The therapeutic alliance—the cooperative connection between clients and providers—is a strong predictor of outcomes across many forms of psychotherapy, but its role in psychedelic-assisted therapy (PAT) has been largely overlooked. Only two publications directly address the alliance in PAT, despite years of recommendations emphasizing it. Adding alliance measures to PAT trials is low-cost and feasible, and clinicians can improve the alliance through simple behaviors like respecting patient autonomy, listening, and addressing practical concerns. Greater focus on the alliance could clarify how PAT works and boost its effectiveness, potentially reducing human suffering more efficiently.
A brief mindfulness intervention (bMBI) alters the autonomic nervous system (ANS) and improves coordination between its subsystems. In young adults, two sessions of bMBI increased respiratory sinus arrhythmia (RSA) and reduced skin conductance level (SCL) during mindfulness practice compared to an audiobook-listening control group. The bMBI group also showed greater declines in blood pressure during mindfulness and after a psychosocial stress test. During stress, the bMBI group displayed reciprocal RSA-SCL patterns (RSA up, SCL down), while controls showed non-reciprocal coordination (both up). These results suggest that examining coordination across ANS measures can explain prior inconsistent findings and that brief mindfulness may promote adaptive stress responses.