Personality disorders involve rigid, maladaptive patterns of thinking and relating to others, which are hard to treat. Schema therapy, which targets early maladaptive schemas formed from unmet emotional needs, shows moderate effectiveness mainly for borderline personality disorder. Psilocybin, a psychedelic, may relax deeply held beliefs and increase cognitive flexibility, according to predictive coding models. This theoretical article proposes combining psilocybin with schema therapy—called Psilocybin-Assisted Schema Therapy (PAST)—to help patients revise maladaptive self-beliefs and improve treatment outcomes for Cluster B and C personality disorders. The framework awaits empirical testing.
Personality disorders involve rigid, maladaptive patterns of self and interpersonal functioning that are hard to treat. Schema Therapy, which targets early maladaptive schemas and schema modes, shows moderate effectiveness mainly for borderline personality disorder. Psilocybin can induce enduring personality change by relaxing high-level beliefs, as described by the REBUS and REBAS models. Conceptual parallels between early maladaptive schemas and high-level priors suggest psilocybin may enhance Schema Therapy by increasing cognitive flexibility. Psilocybin-Assisted Schema Therapy (PAST) is proposed, combining psilocybin sessions with integration using Schema Therapy techniques to strengthen adaptive modes and reduce dysfunctional ones. PAST may improve outcomes and shorten treatment for Cluster B and C personality disorders, pending empirical validation.
Disjunctivism, the view that no single feature is common to all mental phenomena, has become more appealing as other proposals for a mark of the mental face difficulties. A revised form of disjunctivism is developed that avoids traditional problems. On this account, all mental states exemplify either intentional presentationality or phenomenal presentationality (or both). These two features are irreducible to each other but are species of the common genus of presentationality: presenting something to the subject. This presentationality uniformly marks the mental domain. The account is labeled 'sui generis disjunctivism' because it is in the spirit but not the letter of disjunctivism.