Psychedelic-assisted Psychotherapy Research Articles

Significant Psychedelic Experiences Evaluated for Mystical Characteristics Associated with Cannabis Use Reduction and Psychological Flexibility Improvement: A Naturalistic Cross-Sectional Retrospective Survey

ABSTRACT Treating cannabis use disorder remains a significant challenge in the field of addiction medicine. Some recent studies point to psychedelic-assisted psychotherapy as a potential treatment option for substance use disorders. The objective of this study was therefore to explore the impact of naturalistic psychedelic experiences on cannabis use and psychological flexibility. An online retrospective survey was carried out on 152 cannabis users who also reported a significant experience induced by psychedelics in the past. Following a psychedelic experience, there was a significant and sustained reduction of average CUDIT score (p < .001), frequency of cannabis use (p < .001), and acute duration of daily intoxication (p < .001). Cannabis use reduction during the first month post-experience was significantly associated with the intensity of the mystical experience (p = .01). Participants reported a concomitant increased lasting improvement of psychological flexibility following the experience (p < .001), which was correlated to the intensity of the mystical experience during the first month post-experience (p = .04). This study demonstrates that naturalistic psychedelic experiences may be followed by a decrease in cannabis use. Positive health outcomes appear potentially connected to the intensity of the mystical experience, as well as an improvement in psychological flexibility.

Psychothérapie assistée par psychédéliques (PAP) : le modèle genevois

BackgroundIn this article, we aim to describe an interdisciplinary model for psychedelic assisted psychotherapy (PAP) that we have developed at the Geneva University Hospitals, in an institutional setting. Our model integrates the collaborative efforts of psychiatrists, psychologists, and nurses establishing a structured framework for administering PAP in a safe, controlled, and scientifically rigorous manner. IntroductionPsychedelic assisted psychotherapy (PAP) is a psychotherapeutic approach that utilizes the profound alteration of the state of consciousness induced by psychedelic substances to enhance therapeutic outcomes. This innovative approach, which has been neglected due to historical biases rather than empirical evidence, is now experiencing a renewed interest among clinicians. Contemporary research, equipped with advanced methodologies and a rigorous scientific approach, is showing significant therapeutic potential for a range of mental health disorders. In Switzerland, the legal framework has allowed since 2014 for exceptional authorizations for the medicinal use of LSD and psilocybin for therapeutic purposes, under strict regulations. MethodHere, we provide a comprehensive description of the PAP protocol implemented at the Geneva University Hospitals, beginning with its inception in September 2020. Our methodological outline includes the administrative and clinical selection criteria for patient eligibility; the preparatory sessions designed to introduce the patients with psychoeducation interventions and the analysis of intention and therapeutical objectives; the controlled administration of psychedelics in a supportive environment; and the integration sessions that follow psychedelic experiences. Our protocol emphasizes safety, ethical considerations, and the importance of a supportive therapeutic relationship throughout the process. We also describe questionnaires we use to qualify and assess the alteration in the state of consciousness, namely The Five Dimension Altered States of Consciousness (5AD-ASC) and the Mystical Experience Questionnaire (MEQ). Since the start of the program in September 2020 and up to February 2024, a total of 224 personal authorizations (114 LSD, 110 Psilocybin) have been issued to the Geneva University Hospital PAP team, for a total of 396 individual sessions. DiscussionThe core argument presented in this article is that the psychedelic-induced alteration of consciousness is a novel therapeutic tool, which works as a potent catalyst that can be synergistically combined with traditional dialogue-based psychotherapy. This combination has the potential to support the psychotherapeutic processes and enable breakthroughs in cases where conventional therapy has reached its limits. We discuss the implications of this approach, reflecting on both its challenges and its transformative potential within its clinical application. ConclusionThe conclusion of our article is an endorsement of the continued basic and clinical research on PAP. By presenting a detailed framework of the PAP process, including its preparatory, experiential, and integrative phases, we advocate for a structured and scientifically grounded exploration of its therapeutic efficacy. Our conclusion calls for a broader acceptance and integration of PAP within clinical practice, provided it is underpinned by ongoing research, ethical practice, and institutional support.

