RESUMO
RATIONALE: Psychedelic-assisted psychotherapy (PAP) has emerged as a potential treatment for a variety of mental health conditions, including substance use disorders and depression. Current models of PAP emphasize the importance of psychotherapeutic support before, during, and after ingestion of a psychedelic to maximize safety and clinical benefit. Despite this ubiquitous assumption, there has been surprisingly little empirical investigation of the "psychotherapy" in PAP, leaving critical questions about the necessary and sufficient components of PAP unanswered. OBJECTIVES: As clinical trials for psychedelic compounds continue the transition from safety- and feasibility-testing to evaluating efficacy, the role of the accompanying psychotherapy must be better understood to enhance scientific understanding of the mechanisms underlying therapeutic change, optimize clinical outcomes, and inform cost-effectiveness. RESULTS: The present paper first reviews the current status of psychotherapy in the PAP literature, starting with recent debates regarding "psychotherapy" versus "psychological support" and then overviewing published clinical trial psychotherapy models and putative models informed by theory. We then delineate lessons that PAP researchers can leverage from traditional psychotherapy research regarding standardizing treatments (e.g., publish treatment manuals, establish eligibility criteria for providers), identifying mechanisms of change (e.g., measure established mechanisms in psychotherapy), and optimizing clinical trial designs (e.g., consider dismantling studies, comparative efficacy trials, and cross-lagged panel designs). Throughout this review, the need for increased research into the psychotherapeutic components of treatment in PAP is underscored. CONCLUSIONS: PAP is a distinct, integrative, and transdisciplinary intervention. Future research designs should consider transdisciplinary research methodologies to identify best practices and inform federal guidelines for PAP administration.
RESUMO
In recent years a renewed scientific, public and commercial interest in psychedelic medicines can be observed across the globe. As research findings have been generally promising, there is hope for new treatment possibilities for a number of difficult-to-treat mental health concerns. While honouring positive developments and therapeutic promise in relation to the medical use of psychedelics, this paper aims to shine a light on some underlying psycho-cultural shadow dynamics in the unfolding psychedelic renaissance. This paper explores whether and how the multi-layered collective fascination with psychedelics may yet be another symptom pointing towards a deeper psychological and spiritual malaise in the modern Western psyche as diagnosed by C. G. Jung. The question is posed whether the West's feverish pursuit of psychedelic medicines-from individual consumption to entheogenic tourism, from capitalist commodification of medicines and treatments to the increasing number of ethical scandals and abuse through clinicians and self-proclaimed shamans-is related to a Western cultural complex. As part of the discussion, the archetypal image of the Hungry Ghost, known across Asian cultural and religious traditions, is explored to better understand the aforementioned shadow phenomena and point towards mitigating possibilities.
Ces dernières années, on peut observer à travers le monde un regain d'intérêt scientifique, public et commercial pour les médecines psychédéliques. Comme les résultats de la recherche ont été dans l'ensemble prometteurs, il y a l'espoir que de nouvelles possibilités de traitement voient le jour pour certains problèmes de santé mentale difficiles à traiter. Tout en respectant avancées positives et promesses thérapeutiques en ce qui concerne l'utilisation médicale des psychédéliques, cet article vise à éclairer certaines dynamiques psychoculturelles d'ombre, qui sont sous-jacentes dans la renaissance psychédélique en cours. Cet article explore si et comment la fascination collective et à plusieurs niveaux pour les psychédéliques pourrait être encore un symptôme indicatif d'un malaise psychologique et spirituel plus profond dans la psyché occidentale moderne, tel que diagnostiqué par C. G. Jung. La question est posée de savoir si la poursuite fébrile des médicaments psychédéliques par l'Occident - de la consommation individuelle au tourisme lié aux substances enthéogènes - de la marchandisation capitaliste des médicaments et des traitements au nombre croissant de scandales éthiques et d'abus par des praticiens et des chamans autoproclamés - serait liée à un complexe culturel occidental. Dans le cadre de la discussion, l'image archétypale du Spectre Affamé, connue à travers les traditions culturelles et religieuses asiatiques, est étudiée afin de mieux comprendre les phénomènes d'ombre mentionnés ci-dessus et de suggérer des possibilités d'atténuation.
En los últimos años se ha observado en todo el mundo un renovado interés científico, público y comercial por las medicinas psicodélicas. Como los resultados de las investigaciones han sido en general prometedores, hay esperanzas de nuevas posibilidades de tratamiento para una serie de problemas de salud mental difíciles de tratar. A la vez que se reconocen los avances positivos y las promesas terapéuticas en relación con el uso médico de los psicodélicos, este artículo pretende arrojar luz sobre algunas dinámicas psico-culturales subyacentes en el renacimiento psicodélico que se está produciendo. Este artículo explora si la fascinación colectiva por los psicodélicos puede ser otro síntoma que apunte hacia un malestar psicológico y espiritual más profundo en la psique occidental moderna, tal y como lo diagnosticó C. G. Jung. Se plantea la cuestión de si la febril búsqueda de medicinas psicodélicas en Occidente -desde el consumo individual hasta el turismo enteogénico, desde la mercantilización capitalista de medicinas y tratamientos hasta el creciente número de escándalos éticos y abusos por parte de clínicos y autoproclamados chamanes- está relacionada con un complejo cultural occidental. Como parte del debate, se explora la imagen arquetípica del Fantasma Hambriento, conocida en todas las tradiciones culturales y religiosas asiáticas, para comprender mejor los fenómenos de sombra mencionados y apuntar hacia una posible mitigación de los mismos.
