Provider perspectives on challenges in treatment during psychedelic therapy

Rationale: Psychedelic treatments are considered to involve unique treatment challenges relative to other psychiatric interventions, though these are typically not explored in detail within clinical trial reports. Objectives: To determine the types of challenges that providers encounter while administering psychedelic drugs in research settings and to assess provider opinions on safeguards that may be pursued to improve outcomes. Methods: An anonymous survey was distributed via email to contacts listed on clinicaltrials.gov. for clinical trials of psilocybin and LSD, personal contacts of authors, and through snowball sampling. Free response items were reviewed using qualitative thematic analysis. Results: 40 qualified respondents completed the survey. Respondents came from varying educational backgrounds (42.5% M.D./D.O., 57.5% other degrees) and practiced in at least 4 countries, 11 U.S. states, and 16 institutions. Respondents had overseen a total of 1656 psychedelic sessions (average = 41.4). Thematic analysis of free response descriptions pertaining to challenges in psychedelic therapy produced 11 distinct themes, with the most commonly reported challenges being intense dysphoria during treatment sessions (42% of respondents), disappointment with the intervention (25% of respondents), and re-engaging with traumatic experience (17% of respondents). 70% of respondents felt that individuals with PTSD or prior trauma warrant additional psychological support. Respondents recommended 9.8 h of total psychological support for individuals with serious mental illness receiving psychedelic treatment for the first time. Conclusions: Psychedelic providers encounter a variety of challenges over the course of psychedelic treatments. These potentialities should be considered during the development of psychological support protocols for clinical trials and any future clinical guidelines.