Psilocybin-Assisted Therapy
Core Mechanism
Psilocybin disrupts default mode network rigidity; mystical-type experiences occasion lasting shifts in perspective and meaning
Ontology
Rigid self-referential processing (depression) or compulsive patterns maintained by entrenched neural networks
Therapeutic Voice
"Whatever comes, let it come. Whatever goes, let it go. Trust the process."
View of the Person
A consciousness constrained by rigid self-referential processing, capable of liberation through ego dissolution
Evidence
FDA: Breakthrough Therapy designation for TRD and MDD
10+ RCTs
Ko et al. (2022)
Strong preliminary evidence. Goodwin et al. (2022) NEJM trial positive. Regulatory pathway ongoing.
Conditions
Epistemology
Blind Spots
Not FDA approved; challenging experiences can be destabilizing; standardization of therapy component still developing
Contraindications
Active psychosis or personal/family history of psychotic disorders, severe cardiovascular conditions, pregnancy, current use of lithium or tramadol, untreated bipolar I disorder, severe personality disorders with poor reality testing
Training
Not yet FDA-approved at federal level. Oregon (Measure 109, operational 2023) and Colorado (Prop 122, implementation in progress) have created state-regulated facilitator pathways with approved training curricula. Multiple pathways exist: (1) state-licensed facilitator (OR/CO) through programs with state-approved curricula, (2) clinical psychedelic therapy training for licensed clinicians (CIIS, IPI, ATMA), (3) research-context training. Some programs serve both states; others are state-specific.
Oregon: OHA-approved training program → state facilitator license. Colorado: DORA Natural Medicine Division → facilitator certification. Clinical: CIIS Certificate in Psychedelic-Assisted Therapies & Research; IPI year-long training. No federal certification pathway.
State facilitator programs: 120–200+ hrs (varies by program), typically including didactic, experiential, practicum, and supervised components. CIIS certificate: multi-semester. IPI: year-long.
Facilitator programs: $5K–15K+ depending on program. CIIS: graduate tuition rates. State licensing fees additional.
Philosophical Roots
James (mystical experience); Huxley (doors of perception, reducing valve theory); Watts (ego dissolution); Buddhist concepts (non-self, interconnection); Carhart-Harris (entropic brain hypothesis)
Related Modalities
Controversies & Ethical Concerns
Not yet FDA approved. Breakthrough Therapy designation. Standardization of therapy component still developing
Clinical Vignettes
See how Psilocybin-Assisted Therapy formulates these cases:
Test Yourself
Default mode network and psilocybin?
Show answer
DMN active in self-referential thinking. Psilocybin disrupts it, loosening rigid self-narratives.