OPEN Foundation

Menu

Author name: Dilara Oexemann

Affect and Psychedelic Therapy: From Raw Emotion to Narrative Memory

/ Neuroscience, Psychology /

In recent years, psychedelic-assisted therapy (PAT) emerged as a promising approach for treating various mental health disorders. Using psychedelic substances in combination with psychotherapy seems to work by facilitating emotional breakthroughs and supporting deep psychological healing. Unlike conventional treatments that rely on verbal processing and cognitive restructuring, psychedelics seem to activate raw, pre-verbal emotional states that are difficult to express through language. This may allow individuals to engage with emotions in a fundamentally different way (van Elk & Yaden, 2022).

Affect theory offers a useful framework for understanding this process. It focuses on the primary, bodily experiences of emotion that precede cognitive interpretation (Bazinet & Van Vliet, 2020; Massumi, 1995; Tomkins, 1984). This article examines how psychedelics help individuals integrate raw affect into coherent personal narratives, both in individual and group therapy settings. Drawing on neuroscientific research and clinical case studies, it investigates how psychedelics influence key brain structures to impact memory reconsolidation and emotional integration, while also exploring how shared experiences in group settings influence emotional processing and meaning-making. Many patients undergoing PAT describe deeply emotional experiences that are difficult to articulate – from unexplained tears to waves of sensation or joy unconnected to specific memories – suggesting that psychedelics engage affect before it is structured into recognizable emotions or integrated into personal narratives.

Part I: Psychedelics and the Individual Integration of Affect

The Pre-Verbal Nature of Affect in Psychedelic Experiences

To comprehend how psychedelics influence emotion, we first need to distinguish between affect and emotion. Affect refers to the immediate, physiological experience of feeling and can be understood as a bare sensation before the mind is able to categorize it or express itself verbally. Emotions, in contrast, are affect that has been processed and framed within personal and cultural narratives (Neurolaunch, 2024; Russell, 2003).

Metaphorically, affect is the electric charge behind an emotional response: The racing heart before fear is recognized or the lump in the throat predisposing sadness. This distinction is important because psychedelics seem to amplify affect by bringing people into direct contact with these raw states before their mind has a chance to digest them.

Psychedelic experiences often feel overwhelming and difficult to articulate. Psychedelic users describe profound yet elusive emotional shifts: “Something deep inside” moved, a flood of feeling beyond words (Yaden et al., 2024). This aligns with affect theory’s emphasis on the physical, non-verbal nature of emotions. Rather than just recognizing feelings, psychedelics allow individuals to live them before they are shaped by habitual thought patterns.

Many personal accounts shared online illustrate this deeply embodied transformation. For example, one individual sharing their experience with psilocybin recalls, “Instead of knowing we are worthy of love, we actually felt worthy of love and held the memory of that sense in our bodies long after the experience” (Mind Medicine Australia, 2022). What is described is the physical feeling before making meaning from it. Another describes an unfolding awareness: “While initially I didn’t understand what I was seeing, the more I engaged with a conversation inward, the more I heard back and saw very clearly LIGHT” (Piece in the Journey, 2023). Others report intense emotional release, as one recounts, “Fifteen minutes after gulping down the psychedelic tea my eyes start streaming… emotions erupt and spread like wildfire” (Coxon, 2018), again showing that the physical sensation can predispose its understanding.

This therapeutic mechanism could be valuable because it engages emotions in a way that conventional treatments often do not, allowing individuals to feel before understanding. 

Psychedelics, Memory Reconsolidation, and Narrative Integration

Beyond heightening affect, psychedelics also facilitate memory reconsolidation, which is understood as a process in which deeply ingrained emotional memories become malleable, open to reorganization and reinterpretation (O’Brien, 2023). This is especially relevant in therapies for PTSD and trauma, where patients revisit painful memories with newfound emotional flexibility.

PAT seems to address both affect and its cognitive integration. Looking at how psychedelics influence the brain may help explain their role in affect. Neuroscientific research suggests that psychedelics affect brain regions involved in emotional processing.

The amygdala regulates fear and threat responses. Psychedelics appear to reduce its hyperactivity, which allows individuals to engage with traumatic memories in a less defensive manner (Stoliker et al., 2024).

The hippocampus is critical for memory formation and retrieval. Psychedelics seem to influence neurogenesis, the formation of new neurons, in this brain structure, which may promote new associations between past experiences and present emotional states. This in turn may promote more adaptive responses (Catlow et al., 2016).

The prefrontal cortex helps integrate experiences into coherent narratives. Psychedelics have shown to be able to promote both the functional and structural plasticity of this brain region and may increase its connectivity to emotion-processing centers. This may enable individuals to reframe past experiences with greater clarity and self-compassion (Ly et al., 2018).

Furthermore, psychedelics impact the default mode network (DMN), which is linked to self-reflection, mind-wandering, and personal identity. In PTSD and depression, an overactive DMN reinforces rigid thought patterns and negative self-perception. By temporarily disrupting this network, psychedelics may induce cognitive flexibility, which could lead the individual to form new insights and reframe emotions. This shift may help reprocess memories and integrate past experiences more adaptively, explaining the effectiveness of PAT in treating trauma (Gattuso et al., 2022).

Integrating this knowledge into clinical practice is essential for therapists to remain sensitive and responsive to the unique needs of each client. 

From Affect to Meaning: Why This Matters for Healing and Clinical Practice

Effective psychological healing involves more than just the re-experiencing of emotions; it requires the capacity to process and integrate affective states into a coherent self-narrative. Many individuals experience affective dysregulation, wherein unresolved emotional residues from past trauma contribute to psychopathologies (Dvir et al., 2014). PAT seems to bring these affects to the surface and has the potential for the reassessment and integration of cognitive and emotional experiences, leading to lasting psychological transformation.

The role of the psychotherapist is essential in guiding this process. Within a structured therapeutic setting, the clinician supports individuals in maintaining engagement with difficult affective material while reducing the risk of dysregulation or re-traumatisation. Psychedelics may bring unresolved affect to the surface, but without proper therapeutic support, individuals may struggle to make sense of these experiences (Phelps et al., 2017).

The psychotherapist plays a crucial role in recognizing and addressing the challenges that arise when raw affective states emerge in PAT (Carbonaro et al., 2016, Gashi et al., 2021). Several key considerations include:

Overwhelm and Emotional Flooding The intensity of raw affective experiences can be difficult to manage, potentially leading to emotional dysregulation or re-traumatization if not properly supported. 

Difficulty in Verbalizing Affect Because psychedelics engage pre-verbal emotional states, individuals may struggle to articulate their experiences, making post-session integration challenging.

Variability in Responses Not all individuals experience affect in a transformative or coherent way. Some may have fragmented or distressing experiences that require careful therapeutic navigation.

The Need for Structured Integration Support Without proper guidance, psychedelic experiences can remain disorganized, offering temporary emotional release without deeper psychological integration.

To address these challenges, psychotherapists may adopt specific strategies:

Providing a safe environment Previous research found the importance of set and setting for the success of psychedelic experiences and PAT (Borkel et al., 2023). By offering a therapeutic setting, reassurance, and emotional containment, therapists help individuals remain present with challenging affective states.

Facilitating meaning-making PAT often incorporates elements of other behavioral interventions that therapists should be trained in (Luoma et al., 2019). Through dialogue and reflection, therapists assist in linking psychedelic experiences to personal history, helping individuals integrate affect into an adaptive self-narrative.

Preventing overwhelm and dissociation The acute effects of psychedelics can often be overwhelming or challenging (Barrett et al., 2016). By monitoring distress levels and offering grounding techniques, therapists ensure that the therapeutic process remains constructive rather than overwhelming.

Supporting long-term integration Psychedelic integration is an important aspect of PAT and requires training from the psychedelic therapist (Bathje et al., 2022). Beyond the psychedelic session itself, therapists help individuals apply insights gained during PAT to their daily lives, reinforcing sustained improvements in mental health and well-being.

