Motivation and emotion/Book/2020/Ayahuasca and emotion

Overview
This book chapter discusses the emerging uses of the traditional psychedelic Amazonian tea brew Ayahuasca and its effects on emotion. Ayahuasca has been described as a healing plant for emotional related issues (Kjellgren, Eriksson & Norlander, 2009). It is also said to improve overall psychological well-being. Research suggests this plant may be used medically to help with both psychological conditions such as (but not limited to) depression, anxiety, addiction and post traumatic stress disorder (PTSD). It is also said to improve mindfulness, which in turn has been proven to increase mental health and wellbeing.

Focus questions:
 * What is Ayahuasca?
 * What is Emotion?
 * How does Ayahuasca affect Emotion?
 * The future for Ayahuasca as an emerging medicine?

Ayahuasca
The traditional Amazonian psychedelic tea, Ayahuasca (pronounced ‘eye-ah-WAH-ska’), which translates into English as the 'vine of the soul', is a compound of two natural plant (Kjellgren, Eriksson & Norlander 2009). The base of this tea contains a combination of the stem and bark of the Banisteriopsis caapi vine (containing beta-carboline alkaloids) and leaves of the Psychotria viridis bush (supplying the hallucinogen N,N-dimethyltryptamine, DMT) but can include a variety of other natural plants. This psychedelic tea has been part of the practices of approximately 100 Indigenous groups in the Amazon, spread across Colombia, Ecuador, Peru, Bolivia, Brazil, and Venezuela (Hamill, Hallak, Dursun & Baker, 2019). Shaman’s traditionally used Ayahuasca for religious, spiritual, healing and medicinal purposes. It is an experience seen by some as a rite of passage, but with time this psychedelic tea has been globalised to places such as North America and Europe not only with religious and spiritual purposes, but also appropriated for recreational purposes.



Immediate Physiological Effects of Ayahuasca
The psychedelic tea is brewed for hours with the combination of the leaves and stalks and it is consumed as a drink. The leaves naturally contain the hallucinogenic chemical N,N-dimethyltryptamine (DMT) while the vines contain MAO inhibitors (MAOIs). Neither of these key ingredients have psychedelic effects when ingested on their own, but when the vines are ingested, they inhibit your stomach enzymes from deactivating the DMT, therefore allowing the DMT to travel through the blood and penetrate through the blood brain barrier (Hamill, Hallak, Dursun & Baker, 2019).

There is usually a half an hour waiting period between the consumption of the tea and the effects of the tea being felt. The peak of the effects is usually felt between 60 minutes to 120 minutes after consumption, with the effects subsiding at around four to six hours (Kjellgren, Eriksson & Norlander, 2009).

According to a study conducted in 2009, shortly after consuming Ayahuasca participants began to experience changed perceptions and feelings of vulnerability (Kjellgren, Eriksson & Norlander, 2009). Soon after, feelings of confusion, paranoia and fear arose and many began to re-experience traumatic memories and gain new insights into personal matters. Commonly, this section of the experience peaked with intense vomiting (also known as purging) which is considered an extremely integral part of the trip as many feel as though this is a detoxification of all negative energies, which are released, and with this, previous negative feelings begin to subside.



After this, participants described a transcendental experience in a spiritual world, encountering plant and animal spirits and even contact with a higher power. Feelings of oneness with the universe, profound peace and ecstasy, and newly gained understandings of death and what comes after. Sense of time is altered, and users experience feelings of timelessness, time speeding up or slowing down, or traveling in time. Through all this, users remained aware of their surroundings and were able to speak. This process can be seen in Figure 2 and is referred to within the study as the 'transcendental circle". The stages are listed as;


 * 1) Motivation and aim
 * 2) Contractile frightening state
 * 3) Sudden transformation of the experience
 * 4) Limitless expansive states with transcendental experiences reflections
 * 5) Changed worldview and new orientation



Common visual effects can include objects appearing to vibrate or increase in brightness, colours intensify, moving geometric patterns and intricate images occur with eyes closed or open, kaleidoscopic imagery or visions of people, beautiful scenery, or snakes or jungle animals. Figure 3 is an exemple of some of the visual imagery one may experience during the peak of their Ayahuasca experience.

Side effects

 * Nausea
 * Vomiting - known as purging and as an integral part of the ceremony
 * Euphoria
 * Diarrhoea
 * Dilated pupils
 * Confusion
 * Agitation
 * Paranoia
 * Increased body temperature
 * Increase blood pressure
 * Increase heart rate
 * Sweating
 * Visual and auditory stimulation

When not to take Ayahuasca
If you are taking prescribed medications such as but not limited to (Temple of the Way of Light, 2020)


 * Monoamine Oxidase Inhibitors (MAOIs)
 * Central Nervous System (CNS) Depressants (and sleeping pills)
 * Selective Serotonin Reuptake Inhibitors (SSRIs) →if Ayahuasca is taken when on SSRI's, the individual may experience serotonin syndrome.
 * Anti-hypertensives (blood pressure medications)
 * Antibiotics

Important to discuss with your GP if you suffer from any of these conditions prior to taking Ayahuasca (many Ayahuasca retreats require a medical clearance before attending the ceremonies).


