Abstract
Background and Aims
Research on psychedelic-assisted therapy (PAT), a promising treatment option for major depression, has not revealed if potential clients show preferences about the demographic characteristics of providers comparable to those common in other forms of psychotherapy. Previous work suggests that honoring comparable client preferences can enhance therapeutic outcomes. This study aims to investigate the importance ratings for a same-gender and a same-race therapist in both cognitive behavioral therapy (CBT) and PAT.
Methods
Participants (N = 635) responded between December 2020 and January 2021 on Amazon's Mechanical Turk crowdsourcing platform. Participants rated the import of provider characteristics, including having a provider who is the same-gender or the same-race, for a CBT therapist and a PAT guide.
Results
Importance ratings for a same-gender practitioner varied by both race and gender; racial and ethnic minority and female participants had the highest importance ratings for a same-gender practitioner. A same-gender CBT therapist was more important than a same-gender PAT guide. Importance ratings for a same-race practitioner did not differ by therapy type or gender and only varied by race; racial and ethnic minority participants rated a same-race practitioner as more important than White participants.
Conclusions
Accommodating client preferences appears important, particularly for members of racial, ethnic, and gender minority groups. A concerted effort to train diverse CBT therapists and PAT guides to meet this demand seems justified.
Introduction
Depression, a significant global health concern, has an increasing prevalence annually (R.D. Goodwin et al., 2022; Moreno-Agostino et al., 2021), with lifetime rates in the United States exceeding 20% (Hasin et al., 2018). Conventional treatments, including pharmacological, psychological, and combined interventions, have meaningful drawbacks. These drawbacks can include medication side-effects, slow onset of improvements, and modest success rates (Cuijpers et al., 2023; Davies & Read, 2019; Earleywine & De Leo, 2020; Edinoff et al., 2021). The shortcomings inspired Psychedelic-Assisted Therapy (PAT), which has focused primarily on those who found first-line treatments for depression ineffective (Carhart-Harris et al., 2018; Ross et al., 2016). PAT offers rapid relief lasting at least several weeks (von Rotz et al., 2023; G.M. Goodwin et al., 2022). The treatment fosters adaptive relational and insightful processes, and facilitates emotional breakthroughs (Penn, Phelps, Rosa, & Watson, 2021; Roseman et al., 2019), while improving cognitive flexibility (Davis, Barrett, & Griffiths, 2020) and neuroplasticity (Calder & Hasler, 2023). Comparable mechanisms appear to underlie PAT-induced improvements of maladaptive substance use (Bogenschutz et al., 2015; Johnson, Garcia-Romeu, Cosimano, & Griffiths, 2014), end-of-life anxiety (Griffiths et al., 2016; Grob et al., 2011; Ross et al., 2016), and Post-Traumatic Stress Disorder (Krediet et al., 2020; Mitchell et al., 2021), with the potential to address a range of other mental health conditions (See La Torre, Mahammadli, Faber, Greenway, & Williams, 2023; Luoma, Chwyl, Bathje, Davis, & Lancelotta, 2020). While researchers have explored various psychedelic compounds such as 3,4-methylenedioxymethamphetamine (MDMA) and ketamine for treating psychological disorders, psilocybin for the treatment of depression has the most extensive and robust empirical support.
As with many mental disorders, depression disproportionately affects racial and ethnic minority (REM) group members in both prevalence and treatment rates. The United States past-year prevalence rate (13.9%) in multiracial adults exceeds the 8.9% rate for White adults (SAMHSA, 2022), potentially stemming from discrimination, socioeconomic challenges, and adverse life events (Bailey, Mokonogho, & Kumar, 2019). Rates of relevant treatment can vary by over 20 percentage points, with REM individuals not receiving interventions exceeding 68% compared to 40% for White individuals (Alegría et al., 2008). Clients report comparable disparities in their quality of their treatment as well (Virnig et al., 2004).
Access, participation, and clinical trials in PAT show the same problem (George, Michaels, Sevelius, & Williams, 2019; Williams, Reed, & George, 2020). Most relevant trials enroll White men primarily, limiting generalization (George et al., 2019), probably stemming from poor understanding symptom expression moderated by culture as well as inadequate recruitment (Williams, Ching, Printz, & Wetterneck, 2018; Williams., Metzger, Leins, & DeLapp, 2018). Impressions of some barriers to treatment might improve when the client and practitioner match on important demographics, including gender, race, and ethnicity. The potential for sharing a view of the world can enhance treatment credibility, perception of improvement, and trust (Weekes et al., 2010). Although estimates of the impact of client-therapist demographic similarity on therapeutic outcomes varies (Cabral & Smith, 2011; Maramba & Nagayama Hall, 2002; Shin et al., 2005; Swift, Callahan, Cooper, & Parkin, 2018), many clients prefer a practitioner of the same race or gender.
The intertwined nature of race and the psychedelic experience buttresses arguments for the inclusion of diverse participants and diversity among practitioners. Race remains a principal component of both set and setting in PAT that might influence the subjective psychedelic experience. Some researchers posit that an individual's racial background and experience of race contribute to a broader cultural context that influences perceptions of subjective drug effects (Neitzke-Spruill, 2020).
When exploring the potential benefits of shared characteristics between a client and a practitioner, the intersection of ethnic identity and gender identity represents an additional, significant aspect to consider. A gender-match might alleviate some fear of sexual or other abuse during therapy in the face of documented abuse in clinical trials (McNamee, Devenot, & Buisson, 2023). A desire for shared characteristics with one's guide during a psychedelic experience seems unsurprising, yet research into this topic remains scant.
Existing research has primarily explored client preferences within conventional therapies, such as Cognitive Behavioral Therapy (CBT), leaving preferences in PAT understudied. This study aims to investigate importance ratings for a same-gender and a same-race therapist in CBT compared to PAT. We hypothesize that participants will deem engagement with a practitioner sharing their demographics as crucial, regardless of therapy type. We hypothesized that matching gender and ethnic group might be particularly important for women and REM participants, as previous work has suggested.
