Psychedelic Therapy

Disclaimer Psychedelics show promise in treating a variety of disorders, but these powerful tools carry medical risks. Psychedelics are capable of causing long-lasting changes to personality and cognition. People can possess undiagnosed genetic, developmental, neurological, endocrinological, or traumagenic conditions that interact with the experience. This guide is not medical advice. This guide does not replace the counsel of any trained medical professional. We are not medical professionals. Our team members are volunteers. A publicly-funded United Kingdom center for learning research published a 2011 meta-analytical systematic review of 838 studies. [1] It illuminated a stark problem in investigating particular styles of learning experiences. There is a substantial detriment to the field of education due to the conceptual confusion from having no set-defined vocabulary to draw from. EffectIndex is in the unique position of having developed a vocabulary, since 2011, to comprehensively describe the nature of experience and behavior under the influence of psychotropic substances. For both researchers and clinical populations, improving communication is crucial in emerging studies on psychotherapy. These are scientifically-supported therapy principles and techniques designed to be easily understood by the general public. Even in the absence of hallucinogens, applying these skills to modify automated dysfunctional cognitive processes can be as effective as lone pharmacological treatments or the entire collection of cognitive behavioral therapy instruction. [2] [3] [4] [5]

Generalized Therapy Mechanism: Emotional Dialecticism

Therapeutic skills for controlling behavior aim to teach how to regulate emotion. Impaired emotional processing significantly impairs the ability to make decisions. [6] Effective emotion regulation requires combining the experience or expression of emotion with the ability to actively change emotion. [7] Skills in identifying, labelling, and making sense of the information an emotion provides are essential. Western cultures tend to have the view that emotions are polarizable, for example feeling only happy versus feeling only sad. [8] [9] A 2015 meta-analysis of 63 studies indicates that mixed emotions can be reliably detected, feeling happy and sad at the same time. [10] Hoemann, K. et al. suggest that brains generate a singular emotion product with a large number of dimensions, as opposed to multiple fundamental emotions in parallel. [11] Recognizing these dimensions, in terms of blending positive and negative emotions together, is strongly associated with good physical health. [12] Blending emotions also lessens typical age-related health declines. The term for holding seemingly contradictory positions at the same time is dialecticism. Many modern therapy approaches (ACT, CBT, FAP, ICT, MBCT, SARP) overtly emphasize dialecticism. They simultaneously push for acceptance of behavior and change in behavior. This guide will focus on Dialectical Behavior Therapy (DBT). DBT is a more personalized extension of Cognitive Behavioral Therapy (CBT). [13] [14] Furthermore, Dialectical Behavior Therapy demonstrates effectiveness for a wide variety of neurological disorders.

Acceptance

It's a mistake to think acceptance is so naturally part of who we are that no training/practice is required. Immediately offering advice on what needs to change can increase emotional intensity which can legitimately lead to extreme behavior and emotional dysregulation. [15] Communicating understanding of where someone is standing on an issue—validation—reduces emotional intensity and cues an adaptive response. Active, disciplined, and precise validation is required to motivate emotion regulation and create the conditions for change. DBT defines validation as empathy plus the communication that the perspective is valid in some way. Nonverbal expressions are often more powerful than explicitly verbal ones.

Validate a Behavior’s

Levels of Validation

Validation strategies teach the recognition of emotion and cue the expression of that emotion. Bringing attention to an emotion signals the body's physiological response. The trick is to articulate what emotional dimensions are valid in a response. Validating a difficult, avoided emotion increases contact with that emotional experience. This can strengthen abilities in accepting emotional experiences. Bringing disconnected emotional states together may be vital for adapting emotions into effective responses. Don't fake understanding and relating with people. Rescuing people from experiencing sadness or despair through a bait and switch may communicate nonacceptance, which raises dysregulation. Primary emotions—those first flashes of response—are like a spotlight. When there is clarity, they are naturally used to solve problems. Emotional processing takes time, but it can be helped by striking the right balance between expressing compassion, support, and providing explicit next-step direction. The overall dilemma is that invalidation is necessary to communicate what is ineffective and what does not make sense. Practitioners must be open to what is valid without reinforcing dysfunctional behavior. The same response can be valid and invalid at the same time. For example, self-harm is remarkably dysfunctional (invalid); however, given that it may produce relief from unbearable emotions, it is valid as a means to effectively regulate emotions. DBT's main idea is to help others experience emotions without maladaptive coping. It's guided by exposure therapy principles. Emotional competence will increase through widening emotional awareness, increasing tolerance for painful emotion, and preventing behaviors that function as an escape. For trauma, using validation to direct attention towards a sense of control and diminishing the sense of isolation may be more helpful than leaning into the emotional experience. Establishing trust and understanding comes before recommending solutions. Be precise about what you are validating. Invalidate the invalid nonjudgmentally, describing how a response doesn't make sense or doesn't work. Keep an eye out for self-invalidation. You don't need to walk on eggshells when you can genuinely, with empathy, describe what is valid and what is invalid.

