What Kind of Therapy is Used in Psychedelic Medicine?

Psychedelic therapy is the combination of a psychedelic experience with integration therapy. Clients draw meaning from their psychedelic experiences by working with a talk therapist who’s experienced in psychedelic integration. But is this therapy based in CBT, DBT, or something else? What kind of therapy is used in psychedelic medicine? Let’s apply therapeutic frameworks to entheogenic integration therapy. (Image from Mush Stock)

The rate of mental health disorders is rising, while our current tools to fight this trend are coming up short. Talk therapy and medication alone provide limited help for patients with treatment-resistant disorders. These patients may feel hopeless, especially if months of talk therapy and antidepressants haven’t improved their symptoms.

Psychedelic therapy is showing great promise, even for patients who have not responded to front-line treatments. With psilocybin and MDMA recently undergoing late-stage trials with impressive results, data is hopefully paving the way for FDA approval in TRD and PTSD. 

Once psychedelic therapy is made legal, we’ll need all-hands-on-deck – this way we can ensure widespread access for people who need it most. Psychedelic Support is passionate about educating therapists to provide evidence-based psychedelic therapy. This includes a novel framework for psychedelic integration therapy. It’s called Psychedelic Harm Reduction and Integration. 

Frameworks help provide structural support to clinical care. We don’t need to throw out the baby with the bathwater when building this new healing and wellness paradigm. We can use our existing foundation for talk therapy within the context of psychedelic medicine. 

Methods like psychoanalytic theory and cognitive-behavioral therapy can be applied to these medicines and therapists need to pull from each of these methods to meet the unique needs of each and every patient. 

Here are existing frameworks and their applications in psychedelic integration therapy:

Cognitive-Behavioral Models in Entheogenic Therapy

Cognitive-Behavioral Therapy (CBT) focuses on the relationships between feelings, thoughts and actions. It was developed in the 1960s. Traditional therapists use it to treat patients with depression, anxiety, substance abuse, and more. 

CBT is based on a straightforward model where underlying beliefs create cognitive distortions, and lead to automatic thoughts. Therapists use CBT to help a patient to modify their behavior by: 

• Discovering underlying beliefs 
• Challenging cognitive distortion 
• Creating new pathways for thoughts 

This framework is then applied to a patient’s unique goals and challenges.² 

This practical model can be applied to psychedelic therapy. These medicines can work at every level of CBT by revealing underlying beliefs and cognitive distortions – and they can forge new pathways for automatic thoughts. 

“Psychedelics relax high-level priors” says a 2019 review in Pharmacological Revolution. This means that during psychedelic experiences, patients are more open to new ideas. They can relax their prior worldviews, allowing in new ones. 

Therapists who practice CBT are primed to integrate psychedelic therapy into their work. Psychedelics can help patients under a CBT framework by creating new pathways for thoughts and feelings. 

Transpersonal Therapy and Psychedelic Medicine

The transpersonal framework for therapy comes from a more spiritual philosophy than CBT. Transpersonal therapy looks at a person’s thoughts and worldview. It also looks into their connection with the world. This includes a connection with a higher power or a spiritual experience of the world. 

This integration of spirituality with psychotherapy has deep roots. It goes back to the human potential movement of the 60s. Transpersonal frameworks go against the western medical approach of separating therapy from spirituality. This approach “reduces humans to just their biology,” neglecting the spiritual side of the person. 

Psychedelics are meaning-enhancing substances. Many people come away from their experiences with new spiritual beliefs and ideas. In one study, 75-86% of hallucinogenic therapy participants considered their experience with the medicine one of the five most spiritually significant in their lives. Spiritual processing is an essential component of psychedelic integration therapy. 

Therapists who come from a transpersonal approach are also perfectly poised to deliver psychedelic therapy. This approach can help patients integrate the deeply spiritual component of hallucinogenic experiences. 

