Psychedelic therapy: what is it and how does it work?

Written by Lotte Boekhout

You hear more and more about psychedelic therapy. Perhaps you have read accounts from people who experienced a breakthrough after years of therapy. Or you have come across research into psilocybin for depression or MDMA for PTSD.

In this article, I explore the world of psychedelic therapy. What does the term actually mean? How do truffles and psilocybin relate to it? Which psychedelics are being studied for therapeutic use? And what is the current situation with psychedelic therapy in the Netherlands?

What is psychedelic therapy?

In psychedelic therapy, a psychedelic substance is used as part of a therapeutic programme. The psychedelic experience is not separate from everything else. Preparation comes beforehand, and afterwards there is space to process and integrate the experience.

Before a session, you will usually discuss the difficulties you are facing, what you hope to explore and what might emerge during the experience. The psychedelic experience itself follows. Afterwards, you reflect on what you have experienced and how to move forward with it.

That last part is sometimes underestimated.

A psychedelic experience can be intense. Emotions, memories or insights may emerge that you cannot simply finish processing that same evening.

Perhaps you suddenly see something that has been present for years in a different light. Perhaps you feel sadness that is usually hard to reach. Or you notice a pattern in yourself that you previously understood intellectually but could never truly feel.

This is where another part of the therapeutic process begins. What will you do with that experience? What does it mean for daily life? Can you carry something you saw or felt during the experience into the days that follow?

That is why psychedelic therapy involves more than the substance or the experience itself. Preparation, support during the experience and the conversations afterwards all form part of it.

What happens during a psychedelic therapeutic experience?

Psychedelics can temporarily change how you experience yourself, your surroundings and your thoughts. A great deal also changes in the brain, with different areas communicating with one another in different ways.

As a result, familiar patterns of thinking and responding may temporarily become less fixed.

This may allow you to see something from a different angle. A thought that usually triggers a particular reaction may feel different. A memory may become clearer. An emotion may feel stronger. Sometimes you suddenly see a connection you had not noticed before.

This can create room for something new.

For example, you may have known for years that you always put yourself last. You can explain exactly where it comes from and know that you would like to do things differently. Yet you still find it difficult to make a real change.

A psychedelic experience may offer a different way into this. Not because the substance solves the problem for you, but because it may allow you to experience something differently from usual. This can provide valuable material to explore further in therapy afterwards.

Which psychedelics are used in therapy?

Several psychedelics and other substances that alter consciousness are being studied. They do not all work in the same way, nor are they being investigated for the same difficulties.

Psychedelic therapy with psilocybin

Psilocybin is the active substance in magic mushrooms and truffles, and is one of the best-known psychedelics.

Scientific research is investigating psilocybin for depression, including treatment-resistant depression. This means that someone has tried several treatments for depression without enough improvement. There is particular interest in psilocybin for this group because existing treatments do not work sufficiently well for everyone.

The findings from several studies are interesting. In a number of studies, psilocybin treatment appears to bring a substantial reduction in depressive symptoms for some people.

Researchers are also exploring psilocybin for people with serious or incurable illnesses. When you know that your life may end soon, fear, sadness and questions about life and death can become particularly prominent. Fear of dying may, for example, become so overwhelming that someone finds little room to enjoy the time they have left.

Researchers are therefore also asking whether psilocybin might help with this fear and existential distress. Some people describe a greater sense of peace or acceptance about approaching the end of life after such an experience. That does not mean that fear of death simply disappears. A psychedelic experience may, however, make it possible to see your situation differently.

Personally, I find this one of the interesting aspects of psychedelic research: exploring not only whether symptoms can ease, but also whether someone can learn to relate differently to something for which there is ultimately no solution.

Psychedelic therapy with MDMA

Most people probably know MDMA as a recreational drug. In therapy research, it is used in a very different way. MDMA-assisted therapy is mainly being studied for PTSD, or post-traumatic stress disorder.

One reason MDMA is of interest in trauma work is that it can increase feelings of trust, connection and safety. At the same time, the fear and tension usually associated with traumatic memories may temporarily feel less intense.

Shame, guilt and a negative view of yourself often play a part in trauma, too. These beliefs can make it difficult to look at a traumatic experience. With MDMA, some people may find more space to view themselves and their experiences with compassion. This may make it easier to discuss traumatic memories without becoming completely overwhelmed.

A considerable amount of research has now been conducted into MDMA-assisted therapy for PTSD. The results are promising, although this does not mean the treatment works for everyone. Many questions remain. Here, too, MDMA alone is not the therapy. Preparation, therapeutic support and processing the experience afterwards are important parts of the whole.

Psychedelic therapy with ketamine

Ketamine is not a classic psychedelic, but it is often discussed within the broader field of treatments involving substances that alter consciousness.

