Psychedelics and Psychotherapy: Cognitive-Behavioral Approaches as Default
David B. Yaden, Dylan Earp, Marianna Graziosi, Dara Friedman-Wheeler, Jason B. Luoma, Matthew W. Johnson
Frontiers in Psychology May 23, 2022 DOI: 10.3389/fpsyg.2022.873279 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Topics | LSD Psilocybin Psychedelic-assisted therapy |
| Keywords | Psychedelics Psychedelic assisted therapy Psychedelic treatment Psychedelic integration Psychedelic preparation Psychotherapeutic modalities Cbt Dbt Behavioral therapy Psychological frameworks Psychotherapy Evidence-based treatment Optimal outcomes Therapeutic impact Gold standard Effective therapy Best practices Empirical backing Safety Practical application |
| Citations | 106 |
| Key points | Argues that cognitive-behavioral therapies, especially ACT, have the strongest rationale for psychedelic-assisted psychotherapy due to cultural sensitivity, minimal speculative assumptions, and strong empirical support. |
Abstract
The acute subjective effects of psychedelics are responsive to users’ expectations and surroundings (i.e., “set and setting”). Accordingly, a great deal of thought has gone into designing the psychosocial context of psychedelic administration in clinical settings. But what theoretical paradigms inform these considerations about set and setting? Here, we describe several historical, sociological influences on current psychedelic administration in mainstream European and American clinical research settings, including: indigenous practices, new age spirituality from the 1960s, psychodynamic/psychoanalytic approaches, and cognitive-behavioral approaches. We consider each of these paradigms and determine that cognitive-behavioral therapies, including newer branches such as acceptance and commitment therapy (ACT), have the strongest rationale for psychedelic-assisted psychotherapy going forward. Our primary reasons for advocating for cognitive-behavioral approaches include, (1) they avoid issues of cultural insensitivity, (2) they make minimal speculative assumptions about the nature of the mind and reality, (3) they have the largest base of empirical support for their safety and effectiveness outside of psychedelic therapy. We then propose several concepts from cognitive-behavioral therapies such as CBT, DBT, and ACT that can usefully inform the preparation, session, and integration phases of psychedelic psychotherapy. Overall, while there are many sources from which psychedelic psychotherapy could draw, we argue that current gold-standard, evidence-based psychotherapeutic paradigms provide the best starting point in terms of safety and efficacy.