Essential concepts of psychedelic-assisted therapy
| Set and setting | One’s mindset ("set") and the physical environment ("setting") can strongly influence psychedelic subjective effects. Appropriate preparation by the practitioner, which includes building a strong therapeutic alliance and administering the psychedelic in a supportive environment, will minimize adverse experiences and enhance therapeutic efficacy. |
| Intention24 | Defining and setting an intention for what one hopes to gain from a psychedelic experience may increase the likelihood of a powerful and therapeutic psychedelic experience. |
| Ego dissolution | Losing one’s sense of self is a key feature of the psychedelic experience that can produce positive effects, such as feelings of unity, or negative effects, such as anxiety. This experience tends to be limited to classic psychedelics (psilocybin, lysergic acid diethylamide) and does not usually occur with MDMA. |
| Mystical experience | This transformational state, sometimes elicited by psychedelics, is marked by ineffability, ego dissolution, positive mood, transcendence of time and space, and feelings of unity with ultimate reality. The degree to which participants have a mystical experience has been positively correlated with therapeutic effect with classic psychedelics, but not with MDMA. |
| Challenging experience, bad trip | A negative psychedelic experience is marked by fear, dysphoria, paranoia, or confusion. Preparation, setting an intention, and taking a psychedelic under the care of a therapist can reduce the risk. Many who have had a challenging psychedelic experience ultimately report it was helpful, though some report long-term psychological harms. |
| Neuroplasticity | In this adaptive process, neuronal connections (eg, dendritic spines, synaptic proteins) change in response to a stimulus or experience. This can lead to formation of new neuronal connections or extinction of previously established ones. Psychedelics may enhance neuroplasticity for weeks after exposure. |
| Suggestibility25 | The quality of readily and uncritically accepting and acting upon others’ suggestions is enhanced by psychedelics and may be helpful for psychotherapy. |
MDMA = 3,4-methylenedioxymethamphet amine