Psychedelic Therapy

Psychedelic Therapy: Current Approaches and Trends

Current treatments for people diagnosed with mental illnesses such as anxiety, depression, and PTSD, include cognitive behavioural therapy (CBT) or dialectical behaviour therapy (DBT), which focus on managing emotions and negative thoughts and behaviours. Although these options benefit some patients may benefit, others often start considering non-traditional treatment methods such as psychedelic therapies when traditional methods fail. Clinical trials on psychedelic-assisted psychotherapy are rapidly evolving in the United States and Canada.  

What is Psychedelic Therapy?

Psychedelic therapy is a way of treating mental health disorders using specific doses of psychedelic substances as an adjunct to psychotherapy to overcome the mental barriers within the sufferer’s mind. These drugs are (ideally) used in a controlled, clinical setting with trained psychotherapists. Therapy using psychedelic drugs rose to prominence in the early 1950s following the discovery of the LSD. However, due to the ban on psychedelics in the late 70s, these therapeutic practices became illegal and board-certified therapists stopped psychedelic therapies out of fear of losing their licenses.

Nonetheless, recent research into psychedelics has shown potential uses of psychedelic drugs in the treatment of various mental health problems, including post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), depressions, anxiety, cluster headaches and drug addictions.

Protocols in Psychedelic Therapy

There are several types of psychedelic therapy available. However, during psychedelic-assisted therapy, it is important to factor in set and setting. Set refers to the overall mindset, or expectations, experience and mood of the sufferer, and the setting refers to the location of the session, including the comfort and quality of the room itself.

Psychedelic therapy has been conducted for years in the context of spiritual healing.  Many shamanic practitioners work with naturally occurring psychedelics in Mexico, Brazil, and Peru.

A typical approach to psychedelic therapy involves patient participation in therapy before and after the drug is administered. Some therapists prefer to give frequent low or moderate doses of psychedelic drugs. This allows the therapist to be present and interact with the sufferer, as they manage the revelations of their deep psychedelic experience. Due to low doses, this experience is gradual, and not overpowering. 

More often, psychedelic-assisted therapy includes one to three high doses of a psychedelic drug. In this case, using a comfortable setting, eye shields, headphones and relaxing music, the patient usually manages the experience on their own. The staff is present, on hand when needed, but do not navigate the experience. Afterwards, the patient can reflect on what happened during the session and then change the problematic behaviours, thoughts or ideas.

Types of Psychedelic-Assisted Psychotherapies:

  • MDMA for post-traumatic stress disorder (PTSD). The results of clinical trials are very promising, and researchers at the Multidisciplinary Association for Psychedelic Studies (MAPS), including Michael C. Mithoefer, are currently conducting  Phase 3 trials of MDMA-assisted PTSD treatment at the 15 research sites, including United States, Canada, and Israel. If approved, the psychedelic drug could be available to the general public in late 2022 or early 2023. An independent preliminary study found MDMA-assisted psychotherapy had larger effect sizes compared to prolonged exposure therapy when evaluated by clinician-observed outcomes, by patient self-report outcomes, and also by drop-outs. It is also being studied for the treatment of social anxiety in autistic adults and alcohol use disorder.
  • Psilocybin for depression and anxiety. Psilocybin has a very high safety ratio and  low risk. A series of studies at Johns Hopkins University showed that psilocybin can help reduce depression and anxiety in patients with late-stage terminal cancer. Psilocybin-assisted therapy was also associated with increased quality of life, improved optimism, and reduced anxiety. About 80 percent of participants continued to show improvements six months later.
  • Ketamine-assisted therapy for depression. Ketamine is currently the only legal psychedelic available at many clinics for the treatment of depression, anxiety, addiction, and suicidality in Canada, the United States, and other places around the world, including Australia and the United Kingdom.
  • LSD-assisted therapy. Researchers in Switzerland and the United States are currently in  Phase 2 trials with several LSD-assisted therapies. Studies have shown that LSD therapy is promising for decreasing alcohol misuse. The research is also focused on sufferers with anxiety and depression.
  • Psychedelic-assisted addiction therapy. Some psychedelics are showing results in treating drug addiction. Ibogaine is a promising treatment for opioid abuse. Psychedelic retreats and clinical trials are exploring ayahuasca-assisted therapy to see whether it can treat dependence. The research involving members of Brazilian religious groups who regularly drink ayahuasca sacramentally has shown that, compared with a control group, long-term regular drinkers of ayahuasca tend to have a lower prevalence of substance use, structural brain changes that do not suggest evident pathology, and better neuropsychological performance and psychosocial adaptation. 

While psychedelic-assisted therapy shows strong clinical results, research is still required to ensure high levels of safety and to optimize clinical effectiveness. To offer these therapies to a much larger population, more work is needed to understand the psychological risks and to determine what works best for different clinical indications.

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