Psychedelics and Psychotherapy: Cognitive-Behavioral Approaches as Default
This paper (2022) explores historical and sociological influences on current psychedelic administration in mainstream European and American clinical research settings. It considers these dynamics in relation to cognitive-behavioural therapies (CBT) and acceptance and commitment therapy (ACT). The paper advocates for CBTs for several reasons, such as the large base of empirical evidence they have. Several types of CBTs are discussed and how they can be used to inform the preparation, session, and integration phases of psychedelic psychotherapy.
Authors
- Matthew Johnson
- David Yaden
- Jason Luoma
Published
Abstract
The acute subjective effects of psychedelics are responsive to users’ expectations and surroundings (i.e., “set and setting”). Accordingly, a great deal of thought has gone into designing the psychosocial context of psychedelic administration in clinical settings. But what theoretical paradigms inform these considerations about set and setting? Here, we describe several historical, sociological influences on current psychedelic administration in mainstream European and American clinical research settings, including: indigenous practices, new age spirituality from the 1960s, psychodynamic/psychoanalytic approaches, and cognitive-behavioural approaches. We consider each of these paradigms and determine that cognitive-behavioural therapies, including newer branches such as acceptance and commitment therapy (ACT), have the strongest rationale for psychedelic-assisted psychotherapy going forward. Our primary reasons for advocating for cognitive-behavioural approaches include, (1) they avoid issues of cultural insensitivity, (2) they make minimal speculative assumptions about the nature of the mind and reality, (3) they have the largest base of empirical support for their safety and effectiveness outside of psychedelic therapy. We then propose several concepts from cognitive-behavioural therapies such as CBT, DBT, and ACT that can usefully inform the preparation, session, and integration phases of psychedelic psychotherapy. Overall, while there are many sources from which psychedelic psychotherapy could draw, we argue that current gold-standard, evidence-based psychotherapeutic paradigms provide the best starting point in terms of safety and efficacy.
Research Summary of 'Psychedelics and Psychotherapy: Cognitive-Behavioral Approaches as Default'
Introduction
Yaden and colleagues situate their paper in the context of a renewed clinical interest in classic psychedelics such as psilocybin, noting that these compounds show therapeutic promise for mood and substance use disorders and that their acute subjective effects are highly sensitive to expectations and the surrounding psychosocial context ("set and setting"). They observe that contemporary clinical practice and research draw on diverse historical and sociological influences—including indigenous ritual practices, 1960s-era new age spirituality, psychodynamic/psychoanalytic traditions, and cognitive‑behavioural paradigms—and highlight a need to consider which theoretical frameworks should best inform the therapeutic contexts used in mainstream European and American clinical settings. The paper sets out to review those four influence domains briefly, identify strengths and problems with each, and argue that cognitive‑behavioural approaches (broadly defined to include traditional CBT, dialectical behaviour therapy or DBT, and acceptance and commitment therapy or ACT) provide the strongest rationale to serve as the default psychotherapeutic paradigm for psychedelic‑assisted therapy in contemporary clinical research. The authors also aim to translate selected concepts from CBT/DBT/ACT into practical suggestions for the three phases of psychedelic therapy—preparation, dosing session, and integration—and to call for empirical testing of these proposed pairings and adaptations.
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Yaden, D. B., Earp, D., Graziosi, M., Friedman-Wheeler, D., Luoma, J. B., & Johnson, M. W. (2022). Psychedelics and Psychotherapy: Cognitive-Behavioral Approaches as Default. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.873279
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