Dark loops: contagion effects, consistency and chemosocial matrices in psychedelic-assisted therapy trials

What happens when an emerging programme of medical research overlaps with a surging social movement? In this article we draw on the anthropological term ‘chemosociality’ to describe forms of sociality born of shared chemical exposure. Psychedelic administration in the context of recent clinical trials appears to have been particularly chemosocial in nature. We argue that one consequence is that psychedelic-assisted therapy (PAT) clinical research trials tend to breach key assumptions underlying the logic of causal inference used to establish efficacy. We propose the concept of dark loops to describe forms of sociality variously emerging from, and impacting participant experiences in, PAT trials. These dark loops are not recorded, let alone incorporated into the causal pathways in the interpretation of psychedelic trial data to date. We end with three positions which researchers might adopt in response to these issues: chemosocial minimisation where research is designed to attenuate or eliminate the effects of dark loops in trials; chemosocial description where dark loops (and their impacts) are openly and candidly documented and chemosocial valorisation where dark loops are hypothesised to contribute to trial outcomes and actively drawn upon for positive effect. Our goal is to fold in an appreciation of how the increasingly-discussed hype surrounding psychedelic research and therapeutics continues to shape the phenomena under study in complex ways, even as trials become larger and more rigorous in their design

Physical activity interventions for young people with increased risk of problematic substance use: a systematic review including different intervention formats

Objective: This systematic review investigates physical activity (PA) interventions for (1) reducing substance use and associated outcomes, (2) increasing physical activity, and (3) improving mental health in young people aged 12–25 years at increased risk for problematic substance use. Method: Four databases (PsycINFO, CINAHL, SPORTDiscus, and Medline) and grey literature, including hand searches, were searched (2021–2022). Non-randomized controlled or randomized controlled trials of a) multimodal or unimodal, short or long-term physical activity interventions in young people at increased risk of problematic substance use that b) investigated substance use outcomes were included. PA and mental health outcomes were explored where possible. Results: Sixty-one percent of the studies (k = 17/28) reported a significant improvement in outcomes related to tobacco (e.g., abstinence, cravings, withdrawal symptoms, smoking pattern), alcohol (e.g., quantity, frequency), or other substance use (e.g., frequency, quantity, recent use). Eight studies reported an increase in PA participation; two reported a beneficial effect on depression symptoms. The certainty of the evidence, i.e., the confidence in the reported effect estimates, was downgraded based on the risk of bias assessment. Findings should therefore be interpreted cautiously. Conclusions: A range of physical activity intervention formats and modalities may decrease substance use and associated outcomes and increase physical activity participation among people at risk for problematic substance use. Future research is warranted to better establish efficacy and investigate the effectiveness of implementing physical activity as part of treatment for substance use in young people

Underreporting of implementation strategies and barriers in physical activity interventions for young people at risk of problematic substance use: a brief report

BACKGROUND: Several studies have assessed whether physical activity interventions can reduce substance use in young people at risk of problematic substance use. This report identifies and describes the reporting of implementation characteristics within published studies of physical activity interventions for young people at risk of problematic substance use and provides recommendations for future reporting. METHODS: Reported implementation strategies (including intervention manualization), barriers, implementation fidelity, and personnel acceptance were extracted from studies of physical activity interventions for young people aged 12-25 years at risk of problematic substance use that were included in a previous systematic review of intervention efficacy. RESULTS: Implementation strategies were reported in less than half of the included studies (42.9%), implementation barriers in only 10.7% of studies, intervention fidelity in 21.4%, and personnel acceptance in a single study (3.6%). CONCLUSIONS: Results indicate insufficient reporting of implementation strategies, barriers, fidelity, and personnel acceptance. Consideration of implementation characteristics is essential for implementing physical activity interventions in practice. Inadequate or limited reporting of these characteristics may contribute to delayed uptake and adoption of evidence-based interventions in clinical practice. Recommendations to improve the reporting of implementation information include integrating standards for reporting implementation characteristics into existing reporting guidelines, developing an international taxonomy of implementation strategies, and upskilling intervention researchers in the fundamentals of implementation science

Behaviour change techniques in physical activity-focused interventions for young people at risk of problematic substance use: a systematic review and meta-analysis.

