Psychedelic medicine at a crossroads: Advancing an integrative approach to research and practice

Abstract

Psychedelics have been already used by human societies for more than 3000 years, mostly in religious and healing context. The renewed interest in the potential application of psychedelic compounds as novel therapeutics has led to promising preliminary evidence of clinical benefit in some psychiatric disorders. Despite these promising results, the potential for large-scale clinical application of these profoundly consciousness-altering substances, in isolation from the sociocultural contexts in which they were traditionally used, raises important concerns. These concerns stem from the recognition that the mechanisms of therapeutic action of psychedelics are not entirely dependent on neurobiology, but also on the psychological, social and spiritual processes for their efficacy. For these reasons, physicians or psychotherapists involved in psychedelic-assisted psychotherapy need training in ways to accompany patients through this experience to promote positive outcomes and address potential side effects. Psychedelic therapies may foster the emergence of a novel paradigm in psychiatry that integrates psychopharmacological, psychotherapeutic, and cultural interventions for patients with mental health issues.

Culture, context, and ethics in the therapeutic use of hallucinogens: Psychedelics as active super-placebos?

“…However, the mobilization of indigenous and mestizo shamanic technical knowledge to improve the therapeutic uses of psychedelics emerging in the Global North also raises ethical questions about cultural appropriation and the fairness of the transmission of this knowledge. Gobbi et al (2022) express similar concerns and emphasize the importance of developing clinical guidelines and appropriate training for psychedelic-assisted therapies. Close attention to the utilization of cultural and contextual factors will be key in this process.…”

“…According to one now-popular story, serotonergic psychedelics drastically reduce habitual constraints on perception (increase brain entropy, in the language of computational neuroscience) by increasing the functional connectivity of disparate brain networks that do not habitually communicate with another (Gobbi et al, 2022). Such “unconstraining” of cognitive resources is thus thought to enable one to overcome maladaptive schemas and other symptoms of adverse mental health at unprecedented speed (Carhart-Harris & Friston, 2019; for a critical discussion, see Lifshitz et al, 2018).…”

“…appears to be an important mechanism of their therapeutic efficacity. In their afterword to this special issue, Gobbi et al (2022) thus call for further studies on the mediating impact of cultural meaning and practices on the therapeutic effects of psychedelics.…”

Psychedelics in developmental stuttering to modulate brain functioning: a new therapeutic perspective?

“…When combined with psychological support/therapy ( Fuentes et al, 2020 ; Gobbi et al, 2022 ; Lowe et al, 2022 ), the therapeutic effects of psychedelics for mental diseases like major and resistant depression ( Carhart-Harris et al, 2021 ; Goodwin et al, 2022 ), anxiety ( Gasser et al, 2014 , 2015 ; Holze et al, 2023 ), and alcohol use disorder ( Bogenschutz et al, 2022 ) are highly promising, even if one cannot rule out the essential role of psychotherapy in the reappraisal of negative biases after the psychedelic experience. Undoubtedly, more studies are required to understand these links.…”