Learnings from a hybrid communities of practice group therapy model to support psilocybin-assisted therapy for patients with a terminal diagnosis

Patients with terminal illness often experience hopelessness, loss of meaning, uncertainty, anxiety, and depression. The introduction argues that standard antidepressant and anxiolytic medicines may reduce symptoms but do not address deeper existential distress. It also notes that psilocybin-assisted therapy has shown promising effects in palliative cancer populations, yet much of the existing work has focused on individual therapist-patient models. The authors highlight that group psychedelic therapy is comparatively under-studied, even though group and community-based approaches have a longer history in some healing traditions and may offer advantages such as shared support, broader access, and lower cost. Tsang and colleagues set out to fill this gap by describing a hybrid, group-based psilocybin-assisted therapy model built around a resilience-oriented Community of Practice (CoP) curriculum. The study aimed to explore the practicality of delivering psilocybin-assisted therapy to patients with terminal diagnoses in a cohort structure, and to understand participant experiences, perceived benefits, and challenges. The paper positions this as an effort to contribute to learning about how psilocybin-assisted therapy might be delivered in Canada and elsewhere in a more scalable, community-based format.

This was a qualitative study nested within an established psychedelic therapy programme at Roots to Thrive. The programme had previously been developed for healthcare provider resilience and then adapted for a 12-week group ketamine-assisted therapy model before being further adapted for psilocybin-assisted therapy for people facing end-of-life distress. The intervention used a hybrid format: virtual group preparation and integration sessions, plus one in-person group psilocybin medicine session. The preparation/integration component ran for 6 to 8 weeks with weekly two-hour sessions, and the medicine session lasted approximately eight hours. Each cohort included up to eight participants. Participants were recruited from the programme’s database of patients who had taken part in Roots to Thrive psilocybin-assisted therapy and who had distress related to a terminal cancer diagnosis. The extracted text states that participants met the programme’s inclusion and exclusion criteria, but the full criteria are embedded in the text rather than in a structured methods narrative. In broad terms, eligible patients had a terminal diagnosis with a predicted life expectancy of less than 2 years, were adults, were ambulatory enough to participate, and had distress that had not responded adequately to other treatments. Several psychiatric, medical, and medication-related exclusions were listed, including psychotic disorders, certain bipolar or personality disorders unless separately reviewed, and unstable cardiovascular, epileptic, or metabolic conditions. The programme was accessed first through Canada’s Section 56 exemption and later through the Special Access Programme. The preparatory curriculum focused on body awareness, emotions, thoughts, values, relationships, nervous system regulation, and the concept of trusting one’s “inner healing intelligence”. It incorporated breathwork, grounding, tapping/Emotional Freedom Techniques, mindfulness, relational co-regulation, reflective writing, and lived experience. During the medicine session, the setting was a roughly 1,000 square foot dosing room. Two facilitators were present per participant, with roles that could include nurses, therapists, or energy workers depending on need; at least one physician and two nurses were present for each group of eight. Private or quiet spaces were available for anyone needing reduced stimulation or one-to-one support. Participants were allowed to withdraw at any point. Data collection consisted of semi-structured interviews conducted at the end of each cohort, all at one clinic location in Nanaimo, British Columbia. Interviews were recorded, manually transcribed, cleaned to remove identifying information, and managed in Microsoft Word and Excel. Two reviewers independently coded the transcripts, discussed and refined codes, and a third reviewer checked the initial codebook and themes. The authors state that they used Merriam’s Basic Qualitative Research Approach, with grounded theory used pragmatically as an inductive strategy to allow categories and relationships to emerge from the data.

