Depressive DisordersAnxiety DisordersObsessive-Compulsive Disorder (OCD)Palliative & End-of-Life Distress

Toward a contextual psychedelic-assisted therapy: Perspectives from Acceptance and Commitment Therapy and contextual behavioral science

This theoretical paper (2019) proposes Contextual Behavioural Science (CBS) as an ideal framework for understanding psychedelic experiences and therapeutic change. The authors argue that CBS-based therapies, such as Acceptance and Commitment Therapy (ACT), are uniquely positioned to deepen and maintain the acute effects of psychedelic-assisted therapy.

Authors

  • Jason Luoma

Published

Journal of Contextual Behavioral Science
individual Study

Abstract

After two decades of quiescence, clinical psychedelic research re-started in the 1990s and is rapidly accelerating. Early evidence for effectiveness is promising, but understanding of the psychological processes of change underlying observed benefits is limited. This paper outlines contextual behavioral science (CBS) as an ideal framework for understanding psychedelic experiences and the psychological processes of change involved in psychedelic assisted therapy. This paper argues that CBS-based therapies, such as Acceptance and Commitment Therapy (ACT), can contribute to deepening and maintaining the often profound acute effects of psychedelics. The paper begins by briefly outlining the current state of clinical psychedelic research. It then progresses to outlining why CBS may be uniquely positioned to potentially increase the efficacy of psychedelic-assisted therapy, how this scientific model fits with existing data on psychedelic-assisted therapy, as well as with leading neuroscientific theories such as the entropic brain theory. Finally, it concludes by suggesting avenues for future research on how CBS could contribute to psychedelic science, and vice versa.

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Research Summary of 'Toward a contextual psychedelic-assisted therapy: Perspectives from Acceptance and Commitment Therapy and contextual behavioral science'

Introduction

Clinical research into classical psychedelics has experienced a rapid revival since the 1990s after decades of near-halt following legal restrictions in the 1970s. Early and recent trials report promising therapeutic signals across a range of conditions — including depression, anxiety associated with life‑threatening illness, obsessive‑compulsive disorder, and addictions — but the field still lacks a cohesive, empirically grounded account of the psychological processes that mediate therapeutic change. In particular, the psychotherapy element that accompanies dosing in modern trials (preparation, supported dosing sessions, and integration) is variably described and has not been systematically manipulated to determine how it contributes to outcomes. Luoma and colleagues propose that contextual behavioural science (CBS) and its clinical application, Acceptance and Commitment Therapy (ACT), provide an especially suitable scientific framework for understanding psychedelic experiences and for guiding psychedelic‑assisted therapy. The paper sets out to map the psychological flexibility model onto phenomenology and findings from psychedelic research, to relate CBS to neuroscientific accounts such as the entropic brain theory, and to suggest empirical and clinical research priorities for integrating CBS principles into psychedelic therapy protocols.

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References (48)

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