Patch Kyle, Smith William R
Department of Bioethics, National Institutes of Health, Washington, DC, USA.
Carey Law School, University of Pennsylvania, Philadelphia, PA, USA.
J Psychopharmacol. 2025 May 26:2698811251337372. doi: 10.1177/02698811251337372.
Research on the therapeutic potential of psychedelics has surged, prompting a re-examination of the role of set and setting in psychedelic-assisted therapy. Yet, these concepts are vague and typically defined over inclusively. We believe that set and setting research should be methodologically reductionist, focusing on specific components rather than set and setting as such. To that end, we propose the mechanism-first approach, which begins with specific, paradigmatic set and setting components, such as "openness to the psychedelic experience" or calming lighting and music. It seeks to understand the mechanisms through which these components affect psychedelic outcomes. Once the mechanisms in paradigmatic cases are understood, researchers can ask whether other mental and environmental factors play the same or similar mechanistic roles. As the process iterates over time, understanding of set and setting expands to include more components. Setting aside the vague, standard definitions of set and setting and focusing, instead, on specific components of set and setting, the mechanism-first approach encourages productive research agendas, focused on specific projects that are mutually informative. To defend it, we outline the problems with standard definitions of set and setting, describe the mechanism-first approach in detail, illustrate it by considering its implications for selected, active research projects, and respond to objections to our approach.
对迷幻药治疗潜力的研究激增，促使人们重新审视“心境和环境”在迷幻药辅助治疗中的作用。然而，这些概念模糊不清，通常定义得过于宽泛。我们认为，“心境和环境”研究在方法上应采用简化论，关注特定组成部分而非“心境和环境”本身。为此，我们提出机制优先方法，该方法从特定的、典型的“心境和环境”组成部分入手，比如“对迷幻体验的开放性”或舒缓的灯光与音乐。它试图理解这些组成部分影响迷幻药治疗效果的机制。一旦理解了典型案例中的机制，研究人员就可以探究其他心理和环境因素是否发挥相同或相似的机制作用。随着时间的推移，这一过程不断重复，对“心境和环境”的理解会扩展到包含更多组成部分。抛开“心境和环境”模糊的标准定义，转而关注“心境和环境”的特定组成部分，机制优先方法鼓励开展富有成效的研究议程，专注于相互提供信息的特定项目。为了捍卫这一方法，我们概述了“心境和环境”标准定义存在的问题，详细描述了机制优先方法，通过考虑其对选定的正在进行的研究项目的影响来说明该方法，并回应针对我们方法的反对意见。
