How Psychedelic-Assisted Treatment Works in the Bayesian Brain

Psychedelics are experiencing a renaissance in clinical research, with promising results for psychedelic-assisted treatment. This paper provides the first account of how pharmacological and psychological effects interact in such therapy. Building on the REBUS hypothesis and the contextual model, it argues that psychedelics amplify common factors of psychotherapy, particularly by attenuating the precision of high-level predictions, making them more revisable by bottom-up input. Psychotherapy provides a safe environment and remedial expectations, which become incorporated during prediction revision—a process reinforced and accelerated by psychedelics, ultimately leading to symptom relief.

Study at a glance

Abstract

Psychedelics are experiencing a renaissance in clinical research. In recent years, an increasing number of studies on psychedelic-assisted treatment have been conducted. So far, the results are promising, suggesting that this new (or rather, rediscovered) form of therapy has great potential. One particular reason for that appears to be the synergistic combination of the pharmacological and psychotherapeutic interventions in psychedelic-assisted treatment. But how exactly do these two interventions complement each other? This paper provides the first account of the interaction between pharmacological and psychological effects in psychedelic-assisted treatment. Building on the relaxed beliefs under psychedelics (REBUS) hypothesis of Carhart-Harris and Friston and the contextual model of Wampold, it argues that psychedelics amplify the common factors and thereby the remedial effects of psychotherapy. More precisely, psychedelics are assumed to attenuate the precision of high-level predictions, making them more revisable by bottom-up input. Psychotherapy constitutes an important source of such input. At best, it signalizes a safe and supportive environment (cf. setting) and induces remedial expectations (cf. set). During treatment, these signals should become incorporated when high-level predictions are revised: a process that is hypothesized to occur as a matter of course in psychotherapy but to get reinforced and accelerated under psychedelics. Ultimately, these revisions should lead to a relief of symptoms.