Positive psychology in the investigation of psychedelics and entactogens : A critical review
Henrik Jungaberle, Sascha Thal, Andrea Zeuch, Ansgar Rougemont-Bücking, Maximilian von Heyden, Helena Aicher, Milan Scheidegger
Rationale : We reviewed the concepts and empirical findings in studies with psychedelics and entactogens related to positive psychology – the study of healthy human functioning, well-being and eudaemonia. It is an unresolved question how beneficial effects of psychedelics and entactogens are related to the potential risks of these substances – particularly in non-clinical settings.
Methods : We searched in PubMed, PsychINFO and the Cochrane Library for controlled clinical and epidemiological studies which applied concepts from positive psychology. We included N = 77 eligible studies with 9876 participants published before November 1st2017:(1) quantitative studies (N = 54), (2) preliminary or exploratory studies and reviews not including meta-analyses (N = 17), and (3) studies evidencing primarily negative results (N = 6).
Results : Positive psychology concepts have been applied for measuring effects of clinical trials, recreational and ceremonial use of psychedelics and entactogens. Psychedelics and entactogens were shown to produce acute and long-term effects on mood, well-being, prosocial behaviours, empathy, cognitive flexibility, creativity, personality factors like openness, value orientations, nature-relatedness, spirituality, self-transcendence and mindfulness-related capabilities.
Conclusions : There is preliminary evidence for beneficial effects of psychedelics and entactogens on measures of positive psychology in clinical and healthy populations, however their sustainability remains largely unresolved. The reported results must be considered preliminary due to methodological restrictions. Since longitudinal data on both positive and adverse effects of psychedelics are lacking, more rigorous and standardized measures from positive psychology should be applied in less biased populations with prospective longitudinal designs to carefully assess the benefit-risk-ratio.
While previous psychedelic research mainly focused on pathophysiological disease models and clinical applications, potential beneficial effects of psychedelics and entactogens on healthy human functioning remain barely investigated. Psychedelics (serotonergic hallucinogens like LSD or psilocybin) and entactogens (like MDMA) are used for basic and clinical research, experimental therapy, but also in recreational and psychospiritual settings. Although the latter practices are illicit or strictly regulated for public health concerns, millions of users worldwide consume psychedelic substances without serious mental health problems (Krebs & Johansen, 2013). There are consistent claims by users and researchers that psychedelics might be useful in improving healthy human functioning (Mackenzie, 2014; Walsh, 1982), however more empirical research is needed to move beyond anecdotal evidence and carefully balance beneficial effects and harm potential.
1.1. Types of studies in the psychedelic field
Basic research with psychedelics is focused on understanding mental functions and their relationship with neuronal processes in the brain (Kyzar, Nichols, Gainetdinov, Nichols, & Kalueff, 2018). Clinical research emphasizes the improvement of symptom measures in the treatment of diagnosed patients (e.g., Clinician-Administered PTSD Scale (CAPS) in trauma patients or depression scores) where psychedelics and entactogens are predominantly expected to provide valuable pharmacological tools for the augmentation of psychotherapy (Majić et al., 2017; Vollenweider & Kometer, 2010). Studies in non-clinical populations mostly focus on pathologies assumed to be induced by or associated with the misuse of these substances like impairment of memory, psychotic episodes or substance use disorders (Carhart-Harris et al., 2016; Krebs & Johansen, 2013; Nesvag, Bramness, Ystrom, Suzanne Krebs, & Johansen, 2015; Rogers et al., 2009).
1.2. Risks and safety issues
Clinical settings supervised by medical doctors and psychotherapists were shown to provide safe environments for the administration of psychedelics and entactogens with marginal risks for severe incidents (Danforth, Struble, Yazar-Klosinski, & Grob, 2016). Yet a systematic evaluation of these risks in naturalistic medical settings still has to be conducted (Heal, Gosden, & Smith, 2018). In contrast, the recreational use of psychedelics and entactogens in the context of parties, festivals, ceremonies or private homes has generally been considered unsafe – not to speak of the fact that it is illicit to use, own or sell these substances in almost all countries. Globally there is a lack of structured and comparable reporting systems concerning drug-related incidents and deaths. Nevertheless, we see that MDMA related deaths are on the rise in several countries (ibid). Typical risks associated with the recreational use of MDMA include hyperthermia, dehydration, drug interactions, hyponatremia and overdose (Rigg & Sharp, 2018). A study conducted before the rise in media popularity of MDMA estimated the amount of ecstasy related deaths in the US to be about 50 a year (Rogers et al., 2009).
Death due to direct LSD toxicity is unknown (Nichols, 2016). Major risks associated with the recreational use of classical psychedelics are anxiety and panic attacks, manifestation or exacerbation of psychotic disorder and hallucinogenic persisting perception disorders (Baggott, Coyle, Erowid, Erowid, & Robertson, 2011; Heyden & Jungaberle, 2017). It is agreed upon that toxicity of LSD, ayahuasca, psilocybin and DMT is generally low. Due to the development of new psychoactive substances like the NBOMe compounds several recent psychedelics have been linked to severe hospitalizations and fatalities (Nichols, 2016).
1.3. Benefits and positive psychology in the investigation of psychedelics and entactogens
Due to such risks LSD and other psychedelics have been listed in Schedule 1 of the US Controlled Substances Act and little attention has been given to the potential of psychedelics to improve healthy peoples’ lives through the enhancement of characteristics that are not directly linked to risks and pathologies (Elsey, 2017). Although it is recognized that adverse effects of these substances in uncontrolled settings may entail detrimental ramifications (Carvalho et al., 2014), the focus of the present paper revolves around beneficial effects across different intra- and interpersonal domains. In his review Elsey (2017) concludes that for some people the psychedelic experience may not only produce improvements in mood but may also give access to states of consciousness and insights of great significance to the individual and his social group. With precursors since the 1960ties – like Maslow’s theory of self-actualization (Walsh, 1982) – the domain of positive psychology started as a new field of
research in the 1990ties. Seligman and Csikszentmihalyi (2000) define positive psychology as “the scientific study of positive human functioning and flourishing on multiple levels that include the biological, personal, relational, institutional, cultural, and global dimensions of life”. Peterson (2009) defined it as “the scientific study of what makes life most worth living”. Hence, positive psychology provides a valuable conceptual framework to further elucidate the potential beneficial effects of psychedelics and entactogens on healthy human functioning.
Here we investigate the claim that psychedelics and entactogens may produce acute and longterm beneficial outcomes in healthy mental functioning in both clinical and healthy populations by critically reviewing the current research literature. Specifically, we explored how beneficial effects were conceptually defined and empirically measured in these studies, including methodological limitations. Finally, we discuss the consequences of conducting research about psychedelics with concepts from positive psychology highlighting possible avenues for future studies.