What is psilocybin therapy?
Psilocybin therapy is an investigative, blended pharmacological and psychological approach to treating mental health challenges that deploys the psychoactive effects of psilocybin under psychologically supportive conditions.
In this article:
- 1 History and Legality of Psilocybin Therapy
- 2 How to Get Psilocybin Assisted Therapy
- 3 How Psilocybin Assisted Therapy Works
- 4 Effects of Psilocybin
- 5 Research Into Psilocybin Therapy
- 6 Risks of Psilocybin Therapy
- 7 What Does Psilocybin Therapy Treat
- 8 Countries Where Psilocybin Therapy is used
- 9 How to Set Up a Psilocybin Therapy Session
- 10 Final Thoughts on Psilocybin Therapy
Certain species of mushrooms, frequently called “magic mushrooms,” contain the active ingredient psilocybin. Psilocybin produces psychedelic effects in humans that ingest it, such as sensory hallucinations and feelings of euphoria that last for hours.
Early results from ongoing research suggest that, when administered with psychological support from specially-trained therapists, psilocybin could be an effective, safe medicine for patients with anxiety, depression, addiction, and other mental illnesses. Various researchers and institutions are now investigating how efficacious psilocybin therapy might be, particularly in combating treatment-resistant depression.
Among the most common types of mental illness, an estimated 7.1 percent of American adults experienced at least one episode of depression during the previous year according to the National Institute of Mental Health. Conventional treatments such as psychotherapy and antidepressants are often very effective.
However, there is both growing concern about treatment-resistant forms of depression, and an increasing desire to treat these mental health issues in new ways. Along with revelations from the medical community that substances such as psilocybin may be another effective tool in the treatment of depression, a new level of interest in the use of psychedelic drugs to treat mental illness has arisen in the community.
History and Legality of Psilocybin Therapy
If you’re itching to answer questions like, “Where can I find psilocybin depression therapy?” you’ll quickly realize that legality is still a problem. Yet the use of psychedelics for spiritual and medicinal purposes is nothing new, even if this increased level of scrutiny from governments and researchers is.
Many religious and cultural traditions have created spiritual rituals and medical practices that utilize psychedelic substances. But when Europeans “discovered” LSD in the 1940s, the world saw a new, intense focus on psychedelic compounds and mental health.
Swiss chemist Albert Hofmann, an employee of a company called Sandoz, first extracted pure psilocybin from the mushroom Psilocybe mexicana in 1959. Sandoz began to market the psilocybin to clinicians as a psychotherapy tool.
This enthusiasm spread to the US, and in 1960, Timothy Leary began to experiment himself by using magic mushrooms containing psilocybin. Leary and a colleague at Harvard University, Dr. Richard Alpert, began to test whether pure, extracted psilocybin could help reduce rates of recidivism and serve as an effective aid in psychotherapy. Harvard suspended Leary and Alpert by 1963 for their work with psilocybin mushrooms.
In fact, although thousands of studies on the use of psilocybin and LSD were conducted in the US from the 1940s through the 1960s, this line of research was mostly ended in 1970 by the passage of the Controlled Substances Act (CSA). The CSA placed psilocybin in the Schedule I drug category, which means that it has “significant potential for abuse and dependence” and “no recognized medicinal value” and this made any possession and use of psilocybin mushrooms illegal.
This persisted until 2006, when researchers gained approval to research the treatment potential of psilocybin. That work found that psilocybin could have a positive impact on well-being and is generally safe.
In 2019, the United States Food and Drug Administration (FDA) granted psilocybin breakthrough therapy status to foster further research into its use in the treatment of depressive disorders. In November 2020, Oregon decriminalized the use or possession of psilocybin mushrooms for medical reasons, such as anxiety, depression, or PTSD, and legalized psilocybin for people age 21 and older. Psilocybin is also decriminalized in Santa Cruz and Oakland, California; Denver, Colorado; Ann Arbor, Michigan; Somerville, Massachusetts; and Washington, DC.
How to Get Psilocybin Assisted Therapy
If you’re wondering about this promising-sounding option, you’re not alone. But since psilocybin assisted therapy is still not available in most places, a psychedelic clinical trial may be your best option.
So—how to get into a psilocybin assisted therapy trial, then?
