Mapping cognitive-behavioral approach in psychedelic-assisted treatment: a systematic review across phases with classic and non-classic psychedelics

Abstract

The use of psychedelics in the treatment of psychopathologies has been expanding, highlighting Psychedelic-Assisted Psychotherapy (PAP) as a promising resource in mental health care. This systematic review investigates. This systematic review investigates whether and how cognitive-behavioral therapies are integrated with psychedelic substances—both classical and atypical—for the treatment of mental disorders. A PRISMA-based search was conducted across four databases (Embase, PsycArticles, PubMed, and Web of Science) up to May 2025. The review included 9 clinical trials involving a total of 283 patients; these studies used ketamine (n = 5), psilocybin (n = 3), and 3,4-methylenedioxymethamphetamine (n = 1). Among the Cognitive Behavioral Approaches (CBAs) applied, traditional Cognitive Behavioral Therapy (CBT) was predominant (n = 6), followed by emerging modalities such as Mindfulness-Based Cognitive Therapy (MBCT) (n = 2) and Acceptance and Commitment Therapy (ACT) (n = 1). Considerable variability was observed across study designs, particularly in terms of the timing of psychotherapeutic interventions, which occurred before, during, or after the psychedelic experience, with or without concurrent support. The findings indicate that cognitive-behavioral strategies have been incorporated into psychedelic-assisted interventions in diverse ways, across different phases of treatment and with distinct therapeutic purposes. Nonetheless, the therapeutic approaches applied remain highly heterogeneous between studies, highlighting the need for further research to clarify how these models are implemented and characterized in practice.