Methods
Participants
We recruited 1,489 participants from Amazon's Mechanical Turk (MTurk) crowdsourcing platform between December 2020 and January 2021. Our focus on psilocybin treatment for depression informed our participant selection process. To qualify for participation in the survey, prospective participants must have scored a four or above on the Center for Epidemiological Studies-Depression scale (CES-D; Andersen, Malmgren, Carter, & Patrick, 1994), indicating depressive symptoms. We included several attention checks throughout the survey to ensure validity. These included multiple choice questions designed to assess a clear understanding of the treatments described. Our final analyses did not include those who failed any attention checks (n = 677). Comparable problems with attention have appeared in MTurk samples in other work (Ophir, Sisso, Asterhan, Tikochinski, & Reichart, 2019). We also dropped 177 participants who withdrew from the study early. A final total of 635 participants provided data, though missing values altered degrees of freedom for some analyses.
See Table 1 for demographic characteristics of the sample. Participants' ages ranged between 18 and 77 years (M = 34.84; SD = 11.5). The sample was gender-balanced, with 54% of participants identifying as female and 44% identifying as male. Most participants identified as White (56.9%), followed by 21.7% who identified as Asian, 9.4% as Latinx, 8.1% as African or Caribbean, 2.7% as multiracial, and 1.0% as Native American. Participants who declined to answer made up 0.02% of the sample. Participants reported their current racial and ethnic identities to the question, “What is your race?” Answer options included “Asian”, “Native American,” “African or Caribbean,” and “White”. In addition, participants were able to choose “Multiracial,” “Latinx,” and a write-in option for their racial identity. Existing literature suggests that separating race and ethnicity, particularly for those with Hispanic or Latino origins, is problematic, outdated, and leads to poorer differential non-response rates to questions of race (Porter & Snipp, 2018). Most participants received education past high school (79.3%). A sample of primarily White and highly educated participants is in line with previous critiques of the representativeness of crowdsourcing platforms (Chandler & Shapiro, 2016). As crowdsourcing platforms become an increasingly common method for recruitment among online survey studies, it is important to take steps to ensure an adequately diverse and representative sample for the study question at hand. Newer platforms, including Prolific, offer demographic screeners and selection methods that might be helpful to consider for future studies. Nevertheless, data quality from crowdsourcing platforms meets psychometric standards associated with published research (Buhrmester, Kwang, & Gosling, 2011).
Demographics
| Sample (N = 635) | |
| Mean age (SD) | 34.84 (11.5) |
| % Female | 54.0% |
| % White | 56.9% |
| % REM | 42.9% |
| % Asian | 21.7% |
| % Latinx | 9.4% |
| % African or Caribbean | 8.1% |
| % Multiracial | 2.7% |
| % Native American | 1.0% |
| Hallucinogen use | |
| Psilocybin (yes) | 22.3% |
| Other hallucinogen (yes) | 27.3% |
Procedures
A local university Institutional Review Board approved all study procedures. Study materials, including treatment vignettes, appear in the appendices. Participants began the study by answering questions about their demographic characteristics and any symptoms of depression they experienced. Following this, participants read two brief vignettes (about 300 words each) about CBT and PAT (counterbalanced). Participants then rated the importance of therapist and guide characteristics, including being the same gender or race as them.
Measures
Hallucinogen use
Participants responded “yes”, “no”, or “prefer not to say” to questions about their hallucinogen use related to psilocybin or other psychedelics. Participants reported psilocybin use (22.3% “yes”) and 27.3% reported other hallucinogen use (“yes”) at approximately equal rates. We grouped those who chose “prefer not to say” (2.4% for psilocybin and 1.3% for others) into the “no” category given the base rate of use in the sample and population. (Changing these groupings to “yes” had no appreciable impact on correlations with other variables.) The rate of psilocybin use among participants in this study exceeds the U.S. national average rate for past-year hallucinogen use, which is approximately 9.3% (SAMHSA, 2022).
PAT guide and CBT therapist characteristics
Participants read descriptions of PAT and CBT (see Appendices A and B). PAT and CBT descriptions appeared in counterbalanced and randomized order. Participants then rated the importance of a gender and race match (“If you were depressed and wanted to try this treatment, how important would it be to you that the guides/therapist had…1) the same gender identity as you? 2) the same race as you?”). Participants responded on a scale of 0 (Not at all important) to 100 (Extremely important). Participants also rated the importance of other guide or therapist characteristics not addressed here (see Earleywine et al., 2022 for a full description).
Results
Analytic plan
Skews exceeded acceptable levels |1.00| for all importance ratings, but responded well to square root transformations, which decreased them below |0.80|, thus permitting parametric analyses (Osborne, 2007). Importance ratings for a same-gender practitioner violated Mauchly's test of sphericity, so we report the Greenhouse-Geisser corrections for the related analyses. To keep Type I error rates reasonable, we considered results significant only at the p < 0.001 level for hypothesis tests. Marital status, education level, previous therapy experience, and lifetime hallucinogen use were covariates for all analyses. Given the low percentage of participants who comprised separate racial and ethnic group categories (i.e., Asian, Latinx, African or Caribbean, multiracial, and Native American), we collapsed groups to form a REM group to achieve the statistical power necessary to detect significant results in ratings that might vary with ethnic group. For illustrative purposes, we also analyzed each ethnic group's unique influence on preference ratings for a same-gender or a same-race practitioner.
Missing data
Recent advancements in missing data imputation have notably influenced psychedelic research (see Anderson et al., 2020; Hutten et al., 2020). Little's MCAR (Missing Completely At Random) test provided significant results (99.55(65), p < 0.004), implying that our data might not be missing completely at random (MCAR). This significant result is a common occurrence in larger samples, however, where even minor irregularities become significant due to the high power (refer to Van Buuren, 2018 for more detail). Participant ratings of import for a practitioner's same race recorded the highest missing value rate (n = 67 or 10.1% for CBT, and n = 64 or 9.3% for PAT), but missingness did not covary significantly with gender or ethnic group. We addressed this issue using the Expectancy-Maximization (EM) algorithm in SPSS (as suggested by Little & Rubin, 1987) to estimate the missing values for the reported statistics here. The overall pattern of significance remained consistent even in analyses that did not use these substituted values, despite the loss of degrees of freedom. T-tests comparing those with estimated values to the others showed no significant differences. In short, missing data did not seem to contribute to the effects identified here.
