What To Expect During Psychedelic-Assisted Therapy: An All-Inclusive Guide

A variety of consciousness-altering drugs, known as psychedelics, have captured the attention of clinicians, patients, investors, and policymakers worldwide in light of a growing body of research indicating the powerful therapeutic potential of these substances. Psychedelic-assisted therapies (PAT) using substances like psilocybin, MDMA, and ketamine demonstrate significant promise to generate positive treatment outcomes for individuals affected by conditions like post-traumatic stress disorder (PTSD), treatment-resistant depression (TRD), substance use disorders (SUDs), and other mental health disorders. 

While clinical research on the benefits and risks of these therapies is ongoing, recent developments indicating potential mental health benefits associated with psychedelic substances have incited national and international movements to decriminalize and legalize certain psychedelics. Such promising results have further driven the development of new university-based research programs, FDA approval of a ketamine-based nasal spray for depression, and an increasing number of therapeutic centers around the country. 

With increasing acceptance and awareness of PAT, more people are taking an interest in the benefits offered by this approach to psychotherapy. However, given that most psychedelic substances remain illegal in the US and other countries, what exactly is involved in PAT treatment and how to access such treatment remains unclear to many curious potential patients. So, what is a psychedelic-assisted therapy session like, and what exactly happens in these treatments? This article will shed some light on these topics, providing more information on what PAT practices have been studied and what these treatments typically involve.

Therapeutic Psychedelics

Also known as psychedelic-assisted psychotherapy (PAP), psychedelic-assisted therapies involve the supervised administration of certain psychedelic drugs to a patient under the guidance of a specialized, licensed psychotherapist or psychiatrist. PAT involves using medically supervised administration of psychedelic drugs in conjunction with psychotherapy to address certain persistent mental health conditions. 

Drugs classified as “psychedelics” (also called “hallucinogens”) are a group of natural or synthetic psychoactive substances that cause altered states of human perception and mood. Psychedelics affect various cognitive processes in ways that can transform how individuals understand themselves, others, and the world more generally. Such effects have been considered to be particularly important for people struggling with inflexible thought patterns involved in many mental health disorders.

However, because the US Drug Enforcement Administration (DEA) classifies many of these potentially therapeutic psychedelics — such as MDMA, LSD, and psilocybin — as Schedule I controlled substances, these drugs are considered illegal, and they are difficult to obtain for research or medicinal application.

As of now, ketamine is the only legal psychedelic substance available to the public across the US, and the only country to have legalized therapeutic uses of psilocybin and MDMA is Australia. That said, some US states are moving toward legalizing psilocybin, with Oregon and Colorado having legalized therapeutic applications of the substance, and other states like California have seen recent efforts to legalize psychedelic treatments with psilocybin as well. However, psychedelic-assisted therapy may be available through research centers that are conducting controlled trials on PAT using a variety of psychedelics for individuals with specific conditions.

The following substances are most commonly applied in current studies and treatment centers using psychedelic drugs to treat various mental health disorders:

Psilocybin

Psilocybin is a naturally occurring psychedelic fungal compound that interacts with serotonin receptors in the brain, producing the hallucinatory experiences for which these “magic mushrooms” are well-known. Such effects induced by the compound have particularly occupied the interests of researchers in recent years, as these hallucinatory experiences are often accompanied by profound antidepressant and antianxiety effects. The evidence of psilocybin’s clinical significance even prompted the U.S. Food and Drug Administration (FDA) to designate the federally illegal compound as a “breakthrough therapy” for treatment-resistant depression (TRD) and major depressive disorder (MDD) in 2018 and 2019, respectively.

LSD 

Lysergic acid diethylamide (LSD) is a laboratory-synthesized psychedelic substance that also interacts with serotonin receptors in the brain to produce hallucinatory experiences. Despite being widely illegal in the United States and across the globe due to stigma associating the drug with recreational abuse and countercultural movements, LSD demonstrates serious potential to provide therapeutic benefits to individuals affected by anxiety and comorbid depression.

