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EASS Speaker Spotlight: Psychedelics in Psychotherapy

Research assessing the therapeutic utility of psychedelics first gained traction in the 1960s and has recently seen an increase in novel research attempting to harness psychedelics as an augmentation for psychotherapy. In light of this resurgence of psychedelic research, Drs David Mathai, Victoria Mora, and Albert Garci-Romeu have synthesized the history of psychedelic research, current frameworks for ketamine as a psychotherapy aid, and areas for growth. Medication assisted therapy is a long-standing practice in which the synergistic effects of a pharmacological intervention coupled with a psychosocial intervention is thought to increase treatment gains above and beyond medication or psychotherapy alone. This approach may be particularly useful in cases of treatment non-response, symptom relapse, and treatment of residual symptoms. These authors also highlight that combining treatment modalities results in gains beyond symptom reduction such as increasing psychological flexibility and improving quality of life. As it relates to psychedelic treatment, this approach has been used for treatment of depression and posttraumatic stress disorder.

Use of psychedelics as a therapeutic tool first emerged in 1962 with phencyclidine sparking interest in its use as an antidepressant. The first randomized controlled trial for ketamine was published in 2000 with ketamine as a treatment for depression but ketamine-assisted therapy (KAP) began to gain increased traction in the last several years. KAP emphasizes the role of “set and setting” to create an environment in which the dosage can be safely increased to achieve therapeutic benefit via altering consciousness. Two strategies have been applied to KAP. The first, psycholytic therapy, applies low doses of ketamine to facilitate psychotherapy while the second, psychedelic therapy, applies higher doses of ketamine to induce “profound, mystical-, and peak-type experiences,” (p. 5) in what are referred to as “experience-oriented approaches.” KAP may also function via a “plasticity-oriented” approach in which ketamine is thought to have an additive effect with psychotherapy by increasing neuroplasticity that facilitates change during cognitive and behavioral interventions. Though initial work shows promise for KAP, more work is needed to understand for what symptoms and in what contexts the addition of ketamine could result in therapeutic benefit as well as mechanisms of action from psychedelic therapy to symptom reduction. To that end, these authors have proposed a trial for treatment resistant depression that combines esketamine with Acceptance and Commitment Therapy (ACT). These authors selected ACT given that the construct of psychological flexibility within ACT is thought to be well-suited for use of esketamine with existing work demonstrating a mediating effect of psychological flexibility on pathways from psychedelic effects and subsequent depression symptoms.

Dr. Albert Garcia-Romeu, Ph.D., is an assistant professor in the department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine. He is also a guest researcher at the National Institute of Drug Abuse in the Intramural Neuroimaging Research branch. His work examines the effects of psychedelic drugs and the use of psilocybin to augment addiction treatment as well as the underlying neural and psychological mechanisms of psychedelics.

Dr. Garcia-Romeu is the featured Emerging Addiction Science Seminar Series speaker on March 23. Please see https://alcoholstudies.rutgers.edu/events/ for additional details and to register to attend.

Mathai DS, Mora V, Garcia-Romeu A. Toward Synergies of Ketamine and Psychotherapy. Front Psychol. 2022 Mar 25;13:868103. doi: 10.3389/fpsyg.2022.868103. PMID: 35401323; PMCID: PMC8992793.