Research Summary – Facilitator Training for Psilocybin Treatment for Depression

Context and background

• Depression in cancer: Severe depression is common among people with life-threatening diseases such as cancer. In this group, estimates range from 13 to 27 %. Depression in cancer is associated with poorer adherence, shorter survival, reduced quality of life, and an increased risk of suicide..
• Psilocybin: psilocybin is a psychedelic compound that can alter feelings, perception, and cognition.. Recent studies show that psilocybin has potential in the treatment of depression, especially in patients with life-threatening conditions.. The effects are strongly influenced by set (the mental preparation) and setting (the physical and social environment). Therefore, careful preparation and integration sessions surrounding the psilocybin dose are scheduled in clinical studies. Although pharmacological effectiveness is extensively researched, little attention is paid to the psychotherapeutic component and the training of caregivers..
• CAPSI study: to investigate the antidepressant effect of psilocybin in cancer patients with depression, the CAPSI-project (Cancer related major depression treated with a single dose of psilocybin). This randomized, double-blind phase II study compares a single dose of psilocybin of 25 mg with an active placebo (1 mg). 100 patients will be recruited between 2024 and 2025 at four Swedish locations; the primary outcome is depression severity six weeks after dosing.. The study combines psychotherapeutic guidance with one dosing session, two preparation sessions, and three integration sessions.. In addition to clinical outcomes, EEG, MEG, fMRI, PET, and blood tests are collected to identify biomarkers for response..

Goal of the training research

Psilocybin studies make use of facilitators (therapists or nurses) who prepare patients, guide them during the dosing session, and support them during integration sessions. Little is known about which skills are required, which professional groups are suitable, and what a training course should look like.. The research published in April 2026 in BMC Medical Education describes and evaluates a 15-week training program for nine nurses who became facilitators in the CAPSI project. The goal was both to describe the content of the training and to measure the effects on their skills and experiences..

Methodology

Participants

• Population: nine registered nurses from four Swedish centers, average age 37.4 years (SD 5.1). They had an average of 13.1 years of work experience as nurses; five had a specialization in psychiatry..
• Professional background: Eight nurses held a bachelor's degree, one a master's. Several had experience in intensive care or anesthesia; only one had basic training in psychotherapeutic methods..

Training program

The program, designed by two researchers from the CAPSI team (DS Stenbæk and M. Beckman), consisted of two parts.:

1. Six biweekly webinars (3 hours per session). Themes:
   • Introduction to psilocybin, the CAPSI protocol, and depression/anxiety in cancer.
   • Therapeutic communication and verbal relational skills; session preparation.
   • Further training in communication and patient exercises (webinars 3 and 5).
   • Dosage session and the role of music, including the Copenhague Music Program and the “Guided Music Visualization & Association” exercise.
   • Integration sessions and a practical roadmap for the entire treatment process.
2. Three-day on-site workshop (7 p.m.) at the Karolinska Institutet. This intensive meeting offered practical exercises, role-playing, and a review of the webinar material.. The sessions were led by the head trainers together with a music/GIM therapist.

During the training, participants had access to an online platform with materials. Preparatory reading material was provided for each webinar..

Evaluation

• Subjective evaluation: During the workshop, the nurses wrote a free-text reflection on the webinars; after the workshop, they did so again regarding the on-site training. One week after the training, they completed an online survey consisting of 13 Likert questions (1 = 'definitely not' to 5 = 'definitely') and open-ended questions..
• Objective evaluation: Before and after the training, the participants performed two standardized telephone role-plays with an actor (simulation of the first patient contact). The recordings were coded using the relational components of the Motivational Interviewing Treatment Integrity (MITI) code 4.2 (Swedish version). Measurements involved two global scores – Partnership and Empathy – and ten behavior counters (Affirm, Seeking collaboration, Emphasizing autonomy, Persuade, Confront, Giving information, Persuade with permission, Simple reflection, Complex reflection, Question). Inter-rater reliability was checked; coders were trained and blind to pre/post status.
• Statistics: Due to a non-normal distribution, the change between pre- and post-training was analyzed using the Wilcoxon signed-rank test, applying the Benjamini–Hochberg correction for multiple testing. Effect sizes were calculated using Pearson's. r.