Psychedelic-assisted psychotherapy: where is the psychotherapy research?

Psychedelic-assisted psychotherapy (PAP) has emerged as a potential treatment for a variety of mental health conditions, including substance use disorders and depression. Current models of PAP emphasize the importance of psychotherapeutic support before, during, and after ingestion of a psychedelic to maximize safety and clinical benefit. Despite this ubiquitous assumption, there has been surprisingly little empirical investigation of the "psychotherapy" in PAP, leaving critical questions about the necessary and sufficient components of PAP unanswered. As clinical trials for psychedelic compounds continue the transition from safety- and feasibility-testing to evaluating efficacy, the role of the accompanying psychotherapy must be better understood to enhance scientific understanding of the mechanisms underlying therapeutic change, optimize clinical outcomes, and inform cost-effectiveness. The present paper first reviews the current status of psychotherapy in the PAP literature, starting with recent debates regarding "psychotherapy" versus "psychological support" and then overviewing published clinical trial psychotherapy models and putative models informed by theory. We then delineate lessons that PAP researchers can leverage from traditional psychotherapy research regarding standardizing treatments (e.g., publish treatment manuals, establish eligibility criteria for providers), identifying mechanisms of change (e.g., measure established mechanisms in psychotherapy), and optimizing clinical trial designs (e.g., consider dismantling studies, comparative efficacy trials, and cross-lagged panel designs). Throughout this review, the need for increased research into the psychotherapeutic components of treatment in PAP is underscored. PAP is a distinct, integrative, and transdisciplinary intervention. Future research designs should consider transdisciplinary research methodologies to identify best practices and inform federal guidelines for PAP administration.

Attitudes of European psychiatrists on psychedelics: a qualitative study

Introduction and aimIt is important to understand how mental health practitioners view recent findings on psychedelic-assisted psychotherapy (PAP) as there is potential this treatment may be incorporated into clinical practice. The aim of our study was to explore how psychiatrists who are not involved in psychedelic research and who are located in the European region perceive psychedelics and PAP.MethodsWe conducted online semi-structured interviews with 12 psychiatry specialists and psychiatry trainees from 8 European countries. Data were analyzed using a general inductive approach informed by codebook thematic analysis.ResultsBased on the interviews, we developed four main themes and 14 sub-themes, including (1) Psychedelics hold potential, (2) Psychedelics are dangerous, (3) Future of psychedelics is uncertain, and (4) Psychiatry is ambivalent toward psychedelics.DiscussionOur respondents-psychiatrists acknowledged the potential of PAP but remained cautious and did not yet perceive its evidence base as robust enough. Education on psychedelics is lacking in medical and psychiatric training and should be improved to facilitate the involvement of mental health experts in decision-making on PAP.

Perspectives and preliminary experiences of psychedelics for the treatment of eating disorders: A systematic scoping review.

Research regarding the therapeutic application of psychedelics and psychedelic-assisted psychotherapy in the treatment of eating disorders (EDs) has begun to emerge. This systematic scoping review aimed to map and synthesise the existing evidence regarding the participant reported efficacy and perspectives concerning psychedelics in the treatment of EDs, and to identify significant research gaps. A systematic search was undertaken across several databases in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. 1290 publications were identified, 1135 after duplicates removed, with 17 meeting full-eligibility criteria. Overall, findings suggested that most participants reported experiencing a meaningful reduction in their ED symptoms and having positive experiences or an openness to explore psychedelics as a treatment for ED symptoms, although some noted concerns of adverse effects and the importance of having psychological support to increase safety and efficacy. While preliminary research suggests psychedelics and psychedelic-assisted psychotherapy may be a viable treatment option for ED symptoms, further research with more robust research designs is required to increase confidence in its efficacy, generalisability, and safety as a therapeutic medium.