In the Netherlands, ketamine is used medically in certain circumstances for people with severe depression who do not respond sufficiently to other treatments. These are people for whom earlier treatments, such as antidepressants, have not helped enough.

Treatment takes place in a medical setting under professional supervision.

Psychedelic therapy with LSD, ayahuasca and ibogaine

Alongside psilocybin, MDMA and ketamine, researchers are also looking at other psychedelics and substances that alter consciousness, including LSD, ayahuasca and ibogaine.

Ibogaine is attracting attention in addiction research, among other areas. Researchers are investigating whether it might help interrupt persistent patterns of addiction. I see considerable potential in it. However, it is important to know that ibogaine carries significant physical risks. It cannot simply be compared with other psychedelic substances.

Which difficulties are being studied in psychedelic therapy research?

Research into psychedelic therapy covers several psychological difficulties and conditions. These include PTSD and trauma, depression, treatment-resistant depression, anxiety disorders and anxiety in people with serious or terminal illnesses. Addiction, obsessive-compulsive disorder and eating disorders are also being investigated.

Interesting findings have emerged for some applications. For others, we still know much less.

You therefore increasingly hear statements such as ‘MDMA helps with trauma’. I understand where these statements come from, but the reality is more complicated.

A substance may appear to work well for one group and have a very different effect in another. How it is used also matters. The dose, surroundings, support and accompanying therapy can all make a difference.

There is certainly reason to be curious about what psychedelics might offer in therapy. At the same time, research is still exploring whom they help, when they help and how they can be used safely.

What is the situation with psychedelic therapy in the Netherlands?

Psychedelic therapy is currently only available to a limited extent in the Netherlands.

Ketamine is used medically in certain circumstances. Psilocybin and MDMA are not currently available as routine treatments within Dutch mental healthcare.

Scientific research into various psychedelic treatments is taking place in the Netherlands. To participate, you must meet the requirements of the particular study. Not everyone who is interested can therefore take part.

Interest in psychedelic therapy is much greater than the availability of established services. This is also where a grey area emerges.

Truffle ceremony or truffle therapy: what is the difference?

Truffle ceremonies, journeys and sessions are offered in various places in the Netherlands. Sometimes the terms ‘psychedelic therapy’ or ‘truffle therapy’ are used as well.

I would pay close attention to that.

A truffle ceremony may focus on personal development, self-exploration or spirituality. That can be a valuable experience. It is, however, different from a therapeutic treatment for conditions such as PTSD, trauma or depression.

A truffle ceremony usually involves psychedelic truffles containing psilocybin. The emphasis may be on personal growth, awareness, self-exploration or a spiritual experience.

In psychedelic therapy, the substance is part of a therapeutic treatment programme. Preparation, support and integration are included, and the work takes place within a therapeutic or medical framework.

Someone may know a great deal about truffles and psychedelics and be a skilled ceremony facilitator. That does not automatically mean they are qualified or sufficiently trained to treat a mental health condition. I consider that distinction important.

How can you tell whether something is therapy?

If you are considering a psychedelic treatment or truffle ceremony, look carefully at exactly what is being offered.

Does the provider talk about treating trauma, depression or PTSD? Ask who will deliver the treatment, what training they have and how much experience they have with the difficulties you are facing.

Ask about preparation, too. What happens during the psychedelic experience? What happens afterwards? Is aftercare available?

In my view, these are questions you should feel free to ask before committing to anything.

I worked in mental healthcare for ten years and am a therapist myself. Even so, I do not offer psychedelic therapy. Not because I do not believe in the possibilities of psychedelics, but because I believe it is essential to consider carefully what someone needs and the potential risks of working with psychedelics, particularly for people with psychological vulnerabilities.

When someone comes to me with severe psychological difficulties, I first consider the person and what they need. A psychedelic experience is not automatically an appropriate next step. Sometimes something else is needed first.

A good facilitator considers not only what someone wants, but also what they need at that particular moment. Sometimes that means honestly saying that a psychedelic experience would not be advisable right now.

A final thought

Psychedelic therapy is an interesting field of research that has attracted considerable attention in recent years. The findings so far give good reason to continue exploring what psychedelics might offer for different psychological difficulties.

At the same time, it is not yet a routine treatment for most conditions in the Netherlands. And a truffle ceremony is different from psychedelic therapy.

That does not mean a truffle ceremony cannot be valuable for you. It may be of interest if you are curious about yourself, want to understand certain patterns better, would like to connect more closely with your emotions or feel that something within you needs attention.

You do not necessarily need a diagnosis or a major problem. Sometimes you simply notice that you feel stuck in some way, or want to explore yourself at a deeper level.

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