With psychedelic-assisted psychotherapy (PAP) becoming increasingly more studied and adapted, ketamine has emerged as a psychoactive substance that can be combined with psychotherapy to help those struggling with a variety of psychological conditions such as depression, anxiety, substance abuse, and obsessive and compulsive behaviors.
The new wave of a psychotherapeutic modality called Acceptance and Commitment Therapy (ACT) is increasingly discussed as a framework that can deepen and maintain “the often profound acute effects of psychedelics” including Ketamine.
ACT has been utilized and adapted in clinical trials such as psilocybin for treatment-resistant depression at Imperial College London and MDMA-assisted therapy for social anxiety disorder at Portland Psychotherapy. The manual for psilocybin-assisted therapy for depression published by Yale University furthermore highlights the synergy between ACT and psychedelic-assisted psychotherapy.
Psychological Flexibility, Contextual Behavioral Science, and the Gold Standard of Psychedelic-Assisted Psychotherapy
Can ACT be the gold standard of psychedelic-assisted psychotherapy? ACT is informed by contextual behavioral science (CBS), an approach that effectively fits into making sense of often ineffable psychedelic experiences through studying contexts that encompass individual and socio-cultural environments. The scientifically supported theory of CBS is well positioned to support individuals’ processing and integration of psychedelic experience. Part of the CBS theory is a framework that pins rigidity and experiential avoidance as key variables in most forms of psychopathology. Psychological flexibility, then, is a way in which individuals can heal and live a more whole and meaningful life.
What is Acceptance and Commitment Therapy (ACT)?
ACT aims to increase psychological flexibility through six interconnected core processes such as acceptance of experience, awareness/contacting of the present moment, defusion from getting overly attached to thoughts and beliefs, flexible experience of sense of self (self as context), clarification of values, and taking committed actions towards living a life that is value-driven and meaningful.
How is ACT compatible with psychedelic therapy?
Acceptance involves the willingness to allow emotions, thoughts, and other internal experiences to be present instead of avoiding them through distracting, numbing, or withdrawing. ACT proposes acceptance because our agenda of control to feel and think in a certain way often comes with the cost of moving away from a life that is value-driven and meaningful.
In fact, rejection of our internal experience can create additional pain and suffering. Psychedelic experiences can induce highly intense thoughts, sensations, emotions, memories, and non-ordinary states of consciousness for which acceptance can help individuals to surrender to the experience and harness what may serve them from the experience. The commonly used phrase in psychedelic assisted psychotherapy is “trust, let go, and be open”, coined by William A. Richards who has been a psychologist at Johns Hopkins University School of Medicine, Bayview Medical Center.
Contacting the present moment is to intentionally become aware of the internal and external experience directly without judgment, quite similarly to the practice of mindfulness. It opens us up to our experience and provides the foundation for countering experiential avoidance and facilitating acceptance. Cognitive defusion also supports the process of acceptance through helping individuals in loosening the grip their thoughts have over them and be more flexible and functional in their behaviors.
The aforementioned flexibility in relating to our thoughts can then foster flexibility in the ways in which we relate to our sense of self. On one hand, our sense of self can be driven by the content of our thoughts and memories in a linear fashion while on the other hand, our sense of self can be contextual (self as context) and supportive of the transcendent experience of unity and ego dissolution that can occur during psychedelic experiences.
Integration is a vital component of psychedelic assisted psychotherapy, and the ACT process of values can help individuals clarify what makes their lives rich and meaningful, and take committed actions toward living the life that matters to them. In his book Psychedelic Integration: Psychotherapy for Non-Ordinary States of Consciousness (2022), Marc Aixalà defines integration in the context of psychedelic therapy as “the higher level understanding of the experience and the proper application of the insights and lessons derived from it in our daily lives” with the goal of helping individuals “regain the feeling of control”. Clarifying values can provide an excellent map for identifying meaningful directions in life, and committed actions can help individuals to foster a sense of control and mastery.
The framework of Acceptance and Commitment Therapy (ACT) aligns itself with Ketamine-Assisted Psychotherapy as both approaches synergistically foster psychological flexibility and promote the well-being of individuals. The tools from ACT can help individuals to accept and open up to the profound psychedelic experiences with resilience and integrate them with purpose and commitment.
About the Author
Tim Oh, LMSW
Tim provides clinical care to adults and adolescents with anxiety, depression, trauma and stressor-related disorders, substance abuse, dual diagnosis, and high-risk behaviors such as suicidality and self-harm. He strives to ...
