MD (Res) Scholarship 2019 (2): Dr Camilla Day; King’s College London


Project Title: A mixed method study investigating the role of self-compassion, the therapeutic relationship and the phenomenology of psilocybin with psychological support for Treatment Resistant Depression.

Supervisors: Professor Anthony Cleare and Dr James Rucker

Project Summary

Treatment resistant depression leads to high rates of disability and mortality and a very high socioeconomic burden, being the leading cause of disability worldwide. Novel interventions are needed to meet this need and recent trials investigating the effect of psilocybin with psychological support for depressive symptoms have shown a good safety project with promising results.

This MD (Res) will form part of the tertiary outcomes of the Psilocybin in Depression Resistant to standard treatment (PsiDer) trial led by Dr James Rucker at the Centre for Affective Disorders, South London and Maudsley NHS Trust and King’s College London. The PsiDer trial is funded by the National Institute for Health Research to investigate the safety, feasibility and efficacy of psilocybin in treatment resistant depression, using the gold standard design of a randomised control trial. The study will recruit up to 60 participants with current depression unresponsive to usual treatments. The main outcome of the study will be to evaluate the feasibility of an RCT design in which a single dose of oral psilocybin 25mg vs placebo will be given to adult participants with treatment resistant major depressive disorder (TRD), under psychologically supportive conditions, with 3 weeks of follow up. At 3 weeks follow up all participants will be offered an open label extension consisting of a single dose of 25mg psilocybin, delivered under identical conditions with a further 12 weeks of follow up. Secondary outcomes will be changes in depressive symptoms on Quick Inventory for Depressive Symptoms (QIDS) between placebo and psilocybin groups. Currently the study protocol is about to go through ethics, having just finished contract negotiation.

There is a basic assumption that the context in which psilocybin is taken dramatically alters the dosing experience and outcome for the individual but there has been little research into this complex interplay. Using a mixed method approach this MD (Res) aims to investigate how these contextual and experiential factors influence outcome so that we can learn how to optimise the context to improve outcomes for people with depression. In particular I shall use a validated scale (STAR-P and STAR-C) to investigate if therapeutic relationship, from the point of view of participant as well as clinician, effects changes in depressive symptoms after psilocybin. I shall also be using another validated scale (Kristen Neff Self-Compassion Trait Scale) to investigate if changes in self-compassion before and after psilocybin effect changes in depressive symptoms. I shall then see if increases in self-compassion states mediate the relationship between baseline therapeutic relationship and changes in depressive symptoms. I also aim to develop my own compassion experience scale to quantify the types of dosing experiences that may be important for changes in depressive symptoms. In order to complement these quantitative methods, I shall carry out semi-structured interviews in 8 individuals (4 men and 4 women) at three time point for a longitudinal analysis (interpretative phenomenological analysis) of people’s lived experience of depression and psilocybin with psychological support. The main aims of this qualitative analysis, is to optimise outcomes for psilocybin interventions, and also to understand the aetiology and treatment of depression from the point of view of the participant.

Student:

Camilla is an ST6 General Adult Psychiatrist at South London and Maudsley NHS Trust and Honorary Research Associate at the Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London. She is currently working at St Thomas’ Hospital Liaison and Perinatal teams but is about to start working in a therapeutic community for personality disorders at the Maudsley Hospital in February 2020. She started out studying psychology and physiology at St Edmund Hall, Oxford University and went onto to do fast track medicine at Warwick Medical School where she won a research scholarship. She then did an academic foundation programme in psychiatry in West Midlands and then moved to London to do her psychiatric training at South London and Maudsley NHS Trust. She has always been involved in psychiatric research and over the years has developed an interest in psychotherapy. She started working in the field of psychedelic research in 2014 with the Imperial Psychedelic Research Group where she volunteered as a guide for 11 participants receiving psilocybin for depression and collaborated in qualitative research. She is currently doing a part-time mixed methods MD Res in psilocybin for treatment resistant depression, having been fortunate to receive the Tom Palmer award from Mental Health Research UK.