Overview of Psychedelic-Assisted Therapy

The psychedelic-assisted therapy model involves the therapeutic use of a potent psychoactive medicine in conjunction with a psychotherapeutic process or other therapies to enhance treatment outcomes.

Although variations of psychedelic-assisted therapy exist, this approach typically includes:

Please ensure that you read through all items before proceeding by selecting each part of the image.

Preparation Sessions

Preparation includes the assessment of the client’s eligibility and suitability and the psychoeducation that underlies both informed consent and the building of skill in navigating alternate states of consciousness. This includes both psychological and physical dimensions of the experience, as well as its possible transpersonal and spiritual aspects for clients oriented towards those domains. Research (Carhart-Harris et al 2018) shows that how a client is prepared for psychedelic-assisted therapy influences the outcomes.

During Preparation Sessions, clients will learn about the importance of setting an intention, the importance of music in their Medicine Session, the role of a support person, the differences between expectations and intentions, and the important role of set and setting.

Psychedelic Medicine Sessions

Immersive Medicine Sessions are several hours in length, with variability depending on the substance used, goals for the session, client response to the psychedelic medicine selected, and the general unfolding of the session.

Integration Sessions

Integration begins following an immersive medicine session, usually within 24-28 hours of its completion. The etymology of the word ‘integrate’ refers to the act of bringing together the parts of a whole. This process can be viewed as bottom-up processing which will be discussed next module where sensory, somatic, emotional, and other dimensions of present moment experience form the primary, although not exclusive, building blocks of a cognitive formulation. There will also be clients who have a preference to process cognitively and emotionally. Psychedelic-Harm Reduction and Integration may thus be seen as a means of bringing together potentially disparate or discrete experiences, and ways of thinking about them, (common for example in post-traumatic stress), processing them in part, through the body, and ultimately bringing them into a coherent, functional, or helpful narrative.

There are several important aspects to integration. What follows is a framework developed through our applied integration, clinical work, and the literature (Watts & Luoma, 2020; Wong, 2020; Woods et al., 2019). It has been derived from a variety of sources, intended to give therapists and those working underground a structure for assessing the common client integration needs at any given stage of the integration process. The following needs framework includes the following phases.

  • Regulation

  • Normalizing

  • Metabolizing

  • Meaning-making

  • Keeping it alive

  • Connection to others

  • Committed actions

  • Spiritual needs

Throughout this module, we will be breaking down the integration needs framework to better understand how this aligns with optimal outcomes of psychedelic-assisted therapy.

All three of these components are thought to be critical to the therapeutic outcome. Research (Carhart-Harris et al 2018) shows that how a client is prepared for psychedelic-assisted therapy influences the outcomes. Research (Gorman et al., 2021; Mithoefer, 2016; Pilecki et al., 2021) also shows that Integration Sessions can provide opportunities for clients to make meaning of their experience during Medicine Sessions and use these experiences to make behavioural and life changes.

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In future courses, you will receive specific training for each psychedelic-assisted therapy protocol to help build upon this brief overview.

Psychedelic Medicines

In the following section, we will learn about the three psychedelic medicines that Numinus uses to deliver psychedelic-assisted therapy.

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Psilocybin is a natural compound produced by numerous mushroom species most of which are in the genus Psilocybe. In the context of modern clinical research, it is manufactured synthetically to control potency and purity.

Psilocybin reliably induces profound changes in:

  • Sensory perception

  • Emotion

  • Thought

  • Sense of self, characterized by marked alterations in all mental functions, including:

    • Perception

    • Mood

    • Volition

    • Cognition

  • Self-experience (Griffiths et al., 2011; Studerus et al., 2012; Usona Institute, 2021)

Cultural Safety and Humility

At Numinus, we recognize and reaffirm Indigenous Peoples in their continued use and stewardship of sacred plant medicines in healing traditions and cultural practices since Time Immemorial. With humility and gratitude, we recognize Psilocybe mushrooms are sacred plant medicines rooted in Indigenous histories of the Mazatec, Nahua, and among other Indigenous Peoples, and modern psilocybin-assisted therapy would not be possible without their Knowledge, wisdom, and worldview.

