What is psychedelic therapy?
If you're working with clients who haven't responded to traditional treatments like SSRIs, you might be hearing more about psychedelic-assisted therapy. This emerging psychiatric approach combines carefully supervised psychedelic substances, such as psilocybin and methylenedioxymethamphetamine (MDMA), with structured psychotherapy to help address treatment-resistant conditions.
Unlike conventional medication approaches, psychedelic therapy works by inducing controlled altered states of consciousness that can enhance your client's therapeutic breakthroughs. You'll find this particularly relevant for clients dealing with different mental health disorders, such as posttraumatic stress disorder (PTSD) (Morland & Woolley, 2024), treatment-resistant depression, and severe anxiety, where traditional methods like selective serotonin reuptake inhibitors (SSRIs) may have reached their limits.
The difference lies in how these substances facilitate deeper emotional processing. While your standard therapy sessions help clients work through issues consciously, psychedelics can help them access and process experiences that might otherwise remain buried or difficult to reach through talk therapy alone.
Current psychedelic research and applications
One of the most studied forms is MDMA-assisted therapy, primarily used for PTSD symptoms (Riaz et al., 2023). The therapeutic potential of psychedelic medicine is supported by human hallucinogen research, suggesting long-term benefits in emotional processing and cognitive flexibility (Tupper et al., 2015). If you're considering referrals, you should know that randomized controlled trials have demonstrated significant reductions in trauma-related symptoms, often with lasting effects beyond the treatment period.
However, clinical trials remain essential to establish efficacy and safety, as these substances are not yet widely approved for clinical use (Maia et al., 2024). Compared to conventional methods, psychedelic-assisted therapy requires careful administration within structured therapeutic settings to minimize risks.
The Multidisciplinary Association for Psychedelic Studies (MAPS) has led research on its use in substance abuse treatment (Emerson et al., 2014). However, you'll want to note that while early findings are encouraging, these treatments aren't yet widely approved for standard clinical use. This means your clients may need to access these treatments through clinical trials or specialized research programs.
What makes this approach particularly relevant for your practice is its potential effectiveness with clients who haven't found relief through conventional treatments. The structured therapeutic settings required for safe administration mean you'll need to work with specialized providers trained in psychedelic-assisted therapy protocols.
Purpose of psychedelic therapy
You can consider psychedelic therapy for clients dealing with several challenging conditions, particularly when traditional approaches haven't provided adequate relief. Research suggests therapeutic efficacy in managing treatment-resistant depression, major depressive disorder, and alcohol use disorder within controlled clinical settings (Yao et al., 2024).
Anxiety reduction
Psilocybin-assisted psychotherapy shows promising results in reducing anxiety, particularly in individuals with life-threatening diseases. Unlike conventional medications, psychedelic substances may provide long-lasting relief after a single session. Preliminary findings suggest that psychedelics promote emotional flexibility, helping patients manage distress more effectively.
Emotional processing
Psychedelics such as lysergic acid diethylamide (LSD) and psilocybin enhance emotional openness, making psychedelic-assisted psychotherapy beneficial for trauma recovery. This therapy can help patients process repressed emotions, allowing for deeper introspection.
Neuroplasticity
Psychedelics influence neuroplasticity, promoting new neural connections that may support mental resilience. According to Grieco et al. (2022), substances like LSD and psilocybin stimulate synaptic growth, potentially aiding in treating depression and treatment-resistant depression.
Spiritual exploration
Some individuals undergoing psychedelic-assisted psychotherapy report profound experiences of interconnectedness and meaning, contributing to overall well-being. These effects may be particularly beneficial for those struggling with existential distress.
Treating mental health conditions
Psychedelic therapy is being studied for its effectiveness in treating depression, major depressive disorder, substance abuse, and alcohol use disorder.
Additionally, controlled administration under health care providers is crucial to monitoring physiological responses, such as blood pressure regulation, and ensuring safety and efficacy in therapeutic applications.
Types of psychedelic therapy treatments
Psychedelic therapy involves various controlled substances used in clinical settings to treat substance use disorders, chronic stress, psychotic disorders, and eating disorders. Each treatment produces unique psychedelic experiences that impact cognition, emotions, and neuroplasticity.
Psilocybin treatment
Psilocybin treatment, derived from "magic mushrooms," is studied for its potential to treat depression and substance use disorders (Ziff et al., 2022). Clinical trials comparing psilocybin to a placebo group have shown significant symptom reduction in major depressive disorder.
Ayahuasca
Ayahuasca, a plant-based psychedelic brew from the Amazon, contains DMT, which induces intense psychedelic experiences (Ruffell et al., 2023). Studies suggest that Ayahuasca may help in substance abuse treatment, promoting emotional processing and self-reflection. Early findings indicate potential benefits in drug abuse recovery, particularly in reducing cravings and enhancing psychological insight when administered under medical supervision.
