2022年10月21日

在廣泛定義的迷幻劑臨床開發方麵取得最大進展的組織傾向於優先考慮給藥前後的心理支持。美國精神病學協會的一份立場聲明指出，在初步研究中，致幻劑“通常與研究人員提出的結構化心理治療方案相結合，作為實現充分治療效益和確保參與者安全和福祉的組成部分。”Cybin公司首席執行官道格·德賴斯代爾認為，這種支持不應該與心理治療相混淆。“但是讓病人做好準備是很重要的，”Drysdale補充道。這樣的療程可以幫助患者設定期望，所以他們在迷幻治療過程中不會感到震驚或驚訝。這樣的會議還可以幫助患者為他們的治療過程設定明確的目標。德賴斯代爾說:“從我們得到的反饋和學術研究來看，準備工作似乎會帶來更好的結果。”迷幻藥研究多學科協會(MAPS)和指南針路徑(納斯達克:CMPS)各自創建了治療範式，分別指導MDMA和裸蓋菇素的使用。MAPS和Compass還為對迷幻療法感興趣的心理和行為健康專業人員提供培訓項目。Cybin已經創建了EMBARK框架，它可以用於各種適應症和不同的治療。 “EMBARK has been designed to be very flexible and adaptable,” Drysdale said. The company has a Phase 1/2a study underway for its deuterated psilocybin analog CYB003 for major depressive disorder and another for deuterated DMT-based CYB004 in anxiety disorders. The company has also co-sponsored a randomized, placebo-controlled trial of psychedelic therapy with psilocybin in frontline clinicians with COVID-related distress. That study will also use the EMBARK framework. EMBARK is an acronym encompassing six domains. Its six letters stand for “existential/spiritual,” “mindfulness,” “body aware,” “affective/cognitive,” “relational” and “keeping momentum.” “The idea is to have various approaches across the spectrum that can be deployed to help the patient through that sort of spiritual/mindful session that they are about to embark upon,” Drysdale said. Drysdale said that the mystical dimension of the experience is correlated with the therapeutic effects. The company uses the 30-question Mystical Experience Questionnaire (MEQ30) to track the degree to which a psychedelic induces a mystical experience. “There’s definitely some connection between the depth of the psychedelic experience and the outcome,” Drysdale said. “Some people tend to describe it as being ‘spiritual’ or ‘mystical’ in some way.” The mindfulness dimension of the framework involves being aware of the inner experience during the psychedelic experience. Clinical trial participants wear eye masks and headphones to accentuate introspection. “We tell patients when they start to experience things to move inwards and move towards them rather than trying to run away from them,” Drysdale said. The body-based focus of the framework can help heal the rift that often appears between the mind and body. For example, physical awareness and health directly relate to mental health. The affective/cognitive part of the framework is included to help patients understand they are likely to become emotional during the psychedelic experience. “They can become emotional in a very positive way or in quite a traumatic way sometimes,” Drysdale said. The framework “encourages patients to embrace and welcome those emotional states during the session,” he added. “Sometimes, the boundaries between self and other — self and the universe — can dissolve and disappear,” Drysdale said. The relational component involves building a relationship with the therapist or facilitator before the experience. Having a degree of trust in that person can help patients relax and go inward during the session. The final part of the framework, ‘keeping momentum,’ instructs patients to remember the psychedelic experience as a motivator after it has concluded. The idea is not to let the experiences disappear. “Patients often forget more than 50% of what they experienced within a couple of days,” Drysdale said. Keeping momentum also can involve continuing to dwell on the intention that accompanied the experience. “‘Keeping momentum’ can also mean a follow-up session,” Drysdale said. “Two sessions close together are often better than one.” The momentum can also involve integrating the psychedelic experience into either psychotherapy sessions or their lives.