A Comprehensive Guide to Psychedelic-Assisted Therapy

Psychedelic-assisted therapy, an alternative approach to mental health treatment, has garnered popularity in recent years due to increased research and public attention. Psychedelic substances have shown promise in critical trials for providing lasting therapeutic benefits that may soon find their way into mainstream medicine. With this new form of mental healthcare on the rise, it’s important to know its benefits, risks, and origins.

What is psychedelic-assisted therapy?

Psychedelic-assisted psychotherapy involves the use of psychedelic compounds in conjunction with talk therapy in a controlled, facilitated setting. For those who have not had luck with standard medication and traditional therapeutic techniques, psychedelic therapy may be a promising alternative, especially for those with treatment-resistant mental illnesses. 

Why psychedelic therapy?

Conventional therapies and anti-depressant medications typically focus on symptom management instead of dealing with the underlying causes of mental health issues. The psychedelic experience can lead to altered states of consciousness that can change the way patients perceive and think about things.

Many individuals who are treated with psychedelics have reported positive behavioral changes and the ability to process suppressed emotions or pent-up trauma. Furthermore, unlike many traditional treatments, which can take several weeks or months to start showing results, psychedelic therapy can lead to lasting therapeutic benefits and profound, life-changing insights shortly after just one treatment.

What drugs does psychedelic therapy use?

Different psychedelic drugs will have varying effects on an individual’s emotions, cognition, and perception, which is why certain substances do best for specific forms of therapy. Psychedelic-assisted therapy tends to use classic psychedelics, which are a group of psychoactive compounds that employ their influence by interacting with the serotonin 2A receptor (5-HT2AR). The substances bind and react with these receptors, leading to changes in the brain that cause ‌hallucinogenic and psychoactive effects.

 Classic psychedelics tend to occur in nature, such as magic mushrooms (psilocybin), DMT, mescaline, ibogaine, and ayahuasca, along with LSD, a synthetic compound made from modifying the structure of alkaloids derived from a fungus called ergot. Despite these substances differing chemical structures, many of them tend to have notably similar effects. 

Substances like ketamine and 3,4-methylenedioxymethamphetamine (MDMA or ecstasy) are also frequently used in psychedelic-assisted therapy, but they do not fall under the classic psychedelic category. Instead, they have different classifications due to their pharmacological characteristics and distinct effects. For instance, MDMA is classified as an empathogen. Though the substance alters senses and perception, it is primarily a stimulant that causes effects like pleasure, empathy, and connection with others.

On the other hand, ketamine is considered a dissociative anesthetic. While it can cause some hallucinogenic effects, it primarily induces a state of dissociation, causing individuals to feel detached from their bodies and surroundings.   Both substances have their unique roles in a therapeutic context.

How much does psychedelic-assisted therapy cost?

The prices of treatment vary depending on the type and amount of psychedelic compound used. Ketamine and psilocybin-assisted therapy are the only psychedelic therapies currently available in the U.S., but as research grows, other compounds may be added as a facilitated treatment option.

Ketamine-assisted therapy can cost anywhere between $400 to $2,000 per infusion, depending on location, dosage amount, appointment duration, and condition being treated. Psilocybin therapy can range from $2,000 to $3,000. Most insurance plans do not cover psychedelic-assisted therapy.

However, Enthea, a third-party administrator of health insurance plans, covers ketamine therapy as a workplace benefit. The company plans to cover other psychedelic therapies, like psilocybin-assisted therapy, once the substances reach FDA approval. The prices of psychedelic-assisted therapy are also expected to lower over the next few years as the industry expands.

Where is psychedelic-assisted therapy available?

Currently, the only American states that have legalized psychedelic-assisted therapy are Oregon and Colorado. Earlier this year, the nation’s first psilocybin service centers opened throughout Oregon. Colorado will begin starting applications in September of next year, so psilocybin centers are unlikely to be available in the state until around 2025. 

This year, several other states like California, Washington, New York, and Michigan have proposed their own variations of psychedelic reform in hopes of decriminalizing natural psychedelics (entheogens) or legalizing them for therapeutic use. However, many lawmakers believe their states should have more solidified guidelines before passing any psychedelic laws. 