Psychoanalytic Therapy

Psychoanalytic therapy is most commonly associated with Sigmund Freud. He argued that every person needed to reach specific developmental stages before progressing in their lives. Psychoanalytic theory relies on the idea of the unconscious brain. The unconscious brain is a layer underneath our conscious thoughts and actions. 

Psychoanalytic theory was used as a tool in early psychedelic medicine research. Researchers in the 1950s and 1960s believed that psychedelics could “interfere with the structural integrity of the ego”. This allowed access to the underlying subconscious and opened the cognitive floodgates for vivid imagination, intense emotions, and a loss in protective boundaries. 

This ability to access the unconsciousness made psychedelics integral tools in psychotherapy during the mid-20th century. Yet despite the work and research in the area of psychoanalysis, this approach is rarely practiced today. Theories of the unconscious brain have largely been discarded by western science. 

Some scholars argue that psychedelics could help us understand consciousness better. There’s no question that these medicines have the ability to shake up our underlying thoughts and ideas. Therapists who study and use psychoanalytic theory have a unique understanding of the mind’s unconscious underpinnings. Using this knowledge, they can unpack insights from these non-ordinary states of consciousness.

Somatic Therapy and Psychedelics

Somatic therapy connects the mind and body more than other frameworks. It relies on the idea that trauma not only lives in the mind, but in the body as well. Past trauma can become trapped in the body, creating stress, life challenges, and illness. 

Because of its focus on trauma, somatic therapy is used to treat PTSD. There’s still limited evidence for somatic therapy, and many scholars are skeptical. The somatic approach to trauma is newer than other models. Many clinicians and researchers believe that more research is needed to validate its effectiveness.

Psychedelic therapy has also been shown to be effective for trauma-centered diagnoses like PTSD. In trials, MDMA has shown unparalleled effectiveness for relieving symptoms of PTSD. Combining somatic and MDMA therapy to treat PTSD may be an appropriate integrative strategy to ease and even eliminate symptoms. 

Somatic therapy, CBT, and psychoanalysis can be useful tools in psychedelic integration therapy. Each of these approaches may be insufficient on their own. But a combined approach can help therapists assist patients in gleaning new insights. Let’s explore what this combined approach looks like. 

Psychedelic Harm Reduction and Integration: A Combined Approach

Psychedelic Harm Reduction and Integration Therapy (HRIT) combines theories of psychotherapy to create a new model. It relies heavily on principles of harm reduction, mindfulness, and psychodynamic theory. One of the strengths of PHRI is that it isn’t limited to the traditional therapy setting. It can be used in group therapy, spiritual practices, or in talk therapy sessions. 

Harm Reduction is an especially important philosophy within entheogenic medicine. The idea behind harm reduction may seem obvious; we don’t want to create harm. Yet HRIT combines several philosophies, to create an approach that is brand new in therapy.¹⁴

Principles behind HRIT:¹⁴

• A non-judgemental approach. People who use drugs are not bad people. This directly contradicts the moral model of addiction, which remains the dominant perception. 

• Patients should have self-determination in their care. Patients should have the tools to make informed decisions, whether those include using psychedelic substances or not. 

• Qualities like flexibility, honesty, warmth, and respect, are integral to the therapeutic process. In HRIT, the therapist-client relationship is non-authoritative and non-hierarchical.

• Working in Non-ordinary States of Consciousness. Therapists must be able to help patients through experiences that may be challenging or frightening. HRIT guides through helping patients with loss of self, and an inner-directed approach.

… And Many More. 

PHRI is a fresh, inclusive framework for delivering psychedelic integration therapy. We believe that psychedelics and PHRI will revolutionize mental health, and improve so many lives.. 

Psychedelic Support helps therapists practice with the PHRI model. If you’re interested in expanding your practice to include psychedelic integration, we’d love to help. Check out our free courses page to learn about psychedelic medicines, harm reduction, and continuing breakthroughs in psychedelic medicine. 

