Peak experiences and the afterglow phenomenon: when and how do therapeutic effects of hallucinogens depend on psychedelic experiences
This review (2015) looks at the influence of subjective (therapeutic) effects on the (treatment) outcomes of psychedelic experiences. This is put in context of the neuronal mechanism of psychedelics, but that relationship is still something that we know little about.
Authors
- Tomislav Majic
Published
Abstract
Interest in the therapeutic potential of psychedelic substances has recently resumed. During an early phase of human psychedelic research, their therapeutic application in different pathologies had been suggested, and the first evidence for efficacy was provided. The range of recent clinical applications of psychedelics spans from cluster headaches and obsessive-compulsive disorder to addiction and the treatment of fear and anxiety in patients suffering from terminal illness, indicating potentially different therapeutic mechanisms. A variety of approaches in psychotherapy emphasize subjective experiences, such as so-called peak experiences or afterglow phenomena, as differentially mediating therapeutic action. This review aims to re-evaluate earlier and recent concepts of how psychedelic substances may exert beneficial effects. After a short outline of neurophenomenological aspects, we discuss different approaches to how psychedelics are used in psychotherapy. Finally, we summarize evidence for the relationship between subjective experiences and therapeutic success. While the distinction between pharmacological and psychological action obviously cannot be clear-cut, they do appear to contribute differently from each other when their effects are compared with regard to pathologies.
Research Summary of 'Peak experiences and the afterglow phenomenon: when and how do therapeutic effects of hallucinogens depend on psychedelic experiences'
Introduction
Over the past two decades there has been a renewed scientific interest in hallucinogenic substances such as psilocybin and ketamine. Majić and colleagues place this revival against a history in which psychedelics were used both to model psychosis and as therapeutic tools; modern neuroimaging and improved methodological standards have prompted fresh hypotheses about their mechanisms. Earlier work emphasised that psychedelic-assisted therapy produces altered states of consciousness (ASCs), including intense mystical or peak experiences and a subsequent ‘‘afterglow’’, and proposed these subjective phenomena as central to therapeutic benefit. More recent approaches have also posited pharmacological, experience-independent mechanisms, particularly in the case of ketamine. This review aims to re-evaluate historical and contemporary concepts about how psychedelics may produce therapeutic effects. Majić and colleagues focus primarily on classical serotonergic hallucinogens and include specific reference to ketamine, while excluding MDMA and ibogaine from detailed consideration. They outline neurophenomenological issues, survey therapeutic models and clinical applications, and examine the evidence linking particular subjective experiences (for example, mystical peak experiences and afterglow periods) to clinical outcomes.
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Majić, T., Schmidt, T. T., & Gallinat, J. (2015). Peak experiences and the afterglow phenomenon: when and how do therapeutic effects of hallucinogens depend on psychedelic experiences. Journal of Psychopharmacology, 29(3), 241-253. https://doi.org/10.1177/0269881114568040
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