Psychedelic drug-induced psychological crises: attitudes of the "crisis therapist"

Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy-A systematized review

BACKGROUND

Clinical trials are currently investigating the potential of substance-assisted psychotherapy (SAPT) as treatment for several psychiatric conditions. The potential therapeutic effects of SAPT may be influenced by contextual factors including preparation prior to and integration after the substance-assisted therapy sessions.

AIMS

This systematized review outlines recommendations for current practice in preparatory sessions in SAPT including safety measures and screening procedures, preparation of set and setting, session contents, methods, and roles, prerequisites, and appropriate conduct of therapists.

METHODS

A systematized review of the literature was conducted based on PRISMA guidelines. MEDLINE (OVID), PsycINFO (OVID), and Cochrane Library were searched and clinical trials, treatment manuals, study protocols, case studies, qualitative studies, descriptive studies, theoretical papers, reviews, book chapters, and conference proceedings published until February 1, 2022 were retrieved.

RESULTS

The final synthesis included k = 83 sources. Information about safety measures including screening of participants, set and setting, contextual-, physiological-, and psychological preparation, roles, competencies, prerequisites, and characteristics of the therapists, and the establishment of a therapeutic relationship were summarized and discussed.

CONCLUSION

It is concluded that there is a consensus in the literature about the importance of adequate preparation before the administration of psychoactive substances in SAPT. However, the extent and approaches for these sessions vary across different models and there is a need for timelier and more rigorous qualitative and quantitative investigations assessing different approaches and techniques for the optimal preparation of clients in SAPT.

Psychological variables implied in the therapeutic effect of ayahuasca: A contextual approach

Ayahuasca is a psychedelic decoction originating from Amazonia. The ayahuasca-induced introspective experience has been shown to have potential benefits in the treatment of several pathologies, to protect mental health and to improve neuropsychological functions and creativity, and boost mindfulness. The underlying psychological processes related to the use of ayahuasca in a psychotherapeutic context are not yet well described in the scientific literature, but there is some evidence to suggest that psychological variables described in psychotherapies could be useful in explaining the therapeutic effects of the brew. In this study we explore the link between ayahuasca use and Decentering, Values and Self, comparing subjects without experience of ayahuasca (n = 41) with subjects with experience (n = 81). Results confirm that ayahuasca users scored higher than non-users in Decentering and Positive self, but not in Valued living, Life fulfillment, Self in social relations, Self in close relations and General self. Scores in Decentering were higher in the more experienced subjects (more than 15 occasions) than in those with less experience (less than 15 occasions). Our results show that psychological process variables may explain the outcomes in ayahuasca psychotherapy. The introduction of these variables is warranted in future ayahuasca therapeutic studies.

Socio-Cultural and Psychological Aspects of Contemporary LSD use in Germany

The current study uses a qualitative methodology to investigate socio-cultural and psychological aspects involved in the use of LSD and comparable psychedelic substances. To date, 26 narrative interviews have been conducted with 12 female and 14 male users aged 19 to 53 years. The resulting data were subjected to content analysis in several thematic areas. Subjective reports of LSD use and experiences are considered among the complex interrelationship of drug effects, individual and environmental factors, as well as in comparison to the results reported in earlier research. Preliminary results suggest the use of LSD is largely independent of the “party drugs” scene, although its users do embrace elements of alternative lifestyles and subcultures. The majority of participants report their LSD experiences to be of great importance and to have intellectual relevance for their individuation process and personality development. Exploration of the self and the desire to experience profound changes in their perception of the world are reported as primary motives for LSD use, in addition to its hedonistic value. Individual backgrounds, knowledge and patterns of reaction are found to strongly influence the character of the drug effects that are experienced. Next to a wide range of extra-pharmacological factors, various methods for actively modifying LSD induced states were discovered to determine the general character of LSD experiences. These are discussed with regard to their implications for the development of suitable harm reduction concepts.