Additionally, Australia has recently approved psilocybin and MDMA as prescribed treatments for PTSD and treatment-resistant depression. As the legal landscape surrounding psychedelics changes in the upcoming years, the therapy option may become more popularized in more places around the globe.

The therapeutic process

Though the therapeutic process may vary depending on the substance used for treatment, the procedure is relatively similar across the board. During a psychedelic-assisted therapy session, patients are cared for by highly trained clinicians who meet specialized standards for certification.

The clinicians must adhere to carefully crafted comprehensive guidelines to ensure each patient receives exceptional care during their psychedelic treatment. They are bound by legal and ethical measures that will continue to update as the landscape of psychedelic therapy evolves. 

Before treatment

Prior to the actual psychedelic experience, clients must apply to a clinic and undergo a brief consultation appointment. This first appointment will determine whether or not psychedelic therapy is the right treatment option for the client.

The licensed facilitator will go through the client’s background and medical history in search of risk factors that would make them ineligible for treatment. Facilitators have the right to deny treatment to anyone, but the main disqualifiers are individuals with thoughts of harming others or those experiencing active psychosis. 

Next, clients must attend a preparation appointment before treatment to prepare them for their psychedelic experience. The facilitator will explain the process and effects of the psychedelic substance so that the client knows what to expect.

Additionally, clients are given various self-help strategies to work through any uncomfortable feelings they experience during the treatment. Before the administration appointment, facilitators will also help clients set their intentions for the session so that they get the most out of their experience. 

During treatment

On the day of the session, clients will meet their facilitator in a specialized room prepared with the client’s safety and comfort in mind. The facilitator then administers the psychedelic substance in a controlled manner. The dosage will vary depending on the treatment and the client’s specific needs. Clients will often wear a blindfold and sit or lay in a comfortable position to adjust them to their trip and minimize any external distractions.

During the psychedelic experience, the facilitator will remain present with the client at all times and offer support and guidance as needed. Many psychedelic centers will encourage their clients to follow their emotions and introspective thought processes so that they can come to their own new insights.

Clients must remain at the facility until the effects of the substance have entirely worn off. Based on the administration method for ketamine, the appointment may last around 1 to 3 hours, whereas psilocybin treatments can last up to 6 hours. 

After treatment

A few days to a week after the psychedelic treatment, patients must attend a post-integration appointment to discuss their experience with their facilitator and process how their experience went along with what personal insights they may have come across.

These appointments are essential to the client’s safety, as facilitators can monitor whether there were any adverse effects from the treatment or if there were any changes to the client’s well-being. Facilitators can also determine whether the client could benefit from additional treatments or if they need a referral to another specialist who could find a more effective treatment. 

Clients may also attend follow-up appointments, which can be scheduled as needed based on the client’s goals and progress. Regular follow-up appointments can benefit the client by helping them integrate their psychedelic experience and revelations into everyday life. Follow-up appointments not only improve the trust and relationship between a client and facilitator but also help maintain the therapeutic experience 

“Set” and “setting”

The effects of psychedelics can vastly change due to the “set and setting.” Set refers to the emotional and psychological state of the individuals. This includes their mindset, current emotional well-being, and intentions for the trip.

The setting is the environment that a person is in during their psychedelic trip. A comfortable setting would include the location, sounds, ambiance, lighting, and the presence of supported and trusted individuals (or trip sitters). Psychedelic therapy emphasizes the significance of these two factors to ensure a positive experience for patients as they go through their psychedelic experiences.

How many sessions are needed?

Some patients may benefit from multiple treatment sessions. The amount of sessions that are needed is dependent on multiple factors, such as the severity of the conditions, the patient’s response to medication, and the availability of the facilitation center. 

Psilocybin-assisted therapy can involve one or more sessions of therapy. In some studies, researchers have found that a single high-dose session can offer long-lasting therapeutic benefits, while others have multiple sessions with varying doses.

The client can discuss with their facilitator which means of dosing works best for them. The amount of the dosage can vary widely. In some protocols, patients receive 10 to 30 mg of psilocybin per session, administered orally as a capsule or, in some cases, a synthetic form of psilocybin. 

