Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy-A systematized review
Using data from 83 sources, this review outlines recommendations for current practice in preparatory sessions in substance-assisted psychotherapy (SAPT), providing information on safety measures and screening procedures, preparation of set and setting, session contents, methods, and roles, prerequisites, and appropriate conduct of therapists.
Authors
- Stephen Bright
Published
Abstract
Background
Clinical trials are currently investigating the potential of substance-assisted psychotherapy (SAPT) as a treatment for several psychiatric conditions. The potential therapeutic effects of SAPT may be influenced by contextual factors including preparation prior to and integration after the substance-assisted therapy sessions.
Aims
This systematized review outlines recommendations for current practice in preparatory sessions in SAPT including safety measures and screening procedures, preparation of set and setting, session contents, methods, and roles, prerequisites, and appropriate conduct of therapists.
Methods
A systematized review of the literature was conducted based on PRISMA guidelines. MEDLINE (OVID), PsycINFO (OVID), and Cochrane Library were searched and clinical trials, treatment manuals, study protocols, case studies, qualitative studies, descriptive studies, theoretical papers, reviews, book chapters, and conference proceedings published until February 1, 2022 were retrieved.
Results
The final synthesis included k = 83 sources. Information about safety measures including screening of participants, set and setting, contextual-, physiological-, and psychological preparation, roles, competencies, prerequisites, and characteristics of the therapists, and the establishment of a therapeutic relationship were summarized and discussed.
Conclusion
It is concluded that there is a consensus in the literature about the importance of adequate preparation before the administration of psychoactive substances in SAPT. However, the extent and approaches for these sessions vary across different models and there is a need for timelier and more rigorous qualitative and quantitative investigations assessing different approaches and techniques for the optimal preparation of clients in SAPT.
Research Summary of 'Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy-A systematized review'
Introduction
Thal and colleagues situate their review within the resurgence of clinical interest in substance-assisted psychotherapy (SAPT), noting that a range of compounds have been used as adjuncts to psychotherapeutic work, including serotonergic psychedelics (e.g. LSD, psilocybin), MDMA, ketamine, and complex agents such as ibogaine. Earlier research and contemporary trials point to a strong influence of non-pharmacological factors on outcomes — in particular psychological preparation before dosing, support during the drug-assisted session, and post-session integration. The authors highlight ongoing debates about whether the acute subjective effects (mystical-type experiences, emotional breakthroughs, ego dissolution, challenging experiences) are necessary mediators of long-term therapeutic change or might instead be biomarkers of receptor activation and plasticity.
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(2022). Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy-A systematized review. Journal of Psychopharmacology. https://doi.org/10.1177/0269881122112795
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