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Decision-Making around Psychedelics for Depression and Anxiety: a Model Based on Online Discussions

David T. Kryszajtys, Jacqueline L. Bender, Brian Rush, Carol Strike

International Journal of Mental Health and Addiction April 1, 2024 DOI: 10.1007/s11469-023-01148-1 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Qualitative study using constructivist grounded theory Peer reviewed
Sample size 98
Population Members of online communities discussing self-treatment with psychedelics for depression or anxiety
Topics Anxiety Depression
Keywords Psychedelics Online community Decision-making
Citations 2
Key findings People decide to self-treat depression and anxiety with psychedelics through a four-stage process starting with dissatisfaction with standard treatment, relying on personal and peer experiences rather than scientific evidence.

Abstract

Little is known about how people decide to use psychedelics to self-treat depression and anxiety, though the practice is growing. We explored online community discussions of members’ decisions around self-treatment with psychedelics for depression or anxiety. We used constructivist grounded theory to select and analyze 98 members’ posts across 95 discussion threads (99, 552 words) and identified a four-stage decision-making model. In stage one, decision-making began after dissatisfaction with standard mental health treatment. In stage two, members considered various psychedelic self-treatment options but explained that information was limited. In stage three, they engaged in trial and error when making decisions, despite uncertainties around safety. In stage four, they continued or discontinued self-treatment. Those who continued adapted their practice to their evolving treatment needs. Firsthand and peers’ experiences informed decisions. Available scientific evidence initially validated the psychedelic self-treatment but were not instructive. Many avoided healthcare and official information sources due to stigma and legal concerns. Research and knowledge translation efforts are needed to identify general concerns with self-treatment and provide user-informed decisional support to reduce harm and maximize benefit. Services supporting psychedelic self-treatment decisions can leverage our findings to create resources based on people’s lived experiences.

Comparable studies

Other qualitative studies on anxiety, most cited first.

Study Year Design Participants
LSD-assisted psychotherapy for anxiety associated with a life-threatening disease: A qualitative study of acute and sustained subjective effects Patients with anxiety associated with life-threatening diseases 2014 Prospective follow-up with qualitative content analysis n = 10
An exploratory mixed methods study of the acceptability and effectiveness of mindfulness -based cognitive therapy for patients with active depression and anxiety in primary care Primary care patients with recurrent depression or recurrent depression and anxiety 2006 Exploratory mixed methods study n = 13
Cancer at the Dinner Table: Experiences of Psilocybin-Assisted Psychotherapy for the Treatment of Cancer-Related Distress Adult participants with clinically elevated anxiety associated with a cancer diagnosis 2017 Qualitative study using interpretative phenomenological analysis n = 13
Extended difficulties following the use of psychedelic drugs: A mixed methods study Participants who reported extended difficulties following psychedelic experiences 2023 Convergent mixed-method study n = 608
Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an “on the job“ program Interdisciplinary palliative care team staff 2017 Observational mixed-method pilot evaluation n = 28

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