Psychedelic Therapy: What to Know About an Emerging Treatment Option

What Is Psychedelic Therapy?

Psychedelic therapy is a relatively new type of therapy that involves the use of a psychedelic drug like LSD, MDMA, ‘magic mushrooms,’ or other hallucinogenic drugs. In psychedelic therapy, a patient will be administered a drug in a controlled, supervised setting. Sessions without drugs occur both before psychedelics are administered to prepare the patient for the experience, and again afterward to integrate the experience.²

As the drug takes effect, the clinicians guide the person to work through difficult thoughts, feelings, and memories in sessions that normally last 6-8 hours. Music, guided imagery, relaxation techniques, and creative outlets like drawing and writing are often used. Clinicians also are there to help patients stay safe, comfortable, and to work through any difficult thoughts and feelings that emerge during the session.²

Depending on the type of psychedelic being administered, the protocol being followed, and the individual patient’s experience, psychedelics may be administered in only one session or more than once to achieve the desired result. Psychedelic therapy has shown promising results in people with depression, trauma, substance use disorders, anxiety, end-of-life concerns, and obsessive compulsive disorder.^1,4

Misconceptions About Psychedelic Therapy

Dr. Matthew Johnson from Johns Hopkins university explains a few of the common misconceptions of psychedelic therapy: “One is that it is just the drug. It involves a whole therapeutic process with preparation, intention, monitoring, and follow up discussion. Another is that the drug is an escape or reliable euphoriant. Many times people find these sessions quite challenging and exhausting, and people come out feeling like they have done their own psychological heavy lifting, taking responsibility for their own problems.”¹¹

Is Psychedelic Therapy Legal?

In almost all states in the US, psychedelic drugs are controlled substances, meaning they are illegal to possess, use, or distribute. Because of the legal status of these drugs and the fact that psychedelic therapy is not currently FDA-approved, psychedelic therapy is not widely available.³ It is likely that these restrictions will change in the coming years, allowing certain providers the ability to provide psychedelic treatment within the US.

In Washington D.C. and Oregon, laws are already beginning to change in ways that improve access to psychedelics for medical use.³ As more research emerges from credible universities, it becomes more likely that certain psychedelics will become FDA-approved treatments. It is also likely that there will be high costs and strict licensing requirements that make this treatment less accessible for people, even after it is legal and approved.

Where Can You Legally Get Psychedelic Therapy?

Dr. Johnson sums up the legal status of psychedelic therapy when he says, “it is currently illegal unless it is done in an approved research context.” Currently, the only clinics that have the ability to provide this kind of treatment are those linked to major universities with contracts to administer these drugs for research purposes. The only exception to this is ketamine, which has been approved for supervised use as an infusion and as a nasal spray (Spravato) for cases of severe depression.

Some of the universities providing this type of therapy include Johns Hopkins, Emory University, Yale University, NYU, and University of Connecticut.³ There is a more inclusive list of psychedelic therapy options provided by the Multidisciplinary Association for Psychedelics Studies website. People interested in certain types of psychedelic therapy travel outside of the country to places like the Netherlands or Peru, where the laws around these drugs are more relaxed.

What Are the Effects of Psychedelics?

Psychedelics alter a person’s mind, mood, and senses in ways that change their perception of reality. The main difference between psychedelics and other drugs is that psychedelics are known to cause altered perceptions of reality.⁵ Depending on the type of psychedelic drug, the effects can last for a few hours or for almost a full day.

Some of the commonly reported effects of psychedelics include:⁵

• Auditory and visual hallucinations (seeing and hearing things that others do not)
• Disorientation, confusion, and trouble thinking clearly and organizing information
• Feelings of connection, unity, and ‘oneness’ with others and the universe
• Heightened senses that cause more intense feelings, sights, smells, etc.
• Fear, paranoia, racing thoughts, and anxiety
• Depersonalization and derealization (losing touch with self or surroundings)
• Blissful states, euphoria, and positive changes in mood
• Spiritual awakenings, personal revelations, and enhanced creativity
• Distorted sense of time (time feels longer or shorter)
• Increased heart rate and blood pressure