Without this structured framework, psychedelic experiences risk remaining intense but disorganised, offering emotional release without deeper psychological integration. By combining affect theory with clinical practice, therapists can optimize PAT’s effectiveness, ensuring that psychedelically induced affective shifts contribute to meaningful and lasting change.

Looking Ahead

Looking at the role of affect in PAT in different contexts could provide important information about how to maximize therapeutic results. To make sure that psychedelic therapy is tailored to each patient’s needs, future studies could examine the subtleties of these processes.

What is already clear is that psychedelics do not simply evoke emotion; they offer a powerful mechanism for transforming it. By engaging with affect at its most fundamental level, they provide a unique window into the relationship between feeling, memory, and meaning. However, special attention must be paid to the integration and transformation into understandable emotions to achieve this therapeutic effect.

A better understanding of affect and its role in PAT may have the potential to improve its treatment protocols and emphasizes the importance of the psychedelic psychotherapist.

References

  1. Barrett, F. S., Bradstreet, M. P., Leoutsakos, J.-M. S., Johnson, M. W., & Griffiths, R. R. (2016). The challenging experience questionnaire: Characterization of challenging experiences with psilocybin mushrooms. Journal of Psychopharmacology, 30(12), 1279–1295. https://doi.org/10.1177/0269881116677583
  2. Bathje, G. J., Majeski, E., & Kudowor, M. (2022). Psychedelic integration: An analysis of the concept and its practice. Frontiers in Psychology, 13, Article 824077. https://doi.org/10.3389/fpsyg.2022.824077
  3. Bazinet, T., & Van Vliet, L. (2020). Affect. International Encyclopedia of Human Geography (Second Edition), 47-52. https://doi.org/10.1016/B978-0-08-102295-5.10799-1
  4. Borkel, L. F., Rojas-Hernández, J., Henríquez-Hernández, L. A., Santana Del Pino, Á., & Quintana-Hernández, D. J. (2023). Set and setting predict psychopathology, wellbeing, and meaningfulness of psychedelic experiences: A correlational study. Expert Review of Clinical Pharmacology, 17(2), 165-176. https://doi.org/10.1080/17512433.2023.2295997
  5. Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S., MacLean, K. A., Jesse, R., Johnson, M. W., & Griffiths, R. R. (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology, 30(12), 1268–1278. https://doi.org/10.1177/0269881116662634
  6. Catlow, B. J., Jalloh, A., & Sanchez-Ramos, J. (2016). Hippocampal neurogenesis: Effects of psychedelic drugs. In Neuropathology of drug addictions and substance misuse: Volume 2: Stimulants, club and dissociative drugs, hallucinogens, steroids, inhalants and international aspects (pp. 821-831). Elsevier. https://doi.org/10.1016/B978-0-12-800212-4.00077-7
  7. Coxon, R. (2018, December 14). I took psychedelic drugs on a self-help retreat and this is what I learnt. HuffPost UK. https://www.huffingtonpost.co.uk/entry/psychedelic-drugs-magic-mushrooms_uk_5c128129e4b0449012f7a4a7
  8. Dvir, Y., Ford, J. D., Hill, M., & Frazier, J. A. (2014). Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities. Harvard Review of Psychiatry, 22(3), 149–161. https://doi.org/10.1097/HRP.0000000000000014
  9. Gashi, L., Sandberg, S., & Pedersen, W. (2021). Making “bad trips” good: How users of psychedelics narratively transform challenging trips into valuable experiences. International Journal of Drug Policy, 87, 102997. https://doi.org/10.1016/j.drugpo.2020.102997
  10. Gattuso, J. J., Perkins, D., Ruffell, S., Lawrence, A. J., Hoyer, D., Jacobson, L. H., Timmermann, C., Castle, D., Rossell, S. L., Downey, L. A., Pagni, B. A., Galvão-Coelho, N. L., Nutt, D., & Sarris, J. (2022). Default mode network modulation by psychedelics: A systematic review. International Journal of Neuropsychopharmacology, 26(3), 155–188. https://doi.org/10.1093/ijnp/pyac074
  11. Luoma, J. B., Sabucedo, P., Eriksson, J., Gates, N., & Pilecki, B. C. (2019). Toward a contextual psychedelic-assisted therapy: Perspectives from Acceptance and Commitment Therapy and contextual behavioral science. Journal of Contextual Behavioral Science, 14, 136–145. https://doi.org/10.1016/j.jcbs.2019.10.003
  12. Ly, C., Greb, A. C., Cameron, L. P., Wong, J. M., Barragan, E. V., Wilson, P. C., Burbach, K. F., Soltanzadeh Zarandi, S., Sood, A., Paddy, M. R., Duim, W. C., Dennis, M. Y., McAllister, A. K., Ori-McKenney, K. M., Gray, J. A., & Olson, D. E. (2018). Psychedelics promote structural and functional neural plasticity. Cell Reports, 23(11), 3170–3182. https://doi.org/10.1016/j.celrep.2018.05.022
  13. Massumi, B. (1995). The autonomy of affect. Cultural Critique, 31(II), 83–109. https://doi.org/10.2307/1354446
  14. Mind Medicine Australia. (2022, September 28). Psychedelic healing stories from Australia: Charlotte’s experience with psilocybin. Mind Medicine Australia. https://mindmedicineaustralia.org.au/psychedelic-healing-stories-from-australia-charlottes-experience-with-psilocybin/
  15. Neurolaunch. (2024, October 19). Affect vs. emotion: Understanding the difference. https://neurolaunch.com/affect-vs-emotion/
  16. O’Brien, A. (2023). Memory reconsolidation in psychedelic therapy (Position paper). https://www.woundedhealersinstitute.org/wp-content/uploads/Mem-Re-psychedelicsFINAL-1.pdf
  17. Phelps, J. (2017). Developing guidelines and competencies for the training of psychedelic therapists. Journal of Humanistic Psychology, 57(5), 503-520. https://doi.org/10.1177/0022167817711304
  18. Peace in the Journey. (2023, October 10). An unconventional journey: Reaffirming my path through psychedelics. Peace in the Journey. https://www.peaceinthejourney.com/blog/an-unconventional-journey-reaffirming-my-path-through-psychedelics
  19. Russell, J. A. (2003). Core affect and the psychological construction of emotion. Psychological Review, 110(1), 145–172. https://doi.org/10.1037/0033-295X.110.1.145
  20. Stoliker, D., Novelli, L., Vollenweider, F. X., Egan, G. F., Preller, K. H., & Razi, A. (2024). Neural mechanisms of resting-state networks and the amygdala underlying the cognitive and emotional effects of psilocybin. Biological Psychiatry, 96(1), 57-66. https://doi.org/10.1016/j.biopsych.2024.01.002
  21. Tomkins, S. S. (1984). Affect theory. In Approaches to emotion (1st ed., pp. 33). Psychology Press. https://doi.org/10.4324/9781315798806-11
  22. Van Elk, M., & Yaden, D. B. (2022). Pharmacological, neural, and psychological mechanisms underlying psychedelics: A critical review. Neuroscience & Biobehavioral Reviews, 140, 104793. https://doi.org/10.1016/j.neubiorev.2022.104793
  23. Yaden, D. B., Goldy, S. P., Weiss, B., & Griffiths, R. R. (2024). Clinically relevant acute subjective effects of psychedelics beyond mystical experience. Nature Reviews Psychology, 3, 606–621. https://doi.org/10.1038/s44159-024-00286-8

Affect and Psychedelic Therapy: From Raw Emotion to Narrative Memory Read More »

Comparing Psychedelic-Assisted Therapy with Traditional Therapy for Mental Illnesses – Part 2

/ Anxiety Disorders / PTSD, Depressive Disorders, Psychiatry & Medicine, Psychology, Substance Use Disorder /

Read part 1 here

As the field of mental health treatment advances, a critical evaluation of psychedelic-assisted therapy (PAT) in comparison with conventional therapeutic modalities becomes increasingly important. The persistent challenges of treatment resistance, high dropout rates, and relapse incidents in traditional approaches necessitate exploration of novel interventions. This comparative analysis examines the therapeutic mechanisms, clinical outcomes, and treatment efficacy of PAT versus established protocols across multiple psychiatric conditions, including substance use disorders, major depressive disorder, anxiety disorders, and post-traumatic stress disorder. The emerging evidence base suggests potential advantages in treatment adherence and sustained remission rates, warranting rigorous investigation of these therapeutic paradigms.

