Dosing and Therapeutic Conduct in Administration Sessions in Substance-Assisted Psychotherapy: A Systematized Review

Abstract

While the potential of serotonergic psychedelics and related substances as adjuncts in substance-assisted psychotherapy (SAPT) has been investigated for the treatment of several disorders, evidence for the appropriate therapeutic conduct in administration sessions is sparse. In this article, we discuss the current evidence for best therapeutic practice during administration sessions with serotonergic psychedelics and entactogens as adjuncts to psychotherapy. We conducted a systematized review of the literature following PRISMA guidelines. PsycINFO, MEDLINE, and Cochrane Library databases were searched. Clinical trials, treatment manuals, study protocols, qualitative studies, case studies, descriptive studies, opinion papers, reviews, book chapters, and conference proceedings published until February 1, 2022 were retrieved. The final synthesis included k = 82 sources. Information about substances, dosages, number of administration sessions, issues that are common for clients, different types of experiences, music, and therapeutic conduct was summarized, compared, and critically discussed. The effects different therapeutic models, methods, techniques, and more complex interventions each have on the therapeutic outcome have not been investigated by means of rigorous research. Most of the available evidence we retrieved was anecdotal limiting any conclusive statements regarding appropriate therapeutic conduct during administration sessions. Consequently, essential components of therapeutic interventions remain largely tentative, necessitating systematic investigation.

Perspectives and preliminary experiences of psychedelics for the treatment of eating disorders: A systematic scoping review

“…To date, studies investigating psychedelic assisted psychotherapies have adopted diverse treatment approaches. Although the presence of preparation, support and integration sessions are most consistently implemented, the therapeutic frameworks being used are far from consistent (Cavarra et al., 2022; Thal et al., 2024). Further, clinicians administering psychedelic‐assisted psychotherapy should receive specialised training to ensure that such treatments are delivered safely and effectively.…”

Therapeutic frameworks in integration sessions in substance‐assisted psychotherapy: A systematised review

“…SAPT generally comprises psychological support in combination with dosing sessions that involve the ingestion of psychoactive substances in a controlled setting with trained clinicians present. Less commonly, different models of conventional psychotherapy may serve as a foundation for the therapeutic process in SAPT (see Thal et al, 2021Thal et al, , 2023. The process involves various non-pharmacological components, such as screening/assessment and preparation sessions, which are thought to be important for both the safety and efficacy of this treatment (Thal et al, 2022).…”

“…Once preparation is complete, participants will typically have their first administration session. Psychoactive substances are used in one or more sessions, which are guided by one or two therapists co-facilitating (Thal et al, 2023). Subsequent sessions without the assistance of substances are usually incorporated after the first administration session (Bogenschutz, 2013;Grof, 1980).…”

“…Indeed, the effectiveness of therapeutic practices in combination with psychoactive substances has not been systematically investigated and remains tentative (Thal et al, 2023).…”