All About Psychedelic Therapy

“Psychedelic therapy is the process of taking a psychedelic substance within a therapeutic setting, which typically includes psychotherapy,” explains Kyle Buller, MS, cofounder and director of training and clinical education at Psychedelics Today.

However, it’s important to remember that psychedelics are still federally illegal in the United States.

“Most of the psychedelic therapy taking place is within clinical research studies in the underground and in places where psychedelics are legal,” Buller notes.

Various psychedelic substances are currently being studied and tested for use in therapeutic settings, including:

• psilocybin (magic mushrooms)
• MDMA
• ketamine
• lysergic acid (acid)

“In clinical studies, psilocybin and MDMA are two compounds that are being investigated for their therapeutic use. Ketamine is not classified as a ‘traditional psychedelic,’ but this compound is used the most right now as legal psychedelic therapy,” Buller adds.

If you’re interested in psychedelic therapy, you might have many questions, such as:

• How many total sessions do you need?
• What might each session entail?
• What can someone expect to experience?

“We’re still in the early stages of figuring out what the ideal therapy process looks like and how many sessions are needed,” says Buller.

What happens during psychedelic therapy?

Based on clinical research, Buller says it’s common to start with a few preparatory sessions with your therapist, which may include:

• reviewing and granting informed consent to your therapist and their practice
• engaging in psychotherapy
• participating in 2-3 dosing sessions with the psychedelic medicine

During these therapeutic sessions, Buller reports that you might:

• lay on a couch or mat on the ground
• wear eye shades to keep an internal focus on the session
• wear headphones, as music can be an important part of the therapy session
• be guided by the therapist to focus your attention inward and work through emotions or experiences that may come up

What type of feelings or sensations might come up?

A person’s experience can largely depend on the substance and dosage used. However, Buller notes that someone may experience:

• a sense of timelessness
• a sense of ego dissolution
• a feeling that you could be dying, which is sometimes known as “ego death”
• a mystical-type feeling of spiritual oneness
• the sense that all things are connected
• reliving past memories and experiences, including traumatic ones

According to Buller, you may be encouraged by your therapist to participate in traditional psychotherapy after completing psychedelic-assisted therapy. These are often referred to as “integration sessions” and can help you better understand and process your experience.

“Psychedelic therapy shows promise for shifting and changing the mental health paradigm,” says Buller.

Psychedelic studies and clinical trials are still in progress, now more than ever before. But the research that’s currently available suggests that psychedelic therapy can be used to improve mental health in many ways.

Studies indicate that certain psychedelics may help manage or treat common mental health conditions, like:

• post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (C-PTSD): MDMA, ketamine, and psilocybin may help reduce symptoms of PTSD and C-PTSD from trauma seen in veterans and survivors of domestic abuse
• anxiety: psilocybin, ketamine, and MDMA might help relieve anxiety, including stress and anxiety related to end of life
• depression: psilocybin may be effective for treating depression, especially treatment-resistant types
• substance use disorders: Ibogaine and ketamine can be used for treating substance use disorders
• suicidal ideation: ketamine may be helpful for people with suicidal ideation

Psychedelic therapy can offer other lasting positive effects, as well. A 2021 study indicates that people who have taken psychedelics report experiencing improved:

• optimism
• self-esteem
• mood
• resilience
• mindfulness
• psychological flexibility

“The Johns Hopkins research investigating psilocybin therapy suggested that participants still reported a positive change in their personality up to 14 months after their psychedelic experience,” adds Buller.

“There haven’t been many advancements in psychiatry and psychology in a long time,” says Buller. “I believe by adding psychedelics into the therapeutic toolbox, we’ll be able to advance the field of psychology in a new way and offer hope through new tools for people with mental health conditions.”

Although research and anecdotal evidence on the benefits of psychedelic therapy seem promising, it’s important to beware of the potential risks.

“Psychedelics are relatively safe on the physiological level, so most of the risk is in the psychological and emotional domain,” says Buller.

Buller notes that some clients might experience a heightened sense of anxiety or depression after sessions. He warns that certain contraindications may even pose health or safety issues, such as:

• some medications
• cardiovascular issues
• a family history of mental health disorders like psychosis or schizophrenia

For example, anticonvulsant medication Lamictal may need to be weaned for 10 days before beginning ketamine infusion therapy.

Difficult experiences, which are sometimes called “bad trips,” can happen sometimes, too.

According to Buller, negative or uncomfortable experiences can be reduced by focusing on “set and setting,” and by working with a trained professional or guide.

“Psychedelic therapy isn’t going to be for everyone, and not everyone is going to respond well,” he adds.

“I’ve worked with some integration clients in the past that have been traumatized by their psychedelic experience, which has caused significant stress and anxiety in their daily lives. Some of this can be mitigated, but this is why it’s important to do a detailed risk-benefit analysis before engaging in this type of work.”

If you’re interested in psychedelic therapy, you might be wondering how and where you can access it and if it’s even legal.

“As mentioned, most legal psychedelic-assisted psychotherapy happening right now in the United States is done within clinical research or in the underground,” says Buller.

“Oregon just legalized psilocybin therapy services in 2020, so we’ll see psilocybin therapy being offered legally in the state as soon as the regulatory board finalizes and rolls out the program,” he adds.

But it’s not totally legal throughout the United States just yet. There are still ways to get involved, though, such as participating in a clinical trial or finding clinics or centers for psychedelics that offer ketamine therapy.

Financial accessibility

Buller notes that ketamine therapies may be expensive since they’re not typically covered by insurance. He warns that psychedelic retreats in other countries can also be costly and aren’t always therapy-oriented.

“We also have to acknowledge that outside of the ‘therapy’ realm, many individuals enjoy psychedelic substances in the comfort of their own home with close friends or family,” he says.

“While this may be risky for those with severe mental health disorders, many are finding benefits on their own.”

Psychedelic therapy can be used as an alternative treatment for many mental health conditions, including:

• depression
• anxiety
• substance use disorder

While it’s not totally accessible in the United States right now, there are ways to safely and legally access the therapeutic benefits of psychedelics in many parts of the world.

“While there’s so much promise in the psychedelic landscape, it’s also important to urge caution, as well,” says Buller. “These are extremely powerful substances that should be approached with respect.”

When used appropriately and under the supervision of a trained professional, psychedelic-assisted therapy may have the potential to heal our individual and collective mental health and overall well-being.