Everyone is affected differently by drugs, and psychedelics can be even less predictable in their effects than other kinds of drugs. Most people who take psychedelics report having very intense experiences, and depending on the person, situation, and setting, may describe these as either very positive or very negative.⁶

Most of the effects of psychedelics wear off after the drug leaves their system, but the experience often leaves a lasting impression on people. Feeling a shift or change in consciousness is not uncommon, and spiritual awakenings and personal revelations about oneself can also occur. Researchers are especially interested in these lasting effects, and how they may be able to be used to help people overcome psychological issues and disorders.⁷

Types of Psychedelic Drugs

There are many different types of psychedelic drugs that have been experimented for their possible uses to treat mental illness and addiction, including:^1,2,4,5,7,8

• Lysergic acid diethylamide (or LSD) is a chemical derived from a specific kind of bread mold. LSD has been used to treat anxiety, end-of-life concerns (for people with terminal illnesses) and addictions.
• Psilocybin (also called shrooms or magic mushrooms) are wild mushrooms that grow naturally in certain parts of the world, including the US. Psilocybin has been used therapeutically to help people with depression, anxiety, depression, and end-of-life concerns.
• MDMA (also called Molly or ecstasy) is a lab-created ‘empathogen’ which causes positive emotional shifts and has been used to treat depression and PTSD.
• Ketamine is a prescribed medication that is often used for anesthesia, but is sometimes used in smaller doses for therapeutic effects. Specifically, ketamine has shown promise in treating treatment-resistant depression and alcohol use disorder.
• DMT is a naturally occurring brain chemical that is linked to altered states of consciousness but can also be chemically induced with certain plants like Ibogaine and Ayahuasca. These plants have been used for centuries by shamans and healers, but are sometimes used for their therapeutic benefit in treating people with certain kinds of addiction.

What About Marijuana?

Marijuana (or cannabis) is not technically considered a psychedelic drug, although it does have some hallucinogenic properties. Based on these properties and some of the emerging research on the therapeutic uses of marijuana for both medical and psychological problems, some experts want marijuana to be included as an option for psychedelic therapy.

Due to changing drug laws on marijuana, psychedelic therapy involving marijuana may be more accessible than other forms of psychedelic therapy. Early studies do suggest marijuana can have some therapeutic value for both medical and mental health conditions.¹⁰ It is likely that in the coming years, more research will emerge on cannabis-assisted therapy, which is currently being practiced in certain clinics around the US.

What Issues Can Psychedelic Therapy Treat?

Psychedelic research is still in its early stages in many ways, so there is much that is not fully known or understood about this treatment, how it works, why it works, and what it can help with. Each year, a growing body of research adds credibility to psychedelic treatment and proves that for some, this kind of treatment is highly effective, and even life-changing.

Here is a summary of the research on what issues psychedelic therapy has proven to help:^1,3,4,7,8

• Major depressive disorder, and especially treatment-resistant depression has been improved and in some cases, even put into remission with the use of psychedelics. In one study, 71% of depressed people saw significant improvements after receiving psilocybin and 54% achieved complete remission of their symptoms. Ketamine has also shown promising results in treating depression, particularly in regards to suicidal thinking.
• End-of-life concerns for people with terminal illnesses and cancers have also been treated with psychedelics like psilocybin and LSD. Many studies note that people with end-of-life anxiety and depression were able to come to terms with their illness and reported being less afraid to die after treatment.
• Posttraumatic stress disorder has also been treated with psychedelics like MDMA and is currently in stage 3 clinical trials to become an FDA approved treatment for PTSD after studies found 83% of those treated experienced improved symptoms.
• Substance use disorders and addictions have also been effectively treated with psychedelics like Ibogaine, Ayahuasca, LSD, and psilocybin, and have shown higher rates of remission than in control groups. Psychedelic treatment has also shown promising results in people who are trying to quit smoking, with 80% of people treated still not smoking at a six-month follow-up.
• Anxiety has also been treated with psychedelics like Psilocybin and LSD, and has shown promising results, especially with people who have social anxiety related to Autism Spectrum Disorder. People with anxiety-related conditions like obsessive compulsive disorder (or OCD) have also been treated successfully with psychedelics.

