Balazs Szigeti - The influence of expectancy and suggestibility in psychedelic medicine

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The influence of expectancy and suggestibility in psychedelic medicine

Previously it has been observed that patient expectations can influence therapeutic outcomes for a range of medical interventions. In most trials, researchers attempt to eliminate such expectancy effects by experimental ‘blinding’, i.e., by not telling patients whether they will receive placebo or an active medication. Psychedelic assisted therapy may be particularly vulnerable to expectancy biases, because the conspicuous subjective drug effects elicited by psychedelics make it easy for patients to distinguish placebo from the active treatment. Here, we discuss the association between baseline expectancy and therapeutic response in a double-blind, randomized head-to-head comparison trial of escitalopram and psilocybin in the treatment of major depressive disorder. We found that patients had significantly higher expectations for psilocybin relative to escitalopram. Increased expectations in the escitalopram arm were associated with improved therapeutic outcomes, but surprisingly the same association was not found in the psilocybin arm. When the trial outcomes were adjusted for the expectancy difference, the between-treatment difference was no longer significant on most scales, implying that the observed expectancy imbalance biased the results towards favoring psilocybin. Furthermore, we observed a strong association between trait suggestibility and psilocybin’s therapeutic efficacy. Overall, our results suggest that psychedelic therapy may be less vulnerable to expectancy biases than previously suspected, but a relationship between baseline trait suggestibility and response to psilocybin therapy implies that highly suggestible individuals may be primed for good outcomes after psilocybin therapy.

Balázs has a physics degree from Imperial College London and earned a PhD in computational neuroscience from the University of Edinburgh. After graduating, he spent a few years as a biomedical software engineer at the Icahn Institute of Genetics in New York. He became involved with psychedelics science in 2016, when he started collaborating with the Global Drug Survey. He invented 'self-blinding', a novel methodology that enables self-experimenters to implement their own placebo control without clinical supervision. Using this methodology, Balázs designed and lead the self-blinding microdose study, the largest placebo-controlled study on psychedelics microdosing to-date. Balázs is currently a postdoctoral researcher at Imperial College’s Center for Psychedelic Research where he investigates the intersection of placebo effect and psychedelic medicine