Substance Use Disorders

Traditional Therapy

The cornerstone of conventional addiction treatment lies in its comprehensive approach, combining behavioral interventions with medication-assisted therapy. At its foundation, Cognitive-Behavioral Therapy (CBT) works alongside other evidence-based approaches such as Motivational Enhancement Therapy and Contingency Management to help patients identify and modify negative thought patterns while developing effective coping strategies (Mayo Foundation for Medical Education and Research, 2019).

The pharmacological component of traditional treatment varies based on the specific addiction. For opioid dependence, medications like methadone and buprenorphine help manage withdrawal symptoms and cravings. Alcohol addiction treatment often involves naltrexone or acamprosate, which help reduce cravings and maintain abstinence (National Institute on Drug Abuse, 2023). This medication-assisted approach, combined with regular therapy sessions, creates a structured framework for recovery (Ray et al., 2020).

The key advantage of traditional therapy lies in its widespread availability and insurance coverage, which increase access to treatment for many individuals (Maclean & Saloner, 2020). Practitioners who specialize in these methods have extensive experience, allowing them to tailor treatment plans to meet the unique needs of each patient (Kuhlemeier et al., 2021). The integration of therapy into daily life fosters consistent support, which is crucial for long-term success (Pettersen et al., 2023).

However, these traditional methods also face significant limitations. Despite the structured programs, relapse rates remain alarmingly high, typically ranging from 40-60% (NIDA, 2023). Many individuals continue to struggle with persistent cravings, and traditional approaches often fail to address underlying psychological trauma that may contribute to addictive behaviors (Najavits, 2022). Additionally, maintenance medications can carry side effects that diminish quality of life and may even lead to new dependencies (SAMHSA, n.d.). The slow pace of progress can be discouraging for patients and lead to high drop-out rates, estimated at 30.4% in some studies (Lappan et al., 2020).

Psychedelic-Assisted Therapy

PAT has emerged as an alternative in the realm of addiction treatment, showing promise in facilitating profound therapeutic breakthroughs (Rieser et al., 2022). Recent clinical trials have demonstrated promising outcomes for treating certain substance dependencies with PAT, with success rates reported between 60% and 80% in some studies (Johnson et al., 2014; Johnson et al., 2017; Jones et al., 2022). Psychedelics facilitate deep emotional processing and introspection, allowing individuals to confront and reframe entrenched thought patterns related to addiction. Through limited sessions, PAT promotes neuroplasticity, potentially establishing new neural pathways that support lasting behavioral and perceptual changes (Calder & Hasler, 2023).

One of the most compelling advantages of PAT is its potential for rapid and significant reductions in substance use and cravings, often achieved after just two or three sessions. Participants frequently report transformative experiences that allow them to process underlying trauma and gain new insights into their addiction. This method not only targets the symptoms of addiction but also addresses the core issues that may drive it, making it a potentially more time-efficient treatment option (Valdez et al., 2024). The quick and impactful effects have the potential to lower dropout rates, as participants may feel motivated by early progress and sustained improvements.

However, PAT faces accessibility challenges, including legal restrictions, high upfront costs, and limited insurance coverage. As PAT is not suitable for individuals with certain psychiatric conditions or a family history of psychosis (Marrocu et al., 2024, Simonsson et al., 2023), and this treatment carries the risk for challenging acute experiences, expert guidance, careful screening and detailed protocols are required. Additionally, further controlled trials and longitudinal research are needed to clarify its impact on relapse rates.

Major Depressive Disorder

Traditional Therapy

Traditional methods for treating depression primarily rely on a combination of antidepressant medications and psychotherapy. Selective Serotonin Reuptake Inhibitors (SSRIs) are typically the first-line pharmacological treatment, known for their well-documented safety profile and established efficacy in alleviating depressive symptoms (IQWiG, 2024). Alongside medication, CBT is the most popular psychotherapy and helps individuals explore feelings, develop coping strategies, and address cognitive distortions contributing to their depression. This dual approach supports a holistic understanding of both the chemical and emotional aspects of the condition (Zagorski, 2019).

The advantages of these conventional methods include their extensive research backing, widespread availability, and general acceptance within the medical community. The structured nature of treatment enables healthcare providers to monitor progress closely and adjust medications as necessary, which is crucial for optimizing outcomes. Comprehensive insurance coverage further enhances accessibility, making treatment feasible for many patients (Cuijpers et al., 2020).

However, significant limitations exist within traditional treatment methods. SSRIs could take up to 4-6 weeks to show therapeutic effects, during which time patients may continue to endure severe symptoms (National Center of Biotechnology Information, 2020, NHS, 2021a). Common side effects, such as emotional blunting, sexual dysfunction, and weight changes, can negatively impact patients’ quality of life and adherence to treatment (NHS, 2021b). Approximately 30-50% of patients show little to no response to traditional antidepressants, leading to a frustrating cycle of medication trials (Rafeyan et al., 2020). While CBT offers valuable support, it may not adequately address deeper emotional trauma, and its effectiveness often hinges on patient engagement (NHS, 2022). 

Psychedelic-Assisted Therapy

PAT for depression, particularly with psilocybin, MDMA, or ketamine, represents a significant shift in treatment paradigms. Emerging clinical trials have demonstrated rapid and substantial reductions in depressive symptoms often following just one or two therapeutic sessions (Raison et al., 2023). The effects can last for several months, offering hope for those who have struggled with traditional methods. The unique mechanisms through which psychedelics operate involve facilitating profound emotional breakthroughs, allowing individuals to confront suppressed emotions and trauma that conventional therapies may overlook (Roseman et al., 2019).

Patients frequently report experiencing a renewed sense of interconnectedness and meaning in life, which addresses existential aspects of depression that medications alone often fail to target. The neuroplastic effects of psychedelics may also assist in breaking rigid thought patterns, allowing for a more flexible approach to emotional processing and coping (Chou et al., 2023). In a recent randomized controlled trial, Carhartt-Harris et al. (2021) found no significant differences between escitalopram and psilocybin treatments at the 6-week post-treatment mark. However, psilocybin showed favorable effects over escitalopram on several secondary measures, including higher response and remission rates.

As with addiction treatment, this approach is not without its challenges. Further research is needed on secondary outcomes and long-term effects to establish PAT as a fully evidence-based approach that qualifies for insurance coverage. Specific treatment protocols are yet to be established. The intense nature of the psychedelic experience necessitates thorough screening, preparation, integration support, and expert guidance to ensure safety and maximize therapeutic benefits (Psychedelic-assisted psychotherapy: Hope and dilemma, 2023).

Anxiety Disorders

Traditional Therapy

Conventional treatment for anxiety disorders primarily involves a combination of medication and psychotherapy. SSRIs and benzodiazepines are the main pharmacological interventions (Benzodiazepine Information Coalition, 2022, IQWiG, 2024), while CBT is widely recognized as the gold standard for psychological treatment. CBT focuses on identifying and challenging negative thought patterns, providing patients with practical tools and coping strategies they can apply in their daily lives. This structured approach aims to empower individuals to manage their anxiety more effectively and improve their overall quality of life (Nakao et al., 2021).

The advantages of traditional treatments are numerous. They are supported by decades of research, extensively available, and typically covered by most insurance plans. Medications can provide relatively quick relief from acute anxiety symptoms, while CBT fosters long-term coping skills that can mitigate future episodes of anxiety. This dual approach creates a well-rounded treatment strategy that addresses both immediate and ongoing needs (Stein et al., 2010).

