Memory, trauma, and self: Remembering and recovering from sexual abuse in psychedelic-assisted therapy

After a decades-long pause, psychedelics are again being intensely investigated for treating a wide range of neuropsychiatric ailments including depression, anxiety, addiction, post-traumatic stress disorder, anorexia, and chronic pain syndromes. The classic serotonergic psychedelics psilocybin and lysergic acid diethylamide and nonclassic psychedelics 3,4-methylenedioxymethamphetamine and ketamine are increasingly appreciated as neuroplastogens given their potential to fundamentally alter mood and behavior well beyond the time window of measurable exposure. Imaging studies with psychedelics are also helping advance our understanding of neural networks and connectomics. This resurgence in psychedelic science and psychedelic-assisted therapy has potential significance for the fields of neurosurgery and neuro-oncology and their diverse and challenging patients, many of whom continue to have mental health issues and poor quality of life despite receiving state-of-the-art care. In this study, we review recent and ongoing clinical trials, the set and setting model of psychedelic-assisted therapy, potential risks and adverse events, proposed mechanisms of action, and provide a perspective on how the safe and evidence-based use of psychedelics could potentially benefit many patients, including those with brain tumors, pain syndromes, ruminative disorders, stroke, SAH, TBI, and movement disorders. By leveraging psychedelics' neuroplastic potential to rehabilitate the mind and brain, novel treatments may be possible for many of these patient populations, in some instances working synergistically with current treatments and in some using subpsychedelic doses that do not require mind-altering effects for efficacy. This review aims to encourage broader multidisciplinary collaboration across the neurosciences to explore and help realize the transdiagnostic healing potential of psychedelics.

Disengaged: A systematic review of community engagement in psychedelic-assisted therapy research.

Supporting desistance from crime: The promise of psychedelic-assisted therapy in correctional and reentry contexts.

Psychedelic-assisted therapy (PAT) is permitted in Switzerland under its limited medical use program. Data from patients in this program represent a unique opportunity to analyze the real-world practice of PAT. This study compared the subjective effects of lysergic acid diethylamide (LSD) and psilocybin between patients undergoing PAT and healthy volunteers. For the patients, it also investigated the relationship between antidepressant effects and six measures of acute drug effects. We compared data on acute psychedelic drug effects between 28 PAT patients with data from 28 healthy participants who participated in a randomized, double-blind crossover trial. All participants received varying doses of psilocybin and LSD. Subjective effects were assessed on an hourly basis during the acute drug effects, and the Mystical Experience Questionnaire (MEQ) was completed retrospectively. For patients, depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). Ratings of overall drug effect and mystical experience were similar across groups. Compared with healthy controls, patients reported lower ratings of ego dissolution. Patients showed a significant decrease in MADRS scores, and the greatest predictor of antidepressant outcome was relaxation during the PAT session. We did not observe a relationship between mystical-type experiences and antidepressant effects. Most patients experienced mild adverse effects which resolved within 48 h. PAT reduced depressive symptoms in this heterogeneous patient group. Patients may experience more challenging psychedelic effects and reduced ego dissolution. Hourly assessment of drug effects may predict clinical outcomes better than retrospectively assessed mystical experiences, and the impact of relaxation during PAT should be investigated further.

Psilocybin, a naturally occurring psychedelic compound found in certain fungi has long been used by Indigenous cultures within ritual and ceremony for healing and spiritual purposes (Spiers et al., 2024). While emerging evidence points to psychedelic agents being novel avenues for the treatment of substance use disorders, the predominantly Western medical models of psychedelic-assisted therapy (PAT) being developed lack Indigenous wisdom and input, raising concerns about cultural safety, efficacy, ownership, and continuing colonial dynamics. In Aotearoa (New Zealand), the enduring impacts of colonisation on Māori include the suppression of Indigenous wisdom, even as research affirming the knowledge and practice of traditional Māori healing is on the rise.The Tū Wairua project will explore the integration of rongoā Māori (traditional Māori healing practices) with PAT for addressing problematic methamphetamine use (PMU) in Māori communities. This Māori-led project is driven by Kaupapa Māori methodology, rongoā Māori conceptualisations of health and informed by biomedical psychedelic science. Based at Rangiwaho Marae in Te Tairāwhiti (Gisborne), a community with a high Māori population and a significant burden of PMU, the project aims to develop a decolonised culturally-appropriate approach to PAT to explore the efficacy of psilocybin in treating PMU.This research represents a shift toward health interventions that respect and extend Indigenous wisdom, addressing the unique needs of Māori communities. It also seeks to develop a skilled Māori workforce to continue these healing practices, and challenge current legislation that restricts the use of Indigenous psychedelic medicines. In creating sustainable pathways for collective healing through a community-driven, culturally-resonant PAT, Tū Wairua charts new directions in Indigenous-led psychedelic science.

