Exploring Research Results NR505 Assignment

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Exploring Research Results NR505 Assignment

Exploring Research Results NR505 Assignment

Using the following steps found within the translation phase of the Practice Evidence Translation (PET) model developed by Johns Hopkins, select a research result reported in a journal article that supports your PICOT/PICo question. Please respond to the following steps. Please note that wording of the steps may have been modified slightly from the PET so that they help with this posting. Include the permalink at the end of your posting.

  • Using references, identify the research result that you could use in your practice setting.
  • Determine fit, feasibility, and appropriateness of the result for your practice setting.
  • Using Plan-Do-Study-Act (PDSA), outline an action plan.
  • Identify the resources (physical, personal, technology) needed to implement your action plan.
  • Determine the criteria that you would use to determine whether the implementation of your project was successful.
  • Identify one future research study that would be useful in extending knowledge of your selected project result.

My PICOT QUESTION: In patients with either mood, stress, or anxiety disorders that are not at high clinical risk for psychosis (P), will implementing psychedelic-aided psychotherapy (I) contribute to decreased drug relapse rates and reduced stress- and anxiety-related symptoms (O) over the year following completion of treatment (T) as compared with patients undergoing traditional substance abuse therapy (C)?

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Psychedelic-aided Psychotherapy: Preparing a Quantitative Review

Chamberlain College of Nursing

NR505: Advanced Research Methods: Evidence-Based Practice

February 2018

Psychedelic-aided Psychotherapy: Preparing a Quantitative Review

PICOT Question

Exploring Research Results NR505 Assignment

In patients with either mood, stress, or anxiety disorders that are not at high clinica risk for psychosis (P), will implementing psychedelic-aided psychotherapy (I) contribute to decreased drug relapse rates and reduced stress- and anxiety-related symptoms (O) over the year following completion of treatment (T) as compared with patients undergoing traditional substance abuse therapy (C)?  Quantitative review and analysis of contemporary literature should be able to answer this question.

Research Critique Table

 

Citations

Purpose of Research Research Designs and Sample Data Collection Methods Results Strengths and Weaknesses
 

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“To evaluate the association between the lifetime use of psychedelics and current mental health in the adult population.” “Multivariate logistic regression to calculate associations between the past year mental health indicators and use of psychedelics.”

 

n = 130,152

 

Randomly selected as representative of the adult population of the United States from years 2001 through 2004 of the National Survey on Drug Use and Health – variables include K6 scale psychological distress, lifetime and past year use of select psychedelics, and symptoms of mood, stress, and anxiety disorders Exploring Research Results NR505 Assignment No significant correlations between psychedelic use, whether overall or specific and whether past year or lifetime, and any mood, stress, or anxiety disorders; “in several cases psychedelic use was associated with lower rate of mental health problems.” A sample size of 130,152 subjects yields robust statistical conclusions, especially when selected as representative of the population.

 

However, while cross-sectional analysis can establish correlative and epidemiological relationships, this method is unreliable in determining causation.  Also, self-reported illicit behaviors are frequently underreported.

 

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To evaluate the use of psilocybin, a serotonergic hallucinogen, for efficacy in treating patients with treatment-resistant depression

 

ANOVA time-series analysis from questionnaires of patients with treatment-resistant depression to determine quality of initial psilocybin-aided treatment experience and five-week health outcomes

 

n = 20

 

Altered States of Consciousness questionnaire to determine quality of treatment experience, Self-Reported Quick Inventory of Depressive Symptoms as a measure of clinical outcome Following treatment, occurrence and magnitude of Oceanic Boundlessness and Dread of Ego Dissolution experiences during psychedelic-aided psychotherapy diminished depressive symptoms over time. One of the only studies to evaluate the impact of psychedelic-aided psychotherapy on patients with depression.  Self-reported quality measures are adequate in determining patient perceptions, important in evaluating the efficacy of mental health treatment.

 

However, the sample size is nd the robustness of the time-series model might require further review.

