Exploring the Therapeutic Potential of Psychedelics in Mental Health

The conversation around mental health treatment is ever-evolving, and integrating new modalities continues to push boundaries. One such groundbreaking area is the exploration of psychedelics as a treatment for mental health conditions such as PTSD, anxiety, substance use disorders, and depression. While these treatments have long been stigmatized, recent studies and growing evidence suggest that psychedelics may offer significant relief to individuals resistant to traditional therapies.

The Research Behind Psychedelics as Therapy

Studies have provided compelling evidence for the effectiveness of psychedelic-assisted therapy. For instance, Agrawal et al. (2024) demonstrated the potential of psilocybin in addressing depression in cancer patients. Their study revealed that participants experienced a significant reduction in depressive symptoms—80% reported sustained remission, and half showed complete remission even eight weeks post-treatment. This research underscores the need for alternative approaches in populations where conventional therapies fail to produce adequate outcomes. However, this study lacked a control group, making it difficult to establish causation definitively. The open-label design also raises questions about potential placebo effects or biases in participant responses.

Similarly, research by Van Der Kolk et al. (2024)  highlighted the use of MDMA-assisted therapy for PTSD. Their findings suggested markedly reduced symptoms, especially for individuals experiencing alexithymia (difficulty identifying and expressing emotions). The study demonstrated that MDMA, in a controlled and supportive therapeutic environment, could play a pivotal role in helping clients process trauma and achieve significant symptom relief. However, the study's participant pool was predominantly white and non-Hispanic, which limits the generalizability of the results. Future studies must prioritize diversity to ensure findings are applicable across various populations and cultural contexts.

Expanding Treatment Horizons: Ibogaine and Substance Use Disorders

Rodríguez-Cano et al. (2022) conducted a qualitative study to explore the use of ibogaine as a treatment for substance use disorders (SUDs). Ibogaine, a psychoactive compound derived from the iboga plant, has a long history of use in the Bwiti spiritual practices of Africa. However, due to legal restrictions, its therapeutic application often occurs in underground or unregulated settings, highlighting both its potential and the ethical challenges surrounding its use.

The study involved qualitative, semi-structured interviews with 13 participants who had recently undergone ibogaine treatment. These individuals sought treatment specifically for SUDs or for other reasons while also struggling with SUDs. The results were promising, with participants reporting significant reductions in substance use and substantial psychological benefits, including enhanced personal insight. However, the study also identified serious safety concerns, as some participants experienced severe adverse side effects. There is also concern related to the potential for death in those with cardiac health issues and drug-related interactions.

Study Limitations and Flaws

Despite its promising findings, the study had several notable limitations:

• Small Sample Size: With only 13 participants, the study lacks the statistical power to generalize its findings to larger populations.

• Unregulated Treatment Settings: Since participants underwent ibogaine treatment in uncontrolled, underground environments, there was no standardization of dosages or protocols, making it difficult to assess safety and efficacy reliably.

• Self-Reported Data: The reliance on subjective accounts from participants introduces the potential for bias, including memory distortion or overemphasis on positive outcomes due to personal expectations.

• Short Follow-Up Period: The study did not include long-term follow-up to evaluate whether the reductions in substance use and psychological benefits were sustained over time.
  

Researchers also raised concerns about the environmental and cultural impacts of ibogaine use. Overharvesting the iboga plant could threaten its availability for indigenous communities, posing ethical dilemmas about its use in therapeutic contexts.

While ibogaine shows potential as an alternative therapy for SUDs, its use must be approached cautiously, considering the ethical, safety, and ecological challenges. Counselors should advocate for further research to establish standardized protocols, minimize risks, and ensure culturally respectful practices.

Neuroscience and Psychedelics: A Look Into Ego Dissolution

One of the most fascinating aspects of psychedelics is their ability to alter neural connectivity. Lebedev et al. (2015)  identified decreased functional connectivity between the

medial temporal lobe (associated with memory) and high-level cortical regions (involved in

executive function and self-perception). This disruption can lead to ego dissolution, where individuals lose the rigid boundaries of self. For people with conditions like PTSD or depression, this altered state of consciousness may facilitate new perspectives and emotional breakthroughs that are challenging to achieve in standard therapy.

