Psychedelic-Assisted Psychotherapy Using a Process Based Therapy Framework

Psychedelic-assisted psychotherapy shows promise for depression, PTSD, and substance use disorders, but evidence for its therapeutic mechanisms and optimal frameworks is still early. This review introduces process-based therapy, which targets core transdiagnostic processes like psychological flexibility, emotion regulation, and decentering, rather than disorder-specific protocols. The authors propose integrating these principles into each phase of psychedelic-assisted psychotherapy—preparation, dosing, and integration—using an idiographic, process-driven approach. Treatment strategies are selected based on functional analyses, case conceptualization, patient preferences, and qualitative and quantitative data. This paradigm aims to optimize outcomes by moving away from specific treatment brands toward an empirically grounded, process-based framework.

Study at a glance

Abstract

Psychedelic-assisted psychotherapy (PAP) has emerged as a promising intervention for conditions such as depression, PTSD, and substance use disorders by enhancing the therapeutic potential of psychedelics with structured psychological support during preparation, dosing, and integration phases. Despite encouraging trial results, evidence for therapeutic mechanisms and optimal frameworks for PAP remain in nascent stages. We explore candidate therapies and frameworks for PAP. Concurrently, clinical science is shifting toward process-based therapy (PBT; Hofmann & Hayes, 2019), which targets core transdiagnostic processes rather than disorder-specific protocols. While previous reviews of multiple mechanisms (e.g., Yaden et al., 2022) and disorder-specific papers (e.g., Sloshower et al., 2020) have identified key processes to target in psychedelic-assisted psychotherapy, this review introduces PBT and situates candidate mechanisms—such as psychological flexibility, emotion regulation, and decentering—within its framework. We explore how PBT principles can inform each phase of PAP, providing an idiographic, process-driven approach. Treatment strategies are selected based on functional analyses, case conceptualization, patient preferences, and qualitative and quantitative data collected throughout the treatment process. By moving away from specific brands of treatment, and instead integrating a PBT approach within PAP, we propose a novel, empirically grounded paradigm for optimizing therapeutic outcomes in this emergent field.