Change

Change can be invalidating, which intensifies emotional dysregulation, so it's important to frequently reiterate why a task is important. Understanding behavior change is important for everyone because treatment providers and social networks often unintentionally reinforce dysfunctional behavior.

Exercising Metacognition - Creating Maps

DBT manuals suggest the technique of creating a behavior map. The map specifies the targeted behavior, the behaviors leading up to it, and the consequences of the target behavior. For unwanted behaviors, it recommends changing something in the web of behaviors leading up to it. This practice is called Behavioral Chain Analysis, Behavioral Activation, or Concept Mapping. It’s an observably successful therapeutic method with its mechanisms in the skills of personal awareness, otherwise known as metacognition.
In the scientific literature on education, multiple meta analyses consider metacognition as either the most or the second most effective strategy to increase knowledge transfer and retention. [1] [16] [17] [18] When comparing 556 studies to 1772 studies, the addition of metacognitive learning components clearly outperforms a simple presentation of information for understanding/use. Concept mapping reliably produces gains in critical thinking abilities [19] and improves central ideas with no loss of knowledge gained elsewhere. It's multisensory (verbal & visuospatial) and adds reflection brain processes on top of retrieval. High-ability and older students also benefit more from this practice when measured across a large range of education levels and subjects studied. The authors cautiously suggest the overall benefit may be due to greater learning engagement rather than the properties of concept maps as an information medium. Creating maps with pre-constructed materials cause the observable benefits to disappear. Generally, there are better results creating maps where meaning is signaled by node proximity, shape, and color.

Interfering Aspects and How to Deal With Them

Problem Based Learning (PBL) has strong positive effects for increasing efficacy in acquiring skills. [19] [20] More recent meta analyses report students gain somewhat less knowledge, but this is a trade-off. PBL emphasizes elaborating the principles that act as the links between concepts. [20] [21] [22] Elaboration demonstrably creates an easier recall of knowledge and greater skills in application/inference. [23] PBL does not, however, significantly affect critical thinking skills. To reduce the amount of time it takes to do a task, a 2013 meta analysis of 289 studies suggests small breaks are specifically tailored for this. [24] When measured over the range of seconds to a month-long break, a 2006 meta analysis of 184 studies found generally a 15 minute to one day break encourages the highest retention of information. [25] Dialectical Behavior Therapy helps clarify the if–then effects of behavior; behavior rehearsal is essential. Participants learn to observe/describe their own style of thinking and their underlying assumptions. They notice when their cognition is ineffective, and confront their problematic thoughts so that they may create a more functional or dialectical sense of truth. The main aim is not to blitzkrieg a problematic thought organization. The main aim is to weave a subtle cognitive change informally throughout with a strong emphasis on intuitive knowing that combines both rational and emotional responses.

Additional All-Use Techniques and Strategies

Effective Learning

The brain distributes neural activity. [26] Cognitive functioning exists as self-sustained cyclic patterns of activation, otherwise known as neural networks. [27] Regions implicated creating associations, processing environments, and memorization are all notably highly interconnected. [28]
  • The Left-Brain/Right-Brain hypothesis emerged due to a misinterpretation of brain scan images, believing ‘hot spots’ as isolated functional units. These ‘hot spots’ are set by arbitrary thresholds in statistical mapping. There is not any rigorous neuroscientific evidence in favor for stability in hemisphere-based individual differences. [1] [26]
  • Multiple intelligences are not particularly useful due to the brain’s processing complexity. Higher oversimplification creates higher inaccuracy/imprecision. [26]
  • There is no robust evidence for efficacy in designing instruction towards specific learning styles. [1]

Variety Outperforms Monotony

Learning preferences still exist, but presenting instructional material in a multisensory format is distinctly more advantageous for learners. [1] [26] [29] Meta analyses point to better learning performances when:
  • Unconventional teaching methods are explored, like a lack of lectures (2016, 8 studies for nursing students) [19]
  • Social and emotional education are presented alongside material (2011, 213 school-based interventions) [30]
  • Learning strategies vary (1986, 84 studies on vocabulary instruction) [31]
  • Tests are in mixed format or multiple choice (2017, 118 studies) [32]
  • Instruction is a blend of online and face-to-face instruction, rather than purely one or the other (2009, 176 studies) [33]