Lysergic acid diethylamide (LSD)
Lysergic acid diethylamide (LSD) is a powerful psychedelic known for altering perception and cognition (Stork & Henriksen, 2014). Research in human psychopharmacology suggests LSD enhances emotional resilience and introspection, which may be beneficial in managing chronic stress and psychotic disorders (Liechti, 2017). Its therapeutic value is being explored for treatment-resistant depression, with some studies showing potential long-term relief from symptoms.
Psilocin
Psilocin, the active metabolite of psilocybin, directly interacts with serotonin receptors, producing rapid therapeutic effects (Wulff et al., 2023). It is studied in psilocybin treatment trials for depression and anxiety. Unlike psilocybin, which requires metabolic conversion, psilocin acts immediately, potentially offering a faster onset of benefits for individuals with severe PTSD and mental illness.
Mescaline (peyote)
Mescaline, found in peyote and San Pedro cacti, has been traditionally used for spiritual and healing purposes. In modern clinical settings, mescaline is being researched for its role in treating substance use disorders and depression. Early studies suggest it may contribute to increased emotional awareness and cognitive flexibility, making it a candidate for psychedelic-assisted psychotherapy.
DMT
DMT (N, N-Dimethyltryptamine) is a short-acting psychedelic known for its intense psychedelic experiences (Alcohol and Drug Foundation, 2023). Some studies explore its potential role in addressing drug abuse and addiction when used in a controlled clinical setting with psychological support.
5-MeO-DMT
5-MeO-DMT, found in certain toad secretions and synthetic formulations, is a potent psychedelic with rapid and profound effects (Calina et al., 2021). Placebo group comparisons in early trials show promising results, though more studies are needed to confirm its safety and clinical outcomes.
Ibogaine
Ibogaine, derived from the African iboga plant, is being researched for its role in treating substance abuse and alcohol use disorder (Brown, 2013). Studies suggest that ibogaine may interrupt addictive patterns by resetting neural pathways associated with drug abuse.
MDMA
MDMA, commonly known as ecstasy, is primarily studied for MDMA-assisted psychotherapy in severe PTSD cases (Riaz et al., 2023). Unlike classical psychedelics, MDMA enhances emotional connectivity and reduces fear responses, improving the effectiveness of psychedelic-assisted psychotherapy.
Potential benefits of psychedelic therapy
Psychedelic therapy, as we have discussed, can then offer various potential benefits:
- Rapid, lasting results: Unlike traditional treatments that may take weeks or months to show effects, psychedelic therapy often delivers sustained psychological improvements after just one to three sessions, particularly valuable for your clients who've struggled with chronic conditions.
- Breakthrough for treatment-resistant cases: You can offer hope to clients with treatment-resistant depression, PTSD, or obsessive-compulsive disorder when conventional approaches have reached their limits.
- Enhanced emotional processing: Classic hallucinogens help suppress the brain's default mode network, allowing your clients to process trauma and anxiety without their usual psychological defenses interfering with therapeutic work.
- Neuroplasticity enhancement: These substances promote new neural connections that can help break rigid thought patterns, especially beneficial for clients with OCD or trauma-related conditions where mental flexibility has been compromised.
- End-of-life support: For clients with advanced-stage cancer or terminal diagnoses, psychedelic therapy can significantly reduce existential distress and improve emotional resilience during their most challenging times.
Risks and other considerations
While psychedelic therapy shows promise, you need to understand the potential risks before considering referrals for your clients.
Psychological risks
Clients with certain psychiatric conditions face increased risks. Those with schizophrenia, bipolar disorder, or family histories of psychotic disorders should generally avoid psychedelic treatments, as these substances can potentially trigger psychotic episodes or mania.
Preparation and setting requirements
Successful outcomes depend heavily on proper preparation, safe clinical settings, and trained facilitators. Poor preparation or inappropriate settings can lead to challenging experiences that may be traumatic rather than therapeutic.
Duration of effects and integration
Acute effects vary by substance, from 15 minutes for DMT to 12 hours for LSD. However, the therapeutic benefits often last weeks or months beyond the session itself. Integration therapy is crucial during this period, helping clients process and apply insights gained during their psychedelic experience to their daily lives.
Legal status and access
Currently, most psychedelic substances remain federally controlled, with access primarily through FDA-approved clinical trials or specialized research programs. MDMA therapy recently received breakthrough therapy designation for PTSD treatment, and psilocybin has a similar status for treatment-resistant depression.
Main takeaways
Psychedelic therapy is emerging as a promising approach for therapeutic purposes, offering potential benefits for individuals with PTSD diagnosis, obsessive-compulsive disorder, substance use disorders, and advanced-stage cancer.
