Anon Psych retweetledi
Anon Psych
1.7K posts
Anon Psych
@AnonPsych2
Anonymous lurker. Clinical psychologist. Pychoanalysis & psychedelics.
Katılım Mart 2021
588 Takip Edilen343 Takipçiler
"The characterization of this intervention as categorically distinct from psychotherapy and
unrelated to treatment efficacy is difficult to sustain, and is further contradicted by the present results."
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"A more defensible interpretation is that the preparatory sessions were highly effective at establishing strong therapeutic alliance across pts, & that this almost uniformly strong alliance contributed to the acute experiences, which in turn facilitated therapeutic benefits."
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"The available evidence is more
consistent with a meaningful role of therapeutic alliance in shaping both the psychedelic
experience and clinical outcomes."
Franklin King MD@KingFranklinIV
New preprint by @trpwolff challenging methods and conclusions in the recent Goodwin et al paper that found no association between psilocybin outcomes and therapeutic alliance: osf.io/preprints/psya…
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Anon Psych retweetledi
@BadreNicolas There is nothing simple about helping patients "feel safe to engage autonomously with the drug experience"
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@alphaporgs Alliance predicts subjective fx, subj fx predict therapeutic outcomes. That's path analysis
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@AnonPsych2 "The therapeutic alliance appeared to facilitate the psychedelic experience, and these experiences in turn had stronger nominally significant direct effects on clinical outcomes. The effects of the alliance itself on therapeutic efficacy were either limited or absent."
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Even in Compass trials where "psychological support" is minimalized, therapeutic alliance modulates outcomes
"there were nominally significant effects of therapeutic alliance on psychedelic experience"
sciencedirect.com/science/articl…
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Anon Psych retweetledi
@insidepharma @DrAdamBorecky Trials rely on highly trained mental health professionals for a reason. If REMS allows MAs to oversee sessions at scale, how confident are we that the real-world benefit–risk profile will match trial outcomes?
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Anon Psych retweetledi
Yes - the hourly reimbursement rate is the same, but a Spravato room's real margin comes from staggering 3-4 patients through overlapping windows with one MA. That's the multiplier. Whether COMP360 or CYB003 can do the same thing comes down to one regulatory decision: does REMS allow multi-patient monitoring by an MA, or require 1:1 licensed clinician presence? If it's the former, your math works. If it's the latter, the same rate per hour yields completely different room economics.
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Totally disagree. Who wants to trip (in many instances probably for the first time) with a minimally trained stranger with you as your only source of support and guidance?
Doug Drysdale@insidepharma
@PsychedVantage @DrAdamBorecky The pre and post session support will continue to be important IRL. During treatment, when patients are wearing eye masks and headphones, the observers are there primarily for safety.
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Anon Psych retweetledi
Here is the distribution of placebo responses in major depression (MDD) and treatment resistant depression (TRD), the four vertical lines are the four recent psychedelic trials I mentioned below. There is a lower placebo response in TRD, however the psychedelic studies appear even lower than those, the avg across these 4 trials is (+0.3-3.7-1.2-1.5)/4~-1.5.
For MDD replotting data from: tinyurl.com/mp93f37n
For TRD replotting data from: tinyurl.com/msfuhz7d
Balázs Szigeti@psybalazs
Another day, another psychedelic trial with missing placebo response (tinyurl.com/3pzpxpac), this time with 5-MeO-DMT. In this case the patients actually got WORSE in the placebo group. In the past month, 4 high profile psychedelic trials came out, all on treatment-resistant depression, all showing the same phenomena: there is virtually no placebo response in the control arm of psychedelic studies, see image below (negative values indicate improvement as you want less depression): A: 5-meo vs PL, placebo response is +0.3 MADRS units (tinyurl.com/3pzpxpac) B: psilocybin vs active PL (nicotinamide), placebo response is -1.5 MADRS units (tinyurl.com/yueyphn5) C: psilocybin vs PL, placebo response is -1.2 MADRS units (COMP005 tinyurl.com/cjjmh8x7) D: psilocybin vs active PL (1mg psilocybin), placebo response -3.7 MADRS units (COMP006 tinyurl.com/cjjmh8x7) The typical placebo response in trials on major depression of antidepressants is -9 MADRS points (shorturl.at/fwTNs). The typical placebo response in trials on TRD with ketamine -7 MADRS points (shorturl.at/ZS0QQ).
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Anon Psych retweetledi
GH001 vs Placebo in Patients With Treatment-Resistant Depression
A Randomized Clinical Trial
$GHRS
jamanetwork.com/journals/jamap…
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Psychological support in psychedelic-assisted therapy clinical trials: A systematic review
"Findings indicate that the psychological interventions in most therapeutic psychedelic trials qualify as psychotherapy."
journals.sagepub.com/doi/abs/10.117…
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Anon Psych retweetledi
The solution to the "blinding problem" in psychedelic research: just compare the drug of interest to another drug that causes profound shifts in identity and sense of self, intense and vivid emotional experiences, mutative insights, and connection to others and the world--simple!
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@psybalazs @RCarhartHarris @insidepharma I personally find this blind v blind comparison much more compelling. Doesn't require so many epistemic hoops.
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Its work in progress, but I am 75% sure that if you look at the patient improvement in blinded antidepressants vs. psychedelics the results will be qualitatively the same as here. You can already see it if you read between the lines of this paper. Look at the results of our H1 and H2:
- H1: the difference between psychedelic and OLADs is 0.3 points favoring OLADs
- H2: the difference between blinded and OL antidepressants is about 1.3 points favoring OL
=> The difference between psychedelic and blinded ADs will be around ~1 point, favoring psychedelics. That one point is 1/3 of the minimal clinically important difference, i.e. practically negligible.
Again this is work in progress, stay tuned for formal analysis
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Here's a provocative position: I don't believe in the importance of blinding integrity.
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@psybalazs @RCarhartHarris @insidepharma "I am not aware of a single AD paper where baseline expectancy correlated with outcomes" -- Yours? (Not trying to be snarky..just trying to understand where you're coming from in your thinking) pubmed.ncbi.nlm.nih.gov/38247730/
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"know expectancy does contribute to AD efficacy" this is not nearly as well established as people think. I am not aware of a single AD paper where baseline expectancy correlated with outcomes - LMK if there are such paper.
There are some papers that use the overt-covert paradigm, but then its about all effects related to knowing the treatment, not just expectancy. Even is there are no expectancy effects in a treatment that does not mean that the unmasking bias is zero, see our 2024 review paper with @TheBorisLab.
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Anon Psych retweetledi
It's a tested hypothesis in 4 trials, 3 of which are about to publish and one of which is already published. 4 tests with consistent results: no r'ship between expectancy and response. Folk will be needing to update their priors on this... pubmed.ncbi.nlm.nih.gov/38247730/
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