Expert Opinion on Psychedelic-Assisted Psychotherapy for People with Psychopathological Psychotic Experiences and Psychotic Disorders

Experts in psychiatry, clinical psychology, and psychedelic research agree that excluding people with personal or family histories of psychosis, bipolar disorder, or similar conditions from psychedelic clinical trials may be justified only when protocols offer minimal psychological support. In interviews with 12 experts, themes derived from interpretative phenomenological analysis indicated that psychedelic-, ketamine-, and MDMA-assisted psychotherapy with high levels of support are not necessarily contraindicated for all such individuals and may benefit some. Factors like specific symptoms, illness duration, severity, therapeutic alliance, trauma's role, and available supports could help predict outcomes. More research is needed to develop a safe protocol for this population.

Study at a glance

Abstract

Currently, individuals with personal or familial histories of psychopathological experiences of psychosis, psychotic spectrum disorders, bipolar disorder, and similar conditions are excluded from most psychedelic clinical trials, studies, and treatment programs. This study sought to determine why such an exclusion exists, what the implications of the exclusion criteria are, and if there was agreement in expert opinion. In-depth interviews with 12 experts in the fields of psychiatry, clinical psychology, medicine, and the effects of psychedelics were conducted in an expert consultation format. Interviews were transcribed, and themes were produced using an interpretative phenomenological analysis (IPA) approach. We found that while the exclusion criteria may be justified for psychedelic protocols that provide minimal psychological support for participants, experts agreed that psychedelic-, ketamine-, and MDMA-assisted psychotherapy are not necessarily contraindicated for all individuals within this group. Rather, results suggest that psychedelic-assisted psychotherapy as well as therapy with MDMA and ketamine, which include high levels of support, may be of benefit to some individuals experiencing said conditions and symptoms. Potentially relevant factors for predicting treatment outcomes include specific symptom endorsement, illness duration, symptom severity, quality of therapeutic alliance, role of trauma in symptom etiology and perpetuation, and the level of other supports in the client’s life. An analysis of expert opinions revealed that psychedelic-assisted psychotherapy can potentially benefit people with psychopathological psychosis and psychotic conditions under the right conditions. However, more research needs to be carried out to determine the risks and develop a protocol specific to this population.