Research conducted over the past 15 years has demonstrated the beneficial effect of psilocybin-assisted therapy on:

  • End-of-life anxiety and psychological distress (Agin-Liebes et al., 2020; Grob et al., 2011; Reiche et al., 2018)

  • Depression (Carhart-Harris et al., 2018; Robin L Carhart-Harris et al., 2016)

  • Substance use disorders (Bogenschutz et al., 2015; Johnson et al., 2014; Johnson et al., 2017)

  • Obsessive-compulsive disorder (Moreno et al., 2006)

  • Migraines (Schindler et al., 2021)

  • Demoralization (Anderson et al., 2020)

Learn More

To learn more about psilocybin, please watch Psilocybin Mushrooms and the Path to Higher Consciousness.

MDMA is a synthetic compound that was first developed by Merck in 1912. It was re-discovered by Shulgin in the 1970s and was introduced as an adjunct to psychotherapy at that time.

The effects of MDMA can include:

  • Increased feelings of interpersonal closeness

  • Increased compassion for self and others

  • Reduced anxiety

  • Reduced defences and fear of emotional injury

  • Making unpleasant memories less disturbing while enhancing communication and capacity for introspection (Bedi et al., 2014; Carhart-Harris et al., 2014; MAPS, 2021; Wardle & de Wit, 2014; Wardle et al., 2014)

Taken together, these factors provide the opportunity for reconsolidation of trauma-based memories and corrective emotional experiences within the context of therapy. MAPS PBC has been completing numerous studies in the United States, Canada, Europe, and Israel demonstrating the safety and efficacy of MDMA-Assisted Therapy to treat PTSD (Feduccia et al., 2018; Feduccia et al., 2019; Jerome et al., 2020; Mitchell et al., 2021; Mithoefer et al., 2019).

Research findings demonstrate that MDMA-assisted therapy may be efficacious for treating:

  • Social anxiety among adults with autism (Danforth et al., 2018)

  • End-of-life anxiety/psychological distress (Wolfson et al., 2020)

  • Alcohol use disorder (Sessa et al., 2019)

  • Eating disorders (Brewerton et al., 2021)

Learn More

To learn more about MDMA, please watch Your Brain on MDMA.

Ketamine is a synthetic compound that was first developed by Parke Davis as an analogue of phencyclidine in 1962. It was initially developed as an anaesthetic but has also been investigated for use in pain management and mental health treatment.

The effects of ketamine can include:

  • A time-out from ordinary, usual mind

  • A relief from negativity

  • An openness to the expansiveness of the mind with greater access to the self in a larger sense (Dore et al., 2019)

  • Acute changes in somatic, perceptual, cognitive, and affective processes (Kohtala, 2021; Mathai et al., 2020)

Research findings demonstrate that ketamine-assisted therapy may be efficacious for treating:

  • Depression (aan het Rot et al., 2010; Caddy et al., 2015; Caddy et al., 2014; Covvey et al., 2012; Coyle & Laws, 2015; Fond et al., 2014; Garay et al., 2017; Han et al., 2016; Hasselmann, 2014; Katalinic et al., 2013; Kishimoto et al., 2016; Kleeblatt et al., 2017; Kolar, 2018; Kraus et al., 2017; Lee et al., 2015; McGirr & Berlim, 2014; Papadimitropoulou et al., 2017; Papakostas, 2020; Romeo et al., 2015; Serafini et al., 2014; Zheng et al., 2020)

  • Post-traumatic stress disorder (Li & Vlisides, 2016; Walsh et al., 2022; Yavi et al., 2022)

  • Suicidal thought (Bartoli et al., 2017; D'Anci & Uhl, 2020; Dadiomov & Lee, 2019; Reinstatler & Youssef, 2015; Wilkinson et al., 2018; Witt et al., 2020)

  • Bipolar disorder (Alberich et al., 2017; Fornaro et al., 2020; McCloud et al., 2015)

  • Anxiety (Dore et al., 2019; Glue et al., 2018; Shadli et al., 2018), PTSD (Albott et al., 2018; Feder et al., 2014; Ross et al., 2019)

  • Obsessive-compulsive disorder (Rodriguez et al., 2013)

  • Substance use disorders (Azhari et al., 2021; Dakwar, Anerella, et al., 2014; Dakwar et al., 2017; Dakwar, Levin, et al., 2014; Dakwar et al., 2020; Dakwar et al., 2019; Dakwar et al., 2018; Jovaisa et al., 2006; Krupitsky et al., 2002; Krupitsky et al., 2007; Krupitsky et al., 1992; Krupitsky & Grinenko, 1997; Pizon et al., 2018; Rothberg et al., 2021; Shah et al., 2018)

Learn More

To learn more about ketamine, please watch What Ketamine Actually Does to your Brain.

