In recent years PAT has garnered considerable attention for its promise in treating various mental health conditions, most notably depression, PTSD, and anxiety. This innovative approach to mental health care leverages the unique effects of psychedelic medicines paired with therapy to facilitate profound relief in treatment-resistant clients. Central to understanding the potential of this therapy are three key concepts: the inherent novelty of psychedelic experiences, the opportunity for transformation within liminal experience, and the mutual benefit that sitting with discomfort can provide to both PAT facilitators and their clients.
A driving factor in the efficacy of psychedelic-assisted therapy is the inherent novelty of psychedelic experiences. All psychedelic compounds, to various degrees, induce states of consciousness that differ markedly from everyday perception and thought processes. Research suggests that the neurobiological changes during a psychedelic experience increase neuroplasticity—the brain’s ability to form new connections and pathways (Nichols, 2016). This heightened state of neuroplasticity opens a window for therapeutic intervention, during which new patterns of thought and behavior can be established, offering hope for individuals stuck in cycles that no longer serve them (Ly et al., 2018). As the neural pathways information normally follows are interrupted, stimuli are rendered novel in a way that our brains have likely not experienced since childhood. Similarly, many psychedelic drugs likely share the ability to reopen the social reward learning critical period, prompting increased malleability for synaptic, circuit and behavioral modification.This critical phenomenon has created what many call the “child-like wonder” associated with a positive PAT experience, as well the opportunity for transformative therapeutic work, particularly for clients with PTSD (Nardou et al., 2023).
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However, the journey through a psychedelic experience rife with novel stimuli is not always comfortable or easy. The very nature of psychedelic medicine precipitates profound and sometimes unsettling revelations and emotional breakthroughs. Within this discomfort lies the opportunity for transformation. Encouraging clients to adopt a mindset of sitting in and moving through a challenging experience, rather than resisting or avoiding it, is crucial to a transformative experience. An approach that directs clients to recognize and yield into the liminality of their experience allows for the confrontation and integration of deeply buried psychological issues, facilitating a transformative process (Hartogsohn, 2016). A deep resistance to the novelty inherent to a PAT session can arise in a client, oftentimes characterized by fear, anxiety, and discomfort. A skillful facilitator must be able to guide a client through their resistance towards release. Preparing a client for the phenomenological novelty that awaits them prior to a PAT session is paramount in cultivating a positive, long-lasting outcome.
This process of sitting with discomfort is not solely the responsibility of the client; it is equally important for the facilitator to practice navigating liminal experience. Facilitators who practice in the realm of psychedelic-assisted therapy must also cultivate the ability to be present with discomfort—both their own and their clients’. This mutual practice enhances the therapeutic alliance, deepens the integrity of the container, and provides a model for clients to emulate. It underscores the shared vulnerability between client and therapist, fostering a deeper, more empathetic connection that is conducive to healing.
To practice sitting with discomfort, Beckley Academy has developed a tool that prospective PAT facilitators can use for self-practice and also with their clients.
To download the resource, click here
References
Hartogsohn, I. (2016). Set and setting, psychedelics and the placebo response: An extra-pharmacological perspective on psychopharmacology. Journal of Psychopharmacology, 30(12), 1259-1267.
Ly, C., Greb, A. C., Cameron, L. P., Wong, J. M., Barragan, E. V., Wilson, P. C., … & Olson, D. E. (2018). Psychedelics promote structural and functional neural plasticity. Cell Reports, 23(11), 3170-3182.
Nardou R, Sawyer E, Song YJ, Wilkinson M, Padovan-Hernandez Y, de Deus JL, Wright N, Lama C, Faltin S, Goff LA, Stein-O’Brien GL, Dölen G. (2023) Psychedelics reopen the social reward learning critical period. Nature. 618(7966):790-798. doi: 10.1038/s41586-023-06204-3. Epub 2023 Jun 14. PMID: 37316665; PMCID: PMC10284704.
Nichols, D. E. (2016). Psychedelics. Pharmacological Reviews, 68(2), 264-355.
Watts, R., & Luoma, J. B. (2020). The use of the psychedelic ego-dissolution inventory (PEDI) in psychedelic-assisted psychotherapy. Frontiers in Psychology, 11, 1639.