Traditional treatments have notable limitations. While benzodiazepines provide short-term anxiety relief, they pose risks of dependency and cognitive impairment when used long-term (NHS, 2024). As for depression, SSRIs often require weeks to work and may produce intolerable side effects. Drop out rates for anxiety treatments can reach 17% (Gersh et al., 2017), and even when effective, therapy can be a lengthy process, with many patients experiencing residual symptoms or relapse post-treatment (Batelaan et al., 2017). Additionally, these methods may fail to address the deeper emotional and existential issues underlying anxiety disorders.

Psychedelic-Assisted Therapy

PAT has emerged as a promising alternative for addressing anxiety disorders, particularly in patients facing existential anxiety related to life-threatening illnesses (Schimmers et al., 2022). Clinical trials indicate that a single dose of psilocybin can significantly reduce anxiety and improve well-being for up to a month (Barrett et al., 2020). The treatment’s unique ability to foster profound shifts in perspective and emotional processing enables patients to confront their fears in ways that traditional therapies often do not allow (Lafrance et al., 2021). 

During sessions, patients commonly experience a release from rigid thought patterns and fear responses, leading to a deeper acceptance of their fears and sustained mental health improvements (Davis et al., 2020, Feulner et al., 2023). Compared to conventional psychotropic medications, psychedelics may offer a safer, effective alternative, with generally low physiological toxicity, minimal abuse potential, and few lasting adverse effects when used in a controlled, clinical setting (Lowe et al., 2022)

Despite its promise, this approach also faces significant challenges similar to the ones mentioned before in terms of legal restrictions, accessibility, and insurance coverage. The intense nature of the experience requires careful screening and preparation, as anxiety itself can complicate the therapeutic process. The need for specialized therapeutic support in a carefully controlled environment adds further complexity to this treatment modality (King & Hammond, 2021). Not all patients are suitable candidates, and while psychedelics are generally considered physiologically safe, more research is needed to confirm their safety for individuals with cardiovascular issues, which often co-occur with anxiety disorders (Wsół, 2023). 

PTSD

Traditional Therapy

Treatment for Post-Traumatic Stress Disorder (PTSD) traditionally revolves around trauma-focused psychotherapy and medication. Evidence-based approaches such as Prolonged Exposure Therapy (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR) are often used in conjunction with SSRIs or other psychiatric medications. These established methods aim to help patients process traumatic memories and reduce the distress associated with them, fostering a sense of safety and control (Watkins et al., 2018).

The advantages of these treatments are significant. They are widely available through mental health professionals, typically covered by insurance, and are backed by extensive research demonstrating their efficacy. Practitioners are well-trained in these methods, allowing for the integration of treatment into existing mental health care systems. This structured approach also facilitates careful monitoring of progress and adjustments to treatment as needed.

However, traditional therapies for PTSD face considerable challenges. The process of revisiting traumatic memories can be intensely distressing, leading to dropout rates of up to 20.9% (Varker et al., 2021). Many patients find the gradual exposure process overwhelming, which can reinforce avoidance behaviors (Shor et al., 2021). While SSRIs can help manage symptoms, they often provide incomplete relief and may produce side effects. A randomized clinical trial found that 60-72% of veteran patients continue to meet PTSD diagnostic criteria despite comprehensive treatment​ (Steenkamp et al., 2015). The lengthy duration of treatment can also be prohibitive, requiring months or years of consistent therapy.

Psychedelic-Assisted Therapy

MDMA-assisted therapy has emerged as a revolutionary approach for treating PTSD, demonstrating remarkable efficacy in clinical trials. This method combines the unique pharmacological properties of MDMA with specialized psychotherapy, often achieving significant symptom reduction in just a few intensive sessions (van der Kolk et al., 2024, Mitchell et al., 2023). In one of the first randomized controlled trials of MDMA-assisted therapy for PTSD, 83% of participants receiving MDMA no longer met PTSD criteria, compared to only 25% in the placebo group (Mithoefer et al., 2011).

The treatment’s success stems from MDMA’s ability to create a state of increased emotional openness and reduced fear response, allowing patients to process traumatic memories without becoming overwhelmed (Morgan, 2020). MDMA is thought to aid treatment by increasing empathy and reducing amygdala activation, which is linked to trauma-related stress responses, leading to improved trauma processing during therapy (Henner et al., 2022). Compared to conventional prolonged PE therapy for PTSD, MDMA-assisted psychotherapy has demonstrated significantly lower dropout rates (Amoroso et al., 2016).

As with the previously mentioned disorders, MDMA-assisted therapy faces several implementation challenges. The treatment requires specialized training for therapists and carefully controlled environments, making it more resource-intensive than conventional approaches. Additionally, the intensive nature of the sessions necessitates thorough medical screening and trained professional guidance. While the therapy shows high success rates, it may not be suitable for everyone and more research into long-term effects is needed (Mohamed et al., 2022).

In Conclusion – Psychedelic therapy vs Traditional Therapy

The comparison between traditional and PAT reveals a complex landscape in mental health treatment. While traditional therapies offer established protocols, widespread accessibility, and insurance coverage, they often face limitations in effectiveness, require extended treatment periods, and may not adequately address underlying trauma. The high relapse rates in addiction treatment, delayed onset of antidepressant effects, dependency risks with anxiety medications, and significant dropout rates in PTSD therapy highlight the need for alternative approaches.

PAT demonstrates promising potential across all four conditions, offering rapid and profound therapeutic breakthroughs with lasting effects. The ability to achieve significant improvements in relatively few sessions, coupled with deep emotional processing and neuroplastic effects, suggests a paradigm shift in mental health treatment. However, current challenges including legal restrictions, high costs, limited accessibility, and the need for specialized support must be addressed before widespread implementation is possible.

Rather than viewing these approaches as competing alternatives, the future of mental health treatment likely lies in their thoughtful integration. The established infrastructure of traditional therapy could provide the foundation for incorporating PAT where appropriate, combining the best aspects of both modalities. As research continues and regulatory frameworks evolve, the potential for psychedelic medicines to complement existing treatments offers hope for more effective, efficient, and lasting solutions to mental health challenges.

The ongoing clinical trials, increasing public acceptance, and growing interest from healthcare providers suggest a promising trajectory. With careful development of treatment protocols, appropriate training programs, and eventual insurance coverage, these innovative approaches could help address the current mental health crisis while providing new options for patients who have not found relief through conventional treatments alone. As we move forward, the focus should be on creating an integrated healthcare system that can safely and effectively deliver both traditional and psychedelic-assisted therapies to those who need them most.

Psychedelics vs. Traditional Treatments —How Do They Stack Up for Mental Health Disorders? – Part 1