Emotional Processing

Mindfulness

A 2013 meta-analysis examining 209 studies suggests mindfulness-based therapy is more effective than psychological education, supportive therapy, relaxation procedures, and imagery/suppression techniques. [34] It is particularly effective for reducing anxiety, depression and stress. Mindfulness is another practice of metacognition. It is clinically defined as nonjudgmentally observing phenomena that enters an individual’s awareness, such as perceptions, cognitions, emotions, or sensations. [35] These are observed carefully but are not evaluated as good or bad, true or false, healthy or sick, or important or trivial. It's bringing one’s complete attention to the present experience on a moment-to-moment basis. This skill is primarily practiced through meditation, optionally with audio guidance. Substances that induce time distortion and ego death may aid this process. Different meditative practices increase gray matter in different parts of the brain. [36]
The important consequence of mindfulness practice is the realization that most sensations, thoughts, and emotions fluctuate, or are transient, passing by “like waves in the sea”.

Positive Psychology

2019 and 2017 meta analyses of meta analyses advise that positive psychology intervention effects are overestimated by the current scientific literature. [37] [38] Across more than 50 meta analyses, there are small to moderate positive effects on mental well being, and mood. [37] [39] [40] Reductions in depression, stress, and negative emotions are hit-and-miss. The effectiveness of this type of intervention increases with age. [37] [41] [42] Interventions in children show very little results. [43] Post-college aged adults show the highest effect sizes. Though regardless of age, self-compassion and the active process of forgiving are endorsed as a few of many factors to reliably improve psychological well-being. [44] [45] [46] There is no true 'one size fits all' method for positive interventions, and gratitude does not necessarily produce unique outcomes. [37] The takeaway here is that the prevailing scientific evidence advocates positive psychological interventions to increase cognitive well-being and optimism. [47] [48]

Art Therapy

Systematic reviews for art therapy find observable reductions in depression, anxiety, symptoms of trauma, distress, and improvements in mood, coping, and some aspects of quality of life. [49] [50] [51] These results need to be taken with a grain of salt due it always being in combination with psychotherapy and the limited number/low quality of randomized controlled trials. Art therapy encompasses any creative output such as drawing, sculpting, painting, music, drama, or dance. It enables distancing and integration of emotion while stimulating meaning-making processes. Substances that enhance creativity may aid this process.

Being in Nature

A 2019, 2015 and two 2014 meta analyses suggest contact with nature has a small to moderate significant effect on improving positive emotions, decreasing negative emotions, and sustaining improvements for self-reported mental health, general health, and personal growth. [52] [53] [54] [55] Substances that induce the feeling of unity and interconnectedness may aid this process.

Being Alone

Newcomers should not be alone. Hallucinogenic substances enhance the intensity of emotion. There is the chance for currently felt negative emotions to become all-encompassing, also known as 'having a bad trip'.

Expressive Writing

A 2006 meta analysis of 146 studies suggests writing has a modest but observable beneficial effect on overall functioning. [56] [57] Its benefits are more related to processing emotions (distress, depression, positive functioning) than to cognition (schemas, dysmorphia). In controlled studies, it is more effective for people to write in private and keep their writing to themselves. Expressive writing provides a means of expressing and processing emotions that avoids the barriers and/or the negative consequences that may accompany sharing. PTSD patients who shared their writing with a group had worse emotional and physical health outcomes 5 weeks later. [58] Other studies using expressive writing with PTSD patients did not show negative effects. Thus, the authors concluded that sharing with the group may have been the cause of the negative effects. Even a single writing session can provide benefits. The best outcomes tend to appear with at least three 15 minute writing sessions a week spaced a few days apart. Writing about positive experiences is just as beneficial as writing about negative ones. Switching topics does not make a difference. As a side-note, with temperance, the highest learning benefits are suggested to result from individuals studying maps and mixed groups creating maps. [16] [17] Studying maps outperformed studying outlines/lists. Creating maps outperformed reading text, attending lectures, and class discussion.

