Pagni Broc A, Zeifman Richard J, Mennenga Sarah E, Carrithers Brennan M, Goldway Noam, Bhatt Snehal, O'Donnell Kelley C, Ross Stephen, Bogenschutz Michael P
Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York (Pagni, Zeifman, Mennenga, Carrithers, Goldway, O'Donnell, Ross, Bogenschutz); School of Life Sciences, Arizona State University, Tempe (Mennenga); Department of Psychology, New York University, New York (Goldway); Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque (Bhatt).
Am J Psychiatry. 2025 Jan 1;182(1):114-125. doi: 10.1176/appi.ajp.20230887.
Evidence suggests that psilocybin-assisted therapy (PAT) leads to durable shifts in personality structure. However, such changes have yet to be characterized in disorders of addiction. In this secondary analysis from a randomized controlled trial, the authors examined the effect of PAT on personality dimensions in patients with alcohol use disorder (AUD), hypothesizing that PAT would attenuate personality abnormalities in AUD and that reductions in trait impulsiveness would be associated with lower drinking.
Eighty-four adults with AUD were randomized to two medication sessions of either psilocybin (N=44) or active placebo (diphenhydramine; N=40), received 12 weekly psychotherapy sessions, and completed follow-up for an additional 24 weeks. Changes in personality traits (week 36 vs. baseline) were assessed with the revised NEO Personality Inventory; daily alcohol consumption was quantified using the timeline followback.
Relative to the placebo group, the psilocybin group showed significant reductions in neuroticism and increases in extraversion and openness. Secondary analyses showed that reductions in neuroticism were driven by decreases in the facets depression, impulsiveness, and vulnerability; increases in openness were driven by increases in the facets openness toward feelings and fantasy. Across all participants, decreases in impulsiveness were associated with lower posttreatment alcohol consumption, and an exploratory analysis revealed that these associations were strongest among psilocybin-treated participants who continued moderate- or high-risk drinking prior to the first medication session.
PAT elicited durable shifts in personality, suggesting normalization of abnormal personality trait expression in AUD. Further study is needed to clarify whether PAT exerts its beneficial effects by reducing impulsiveness or whether impulsive individuals inherently respond better to PAT.
有证据表明，裸盖菇素辅助治疗（PAT）可导致人格结构发生持久变化。然而，此类变化在成瘾性障碍中尚未得到描述。在这项来自随机对照试验的二次分析中，作者研究了PAT对酒精使用障碍（AUD）患者人格维度的影响，假设PAT会减轻AUD患者的人格异常，且特质冲动性的降低与饮酒量减少相关。
84名患有AUD的成年人被随机分为两组，分别接受两次裸盖菇素用药治疗（N = 44）或活性安慰剂（苯海拉明；N = 40），接受为期12周的每周一次心理治疗，并额外完成24周的随访。使用修订后的大五人格量表评估人格特质的变化（第36周与基线相比）；使用时间线追溯法对每日饮酒量进行量化。
相对于安慰剂组，裸盖菇素组的神经质显著降低，外向性和开放性增加。二次分析表明，神经质的降低是由抑郁、冲动性和脆弱性等方面的减少所驱动；开放性的增加是由情感开放性和幻想开放性等方面的增加所驱动。在所有参与者中，冲动性的降低与治疗后饮酒量的减少相关，一项探索性分析显示，这些关联在首次用药前持续进行中度或高风险饮酒的裸盖菇素治疗参与者中最为明显。
PAT引起了人格的持久变化，表明AUD患者异常人格特质表达趋于正常化。需要进一步研究以阐明PAT是通过降低冲动性发挥其有益作用，还是冲动个体本身对PAT反应更好。
