Journal of Contextual Behavioral Science
December 14, 2019
Rosalind Watts, Jason B. Luoma
261 citations
Psilocybin, a hallucinogen, significantly reduces anxiety in patients undergoing psychological therapy. In a sample of 60 individuals with anxiety disorders, 70% reported decreased symptoms after treatment combined with psilocybin and acceptance and commitment therapy. This approach enhances experiential learning, allowing patients to confront and manage their fears more effectively. The intervention showed an effect size of 0.8, indicating strong benefits. By influencing neurotransmitter receptors, psilocybin may promote greater psychological flexibility, a key factor in successful counseling outcomes in clinical psychology and psychiatry.
Journal of Psychoactive Drugs
June 12, 2020
Jason B. Luoma, Christina Chwyl, Geoff J. Bathje et al.
206 citations
Placebo-controlled clinical trials of psychedelic-assisted therapy for mental health conditions have resumed after a two-decade pause. Nine randomized, placebo-controlled trials published since 1994 examined psilocybin, LSD, ayahuasca, and MDMA. A significant mean between-groups effect size of 1.21 (Hedges g) was found, larger than typical effects for psychopharmacological or psychotherapy interventions. Effects were generally maintained at follow-up in the three studies that maintained a placebo control. Analyses support efficacy across post-traumatic stress disorder, anxiety/depression associated with a life-threatening illness, unipolar depression, and social anxiety among autistic adults. Larger trials with more diverse samples are needed to examine moderators and mediators and long-term effects.
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.
Frontiers in Psychology
May 23, 2022
David B. Yaden, Dylan Earp, Marianna Graziosi et al.
106 citations
The acute effects of psychedelics depend on users' expectations and surroundings (set and setting). Current clinical psychedelic administration draws on indigenous practices, 1960s new age spirituality, psychodynamic approaches, and cognitive-behavioral therapies. Cognitive-behavioral therapies, including acceptance and commitment therapy (ACT), have the strongest rationale for psychedelic-assisted psychotherapy because they avoid cultural insensitivity, make minimal speculative assumptions about the mind and reality, and have the largest empirical support for safety and effectiveness outside psychedelic therapy. Concepts from CBT, DBT, and ACT can usefully inform preparation, session, and integration phases. Evidence-based psychotherapeutic paradigms provide the best starting point for safety and efficacy.
Journal of Psychopharmacology
March 1, 2022
Gabrielle Agin-Liebes, Richard J. Zeifman, Jason B. Luoma et al.
51 citations
People who participated in ayahuasca retreats in Central and South America reported reduced negative mood and increased positive mood and psychological flexibility three months later. Acute experiences of cognitive reappraisal during the ceremony were the strongest predictor of improvements in positive mood and flexibility. Increases in psychological flexibility statistically accounted for the link between acute psychological factors, including reappraisal, and later mood improvements. The findings suggest that acute reappraisal and subsequent gains in psychological flexibility are key mechanisms behind psychedelic-assisted therapy's benefits, supporting the integration of mindfulness-based and third-wave therapy approaches with such interventions.
Journal of Contextual Behavioral Science
October 1, 2019
Jason B. Luoma, Pablo Sabucedo, Johan G. Eriksson et al.
51 citations
No Summary
Journal of Psychopharmacology
June 18, 2024
Kim Hoffman, Alissa Bazinet, Kellie Pertl et al.
14 citations
Experts with extensive experience facilitating psilocybin experiences, including in ceremonial settings, indigenous practices, and clinical trials, developed a set of core measures to monitor the safety, quality, and outcomes of supervised psilocybin services. Through a three-phase e-Delphi process with 36 experts, 55 candidate measures were identified and then prioritized to a core set of 11 process measures (e.g., preparatory hours with client, documentation of touch/sexual boundaries), 11 outcome measures (e.g., adverse events, well-being), and 17 structure measures (e.g., facilitator training in trauma informed care). The findings suggest that service providers and policy makers should consider standardizing these measures for community-based psilocybin services.
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.
Neuroethics
May 13, 2026
Christina Chwyl, Alissa Bazinet, Adrianne R. Wilson-Poe et al.
Informed consent in psychedelic-assisted services is ethically complex and lacks standardization. Expert recommendations from 36 participants (71% white, 53% female, average 15.2 years of experience in clinical trial, underground, or ceremonial settings) emphasized that consent should be an ongoing process built on a strong therapeutic relationship and client empowerment. Comprehensive disclosure of risks and benefits is needed, including long-term psychological and social changes and the possibility of disappointing experiences. Detailed consent around touch and boundaries is crucial, with explicit boundary-setting before administration and attention to non-verbal cues. Provider training should cultivate deep respect for client agency and experiential learning of relational and boundary skills.
BMC Psychology
January 21, 2026
Christina Chwyl, Angelica Spata, Will Lucas et al.
Psychological context, or 'set,' is more strongly linked to the outcomes of psychedelic experiences than the specific substance used, suggesting a 'mindset-over-molecule' pattern. The findings indicate that the mental state and expectations of the user play a more influential role than the chemical properties of the drug alone.
Research Square
September 12, 2025
Christina Chwyl, Angelica Spata, Will Lucas et al.
Psilocybin and MDMA produce greater self-transcendent and mystical experiences than cannabis, even after accounting for contextual factors like personality and motivations, but the substance effects are small. Psychological factors—especially surrendering to the experience and having spiritual or prosocial motivations—are much stronger predictors, accounting for up to 58% of the variance in these experiences, compared to 10% or less for the substance alone. The findings suggest that mindset matters more than the specific molecule for producing self-transcendent and mystical experiences.
September 7, 2025
Mathew Herbert, Brian H. Blanco, Dimitri Perivoliotis et al.
preprint
MDMA-assisted psychotherapy shows promise for treating PTSD, but the FDA rejected its current form due to concerns about standardization and empirical grounding of the psychotherapy methods. Acceptance and Commitment Therapy (ACT), an evidence-based cognitive behavioral therapy, is proposed as a well-suited alternative to pair with MDMA. The subjective effects of MDMA directly support key ACT processes; ACT methods could prepare patients for MDMA administration, guide therapists during sessions, and help integrate MDMA experiences to improve functioning and quality of life. ACT offers a scalable, structured yet flexible framework for a new PTSD treatment approach.