Studies of psychedelics such as ketamine, MDMA, DMT, and psilocybin are ongoing at various stages and waiting to begin, and they enroll both individuals with particular mental health issues and healthy volunteers. Regulatory hurdles are slowly giving way to a number of psilocybin studies, and research is growing exponentially around the world. New investigations into how the brain works, the nature of consciousness, and the therapeutic use of psychedelics are appearing frequently.
Usually you must find, register, and be deemed eligible by researchers or organizations to participate in psilocybin studies. Multiple groups are running trials, in many different locations.
A psychedelic clinical trial evaluates the efficacy and safety of the drugs or other therapies under investigation by collecting data. To become approved and available to patients, the drugs must pass through a sequence of stages or phases.
First, scientists thoroughly test a new substance in animals and/or human cells to gain initial safety and toxicity information. In some cases, especially when a drug is already known such as with some psychedelics, enough research already exists in scientific journals to reduce the need for animal testing.
After this stage of review, the FDA can grant phase 1 approval: at phase 1, the team tests the drug in a small number of healthy individuals. After a successful phase 1, the FDA can allow phase 2 to begin, and the drug will be given to people who have a condition or disease to evaluate effectiveness at symptom reduction and safety.
Various academic institutions, organizations, and corporations are leading the field forward in psychedelic clinical research and trials. Three leading organizations in psychedelic research are the Heffter Research Institute, the Beckley Foundation, and the Usona Institute. The Multidisciplinary Association for Psychedelic Studies (MAPS) is non-profit organization dedicated to research and education surrounding the legal, medical, and cultural contexts of marijuana and psychedelic use. MAPS owns the MAPS Public Benefit Corporation, which sponsors psychedelic trials for anxiety-related conditions.
The particular focus of the Imperial Center for Psychedelic and Consciousness Research of the Imperial College London is researching treatments for depression within the broader context of the clinical use of and mechanisms of action of psychedelics. Mental healthcare company COMPASS Pathways is conducting clinical psilocybin trials in North America and Europe for treatment-resistant depression.
Researchers from the Center for Psychedelics and Consciousness Research at Johns Hopkins University investigate how psychedelics affect behavior, brain function, cognition, mood, and biological markers of health. New York University (NYU) also has a psychedelic research program.
Many other organizations and universities around the world are conducting research, and you can also find clinical trials in the US on psilocybin here. These are all excellent resources if you are wondering how to get into a psilocybin therapy study.
How Psilocybin Assisted Therapy Works
Our life experiences, past and current, and whatever significance we take from them can cause negative emotional, psychological, and physical symptoms that can become overwhelming. Discrimination, abuse, loss, poverty, trauma, and other negative life experiences can shape how we perceive ourselves, others, and the world around us.
This in turn affects our ability to navigate our emotions and use them to react and respond to life’s challenges. But poor ability to respond to those challenges results in more problems and habitual patterns—and the cycle continues.
Individuals who have often struggled with treatment-resistant anxiety and depression, perhaps even for life, are most likely to seek psilocybin-assisted psychotherapy. They are still desperately seeking relief from their debilitating symptoms, even though they have tried other forms of therapy. Psilocybin can help clients reconnect with a sense of passion, purpose, and creativity in the world, and break out of self-destructive patterns in their lives.
Although the pharmacological effects of psilocybin are important, the psychological support element of the therapy is just as critical. In the initial preparation sessions, the patient and therapist become comfortable together and form a trusting relationship. This is the only way to ensure the patient can feel at ease enough during the psilocybin session to manage it and be supported enough to really gain from the psychological component of the treatment.
So how does a psychedelic-assisted therapy session work? During the psilocybin session, the patient lies down in a comfortable specially-designed room on a bed. In this comforting and safe environment, they receive a capsule with a low dose of psilocybin with a professional supervising them.
During the experience, patients focus internally by wearing an eye mask and listening to a specially designed music playlist. Typically, the psilocybin experience lasts six to eight hours and a therapist is there the whole time.
Next, during integration, patients discuss their psilocybin session experiences with guidance from their therapist to generate ideas and insights from the experience. This critical component of the process helps the patient change unhelpful behavioral and emotional patterns and find meaning in their experience.
Working with a psychotherapist ensures the patient processes their psychedelic experience in a way nurtures enduring mental health benefits. Although many people who experience psilocybin therapy describe it as decades of therapy in a night or afternoon, and it truly can feel like that, it’s still just a night or an afternoon. The lasting change comes not on dosing day, but from the hard work of integration.