References

  1. Amoroso, T., & Workman, M. (2016). Treating posttraumatic stress disorder with MDMA-assisted psychotherapy: A preliminary meta-analysis and comparison to prolonged exposure therapy. Journal of Psychopharmacology, 30(7), 595-600. https://doi.org/10.1177/0269881116642542
  2. Barrett, F. S., Doss, M. K., Sepeda, N. D., Pekar, J. J., & Griffiths, R. R. (2020). Emotions and brain function are altered up to one month after a single high dose of psilocybin. Scientific Reports, 10, 2214. https://doi.org/10.1038/s41598-020-59282-y
  3. Batelaan, N. M., Bosman, R. C., Muntingh, A., Scholten, W. D., Huijbregts, K. M., & van Balkom, A. J. L. M. (2017). Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: Systematic review and meta-analysis of relapse prevention trials. BMJ, 358, j3927. https://doi.org/10.1136/bmj.j3927
  4. Benzodiazepine Information Coalition. (2022, July 27). Mechanism of action – Benzodiazepine Information Coalition. https://www.benzoinfo.com/mechanism-of-action/
  5. Calder, A. E., & Hasler, G. (2023). Towards an understanding of psychedelic-induced neuroplasticity. Neuropsychopharmacology, 48, 104–112. https://doi.org/10.1038/s41386-022-01389-z
  6. Carhart-Harris, R., Giribaldi, B., Watts, R., Baker-Jones, M., Murphy-Beiner, A., Murphy, R., Martell, J., Blemings, A., Erritzoe, D., & Nutt, D. J. (2021). Trial of psilocybin versus escitalopram for depression. The New England Journal of Medicine, 384(15), 1402–1411. https://doi.org/10.1056/NEJMoa2032994
  7. Chou, T., Deckersbach, T., Dougherty, D. D., & Hooley, J. M. (2023). The default mode network and rumination in individuals at risk for depression. Social Cognitive and Affective Neuroscience, 18(1). https://doi.org/10.1093/scan/nsad032
  8. Cuijpers, P., Stringaris, A., & Wolpert, M. (2020). Treatment outcomes for depression: Challenges and opportunities. The Lancet Psychiatry, 7(11), 925-927. https://doi.org/10.1016/S2215-0366(20)30036-5
  9. Davis, A. K., Barrett, F. S., & Griffiths, R. R. (2020). Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. Journal of Contextual Behavioral Science, 15, 39–45. https://doi.org/10.1016/j.jcbs.2019.11.004
  10. Feulner, L., Sermchaiwong, T., Rodland, N., & Galarneau, D. (2023). Efficacy and safety of psychedelics in treating anxiety disorders. Ochsner Journal, 23(4), 315-328. https://doi.org/10.31486/toj.23.0076
  11. Gersh, E., Hallford, D. J., Rice, S. M., Kazantzis, N., Gersh, H., Gersh, B., & McCarty, C. A. (2017). Systematic review and meta-analysis of dropout rates in individual psychotherapy for generalized anxiety disorder. Journal of Anxiety Disorders, 52, 25-33. https://doi.org/10.1016/j.janxdis.2017.10.001
  12. Henner, R. L., Keshavan, M. S., & Hill, K. P. (2022). Review of potential psychedelic treatments for PTSD. Journal of the Neurological Sciences, 439, 120302. https://doi.org/10.1016/j.jns.2022.120302
  13. IQWiG (2024, April 15). Depression: Learn More – How effective are antidepressants? InformedHealth.org – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK361016/
  14. Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P., & Griffiths, R. R. (2014). Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. Journal of Psychopharmacology, 28(11), 983-992. https://doi.org/10.1177/0269881114548296
  15. Johnson, M. W., Garcia-Romeu, A., & Griffiths, R. R. (2017). Long-term follow-up of psilocybin-facilitated smoking cessation. American Journal of Drug and Alcohol Abuse, 43(1), 55-60. https://doi.org/10.3109/00952990.2016.1170135
  16. Jones, G., Ricard, J. A., Lipson, J., & Nock, M. K. (2022). Associations between classic psychedelics and opioid use disorder in a nationally-representative U.S. adult sample. Scientific Reports, 12, Article 4099. https://doi.org/10.1038/s41598-022-08045-7
  17. King IV, F., & Hammond, R. (2021). Psychedelics as reemerging treatments for anxiety disorders: Possibilities and challenges in a nascent field. FOCUS, 19(2), 167–174. https://doi.org/10.1176/appi.focus.20200047
  18. Kuhlemeier, A., Desai, Y., Tonigan, A., Witkiewitz, K., Jaki, T., Hsiao, Y., Chang, C., & Horn, M. (2021). Applying methods for personalized medicine to the treatment of alcohol use disorder. Journal of Consulting and Clinical Psychology, 89(4), 288–300. https://doi.org/10.1037/ccp0000634
  19. Lafrance, A., Strahan, E., Bird, B. M., St. Pierre, M., & Walsh, Z. (2021). Classic Psychedelic Use and Mechanisms of Mental Health: Exploring the Mediating Roles of Spirituality and Emotion Processing on Symptoms of Anxiety, Depressed Mood, and Disordered Eating in a Community Sample. Journal of Humanistic Psychology, 0(0). https://doi.org/10.1177/00221678211048049
  20. Lappan, S. N., Brown, A. W., & Hendricks, P. S. (2020). Dropout rates of in-person psychosocial substance use disorder treatments: A systematic review and meta-analysis. Addiction, 115(2), 201-217. https://doi.org/10.1111/add.14793
  21. Lowe, H., Toyang, N., Steele, B., Grant, J., Ali, A., Gordon, L., & Ngwa, W. (2022). Psychedelics: Alternative and potential therapeutic options for treating mood and anxiety disorders. Molecules, 27(8), 2520. https://doi.org/10.3390/molecules27082520
  22. Maclean, J. C., & Saloner, B. (2019). The effect of public insurance expansions on substance use disorder treatment: Evidence from the Affordable Care Act. Journal of Policy Analysis and Management, 38(2), 366–393. https://doi.org/10.3386/w23342
  23. Marrocu, A., Kettner, H., Weiss, B., Zeifman, R. J., Erritzoe, D., & Carhart-Harris, R. L. (2024). Psychiatric risks for worsened mental health after psychedelic use. Journal of Psychopharmacology, 38(3), 225–235. https://doi.org/10.1177/02698811241232548
  24. Mayo Foundation for Medical Education and Research (2019). Cognitive-behavioral therapy. Mayo Clinic. Retrieved November 12, 2024, from https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
  25. Mithoefer, M. C., Wagner, M. T., Mithoefer, A. T., Jerome, L., & Doblin, R. (2011). The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: The first randomized controlled pilot study. Journal of Psychopharmacology, 25(4), 439-452. https://doi.org/10.1177/0269881110378371
  26. Mohamed, A., Touheed, S., Ahmed, M., Hor, M., & Fatima, S. (2022). The efficacy of psychedelic-assisted therapy in managing post-traumatic stress disorder (PTSD): A new frontier? Cureus, 14(10), e30919. https://doi.org/10.7759/cureus.30919
  27. Najavits, L. M. (2022). Trauma and Addiction: A Clinician’s Guide to Treatment. In: Schnyder, U., Cloitre, M. (eds) Evidence-Based Treatments for Trauma-Related Psychological Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-97802-0_17
  28. Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. Biopsychosocial Medicine, 15(1), 16. https://doi.org/10.1186/s13030-021-00219-w
  29. National Center for Biotechnology Information. (2020). Selective serotonin reuptake inhibitors (SSRIs) for treating depression. In Institute for Quality and Efficiency in Health Care (IQWiG). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554406/
  30. NIDA (2023, September 25). Treatment and Recovery. Retrieved from https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
  31. NHS (2021a, December 8). Overview – Selective serotonin reuptake inhibitors (SSRIs). https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/overview/
  32. NHS (2021b, December 8). Side effects – Selective serotonin reuptake inhibitors (SSRIs). https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/side-effects/
  33. NHS (2022, November 10). Overview – Cognitive behavioural therapy (CBT). https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/
  34. NHS (2024, September 30). Side effects of diazepam. https://www.nhs.uk/medicines/diazepam/side-effects-of-diazepam/
  35. Pettersen, G., Bjerke, T., Hoxmark, E. M., Eikeng Sterri, N. H., & Rosenvinge, J. H. (2023). From existing to living: Exploring the meaning of recovery and a sober life after a long duration of a substance use disorder. Nordic Studies on Alcohol and Drugs, 40(6), 577–589. https://doi.org/10.1177/14550725231170454
  36. Psychedelic-assisted psychotherapy: Hope and dilemma. (2023). The Lancet Regional Health – Europe, 32, Article 100727. https://doi.org/10.1016/j.lanepe.2023.100727
  37. Rafeyan, R., Papakostas, G. I., Jackson, W. C., & Trivedi, M. H. (2020). Inadequate response to treatment in major depressive disorder: Augmentation and adjunctive strategies. The Journal of Clinical Psychiatry, 81(3), OT19037BR3. https://doi.org/10.4088/JCP.OT19037BR3
  38. Raison, C. L., Sanacora, G., Woolley, J., …, & Griffiths, R. R. (2023). Single-Dose Psilocybin Treatment for Major Depressive Disorder: A Randomized Clinical Trial. JAMA, 330(9), 843-853. https://doi.org/10.1001/jama.2023.14530
  39. Roseman, L., Haijen, E., Idialu-Ikato, K., Kaelen, M., Watts, R., & Carhartt-Harris, R. (2019). Emotional breakthrough and psychedelics: Validation of the Emotional Breakthrough Inventory. Journal of Psychopharmacology, 33(9). https://doi.org/10.1177/0269881119855974
  40. SAMHSA (n.d.). Medications, counseling, and related conditions. U.S. Department of Health and Human Services. Retrieved from https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions
  41. Schimmers, N., Breeksema, J. J., Smith-Apeldoorn, S. Y., Veraart, J., van den Brink, W., & Schoevers, R. A. (2022). Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: A systematic review. Psychopharmacology (Berlin), 239(1), 15–33. https://doi.org/10.1007/s00213-021-06027-y
  42. Shor, R., Lee, D. J., Thompson-Hollands, J., & Sloan, D. M. (2021). Psychometric properties of the Posttraumatic Avoidance Behaviour Questionnaire among a treatment-seeking adult sample. Psychological Trauma: Theory, Research, Practice, and Policy, 14(3), 393–398. https://doi.org/10.1037/tra0001060
  43. Simonsson, O., Goldberg, S. B., Chambers, R., Osika, W., Simonsson, C., & Hendricks, P. S. (2023). Psychedelic use and psychiatric risks. Psychopharmacology. https://doi.org/10.1007/s00213-023-06478-5
  44. Steenkamp, M. M., Litz, B. T., Hoge, C. W., & Marmar, C. R. (2015). Psychotherapy for military-related PTSD: A review of randomized clinical trials. JAMA, 314(5), 489–500. https://doi.org/10.1001/jama.2015.8370
  45. Stein, D. J., Hollander, E., & Rothbaum, B. O. (Eds.). (2010). Textbook of anxiety disorders (2nd ed.). American Psychiatric Publishing. https://books.google.de/books?id=DKDDqOw6Y7wC&lpg=PA429&ots=oVpJRSnCbY&dq=pharmacological%20plus%20cbt%20anxiety&lr&hl=de&pg=PA412#v=onepage&q=pharmacological%20plus%20cbt%20anxiety&f=false
  46. Valdez, T., Patel, V., Senesombath, N., Hatahet-Donovan, Z., & Hornick, M. (2024). Therapeutic potential of psychedelic compounds for substance use disorders. Pharmaceuticals, 17(11), 1484. https://doi.org/10.3390/ph17111484
  47. Varker, T., Jones, K. A., Arjmand, H.-A., Hinton, M., Hiles, S. A., Freijah, I., Forbes, D., Kartal, D., Phelps, A., Bryant, R. A., McFarlane, A., Hopwood, M., & O’Donnell, M. (2021). Dropout from guideline-recommended psychological treatments for posttraumatic stress disorder: A systematic review and meta-analysis. European Journal of Affective Disorders Reports, 4. https://doi.org/10.1080/20008198.2020.1754827
  48. Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 258. https://doi.org/10.3389/fnbeh.2018.00258
  49. Wsół, A. (2023). Cardiovascular safety of psychedelic medicine: Current status and future directions. Pharmacological Reports, 75(5), 1362–1380. https://doi.org/10.1007/s43440-023-00539-4
  50. Zagorski, N. (2019). Combining CBT with antidepressant found to be effective regardless of order. Psychopharmacology, 5(3). https://doi.org/10.1176/appi.pn.2019.pp3a3