Preferences for a same-gender practitioner
See Table 2 for means and effect sizes based on covariate adjusted and transformed mean importance ratings for a same-gender practitioner for CBT and PAT by gender and race. With collapsed racial and ethnic (REM) and gender groups, the importance of a same-gender practitioner varied with participants' race (F(1,623) = 14.392, p < 0.001) and gender (F(1,623) = 20.019, p < 0.001), but the interaction did not reach significance (F(1,623) = 0.236, p = 0.627). REM participants preferred a same-gender CBT therapist more than a same-gender PAT guide. REM participants had a stronger preference than White participants for a same-gender practitioner across both treatment types. Females preferred a same-gender CBT therapist more than a same-gender PAT guide. Females had a stronger preference than males did for a same-gender practitioner, regardless of treatment type. Notably, mean importance scores for the two types of therapy differed significantly (F(1,623) = 10.202, p = 0.001), indicating that the importance of a same-gender practitioner depended on the type of therapy. A same-gender CBT therapist was more important to participants than a same-gender PAT guide.
Preferences for a same-gender practitioner
| Group | N | Ma | Mb | SDc | d | |
| CBT | White vs. REM males | 263 | 3.320 | 4.253 | 3.144 | −0.297 |
| White vs. REM females | 368 | 4.430 | 5.832 | 3.503 | −0.400 | |
| PAT | White vs. REM males | 263 | 3.209 | 4.065 | 3.130 | −0.274 |
| White vs. REM females | 368 | 4.221 | 5.072 | 3.527 | −0.241 |
a Covariate adjusted and square root transformed mean importance ratings for first group.
b Covariate adjusted and square root transformed mean importance ratings for second group.
c Pooled standard deviations.
Further analyses suggested that members of specific racial or ethnic backgrounds show a stronger preference for a same-gender practitioner compared to others. Figure 1 illustrates transformed and standard errors for each racial or ethnic group in both conditions. Importance ratings for a same-gender practitioner from Asian or African or Caribbean participants are noticeably and significantly higher than those from White, Latinx, or multiracial backgrounds. Effect sizes support the unique contribution of participants of Asian or African American or Caribbean descent in importance ratings for a same-gender practitioner. Asian participants' mean importance ratings for a same-gender practitioner were significantly different from those of White (Cohen's d = −0.405) and multiracial (Cohen's d = 0.493) participants in the CBT condition, and from White (Cohen's d = −0.405), African or Caribbean (Cohen's d = −0.241), and multiracial (Cohen's d = 0.459) participants in the PAT condition. African or Caribbean participants' mean importance ratings for a same-gender practitioner were significantly different from those of multiracial (Cohen's d = 0.733) and White (Cohen's d = −0.592) participants in the CBT condition, and from Asian (Cohen's d = −0.241) participants in the PAT condition. See Table 3 for all significant effect sizes.
Preferences for a Same-Gender Practitioner at the Individual Ethnic Group Level. Square root transformed mean importance ratings with standard error bars for a same-gender practitioner for both CBT and PAT
Citation: Journal of Psychedelic Studies 8, 3; 10.1556/2054.2024.00334
Significant effect sizes between individual racial or ethnic groups for ratings of a same-gender CBT or PAT practitioner
| Group | N | Ma | Mb | SDc | d | |
| CBT | White vs. African or Caribbean | 435 | 4.034 | 6.085 | 3.463 | −0.592 |
| White vs. Asian | 501 | 4.034 | 5.443 | 3.478 | −0.405 | |
| African or Caribbean vs. Multiracial | 99 | 6.085 | 3.819 | 3.091 | 0.733 | |
| Asian vs. Multiracial | 165 | 5.443 | 3.819 | 3.296 | 0.493 | |
| PAT | White vs. Asian | 501 | 3.835 | 5.234 | 3.459 | −0.405 |
| African or Caribbean vs. Asian | 174 | 4.362 | 5.234 | 3.617 | −0.241 | |
| Asian vs. Multiracial | 165 | 5.234 | 3.748 | 3.239 | 0.459 |
a Covariate adjusted and square root transformed mean importance ratings for first group.
b Covariate adjusted and square root transformed mean importance ratings for second group.
Preferences for a same-race practitioner
Unlike preference for a same-gender practitioner, therapy type did not affect how important participants rated a same-race therapist or guide (F(1,627) = 4.322, p = 0.038). Males and females also did not differ in how important they rated a same-race practitioner (F(1,627) = 0.082, p = 0.775). Given these results, we collapsed across gender and therapy type to examine the difference between REM participants' and White participants' importance ratings for a practitioner of the same race. REM participants and White participants differed in how important they rated a same-race practitioner (F(1,627) = 34.088, p < 0.001). A preference for a same-race practitioner significantly differed between racial groups REM participants rated a same-race practitioner as more important than White participants (F(1,627) = 34.088, p < 0.001). Please see Table 4 for covariate-adjusted and transformed means and effect sizes.
Preferences for a same-race practitioner
| Group | N | Ma | Mb | SDc | d |
| White vs. REM | 631 | 3.999 | 5.329 | 5.181 | −0.257 |
a Covariate adjusted and square root transformed mean importance rating for first group.
b Covariate adjusted and square root transformed mean importance rating for second group.
c Pooled standard deviations.
Between-group analyses revealed similar results for importance ratings of a same-race CBT or PAT practitioner (see Fig. 2 for transformed means and standard errors). Differences between White and REM individuals (when racial and ethnic groups are collapsed) ratings for a same-race CBT and PAT practitioner are largely driven by Asian participants' desires for a same-race practitioner. African or Caribbean participants' importance ratings are also noticeably disparate from ratings from other ethnic groups. Effect sizes provide support for the significant differences between mean same-race importance ratings from Asian and African or Caribbean participants compared to other groups (see Table 5 for significant effect sizes). Asian participants mean importance ratings were significantly different from White (Cohen's d = −0.766, p < 0.001) and multiracial (Cohen's d = 0.499, p < 0.001) participants when rating a same-race CBT practitioner and from White (Cohen's d = −0.730, p < 0.001), multiracial (Cohen's d = 0.503, p < 0.001), and African or Caribbean (Cohen's d = −0.600, p < 0.001) participants' ratings of a same-race PAT practitioner.
