Psychedelic Identity Shift: A Critical Approach to Set And Setting

Psychedelic medicine relies on set and setting, but the specific therapeutic frameworks used alongside the drugs are rarely studied. Analyzing a treatment manual and post-session reports from a pilot psilocybin-assisted smoking cessation study, this article shows how therapeutic frameworks interact with psilocybin to rapidly reshape participants' identity and sense of self. Multiple domains of identity shift were identified that appear to serve as mechanisms for quitting smoking, each present in the manualized treatment. As psychedelic medicine becomes mainstream, consensual, evidence-based approaches to identity shift that respect patient autonomy and encourage empowerment should become key in psychedelic bioethics.

Study at a glance

Abstract

While the literature on psychedelic medicine emphasizes the importance of set and setting alongside the quality of subjective drug effects for therapeutic efficacy, few scholars have explored the therapeutic frameworks that are used alongside psychedelics in the lab or in the clinic. Based on a narrative analysis of the treatment manual and post-session experience reports from a pilot study of psilocybin-assisted treatment for tobacco smoking cessation, this article examines how therapeutic frameworks interact with the psychedelic substance in ways that can rapidly reshape participants' identity and sense of self. We identified multiple domains relating to identity shift that appear to serve as smoking cessation mechanisms during psilocybin sessions, each of which had an identifiable presence in the manualized treatment. As psychedelic medicine becomes mainstream, consensual and evidence-based approaches to psychedelic-assisted identity shift that respect patient autonomy and encourage empowerment should become areas of focus in the emergent field of psychedelic bioethics.