What is Psychedelic-Assisted Therapy?
The psychedelic renaissance is here, and it shows no sign of abating. Psychedelic substances such as psilocybin, LSD, ayahuasca, ketamine, and MDMA are demonstrating mounting promise in helping people break out of damaging systems of thinking and make meaningful changes in their lives. For the first time in decades, the public view of psychedelics is shifting from one associated exclusively with the counterculture era of the 1960s to one which recognizes the multitude of therapeutic benefits of psychedelics can have when used responsibly and in appropriate settings.
A core part of this ongoing revolution is the emergence of psychedelic-assisted therapy. Psychedelic-assisted therapy is the process by which an individual is given a psychedelic substance, such as psilocybin or LSD, in a clinical setting and under the supervision of a trained therapist. These sessions have been proven to help people suffering from conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), and addiction.
Let’s dive into psychedelic-assisted therapy: How does it work? What results have we seen so far? And what role does integration play in positive outcomes?
How Does Psychedelic-assisted Therapy Work?
Psychedelic-assisted therapy is centered around the ingestion of a psychedelic substance. Researchers have conducted clinical trials on a whole host of substances, including psilocybin, DMT, and MDMA; but at the moment, the only psychedelic therapy publicly available in the US is ketamine-assisted therapy (and this is only available off-label, currently not covered by most health insurance).
The therapy as a whole, however, is made up of more than just the psychedelic journey. Researchers or clinicians will typically run a handful of preparation therapy sessions beforehand and follow it with integration therapy sessions. Oftentimes the patient has more than one journey, all of which are sandwiched between preparation and integration sessions.
Prior to the journey, the therapist will usually prepare the patient for the session by setting some expectations about the challenging nature of moderate-to-high dose psychedelic journeys, encouraging curiosity and openness to whatever arises. It’s key to understand that attempted avoidance of a “bad trip” may work conversely to make the experience even more challenging for the individual.
During the journey, the therapist supervises the individual and, when necessary, provides guidance and support. The patient may experience visual hallucinations, out-of-body sensations, loss of a sense of self (often known as ego dissolution), or revisit past traumas or memories. They may have what is deemed as a “mystical experience,” with feelings of transcendence and euphoria, and “meet” other mystical beings. Having someone to hold this space for the person going through the trip can help them navigate the waters as they feel cared for and safe.
Many professionals find that more ‘hands-off’ techniques can be preferable in psychedelic therapy – such as the ACE model, standing for “Accept, Connect, Embody.” This technique trains participants prior to the session to accept negative emotions, connect to their positive aspects, and feel all emotions in the body, allowing therapists to adopt a more non-directive role during the experience. This allows the participant to come to insights and revelations on their own, without the potential for the therapist’s own biases to imprint on the person taking the medicine.
After the session, the patient will attend one or more integration therapy sessions with the therapist, where they discuss what came up during the journey and how they can take the lessons learned forward into their everyday lives.
What Kind of Results Have We Seen So Far?
Over the last two decades, there has been a surge in research on the therapeutic of psychedelic medicines for conditions including depression, anxiety and mood disorders, PTSD, substance use dependencies, and eating disorders.
A meta-analysis of placebo-controlled trials of psychedelic-assisted therapy found that it was effective for treating PTSD, unipolar depression, anxiety/depression associated with a life-threatening illness, and social anxiety among autistic adults.1 The psychedelics used in the trials included psilocybin, LSD, ayahuasca, and MDMA, and 80% of participants were more likely to experience a positive outcome from the therapy than the placebo treatment.
In 2019, the FDA named psilocybin-assisted therapy as a “breakthrough therapy” – truly signaling the promise of psilocybin and the changing tide towards its clinical use. In one recent study conducted by Robin Carhart-Harris and the team at Imperial College London, psilocybin was shown to be at least as effective as leading antidepressant escitalopram in treating depression symptoms.2
When it comes to substance dependencies, the findings here are exciting too. Johns Hopkins researchers conducted a study on using psilocybin alongside cognitive behavioral therapy for smoking cessation and found an 80% abstinence rate over six months post-therapy.3
Research done by the Multidisciplinary Association for Psychedelic Studies (MAPS) has shown clear promise for the use of MDMA-assisted therapy for the treatment of severe PTSD, including people with common comorbidities such as dissociation, depression, substance use disorders, and childhood trauma. A 2021 study indicated that “MDMA-assisted therapy is highly efficacious in individuals with severe PTSD, and treatment is safe and well-tolerated, even in those with comorbidities.”4 Participants of the study received therapy with either MDMA or placebo, combined with three preparatory and nine integrative sessions.
This is just a small snapshot of the expansive research taking place, which spans institutions, medicines, and conditions.
The Vital Role of Psychedelic Integration
The psychedelic journey itself is but one part of the entire process towards healing and growth that’s facilitated by psychedelic-assisted therapy and should be followed by integration sessions. But what is integration, exactly?
Integration is the process of exploring what came up during the journey, making meaning of those feelings, sensations, and ideas, and understanding how they can be applied to daily life. The person may have had specific intentions of what they wanted to gain from the experience, and integration therapy can help turn these into a reality.
“Having an objective, experienced professional support before and after a psychedelic journey can be the difference between a strange trip that becomes a memory and a concrete experience that allows an individual to make positive changes in their life,” explains Psychedelic Integration Coach, Leia Friedwoman.
Leia says that the journey itself isn’t an instant cure and integration support post-trip is vital, as “it can be hard to hold that space for oneself while unpacking everything that came up.”
“The therapist or coach can offer trauma-informed guidance and care that allow the individual to incorporate the fruits of their journey in a sustainable way,” she explains.
Are you interested in learning more about psychedelic integration? Check out our ebook on entering the field of psychedelic integration therapy and coaching.
Psychedelics on their own are no magic bullet to solving a person’s problems. However, when taken in a safe setting, with therapeutic guidance and post-journey support, they have huge potential to help people instill positive changes in their lives. As many substances move towards gaining legal status in the US elsewhere, and psychedelic-assisted therapy training programs continue to pop up, we hope to see more widespread access to these much-need treatment options.
References
1. Luoma, J. B., Chwyl, C., Bathje, G. J., Davis, A. K., & Lancelotta, R. (2020). A Meta-Analysis of Placebo-Controlled Trials of Psychedelic-Assisted Therapy. Journal of Psychoactive Drugs, 52(4), 289–299. https://doi.org/10.1080/02791072.2020.1769878
2. Carhart-Harris, R., Giribaldi, B., Watts, R., Baker-Jones, M., Murphy-Beiner, A., Murphy, R., Martell, J., Blemings, A., Erritzoe, D., & Nutt, D. J. (2021). Trial of Psilocybin versus Escitalopram for Depression. New England Journal of Medicine, 384(15), 1402–1411. https://doi.org/10.1056/nejmoa2032994
3. Garcia-Romeu, A., Griffiths, R., & Johnson, M. (2015). Psilocybin-Occasioned Mystical Experiences in the Treatment of Tobacco Addiction. Current Drug Abuse Reviews, 7(3), 157–164. https://doi.org/10.2174/1874473708666150107121331
4. Mitchell, J. M., Bogenschutz, M., Lilienstein, A., Harrison, C., Kleiman, S., Parker-Guilbert, K., Ot’alora G., M., Garas, W., Paleos, C., Gorman, I., Nicholas, C., Mithoefer, M., Carlin, S., Poulter, B., Mithoefer, A., Quevedo, S., Wells, G., Klaire, S. S., van der Kolk, B., . . . Doblin, R. (2021). MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine, 27(6), 1025–1033. https://doi.org/10.1038/s41591-021-01336-3
