Top 10 Articles on Psychedelics and Integration

Ensuring that patients gain the full therapeutic benefits of psychedelics when undergoing psychedelic-assisted therapy is a priority for researchers and therapists alike. Ingmar Gorman and colleagues (2021) provide a framework for minimizing potential harm and facilitating the integration of the insights gained during the experience. In ‘Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice‘ they offer insights as to how therapists can help their patients to make sense of their experience in the integration process. Dealing with phenomena such as challenging experiences, ego-dissolution, and unmet expectations, among others, is also discussed. Albert Garcia-Romeu and William Richards (2018) offer further perspectives on the importance of integration in their review article. The authors deem integration to be an essential part of the therapeutic process, serving as “a crucial means to bridge the session experience with everyday life.”

During the first age of psychedelic research in the 1950s and 1960s, little attention was given to helping patients integrate their experiences. Nevertheless, researchers like William Richards and colleagues (1972) who studied ‘LSD-Assisted psychotherapy and the human encounter with death’ saw the value in post-session interviews to help people make sense of their psychedelic experience. The integration sessions offered in the study focused on applying insights to everyday living insofar as was possible.

Now, nearly 50 years later, different therapeutic frameworks have been proposed to facilitate the integration process. Jordan Sloshower and colleagues (2020) make a case for using Acceptance and Commitment Therapy (ACT) as an overarching therapeutic framework. In ‘Psilocybin-assisted therapy of major depressive disorder using Acceptance and Commitment Therapy as a therapeutic frame’ they suggest ACT and psilocybin-therapy act in unison to possibly amplify a person’s response to psilocybin, leading to longer-lasting therapeutic outcomes. The benefits of using a contextual behavioral science (CBS) model such as ACT are reiterated by Jason Luoma and colleagues (2019).

Therapists are an essential component of psychedelic-assisted therapy as they help patients prepare for the experience, guide them through the experience, and integrate the insights gained during the experience. In their 2008 publication ‘Human hallucinogen research: guidelines for safety’ Matthew Johnson and colleagues at Johns Hopkins emphasize the importance of developing a strong patient-therapist relationship. Developing trust and rapport with the patient helps to facilitate the therapeutic process overall. Ensuring therapists are adequately equipped to monitor and guide a psychedelic experience is of the utmost importance. Janis Phelps (2017) discusses the six core competencies any psychedelic therapist should possess as well as offering guidelines for training future therapists. Additionally, whether a therapist should have firsthand experience with psychedelics remains an open question. The history of therapists using psychedelics is discussed by Elizabeth Nielson and Jeffery Guss (2018). The authors also suggest a study is needed to explore how the use of psilocybin by therapists may influence how they approach therapy and integration for patients.

As we progress through the Psychedelic Renaissance, it is likely that disorder-specific psychotherapeutic models will be developed. In ‘Development of a Psychotherapeutic Model for Psilocybin-Assisted Treatment of Alcoholism’ Michael Bogenschutz and Alissa Forcehimes (2016) discuss the therapy model ‘Motivational Enhancement and Taking Action (META)’ they are trialling in a psilocybin study for alcohol use disorder. Therapists use the META model to discuss how the psychedelic experience has affected the patient’s relationship toward alcohol and their desire to change drinking behaviour.

Integration should also be a key concern when it comes to challenging experiences. Theresa Carbonaro et al. (2016) conducted a ‘Survey study of challenging experiences after ingesting psilocybin mushrooms’ and found that the single worst difficult experience (‘bad trip’) was associated with acute and long-term negative outcomes. The survey found enduring psychotic symptoms, but conversely also that the experience helped others, with 84% of respondents indicating they benefitted from the experience. Challenging experiences can arise from improper use without guidance, but also from an inappropriate setting. María Gómez-Sousa et al. (2021) reported on the ‘Acute Psychological Adverse Reactions in First-Time Ritual Ayahuasca Users’ and found the lack of screening and poor guiding skills as two reasons contributing to the occurrence of challenging experiences.

Integrating psychedelic experiences does not only happen through talk and reason, the setting in which it happens may prove to be just as important. In ‘The potential synergistic effects between psychedelic administration and nature contact for the improvement of mental health,’ Sam Gandy and colleagues argue that there is a synergy between nature contact and psychedelics for the improvement of mental health. Although still only hypothesized, so not formally researched, they argue that integration sessions in nature, with accompanying exercises, could enhance integration processes.

Both psychedelics and mindfulness meditation are two ways through which depression may be treated. In ‘Depression, Mindfulness, and Psilocybin’ Kirstin Heuschkel and Kim Kuypers (2020) compare the mechanisms through which both methods work. Most importantly, they argue that mindfulness meditation may increase or prolong the positive effects after psilocybin-assisted therapy. A similar argument is made by Jake Payne and colleagues (2021) who make the analogy that psychedelics can provide a compass, the direction, and mindfulness the vehicle, the integration. In ‘Combining Psychedelic and Mindfulness Interventions: Synergies to Inform Clinical Practice’ they build further on earlier research that showed the benefit of combining mindfulness meditation and CBT.

Therapists who provide psychedelic (integration) should have two goals in mind for their patients. The first is to maximize the benefits of therapy. The second is to reduce the risks of harm. ‘Ethical and legal issues in psychedelic harm reduction and integration therapy’ by Brian Pilecki and colleagues (2021) tackles these issues and provides guidance for therapists on how to help clients and navigate the legal landscape.