Psychedelic-Assisted Therapy

Psychedelic-assisted therapy (PAT) is a novel form of mental health treatment that in-volves a combination of psychotherapy and psychedelic experiences. While PAT has been around since the 1950s, there has been a recent resurgence in clinical research and increased openness by funders, regulatory bodies, and the public to explore its potential applications. Still in the research phase, PAT is currently not yet publicly available as of 2024, though it might be within the next several years.

What Are Psychedelics?

Psychedelic substances are a class of psychoactive compounds that induce alterations in perception, mood, and cognition. Common examples include the “classic” psychedelics psilocybin, LSD, and DMT, which exert different effects on the brain through a common pathway interacting with serotonin receptors. Other substances, such as MDMA, are also often called psychedelic but have distinctive features. For example, MDMA is debatably more accurately termed an empathogen for its documented effects in increasing empathy and warmth towards self and others. Psychedelics have been used for centuries in religious, spiritual, and other cultural contexts. For example, DMT is often consumed as part of a psychoactive brew, termed Ayahuasca, which has a long history of indigenous use in Central and South America. Research suggests that with adequate screening and when used in safe and supportive settings, some psychedelic substances can be used safely as part of mental health treatment.

What Is PAT?

The PAT model that exists today differs by psychedelic substance and targeted condition, but generally relies on psychotherapy or counseling before and after a psychedelic experience. There is some debate in the ﬁeld about how much therapy is necessary to provide this treatment safely and effectively; although some argue that minimal basic support is enough, the general consensus is that psychotherapy before and after a psychedelic experience is important in deriving therapeutic effects. The common framework of the PAT model includes:

Preparation sessions: Initial counseling sessions are meant to establish a supportive therapeutic relationship, provide information about the psychedelic substance being used, address safety concerns, and help instruct the client in how to best approach their psychedelic session.
Dosing sessions: During this session, the client takes the psychedelic substance in a comfortable, safe, and supportive environment. Licensed prescribers are involved in this phase by either being on-site or on-call during this session. Dosing sessions typically range from 4–10+ hours depending on the substance being used.
Integration sessions: Follow-up non-drug sessions help clients translate any insights, new experiences, or changes in perspective into long-term change. Integration is tailored to treatment goals and often involves making behavioral changes. Integration may or may not involve additional evidence-based change strategies.

While PAT clinical trials have used a variety of psychotherapies and theoretical orientations, there is a growing movement to prioritize the implementation of evidence-based approaches within PAT research. Therefore, there is a large role for CBT to inform PAT treatments and merge the best available therapy interventions with the therapeutic potential of psychedelic experiences.

Current Evidence

Research into PAT is rapidly evolving with a range of studies highlighting its potential efficacy in treating various conditions. The largest number of supportive placebo-controlled clinical trials are with MDMA-assisted therapy for PTSD, psilocybin-assisted therapy for depression, psilocybin-assisted therapy for alcohol use disorder, and psilocybin-assisted therapy for anxiety and depression related to life-threatening illness. As of the summer of 2024, there are less than 30 randomized clinical trials in total on PAT—using a variety of designs and drugs, for various problems, with a range of sample sizes and follow-up lengths. Studies can vary in regard to quality and therefore the data should be considered preliminary. In addition, there are hundreds of clinical trials currently registered on clinicaltrials.gov, so more data will be available in the next few years.

Legal Status and Current Availability

PAT is not yet legally available. Estimates of availability at the federal level range from 2025–2028. Exceptions to this include:

Ketamine treatment: Ketamine is a dissociative anesthetic with some psychedelic properties that is legally available and is currently used within a PAT model in certain clinics. There is signiﬁcant evidence to suggest that intravenous or nasal-administered ketamine (with no psychotherapy) is helpful in treating depression and some limited evidence for the use of ketamine as a psychedelic in combination with psychotherapy.
State-legal programs: States like Oregon and Colorado have adopted state initiatives to provide psilocybin services to the public.
Religious use: There are some spiritual and religious groups who use psychedelics as part of their practices, with some being recognized by the U.S. government as having a religious exemption for legal use.
International travel: Clients with resources can consider traveling to other countries like the Netherlands or Jamaica where, for example, psilocybin-containing mush-rooms are legal. However, there is less certainty about the quality of retreat centers and treatment options operating in international settings.
Clinical trials: Clients can look for applicable clinical trials on clinicaltrials.gov.