ABSTRACTAustralian government approval has been granted for 3,4‐methylenedioxy‐methamphetamine (MDMA) treatment of post‐traumatic stress disorder and psilocybin for treatment‐resistant depression, but the process of translating psychedelic‐assisted therapies (PAT) into more widespread use is complex. Along with establishing the efficacy and feasibility of PATs, their acceptability amongst consumers is a crucial factor of successful implementation. This study utilised the Theory of Planned Behaviour to evaluate the acceptability of PATs amongst mental health consumers, identifying potential influences of these attitudes and predictors of PAT uptake. Participants completed an online survey between February and July 2023. Survey items evaluated consumer characteristics, acceptability of PAT (effectiveness, efficacy and social norms) and behavioural intentions to undertake PAT. The 254 participants had a mean age of 42.5 years (SD = 12.8) and 79.1% were female. Three quarters expressed a desire to access PAT. Acceptability scores indicated strong agreement regarding the effectiveness of PAT, social norms that moderately endorsed PAT and mixed feelings about its expected efficacy. Whilst univariate analyses indicated that previous psychedelic experience was associated with increased acceptability of PAT (ds = 0.63–0.80), multivariate analyses revealed that intentions to access PAT were associated with higher acceptability scores (ds = 0.37–1.32) and poorer experiences of conventional therapy (d = −0.31). Although a relatively large portion of participants had used psychedelics recreationally, the desire to access PATs was more strongly related to its acceptability, along with more negative experiences of conventional therapy. This implies that mental health consumers who are looking for alternatives to conventional therapy may view PATs as a desirable option, despite some safety reservations.

SPECIAL ISSUE: Do Biofeedback, Neurofeedback, and Neuromeditation Have a Role in Psychedelic-Assisted Therapies?

There is a disparity between contemporary scientific investigations into psychedelic phenomena and their 20th-century counterparts, notably the lack of examination of psychedelic experiences within group settings. Whereas early research studies from the 1950s to the 1970s explored communal settings in psychedelic-assisted therapy (PAT), today's resurgence of scholarship in the field primarily considers individualised, often clinical, settings. Consequently, there is an absence of empirical research and theoretical innovation on collective psychedelic contexts, for example, how social connectedness occurs relationally and what its impacts are. This paper addresses this gap by revisiting and applying Emile Durkheim's theory of "collective effervescence." By analysing interview data from participants of a group-based weeklong PAT retreat and supplementing it with ethnographic data, this study highlights the usefulness of incorporating sociological theory to examine and explain the social dynamics and therapeutic outcomes of collective psychedelic experiences. In doing so, this research study contributes to bridging the divide between psychedelic science, psychedelic studies and the social sciences by offering sociological insight into the transformative yet hitherto neglected potential of group-based psychedelic events for therapeutic benefits.

Background Numerous clinical trials have supported psychedelic-assisted therapy (PAT) as a treatment for psychiatric disorders such as depression, anxiety, post-traumatic stress, and substance use. While empirical evidence indicates PAT’s benefits, the perspectives of mental health practitioners on this topic remain unclear. Methods This quantitative study attempted to capture psychoanalyst practitioners’ attitudes toward PAT. A sample of 130 graduate-level trained psychoanalysts in at least part-time clinical practice was recruited to participate in an online survey. Results The study found that psychoanalysts were cautiously supportive of PAT, open to their clients engaging in PAT, and optimistic about PAT’s potential in treating mental disorders. Additionally, they reported that PAT would be ineffective in treating substance use disorders (SUDs). Lastly, participants who reported a history of psychedelic use were significantly more likely to have greater positive attitudes toward PAT than those who had not. Conclusion Results indicate the potential for misinformation about psychedelics and a lingering cultural stigma regarding the utility of psychedelics in the therapeutic environment among psychoanalysts. Therefore, education on the risks, potential benefits, and limitations of the evidence base of psychedelics and their effectiveness across psychiatric disorders appears warranted in the psychoanalytic community.

