Psychedelic-assisted psychotherapy: Where is the psychotherapy research?
This review (2024) scrutinizes the role of psychotherapy in psychedelic-assisted psychotherapy (PAP/PAT) for mental health conditions. It underscores a significant research gap in understanding the psychotherapeutic elements within PAT, despite its assumed importance for safety and efficacy. The paper calls for a transdisciplinary approach in future research to optimize PAT clinical outcomes and inform federal guidelines.
Authors
- Joshua Woolley
- Jordan Aday
- Ellen Bradley
Published
Abstract
Rationale
Psychedelic-assisted psychotherapy (PAP) has emerged as a potential treatment for a variety of mental health conditions, including substance use disorders and depression. Current models of PAP emphasize the importance of psychotherapeutic support before, during, and after ingestion of a psychedelic to maximize safety and clinical benefit. Despite this ubiquitous assumption, there has been surprisingly little empirical investigation of the “psychotherapy” in PAP, leaving critical questions about the necessary and sufficient components of PAP unanswered.
Objectives
As clinical trials for psychedelic compounds continue the transition from safety- and feasibility-testing to evaluating efficacy, the role of the accompanying psychotherapy must be better understood to enhance scientific understanding of the mechanisms underlying therapeutic change, optimize clinical outcomes, and inform cost-effectiveness.
Results
The present paper first reviews the current status of psychotherapy in the PAP literature, starting with recent debates regarding “psychotherapy” versus “psychological support” and then overviewing published clinical trial psychotherapy models and putative models informed by theory. We then delineate lessons that PAP researchers can leverage from traditional psychotherapy research regarding standardizing treatments (e.g., publish treatment manuals, establish eligibility criteria for providers), identifying mechanisms of change (e.g., measure established mechanisms in psychotherapy), and optimizing clinical trial designs (e.g., consider dismantling studies, comparative efficacy trials, and cross-lagged panel designs). Throughout this review, the need for increased research into the psychotherapeutic components of treatment in PAP is underscored.
Conclusions
PAP is a distinct, integrative, and transdisciplinary intervention. Future research designs should consider transdisciplinary research methodologies to identify best practices and inform federal guidelines for PAP administration.
Research Summary of 'Psychedelic-assisted psychotherapy: Where is the psychotherapy research?'
Introduction
High-dose administration of classic psychedelics paired with psychotherapeutic support before, during, and after dosing sessions is increasingly being studied as a potential treatment for several psychiatric conditions. Aday and colleagues describe two principal rationales for combining drug and psychotherapy: safety (therapeutic support is thought to reduce the acute risks of giving a psychedelic) and efficacy (psychedelics may transiently relax prior beliefs, increase suggestibility, and promote neuroplasticity in ways that could augment psychotherapeutic processes). The authors emphasise that this context sensitivity makes it important to understand which psychotherapeutic elements are necessary or sufficient for clinical benefit. The paper sets out to review the current status of psychotherapy within psychedelic-assisted psychotherapy (PAP), summarising psychotherapeutic models used in published clinical trials and putative models proposed in the literature. It also aims to draw lessons from decades of traditional psychotherapy research about standardising treatments, identifying mechanisms of change, and optimising trial design, with the overarching goal of highlighting gaps and priorities for empirical study of the psychotherapeutic component of PAP.
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Aday, J. S., Horton, D., Fernandes-Osterhold, G., O'Donovan, A., Bradley, E., Rosen, R., & Woolley, J. (2023). Psychedelic-assisted psychotherapy: Where is the psychotherapy research?. https://doi.org/10.31234/osf.io/s3yjd
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