Psychedelic-assisted psychotherapy: Clarifying the role of the "psychotherapy"
Stefan Jerotić, Olga Čolović, Nađa Marić
Medicinska istrazivanja 2026 DOI: 10.5937/medi0-62051 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Randomized Peer reviewed |
|---|---|
| Population | Patients with MDD and PTSD |
| Topics | Depression Psilocybin Psychedelic-assisted therapy |
| Keywords | Intervention counseling Therapeutic relationship Narrative review Psychotherapist Therapeutic approach Clinical psychology Clinical trial |
| Key findings | The role of psychotherapy in psychedelic-assisted psychotherapy remains poorly defined, with evidence suggesting treatment outcomes may not depend on the number of psychotherapy hours. |
Abstract
Psychedelic-assisted psychotherapy (PAP) is emerging as a novel intervention for major psychiatric disorders, most notably major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). While psychotherapy is widely regarded as a core element of PAP its precise role remains poorly defined. This narrative review traces the development of PAP within contemporary Western psychiatry, outlines the therapeutic framework of preparation, dosing, and integration, and synthesizes findings from recent high-impact randomized controlled trials with psilocybin and MDMA. The primary purpose of this review is to clarify the role of psychotherapy in PAP. Despite methodological rigor, studies differ substantially in their therapeutic orientation, degree of manualization, and therapist involvement, yet all report significant clinical benefit. Some evidence points to the fact that treatment outcomes may not depend on the number of psychotherapy hours, raising questions about whether psychotherapy functions as an active ingredient, a facilitative context, or a safeguard. In light of these inconsistencies, we discuss novel phenomenological accounts of change in PAP, which propose that psychedelics exert therapeutic effects by altering "existential feelings," with psychotherapy primarily serving to stabilize and integrate these shifts. Current evidence highlights both the promise of PAP and the unresolved uncertainty regarding its psychotherapeutic components. Clarifying these issues will require trials that explicitly address psychotherapeutic variables, as well as the establishment of standardized protocols, ethical safeguards, and licensure pathways for practitioners.
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
Cites 32
- 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
- Trial of Psilocybin versus Escitalopram for Depression New England Journal of Medicine April 14, 2021
- Human hallucinogen research: guidelines for safety. Journal of Psychopharmacology July 1, 2008
- Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study Journal of Psychopharmacology January 13, 2015
- MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine June 1, 2021
and 27 more in the library