The long & short of psychedelic-assisted therapy. Maximalists vs minimalists.

If you want to provide psychedelic-assisted therapy (PAT), you will need a protocol to follow.

What that protocol will look like, is currently a hot debate within the psychedelics field. Here is what the two sides have to say.

One side, the maximalists, argue that psychedelic-assisted therapy needs a lot of support. More than with any other medication, patients need to know what they are getting into. After treatment, integration encompasses more than just a debrief session.

The other side, the minimalists, argue that much less time investment might get us to similar outcomes. Patients don’t need to be burdened with repeated and expensive travel for multiple preparation sessions. They make a case for attendants that are present during a psychedelic session and leave the integration to the existing care network.

Here are 4 of the arguments the minimalists put forth.

1. Participants know what they are getting into. Preparation doesn’t need to take long.

Psychedelic study protocols demand up to 8 hours of preparation, spread out over 4 sessions.

But what if you can make someone feel supported and comfortable with just a short day of information & a guided breathing session.

That is what you currently see in many ketamine clinics. And it’s what Peter Hendricks and the team at Eleusis found in a recent study.

“I think the available data, including from the study that we’re discussing now, would suggest that therapeutic experiences are indeed possible with paired down preparation.”

2. Therapists don’t have the skillset for guiding. Cheaper attendants & monitors are enough.

Two highly paid therapists usually sit in on a PAT session.

But in most PAT sessions, nothing much happens. It’s a setting where support is vital, but not where active therapy is done (remember: someone is tripping). Matthew Johnson and colleagues, writing about the safety in PAT state that “reassurance has been sufficient to handle all cases of acute psychological distress that have arisen.”

The minimalists prefer attendants, personnel that may even be better at supporting a participant. A monitor (overseeing multiple rooms) can then jump in if necessary (e.g. attendant toilet break).

Toning down the qualifications of the person in the room during PAT may most significantly change the cost equation

3. Participants get the message. Integration is overrated.

Without taking action on insights gained, PAT is just a trip.

However, do the participants need a (psychedelic) therapist to take action on those new insights?

Speaking from his clinical experience, Hendricks argues no: “… many people would benefit in the absence of extensive integration psychotherapy. They get the message loud and clear.”

Five years after the landmark smoking cessation trial, 60% were still not smoking (which is better than in just about any other – more intensive – intervention). The participants received no substantive integration.

Does integration after PAT help, most probably? But if it’s necessary, we will have to find out.

4. Access is the most important factor. Let’s not do all unnecessary things.

Underlying the 3 points above is one key factor, access. If PAT becomes cheaper, if there are fewer visits people have to come to, it can become more accessible.

“Can we provide safety with an attendant with a minimal amount of psychotherapy and still see safety, tolerability and crucially effectiveness?” asks Shlomi Raz. If yes, it could mean a more affordable and practical form of psychedelic drug therapy available for all who would like to pursue it.

This is just one side of the debate – tomorrow I will highlight 4 arguments the maximalists make.

To see both perspectives in full – read my latest column for Lucid News.