Does it seem like whenever an exciting new treatment or innovation comes along, it gets applied to everything? That may be happening with psychedelic therapy. Some clinicians, companies, and even state legislatures appear to consider using psychedelics to treat any mental and physical health difficulties.
Studies have found beneficial effects of psychedelic-assisted therapies for treatment-resistant depression, multiple forms of trauma/PTSD, and existential distress experienced in terminal illnesses. Some preliminary evidence suggests major depression generally and prolonged grief may also benefit.
However, there is not yet evidence to support the use of psychedelic-assisted therapy with other mental health difficulties. It’s not that we know they do not work. We just do not know whether they do. Psychedelics are chemical substances with known downsides (e.g., increased risk of psychosis). “Throwing spaghetti at the wall” of nearly any disorder risks unknown short- or long-term side effects.
Some clinicians and consumers have begun to advocate using psychedelics without the “assisted therapy” part. However, most psychedelics research finds that the therapy component is the crucial element for client progress. The role of the psylocibyn, MDMA, LSD, ketamine and other substances are to reduce fear reactions, increase social learning and facilitation, and enhance openness to experience. This appears to enhance the therapeutic alliance and facilitates learning skills in therapy.
Individuals more effectively integrate methods to influence their environment (e.g., via problem solving or behavioral activation). They also grow greater willingness to contact difficult experiences and effectively build adaptive coping strategies for them (e.g., through CBT or exposure therapies). Without the therapy portion, people often drift back to old habits and environments without tools to affect change.
One expert summed up the data: “It’s not the drug [that treats] – it’s the therapy that’s enhanced by the drug.” So as with any therapy, the combination of the therapeutic alliance and learning instrumental coping skills appear necessary for psychedelics to work.
Practices continue to pop up for psychedelic therapies (many of whom do follow the research). And multiple states have begun to consider legislation for more psychedelic therapy certifications. Some could say the research has not caught up with the treatment need. Others might argue we are putting the cart before the horse of the knowledge we currently have. Either way, for treating a lot of conditions, the jury’s still out. When it comes to the mental and physical health of those we serve, perhaps it helps most to do things well as opposed to do them quickly?