Ketamine 

Ketamine is considered a dissociative anesthetic that distorts sensory perception, with approved uses in various hospital and veterinary settings. Unlike the other psychedelics on our list, ketamine is classified as a Schedule III drug, meaning the US federal government considers the substance to have legitimate medical applications and a lower potential to create dependence or addiction in users. 

In clinical medicine, ketamine is often used as a general anesthetic, but it is also used to alleviate treatment-resistant pain and seizures. Additionally, ketamine has been found to provide relief for individuals affected by symptoms associated with PTSD, TRD, and MDD. For treating depression, ketamine is available specifically in the form of esketamine (S(+)-ketamine), an FDA-approved intranasal spray taken under clinical supervision. Ketamine can also be administered off-label through an IV infusion.

MDMA 

Also referred to as “ecstasy” or “molly,” the compound 3,4-methylenedioxymethamphetamine (MDMA) is a laboratory-synthesized psychedelic drug derived from amphetamines. This substance is known for its hallucinogenic and stimulant effects that produce feelings of intensified sensory perception, elevated mood, sociability, and increased energy. 

Like psilocybin and LSD, MDMA is a highly illegal substance that the US government recognizes as having no medical use and a high potential for addiction. However, MDMA shows remarkable potential as a therapeutic drug for helping those who suffer from PTSD, certain eating disorders, and anxiety experienced as a result of living with life-threatening illnesses or autism. 

Who Can Benefit from Psychedelic Therapy?

Psychedelic-assisted therapies are still undergoing different experimental trials using varying techniques, with different drugs also being applied to treat different conditions. Most of the research on the medicinal benefits of using psychedelic substances for therapeutic purposes involves using these techniques to treat psychiatric disorders. 

Various psychedelic therapies have shown strong promise to treat the symptoms associated with the following psychiatric conditions:

• Post-traumatic stress disorder (PTSD)
• Treatment-resistant depression (TRD)
• Major depressive disorder (MDD)
• Social anxiety disorder (SAD), particularly in patients with forms of autism
• Binge eating disorder (BED)
• Alcohol, tobacco, and other substance use disorders (SUDs)
• Depression or anxiety associated with end-of-life care

What Happens During Psychedelic-Assisted Therapy Sessions?

Psychedelic-assisted therapy involves the supervised use of psychedelic drugs in combination with psychotherapy. PAT is still considered a novel treatment model, with many therapies taking place in isolated experimental trials, which can vary widely in procedures and therapeutic approaches depending on the medical trial. Also, different psychedelic drugs produce different effects and are used in specific ways when treating different disorders, so there is a lot of variation in the methods and therapeutic approaches used in PAT. 

Nevertheless, the main objective of PAT, in a general sense, is to have the psychedelic substance and psychotherapy work together to create long-lasting psychological and behavioral changes for the good of the patient. While the application of psychedelic therapies is limited to isolated clinical trials and can be practiced according to radically diverse methods and contexts, some standard phases can broadly characterize the PAT treatment process.

Preparatory Sessions

Before the patient even receives a dose of psychedelic drugs, it’s important that they meet at least once with the psychotherapist involved in their treatment. These initial meetings are essential to the treatment as they accomplish the following steps:

• Establish a trusting therapeutic alliance between patient and therapist
• Allow the therapist to gather detailed information about the individual patient’s personal and trauma history
• Inform patients about what to expect during the following stages of treatment, particularly regarding the effects they will experience while under the influence of psychedelic drugs
• Address a patient’s possible concerns about the treatment
• Discuss the procedure in context with its reasoning, possible benefits, risks, and the pros and cons of alternatives with the patient to verify their understanding, autonomy, and decision-making
• Obtain necessary, properly informed consent with supportive documentation 
• Prepare patients for the subsequent phases of the treatment by encouraging openness and comfort in the setting and with the therapist

Generally, the initial consultation phase may take place over the course of a single 90-minute session or over the course of numerous sessions for up to 5 weeks. What is essential is that the preparatory stages of treatment establish a foundation of trust and open communication between the therapist and the client. This preliminary assessment phase enhances therapy by obtaining informed consent and making sure the therapist comprehensively understands a client’s mental health concerns, personal history, and overall readiness for the psychedelic experience. 