Using Groups: The Benefits of Teaching

A 2009 meta analysis of 176 studies and a 2001 meta analysis of 122 studies show that using collaborative material greatly outperforms working independently. [59] [60] The 2009 analysis indicates a five-fold increase in learning compared to working independently, which offered little to no benefit at all. The key advantage is allowing students to share and debate their ideas. Both contesting ideas⁠ (exposing flawed reasoning⁠) and learning eachother's perspectives enrich overall understanding. [61] [62] Peer teaching does not necessarily differ from faculty teaching either, according to a 2016 meta analysis. [43] Acting as a tutor increases teaching skills, academic achievement, and positive attitudes for the taught subject. [63] [64] Teachers reinforcing directly related material in short-duration structured programs—with mnemonic devices, graphic organizers, and mental imagery techniques—generate the strongest effect on learner performance. [1] [17] [64] Learners also perform better with extra feedback and low irrelevant cognitive load. [65] Enacting a group strategy creates even greater positive effects, although the effect sizes are highly related to the social environment. [60]

Tripsitting

Tripsitting is the equivalent of babysitting. The sitter’s role is not to direct the trip, but rather to act as a supportive presence. They facilitate a comfortable exploration of altered consciousness. Effective tripsitters must understand the possible subjective effects that may arise to be able to communicate understanding/validation. A 2007 meta analysis encompassing 355,325 students weighted teacher-student relationship variables. [62] As correlations, it suggests (in order) the most benefits are derived from:
  • Students initiating and managing their own activities, which gives a sense of ownership and control over the learning process [62]
  • An empathic climate emphasizing the perception of care. Gestures of support differ from physical exploitation. It's important to have strong, established physical boundaries because psychedelics may kindle romantic, codependent, or otherwise confusing feelings during the trip. [62]
  • Fostering a warm and acceptant environment focused on internal motivations. Both people and surroundings greatly influence a psychedelic experience. Teachers honoring students' voices encourages genuine trust. [61] [62]
  • Encouraging higher order thinking. The highest transferable person-centered variables are critical and creative thinking. Teachers must encourage learning, thinking, and growth-centered beliefs. It's also beneficial to be familiar with spiritual/metaphysical disciplines due to the transpersonal nature of psychedelic states, [62]
Research on the effectiveness of communication skills training is embedded in research on behavioral marital therapy, prevention training, and parenting interventions. [66] Even with some noted publication bias, a 2005 meta-analysis of 30 studies suggests behavioral marital therapy is better than the absence of treatment. [67] Communication problems are seen as excesses and deficits in specific types of behaviors. [68] The basic strategies for teaching communication skills are typical in behavioral skill training: instruction, modeling, behavioral rehearsal, and feedback. Couples are encouraged to be genuine and make direct statements of their desires. Blame, an indictment of guilt, is discouraged and acknowledging one's own contribution to the problems are encouraged. Good communication skills focus on the topic at hand and do not interrupt nor use extreme terms such as "always" and "never". They highlight positives and focus on the present when problem solving; they avoid applying stagnant labels and coercive messages. A more in-depth look at communication models can be found here and here.

Small Groups: 1-3 Individuals

Small groups outperform individuals, individualized instruction, and large groups. [1] [24] The main beneficial effects are on achievement, persistence, and attitudes. [60] [61] The social context moderating effect sizes is greater, but small groups consistently produce better products and more gains in each respective individual's knowledge. For learning outcomes, mixed groups creating maps outperformed reading text, attending lectures, and class discussions. [16] [17]

Large Groups: 3+ Individuals

Groups of three to five also outperform individual learning. [60] However, groups larger than five with no specific cooperative learning strategy fail to significantly benefit individual achievement. This finding is especially relevant for exploratory environments and the creation of tools for other tasks. Group cognitive therapy is generally as effective as individualized treatment. [69] [70] [71] Psychoeducational groups reduce relapse/rehospitalization, essentially acting as harm-reduction. [72] An inherent risk exists that group members may engage in coruminating behavior. An unfocused excessive discussion of problems without knowledgeable guiding information has potentially harmful effects on group members' functioning. [73] The sharing of negative experiences in the absence of a structured environment may promote coping and social skills that increase the frequency of negative thoughts and feelings, subsequently decreasing functional behavior.

Bibliography

Blewett, D. B., & Chwelos, N. (2002). Handbook for the therapeutic use of lysergic acid diethylamide-25: individual and group procedures. Multidisciplinary Association for Psychedelic Studies. Grof, S. (1980). LSD psychotherapy. Hunter House. Koerner, K. (2012). Doing dialectical behavior therapy: A practical guide. Guilford Press. Leary, T. F. (1964). The Psychedelic Experience: A Manual Based on the Tibetan Book of The Dead. Citadel. O'Donohue, W. T., Fisher, J. E., & Hayes, S. C. (Eds.). (2004). Cognitive behavior therapy: Applying empirically supported techniques in your practice. John Wiley & Sons.

Copyright © Graham Reed 2020. Content is available under the Creative Commons Attribution-ShareAlike License for non-commercial use (Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)). Additional terms may apply; contact GrahamxReed@gmail.com for more information and commercial inquiries.

- Graham


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Graham