New Paper Discusses Value of Psychedelic-Assisted Psychotherapy

A new paper published in the American Journal of Psychiatry discusses the potential problems of using the term “psychedelic-assisted psychotherapy” for all psychedelic treatment modalities.

Published in the American Journal of Psychiatry, and co-authored by executives from Compass Pathways, the paper argues that a blanket “psychedelic-assisted psychotherapy” for all treatments isn’t necessarily accurate or optimal for some cases. From the paper:

In summary, “psychedelic-assisted psychotherapy” does not capture the true mechanism of change facilitated by psychedelic experience. The effects observed thus far in the best controlled studies of psychedelic treatment must be attributed to the drug itself and not to psychotherapy. In the case of psilocybin, for example, let us say simply “psilocybin treatment.” To continue to use the “PAT” phrase at this stage risks confusing and impeding the development of serotonergic agonists as medications at psychedelic doses. We can think more clearly without it.

EF Hutton analyst Elemer Piros provides a good summary in his note on the paper. See his full comments here.

As it was shown by COMPASS and others, this may not be the case with high-dose psilocybin in certain indications, such as treatment of depression. As a matter of fact, the clinical benefit derived from psilocybin administration was maximal on the next day following drug treatment. Subsequent sessions of integration may have facilitated the contextualization of the experience, but did not lead to additional clinical gains.

As far as “therapy” during a psilocybin session may not be productive (or maybe counterproductive), as the intensity of the psychedelic experience may preclude a meaningful “therapeutic” interaction with the therapist. Anecdotally, from a currently running LSD trial, patients are quite content with “the therapist sitting in a room and reading a book in the corner” – providing a safety net only. Structured follow-on therapy may further enhance the benefit derived from a drug or TMS treatment, or may be instrumental to prevent relapse.

However, the path to regulatory approval should be simplified by understanding what the clinical benefit is from the drug, accompanied by psychological support before, during and after administration. For this paradigm, the authors suggest to part with the notion of “psychedelic-assisted psychotherapy” and replacing it with “psilocybin treatment”.

And from the paper’s conclusion:

While the experience appears to be therapeutic for depressed patients, it has not been shown to be a psychotherapy as normally understood. Hence it does not provide “psychedelic-assisted psychotherapy.” Indeed, psychedelic states are largely incompatible with the interactions of conventional psychotherapy. To understand the actions of existing and future drugs with psychedelic properties, regulators are likely to prefer psychological support to be focused on safety, not efficacy. In no way does this difference in emphasis diminish the importance of such support for the development of the approach.

An interesting distinction that could have repercussions for treatment modalities and dealings with regulatory bodies.

Read the full paper here.

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