Blending the Art and Science of Psychedelic-Assisted Therapy
Psychedelic-Assisted Therapy’s Place in the Western World
Over the past two decades, psychedelic-assisted therapy for the treatment of various mental health conditions has become increasingly more prevalent in the Western world. In many ways the use of psychedelics as an innovative treatment in psychiatry has grown out of necessity. As the global mental health crisis continues to worsen, people who have been failed by traditional pharmaceutical drugs or talk therapy are looking for more effective ways to improve their mental health and wellbeing.
While the adoption of psychedelic compounds in psychiatry is relatively new, psychedelic compounds have been investigated by psychiatrists since the 1950s. And, of course for millennia, psychedelic plants have been used in religious and ceremonial environments by indigenous peoples around the globe. Due to the history and evolution of psychedelic medicines in therapeutic settings, a variety of different methodologies have emerged. Referring to the compound and the treatment experience, these different methods have generally categorized as holistic and biomedical.
The question about whether psychedelic-assisted therapies should adhere to a more holistic or more biomedical methodologies is top-of-mind for many in the psychedelic community. Through working relationships with therapists, doctors, and clinicians throughout the world, we at Maya believe that it is essential to understand the nuances between holistic and biomedical approaches to psychedelic medicine, but also to consider how these methodologies could be hybridized to create the best care journey for those in need.
A Holistic Approach
There are many holistic models of healthcare, but generally they are all defined as taking into account the ‘whole person’, including spiritual, mental, intellectual, physical, social, and emotional wellbeing. Many holistic practitioners believe that achieving a balance between these integral parts of one’s being is the goal in the care journey. To this end, healers in this space often use traditional medicines and alternative therapies together to create a more comprehensive protocol for wellness.
Holistic care often depends on a practitioner’s intuition and understanding of their client’s full health picture, taking into consideration family history and any trauma that they may have experienced. This applies to psychedelic medicine as well. In fact, according to the MAPS-MDMA protocol for treating PTSD, psychedelic-assisted therapy practices should operate on an “inner healer directive” in which “It is essential to encourage the participant to trust their inner healing intelligence, which is a person’s innate capacity to heal the wounds of trauma. It is important to highlight the fact that the participant is the source of their own healing.”
This suggested approach to psychedelic therapy hinges on the intuition of the therapist and their comprehensive understanding of their client as a whole person. The therapist discerns when to intervene and how to allow the person’s “innate capacity” to heal themselves. They decide when to engage in complementary and alternative medicines within their protocols and for how long. Decisions regarding protocols, doses, compounds, etc. vary depending on their assessment of the whole person, including personal history, along with spiritual, physical, mental, and emotional health.
One of the most critical pieces of a holistic psychedelic-therapy journey includes an integration protocol, so that people can apply what they have learned from their psychedelic experience into their daily lives. According to Dr. Ingmar Gorman, “Individuals who have had difficult experiences can benefit from a better understanding of the often-challenging feelings stirred up by psychedelics; while those who have found the use of psychedelics to be a positive method of gaining insight can use supportive therapy to bolster and integrate that knowledge into their daily lives.”
Ultimately the power of a holistic approach to psychedelic medicine is that it seeks to both understand the person as a complex and multi-layered being, and simultaneously unveil the systemic causes of imbalance. Once root causes come to light, practitioners can address them according to their expertise, training, and intuition. This is one of the most marked differences between a holistic and biomedical approach to psychedelic therapy.
Although conventional medicine depends on scientific trials, data and research, the world of holistic healthcare and alternative therapies (including psychedelic therapy) still lack the kind of measurement-based support they deserve. While intuition and qualitative observations have intrinsic value, the field of psychedelic therapy could be accelerated by generating the kind of clinical data found in the more conventional biomedical space.