While classic hallucinogens show potential in creating new neural connections and promoting neuroplasticity, their use requires careful oversight in clinical settings. Ongoing research and human psychopharmacology studies continue to assess these treatments' risks and therapeutic value. As scientific understanding evolves, psychedelic therapy may become a transformative tool in modern mental health care under appropriate medical supervision.
References
Alcohol and Drug Foundation. (2023, August 24). DMT - Alcohol and Drug Foundation. https://adf.org.au/drug-facts/dmt/
Brown, T. (2013). Ibogaine in the treatment of substance dependence. Current Drug Abuse Reviews, 6(1), 3–16. https://doi.org/10.2174/15672050113109990001
Calina, D., Carvalho, F., & Docea, A. O. (2021). Toxicity of psychedelic drugs. In Elsevier eBooks (pp. 545–556). https://doi.org/10.1016/b978-0-323-85215-9.00022-2
Emerson, A., Ponté, L., Jerome, L., & Doblin, R. (2014). History and future of the Multidisciplinary Association for Psychedelic Studies (MAPS). Journal of Psychoactive Drugs, 46(1), 27–36. https://doi.org/10.1080/02791072.2014.877321
Grieco, S. F., Castrén, E., Knudsen, G. M., Kwan, A. C., Olson, D. E., Zuo, Y., Holmes, T. C., & Xu, X. (2022). Psychedelics and neural plasticity: Therapeutic implications. The Journal of Neuroscience, 42(45), 8439–8449. https://doi.org/10.1523/jneurosci.1121-22.2022
Liechti, M. E. (2017). Modern clinical research on LSD. Neuropsychopharmacology, 42(11), 2114–2127. https://doi.org/10.1038/npp.2017.86
Maia, J. M., de Oliveira, B. S. A., Branco, L. G. S., & Soriano, R. N. (2024). Therapeutic potential of psychedelics: History, advancements, and unexplored frontiers. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 131, Article 110951. https://doi.org/10.1016/j.pnpbp.2024.110951
Morland, L., & Woolley, J. (2024, August 27). Psychedelic-assisted therapy for PTSD. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/professional/treat/txessentials/psychedelics_assisted_therapy.asp
Riaz, K., Suneel, S., Hamza Bin Abdul Malik, M., Kashif, T., Ullah, I., Waris, A., Di Nicola, M., Mazza, M., Sani, G., Martinotti, G., & De Berardis, D. (2023). MDMA-based psychotherapy in treatment-resistant post-traumatic stress disorder (PTSD): A brief narrative overview of current evidence. Diseases, 11(4), Article 159. https://doi.org/10.3390/diseases11040159
Ruffell, S., Crosland‐Wood, M., Palmer, R., Netzband, N., Tsang, W., Weiss, B., Gandy, S., Cowley‐Court, T., Halman, A., McHerron, D., Jong, A., Kennedy, T., White, E., Perkins, D., Terhune, D. B., & Sarris, J. (2023). Ayahuasca: A review of historical, pharmacological, and therapeutic aspects. Psychiatry and Clinical Neurosciences Reports, 2(4). https://doi.org/10.1002/pcn5.146
Stork, C. M., & Henriksen, B. (2014). Lysergic acid diethylamide. In P. Wexler (Ed.), Encyclopedia of toxicology (3rd ed.). Academic Press. https://www.sciencedirect.com/science/article/abs/pii/B9780123864543007442
Tupper, K. W., Wood, E., Yensen, R., & Johnson, M. W. (2015). Psychedelic medicine: a re-emerging therapeutic paradigm. Canadian Medical Association Journal, 187(14), 1054–1059. https://doi.org/10.1503/cmaj.141124
Wulff, A. B., Nichols, C. D., & Thompson, S. M. (2023). Preclinical perspectives on the mechanisms underlying the therapeutic actions of psilocybin in psychiatric disorders. Neuropharmacology, 231, Article 109504. https://doi.org/10.1016/j.neuropharm.2023.109504
Yao, Y., Guo, D., Lu, T.-S., Liu, F.-L., Huang, S.-H., Diao, M.-Q., Li, S.-X., Zhang, X.-J., Kosten, T. R., Shi, J., Bao, Y.-P., Lu, L., & Han, Y. (2024). Efficacy and safety of psychedelics for the treatment of mental disorders: A systematic review and meta-analysis. Psychiatry Research, 335, Article 115886. https://doi.org/10.1016/j.psychres.2024.115886
Ziff, S., Stern, B., Lewis, G., Majeed, M., & Gorantla, V. R. (2022). Analysis of psilocybin-assisted therapy in medicine: A narrative review. Cureus, 14(2), Article e21944. https://doi.org/10.7759/cureus.21944
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