In this stage of treatment, the therapist will also elaborate on the therapy process, answer any questions the patient expresses about the treatment, and discuss potential benefits and risks. The therapist may additionally ask about the client’s experiences with psychedelics to gauge the individual’s familiarity and comfort level with altered states of consciousness. Overall, communicating and understanding the client’s expectations surrounding the psychedelic experience and the treatment process is critical to effectively meeting the specific needs of a particular patient and ensuring positive therapeutic outcomes.

Also, during the preparatory phase of PAT, specific therapeutic goals will often be explored and established by the therapist and client. Such goals may range from addressing specific traumatic experiences to gaining insights into personal patterns and behaviors.

While the informational and rapport-building meetings establish a certain “set” (or mindset) that prepares the patient for the drug phase of the treatment, these meetings also get the patient acquainted with the particular “setting” where the psychedelic experience will take place. Patients in the consultation phase typically find themselves in a comfortable, soothing environment conducive to an inner-directed experience. Familiarity with a comfortable setting is said to enhance the efficacy of PAT by allowing the patient to feel complete safety and low anxiety while in the space. 

Yet, despite evidence and theoretical reasons supporting the importance of set and setting, these aspects of the treatment experience are far from being standardized. Empirically, clinicians still lack a model identifying what specific factors or elements of set and setting will maximize the effectiveness of psychedelic-assisted therapies.

Drug Treatment Sessions

The next stages of psychedelic-assisted therapy treatment involve the administration of psychedelic drugs during sessions guided and monitored by 1–2 therapists, sometimes alongside other medical professionals who monitor the patient’s vital signs and state of health during the process. Drugs are applied for one or more sessions lasting as short as 45 minutes (ketamine) or as long as eight hours (psilocybin). 

Patients will typically receive a moderate to large dose of a psychedelic drug in each session, with dosages being carefully tailored to the individual’s needs and treatment goals. Drugs are often administered by oral ingestion, except for  IV ketamine therapies. If multiple sessions are performed in conjunction with the psychedelic drug administration, these sessions are spaced over the course of several weeks. 

During the drug application sessions, patients typically lay in a comfortable position surrounded by a soothing environment that is decorated more like a living room than a medical office. The sessions also often make use of eyeshades and specific instrumental music that has been clinically tested and selected to evoke the transformative experiences aimed at in PAT. These elements are meant to encourage the patient to direct their attention inward, facilitating introspection and exploration of thoughts, feelings, and memories that may surface during the experience. 

The therapeutic guide is present during either much or all of the session to help the patient remain open and attentive to these emotional and experiential elements of the drug’s effects. Throughout the session, the therapist will monitor a client’s physical and emotional state to ensure their well-being, potentially adjusting the course of the session according to the individual’s responses to treatment. Depending on the therapeutic style applied in the treatment, the therapist can take a more or less directive approach to guide the patient through the experience.  

Integration Sessions

After the psychedelic drug sessions are finished, the therapist will often engage in a supportive follow-up process with the client. These sessions are called the integration phase of treatment, and they focus on allowing the client to reflect on and further make sense of the insights and emotions experienced during the drug application session(s), with the ultimate aim of helping the client integrate these newfound perspectives into their daily life.

In the integration phase, the patient expresses the thoughts, feelings, and questions that have arisen following the dosing session(s). The therapist listens and provides guidance to help the patient articulate, understand, and integrate the insights gained from the psychedelic experience into their lives and behaviors to facilitate long-lasting improvements in functioning or emotional well-being. At this stage, a therapist will answer the patient’s questions about events that occurred during drug treatment sessions, as well as encourage the patient to process any new insights concerning their trauma, history, relationships, and personal life that may have arisen during or after the drug experience.

This post-session care and integration period is considered to be crucial in solidifying the transformative effects of the psychedelic experience, as these sessions generally involve deeper reflection, introspection, and consolidation of personal insights, which establish an increased understanding of the significance of the psychedelic experience in the individual’s own personal history, stabilizing profound positive changes in the individual’s life. Furthermore, if a patient experiences psychological distress or suffering as a result of the experience, integration sessions can be used to confront these issues to ensure positive therapeutic outcomes. 