Ketamine-assisted therapy typically involves multiple series of treatments over the course of several weeks or months. The number of treatment sessions and dosage can vary based on the administration method of ketamine therapy. The most common method of ketamine therapy in clinical settings is intravenous infusion, where ketamine is administered directly into the bloodstream through an IV.

Other common methods include administering ketamine through intramuscular injection or a nasal spray called Sprayvato. Nasal spray treatments can often be taken home; however, this does not ensure the treatment is taken correctly or not abused. Oral administration is another option for ketamine therapy, but it is less popular, especially in clinical settings. 

MDMA-assisted therapy, especially in the context of treating PTSD, typically requires two to three sessions. MDMA is usually administered orally in capsule form with dosages ranging from 75 to 125 mg per session. In some protocols, a lower supplemental dose is given a few hours into the session in order to prolong the therapeutic window. 

The healing potential of psychedelics

Psychedelics have several therapeutic uses that have been noted by historical accounts, modern research, anecdotal evidence, and clinical trials. With growing evidence supporting their ability to treat various conditions, psychedelics are gradually becoming more accepted as a legitimate alternative to standard pharmaceutical treatments and therapy.

How can psychedelics change the brain?

Research has found that psychedelic substances have the ability to rewire the brain. Researchers have recently discovered that psychedelics stimulate the growth of new brain cells and neural connections while promoting neuroplasticity, which allows the brain to reorganize its structure and function (1).

Scientists believe that the rewiring of the brain occurs because of the altered activity of neurotransmitters like serotonin, dopamine, and glutamate. These neurotransmitters help with mood regulation, learning, cognition, and memory, 

When an individual struggles with a mental health condition, the typical neurotransmitter activity and neural pathways may be imbalanced. Since psychedelics have been found to alter the brain in such a way, they have the potential to “reset” it, allowing individuals to break past negative thought patterns that form the foundation of several mental health disorders.

As a result, people treated with psychedelics may be able to approach difficult emotions and challenges in more adaptive and accepting ways, especially when they undergo talk therapy along with their treatment. 

Another theory as to why psychedelics positively affect people’s outlooks and behavior is through their ability to induce experiences commonly described as “mystical” or “spiritual.” These experiences appear to be caused by the reduction of activity of the default mode networks (DMN). The DMN is an area of the brain that becomes activated when the mind is at rest instead of focused on the external world.

It is usually active when the mind is wandering and thinking about one’s self, others, or reflecting on the past or future. Hyperactivity in the DMN is associated with negative, obsessive, or anxious thoughts. The DMN is also linked to the perception of pain, self-concept, sleep, and stress response. Research has found that classic psychedelics can modulate the DMN, which potentially alleviates the symptoms associated with its dysregulation.

Moreover, the reduced sense of self and increased feelings of connectedness associated with DMN modulation have a possible link to the therapeutic outcomes of psychedelics (2). Although scientists are still determining the mechanisms behind psychedelics, the connections they have found so far appear promising for the future of psychedelic health care.

What conditions could psychedelics treat?

Psychedelics have been found to treat a variety of conditions. Some substances and types of therapy work best for specific conditions and personal needs. As research progresses, scientists expect to find more conclusive evidence for the following list of health conditions:

•  Depression: Several studies have found that psychedelic therapy can significantly reduce symptoms of depression, especially for those with major depressive disorder and treatment-resistant depression. Though many different psychedelics have shown promise in treating depression, the most commonly used are psilocybin and ketamine. 
• Anxiety disorders: Psilocybin and MDMA have shown promise in treating several anxiety disorders, such as social anxiety, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD).
• PTSD: Ketamine, psilocybin, and MDMA-assisted therapy have successfully been used as a treatment for post-traumatic stress disorder (PTSD). MDMA has shown the most promise in alleviating severe PTSD symptoms by helping patients work through their trauma and process their emotions and memories.
• Substance abuse disorders and addiction: Psilocybin, LSD, and ibogaine have been studied to help individuals with abuse disorders such as nicotine addiction, alcohol use disorder, gambling addiction, and opioid addiction. These substances help patients recognize and break well-established patterns in their brains that cause cravings. They can also help patients recognize the underlying causes that contribute to their addictive patterns so that they can have lasting results from addictive behavior.
• End-of-life anxiety: Psychedelics, especially psilocybin, can be useful for alleviating anxiety in patients with terminal illnesses like end-stage cancer. In controlled therapeutic settings, psilocybin can reduce existential distress while increasing patient optimism and quality of life.
• Eating disorders: Psilocybin and other classic psychedelics have shown promise in studies to treat eating disorders like anorexia nervosa and binge eating disorder.
• Chronic pain disorders: According to more recent studies, psilocybin has shown promise in treating various chronic pain conditions like fibromyalgia and arthritis. 