 

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To examine the timing of onset for anxiety and substance dependence disorders in patients with comorbid anxiety and substance use disorders to determine the relationship of causality Three logistic regression models were used to analyze temporal elements of the relationship between anxiety disorders and substance dependence

 

n = 788

National Comorbidity Survey, meant to represent the non-institutionalized United States population ages 15-54, using data from fieldwork carried out from September 1990 to February 1992 “Substance dependence temporally precedes several anxiety disorders, particularly panic disorder.”  However, substance dependence precedes other disorders.

 

Advances beyond epidemiological correlations between anxiety and substance abuse to address causation.

 

However, simple temporal trends do not unequivocally indicate causation.  A precedent does not always cause its succedent.

Exploring Research Results NR505 Assignment

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To determine accuracy of clinician-identified elevated depressive symptoms for substance abuse patients and identify characteristics associated with accurate identification of elevated depressive symptoms Logistic regression models with cluster robust variance estimation for each independent variable

n = 215

Convenience sampling to recruit clinics from two Australian states – participating clinics provided questionnaires on substance use and a Patient Health Questionnaire (PHQ-9) to assess symptoms of depression. Clinician sensitivity and years of experience in addition to clients’ main substance and length of treatment were positively associated with the accuracy of symptom identification. PHQ-9 has been proven reliable and valid for identifying depression in populations with substance abuse problems.

 

However, variables used to measure sensitivity and specificity of clinician judgments were imprecise so conclusions may reflect such imprecision.

 

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Summary

The instance of a substance use disorder correlates heavily with the instance of a mood, anxiety, or stress disorder (Lai, Cleary, Sitharthan, & Hunt, 2015).  Profound epidemiological conclusions suggest that psychotherapy aided by the administration of lysergic acid diethylamide, psilocybin, dimethyltryptamine, and mescaline are exponentially more effective than traditional rehabilitative psychotherapy protocols in curbing abuse of and dependence upon nicotine, tobacco, and illicit substances (Bogenschutz & Johnson, 2016).  Psychedelic compounds, most notably serotonergic hallucinogens, bring about profound neurobiological alterations upon administration: neuronal hierarchies are altered and even reversed both regionally and globally – signals at posterior locations are stronger, and signals at anterior locations are weaker, which globally reverses the hierarchy of lobes as the occipital lobe has more influence than the parietal, central, and frontal lobes hierarchically while the typical lobal hierarchy is organized in the opposite order; 5-HT2 serotonin receptors are stimulated; and glutamine transmission is stimulated in the cerebral cortex with subsequent changes in cortical information transmission (Alonso, Romero, Mañanas, & Riba, 2015).  This allows for intense perceptual experiences and, consequentially, an opening for influence over a patient’s thought process, which would explain abnormally extreme benefits in reversing addictive and abusive tendencies.

The impact of psychedelic-aided psychotherapy lasts far beyond the administration of hallucinogens.  Following a psychedelic-induced experience, a person’s neurons demand less serotonin as a result of rapid downregulation of serotonin receptors, credited with optimizing mood regulation and energy-related functions and essentially freeing a patient from past guilts and anxiety, which contributes to psychological dependency and drug relapse.  Lifetime use of psychedelics predicts a 40% reduction in the likelihood that a person in the general population has abused opioids in the past year (Pisano, Putnam, Kramer, Franciotti, Halpern, & Holden, 2017).  Furthermore, the use of serotonergic hallucinogens is associated with lower risk of psychological distress, suicidal thinking, suicidal planning, and suicide attempt (Hendricks, Thorne, Clark, Coombs, & Johnson, 2015) and is not a reliable predictor of general mental illness, risk-taking behavior, or self-destructive thinking (Johansen & Krebs, 2015).  However, the use of psychedelic substances has been linked to first-onset psychosis and exacerbation of psychotic symptoms for those predisposed (Vallersnes, Dines, Wood, Yates, Heyerdahl, Hovda, Giraudon, Euro-DEN Research Group, Dargan, 2016).  If the use of psychedelic-aided psychotherapy is superior in utility, efficacy, and perhaps even safety as compared to traditional rehabilitative therapy in combatting substance abuse and dependency, the rescheduling and approval of psychedelics as therapeutic aids should have substantial benefits in dealing with the public health issue of substance abuse and dependency.  On the other hand, even with evidence that psychedelics may stabilize mood and reduce stress and anxiety, the safety and efficacy of psychedelic-aided psychotherapy should be reviewed specifically for patients with mood, stress, and anxiety disorders alongside substance use disorders as substance abuse and dependency are strongly linked to such comorbid disorders (Lai, Cleary, Sitharthan, & Hunt, 2015). Exploring Research Results NR505 Assignment

