Expert Opinion on Psychedelic-Assisted Psychotherapy for People with Psychotic Symptoms

Introduction

The paper situates itself in the history of psychedelic research, noting that since the First Wave in the 1950s people with personal or familial histories of psychotic symptoms have routinely been excluded from clinical studies and treatment programmes. The authors describe multiple reasons for this exclusion: clinician and regulatory caution, early misperceptions that psychedelics are psychotomimetic (i.e. mimic psychosis), and politicised reactions that followed early research. They also highlight countervailing evidence and perspectives: destabilisation linked to psychedelics appears mostly in uncontrolled, recreational contexts rather than in supported clinical settings, and longstanding Indigenous practices show individuals with hallucinations participating in—and sometimes leading—psychedelic rituals without clear worsening of psychosis. The introduction further notes that ethnoracially diverse participants and people with broader psychiatric presentations have been underrepresented in contemporary psychedelic trials, with direct consequences for BIPOC communities given higher rates of psychosis diagnoses in some groups. This study therefore set out to investigate expert opinion about the rationale for excluding people with psychotic symptoms from psychedelic-assisted psychotherapy (PAP). The specific aims were to understand when such exclusions might be justified, what the implications of blanket exclusions are, and whether an expert consensus exists about the potential for PAP to be safe or beneficial for some people with psychotic symptoms. The authors framed the question in light of recent advances combining psychotherapy with pharmacology and the increasing interest in trauma-informed models that might align with certain psychedelic-assisted approaches.