The role of psychedelic research

The increased interest in psychedelic therapy has led to more studies being conducted on their efficacy and therapeutic range. University researchers and psychedelic associations are major contributors to our current understanding of psychedelic therapy. 

Johns Hopkins University’s Center for Psychedelic and Consciousness Research has been at the forefront of studying psychedelics for their therapeutic potential. Johns Hopkins is one of the first research centers in the U.S. dedicated to studying psychedelics and has contributed significantly to our understanding of these substances and their medical applications.

One of their most notable studies found that two doses of psilocybin treatment could relieve symptoms of major depressive disorder in most patients for up to a year. The randomized controlled study demonstrates the potential of psychedelics in mental health interventions, especially under the guidance of a facilitated setting (3).

In addition, the Multidisciplinary Association for Psychedelic Studies (MAPS) has played a pivotal role in advancing psychedelic research and pushing for a greater understanding of these substances. The nonprofit research organization has conducted several clinical trials, especially for substances like psilocybin and MDMA.

One of MAPS’s most significant milestones was their work toward achieving breakthrough therapy designation for MDMA-assisted psychotherapy. The designation, granted by the US Food and Drug Administration (FDA), acknowledges the therapeutic potential of MDMA and will help catalyze the accelerated research and development of the therapy so that it can become FDA-approved.

The ongoing research and clinical trials on psychedelic therapy have provided a substantial scientific foundation by which future research, legal regulations, and therapeutic practices can be built. The combined efforts of researchers around the globe not only develop new therapeutic means but also play a crucial role in challenging longstanding stigmas, paving the way for more evidence-based discussions surrounding psychedelic policy and therapy.

Safety and risks

Despite the therapeutic uses of psychedelic substances, it is important to understand their risks and approach their use with caution. 

How safe are psychedelics?

Psychedelic drugs are generally considered safe, especially when taken responsibly and in a controlled setting. Typically, pure psychedelics are not toxic and do not pose the risk of an overdose or dependence. Psychedelics have also been found to have a low abuse potential, especially compared to other drugs (4).

However, too high of dosages can lead to a “bad trip” or other negative physical and psychological effects. When psychedelics are administered at correct doses under the supervision of trained professionals, they pose even less of a risk (5).  

Who shouldn’t take psychedelic substances?

Psychedelic therapy might not be the best choice for everyone, especially for those with underlying health conditions. There are certain risk factors that need to be taken into account before taking psychedelics, such as:

• If you are pregnant or nursing
• If you have a history of certain mental health disorders
• If you have a family history of psychotic disorders
• If you are taking certain medications
• If you have a cardiovascular condition such as high blood pressure
• If you have epilepsy

If you are unsure whether psychedelic therapy is right for you, consult a medical professional. Psychedelic facilitators will also keep note of any conditions you have to determine if psychedelic therapy is a safe option.

What are the adverse effects of psychedelics?

