EMBARK Psychedelic Therapy for Depression

Abstract

Abstract EMBARK Psychedelic Therapy for Depression: A New Approach for the Whole Person is a comprehensive guidebook for clinicians that presents a novel therapeutic framework for administering psychedelic medicines. The EMBARK model was developed in response to the growing interest in psychedelic medicines for treating mental health disorders, particularly depression, and the identified gaps in existing models of psychedelic-assisted therapy (PAT). The conventional history of PAT research has been criticized for missing critical histories of harm and the stories of marginalized groups, highlighting the need for a comprehensive, ethical, and inclusive framework. Previous PAT models have been found to lack attentiveness to the body, focus on the therapist-participant relationship, counseling for spiritual experiences, and ethical considerations. They also suffered from underdeveloped therapeutic frames and a reliance on single evidence-based, non-psychedelic PAT approaches. The EMBARK model addresses these shortcomings by offering a transdiagnostic and trans-drug approach adaptable to various indications and psychedelic medicines. It is built upon four Cornerstones of Care: Trauma-Informed Care, Culturally Competent Care, Ethically Rigorous Care, and Collective Care, reflecting a foundational belief that efficacious treatment is ethical treatment. The EMBARK acronym points to six Clinical Domains that commonly emerge in psychedelic experiences: Existential-Spiritual, Mindfulness, Body Aware, Affective-Cognitive, Relational, and Keeping Momentum. For the treatment of depression, twelve mechanisms of therapeutic change are outlined. It also provides a comprehensive guide to the clinical considerations and treatment factors, including therapist credentials, skills, therapeutic presence, personal growth, experiential training, and personal commitment to receiving supervision, peer consultation, and support as a provider. The EMBARK approach incorporates evidence-based treatment techniques and points to an emerging evidence-base for the approach from ongoing randomized controlled trials (RCTs). EMBARK psychedelic therapy is intended to be open-sourced to the clinical community for development and adaptation to other psychedelic medicines (e.g., DMT, LSD, MDMA, ketamine) other contexts (e.g. group therapy, conjoint/couples therapy), diverse populations (e.g., LGBTQIA+ participants) and to inform the development of psychedelic practitioner trainings.