Samuli Kangaslampi

RationaleCase reports and early clinical research suggest classic psychedelics can occasion intense recall and processing of autobiographical memories. Such memory experiences have seen very little study more recently, although they may hold importance for both therapeutic effects and potential iatrogenic harms.ObjectivesThis prospective, exploratory study aimed to assess 1) the extent and content of memory experiences in naturalistic psychedelic use, as well as their associations with 2) elements of set and setting, 3) emotional breakthroughs and psychological insights, and 4) longer-term changes in well-being and later subjective evaluations of the experience.MethodsEnglish-speaking adults (N = 66, Mage = 34.91, 60.1% male) planning to take a classic psychedelic were assessed online before, 1-3 days, and 3-5 weeks after taking the psychedelic with self-report instruments.ResultsOn average, participants spent around a quarter of their psychedelic experience recalling past events, although variance was high. Positive and recent memories were most commonly recalled. Four in ten participants recalled usually avoided memories, nearly half potentially traumatic experiences, and a quarter memories of events they had never recalled before. Memory experiences, especially recalling avoided memories, were associated with more emotional breakthroughs and psychological insights and higher evaluations of the experience as useful, but did not predict changes in well-being.ConclusionsRecalling past events of one’s life may form a major, largely neglected element of many psychedelic experiences and be associated with therapeutic processes. Recalling apparent memories never remembered before under psychedelics may be more common than previously thought and needs careful study and consideration.

This commentary critically examines the interpretation and analytic choices in Goodwin and colleagues’ recent analysis of therapeutic alliance in psilocybin treatment for treatment-resistant depression. While the authors conclude that alliance did not meaningfully contribute to treatment efficacy, we argue that this interpretation is not supported by the reported results, which are, in addition, shaped by methodological decisions that obscure relevant effects. By contextualizing the observed associations, clarifying the logic of mediation analysis, and pointing out methodological weaknesses, we show that the available evidence is more consistent with a meaningful role of therapeutic alliance in shaping both the psychedelic experience and clinical outcomes. Furthermore, we highlight unexplained deviations from the study protocol that warrant scrutiny. These concerns underscore the importance of accurately characterizing psychological and contextual factors in psychedelic treatment research and calls for more comprehensive and transparent analyses of psychotherapeutic processes.

In their recent case report article, Peck and colleagues suggested that two patients recovered dissociated traumatic memories during psilocybin treatment for anorexia nervosa. These case reports are of clinical and scientific interest and confirm that psychedelics may induce vivid memory-like experiences. However, the reports warrant scrutiny. Here, based on what is known about recovered memories and the effects of psychedelics, we argue that the authors may not have adequately considered alternative explanations. The cases do not necessarily demonstrate that psilocybin induces recovery of dissociated traumatic memories or could treat dissociative amnesia. We further caution against the authors’ suggestion of explicitly preparing patients for the emergence of forgotten material.

Rationale: Since the earliest LSD research, psychedelics have been claimed to enhance autobiographical memory. Revisiting and processing autobiographical memories has further been suggested to be a major component of the therapeutic action of psychedelics. However, modern psychedelic research has largely neglected autobiographical elements of psychedelic experiences, and many vital questions remain unanswered. Objectives: We present and discuss six open questions related to psychedelics and autobiographical memory: (1) Do psychedelics enhance autobiographical recall? (2) Is recall and processing of significant autobiographical (e.g., traumatic) memories a common part of psychedelic experiences? (3) Do psychedelics promote the development of false or inaccurate memories? (4) How do autobiographical memories change if they are recalled and reconsolidated under the effects of psychedelics? (5) What are memories of psychedelic experiences like? (6) Are autobiographical experiences under psychedelics of particular importance for their therapeutic effects? Results: We present the background and current limited state of evidence for each question and provide suggestions on how future studies could best address them. Conclusions: Besides advancing basic research, answering these pressing questions is highly relevant for the possible therapeutic use of psychedelics, both in terms of developing and optimizing new interventions and for avoiding iatrogenic harms. Ideally, future psychedelic-assisted interventions could harness the possible synergies between the effects of psychedelics and existing memory-based therapies.