Effects of Psilocybin
Psilocybin is a hallucinogen. It impacts mood, perception, altered consciousness, and cognition by activating serotonin receptors, typically in the prefrontal cortex—the part of the brain that most affects those responses. Hallucinogens also work in other regions of the brain, such as those that regulate panic and arousal responses.
Thinking of those responses—mood, arousal, perception, panic—it’s easy to understand that although psilocybin is known for causing hallucinations, it may not always trigger these active visual or auditory experiences. Instead, by changing those responses, it often distorts how users perceive people and things that are actually present in their environment.
The quantity of psilocybin, expectations of what the experience will be like, and past experiences can all affect the effects of the drug for a given use. However, some things are constant.
The body converts psilocybin to psilocyn after the gut absorbs it. In general, psilocybin’s hallucinogenic effects last between 4 and 6 hours and occur within 30 minutes of ingestion.
Changes in thought patterns and sensory perception can last for several days in some people, so be ready in case that’s you. And more recent research indicates that emotions and brain function are altered for over one month after just one high dose of psilocybin, so how long certain changes persist may be dose dependent in part.
The effects of psilocybin are similar to those of LSD. Many people experience feelings of euphoria, relaxation, intense changes in feeling and mood, and an altered perception of time and space. Other possible effects of psilocybin include:
- spiritual awakening, highly introspective experiences
- labile, quickly changing emotions
- the feeling or idea that surroundings are unreal, derealization
- a dream-like sense of disengagement, depersonalization
- distorted perceptions and thinking, including an altered sense of time or place
- vivid colors, halos of light, and other visual distortions and alterations
- dilated pupils
- muscle weakness
- impaired concentration
- lack of coordination
- unusual body sensations
Hallucinations are another frequent psilocybin experience. Research indicates that this may be the result of more communication between different brain networks.
Some scientists in this field believe that it’s this action, the formation of new brain connections, that allows psilocybin to have such a beneficial impact on depression and on helping people beat depressive symptoms and break depressive patterns. Of course, between individual differences in personality and mental state and the immediate environment, the effects of psilocybin vary from person to person.
Unfortunately, a higher risk of a bad experience can come with a patient who has fears about using the drug, or who simply experiences challenges with mental health related to the therapy. The most frequently reported adverse event after recreational use of psilocybin is psychological distress, in the form of anxiety, or in certain cases, short-term psychosis.
Research Into Psilocybin Therapy
Research into psilocybin-assisted therapy for depression is ongoing, but promising, with clinical trials yielding promising results.
A 2016 study from Griffiths et al. indicated that psilocybin therapy significantly reduced symptoms of depression and anxiety in people who were undergoing cancer treatment. The psilocybin therapy was also linked to other benefits, including increased optimism and better quality of life. Furthermore, the same team found that the effects were enduring for years after treatment, and that participants continued to describe their experiences with psilocybin-assisted therapy as spiritually significant and personally meaningful.
In 2019, the FDA granted breakthrough therapy status to psilocybin-assisted therapy. The goal of this status, which is reserved for drugs that have shown preliminary results in the treatment of serious illnesses in clinical trials, is to hasten the research and development process.
Findings from 2020 led by John Hopkins Medicine researchers and published in JAMA Psychiatry suggest that psilocybin-assisted therapy is efficacious among patients with major depressive disorder (MDD). In this randomized clinical trial, psilocybin-assisted therapy produced rapid, large, and sustained antidepressant effects in these MDD patients.
The study found that two doses of psilocybin and supportive psychotherapy produced significant, rapid antidepressant effects. Around 67 percent of participants experienced a lasting 50 percent reduction in symptoms. Over half of participants who had psilocybin—54 percent—were no longer depressed within four weeks of treatment.
MDD is a major burden on public health, in part because current treatments—which are ongoing—are limited in terms of both adherence and effectiveness. In contrast, this and other research indicates that just 1 or 2 psychologically supported doses of psilocybin produce significant antidepressant effects in patients with treatment-resistant depression and cancer.
In 2021, researchers led by Carhart-Harris published the first randomized controlled trial comparing psilocybin with a standard selective serotonin reuptake inhibitor (SSRI) antidepressant. Although the work was fairly small and didn’t assess other measures of well-being, it found that psilocybin improved symptoms of depression just as well as the antidepressant—with fewer side effects.