Search strategy involved looking for scholarly peer-reviewed studies – omitting systematic reviews, meta-analyses, clinical practice guidelines, and other secondary analyses – that quantitatively assessed the relationships linking psychedelic use to mood, stress, anxiety, and drug abuse in the general population; psychedelic-aided psychotherapy to mood, stress, anxiety, and drug abuse in patients; and any material that could contribute to a determination about the safety and efficacy of psychedelic-aided psychotherapy in bringing about superior mental health outcomes in patients with comorbid substance use and mood, stress, or anxiety disorders.  Findings were limited when using combinations of search terms including “psychedelic”, “hallucinogen”, or “psychedelic-aided psychotherapy” alongside “mood”, “stress”, “anxiety”, “drug abuse”, “drug dependency”, “substance use”, “substance abuse”, “drug addiction”, “substance addiction”, “disorder”, or “therapy”.  Rather, the search terms “psychedelic” and “hallucinogen” alone yielded the most relevant and useful results.

However, even with these search terms, results were scarce and most did not address substance abuse, mood, anxiety, or stress.  Therefore, research on the relationships that link substance abuse and dependence to mood, anxiety, and stress symptoms and disorders was reviewed, which helps to deduce the importance of further research into psychedelic-aided psychotherapy for patients with comorbid substance use and mood, anxiety, or stress disorders.

Limitations to research include the scarcity of psychedelic-aided psychotherapy research as a result of social stigma and government regulation and the unwillingness of study subjects to participate in studies or report psychedelic use honestly as a result of the same factors.  Thus, finding adequate, current, relevant, and peer-reviewed scholarly-sourced material is challenging.  Consulting earlier and secondary-source research and analysis may be necessary to derive sound conclusions.

Theoretical Framework

The use of psychedelic-aided psychotherapy fits well into the transactional model of stress and coping, developed by Dr. Richard Lazarus and Dr. Susan Folkman.  Under this model, perceived endangerments of wellbeing beyond a person’s control create stress for that person, the degree of stress determined by the perceived implications of the event for the person – the more there is at stake, the more intense the stress response.  Major life events are turning points whereby prior influential factors manifest into corresponding stress or coping response whereas daily hassles are an underappreciated element in overall stress and coping outcomes.

People with high depressive symptoms are more vulnerable to perceived threat and hostility and thus more vulnerable to stress.  Also, those with low self-esteem and undeveloped social support systems are more prone to stress-related illnesses (Seiffge-Krenke, 2013).  This can explain comorbidity between mood, stress, and anxiety disorders.  An event itself, whether natural or random, is not the sole contributor to stress.  Rather, internal factors that determine a person’s responses exert an even greater influence.  This underscores the importance of addressing underlying stress-response, anxiety-proneness, and mood-destabilizing influences within a patient’s mind dealing with comorbid substance use and mood, stress, or anxiety disorders.

Under the transactional model of stress and coping, the most relevant and practical ways of coping are either problem-focused, intended to alter the person-environment relationship, or emotion-focused, aimed at managing emotional distress.  On the other hand, implementing coping strategies of confronting and attacking causes of stress head-on or ignoring and avoiding problems each cause negative emotions and thus contribute to negative stress outcomes (Seiffge-Krenke, 2013).

