Psychedelics and Psychotherapy: Cognitive-Behavioral Approaches as Default.

The acute subjective effects of psychedelics are responsive to users' expectations and surroundings (i.e., "set and setting"). Accordingly, a great deal of thought has gone into designing the psychosocial context of psychedelic administration in clinical settings. But what theoretical paradigms inform these considerations about set and setting? Here, we describe several historical, sociological influences on current psychedelic administration in mainstream European and American clinical research settings, including: indigenous practices, new age spirituality from the 1960s, psychodynamic/psychoanalytic approaches, and cognitive-behavioral approaches. We consider each of these paradigms and determine that cognitive-behavioral therapies, including newer branches such as acceptance and commitment therapy (ACT), have the strongest rationale for psychedelic-assisted psychotherapy going forward. Our primary reasons for advocating for cognitive-behavioral approaches include, (1) they avoid issues of cultural insensitivity, (2) they make minimal speculative assumptions about the nature of the mind and reality, (3) they have the largest base of empirical support for their safety and effectiveness outside of psychedelic therapy. We then propose several concepts from cognitive-behavioral therapies such as CBT, DBT, and ACT that can usefully inform the preparation, session, and integration phases of psychedelic psychotherapy. Overall, while there are many sources from which psychedelic psychotherapy could draw, we argue that current gold-standard, evidence-based psychotherapeutic paradigms provide the best starting point in terms of safety and efficacy.

The effects of the therapeutic workplace and heavy alcohol use on homelessness among homeless alcohol-dependent adults.

BACKGROUND: A clinical trial demonstrated that a therapeutic workplace could promote alcohol abstinence in homeless, alcohol-dependent adults. This secondary-data analysis examined rates of homelessness and their relation to the therapeutic workplace intervention and alcohol use during the trial. METHODS: In the trial, homeless, alcohol-dependent adults could work in a therapeutic workplace for 6 months and were randomly assigned to Unpaid Training, Paid Training, or Contingent Paid Training groups. Unpaid Training participants were not paid for working. Paid Training participants were paid for working. Contingent Paid Training participants were paid for working if they provided alcohol-negative breath samples. Rates of homelessness during the study were calculated for each participant and the three groups were compared. Mixed-effects regression models were conducted to examine the relation between alcohol use (i.e., heavy drinking, drinks per drinking day, and days of alcohol abstinence) and homelessness. RESULTS: Unpaid Training, Paid Training, and Contingent Paid Training participants did not differ in the percentage of study days spent homeless (31%, 28%, 17%; respectively; F(2,94)=1.732, p=0.183). However, participants with more heavy drinking days (b=0.350, p<0.001), more drinks per drinking day (b=0.267, p<0.001), and fewer days of alcohol abstinence (b=-0.285, p<0.001) spent more time homeless. CONCLUSIONS: Reducing heavy drinking and alcohol use may help homeless, alcohol-dependent adults transition out of homelessness.

Manipulating regulatory focus in cigarette smokers.

Regulatory focus theory (RFT; Higgins, 1997) may help to address the issue of motivation in cigarette smoking cessation. RFT suggests that individuals may be motivated to approach desired end-states (e.g., improved lung capacity) and/or avoid undesired end-states (e.g., illness). These motivations are referred to as promotion focus, in which people attempt to achieve their aspirations, and prevention focus, in which people are motivated to live up to responsibilities. According to RFT, smoking-related messages framed to match an individual's regulatory focus should be more effective than those that do not match. The current study attempted to prime promotion and prevention focus in a sample of cigarette smokers, to determine if priming impacts memory for smoking-related narratives. We expected that participants in the promotion-focus condition would outperform those in the prevention-focus condition on recall of materials reflecting approach strategies, whereas those in the prevention-focus condition would score better on recall of vignettes depicting avoidance. This hypothesis was not supported. There was, however, a significant interaction between participants' recall of vignettes depicting smoking vs. abstaining and approach vs. avoidance strategies, such that participants recalled smoking vignettes better when the described-person's goal was smoking to avoid an undesired state and recalled abstaining vignettes better when the target's goal was to approach a desired state. Further research into how regulatory focus theory may apply to adult cigarette smokers is warranted.

Assessment of Individual Differences in Regulatory Focus among Cigarette Smokers.

Smoking cessation programs might benefit from tailoring messages to individual differences in regulatory focus (see Higgins, 1997), but there is little evidence on the stability or convergent validity of regulatory focus measures. In two studies, smokers completed four measures of regulatory focus: (a) Regulatory Focus Questionnaire (RFQ); (b) actual-ideal and actual-ought self-discrepancies; (c) response duration in naming name ideal or ought self-guides; and (d) reaction time for lexical decisions about one's ideal or ought self-guides. Study 1 included a one-month retest. Retest reliability was adequate, but convergent validity was poor. Questionnaire and self-discrepancy measures were unrelated to each other or to the reaction time measures. To facilitate future studies of tailored health behavior change interventions, research is needed to determine whether weak convergent validity resulted from (a) invalidity of some or all of the regulatory focus measures or (b) validity of each for measuring a different aspect of the construct.

Depressive symptoms, depression proneness, and outcome expectancies for cigarette smoking.

The high rates of cigarette smoking among depressed persons may be partially explained by increased positive expectancies for cigarette smoking among this population. In view of theoretical and empirical work on depressed people's negative views of the future, though, it would be expected that depressed smokers would hold particularly negative expectancies about the effects of cigarette smoking. The two current studies examined the relations between depression and smoking outcome expectancies in (a) a general population of adult regular smokers and (b) adult smokers seeking to quit smoking. Depressive symptoms and depression proneness both showed significant positive correlations with positive expectancies for cigarette smoking. Several positive correlations with negative expectancies also emerged. Thus, experiencing depressive symptoms may serve to amplify both favorable and unfavorable expectancies about the effects of smoking.

Effect of cognitive behavior therapy on smokers' compensatory coping skills.

Cognitive behavior therapy for depression has been adapted for use in cigarette smoking cessation groups. CBT appears to be an effective treatment, though results are mixed as to whether it is especially helpful for smokers vulnerable to depression, and little is known about what mediates its effects. Based on the hypothesis that CBT works by way of teaching compensatory skills for coping with negative thinking and emotions, this study compared CBT with a time-matched comparison condition incorporating health education and scheduled, reduced smoking. There was a nonsignificant trend favoring CBT in achieving abstinence, but CBT did not enhance smokers' compensatory coping skills. Discussion focuses on the need to examine a wide range of possible mediating variables in future research on CBT for smoking cessation.

Cognitive coping skills and depression vulnerability among cigarette smokers.

Cigarette smokers vulnerable to depression experience considerable difficulty in quitting smoking, possibly because they use smoking to manage negative affect and possess underdeveloped alternative coping skills for doing so. Efforts to adapt cognitive behavior therapy (CBT) of depression to the treatment of depression-vulnerable smokers have achieved inconsistent results. This research tested one possible explanation for these mixed results, the possibility that depression-vulnerable smokers are not actually deficient in the skills taught in CBT. Regular smokers with a history of major depression, but not currently in a depressive episode (n = 66), scored worse than did the never-depressed smokers (n = 68) on the Ways of Responding [WOR; Behav. Assess. 14 (1992) 93] test of skills for coping with negative moods and automatic thoughts. Results were similar in analyses using self-rated depression proneness, rather than interview-based diagnosis of past major depression, as the marker of depression vulnerability. Results were (nonsignificantly) stronger for Caucasian (n = 54) than for African-American (n = 73) smokers. Implications for future research on cognitive coping, CBT, and smoking are discussed.