Comparing Psychedelic-Assisted Therapy with Traditional Therapy for Mental Illnesses – Part 2 Read More »

Psychedelics vs. Traditional Treatments —How Do They Stack Up for Mental Health Disorders? – Part 1

/ Depressive Disorders, LSD, MDMA, Mushrooms / Psilocybin, Psychiatry & Medicine /

The treatment landscape for mental health conditions has evolved significantly over the past decades, with selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, and cognitive-behavioral therapy (CBT) being the primary therapeutic interventions. While these conventional approaches have demonstrated considerable efficacy and improved countless lives, clinical data indicates that a substantial portion of patients exhibit treatment resistance or experience relapse over time. 

This therapeutic gap has prompted researchers to investigate novel approaches, leading to renewed scientific interest in psychedelic-assisted therapy (PAT). The potential therapeutic applications of classical psychedelics such as psilocybin and LSD, as well as entactogens like MDMA, have garnered attention in contemporary psychiatric research. As clinical trials advance and mechanistic studies deepen our understanding of these compounds, the field moves forward in balancing hope with caution.

This review examines the distinct mechanisms, therapeutic potentials, and limitations of both conventional and psychedelic-assisted treatments, providing a comprehensive analysis of their roles in modern psychiatric care.

Psychedelic-Assisted Therapy vs traditional treatments – In a nutshell

Traditional Treatments Psychedelic-Assisted Therapy (PAT)
Primary Approaches SSRIs, benzodiazepines, cognitive-behavioral therapy (CBT) Psilocybin, LSD, MDMA, often combined with psychological support
Mechanism of Action Targets neurotransmitter systems (e.g., serotonin for SSRIs, GABA for benzodiazepines) Primarily acts on serotonin 5-HT2A receptors; impacts the default mode network (DMN)
Duration of Treatment Long-term, often months to years Short-term, typically involves 2-3 sessions over a few months
Therapeutic Effects Effective for symptom management, but may not address underlying trauma Facilitates neuroplasticity, may lead to psychological breakthroughs and sustained improvements
Side Effects Physical and emotional side effects (e.g., nausea, insomnia); potential dependency risks for benzodiazepines Low toxicity, but may cause psychological distress; requires controlled settings
Limitations Treatment resistance, relapse risk, and long wait times for psychotherapy Potential for adverse effects in vulnerable individuals, lack of long-term data
Implementation Widely available in healthcare systems, often requires ongoing adherence Requires structured setting and trained facilitators; typically includes preparation and integration phases

Mechanisms of Action: Different Pathways, Different Potentials

Traditional psychiatric interventions and emerging psychedelic therapies operate through distinct neurobiological pathways. Conventional treatments primarily target specific neurotransmitter systems: SSRIs treat depression by blocking serotonin reuptake in the brain, allowing more serotonin to remain active in neural synapses (IQWiG, 2024). Benzodiazepines reduce anxiety by enhancing GABA activity, which decreases overall brain cell excitability (Benzodiazepine Information Coalition, 2022). These pharmacological mechanisms typically require sustained administration to maintain therapeutic effects (Donald et al., 2021). CBT complements these approaches by promoting neuroplasticity through systematic modification of thought patterns and behaviors, leading to structural and functional changes in regions associated with emotional regulation (Nakao et al., 2021).

Psychedelic compounds exert their effects primarily through serotonin 5-HT2A receptor agonism (Vargas et al., 2023). This mechanism induces rapid alterations in neural connectivity and information processing (Smausz et al., 2022). Of particular interest is their impact on the default mode network (DMN), where overactivity correlates with various psychiatric conditions (Chou et al., 2023). Research indicates that psychedelics may temporarily disrupt DMN connectivity, potentially facilitating the formation of novel neural pathways. This neuroplastic effect, combined with the compounds’ ability to enhance emotional processing, provides a neurobiological basis for the acute and sustained therapeutic effects observed in clinical trials (Gattuso et al., 2022).

The distinct mechanisms of action between conventional treatments and psychedelic interventions present both advantages and limitations. Traditional approaches effectively target symptom management but may overlook underlying psychological trauma (IQWiG, 2024). PAT shows potential for deep neurobiological restructuring, yet the intensity of these interventions can be difficult and result in lasting negative effects for some individuals (Evans et al., 2023).

Treatment Protocols: Contrasting Continuous Care with Rapid-Acting Interventions

Building on the neurobiological foundations, treatment duration and efficacy present notable distinctions between conventional and psychedelic-assisted approaches. While traditional pharmacotherapy has proven effective for many individuals, it typically requires extended periods of administration, with patients maintaining antidepressant regimens for months to years (Hu et al., 2024). This prolonged treatment course often accompanies various side effects (NHS, 2021b). Additionally, resource limitations in mental health services frequently result in extended wait times for traditional psychotherapeutic interventions like CBT (PricewaterhouseCoopers, n.d.).