Although negative effects are rare, they are still a risk worth noting before considering psychedelic therapy. However, these risks are substantially reduced in controlled clinical settings. Some side effects of psychedelics include:

• Bad trips: A bad trip can occur in some individuals who take psychedelics and lead to distressing thoughts and extreme paranoia. Bad trips typically only last through the duration of the trip and rarely lead to psychological harm.
• Psychosis: In very rare cases, psychedelics can trigger episodes of psychosis, causing individuals to lose touch with reality and have trouble differentiating what is real and not real. This risk is more common in people who have a mental health disorder or have family members with a history of psychosis or other mental health disorders.
• Psychedelic flashbacks: Some individuals who take psychedelics may experience random flashbacks of their psychedelic experience, even long after taking the substance. This symptom is known as Hallucinogen Persisting Perception Disorder (HPPD) and can include distortions of perception days, weeks, and sometimes even years after using the substance. These flashbacks can be distressing for some individuals and are typically triggered by fatigue or stress.
• Risk of accidents: Because psychedelics can alter an individual’s perception, motor functions, and cognition, there is an increased risk of accidents like trips or falls. This risk can be minimized in controlled clinical settings.

Integrating psychedelics into Western medicine

Traditional roots and ancient wisdom

The recent history of psychedelic medicine in the U.S. tells only a small story of their longstanding spiritual and cultural history worldwide. Though psychedelic-assisted therapy has gained traction in recent years, psychedelic medicine is not a new means of healing in human history.

Many indigenous cultures around the world have used these naturally occurring plants and fungi and passed down their knowledge to future generations. For thousands of years, these substances have been deeply embedded into some culture’s spiritual practices, healing ceremonies, and rituals.

For instance, in the Amazon basin, Ayahuasca has been used by shamans to heal individuals by connecting them to the spirit world. Similarly, in North America, some Native American tribes still use peyote, a psychedelic cactus, in spiritual ceremonies.

This practice has occurred for centuries. The traditional use of these substances has a history of respectful and intentional use for specified purposes, and they are often held in extreme reverence due to their spiritual nature.

Introduction of psychedelics to the “West”

Psychedelics have only been a part of “Western” medicine since the late 1950s. Psilocybin mushrooms were introduced to the U.S. by New York banker and ethnomycologist R. Gordon Wasson in 1957. Wasson visited a small Oaxican village in Southern Mexico, where he met María Sabina, a well-known healer in her community.

Sabina generously shared her knowledge of the sacred medicine and allowed Wasson to be the first Westerner to partake in such a ceremony. Wasson documented his experience in an article published in TIME Magazine, leading to a surge of interest in the West. Celebrities, tourists, and those looking to “find God” visited Sabina’s Mazatec town in search of the magic mushroom, and word of its existence spread quickly around the world.

Similarly, ayahuasca was introduced in the latter half of the 20th century by researchers and ethnobotanists who wrote about its use in traditional Amazonian practices. Since then, scientists and psychonauts alike have been intrigued by ayahuasca’s ability to induce spiritual and therapeutic experiences. The same instances repeated for almost all other entheogens. Soon, the West knew about many of these naturally occurring and mind-altering substances and grew fascinated with their effects.

The sudden emergence of psychoactive drugs resulted in an increase in research and a new counterculture movement. Between the early 1940s to 1960s, scientists made serval discoveries about the healing aspects of psychedelics and even synthesized their own.

However, once the recreational use of these substances began to increase, the 1960s War on Drugs put these studies on hold as all psychedelic substances were criminalized as Schedule I substances. Due to their criminalization, psychedelics became more stigmatized, and no efforts were made to carry on research until the late 90s and early 2000s.

As more organizations and state governments have shown their support for psychedelic therapy, the stigmatization has gone down, and even more research has come to light about how safe and effective psychedelics can be for treating mental health concerns.

Intersectional conflicts

As psychedelic therapy becomes more mainstream in modern medicine, it is important to reflect on the cultures who knew of these medicines long before scientists began researching them. The history of psychedelics in the West is often overlooked, which entirely devalues the contributions and wisdom of indigenous communities who used these substances for sacred and healing purposes.

By disregarding the complex history of psychedelic medicine, those who have held such sacred knowledge for generations are erased from the narrative and face issues like marginalization, negative social stigmas, and exploitation.

As our society delves deeper into psychedelic medicine, it is important to respect the age-old traditions and knowledge that go beyond our modern understanding. Our current psychedelic renaissance could learn valuable knowledge beyond clinical research by respecting the indigenous roots of these medicines and recognizing their spiritual contexts.

