Written by, Dr Sara Tookey
Perhaps you've heard the term “psychedelics” being discussed more openly across mainstream spaces lately? This is largely due to a phenomenon known as the ‘Psychedelic Renaissance’, which has been gaining momentum, capturing the attention of scientists, mental health professionals, policymakers and the general public. This renaissance marks a revival of research into psychedelic substances such as psilocybin, LSD, and MDMA, focusing on their potential therapeutic benefits, especially for mental health conditions. In some regions psychedelics are being approved for medical use, decriminalised or are obtaining full legalised status.
As a therapist involved in psychedelic research, I’ve witnessed the power these experiences can have when applied therapeutically. In this article, we'll delve into what's driving this renewed interest in psychedelic-assisted therapy and why it's such a crucial conversation for the future of mental healthcare.
The Comeback of Psychedelic Science
Psychedelics have been around for thousands of years. They have been held as sacred for many cultures and demonised and subsequently made illegal by others. In the 1950s psychedelic drugs were the subject of extensive psychiatric research in the US. By 1960, they had been found to be non-addictive, to have remarkable safety profiles, and with the potential to treat a range of psychological conditions. However, in 1968, the possession of psychedelics was criminalised by the US federal government. As the “War on Drugs” was forged, research into psychedelics was halted for decades and psychedelics became known as dangerous recreational drugs with no medical value.
Now we are seeing psychedelics undergo a major scientific renaissance. Researchers around the world are rigorously re-examining these compounds as potential breakthrough treatments for conditions like depression, anxiety, OCD, anorexia, PTSD, addiction and existential distress at end-of-life. This burgeoning field has been termed the “psychedelic renaissance”.
Recent early clinical trials have produced remarkable results in treating mental illnesses that conventional methods often struggle with. For example, studies have found that a few guided sessions with psilocybin can rapidly reduce anxiety and depression symptoms in people with cancer and the benefits last for months (See the research studies here Griffiths et al., 2016; Ross et al., 2016). Other research found MDMA-assisted therapy helped participants overcome PTSD, including hard-to-treat dissociative PTSD (See the research studies here Mitchell et al., 2021; Mithoefer et al., 2019). Research findings show significant improvements in depression for people where no other treatment has been successful (See the research studies here Carhart-Harris et al., 2021; Davis et al., 2021; Goodwin et al., 2022). Findings have also indicated that ketamine, which has some psychedelic effects, can lift people from severe depression within hours when other treatments have failed.
Mental illnesses are typically treated with pharmaceuticals or talking therapy, or a combination of the two. The first-line of treatment is often SSRIs, with many being prescribed by a family doctor or general practitioner, NOT a psychiatrist or a trained mental health professional. These drugs can take weeks to take effect, they often have unpleasant side effects and for many they simply don’t work. Remission rates vary from 30 to 45 percent (Carvalho et al., 2007) - meaning that for 55 to 70 percent of people, SSRIs do not alleviate their depression.
Compared to existing pharmaceuticals that require daily, lifelong use, for some people psychedelics appear to yield durable relief after limited doses. This challenges the standard psychiatric paradigm. The profound changes psychedelics catalyse feel wholly different from conventional therapies. Research is currently underway to determine the long-term efficacy of this approach to treatment. However, many participants involved in these studies have described their psychedelic sessions as among the most meaningful experiences of their lives (See and research here Griffiths et al., 2008). Who can say that about SSRI-effects?
How Psychedelic-Assisted Therapy Works
Despite the use of psychedelics over centuries and the recent resurgence of research into this area, how psychedelics work remains debated. Proposed theories include:
Default Mode Network Disruption: Psychedelics may relax a person’s beliefs, by reducing activity in the default mode network (DMN) in the brain (See the research here Carhart-Harris & Friston, 2019; Gattuso et al., 2023). The DMN consists of interconnected brain areas involved in introspective processes like self-reflection and rumination. This network is involved when the mind wanders, when we imagine the future and when we empathise with others. Overactivity in the default mode network has been associated with conditions like depression, anxiety and OCD. This theory proposes that the intense psychedelic experience seems to temporarily weaken engrained thought patterns underlying conditions like depression. This allows old perspectives to move out of focus and new outlooks and emotions arise. With guidance and dedication to the process, patients can integrate these insights after sessions and have the opportunity to sustain positive changes in their worldview and mental health ( See the research here Barber & Aaronson, 2022).
Social Cognition and Theory of Mind: A recent analysis has added an additional layer to the DMN theory. It found psychedelics activate overlapping regions involved in self-reflection, autobiographical memory and social thinking. Rather than disabling the DMN, psychedelics seem to alter how brain systems underlying our sense of self and social cognition interact (Soares et al., 2023). This suggests psychedelics may increase empathy, emotional openness and feelings of connection by changing neural networks that shape our perceptions of ourselves and others.
Reopening Critical Periods: Recent animal research found psychedelics can temporarily reopen "critical periods'' in the mouse brain when it is highly receptive to learning from the environment (Nardou et al., 2023). Critical periods are times of heightened neural plasticity when the brain readily forms new connections, like in childhood development. It's believed that psychedelics have a unique ability to facilitate new learning and personal growth, which could be at the core of their therapeutic effects.
While intriguing theories exist about how psychedelics impact the brain, there's still a lot we don't understand about how they work. More research is needed to unravel the complex interplay between acute psychedelic drug effects, changes in brain activity and the psychotherapy process. It's tricky to tease apart how much of the benefits come from the psychedelic experience versus the therapy sessions that guide them.