Challenges and Considerations

As psychedelics gain attention, providers are increasingly likely to encounter clients who have experimented with or expressed interest in these substances. Hearn et al. (2022)  found that while attitudes toward psychedelics are shifting, many people remain neutral or cautious. Younger counselors and students tend to hold more positive views, with many recognizing the potential for psychedelics to enhance empathy and therapeutic training. However, skepticism persists, particularly among those with more experience or limited exposure to newer research.

The growing trend of self-administration also highlights the need for providers to stay informed. Yockey et al. (2020) revealed a 54.6% increase in LSD use among U.S. adults between 2015 and 2018, particularly among individuals aged 26-36. Without a solid understanding of psychedelic effects, health professionals may be ill-equipped to guide clients who have had these experiences.

Implications

The implications of this research extend far beyond individual cases. Before making any choices, individuals should remain informed about the evolving landscape, including both the potential risks and applications of psychedelics. Understanding these therapies' risks, benefits, and integration processes is imperative. 

Additionally, providers must be prepared to navigate the ethical and practical challenges of discussing psychedelics with clients. Above all,  this includes maintaining unconditional positive regard, addressing misconceptions, and providing evidence-based recommendations when clients inquire about these treatments. Psychedelic-assisted therapy is not a one-size-fits-all solution, and providers should know when to refer clients to trained practitioners specializing in this modality.

The Road Ahead: Opportunities for Growth and Advocacy

The growing body of evidence surrounding psychedelics presents a unique opportunity to understand a once-maligned option. By staying updated with emerging research, providers can position themselves as informed advocates for their clients, helping them navigate new treatment options with confidence and care.

Future research must address gaps, such as the underrepresentation of diverse populations in clinical studies,  the long-standing stigma surrounding psychedelics, and the indigenous groups who have a rich history of utilizing them. Providers may have a crucial role in shaping the future of health and wellness by fostering open, evidence-based conversations about these treatments.

Ultimately, the integration of psychedelics into the larger social sphere appears to be gaining traction. Leading with curiosity offers a chance to rethink the possibilities of healing and provide relief to individuals who have long struggled with mental health challenges.

References

• Agrawal, M., Richards, W., Beaussant, Y., Shnayder, S., Ameli, R., Roddy, K., Stevens, N., Richards, B., Schor, N., Honstein, H., Jenkins, B., Bates, M., & Thambi, M. (2024). Psilocybin-assisted group therapy in patients with cancer diagnosed with major depressive disorder. Cancer, 130(7), 1137-1146. https://doi.org/10.1002/cncr.35010

• Hearn, B., Brubaker, M. D., & Richardson, G. (2022). Counselors’ attitudes toward psychedelics and their use in therapy. Journal of Counseling & Development, 100(3), 364–373. https://doi.org/10.1002/jcad.12429

• Hearn, B. G. (2020). Psychedelics, mystical experiences, and meaning-making: A renegotiation process with the challenges of existence. Journal of Humanistic Counseling, 60(3). DOI: 10.1002/johc.12164

• Henner, R. L., Keshavan, M. S., & Hill, K. P. (2022). Review of potential psychedelic treatments for PTSD. Journal of the Neurological Sciences, 439, 120302. https://doi.org/10.1016/j.jns.2022.120302

• Lebedev, A. V., Lövdén, M., Rosenthal, G., Feilding, A., Nutt, D. J., & Carhart-Harris, R. L. (2015). Finding the self by losing the self: Neural correlates of ego-dissolution under psilocybin. Human Brain Mapping, 36(8), 3137–3153. https://doi.org/10.1002/hbm.22833

• Rodríguez-Cano, B. J., Kohek, M., Ona, G., Alcázar-Córcoles, M. Á., dos Santos, R. G., Hallak, J. E. C., & Bouso, J. C. (2022). Underground ibogaine use for the treatment of substance use disorders: A qualitative analysis of subjective experiences. Drug and Alcohol Review, 42(2), 401-414. https://doi.org/10.1111/dar.13587

• Van der Kolk, B. A., Wang, J. B., Yehuda, R., Bedrosian, L., Coker, A. R., Harrison, C., Mithoefer, M., Yazar-Klosinski, B., Emerson, A., & Doblin, R. (2024). Effects of MDMA-assisted therapy for PTSD on self-experience. PLOS ONE. https://doi.org/10.1371/journal.pone.0123456

• Yockey, R. A., Vidourek, R. A., & King, K. A. (2020). Trends in LSD use among US adults: 2015–2018. Drug and Alcohol Dependence, 212, 108071. https://doi.org/10.1016/j.drugalcdep.2020.108071