A Biomedical Approach
For the past century, most Western medicine has operated from a biomedical approach. According to the classic definition of biomedicine, “medical doctors and other healthcare professionals… treat symptoms and diseases using drugs, radiation, or surgery.” A biomedical approach to mental health typically operates under the assumption that “mental disorders are brain diseases and emphasizes pharmacological treatment to target presumed biological abnormalities.” As compared to holistic care, the biomedical model is typically focused on targeted treatment and a textbook diagnosis.
When applied to psychedelic medicine, a biomedical approach often overlooks the spiritual and intuitive portion of the therapeutic protocol, which is absolutely essential for a comprehensive care journey. However, a more targeted approach to psychedelic medicine can also be more cost-effective as a business model. This may be why we are seeing an upsurge in Ketamine infusion clinics in which there little to no “assisted-therapy” in the treatment protocol. Of course, much gets lost in these solely biomedical transactions, most notably the sustained support of a licensed clinical therapist throughout the journey into integration. However, more long-term research is needed to truly understand the different health outcomes that result from Ketamine infusion versus Ketamine-assisted therapy clinics.
It might seem easy to condemn a biomedical approach when applied to psychedelic therapy, but there are many factors to consider. Firstly, it is important to note that historically, biomedicine came to rise in the nineteenth century as it became required for healthcare workers to receive university-level medical training. It was at this time that labs were also established to ramp up medical research and empirical studies.
Biomedicine has produced empirically supported treatments for a variety of mental health disorders, which have proven effective for some people. And, until very recently, this approach was the primary and in many cases the only way for some people to address mental health concerns. Perhaps most importantly, the biomedical approach to healthcare emphasizes scientific research and data collection, which has led us to understand different mental health conditions more thoroughly and to evolve treatments along the way.
A Hybridized Approach
As of 2021, our perspective on this topic is informed by the gift of hindsight. We can assess what has worked well in biomedicine and conventional psychiatry as well as the benefits of holistic and alternative medicine. Instead of choosing between a holistic or biomedical approach, we at Maya believe that a hybridized approach is best for practitioners, their clients and patients, and the psychedelic healthcare movement at-large.
What if psychedelic-assisted therapy could be rooted in a whole-person approach of holistic care, while being supported by the type research and data found in the world of biomedicine?
This hybridized approach could provide the evidence needed to advance psychedelic therapy medically, politically, and culturally. An emphasis on data collection would also ensure that practitioners have the insights they need to determine best practices, so they can provide optimal care for those in need. And, perhaps most urgently, real-world evidence for the safety and efficacy of psychedelic treatments can help us avoid a recurrence of the politicized propaganda that reversed so much progress in this field in the mid-20th century. While this concept might be novel when applied to the field of psychedelic therapy, a hybridized model of healthcare isn’t new to the medical world.
Beginning in the 1960’s, American psychiatrist George Engel began publishing a series of papers questioning the biomedical model. Instead, he argued that the “biopsychosocial” approach should take into account the somatic, emotional, and psychosocial needs of patients. In this way, he argued for the biopsychosocial care model where “patients would continue to be cared for from a disease standpoint but, additionally, psychological and social information would be given equal standing in the care process.”
According to Engel, the biopsychosocial model “encompassed information from the levels below and above the human being as experienced by each person—that is, the health professional seeks to integrate data from the human/psychological level with data from the biological level (below) and data from the social level (above) to construct the biopsychosocial description of each patient.”
In other words, Engel believed that the data gathered from each level of a person’s whole-person experience was necessary in order to draw a comprehensive picture of who they were and what the proper treatment should be. Similarly, we believe that a whole-person approach and data generated from measurement-based care is critical to create effective protocols and to demonstrate the power of psychedelic-assisted therapy.
What is Measurement-Based Care?
According to the Journal of the American Medical Association (JAMA), measurement-based care is “the systematic evaluation of patient symptoms before or during an encounter to inform behavioral health treatment.” By leveraging critical insights throughout a client’s treatment protocol, measurement-based care has been proven to “expedite improvements” and “detect patients whose health would otherwise deteriorate.” Despite this fact, measurement-based care is typically underused. In fact, according to JAMA, “less than 20 percent of behavioral health practitioners integrate it into their practice.”
