Psilocybin-assisted therapy and HIV-related shame

Abstract

As a proposed mediator between stigma-related stressors and negative mental health outcomes, HIV-related shame has been predictive of increased rates of substance use and difficulties adhering to antiretroviral treatment among people with HIV. These downstream manifestations have ultimately impeded progress toward national goals to End the HIV Epidemic, in part due to limited success of conventional psychotherapies in addressing HIV-related shame. In a pilot clinical trial (N = 12), receipt of psilocybin-assisted group therapy was associated with a large pre-post decrease in HIV-related shame as measured by the HIV and Abuse Related Shame Inventory, with a median (IQR) change of - 5.5 (- 6.5, - 3.5) points from baseline to 3-months follow-up (Z = - 2.6, p = 0.009, r = - 0.75). A paradoxical exacerbation of sexual abuse-related shame experienced by two participants following receipt of psilocybin raises critical questions regarding the use of psilocybin therapy among patients with trauma. These preliminary findings carry potential significance for the future of HIV care.

Keywords: HIV; LGBTQ; Psilocybin; Psychedelics; Psychotherapy; Shame; Stigma.

Figure 1

Participant scores on the HIV and Abuse Related Shame Inventory at multiple time points from baseline to three months following a 6-week psilocybin-assisted group therapy intervention (2017–2019). (a) HIV-related shame scores declined from baseline to all time points following receipt of psilocybin (p < 0.05; n = 12). (b) More variable trajectories were observed among sexual abuse-related shame scores over time (n = 6).