Top 10 Articles on Psychedelics and Integration

This post was made by Floris Wolswijk in cooperation, and co-published↗, with the MIND Foundation

Psychedelic-assisted therapy entails several stages that are considered essential in order to gain the best possible therapeutic outcomes. Most commonly the preparation, dosing session, and integration are recognized. Though surrounding that there is also patient referral & screening beforehand and after-care procedures (Gründer & Jungaberle, 2021). Here we will focus on the integration that happens after a dosing session.

Following a psychedelic therapy session, further therapy sessions are needed to make sense of the insights gained during the experience. This phase is known as the integration phase, which Tehseen Noorani (2019) defined as “the catch-all term for a range of ways of understanding the work required to bring the meaning and fruits of the psychedelic experience to bear upon one’s life in the aftermath of the acute drug effects.”

During the first wave of psychedelic research in the 1950s and 1960s, the importance of integration was not fully recognized. Some studies do mention the need for follow-up discussions after the psychedelic experience however, the necessity of this phase is ill-defined. Robin Carhartt-Harris (2018, 2019) proposed the comprehensive REBUS and the Anarchic Brain model on how psychedelics work in the brain and on cognition: through binding to serotonin receptors, psychedelics can cause us to revise our high-level priors or ‘beliefs.’ If carefully mediated, belief-relaxation can lead to improvements in mental health.

In this sense, psychedelic therapy has the potential to remediate aberrant or abnormal beliefs which may have become ingrained as a result of trauma. Thus, the integration phase is essential for helping people assess and successfully employ the changes to their beliefs they experienced while under the influence of psychedelics. This integration work has been studied in most detail on the individual level, though upcoming research also highlights the importance of peer-support as an important factor of integration (Amato, 2021 [editor’s note: this link leads to Maria Amato’s research talk at INSIGHT 2021 conference]).

Today, modern researchers recognize the importance of the integration phase. They are continuously exploring the potential of various models for facilitating integration in the best possible way. Additionally, there is a lack of empirical evidence thus far on integration in particular contexts such as group therapy, as well as the overall cost-effectiveness of the approach. Past and present research into this particular aspect of psychedelic science is discussed below.

Top 10 Psychedelics and Integration Papers Walkthrough

1. Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice 

Ensuring that patients gain the full therapeutic benefits of psychedelics when undergoing psychedelic-assisted therapy is a priority for researchers and therapists alike. Ingmar Gorman and colleagues (2021) provide a framework for minimizing potential harm and facilitating the integration of the insights gained during the experience. In ‘Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice‘ they offer insights as to how therapists can help their patients to make sense of their experience in the integration process. Dealing with phenomena such as challenging experiences, ego-dissolution, and unmet expectations, among others, is also discussed.  

Albert Garcia-Romeu and William Richards (2018) offer further perspectives on the importance of integration in their review article. The authors deem integration to be an essential part of the therapeutic process, serving as “a crucial means to bridge the session experience with everyday life.” 

2. LSD-assisted psychotherapy and the human encounter with death 

During the first age of psychedelic research in the 1950s and 1960s, little attention was given to helping patients integrate their experiences. Nevertheless, researchers like William Richards and colleagues (1972) who studied ‘LSD-Assisted psychotherapy and the human encounter with death’ saw the value in post-session interviews to help people make sense of their psychedelic experience. The integration sessions offered in the study focused on applying insights to everyday living insofar as was possible. 

3. Psilocybin-assisted therapy of major depressive disorder using Acceptance and Commitment Therapy as a therapeutic frame

Now, nearly 50 years later, different therapeutic frameworks have been proposed to facilitate the integration process. Jordan Sloshower and colleagues (2020) make a case for using Acceptance and Commitment Therapy (ACT) as an overarching therapeutic framework. In ‘Psilocybin-assisted therapy of major depressive disorder using Acceptance and Commitment Therapy as a therapeutic frame’ they suggest ACT and psilocybin-therapy act in unison to possibly amplify a person’s response to psilocybin, leading to longer-lasting therapeutic outcomes. The benefits of using a contextual behavioral science (CBS) model such as ACT are reiterated by Jason Luoma and colleagues (2019). 

4. The use of the psychological flexibility model to support psychedelic assisted therapy 

Another model, presented and discussed by Rosalind Watts and Jason Luoma (2020), is named Acceptance, Connect and Embody (ACE). This psychological flexibility model is currently being used in a psilocybin trial for depression, with accompanying positive outcomes (Carhart-Harris et al., 2021). The model uses the six psychological flexibility processes outlined below to better integrate the revelations of the psychedelic experience into everyday life. ‘The use of the psychological flexibility model to support psychedelic assisted therapy’ is divided into two triads, the acceptance triad (defusion, present moment focus, willingness) and the connection triad (self as context, values, committed actions). Psychological flexibility is identified as a possible key to facilitating positive change. 