It’s worth noting that this adoption rate is on the rise. According to a Crunchbase News article, “health care data infrastructure will be the backbone of the whole health system.” This emphasis on the "digitization of the patient experience” will spur new opportunities for technology to optimize a patient’s healthcare journey to promote better health outcomes.
Of course, the power of measurement-based care can and should be applied to psychedelic-assisted therapy practices, a field with perhaps the most potential and a minimal amount of medical understanding. In order to systematically evaluate clients as they go through a psychedelic journey, practitioners need an easy way to collect baseline health and wellness information. Viewed holistically, this baseline data would capture where people are coming from spiritually, mentally, intellectually, physically, socially, and emotionally. To gather this information, psychedelic practitioners need standardized assessments and scales, validated by the academic community. They also need automated ways to illustrate this data so clients, patients, fellow practitioners, researchers, and legislators alike can understand the safety and efficacy of responsible psychedelic treatment.
By gaining quantitative and qualitative insights into their practice, psychedelic therapists could use data alongside intuition to create custom protocols to better serve their clients unique needs. In turn. the data collected by these assessments would enable clients to better understand what their healing journey will look like and how their health and wellbeing has progressed over time.
After spending time with countless therapists pioneering the field, we know that many of them are observing groundbreaking progress with their clients, but they don’t have an accessible way to translate these observations into quantitative health outcomes. As a result, there is a paucity of clinical data from the field of psychedelic therapy in general. The adoption of a measurement-based care approach would enable practitioners to turn their observations into clinical data to contribute to the larger psychedelic research collective. In many ways, the advancement of psychedelic healthcare hinges on our collective ability to measure and demonstrate the power of psychedelic-assisted therapy through data.
Implementing Measurement-Based Care in Psychedelic Therapy
So why aren’t practitioners implementing measurement-based care? According to JAMA, a few of the primary barriers to implementing data collection measures in the general field of behavioral healthcare include a lack of “measurement feedback systems,” “patient concerns about confidentiality breach,” and “practitioner beliefs that measures are no better than clinical judgment.” The field of psychedelic therapy faces many of the same challenges, and more given the cultural and historic nature of the compounds they work with.
We believe that practitioners are not limited by their abilities, protocols, or the power of the medicine, but because they aren’t equipped with proper tools designed specifically to meet their unique needs. We’re dedicated to solving these challenges and to supporting those on the frontlines of psychedelic healthcare, by providing the resources, technology, and insights they need to thrive.
The Maya Platform
It is becoming clear that psychedelic medicine has the power to shift the paradigm of mental healthcare on a global scale. That’s why we built Maya, a HIPAA-compliant software platform designed to help psychedelic practitioners manage their practice, measure progress, and illustrate health outcomes, so they can optimize services, scale safely, and help advance psychedelic healthcare.
The Maya platform was built to empower therapists with the flexibility to continue to provide the same holistic care that most of them are used to, while generating invaluable insights that they can use to elevate their practice. We carefully designed the features of Maya in partnership with psychedelic practitioners around the world, so that it truly serves their unique needs.
We see the beauty and transformational power of holistic healing and want to support the amazing work that is happening in this space. Simultaneously, we want to help advance psychedelic healthcare by creating an easy way for therapists to implement measurement-based care in their practice. We believe that there is so much intrinsic value in both the holistic and biomedical approach to psychedelic healing and that we have only scratched the surface.
If you’re a psychedelic practitioner looking to learn more about Maya or measurement-based care, please contact us.
Other Helpful Resources
Holistic medicine: A new medical system based on body constitution and functional status - Bing Yuan
Modeling towards a more holistic medicine: The Virtual Physiological Human (VPH) - S. Van Sint Jan, L. Geris
The evolution of the field of legal medicine: A holistic investigation of global outputs with bibliometric analysis - Emre Demir Eda Yaşar, Vahdet Özkoçak, Engin Yıldırım