Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy—A systematized review

Abstract

Background: Clinical trials are currently investigating the potential of substance-assisted psychotherapy (SAPT) as treatment for several psychiatric conditions. The potential therapeutic effects of SAPT may be influenced by contextual factors including preparation prior to and integration after the substance-assisted therapy sessions. Aims: This systematized review outlines recommendations for current practice in preparatory sessions in SAPT including safety measures and screening procedures, preparation of set and setting, session contents, methods, and roles, prerequisites, and appropriate conduct of therapists. Methods: A systematized review of the literature was conducted based on PRISMA guidelines. MEDLINE (OVID), PsycINFO (OVID), and Cochrane Library were searched and clinical trials, treatment manuals, study protocols, case studies, qualitative studies, descriptive studies, theoretical papers, reviews, book chapters, and conference proceedings published until February 1, 2022 were retrieved. Results: The final synthesis included k = 83 sources. Information about safety measures including screening of participants, set and setting, contextual-, physiological-, and psychological preparation, roles, competencies, prerequisites, and characteristics of the therapists, and the establishment of a therapeutic relationship were summarized and discussed. Conclusion: It is concluded that there is a consensus in the literature about the importance of adequate preparation before the administration of psychoactive substances in SAPT. However, the extent and approaches for these sessions vary across different models and there is a need for timelier and more rigorous qualitative and quantitative investigations assessing different approaches and techniques for the optimal preparation of clients in SAPT.

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

“…Herein, it may be more important to utilise a framework whereby the clientand therapistcan make sense of their past, present and future experiences, considering variables such as the client's motivation, needs and state of functioning (Levine & Ludwig, 1965). Irrespective of the therapeutic framework, important considerations such as rigorous pre-screening, contextual factors (i.e., set and setting), preparation (e.g., safety, knowledge, intentions) and integration (i.e., meaning making) seem to be common amongst all approaches and are considered to be poignant factors regarding therapeutic outcome (Bogenschutz & Forcehimes, 2017;Bogenschutz & Ross, 2018;Thal et al, 2021Thal et al, , 2022. A tendency to propagate adjusting therapeutic frameworks to the clients' needs could also be observed in more recent publications with authors suggesting moving from fixed numbers of preparation, administration and integration sessions to a more flexible approach in which the number of sessions is based on individual clients' needs (see Brennan & Belser, 2022;Oehen & Gasser, 2022;Timmermann et al, 2022;Wolfson, 2022).…”

“…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). These aspects usually require the active participation of both therapist and client, thereby expanding the conceptual understanding of SAPT from "drug efficacy" to "experience efficacy" (Schenberg, 2018).…”

Development and psychometric validation of a novel scale for measuring ‘psychedelic preparedness’

“…Despite the establishment of recent guidelines for PPI strategy in psychedelic science 62 , the lack of patient/public collaborators acknowledged in this field is still evident. In this paper, we aimed to address this issue by incorporating PPI into our scale development process, allowing us to test clinical and theoretical tenets of psychedelic preparedness 9,16 , while also identifying gaps in our understanding of the acceptability and feasibility of the scale, among end-users who would actually be using it 60,63 . This approach aligns with the principles of Community-Based Participatory Research (CBPR), which promotes equitable partnerships between researchers and communities, emphasising the value of local knowledge and expertise 64 .…”

“…Psychedelics initiate perhaps uniquely radical alterations in perception and behaviour, with their complex phenomenology ranging from feelings that one is dying 4 , to vivid reliving of past traumatic events 5 , to interacting with divine or malevolent entities 6 . Accordingly, the need to prepare for upcoming psychedelic experiences is being increasingly acknowledged by researchers and practitioners as essential [7][8][9][10][11] . As such, the typical structure of a modern psychedelic trial will involve an explicitly mentioned 'preparation phase' intended to generate appropriate expectations, and to provide participants with strategies to optimise their upcoming psychedelic experience.…”

Editorial: The psychotherapeutic framing of psychedelic drug administration

“…With the application of set and setting protocols (i.e., psychological support protocols), or more elaborated psychotherapy models of administration, the rate of adverse responses in modern psychedelic-assisted psychotherapy (PAP) controlled trials have dropped significantly (Schlag et al, 2022 ). However, it is still unclear which PAP models should be considered best practice, and thus considerable heterogeneity in the psychological protocols used in clinical trials (Thal et al, 2022 ). Some researchers have suggested added elements of evidence-based, condition-specific psychotherapies (e.g., Sloshower et al, 2020 ; Horton et al, 2021 ).…”