Must Psilocybin Always “Assist Psychotherapy”?
This commentary (2023) critically re-evaluates the role of psychedelics in psychotherapy, focusing on psilocybin's use and challenging its current understanding in mental health treatment. Concluding that psychedelic-assisted psychotherapy is a misnomer, it proposes psilocybin treatment as a more accurate term, foreseeing a future where psychedelics could precede various psychotherapies, antidepressants, or neurostimulation for specific conditions.
Authors
- Guy Goodwin
- Ekaterina Malievskaia
- Charles Nemeroff
Published
Abstract
generated by Blossom as the commentary has no abstract.This article critically re-evaluates the use of psychedelics, particularly psilocybin, in modern psychotherapy, challenging the prevailing notion of 'psychedelic-assisted psychotherapy.' It argues for viewing psilocybin as a catalyst for therapeutic change, not a treatment modality per se, in light of historical and contemporary practices. Tracing the shift from LSD use in psychodynamic psychotherapy in the 1950s to recent psilocybin trials for conditions like cancer and treatment-resistant depression, the paper underscores the safety-oriented nature of psychological support in these studies, diverging from traditional evidence-based psychotherapies. The article delves into the neurobiological mechanisms of psychedelics, emphasizing their serotonergic properties and enduring brain connectivity changes, and considers the ethical complexities of using MDMA for PTSD treatment. Concluding that 'psychedelic-assisted psychotherapy' is a misnomer, it suggests the more accurate term 'psilocybin treatment' to reflect the unique mechanisms of psychedelic-induced change, foreseeing a potential future where psychedelics precede a variety of focused psychotherapies, antidepressants, or neurostimulation for specific clinical conditions.
Research Summary of 'Must Psilocybin Always “Assist Psychotherapy”?'
Introduction
Goodwin and colleagues open by questioning the now-common phrase "psychedelic-assisted psychotherapy," asking whether it accurately describes how serotonergic psychedelics such as psilocybin produce therapeutic effects. They note that some recent definitions present the drug as a catalyst that enhances a separate, relationship-centred psychotherapy; this framing, the authors argue, rests on a dualism that is not clearly supported by existing clinical evidence. Historical practice is reviewed to show two distinct traditions: a psycholytic approach that used low, repeatedly administered doses to facilitate psychotherapy, and a higher-dose psychedelic approach emphasising preparation and supportive presence rather than active therapeutic interventions during the acute drug state. The commentary sets out to clarify the roles of drug action and psychological support in modern clinical studies of psychedelics, with particular focus on psilocybin. Rather than reporting new empirical data, the paper evaluates historical context and findings from recent controlled trials to assess whether the therapeutic effects observed should be attributed primarily to a formal psychotherapy augmented by a drug, or to the pharmacological action of the drug itself delivered with safety-focused support. The aim is practical and regulatory: to consider how the distinction matters for interpreting trial results and for the approval and implementation of these agents in clinical practice.
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Study Details
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- APA Citation
Goodwin, G. M., Malievskaia, E., Fonzo, G. A., & Nemeroff, C. B. (2024). Must Psilocybin Always “Assist Psychotherapy”?. American Journal of Psychiatry, 181(1), 20-25. https://doi.org/10.1176/appi.ajp.20221043
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Smith, K. A., Harcourt, E., Cipriani, A. · BJPsych Open (2026)
Goodwin, G. M., Aaronson, S. T., Alvarez, O. et al. · Journal of Affective Disorders (2026)
Johnson, M. W., Naudé, G. P., Hendricks, P. S. et al. · JAMA Network Open (2026)
Garcia-Romeu, A., Naudé, G. P., Rebman, A. W. et al. · Scientific Reports (2026)
Goldy, S. P., Sepeda, N. D., Hilbert, S. N. et al. · Psychiatry Research (2026)
Gründer, G., Mertens, L. J., Spangemacher, M. et al. · European Neuropsychopharmacology (2026)
Modlin, N. L., Williamson, V., Goodwin, G. M. et al. · EClinicalMedicine (2025)
Meshkat, S., Kaczmarek, E., Doyle, Z. et al. · Psychedelic Medicine (2025)
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Seybert, C., Schimmers, N., Silva, L. et al. · Lancet (2024)
Shinozuka, K., Jerotic, K., Mediano, P. A. M. et al. · Translational Psychiatry (2024)
Maples-Keller, J. L., Hyatt, C. S., Phillips, N. L. et al. · Journal of Psychoactive Drugs (2024)
Aday, J. S., Horton, D. M., Fernandes-Osterhold, G. et al. · Psychopharmacology (2024)
Weiss, B., Leor Roseman, •., Giribaldi, B. et al. · International Journal of Mental Health and Addiction (2024)
Rosenblat, J. D., Meshkat, S., Doyle, Z. et al. · Med (2024)
Gründer, G., Brand, M., Mertens, L. J. et al. · Lancet Psychiatry (2024)
Aicher, H. D., Schmid, Y., Gasser, P. · Die Psychotherapie (2024)
Rodgers, A., Bahceci, D., Davey, C. G. et al. · Australian and new-zealand Journal of Psychiatry (2023)
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