Psychedelic-Assisted Group Therapy: A Systematic Review

This review (2019) investigates what research has been done with psychedelic-assisted group therapy. It identifies 12 studies, mostly with LSD (2 with psilocybin), and ranging from surveys to randomized controlled trials.

Abstract

“Contemporary research with classic psychedelic drugs (e.g. lysergic acid diethylamide (LSD) and psilocybin) is indebted to the 20th century researchers and clinicians who generated valuable clinical knowledge of these substances through experimentation. Several recent reviews that highlight the contributions of this early literature have focused on psychedelic-assisted individual psychotherapy modalities. None have attempted to systematically identify and compile experimental studies of psychedelic-assisted group therapy. In therapeutic settings, psychedelics were often used to enhance group therapy for a variety of populations and clinical indications. We report on the results of a systematic review of the published literature in English and Spanish on psychedelic-assisted group therapies. Publications are characterized by their clinical approach, experimental method, and clinical outcomes. Given the renewed interest in the clinical use of psychedelic medicines, this review aims to stimulate hypotheses to be tested in future research on psychedelic-assisted psychotherapy, group process, and interpersonal functioning.“

Authors: Alexander Trope, Brian T. Anderson, Andrew R. Hooker, Giancarlo Glick, Christopher Stauffer & Joshua D. Woolley

Summary

Introduction

The use of psychedelics in group settings for religious purposes dates back centuries. However, a group therapy approach has yet to be used in any published 21st-century clinical trial.

Group psychedelic use in nonclinical contexts is beyond the scope of this review, but anthropological studies have shown that using these substances in a culture-affirming, ritual context is safe and effective.

The topic of group administration of psychedelics is important to several emerging trends in contemporary psychedelic research. In one study, participants who received enhanced psychological support demonstrated greater positive behavior changes attributed to their psilocybin experience. Recent psychedelic-assisted individual psychotherapy trials have repeatedly requested to meet other participants, and non-medical psychedelic users in the community also increasingly seek out group support. This suggests that incorporating groups into psychedelic therapy might enhance both participant satisfaction and outcomes.

Group therapy is cost- and time-saving and equivalence between non-psychedelic individual and group therapy has been demonstrated for a range of clinical outcomes and styles of therapy. Whether psychedelic-assisted group therapy is equivalent to individual approaches remains unknown.

Methods

We searched PsycINFO, MEDLINE, Erowid Reference Vaults and MAPS for studies on group therapy using lysergic acid diethylamide, mescaline, psilocybin, hallucinogen, DPT or psychedelic AND group therapy, group psychotherapy OR group support.

We excluded 276 papers after reading titles and abstracts, and 45 papers were excluded due to inability to locate the abstract or full text in English or Spanish. 12 studies met inclusion criteria.

Author Manuscript

Chwelos, Blewett, Smith, and Hoffer (1959) presented a case series of chronic alcoholics treated with a combination of LSD-assisted individual psychotherapy and LSD-assisted group therapy in an inpatient alcohol treatment program. Of the 40 participants treated, 19 were deemed “much improved”, 11 “moderately improved”, and 17 “unchanged”.

Jensen (1962) conducted a controlled study of an inpatient treatment program for alcoholics using group therapy, Alcoholics Anonymous meetings, and individual LSD-assisted psychotherapy. The results revealed that 34 patients remained sober and 7 were considered improved after 6-18 months.

Cheek, Osmond, Sarett, and Albahary (1966) reported on a 4-week inpatient group therapy program that included 2 LSD-assisted group sessions for each participant. The program used AA as a model and employed AA language and concepts. The outcomes of this cohort were compared to a control group of 34 alcoholics who received the hospital’s regular 6-week treatment program but did not receive LSD.

Smart et al. (1966) conducted a single-blind, 3-arm controlled clinical trial of high-dose individual LSD administrations coupled with non-drug group psychotherapy sessions in an inpatient alcohol treatment program. They found no statistically significant difference between treatment arms in terms of abstinence rates or average number of drinking episodes.

