Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development
This theoretical commentary (2018) highlights the paradigm-shifting implications of psychedelic-assisted psychotherapy in light of a triple crisis within contemporary psychiatry, concerning the lack of reliable therapeutics, a heterogeneity of diagnoses, and a reductionist understanding of mental disorders that explains away the psyche by reducing it to underlying brain processes, whereas the new paradigm aims to incorporate these dimensions in a holistic understanding of human beings and the social factors of their culture and environment.
Authors
- Eduardo Schenberg
Published
Abstract
Mental disorders are rising while development of novel psychiatric medications is declining. This stall in innovation has also been linked with intense debates on the current diagnostics and explanations for mental disorders, together constituting a paradigmatic crisis. A radical innovation is psychedelic-assisted psychotherapy (PAP): professionally supervised use of ketamine, MDMA, psilocybin, LSD and ibogaine as part of elaborated psychotherapy programs. Clinical results so far have shown safety and efficacy, even for “treatment resistant” conditions, and thus deserve increasing attention from medical, psychological and psychiatric professionals. But more than novel treatments, the PAP model also has important consequences for the diagnostics and explanation axis of the psychiatric crisis, challenging the discrete nosological entities and advancing novel explanations for mental disorders and their treatment, in a model considerate of social and cultural factors, including adversities, trauma, and the therapeutic potential of some non-ordinary states of consciousness.
Research Summary of 'Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development'
Introduction
Psychiatric research and development has been described as facing a paradigmatic crisis: the prevalence of mental disorders is rising while the development of novel psychiatric medications has slowed. Debates have intensified about diagnostic systems and explanatory models, with initiatives such as the Research Domain Criteria (RDoC) and network psychopathology offering dimensional, systems-based alternatives to categorical nosologies like the DSM. These debates highlight a broader explanatory impasse in psychiatry, summarised by competing claims that mental disorders are reducible to brain dysfunctions versus concerns that psychiatry is neglecting the psychological/experiential (“the psyche”). Laviola and colleagues introduce psychedelic-assisted psychotherapy (PAP) as a potential radical innovation addressing both treatment and explanatory gaps. Rather than presenting detailed new trial data, the paper reviews clinical developments with substances such as ketamine, MDMA, psilocybin, LSD and ibogaine and explores how combining potent psychoactive drugs with structured psychotherapy may alter therapeutic paradigms, diagnostic thinking and explanatory models in psychiatry. The authors frame PAP not only as a set of promising interventions but also as a model that emphasises the therapeutic role of meaningful altered states of consciousness within biopsychosocial contexts.
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Schenberg, E. E. (2018). Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development. Frontiers in Pharmacology, 9. https://doi.org/10.3389/fphar.2018.00733
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