Therapeutic frameworks in integration sessions in substance‐assisted psychotherapy: A systematised review

Abstract

Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance‐assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integration sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematised review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed‐methods investigations, treatment manuals, study protocols, quasi‐experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until 11 November 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcomes have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic–experiential tradition. While integration is regarded as crucial for the safe application of SAPT, there is currently an insufficient evidence base to suggest that any type of therapy is effective for guiding integration sessions. A systematic investigation of different therapeutic frameworks for integration and additional therapy‐related factors is needed.

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

“…To date, studies investigating psychedelic assisted psychotherapies have adopted diverse treatment approaches. Although the presence of preparation, support and integration sessions are most consistently implemented, the therapeutic frameworks being used are far from consistent (Cavarra et al, 2022;Thal et al, 2024). Further, clinicians administering psychedelic-assisted psychotherapy should receive specialised training to ensure that such treatments are delivered safely and effectively.…”

Coming back together: a qualitative survey study of coping and support strategies used by people to cope with extended difficulties after the use of psychedelic drugs

“…Integration has been defined as a process following psychedelic experiences in which important lessons from the experience are discerned and integrated into the daily life of the person in a way that allows them to live a fuller, less stressful life ( Richards, 2017 ). It is commonly included as one of the three stages of psychedelic-assisted therapy – preparation, the drug experience, and integration – with most clinical trial treatment protocols including one or two sessions of integration after the drug session ( Thal et al, 2023 ). These treatment protocols typically do not anticipate and are not designed to treat problems that may emerge during or after a psychedelic experience ( Jacobs et al, 2023 ).…”

“…There is a wide range of possible therapeutic approaches to psychedelic integration ( Thal et al, 2023 ), many of which indicate the importance of psychological flexibility ( Hayes et al, 2011 ), including but not limited to Acceptance and Commitment Therapy (ACT) and the Acceptance, Commitment and Embody (ACE) model ( Watts and Luoma, 2020 ) for those using psychedelics for mental health treatment. Focusing on the metaphysical and existential challenges often arising from psychedelic experiences, some have proposed more existential (e.g., Carnahan, 2023 ) or transpersonal (e.g., Papaspyrou, 2015 ) therapeutic approaches to integration, whereas others also note the potential benefit of somatic practices, such as yoga and breathing techniques ( Gorman et al, 2021 ).…”

“…Focusing on the metaphysical and existential challenges often arising from psychedelic experiences, some have proposed more existential (e.g., Carnahan, 2023 ) or transpersonal (e.g., Papaspyrou, 2015 ) therapeutic approaches to integration, whereas others also note the potential benefit of somatic practices, such as yoga and breathing techniques ( Gorman et al, 2021 ). However, to date, there has been no controlled comparative research into different models ( Thal et al, 2023 ). Furthermore, while there is much in the literature on how to deal with challenging experiences in the acute phase of a psychedelic experience, there is very little research on what helps people cope with lasting post-psychedelic difficulties.…”