It’s important to note that the results of psychedelics aren’t the same for each person, and may not provide benefits for everyone. As Dr. Johnson from Johns Hopkins notes, “the effects are extremely variable.” Still, many people do report experiencing benefits when they receive this treatment in controlled treatment settings with licensed and trained clinicians.

Dr. Clancy Cavnar, PsyD, research associate of the Nucleus for Interdisciplinary Studies of Psychoactives (NEIP), explains that most people see results: “Even if it is mild, it should bring some relief, insight, or hope.” She goes on to explain that sometimes, the results don’t happen immediately and suggests people to “be patient because sometimes the greatest effect is the way you view the world and your role in it after the drug has worn off.”¹²

What Is Psychedelic Therapy NOT Appropriate For?

There are some people who may not respond well to psychedelic therapy, and others who may even experience adverse effects from it. Dr. Johnson and Dr. Cavnar both do not recommend psychedelic therapy for anyone with schizophrenia, psychosis, or a history of seeing or hearing things that aren’t there, as they can be “destabilized” by the experience.

Also, Dr. Cavnar expresses that others who should not consider psychedelic therapy include people without a support system of friends and family, people nervous or unsure about the experience or treatment providers, and people on other prescribed or recreational drugs. The risk of adverse effects increases when a person is taking other drugs, including medications prescribed for a mental health condition.

It’s also important that people interested in psychedelic therapy go into the treatment informed and with realistic expectations. Dr. Cavnar emphasizes that people should not “expect it will instantly cure you.” Anyone getting this therapy needs to understand that it involves a lot more than just taking a drug. As Dr. Johnson explains, “It involves a whole therapeutic process with preparation, intention, monitoring, and follow-up discussion.”

Is Psychedelic Therapy Right For You?

There is no one-size-fits-all treatment for people with mental health or addictive disorders. While psychedelic therapy has evidence to suggest it can help with certain disorders like PTSD, depression, or anxiety, other factors also need to be considered.

Because all treatments carry some risk for adverse effects and these risks are higher whenever a drug is being administered, psychedelic treatment should only be considered when the benefits outweigh the potential risks. Individual needs, expectations, personal preferences, and how comfortable someone is with the treatment and the person providing it all need to be carefully weighed when deciding to enter treatment.

Logistical issues like how much the treatment costs, where it is offered, and whether a person is eligible also need to be accounted for. It’s also important for people to do their own research about psychedelics, their effects, and read about some of the experiences of other people before entering treatment.

Some of the questions and considerations that anyone interested in psychedelic therapy need to consider include:

• How familiar are you with altered states of consciousness?
• Have you had past experiences with drugs that were scary, dangerous, or bad?
• Are you expecting psychedelic therapy to provide an ‘instant cure’?
• What other types of treatment have you considered or tried before?
• Are you taking any prescribed or recreational drugs that could interfere?
• Is psychedelic therapy even an option for you where you live?
• If you had a negative experience or ‘bad trip’ would you still think it was worth it?

Is Psychedelic Therapy Effective?

Like all treatments for mental illness and addiction, what works for one person may not work for another. There is research to support that psychedelic therapy can help people with depression, anxiety, PTSD, OCD, substance addictions, and end-of-life concerns. Still, there is no guarantee that you will benefit from this treatment, even if you have one of these issues.

Researchers in this field also emphasize that the benefits people experience in psychedelic treatment are often not just related to the drug, but instead to:^5,6

• The environment created by the clinic including the “setting” being comfortable, therapeutic, safe, and with people who are familiar
• The emotional state of the person before taking the drug and not having taken other mind or mood altering drugs
• The level of training, experience, and expertise of the clinicians who are guiding people through the experience
• The ability of the clinicians to help people get through difficult, scary, and painful thoughts, feelings, and hallucinations
• The person having information about the treatment, drug, effects, and what to expect in treatment
• The person coming back for an ‘integration’ session after receiving the drug to process through their feelings, experience, and find ways to apply what they learned to their life and make lasting changes

Benefits of Psychedelic Therapy

In the right setting with appropriately trained professionals, psychedelic therapy can be very effective for some people. Some people describe having deeply impactful emotional and spiritual experiences when taking psychedelics. These experiences are of specific interest to researchers, who believe that they have the potential to cause lasting changes in mood, perception and consciousness that can improve mental wellbeing.

