<story><title>Psilocybin-assisted psychotherapy vs. placebo in treatment of alcohol disorder</title><url>https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2795625</url></story><parent_chain><item><author>UniverseHacker</author><text>&amp;gt; I think it&amp;#x27;s possible that the phenomenological experience _is_ the mechanism of action for these substances, that the actual experience of the trip is what makes the difference.&lt;p&gt;I was really confused about the entire concept of blinding a study like this until I read your comment... Now I realize they are indeed proceeding from the assumption that the phenomenological experience is somehow distinct from the mechanism of action.&lt;p&gt;That seems really unlikely to me- these drugs are unique because of the phenomenological experience! It seems self evident that this experience is the reason for therapeutic effects.&lt;p&gt;Imagine the absurdity of trying to design a study blinding the effects of meditation for example. Meditation has measurable benefits, but what are the chances those aren&amp;#x27;t caused by the psychological effects of experiencing meditation?</text></item><item><author>roughly</author><text>Something that&amp;#x27;s going to be interesting with psychedelics and psychedelic research is that a lot of this sort of research seems to try to &amp;quot;control for&amp;quot; the phenomenological experience in favor of focusing on the biochemical mechanism of action - I think it&amp;#x27;s possible that the phenomenological experience _is_ the mechanism of action for these substances, that the actual experience of the trip is what makes the difference.</text></item><item><author>phren0logy</author><text>The comparison condition was psilocybin or diphenhydramine (Benadryl), and both groups got addiction counseling.&lt;p&gt;&amp;gt;Participants correctly guessed their treatment assignment in 93.6% of the first sessions, reporting a mean (SD) certainty of 88.5% (23.2%). In the second session, 94.7% guessed correctly, and mean (SD) certainty was 90.6% (21.5%). Study therapists correctly guessed treatment 92.4% of the time for first sessions and 97.4% for second sessions, and their mean (SD) certainties were 92.8% (16.3%) and 95.4% (2.9%), respectively.&lt;p&gt;This is not a criticism, as these trials are very hard to blind, but as you can see in hindsight they could as well have not bothered with blinding at all. So we need to interpret this as a randomized but unblinded trial.&lt;p&gt;The researchers are well aware of this, and I suspect it will inform the next steps of their research.&lt;p&gt;&amp;gt;Several limitations of the study warrant discussion. First, diphenhydramine was ineffective in maintaining the blind after drug administration, so biased expectancies could have influenced results. Control medications such as methylphenidate,42 niacin,2 and low-dose psilocybin1 likewise did not adequately maintain blinding in past psilocybin trials, so this issue remains a challenge for clinical research on psychedelics.</text></item></parent_chain><comment><author>mrcartmeneses</author><text>It’s worth trying because it could be that there is a chemical mechanism rather than it being the trip. For example ketamine can ‘cure’ people of alcoholism and depression at doses that do not produce ‘profound’ experiences or at doses that do. Having said that I accidentally had a ‘therapy’ session while completely off my tits on LSD and it helped with things that I’d not previously been helped with on other trips.&lt;p&gt;The issues at hand are complex, it’s worth trying to control just to find out what the mechanisms are.&lt;p&gt;Also apologies for all of the air quotes in this ‘comment’</text></comment>
<story><title>Psilocybin-assisted psychotherapy vs. placebo in treatment of alcohol disorder</title><url>https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2795625</url></story><parent_chain><item><author>UniverseHacker</author><text>&amp;gt; I think it&amp;#x27;s possible that the phenomenological experience _is_ the mechanism of action for these substances, that the actual experience of the trip is what makes the difference.&lt;p&gt;I was really confused about the entire concept of blinding a study like this until I read your comment... Now I realize they are indeed proceeding from the assumption that the phenomenological experience is somehow distinct from the mechanism of action.&lt;p&gt;That seems really unlikely to me- these drugs are unique because of the phenomenological experience! It seems self evident that this experience is the reason for therapeutic effects.&lt;p&gt;Imagine the absurdity of trying to design a study blinding the effects of meditation for example. Meditation has measurable benefits, but what are the chances those aren&amp;#x27;t caused by the psychological effects of experiencing meditation?</text></item><item><author>roughly</author><text>Something that&amp;#x27;s going to be interesting with psychedelics and psychedelic research is that a lot of this sort of research seems to try to &amp;quot;control for&amp;quot; the phenomenological experience in favor of focusing on the biochemical mechanism of action - I think it&amp;#x27;s possible that the phenomenological experience _is_ the mechanism of action for these substances, that the actual experience of the trip is what makes the difference.</text></item><item><author>phren0logy</author><text>The comparison condition was psilocybin or diphenhydramine (Benadryl), and both groups got addiction counseling.&lt;p&gt;&amp;gt;Participants correctly guessed their treatment assignment in 93.6% of the first sessions, reporting a mean (SD) certainty of 88.5% (23.2%). In the second session, 94.7% guessed correctly, and mean (SD) certainty was 90.6% (21.5%). Study therapists correctly guessed treatment 92.4% of the time for first sessions and 97.4% for second sessions, and their mean (SD) certainties were 92.8% (16.3%) and 95.4% (2.9%), respectively.&lt;p&gt;This is not a criticism, as these trials are very hard to blind, but as you can see in hindsight they could as well have not bothered with blinding at all. So we need to interpret this as a randomized but unblinded trial.&lt;p&gt;The researchers are well aware of this, and I suspect it will inform the next steps of their research.&lt;p&gt;&amp;gt;Several limitations of the study warrant discussion. First, diphenhydramine was ineffective in maintaining the blind after drug administration, so biased expectancies could have influenced results. Control medications such as methylphenidate,42 niacin,2 and low-dose psilocybin1 likewise did not adequately maintain blinding in past psilocybin trials, so this issue remains a challenge for clinical research on psychedelics.</text></item></parent_chain><comment><author>BurningFrog</author><text>...or try to study the effects of a university education with a double blind study.&lt;p&gt;There are probably rules demanding blinding for these studies. Let&amp;#x27;s hope they don&amp;#x27;t hold back the research for too long.</text></comment>