Psilocybin Group Therapy Can Help People Living with HIV

An estimated 39.9 million people across the globe are living with HIV, according to 2023 statistics from the World Health Organisation (WHO). And, while the stigma associated with it is slowly starting to recede, shame can still be a major stressor for those who are seropositive. It is vital to remember that the horror of the 80s and 90s AIDS Crisis is still seared across many people’s living memory. 

Shame Causes Negative Life Effects

The shame associated with HIV has been shown to lead to negative life circumstances such as increased substance use, higher likelihood of incarceration, unsafe sexual behavior, not receiving the appropriate healthcare, and insecure housing. This makes the experience of living with HIV far more difficult than necessary. This leads to larger goals to end the epidemic being compromised, according to the National Institute of Health. 

However, there is some hope. A newly published study in the journal Nature assesses how psilocybin-assisted group therapy could target shame (and thus, the associated negative outcomes) in those living with HIV. The study makes a point of the limited success traditional psychotherapies have demonstrated when attempting to treat shame in the seropositive community. But while this research is still in its early days, excitingly, the results look promising. 

How Did the Study Work?

The study, carried out by Nicky Mehtani and researchers from The University of California, San Francisco, and the University of Alabama at Birmingham, went as follows:

Twelve participants living with HIV were recruited for a pilot clinical trial. The researchers used the HIV and Abuse Related Shame Inventory (HARSI)  to measure shame. The HARSI scale was devised by mental health professionals to measure how shame affects an HIV patient’s mental health, and how they respond to proper care and treatment. 

Participant’s Shame Scores Dropped After Psilocybin Group Therapy

The results of the trial demonstrated that, on average, the participant’s shame scores dropped by 5.5 points over the course of a 6 week period. During this period they took psilocybin once a week. These results remained stable for 3 months after treatment. The participants who benefited the most were those who had a HARSI score of 20 (out of 50). This is a statistically significant decrease that makes a case for group therapy being a more effective approach for combating chronic shame. 

Psilocybin Group Therapy Can Help People Living with HIV

The authors wrote;

“Compared with individual therapy, group therapy itself may foster decreased shame among [people with HIV],” 

“While not statistically significant, our analyses revealed…that the group therapy alone likely contributed to decreased HIV-related shame among participants. [W]hile the contributory effects of group therapy and psilocybin in this study cannot be disentangled, overall findings suggest synergistic effects of these modalities on reducing HIV-related shame.”

Psilocybin Group Therapy Can Help People Living with HIV

The study authors put forward that psilocybin could reduce HIV-related shame because the magic mushroom extract induces “hyper-associative” thinking. This helps people to focus less on themselves, which in turn, reduces the shame they direct towards themselves. 

The authors explained;

“In the context of this study, chronic shame related to HIV could be considered a form of negative self-focused attention, and psilocybin may mitigate the physiological responses associated with this shame,” 

“Such a reduction in shame may encourage people with HIV and sexual and gender minorities to adopt a wider range of adaptive coping strategies to regulate negative affects… and allow for a potential break from activities that could perpetuate a ‘spiral’ of shame.”

A History of Trauma Should Be Taken Into Account

While the results were majoritively positive, two of the participants did report an increase in feelings of shame, specifically connected sexual trauma from their past, after they took psilocybin. Of the 12 participants, half of them (6) reported a history of sexual abuse. The researchers described the increased shame of the two participants as an “unexpected outcome”. Due to this however, the researchers emphasize that those with a history of trauma may not be suitable for this kind of therapy. 

“These findings underscore the importance of addressing ethical considerations, safety, and potential adverse effects of psychedelics among diverse populations as this field of research evolves,” the authors write. “For example, specific counseling regarding psilocybin-related risks may be warranted for people with significant histories of trauma, as some symptoms might be expected to temporarily worsen before improving.”

Study Limitations

While the study is definitely promising, and a long-time coming in an under researched area, there are some limitations. Firstly, the sample size is extremely small. Secondly, there was no control group with which to compare results. Another limitation was the lack of diversity within the group, with the researchers selecting a group of “gay-identified, cis-gender, older-adult male participants”, with the hope that this familiarity would encourage feelings of unity, safety, and trust in the group therapy environment. Additionally, 75% of the study participants were white. This is a significant shortcoming, as it is well-known that Indigenous, Black and people of color tend to be disproportionately affected by the HIV epidemic. Finally, the study used self-reported data, an unavoidable element, but one that can be affected by “social desirability bias” and “recall bias”. 

The study authors outlined how future studies must diversify, writing; 

“In future clinical trials of psychedelic therapies, it will be critical to incorporate measures of shame and recruit larger, more diverse populations, including people with HIV across various age groups, lengths of time since HIV diagnosis, sexual and gender identities, substance use patterns/diagnoses, and sociodemographic and racial/ethnic backgrounds, with interventions tailored to the specific needs of these communities.”

A Hope For The Future

For those that live with HIV, a real and effective intervention that could improve mental health, and thus broader health outcomes, could significantly improve their quality of life. This means that this research is a light on the horizon for many affected people. 

The study authors wrote;

“While further research is needed, this analysis instills hope for the development of innovative and accessible psychedelic therapy interventions that may alleviate the burden of shame experienced by [people living with HIV].”