 * Borderline disorders
 * Bipolar disorders
 * Psychosis
 * Schizophrenia
 * Family history of mental health problems
 * Chronic high blood pressure
 * Heart conditions
 * Diabetes

Emotion
Emotion consists of neural circuits (that are at least partially dedicated response systems). Emotions encompass feelings/states/processes that motivate and organise cognition and action (Reeves, 2018). Emotion also provides information to the person experiencing it, and may include antecedent cognitive appraisals and ongoing cognition including an interpretation of its feeling state, expressions, or social-communicative signals, and may motivate approach or avoidant behaviour, exercise control/regulation of responses, and be social or relational in nature." (Izard, 2010). Theorists such as Robert Plutchik suggested that there are 8 basic emotions; joy, trust, fear, surprise, sadness, disgust, anger and anticipation and 24 extensions of these emotions as depicted in Figure 4 (Plutchik, 1980). Another prominent theory of emotion is the James-Lang Theory which suggests that emotions are a result of physiological response to internal or external stimuli (Cannon, 1987).

Ayahuasca's effects on Emotion
In recent times, Ayahuasca ceremonies have gained significant interest in the western world not only by the mainstream public but also by researchers and academics looking at its potential positive health benefits. It has been observed and discussed that Ayahuasca and its active ingredient DMT have anxiolytic properties. On a physiological level, DMT works as a partial agonist at 5-HT receptors which are also known as our serotonin receptors which of course is a key component of many different mental health concerns. There have been some neuroimaging studies which show that Ayahuasca increases blood perfusion in frontal brain regions, the insula, the left nucleus accumbens, the left amygdala the parahippocampal gyrus, and the left subgenual area (Frecska, Bokor & Winkelman, 2016). This may suggest that Ayahuasca’s effects are highly involved in introspection and emotional processing. Therefore this section will review some of the current literature examining the use of Ayahuasca and its effects on emotion, mental health and wellbeing.

Ayahuasca and Mental Illness
In 2020 a study was conducted to look at the effects of Ayahuasca on psychological and physical health variables in naïve Ayahuasca users (Palhano-Fontes, Barreto, Onias, Andrade, Novaes, Pessoa, & Tófoli, 2019). They used 40 Ayahuasca-naïve subjects who were assessed before using Ayahuasca for the first time, and they were followed up at 1 and 6 months after. Using the Mini-International Neuropsychiatric Interview (MINI) it was found that 45% of the sample met the diagnosis criteria for some form of psychiatric disorder with the most commonly reported being Generalised Anxiety Disorder (GAD). At the 1-month follow up, 61% of participants who initially met the diagnosis criteria no longer met the criteria and 22% of participants showed a decrease in the number of psychiatric disorders for their previously met diagnosis criteria. Overall, 83% of participants reported a clinical improvement. This improvement lasted until the 6-months follow-up. Similarly this same research group conducted a study where, in a sample of 380 long term Ayahuasca users, half the participants reported reducing or eliminating their prescription drugs after beginning to use Ayahuasca regularly (Palhano-Fontes, Barreto, Onias, Andrade, Novaes, Pessoa, & Tófoli, 2019) Though research has suggested Ayahuasca may help with symptom reduction for some mental health conditions, the most research has been conducted on its effects on depression and mindfulness.

Ayahuasca and Depression
Depression has many different forms but all depressive disorders include features such as the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual's capacity to function. What differs among them are issues of duration, timing, or presumed aetiology (DSM-5). Depressive disorders can be very debilitating and harmful to an individual wellbeing and can even be fatal if left untreated - suicide is the leading cause of death in Australia for those between the ages of 15-44 (Australian Institute of Health and Welfare, 2020). Therefore it is of great interest to help those with depression to find ways of controlling their symptoms.

In 2019 a study was conducted looking at the rapid antidepressant effects of Ayahuasca as a treatment for treatment-resistant depression. A randomised placebo control trial was adopted. All participants were aged between 18 and 60 years and in moderate to severe depressive episodes at the time of screening, with treatment-resistant depression (Santos, Sanches, Osório & Hallak, 2018). They used the MADRS and the HAM-D assessment to record depression levels. These levels were recorded 1 day before administration and then 1 (D1), 2 (D2) and 7 (D7) days after dosing. They found that after a single dose of Ayahuasca there was a rapid antidepressant effect compared to those within the placebo group. Additionally they stated the improvements in psychiatric scales for the Ayahuasca group were significantly higher than those of the placebo group at all followups after dosing, with increasing between-group effect sizes from D1 to D7 (Santos, Sanches, Osório & Hallak, 2018). This may suggest for those who are at immediate risk of self harm or suicide, the use of Ayahuasca may be an effective treatment plan in the prevention of these detrimental outcomes.

