Equity and Ethics

Psychedelics and Psychotherapy

This book chapter (2020) in Pharmacopsychiatry provides an excellent review of our current understanding of psychedelics for psychotherapy.

Authors

  • Matthew Johnson
  • Sandeep Nayak

Published

Pharmacopsychiatry
meta Study

Abstract

Psychedelics have shown great promise in modern clinical trials for treating various psychiatric conditions. As a transdiagnostic treatment that exerts its effects through subjective experiences that leave enduring effects, it is akin to psychotherapy. To date, there has been insufficient discussion of how psychedelic therapy is similar to and different from conventional psychotherapy. In this article, we review the shared features of effective conventional psychotherapies and situate therapeutic psychedelic effects within those. We then discuss how psychedelic drug effects might amplify conventional psychotherapeutic processes-particularly via effects on meaning and relationship-as well as features that make psychedelic treatment unique. Taking into account shared features of conventional psychotherapies and unique psychedelic drug effects, we create a framework for understanding why psychedelics are likely to be effective with very diverse types of psychotherapies. We also review the formal psychotherapies that have been adjunctively included in modern psychedelic trials and extend the understanding of psychedelics as psychotherapy towards implications for clinical ethics and trial design. We aim to provide some common conceptual vocabulary that can be used to frame therapeutic psychedelic effects beyond the confines of any one specific modality.

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Research Summary of 'Psychedelics and Psychotherapy'

Introduction

The paper frames modern therapeutic psychedelic research within the broader history of psychotherapy and argues that psychedelic-assisted interventions fulfil the core features of psychotherapy as defined by Jerome Frank: an emotionally charged, confiding relationship with an expert, a healing setting, a plausible explanatory rationale, and a ritual requiring joint participation. From this perspective, the authors propose that durable changes following psychedelics are not reducible to acute pharmacology alone but depend critically on the subjective experience and on learning and integration that follow the drug session. Nayak and colleagues set out to treat psychedelic therapy explicitly as psychotherapy: they review how psychedelics interact with well-established common factors of effective psychotherapies, outline the ways psychedelic effects may amplify psychotherapeutic processes (especially meaning-making, relationship, and skill acquisition), survey formal psychotherapeutic frames used in modern trials, and discuss the clinical, ethical, and methodological implications for trial design and practice. The paper is presented as a conceptual/narrative review aimed at providing vocabulary and practical prescriptions for thinking about psychedelic treatments within psychotherapy frameworks.

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Study Details

References (30)

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