How psilocybin therapy can help with OCD

Studies suggest that psilocybin-assisted therapy may be effective in the treatment of OCD.

Photo by Anton on Unsplash

OCD (obsessive compulsive disorder) is a mental health disorder that affects between one to three percent of the global population. Individuals with OCD struggle with obsessions – intrusive thoughts that are often thoughts that are negative or anxiety producing like an insistence on symmetry and order, or the fear of contamination, along with compulsions – repetitive actions like excessive handwashing or housecleaning that are undertaken to ameliorate the anxiety associated with the obsession. Related to OCD are disorders such as trichotillomania (hair pulling), excoriation disorder (skin picking), body dysmorphia and hoarding.

At present the most effective approach for treating OCD is a combination of Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP), but several clinical trials have found psilocybin-assisted therapy to be promising option.

According to a study by Owe-Larsson and colleagues, factors involved in the development of OCD include genetics, Early Maladaptive Schemas (EMS), and Error-related negativity (ERN) – a brain wave pattern indicating increased tendencies for error detection.

OCD is hereditary in up to 45 percent of cases and studies on mice who overgroom identified SAPAP3 as a risk gene for OCD. In an animal study, Brownstien and colleagues found that a single treatment with psilocybin significantly reduced OCD-like excessive self-grooming in mice with SAPAP3 genes for up to six weeks.

According to psychologist Jeffrey Young’s schema theory, EMS are dysfunctional cognitive patterns (in the domains of (1) disconnection and rejection, (2) impaired autonomy and performance, (3) impaired limits, (4) other-directedness and (5) hypervigilance and inhibition) that individuals with OCD develop in childhood as a response to not getting their emotional needs met.

An ERN is a negative electrical response in the brain that appears after a response is made, and in particular when an error has been detected. Brain imaging studies have shown that people with OCD exhibit a larger ERN amplitude than normal. This suggests that in someone with OCD, the brain’s error-monitoring system is overactive, leading to hypervigilance to environmental threats and heightened sensitivity to mistakes, flaws or imperfections.

How Psilocybin Can Ameliorate OCD Symptoms

The Default Mode Network (DNM) is an interconnected group of brain regions involved in maintaining our EMSes. Overactivity in the DMN has been linked to conditions such as depression, anxiety, and OCD. As we grow and mature, we develop habitual ways of responding to situations, people, places, and things. Overtime, these habitual responses lead to the development of established pathways of communication between the different regions of the DMN, which result in schemas  – set ways of viewing a stimuli or situation. In the same way that well-trodden paths in a forest become the only trails that we use when we go for a hike – keeping us “safe” but also holding us back from exploring new, off-piste sections of the woods – these well-worn pathways of the DMN constrain our brains and become our “default mode” of perceiving ourselves, others, and the world. Psilocybin disrupts activity in these established pathways, which can weaken negative schemas and create new pathways that encourage development of new, more adaptive schemas. This can result in a person with OCD receiving insight into what’s triggering their obsessive thinking and compulsive behaviors, which may in turn help their brains to loosen its grip on maladaptive OCD schemas.

Tolerance to stress is mediated by the 5-HT2A receptor in the brain. As a 5-HT2A receptor agonist, psilocybin can enhance neuroplasticity in the prefrontal cortex and encourage functional and structural changes to decrease sensitivity to error-related stimuli. Carhart-Harris and colleagues found that psilocybin “augments autobiographical recollection”, “aids in the recall of salient memories” and is “associated with the reversal of negative cognitive biases”. This suggests that psilocybin therapy could be a key step in priming an individual with OCD for psychotherapy and long-term management of symptoms.

By Michele Koh Morollo, NUMEN NoSC Therapies