Emerging clinical evidence suggests that PAT may achieve therapeutic outcomes through significantly fewer interventions. Research with psilocybin in major depressive disorder demonstrates that a single 25mg dose, combined with psychological support, can produce substantial and sustained reductions in depressive symptoms (Raison et al., 2023). Similarly, MDMA-assisted therapy for PTSD has shown remarkable efficacy, with over 50% of participants no longer meeting diagnostic criteria after two sessions (van der Kolk et al., 2024). The treatment typically involves 2-3 guided sessions integrated with psychotherapy over several months (Mitchell et al., 2023).

The intensity of psychedelic experiences may pose challenges for some individuals, potentially inducing anxiety or distress, particularly when compared to conventional treatments like SSRIs or talk therapy which typically have more predictable response patterns. While the shorter treatment duration offers an attractive alternative to traditional long-term therapeutic approaches, the long-term implications of PAT require more thorough investigation.

Emotional Breakthroughs and Psychotherapeutic Integration

The therapeutic mechanisms of conventional and psychedelic treatments further diverge in their capacity to facilitate psychological breakthroughs. Psychedelic compounds can induce altered states of consciousness that enable patients to access and process repressed emotional content and trauma (Roseman et al., 2019). These experiences, when conducted in controlled therapeutic environments, often represent critical junctures in the treatment process.

Conventional therapeutic approaches primarily emphasize symptom management and gradual cognitive and behavioral modification (Stein et al., 2022). While traditional psychotherapy facilitates emotional understanding, it rarely produces the acute psychological insights characteristic of psychedelic experiences. MDMA-assisted therapy demonstrates this distinction, with patients reporting to process traumatic memories with reduced emotional activation (Morgan, 2020), potentially achieving therapeutic outcomes that conventional methods find challenging to replicate.

PAT functions not as a standalone treatment but as a catalyst within a comprehensive therapeutic framework (Brennan & Belser, 2022). The process involves three key phases: preparation, the psychedelic experience, and integration therapy (Mitchell et al., 2023). This structured approach, combined with careful consideration of patients’ psychosocial resources and support systems, is essential for optimizing therapeutic outcomes and minimizing risks.

Side Effects and Safety Concerns

Treatment modalities demonstrate distinct safety profiles and contraindications. SSRIs commonly induce physiological and emotional side effects, including nausea, insomnia, and sexual dysfunction (NHS, 2021). Long-term benzodiazepine use presents risks of dependency and cognitive impairment (NHS, 2024). While CBT exhibits minimal adverse effects, accessibility limitations and duration requirements pose practical constraints (NHS, 2022).

Psychedelic compounds demonstrate favorable physiological tolerability, with substances like psilocybin showing low toxicity and minimal addictive potential (National Institute on Drug Abuse, 2024). However, psychological risks emerge particularly in non-controlled settings (Barber et al., 2023). Adverse psychological reactions require careful therapeutic management to maintain safety parameters (Brooks, 2018).

Research indicates specific risk factors in PAT, including potential psychotic episodes in vulnerable individuals (Simonsson et al., 2023). Recent data suggests 16% of participants experience decreased psychological well-being four weeks post-treatment, with elevated rates among those with personality disorder diagnoses (Marrocu et al., 2024). Personality traits, particularly neuroticism, further influence treatment outcomes in both conventional and psychedelic interventions. While high neuroticism correlates with increased acute adverse effects in PAT, these individuals often report enhanced long-term outcomes (Mason et al., 2020). Similarly, conventional treatments consistently demonstrate reduced efficacy in individuals with high neuroticism scores (Mulder, 2011).

Implementation of PAT requires comprehensive screening protocols to identify contraindications and optimize patient selection. Clinical settings provide essential safeguards, resulting in predominantly positive therapeutic outcomes with minimal adverse effects (Williams et al., 2021). Further research is needed to better understand how individual differences, particularly personality traits, influence treatment responses. This knowledge would enable more precise patient selection and personalized treatment approaches, ultimately enhancing safety and therapeutic efficacy.

Durability of Therapeutic Effects: Comparing Long-Term Outcomes Across Treatment Modalities

Potential long-term therapeutic efficacy represents a significant advantage of PAT. Clinical trials demonstrate sustained symptom reduction across multiple conditions: psilocybin for depression (Gukasyan et al., 2022), MDMA for PTSD (van der Kolk et al., 2024), and ketamine for treatment-resistant depression (Murrough et al., 2013). These outcomes contrast with conventional treatments’ requirement for continuous medication administration without addressing underlying pathological mechanisms.

The potential for achieving substantial therapeutic change within limited sessions warrants methodological consideration. While preliminary data indicates promising results, psychedelic research in psychopharmacology is still in its beginning. Current limitations include a lack of longitudinal and follow-up studies, resulting in an incomplete understanding of delayed adverse effects and individual response variations.

Where Do We Go from Here?

Current evidence necessitates a balanced evaluation of PAT. While contraindications and methodological challenges persist, clinical trial data demonstrates significant therapeutic potential, particularly for treatment-resistant conditions including PTSD, depression, and substance use disorders (Belouin & Henningfield, 2018). These novel interventions may address limitations inherent in conventional treatment approaches.

The evolution of psychiatric medicine suggests an integrative framework incorporating both established and emerging therapeutic modalities. Psychedelic compounds, when administered within structured clinical settings, represent a promising pharmacological class that may complement existing treatment paradigms (Yaden et al., 2024). This integration has the potential to advance therapeutic mechanisms beyond symptom management toward sustained psychological transformation, directly addressing underlying trauma and promoting long-term healing.

The successful implementation of psychedelic-assisted therapy (PAT) requires a multi-faceted approach encompassing patient screening, preparation protocols, and integrated aftercare support. Critical research priorities include understanding neurobiological mechanisms, identifying reliable biomarkers for treatment response, and examining interactions with concurrent therapies. While current evidence supports PAT’s potential, limitations in longitudinal data and study population diversity constrain its broader clinical application. Ko et al. (2022) highlight the need for expanded research across diverse demographic groups to establish standardized safety protocols and treatment guidelines. Future studies should focus on systematic outcome assessment, monitoring of adverse effects, and analysis of population-specific treatment responses to optimize clinical effectiveness and safety standards.

The emerging evidence base supporting PAT’s therapeutic potential, combined with increasing institutional support and methodological refinement, indicates a promising direction for psychiatric medicine. As research continues and treatment guidelines evolve, these interventions may significantly expand the therapeutic options available to clinicians and patients, potentially transforming the landscape of mental health treatment.

Comparing Psychedelic-Assisted Therapy with Traditional Therapy for Mental Illnesses – Part 2

