Working with Weirdness: A Response to “Moving Past Mysticism in Psychedelic Science”

Breeksema, Joost J.; Elk, Michiel van

doi:10.1021/acsptsci.1c00149

Cited by 41 publications

(19 citation statements)

References 15 publications

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“…The potency of participants’ mystical experiences has been found to correlate with a range of treatment benefits, including reductions in symptoms of depression ( Davis et al, 2021 ) and treatment-resistant depression ( Roseman et al, 2018 ), increased motivation to stop problematic cocaine use ( Dakwar et al, 2014 ), decreases in cancer-related depression and anxiety ( Griffiths et al, 2016 ; Ross et al, 2016 ), greater success in nicotine cessation ( Johnson et al, 2014 ), and other positive changes in psychological functioning ( Griffiths et al, 2018 ). Despite calls for further elucidation of specific therapeutic mechanisms in this domain ( Roseman et al, 2018 ; Breeksema and van Elk, 2021 ; Jylkkä, 2021 ; Sanders and Zijlmans, 2021 ), existential and spiritual elements of PAP warrant recognition as potential sources of treatment benefit ( Johnson et al, 2019 ).…”

Section: Embark’s Structurementioning

confidence: 99%

Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model

Brennan

Belser²

2022

Front. Psychol.

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The current standard of care in most uses of psychedelic medicines for the treatment of psychiatric indications includes the provision of a supportive therapeutic context before, during, and after drug administration. A diversity of psychedelic-assisted psychotherapy (PAP) models has been created to meet this need. The current article briefly reviews the strengths and limitations of these models, which are divided into basic support models and EBT-inclusive therapy models. It then discusses several shortcomings both types of models share, including a lack of adequate attention to embodied and relational elements of treatment, and insufficient attention to ethical concerns. The article then introduces the EMBARK model, a transdiagnostic, trans-drug framework for the provision of supportive psychotherapy in PAP clinical trials and the training of study therapists. EMBARK was designed to overcome challenges that prior models have had in conceptualizing therapeutic change in psychedelic treatment, incorporating elements of non-psychedelic evidence-based therapies, incorporating therapists’ prior skills and clinical orientations, delimiting therapist interventions for research standardization, and determining specific factors that contribute to treatment outcomes. The article explains EMBARK’s six clinical domains, which represent parallel conceptualizations of how therapists may support therapeutic benefit in PAP treatment, and its four care cornerstones, which reflect therapists’ broad ethical responsibility to participants. The article describes how these elements of the model come together to structure and inform therapeutic interventions during preparation, medicine, and integration sessions. Additionally, the article will discuss how EMBARK therapist training is organized and conducted. Finally, it will demonstrate the broad applicability of EMBARK by describing several current and upcoming PAP clinical trials that have adopted it as the therapeutic frame.

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Section: Embark’s Structurementioning

confidence: 99%

Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model

Brennan

Belser²

2022

Front. Psychol.

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“…Sanders and Zijlmans ( 36 ) dismiss the concept of mysticism in psychedelic research as non-empirical, while they do support the validity of the three primary instruments (MEQ, HMS, and ASC) used. This was challenged by Breeksema and van Elk ( 37 ) on the basis that mysticism as an element of the full human experience, is clinically valid and has been rigorously studied, with multiple well-established instruments. Jylkka ( 38 ) agreed with Sanders and Zijlmans that these instruments place specific interpretation on the subjects' experience and are not sufficiently secular, and therefore more neutral instruments are needed.…”

Section: Introductionmentioning

confidence: 99%

Psychedelics, Mystical Experience, and Therapeutic Efficacy: A Systematic Review

et al. 2022

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The mystical experience is a potential psychological mechanism to influence outcome in psychedelic therapy. It includes features such as oceanic boundlessness, ego dissolution, and universal interconnectedness, which have been closely linked to both symptom reduction and improved quality of life. In this review, 12 studies of psychedelic therapy utilizing psilocybin, ayahuasca, or ketamine were analyzed for association between mystical experience and symptom reduction, in areas as diverse as cancer-related distress, substance use disorder, and depressive disorders to include treatment-resistant. Ten of the twelve established a significant association of correlation, mediation, and/or prediction. A majority of the studies are limited, however, by their small sample size and lack of diversity (gender, ethnic, racial, educational, and socioeconomic), common in this newly re-emerging field. Further, 6 out of 12 studies were open-label in design and therefore susceptible to bias. Future studies of this nature should consider a larger sample size with greater diversity and thus representation by use of randomized design. More in-depth exploration into the nature of mystical experience is needed, including predictors of intensity, in order to maximize its positive effects on treatment outcome benefits and minimize concomitant anxiety.Systematic Review Registration: PROSPERO, identifier CRD42021261752.

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“…Finally, recent articles have described how psychedelics may alter metaphysical or ontological beliefs ( Nayak and Griffiths, 2022 ; Timmermann et al, 2021 ). Such experiences may be highly meaningful but can also induce an “ontological shock,” particularly when conflicting with prior held religious, personal, or spiritual beliefs ( Breeksema and Van Elk, 2021 ). This introduces ethical and metaphysical challenges, and a deep responsibility for therapists to mitigate potential adversity when patients are confronted with profound metaphysical experiences ( Timmermann et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Adverse events in clinical treatments with serotonergic psychedelics and MDMA: A mixed-methods systematic review

et al. 2022

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Introduction: Small-scale clinical studies with psychedelic drugs have shown promising results for the treatment of several mental disorders. Before psychedelics become registered medicines, it is important to know the full range of adverse events (AEs) for making balanced treatment decisions. Objective: To systematically review the presence of AEs during and after administration of serotonergic psychedelics and 3,4-methyenedioxymethamphetamine (MDMA) in clinical studies. Methods: We systematically searched PubMed, PsycINFO, Embase, and ClinicalTrials.gov for clinical trials with psychedelics since 2000 describing the results of quantitative and qualitative studies. Results: We included 44 articles (34 quantitative + 10 qualitative), describing treatments with MDMA and serotonergic psychedelics (psilocybin, lysergic acid diethylamide, and ayahuasca) in 598 unique patients. In many studies, AEs were not systematically assessed. Despite this limitation, treatments seemed to be overall well tolerated. Nausea, headaches, and anxiety were commonly reported acute AEs across diagnoses and compounds. Late AEs included headaches (psilocybin, MDMA), fatigue, low mood, and anxiety (MDMA). One serious AE occurred during MDMA administration (increase in premature ventricular contractions requiring brief hospitalization); no other AEs required medical intervention. Qualitative studies suggested that psychologically challenging experiences may also be therapeutically beneficial. Except for ayahuasca, a large proportion of patients had prior experience with psychedelic drugs before entering studies. Conclusions: AEs are poorly defined in the context of psychedelic treatments and are probably underreported in the literature due to study design (lack of systematic assessment of AEs) and sample selection. Acute challenging experiences may be therapeutically meaningful, but a better understanding of AEs in the context of psychedelic treatments requires systematic and detailed reporting.

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Working with Weirdness: A Response to “Moving Past Mysticism in Psychedelic Science”

Cited by 41 publications

References 15 publications

Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model

Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model

Psychedelics, Mystical Experience, and Therapeutic Efficacy: A Systematic Review

Adverse events in clinical treatments with serotonergic psychedelics and MDMA: A mixed-methods systematic review

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