Psilocybin and Mental Health: A Deeper Look Beyond Psychedelic Therapy
By Tommaso Barba, Neuroscientist
The world of mental health treatment has been revolutionised by the re-emergence of psychedelic substances, with psilocybin, a naturally occurring compound found in certain species of mushrooms, leading the way. However, the term "psychedelic-assisted therapy" may not fully encapsulate the profound transformations facilitated by these substances.
Recently, a provocative opinion piece emerged, asserting that psilocybin is not merely a catalyst, but a potent therapeutic agent in its own right. This perspective relegates the 'therapy' component of 'psilocybin-assisted therapy' to a secondary role. But is this the most accurate or beneficial way to frame the issue? Could reducing the emphasis on mandatory therapeutic support increase accessibility, or might it pave the way for potential disasters? Let's delve deeper.
A Historical Glimpse at Psychedelic Use in Therapy
Historically, psychedelic substances like LSD and psilocybin were employed in therapy to facilitate the release of repressed memories and feelings and promote mental relaxation. This approach was rooted in the psychodynamic tradition, where the therapist-guided exploration of the unconscious mind was seen as a pathway to healing.
However, the psychedelic experience, with its potential to catalyse deep personal insights and emotional breakthroughs, seems to transcend the conventional boundaries of therapy.
The Three Pillars of Psychedelic Therapy: Preparation, Guiding and Integration
In the administration of psychedelic treatments, 3 key elements are often highlighted: preparation, guiding, and integration.
Preparation involves getting ready for the psychedelic experience while ensuring a safe and supportive environment. Integration, on the other hand, is the process of making sense of the psychedelic experience and incorporating the insights gained into your every day.
Yet, the role of integration, despite its traditional emphasis, remains a subject of ongoing debate. Some evidence suggests that the significant reduction in depressive symptoms observed in individuals occurs immediately following treatment before any formal integration takes place.
This raises the question: Is the therapeutic effect attributed to the drug itself, rather than the psychotherapy that accompanies it?
Unravelling the Therapeutic Potential of the Psychedelic Experience
Years of research have illuminated the potential therapeutic power of the psychedelic experience itself, which can facilitate deep emotional catharses, promote the acquisition of significant life insights, and induce profound mystical experiences.
Yet, the simple ingestion of psilocybin may not be sufficient to catalyse these transformative experiences. The 'set' and 'setting' surrounding the use of the drug, from the music played to the ability to feel safe and surrender to the experience, may play a pivotal role.
A recent research paper further complicates this dynamic, suggesting that the therapeutic alliance formed with the therapist before the dosing session can predict the depth of emotional breakthroughs experienced later on. This finding underscores the intricate interplay between human and pharmacological factors in psychedelic therapy, a relationship that may be challenging to disentangle.
Naturalistic Research Findings of Psychedelic Use for Mental Health
On the other hand, naturalistic research, which assesses the use of psychedelic drugs in private settings and their impact on individuals' lives, offers a different perspective. Evidence suggests that individuals self-medicating with psychedelics reported significant positive changes.
Specifically, 64% of respondents experienced positive shifts the day after their psychedelic experience, with 52% reporting enduring improvements. Intriguingly, these enhancements might be fostered by the psychedelic experience itself, as these subjects did not receive any form of structured integration or psychotherapy alongside their use of the substance.
In a similar vein, the largest clinical trial of psilocybin for depression to date demonstrated that long-lasting antidepressant effects could be achieved with minimal therapeutic support (around 2 hours of preparation, 2 hours of integration, plus acute support during the experience). Sometimes, the keys to future understanding can be found in a careful analysis of our past knowledge.
Antidepressants and Therapy: Parallels with Psilocybin
There is a wealth of evidence from the use of classic antidepressants, such as SSRIs and SNRIs, that combining these medications with psychotherapy can enhance their efficacy to a degree that surpasses the effectiveness of either treatment used in isolation. However, it's also clear that antidepressants can be therapeutic on their own for a significant proportion of individuals.
This parallel may extend to psilocybin. Combining this potent psychedelic with structured, long-term therapy could potentially yield the most beneficial results, particularly for those grappling with severe mental health challenges.
In navigating the turbulent seas of the psyche, the guidance of expert sailors - experienced therapists, shamans, and other guides - may prove invaluable. However, it's important to acknowledge that not everyone may require such structured guidance.
Therapy is a significant investment of time and resources and mandating extensive therapy alongside FDA-approved psilocybin could create a substantial barrier to access. Particularly in the United States, where the cost of healthcare is a significant concern, insurance companies may be less willing to cover such comprehensive treatment plans.
Legislative Changes and Safety Precautions To Consider Before Using Psychedelics
The rise of legislative initiatives advocating for the decriminalisation or legalisation of psychedelics worldwide compels us to consider alternative strategies to maximise benefits and minimise potential harms associated with these powerful substances.
We must ensure that individuals approach psychedelics with the respect and caution they warrant, guarding themselves against dysfunctional attitudes such as 'spiritual bypassing' - a term that refers to the use of spiritual beliefs to avoid confronting emotional wounds, unresolved issues, and fundamental psychological needs and delusional thinking, which can be a potential pitfall in the psychedelic journey.
To facilitate this, there should be a strong emphasis on harm reduction information. This includes providing resources for individuals to understand the potential risks and benefits of psychedelic use and strategies to handle any difficulties that may arise during a psychedelic experience.
Moreover, online integration options should be made widely available. These could include platforms for individuals to connect with integration specialists and resources designed to assist in navigating the post-psychedelic experience. Such resources can play a vital role in maximising well-being and personal growth following a psychedelic journey.
The Future of Using Psychedelics for Mental Health
How this intricate debate on the optimal use of psychedelic drugs will unfold in the future remains uncertain, and only time will provide us with definitive answers. However, it's possible that we may find ourselves at a crossroads. On one path, we may see medical access to psychedelics, primarily focused on individuals with severe mental health conditions and characterised by flexible but mandatory therapeutic support.
On the other path, we may see room for more naturalistic and private use, where individuals are empowered to explore these substances in a safe, respectful, and informed manner, with optional access to professional guidance and integration resources.
These two paths need not be mutually exclusive. Instead, they could represent different points on a spectrum of psychedelic use, each catering to different needs and circumstances. As we navigate this exciting frontier, it's crucial that we remain open to diverse approaches, always prioritising safety, respect, and the potential for healing and growth.