One group was given a full dose of psilocybin with psychotherapy followed by daily placebos. The other received the SSRI escitalopram daily with psychotherapy plus two tiny amounts of psilocybin—this was to minimize the anticipated effect of self-referrals by people who might prefer psilocybin or believe it superior to traditional pharmaceutical choices. All of the participants suffered from major depressive disorder (MDD).
Although the two groups did not show significantly different scores in terms of reduction of major depression itself, in negative side effects and treatment resistance, the psilocybin group did much better than the antidepressant group. The psilocybin participants showed significant drops in anhedonia (a lack of the ability to feel pleasure) and suicidality. Of special note, 70 percent of psilocybin subjects responded to the treatment, compared with 48 percent of SSRI subjects.
Researchers are also exploring the general psychopharmacology of psilocybin, and the potential for psilocybin to treat other conditions, including anxiety, alcohol use disorder and other addictions, depression in people with cancer, and migraine and cluster headaches.
Risks of Psilocybin Therapy
Psilocybin is generally described as safe, particularly under close supervision and care. However, it can also produce unwanted side effects, such as:
At times, psilocybin induces psychedelic experiences that can result in what can only be described as a “bad trip.” During this frightening experience, a person may experience intense feelings of paranoia and anxiety along with delusions and hallucinations.
Although there’s no certain way to stop a bad trip in its tracks, it’s definitely helpful to be with a supportive, knowledgeable person in a comforting environment. This is why it is so important to engage the supervision of a mental health professional before trying psilocybin therapy for depression.
For people with a history of psychosis or mania, psilocybin has the potential to pose special risks. For this reason, psilocybin-assisted therapy may not be for people with certain mental health conditions such as schizophrenia or bipolar disorder.
Psilocybin remains a Schedule I substance and illegal for use, despite interest in its therapeutic potential. However, research suggests a low risk of abuse and physical dependence. Researchers from at least one study recommend scheduling psilocybin no more restrictively than a Schedule IV—the category reserved for substances such as Ambien and Xanax with a low potential for abuse and a low risk of dependence.
What Does Psilocybin Therapy Treat
Psilocybin is currently designated a Schedule I substance, meaning that according to the federal government, it has “no currently accepted medical use and a high potential for abuse.” This appears to be at odds with the research, as explained above.
Psilocybin may reduce distressing emotional symptoms such as anxiety, depression, and obsessive-compulsive disorder (OCD), or accelerate the healing process, eliminating such symptoms. A wide variety of conditions might be treated with psilocybin-assisted psychotherapy, and researchers are currently studying and exploring many of them. Most ongoing studies involving psilocybin focus on the management and resolution of mental health conditions, especially treatment-resistant cases.
Some conditions being researched in the context of psilocybin-assisted therapy include:
- General anxiety disorder
- Treatment-resistant depression
- End-of-life anxiety
- Major depressive disorder
- Eating disorders
- Suicidal ideation
- Substance use disorders/addiction
The topic of any given research study into psilocybin depends on the researcher, of course, but the studies that are most advanced, largest, and well-supported tend to address these issues.
Countries Where Psilocybin Therapy is used
When it comes to enrolling in psychedelic research studies and which countries allow you to do it, there are a few basic factors that control your options:
- the legal status and availability of psilocybin
- the physical location of the organization conducting the study
- in some cases, factors about the patient
Referring to the organizations discussed above in the context of research, most of the ongoing studies are in the UK, the US, or Canada, with a few in Israel as well. But you can also find psilocybin therapy and experiences more readily in the Netherlands, and in Canada for some patients who need palliative care. Australia may also be on the verge of reclassifying psilocybin, and Brazil and Jamaica are also relatively friendly toward psilocybin use.
How to Set Up a Psilocybin Therapy Session
Traditionally, there are three parts to psychedelic-assisted therapy, all centered around the dosing session: preparation, support, and integration. Preparation sessions, which take place before the dosing session, have several important goals:
- Developing therapeutic rapport between therapist and participant
- Collecting patient information and history
- Provide psychoeducation concerning the therapeutic approach to be used, the psychedelic experience, and expectations for the patient
In the psilocybin session itself, the therapist typically provides emotional support and encourages the patient to focus their mind inward and engage with difficult sensations, thoughts, or memories that arise. They also care for the patient’s safety and immediate needs.
