Psychological support in psychedelic trials is usually only psychotherapy.

There is a new scientific article that investigates whether the psychological support in psychedelic treatment studies should actually be considered psychotherapy.

In it, we discuss:

The authors state that there is considerable ambiguity in the current debate regarding the role of psychological support in psychedelic treatments. Is it primarily a therapeutically effective intervention, or rather a safety framework that helps mitigate risks? According to the authors, this has major implications for regulation, training, study design, and clinical application.

The real focus of this article is not on new patient outcomes, but on the nature of the support used in existing trials. The researchers conducted a systematic review according to the PRISMA guidelines and searched PubMed and PsycINFO for clinical studies with psilocybin, MDMA, or LSD in which some form of psychological support was described. Subsequently, they assessed the articles using a 4-point common factors framework for psychotherapy.

The results show that most psychological interventions in therapeutic psychedelic studies indeed qualify as psychotherapy according to this approach. In total, the authors screened 224 records, reviewed 52 full texts, and included 29 clinical studies with a total of 449 patients. Of all 29 included studies, 69 percent met all four criteria of the framework.

It also appears that studies explicitly describing themselves as psychotherapy usually actually are. Of the 19 studies labeled as psychotherapy, 84 percent met all four factors. Among the 10 studies not labeled as psychotherapy, 40 percent still met all four factors. With this, the authors suggest that even when researchers do not call it psychotherapy, psychotherapeutic elements are often present in practice.

It is important to note, however, that this is a systematic review of trial descriptions and not an effectiveness analysis of which form of support works best. The article therefore does not demonstrate that more psychotherapy automatically leads to better outcomes, but rather that the complexity of guidance in many psychedelic trials is likely underestimated. The authors therefore emphasize the importance of appropriate training for practitioners, attention to the duration of the treatment trajectory, and handling this complexity of intervention with ethical care.

In one sentence: this article shows that the psychological support in most psychedelic clinical trials actually has characteristics of psychotherapy, even when it is not always labeled as such.

To better investigate the effectiveness of psychedelics, it would also be nice to fully to measure what psychedelic sessions without psychotherapeutic support can achieve.