Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model
After reviewing limitations of existing psychedelic‑assisted psychotherapy approaches—particularly their neglect of embodied, relational and ethical dimensions—this paper introduces EMBARK, a transdiagnostic, trans‑drug framework that defines six clinical domains and four care cornerstones to standardise therapist interventions across preparation, medicine and integration sessions. EMBARK is designed to integrate evidence‑based therapies and therapists’ prior skills, delimit interventions for research, and clarify factors driving treatment outcomes, and is already being adopted in multiple PAP trials.
Abstract
The current standard of care in most uses of psychedelic medicines for the treatment of psychiatric indications includes the provision of a supportive therapeutic context before, during, and after drug administration. A diversity of psychedelic-assisted psychotherapy (PAP) models has been created to meet this need. The current article briefly reviews the strengths and limitations of these models, which are divided into basic support models and EBT-inclusive therapy models. It then discusses several shortcomings both types of models share, including a lack of adequate attention to embodied and relational elements of treatment, and insufficient attention to ethical concerns. The article then introduces the EMBARK model, a transdiagnostic, trans-drug framework for the provision of supportive psychotherapy in PAP clinical trials and the training of study therapists. EMBARK was designed to overcome challenges that prior models have had in conceptualizing therapeutic change in psychedelic treatment, incorporating elements of non-psychedelic evidence-based therapies, incorporating therapists’ prior skills and clinical orientations, delimiting therapist interventions for research standardization, and determining specific factors that contribute to treatment outcomes. The article explains EMBARK’s six clinical domains, which represent parallel conceptualizations of how therapists may support therapeutic benefit in PAP treatment, and its four care cornerstones, which reflect therapists’ broad ethical responsibility to participants. The article describes how these elements of the model come together to structure and inform therapeutic interventions during preparation, medicine, and integration sessions. Additionally, the article will discuss how EMBARK therapist training is organized and conducted. Finally, it will demonstrate the broad applicability of EMBARK by describing several current and upcoming PAP clinical trials that have adopted it as the therapeutic frame.
Research Summary of 'Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model'
Introduction
Psychedelic medicines are increasingly administered within psychotherapeutic frameworks because much of their putative efficacy appears to arise from acute alterations in subjective experience that, when properly supported, can translate into clinical benefit. Reiff and colleagues note that almost all clinical trials of classic serotonergic psychedelics and MDMA embed drug administration within a therapeutic context; nonetheless, a plurality of adjunctive psychotherapy models has arisen, differing in how much non-drug therapy time they provide, whether they explicitly incorporate non-psychedelic evidence-based therapies (EBTs), and how prescriptive they are about therapist interventions. The field lacks robust empirical evidence to guide which of these features most influence clinical outcomes. This article aims to (1) review contemporary PAP models, grouped into “basic support” and “EBT-inclusive” approaches, highlighting their strengths and limitations; and (2) introduce EMBARK, a transdiagnostic, trans-drug model designed to address perceived shortcomings of prior approaches. EMBARK was developed as an adaptable therapeutic frame for training study therapists and structuring psychotherapy in PAP clinical trials, with the intention that it can be tailored to particular drugs and indications and used both within Cybin-sponsored studies and by external groups wishing to adopt or adapt it.
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Brennan, W., & Belser, A. B. (2022). Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.866018
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