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Cited by 110Psychedelics and Drug StudiesPsychotherapy Techniques and ApplicationsReligion, Spirituality, and Psychology

Psychedelics and psychotherapy: Cognitive-behavioral approaches as default

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Yaden, David B., Earp, Dylan, Graziosi, Marianna, Friedman-Wheeler, Dara, Luoma, Jason B., Johnson, Matthew W.·2022·Frontiers in Psychology
DOI 10.3389/fpsyg.2022.873279PMC PMC9169963
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Abstract

The acute subjective effects of psychedelics are responsive to users' expectations and surroundings (i.e., "set and setting"). Accordingly, a great deal of thought has gone into designing the psychosocial context of psychedelic administration in clinical settings. But what theoretical paradigms inform these considerations about set and setting? Here, we describe several historical, sociological influences on current psychedelic administration in mainstream European and American clinical research settings, including: indigenous practices, new age spirituality from the 1960s, psychodynamic/psychoanalytic approaches, and cognitive-behavioral approaches. We consider each of these paradigms and determine that cognitive-behavioral therapies, including newer branches such as acceptance and commitment therapy (ACT), have the strongest rationale for psychedelic-assisted psychotherapy going forward. Our primary reasons for advocating for cognitive-behavioral approaches include, (1) they avoid issues of cultural insensitivity, (2) they make minimal speculative assumptions about the nature of the mind and reality, (3) they have the largest base of empirical support for their safety and effectiveness outside of psychedelic therapy. We then propose several concepts from cognitive-behavioral therapies such as CBT, DBT, and ACT that can usefully inform the preparation, session, and integration phases of psychedelic psychotherapy. Overall, while there are many sources from which psychedelic psychotherapy could draw, we argue that current gold-standard, evidence-based psychotherapeutic paradigms provide the best starting point in terms of safety and efficacy.

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  • Cognitive-behavioral therapies have the strongest evidence in PAP.

    “While cognitive-behavioral therapies (CBTs) have the strongest evidence in PAP, 69”

    From The revival of psilocybin between scientific excitement, evidence of efficacy, and real-world challenges (2024) · cites this paper as [69]

    In “Cognitive-Behavioral Approaches,” the authors describe substantial evidence for these therapies’ safety and efficacy generally, and in “Addressing Objections” they argue that CBT is the strongest candidate to pair with psychedelics. They also acknowledge a paucity of research on psychotherapeutic pairings with psychedelics. The paper therefore supports a strong rationale for CBT in PAP, but not the stronger claim that it has the strongest evidence specifically within PAP. Page numbers are unavailable in our copy. (LLM, conf=0.86)

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  • Debate continues over which therapeutic modalities best complement psychedelic treatment, with various adapted and ad hoc models being evaluated in clinical research presently.

    “Debate continues over which therapeutic modalities best complement psychedelic treatment (110–112), with various adapted and ad hoc models being evaluated in clinical research presently (106).”

    From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [110]

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Research works printed but not linked: 7

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  2. Eagle M. N. (1984). “ Psychoanalysis and modern psychodynamic theories,” in Personality and Behavioral Disorders, eds Endler N. S. McVicker-Hunt J. (New York, NY: Wiley), 73– 112.
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  6. Miller M. (2019). Chemical hints of ayahuasca use in pre-Columbian shamanic rituals. Proc. Natl. Acad. Sci. U.S.A. 116 11079– 11081.
  7. Yaden D. B. Nayak S. Griffiths R. R. (in press). “ Belief change and agnostic frames in psychedelic research and clinical application,” in Psychedelics and Philosophy, ed. Letheby C. (Oxford: Oxford University Press).

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Authors
Yaden, D. B., Earp, D., Graziosi, M., Friedman-Wheeler, D., Luoma, J. B., & Johnson, M. W.
Affiliations
  • Johns Hopkins University (US)
  • University of California, Berkeley (US)
  • Hofstra University (US)
Corresponding author
Yaden, David B.
ORCID
Venue
Frontiers in Psychology
Publisher
Frontiers Media SA
Published
2022-05-23
Volume
13
Pages
873279-873279
ISSN
1664-1078 (ISSN-L)
DOI
10.3389/fpsyg.2022.873279
PMC
PMC9169963
OpenAlex
W4281397183
Cited by
110
References
101
Citations by year
2026: 18 · 2025: 23 · 2024: 42 · 2023: 25 · 2022: 1
FWCI
3.80
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • Johns Hopkins University
  • Steven and Alexandra Cohen Foundation
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Health › Religion, Spirituality, and Psychology
Keywords
psychedelics, psychedelic-assisted psychotherapy, cognitive behavioral therapy, set and setting, acceptance and commitment therapy, dialectical behavior therapy, psychodynamic approach, New Age, cultural insensitivity

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