Therapeutic frameworks in integration sessions in substance‐assisted psychotherapy: A systematised review

Serotonergic psychedelics and entactogens are being studied as adjuncts in substance-assisted psychotherapy (SAPT) for various disorders. SAPT includes three phases: preparation, administration, and integration, where insights from the psychedelic experience are applied to everyday life. A systematised review of 75 publications found that the effects of different therapeutic approaches for integration sessions on outcomes have not been rigorously investigated. Most available evidence lacks empirical data, limiting conclusions about appropriate frameworks. Current clinical studies mostly draw from the humanistic–experiential tradition. Although integration is considered crucial for safe SAPT, there is insufficient evidence to suggest any therapy type is effective for guiding integration sessions.

Study at a glance

Abstract

Abstract Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance‐assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integration sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematised review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed‐methods investigations, treatment manuals, study protocols, quasi‐experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until 11 November 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcomes have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic–experiential tradition. While integration is regarded as crucial for the safe application of SAPT, there is currently an insufficient evidence base to suggest that any type of therapy is effective for guiding integration sessions. A systematic investigation of different therapeutic frameworks for integration and additional therapy‐related factors is needed.