Presence, Trust, and Empathy: Preferred Characteristics of Psychedelic Carers

Thal, Sascha B.; Engel, Liam B.; Bright, Stephen

doi:10.1177/00221678221081380

Cited by 15 publications

(18 citation statements)

References 56 publications

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“…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.…”

Section: Cushion Presencementioning

confidence: 99%

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

Brennan

Belser²

2022

Front. Psychol.

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The current standard of care in most uses of psychedelic medicines for the treatment of psychiatric indications includes the provision of a supportive therapeutic context before, during, and after drug administration. A diversity of psychedelic-assisted psychotherapy (PAP) models has been created to meet this need. The current article briefly reviews the strengths and limitations of these models, which are divided into basic support models and EBT-inclusive therapy models. It then discusses several shortcomings both types of models share, including a lack of adequate attention to embodied and relational elements of treatment, and insufficient attention to ethical concerns. The article then introduces the EMBARK model, a transdiagnostic, trans-drug framework for the provision of supportive psychotherapy in PAP clinical trials and the training of study therapists. EMBARK was designed to overcome challenges that prior models have had in conceptualizing therapeutic change in psychedelic treatment, incorporating elements of non-psychedelic evidence-based therapies, incorporating therapists’ prior skills and clinical orientations, delimiting therapist interventions for research standardization, and determining specific factors that contribute to treatment outcomes. The article explains EMBARK’s six clinical domains, which represent parallel conceptualizations of how therapists may support therapeutic benefit in PAP treatment, and its four care cornerstones, which reflect therapists’ broad ethical responsibility to participants. The article describes how these elements of the model come together to structure and inform therapeutic interventions during preparation, medicine, and integration sessions. Additionally, the article will discuss how EMBARK therapist training is organized and conducted. Finally, it will demonstrate the broad applicability of EMBARK by describing several current and upcoming PAP clinical trials that have adopted it as the therapeutic frame.

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Section: Cushion Presencementioning

confidence: 99%

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

Brennan

Belser²

2022

Front. Psychol.

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“…The number of people in these spaces was seen as an advantage by some forum participants.many heads are better than one.Of course, preference for online remote sitters depended on personal comfortability with digital spaces.Nothing wrong with an online trip sitter if you dont mind being online.Multiple participants were vocal in their criticism of remote sitters, suggesting remote sitters were not a useful safety mechanism in emergencies.Still, there are plenty of cases (I witnessed a few myself) when things went remarkably wrong. In most of such situations the idea of speed-dialing someone or chatting over net or anything alike is just a joke.Other participants implied remote-sitters may be more useful for integration than for the provision of support to people currently under the influence of psychedelics.Online, through Skype or something would be cool for afterwards…possibly next day even depending on how intense the experience is.Besides some limited analysis of online forums (Thal et al, 2022a, 2022b) and a unique study of online ayahuasca ceremonies undertaken by followers of the Santo Daime religion following COVID-19 restrictions (Hartogsohn, 2022), online psychedelic care services are largely unexplored. The provision of social support through online peer counseling is being explored (Fukkink, 2011) and online therapeutic interventions have evidenced decreases in anxiety and depression (e.g., Cohen & Kerr, 1999; Kessler et al, 2009).…”

Section: Findings and Discussionmentioning

confidence: 99%

“…This paper analyzed data from a larger project investigating psychedelic care discussion among participants of psychedelic forums (see Thal et al, 2022aThal et al, , 2022b. Most data regarding drug-related harms have been obtained from clients receiving treatment for unwanted outcomes of their drug use (Miller & Sønderlund, 2010).…”

Section: Methodsmentioning

confidence: 99%

“…Besides some limited analysis of online forums (Thal et al, 2022a(Thal et al, , 2022b) and a unique study of online ayahuasca ceremonies undertaken by followers of the Santo Daime religion following COVID-19 restrictions (Hartogsohn, 2022), online psychedelic care services are largely unexplored. The provision of social support through online peer counseling is being explored (Fukkink, 2011) and online therapeutic interventions have evidenced decreases in anxiety and depression (e.g., Cohen & Kerr, 1999;Kessler et al, 2009).…”

