Psilocybin-Assisted Psychotherapies

This post was co-authored by Eugene Rubin, M.D., Ph.D., and Charles Zorumski, M.D.

Recent studies have fueled excitement about the potential use of psilocybin-assisted psychotherapy for the treatment of several psychiatric disorders, including treatment-resistant depression. In controlled research settings, one or two administrations of psilocybin-assisted psychotherapy may alleviate depressive symptoms for an extended period. Three recent articles add useful perspectives to the discussion about emerging therapies using psychedelic drugs and support the importance of proceeding with caution.

Psychotherapies, like pharmacotherapies, can have serious side effects. In a recently published opinion piece in JAMA Psychiatry, Sarah McNamee, Nese Devenot, and Meaghan Buisson warn of potential risks associated with the psychotherapy component of psychedelic-assisted therapy. They note the “lack of empirical evidence for the quality and safety of the psychological support provided during dosing sessions.” Patients can be vulnerable to “therapeutic” suggestions. The psychotherapy practices involved in psychedelic-assisted therapy have not been well studied, and there are reports of boundary violations by therapists.

In another article in JAMA Psychiatry, Jacob Aday, Robin Carhart-Harris, and Joshua Woolley say that “as psychedelic drugs appear to heighten emotional sensitivity, risks for hypersensitivity to emotional and relational cues must be considered a potential risk.” In addition, they warn that “the heightened state of vulnerability and suggestibility induced by psychedelic drugs raises the risk of sexual misconduct by health care professionals.”

In a recent review published in the journal Psychiatric Services, Gregory Barber and Charles Dike discuss “ethical and practical considerations for the use of psychedelics in psychiatry.” They note that the excitement about psychedelic-assisted therapies far exceeds current data supporting their use. They are concerned that public acceptance of psychedelic treatments may lead to the use of psychedelic-assisted therapy in “uncontrolled settings with untrained facilitators who may not be equipped to manage complex and challenging clinical situations.”

Barber and Dike also mention that “research has indicated that psychedelic-assisted psychotherapy may produce enduring changes in people’s lives beyond a reduction in psychiatric symptomatology alone.” It is possible that this class of drugs has a much broader influence on a person’s personality than other psychiatric medications. Aday and colleagues point out that “cases of individuals altering their careers, marital relationships, or metaphysical beliefs after psychedelic experiences have been reported.”

Although psilocybin has demonstrated potential to help in the treatment of various psychiatric disorders, it is important to realize that its therapeutic use is still in investigational stages. Further research is necessary in order to develop methods that maximize benefits and minimize risks. Will public availability of psilocybin interfere with the ability to conduct such research? Time will tell.

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