Twenty-five participants were enrolled across four iterative cohorts over one year, and 21 participants completed the programme, which the authors report as an 84% completion rate. In total, 31 in-person psilocybin medicine sessions were delivered because six participants later repeated the medicine session as alumni. Two participants died during the preparation phase from their underlying cancer before receiving psilocybin. One participant withdrew before the medicine session, and another did not fully engage with integration sessions. The qualitative analysis was based on post-programme exit interviews from 21 participants. The authors report five main thematic areas from the interviews: trust and attunement with the innate self, gaining capacity and perspective, authenticity and honesty, connection and regulation with others, and navigating loss and death. Within these themes, participants frequently described greater self-trust, better ability to notice and respond to internal cues, and increased confidence in the therapeutic process and team. Several participants emphasised the importance of managing expectations and being open, with one saying, “trust the process. Be open. Be vulnerable. Be 100% honest.” Regulation practices such as breathwork and tapping were commonly mentioned, and the authors note 32 mentions of different regulation practices. Sixteen participants specifically valued tapping/Emotional Freedom Techniques. Participants also described greater perspective, less attachment to external “noise”, increased positivity, and more peace. Nineteen participants commented on this broader shift in outlook, and seven described feeling lighter or less stressed. Some reported improvements in mood-related symptoms, including less crying, fewer panic attacks, and more positive engagement with daily life. Seven participants mentioned greater honesty and authenticity. Several comments suggested that the experience helped them process anger, fear, and grief more directly. A central finding was the importance of connection to community. The virtual CoP was described as helping to build continuity and familiarity before the medicine session, and the group experience itself was often seen as highly meaningful. Participants said the group made the process safer, more powerful, and less lonely. The authors state that the CoP was mentioned in 22 quoted statements and that multiple participants described the group process as the most helpful part of the programme. At the same time, some participants reported challenges with the group setting: three disliked the music, three disliked aspects of the physical environment such as fan noise or lack of natural light, two experienced abdominal discomfort, and two would have preferred a private rather than group medicine session. Sixteen participants said they would join another group session, while one preferred a private sit and others were undecided. Some participants who had experienced psilocybin in more than one format said they preferred whole mushrooms to synthetic or extract versions, describing differences in depth and quality of the experience. The paper also notes that the group model seemed to work differently from an individual model because it incorporated peer witnessing, shared vulnerability, and continuity of community.

The authors interpret the findings as showing that a hybrid group psilocybin-assisted therapy model can be feasible for patients with terminal diagnoses and may offer distinctive therapeutic advantages beyond simple efficiency. They argue that participants’ accounts were consistent with key goals in psilocybin-assisted therapy, including establishing intentions, then surrendering to the experience and trusting “inner healing intelligence”. They also suggest that the preparatory curriculum should provide enough structure to support confidence and predictability, but avoid excessive information that might unnecessarily prime expectations. Tsang and colleagues place their findings in the context of earlier psychedelic therapy work and broader group therapy literature, noting that earlier studies have also found benefits such as increased positivity, peace, honesty, and emotional processing. They emphasise that structured virtual CoPs appeared to support continuity, peer witnessing, and relational safety before the in-person medicine session, while also acknowledging that the virtual format reduced embodied presence and could feel awkward. They argue that the group setting may be especially valuable for participants who value community and can tolerate shared sensory and emotional experiences, but that it is not necessarily a replacement for individual therapy. Instead, they present the model as a potentially scalable and therapeutically distinct option that may broaden access and lower cost compared with dyad-based delivery. The authors acknowledge several limitations. Selection bias was important because enrolment depended on patients’ ability to obtain legal access through Health Canada mechanisms, which likely favoured those with greater resources or navigational capacity. They also note possible confounding because five participants had already accessed private psilocybin treatment before joining the programme. The study was not a clinical trial, had no randomisation or control group, and therefore cannot support causal claims about efficacy. More generalisable research on hybrid group psilocybin-assisted therapy is needed. In terms of implications, the authors suggest that future programmes should screen for sensory sensitivity, privacy needs, and willingness to be exposed to other participants’ distress during dosing. They also argue for careful attention to room design, music, and movement, as well as to the balance between adequate preparation around death and dying and the risk of overwhelming participants. The discussion further highlights the need to support therapy teams and to consider group-based delivery as a possible way to improve access and reduce cost in end-of-life care.