THE PSYCHOTHERAPEUTIC POINT OF VIEW OF PSYCHEDELIC-ASSISTED TREATMENT

The psychotherapeutic setting offers a highly controllable and supportive environment that most likely differs from the patient's other past and present environments. As time passes, the patient regularly exposed to this therapeutic environment gradually adapts to it. In doing so, it slowly updates its high-level forecasts that were formed in less controllable environments and therefore indicate large uncertainty. Because the therapeutic environment strongly contradicts the rigid prediction of uncontrollability and uncertainty, the sensory prediction error becomes larger and larger. At a certain point, the sensory inputs that signal safety and support can no longer be explained, initiating an updating process.

Psychedelics appear to amplify the restorative effect of real relationships. From a psychological point of view, we have already said that psychedelics tend to increase feelings of connection with the therapist. The socializing effect of MDMA is typical.

Psychedelics (to some extent) give us what we expect to get from them, like a placebo. This is not a new idea. Weil (1972) described psychedelics as a kind of active placebo: while they certainly do something, most of what it is may come from the users themselves.

Grof (2008) argues that “psychedelics function more or less as nonspecific catalysts and amplifiers of the psyche.” Finally, Matthew Johnson, quoted by Pollan (2018) says about psychedelic treatment: “Whatever we are delving into here, it is in the same realm as placebo. But a placebo on a rocket.”

Psychotherapy has also been described as a placebo (open-label). Consequently, we can say that a psychedelic session enhances the placebogenic effects of psychotherapy, making psychedelic-assisted treatment a sort of super placebo.

Psychotherapy (co)defines a patient's set and setting, i.e. his internal and external environment: it induces expectations of repair and provides a safe environment. When the brain enters an anarchic state due to the supposed effects of psychedelics, the bottom-up signals sent from these internal and external environments become more influential. In this way, the patient should be able to transfer the safety and controllability of the therapeutic environment to his own generative model, enhancing the path of the real relationship. Similarly, psychedelics also appear to enhance the expectation pathway.

On the one hand, it is hypothesized that the impact of restorative expectations is less limited by higher-level forecasts. Any positive basic feelings and attitudes a patient may have towards a psychedelic experience tend to be amplified with psychedelics.