The psychedelic psilocybin and the entactogen 3,4-methylenedioxymethamphetamine (MDMA) are being scientifically studied again after a long hiatus, and especially for their potential in the treatment of psychiatric disorders. Their profound effect on cognitive, perceptual, and affective processes have led to several clinical studies during the last decade that have forced the reconsideration of the utility of these substances. The research includes clinical trials with psilocybin-assisted psychotherapy for depressive and anxiety symptoms, and MDMA-assisted psychotherapy for the treatment of post-traumatic stress disorder (PTSD). The results have shown a significant reduction in depressive and anxiety symptoms in psilocybin-assisted psychotherapy, and in PTSD symptoms in MDMA-assisted psychotherapy, with acceptable adverse effects. Moreover, the reductions in symptoms have been shown to be sustained several years later. Given the results indicate short- and long-term safety and efficacy, even for treatment resistant conditions, this suggest that these substances administered with psychotherapy are promising and deserve to be taken seriously as a therapeutic tool. The present thesis provides an overview of the latest clinical studies on the treatment of depression, anxiety, and PTSD with psilocybin and MDMA, respectively, as well as reviews the history, mechanisms of action, the therapeutic process used with psilocybin and MDMA, and any adverse physiological and psychological effects of both substances.

Background: Work related stress, depression and anxiety are common. Despite evidence that these problems can be successfully treated in the workplace, take-up of psychological treatments by workers is low, resulting in many going untreated. One way to address this may be through the use of digital mental health interventions (DMHIs) in the workplace, but there is a lack of information about their appeal and effectiveness. Research questions: 1. What is the evidence for delivering DMHIs in the workplace? 2. What are the advantages and disadvantages to delivering DMHIs in the workplace? 3. What features of DMHIs influence engagement and adherence? What can be done to improve these? 4. What are employers' priorities when selecting DMHIs for their workforce? Method of investigation: Mixed methods were used to answer the research questions. Summary of conclusions: There is evidence for the efficacy of workplace DMHIs, especially if they are delivered over a short timeframe, utilise secondary modalities to deliver the interventions (emails and text messages), and use elements of persuasive technology (self-monitoring and tailoring). Use of online-facilitated discussion groups may increase engagement. Both employees and employers identified convenience, flexibility, and anonymity as advantages of DMHIs. Employers also valued the potential of DMHIs to reach many employees. The main barrier to engagement for employees was lack of time. For employers, barriers to purchasing DMHIs were employees' lack of access to equipment, and their low interest and skills. Cost and effectiveness were priorities for decision makers when purchasing DMHIs. Further work needs to be done with workers and employers to design and deliver DMHIs that meet both their needs.

The study investigated 17 suicidal girls attending Equine Assisted Psychotherapy (EAP) sessions as a complementary therapy. In particular, the study focused on three main issues. First, whether the patients’ happiness, warm emotions, awareness, relaxation, control, loquacity, and coordination improved over time. Second, whether riders and novices benefited equally from the therapy. Lastly, whether and how horse responsiveness and patient’s motivation affected the outcome. Individual Growth Curves analysis was used to answer these questions. The results showed a significant improvement in awareness and coordination, and a small change in warm emotion and relaxation over time. Moreover, previous riding experience was related to higher scores in warm emotions, awareness, control, and coordination. However, this effect faded over time as the clients became more familiar with EAP. Finally, the patient’s attitude, reflected in the horse’s responses, influenced positively the overall outcome. In conclusion, beginners might need more time in order to feel comfortable with the EAP environment. Thus, it is crucial to set appropriate goals. Additionally, patient’s motivation is an important factor for the success of the therapy, as it will be reflected in the horse’s responsiveness, and will eventually lead to greater improvements. Overall, the results suggested that patients’ experiences with horse riding, horse responsiveness, and motivation are important elements of EAP that are related to improvements in suicidal girls over time.

The study investigated 17 suicidal girls attending Equine Assisted Psychotherapy (EAP) sessions as a complementary therapy. In particular, the study focused on three main issues. First, whether the patients’ happiness, warm emotions, awareness, relaxation, control, loquacity, and coordination improved over time. Second, whether riders and novices benefited equally from the therapy. Lastly, whether and how horse responsiveness and patient’s motivation affected the outcome. Individual Growth Curves analysis was used to answer these questions. The results showed a significant improvement in awareness and coordination, and a small change in warm emotion and relaxation over time. Moreover, previous riding experience was related to higher scores in warm emotions, awareness, control, and coordination. However, this effect faded over time as the clients became more familiar with EAP. Finally, the patient’s attitude, reflected in the horse’s responses, influenced positively the overall outcome. In conclusion, beginners might need more time in order to feel comfortable with the EAP environment. Thus, it is crucial to set appropriate goals. Additionally, patient’s motivation is an important factor for the success of the therapy, as it will be reflected in the horse’s responsiveness, and will eventually lead to greater improvements. Overall, the results suggested that patients’ experiences with horse riding, horse responsiveness, and motivation are important elements of EAP that are related to improvements in suicidal girls over time.