References

  1. Barber, G. S., & Dike, C. C. (2023). Ethical and practical considerations for the use of psychedelics in psychiatry. Psychiatric Services, 74(8), 838–846. https://doi.org/10.1176/appi.ps.20220525
  2. Belouin, S. J. & Henningfield, J. E. (2018). Psychedelics: Where we are now, why we got here, what we must do. Neuropharmacology, 142, 7-19. https://doi.org/10.1016/j.neuropharm.2018.02.018
  3. Benzodiazepine Information Coalition. (2022, July 27). Mechanism of action – Benzodiazepine Information Coalition. https://www.benzoinfo.com/mechanism-of-action/
  4. Brennan, W. & Belser, A. B. (2022). Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.866018
  5. Brooks, M. (2018, July 20). Psilocybin “Bad trips” underscore need for research safeguards. Medscape. https://www.medscape.com/viewarticle/874136?form=fpf
  6. Chou, T., Deckersbach, T., Dougherty, D. D., & Hooley, J. M. (2023). The default mode network and rumination in individuals at risk for depression. Social Cognitive and Affective Neuroscience, 18(1). https://doi.org/10.1093/scan/nsad032
  7. Donald, M., Partanen, R., Sharman, L., Lynch, J., Dingle, G. A., Haslam, C., & van Driel, M. (2021). Long-term antidepressant use in general practice: a qualitative study of GP’s views on discontinuation. Br J Gen Pract., 71(708), e508-e516. https://doi.org/10.3399/BJGP.2020.0913
  8. Evans, J., Robinson, O. C., Ketzitzidou Argyri, E., Suseelan, S., Murphy-Beiner, A., McAlpine, R., Luke, D., Michelle, K., & Prideaux, E. (2023). Extended difficulties following the use of psychedelic drugs: A mixed methods study. PLOS ONE, 18(10). https://doi.org/10.1371/journal.pone.0293349
  9. Gattuso, J. J., Perkins, D., Ruffell, S., Lawrence, A. J., Hoyer, D., Jacobson, L. H., Timmermann, C., Castle, D., Rossell, S. L., Downey, L. A., Pagni, B. A., Galvao-Coelho, N. L., Nutt, D., & Sarris, J. (2023). Default Mode Network Modulation by Psychedelics: A Systematic Review. Int J. Neuropsychopharmacol., 26(3): 155-188. https://doi.org/10.1093/ijnp/pyac074
  10. Gukasyan, N., Davis, A. K., Barrett, F. S., Cosimano, M. P., Sepeda, N. D., Johnson, M. W., & Griffiths, R. R. (2022). Efficacy and safety of psilocybin-assisted treatment for major depressive disorder: Prospective 12-month follow-up. Journal of Psychopharmacology, 36(2). https://doi.org/10.1177/02698811211073759
  11. Hu, Y., Xue, H., Ni, X., Guo, Z., Fan, L., & Du, W. (2024). Association between duration of antidepressant treatment for major depressive disorder and relapse rate after discontinuation: A meta-analysis. Psychiatry Research, 337, 115926. https://doi.org/10.1016/j.psychres.2024.115926
  12. Institute for Quality and Efficiency in Health Care (IQWiG). (2024, April 15). Depression: Learn More – How effective are antidepressants? InformedHealth.org – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK361016/
  13. Ko, K., Knight, G., Rucker, J. J., & Cleare, A. J. (2022). Psychedelics, Mystical Experience, and Therapeutic Efficacy: A Systematic review. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.917199
  14. Mason, N. L., Dolder, P. C., & Kuypers, K. P. (2020). Reported effects of psychedelic use on those with low well-being given various emotional states and social contexts. Drug Science Policy and Law, 6, 205032451990006. https://doi.org/10.1177/2050324519900068
  15. Mitchell, J. M., Ot’alora G., M., van der Kolk, B. et al. (2023). MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Nat Med, 29, 2473–2480. https://doi.org/10.1038/s41591-023-02565-4
  16. Morgan, L. (2020). MDMA-assisted psychotherapy for people diagnosed with treatment-resistant PTSD: what it is and what it isn’t. Annals of General Psychiatry, 19(33). https://doi.org/10.1186/s12991-020-00283-6
  17. Marrocu, A., Kettner, H., Weiss, B., Zeifman, R. J., Erritzoe, D., & Carhart-Harris, R. L. (2024). Psychiatric risks for worsened mental health after psychedelic use. Journal of Psychopharmacology, 38(3), 225–235. https://doi.org/10.1177/02698811241232548
  18. Mulder, R. T. (2011). The influence of personality on the treatment outcome of psychopathology. Word Psychiatry, 10(2), 115-116. PMID: 21633687
  19. Murrough, J. W., Perez, A. M., Pillemer, S., Stern, J., Parides, M. K., aan het Rot, M., Collins, K. A., Mathew, S. J., Charney, D. S., Iosifescu, D. V. (2013). Rapid and longer-term antidepressant effects of repeated ketamine infusions in treatment-resistant major depression. Biological Psychiatry, 74(4), 250-6. https://doi.org/10.1016/j.biopsych.2012.06.022
  20. Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. Biopsychosocial Medicine, 15(1), 16. https://doi.org/10.1186/s13030-021-00219-w
  21. National Institute on Drug Abuse (2024, June 24). Psilocybin (Magic Mushrooms) | National Institute on Drug Abuse. https://nida.nih.gov/research-topics/psilocybin-magic-mushrooms
  22. NHS (2021, December 8). Side effects – Selective serotonin reuptake inhibitors (SSRIs). https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/side-effects/
  23. NHS (2022, November 10). Overview – Cognitive behavioural therapy (CBT). https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/
  24. NHS (2024, September 30). Side effects of diazepam. https://www.nhs.uk/medicines/diazepam/side-effects-of-diazepam/
  25. PricewaterhouseCoopers. (n.d.). “Waiting times” in mental healthcare. https://www.pwc.nl/en/insights-and-publications/services-and-industries/public-sector/social-determinants-of-health/waiting-times-in-mental-healthcare.html
  26. Simonsson, O., Goldberg, S. B., Chambers, R., Osika, W., Simonsson, C., & Hendricks, P. S. (2023). Psychedelic use and psychiatric risks. Psychopharmacology. https://doi.org/10.1007/s00213-023-06478-5
  27. Stein, D. J., Shoptaw, S. J., Vigo, D. V., Lund, C., Cuijpers, P., Bantjes, J., Sartorius, N., & Maj, M. (2022). Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration. World Psychiatry, 21(3), 393-414. https://doi.org/10.1002/wps.20998
  28. Raison, C. L., Sanacora, G., Woolley, J., …, & Griffiths, R. R. (2023). Single-Dose Psilocybin Treatment for Major Depressive Disorder A Randomized Clinical Trial. JAMA, 330(9), 843-853. https://doi.org/10.1001/jama.2023.14530
  29. Roseman, L., Haijen, E., Idialu-Ikato, K., Kaelen, M., Watts, R., & Carhart-Harris, R. (2019). Emotional breakthrough and psychedelics: Validation of the Emotional Breakthrough Inventory. Journal of Psychopharmacology, 33(9). https://doi.org/10.1177/0269881119855974
  30. Smausz, R., Neill, J., & Gigg, J. (2022). Neural mechanisms underlying psilocybin’s therapeutic potential – the need for preclinical in vivo electrophysiology. Journal of Psychopharmacology, 36(7), 781-793. https://doi.org/10.1177/02698811221092508
  31. van der Kolk, B. A., Wang, J. B., Yehuda, R., Bedrosian, L., Coker, A. R., Harrison, C., Mithoefer, M., Yazar-Klosinki, B., Emerson, A., & Doblin, R. (2024). Effects of MDMA-assisted therapy for PTSD on self-experience. PLoS ONE 19(1). https://doi.org/10.1371/journal.pone.0295926
  32. Vargas, M. V., Dunlap, L. E., Dong, C., Carter, S. J., Tombari, R. J., Jami, S. A., Cameron, L. P., Patel, S. D., Hennessey, J. J., Saeger, H. N., Mccorvy, J. D., Gray, J. A., Tian, L., & Olson, D. E. (2023). Psychedelics promote neuroplasticity through the activation of intracellular 5-HT2A receptors. Neuroscience, 379, 6633. https://doi.org/10.1126/science.adf0435
  33. Williams, M. L., Korevaar, D., Harvey, R., Fitzgerald, P. B., Liknaitzky, P., O’Carroll, S., Puspanathan, P., Ross, M., Strauss, N., & Bennett-Levy, J. (2021). Translating psychedelic therapies from clinical trials to community clinics: building bridges and addressing potential challenges ahead. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.737738
  34. Yaden, D. B., Berghella, A. P., Hendricks, P. S., Yaden, M. E., Levine, M., Rohde, J. S., Nayak, S., Johnson, M. W., & Garcia-Romeu, A. (2024). IUPHAR-review: The integration of classic psychedelics into current substance use disorder treatment models. Pharmacological Research, 199, 106998. https://doi.org/10.1016/j.phrs.2023.106998

Psychedelics vs. Traditional Treatments —How Do They Stack Up for Mental Health Disorders? – Part 1 Read More »

Exploring the foundations & Future of Psychedelic-assisted EMDR therapy - Online Event - April 7

REGISTER NOW