Aim This systematic review investigates behaviour change techniques in interventions promoting physical activity for young people aged 12-25 years at heightened risk of problematic substance use, and the effect of these techniques on physical activity participation and substance use outcomes. Methods Four databases (PsycINFO, CINAHL, SPORTDiscus and Medline) were searched between November 2020 and November 2022 for randomized and non-randomized controlled studies according to inclusion criteria. Meta-analyses were calculated using weighted, standardized averages of effect sizes (Hedges' g). Results Twenty-eight studies were included, 14 studies in the meta-analysis (intervention n = 1328; control n = 845). Reported BCTs included behavioural instructions, social comparison and goal setting. There was a significant effect of behaviour change techniques on combined substance use outcomes, such as cravings and consumption, for interventions reporting multiple behaviour change techniques (g = -0.33, p < .001, 95% CI [-0.50,-0.16]) or one single behaviour change technique (g = -1.84, p < .001, 95% CI [-2.89,-0.8]). Limitations include unexplained variance and limited reporting of relevant behaviour change technique data in the included studies. Conclusion The results indicate that using behaviour change techniques in interventions that promote physical activity for young people has an effect on substance use. Further research needs to be completed comparing the impact of the number and type of behaviour change technique, and improved reporting of intervention content is required

Dark Loops: Contagion effects, consistency and chemosocial matrices in psychedelic-assisted therapy trials

What happens when an emerging programme of medical research overlaps with a surging social movement? In this article we draw on the anthropological term ‘chemosociality’ to describe forms of sociality born of shared chemical exposure. Psychedelic administration in the context of recent clinical trials appears to have been particularly chemosocial in nature. We argue that one consequence is that psychedelic-assisted therapy (PAT) clinical research trials tend to breach key assumptions underlying the logic of causal inference used to establish efficacy. We propose the concept of dark loops to describe forms of sociality variously emerging from, and impacting participant experiences in, PAT trials. These dark loops are not recorded, let alone incorporated into the causal pathways in the interpretation of psychedelic trial data to date. We end with three positions which researchers might adopt in response to these issues: chemosocial minimisation where research is designed to attenuate or eliminate the effects of dark loops in trials; chemosocial description where dark loops (and their impacts) are openly and candidly documented, and chemosocial valorisation where dark loops are hypothesised to contribute to trial outcomes and actively drawn upon for positive effect. Our goal is to fold in an appreciation of how the increasingly-discussed hype surrounding psychedelic research and therapeutics continues to shape the phenomena under study in complex ways, even as trials become larger and more rigorous in their design

Psychedelic-Assisted Psychotherapy, Patient Vulnerability and Abuses of Power

Recent high-profile findings supporting the possible efficacy of psychedelic-assisted psychotherapy (Psy-AP) for indications including treatment-resistant depression and post-traumatic stress disorder make it increasingly likely that these treatments will become more widely available. While social and popular media discussions have highlighted interpersonal risks associated with Psy-AP, within psychiatry there has been little focus on this issue. In this viewpoint, we argue that while abuse of power unarguably happens in psychotherapeutic relationships more broadly, there are factors rendering Psy-AP modalities particularly vulnerable to such issues, while also presenting obstacles to reporting. Mainstream psychiatric institutions have a key role to play in increasing awareness of interpersonal risks in Psy-AP and developing protocols consistent with accepted standards of clinical care to manage them

Methodological issues undermine evidence about adverse effects of psilocybin-assisted psychotherapy

Methodological issues undermine evidence about adverse effects of psilocybin-assisted psychotherap

Development of the MDMA-Assisted Psychotherapy Side Effects Tool (M-SET): A Delphi Study

Background: Despite growing interest in the therapeutic potential of MDMA, no targeted measure to systematically assess side effects of MDMA-Assisted Psychotherapy (MDMA-AP) exists. Our aim was to develop an MDMA-assisted psychotherapy Side-Effects Tool (M-SET) to capture side effects over a course of MDMA-AP and at follow-up. Method: Informed by a systematic review as well as a review of other relevant measures, we drafted a list of potential side effects. Face and content validation were obtained via a modified two-round online Delphi process, involving experts in MDMA-AP and the neuropsychopharmacology of MDMA. Results: Twelve experts consented to participate over two rounds of Delphi panel deliberations (response rate: R1 = 83-92%, R2 = 75%). The Delphi panelists were asked to keep, discard, modify or suggest additional items. The final version of the M-SET consists of 165 items across four questionnaires that collect information at: screening, baseline, the day of medication sessions and longer-term follow-up. Conclusion: The use of a modified Delphi technique proved a successful method to generate content for the first structured tool designed to evaluate side effects specifically associated with MDMA-AP. The M-SET is recommended for use in both research and clinical settings. Its implementation has the potential to improve the safety of delivering MDMA-AP, as well as support the development of a more systematic and robust evidence base on its safety and tolerability