With several classical psychedelics being designated as breakthrough therapies and the recent review of a New Drug Application for 3,4-Methylenedioxymethamphetamine in the treatment of posttraumatic stress disorder, the likelihood of psychedelic medication becoming approved for clinical use in the United States is high. Psychedelic-assisted therapy (PAT) may have a high demand in rural America, where residents experience higher burdens of morbidity and premature mortality, due to unique social disparities not shared by urban residents. In these rural settings, barriers to accessing PAT include geographic, economic, and cultural factors as well as the preexisting shortage of health care providers. Disparate access to PAT for rural residents in the United States could exacerbate existing rural-urban inequities. Thus far, the potential challenges of implementing PAT in rural communities have not been extensively discussed in the medical literature. In this perspective, we explore notable implementation barriers in the rural setting and propose potential solutions, including the incorporation of PAT into rural health care training programs, leveraging tools for remote care such as teletherapy for PAT preparation and integration sessions, and implementing new models of care and economic incentives to enable rural PAT providers and rural generalists to deliver PAT. Providing PAT in rural areas will require creative approaches to surmount significant obstacles: the potential solutions discussed here may help ensure rural populations are not left behind if psychedelic medicine is reincorporated into clinical practice in the United States.

Psychedelic-assisted therapy (PAT) is a burgeoning treatment with growing interest across a variety of settings and disciplines. Empirical evidence supports PAT as a novel therapeutic approach that provides safe and effective treatment for people suffering from a variety of diagnoses, including treatment-resistant depression, substance use disorder, and post-traumatic stress disorder. Within the palliative care (PC) field, one-time PAT dosing may lead to sustained reductions in anxiety, depression, and demoralization-symptoms that diminish the quality of life in both seriously ill patients and those at end of life. Despite a well-noted psychedelic renaissance in scholarship and a renewed public interest in the utilization of these medicines, serious illness-specific content to guide PAT applications in hospice and PC clinical settings has been limited. This article offers 10 evidence-informed tips for PC clinicians synthesized through consultation with interdisciplinary and international leading experts in the field with aims to: (1) familiarize PC clinicians and teams with PAT; (2) identify the unique challenges pertaining to this intervention given the current legalities and logistical barriers; (3) discuss therapeutic competencies and considerations for current and future PAT use in PC; and (4) highlight critical approaches to optimize the safety and potential benefits of PAT among patients with serious illness and their caregivers.

Psychedelic-assisted therapy research for depression and PTSD has been fast tracked in the United States with the Food and Drugs Administration (FDA) granting breakthrough designations for MDMA (post-traumatic stress disorder) and psilocybin (major depressive disorder). The psychotherapeutic treatments accompanying these psychedelics have not been well-studied and remain controversial. This article reviews the challenges unique to psychedelic-assisted therapy and introduces a newly optimised psychological flexibility model that adapts Contextual Behavioural Science (CBS)/Acceptance and Commitment Therapy (ACT) to those multiple challenges, including ego inflation, traumatic memories, and the perceived presence of entities. A methodology aligned with biological mechanisms, psychological processes and therapeutic contexts may be advantageous for improving outcomes. This model expands ACT by integrating practices and data from psychedelic-assisted therapy research into a Contextual Behavioural Science framework, allowing both fields to inform each other. Psychological flexibility processes are questioned and adapted to a psychedelic context, and interventions that operationalise these processes are considered. The principle through-line of the paper is to consider varied constructs of Self, as understood by these fields, and integrates respective elements of varied self-models, interventions and data into a Spectrum of Selves model for psychedelic-assisted therapy. Secondly the paper examines how to select and retain new self-perspectives and their corresponding behaviours systemically, drawing from evolutionary science principles. A case example of such behavioural reinforcement is provided, as well as a psychedelic integration checklist to guide the practical implementation of such an approach. This method can enable a coherent therapeutic framework with clear operational relationships between (1) problematic behaviour patterns that an individual wishes to address (2) the guided psychedelic experiences of that individual, and (3) the barriers to maintaining any changes, thus increasing theoretical-practical coherence, broadening treatment benefits and reducing relapse in psychedelic-assisted therapy. Research questions for further developing a CBS-consistent psychedelic-assisted therapy are offered.