5. Human hallucinogen research: guidelines for safety 

Therapists are an essential component of psychedelic-assisted therapy as they help patients prepare for the experience, guide them through the experience, and integrate the insights gained during the experience. In their 2008 publication ‘Human hallucinogen research: guidelines for safety’ Matthew Johnson and colleagues at Johns Hopkins emphasize the importance of developing a strong patient-therapist relationship. Developing trust and rapport with the patient helps to facilitate the therapeutic process overall. 

Ensuring therapists are adequately equipped to monitor and guide a psychedelic experience is of the utmost importance. Janis Phelps (2017) discusses the six core competencies any psychedelic therapist should possess as well as offering guidelines for training future therapists. 

Additionally, whether a therapist should have firsthand experience with psychedelics remains an open question. The history of therapists using psychedelics is discussed by Elizabeth Nielson and Jeffery Guss (2018). The authors also suggest a study is needed to explore how the use of psilocybin by therapists may influence how they approach therapy and integration for patients. 

6. Development of a Psychotherapeutic Model for Psilocybin-Assisted Treatment of Alcoholism 

As we progress through the Psychedelic Renaissance, it is likely that disorder-specific psychotherapeutic models will be developed. In ‘Development of a Psychotherapeutic Model for Psilocybin-Assisted Treatment of Alcoholism’ Michael Bogenschutz and Alissa Forcehimes (2016) discuss the therapy model ‘Motivational Enhancement and Taking Action (META)’ they are trialling in a psilocybin study for alcohol use disorder. Therapists use the META model to discuss how the psychedelic experience has affected the patient’s relationship toward alcohol and their desire to change drinking behaviour. 

7. Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences 

Integration should also be a key concern when it comes to challenging experiences. Theresa Carbonaro et al. (2016) conducted a ‘Survey study of challenging experiences after ingesting psilocybin mushrooms’ and found that the single worst difficult experience (‘bad trip’) was associated with acute and long-term negative outcomes. The survey found enduring psychotic symptoms, but conversely also that the experience helped others, with 84% of respondents indicating they benefitted from the experience. 

Challenging experiences can arise from improper use without guidance, but also from an inappropriate setting. María Gómez-Sousa et al. (2021) reported on the ‘Acute Psychological Adverse Reactions in First-Time Ritual Ayahuasca Users’ and found the lack of screening and poor guiding skills as two reasons contributing to the occurrence of challenging experiences. 

8. The potential synergistic effects between psychedelic administration and nature contact for the improvement of mental health 

Integrating psychedelic experiences does not only happen through talk and reason, the setting in which it happens may prove to be just as important. In ‘The potential synergistic effects between psychedelic administration and nature contact for the improvement of mental health,’ Sam Gandy and colleagues argue that there is a synergy between nature contact and psychedelics for the improvement of mental health. Although still only hypothesized, so not formally researched, they argue that integration sessions in nature, with accompanying exercises, could enhance integration processes. 

9. Depression, Mindfulness, and Psilocybin: Possible Complementary Effects of Mindfulness Meditation and Psilocybin in the Treatment of Depression 

Both psychedelics and mindfulness meditation are two ways through which depression may be treated. In ‘Depression, Mindfulness, and Psilocybin’ Kirstin Heuschkel and Kim Kuypers (2020) compare the mechanisms through which both methods work. Most importantly, they argue that mindfulness meditation may increase or prolong the positive effects after psilocybin-assisted therapy. 

A similar argument is made by Jake Payne and colleagues (2021) who make the analogy that psychedelics can provide a compass, the direction, and mindfulness the vehicle, the integration. In ‘Combining Psychedelic and Mindfulness Interventions: Synergies to Inform Clinical Practice’ they build further on earlier research that showed the benefit of combining mindfulness meditation and CBT. 

10. Ethical and legal issues in psychedelic harm reduction and integration therapy 

Therapists who provide psychedelic (integration) should have two goals in mind for their patients. The first is to maximize the benefits of therapy. The second is to reduce the risks of harm. ‘Ethical and legal issues in psychedelic harm reduction and integration therapy’ by Brian Pilecki and colleagues (2021) tackles these issues and provides guidance for therapists on how to help clients and navigate the legal landscape.