Set and setting in psilocybin-assisted therapy: A qualitative study of patients with cancer and depression.
Yvan Beaussant, Elise Tarbi, Kabir Nigam, Skye Miner, Zachary Sager, Justin Sanders, Michael Ljuslin, Benjamin Guérin, Roxanne Sholevar, Kimberly Roddy, James A Tulsky, Manish Agrawal
General hospital psychiatry January 1, 2025 Peer reviewed DOI: 10.1016/j.genhosppsych.2025.10.010 via PubMed
Summary
Psilocybin-assisted therapy (PAT) is seen as beneficial for patients with cancer-related depression, with acceptability influenced by therapeutic context. In interviews with 28 participants, the experience was described as intense, requiring a mindset of 'surrender' to navigate its unpredictability. A safe and supportive environment was crucial, while preparation and integration were essential for maximizing benefits. Music's role varied, sometimes enhancing or distracting from the experience. The findings emphasize the importance of patient-centered approaches in optimizing PAT.
Study at a glance
| Design | qualitative study |
|---|---|
| Sample size | 28 |
| Population | patients with cancer and depression participating in a clinical trial of psilocybin-assisted therapy |
| Key finding | Therapeutic structure, preparation, and setting significantly shape the acceptability of psilocybin-assisted therapy for patients. |
Abstract
Psilocybin-assisted therapy (PAT) shows promise for cancer-related depression, yet little research has examined how therapeutic context shapes patient experiences. While set (mindset) and setting (environment) are considered central to psychedelic treatment, empirical evidence on their role in PAT acceptability remains limited. This study explores factors influencing the acceptability of PAT from the perspective of patients with cancer and depression. We conducted semi-structured interviews with participants in a clinical trial of psilocybin-assisted therapy. Using template analysis, we examined themes related to the acceptability of the experience and the surrounding therapeutic environment. Participants (n = 28) described the psilocybin experience as intense and demanding, with therapeutic benefits closely tied to their ability to "surrender"-a term used to describe accepting and remaining open to the experience's intensity and unpredictability. A safe, supportive, and ethical environment was critical in fostering trust and engagement. Preparation and integration were key to maximizing benefit. Music played a significant but variable role, sometimes enhancing and other times distracting. While the clinical setting provided safety, ceremonial elements added meaning for many. Findings highlight how therapeutic structure, preparation, and setting shape PAT acceptability, supporting the need for patient-centered approaches to optimize care and outcomes.