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

大约20%的年轻人在生活中经历过自我伤害行为。自我伤害可能发生在不同的精神健康障碍中，并导致负面后果和自杀风险。目前可用的疗法往往时间长、费用高，并不适合每个人，因此研究替代疗法至关重要。结合迷幻药物的治疗最近被证明对各种精神健康障碍有帮助，包括抑郁症和创伤后应激障碍。这项研究项目将探索一种新的心理干预方法，结合低剂量的迷幻裸盖菇素来针对年轻人(16-25岁)的自我伤害行为。该项目将使用定量和定性的方法，与慈善组织药物科学合作，目的是：1)测试迷幻药物和治疗技术相结合可以减少自我伤害行为的心理过程(研究1)；2)探索实施迷幻增强的心理干预的可接受性和社会障碍(研究2)。我们之前的研究表明，自我伤害的心理形象在自我伤害的个人中很常见，可以增加这种行为的冲动。研究一将检验将亚致幻剂量的裸盖菇素与一种名为意象重写的认知行为疗法相结合，是否可以改变一些不利于自我伤害行为的思维方式，比如体验生动的心理意象。意象重写引导个体用另一种形象取代导致自我伤害的心理意象，而另一种形象反而会阻止自我伤害，并促进替代应对策略。在重新编写图像脚本的过程中，个体害怕将负面的心理图像和情绪带入脑海中是很常见的。这就是裸盖菇素可以扮演改变游戏规则的角色的地方。迷幻物质可以增加对困难情绪的耐受能力，使思维方式更灵活，个人更开放地接受变化。我们假设裸盖菇素可以促进面对重写图像时产生的情绪，并使其更容易产生新的有用的心理图像。研究1将测量重写图像是否可以减少导致年轻人自我伤害的心理图像以及与最近的自残行为相关的负面情绪，以及这种影响是否比单独重写图像更明显和持久。自我伤害是一种高度污名的行为，这会影响寻求和获得支持的年轻人以及提供护理的临床医生。娱乐性使用迷幻药在年轻人中很常见，但他们对潜在治疗用途的态度尚不清楚。研究2将调查有过自我伤害经历的不同年轻人和临床医生对使用迷幻药结合心理治疗的期望、信念、恐惧和需求。基于药物科学在探索社会态度和传播关于药物的证据方面的专业知识，我们将与年轻人和访谈临床医生进行焦点小组，以了解存在哪些障碍和需要进行哪些调整才能实施这一新的干预措施。这些研究将结合实验心理学研究结果和利益相关者的知识，为在年轻人日益增长的精神健康需求领域开发高度创新的治疗方法铺平道路。该项目旨在调查开发新的心理干预措施与迷幻药物相结合的潜力，以针对年轻人的自我伤害行为。大约20%的年轻人报告在他们的生活中有过自我伤害(Gillie等人，2018年)，随着比率的增加(McManus等人，2019年)。

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).