With profound alterations to brain function in psychedelic-aided psychotherapy, a major life event is induced through the administration of hallucinogens, which can act as a turning point in the line of thinking for patients with mood-, stress-, and anxiety-related mental health issues.  With therapy directed at assessing and implementing problem-focused and emotion-focused coping mechanisms, the altered state of consciousness allows a patient to make this major life event a turning point in which they can literally adopt new stress-management and coping strategies overnight.

However, in such an intensely altered state of consciousness, a patient with such characteristics may be prone to intense stress-responses in the face of a perceived threat or to a perceptual head-on confrontation of stress-causing life factors.  This further reinforces the importance of assessing the impact of mood, stress, and anxiety on the efficacy of hallucinogen-aided therapy as well as its safety and impact upon existing disorderly symptoms.

Change Model

According to Lewin’s Three-Step Change Theory, the first step in changing behavior is to detach from existing situations or status quo.  Psychedelic-aided psychotherapy, in accordance with the model, offers an opportunity to break with practical totality from existing situations, relieve patients from restraining factors from recovery, and arranging each of these influences for the purpose o utcome.

The second step, in which a person must adopt a new equilibrium and thus a new status quo, unearths one of the most beneficial components of psychedelic-aided psychotherapy.  Under an intensely atypical state of consciousness, in which information transmission and processing functions are fundamentally altered, a patient is much more capable of adopting new insights as internal norms.  Thus, conclusive implementation of new coping and stress management strategies in both the short term and long term maximize the probability for a positive health outcome.

In the third stem, the new equilibrium is solidified, new patterns reinforced, and new strategies institutionalized within a person (Kritsonis, 2005).  This is the role of follow-up protocols typically associated with psychedelic-aided psychotherapy, in which symptoms are continually assessed and the impact of treatment continuously reviewed.  The execution of these three steps in implementing stress-management, coping, and relapse-prevention processes is the primary goal of psychedelic-aided psychotherapy. Exploring Research Results NR505 Assignment

Research Literature Support

Recent research indicates that stigmas which have produced barriers to research and treatment are unfounded, rather finding that psychedelic use and psychedelic-aided psychotherapy can safely mitigate symptoms associated with mood, anxiety, stress, and substance use disorders.

A 2013 peer-reviewed quantitative study extracted data from years 2001-2004 from the National Survey on Drug Use and Health to predict mental health outcomes associated with the use of psychedelic substances.  Substances of interest included lysergic acid diethylamide (LSD), psilocybin, mescaline, and peyote.  Of 130,152 total respondents, 21,967 respondents or 13.4% reported the use of one of these substances in their lifetimes.  Assessing potential negative mental health outcomes, respondents were screened for psychological distress based on the K6 scale; history of mental treatment whether inpatient, outpatient, pharmacological, or needed but not administered; symptoms of panic disorder, a major depressive episode, mania, social phobia, general anxiety disorder, agoraphobia, posttraumatic stress disorder, non-affective psychosis, and the seven non-affective symptoms of psychosis (“heard voices others could not”, “felt force taking over mind”, “felt force inserting thoughts”, “felt force stealing thoughts”, “felt force using special signals”, “believed plot to harm [respondent]”, and “saw a vision others could not”).  The authors used the World Health Organization’s Composite International Diagnostic Interview short-form (CIDI-SF) screening scale for diagnostic criteria and, while they noted potential false-positive diagnoses derived from this diagnostic method, they inferred that most false positives had some degree of a given disorder even if they did not meet the full criteria of diagnosis.  Using multivariate logistic regression to extrapolate relationships between variables, the authors determined that there were “no significant associations” between “lifetime use of any psychedelics, lifetime use of specific psychedelics,… or past year use of LSD and increased rate of any of the [screened] mental health outcomes.  Rather, in several cases psychedelic use was associated with lower rate of mental health problems” (Krebs & Johansen, 2013).  The central strength of this study is that a sample of 130,152 respondents yields robust statistical conclusions but, using cross-sectional analysis, epidemiological relationships are examined without focus upon causation.

