Over the past decade, psilocybin-assisted therapy1 has received increasing attention as potentially one of the most effective treatments for depression. While researchers continue to study the efficacy of this therapy, research strongly suggests that psilocybin-assisted therapy could have long-lasting positive effects on numerous mental health conditions.
Experiments with psychedelics-assisted therapy date back to the late 1950s. The use of psilocybin mushrooms in early research explored psilocybin’s role in creating mystical or consciousness-elevating experiences. These psychedelic effects quickly gained notoriety, leading to the widespread use of psilocybin mushrooms beginning in the 1960s. Psilocybin mushrooms and other forms of the substance were made illegal in 1968. It was later classified as a Schedule I drug — the most restrictive category that defines drugs as having no accepted medical use and a high potential for abuse — when the Controlled Substances Act passed in 1970.
Despite the legal restrictions, an underground culture of psilocybin-assisted therapy has existed for nearly 50 years. The recent revival of research into psilocybin has been more clinically rigorous compared to the early studies. This has resulted in a number of contemporary clinical trials investigating the effects of psychedelic-assisted therapy. This research has also lent support to legal psilocybin service centers, which will allow adult use of this substance in Oregon and Colorado.
Today, Oregon and Colorado offer courses for people to become licensed practitioners who can supervise adult psilocybin use outside of clinical settings.
Protocol for Psilocybin-Assisted Therapy
Protocols are also now being developed for psilocybin-assisted therapies provided by clinicians. A psychiatric or psychological evaluation (typically called assessment and preparation sessions) will often take place in the days prior to the session to ensure the inquiring patient is qualified for the treatment. This often involves a psychiatrist asking questions about mental health history, relationship with substances, and other topics that will give them clinical insight into the current state of the potential patient’s mental health.
Talk-therapy sessions often precede clinical psilocybin treatment. This occurs two to three weeks before treatment, with at least two to three sessions, to help the patient get their mindset, or “set,” in order ahead of the mushroom experience. In the talk therapy session, the therapist and patient review why the patient is seeking the treatment and what the intended outcomes are (setting intentions). The therapist may offer journal prompts or suggest other mindfulness techniques, such as meditation, to set the patient up for a successful mushroom experience.
On the day of treatment, the patient is required to refrain from food and water in order to limit gastrointestinal issues during the psychedelic experience, especially as vomiting and nausea are not uncommon when consuming psilocybin in larger doses. The patient then arrives at the therapy center, where they will spend the rest of the day, and often a night, under the care of a psilocybin-assisted therapy clinician or professional. Therapists and guides typically ensure that a person has everything they need and provide guidance in case the experience becomes difficult, scary, or otherwise challenging. This may look like the therapist helping the patient navigate challenging moments, and helping the patient maintain a curious and engaged attitude toward the experience. They also often assist with activities such as helping a person get to the bathroom or bringing them water when they are thirsty.
During clinical sessions, a patient typically ingests anywhere between 3 grams to 5 grams of mushrooms, often in incremental doses rather than all at once. The therapist prepares instrumental music for the patient to listen to that helps create the container of the environment, also known as the “setting.” The patient puts on a blindfold and lays down on a bed or couch, or reclines in an anti-gravity chair, and lets the mushrooms and music wash over them for roughly six hours.
Once the medicine has subsided, the therapist will talk to the patient about what they saw or experienced and assess how they are feeling. The following day, there is usually a talk-therapy session, also called integration, to help them make sense of the experience. In this session, the patient and the therapist often discuss strategies to help them process the lessons, ideas, new feelings, or concepts they experienced in the psilocybin session so they can integrate them into their life.
