Intentional Choices of Metaphors for Psychedelic-Assisted Therapy
M. Earleywine, Henry A MacConnel, Joseph A. de Leo
Cognitive and Behavioral Practice April 1, 2025 DOI: 10.1016/j.cbpra.2025.04.002 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Topics | Psychedelic-assisted therapy |
| Key points | Proposes that the "batting practice" metaphor from baseball offers advantages over common PAT metaphors by emphasizing autonomy, incremental skill-building, and process over outcomes within a cognitive-behavioral framework. |
Abstract
Metaphors applied in psychedelic-assisted therapy (PAT) influence expectations and outcomes. They might help minimize therapist burnout as well. Nevertheless, relatively few publications address their conscious application, especially within a cognitive behavioral framework. Metaphors in PAT related to journeys, rewiring the brain, and medicines are prevalent, but these approaches may not appeal to all clients and might not provide an ideal focus for interventions devoted to learning and cognition, such as those used in cognitive-behavioral therapies. This paper introduces “batting practice” from the sport of baseball as an alternative metaphor. Batting practice emphasizes autonomy, agency, and responsibility, as well as the incremental and skill-building nature of PAT within a cognitive-behavioral perspective. Depicting the therapist as a coach also has advantages, reimagining the therapist-client interaction and time “in the cage,” emphasizing active engagement, ongoing effort, gradual improvements, and periods of progress and stagnation. The batting practice metaphor also emphasizes persistence, patience, mindfulness, and teamwork, paralleling the processes of ongoing integration present in PAT. Application of this metaphor can highlight a focus on the process (“practice”) rather than outcomes, as well as learning opportunities that improve skills across a season or lifetime. We also highlight potential shortcomings of this metaphor to encourage flexibility and enhance awareness as discussions of PAT metaphors continue. Ideally, clients and therapists can collaborate on metaphorical language to optimize outcomes in psychedelic-assisted CBT.
Comparable studies
Other theoretical and historical papers on psychedelic-assisted therapy, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Theorizing that Psychedelic Assisted Therapy May Play a Role in the Treatment of Trauma-Induced Personality Disorders. | 2024 | Theoretical or philosophical paper | |
| Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance | 2020 | Theoretical or philosophical paper | |
| Awe: a putative mechanism underlying the effects of classic psychedelic-assisted psychotherapy | 2018 | Theoretical or philosophical paper | |
| Ethical and legal issues in psychedelic harm reduction and integration therapy | 2021 | Theoretical or philosophical paper | |
| Towards psychedelic apprenticeship: Developing a gentle touch for the mediation and validation of psychedelic-induced insights and revelations. | 2022 | Theoretical or philosophical paper |
Citations in the library
Cites 13
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- Classic Hallucinogens and Mystical Experiences: Phenomenology and Neural Correlates. Current Topics in Behavioral Neurosciences 2018
- Psilocybin-assisted therapy of major depressive disorder using Acceptance and Commitment Therapy as a therapeutic frame Journal of Contextual Behavioral Science 2020
- Ketamine for the treatment of major depression: a systematic review and meta-analysis EClinicalMedicine August 1, 2023
and 8 more in the library