Psychedelics and Psychotherapy

Abstract

Psychedelics have shown great promise in modern clinical trials for treating various psychiatric conditions. As a transdiagnostic treatment that exerts its effects through subjective experiences that leave enduring effects, it is akin to psychotherapy. To date, there has been insufficient discussion of how psychedelic therapy is similar to and different from conventional psychotherapy. In this article, we review the shared features of effective conventional psychotherapies and situate therapeutic psychedelic effects within those. We then discuss how psychedelic drug effects might amplify conventional psychotherapeutic processes—particularly via effects on meaning and relationship—as well as features that make psychedelic treatment unique. Taking into account shared features of conventional psychotherapies and unique psychedelic drug effects, we create a framework for understanding why psychedelics are likely to be effective with very diverse types of psychotherapies. We also review the formal psychotherapies that have been adjunctively included in modern psychedelic trials and extend the understanding of psychedelics as psychotherapy towards implications for clinical ethics and trial design. We aim to provide some common conceptual vocabulary that can be used to frame therapeutic psychedelic effects beyond the confines of any one specific modality.

The Potential Role of Psychedelic Drugs in Mental Health Care of the Future

“…But they will likely reduce the overrated role of such self-experience and with it the general exceptionalism in the psychedelic therapy theories of the past. This will likely bring the skills of psychedelic therapists in line with those of non-psychedelic therapists and the processes distilled from general psychotherapy research [6,44].…”

“…Nevertheless, it was not until the discovery of LSD in 1943 by Albert Hofmann in Basel and the first clinical experiments that followed, beginning in Switzerland, that research into psychedelics gained momentum worldwide. Again, the psychedelic experience induced by LSD was not only considered a model psychosis resembling many features of schizophrenia; rather, it was recognized early on that LSD could facilitate the psychotherapeutic process [6]. Clinical studies with LSD began in 1947 and covered a wide range of disorders, including schizophrenia, alcohol and opiate dependence, PTSD, and terminal illness [4].…”

“…Clinical studies usually involve screening, preparation, 1 or 2 medium-to high-dosing sessions of a psychedelic, and aftercare sessions that are historically conceptualized as integration [30]. While from the 1950s onward, psychoanalytic talking therapy, guided imagery, and hypnotic interventions have surrounded the application of the substance, today third-wave cognitive-behavioral therapy models or a general psychotherapy framework also are being applied in these treatments [6,31]. In the future, the investigation of psychedelic-assisted group therapy in standard setting 2 (individuals being treated in a group context with no or minimal interaction between patients) and standard setting 3 (individuals being treated with therapeutic group interaction) will need to be investigated [32].…”

“…Two of these compounds have received "breakthrough" status from the US Food and Drug Administration (FDA): MDMA for post-traumatic stress disorder (PTSD) and psilocybin for both major depression and treatment-resistant major depression (TRD). MDMA can be expected to be approved by the FDA for the treatment of PTSD within just a few years because results from 6 Phase II trials that demonstrated efficacy, as well as safety with large effect sizes [2], were recently confirmed by a larger Phase III trial (Rick Doblin, personal communication). Introducing these compounds into the health care system will, however, challenge our current treatment paradigms in psychiatry and psychopharmacology.…”

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“…Rather, it must always be embedded in psychotherapeutic support. The scope and nature of this psychotherapeutic program are the subjects of intense research, the current status of which is presented in the overview by Nayak and Johnson [6]. What is the mechanism of action of psychedelics?…”