Integration

Integration is the period that follows the psychedelic experience in which the client is working to bring whatever insights that have arisen or learning that has been acquired into everyday life. This process can be viewed as bottom-up, in which 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 (top-down).

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 (Gorman et al., 2021; Mithoefer, 2016; Pilecki et al., 2021). While integration can be done by the individual independently, engaging with a health professional or guide is encouraged. Integration is one of the key practices that distinguishes recreational and therapeutic uses of psychedelic medicines and correlates with longer-term outcomes (Curtis et al., 2020; Phelps, 2017; Schenberg, 2018).

Integration Logistics

The health professional guiding the Integration Sessions can mitigate potential adverse psychological effects resulting from the psychedelic journey through psychotherapy and by assessing the client’s state post-experience. Supporting clients’ integration exposes health professionals to significantly less risk relative to other aspects of a psychedelic journey because the client has already consumed the medicine given that integration follows the psychedelic Medicine Sessions. As a health professional taking on this work, it's important to work through the following logistical considerations:

• First session is recommended to be scheduled within the first two days of the experiential session (60 - 90 min)
• Goals should be established in the first session and shifted with the changing needs of the client
• Subsequent sessions may occur over a range of weeks to months - trials tend to provide 2-3 sessions per assisted session (Mitchell et al., 2021; Watts, R. 2021)
• Some clients may remain in ongoing therapy
• Other clients seek integration services for a single session or multiple sessions, months to years following the psychedelic sessions

Approach to Supporting Integration

The health professional guiding integration is engaged in a client and relationship-centered approach that relies upon meeting the client where they are rather than where the health professional believes they should be. The health professional should support clients’ opening, reconstructing, and embodying of the learning that arises from the altered state. This may take the form of assisting clients in developing novel cognitive, emotional, or behavioural responses that are aligned with their newly formed values and intentions. Therefore, it is important that both the health professional and client remain open through the unfolding of the process, in order to extract the deepest learning, understanding that integration is an emergent process. Process-oriented and experiential approaches to psychotherapy that focus on a present moment orientation are commonly utilized in this work because they are viewed as consistent with an inner-directed approach to psychedelic-assisted therapy. Insofar as integration is non-linear and exploratory, the client’s original intentions for engaging in psychedelic experiences can serve as an important constraint and anchor in the process. We have a bias toward the use of these kinds of modalities but recognize that other psychotherapeutic models may be of equal benefit. Research in the field is extremely limited, and it remains to be seen whether one therapeutic modality will be more effective than another for integrating psychedelic experiences.

Psychedelic experiences can disrupt clients’ existing resources for coping. They may help to deconstruct or loosen tightly held views and disrupt habitual ways of being that can be perceived as dysregulating or exciting, depending on the person and their circumstances. Explanations for this process may be framed in terms of the entropic brain hypothesis (Carhart-Harris, 2018).

Attitudinal Foundations

While there is no empirical evidence that any therapeutic approach is essential for psychedelic integration, there is growing consensus that certain qualities can be supportive in this work (Phelps, 2017; Kabat-Zinn, 2013; Woods & Rockman, 2021):

Therapies Commonly Applied to Integration

There are also a number of other therapeutic approaches that can be used as a frame of reference for integration, and these are the most common currently in use:

• Acceptance and Commitment Therapy
• Emotion Focused Therapy
• Internal Family Systems
• Jungian Therapy
• Transpersonal Psychotherapy
• Mindfulness-based programsand inquiry
• Motivational enhancement therapy and motivational interviewing
• Somatic therapies: somatic experiencing, sensorimotor psychotherapy, hakomi etc.

References

Carhart-Harris, R. L. (2018). The entropic brain-revisited. Neuropharmacology, 142, 167-178.

Curtis, R., Roberts, L., Graves, E., Rainey, H. T., Wynn, D., Krantz, D., & Wieloch, V. (2020). The Role of Psychedelics and Counseling in Mental Health Treatment. Journal of Mental Health Counseling, 42(4), 323-338.

Kabat-Zinn, J. 1990, 2013. Full Catastrophe Living. Bantam Books.

Gorman, I., Nielson, E. M., Molinar, A., Cassidy, K., & Sabbagh, J. (2021). Psychedelic harm reduction and integration: A transtheoretical model for clinical practice. Frontiers in Psychology, 12, 645246-645246.

Kabat-Zinn, J. (2013). Full catastrophe living, revised edition: how to cope with stress, pain and illness using mindfulness meditation. Hachette UK.

Kanter, J. W., Baruch, D. E., & Gaynor, S. T. (2006). Acceptance and commitment therapy and behavioral activation for the treatment of depression: Description and comparison. The Behavior Analyst, 29(2), 161-185.

Kuhfuß, M., Maldei, T., Hetmanek, A., & Baumann, N. (2021). Somatic experiencing–effectiveness and key factors of a body-oriented trauma therapy: a scoping literature review. European journal of psychotraumatology, 12(1), 1929023.

Mithoefer, M. (2016, May 25). A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder. Multidisciplinary Association for Psychedelic Studies (MAPS).

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy (norton series on interpersonal neurobiology). WW Norton & Company.

Phelps, J. (2017). Developing guidelines and competencies for the training of psychedelic therapists. The Journal of Humanistic Psychology, 57(5), 450-487.

Pilecki, B., Luoma, J. B., Bathje, G. J., Rhea, J., & Narloch, V. F. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm Reduction Journal, 18(1), 40-40.

Schenberg, E. E. (2018). Psychedelic-assisted psychotherapy: A paradigm shift in psychiatric research and development. Frontiers in Pharmacology, 9, 733-733.

Silveira, J., & Rockman, P. (2021). Managing Uncertainty in Mental Health Care. Oxford University Press.

Tatarsky, A. (2007). Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems. Jason Aronson.

Walsh, Z., & Thiessen, M. S. (2018). Psychedelics and the new behaviourism: Considering the integration of third-wave behaviour therapies with psychedelic-assisted therapy. International Review of Psychiatry, 30(4), 343-349.

Watts, R. (2021). Psilocybin for Depression: The ACE Model Manual.

Watts, R., & Luoma, J. B. (2020). The use of the psychological flexibility model to support psychedelic assisted therapy. Journal of Contextual Behavioral Science, 15, 92-102.

Wolff, M., Evens, R., Mertens, L., & Koslowski, M. (2020). Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance. Frontiers in Psychiatry, 11.

Wong, A. (2020, May). Why you can't think your way out of trauma. Psychology Today.

Woods, S.L., and Rockman, P. (2021), Mindfulness-Based Stress Reduction: Protocol, Practice, and Teaching Skills. New Harbinger Publications Inc.

Woods, S. L., Rockman, P., & Collins, E. (2019). Mindfulness-based cognitive therapy: Embodied presence and inquiry in practice. New Harbinger Publications.