Depressive DisordersObsessive-Compulsive Disorder (OCD)Palliative & End-of-Life DistressAnxiety Disorders

Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

This model-building article (2020) argues that psychedelic-assisted therapy works to relax beliefs and increases acceptance via operant conditioning. This leas to less avoidance, more learning, and positive psychological outcomes.

Authors

  • Lea Mertens
  • Henrik Jungaberle
  • Gerhard Gründer

Published

Frontiers in Psychiatry
meta Study

Abstract

The efficacy of psychedelic-assisted therapies for mental disorders has been attributed to the lasting change from experiential avoidance to acceptance that these treatments appear to facilitate. This article presents a conceptual model that specifies potential psychological mechanisms underlying such change, and that shows substantial parallels between psychedelic therapy and cognitive behavioral therapy: We propose that in the carefully controlled context of psychedelic therapy as applied in contemporary clinical research, psychedelic-induced belief relaxation can increase motivation for acceptance via operant conditioning, thus engendering episodes of relatively avoidance-free exposure to greatly intensified private events. Under these unique learning conditions, relaxed avoidance-related beliefs can be exposed to corrective information and become revised accordingly, which may explain long-term increases in acceptance and corresponding reductions in psychopathology. Open research questions and implications for clinical practice are discussed.

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Research Summary of 'Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance'

Introduction

Recent early-phase clinical trials have reported that single or a few administrations of classic serotonergic psychedelics (most often psilocybin, but also LSD and ayahuasca) can produce substantial and sometimes sustained symptom reductions across a range of conditions, including depression, distress tied to life-threatening illness, obsessive–compulsive disorder and substance-use disorders. Previous work has suggested that a common pathway for these benefits is a shift from experiential avoidance to greater acceptance, but the psychological mechanisms by which psychedelic therapy might produce such change remain underspecified. Wolff and colleagues set out to clarify those mechanisms by developing a conceptual model from a cognitive–behavioural therapy (CBT) perspective, anchored in the relaxed-beliefs account of psychedelic action. The paper proposes that psychedelic-induced relaxation of high-level beliefs, when combined with typical therapeutic context factors, can increase motivation for acceptance via operant conditioning and create episodes of relatively avoidance-free exposure to highly intensified private events; under these learning conditions, avoidance-related beliefs may be revised and longer-term acceptance increased. The authors outline the model, relate it to existing CBT processes, review supporting empirical and qualitative observations, and discuss implications for research and clinical practice.

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References (64)

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