![]() ![]() Therapeutic alliance ahead of the second session had a direct impact on final depression scores, not mediated by the acute experience, with a weaker alliance ahead of the second psilocybin session predicting higher absolute depression scores at endpoint ( β = −0.49, p < 0.001)ĭiscussion: Future research could consider therapist training and characteristics specific participant factors, e.g., attachment style or interpersonal trauma, which may underlie the quality of the therapeutic relationship, the psychedelic experience and clinical outcomes and consider how therapeutic approaches might adapt in cases of weaker therapeutic alliance.Ĭlinical Trial Registration: This trial is registered at, identifier (NCT03429075). Emotional breakthrough, but not mystical experience, during the first session had a positive effect on therapeutic alliance ahead of the second session ( β = 0.79, p < 0.0001). Exploratory path models revealed that final depression outcomes were more strongly affected by emotional breakthrough during the first, and mystical experience during the second session. Results: The strength of therapeutic alliance predicted pre-session rapport, greater emotional-breakthrough and mystical-type experience (maximum EBI and MEQ scores across the two psilocybin sessions) and final QIDS scores ( β = −0.22, R 2 = 0.42 for EBI Max β = −0.19, R 2 = 0.32 for MEQ Max). The same analysis was performed on the escitalopram arm to test specificity. Path analyses tested the hypothesis that therapeutic alliance (Scale To Assess the Therapeutic Relationship Patient Version, STAR-P) would predict depression outcomes via its influence on the acute psychedelic experience, specifically emotional-breakthrough (EBI) and mystical-type experiences (MEQ). The primary outcome was depression severity 6 weeks post treatment (Quick Inventory of Depressive Symptomatology, QIDS-SR-16). A new psychedelic therapy model, called “Accept-Connect-Embody” (ACE), was developed in this trial. This analysis focused on the psilocybin condition ( n = 30), who received two oral doses of 25 mg psilocybin, 3-weeks apart, with psychological preparation, in-session support, and integration therapy. Methods: This 2-arm double-blind randomized controlled trial compared escitalopram with psychedelic-assisted therapy for moderate-severe depressive disorder ( N = 59). We aimed to investigate the relationships between therapeutic alliance and rapport, the quality of the acute psychedelic experience and treatment outcomes. 6Psychedelics Division Neuroscape, Department of Neurology, University of California, San Francisco, San Francisco, CA, United Statesīackground: Across psychotherapeutic frameworks, the strength of the therapeutic alliance has been found to correlate with treatment outcomes however, its role has never been formally assessed in a trial of psychedelic-assisted therapy.5Department of Psychology, Royal Holloway University, Surrey, United Kingdom.4Medical Psychotherapy and General Adult Psychiatry, Devon Partnership NHS Trust, Exeter, United Kingdom. ![]()
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