Sub-acute and long-term effects of ayahuasca on affect and cognitive thinking style and their association with ego dissolution
M. V. Uthaug, K. van Oorsouw, K. P. C. Kuypers, M. van Boxtel, N. J. Broers, N. L. Mason, S. W. Toennes, J. Riba, J. G. Ramaekers
Rationale : Ayahuasca is a psychotropic plant tea from South America used for religious purposes by indigenous people of the Amazon. Increasing evidence indicates that ayahuasca may have therapeutic potential in the treatment of mental health disorders and can enhance mindfulness-related capacities. Most research so far has focused on acute and sub-acute effects of ayahuasca on mental health-related parameters and less on long-term effects.
Objectives : The present study aimed to assess sub-acute and long-term effects of ayahuasca on well-being and cognitive thinking style. The second objective was to assess whether sub-acute and long-term effects of ayahuasca depend on the degree of ego dissolution that was experienced after consumption of ayahuasca.
Results : Ayahuasca ceremony attendants (N = 57) in the Netherlands and Colombia were assessed before, the day after, and 4 weeks following the ritual. Relative to baseline, ratings of depression and stress significantly decreased after the ayahuasca ceremony and these changes persisted for 4 weeks. Likewise, convergent thinking improved post-ayahuasca ceremony up until the 4 weeks follow-up. Satisfaction with life and several aspects of mindfulness increased the day after the ceremony, but these changes failed to reach significance 4 weeks after. Changes in affect, satisfaction with life, and mindfulness were significantly correlated to the level of ego dissolution experienced during the ayahuasca ceremony and were unrelated to previous experience with ayahuasca.
Conclusion : It is concluded that ayahuasca produces sub-acute and long-term improvements in affect and cognitive thinking style in non-pathological users. These data highlight the therapeutic potential of ayahuasca in the treatment of mental health disorders, such as depression.
Keywords : Ayahuasca . Field study . Creative thinking . Affect . Long-term effects . Mindfulness
Ayahuasca is a psychotropic plant tea from South America used for healing purposes by indigenous people of the Amazon (Schmid 2012). It is known under various names like yage, caapi, natem, mihi, dapa, daime, or hoasca. Ayahuasca is prepared from the Psychotria viridis bush that contains the
serotonergic 2A receptor agonist N,N-dimethyltryptamine (DMT) and the Banisteriopsis caapi liana that contains β- carboline alkaloids such as harmine, harmaline, and tetrahydroharmine (Palhano-Fontes et al. 2015; Riba et al. 2001). The β-carboline alkaloids inhibit the action of monoamine oxidase (MAO) that is responsible for breaking down DMT (Godinho et al. 2017). The inhibition of MAO allows DMT to reach the central nervous system for a prolonged period of time, causing intense alterations in sensory integration and awareness (Riba et al. 2001). The psychotropic effects of ayahuasca correspond with those induced by other psychedelics such as LSD, mescaline, and psilocybin (McKenna 2004). Psychotropic effects of ayahuasca start between 30 and 60 min post-administration, reaching maximum intensity between 60 to 120 min, and can last up to 4 h after administration (Riba et al. 2001).
The acclaimed benefits of ayahuasca are both spiritual and psychotherapeutic (Trichter 2010) and may be due to a symbiotic action between pharmacology and an altered state of consciousness (Re et al. 2016). Interviews with healthy ayahuasca users suggest that ayahuasca elicits spiritual insights, changed worldviews, and a new, more positive orientation towards life (Bouso et al. 2012; Grob et al. 1996; Halpern et al. 2008). Adolescents who regularly consume ayahuasca show less signs of anxiety and are more optimistic, self-confident, insistent, and emotionally mature than their peers (Da Silveira et al. 2005). Taken together, evidence suggests that ayahuasca may be a useful additive to psychotherapy to promote personal reflection and insights about attitude and belief (Trichter et al. 2009). The efficacy of this approach, however, depends on how well insights gained during the ayahuasca experience are integrated into everyday life (Frecska et al. 2016).
There is also evidence that ayahuasca affects thinking style. For example, the acute intake of ayahuasca led to significant increase in two facets of the Five Facets Mindfulness Questionnaire, i.e., non-judgment and non-reactivity (Soler et al. 2016). This suggests that ayahuasca may foster acceptance of thoughts and feelings experienced by the individual, which may be therapeutic for individuals who experience persistent negative thoughts. Increased acceptance of thoughts and feelings might have therapeutic benefits for patients with for example depression by allowing them to not judge or react to for example rumination. Furthermore, it has been demonstrated that ayahuasca acutely increases creative, divergent
thinking while decreasing convergent thinking (Kuypers et al. 2016). The former represents a style of thinking whereby new ideas can be generated in a context in which more than one solution is correct, whereas the latter refers to a style of thinking where there is only one optimal solution to a problem. Interestingly, changes in divergent thinking help to strengthen psychological flexibility and allow adaptive coping styles (Forgeard and Elstein 2014). Imaging studies have shown that enhanced mindfulness capabilities are associated with increased functional brain connectivity (Sampedro et al. 2017;Viol et al. 2017).
Most research on ayahuasca has focused on acute and subacute effects on subjective well-being. However, there are also indications that effects of ayahuasca last far beyond the (sub) acute phase. Previous research demonstrated that a single oral dose of ayahuasca decreased depressive symptoms in three females as measured by the Hamilton Rating Scale for Depression Scale (HAM-D) (De Lima Osório et al. 2011). Depressive symptoms decreased by 79% on day 1 after intake and remained at 66% below their baseline 2 weeks after intake. More recently, 17 patients who received an oral dose of ayahuasca (2.2 mL/kg) showed a significant reduction in depressive symptoms within a day following treatment which was still present 21 days later (Sanches et al. 2016). This suggests that ayahuasca has fast-acting antidepressant properties that can last for up to 3 weeks. It has also been suggested that long-term therapeutic impact of psychedelics in part depends on the quality of psychedelic experience such as the occurrence of a profound psychological insight or the experience of ego dissolution (Roseman et al. 2017).
The present study aimed to assess whether administration of ayahuasca produces long-lasting changes on affect and creativity. The second objective was to assess whether the acute and long-term effects of ayahuasca depend on the degree of ego dissolution that was experienced during the ceremony. In the current study, we predicted that participants’ self-reported mindfulness and life satisfaction and creative divergent thinking would increase after the ayahuasca ceremony as compared to baseline. Moreover, we expected that symptoms of depression, anxiety, and stress-related symptoms would decrease after ayahuasca intake as compared to baseline. We furthermore expected that ayahuasca-induced changes would still be present 4 weeks after the ceremony as compared to baseline. Finally, we expected that positive changes in the dependent variables would be correlated with subjective ratings of ego dissolution.