What Is Psychedelic Therapy?

As the body of evidence supporting psychedelic medicine grows, more clinicians are wondering how to incorporate psychedelic therapy and education into their practice. Psychedelics have been used by indigenous people for centuries, but we have yet to see them in the context of western medicine. How does psychedelic therapy work, what does it look like, and how will clinicians incorporate psychedelics into therapeutic practices? This week, we’ll answer the big question, what is psychedelic therapy?

A Brief History of Psychedelic Therapy

The idea of psychedelic therapy is relatively new to western medicine. After a brief research renaissance in the first part of the 20th century, psychedelics were outlawed by Nixon in the Controlled Substances Act. With the stroke of a pen, the FDA classified psilocybin, MDMA, ayahuasca, and LSD as Schedule1 drugs [1]. 

This ruling limited the study and application of these substances, and we’re only now coming to understand their potential as tools for healing. As is, psychedelics are under the same drug classification as much more damaging substances like heroin and cocaine. Unlike these drugs, psychedelics like psilocybin have relatively low risk for abuse, addiction, and overdose [2].

The psychedelic medicine industry hopes for re-scheduling in the next few years. Canada has actually made psilocybin legal for specific people through a compassionate use policy [1, 3]. This allows practitioners to ask for substances that are not legal for sale. It’s a policy that is limited for patients suffering from life-threatening and serious illnesses, and is only for treatment-resistant conditions [3]. 

In light of promising research, the US FDA has granted breakthrough designation for MDMA and psilocybin. This has allowed for massive research expansion, leading to good outcomes for patients who have struggled with depression and post-traumatic stress disorder. Similarly, early research on LSD and ayahuasca in treating psychiatric disorders has also shown promise [5].

Psychedelic-assisted psychotherapy, or PAP, is a relatively new term. It means integrating ketamine, MDMA, psilocybin, LSD, or ibogaine into more standard psychotherapy. This approach has shown efficacy and safety in phase II trials for patients with treatment-resistant conditions [3]. 

Some results even show that PAP is more effective than standard therapy, with outcomes that are statistically significant for real outcome improvements [4]. But we can’t say for sure how many people can potentially benefit from these treatments until larger phase III trials are completed.

What is Psychedelic Therapy?

PAP is not only a new way of doing treatment and research, it’s a new way of thinking about mental health and how we approach diagnoses. It integrates a patient’s emotions, not only in terms of their brain chemistry and symptoms, but also their past trauma, their culture, their unique way of seeing the world. PAP is experience and integration as medicine [4]. 

Psychedelic therapy “shifts ego from foreground to background”, says researcher Rick Doblin in his 2019 TED talk [5]. Patients experience new perspectives, which help them understand their lives in new ways. These meaningful experiences create cognitive, emotional, and behavioral changes in patients [4].

Rather than mask symptoms like some psychiatric medicines, psychedelic therapy gets to the root of patients’ emotions. Patients have the opportunity to gain new insight about themselves. The support of trained therapists helps them interpret these insights and apply them to cognitive and behavioral patterns [4].

In his comprehensive 2018 review, Eduardo Schenberg calls this approach “the therapeutic potential of non-ordinary states of consciousness” [4]. By using psychedelics as “mind manifesting” tools, psychedelic therapists help patients gain new understanding of their past experiences and present emotions [5]. Rather than correct neurological changes, psychedelic therapy creates temporal changes in consciousness [4]. 

How Does Psychedelic Therapy Work?

Psychedelic therapy works at the intersection of science and the mystical. As indigenous peoples have used plant-based medicinals for centuries for their mystical properties, psychedelic therapy integrates these experiences with cognitive and behavioral approaches. There are several ways that psychedelic therapy can be used as a tool to create positive outcomes for patients. 

Psychedelic therapy helps patients shift from avoidance to acceptance. Many mental health diagnoses are characterized by avoiding negative emotions. Rather than these negative emotions with pharmacology, psychedelic therapy invites patients to experience and eventually “let go” of these negative feelings [6]. 

Another way that psychedelics integrate with therapy is to guide future sessions. If a patient experiences an emotional memory that surprises them, exploring that emotion can give them new insights into past traumas. This approach can contribute to new understandings of adverse experiences and subconscious perceptions [4]. 

As an experience, psychedelic therapy can create lasting positive memories for patients. Past negative events such as adversities, trauma, and abuse can have life-long consequences for mental health. Inversely, the positive experiences that psychedelic therapy fosters can also have lasting and meaningful psychological effects for patients [4]. 

Psychedelic therapy could be cost-effective way to treat symptoms we often consider to be life-long. If a patient can go through a round of psilocybin therapy for depression and experience lasting benefits, they can avoid the cost, side-effects and toxicity of pharmaceuticals. This approach could help reduce or eliminate drug adherence problems, and prevent or eliminate toxicity from polypharmacy [3].

