Psychedelic-assisted therapy studies in eating disorders may miss important outcome mechanisms if they under-measure lived experience.
Evidence
This commentary applies a perspective to PAT research in eating disorders and recommends qualitative and microphenomenological methods across embodiment, intersubjectivity, affectivity, temporality, spatiality, and selfhood.
Caveat
The paper offers conceptual and methodological recommendations, not new outcome data testing psychedelic-assisted therapy in eating disorders.
Simplified
Psychedelic-assisted therapy (PAT) is an emerging intervention in psychiatry, for which there is preliminary evidence for effectiveness in eating disorders (EDs). The subjective psychedelic experience is considered an important driver of positive outcomes following PAT; however, conventional study design approaches often overlook many of the nuances inherent to the experience. Consequently, considerable information is lost between the first-person account and its scientific interpretation and documentation. Phenomenology-a philosophical and empirical approach to studying lived experience-offers tools to assess and understand the experiential mechanisms of PAT. This commentary advances the case for a phenomenological approach to PAT research in EDs, focusing on key domains of experience that underlie both ED psychopathology and psychedelic experiences, including embodiment, intersubjectivity, affectivity, temporality, spatiality and selfhood. We define and outline these phenomenological domains of EDs and psychedelic experiences and critically examine current measurement approaches. Following, we provide specific research recommendations, including phenomenologically grounded qualitative research and (i.e., the assessment of short-lived, pre-conscious experiences), to more fully capture psychedelic experiences and determine their significance for ED outcomes. The application of phenomenology to the PAT study design may contribute to a better understanding of how individuals experience PAT and generate testable hypotheses to advance psychedelic interventions.
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Declarations. Human ethics and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: Author PH has received sessional fees from the Therapeutic Guidelines publication and the Health Education and Training Institute (HETI, NSW), and royalties/honoraria from Hogrefe and Huber, McGraw Hill Education, Blackwell Scientific Publications, BioMed Central, and PLOS Medicine. She has prepared a report under contract for Takeda (formerly Shire) Pharmaceuticals regarding binge eating disorder (July 2017) and was a consultant to Takeda Pharmaceuticals and is a consultant to Tryptamine Pharmaceuticals. PH and ST are Editor in Chief of the Journal of Eating Disorders. Author ST receives royalties from Hogrefe and Huber, BioMed Central, Taylor and Francis and McGraw Hill. He was a consultant to Takeda Pharmaceuticals and has provided a commissioned report to the Victorian Department of Health. JR is an Investigator on an Australian National Health and Medical Research Council funded grant “The urge-to-tic: Examining the neural and experiential bases of Tourette syndrome” (2038866).