Perceptions and attitudes towards psychedelic-assisted psychotherapy among health professionals, patients, and the public: A systematic review

AbstractBackground and aimsScientific interest in the therapeutic potential of psychedelics has been experiencing significant growth. Understanding the perceptions of psychedelic assisted psychotherapy (PAP) among health professional, patients, and the public is essential to guide future research objectives, trial protocols, and identify any barriers to future implementation.MethodsA comprehensive search of the databases (Medline, EMBASE, PSYCHinfo, SCOPUS, and Web of Science) was conducted on the 29th of November, 2022. This review included cross-sectional, longitudinal, and quasi-experimental studies published in peer-reviewed journals exploring perceptions of PAP among the three stakeholder groups. Studies were limited to English-language and the years 2012–2022. The protocol and review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.ResultsThe sample consisted of 29 studies, including n = 17 health professional, n = 6 patients, and n = 6 public. Broadly, knowledge of PAP was low among all three stakeholder groups. There was mixed to positive belief in the therapeutic potential of psychedelics, with male gender, younger age, and personal psychedelic experience/knowledge being key predictors of more favourable views. The majority of findings reported strong endorsement of further research. Consistent themes were identified surrounding concerns about legal status, funding, access, side-effects, and implementation.ConclusionThe evaluated research indicates a need for further research that will provide clarity about safety and elucidate how PAP may be implemented in public health settings. Further education of health professionals and the public should be a priority.

A Review of Psychedelic-Assisted Psychotherapy for Cancer Patients with Emotional Distress

A Review of Psychedelic-Assisted Psychotherapy for Cancer Patients with Emotional Distress

Producing Altered States of Consciousness, Reducing Substance Misuse: A Review of Psychedelic-Assisted Psychotherapy, Transcendental Meditation and Hypnotherapy

A set of interventions that can produce altered states of consciousness (ASC) have shown utility in the treatment of substance misuse. In this review, we examine addiction-related outcomes associated with three common interventions that produce ASCs: psychedelic-assisted psychotherapy (PP), Transcendental Meditation (TM) and hypnotherapy (HT). While procedurally distinct, all three interventions are associated with some common phenomenological, psychological, and neurobiological features, indicating some possible convergent mechanisms of action. Along with addiction and mental health outcomes, these common features are reviewed, and their impact on substance misuse is discussed. While our review highlights some mixed findings and methodological issues, results indicate that PP and TM are associated with significant improvements in substance misuse, alongside improvements in emotional, cognitive and social functioning, behavior-change motivation, sense of self-identity, and meaning. In contrast, and despite its broader acceptance, HT has been associated with mixed and minimal results with respect to substance misuse treatment. Authors identify key research gaps in the role of ASC interventions in addiction and outline a set of promising future research directions.

Nursing in psychedelic-assisted psychotherapy: new opportunities and future prospects

This article looks at the emerging field of psychedelic-assisted psychotherapy and the nurse's role within that – something which is currently unexplored and wholly undefined. It draws from lived experience in psychedelic-assisted psychotherapy and is co-authored by a significant contributor in this field. The aim of the article is to give nurses a brief introduction to the field of psychedelic-assisted psychotherapy (history and present) and provide insights on professional development opportunities in the wake of such treatments being widely recognised, accepted and in need of nursing input in the future.

Informed Consent to Psychedelic-Assisted Psychotherapy: Ethical Considerations.

Informed Consent to Psychedelic-Assisted Psychotherapy: Ethical Considerations.

