Psychotherapeutisches Setting und Integration bei psychedelikaassistierter Therapie

 

 Buy Article Permissions and Reprints

ZUSAMMENFASSUNG

Gegenstand und Ziel Der vorliegende Artikel beschäftigt sich mit der Behandlung von psychischen Erkrankungen mit psychedelischen Substanzen aus einem psychotherapeutischen Blickwinkel. Dabei wird die Rolle der „Integration“ von psychedelischen Erfahrungen diskutiert. Es wird der Frage nachgegangen, wie die außergewöhnlichen Erfahrungen, die Menschen unter Psychedelikaeinfluss oftmals erleben, für den psychotherapeutischen Fortschritt nutzbar gemacht werden können.

Material und Methoden Zunächst wird ein einführender Überblick über die Phasen psychedelikaassistierter Therapie (PAT) gegeben. Anschließend wird am Beispiel der Behandlung therapieresistent-depressiver Patienten mit Psilocybin in einer klinischen Studie (EudraCT: 2019–003984–24; NCT04670081) eine Möglichkeit für die psychotherapeutisch begleitete Integration psychedelischer Erfahrungen beschrieben.

Ergebnisse und Schlussfolgerung(en) Die Integration psychedelischer Erfahrungen in den Lebensalltag ist ein wissenschaftlich noch wenig untersuchter, jedoch essenzieller Teil der PAT. Es sollten evidenzbasierte Protokolle entwickelt werden, um die Wirksamkeit und Sicherheit der Therapie durch Methoden zur Integration zu erhöhen.

Klinische Relevanz Es ist zu erwarten, dass die Integration psychedelischer Erfahrungen mit Einführung der PAT in etablierte Gesundheitssysteme zunehmend an Bedeutung gewinnen wird. Klinische Studien müssen diesem Bedarf mit neuen psychotherapeutischen Behandlungskonzepten begegnen.

ABSTRACT

Objective This article offers a psychotherapeutic perspective onto the treatment of mental disorders with psychedelic substances. We discuss the role of the so-called “integration” of psychedelic experiences and pose questions as to how the often extraordinary experiences under the influence of psychedelics can be used for psychotherapeutic progress.

Material and methods An introductory overview of the three phases of psychedelic-assisted therapy (PAT) is given. Using the example of treatment with psilocybin in a clinical study (EudraCT: 2019–003984–24; NCT04670081) with patients suffering from treatment-resistant depression, this article also describes a case of psychotherapeutic integration of psychedelic experiences.

Results and conclusion(s) The integration of psychedelic experiences into the everyday life of patients is a crucial part of PAT that has not yet been sufficiently investigated. Researchers and practitioners should develop evidence-based protocols for integration to increase the efficacy and safety of this therapy.

Clinical relevance With the introduction of psychedelic-assisted therapies into established healthcare systems, it is to be expected that the integration of psychedelic experiences will become increasingly important. Clinical studies must address this need with new treatment protocols for psychotherapy.

Publication History

Article published online:
14 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• Literatur