Preferences for a Same-Race Practitioner at the Individual Ethnic Group Level. Square root transformed mean importance ratings with standard error bars for a same-race practitioner for both CBT and PAT
Citation: Journal of Psychedelic Studies 8, 3; 10.1556/2054.2024.00334
Significant effect sizes between individual racial or ethnic groups for ratings of a same-race CBT or PAT practitioner
| Group | N | Ma | Mb | SDc | d | |
| CBT | White vs. Asian | 501 | 2.748 | 5.115 | 3.092 | −0.766 |
| Asian vs. Multiracial | 165 | 5.115 | 3.470 | 3.300 | 0.499 | |
| PAT | White vs. Asian | 501 | 2.684 | 4.924 | 3.066 | −0.730 |
| African or Caribbean vs. Asian | 174 | 2.892 | 4.924 | 3.389 | −0.600 | |
| Asian vs. Multiracial | 165 | 4.924 | 3.340 | 3.149 | 0.503 |
a Covariate adjusted and square root transformed mean importance ratings for first group.
b Covariate adjusted and square root transformed mean importance ratings for second group.
Discussion
Previous psychotherapy research suggests that client preferences for a practitioner who is the same gender or race can impact treatment outcomes, particularly when clients present with anxiety or depression. Clients who receive their preferred therapist are less likely to drop out; they also report a better experience and show greater improvements (Constantino, Boswell, & Coyne, 2021; Swift et al., 2018). Although recognized factors like psychological mindset (i.e., “set”) and environment (i.e., “setting”) shape PAT outcomes (see Leary, Metzner, & Alpert, 1964; Metzner, 1998), scant research scrutinizes the impact of client preferences for a same-gender or same-race PAT guide. Our current study aimed to understand how preferences for a same-gender or same-race practitioner might vary between CBT and PAT, and whether effects varied with the participant's gender or race. Generally, women and REM participants preferred practitioners who matched their gender, especially for CBT. In addition, REM participants' ratings of the import of a same-race practitioner exceeded those ratings of importance from White participants, regardless of therapy or their own gender.
Participants' gender influenced the importance they assigned to a same-gender practitioner, across both therapy types. Women considered having a same-gender CBT therapist or PAT guide more important than males did. Our results align with previous psychotherapy research, which suggests a preference for a female practitioner among female clients and no preference, or a preference for a female practitioner, among male clients (Pikus & Heavey, 1996). Other findings varied. For example, previous work suggested that most clients do not express a preference for the gender of their therapist, but those who did report one favored a female practitioner (Liddon, Kingerlee, & Barry, 2018). Clients might feel more comfortable talking about problems to a practitioner who is their same sex. They might also express a desire for traits often associated with stereotypes of females, such as warmth, or understanding emotions well (Liddon et al., 2018; Pikus & Heavey, 1996).
Participants' race also influenced the importance that they assigned to a same-gender practitioner. REM participants displayed a more robust preference for a same-gender practitioner in both CBT and PAT contexts. All participant groups, regardless of gender or race, deemed a same-gender CBT therapist more crucial than a same-gender PAT guide. Psychedelic experiences, being intrapersonal by nature, could lead clients to assign greater value to a practitioner's psychedelic experience over demographic factors like gender (Earleywine, Low, Altman, & De Leo, 2022). Clients might value other qualities like presence, trustworthiness, and empathy in a PAT guide (Thal, Engel, & Bright, 2022) more than a gender or racial match. Furthermore, the difference in treatment duration could play a role in why the importance of a same-gender PAT guide did not score as high as a same-gender CBT therapist. With 12 to 20 weekly sessions, the CBT treatment course described to participants in our study was longer than PAT's two sessions. With fewer meetings and a brief relationship with a PAT guide, the importance of gender matching might diminish. Only further work can disentangle these potential causes of the effect. Other findings related to importance ratings for gender dovetail with previous work. Compared to members of other races, participants of Asian and African/Caribbean descent rated the import of a same-gender practitioner significantly higher for both treatments. The results for Asian participants underscores other findings revealing that individuals of Asian descent use psychedelics at a substantial rate, often to contend with racial discrimination and trauma (Ching, Davis, Xin, & Williams, 2023). A shared background might assuage client's apprehension around addressing and discussing racial trauma in therapy.
Effects related to a same-race practitioner were more straightforward, with only race contributing to ratings of importance. Participants did not show significant differences in the importance of having a same-race practitioner across therapy types, indicating that having a same-race CBT therapist was equally as vital as having a same-race PAT guide. The importance ratings from males and females were also similar. Consequently, we merged across these factors to examine the significant effects of race. Both male and female REM participants deemed a same-race practitioner more important than White participants did. These results align with previous research that revealed that participants of Black or African American descent had a stronger preference for same-race therapist compared to Asian/Asian American, Latinx, and White participants (Ilagan & Heatherington, 2022). Participants in that study who strongly identified with their culture also showed a strong preference for a therapist who is the same race. The size of our sample prevented comparable comparisons with adequate statistical power, but this finding supports efforts at replication and extension with large, diverse samples or targeted looks at specific ethnic groups.
Other limitations suggest directions for future work. Demographic over-representativeness (i.e., White, highly educated) and potentially heightened rates of depression in Amazon MTurk workers (Arditte, Cek, Shaw, & Timpano, 2016; McCredie & Morey, 2019; Ophir et al., 2019; Walters, Christakis, & Wright, 2018) limit current generalizability. A larger, more diverse sample would permit robust between-group analyses of importance ratings for same-gender and same-race practitioners. Preliminary findings pertaining to specific racial and ethnic group members' desire for a same-gender or same-race mental health practitioner underscore the need for future research to feature large, diverse samples. Community engagement and collaboration, as well as targeted, culturally inclusive recruitment materials would likely lead to a more diverse sample (Waheed, Hughes-Morley, Woodham, Allen, & Bower, 2015). Refining our categorization of race and including more nuanced categories would have benefitted this research. Research efforts including more racial categories will yield valuable information about client preferences for providers pertaining to between- and within-racial differences and how specific a provider's background must be to meet their preference. Research efforts directed at elucidating client preferences within a specific racial group might also be an alternative path forward. Further, efforts to keep the treatment descriptions brief sacrificed exhaustiveness. Descriptions did not include potentially relevant details including cost, practitioner and treatment availability, as well as all potential risks. Ratings likely differ based on the provided details about each treatment. Both the extant literature and the current results shed light on an apparent preference for similar practitioners, yet the association between therapist-client similarity and psychotherapy treatment outcomes remains unclear (Flaskerud, 1990; Herman, 1998). The current study's novelty stems from the exploration of gender and racial matching in PAT, supporting future studies linking client preferences to outcomes in psychedelic-assisted interventions. The results also underscore the need to train more diverse PAT therapists.