The widely accepted theory about the importance of “Set and Setting” highlights the crucial role that psychological mindset and environmental context play in shaping psychedelic experiences. "Set" refers to the mental state, intentions, expectations and personality of the person having the experience. "Setting" is the physical, social and cultural environment in which the psychedelic session takes place (Hartogsohn, 2017).
This theory proposes that set and setting profoundly influence the subjective effects of psychedelics as well as the outcomes. A supportive set and setting can facilitate healing, growth and positive outcomes (Carhart-Harris et al., 2018). However, challenging set or setting factors may precipitate difficult, even traumatic experiences (Johnson et al., 2008). Extensive preparation of set, optimising setting for comfort and safety, and integration practices afterwards are considered crucial for safe, beneficial psychedelic-assisted therapy. The quality of the therapist-patient relationship also interacts with set and setting. Trust and compassionate care from guides can help anchor challenging psychedelic journeys (Murphy et al., 2022; Watts et al., 2017). In summary, set, setting and a trusting therapeutic relationship are crucial contextual factors mediating psychedelic effects. Carefully considering them is key for therapeutic applications.
Developing a more comprehensive understanding of how the subjective psychedelic experience is connected with changes in the brain and the role of the psychotherapeutic processes involved will be key. For now, it’s wise to keep an open yet sceptical mindset about explanations proposed for how psychedelics lead to psychological changes. Careful research can continue uncovering deeper insights into these multifaceted substances. Nevertheless, we have more to learn about how they exert their powerful influences on the mind, brain and behaviour.
Questions and Challenges
While the research findings are promising, many questions remain unanswered about psychedelic-assisted therapies. Most study participants so far have been white, highlighting the urgent need to study psychedelics across diverse populations (see research article here Thrul & Garcia-Romeu, 2021). There is still much to learn regarding how psychedelics work, who they can help most, and the best ways to deliver treatment equitably and effectively.
In addition to testing efficacy and safety through larger trials, responsible implementation poses philosophical and practical challenges. As these treatments move towards mainstream acceptance, avoiding commercialisation and the 'hype' crucial. The psychedelic experience is hard to quantify and doesn't fit biomedical models neatly. As research protocols continue to test and refine techniques, retaining a sense of awe and open-minded inquiry will be important. Even if clinical techniques are sound, applying them thoughtfully in complex social contexts requires wisdom and flexibility. Advocates will need to be discerning to integrate psychedelics responsibly into mental healthcare and society.
It is also vital we honour the Indigenous roots of most psychedelics. These compounds initially emerged through deep traditional relationships with plant medicines. As Western science explores their healing potential, preventing extractive dynamics and embracing Indigenous wisdom practices on their own terms are imperatives. Indigenous philosophies can guide this renaissance toward an equitable future where communal healing spaces thrive alongside clinical applications. It is important to acknowledge that there are alternative contexts outside of clinical treatment that offer therapeutic psychedelic experiences. These may include spiritual or religious settings. This article merely focuses more on clinical perspectives, since this is the area I can speak from with my knowledge and experience.
On a practical level, training of psychedelic therapists and careful screening will be key to ensure safety and ethical care. Holistic approaches in tune with psychedelics’ multifaceted impacts are ideal. Despite remaining questions, this revival represents long-overdue re-evaluation of mental healthcare. With care and wisdom, psychedelics could help alleviate the suffering of many.
The Necessity of Clinical Standards of Care in Psychedelic Therapy
The growing popularity of psychedelic therapies has led to a rapid increase in retreats and clinics offering these treatments. However, many do not establish or follow rigorous clinical standards of care, which can endanger participants and the potential for these therapies. Psychedelic therapy is not without its risks (Evans et al., 2023; we address these risks in our Aug 2024 article). Implementing ethical and clinical standards is critical. This should include:
Ensuring Participant Safety: Careful screening, medical supervision and appropriate dosing guidelines to minimise risks and promote safe environments.
Promoting Ethical Practices: Clear informed consent, confidentiality and professionalism protocols to prevent potential for exploitation and to build patient trust.
Facilitating Effective Treatment: While it’s important to understand how psychedelic-assisted therapies can be applied across various settings (like in clinics, retreats, etc), clinical research trials need to continue to develop and implement clearly defined protocols and allow for controlled comparisons to learn how psychedelic-assisted therapies can be most effective and for whom.
The Importance of Preparation and Integration
Psychedelic-assisted therapy can be a major catalyst for change, but it is not the magic cure. Work is often required after the psychedelic session to make sense of one’s experience and integrate insights into their daily life. In addition to clinical standards during sessions, properly preparing participants beforehand and integrating insights afterwards is equally important. People embarking on psychedelic therapy must learn to navigate potential challenges and set supportive intentions. Post-session integration through self-reflection, non-directive integration sessions or sharing circles, and or psychedelic-informed psychotherapy (which I plan to write more about in a future post) can support lasting wellbeing improvements. Psychedelics alone are not therapy — support before, during and after facilitates the healing in psychedelic-assisted therapy. You can learn more about preparation, integration and psychedelic-informed therapy from our integration therapy page and related blog articles.
Conclusion & Summary
In summary, the psychedelic renaissance offers new optimism and questions. There is still much more to learn about how psychedelics work, who they can help most, and the best ways to deliver treatment equitably and effectively. These substances display unique potential for mental health, but realising benefits requires responsible science, attending to possible risks and implementing compassionate care. By proceeding thoughtfully and prioritising ethics and the wellbeing of individuals receiving these treatments above all, psychedelic-assisted therapies could offer a desperately-needed shift to the existing model of mental healthcare.
Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance.
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