Psychedelics—also known as hallucinogens and entheogens—comprise a family of psychoactive molecules that are both found in nature and synthetically engineered in the lab. As a class, psychedelic compounds produce phenomenologically complex and novel experiences that have recently captured the attention of mental health clinicians and researchers. However, psychedelic clinical research and treatment remain limited, with most studies exploring the efficacy and safety of protocols for individuals with anxiety, depression, substance use, and posttraumatic stress disorder (PTSD), while individuals with personal or familial histories of psychosis, psychotic disorders, and bipolar disorder are mostly excluded from treatment and research. The overarching objectives of this thesis included determining 1) whether excluding this group from psychedelic clinical research is justified, 2) when psychedelic drug administration and psychedelic-assisted psychotherapy (PAP) may be contraindicated for this group, 3) if people with a history of psychosis or a psychotic disorder may be able to treat their psychotic symptoms with PAP, 4) if people with a history of psychosis or psychotic disorder may be able to treat their co-morbid conditions like anxiety, depression, substance use, or PTSD with PAP, 5) what a PAP treatment protocol for this group could look like 6) how individuals with reported histories of psychosis and psychotic disorders describe their experiences of psychedelic drug use and 7) whether naturalistic psychedelic use has an overall positive or negative effect on emotional well-being and psychological functioning for this group. Results from the first study—a qualitative study with experts in medicine, mental health, and psychedelics—suggest that certain individuals with histories of psychosis and psychotic disorders may benefit from PAP under the right conditions, such as when psychosis is etiologically connected to traumatic events, when the protocol offers extensive support for the patient, and when psychosis is not the result of amphetamine use or medical conditions such as epilepsy. Moreover, results suggest that the effects of the specific psychedelic that is administered must be carefully considered and support outside of therapy must also be assessed. Other factors such as personality traits, ability to form rapport with a guide or sitter, symptom severity, specific symptom endorsement, symptom duration, age, the presence of physiopathology and more must also be taken into consideration. For the second study, a cross-sectional, retrospective, phenomenological survey report was administered to individuals who reported a history of one or more psychotic experiences and/or diagnosis of a psychotic condition who also had at least one psychedelic drug experience in their lifetime. The survey asked participants to describe one memorable instance of psychedelic drug use and found that in a sample of 100, most individuals (n=88) describe some degree of personal growth resulting from their experience. Many also describe mystical-type experiences, gaining insight or awareness during their experience, heightened appreciation for life, and improved mental health and emotional well-being. Descriptions of symptomatic relief included reduced paranoid thinking, changes in relationships with symptoms, and decreased suicidal ideation. Approximately 11% of the sample described negative experiences including perseverating psychological impairment, symptom exacerbation, and psychedelic-induced suicidality. A slightly larger portion of the sample described mixed-type experiences, i.e., experiencing positive and negative effects alongside each other. The findings of these studies fill a major gap in the literature by suggesting that individuals with histories of psychotic symptoms and disorders may be able to partake in psychedelic studies and treatment under certain circumstances. This is because experts have explicitly stated that psychedelic use is not necessarily contraindicated for everyone with psychotic conditions and symptoms, but rather that most PAP protocols for anxiety, depression and other conditions do not offer enough support. At the same time, exclusion criteria are required by the FDA. Additionally, survey reports from individuals with lived experiences of psychosis further back the position that PAP could be a viable treatment option for this group through their survey reports. Specifically, the high prevalence of positive and therapeutic experiences with psychedelics in naturalistic settings suggests that clinically supervised psychedelic drug use may generate similar or even better outcomes for this population. Although a minority had adverse experiences, it remains to be studied as to whether similar effects might be experienced at a similar rate or similar degree of frequency in clinical studies, which utilize harm reduction strategies, maximize safety, and implement preparatory and integration sessions, elements which were notably absent from reports of adverse experiences in the survey. Results also shed light on what a psychedelic treatment protocol could look like for this group, and how individuals with histories of psychotic experiences and diagnosed psychotic conditions describe their experiences of psychedelic use and the effects of psychedelic drugs on their emotional and psychological functioning.