Question

What is the difference between psychedelic-assisted therapy and psychedelic therapy?

Psychedelic-assisted therapy involves consuming a psychedelic medicine in the presence of a therapist who will utilize therapeutic modalities to enhance the effectiveness of therapy for certain conditions. Psychedelic-assisted therapy typically involves Preparation Sessions before the Medicine Sessions and Integration Sessions after.

Psychedelic therapy on the other hand refers to clients simply consuming the psychedelic medicine and allow their inner healing potential to lead the way. There is typically no Preparation or Integration Sessions included with psychedelic therapy. Currently, ketamine treatments are the only psychedelic therapy program offered at Numinus. Ketamine treatments are used primarily to treat depression as we will learn more about later in the course.

Learn More

To learn more about these and other psychedelic medicines within the context of psychedelic-assisted therapy, consider watching Michael Pollan’s How to Change Your Mind documentary series on Netflix.

References

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Papadimitropoulou, K., Vossen, C., Karabis, A., Donatti, C., & Kubitz, N. (2017). Comparative efficacy and tolerability of pharmacological and somatic interventions in adult patients with treatment-resistant depression: a systematic review and network meta-analysis. Curr Med Res Opin, 33(4), 701-711.

Papakostas, G. I. (2020). Happiness and Treatment Outcome in Resistant Depression. J Clin Psychiatry, 81(6).

Pizon, A. F., Lynch, M. J., Benedict, N. J., Yanta, J. H., Frisch, A., Menke, N. B., . . . Kane-Gill, S. L. (2018). Adjunct Ketamine Use in the Management of Severe Ethanol Withdrawal. Crit Care Med, 46(8), e768-e771.

Reiche, S., Hermle, L., Gutwinski, S., Jungaberle, H., Gasser, P., & Majic, T. (2018). Serotonergic hallucinogens in the treatment of anxiety and depression in patients suffering from a life-threatening disease: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry, 81, 1-10.

Reinstatler, L., & Youssef, N. A. (2015). Ketamine as a potential treatment for suicidal ideation: a systematic review of the literature. Drugs R D, 15(1), 37-43.

Rodriguez, C. I., Kegeles, L. S., Levinson, A., Feng, T., Marcus, S. M., Vermes, D., . . . Simpson, H. B. (2013). Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept. Neuropsychopharmacology, 38(12), 2475-2483.

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Ross, C., Jain, R., Bonnett, C. J., & Wolfson, P. (2019). High-dose ketamine infusion for the treatment of posttraumatic stress disorder in combat veterans. Ann Clin Psychiatry, 31(4), 271-279.

Rothberg, R. L., Azhari, N., Haug, N. A., & Dakwar, E. (2021). Mystical-type experiences occasioned by ketamine mediate its impact on at-risk drinking: Results from a randomized, controlled trial. Journal of psychopharmacology (Oxford, England), 35(2), 150-158.

Schindler, E. A. D., Sewell, R. A., Gottschalk, C. H., Luddy, C., Flynn, L. T., Lindsey, H., . . . D'Souza, D. C. (2021). Exploratory Controlled Study of the Migraine-Suppressing Effects of Psilocybin. Neurotherapeutics, 18(1), 534-543.

Serafini, G., Howland, R. H., Rovedi, F., Girardi, P., & Amore, M. (2014). The role of ketamine in treatment-resistant depression: a systematic review. Curr Neuropharmacol, 12(5), 444-461.

Sessa, B., Sakal, C., O'Brien, S., & Nutt, D. (2019). First study of safety and tolerability of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in patients with alcohol use disorder: preliminary data on the first four participants. BMJ Case Rep, 12(7).

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