Psychedelic-assisted psychotherapy

Psychedelic-assisted psychotherapy is an emerging therapeutic approach that combines the use of psychedelics (a subclass of hallucinogenic drugs) and psychotherapy for the treatment of mental health disorders like post-traumatic stress disorder (PTSD) and treatment-resistant depression.

In psychedelic therapy, the use of psychedelics is typically combined with talk therapy. A range of consciousness-altering psychedelic drugs are currently being used or researched for therapeutic purposes in both clinical and nonclinical settings. Some are derived from plants, like psilocybin (magic mushrooms), DMT, peyote, ayahuasca, and ibogaine. Others — including ketamine, MDMA, and LSD — are chemical compounds.

The early, promising effect of single-dose psilocybin for treatment-resistant depression in clinical trials has provided new hope for the treatment for mental health conditions. Australia has become the first country to approve the prescribing of two psychedelic substances, 3,4-methylenedioxymethamphetamine (MDMA; colloquially known as ecstasy or molly) and psilocybin (a compound derived from magic mushrooms), for the treatment of PTSD and treatment-resistant depression.

Researchers have found that taking psychedelics is not a passive experience: The mindset of the patient matters. Taking the drug opens the mind; therapy helps people through the experience and guides them to do the necessary work of digesting the newly exposed information and, eventually, recalibrating their psychological reality. Therapy allows patients to explore and come to terms with challenging psychological material that is keeping them stuck. It also helps them reorganize their consciousness in the wake of the psychedelic experience. Therapists prepare patients for the experience by establishing a completely safe and trusting environment and establishing goals for treatment. They provide a reassuring presence even before the drug is administered, during the time it is active, and after the pharmacologic effects have worn off. Always taking their cue from the patient’s needs and the nature of their uniquely individual experience, therapists guide them through the process. Therapists help patients revisit past events and emotions that have been problematic. They also conduct subsequent debriefing sessions to help patients consolidate insights and establish new ways of seeing themselves in relation to the world.

On one hand, PAP has long-lasting positive effect on clients. On the other hand, critics draw attention to the paucity of substantial evidence due to small sample sizes in trials, the absence of clarity regarding ideal candidates for this treatment, and potential for adverse experiences in some patients, leading to exacerbated psychological challenges, commonly referred to as so-called ‘bad trips’.

Another primary concern within the medical community is that the treatment protocol is complex. Due to the psychotherapy element involved, a rigid set of guidelines cannot be easily established. Additionally, there are logistical and training challenges associated with the integration of this novel treatment approach into existing health-care systems. Training therapists and health-care professionals to administer psychedelic-assisted therapy would require the provision of specialised education, which is not readily available.

The long-term effectiveness of psychedelic-assisted psychotherapy and its potential to outperform existing medications for PTSD and treatment-resistant depression can only be determined through more trials and subsequent observational studies. The resolution of this dilemma thus hinges on more evidence and it will take time to accumulate adequate data. Numerous uncertainties remain, and decisions about approval for medical usage are complex.