Current Perspective on the Therapeutic Preset for Substance-Assisted Psychotherapy

Abstract

The present narrative review is the first in a series of reviews about the appropriate conduct in substance-assisted psychotherapy (SAPT). It outlines a current perspective onpreconditions and theoretical knowledge that have been identified as valuable in the literaturefor appropriate therapeutic conduct in SAPT. In this context, considerations regarding ethics and the spiritual emphasis of the therapeutic approaches are discussed. Further, current methods, models, and concepts of psychological mechanism of action and therapeutic effects of SAPT are summarized, and similarities between models, approaches, and potential mediators for therapeutic effects are outlined. It is argued that a critical assessment of the literature might indicate that the therapeutic effect of SAPT may be mediated by intra- and interpersonal variables within the therapeutic context rather than specific therapeutic models per se. The review provides a basis for the development and adaptation of future investigations, therapeutic models, training programs for therapists, and those interested in the therapeutic potential of SAPT. Limitations and future directions for research are discussed.

Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model

“…EBT-inclusive models have a variety of strengths in comparison to basic support approaches. For instance, they integrate therapeutic interventions and knowledge from extrinsic, non-psychedelic EBTs that may enhance treatment efficacy beyond what drug administration alone can provide ( Thal et al, 2021 ). Secondly, the incorporation of an extrinsic EBT offers a more developed framework for training therapists and delimiting specified treatment interventions, which enhances the ability to assess treatment fidelity in clinical trials.…”

“…Generally, the limitations of EBT-inclusive approaches stem from their introduction of potentially deleterious constraints into how therapeutic benefit is conceptualized in PAP treatment. Therapeutic outcomes in PAP are likely to result from a participant’s engagement with many facets of themselves and their illness during treatment ( Kelly et al, 2021 ; Thal et al, 2021 ; Miceli McMillan and Jordens, 2022 ). Medicine sessions can foster a broad range of experiences that inspire participants to make beneficial meaning of their treatment in an equally broad range of ways that include spiritual, existential, emotional, relational, cognitive, or embodied dimensions ( Masters and Houston, 1966 ; Belser et al, 2017 ; Watts et al, 2017 ; Malone et al, 2018 ; Nielson et al, 2018 ; Michael et al, 2021 ).…”

“…This inattention may reflect the ongoing effort to characterize PAP within the institutional bounds of Western psychiatry and psychology, which attend more exclusively to cognitive and neural phenomena. As such, beneficial outcomes of PAP treatment have been conceptualized in neuropsychological terms that omit participants’ experiences of embodiment ( Kelly et al, 2021 ; Thal et al, 2021 ), such as the “reset” of a maladaptive neural status quo ( Carhart-Harris et al, 2017 ; Carhart-Harris and Friston, 2019 ), increased psychological flexibility ( Watts and Luoma, 2020 ; Agin-Liebes et al, 2022 ), cognitive reappraisal ( Agin-Liebes et al, 2022 ), altered neural responses to affect ( Barrett et al, 2020 ), or increased neuronal and mental plasticity ( Kočárová et al, 2021 ). This centering of the brain-mind may seem unremarkable, given the prevalence of neuropsychological explanations offered by most psychotherapies.…”

“…The quality of presence provided by clinicians during medicine sessions is considered to be a central element of PAP, due in large part to the heightened sensitivity of a participant in that setting ( Johnson et al, 2008 ; Phelps, 2017 ; Thal et al, 2021 , 2022 ). In EMBARK, therapists are encouraged to adopt a presence that reflects attributes represented by the acronym “CUSHION.” These attributes include Calm, Unhurried, Supportive, Human, Impeccably boundaried, Openhearted, and Non-judgmental.…”

Translating Psychedelic Therapies From Clinical Trials to Community Clinics: Building Bridges and Addressing Potential Challenges Ahead

“…They can open an individual to strong emotions -among them fear, rage, joy, sorrow, and shame -commonly experienced during psychedelic therapy sessions, along with vivid visual images, deep memories, and powerful insights. Indeed, the phenomenological and emotional effects of psychedelics appear central to the therapeutic process (6)(7)(8).…”