The Potential of Psychedelic-Assisted Therapy for OCD

Source: Marek Piwnicki/Pexels

Oregon, where I practice as a licensed psychologist, recently passed laws that permit the use of psilocybin (“magic mushrooms”) for what is called “psilocybin services.” Psilocybin services involve a client meeting with a licensed facilitator and undergoing a dosing session, in which they take psilocybin under the care of the facilitator until the facilitator decides the client is ready to end their dosing session. Following the session, they may schedule an optional "integration" session in which the client processes what happened during the dosing session and afterward.

Psilocybin services have some overlap with what is known more broadly as psychedelic-assisted therapy (PAT). PAT involves a client undergoing a psychedelic trip (e.g., psilocybin, MDMA, LSD) while being supervised by one or more—often two—facilitators. Typically, in PAT, someone attends one to three dosing sessions (using the psychedelic) with integration sessions in between.

Research to date supports the use of PAT in treating behavioral health conditions such as posttraumatic stress disorder (PTSD; Henner, Keshavan, & Hill, 2022) and major depressive disorder (Romeo, Karila, Martelli, & Benyamina, 2020). (In contrast to PAT, psilocybin services in Oregon are explicitly not considered health care or treatment.)

Although I’m not trained in psilocybin services or PAT, I occasionally field questions from my clients about the use and effectiveness of psychedelics as a possible treatment for what they're struggling with. As I specialize in anxiety, my practice includes many people with obsessive-compulsive disorder (OCD). Recently I came across a review published this year (2024) on the use of PAT in OCD, and I thought I’d share the results.

The Study

Currently, the evidence-based treatment for OCD with the most research support is exposure and response (or ritual) prevention (ERP for short). ERP involves clients systematically approaching and staying in contact with stimuli they typically avoid or find triggering. Although ERP can be very effective, it does not work for everyone, and some people drop out of treatment (Ong et al., 2016)

In their review of PAT for OCD, Graziosi and colleagues (2024) sought out and reviewed published studies on the use of psychedelics with what is called obsessive-compulsive and related disorders (OCRD). OCRD is broader than OCD in that it, in addition to OCD, includes people who pick at their hair (trichotillomania) and skin (excoriation disorder), as well as body dysmorphia.

Because there were so few published studies on PAT for OCD, the researchers cast a wide net in terms of the types of studies they included. They found only two controlled clinical trials for PAT: one study was with a sample of nine people with OCD, and another had a sample of 12 people with body dysmorphia. The authors also included uncontrolled case studies. I’ll note that many of the case studies they included are 30 or more years old, which is very old for research studies. Methods change and standards have become more rigorous over time. Lastly, in addition to studies with human participants, the researchers looked at studies on the use of psychedelics in animal models.

The various studies included different psychedelic substances. One theme the authors found was that LSD was not as well tolerated among people with OCRD. Participants who took LSD reported worsening anxiety and OCD symptoms. By contrast, psilocybin was well tolerated by participants.

Compared to other conditions with more support for PAT such as major depressive disorder for which a single dose can have a lasting impact, people with OCD tended to require repeated doses to maintain the effects. That is, the effects of a single dose of a psychedelic substance for people with OCD did not appear as long-lasting as for people with major depression or PTSD. Even if improvement in symptoms following treatment with psilocybin did not endure, participants seemed more open to evidence-based treatment for OCD following dosing sessions. Following PAT, they tended to demonstrate greater insight into their OCD symptoms and were more open to trying psychotherapy. For these reasons, the authors suggest that PAT may be combined with ERP for people with OCD because people may be more open to and willing to engage in ERP after PAT sessions.

Conclusions

To summarize, the bad news is that the effects of PAT with psilocybin appear to be shorter-lived when treating people with OCD compared to people with conditions such as depression or PTSD. The good news is that PAT may help people with OCD develop greater insight into and understanding of their symptoms. Consequently, they may be more willing to engage in effective psychotherapies for OCD such as ERP following PAT dosing sessions. For these reasons, a combined approach of PAT followed by ERP might be the most effective course of treatment.

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I’ll note here that the conclusions are based on only a few controlled trials. According to the authors, though, five ongoing clinical trials are studying the effects of psilocybin and OCD, so we should hopefully have more answers in the next few years.

I would like to thank psilocybin services facilitator Brian Pilecki, Ph.D., for reading a draft of this post.

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