Psychedelics and critical theory

AbstractIn the monograph Philosophy and Psychedelics: Frameworks for Exceptional Experience, Hauskeller raises the important subject of individualization and alienation in psychedelic psychotherapy. Under the prevailing conditions of neoliberalism, Hauskeller contends that psychedelic-assisted psychotherapy appropriates Indigenous knowledges in an oppressive fashion, may be instrumentalised to the ends of productivity gain and symptom suppression, and may be utilised to mask societal systems of alienation. Whilst offering a valuable socio-political critique of psychedelics' clinical uptake, we suggest that Hauskeller's view does not adequately acknowledge the ways in which psychedelics offer a challenge to the Western reductive bio-medical understanding of healing and wellbeing. It is contended herein that Indigenous knowledges, in alliance with a range of emerging sciences, offer both an engagement with ethnomedicines in a less harmfully appropriative fashion, and a renewed understanding of the means by which psychedelics achieve therapeutic change. With this understanding, what becomes apparent are the potential ways in which psychedelic medical usage may produce positive feedback upon the oppressive systems in which we are embedded. That is, transpersonal experience through encounters with the ineffable may offer a revisioning of Western psychology and cognitive science. Indeed, if psychedelics are approached with an understanding of the actual means by which they produce therapeutic outcomes—changing mental representations of the self, or self-insight derived through non-ordinary states of consciousness—then psychedelic psychotherapy offers a reimagining of psychiatric nosology, challenging conventional understandings of both pathology and wellbeing through an overturning of specified and discrete deficit models of psychopathology. This may provide both a critique of the prevailing categories used to describe madness and an expansion of our understanding of the mind-body relation, as well as an increased recognition of positive psychology grounded in cross-cultural contemplative traditions. This provides an implicit challenge to the pharmaceutical industrial-complex and its profit motives; and the corresponding neoliberalist, globalising tendencies which Hauskeller seeks to address.

Peer support and psychedelics

LAY SUMMARY The new practices of psychedelic-assisted psychotherapy and state-run psychedelic services need trained facilitators. This article aligns the role of peer support in both the psychedelic and the Veteran communities, displaying core competencies and current practices, while also highlighting further needs in training and supervision. Continued work with peer support in the legal facilitation of psychedelic experiences will deepen understanding of psychedelic peership (i.e., when someone with previous firsthand experience with psychedelics facilitates the psychedelic therapy session of another).

When the Trial Ends: The Case for Post-Trial Provisions in Clinical Psychedelic Research

The ethical value—and to some scholars, necessity—of providing trial patients with post-trial access (PTA) to an investigational drug has been subject to significant attention in the field of research ethics. Although no consensus has emerged, it seems clear that, in some trial contexts, various factors make PTA particularly appropriate. We outline the atypical aspects of psychedelic clinical trials that support the case for introducing the provision of PTA within research in this field, including the broader legal status of psychedelics, the nature of the researcher-therapist/participant relationship, and the extended time-frame of the full therapeutic process. As is increasingly understood, the efficacy of psychedelic-assisted psychotherapy is driven as much by extrapharmacological elements and the cultural therapeutic container as by the drug itself. As such, we also advocate for a refocusing of attention from post-trial access to a broader concept encompassing other elements of post-trial care. We provide an overview of some of the potential post-trial care provisions that may be appropriate in psychedelic clinical trials. Although the World Medical Association’s Declaration of Helsinki calls on researchers, sponsors, and governments to make provisions for post-trial access, such provision may feel impracticable or out-of-reach within psychedelic trials that are already constrained by a high resource demand and significant bureaucratic burden. We show how conceiving of post-trial provision as an integral site of the research process, and an appropriate destination for research funding, will serve to develop the infrastructure necessary for the post-legalisation psychedelic medicine ecosystem.

Mystical and Affective Aspects of Psychedelic Use in a Naturalistic Setting: A Linguistic Analysis of Online Experience Reports

ABSTRACT Analyzing online retrospective experience reports of psychedelic use can provide valuable insight into their acute subjective effects. Such reports are unexplored in relation to mystical states, which are thought to be a therapeutic mechanism within psychedelic-assisted psychotherapy. We created a set of words that, when encountered in an experience report, indicate the occurrence of mystical elements within the experience. We used the Shroomery.org website to retrieve 7317 publicly available retrospective psychedelic experience reports of psychedelic use, primarily of psilocybin, and have a designated experience intensity level self-assessed by the text authors during submission of the report. We counted the mystical language words using Linguistic Inquiry and Word Count (LIWC) software and additionally performed sentiment analysis of all reports. We found that the occurrence of mystical language grew with increased self-reported experience intensity. We also found that negative sentiment increased, and positive sentiment decreased as self-reported psychedelic experience intensity increased. These two findings raise the question of whether mystical experiences can co-exist with challenging elements within the psychedelic experience, a consideration for future qualitative studies. We present a new mystical language dictionary measure for further use and expansion, with some suggestions on how it can be used in future studies.

