Harm Reduction Journal
April 11, 2021
Brian Pilecki, Jason B. Luoma, Geoff J. Bathje et al.
135 citations
As clinical trials show strong evidence for psychedelic-assisted therapy's benefits, many people are using psychedelics on their own rather than waiting for legal medical access. Therapists have an ethical duty to support these clients, but incorporating psychedelics into traditional psychotherapy poses risks given their prohibited status. This paper explicates these risks and describes ways therapists can mitigate them while practicing within legal and ethical boundaries. A harm reduction approach is emphasized as a useful framework for conducting therapy around clients' psychedelic use. Therapists can meet with clients before and after personal psychedelic experiences to help minimize risk and maximize benefit. Common clinical scenarios in this growing area are discussed.
Journal of Contextual Behavioral Science
October 1, 2019
Jason B. Luoma, Pablo Sabucedo, Johan G. Eriksson et al.
51 citations
No Summary
Human psychopharmacology
May 1, 2022
Jason B Luoma, Ben Shahar, M Kati Lear et al.
26 citations
Adding MDMA to psychotherapy may help treat social anxiety disorder by triggering three key processes of change. MDMA can enhance memory reconsolidation, allowing patients to reprocess painful social memories. It can also induce self-transcendent emotions like compassion, love, and awe, which counteract shame and social disconnection. Finally, MDMA may strengthen the therapeutic relationship, a robust predictor of positive outcomes. These effects likely extend beyond the drug sessions themselves.
Frontiers in Psychiatry
July 15, 2023
M. Kati Lear, Sarah M. Smith, Brian Pilecki et al.
14 citations
An open-label pilot study will test MDMA-assisted therapy for social anxiety disorder. Twenty participants with moderate-to-severe generalized social anxiety will be randomly assigned to immediate or delayed treatment. The immediate group receives three preparation sessions, two MDMA medicine sessions, and six integration sessions over about 16 weeks. The primary outcome is symptom reduction measured by the Liebowitz Social Anxiety Scale at post-treatment and 6-month follow-up. Secondary outcomes include changes in functional impairment, safety, and processes like shame, belongingness, self-concealment, and self-compassion. Results will inform the design of larger randomized controlled trials.
Journal of Psychedelic Studies
August 21, 2023
Stacey B. Armstrong, Adam W. Levin, Yitong Xin et al.
12 citations
Among 856 U.S. mental health professionals—social workers, psychiatrists, and psychologists—there were no differences in confidence that psychedelic-assisted therapy (PAT) would be effective. However, psychiatrists showed a better understanding of PAT than social workers. Psychologists rated PAT as more acceptable than social workers did, and psychologists also rated it as a more reasonable treatment approach than both social workers and psychiatrists. Social workers perceived greater disadvantages of PAT than psychologists and psychiatrists, and they were less likely than both other groups to believe PAT could permanently improve clients' lives. The findings indicate a need for education and training across professions as PAT moves toward approval.
Journal of Psychedelic Studies
April 5, 2024
Brian Pilecki, Jason B. Luoma, Kati M. Lear
9 citations
Psychological flexibility may be a core process behind the therapeutic benefits of psilocybin. In a pilot study, nine participants attended a 7-day psilocybin retreat and completed measures at baseline, 2 months, and 6 months. They showed significant improvements in cognitive defusion, valued living, and self-compassion, along with a trend toward increased overall psychological flexibility. Other measures included acute drug effects, belief in oneness, social safeness, mental health, burnout, and emotion expressivity. These results offer preliminary evidence that psilocybin experiences may improve psychological flexibility.
Research Square
August 5, 2025
Christina Chwyl, Odin S. Elvenes, Andrew S. R. Kleven et al.
2 citations
Therapists who support clients after psychedelic experiences report ten key challenges, including unearthing trauma, destabilization or psychological crisis, re-adjusting to daily life with new insights and heightened sensitivity, relational harms from boundary violations, confusion about chaotic experiences, identity and worldview crises, feeling overwhelmed by needed changes, relationship disruption, disappointment after high hopes, and using psychedelics as escape. Based on interviews with 20 licensed mental health professionals (90% white, 70% cisgender women, modal integration clients 25–30), findings suggest that effective integration begins in preparation, involves setting realistic expectations, creating safe therapeutic environments, bolstering coping and social support, using trauma processing techniques, facilitating client-led meaning-making, and supporting gradual, values-guided life changes.
June 4, 2026
Jason B Luoma, M. Kati Lear, Brian Pilecki et al.
preprint
MDMA-Assisted Therapy (MDMA-AT) produced a large reduction in social anxiety symptoms compared to a waitlist condition in adults with social anxiety disorder. In a randomized open-label trial of 20 participants, those receiving MDMA-AT showed an average decrease of 43.3 points on the Liebowitz Social Anxiety Scale after 16 weeks, while the waitlist group did not. Improvements also occurred in functioning, shame, acceptance, belongingness, self-concealment, and self-compassion. Adverse events were mild to moderate and temporary; no serious adverse events occurred. These preliminary findings suggest MDMA-AT is safe and feasible for social anxiety disorder and warrant further research.
Jason B Luoma, M. Kati Lear, Kyong Yi et al.
preprint
A man in his late 30s with generalized social anxiety disorder (SAD) received MDMA-assisted therapy that included imaginal exposure to shame-related memories and in vivo social exposures during drug sessions, plus imagery rescripting and social activation homework. His symptoms and functional impairment, measured by the Leibowitz Social Anxiety Scale and Sheehan Disability Scale, showed significant reduction. He reported increased social engagement, less anxiety in social situations, and more self-compassion. The participant found exposures during MDMA sessions particularly impactful, allowing access to intrinsic desires for social connection. The authors suggest MDMA-assisted therapy with exposure techniques may be a promising treatment for SAD, warranting further research.