Current perspectives on psychedelic therapy: use of serotonergic hallucinogens in clinical interventions

Abstract

Humans have used serotonergic hallucinogens (i.e. psychedelics) for spiritual, ceremonial, and recreational purposes for thousands of years, but their administration as part of a structured therapeutic intervention is still a relatively novel practice within Western medical and psychological frameworks. In the mid-20^th century, considerable advances were made in developing therapeutic approaches integrating administration of low (psycholytic) and high (psychedelic) doses of serotonergic hallucinogens for treatment of a variety of conditions, often incorporating psychoanalytic concepts prevalent at that time. This work contributed seminal insights regarding how these substances may be employed with efficacy and safety in targeted therapeutic interventions, including the importance of optimizing set (frame of mind) and setting (therapeutic environment). More recently, clinical and pharmacological research has revisited the effects and therapeutic potential of psychedelics utilizing a variety of approaches. The current article provides an overview of past and present models of psychedelic therapy, and discusses important considerations for future interventions incorporating the use of psychedelics in research and clinical practice.

Keywords:

• Psychedelic therapy
• hallucinogens
• psilocybin
• LSD

Notes

Acknowledgements

The authors would like to thank Mary Cosimano, MSW, Matthew W. Johnson, PhD, and Katherine MacLean, PhD, for their meticulous work in helping train the first author (AGR) in good clinical practice administering psychedelics. The authors would also like to thank August Holtyn, PhD, and Nora Belblidia, MPS, for their helpful comments and support on the manuscript.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Notes

1 For useful discussions of MDMA-assisted therapy see Danforth, Struble, Yazar-Klosinski, and Grob (2016); Greer and Tolbert (1998); Johansen and Krebs (2009); and Sessa (2017). Regarding ketamine-assisted treatment, see Krupitsky et al. (1992, 2007, 291) and Krupitsky and Grinenko (1997).

2 Route of administration is another consideration for working with psychedelics. This generally occurs orally for most, which is convenient for clinical administration, but can also employ alternative routes such as intramuscular or intravenous (e.g. Carhart-Harris et al., 2012; Denber & Merlis, 1955; Strassman & Qualls, 1994), which can affect time of onset and intensity of drug effects.

3 While an in-depth discussion of appropriate preparation, set, setting, and integration for psychedelic therapy is outside the scope of the current manuscript, see Johnson et al. (2008), Carhart-Harris et al. (2018), Erritzoe and Richards (2017), and Hartogsohn (2017) for more detailed considerations.

4 It is important to note that the term ‘challenging experience’ entails acute drug effects of a distressing nature, which largely resolve within a few hours to days. Instances in which individuals develop prolonged reactions involving ongoing psychiatric sequelae are far more severe and unusual than a typical challenging experience, but have been reported in the literature (Strassman, 1984), hence the need for extensive screening and preparation to minimize such risks.

Additional information

Funding

This work was supported by the Heffter Research Institute and Council on Spiritual Practices.