Exploring the neurobiological correlates of psilocybin-assisted psychotherapy in eating disorders: a review of potential methodologies and implications for the psychedelic study design

Elena Koning; Cristiano Chaves; Ryan H Kirkpatrick; Elisa Brietzke

doi:10.1186/s40337-024-01185-8

Exploring the neurobiological correlates of psilocybin-assisted psychotherapy in eating disorders: a review of potential methodologies and implications for the psychedelic study design

J Eat Disord. 2024 Dec 27;12(1):214. doi: 10.1186/s40337-024-01185-8.

Authors

Elena Koning^{1

2

3}, Cristiano Chaves⁴, Ryan H Kirkpatrick^{5

6}, Elisa Brietzke^{5

4}

Affiliations

¹ Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada. [email protected].
² Department of Psychiatry, Queen's University, Kingston, ON, Canada. [email protected].
³ , 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. [email protected].
⁴ Department of Psychiatry, Queen's University, Kingston, ON, Canada.
⁵ Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
⁶ School of Medicine, Queen's University, Kingston, ON, Canada.

Abstract

Eating disorders (EDs) are a group of debilitating mental illnesses characterized by maladaptive eating behaviors and severe cognitive-emotional dysfunction, directly affecting 1-3% of the population. Standard treatments are not effective in approximately one third of ED cases, representing the need for scientific advancement. There is emerging evidence for the safety and efficacy of psilocybin-assisted psychotherapy (PAP) to improve treatment outcomes in individuals with EDs. However, the limited knowledge of the neurobiological mechanisms underlying the therapeutic effects of PAP restricts the ability to confirm its clinical utility. This narrative review presents an overview of methodologies used to elucidate the pathophysiological mechanisms of EDs or the effects of psilocybin that could be employed to probe the neurobiological correlates of PAP in EDs, including magnetic resonance imaging and molecular neuroimaging techniques, electrophysiological approaches, and neuroplasticity markers. Finally, the implications of these methodologies are described in relation to the unique features of the psychedelic study design, challenges, limitations, and future directions to advance the field. This paper represents a valuable resource for scientists during study conceptualization and design phases and stimulates advancement in the identification of effective therapeutic interventions for EDs.

Keywords: Eating disorders; Electrophysiology; Neurobiology; Neuroimaging; Neuroplasticity; Precision psychiatry; Psilocybin; Psilocybin-assisted psychotherapy; Psychedelic research.

Plain language summary

Eating disorders (EDs) are serious mental health conditions that impact eating behaviors, thoughts, and emotions, directly affecting up to 3% of people worldwide. Current treatments are not effective in about one third of cases, highlighting the need for new approaches. Psilocybin-assisted psychotherapy (PAP) is an emerging treatment option that shows promise for improving outcomes in people with EDs. However, there is a lack of understanding for the mechanisms in which PAP may support recovery, making it difficult to confirm its benefits. This review presents several research methods that could help uncover how PAP influences the brain in EDs, including neuroimaging approaches and neuroplasticity markers. The challenges of incorporating these methods into the psychedelic study design and future research directions are also discussed. Together, this review presents a valuable resource for scientists and stimulates advancements in the development of more effective treatments for EDs.

Publication types

Review