Psilocybin‐assisted psychotherapy for treatment‐resistant depression: Which psychotherapy?

This perspective paper examines which one-to-one psychotherapies best align with the psilocybin experience for treating treatment-resistant depression. Evidence from a Cochrane review and a qualitative meta-synthesis indicates that the chosen psychotherapy must prioritize subjective experience, facilitate emotional processing, support connectedness with others, foster self-acceptance, and encourage change based on personal insights. Interpersonal psychotherapy and intensive short-term dynamic psychotherapy are found to be congruent with the psilocybin experience, though other therapies are currently being trialled.

Study at a glance

Abstract

Abstract This perspective paper explores the choice of psychotherapy for psilocybin‐assisted psychotherapy for treatment‐resistant depression. There is evidence to support the use of some psychotherapies in treating ‘treatment‐resistant’ depression, and emerging evidence for the efficacy of psilocybin. The next step which is the focus of this paper is to identify psychotherapies that are both effective and congruent with the psilocybin experience. The evidence for the efficacy of the psychotherapies is drawn from a Cochrane review and the analysis of their congruence with the psilocybin experience is drawn from a qualitative meta‐synthesis of the experience of psilocybin. The paper will examine whether three one‐to‐one psychotherapies identified as effective in the treatment of treatment‐resistant depression are compatible with the psilocybin experience. Each psychotherapy will be examined in relation to its congruence with the qualitative evidence that suggests the choice of psychotherapy needs to give priority to the subjective experience, facilitate emotional processing, support connectedness with others, acceptance of the self as emotional and support change based on the person's insights into their relationships with others and the world in which they live. We conclude that interpersonal psychotherapy and intensive short‐term dynamic psychotherapy align with that experience, although others are currently being trialled.