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Therapeutic Potential of Ayahuasca in Grief

Date 04-15-2021
HC# 072052-662
Caapi (Banisteriopsis caapi, Malpighiaceae)
Chacruna (Psychotria viridis, Rubiaceae)
Chaliponga (Diplopterys cabrerana, Malpighiaceae)

González D, Cantillo J, Pérez I, et al. Therapeutic potential of ayahuasca in grief: a prospective, observational study. Psychopharmacol. 2020;237:1171-1182.

Ayahuasca decoction is used in traditional medicine and spiritual rituals by indigenous people of the Amazon Basin. It is often prepared by boiling the stems of the caapi or yagé (Banisteriopsis caapi, Malpighiaceae) vine with the leaves of chacruna (Psychotria viridis, Rubiaceae) or chaliponga (Diplopterys cabrerana, Malpighiaceae) depending on the geographical locale and plant availability. These plants have constituents with monoamine oxidase inhibitor (MAOI) activity and serotonin activity, which are known to have antidepressant and anxiolytic activity. According to the authors, there is a lack of studies that evaluate the effect of ayahuasca for grief and mourning after the death of a loved one. Prolonged Grief Disorder is a recognized clinical disorder, which has symptoms similar to depression and post-traumatic stress disorder but is not effectively treated with pharmaceuticals. The purpose of this observational study was to evaluate the effect of grief severity after drinking ayahuasca.

Participants (n = 50) booking a stay at the Temple of the Way of Light (in the Peruvian Amazon Rainforest, Peru) from 2015 through 2017 were recruited. Included participants had to be accepted to the center, which required participants to be ≥18 years of age, without previous clinical disorders (i.e., psychosis, depersonalization, or mania), not taking certain medications (i.e., MAOIs or selective serotonin reuptake inhibitors), and without heart conditions or chronic high blood pressure. Pregnant women were not accepted. Participants included in the study reported feeling grief related to the death of a loved one. The center offered retreats of nine, 12, or 30 days, where participants drank ayahuasca between four and nine times in a ceremonial context under the guidance of Shipibo Curanderos (traditional healers). The retreat also offered optional yoga classes, floral and steam baths, and integration circles concerning ayahuasca experiences.

Participants were assessed 15 days before attending the retreat and 15 days, three months, six months, and 12 months after leaving the retreat. Some participants were evaluated two months before entering the center. The following assessments were administered: Texas Revised Inventory of Grief (TRIG) questionnaire quantified the severity of grief, Symptom Assessment-45 (SA-45) Questionnaire assessed psychiatric symptoms, World Health Organization Quality of Life-BREF (WHOQoL-BREF) assessed quality of life, Acceptance and Action Questionnaire (AAQ-II) assessed experiential avoidance versus acceptance, EQ-Decentering scale assessed decentering (defined as the ability to observe one’s thoughts and feelings in a detached manner), and Bereavement Adjustment questionnaire explored bereavement adjustment. Two batches of ayahuasca were used and prepared by Shipibo shamans at the Temple of the Way of Light. Analysis using liquid chromatography-mass spectrometry (LC-MS) determined that one ayahuasca sample contained 2 mg/mL N,N-Dimethyltryptamine, 2 mg/mL harmine, 0.37 mg/mL harmaline, and 1 mg/mL tetrahydroharmine. The other sample contained 2 mg/ mL N,N-Dimethyltryptamine, 2 mg/mL harmine, 0.65 mg/mL harmaline, and 2 mg/mL tetrahydroharmine. No other psychoactive compounds were detected.

The relationship with the deceased was positive for 68% of participants, negative for 12% of participants, and ambiguous for 20% of participants. For 82% of participants, the death was considered a traumatic event and 14% were unsure. The main motivations for attending the retreat were therapeutic (34.1%), spiritual growth (34.1%), and personal development (31.7%). None of the participants reported attendance for drug tourism. Seventy-six percent of participants expected that the ayahuasca ceremonies would improve their grief symptoms, and 24% were not sure. Previous use of ayahuasca was zero in 70% of participants, of the remaining 30% less than three times in 40% of participants, between three and seven times in 40% of participants, and more than seven times in 20% of participants. The participants attended an average of 18.1 days at the center (range 9–30 days), where they participated in an average of 6.62 ayahuasca ceremonies (range 4–9 ceremonies). Fifteen days after leaving the retreat, 53.8% of participants reported that ayahuasca as the most relevant factor in the evolution of their grief symptoms during their stay at the center, followed by the work of the Shipibo healers (35.9%), being with other guests (5.1%), the experience of being in the jungle (2.6%), and having attended other alternative activities, such as yoga classes (2.6%). Although, 78.4% of participants reported that an ayahuasca experience directly affected their grief process.

There was a significant improvement from baseline at all time points on the TRIG; SA-45 global severity index; SA-45 psychopathological subscales; WHOQoL-BREF physical health, psychological health, and social relationships subscales; and AAQ-II (P < 0.05 to P < 0.001 for all time points). The only SA-45 subscale that did not have a significant improvement after 15 days was phobic anxiety. The ayahuasca experiences at the center had a positive effect on grief symptoms for 92.3% of participants, 5.1% of participants reported that it had no influence, and 2.6% of participants experienced a negative effect on their grief process. There was a correlation between avoidance (AAQ-II) and severity of grief (TRIG) (P < 0.01). Also, there was a correlation between improvement in decentering ability (EQ-Decentering) and severity of grief (TRIG) (P < 0.01). A subgroup analysis of nine participants who had an assessment two months prior to the retreat revealed similar results as the entire population, indicating that the outcomes were due to the stay at the center and not the passing of time.

The authors conclude that the severity of grief significantly decreased after drinking ayahuasca, and the effect was maintained over a one-year follow-up. The authors acknowledge the limitation that a large proportion of participants expected that ayahuasca ceremonies would improve their grief symptoms, which could have introduced bias. Another limitation is the absence of a control group of participants who went to the center and did not drink ayahuasca, nor was there an untreated control group. It is possible that the same outcomes could have occurred with the passing of time. The authors report no conflicts of interest.

—Heather S. Oliff, PhD