Psychedelic-assisted psychotherapy: Clarifying the role of the "psychotherapy"
Stefan Jerotić, Olga Čolović, Nađa Marić
Medicinska istrazivanja January 1, 2026 Peer reviewed DOI: 10.5937/medi0-62051 via OpenAlex
Summary
Psychedelic-assisted psychotherapy (PAP) is gaining attention as a treatment for major depressive disorder (MDD) and PTSD, yet the exact role of psychotherapy within PAP is unclear. The review highlights that while studies show significant clinical benefits, they vary in therapeutic approach and therapist involvement. Some findings suggest that the effectiveness may not rely on the amount of psychotherapy provided. The review calls for more research to clarify these roles and establish standardized practices.
Study at a glance
| Design | narrative review |
|---|---|
| Key finding | The review indicates that while psychotherapy is integral to PAP, its specific role and necessity remain uncertain, with some evidence suggesting treatment outcomes may not depend on the number of therapy hours. |
Abstract
Psychedelic-assisted psychotherapy (PAP) is emerging as a novel intervention for major psychiatric disorders, most notably major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). While psychotherapy is widely regarded as a core element of PAP its precise role remains poorly defined. This narrative review traces the development of PAP within contemporary Western psychiatry, outlines the therapeutic framework of preparation, dosing, and integration, and synthesizes findings from recent high-impact randomized controlled trials with psilocybin and MDMA. The primary purpose of this review is to clarify the role of psychotherapy in PAP. Despite methodological rigor, studies differ substantially in their therapeutic orientation, degree of manualization, and therapist involvement, yet all report significant clinical benefit. Some evidence points to the fact that treatment outcomes may not depend on the number of psychotherapy hours, raising questions about whether psychotherapy functions as an active ingredient, a facilitative context, or a safeguard. In light of these inconsistencies, we discuss novel phenomenological accounts of change in PAP, which propose that psychedelics exert therapeutic effects by altering "existential feelings," with psychotherapy primarily serving to stabilize and integrate these shifts. Current evidence highlights both the promise of PAP and the unresolved uncertainty regarding its psychotherapeutic components. Clarifying these issues will require trials that explicitly address psychotherapeutic variables, as well as the establishment of standardized protocols, ethical safeguards, and licensure pathways for practitioners.