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We examined if the therapeutic alliance between study participants and intervention facilitators in a psilocybin-assisted therapy (PAT) trial changed over time and whether there were relationships between alliance, acute psilocybin experiences, and depression outcomes. In a randomized, waiting list-controlled clinical trial for major depressive disorder in adults ( N = 24), participants were randomized to an immediate ( N = 13) or delayed ( N = 11) condition with two oral doses of psilocybin (20mg/70kg and 30mg/70kg). Ratings of therapeutic alliance significantly increased from the final preparation session to one-week post-intervention ( p = .03, d = .43). A stronger total alliance at the final preparation session predicted depression scores at 4 weeks ( r = -.65, p = .002), 6 months ( r = -.47, p = .036), and 12 months ( r = -.54, p = .014) post-intervention. A stronger total alliance in the final preparation session was correlated with higher peak ratings of mystical experiences ( r = .49, p = .027) and psychological insight ( r = .52, p = .040), and peak ratings of mystical experience and psychological insight were correlated with depression scores at 4 weeks ( r = -.45, p = .030 for mystical; r = -.75, p < .001 for insight). Stronger total alliance one week after the final psilocybin session predicted depression scores at 4 weeks ( r = -.85, p < .001), 3 months ( r = -.52, p = .010), 6 months ( r = -.77, p < .001), and 12 months ( r = -.61, p = .001) post-intervention. These findings highlight the importance of the therapeutic relationship in PAT. Future research should explore therapist and participant characteristics which maximize the therapeutic alliance and evaluate its relationship to treatment outcomes. Trial registration: Registration: Clinicaltrials.gov NCT03181529 . https://classic.clinicaltrials.gov/ct2/show/NCT03181529 .

Frequent hemodialysis and conventional hemodialysis were compared for 12 months. Frequent hemodialysis was associated with improvement in primary outcomes (death or change in LV mass and death or change in physical health), but more interventions related to vascular access were required. When 90% or more of usual kidney function is lost, either kidney transplantation or dialysis is required to sustain life. Nearly 400,000 persons in the United States and 2 million worldwide are dependent on dialysis; of these, approximately 90% in the United States and 70% in Canada undergo hemodialysis, which is typically delivered three times a week. 1 The rationale for thrice-weekly hemodialysis was derived from a combination of physiological experiments, assessments of patient acceptance, feasibility, logistics, and costs. 2 – 4 Mortality remains high (approximately 18 to 20% per year) despite improvements in the technology for dialysis, the development of new pharmaceutical . . .