While modern psychedelic therapy tends to focus on addressing specific mental health conditions, psychedelic substances can also address areas of spirituality and personal growth. When psychedelic healing is viewed from a holistic standpoint, its use goes far beyond the boundaries of clinical settings. 

An ongoing concern about the popularized use of psychedelic medicine is how we can respect and honor their indigenous roots while also utilizing them in modern contexts. The contemporary application of psychedelics remains linked to intersectional systemic issues like classism, racism, and capitalism, which shape how we interpret and apply psychedelic therapy.

Dominant Western narratives have glossed over the significant spiritual history of these medicines. The prevailing capitalist system often overlooks the cultures that have shared and developed psychedelic medicines for generations, raising a significant ethical dilemma.

In order to integrate psychedelics into mainstream healthcare, it’s important to not only acknowledge their original stewards but also involve them in open dialogue. By doing so, modern psychedelic practices can appropriately honor and understand both the medical and traditional applications of these substances.

The socioeconomic disparities in healthcare access provide another conflict in the popularization of psychedelic therapy. Individuals from low-income or marginalized groups often face barriers that prevent them from accessing mental healthcare, such as psychedelic-assisted therapy.

The high costs of psychedelic therapy give only limited access to those who can afford it. The commodification of psychedelics in the healthcare system perpetuates an idealogy that these healing and transformative experiences are only reserved for those with the financial means to do so. 

As psychedelics become more integrated into modern medicine and therapy, ethical and inclusive standards should be put in place to protect these substances and the individuals who use them.

The ethical use of psychedelics is a complex and challenging situation; however, it’s critical that we approach the matter with cultural sensitivity and a commitment to social justice.

By dealing with psychedelics through a more intersectional approach, we can start to forge a just system that not only serves the needs of the diverse population but also respects the traditional indigenous practices of psychedelic medicine.

The future of psychedelics for mental healthcare

The future of psychedelic-assisted therapy is dependent on future research and regulatory developments. The data from previous studies, indigenous knowledge, and real-world applications will help guide the path of psychedelic medicine further, ensuring that the implication of the therapy is safe, effective, and accessible for all.

This would require a collective effort from researchers, policymakers, and healthcare facilitators to determine the best method of introducing psychedelic therapy to the greater public. Further legalization efforts and funding can allow scientists to determine definitively if psychedelic therapy is the next big treatment for mental health disorders.

Until then, gradual updates in psychedelic policy will provide access to treatment to a select few who are able to access the limited places that offer it. 

References

1. Calder, Abigail E., and Gregor Hasler. 2022. “Towards an Understanding of Psychedelic-Induced Neuroplasticity.” Neuropsychopharmacology 48 (September): 1–9. https://doi.org/10.1038/s41386-022-01389-z.
2. Gattuso, James J, Daniel Perkins, Simon Ruffell, Andrew J Lawrence, Daniel Hoyer, Laura H Jacobson, Christopher Timmermann, et al. 2022. “Default Mode Network Modulation by Psychedelics: A Systematic Review.” International Journal of Neuropsychopharmacology 26 (3). https://doi.org/10.1093/ijnp/pyac074.
3. Gukasyan, Natalie, Alan K Davis, Frederick S Barrett, Mary P Cosimano, Nathan D Sepeda, Matthew W Johnson, and Roland R Griffiths. 2022. “Efficacy and Safety of Psilocybin-Assisted Treatment for Major Depressive Disorder: Prospective 12-Month Follow-Up.” Journal of Psychopharmacology 36 (2): 151–58. https://doi.org/10.1177/02698811211073759.
4. Johnson, MW, WA Richards, and RR Griffiths. 2008. “Human Hallucinogen Research: Guidelines for Safety.” Journal of Psychopharmacology 22 (6): 603–20. https://doi.org/10.1177/0269881108093587.
5. Johnson, Matthew W., Roland R. Griffiths, Peter S. Hendricks, and Jack E. Henningfield. 2018. “The Abuse Potential of Medical Psilocybin according to the 8 Factors of the Controlled Substances Act.” Neuropharmacology 142 (142): 143–66. https://doi.org/10.1016/j.neuropharm.2018.05.012.