The Emerging Field of Psychedelic Psychotherapy

Abstract

Purpose of review: Few treatments are available for patients with mood disorders or post-traumatic stress disorder (PTSD) who have already failed multiple interventions. After several decades when research into psychedelics was effectively halted by federal legislation, the past several years have shown the re-emergence of thoughtful investigations studying the utility of compounds such as 3,4-methylenedioxymethamphetamine (MDMA) and psilocybin.

Recent findings: Several studies have coupled the safe administration of psychedelic compounds in a controlled environment after several hours of preparation of study participants and followed by multiple sessions to integrate the psychedelic experience. The improvement participants experience appear related to the often profound perspective changes experienced and seem unlike the improvements seen in the currently available care paradigms. Studies cited include treatment resistant depression, end of life despair, and PTSD. Psychedelic psychotherapy, a unique remarriage of biological therapy and psychotherapy, has the potential to transform mental health care.

Keywords: MDMA; Psilocybin; Psychedelic-assisted therapy; Psychedelics; Treatment resistant depression.

Fig. 1

Psychedelic-assisted psychotherapy consists of 3 stages: preparation, dosing, and integration. Though there is some variation across clinical trials, in general, participants undergo an initial evaluation followed by meetings with the psychiatrist to taper off their medications. In preparation, the patient meets with the lead therapist 3 times over the course of 3 weeks, with the co-therapist joining for the final preparation session. Preparation focuses on getting the patient comfortable with the potential range of experiences they may experience under the influence of psychedelics, exploring expectations and setting intentions, and developing strategies for navigating any challenges that might emerge during dosing. Integration also has sessions with the therapist over 3 weeks, with the co-therapist joining only for the first integration session. In integration, the goal is to consolidate the insights gleaned during dosing and help the patient apply these changes to their daily life. Throughout this process, the therapist practices a non-directive, present-focused technique which encourages the patient to engage with all aspects of their current experience