Shame can be a major stressor for people who live with HIV. It can lead to circumstances such as increased substance use, risky sexual behavior, increased likelihood of incarceration, insecure housing, not getting the proper healthcare, and make the task of living with HIV far more negative than necessary, according to the National Institute of Health. Researchers argue that these challenges can, in turn, make it more difficult to reach national goals for ending the HIV epidemic.
A new study published in the journal Nature looks at how psilocybin-assisted group therapy might impact shame — and subsequent negative outcomes — in those who have HIV. The study highlights the limited successes traditional psychotherapies have in effectively treating shame in the seropositive community. And while more research needs to be done to truly gauge if psilocybin-assisted group therapy can help this specific demographic, the results are promising.
Nicky Mehtani and a team of researchers from the University of California, San Francisco, and the University of Alabama at Birmingham, looked at 12 HIV-positive participants in a pilot clinical trial. Researchers measured shame using the HIV and Abuse Related Shame Inventory (HARSI), a psychological tool to measure shame in those living with HIV. Mental health professionals often use the HARSI scale to gauge how shame affects an HIV patient’s mental health and their involvement in proper care and treatment.
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The clinical trial results showed that, on average, study participants’ shame scores dropped by 5.5 points over a six-week period of dosing psilocybin once a week, which held stable for three months post-treatment. Those who experienced the greatest benefit were those who had a score of 20 (out of 50) on the HARSI scale. This decrease is statistically significant and indicates that group therapy might be a better approach for tackling chronic shame.
“Compared with individual therapy, group therapy itself may foster decreased shame among [people with HIV],” the study’s authors write. “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.”
The study’s authors suggest that psilocybin might reduce HIV-related shame because the psychoactive compound promotes “hyper-associative” thinking, helping people focus less on themselves and, therefore, reducing the shame they feel.
“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,” the authors wrote. “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.”
While the results of the trial were generally positive, two study participants experienced an increase in shame, specifically related to past sexual trauma, after taking psilocybin. It should be noted that of the 12 participants, six people reported a history of sexual abuse. Although researchers described the occurrence of increased shame “an unexpected outcome,” they expressed concern about the suitability of psilocybin therapy for people with a history of trauma.
“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 study’s 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.”
While this research is undoubtedly promising, there are some glaring limitations. One of which is the small sample size; another is the absence of a control group. Both issues greatly restrict the extent to which the results can be interpreted. Additionally, the trial intentionally selected a homogenous group of “gay-identified, cis-gender, older-adult male participants” to bolster feelings of trust, safety, and unity within the context of group therapy over a six-week period. 75 percent of the study participants were also white, which is a notable shortcoming considering that Black, Indigenous, and people of color have been disproportionately affected by the HIV epidemic. Lastly, the study used self-reported survey data to assess shame, which can be affected by “recall bias” and “social desirability bias.”
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“In future clinical trials of psychedelic therapies,” the study’s authors wrote, “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.”
An estimated 39.9 million people live with HIV, according to 2023 statistics from the World Health Organization. An intervention that can directly improve mental health and indirectly impact the desire to build health-oriented lifestyles could drastically change the quality of life for the seropositive community.
“While further research is needed,” the study’s authors write, “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].”