Common Myths

Psychedelics are a quick ﬁx: The enthusiasm for PAT has resulted in a perception of psychedelics as a miracle cure or “silver bullet” to treat mental health distress. While psychedelics are associated with stories of signiﬁcant and rapid transformation, they are by no means a miracle cure and require active eﬀort and commitment to produce meaningful, lasting change.
Psychedelics are addictive: While psychedelics can include experiences of positive emotions, there is no current evidence that classic psychedelics such as psilocybin or LSD are associated with physiological dependence, and research shows very little addictive potential. While classic psychedelics, like any drug, can be misused, they appear to have limited potential for addiction. Other substances sometimes called psychedelics, such as MDMA or ketamine, do have some addiction potential, though more data is needed to better characterize the magnitude of risk.
Psychedelics cause psychosis: While psychedelics may have a risk of triggering a psychotic episode in individuals with an underlying predisposition, this appears to be a relatively rare event, especially in clinical settings and with careful screening. Overall, the evidence base suggests that psychedelics can lead to psychotic episodes, but prevalence data is currently lacking.
Psychedelics are dangerous: While risk varies by type, many psychedelics, such as psilocybin or LSD, are relatively physiologically safe and have few dangerous interactions with other drugs. However, psychedelics do come with signiﬁcant behavioral and psychological risks that need to be carefully managed. In general, research shows that most psychedelics are relatively safe compared to most psychiatric or illicit drugs in use. However, each psychedelic substance is unique and some are less safe than others or can be dangerous when mixed with other substances. For example, the psychoactive brew Ayahuasca can be lethal when mixed with certain antidepressant medications. Thus, while the blanket statement that all psychedelics are dangerous is untrue, they do have attendant risks that need to be carefully considered to use them safely.

Future Directions

The ﬁeld is just beginning to understand how psychedelics might be helpful in treating mental health disorders. There is much room to grow in understanding what conditions they might be most helpful in, what psychotherapeutic interventions are the most efficient and effective, and for what populations they are indicated and contraindicated.

Resources

Related Fact Sheets

What is Cognitive Behavior Therapy?

Behavior Therapy and Cognitive Behavior Therapy are types of treatment that are based firmly on research findings. These approaches aid people in achieving specific changes or goals.

Changes or goals might involve:

A way of acting: like smoking less or being more outgoing;
A way of feeling: like helping a person to be less scared, less depressed, or less anxious;
A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts;
A way of dealing with physical or medical problems: like lessening back pain or helping a person stick to a doctor’s suggestions.

Behavior Therapists and Cognitive Behavior Therapists usually focus more on the current situation and its solution, rather than the past. They concentrate on a person’s views and beliefs about their life, not on personality traits. Behavior Therapists and Cognitive Behavior Therapists treat individuals, parents, children, couples, and families. Replacing ways of living that do not work well with ways of living that work, and giving people more control over their lives, are common goals of behavior and cognitive behavior therapy.

How to Get Help

If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet. You may, or may not, find a competent therapist in this manner. It is wise to check on the credentials of a psychotherapist. It is expected that competent therapists hold advanced academic degrees. They should be listed as members of professional organizations, such as the Association for Behavioral and Cognitive Therapies or the American Psychological Association. Of course, they should be licensed to practice in your state. You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations. You may, of course, visit our website (www.abct.org) and click on “Find a CBT Therapist”

The Association for Behavioral and Cognitive Therapies (ABCT) is an interdisciplinary organization committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition. These aims are achieved through the investigation and application of behavioral, cognitive, and other evidence-based principles to assessment, prevention, and treatment.