Early research seems to support their theory, as many people who have received psychedelic therapy report the following experiences:¹

• Increased acceptance of emotions
• Improved ability to process emotions and experiences
• Feelings of oneness or connectedness to others
• Increased insight and awareness into oneself
• Mystical or spiritual experiences
• Profound changes and shifts in consciousness and worldview
• Newfound motivation or commitment to positive life changes
• Improved self-esteem, self-compassion, and more positive view of self
• Acceptance of death (for those with terminal illnesses)

Risks of Psychedelic Therapy

It’s important to note that not everyone has a profound and positive experience when they take psychedelic drugs. Benefits are more likely to happen when the drug is taken in a highly controlled, monitored, and guided treatment setting, instead of when people experiment on their own.

It is not uncommon for people who take psychedelics on their own to report having a ‘bad trip,’ which can be a very frightening, negative, and even traumatic experience.² A very small number of people also have flashbacks of these bad experiences, and develop a condition known as Hallucinogen Persisting Perception Disorder (HPPD).⁷

In a large study of people who have had a bad trip on mushrooms, 62% of people described it as one of the top ten worst psychological experiences of their lives. Interestingly, 84% of people also reported that they felt they learned and benefitted from the experience, even though they felt very scared or disturbed by it.⁶

Some of the experiences reported by people who have a bad trip include:^6,7

• Becoming panicked, paranoid, or intensely afraid
• Experiencing disturbing visual/auditory hallucinations
• Feeling very confused or disoriented
• Not feeling in control of oneself or the experience
• Extreme depersonalization (not feeling like oneself)
• Putting themselves or others in dangerous or risky situations

People receiving psychedelic therapy are more likely to report the experience as being uncomfortable, intense, or draining, but are able to avoid having a bad trip because of the support provided by their guides.

Criticisms of Psychedelic Therapy

While psychedelic therapy has received the attention of respected institutions like Johns Hopkins, Yale University, Emory, and other universities, there are still many critics and skeptics. Some of these concerns are rooted in the complicated history of psychedelics, which became commonly used in the ‘50s and ‘60s as recreational drugs. At this time, psychedelics became synonymous with counterculture movements, ‘hippies,’ and people living on the fringes of society.^5,9

Some of these stereotypes have lived on in the form of stigma against these drugs and the people who use them. The campaign for the “war on drugs” furthered this stigma, while also pushing fear-mongering and misinformation about these drugs, causing many people to see them as more dangerous than they actually are. In reality, there are few long-term effects associated with psychedelic drugs, and these drugs also have a much lower addictive potential than most other substances.⁵

During this time, the CIA was conducting secret experiments on the therapeutic use of these drugs in a top-secret program called MK Ultra.⁹ The public discovery of these inhumane experiments further altered public perception of the therapeutic uses of these drugs. This also led to a ban on psychedelic research that lasted for several decades. It is only within the last 10-15 years that researchers have been able to resume this research to explore the possible therapeutic uses of psychedelic drugs.⁸

Final Thoughts of Psychedelic Therapy

Psychedelic therapy is an emerging area of research that is showing promising results in the treatment of certain mental illnesses and addictive disorders, although how and why the treatment works is still not fully understood. It is believed that these drugs can cause altered states of consciousness that help some people change their experience and understanding of themselves, the world around them, and their inner thoughts and feelings.

Most current research supports the use of this treatment for depression, anxiety, PTSD, addictions, and end-of life concerns for the terminally ill.¹ Not everyone who receives this treatment will benefit from it. Certain people may not qualify because they have a higher risk for adverse effects, including people on psychoactive medication, using other recreational drugs, or people with a history of psychosis.

Currently, psychedelic therapy is only available at major universities that are conducting experimental research on the use of hallucinogenic drugs. In the future, it is likely that laws will change and these treatments will begin to become available in some states as FDA approved treatments.³ For now, the only way to receive this therapy legally is to sign up for a research study or to go abroad to a country where the drug laws are different.