Songs of Life: Psychedelic-Assisted Psychotherapy and Deleuze and Guattari’s ‘Desiring-Production’

This paper argues that practitioners of psychedelic-assisted therapy could learn a great deal from Deleuze and Guattari’s critique of psychoanalysis in Anti-Oedipus, as well as the practice of materialist psychiatry – schizoanalysis – that they offer in its stead. Much of the clinical research on psychedelics (particularly psilocybin) over the past fifteen years has privileged mystical experience, assessed according to a quantifiable scale, as the goal of psychedelic-assisted psychotherapy and source of cure ( Griffiths et al. 2006 , 2016 ; Barrett and Griffiths 2018 ; Pollan 2018 ). Has ‘mystical experience’ become the ‘imperialism of Oedipus’ within the psychedelic revival, towards which all psychedelic experience and activity of the unconscious is expected to tend? Distressed patients would be better held, I contend, through a therapeutic practice that adopts Deleuze and Guattari’s concept of the unconscious as a desiring-machine and the cure as a completion of the process of desiring-production that is not arrested and reduced to pre-assigned ends. In this mode of working with psychedelics, the embodied memories, visions and sensations of the patient do not in a predetermined way ‘express’ or ‘represent’ a perennial, quantifiable experience (or myth). Rather, they enable the positive task of schizoanalysis of learning what a subject’s desiring-machines are and how they work, and the negative task of identifying and destroying all that stands in the way of their functioning.

Ensuring the affordable becomes accessible-lessons from ketamine, a new treatment for severe depression.

In this paper, the case study of ketamine as a new treatment for severe depression is used to outline the challenges of repurposing established medicines and we suggest potential solutions. The antidepressant effects of generic racemic ketamine were identified over 20 years ago, but there were insufficient incentives for commercial entities to pursue its registration, or support for non-commercial entities to fill this gap. As a result, the evaluation of generic ketamine was delayed, piecemeal, uncoordinated, and insufficient to gain approval. Meanwhile, substantial commercial investment enabled the widespread registration of a patented, intranasal s-enantiomeric ketamine formulation (Spravato®) for depression. However, Spravato is priced at $600-$900/dose compared to ~$5/dose for generic ketamine, and the ~AUD$100 million annual government investment requested in Australia (to cover drug costs alone) has been rejected twice, leaving this treatment largely inaccessible for Australian patients 2 years after Therapeutic Goods Administration approval. Moreover, emerging evidence indicates that generic racemic ketamine is at least as effective as Spravato, but no comparative trials were required for regulatory approval and have not been conducted. Without action, this story will repeat regularly in the next decade with a new wave of psychedelic-assisted psychotherapy treatments, for which the original off-patent molecules could be available at low-cost and reduce the overall cost of treatment. Several systemic reforms are required to ensure that affordable, effective options become accessible; these include commercial incentives, public and public-private funding schemes, reduced regulatory barriers and more coordinated international public funding schemes to support translational research.

