Investigating the potential of psychedelic-enhanced cognitive interventions for young people with self-harm behaviour: mechanisms, acceptability....

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Approximately 20% of young people experience self-harm behaviour in their lives. Self-harm can occur across different mental health disorders and lead to negative outcomes and risk of suicide. Current available therapies are often long and costly and do not suit every individual, making it essential to research alternative treatments. Therapy combined with psychedelic drugs has recently been shown to be helpful in a variety of mental health disorders, including depression and post-traumatic stress disorder. This research project will explore a novel psychological intervention combined with a low dose of the psychedelic psilocybin to target self-harm behaviour in young people (aged 16-25).The project will use quantitative and qualitative methods in collaboration with the charity organisation Drug Science with the aim to:1) test the psychological processes by which combining psychedelics and therapy techniques may reduce self-harm behaviour (Study 1);2) explore the acceptability and societal barriers for the implementation of a psychedelic-enhanced psychological intervention (Study 2).Our previous research has shown that mental images of self-harm are common among individuals who self-harm and can increase the urge for this behaviour. Study 1 will examine if the combination of a sub-hallucinogenic dose ofpsilocybin with a cognitive-behavioural therapy technique called Imagery Re-Scripting can change some of the thinking styles that underly self-harm behaviour, such as experiencing vivid mental images.Imagery Re-Scripting guides an individual to replace mental imagery that drives self-harm with an alternative image that will instead discourage self-harm and promote alternative coping strategies. During Imagery Re-Scripting it is common for individuals to fear bringing negative mental images and emotions to mind. This is where psilocybin could play a game-changing role. Psychedelic substances can increase the ability to tolerate difficult emotions, make thinking styles more flexible and individuals more open to change. We hypothesise that psilocybin could facilitate confronting the emotions that arise during Imagery Re-Scripting, and make it easier to generate new helpful mental imagery.Study 1 will measure if Imagery Re-Scripting pluspsilocybin can reduce the mental images that drive self-harm and associated negative emotions in young people with recent self-harm behaviour, and if the effects are more pronounced and durable compared to Imagery Re-Scripting alone.Self-harm is a highly stigmatised behaviour, and this impacts on young people seeking and accessing support and clinicians delivering care. Recreational use of psychedelics is common among young people, but their attitudes toward potential therapeutic use are yet unknown.Study 2 will investigate what are the expectations, beliefs, fears and needs of a diverse group of young people with lived experience of self-harm and of clinicians around the use of psychedelics combined with a psychological therapy. Building on the expertise of Drug Science in exploring societal attitudes and disseminating evidence around drugs, we will conduct focus groups with young people and interview clinicians to understand what barriers are present and what adjustments would be needed to implement this novel intervention.Together, these studies will combine experimental psychology findings with stakeholder knowledge and pave the way for developing a highly innovative therapeutic in an area of growing mental health need for young people. This project aims to investigate the potential for developing novel psychological interventions combined with psychedelic drugs to target self-harm behaviour in young people. Around 20% of young people report having self-harmed in their life (Gillies et al., 2018) with rates increasing(McManus et al., 2019).