To harness these findings for clinical application, a range of practitioners with a rich diversity of ethnic and gender backgrounds is essential. Most participants and researchers in psychedelic medicine are White. A limited subset of practitioners of color exists to meet the demands of diverse clients who likely prefer a therapist who shares their background (Buchanan, 2021). Racial factors influence set and setting, and race-related themes and trauma frequently emerge in PAT (Ching, 2019; Neitzke-Spruill, 2020; Williams et al., 2020). Participants might feel more comfortable discussing topics like race or gender if their therapist or guide shared their background and worldview (Ching, 2019). Apart from subjective comfort levels, clients seeing practitioners of the same ethnic or racial background might have a meaningfully reduced risk of harm and retraumatization (Michaels, Purdon, Collins, & Williams, 2018; Smith, Faber, Buchanan, Foster, & Green, 2022); Client fears of practitioner dismissiveness when discussing the impact of racial trauma are not unfounded; a practitioner who lacks the essential cultural competencies brings a heightened risk of harm.
Considering the intersection of race and gender identity is essential as it contributes to significant variation in lived experiences; A focus on race or gender alone ignores the impact of different forms of oppression (Crenshaw, 1989). The interaction between race and gender contributes to an individual's societal position, and the traumas they might endure. For instance, a Latino male client might fear discrimination or cultural incompetency from their provider, while a Latina female client might also fear sexual abuse or perpetuated misogyny. Shared intersectional identities can lead to a more accurate understanding of clients' lived experiences and decrease the perception of an unequal position of privilege between client and provider, thereby enhancing the therapeutic alliance (PettyJohn, Tseng, & Blow, 2020).
But a shared background alone is insufficient for providing culturally competent care. Proper training is essential. When clients are in an altered state of consciousness, such as during PAT, they are uniquely vulnerable. Components of set and setting, namely physical and emotional safety, become increasingly salient (Buchanan, 2021; Ching, 2019). With proper training, PAT guides and therapists can create a safe environment to ensure clients receive the most benefit from treatment, but this task can require considerable effort and attention from individual clinicians and the whole field. At the individual level, clinicians are responsible for ensuring their own cultural competencies, which includes adhering to the bounds of competency and addressing biases that can cause harm (Michaels et al., 2018; Smith et al., 2022). The identification and culturally sensitive exploration of topics related to race or gender need thoughtful approaches for maximizing PAT's impact without the risk of causing further harm (Buchanan, 2021; Williams et al., 2020). A concerted effort to train diverse psychedelic researchers and therapists is a crucial step toward the ethical practice of PAT (George et al., 2019). Funding organizations (e.g., Multidisciplinary Association of Psychedelic Studies (MAPS)) have started to answer this call (Williams & Leins, 2016). The current data suggest that a world with more diversity in therapists has the potential to create better outcomes for a wider portion of the population.
Funding
The author(s) report there is no funding associated with the work featured in this manuscript. The authors do not report any conflicts of interest.
Disclosure
Data appearing in this manuscript also appeared in previous publication:
Earleywine, M., Low, F., Altman, B.R., & De Leo, J. (2022). How important is a guide who has taken psilocybin in psilocybin-assisted therapy for depression? Journal of Psychoactive Drugs, 55(1), 51–61. The authors acknowledge this in the main text of the manuscript and provide a citation.
References
Alegría, M., Chatterji, P., Wells, K., Cao, Z., Chen, C., Takeuchi, D., & Meng, X. L. (2008). Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatric Services, 59(11), 1264–1272. https://doi.org/10.1176/ps.2008.59.11.1264.
Andersen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D. American Journal of Preventive Medicine, 10(2), 77–84. https://doi.org/10.1016/S0749-3797(18)30622-6.
Anderson, B. T., Danforth, A., Daroff, P. R., Stauffer, C., Ekman, E., Agin-Liebes, G., … Woolley, J. (2020). Psilocybin-assisted group therapy for demoralized older long-term AIDS survivor men: An open-label safety and feasibility pilot study. EClinicalMedicine, 27, 100538. https://doi.org/10.1016/j.eclinm.2020.100538.
Arditte, K. A., Cek, D., Shaw, A. M., & Timpano, K. R. (2016). The importance of assessing clinical phenomena in mechanical turk research. Psychological Assessment, 28(6), 684–691. https://doi.org/10.1037/pas0000217.
Bailey, R. K., Mokonogho, J., & Kumar, A. (2019). Racial and ethnic differences in depression: Current perspectives. Neuropsychiatric Disease and Treatment, 15, 603–609. https://doi.org/10.2147/NDT.S128584.
Bogenschutz, M. P., Forcehimes, A. A., Pommy, J. A., Wilcox, C. E., Barbosa, P. C., & Strassman, R. J. (2015). Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study. Journal of Psychopharmacology (Oxford, England), 29, 289–299. https://doi.org/10.1177/0269881114565144.
Buchanan, N. T. (2021). Ensuring the psychedelic renaissance and radical healing reach the Black community: Commentary on culture and psychedelic psychotherapy. Journal of Psychedelic Studies, 4(3), 142–145. https://doi.org/10.1556/2054.2020.00145.
Buhrmester, M., Kwang, T., & Gosling, S. D. (2011). Amazon’s mechanical turk: A new source of inexpensive, yet high-quality, data? Perspectives on Psychological Science: A Journal of the Association for Psychological Science, 6(1), 3–5. https://doi.org/10.1177/1745691610393980.
Cabral, R. R., & Smith, T. B. (2011). Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes. Journal of Counseling Psychology, 58(4), 537–554. https://doi.org/10.1037/a0025266.
Calder, A. E., & Hasler, G. (2023). Towards an understanding of psychedelic-induced neuroplasticity. Neuropsychopharmacology, 48, 104–112. https://doi.org/10.1038/s41386-022-01389-z.