Section: Remote Sittermentioning

confidence: 99%

“…Emergency hotlines (e.g., police and ambulance) and telephone services available for acute psychological distress (e.g., crisis line services) are already used on a global scale, although their utility can be critiqued (Hoffberg et al, 2020). As evidenced by previous investigations regarding consumer preferences (Thal et al, 2022a), having someone to reach out to in case of an emergency with whom a preexisting relationship has been established may allow for a reduction in anxiety. A pre-selected sober person who knows the consumer well might be best placed to assess the situation, provide direct supports and call for professional help if needed.…”

Section: Remote Sittermentioning

confidence: 99%

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Psychedelic Forum Member Preferences for Carer Experience and Consumption Behavior: Can “Trip Sitters” Help Inform Psychedelic Harm Reduction Services?

Engel

Thal

Bright

2022

Contemporary Drug Problems

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Background: There is limited research on the provision of harm reduction services to people who use psychedelics. Little is known about provision of care to people consuming psychedelics outside of clinical trials. Methods: We investigated how people who used psychedelics discussed their preferences for care (or “trip sitting”) on two online forums: The Shroomery and DMT Nexus. A thematic analysis of the discussion was conducted to better understand consumer preferences for harm reduction services and resources. Results: We identified two key themes: experience and remote sitting. Forum participants valued trip sitters who had experienced psychedelic and other non-ordinary states of consciousness, who had knowledge of the health and medical industry, psychedelic literature and/or had previously cared for other psychedelic consumers. Forum participants also identified the value of consuming a psychedelic without somebody who was in their physical proximity, through communicating their plans to a remote trip sitter. The use of online tools was identified as a way to maximize the benefit of privacy while retaining carer benefits. Conclusion: Demand for trip sitters with lived psychedelic experience is likely influenced by stigma and empathy. Trip sitters who could relate to the effects of psychedelics assisted consumers in avoiding stigma while vulnerable under the effects of psychedelics. As such, psychedelic harm reduction services should be delivered by peers to ensure care maximizes the benefits of empathy. Psychedelic harm reduction services should consider how remote workers could be employed. There is a clear demand for remote psychedelic care services and to our knowledge this has not yet been explored.

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Patient perspectives and experiences with psilocybin treatment for treatment-resistant depression: a qualitative study

Breeksema,

Niemeijer,

Krediet

et al. 2024

Sci Rep

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Psilocybin is the most researched classic psychedelic for Treatment-Resistant Depression (TRD). While optimizing set and setting are considered essential for efficacy and safety, patient perspectives on these aspects have rarely been investigated. To address this knowledge gap, the current paper explored the experiences of 11 TRD patients (8 women, 3 men) participating in a double-blind randomized clinical trial with a single session of oral (1, 10 or 25 mg) psilocybin treatment. After qualitative analysis, three major themes were identified: (1) challenges with trust-building and expectation management; (2) navigating the experience; and (3) the need for a more comprehensive treatment. Subthemes of the first theme include a general distrust in mental healthcare, trust in study therapists, limited time for preparation, and managing expectations. The second theme included the following subthemes: trusting to surrender, profound and overwhelming experiences, and music as a guide. The third theme addressed a desire for multiple psilocybin sessions, and challenges with sensemaking. Patients’ perspectives provided important insights into potential optimization of psilocybin treatment of TRD, including individualized preparation, investment in trust-building, offering additional psilocybin sessions, providing access to sustained (psycho)therapy with trusted therapists, and personalizing treatment approaches, which may also enhance real-world adaption of these treatments.

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Presence, Trust, and Empathy: Preferred Characteristics of Psychedelic Carers

Cited by 15 publications

References 56 publications

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

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

Psychedelic Forum Member Preferences for Carer Experience and Consumption Behavior: Can “Trip Sitters” Help Inform Psychedelic Harm Reduction Services?

Patient perspectives and experiences with psilocybin treatment for treatment-resistant depression: a qualitative study

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