This study will evaluate the feasibility, safety and preliminary efficacy of psilocybin-assisted psychotherapy in military veterans with treatment-refractory posttraumatic stress disorder (PTSD).
Posttraumatic stress disorder (PTSD) is a severe and debilitating mental health condition that significantly impacts patients' lives, leading to functional impairments, strained relationships, and high healthcare costs. About half of the patients with PTSD do not benefit from current evidence-based psychotherapy and available pharmacological treatments offer only limited benefits. Therefore, there is a high need for novel therapeutic approaches in the treatment of PTSD. Psilocybin-assisted psychotherapy is a promising approach combining the pharmacological effects of psilocybin, a serotonergic psychedelic, with psychotherapy. Psilocybin-assisted psychotherapy has shown promising effects in several phase 2 studies in the treatment of mental health conditions such as depression and end-of-life anxiety, with two phase 3 studies underway for treatment-resistant depression. Building on these initial promising results, psilocybin-assisted psychotherapy is increasingly being studied for other psychiatric indications, including PTSD. Many of psilocybin's potential therapeutic mechanisms appear to be transdiagnostic in nature. For example, studies suggest that psilocybin can enhance introspection, emotional processing, and psychological flexibility, all of which could facilitate psychotherapeutic processes. Psilocybin has also been shown to reduce avoidance and promote neural plasticity and cognitive reappraisal, which could be particularly relevant for addressing core symptoms of PTSD, such as persistent avoidance and rigid negative thought patterns. Furthermore, its ability to foster a sense of connectedness aligns well with the therapeutic need of individuals with PTSD who face challenges related to social isolation. Preliminary findings from an initial Phase 2 trial suggest that psilocybin-assisted psychotherapy may be safe and associated with clinically meaningful improvements in PTSD symptoms. However, this study differed from the present study in several important aspects. Participants were not required to have had previous unsuccessful evidence-based psychotherapies for PTSD, and psilocybin administration was not embedded within psychotherapeutic treatment. The current open-label pilot study will focus on veterans with treatment-refractory PTSD, a patient population that frequently shows partial or no response to standard evidence-based PTSD treatment. In addition, psilocybin administration will be part of an extensive psychotherapeutic treatment protocol. This study aims to collect data on the feasibility, preliminary efficacy and safety of psilocybin-assisted psychotherapy in this population, to inform a potential future randomized controlled trial.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
12
Two psilocybin sessions (15 mg psilocybin in the first session; 25 mg psilocybin in the second session) embedded in a psychotherapeutic framework with three preparatory sessions and six integrative sessions.
ARQ National Psychotrauma Centre / ARQ Centrum'45
Oegstgeest, Netherlands
Clinician-Administered PTSD Scale for DSM-5 Revised (CAPS-5-R)
The last month CAPS-5-R is a semi-structured interview that assesses index history of DSM-5-defined traumatic event exposure, including the most distressing event and time since exposure, and rates intrusion symptoms (intrusive thoughts or memories), avoidance, cognitive and mood symptoms, arousal and reactivity symptoms, duration and degree of distress and dissociation. The CAPS-5-R will be administered by a study independent CAPS-5-R rater.
Time frame: From Baseline to 1 month after final integrative psychotherapy session
Semi-structured interview
Comprehensive qualitative information about participants' evaluation of the feasibility, acceptability and efficacy of psilocybin-assisted psychotherapy for PTSD will be collected through a semi-structured interview.
Time frame: One month after final integrative psychotherapy session
Treatment Acceptability/Adherence Scale Modified (TAAS-M)
A modified 10-item version of the Treatment Acceptability and Adherence Scale (TAAS-M) will be used to describe acceptability and adherence to psilocybin-assisted psychotherapy.
Time frame: One month after final integrative psychotherapy session
Feasibility of participant screening and study retention
The feasibility of participant screening and study retention will be assessed by documenting the number and proportion of participants who fail screening, the number and proportion of enrolled participants who discontinue the intervention, and the reasons for screen failure and discontinuation. All measures will be summarized descriptively.
Time frame: From screening until one month after the final integrative psychotherapy session.
Concomitant medication use
Concomitant medication use during study participation will be recorded.
Time frame: From screening until one month after the final integrative psychotherapy session.
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Columbia Suicide Severity Rating Scale (C-SSRS)
The C-SSRS is a clinician-administered measure of suicidal behavior devised to detect potential suicidal thoughts or behaviors during a clinical trial.
Time frame: Measured at several timepoints from screening to one month after the final integrative psychotherapy session.
Adverse events
Severity, incidence and frequency of AEs and serious adverse events (SAEs).
Time frame: From screening until one month after the final integrative psychotherapy session.
Blood pressure
Systiloc and diastolic blood pressure (mmHg) will be monitored.
Time frame: At several timepoints between screening and one month after the final integrative psychotherapy session, including during psilocybin administration.
Heart rate
Heart rate (beats per minute) will be monitored.
Time frame: At several timepoints between screening and one month after the final integrative psychotherapy session, including during psilocybin administration.
Body temperature
Body temperature (°C) will be monitored.
Time frame: At several timepoints between screening and one month after the final integrative psychotherapy session, including during psilocybin administration.
Sheehan Disability Scale
The Sheehan Disability Scale is a 3-item assessment of functional impairment.
Time frame: Change from Baseline to one month after final integrative psychotherapy session
Beck Depression Inventory-II (BDI-II)
The BDI-II is a 21-item self-report measure for depression symptom severity.
Time frame: Change from baseline to one month after final integrative psychotherapy session