The integration phase, which generally starts just one day after the dosing session, involves careful review of the experience. The goal of the review is the reinforcement of particular aspects of the experience through application of therapeutic techniques to foster desirable, sustained patterns of behavior and thought.
Both Mindfulness Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) are well-suited for psychedelic therapy integration in the treatment of MDD. Both focus on a focus on the present moment, acceptance of all that arises in the mind, non-judgmental acceptance of self, and selftranscendence. ACT also explores personal values, the need for values-based action, and the neuroscience and practice behind the development of psychological flexibility. The therapy achieves this through focus on ideas like a flexible experience of the self and present-moment awareness—concepts that psychedelics can enhance.
Furthermore, a range of psychological problems can be linked to psychological inflexibility, including anxiety, depressive, eating, and substance disorders. Avoidance of painful experiences and memories is another issue in treating depression that is a fruitful, synergistic area for psilocybin therapy.
Psilocybin therapists require: at least 5 years of experience treating psychiatric patients in a clinical setting, and an up-to-date license to practice as a psychologist, psychiatrist, psychiatric nurse, or master’s prepared social worker. Other background can also be useful, such as experience conducting cognitive-behavioral and psychodynamic therapies; and experience with altered states of consciousness, including holotropic breathing, hypnosis, mindfulness practices, yoga, and flotation tanks.
Patients should think about their experimental session and prepare as if it is a multi-day experience. Minimize stress, especially the day before, and spend some time in nature if possible. Reduce online time and abstain from spicy, heavy foods, alcohol, and caffeine to prepare for your spiritual experience.
Sample session preparation checklist for the morning of the session:
- Room decor: art and art supplies, flowers, plants, comfort objects, food
- Bed, blankets, sheets, pillow, water-resistant liner in case of incontinence
- Emesis basin
- Music system with ambient speakers
- Lamps and comfortable lighting
- Air purifier
- Monitoring equipment and forms, as needed
- Psilocybin medication
- Rescue medications, if using
After the session, patients should write down anything significant from the session they can remember. Many sense impressions and memories fade rapidly.
Patients should be advised that they should not feel any obligation to be sociable after the session or reveal the details of the experience, even when people who care deeply ask. Patients should limit their discussions of their psilocybin therapy to a trusted few.
To cover the experience in integration, therapists should ask the following questions in their own way:
- The main goal now is to talk about your psilocybin session. We want to learn what you experienced, how the session affected you, and how the session affected your ideas and thinking about your depression/anxiety.
- Please describe everything you remember about your session, from start to finish. What happened? What did you see, feel, or hear? What happened in your body?
- Did you experience anything challenging or difficult? Did you experience any periods of depression, fear, sadness, terror, or other negative emotions? Did you see or hear things that were hard to take? Have any of these gotten worse or persisted?
- What have you been feeling and thinking since the session? Is there anything different about your usual anxious or depressive attitudes, beliefs, thoughts, or emotions?
- How have you been sleeping, drinking, and eating since your session? How did it feel interacting with family and friends since your session? What was it like returning here?
- How are you feeling emotionally today?
Final Thoughts on Psilocybin Therapy
Once dismissed or feared as the risky amusements of a poorly understood counterculture, psychedelics are forging ahead, gaining mainstream medical acceptance as cannabis once did. Several American cities have decriminalized psilocybin for therapeutic purposes. With institutions such as Johns Hopkins University, Imperial College, and NYU fueling the push and providing positive research, it seems likely that this trend will continue.
Various promising studies suggest psilocybin can be safely administered to patients with psychological problems that are difficult to treat, such as anorexia nervosa, post-traumatic stress disorder (PTSD), major depressive disorder, and alcohol-use disorder and other addictions.
At that point, regulators will just need to decide whether this life-changing treatment should be available with or without a prescription.
The financial, emotional, and social costs of debilitating mental-health disorders are in the billions worldwide. Psychedelic-assisted psychotherapy may offer much-needed treatment options for many, even as they open up a new set of challenges for regulators.
Unlike most psychiatric drugs that we use to treat anxiety and depression now, which can technically be used without much supervision, psilocybin treatment is a high-effort endeavor you can’t just pick up down at the neighborhood pharmacy. You need the eyes of a trained therapist, plenty of follow-up, and the right setting to make it work—which is another reason this complex therapy may face challenges in our push-button medical system.