Risks And Side Effects of Psychedelic Therapies

Psychedelic substances are generally considered low-risk, especially when administered in a clinical setting. While the US Controlled Substances Act (CSA) considers psychedelic drugs to have a high potential for abuse and addiction, accumulated evidence from animal studies and clinical research indicates that these claims about psychedelics’ addictive potential are likely exaggerated and incorrect.

Most adverse effects associated with the administration of psychedelics under clinical supervision occur during the time of drug action, meaning there are rarely negative side effects that persist beyond the timeframe that the drug is affecting the body. Some of the short-term undesirable effects that may arise during psychedelic treatments include:

• Anxiety
• Paranoia
• Discomfort
• Increased heart rate, particularly in individuals with heart conditions
• Increase in blood pressure 
• Headaches 

Although uncommon, some risks are less transient associated with psychedelic drugs. For one, there is the potential risk of psychosis in people with psychotic disorders or a predisposition to them. Another highly uncommon effect that has been observed resulting from psychedelic drug treatment is hallucinogen persisting perception disorder (HPPD). This condition is characterized by “flashbacks” and hallucinatory experiences that persist beyond the timeframe during which the drug is active in the body.

However, the occurrence of adverse effects like psychosis or HPPD in the general population is believed to be relatively low, especially in the clinical setting. HPPD most often results from the use of LSD, PCP, natural and synthetic cannabinoids, or other lab-made, “designer drug” compounds in illicitly procured psychedelic drugs, which are not carefully dosed and may be adulterated with other substances.

There is also much research to be done regarding the ways psychedelics may interact with various other medications, including mental health medications. Make sure to tell your treatment provider all the medications and drugs you take when considering whether PAT would be a suitable treatment option for you.

Final Takeaway

Today, studies and clinical trials on the efficacy of various psychedelic-assisted therapies are still in progress. But as clinical research centers, private investment in psychedelic drug development, and legal acceptance continue to expand across the US and other countries, medical knowledge about psychedelic therapy is developing quickly. With research that is currently available, it is strongly suggested that psychedelic drugs have great potential to enhance treatments for various mental health conditions.

However, performing studies with psychedelics remains a challenge, and there have been setbacks as well as successes in psychedelic therapy research. For instance, despite promising results supporting the efficacy of MDMA-assisted therapy in treating PTSD patients, the FDA made a surprising decision in August 2024 to reject the drug’s use as a therapeutic tool in treatments for the disorder. 

Nevertheless, further studies are set to continue investigating psychedelic treatments, and advocates hope that further research will accomplish approvals of therapeutic psychedelic substances in the future. As research continues to unfold, psychedelic-assisted therapy still has the potential to someday emerge as a scientifically recognized and legal treatment option, offering enhanced healthcare to numerous individuals affected by mental health conditions that may be helped with medicinal psychedelic drugs.

Frequently Asked Questions

Are psychedelic-assisted therapies legal?

Currently, most psychedelic drugs are federally illegal, except for certain ketamine products. Therapeutic treatments using psilocybin are legal in Oregon and Colorado, and other US states have made attempts at decriminalizing or legalizing the substance. The only country where therapies using MDMA and psilocybin are legal is Australia.

Who is eligible for psychedelic therapy?

There are a variety of conditions that can be treated with psychedelic therapies in clinical trials or at ketamine treatment centers. Individual clinical trials must be investigated to see if you are eligible. Still, these therapies are typically used in the treatment of PTSD, treatment-resistant depression, addiction, and other mental health disorders. Most clinical trials for psilocybin and other illegal psychedelics require a person to be at least 18 years of age, and ketamine therapy can be administered to individuals as young as 13. Local laws may vary and change, so always be sure to double-check first.

Is psychedelic-assisted therapy safe?

Psychedelic substances are generally considered low risk, especially when administered in a clinical setting, and most negative side effects only occur for the duration of a drug’s activity in the body in dosing sessions. These short-term side effects include discomfort, anxiety, paranoia, increased heart rate, and increases in blood pressure. Inform your provider of any medications you are taking or of any heart conditions to better understand whether PAT is safe for you.