Hold your Horses: What to Hold in Mind Before Pursuing Psychedelic Therapy
Psychedelic therapies hold great promise for expanding consciousness, easing suffering, and fostering personal growth. With the reemergence of research and growing enthusiasm, questions remain about how, why, and for whom these tools work. To be clear, such uncertainties exist for many treatments in medicine and psychotherapy - antidepressants, electroconvulsive therapy, and even talk therapy offer benefits that are widely accepted yet not fully understood.
For those who have suffered for far too long, the hope that psychedelics may provide relief is both compelling and understandable. Patients, clinicians, and the general public are eager to believe in their potential to alleviate mental and emotional anguish. And indeed, there is much to be optimistic about.
However, they are not a universal solution, nor are they appropriate for all situations. These substances have long been used in religious and ceremonial contexts, underground therapeutic settings, as well as recreationally, well outside a medical or mental health system. People with treatment-resistant conditions, difficulty with access to, or tolerance of, other treatments, or those wishing to try more holistic modalities may choose to turn to these therapies without medical clearance or professional help. And this can at times be for good reason. However, thoughtful preparation and a supportive framework, ideally pursued as part of a cohesive and comprehensive treatment strategy, can help ensure their safest and most effective outcomes. So what should we consider?
Preparation and Integration
Psychedelic therapy involves more than just the dosing session - but also setting the stage for healing and processing, before and after the experience. These treatments can be destabilizing, sometimes in profoundly transformative and positive ways! They have the power to reorganize neural networks and shift long-standing psychological patterns. However, to make these changes meaningful and lasting, preparation (before dosing) and integration (after) are essential.
Key preparatory and integrative practices may include individual or group therapy, meditation, movement practices, sleep regulation, and mindful nutrition. Establishing a relationship with a trusted therapist or support system before beginning this journey is strongly recommended. If you have not yet engaged in therapy to explore the issues you hope to address, and to assess readiness, doing so beforehand may be a valuable first step.
It is also important to prepare your environment and community to support the growth that may come about during treatment. There can be unexpected changes in a participant in this kind of therapy and also new and shifting needs, so setting up your life with some additional space, flexibility, and support where possible can also help this experience contribute to lasting improvements in overall wellness. Often what we call psychiatric symptoms are very much affected by one’s environment, family system, and lifestyle, so making concurrent changes to these elements can be extremely helpful as we move toward healing.
Psychological Readiness
Psychedelic experiences can be intense and require some level of stable psychological functioning for optimal outcomes. While research explores their use for conditions such as depression, PTSD, and addiction, certain mental states, such as active psychosis or manic episodes, may increase short and long-term risk. Those struggling with severe instability in their mental state and/or environment, or who overall may have difficulty integrating their experience, may want to wait until they have more support in place. Because of the psychiatric risks, some may choose to avoid psychedelic therapy altogether.
Medical Considerations
Some conditions, which may or may not be diagnosed, can make psychedelics less safe. For instance, pregnant or breastfeeding women are advised to avoid psychedelic therapy. Other conditions, for instance cardiovascular disease (ex. uncontrolled hypertension, heart failure, a history of heart attack or stroke) or epilepsy may be contraindications to using a psychedelic or related substance. A strong family history of some of these conditions may also need to be taken into consideration.
Medication Interactions
There are medications, supplements, and recreationally used drugs that interact with psychedelic substances in ways that could be hazardous. Among these are certain antidepressants, narcotics, sleep medications, some antipsychotics, lithium, and many more. Consulting a knowledgeable healthcare provider is strongly recommended to assess for potentially dangerous interactions.
Beliefs and Expectations
How we think about what we are taking and what we are doing on a healing journey is known to have an enormous impact on its effects. If going into it there is a lot of hesitation, skepticism, negative attitudes, or concern about the outcome of the therapy, it may not be the right time. A little trepidation is normal (this is a big leap for many!) but more intense fear may be trying to tell you to hold off. The therapist you decide to work with is a great resource for thinking through if, when, and how bringing psychedelics into your treatment plan will be most beneficial for your healing.
Some personality traits can also shape how a psychedelic experience unfolds. Paranoid tendencies, difficulty tolerating uncertainty, or severe anxiety may present challenges. These are not necessarily absolutely contraindicated, but may warrant some extra preparation with therapists who specialize in both altered states of consciousness and psychotherapy.
Take-home message:
Psychedelic therapy can be a powerful tool for certain people under certain circumstances. These treatments tend to be most beneficial when used thoughtfully, with medical clearance and professional support for support and integration, with a long-term plan in place. It is best for a participant/patient to check in with themselves as well, to become clearer about whether now is the right time to embark on this particular journey - and if so - how this part of treatment will fit into the overall journey.
Many other therapeutic approaches, lifestyle changes, and interventions can support healing. To know if this is the right next step, a little research, solid personal and professional support, a comprehensive plan, and a good dose of trust go a long way!
References:
Frecska, Ede. (2007). Therapeutic guidelines: dangers and contra-indications in therapeutic applications of hallucinogens. 10.13140/RG.2.1.2364.8888.