References:

1. Schenberg EE. Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development. Front Pharmacol. 2018 Jul 5;9:733. doi: 10.3389/fphar.2018.00733. PMID: 30026698; PMCID: PMC6041963.
2. Chand SP, Kuckel DP, Huecker MR. Cognitive Behavior Therapy. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470241/
3. Carhart-Harris RL, Friston KJ. REBUS and the Anarchic Brain: Toward a Unified Model of the Brain Action of Psychedelics. Pharmacol Rev. 2019 Jul;71(3):316-344. doi: 10.1124/pr.118.017160. PMID: 31221820; PMCID: PMC6588209.
4. Wolff M, Evens R, Mertens LJ, Koslowski M, Betzler F, Gründer G, Jungaberle H. Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance. Front Psychiatry. 2020 Feb 21;11:5. doi: 10.3389/fpsyt.2020.00005. PMID: 32153433; PMCID: PMC7046795.
5. Kasprow MC, Scotton BW. A review of transpersonal theory and its application to the practice of psychotherapy. J Psychother Pract Res. 1999 Winter;8(1):12-23. PMID: 9888104; PMCID: PMC3330526.
6. Friedman, H. (2006). The renewal of psychedelic research: Implications for humanistic and transpersonal psychology. The Humanistic Psychologist, 34(1), 39–58. https://doi.org/10.1207/s15473333thp3401_5
7. Hartogsohn, I. (2018). The meaning-enhancing properties of psychedelics and their mediator role in psychedelic therapy, spirituality, and creativity. Frontiers in Neuroscience, 12. https://doi.org/10.3389/fnins.2018.00129
8. Lantz SE, Ray S. Freud Developmental Theory. [Updated 2021 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557526/
9. Grof, S. (1976). Realms of the Human Unconscious: Observations from LSD Research. New York, NY: E.P. Dutton.
10. Paris J. Is Psychoanalysis Still Relevant to Psychiatry? Can J Psychiatry. 2017 May;62(5):308-312. doi: 10.1177/0706743717692306. Epub 2017 Jan 31. PMID: 28141952; PMCID: PMC5459228.
11. Yaden DB, Johnson MW, Griffiths RR, Doss MK, Garcia-Romeu A, Nayak S, Gukasyan N, Mathur BN, Barrett FS. Psychedelics and Consciousness: Distinctions, Demarcations, and Opportunities. Int J Neuropsychopharmacol. 2021 Aug 20;24(8):615-623. doi: 10.1093/ijnp/pyab026. PMID: 33987652; PMCID: PMC8378075.
12. Yaden DB, Johnson MW, Griffiths RR, Doss MK, Garcia-Romeu A, Nayak S, Gukasyan N, Mathur BN, Barrett FS. Psychedelics and Consciousness: Distinctions, Demarcations, and Opportunities. Int J Neuropsychopharmacol. 2021 Aug 20;24(8):615-623. doi: 10.1093/ijnp/pyab026. PMID: 33987652; PMCID: PMC8378075.
13. Kuhfuß M, Maldei T, Hetmanek A, Baumann N. Somatic experiencing – effectiveness and key factors of a body-oriented trauma therapy: a scoping literature review. Eur J Psychotraumatol. 2021 Jul 12;12(1):1929023. doi: 10.1080/20008198.2021.1929023. PMID: 34290845; PMCID: PMC8276649.
14. Yazar-Klosinski, B., & Mitchell, J. (2021). A randomized, double-blind, placebo controlled phase 3 study assessing efficacy and safety of MDMA-assisted therapy for the treatment of severe PTSD. Biological Psychiatry, 89(9). https://doi.org/10.1016/j.biopsych.2021.02.270
15. Gorman, I., Nielson, E. M., Molinar, A., Cassidy, K., & Sabbagh, J. (2021). Psychedelic harm reduction and integration: A transtheoretical model for clinical practice. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.645246
16. Pickard H. Responsibility without Blame for Addiction. Neuroethics. 2017;10(1):169-180. doi: 10.1007/s12152-016-9295-2. Epub 2017 Jan 7. PMID: 28725286; PMCID: PMC5486507.