A virtual 8-week mindfulness-based program (MORE) reduced daily pain intensity in people with lumbosacral radiculopathy (sciatica) compared with usual care, but did not improve disability, depression, or quality of life. Participants in the mindfulness group also reported greater increases in mindful reinterpretation of pain and trait mindfulness. The authors suggest that fear-avoidance behaviors may explain why pain relief did not translate into reduced disability in this long-duration chronic pain sample.
Group psilocybin therapy is feasible for low-income adults with depression in Oregon's regulated psilocybin program. In an open-label study, 20 participants began treatment and 19 completed two psilocybin administration sessions one week apart, with preparation and integration sessions online. No severe adverse events occurred; participants rated satisfaction 4.8 out of 5, reporting moderate to high benefit and no harm. Exploratory outcomes showed a significant decrease in Hamilton Depression scores with a strong effect size (Cohen's d = 1.89), and all eight domains of the PROMIS-29 significantly improved with effect sizes from 0.667 to 1.774. Further research with comparator groups is warranted.
A 43-year-old man seeking treatment for alcoholism and depression was diagnosed with antisocial personality disorder. Over three years, a series of low-dose ketamine therapy sessions combined with integrative approaches led to resolution of severe alcoholism, a reduction in violent thoughts, and decreased depression symptoms. The case suggests that, with additional precautions, ketamine-assisted psychotherapy can produce clinical improvements in depression, alcohol abuse, and antisocial personality traits.
A qualitative analysis of session recordings from a clinical trial of Mindfulness-Oriented Recovery Enhancement (MORE) for patients with lumbosacral radicular pain identified four stages of how participants learn to relate to chronic pain: Pain Vigilance and Attention Dysregulation, Attention Regulation and its application to Experiential Avoidance, Metacognitive Awareness, and Pain Reappraisal. Some participants initially used attention skills to avoid pain rather than engage with it. The progression, termed the Vigilance-Avoidance Metacognition-Reappraisal (VA-MR) framework, suggests that therapeutic benefit requires a skilled therapist to guide patients through these stages, particularly navigating initial avoidance tendencies.