The results of this study are supported by most other available research.  A study from the same authors with the same goal and the same methods found the same results two years later observing a new dataset, finding no statistically significant link between psychedelic use and mental health disorders or suicidal ideation, planning, or behavior (Johansen & Krebs, 2015).  An aforementioned study linked psychedelic use to reduced psychological distress and suicidality among American adults (Hendricks et al., 2015).  However, with nonaffective psychotic symptoms, research conclusions are mixed.  One study linked psychedelic use to first-onset of psychosis and exacerbation of psychotic symptoms for predisposed subjects (Vallersnes et al., 2016).

Another study released earlier this year sought to evaluate psilocybin for efficacy as a therapeutic aid to treating patients with treatment-resistant depression.  20 patients who had already undergone traditional depression treatment, which failed, were treated with psilocybin in two sessions – in the first session, they were given 10 milligrams, and in the second 25 milligrams.  Using the Altered States of Consciousness (ASC) questionnaire to evaluate the quality and intensity of psychedelic experience and the Self-Reported Quick Inventory of Depressive Symptoms to assess clinical outcome.  ANOA time-series analysis was used to assess the efficacy of psilocybin-aided treatment over time.  From the ASC questionnaires, the authors determined that occurrence and intensity of Oceanic Boundlessness and Dread of Ego Dissolution experiences were responsible for diminishing depressive symptoms over time (Roseman, Nutt, & Carhart-Harris, 2018).  Strengths of the study include that time-series analysis and compartmentalized focus on components of the psychedelic experience yielded causal conclusions, not simply addressing the efficacy of treatment but looking at what aspects of the psychedelic experience contributed to the outcomes.  However, with a small sample size and self-reported quality measures prone to either over- or underreporting, conclusions are not particularly robust and demand additional research.

Fortunately, prior research supports at least the efficacy of psychedelic-aided treatment of depression resistant to traditional treatment.  A study conducted two years earlier with a similarly small sample and similar quantitative design concluded that psilocybin-aided treatment increasingly diminished depressive symptoms over the three months following two oral psilocybin doses, administered a week apart, in the same quantities as the above study (Carhart-Harris et al., 2016).  The year later, a systematic review by unaffiliated researchers supported the efficacy of psilocybin-aided psychotherapy in alleviating symptoms of both mood and anxiety disorders (Mahapatra & Gupta, 2017).  Dr. Suravi Patra calls psilocybin a “true psychedelic, meaning ‘of benefit to mind’,” regarding it as a “positive influence on mental health” overall (2016).  The neurological processes through which serotonergic hallucinogens impact the fibrinolytic system present enormous potential for psychedelic-aided psychotherapy in treating an array of mental illnesses (Idell et al., 2017).

As for causation in the relationship between anxiety and substance dependence disorders, 788 subjects from the National Comorbidity Survey, a population representative of the non-institutionalized American public ages 15-54, one study used three logistic regression models to analyze causation through timing.  For most anxiety disorders, particularly panic disorder, substance dependence occurred prior to a given anxiety disorder with statistically significant frequency.  However, in more than half of substance abuse disorder cases, nearly 40% of post-traumatic stress disorder (PTSD) cases, and nearly 30% of generalized anxiety disorders (GAD cases, the onset of anxiety disorder precedes substance dependence.  The correlations in general are robust, lifetime history of either social phobia, PTSD, or GAD significant predictors of lifetime substance dependence (Goodwin & Stein, 2013).  The main strength of the study is that logistic regression models of temporal sequences yield robust results for not only epidemiological but causal relationships, but frequency of temporal arrangement do not unequivocally indicate causality and future research must review such conclusions.

