PsiloIMAGINE: A Psychedelic-augmented Mental Imagery-based Intervention for Young People With Self-harm

Official title

Investigating the Effects of a Psychedelic-augmented Mental Imagery-based Intervention for Young People With Self-harm Behaviour: an Experimental Medicine Study

Overview

Approximately 20% of young people experience self-harm behaviour in their lives. Self-harm can occur across different mental health disorders, and lead to negative outcomes and risk of suicide. Current treatments are long, costly and do not suit all young people, making it essential to research alternative treatments. Therapy combined with psychedelic drugs has recently been shown to be helpful in a variety of mental health disorders, including depression. This research project will explore the mechanisms by which combining a low dose of psychedelic psilocybin with a cognitive technique may target self-harm behaviour in young people (aged 16-25). Previous research has shown that mental images of self-harm are common among individuals who self-harm and can increase the urge to self-harm. Imagery Re-Scripting (ImRS) is a cognitive technique that guides an individual to replace mental imagery driving self-harm with an alternative image that will instead discourage self-harm and promote alternative coping strategies. However, during ImRS individuals may fear bringing negative mental images and emotions to mind, hindering the process. Psychedelic substances can increase the ability to tolerate difficult emotions, make thinking styles more flexible and individuals more open to change. Based on this, the aim is to test if enhancing a cognitive technique with a low dose psychedelic can modify the cognitive mechanisms maintaining self- harm behaviour. The aim is to examine the effect of a sub-hallucinogenic dose of psilocybin in combination with ImRS on cognitive processes, such as experiencing vivid mental images, and whether it can reduce these mental images and associated negative emotions in young people with recent self-harm behaviour above the effects of ImRS alone. The hypothesis is that psilocybin could facilitate confronting the emotions that arise during ImRS and make it easier to generate new helpful mental imagery. These experimental data could lay the foundation for future treatment development targeting self-harm in young people.

Interventions

• Drug Psilocybin 5 mg with cognitive behavioural therapy intervention
  This is an oral 5mg psilocybin dose preceding a mental imagery rescripting procedure
• Drug Placebo with cognitive behavioural therapy intervention
  This is an oral placebo comparator preceding a mental imagery rescripting procedure

Primary outcome measures

• Frequency of mental imagery [Time frame: Up to 3 months]
• Vividness of mental imagery [Time frame: Up to 3 months]
• Intensity of emotions related to mental imagery [Time frame: Up to 3 months]
• Believability of cognitions related to mental imagery [Time frame: Up to 3 months]
• Schemas [Time frame: Up to 3 months]

Secondary outcome measures (10)

• Approach Avoidance task [Time frame: Up to 5 months]
• Probabilistic Reversal Learning Task [Time frame: Up to 5 months]
• Self-harm Dot Probe Task [Time frame: Up to 5 months]
• Difficulty in Emotional Regulation [Time frame: Up to 5 months]
• Self-compassion [Time frame: Up to 5 months]
• Motivation for Reducing Self-harm [Time frame: Up to 5 months]
• Mystical Experience [Time frame: Up to 5 months]
• Challenging Psychedelic Experience [Time frame: Up to 5 months]
• Emotional Breakthrough [Time frame: Up to 5 months]
• Attrition [Time frame: Up to 5 months]

Eligibility criteria

Inclusion criteria

• At least 2 lifetime episodes of self-harm measured using the Self-Injurious Thoughts and Behaviours Interview (Nock et al., 2007) and at least 1 self-harm episode in the past month
• Self-harm-associated mental imagery in the past 6-weeks measured using the Self-harm Imagery Interview (Hales et al., 2011)
• Any gender
• Age: 16-25 years old
• Good command of the English language
• Mental capacity to provide written informed consent
• Participant is willing to engage in tasks showing images of self-harm
• Participant is willing to talk about mental health and self-harm behaviour
• Normal ECG and blood pressure (determined by study medic)
• Psychedelic naïve
• No recreational drug use 7 days prior to the dosing visit
• Comfortable using a computer and smartphone app for data collection, access to the internet from home and willing to have some of the study visits via video-link

