What is Psychedelic Assisted Therapy?

Combining therapy with sacred plants

What you need to know…

Psychedelic Therapy incorporates the use of psychedelics and usually combines conversational therapy with the consumption of a traditional psychedelic like psilocybin, LSD, or Ayahuasca.

Psychedelic therapy, also known as psychedelic-assisted psychotherapy (PAP), is a psychiatric method that incorporates the consumption of a psychedelic substance during the psychotherapeutic process.

This approach typically merges the use of psychedelics with conversational therapy.

A variety of mind-altering psychedelic drugs are presently being utilized or studied for therapeutic applications in both clinical and non-clinical environments.

Some originate from plants, such as psilocybin (magic mushrooms), DMT, peyote, ayahuasca, and ibogaine, while others like ketamine, MDMA, and LSD are chemical compounds.

Although Indigenous communities have employed psychedelics in therapeutic and spiritual contexts for hundreds of years, the application of psychedelic therapy in Western clinical practices is relatively recent.

The popularity of this approach is growing due to increased legalization of certain psychedelic substances, a surge in mental health disorders, and a stagnation in psychopharmacological research.

What it’s used for

During the period between the 1950s and 1970s — prior to the prohibition of these substances by former President Richard Nixon through the Controlled Substances Act — researchers generated a wealth of evidence confirming and suggesting the therapeutic possibilities of psychedelic therapy in treating:

1. Substance dependence,
2. Mental health disorders such as depression and anxiety,
3. Post-traumatic stress disorder (PTSD).

In recent times, a resurgence in interest and funding has spurred further research, much of which is still underway.

Let’s explore the potential applications of various psychedelics.

Ketamine

Ketamine’s classification as a psychedelic is largely a semantic and subjective discussion as of this writing. Clinical, academic, bioethical, and commercial entities largely disagree on the formal definition of “psychedelic.”

Those skeptical of ketamine being classified as a psychedelic typically defer to the definition of a “classical psychedelic,” which refers exclusively to hallucinogenic compounds that work primarily on the serotonergic 5-HTA2 receptors in the brain. This group includes psilocybin (found in psychedelic mushrooms) and lysergic acid diethylamide (LSD). In comparison, ketamine acts on the brain’s glutamate systems and NMDA receptors.

Ketamine holds the distinction of being the most extensively researched psychedelic substance for mental health treatment.

In small quantities, it has demonstrated positive outcomes in several trials investigating its capacity to alleviate depression, although its effects are temporary.

For instance, significant improvement has been observed in individuals with severe depression post-treatment, with results typically lasting around 6 to 8 weeks on average, according to research.

These discoveries have paved the way for the creation of a drug known as Spravato, a nasal spray that dispenses the active ingredient in ketamine. However, administering ketamine intravenously is generally considered more potent and cost-effective.

MDMA

Several phase 2 clinical trials — studies designed to evaluate the effectiveness of a treatment — indicate that MDMA may alleviate PTSD symptoms for a period extending up to 4 years.

In addition, researchers have concluded a phase 3 trial — intended to assess whether a new treatment outperforms existing ones — involving MDMA-assisted therapy for PTSD. This marked the first phase 3 trial for any form of psychedelic-assisted therapy.

Out of 90 participants suffering from severe PTSD, 67 percent no longer met the criteria for a PTSD diagnosis following three treatments, and 88 percent experienced reduced PTSD symptoms.

The trial’s sponsor, the Multidisciplinary Association for Psychedelic Studies, believes these results could pave the way for approval by the Food and Drug Administration (FDA) as early as 2023.ys the results could make way for Food and Drug Administration (FDA) approval by 2023.

Psilocybin

Psilocybin, the primary ingredient in psychedelic mushrooms, has demonstrated promising outcomes in managing depression and anxiety among individuals with terminal diseases.

Specialists also theorize that it may aid in addressing obsessive-compulsive disorder, substance dependence, and depression that is resistant to treatment. However, additional research is required to substantiate these claims.

LSD

LSD, a potent and enduring psychedelic often regarded as the benchmark for therapeutic psychedelics, has demonstrated efficacy in addressing alcohol use disorder and anxiety among individuals diagnosed with terminal diseases.

The Therapeutic Process​

Experts in the field often distinguish three unique phases of this therapeutic method:

1. Preparation,
2. Psychedelic experience
3. Integration

The non-psychedelic components of this technique are crucial for ensuring both its efficacy and safety.

There are various methods of preparation for psychedelic therapy, ranging from dietary changes to psychotherapy. In clinical trials, participants often undergo several talk-therapy sessions with a trained therapist who will also be present during the psychedelic session. This period is used to establish a therapeutic alliance and delve into the individual’s challenges.

