Current research focuses on demonstrating the safety and efficacy of psychedelic-assisted psychotherapy, which is vital for regulatory approval, through clinical trials.* However, the “psychotherapy” components of these trials are fairly uniform.
Testing the impact of variations on these psychotherapy protocols is a vital next step.
- First, the power of these medicines seems highly dependent upon context, so small “tweaks” could provide large improvements in healing. (Given the early state of the field, we can safely assume we haven’t yet identified the optimal protocols!)
- Second, community practitioners and individuals are already using techniques far more diverse and less controlled than those employed in trials. The community would benefit from an understanding of which of these variations help and which might harm.
Leveraging the existing community of practitioners is the ideal way to address questions about how to optimize these psychedelic-assisted psychotherapy protocols.
- Efficiency. Clinical trials are slow and expensive, so they would not be the most efficient way to address these questions. Mountains of potential data are already “out there” and could have enormous benefits for humanity if collected.
- Detection of small effects. Effect sizes associated with minor “tweaks” in protocols might be small and therefore might require large samples to be detectable. Additionally, tests of moderators (characteristics that influence when one technique works better than another) often have low statistical power, so research on tailoring psychedelic-assisted psychotherapy to individuals will require large and diverse samples.
- Ethics. Collection of naturalistic data on current community practices could provide information on the safety and efficacy of techniques that might be considered too risky or too “fringe” to deliver in clinical trials (e.g., combining substances, religious rituals, etc.).
Further, any research on optimal therapeutic protocols requires engagement from the community of practitioners if it is to have an impact.
- The best-conducted research is useless if therapists and healers don’t find it persuasive enough to change their practices!
- Practitioners have a granular, “on the ground” perspective that can’t be found anywhere else. Their knowledge of what questions arise in everyday practice, and their ideas about which techniques may be worth testing, is invaluable.
*There is also, of course, an abundance of important laboratory research taking place on the neural and cognitive effects of psychedelics. However, this research rarely has direct implications for improving clinical practice, although it may suggest hypotheses.