Comorbidity between mood, stress, or anxiety disorders and substance use disorders is supported heavily by prior research (Lai et al., 2015).  Such disorders are mutually reciprocating (Patel et al., 2016).  However, observing temporal trends and determining cause-and-effect relationships for these disorders can improve mental health outcomes in patients given psychedelic-aided psychotherapy.  For disorders which precede substance abuse and dependence, focus can be placed upon combatting the disorder even prior to substance dependence.  For disorders that can be caused by substance abuse and dependence, combatting addiction can be the central focus as psychedelic-aided psychotherapy has been proven more effective than traditional addiction therapy by a factor of five (Bogenschutz & Johnson, 2016).  Adjusting treatment based upon the causation element of relationships between these comorbid disorders can optimize mental health outcomes for patients administered psychedelic-aided treatments.

In order for any treatment to benefit patients with maximal effectiveness and efficiency, clinicians must be able to identify symptoms and diagnose precisely.  In psychedelic-aided psychotherapy, this is even more important than usual especially if future research indicates a lapse in safety for certain patients.  This also has implications for the applicability of such research – efficacy cannot be accurately assessed without precise clinical identification of symptoms.  One study used convenience sampling to recruit clinics from two Australian states, assessing symptoms of depression through the Patient Health Questionnaire (PHQ-9) among 215 patients.  To determine the accuracy of clinician-identified elevated depressive symptoms among substance abuse patients along with the precision of symptom identification, logistic regression models with robustness adjustments using clusters to estimate variance for each independent variable were applied to data from the questionnaires.  A strength of the study was the use of PHQ-9, proven as a reliable and valid identifier of depression symptoms among substance abuse populations.  By using subjective variables to measure clinician sensitivity and clinician judgment specificity, the study addressed which qualities made clinicians more apt to identify elevated symptoms but bias in measurements renders the study’s conclusions worthy of skepticism.  Nonetheless, the study concluded that clinician sensitivity and years of experience in addition to clients’ primary substance and length of treatment positively correlated with identification of elevated depressive symptoms as well as symptom identification precision (Hobden, Carey, Bryant, Sanson-Fisher, & Oldmeadow, 2017).

Research Approach and Design

For patients with known comorbid substance use and mood, stress, or anxiety disorders, the safety and efficacy of psychedelic-aided psychotherapy has not been studied directly.  A study with a quantitative approach would be best to determine whether the treatment correlates as strongly to positive mental health outcomes for patients with the comorbid disorders as it does for treatment of individual disorders.  With the same barriers to conducting an experimental or quasi-experimental study as is common in psychedelic research, a descriptive design can most effectively establish a hypothesis, which can be tested through further experimental research.  This would take the form of a systematic review, combining results of prior studies and assessing relationships through quantitative analysis.  Subjects’ private information will be inherently protected as the study will only include characteristics of mental disorders, treatments, and use of psychedelics.  An advantage of this approach is that, in relying upon prior research, the barriers to experimental psychedelic research are nonexistent.  However, a disadvantage is that causation likely will not be conclusively established; rather, the study will produce a hypothesis for further testing. Exploring Research Results NR505 Assignment

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Sampling

The target population involves subjects with symptoms of mood, stress, anxiety, or substance abuse disorders with psychedelic use data available.  Studies reviewed must assess the impact of using psychedelics or participating in psychedelic-aided treatment on such symptoms.  This will likely involve nonprobability sampling as the studies available may not all utilize probability sampling.  However, probability-sampled and nonprobability-sampled populations can be separated to assess the impact of sampling on the inclusions.  With some studies already containing upwards of 100,000 subjects, the total sample will likely reach the millions.  In addition, surveys will be added with applicable information that has not yet been used in published research.  Two advantages to this sampling approach are an extremely large sample size and a diminished impact of bias with data coming from many sources.  An obvious disadvantage is that conclusions will inevitably be biased in favor of confirming the conclusions of prior studies as new study participants will not be recruited.