The therapist prepares the patient for the psychedelic session in various ways, emphasizing curiosity and strategies to stay open to difficult experiences. Patients are encouraged to approach intimidating encounters with a mindset of learning (“If you see a door, go through it”; “If you encounter something frightening, approach it and ask, ‘what can you teach me?’”). Many practitioners believe that these challenging experiences are crucial to therapeutic and personal growth. The so-called ‘bad trip’ usually results from an attempt to avoid the experience, but can be lessened with an open and trusting attitude.

During the psychedelic session, the ‘set’ and ‘setting’ are of utmost importance. ‘Set’ refers to the patient’s mindset, which includes transient phenomena like mood and expectation, as well as more lasting aspects like personality and past experiences. ‘Setting’ pertains to the context or environment where the session occurs, encompassing basic elements like room comfort and aesthetics, as well as more intricate factors like the relationship quality with the clinicians and the atmosphere they create. Most modern clinical trials take place in hospitals or research institutes, but the session rooms are designed to mimic comfortable living rooms. Two therapists typically attend each session. The patient can sit or lie on a couch, often with eyeshades on, and sometimes listens to a curated music playlist. The most common method of administration is oral ingestion of a synthesized psychedelic compound (e.g., psilocybin) capsule, with sessions usually lasting about 8 hours.

A prevalent therapeutic approach during psychedelic sessions is non-directiveness: therapists are attentive but generally quiet, supporting the unfolding process, providing help and guidance if necessary, and responding to the patient when they speak, with minimal analysis of the content. Some trials involve a single high-dose psychedelic session (usually 20-30 mg per 70 kg body weight), while others include two or three high-dose sessions. Many trials also employ placebo controls, where the patient typically experiences one placebo session — sometimes a very low dose of the psychedelic or an ‘active placebo’ that causes noticeable somatic effects — in addition to their high-dose session(s).

After the psychedelic session and in the subsequent days, the therapist facilitates an integration process. During these discussions, the patient has the chance to process, understand, and meaningfully express their psychedelic experience.

The Psychedelic Assisted Therapy Experience

Classical psychedelics appear to produce many of their effects through the activation of a specific Serotonin receptor (5HT2A) in the brain. Numerous complex changes in brain activity occur following ingestion of a psychedelic, from reductions in activity in some areas (like the Default Mode Network, which is associated with mind-wandering, thinking about the past or future, and thinking about yourself), to alterations to the way different areas connect to each other (for example, areas of the brain that typically don’t interact much begin to work together). Much of what psychedelics do to brain activity remains to be investigated. What psychedelics do to the mind is also of central relevance to clinical research.

The ‘psychedelic experience’ is certainly not consistent across different people and the range of experiences and responses is wide. However, with specific constraints on ‘set’ and ‘setting’ – as is the case within modern clinical trials – certain subjective features occur for many people in a surprisingly reliable way. These include increased empathy for others; increased compassion for oneself; profound and novel insights about one’s character or life or the world; feelings of deep connectedness with other people or other things; a sense of meaningfulness; a reduced sense of one’s Self, its permanence, and its boundaries; and in some cases, a completely other-worldly experience often referred to as ‘mystical’. Psychedelic experiences entail an ‘altered state of consciousness’, a shift in the fundamental nature of one’s experience that is often startling, and difficult to imagine, much less describe. A common feature of these experiences is that the accompanying insights and perspectives are felt to be more reliable, more ‘true’ or ‘wise’, than one’s usual understanding. Further, the ‘authority’ of these novel perspectives tends to endure well beyond the acute stages of the psychedelic session.

Classical psychedelics, such as LSD and psilocybin, are believed to trigger their effects primarily through activating a specific serotonin receptor in the brain, known as 5HT2A. Following the ingestion of a psychedelic substance, a host of intricate alterations in brain activity occur. These changes range from diminished activity in certain regions (like the Default Mode Network associated with daydreaming and self-referential thoughts) to modifications in the connectivity between different brain areas (for instance, regions that usually don’t interact much start to synchronize).

However, our understanding of how psychedelics influence brain activity is still incomplete and a subject of ongoing research. Equally important to clinical studies is deciphering what psychedelics do to the mind.

The so-called ‘psychedelic experience’ varies greatly among individuals, resulting in a broad spectrum of responses and experiences. Nevertheless, when the ‘set’ (mindset) and ‘setting’ (environment) are carefully regulated, as they are in modern clinical trials, certain subjective features consistently emerge across many individuals. These can include enhanced empathy for others, increased self-compassion, profound and unique insights into one’s personality or life circumstances, feelings of deep connection to other people or entities, a heightened sense of purpose, and a diminished focus on self, its permanence, and boundaries. In some instances, individuals may have completely transcendent experiences often labeled as ‘mystical.’