Carhart-Harris, R. L., Bolstridge, M., Day, C. M. J., Rucker, J., Watts, R., Erritzoe, D. E., … Nutt, D. J. (2018). Psilocybin with psychological support for treatment-resistant depression: Six-month follow-up. Psychopharmacology, 235(2), 399–408. https://doi.org/10.1007/s00213-017-4771-x.
Chandler, J., & Shapiro, D. (2016). Conducting clinical research using crowdsourced convenience samples. Annual Review of Clinical Psychology, 12(1), 53–81. https://doi.org/10.1146/annurev-clinpsy-021815-093623.
Ching, T. H. W. (2019). Intersectional insights from an MDMA-assisted psychotherapy training trial: An open letter to racial/ethnic and sexual/gender minorities. Journal of Psychedelic Studies, 4(1), 61–68. https://doi.org/10.1556/2054.2019.017.
Ching, T. H. W., Davis, A. K., Xin, Y., & Williams, M. T. (2023). Effects of psychedelic use on racial trauma symptoms and ethnic identity among Asians in North America. Journal of Psychoactive Drugs, 55(1), 19–29. https://doi.org/10.1080/02791072.2022.2025960.
Constantino, M. J., Boswell, J. F., & Coyne, A. E. (2021). Patient, therapist, and relational factors. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change (7th ed., pp. 225–263). New York, NY: John Wiley & Sons.
Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics. The University of Chicago Legal Forum, 1989(1), 138–167.
Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D., & Karyotaki, E. (2023). Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: A comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 22(1), 105–115. https://doi.org/10.1002/wps.21069.
Davies, J., & Read, J. (2019). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors, 97, 111–121. https://doi.org/10.1016/j.addbeh.2018.08.027.
Davis, A. K., Barrett, F. S., & Griffiths, R. R. (2020). Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. Journal of Contextual Behavioral Science, 15, 39–45. https://doi.org/10.1016/j.jcbs.2019.11.004.
Earleywine, M., & De Leo, J. (2020). Psychedelic-assisted psychotherapy for depression: How dire is the need? How could we do it? Journal of Psychedelic Studies, 4(2), 88–92. https://doi.org/10.1556/2054.2020.00134.
Earleywine, M., Low, F., Altman, B. R., & De Leo, J. (2022). How important is a guide who has taken psilocybin in psilocybin-assisted therapy for depression? Journal of Psychoactive Drugs, 55(1), 51–61. https://doi.org/10.1080/02791072.2022.2047842.
Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., … Kaye, A. M. (2021). Selective serotonin reuptake inhibitors and adverse effects: A narrative review. Neurology International, 13(3), 387–401. https://doi.org/10.3390/neurolint13030038.
Flaskerud, J. H. (1990). Matching client and therapist ethnicity, language, and gender: A review of research. Issues in Mental Health Nursing, 11(4), 321–336. https://doi.org/10.3109/01612849009006520.
George, J. R., Michaels, T. I., Sevelius, J., & Williams, M. T. (2019). The psychedelic renaissance and the limitations of a white-dominant medical framework: A call for indigenous and ethnic minority inclusion. Journal of Psychedelic Studies, 4(1), 4–15. https://doi.org/10.1556/2054.2019.015.
Goodwin, G. M., Aaronson, S. T., Alvarez, O., Arden, P. C., Baker, A., Bennett, J. C., … Malievskaia, E. (2022). Single-dose psilocybin for a treatment-resistant episode of major depression. The New England Journal of Medicine, 387(18), 1637–1648. https://doi.org/10.1056/NEJMoa2206443.
Goodwin, R. D., Dierker, L. C., Wu, M., Galea, S., Hoven, C. W., & Weinberger, A. H. (2022). Trends in U.S. depression prevalence from 2015 to 2020: The widening treatment Gap. American Journal of Preventive Medicine, 63(5), 726–733. https://doi.org/10.1016/j.amepre.2022.05.014.
Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D., … Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology (Oxford, England), 30(12), 1181–1197. https://doi.org/10.1177/0269881116675513.
Grob, C. S., Danforth, A. L., Chopra, G. S., Hagerty, M., McKay, C. R., Halberstadt, A. L., & Greer, G. R. (2011). Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer. Archives of General Psychiatry, 68(1), 71–78. https://doi.org/10.1001/archgenpsychiatry.2010.116.
Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018). Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry, 75(4), 336–346. https://doi.org/10.1001/jamapsychiatry.2017.4602.
Herman, S. M. (1998). The relationship between therapist-client modality similarity and psychotherapy outcome. The Journal of Psychotherapy Practice and Research, 7(1), 56–64.
Hutten, N. R. P. W., Mason, N. L., Dolder, P. C., Theunissen, E. L., Holze, F., Liechti, M. E., … Kuypers, K. P. C. (2020). Mood and cognition after administration of low LSD doses in healthy volunteers: A placebo controlled dose-effect finding study. European Neuropsychopharmacology: The Journal of the European College of Neuropsychopharmacology, 41, 81–91. https://doi.org/10.1016/j.euroneuro.2020.10.002.
Ilagan, G. S., & Heatherington, L. (2022). Advancing the understanding of factors that influence client preferences for race and gender matching in psychotherapy. Counselling Psychology Quarterly, 35(3), 694–717. https://doi.org/10.1080/09515070.2021.1960274.
Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P., & Griffiths, R. R. (2014). Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. Journal of Psychopharmacology (Oxford, England), 28(11), 983–992. https://doi.org/10.1177/0269881114548296.
Krediet, E., Bostoen, T., Breeksema, J., van Schagen, A., Passie, T., & Vermetten, E. (2020). Reviewing the potential of psychedelics for the treatment of PTSD. The International Journal of Neuropsychopharmacology, 23(6), 385–400. https://doi.org/10.1093/ijnp/pyaa018.
La Torre, J. T., Mahammadli, M., Faber, S. C., Greenway, K. T., & Williams, M. T. (2023). Expert opinion on psychedelic-assisted psychotherapy for people with psychopathological psychotic experiences and psychotic disorders. International Journal of Mental Health and Addiction, 1–25. https://doi.org/10.1007/s11469-023-01149-0.
Leary, T., Metzner, R., & Alpert, R. (1964). The psychedelic experience: A manual based on the Tibetan book of the dead (New Hyde). Park, NY: University Books.