In naturalistic psychedelic use, group use is common and acceptable

AbstractBackground and aimsMost modern modalities of psychedelic-assisted psychotherapy (PAP) aim to minimize harm and maximize support by utilizing close, formalized supervision for a single participant per session. However, these substances are used naturalistically in a wide variety of settings. Our goal was to evaluate the perceived benefits and harms of naturalistic psychedelic use in diverse settings, with and without guidance/supervision.MethodsAn anonymous survey was distributed over Internet forums to solicit responses from English-speaking adults, with questions regarding the setting and perceived mental health-related outcomes of classic psychedelics. Data were analyzed to compare effects of group versus solo setting on perceived outcomes.ResultsFor the goal of improving mental health, use in a solo setting was more common than in a group setting (COR 0.37 (0.20–0.68), p = 0.03) and was associated with more subjective symptom improvement (COR 0.22 (0.11–0.42), p = 0.0002). However, there was no significant difference in perceived overall mental health benefit between use in group and solo settings (p = 1). Subjective negative outcomes on mental health were rare and not associated more so with psychedelic use in any particular setting. A majority of naturalistic psychedelic use took place in an informal setting, with no significant difference between solo or group users (95% vs 91%, p = 0.3).ConclusionsNaturalistic psychedelic users are as likely to report an overall positive outcome and no more likely to report adverse events in group settings than in solo settings. This supports further research into PAP in group settings.

How psychedelic-assisted therapy works for depression: expert views and practical implications from an exploratory Delphi study.

As investigations into the efficacy of psychedelic-assisted psychotherapy to treat depression continue, there is a need to study the possible mechanisms of action that may contribute to the treatment's antidepressant effects. Through a two-round Delphi design, the current study investigated experts' opinions on the psychological mechanisms of action associated with the antidepressant effects of psychedelic-assisted psychotherapy and the ways such mechanisms may be promoted through the preparation, dosing, and integration components of treatment. Fourteen and fifteen experts, including both clinical psychedelic researchers and therapists, participated in Round 1 and Round 2 of the study, respectively. Thematic analysis identified nine important or promising 'mechanistic themes' from Round 1 responses: psychological flexibility, self-compassion, mystical experiences, self-transcendence, meaning enhancement, cognitive reframing, awe, memory reconsolidation and ego dissolution. These mechanisms were presented back to experts in Round 2, where they rated 'psychological flexibility' and 'self-compassion' to be the most important psychological mechanisms in psychedelic-assisted psychotherapy for depression. Strategies or interventions recommended to promote identified mechanisms during the preparation, dosing, and integration components of treatment were nonspecific to the endorsed mechanism. The findings from this study provide direction for future confirmatory mechanistic research as well as provisional ideas for how to support these possible therapeutic mechanisms.

Expert Opinion on Psychedelic-Assisted Psychotherapy for People with Psychopathological Psychotic Experiences and Psychotic Disorders

Expert Opinion on Psychedelic-Assisted Psychotherapy for People with Psychopathological Psychotic Experiences and Psychotic Disorders

Healing Words: Effects of Psychoeducation on Likelihood to Seek and Refer Psychedelic-Assisted Psychotherapy Among BIPOC Individuals

ABSTRACT Psychedelic-assisted psychotherapy (PAP) is gaining renewed interest as a treatment for various mental disorders. However, there has been limited Black, Indigenous, and People of Color (BIPOC) representation in PAP clinical trials, signaling the need for culturally consonant communication about the efficacy and safety of PAP. We randomly assigned 321 BIPOC and 301 non-Hispanic White participants to four different modes of psychoeducation (didactic, visual, narrative, hope-based) and tested effects on likelihood of seeking and referring others to PAP using ANCOVAS. The influences of different psychoeducation components on these likelihoods were also tested using hierarchical regression modeling. Regardless of psychoeducation mode, BIPOC participants were more likely to seek PAP than non-Hispanic White participants after psychoeducation. Further, information on physical safety and success rate of PAP uniquely predicted BIPOC participants’ likelihood of seeking and referring others to PAP after psychoeducation. Our findings suggest that once provided psychoeducation, BIPOC participants are receptive to seeking or referring others to PAP. BIPOC participants also appear to prioritize physical safety and rate of success of PAP in these decisions. Stigma against PAP is likely not the primary barrier to recruitment of BIPOC individuals into PAP trials. Instead, researchers should conduct more psychoeducational outreach to diversify future trials.