Psychedelic experiences induce an ‘altered state of consciousness’, a fundamental shift in the quality of one’s perception that is often surprising and difficult to comprehend, let alone articulate. A common trait of these experiences is the resultant insights and perspectives, which are perceived as being more authentic, more ‘real’ or ‘wise’, than one’s usual understanding. Importantly, the credibility of these new perspectives tends to linger well beyond the immediate stages of the psychedelic session.

Read more about how to regulate psychedelic assisted therapy.

The psychedelic experience

There’s a growing apprehension among experts regarding the surge in self-medication, particularly in relation to psychedelic substances. This concern has been amplified by the findings of the 2020 Global Drug Survey, which highlighted an uptick in individuals reporting self-treatment of various mental health issues using psychedelics.

A significant portion of these worries arises from the potential for contamination in substances that have not been sourced from lab-tested suppliers, coupled with the absence of medical oversight during their use.

Nonetheless, when administered in a clinical environment under professional supervision, psychedelic substances are typically perceived as low risk.

MDMA can sometimes cause short-term high blood pressure, increased heart rate, and elevated body temperature, but these effects typically go away after use.

Psilocybin may similarly elevate blood pressure temporarily or cause light headaches.

However, it’s important to note that psychedelics have been associated with a heightened risk of triggering psychosis in individuals who already have psychotic disorders or are predisposed to them.

Additionally, there’s a potential risk, especially with LSD, of developing a rare condition called hallucinogen persisting perception disorder (HPPD), characterized by intense flashbacks and hallucinations. However, experts point out that this condition tends to be more prevalent when substances are used without medical oversight.

Regarding ibogaine, there are some concerns, including a possible connection to potentially deadly cardiac arrhythmias. Consequently, its use has been restricted to observational trials primarily aimed at addressing opioid addiction.

Finding a professional

There’s a lot of excitement around the potential of psychedelic therapies. As a result, a lot of new therapists, gurus, international retreats, and clinics are opening up.

If you’re interested in participating in a psychedelic-assisted treatment in a clinical setting supported by an expert, a good place to start is the Avatar Healing Arts maintained by Nina Izel.

The Avatar Healing Arts also welcomes questions or concerns about psychedelic-assisted therapy, and can make recommendations to help guide you.

Whether it’s a clinical setting or a retreat, it’s important to understand that ingesting psychedelic substances alters consciousness and can make you vulnerable to suggestion.

As a result, some participants in studies or treatments have alleged unethical and sometimes even criminal behavior. Read reviews, evaluate accreditation, and consider how you might ensure accountability should anything go awry during or after treatment.

How effective are psychedelics compared with current treatments?

Present treatments for depression and anxiety, including both medication and talk therapy, only result in remission for roughly 30-35% of patients. These treatments often see high instances of residual symptoms and recurrence. However, in a study with participants who had not responded to multiple types of conventional therapies, psilocybin-assisted therapy significantly diminished depressive symptoms in over 65% of these ‘treatment-resistant’ individuals.

In another study involving psilocybin-assisted therapy for quitting smoking, 80% of the participants had stopped smoking six months post-therapy, with 67% maintaining their cessation after a year. In comparison, the current “gold-standard” treatments for smoking cessation typically yield a 20% quit rate at follow-up with similarly addicted individuals.

Post-traumatic stress disorder (PTSD) is notoriously difficult to manage with currently available treatments, leading to remission in only 5-10% of sufferers. In contrast, recent Phase 3 trials conducted by MAPS demonstrated that MDMA-assisted therapy resulted in remission in 67% of PTSD patients who hadn’t previously responded to standard treatments. This was achieved after just three medicinal doses of MDMA, combined with a brief course of psychotherapy. A significant reduction in symptoms was observed in 88% of patients, who had been living with PTSD for an average of 14 years on average.

Due to their potential superiority over existing treatments, MDMA and psilocybin have been granted “Breakthrough Therapy” designation, which fast-tracks research and their transition to prescription medicine.

Other References

1. MDMA is not a classical psychedelic, but is associated with various ‘psychedelic effects’ and often discussed among the classical psychedelics.
2. Johnson, M et al. (2014). 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. Journal of Psychopharmacology, 28-11:983-992.
3. Carhart-Harris et al. (2016). Psilocybin with psychological support for treatment-resistant depression. The Lancet, 3-7:619-627.
4. Griffiths, R. R. et al. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of psychopharmacology, 30(12), 1181-1197.
5. Ross et al. (2016). Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. Journal of Psychopharmacology, 30-12:1165-1180.
6. M.C. Mithoefer, T.M. Wagner, A.T. Mithoefer, L. Jerome, R. Doblin, The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study, J. Psychopharmacol. 25 (4) (2011) 439–452.