Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Department of Family Medicine and Community Health, University of Wisconsin, Madison, Madison, WI, USA.
Psychopharmacology (Berl). 2024 Aug;241(8):1517-1526. doi: 10.1007/s00213-024-06620-x. Epub 2024 May 24.
Psychedelic-assisted psychotherapy (PAP) has emerged as a potential treatment for a variety of mental health conditions, including substance use disorders and depression. Current models of PAP emphasize the importance of psychotherapeutic support before, during, and after ingestion of a psychedelic to maximize safety and clinical benefit. Despite this ubiquitous assumption, there has been surprisingly little empirical investigation of the "psychotherapy" in PAP, leaving critical questions about the necessary and sufficient components of PAP unanswered.
As clinical trials for psychedelic compounds continue the transition from safety- and feasibility-testing to evaluating efficacy, the role of the accompanying psychotherapy must be better understood to enhance scientific understanding of the mechanisms underlying therapeutic change, optimize clinical outcomes, and inform cost-effectiveness.
The present paper first reviews the current status of psychotherapy in the PAP literature, starting with recent debates regarding "psychotherapy" versus "psychological support" and then overviewing published clinical trial psychotherapy models and putative models informed by theory. We then delineate lessons that PAP researchers can leverage from traditional psychotherapy research regarding standardizing treatments (e.g., publish treatment manuals, establish eligibility criteria for providers), identifying mechanisms of change (e.g., measure established mechanisms in psychotherapy), and optimizing clinical trial designs (e.g., consider dismantling studies, comparative efficacy trials, and cross-lagged panel designs). Throughout this review, the need for increased research into the psychotherapeutic components of treatment in PAP is underscored.
PAP is a distinct, integrative, and transdisciplinary intervention. Future research designs should consider transdisciplinary research methodologies to identify best practices and inform federal guidelines for PAP administration.
迷幻药辅助心理疗法（PAP）已成为治疗多种心理健康状况（包括物质使用障碍和抑郁症）的一种潜在疗法。目前的 PAP 模式强调在摄入迷幻药之前、期间和之后提供心理治疗支持的重要性，以最大限度地提高安全性和临床获益。尽管人们普遍认为如此，但对于 PAP 中的“心理疗法”却很少进行实证研究，这使得有关 PAP 必要和充分组成部分的关键问题没有得到解答。
随着迷幻化合物的临床试验从安全性和可行性测试向评估疗效过渡，必须更好地了解伴随的心理治疗作用，以增强对治疗变化机制的科学理解，优化临床结果，并为成本效益提供信息。
本文首先回顾了 PAP 文献中心理治疗的现状，首先讨论了最近关于“心理治疗”与“心理支持”的争论，然后概述了已发表的临床试验心理治疗模型和基于理论的推测模型。然后，我们阐述了 PAP 研究人员可以从传统心理治疗研究中汲取的经验教训，包括标准化治疗（例如，发表治疗手册，为提供者制定资格标准）、确定变化机制（例如，测量心理治疗中的既定机制）和优化临床试验设计（例如，考虑进行拆分研究、比较疗效试验和交叉滞后面板设计）。在整个审查过程中，强调了需要增加对 PAP 治疗中心理治疗部分的研究。
PAP 是一种独特的、综合的、跨学科的干预措施。未来的研究设计应考虑采用跨学科研究方法，以确定最佳实践，并为 PAP 管理提供联邦指南。