Liddon, L., Kingerlee, R., & Barry, J. A. (2018). Gender differences in preferences for psychological treatment, coping strategies, and triggers to help-seeking. British Journal of Clinical Psychology, 57(1), 42–58. https://doi.org/10.1111/bjc.12147.
Little, R. J. A., & Rubin, D. B. (1987). Statistical analysis with missing data. New York, NY: John Wiley & Sons.
Luoma, J. B., Chwyl, C., Bathje, G. J., Davis, A. K., & Lancelotta, R. (2020). A meta-analysis of placebo-controlled trials of psychedelic-assisted therapy. Journal of Psychoactive Drugs, 52(4), 289–299. https://doi.org/10.1080/02791072.2020.1769878.
Maramba, G. G., & Nagayama Hall, G. C. (2002). Meta-analyses of ethnic match as a predictor of dropout, utilization, and level of functioning. Cultural Diversity & Ethnic Minority Psychology, 8(3), 290–297. https://doi.org/10.1037/1099-9809.8.3.290.
McCredie, M. N., & Morey, L. C. (2019). Who are the turkers? A characterization of MTurk workers using the personality assessment inventory. Assessment, 26(5), 759–766. https://doi.org/10.1177/1073191118760709.
McNamee, S., Devenot, N., & Buisson, M. (2023). Studying harms is key to improving psychedelic-assisted therapy-participants call for changes to research landscape. JAMA Psychiatry, 80(5), 411–412. https://doi.org/10.1001/jamapsychiatry.2023.0099.
Metzner, R. (1998). Hallucinogenic drugs and plants in psychotherapy and shamanism. Journal of Psychoactive Drugs, 30(4), 333–341. https://doi.org/10.1080/02791072.1998.10399709.
Michaels, T. I., Purdon, J., Collins, A., & Williams, M. T. (2018). Inclusion of people of color in psychedelic-assisted psychotherapy: A review of the literature. BMC Psychiatry, 18, 245. https://doi.org/10.1186/s12888-018-1824-6.
Mitchell, J. M., Bogenschutz, M., Lilienstein, A., Harrison, C., Kleiman, S., Parker-Guilbert, K., … Doblin, R. (2021). MDMA-assisted therapy for severe PTSD: A randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine, 27(6), 1025–1033. https://doi.org/10.1038/s41591-021-01336-3.
Moreno-Agostino, D., Wu, Y. T., Daskalopoulou, C., Hasan, M. T., Huisman, M., & Prina, M. (2021). Global trends in the prevalence and incidence of depression: A systematic review and meta-analysis. Journal of Affective Disorders, 281, 235–243. https://doi.org/10.1016/j.jad.2020.12.035.
Neitzke-Spruill, L. (2020). Race as a component of set and setting: How experiences of race can influence psychedelic experiences. Journal of Psychedelic Studies, 4(1), 51–60. https://doi.org/10.1556/2054.2019.022.
Ophir, Y., Sisso, I., Asterhan, C. S. C., Tikochinski, R., & Reichart, R. (2019). The Turker blues: Hidden factors behind increased depression rates among Amazon’s Mechanical Turkers. Clinical Psychological Science, 8, 65–83. https://doi.org/10.1177/2167702619865973.
Osborne, J. W. (2007). Best practices in quantitative methods. Thousand Oaks, CA: Sage Publications.
Penn, A. D., Phelps, J., Rosa, W. E., & Watson, J. (2021). Psychedelic-assisted psychotherapy practices and human caring science: Toward a care-informed model of treatment. Journal of Humanistic Psychology. https://doi.org/10.1177/00221678211011013.
PettyJohn, M. E., Tseng, C. F., & Blow, A. J. (2020). Therapeutic utility of discussing therapist/client intersectionality in treatment: When and how? Family Process, 59(2), 313–327. https://doi.org/10.1111/famp.12471.
Pikus, C. F., & Heavey, C. L. (1996). Client preferences for therapist gender. Journal of College Student Psychotherapy, 10(4), 35–43. https://doi.org/10.1300/J035v10n04_05.
Porter, S. R., & Snipp, C. M. (2018). Measuring hispanic origin: Reflections on hispanic race reporting. The ANNALS of the American Academy of Political and Social Science, 677(1), 140–152. https://doi.org/10.1177/0002716218767384.
Roseman, L., Haijen, E., Idialu-Ikato, K., Kaelen, M., Watts, R., & Carhart-Harris, R. (2019). Emotional breakthrough and psychedelics: Validation of the emotional breakthrough inventory. Journal of Psychopharmacology, 33(9), 1076–1087. https://doi.org/10.1177/0269881119855974.
Ross, S., Bossis, A., Guss, J., Agin-Liebes, G., Malone, T., Cohen, B., & Schmidt, B. L. (2016). Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: A randomized controlled trial. Journal of Psychopharmacology (Oxford, England), 30(12), 1165–1180. https://doi.org/10.1177/0269881116675512.
Shin, S. M., Chow, C., Camacho-Gonsalves, T., Levy, R. J., Allen, I. E., & Leff, H. S. (2005). A meta-analytic review of racial-ethnic matching for African American and Caucasian American clients and clinicians. Journal of Counseling Psychology, 52, 45–56. https://psycnet.apa.org/doi/10.1037/0022-0167.52.1.45.
Smith, D. T., Faber, S. C., Buchanan, N. T., Foster, D., & Green, L. (2022). The need for psychedelic-assisted therapy in the Black community and the burdens of its provision. Frontiers in Psychiatry, 12, 774736. https://doi.org/10.3389/fpsyt.2021.774736.
Substance Abuse and Mental Health Services Administration (2022). 2021 key substance use and mental health indicators. Retrieved from https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report.
Swift, J. K., Callahan, J. L., Cooper, M., & Parkin, S. R. (2018). The impact of accommodating client preference in psychotherapy: A meta-analysis. Journal of Clinical Psychology, 74(11), 1924–1937. https://doi.org/10.1002/jclp.22680.
Thal, S., Engel, L. B., & Bright, S. J. (2022). Presence, trust, and empathy: Preferred characteristics of psychedelic carers. Journal of Humanistic Psychology, 57(5), 1–24. https://doi.org/10.1177/00221678221081380.
Van Buuren, S. (2018). Flexible imputation of missing data. Boca Raton, FL: CRC Press.
