How Group Therapy May Impact the Future of Psychedelic Medicine
For many years, psychedelic research has focused narrowly on the space between the individual and therapist, or the aesthetic and physical dimensions of their surroundings (set and setting). However, recent studies point to another dimension of set and setting that is critical to improved health outcomes : interpersonal processing. Whether through co-administration or group-based preparation and integration sessions, group therapy can bring a novel set of logistical, theoretical, and psychosocial benefits to psychedelic medicine. It may even alleviate an underlying root cause of the mental health crisis: widespread disconnection.
The Group-Shaped Hole in Modern Psychedelic Research
Until recently, modern research centered on individual responses to psychedelics. As many have noted, this shortcoming seemed out of step with humanity’s history with these compounds. After R. Gordon Wasson’s classic account of his experience taking psilocybin within a shamanistic ceremony in Mexico, the Western world first learned about psilocybin in the context of a ceremonial group setting. Anthropological evidence also points to ritualistic, group use of psychedelic plants across cultures. Likewise, scientists in the 1950s through 70s recorded success treating depression, schizophrenia, and alcohol use disorder through psychedelic-assisted group therapy.
The absence of modern group therapy research also conflicted with fundamental discoveries about psychedelics’ actions on the brain. As conveyed in the Journal of Psychopharmacology, due to the particular way psychedelics antagonize the 5-HT2A serotonin receptor, context may be fundamental to their therapeutic mechanisms. Given that interpersonal dynamics substantially influence attitude and environment, they may also impact the depth and longevity of psychedelics’ therapeutic consequences. By experimenting with various types of group-focused therapy or levels of support, research could also unravel how set, setting, and compounds interact to shape individual responses.
In 2017, theoretical interest in psychedelic-assisted group therapy gained momentum after a study in the Journal of Humanistic Psychology suggested that social connectedness may be a core, underlying facet of therapeutic changes. In interviews six months after participants received psilocybin therapy for treatment-resistant depression, they almost universally mentioned feelings of enhanced connectedness to themselves, other people, and the world.
Given that these compounds treat across a variety of conditions, the researchers later suggested that psychedelics may target an underlying feature of mental health, positing that connectedness could be that feature. These paradigm shifts set the groundwork for a series of studies into psilocybin co-administration and group-focused preparation and integration therapy.
Group Therapy is Theoretically & Logistically Sound
The first modern clinical research into psychedelic-assisted group therapy occurred in 2020. Researchers in The Lancet published an open-label study of its viability for men over 50 with HIV/AIDS-related demoralization, a condition amplified by social isolation. The authors reasoned that because psychedelics inspire people to adopt new, healing interpretations of their lives, psychedelic-assisted group therapy might be especially beneficial for people with demoralization, a situation-specific type of sadness that rarely responds to talk therapy or SSRI antidepressants.
This study was the first to incorporate group-based preparation and integration sessions before and after psilocybin administration. At a three-month follow-up, the participants had clinically meaningful reductions in demoralization related to their illnesses. Because the participants had complex medical and psychiatric histories, this study was also the first to demonstrate psilocybin therapy’s safety and efficacy for individuals with multiple psychiatric conditions.
Using an existential psychotherapy framework aimed to help participants embrace “the here and now,” practice self-compassion, and openly process their emotions, the researchers reported that the group component of therapy encouraged participants to contend directly with shame and isolation-related inner conflicts. Anecdotally, many noted that sharing experiences with other group members helped them feel less alone in their pain. They reported that these connections were important for their processing and making the most out of their treatment. As a result, the group dimension of the therapy seemed to create the ideal platform for anticipating and integrating psilocybin experiences.
This research also modeled the logistical benefits of group preparation and integration. Since individual psychedelic-assisted therapy involves extensive pre- and post-drug evaluations, it’s notoriously time- and resource-intensive. As the researchers noted, by conducting preparatory and integration sessions within group settings, the 18 participants in the above study received 472 total hours in therapy. If therapists met with individuals on a one-on-one basis, the therapists would have needed to devote 954 hours across participants. By conducting preparation and integration sessions with multiple individuals simultaneously, high volumes of people received therapy in approximately half the amount of time. Since group members split costs among themselves, the study also showcased a paradigm that could make psychedelic therapy more affordable.
Investigators shed even more light on these logistical benefits with a January 2022 clinical trial in the Journal of Psychopharmacology, the first placebo-controlled clinical study to co-administer psilocybin to up to six individuals at once. While the previous research evaluated the effects of group therapy before and after psilocybin therapy, this study recorded the effects of providing psilocybin to multiple people while each received one-on-one support. The investigation showed that co-administering psilocybin didn’t adversely affect participants’ cognitive or emotional functioning before or after the treatment.
As the authors explained in an interview, by safely administering psilocybin to multiple people at once, they demonstrated one way of scaling and systematizing psychedelic therapy. Because co-administration could provide more information about treatment protocols at a faster rate, co-administration may also speed the pace at which psychedelic therapies receive FDA approval.
How Group Settings Amplify the Healing Properties of Psychedelics
Beyond these logistical benefits, group therapy may directly intervene on a root cause of the mental health crisis: widespread loneliness and alienation. Considering the clear links between depression, anxiety, and isolation, connecting with a group may directly resolve unmet needs that drive loneliness, fear of judgment, and other thought patterns characteristic of anxiety and depression.
Shared group experiences may even influence long-term psychological health. In a 2021 web-based survey study, researchers in Frontiers in Pharmacology traced the connections between interpersonal processing and psychedelics’ effects, and in turn, how psychedelics modulated interactions between people. The researchers measured “psychosocial mechanisms” across 720 participant reports before and after they took psilocybin in a group retreat setting. They developed a psychometrically validated Communitas Scale, with “Communitas'' referring to feelings of “intense togetherness and shared humanity.” The researchers noted significant correlations between Communitas and reports of well-being and social connectedness during and after the retreats.
Accounting for these findings, the researchers described the resonances between practices in group therapy and long-standing instigators of human connection. For instance, retreat leaders often encourage participants to share their intentions, fears, and other sensitive emotional material with the group. The authors noted that social psychologists understand self-disclosure as a key driver of trust and reciprocity, even among strangers.
Measured self-disclosure also has therapeutic consequences, with group therapy studies finding that clients perceive self-disclosing therapists to be stronger, more trustworthy, and more helpful. It’s also noteworthy that across many psychedelic-assisted therapy trials, participants relate that sharing difficult-to-articulate, yet profound insights with other people reifies the validity of their psychedelic experiences. These interactions in turn extend their beneficial effects.
In this sense, the group can arguably become part of what D.W. Winnicott called a therapeutic holding environment, a context safe enough to invite a release of old patterns of being. Group therapy may therefore instigate exchanges that amplify the therapeutic effects of psychedelics.
Psychedelic-Assisted Group Therapy Goes Where Psychopharmacology Does Not
Currently, research into psychedelic-assisted group therapy is ongoing. The optimal forms of group therapy and their relevance across populations are two of many questions to be answered with future research. Given its novel combination of logistical, theoretical, and psychosocial benefits, group therapy may figure centrally in the mainstreaming of psychedelic medicine. It can bring speed and efficiency to the approval process, streamline the growth of best practices, and bring psychedelics to greater numbers of people.
Since depression, anxiety, and other conditions often involve social isolation, therapeutic group interactions may also target a driving force behind the mental health crisis. By intervening on a fundamental, root cause of distress, psychedelic therapy can promote a level of healing that radically outpaces biomedicine’s more one-dimensional promise: helping people “manage” the downstream symptoms of their suffering without attending to their unmet psychosocial needs.