• 1 Gründer G, Brand M, Mertens LJ. et al Treatment with psychedelics is psychotherapy: beyond reductionism. Lancet Psychiatry 2023 DOI: 10.1016/s2215-0366(23)00363-2
  CrossrefPubMedGoogle Scholar
• 2 Nayak S, Johnson MW. Psychedelics and Psychotherapy. Pharmacopsychiatry 2021; 54: 167-175 DOI: 10.1055/a-1312-7297.
  Article in Thieme ConnectPubMedGoogle Scholar
• 3 Barba T, Buehler S, Kettner H. et al Effects of psilocybin versus escitalopram on rumination and thought suppression in depression. BJPsych Open 2022; 08: e163 DOI: 10.1192/bjo.2022.565.
  CrossrefPubMedGoogle Scholar
• 4 Weiss B, Ginige I, Shannon L. et al Personality change in a trial of psilocybin therapy v. escitalopram treatment for depression. Psychol Med 2023 DOI: 10.1017/s0033291723001514: 1–15
  CrossrefGoogle Scholar
• 5 Roseman L, Haijen E, Idialu-Ikato K. et al Emotional breakthrough and psychedelics: Validation of the Emotional Breakthrough Inventory. J Psychopharmacol 2019; 33: 1076-1087 DOI: 10.1177/0269881119855974.
  CrossrefPubMedGoogle Scholar
• 6 Barrett FS, Johnson MW, Griffiths RR. Validation of the revised Mystical Experience Questionnaire in experimental sessions with psilocybin. J Psychopharmacol 2015; 29: 1182-1190 DOI: 10.1177/0269881115609019.
  CrossrefPubMedGoogle Scholar
• 7 Vollenweider FX, Preller KH. Psychedelic drugs: neurobiology and potential for treatment of psychiatric disorders. Nat Rev Neurosci 2020; 21: 611-624 DOI: 10.1038/s41583-020-0367-2.
  CrossrefPubMedGoogle Scholar
• 8 Aixalà M.. Psychedelic integration: Psychotherapy for non-ordinary states of consciousness. Santa Fe, USA: Synergetic Press; 2022
  Google Scholar
• 9 Bathje GJ, Majeski E, Kudowor M. Psychedelic integration: An analysis of the concept and its practice. Front Psychol 2022; 13: 824077 DOI: 10.3389/fpsyg.2022.824077.
  CrossrefPubMedGoogle Scholar
• 10 King LA, Nutt DJ, Nichols DE. Remove barriers to clinical research for schedule 1 drugs with therapeutic potential. Bmj 2023; 381: 981 DOI: 10.1136/bmj.p981.
  CrossrefPubMedGoogle Scholar
• 11 Majić T, Schmidt TT, Gallinat J. Peak experiences and the afterglow phenomenon: when and how do therapeutic effects of hallucinogens depend on psychedelic experiences?. J Psychopharmacol 2015; 29: 241-253 DOI: 10.1177/0269881114568040.
  CrossrefPubMedGoogle Scholar
• 12 Schenberg EE, King Ft, da Fonseca JE. et al Is Poorly Assisted Psilocybin Treatment an Increasing Risk?. Am J Psychiatry 2024; 181: 75-76 DOI: 10.1176/appi.ajp.20230664.
  CrossrefPubMedGoogle Scholar
• 13 Hipólito I, Mago J, Rosas FE. et al Pattern breaking: a complex systems approach to psychedelic medicine. Neurosci Conscious 2023: 2023-niad017 DOI: 10.1093/nc/niad017
  CrossrefPubMedGoogle Scholar
• 14 Bremler R, Katati N, Shergill P. et al Case analysis of long-term negative psychological responses to psychedelics. Sci Rep 2023; 13: 15998 DOI: 10.1038/s41598-023-41145-x.
  CrossrefPubMedGoogle Scholar
• 15 Sloshower J, Guss J, Krause R. et al Psilocybin-assisted therapy of major depressive disorder using acceptance and commitment therapy as a therapeutic frame. Journal of Contextual Behavioral Science 2020; 15: 12-19
  CrossrefGoogle Scholar
• 16 Gründer G, Brand M, Kärtner L. et al [Are psychedelics fast acting antidepressant agents?]. Nervenarzt 2022; 93: 254-262 DOI: 10.1007/s00115-021-01255-1.
  CrossrefPubMedGoogle Scholar
• 17 Shao LX, Liao C, Gregg I. et al Psilocybin induces rapid and persistent growth of dendritic spines in frontal cortex in vivo. Neuron 2021; 109: 2535-2544.e2534 DOI: 10.1016/j.neuron.2021.06.008.
  CrossrefPubMedGoogle Scholar
• 18 Barrett FS, Doss MK, Sepeda ND. et al Emotions and brain function are altered up to one month after a single high dose of psilocybin. Sci Rep 2020; 10: 2214 DOI: 10.1038/s41598-020-59282-y.
  CrossrefPubMedGoogle Scholar
• 19 Mertens LJ, Koslowski M, Betzler F. et al Methodological challenges in psychedelic drug trials: efficacy and safety of psilocybin in treatment-resistant major depression (EPIsoDE) – rationale and study design. Neuroscience Applied 2022; 01: 100104
  CrossrefGoogle Scholar
• 20 Schmitt A, Kulzer B, Hermanns N.. German version of the GRID Hamilton Rating Scale for Depression (GRID-HAMD). 2015 DOI: 10.13140/RG.2.1.3569.0725
  CrossrefGoogle Scholar
• 21 Carhart-Harris RL, Bolstridge M, Rucker J. et al Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. Lancet Psychiatry 2016; 03: 619-627 DOI: 10.1016/s2215-0366(16)30065-7.
  CrossrefPubMedGoogle Scholar
• 22 Sachse R. Persönlichkeitsstörungen verstehen: zum Umgang mit schwierigen Klienten. Köln: Psychiatrie Verlag, Imprint BALANCE buch + medien verlag; 2020
  CrossrefGoogle Scholar
• 23 McCullough JP. Treating chronic depression with disciplined personal involvement: cognitive behavioral analysis system of psychotherapy (CBASP). Berlin: Springer; 2006
  CrossrefGoogle Scholar
• 24 Schramm E, Klein DN, Elsaesser M. et al Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. Lancet Psychiatry 2020; 07: 801-812 DOI: 10.1016/s2215-0366(20)30099-7.
  CrossrefPubMedGoogle Scholar
• 25 Baier AL, Kline AC, Feeny NC. Therapeutic alliance as a mediator of change: A systematic review and evaluation of research. Clinical psychology review 2020; 82: 101921
  CrossrefPubMedGoogle Scholar
• 26 Murphy R, Kettner H, Zeifman R. et al Therapeutic Alliance and Rapport Modulate Responses to Psilocybin Assisted Therapy for Depression. Front Pharmacol 2021; 12: 788155 DOI: 10.3389/fphar.2021.788155.
  CrossrefPubMedGoogle Scholar
• 27 Zeifman RJ, Kettner H, Ross S. et al Preliminary evidence for the importance of therapeutic alliance in MDMA-assisted psychotherapy for posttraumatic stress disorder. Eur J Psychotraumatol 2024; 15: 2297536 DOI: 10.1080/20008066.2023.2297536.
  CrossrefPubMedGoogle Scholar
• 28 Grof S. Realms of the human unconscious: Observations from LSD research. London: Souvenir Press; 2016
  Google Scholar
• 29 Fiedler P. Verhaltenstherapie in Gruppen. Bern: Beltz; 2005
  Google Scholar
• 30 Yalom ID, Leszcz M. The theory and practice of group psychotherapy. New York: Basic books; 2020
  Google Scholar