“Psychedelic therapy” or “psychedelic-assisted psychotherapy”? A walk through the scientific jargon
A classification of today's applied psychedelic research
When I first started diving into the scientific literature around psychedelics I found it hard to differentiate between labels such as “psychedelic therapy” or “psycholytic therapy”. I spent some time researching and now I would like to present an overview of the information I have gathered. I hope you will find it useful to better understand the scientific jargon!
As of today, more and more literature is popping up around psychedelic research and the topics are vast and hard to summarize. This is why in this article, I am focussing only on the applied research methods of psychedelic interventions, which means only those where the researcher and/or clinician personally works with the substance.
First of all it is important to understand that psychedelic research is classified as psychopharmacological research, even though some researchers do not like to put psychedelics and pharmaceutics in the same category, given the complicated history of these substances and due to the very different subjective effects.
Researching psychedelics can be done through animal research, when the methods used are not ethical to conduct on humans. This approach holds a long tradition back to the middle of the last century, however has been ameliorated now with new technologies. Today’s findings include neurotransmitter identification, neurological phenomena such as sex-specific prepulse inhibition, effects of optogenetics and reward system modulation.
In-vitro research is the main tool if one wants to go even deeper and study how exactly psychedelics interact in the cells of the brain. It provides opportunities for research on psychedelic neurotoxicity and anti-inflammatory properties, but also gives opportunities to synthesize new psychedelic compounds and other psychedelic-related drugs. This gives you great insight into the structural and functional biology of organisms interacting with psychedelics. Biological data backs up the phenomenological findings of psychological research and is therefore of substantial value for our field. But what about humans specifically?
Human research on psychedelics, which is not therapy, is conducted on healthy participants and most often finds itself in the field of neuroscience. A couple of fascinating topics that fall into this category are, amongst many others, acute subjective psychedelic effects, gender differences on acute effects, as well as neuroplasticity, empathy or prosocial behaviour.
Psychedelic therapy is conducted on patients with mental disorders. Here, the main hypothesis is that psychedelics alone already have beneficial effects on the alleviation of human suffering. Therefore it is most often done in a few interventions, with medium-high doses and little to no integration sessions afterwards. The inclusion criteria for these studies right now can be quite strict due to methodological requirements. Some examples of this you can find here on depression and anxiety, alcohol addiction, nicotine addiction and therapy in combination with different music genres.
Now we have entered the therapeutic realm, where psychedelic drugs are beginning to be called entheogens, or entactogens and empathogens (for MDMA specifically), again to distance ourselves from the often negatively associated history of pharma production business.
Psychedelic therapy does not include psychotherapy!
Psychedelic-assisted psychotherapy (PAP) is the most common term to describe conventional psychotherapy with the addition of a few sessions with psychedelic substances. Historically (in the 1950-70ties), there were actually two schools doing this curative method simultaneously: psycholytic therapy was developed in Switzerland. Its practitioners formed the SÄPT (Swiss Doctor’s Association for Psycholytic Therapy) later in 1985 and to this day are regularly providing trainings to German speaking clinicians. This type of therapy includes several sessions using different psychedelic substances with a varying dose range from low to high (e. g. starting the firsts sessions with MDMA and then intensifying following sessions with LSD or a combination of both) and also often so in groups. Psycholytic therapists draw on their own personal experience and concepts from psychodynamic theory and depth psychology to treat their patients over several months or even years. At the same historical time, the US-counterpart was called PAP. The humanistic, transcendental characteristics of this therapy form usually entailed very few, but high-dose and intense psychedelic experiences, trying to induce peak experiences or even ego-dissolutions. This explains why they were only conducted individually (with two clinicians on your side), with eyeshades and headphones and were prepared and followed with individual psychotherapy.
But when it comes to psychedelic research today, both of these therapy forms have joined together under the name PAP! This gradual merging came naturally due to more knowledge around the substance effects (evidence-based research leads the way!). Now we know that very high doses do not necessarily produce more benefit in humans, but actually the positive effects tend to stagnate, whereas the negative effects tend to increase, which is why we are settling for medium doses + psychotherapy. At least, this is the best knowledge we have for now..
Substance-assisted psychotherapy (SAPT) is the umbrella term for psychotherapy where patients take substances either during or in between the therapy sessions. Some clinicians argue that psychotherapy with psychedelics should use the same name, fighting for the normalisation of this method. However conventional SAPT is in many ways very different from clinical psychedelic use: if a patient gets prescribed antidepressants from their psychiatrist, this usually means regular every day intake. When a psychedelic is prescribed, it is limited to very few sessions, which are always supervised by the therapist, understandably because of the intense acute substance effect. Sessions like this can be quite costly and some even argue that the hallucinatory effect might not be as necessary as we think, which is why there is a new line of research interested in creating psychedelics without hallucinatory effects. The future will show whether these types of psychedelics will make it, and if so, whether they will be in the “psychedelic therapy” category or best in combination with psychotherapy.
Psychedelic-assisted group psychotherapy (PAGP) is a subgroup within PAP and today there is only very little empirical data on this form. Therefore we are referring to it as a general term for all clinical psychedelic-assisted group sessions, not differentiating between a closed regular therapy group or an open group, such as a clinical retreat.
To my knowledge, these are today's direct ways to study psychedelic interventions on living organisms. Outlining secondary effects, such as political, social, environmental and philosophical changes caused by these fascinating substances are topics for another day. I hope this helped you to get a general overview of the work that is being done in our time.