In this study it is of interest that researchers contrasted their findings to a similar study looking at the use of ketamine for treatment-resistant depression. They discuss how previous studies with ketamine found the largest between-group effect size at D1 and reducing toward D7 (Berman et al., 2000; Zarate et al., 2006; Murrough et al., 2013; Lapidus et al., 2014). In contrast, the effect sizes observed in this study were large, but smallest, at D1 (Cohen’s d = 0.84), and largest at D7 (Cohen’s d = 1.49). These differences are also reflected in the response rates. At D1, the response rate to ketamine lies between 37 and 70%, whereas in this study 50% of the patients responded to Ayahuasca. At D7, the ketamine response rate ranges between 7 and 35% while in this study 64% responded to Ayahuasca. This may suggest a longer lasting decrease in depression levels with the use of Ayahuasca compared to ketamine, but more research would need to be conducted to further evidence this.

Similarly a study was conducted observing the sub-acute and long-term impacts of Ayahuasca. 57 visitors of Ayahuasca ceremonies in Columbia and the Netherlands agreed to take part in the study consisting of subjective questionnaires and a creative thinking task prior to an Ayahuasca ceremony, the day after, and about 4 weeks after the ceremony (Uthaug, Oorsouw, Kuypers, Boxtel, Broers, Toennes, Riba & Ramaekers, 2018). Ratings of depression and stress significantly decreased after the Ayahuasca ceremony and these changes persisted for at least 4 weeks. They found that subjective ratings of stress and depression significantly decreased from between 36% and 46% respectively during the day after the Ayahuasca ceremony. Ratings of stress and depression remained significantly lower throughout the following month, suggesting that a single Ayahuasca ceremony can bring about changes in affect that last for a prolonged period of time. These findings are similar to those of Osorio and Sanches, which both also support the idea that ayahuasca can reduce symptoms of depression and these changes are persistent over prolonged periods of time.

Ayahuasca and Mindfulness
Mindfulness is the practice of staying present in the current moment and being able to control ones attention. It has been practiced for many years for religious and spiritual purposes and has been adopted by psychological therapies since the 1970's. Research has found that mindfulness is highly successful in managing depression, anxiety, chronic pain, suicidal ideation, addiction recovery and relapse prevention and eating disorders. It has also been found to reduce stress, boost creativity, improve attention, working-memory and concentration and strengthen relationships (Academic Mindfulness Interest Group, 2006).

Using the Five Facet Mindfulness Questionnaire (FFMQ), 25 participants were assessed before, and 24 hours after, an Ayahuasca session to assess whether Ayahuasca may promote mindfulness practices and therefore improve individuals mental health and wellbeing (Murphy-Beiner & Soar, 2020). These five assessed mindfulness facets include;


 * 1) Observe: noticing external and internal experiences, e.g., body sensations, thoughts, or emotions;
 * 2) Describe: putting words to, or labelling the internal experience;
 * 3) Acting with awareness: focusing on the present activity instead of behaving mechanically;
 * 4) Non-judging the inner experience: taking a non-evaluative stance towards the present experience, thoughts, or emotions; and
 * 5) Non-reacting to the inner experience: allowing thoughts and feelings to come, without getting caught up in, or carried away, by them found that Ayahuasca leads to a rapid increase in several mindfulness facets. They saw a decrease in the judgmental processing of personal experiences, a reduction in inner reactivity as well as a increase in the ability to de-center themselves after ayahuasca intake.

Participants concluded that these combined modifications provide an explanatory mechanism that could contribute to the beneficial effects reported for Ayahuasca in the treatment of addiction and depression. In the study discussed previously, looking at the sub-acute and long term effects of Ayahuasca, it was found that there were sub-acute improvements in subjective ratings of mindfulness and satisfaction with life using the same FFMQ scale as the above study. Subjects felt that they were more non-judgmental, acted with more awareness, and were more observant on the day following Ayahuasca. They noted that ratings of mindfulness and satisfaction with life increased by 5–8% relative to baseline, but that Ayahuasca-induced changes in mindfulness were much smaller than changes in symptoms of depression and stress.

Quiz
{Which of these options are a key component of the Ayahuasca? - Hevea brasiliensis + Psychotria virdis - Theobroma cacao - Combretum rotundifolium
 * type=""}

{Which of these options are NOT one of Plutichik's 8 basic emotions? - Joy + Grief - Disgust - Trust
 * type=""}

{What is the leading cause of death in Australia for those between the ages of 15-44? - Car accidents + Suicide - Drug use - Cancer
 * type=""}

Conclusion
The Amazonian psychedelic tea Ayahuasca has been found to produce anxiolytic properties, rapid antidepressant effects, increases of an individuals mindfulness and overall improvements in individuals mental health. Through not only quantitive data but also on qualitative data (as can be seen in the videos of individuals personal experiences) it can be seen{{ic|"can be seen" repeated} that Ayahuasca has a large healing potential for those struggling with anxiety and depression. With suicide being the leading cause of death in Australia for those between the ages of 15-44, it is of great importance that more research be conducted into the use of this emerging plant medicine.