Virnig, B., Huang, Z., Lurie, N., Musgrave, D., McBean, A. M., & Dowd, B. (2004). Does Medicare managed care provide equal treatment for mental illness across races? Archives of General Psychiatry, 61(2), 201–205. https://doi.org/10.1001/archpsyc.61.2.201.
von Rotz, R., Schindowski, E. M., Jungwirth, J., Schuldt, A., Rieser, N. M., Zahoranszky, K., & Vollenweider, F. X. (2023). Single-dose psilocybin-assisted therapy in major depressive disorder: A placebo-controlled, double-blind, randomised clinical trial. EClinicalMedicine, 56, 101809. https://doi.org/10.1016/j.eclinm.2022.101809.
Waheed, W., Hughes-Morley, A., Woodham, A., Allen, G., & Bower, P. (2015). Overcoming barriers to recruiting ethnic minorities to mental health research: A typology of recruitment strategies. BMC Psychiatry, 15, 101. https://doi.org/10.1186/s12888-015-0484-z.
Walters, K., Christakis, D. A., & Wright, D. R. (2018). Are Mechanical Turk worker samples representative of health status and health behaviors in the U.S. Plos One, 13(6), e0198835. https://doi.org/10.1371/journal.pone.0198835.
Weekes, J. (2010). Race-matching in psychotherapy: Findings, inconsistencies, and future directions. Graduate Student Journal of Psychology, 12, 8–13. https://doi.org/10.52214/gsjp.v12i.10867.
Williams, M. T., Ching, T. H. W., Printz, D. M. B., & Wetterneck, C. (2018). Assessing PTSD in ethnic and racial minorities: Trauma and racial trauma. Directions in Psychiatry, 38(3), 179–196.
Williams, M. T., & Leins, C. (2016). Race-based trauma: The challenge and promise of MDMA-assisted psychotherapy. Multidisciplinary Association for Psychedelic Studies (MAPS) Bulletin, 26(1), 32–37.
Williams, M. T., Metzger, I. W., Leins, C., & DeLapp, C. (2018). Assessing racial trauma within a DSM–5 framework: The UConn racial/ethnic stress & trauma survey. Practice Innovations, 3(4), 242–260. https://doi.org/10.1037/pri0000076.
Williams, M. T., Reed, S., & George, J. (2020). Culture and psychedelic psychotherapy: Ethnic and racial themes from three Black women therapists. Journal of Psychedelic Studies, 4(3), 125–138. https://doi.org/10.1556/2054.2020.00137.
Appendix A. CBT Treatment Vignette
Cognitive Behavioral Therapy for Depression
Over 150 research studies support cognitive behavior therapy (CBT) for depression. The treatment rests on a key idea: thoughts and actions affect emotions. Generally, people whose thoughts are flexible, realistic, and adaptive report better moods. People are also happier doing activities that they find meaningful and fun. CBT therapists listen attentively to form a good relationship with clients. They then ask clients about their thoughts to help them move from dysfunctional attitudes to more adaptive ones. For example, depressed people might think “Everyone should like me, or I am a failure.” The therapists might ask clients to examine thoughts like this one to establish how adaptive or true they are. They likely ask about alternative perspectives, too. Eventually, clients can find themselves with more flexible, forgiving thoughts. They might think, “I would prefer to have lots of people like me. If some people don't, though, it's not a disaster.”
CBT therapists also focus on actions. Discussions help clients discover their own values. Then, they can plan appropriate tasks for each day. Some clients realize that they need to change what they do and how they spend their time. Eventually, they schedule each week to include leisure time, socializing, and work that they find meaningful. They learn to solve problems, too. Then they tackle essential tasks that they might have been avoiding. They also make sure that they get appropriate amounts of rest. After 12–20 weekly sessions, at least 50–65% of clients improve dramatically. Clients in this therapy consistently do better than others. They are less depressed than clients who get a placebo pill. They improve more than clients who had to wait to start treatment. They also do better than clients who meet weekly with the therapist simply to talk about their feelings. Improvement can last two years or more.
Please answer these items to show you understand the treatment described above.
- (1)CBT for depression focuses on:
- (a)Uncovering childhood traumas
- (b)A client's thoughts
- (c)The interpretation of dreams
- (2)A CBT therapist will likely ask clients about:
- (a)How they view the world
- (b)If they were fed with a bottle
- (c)Allergic reactions to medications
- (3)CBT for depression usually includes
- (a)12–20 weekly sessions
- (b)45-min sessions on 4 days each week
- (c)Aerobic exercise
Appendix B. PAT Treatment Vignette
Psilocybin Treatment for Depression
Several studies suggest that psilocybin, the active ingredient in “magic” mushrooms, can help depression. The substance works in many biological systems. At least one system appears to link to mood. Most medications for depression require small, daily doses. They appear to reach a helpful level in a few weeks. In contrast, psilocybin treatment relies on only a couple of doses. Symptoms improve very quickly.
Treatment begins when clients meet the guides. The guides explain the procedure and answer questions. These meetings help them develop a trusting relationship. Clients learn that they will wear eyeshades during the sessions. They will also listen to music. Guides encourage clients to look inward. They lie down and focus on their experience. Reactions to the psilocybin can be pleasant. They can also be challenging. Guides can offer reassurance and encouragement. Clients report “mystical” experiences after 30–60 min. Those who feel “at one with the universe” tend to improve the most. Clients also report anxious or weepy periods. Sessions last approximately 5 h.
A typical study includes two sessions a couple weeks apart. Clients return for integration sessions. In these sessions, they discuss their experiences. They relay any insights, too. They often discuss their plans for the future. Most clients report at least a 50% decrease in symptoms one week later. Over 50% of the clients no longer qualify for a diagnosis of depression when they report symptoms one month later. Although the research is in its early stages, psilocybin seems to hold a lot of promise.
Please answer these items to show you understand the treatment described above.
Psilocybin treatment for depression focuses on:
- (a)Taking medication daily
- (b)Learning communication skills
- (c)Two five-hour administration sessions
Guides encourage the client to:
- (a)Discuss how they were parented
- (b)Play a distracting game on the phone
- (c)Focus on their internal experience
Support for psilocybin treatment comes from:
- (a)Over 150 published studies of humans
- (b)A handful of promising studies
- (c)Only research on rodents (so far)!