Exclusion criteria

• Current or past history of psychosis or mania in themselves or a first-degree relative
• Current severe suicidal ideation that constitutes a risk for their participation
• Have a medically significant condition which renders them unsuitable for the psychedelic component of the study (e.g., hypertension, diabetes, severe cardiovascular disease, hepatic or renal failure etc.)
• Previous psychedelic use
• Current or chronic history of kidney or liver disease
• Have previously experienced a serious adverse response after psychedelic use
• Intoxication on any of the visits, as assessed by difficulty in walking, the slurring of speech, difficulty concentrating or drowsiness
• Clinically significant head injury (e.g., requiring medical or surgical intervention) that in the opinion of the investigators, contraindicates their participation
• Severe learning disability (including dyslexia/dyspraxia) that needs support to perform daily work/school tasks
• Unwillingness or inability to follow the procedures outlined in the protocol
• Are currently using a psychoactive medication
• History of psychosurgery
• In the opinion of the study team, they are unlikely to comply with the study protocol and lifestyle restrictions that it imposes
• Unstable physical illness
• Heavy smoker
• Those needing regular specified medication that might interact adversely with psilocybin e.g., selective serotonin reuptake inhibitor, 5HT1 agonists, mirtazapine, trazodone, analgesics that have serotonergic effects (tramadol), MAOI's, antipsychotics with significant 5-HT2A receptor antagonist actions (risperidone, olanzapine, and quetiapine)
• Those unwilling to allow their GP or involved mental health practitioners to be informed of their participation
• Women of childbearing age who are not using reliable contraceptive methods
• Women of childbearing age who are unable to comply with or produce a positive pregnancy urine test

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Triple blind

Primary purpose

Other

Study locations

United Kingdom · 1 center

• Imperial College London — London

Publications

• Passie T, Guss J, Krahenmann R. Lower-dose psycholytic therapy - A neglected approach. Front Psychiatry. 2022 Dec 2;13:1020505. doi: 10.3389/fpsyt.2022.1020505. eCollection 2022. PMID 36532196
• Doss MK, Povazan M, Rosenberg MD, Sepeda ND, Davis AK, Finan PH, Smith GS, Pekar JJ, Barker PB, Griffiths RR, Barrett FS. Psilocybin therapy increases cognitive and neural flexibility in patients with major depressive disorder. Transl Psychiatry. 2021 Nov 8;11(1):574. doi: 10.1038/s41398-021-01706-y. PMID 34750350
• Erritzoe D, Roseman L, Nour MM, MacLean K, Kaelen M, Nutt DJ, Carhart-Harris RL. Effects of psilocybin therapy on personality structure. Acta Psychiatr Scand. 2018 Nov;138(5):368-378. doi: 10.1111/acps.12904. Epub 2018 Jun 19. PMID 29923178
• Roseman L, Demetriou L, Wall MB, Nutt DJ, Carhart-Harris RL. Increased amygdala responses to emotional faces after psilocybin for treatment-resistant depression. Neuropharmacology. 2018 Nov;142:263-269. doi: 10.1016/j.neuropharm.2017.12.041. Epub 2017 Dec 27. PMID 29288686
• Goodwin GM, Aaronson ST, Alvarez O, Arden PC, Baker A, Bennett JC, Bird C, Blom RE, Brennan C, Brusch D, Burke L, Campbell-Coker K, Carhart-Harris R, Cattell J, Daniel A, DeBattista C, Dunlop BW, Eisen K, Feifel D, Forbes M, Haumann HM, Hellerstein DJ, Hoppe AI, Husain MI, Jelen LA, Kamphuis J, Kawasaki J, Kelly JR, Key RE, Kishon R, Knatz Peck S, Knight G, Koolen MHB, Lean M, Licht RW, Maples-Kel PMID 36322843
• Holmes EA, Arntz A, Smucker MR. Imagery rescripting in cognitive behaviour therapy: images, treatment techniques and outcomes. J Behav Ther Exp Psychiatry. 2007 Dec;38(4):297-305. doi: 10.1016/j.jbtep.2007.10.007. Epub 2007 Oct 26. PMID 18035331
• Hasking PA, Di Simplicio M, McEvoy PM, Rees CS. Emotional cascade theory and non-suicidal self-injury: the importance of imagery and positive affect. Cogn Emot. 2018 Aug;32(5):941-952. doi: 10.1080/02699931.2017.1368456. Epub 2017 Aug 25. PMID 28838289
• Di Simplicio M, Appiah-Kusi E, Wilkinson P, Watson P, Meiser-Stedman C, Kavanagh DJ, Holmes EA. Imaginator: A Proof-of-Concept Feasibility Trial of a Brief Imagery-Based Psychological Intervention for Young People Who Self-Harm. Suicide Life Threat Behav. 2020 Jun;50(3):724-740. doi: 10.1111/sltb.12620. Epub 2020 Feb 14. PMID 32057131

Identifiers

NCT: NCT06798636 · 172441 · IRAS ID: 330839

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