RationaleSince the earliest LSD research, psychedelics have been claimed to enhance autobiographical memory. Revisiting and processing autobiographical memories has further been suggested to be a major component of the therapeutic action of psychedelics. However, modern psychedelic research has largely neglected autobiographical elements of psychedelic experiences, and many vital questions remain unanswered.ObjectivesWe present and discuss six open questions related to psychedelics and autobiographical memory: 1. Do psychedelics enhance autobiographical recall? 2. Is recall and processing of significant autobiographical (e.g., traumatic) memories a common part of psychedelic experiences? 3. Do psychedelics promote the development of false or inaccurate memories? 4. How do autobiographical memories change if they are recalled and reconsolidated under the effects of psychedelics? 5. What are memories of psychedelic experiences like? 6. Are autobiographical experiences under psychedelics of particular importance for their therapeutic effects?ResultsWe present the background and current limited state of evidence for each question and provide suggestions on how future studies could best address them. ConclusionsBesides advancing basic research, answering these pressing questions is highly relevant for the possible therapeutic use of psychedelics, both in terms of developing and optimizing new interventions and for avoiding iatrogenic harms. Ideally, future psychedelic-assisted interventions could harness the possible synergies between the effects of psychedelics and existing memory-based therapies.Keywords: Psychedelics, autobiographical memory, LSD, psilocybin

Purpose: This systematic review aimed to evaluate and synthesise qualitative research on adult clients' experiences of psychotherapeutic interventions addressing trauma across multiple modalities. Methods: Six databases (PsycINFO, MEDLINE, The Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and CINAHL) were systematically searched. Google Scholar and reference lists of included and other relevant reviews were also searched, and in total 37 studies met the inclusion criteria. Relevant data were extracted, quality assessed following the Critical Appraisal Skill Programme checklist, and data synthesised using thematic synthesis. Results: The specific helpful factors and perceived impact of the interventions aligned with their theoretical bases. Certain factors were perceived to be helpful or challenging regardless of the modality used, such as relational factors between the client and the therapist, and within group settings. Towards the end of the interventions, feelings of ambivalence and emotional struggles which pervaded the process gradually resolved, as a majority of the clients expressed a sense of benefit from the whole experience. Most of the studies included in this review were published post‐2020, underscoring research interest towards clients' psychotherapeutic experiences. Conclusions: The review provides a comprehensive understanding of helpful and challenging factors of interventions addressing trauma, as perceived by clients. The analysis serves as a foundation for future intervention development. Also, it highlights the importance of therapist responsiveness and discussions with clients at various intervention stages to foster a sense of safety, prevent early drop‐outs, and emphasise clients as agents of change in their therapeutic process.

3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.

3,4-methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on 1) reinforcing motivation, 2) the development of a strong therapeutic alliance, 3) additional emotion and behavior management techniques, 4) more directive exposure-based methods during MDMA sessions, 5) more support for concomitant challenges and integrating treatment benefits, and 6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues.We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.

Background and aims: Ingestion or administration of classic psychedelics is sometimes associated with improvements in well-being or mental health. Acute mystical-type experiences that psychedelics occasion have been suggested to be related to such improvements. Meanwhile, other features of the psychedelic experience, such as psychological insights and emotional breakthroughs, are also increasingly being studied. This review aimed to collect and assess the available evidence for mystical-type experiences under psychedelics associating with medium-to-long term improvements in well-being or mental health, on their own and as compared with other features of the acute experience.Methods: I conducted a pre-registered, comprehensive review of existing empirical studies on the topic, based on a systematic search of the literature.Results: Forty-four eligible studies were found, with most reporting positive associations between mystical-type experiences and improvements in well-being or mental health. The current level of evidence appeared stronger among healthy people, in cross-sectional studies, and for links with positive changes in general well-being and life satisfaction, attitudes and behavior, and anxiety, than for depression or other aspects of well-being and mental health. A few studies suggested that psychological insights and emotional breakthroughs may be as or more closely associated with positive changes than mystical-type experiences.Conclusions: Despite their significant limitations, the identified studies suggest that mystical-type experiences under psychedelics are associated with improvements in some areas of well-being. However, psychological insights and emotional breakthroughs might be at least as important and should also be measured in future studies.