The meaning-amplifying effects of psychedelic therapy can create life-long changes for patients in cognitive, emotional, and behavioral spheres [8]. As we learn more about their applications and uses, we’ll have more understanding about the ways psychedelics create lasting changes for the mind. 

What Does Psychedelic Therapy Look Like?

Psychedelic therapy is different from standard pharmacological therapy. Instead of a patient receiving a prescription and taking it every day, week, or month, dosing is limited to supervised sessions. Patients experience the effects of a psychedelic under direct supervision in extended sessions, then work with their therapist to understand those experiences [4]. 

A trained therapist will develop a strong relationship with a patient before determining and prescribing psychedelic therapy. Building trust and rapport is essential for patients to feel safe during their session and afterwards. This also gives the patient a chance to explore their beliefs, preferences, attitudes, and motivations before undergoing a psychedelic session [4]. 

During these sessions, patients are closely monitored. For MDMA and psilocybin, two clinicians typically stay with them in the room to supervise. Patients should be lying down and comfortable. To limit distractions, patients may wear an eye-mask, and soft music may be playing.  

Dosage, session length, frequency, and repetition for these sessions depends on the substance and patient needs. For instance, ketamine and psilocybin may be used at a low dose for very few sessions while MDMA is typically prescribed at a higher dose for 3 sessions spaced a month apart [4]. In the future, we may expect certain practitioners to specialize in a specific psychedelic substance and diagnosis, such as using psilocybin for depression or MDMA-assisted psychotherapy for PTSD. 

Once these intensive sessions are over, patients are encouraged to share their experiences with their therapist. Following therapeutic sessions help the patient integrate and understand their new perspectives, perceptions, and emotions.  

A Promising Future for Psychedelic Therapy

We’re excited about the future of psychedelic therapy and it’s potential to change lives. By using an experiential medicine approach, psychedelic therapy can get to the root of emotions and trauma to improve outcomes for patients suffering from an array of diagnoses. 

Decriminalizing and de-stigmatize psychedelic substances will allow more people to benefit from access to psychedelic therapy. One of the first steps is changing the Schedule1 classification is FDA approval of psychedelic substances. With enough evidence and support, the DEA can de-schedule them at any time [1]. 

Under breakthrough designations, current studies are in the works to investigate safety and efficacy for different psychedelic compounds and their uses in depression, PTSD, addiction, and many other indications. As this body of research expands, we anticipate changes in psychedelic policy that will help clinicians and patients [1].

Psychedelic therapy has the potential to help so many people, from frontline workers to veterans. We look forward to a future where licensed, qualified therapists will be able to supervise psychedelic usage in tandem with controlled therapy. If you’re interested in psychedelic therapy for yourself or someone else, take a look at our article on Choosing Therapy. If you are a clinician looking to learn more about psychedelic therapy, check out our education section for training programs and continuing medical education courses.  Psychedelic Support offers accredited training content on MDMA, Psilocybin and ketamine assisted therapy training.

References

1. Marks, M., & Cohen, I. G. (2021). Psychedelic therapy: A roadmap for wider acceptance and Utilization. Nature Medicine, 27(10), 1669–1671. https://doi.org/10.1038/s41591-021-01530-3 
2. de Veen, B. T. H., Schellekens, A. F. A., Verheij, M. M. M., & Homberg, J. R. (2016). Psilocybin for treating substance use disorders? Expert Review of Neurotherapeutics, 17(2), 203–212. https://doi.org/10.1080/14737175.2016.1220834 
3. Canada, H. (2005, August 15). Government of Canada. Canada.ca. Retrieved December 16, 2021, from https://www.canada.ca/en/health-canada/services/drugs-health-products/special-access/drugs/special-access-programme-drugs.html 
4. Schenberg EE. Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development. Front Pharmacol. 2018;9:733. Published 2018 Jul 5. https://doi:10.3389/fphar.2018.00733
5. TED. (2019). The future of psychedelic-assisted psychotherapy. YouTube. Retrieved December 16, 2021, from https://www.youtube.com/watch?v=Q9XD8yRPxc8.
6. Wolff, M., Evens, R., Mertens, L. J., Koslowski, M., Betzler, F., Gründer, G., & Jungaberle, H. (2020). Learning to let go: A cognitive-behavioral model of how psychedelic therapy promotes acceptance. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00005 
7. Reiff, C. M., Richman, E. E., Nemeroff, C. B., Carpenter, L. L., Widge, A. S., Rodriguez, C. I., Kalin, N. H., & McDonald, W. M. (2020). Psychedelics and psychedelic-assisted psychotherapy. FOCUS, 19(1), 95–115. https://doi.org/10.1176/appi.focus.19104 
8. Hartogsohn I. The Meaning-Enhancing Properties of Psychedelics and Their Mediator Role in Psychedelic Therapy, Spirituality, and Creativity. Front Neurosci. 2018 Mar 6;12:129. https://doi: 10.3389/fnins.2018.00129. PMID: 29559884; PMCID: PMC5845636.