Toward Consensus in Psychedelic-Assisted Therapy: The Critical Role of Psychotherapeutic Support.

Abstract

To the Editor: Psychedelic-assisted therapy (PAT) combines psychedelics, such as psilocybin, with guided psychotherapeutic support. 1 These substances interact with patient's mindset ("set") and the surrounding environment ("setting"), 2 making the context of the experience a critical factor in therapeutic outcomes.As these substances gain recognition for their therapeutic potential, it is essential to investigate how psychotherapy interacts with and shapes the efficacy of these substances.3 The role of PAT is to enhance safety and effectiveness while minimizing the risk of an aversive effect, such as anxiety or psychosis.1 A recent JCP article by Bender and colleagues 1 examined psychedelic practitioners' views on psychological support in PAT, categorizing responses into emotive (focusing on human and spiritual) and neuromodulatory (focusing on pharmacological effects) approaches.Forty PAT practitioners from 4 countries participated, overseeing a total of 1,656 sessions.Key themes included creating an emotional setting, the role of spirituality, and understanding negative experiences.While respondents slightly favored an emotive approach, there was no consensus on psychological support strategies. 1 The authors have identified an important knowledge gap; as psychedelics gain therapeutic support in several countries, establishing best practice guidelines is crucial.However, even among experienced experts, there is currently no consensus on best practices.1,3 This lack of consensus underscores the challenges in developing clear clinical guidelines.Notably, in 2023, Australia developed strict protocols outlining the use of psilocybin and MDMA for the management of treatment-resistant depression and posttraumatic stress disorder (PTSD).As part of these Scan Now