为裸盖菇素治疗准备身体：癌症患者中的接受性与生成性内感受。

文献信息

中文摘要

癌症患者在接受裸盖菇素治疗时，身体已被疾病和治疗改变——这些身体是他们已学会对其绷紧、与之解离或扫描威胁的身体。关于裸盖菇素辅助治疗癌症相关抑郁和焦虑的研究一致认为，急性主观体验的质量——反映在接纳、臣服、无边感、情绪突破等构念中——是治疗获益的关键预测因素。然而，大多数准备方案侧重于认知性意图设定和基本正念，而忽视直接处理身体。我们提出，此情境中的焦虑和抑郁可能涉及一个尚未被充分明确的躯体基础。我们区分了与致幻剂治疗相关的两种“感受身体”的能力：作为感知的内感受（对自下而上身体信号的知觉通达）和内感受性参与（将身体感知与姿势、呼吸、结构意图和情感立场联系起来的更广泛能力）。我们描述了裸盖菇素治疗中躯体体验的六类现象学分类（外感受、深部躯体、内脏、前庭、伤害性、涌现性）。我们还绘制了接受性练习（旨在改善作为感知的内感受）和生成性练习（旨在改善内感受性参与）。该框架以当前内感受的预测编码解释为基础，但不依赖于任何单一神经科学模型。一项正在进行的针对转移性癌症患者团体静修裸盖菇素治疗的2期试验，将初步检验我们的假设：内感受训练可能影响癌症患者裸盖菇素治疗的治疗结局。

英文摘要

Cancer patients arrive for psilocybin therapy with bodies altered by illness and treatment - bodies that they have learned to brace against, dissociate from, or scan for threat. Research on psilocybin-assisted therapy for cancer-related depression and anxiety consistently identifies the quality of the acute subjective experience - reflected in constructs such as acceptance, surrender, boundlessness, and emotional breakthrough - as a key predictor of therapeutic benefit. Yet most preparation protocols focus on cognitive intention-setting and basic mindfulness while neglecting to address the body directly. We propose that anxiety and depression in this setting may involve a somatic substrate that has not been adequately specified. We distinguish two capacities to 'feel into the body' relevant to psychedelic therapy: interoception as perception (the perceptual access to bottom-up bodily signal) and interoceptive engagement (the broader capacity that links bodily perception to posture, breath, structural intent, and affective stance). We describe a six-category phenomenological taxonomy of somatic experiences in psilocybin therapy (exteroceptive, deep somatic, visceral, vestibular, nociceptive, emergent). We also map receptive practices, designed to improve interoception as perception, and generative practices, designed to improve interoceptive engagement. The framework is grounded in current predictive-coding accounts of interoception, but does not depend on any single neuroscientific model. An ongoing Phase 2 trial of group retreat psilocybin therapy for metastatic cancer patients will provide an initial test of our hypothesis that interoceptive training may influence therapeutic outcomes in psilocybin therapy for patients with cancer.