In 1970, Bowen, Soskin, and Chotlos conducted a controlled clinical trial of high-dose individual LSD sessions combined with the Human Relations Training Laboratory (HRTL) treatment versus two comparator arms: HRTL alone and HRTL combined with an active placebo of low-dose LSD (25mcg).

Author Manuscript

Bierer and Browne (1960) conducted an open-label, pilot study with 75 patients receiving LSD or LSD plus methamphetamine in a group setting at a psychiatric night hospital. The frequency of group sessions varied, and patients had symptoms of schizophrenia, depression, psychopathy, hysteria, anxiety, and homosexuality. The researchers found that 10/75 patients were “Much Improved”, 20/75 were “Improved”, 7/75 were “Slightly Improved” and 20/75 were “Not Improved” after group therapy. There were no suicides in the sample.

Fontana (1961) treated 168 patients with once-monthly LSD-assisted group sessions as an adjuvant to weekly non-drug psychoanalytic group therapy. Of these 166 patients, 93 were rated “Cured” or “Much Improved”.

Hausner and Doleal (1963, 1966) conducted a multi-arm trial of LSD-assisted group therapy in “neurotic” patients. The patients were randomly assigned to one of four arms: a 50mcg s.c. LSD administration arm, a saline-administration arm, a non-drug control arm, and an LSD “ex-patients” arm. Using a neurotic symptoms questionnaire, between-group comparisons were made. The reported changes in neurotic symptoms are likely incorrect.

Participants with the best clinical outcomes were LSD “ex-patients” who were administered 100mcg s.c. in individual sessions and subsequently participated in the therapeutic community of the rehabilitation center.

Spencer (1963) analyzed a case-series of 10 women that met twice weekly for 16 months and received LSD-assisted group therapy. 3 improved sufficiently to require no further psychiatric help, 4 were “helped to a fairly definite degree” and 3 had no improvement.

Ucha Udabe et al. (1968) reported treating 46 patients with weekly psychoanalytic group psychotherapy and a single LSD-assisted group therapy session. The patients were deemed to be “Cured” (10/46), “Improved” (25/46), or “No change” at study completion. A study found that group therapy participants interacted more with each other during the LSD administration group session compared to non-drug group sessions. This increased interaction positively correlated with the group attaining its “deepest” level of communication.

Sokolik and Hausner (1972) report that 6/18 participants showed substantial improvement in both symptoms and interpersonal relations after receiving once-weekly LSD treatments in a group setting.

Gasser (1995) reports that three therapists affiliated with the Swiss Medical Society for Psycholytic Therapy used MDMA and LSD in psychotherapy from 1988-1993. The average duration of therapy was 3 years, and 90% of patients described good or slight improvement.

Discussion

In 12 studies, LSD was most commonly used, with dosages ranging from 50mcg to 400mcg p.o. Studies were methodologically heterogeneous, and included post hoc surveys, case studies, and randomized, active-placebo controlled clinical trials.

We reviewed English- and Spanish-language publications on psilocybin-assisted psychotherapy, but they were limited in methodological rigor when compared to current standards. The clinical outcomes reported here do not permit comment on the efficacy of psychedelic-assisted group therapy.

Early psychedelic researchers focused on group support and psychotherapy, and used a diverse set of group therapy procedures to treat participants with affective and personality disorders as well as substance use disorders.

Three points stand out in surveying this work: safety, efficacy, and comorbid conditions. With proper safeguards, psychedelics can be given safely to some clinical populations via individual dosing sessions with adjuvant group therapy or via group dosing sessions supplemented by non-drug psychotherapy sessions.

Four of five controlled studies on group therapies for alcoholism had null findings, two had statistically significant improvements in their treatment arms, and the other two did not. The single controlled study on group therapies for “neurotics” showed that patients receiving higher dose individual LSD had better outcomes.

Regardless of the clinical population or therapy style, future research should take advantage of methodological and statistical advancements in group therapy research since the above-referenced studies were conducted.

Researchers are considering the use of groups for psychedelic-assisted therapy, but the optimal number of group members, drug dose, sequencing and number of group sessions, and type of group therapy are among the variables to consider.

A group component in psychedelic research protocols serves as a significant manipulation of attitudinal set and environmental setting, and may reveal new pathways toward understanding the human response to psychedelics.