Mental disorders are a prevalent health issue that has an extensive amount of variability in the quantity of disorders, affected populations, and treatment. There are a multitude of approaches or therapeutic methods used by the mental health community. Although each therapy is valuable in unique ways, each therapy may not be suitable to treat every disorder or client. Traditional approaches, such as talk therapy, are effective for certain individuals, whereas some clients may not respond well to any of the traditional talk therapies. When traditional therapies are not working, a referral can be made for a therapy that might suit the client better. Equine-Assisted Psychotherapy (EAP) is an experiential psychotherapy that has done well not only in assisting typical clients, but also with clients that have had trouble in traditional modes of therapy. This is a collaboration of current works and research in EAP, along with the knowledge base of a current licensed practitioner of EAP. The purpose is to lay out the fundamentals of EAP, which offers a different modality than traditional talk therapies. By crafting a better picture of EAP, perhaps it can kindle further research in its efficacy and guide additional mental health professionals towards this type of therapy.

Youth who have experienced maltreatment (abuse, neglect, exposure to violence) typically exhibit worse life outcomes (lower graduation rates, higher incident of substance use, unplanned pregnancies, etc.). Effective therapeutic interventions are important to combat these negative effects. Animal Assisted Intervention (AAI) is a popular and growing field. Anecdotal evidence abounds on the efficacy of AAI, however, there is a lack of quantitative and qualitative research and evidence-backed models of treatment particularly with youth. This study sought to increase the amount of quantitative evidence on AAI by specifically focusing on evaluating the Power Tools for Living Equine Assisted Psychotherapy (EAP) model with youth who have experienced maltreatment. This study analyzed secondary data collected from Special Spirit Inc., an equine therapy center. Three groups of youth placed in out-of-home care at residential treatment facilities in Los Angeles County participated in the Power Tools for Living EAP program. Prior to and after the intervention the youth’s guardian or clinician filled out a Youth Outcomes Questionnaire (YOQ). This data was analyzed but no statistical significant associations were yielded from the analysis. Analysis of the data does provide suggestions for further study that may potentially establish the Power Tools for Living EAP model as an effective intervention for youth who have experienced maltreatment, particularly younger participants and those with higher YOQ scores prior to treatment.

Modeled after Doherty & Simmons’ (1996) study on the practice patterns of marriage and family therapists, this project explored similar questions about equine assisted/facilitated psychotherapists who are members of two main certification organizations, EAGALA and PATH Intl. An Internet survey distributed to equine assisted/facilitated practitioners across the country explored demographic information of the clinician, their clients, and their typical work setting. Equine assisted/facilitated psychotherapy is a growing field and gaining an understanding of the current position of the field allows for growth in areas that are currently underdeveloped within this sector of the mental health field.

Equine assisted psychotherapy (EAP) is an emerging experiential methodology<br />that has recently gained recognition as a method for addressing a range of presenting<br />problems for a wide variety of client populations. Couples therapy is one area that the<br />practice of equine assisted psychotherapy has recently gained traction. This study<br />describes the practice of equine assisted couples therapy in terms of practitioner<br />characteristics, approach to treatment, therapeutic goals and outcomes. Mental health<br />professionals currently using equine assisted psychotherapy to treat couples share their<br />experiences and perspectives to provide an overview of this emerging modality. / Master of Science

With overdose deaths and residential addiction treatment admittance increasing, more treatment options are necessary to meet the demand of services. Equine assisted psychotherapy and learning (EAPL) is a relatively new therapeutic tool in addiction treatment for individuals battling substance use disorder (SUD), and thus, lacks a solid evidence base to be implemented consistently and effectively. The purpose of this dissertation was to determine the effectiveness of EAPL in creating an emotionally safe environment for learning for college-age young adults with a particular focus on those struggling with SUD. This was accomplished in a series of projects focused on: 1) implementing evaluation methodology for tracking emotional safety and learning in young adults participating in equine interaction activities without therapeutic intentions, 2) determining the relationship between physiological responses and emotional safety and learning in young adults participating in outpatient EAPL programming for SUD, and 3) evaluating the treatment outcomes associated with emotional safety and learning for young adults with SUD participating in EAPL at a residential treatment facility. Each project utilized the same three evaluations for evaluating emotional safety and learning: 1) emotional safety evaluation, 2) equine knowledge exam, and 3) physical skills evaluation. In each of the studies, a correlation was found between emotional safety and equine knowledge and handling skills for college-age young adults, however, equine interaction with therapeutic intentions revealed a stronger correlation indicating it is not just the horse that provides the mental health benefits. An emotionally safe environment for learning, was established for college-age young adults within a residential treatment facility, this was not dependent on the length of stay or level of participation suggesting this is an efficient therapeutic option for SUD for this population. Emotional safety for the college-age young adults participating in EAPL was correlated to vital sign measurements, but vital sign measurements of young adults were independent of the vital signs of the therapy horse. Each of the three projects provided vital information filling the gap of knowledge surrounding EAPL as an effective clinical intervention strategy for SUD in college-age young adults and created a basis for further research using more objective measures.