Data Collection Methodology

Data will be collected from a series of existing scientific reviews and primary source articles with information relevant to the PICOT question.  These will all come from government or academic databases as well as scientific journals using the Chamberlain library search engine as well as Google Scholar to ensure all research referenced has undergone adequate screening, each search engine’s filtering process attesting to each source’s academic validity.  Further research into the primary authors in each study as well as into the publishing organization will add an extra layer of scrutiny, confirming that all sources referenced are valid and relevant.  These conclusions will be included in the study, an explanation given for each source that was included and each source that was not included.  Each source must be available through one of such sources, published by a government organization, published by an organization that has published peer-reviewed scholarly material on the same topic at some point.  Conclusions derived from peer-reviewed articles will be assessed both apart from and in cohesion with articles that fulfill other inclusion criteria but have not been peer-reviewed or are in the process of being reviewed.  The same holds true for recently published articles.  Since the contemporary understanding of psychedelic-aided psychotherapy relies on a foundation of research into therapeutic properties of psychedelic substances from prior to the scheduling of most psychedelic compounds used in psychedelic-aided psychotherapy, articles and databases published decades ago must be used.  With regulatory barriers to research continuing in the present, using only recent research fails to capture an adequate understanding.  However, results of such research will be compared and contrasted with the conclusions of recent research so any contradictions can be evaluated.

Search terms will vary based on multiple approaches to answering the PICOT question.  In order to determine the implications of the research, there must be a complete and concrete understanding of the interactions between mood, anxiety, or stress disorders and substance use disorders; the efficacy of traditional rehabilitation for patients with comorbid disorders; the efficacy of traditional rehabilitation for patients with only substance use disorders; the efficacy of traditional mood, stress, and anxiety disorder treatments; and the efficacy of psychedelic-aided psychotherapy in handling each of the disorders either separately or in combination.

There has not been an article published that addresses this question directly.  Rather, potential conclusions must be inferred through an assessment of research that addresses one or more parts of the question.  In addition, the impact of using psychedelic substances in general must be established.  Thus, search term combinations will include “psychedelics” and “depression”, “psychedelics” and “mood”, “psychedelics” and “anxiety”, “psychedelics” and “stress”, “hallucinogens” and “depression”, “hallucinogens” and “mood”, “hallucinogens” and “anxiety”, and “hallucinogens” and “stress”.  This will uncover the impact of psychedelics on mood, anxiety levels, stress levels, and symptoms of depression.  Search term combinations “psychedelics” and “addiction”, “psychedelics” and “dependency”, “psychedelics” and “substance abuse”, “psychedelics” and “drug dependency”, “hallucinogens” and “addiction”, “hallucinogens” and “dependency”, “hallucinogens” and “substance abuse”, “hallucinogens” and “drug dependency” will be used to determine the impact of psychedelics on drug abuse and dependency.  Terms “psychedelics” and “hallucinogens” will be replaced with “psychedelic-aided psychotherapy”, “psychedelic treatment”, “hallucinogen therapy”, and “hallucinogen treatment” to gather sources that have looked directly at the efficacy of psychedelic-aided psychotherapy in dealing with each of the applicable disorders.  Replacing the same terms with “treatment” and “efficacy” will be used to gather data sources for traditional mood, stress, anxiety, and substance use disorder treatments.  Comparing conclusions drawn from each of these categories will determine whether the efficacy of psychedelic use and psychedelic-aided psychotherapy is superior, similar, or inferior to the efficacy of traditional treatment. Exploring Research Results NR505 Assignment

Data points collected will be at least to some degree dependent upon the data available in each source.  Expected data points include lifetime psychedelic use, past year psychedelic use, lifetime substance abuse, past year substance abuse, lifetime substance dependency, past year substance dependency, and symptoms of mood, stress, and anxiety disorders.  Most available research uses self-reports and questionnaires to describe symptoms and characteristics of treatment.  The quality of data will be ensured by the source filtering process, which will scrutinize the authors, publishing organizations, and individual sources.  Examining the relationships between these variables will build a foundation upon which future research can be directed in determining the efficacy of psychedelic-aided psychotherapy and the ideal path to implementation moving forward.  A dataset of this size will yield extremely robust scientific conclusions.