Irritable bowel syndrome (IBS) is prevalent and can be disabling. Many patients remain symptomatic despite behavioral and medical therapies. Psychedelic-assisted therapy (PAT), in which serotonergic agents like psilocybin are administered in a psychotherapeutic context, has shown promise for refractory psychiatric disorders, including major depressive disorder and post-traumatic stress disorder. Emerging evidence suggests PAT may also be beneficial for chronic pain conditions, including fibromyalgia, low back pain, and migraines. IBS is highly comorbid with depression, anxiety, and other chronic pain disorders, suggesting shared cognitive and neurological roots and potentially shared therapeutic targets. In this editorial, we discuss 3 lines of evidence for PAT as a treatment for IBS, under the overarching themes of (1) psychological mechanisms (the findings from historic studies of psychedelics for chronic pain and the elements of psychobiological dysfunction targeted by PAT), (2) central nervous system mechanisms (default mode network modulation and induction of neuroplasticity), and (3) the neurointestinal pathophysiology of IBS that may be modified by PAT. We argue that this evidence suggests PAT is worthy of study as a new therapy for IBS, and potentially for other disorders of gut-brain interaction (DGBI). Successful application of PAT to gastrointestinal disease would represent a major step beyond mind-body dualism, with potential implications for other functional somatic disorders.

The fields of palliative and holistic Nursing are dedicated to providing comprehensive care for the person, emphasizing special attention to the existential and spiritual aspects of care. Psychedelic-assisted therapy has emerged as a promising approach for symptom management in individuals with serious illnesses, particularly those of existential and spiritual origin. People who undergo challenging experiences, as is the case with serious illnesses, often undergo an identity crisis and question the purpose of their lives. Psychedelic therapy, when conducted properly by trained professionals, can facilitate self-exploration and self-transcendence, opening doors to states of expanded consciousness and fostering a profound connection with oneself. This experience can help patients develop a greater sense of self-awareness and a deeper understanding of their existential and spiritual issues, enabling them to find meaning and inner peace. The Theory of Self-Transcendence theory provides a Nursing framework for understanding how psychedelic-assisted therapy can facilitate, through self-transcendence, the journey of spiritual and existential healing, offering the possibility of achieving wellbecoming from a state of vulnerability.

Psychedelic-assisted therapy research for depression and PTSD has been fast tracked in the United States with the Food and Drugs Administration( FDA) granting breakthrough designations for MDMA (post-traumatic stress disorder) and psilocybin (major depressions) disorder. The psychotherapeutic treatments accompanying these psychedelics has not been well studied and remain controversial . This article reviews the challenges unique to psychedelic-assisted therapy and introduces a newly optimised psychological flexibility model that adapts Contextual Behavioural Science (CBS)/Acceptance and Commitment Therapy (ACT) to those multiple challenges, including ego inflation, traumatic memories, and the perceived presence of entities. A methodology aligned with biological mechanisms, psychological processes and therapeutic contexts may be advantageous for improving outcomes. This model expands ACT by integrating practices and data from psychedelic-assisted therapy research into a Contextual Behavioural Science framework, allowing both fields to inform each other. Psychological flexibility processes are questioned and adapted to a psychedelic context, and interventions that operationalise these processes are considered. The principle through-line of the paper is to consider varied constructs of Self, as understood by these fields, and integrates respective elements of varied self-models, interventions and data into a Spectrum of Selves model for psychedelic-assisted therapy. Secondly the paper examines how to select and retain new self-perspectives and their corresponding behaviours systemically, drawing from evolutionary science principles. A brief yet detailed case example of such behavioural reinforcement is provided, as well as a psychedelic integration checklist to guide the practical implementation of such an approach. This method can enable a coherent therapeutic framework with clear operational relationships between 1) problematic behaviour patterns that an individual wishes to address 2) the guided psychedelic experiences of that individual, and 3) the barriers to maintaining any changes, thus increasing theoretical-practical coherence, broadening treatment benefits and reducing relapse in psychedelic-assisted therapy. Research questions for further developing a CBS-consistent psychedelic-assisted therapy are offered.