The Stages of Psychedelic Therapy

Many may not realize that utilizing psychedelics for therapeutic healing involves much more than merely consuming psilocybin mushrooms and waiting for healing to unfold. The process is more complex and requires careful management.

High-dose psychedelic therapy, commonly seen in current clinical trials, typically unfolds over three stages. The initial stage focuses on preparation. Patients, often grappling with severe mental health conditions like debilitating depression, enter this phase vulnerable and uncertain about what lies ahead during the potentially intense psychedelic session. This preparatory phase is essential, as it helps patients address anxieties regarding the dosing day and fosters a stronger bond with their therapist, who often also serves as their trip sitter. Effective preparation is argued to enhance the overall therapeutic experience.

The second stage is the psychedelic experience itself, involving the actual consumption of the psychedelic substance—be it mushrooms, LSD, or MDMA. This session usually occurs in a carefully curated environment, such as a hospital room decorated with soothing art and ambient lighting, with the therapist present to assist during any challenging moments. Music, specifically selected to guide the psychedelic journey, plays a significant role during this phase.

The final stage, which is critical yet often overlooked, is integration. This phase can be described as the process through which insights gained during the psychedelic experience lead to meaningful changes in everyday life. In this collaborative effort, both the patient and therapist explore the revelations from the psychedelic journey and strategize how these insights can be applied to foster positive changes in the patient’s mental health.

Challenges in Integration

Over the past decade, significant advancements in psychedelic research have emerged from institutions like Johns Hopkins and the Psychedelic Research Centre at Imperial College London. Researchers have conducted studies involving LSD, psilocybin, and DMT within neuroimaging frameworks to better understand the effects of these substances on the brain. Numerous measurement scales have been developed to quantify the psychedelic experience, including well-known tools like the Mystical Experience Questionnaire and the Ego Dissolution Inventory.

However, much of the focus has predominantly been on the psychedelic experience itself. While this is undoubtedly intriguing to neuroscientists, psychologists, and philosophers, the experience is only one component of psychedelic therapy. Jordan Slohsower, a psychiatrist from Yale, emphasizes that integration remains a less well-defined and understood aspect of this therapeutic journey:

“While psychedelic integration is widely discussed as part of psychedelic therapy, it remains vaguely conceived, undertheorized, and may lack an operational relationship to the problem being treated. It is often a non-specific mixture of supportive listening and encouragement to engage in introspective practices, such as journaling, meditation, and spending time in nature.”

As psychedelic therapy gains traction in mainstream health care—with larger clinical trials underway and growing public interest—it becomes increasingly crucial to grasp the entirety of the therapeutic process. This objective is at the core of the recent publication in Frontiers.

Measuring Psychedelic Integration

The recent publication introduced two distinct scales, each focusing on different facets of integration. The Integration Engagement Scale (IES) assesses behavioral changes that occur after a psychedelic experience. Patients respond to prompts like, “I’ve found ways to carry the intentions I had for my experience into my daily life,” and “Because of my [psychedelic] experience, I’ve prioritized my overall wellness.”

The second scale, the Experienced Integration Scale (EIS), delves into the psychological aftermath of the psychedelic session. It aims to evaluate whether the patient's mental well-being, emotional stability, and self-perception have improved. Questions include, “I feel greater self-awareness during my experience,” and “I feel harmony between my experience and my inner being.”

By utilizing these scales, researchers and practitioners can gain insights into effectively facilitating the often elusive integration process following psychedelic experiences. For instance, different integration methodologies can be tested within therapeutic protocols to determine which approaches yield the best outcomes based on the scales.

In the coming years, these scales are expected to see widespread application. In an open letter to fellow researchers, the authors stated, “The creation of the scales was a profitless endeavor, undertaken for the greater good and with the intention of public access for use by anyone.”

Next time you encounter services offering “psychedelic integration coaching” or clinics promoting “psychedelic integration services,” inquire whether they utilize the Integration Engagement Scale or the Experienced Integration Scale to measure integration success. Such inquiries can significantly contribute to establishing consistent metrics across various integration support services.