Results

Subjective evaluation

The 13-item survey revealed the following:

Main themes from the free text:

• Need for practical exercise: Participants wanted to learn through experience, both in the role of patient and therapist.. The on-site workshop was considered very valuable and provided a clearer overview of the study..
• Overview and structure: Some nurses felt overwhelmed during the webinars and missed the 'big picture'; they wanted an in-person meeting first and more time to process the information..
• Cross-curricular differences: One suggestion was to involve a nurse as a lecturer to bridge the gap between nursing and the psychotherapeutic approach..

Objective evaluation (MITI scores)

The MITI analysis found a significant improvement in only one of the two global scores; Partnership rose from an average of 2.11 to 2.56 (p = 0.046, r = −0.47). Empathy showed an increase (1.22 to 1.89) with a large effect size (r = −0.50) but did not reach statistical significance. For the behavior counters, predominantly medium effect sizes were observed (for example Simple reflection from 0.44 to 1.67) but no significant changes. It is striking that the nurses primarily provided information (Giving information ≈ 20 utterances per role-play) and did not participate in confrontational or persuasive interventions..

Discussion and interpretation

• Value of physical, active training: Participants appreciated the on-site workshop; online webinars were useful for knowledge transfer but fell short in skills training.. Previous research shows that face-to-face training is often rated higher, although its effectiveness does not differ significantly from online training..
• Modest improvement in relational skills: The training led to a significant increase in the Partnership-score, but MITI scores remained low. Possible explanations are the lack of intensive active components, the short training duration, and the fact that nurses are accustomed to primarily providing information rather than exploratory psychotherapeutic techniques..
• Professional background: Nurses are trained to provide medical information quickly and concretely, while psychotherapists are trained to guide a collaborative process through questions and reflective listening techniques.. The difference in communication skills may contribute to the low baseline scores and limited improvement..
• Limitations: A small sample size (n = 9) and the lack of a control group limit the statistical power; the use of role-plays may limit ecological validity; the timing of the role-plays took place before supervision, meaning that later improvements were not measured.. Only verbal relational skills were measured; other skills (e.g., music accompaniment) were not evaluated..
• Conclusion of the authors: The hybrid training has potential, but results are limited and primarily visible in role-plays. Nurses felt insufficiently prepared afterwards and requested more practical training.. Future research should align training programs based on the baseline of facilitators, add more active components and supervision, and involve larger, diverse cohorts..

CAPSI study and registration details

It Karolinska Institutet outlines the broader context: 70,000 Swedes are diagnosed with cancer annually; approximately one-third develop depression, and there are no specific antidepressant treatments.. CAPSI is recruiting 100 patients in four regions between 2024 and 2026 and is investigating EEG, MEG, fMRI, and PET in addition to clinical outcomes to develop a biomarker for psilocybin response.. The results of CAPSI must determine whether a phase III study is feasible and develop a prognostic tool for use in routine care..

Authors and institutions

• Nikita Sanati Morel (first author) – connected to the Department of Psychology and the Copenhagen University Clinic for Psychedelic Research, Copenhagen (Denmark).
• Dea Siggaard Stenbæk – psychologist and researcher, also affiliated with the Copenhagen University Clinic for Psychedelic Research. She was a co-developer of the training program.
• Johan Lundberg – psychiatrist and professor at the Karolinska Institutet, principal investigator of CAPSI.
• Maria Beckman (corresponding author) – clinical psychologist at the Karolinska Institutet and co-developer of the training program.

Peer review and publication timeline

The study underwent an extensive peer-review process. The original manuscript was submitted on 18 November 2024; after multiple revisions, the final version was accepted on 27 March 2026 and published on 9 April 2026.. Reviewer reports appreciated the detailed description of the training but pointed out the limited sample size and the need for a control group and more concrete hypotheses..

Conclusion

The study describes, for the first time, a structured training program for nurses providing psychotherapeutic support during psilocybin treatment for depression. Although participants found the training useful, they emphasized the need for more extensive and practical exercises to feel adequately prepared. Objective MITI analyses showed only limited improvements in relational skills; this may be due to the short training duration, the use of nurses (who are normally focused on informational communication), and the small sample size. The CAPSI project itself is ongoing and will yield important data on the effectiveness of psilocybin in cancer patients with depression. For future implementation, more extensive training models, differentiated by professional profile, are needed, and supervision and treatment adherence will need to be monitored during the trial.