Psychedelic Therapy’s Transdiagnostic Effects: A Research Domain Criteria (RDoC) Perspective
Summary & key facts
This paper reviews clinical and lab studies about psychedelic therapy, which means using a psychedelic drug together with psychological support. The authors say this approach looks promising for several different mental health problems that share rigid or harmful patterns of feeling, thinking, or acting — especially major depression, depression that hasn't got better with usual treatments, and addiction. They also discuss early evidence for anxiety, obsessive-compulsive disorder, post-traumatic stress, and eating disorders. The review maps findings onto a simple brain-and-behavior framework to try to explain how psychedelics might work, but it also says that which exact symptoms and brain pa
- Psychedelic therapy in research usually means a drug experience plus psychological preparation and follow-up support.
- Researchers find the strongest and most consistent evidence for helpful effects in major depression, depression that resists standard treatment, and some forms of addiction.
- There is emerging, but less certain, evidence that psychedelic therapy may help anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and eating disorders.
- The review looks at how effects might work from small scales (molecules and cells) up to whole brain networks and basic systems like mood, motivation, arousal, social processing, and thinking.
- The authors caution that the specific clinical symptoms and the exact brain circuits that psychedelics affect are not well defined yet.
- A main goal of this kind of research is to move toward more precise and personalized psychedelic treatments, but more studies are needed before that can happen.
Abstract
Accumulating clinical evidence shows that psychedelic therapy, by synergistically combining psychopharmacology and psychological support, offers a promising transdiagnostic treatment strategy for a range of disorders with restricted and/or maladaptive habitual patterns of emotion, cognition and behavior, notably, depression (MDD), treatment resistant depression (TRD) and addiction disorders, but perhaps also anxiety disorders, obsessive-compulsive disorder (OCD), Post-Traumatic Stress Disorder (PTSD) and eating disorders. Despite the emergent transdiagnostic evidence, the specific clinical dimensions that psychedelics are efficacious for, and associated underlying neurobiological pathways, remain to be well-characterized. To this end, this review focuses on pre-clinical and clinical evidence of the acute and sustained therapeutic potential of psychedelic therapy in the context of a transdiagnostic dimensional systems framework. Focusing on the Research Domain Criteria (RDoC) as a template, we will describe the multimodal mechanisms underlying the transdiagnostic therapeutic effects of psychedelic therapy, traversing molecular, cellular and network levels. These levels will be mapped to the RDoC constructs of negative and positive valence systems, arousal regulation, social processing, cognitive and sensorimotor systems. In summarizing this literature and framing it transdiagnostically, we hope we can assist the field in moving toward a mechanistic understanding of how psychedelics work for patients and eventually toward a precise-personalized psychedelic therapy paradigm.