Learning to Let Go : A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

Max Wolff, Ricarda Evens, Lea J. Mertens, Michael Koslowski, Felix Betzler, Gerhard Gründer and Henrik Jungaberle

Frontiers in Psychiatry, February 2020 | Volume 11 | Article 5, 1-13.

doi : 10.3389/fpsyt.2020.00005

 

The efficacy of psychedelic-assisted therapies for mental disorders has been attributed to the lasting change from experiential avoidance to acceptance that these treatments appear to facilitate. This article presents a conceptual model that specifies potential psychological mechanisms underlying such change, and that shows substantial parallels between psychedelic therapy and cognitive behavioral therapy: We propose that in the carefully controlled context of psychedelic therapy as applied in contemporary clinical research, psychedelic-induced belief relaxation can increase motivation for acceptance via operant conditioning, thus engendering episodes of relatively avoidance-free exposure to greatly intensified private events. Under these unique learning conditions, relaxed avoidance-related beliefs can be exposed to corrective information and become revised accordingly, which may explain long-term increases in acceptance and corresponding reductions in psychopathology. Open research questions and implications for clinical practice are discussed.

Keywords : psychedelic therapy, cognitive behavioral therapy, avoidance, acceptance, psilocybin, lysergic acid diethylamide, ayahuasca

 

INTRODUCTION

In recent years, several early-phase clinical trials have provided evidence that classic serotonergic psychedelics—in most cases psilocybin, but also lysergic acid diethylamide (LSD) and the dimethyltryptamine (DMT)-containing brew ayahuasca—may occasion substantial and often sustained symptom reductions in patients treated for depression (1–3), psychological distress related to life-threatening illness (4–8), obsessive-compulsive disorder (9), and substance use disorders (10, 12). It has been proposed that psychedelic therapy works by reducing patterns of experiential avoidance and promoting more adaptive acceptance [(13); see below for definitions of these terms]. However, it remains largely unclear how psychedelic therapy may produce such change. Taking the perspective of cognitive behavioral therapy (CBT), and building on the recently proposed relaxed-beliefs account of psychedelics’ acute brain action (14), the present article aims to clarify the psychological mechanisms underlying the acceptance promoting effects of psychedelic therapy. We propose a conceptual model describing how psychedelic-induced belief relaxation, when combined with specific context factors that are typically present in psychedelic therapy, can facilitate the same acceptance-promoting learning process as that targeted by CBT interventions. In the following, we introduce the concepts of avoidance and acceptance, outline how CBT aims to promote acceptance, and review evidence that psychedelic therapy also promotes acceptance. We then briefly introduce the relaxedbeliefs account and, based on this, present our conceptual model of how psychedelic therapy promotes acceptance. This is followed by a discussion of open research questions and implications for clinical practice.

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