ideation after psychedelic use. Furthermore, decreases in experiential avoidance were significantly associated with decreases in depression severity and suicidal ideation. These results suggest that psychedelics may lead to significant decreases in experiential avoidance, depression severity, and suicidal ideation. Additionally, these findings imply that reduced experiential avoidance may be a transdiagnostic mechanism mediating treatment success within psychedelic therapy. We conclude that integrating psychedelics with psychotherapeutic interventions that target experiential avoidance (e.g. ACT) may enhance therapeutic outcomes.
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“Second, although two of these studies employed prospective designs, their use of naturalistic, volunteer samples with high rates of attrition (> 50%) may have contributed self-selection and sample biases that limit generalizability (Close et al., 2020; Zeifman et al., 2020).”
From Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca (2022) · cites this paper as Zeifman et al., 2020
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“In particular, across three prospective samples, psychological flexibility showed signs of increasing and covarying over time with clinical outcomes including depression and suicidality (Close et al., 2020; Zeifman et al., 2020).”
From Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca (2022) · cites this paper as Zeifman et al., 2020
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“It has been proposed that they exert their effects through the stimulation of psychological flexibility processes that decrease emotional avoidance and increase approach-oriented emotional coping (Davis et al., 2020; Kashdan et al., 2020; Zeifman et al., 2020)”
From Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca (2022) · cites this paper as Zeifman et al., 2020
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“A few recent studies, including three prospective studies, have suggested that psychological flexibility is a key component in psychedelic-induced outcomes (Close et al., 2020; Davis et al., 2020; Zeifman et al., 2020).”
From Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca (2022) · cites this paper as Zeifman et al., 2020
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“Reductions in experiential avoidance were significantly associated with decreases in depression and suicidality scores [55].”
From The psychological processes of classic psychedelics in the treatment of depression: a systematic review protocol (2022) · cites this paper as [55]
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“Through prospective surveys, Zeifman and colleagues [55] found experiential avoidance (the attempt to avoid or ignore negative or unwanted emotions or cognitions [56];) to be significantly reduced at 2 and 4 weeks after psychedelic use.”
From The psychological processes of classic psychedelics in the treatment of depression: a systematic review protocol (2022) · cites this paper as [55]
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“The BEAQ has been shown to have strong internal consistency and discriminant validity, including beingmore strongly correlated with measures of avoidance than with measures of psychological distress (36, 37, 79).”
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“Moreover, within psychotherapeutic treatments, decreases in experiential avoidance are associated with, and predictive of, subsequent decreases in depression severity (73, 74) and suicidal ideation (74, 75).”
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“Moreover, within psychotherapeutic treatments, decreases in experiential avoidance are associated with, and predictive of, subsequent decreases in depression severity (73, 74) and suicidal ideation (74, 75).”
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“In the same sample, we also observed improvements in behavioral indices of emotional processing post psilocybin therapy (89), as well as a correction to the pessimism bias that is known to characterize severe depression (90).”
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“, (12–14)], and suicidal ideation (13, 15).”
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“In the same sample, we also observed improvements in behavioral indices of emotional processing post psilocybin therapy (89), as well as a correction to the pessimism bias that is known to characterize severe depression (90).”
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“Therefore, we suggest that integrating psychedelics and psychotherapeutic interventions that specifically target experiential avoidance may help to enhance and prolong (93) the effectiveness of psychedelic therapy [for discussions, see (87, 94, 95)].”
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“Moreover, within psychotherapeutic treatments, decreases in experiential avoidance are associated with, and predictive of, subsequent decreases in depression severity (73, 74) and suicidal ideation (74, 75).”
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“Given SSRIs putative limited efficacy for mild to moderate depression (52) and suicidal ideation (51), as well as evidence favoring the principle of prophylactic intervention in mental healthcare (67, 68) there may be scope for assessing whether psychedelics can improve and protect mental health in nonclinical populat…”
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“There is, therefore, an important need for exploring novel interventions for depression (61) and suicidal ideation (62).”
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Self-citationGenetic and other risk factors for suicidal ideation and the relationship with depression
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“Furthermore, suicide, which is a key concern linked to depression (42) that can also occur independent of it (43), accounts for nearly one million deaths per year (40).”
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“Psychedelics, Depression, and Suicidal Ideation Worldwide, approximately 350 million people struggle with depression (40) and many more struggle with subclinical depressive symptoms (41).”
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Einige Überlegungen zur Psychodynamik der Ulkuskranken anhand des Giessen-Tests
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Cited by
Sorted by citations
Increased global integration in the brain after psilocybin therapy for depression
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Self-citationTherapeutic alliance and rapport modulate responses to psilocybin assisted therapy for depression
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Self-citationThe Therapeutic Potential of Psilocybin
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“Five other papers on different topics were published using data from these same studies (Kettner et al. 2021; Kuc et al. 2021; Spriggs et al. 2021; Timmermann et al. 2021; Zeifman et al. 2020).”
BackgroundSelf-citation
Metadata
- Authors
- Zeifman, R. J., Wagner, A. C., Watts, R., Kettner, H., Mertens, L. J., & Carhart-Harris, R. L.
- Affiliations
- Imperial College London (GB)
- Heidelberg University (DE)
- Corresponding author
- Zeifman, Richard J.
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2020-08-07
- Volume
- 11
- Pages
- 782-782
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC7438781
- OpenAlex
- W3047886920
- Cited by
- 106
- References
- 98
- Citations by year
- 2026: 13 · 2025: 17 · 2024: 17 · 2023: 17 · 2022: 18 · 2021: 20 · 2020: 4
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Spiral (Imperial College London) (submittedVersion, cc-by)
- Funders
- Canadian Institutes of Health Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- psychedelics, experiential avoidance, depression severity, suicidal ideation, acceptance and commitment therapy, transdiagnostic mechanisms, psychedelic therapy, treatment outcomes
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