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

Summary & key facts

Researchers collected and looked through 75 papers and documents about how therapists help people make sense of their psychedelic experiences after a drug session. They focused on the “integration” phase, which means turning insights from a psychedelic experience into real life. The review found that most clinical work uses ideas from humanistic and experiential therapy, but there is very little solid research testing which approach works best. In short, integration is treated as important, but we do not have good evidence yet about the best way to do it and more careful studies are needed.

Key facts:

• The authors reviewed 75 clinical trials, manuals, protocols, qualitative studies, reviews and opinion pieces published up to November 11, 2022.
• They defined integration as understanding and putting insights from a psychedelic experience into everyday life.
• Most of the existing studies do not provide strong empirical evidence about which therapy methods help during integration sessions.
• Many current clinical studies use therapeutic methods from the humanistic-experiential tradition, which emphasize personal meaning, emotion and self-exploration.
• No type of therapy has been shown, by rigorous research, to be clearly effective for guiding integration in substance-assisted psychotherapy.
• The authors call for systematic studies that directly compare different therapeutic frameworks and therapy-related factors during integration sessions.

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.

Topics

Psychedelics and Drug Studies Psychotherapy Techniques and Applications Religion, Spirituality, and Psychology

Categories

Clinical Psychology Psychology Social Sciences

Tags

Law MEDLINE Political science Psychology Psychotherapist PsycINFO

Substances

LSD MDMA Psilocybin

Conditions & symptoms

Addiction Anxiety Depression PTSD Substance abuse disorder