Psilocybin-assisted psychotherapy for existential distress: practical considerations for therapeutic application—a review

Existential distress, a distinct condition from depression or anxiety, is common among patients with life-threatening illnesses and is linked to worse quality of life, suicidal ideation, and requests for hastened death. Traditional medications and psychotherapy show limited effectiveness for this condition. Psychedelic drugs, such as psilocybin and LSD, combined with psychotherapy, have produced rapid and sustained reductions in existential and psychiatric distress, offering a promising treatment for palliative care patients. This narrative review covers the history of psychedelic medicine, including early studies and modern clinical trials, and outlines practical considerations for psilocybin-assisted therapy, such as pharmacokinetics, patient selection, dosing, protocol design, and safety measures. The review aims to help palliative care providers become familiar with the current science and potential of this treatment.

Study at a glance

Abstract

Existential distress is commonly experienced by patients diagnosed with a life-threatening illness. This condition has been shown to adversely impact quality of life and is correlated with increased suicidal ideation and requests for hastened death. While palliative care teams are experienced in treating depression and anxiety, existential distress is a distinct clinical condition for which traditional medications and psychotherapy approaches demonstrate limited efficacy or duration of effect. Psychedelic drugs, including psilocybin and lysergic acid diethylamide (LSD), in conjunction with psychotherapy have been shown to produce rapid and sustained reductions in existential and psychiatric distress and may be a promising treatment for patients facing existential distress in palliative care settings. In this narrative review article, we describe the history of psychedelic medicine including early studies and the modern wave of research over the past 20 years, which includes high quality clinical trial data. This review outlines specific considerations for therapeutic application of psilocybin including pharmacokinetics, patient selection, dosing, protocol designs, and safeguards to reduce potential adverse effects to help guide future psychedelic practitioners. With growing public interest and evolving state level policy reforms allowing access to psychedelic treatments, it is critical for palliative care providers to gain familiarity with the current state of science and the potential of psilocybin assisted psychotherapy in the treatment of existential distress.