Medicine Sessions, Dose Range, and Therapeutic Effects

Psychedelic substances have a dose-dependent response curve along which noted effects may change significantly in nature. This response curve has what could be considered a general reference range (corresponding to generally suggested dosing), but it may also be quite personalized depending on individual sensitivities which vary widely (Hirschfeld and Schmidt, 2021; Strassman et al., 1994; Jaster, 2021; Studerus et al., 2021).

Optimal dosing depends on what medicine effects one desires to achieve, any contraindications or cautions present, the goals of the session, individual sensitivity, and client history and preference.

Dose-based effects of compounds with psychedelic potential may be thought of as having the following range or general levels.

Please ensure that you read through all items before proceeding by selecting each of the bar graphs below.

Mild

This dose is consistent with alterations in feelings of relaxation, attention, alertness, and presence.

Moderate

In psychedelic-assisted therapy terms, a “psycholytic” or “relational” dose, consistent with greater alteration of the phenomena noted above, plus a sense of greater permeability or porousness of the self, heightened senses, increased access to liminal awareness and right-brain phenomena, and an increased sense of connectedness and often of empathy (Reiff et al., 2020).

Strong

A “psychedelic” dose, consistent with often profound alterations in one’s sense of self (presence, ordinary awareness, physical and psychological boundaries between one’s person and environment), and in one’s senses, perceptions, thought processes, and meaning making. At a higher threshold, there may be “ego dissolution” in which one’s experience of self is as unbounded and formless, or as pure awareness, or as consciousness experiencing itself infinitely. There may also be a sense of the immaterial nature or what is usually considered “reality,” and of the presence of energies, beings, or conscious entities not encountered by the client in an ordinary state of consciousness.

It is important that health professionals do not solely rely on the dose given to determine what the client is experiencing but rather on their observations of the client.

Dosing Considerations

2:07

In this brief audio clip, Cody Callon explains some key dosing considerations.

Individual differences in sensitivity and metabolism mean that different clients will be differently affected by the same medicine at the same dose. When available, knowledge about the types of experiences a client has previously had with psychedelic substances is the best source of information to help predict response. When this is not available, the next best source of information is knowledge of their response to other psychotropic and analgesic substances. Further to this, there may be considerable inter-personal variation between an individual’s different sessions for reasons that are not well understood. With clients who are psychedelically naïve or whose previous psychedelic experiences are remote or mixed in nature, there will inevitably be a significant degree of uncertainty around their sensitivity and the type of response that may be predicted related to a particular dose of a given medicine.

Within this conversation, it’s also important to note that psychological factors can play a role. For example, research has shown that individuals high in the traits of absorption, openness, and acceptance as well as a state of surrender were more likely to have positive and mystical type experiences in response to the acute effects of psychedelics. Whereas those low in openness and surrender or in preoccupied, apprehensive, or confused psychological states were more likely to experience acute, adverse reactions.

Another important consideration here is how defended the individual’s psyche may be. For example, it has been anecdotally observed that clients with a higher degree of structural dissociation–in the secondary to tertiary range – may be more inclined to experience very little psychedelic effect despite high doses of psychedelic medicines. With that said, this is anecdotal and more research is needed to qualify this observation.

Health Professional Tip

What is important is that the attending health professional recognize what sort of medicine experience the client is having and respond appropriately with optimal support for facilitating positive outcomes for that dose of medicine.

Health professionals working with psychedelic-assisted therapy should feel comfortable working flexibly within the spectrum from psycholytic to psychedelic effects, both within and between sessions with a given client.

Client Eligibility

Health professionals should be familiar with contraindications and be mindful of these throughout the Preparation Sessions leading up to the Medicine Sessions. The Preparation Sessions are also an opportunity to continue with psychological screening in case something was missed during their intake screening. Medical and Psychological Screening precedes Preparation Sessions to determine eligibility, but it continues with the health professional’s clinical judgment in the Preparation Sessions. This may result in health professionals deferring Medicine Sessions in favour of more Preparation Sessions or, if needed, to refer to an alternate modality is psychedelic-assisted therapy is deemed inappropriate.

Managing Client Expectations

Clients may have expectations regarding the degree of the effect. It is important that health professionals do not collude with or otherwise reinforce any level of disappointment if effects are less strong than the client was hoping for or expecting. Health professionals encountering this situation might use the opportunity to remind clients about trusting their own inner healing intelligence. They can explore the client’s ability or inability to be present to ‘what is’ by guiding attention with SIBAM to encourage exploration of components of experience. This is in contrast to ruminating or becoming fixed on negative cognitions about the experience they are having.

'There is no such thing as no experience”,

Gabor Maté (2014, personal communication) has wisely said when encountering this situation during ayahuasca integration. Excellent therapeutic progress can be made within a psycholytic ‘relational’ effect range, as we will discuss next.

Relational Therapy

Therapeutic interventions within psychedelic-assisted therapy will look quite different depending on the level of medicine the client is experiencing.

Please ensure that you read through all slides before proceeding by using the arrow keys on your keyboard or using the navigation buttons at the bottom of each slide.

Health Professional Tip

During Medicine Sessions, health professionals should:

  • Remain attuned and present

  • Track clients

  • Make relevant observations of their experience

  • Pay attention to the clients’ physical status, being mindful of any potential deficits in their hydration, elimination, and glycemic status (especially if sessions are many hours long)

  • Take notes of what is said if clients are verbal (helpful during the Integration Sessions)

  • Meet clients when they seek verbal or physical contact for orientation, containment, and support only for the time that it is required (not longer)

  • Abstain from providing therapeutic interventions of the type and frequency to which they are accustomed

References

Aday, J. S., Davis, A. K., Mitzkovitz, C. M., Bloesch, E. K., and Davoli, C. C. (2021). Predicting reactions to psychedelic drugs: A systemic review of states and traits related to acute drug effects. ACS Pharmacological and Translational Science. https://doi.org/10.1021/acsptsci.1c00014

Hirschfeld, T. & Schmidt, T.T. (2021). Dose-response relationships of psilocybin-induced subjective experiences in humans. Journal of Psychopharmacology, 35(4), 384-397. doi: 10.1177/0269881121992676

Jaster, A. M. (2021). Finding the Psychedelic Sweet Spot. Psychedelic Science Review. Retrieved from https://psychedelicreview.com/finding-the-psychedelic-sweet-spot/

Reiff, C. M., Richman, E. E., Nemeroff, C. B., Carpenter, L. L., Widge, A.S., Rodriguez, C. I., Kalin, N. H., McDonald, W. M. (2020). Psychedelics and Psychedelic-Assisted Psychotherapy. The American Journal of Psychiatry. Retrieved from https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010035

Strassman, R. J., Qualls, C. R., Uhlenhuth, E. H., Kellner, R. (1994). Dose-Response Study of N,N-Dimethyltryptamine in Humans: II. Subjective Effects and Preliminary Results of a New Rating Scale. American Medical Association, 51(2), 98-108. Retrieved from https://maps.org/research-archive/w3pb/1994/1994_Strassman_22714_1.pdf

Studerus, E., Vizeli, P., Harder, S., Ley, L., and Liechti, M. E. (2021). Prediction of MDMA response in healthy humans: a pooled analysis of placebo-controlled studies. Journal of Psychopharmacology, 35(5), 556-565. https://doi.org/10.1177/0269881121998322