Psychedelic-assisted psychotherapy: where is the psychotherapy research?
Jacob S. Aday, David Horton, Gisele Fernandes-Osterhold, Aoife O'Donovan, Ellen Bradley, Raymond C Rosen, Joshua Woolley
Psychopharmacology August 1, 2024 DOI: 10.1007/s00213-024-06620-x (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Psilocybin Psychedelic-assisted therapy |
| Keywords | Psychotherapy models Hallucinogenic therapy Psychiatric care Clinical guidelines Psilocybin research Psychedelic treatment |
| Citations | 39 |
| Key findings | The psychotherapeutic components of psychedelic-assisted psychotherapy are under-researched, and future studies should adopt transdisciplinary methods and lessons from traditional psychotherapy research to standardize treatments, identify mechanisms of change, and optimize clinical trial designs. |
Abstract
Psychedelic-assisted psychotherapy (PAP) has emerged as a potential treatment for a variety of mental health conditions, including substance use disorders and depression. Current models of PAP emphasize the importance of psychotherapeutic support before, during, and after ingestion of a psychedelic to maximize safety and clinical benefit. Despite this ubiquitous assumption, there has been surprisingly little empirical investigation of the "psychotherapy" in PAP, leaving critical questions about the necessary and sufficient components of PAP unanswered. As clinical trials for psychedelic compounds continue the transition from safety- and feasibility-testing to evaluating efficacy, the role of the accompanying psychotherapy must be better understood to enhance scientific understanding of the mechanisms underlying therapeutic change, optimize clinical outcomes, and inform cost-effectiveness. The present paper first reviews the current status of psychotherapy in the PAP literature, starting with recent debates regarding "psychotherapy" versus "psychological support" and then overviewing published clinical trial psychotherapy models and putative models informed by theory. We then delineate lessons that PAP researchers can leverage from traditional psychotherapy research regarding standardizing treatments (e.g., publish treatment manuals, establish eligibility criteria for providers), identifying mechanisms of change (e.g., measure established mechanisms in psychotherapy), and optimizing clinical trial designs (e.g., consider dismantling studies, comparative efficacy trials, and cross-lagged panel designs). Throughout this review, the need for increased research into the psychotherapeutic components of treatment in PAP is underscored. PAP is a distinct, integrative, and transdisciplinary intervention. Future research designs should consider transdisciplinary research methodologies to identify best practices and inform federal guidelines for PAP administration.
Comparable studies
Other narrative reviews on psilocybin and psychedelic-assisted therapy, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development | 2018 | Review | |
| Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA. | 2016 | Review | |
| Systematized Review of Psychotherapeutic Components of Psilocybin-Assisted Psychotherapy | 2021 | Systematized review | |
| The Emerging Field of Psychedelic Psychotherapy. | 2022 | Review | |
| Experience of Music Used With Psychedelic Therapy: A Rapid Review and Implications Participants in psychedelic therapy research aged 18–69 with varied backgrounds | 2020 | Rapid review | n = 180 |
Citations in the library
Cited by 41
- Addressing blinding in classic psychedelic studies with innovative active placebos. The International Journal of Neuropsychopharmacology April 1, 2025
- Randomized Controlled Trials of Psilocybin‐Assisted Therapy in the Treatment of Major Depressive Disorder: Systematic Review and Meta‐Analysis Acta Psychiatrica Scandinavica December 3, 2024
- Mapping psilocybin therapy: A systematic review of therapeutic frameworks, adaptations, and standardization across contemporary clinical trials Journal of Affective Disorders July 18, 2025
- A lexicon for psychedelic research and treatment Drug Science, Policy and Law September 1, 2025
- Key competencies for psychedelic treatment in real-world mental health care settings. General Hospital Psychiatry 2025
and 36 more in the library
Cites 58
- Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial Journal of Psychopharmacology November 30, 2016
- Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial Journal of Psychopharmacology November 30, 2016
- Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. The Lancet Psychiatry May 17, 2016
- Trial of Psilocybin versus Escitalopram for Depression New England Journal of Medicine April 14, 2021
- Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder JAMA Psychiatry November 4, 2020
and 53 more in the library