Psychedelic-assisted Psychotherapy in 3-D: Acceptance, Connectedness, and Defensiveness

As psychiatry moves toward a dimension-based classification system, psychedelic-assisted psychotherapy may improve outcomes across diagnostic categories by targeting dimensions like defensiveness, acceptance, and connectedness. This theoretical paper draws on research with psychedelics, infant observation, social psychology, and psychoanalysis to explain why this therapy is well-suited for such dimensions. It begins with existential anxiety in cancer patients, then discusses awe, omnipotence, creativity, and authenticity using models from Winnicott, Stern, and Carhart-Harris/Friston. The paper suggests psychedelic-assisted psychotherapy functions as a transitional space for working through disconnection via illusion-disillusionment, fostering gradual acceptance, and concludes by relating acceptance, connectedness, defensiveness, and the sense of self.

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Abstract

As psychiatry weighs a move from a categorical to a dimensionally-based classification system, clinical research and treatment paradigms may shift towards identifying which dimensions of mental health can improve treatment outcomes across a broad range of diagnostic categories. Psychedelic-assisted psychotherapy, which is currently in clinical trials for a wide range of conditions from PTSD to tobacco dependency, holds promise for just such a dimensional approach to treatment. Anecdotal reports and qualitative studies have hinted at its potential for decreasing defensiveness and increasing feelings of acceptance and connectedness. In this theoretical paper, I draw upon ideas and research with psychedelics, infant observation, social psychology, and psychoanalysis to explain why psychedelic-assisted psychotherapy is especially well-suited for addressing these dimensions of mental health. Because studies already support the use of psychedelic-assisted psychotherapy in one dimensionally-based application – the treatment of existential anxiety in patients with cancer – I begin with a look at psychological models of defensiveness in relation to the fear of death. I then use the models of Winnicott, Stern, Carhart-Harris/Friston and others to discuss the experiences of awe, omnipotence, and creativity within ordinary and psychedelic states, and touch on a fourth dimension of mental health, authenticity. I suggest psychedelic-assisted psychotherapy may be viewed as a transitional space ideally suited for working through experiences of disconnection through the process of illusion-disillusionment, allowing gradual acceptance. I conclude with a summary of how acceptance, connectedness, and defensiveness are related to each other and to one’s sense of self.