Brennan William, Belser Alexander B
Cybin, Inc., Toronto, ON, Canada.
Fordham University, New York City, NY, United States.
Front Psychol. 2022 Jun 2;13:866018. doi: 10.3389/fpsyg.2022.866018. eCollection 2022.
The current standard of care in most uses of psychedelic medicines for the treatment of psychiatric indications includes the provision of a supportive therapeutic context before, during, and after drug administration. A diversity of psychedelic-assisted psychotherapy (PAP) models has been created to meet this need. The current article briefly reviews the strengths and limitations of these models, which are divided into basic support models and EBT-inclusive therapy models. It then discusses several shortcomings both types of models share, including a lack of adequate attention to embodied and relational elements of treatment, and insufficient attention to ethical concerns. The article then introduces the EMBARK model, a transdiagnostic, trans-drug framework for the provision of supportive psychotherapy in PAP clinical trials and the training of study therapists. EMBARK was designed to overcome challenges that prior models have had in conceptualizing therapeutic change in psychedelic treatment, incorporating elements of non-psychedelic evidence-based therapies, incorporating therapists' prior skills and clinical orientations, delimiting therapist interventions for research standardization, and determining specific factors that contribute to treatment outcomes. The article explains EMBARK's six clinical domains, which represent parallel conceptualizations of how therapists may support therapeutic benefit in PAP treatment, and its four care cornerstones, which reflect therapists' broad ethical responsibility to participants. The article describes how these elements of the model come together to structure and inform therapeutic interventions during preparation, medicine, and integration sessions. Additionally, the article will discuss how EMBARK therapist training is organized and conducted. Finally, it will demonstrate the broad applicability of EMBARK by describing several current and upcoming PAP clinical trials that have adopted it as the therapeutic frame.
在大多数将迷幻药物用于治疗精神疾病的情况下,当前的护理标准包括在给药前、给药期间和给药后提供支持性治疗环境。为满足这一需求,已创建了多种迷幻辅助心理治疗(PAP)模式。本文简要回顾了这些模式的优点和局限性,这些模式分为基本支持模式和包含循证疗法(EBT)的治疗模式。然后讨论了这两种模式共有的几个缺点,包括对治疗中体现性和关系性元素缺乏足够关注,以及对伦理问题关注不足。本文接着介绍了EMBARK模式,这是一种用于在PAP临床试验中提供支持性心理治疗以及培训研究治疗师的跨诊断、跨药物框架。EMBARK旨在克服先前模式在概念化迷幻治疗中的治疗变化、纳入非迷幻循证疗法的元素、纳入治疗师先前的技能和临床取向、为研究标准化界定治疗师干预措施以及确定促成治疗结果的具体因素等方面所面临的挑战。本文解释了EMBARK的六个临床领域,它们代表了治疗师在PAP治疗中支持治疗益处的平行概念化方式,以及其四个护理基石,反映了治疗师对参与者广泛的伦理责任。本文描述了该模式的这些要素如何结合在一起,在准备阶段、药物阶段和整合阶段构建并指导治疗干预。此外,本文还将讨论EMBARK治疗师培训是如何组织和开展的。最后,通过描述几个目前正在进行和即将开展的采用它作为治疗框架的PAP临床试验,展示EMBARK的广泛适用性。