Data Analysis

The study is an epidemiological review and, as such, will be built upon correlation.  First, the conclusions of each study will be compared across certain categories that address separate questions.  Relationships between the following variables will be examined: lifetime psychedelic use and lifetime substance abuse; past year psychedelic use and past year substance abuse; lifetime psychedelic use and lifetime substance dependency; past year psychedelic use and past year substance dependency; lifetime psychedelic use and symptoms of anxiety disorders; past year psychedelic use and symptoms of anxiety disorders; lifetime psychedelic use and symptoms of stress disorders; past year psychedelic use and symptoms of stress disorders; lifetime psychedelic use and symptoms of mood disorders; past year psychedelic use and symptoms of mood disorders; traditional treatments and symptoms of mood disorders; traditional treatments and symptoms of anxiety disorders; traditional treatments and symptoms of stress disorders; traditional treatments and substance abuse; traditional treatments and substance dependency; psychedelic-aided psychotherapy and symptoms of mood disorders; psychedelic-aided psychotherapy and symptoms of anxiety disorders; psychedelic-aided psychotherapy and symptoms of stress disorders; psychedelic-aided psychotherapy and substance abuse; and between psychedelic-aided psychotherapy and substance dependency.  Each source will be categorized as indicative of a positive, inconclusive, or negative correlation.  The strength of the correlations will be assessed from source to source as well.  These sources will be placed in a table with descriptions of their results and the total number of sources that indicate either positive or negative correlations will be referenced.  Through this initial analysis, a literary consensus will be established.

Next, subjects from additional databases will be placed alongside subjects included in the articles referenced.  Each subject will be assigned to a database organized by the availability of data.  For example, where all relevant data is included, one database will be formed.  Each subject from which data points are missing will be placed in a separate database with other subjects from which all other data points are present.  From each of these databases, a binary logistic regression will be used to demonstrate the impact of each independent variable on a given dependent variable.  Independent variables will include lifetime psychedelic use, past year psychedelic use, administration of psychedelic-aided psychotherapy, administration of traditional drug rehabilitation treatment, and administration of traditional treatment for mood, stress, or anxiety disorders.  Dependent variables will include past year substance abuse, past year substane dependency, lifetime substance abuse, lifetime substance dependency, symptoms of mood disorders, symptoms of anxiety disorders, and symptoms of stress disorders.

Logistic regressions are commonly used in clinical research as a way of interpreting how a given treatment or other variable impacts the probability of a given outcome (Pope & Stanistreet, 2017).  A binary logistic regression expresses one binary dependent variable as a logarithmic function of independent variables.  The resulting formula takes the form of a natural logarithm: the natural log of each independent variable multiplied by some coefficient then added together.  These coefficients are calculated through the regression.  The result of the function gives an implied probability of an outcome, the dependent variable, in decimal form.  The R2 value and p-value are also calculated.  The R2 value establishes the amount of variance in the dependent variable explained by the logarithmic function of the independent variables.  With a p-value of 0.05 or lower, the relationship between variables is considered extremely significant, decreasing in significance as the p-value rises (Menard, 2018).  This will help determine which independent variables contribute to each potential outcome and whether relationships between these variables and the outcomes can be considered statistically significant.

Conclusion

There has not yet been a study that combines the impact of psychedelics or psychedelic-aided psychotherapy on mood, stress, anxiety, and substance abuse disorder symptoms relative to traditional treatment.  With a quantitative approach to determining each of these impacts, an epidemiological foundation can be established as to the efficacy of psychedelic-aided psychotherapy in treating patients with comorbid substance use and mood, stress, or anxiety disorders.  Exploring Research Results NR505 Assignment

 

 

 

 

Exploring Research Results NR505 Assignment References

¹ Krebs, T. S., & Johansen, P. (2013). Psychedelics and mental health: a population study. Plos One8(8), e63972. doi:10.1371/journal.pone.0063972

²Roseman, L., Nutt, D.J., & Carhart-Harris, R. L. (2018). Quality of acute psychedelic experience predicts therapeutic efficacy of psilocybin for treatment-resistant depression. Frontiers In Pharmacology, Vol 8 (2018), doi:10.3389/fphar.2017.00974/full

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