Mapping cognitive-behavioral approach in psychedelic-assisted treatment: a systematic review across phases with classic and non-classic psychedelics
Yves Martins Varela, Vagner Deuel De O. Tavares, Luiza Macedo Delgado, Heitor Augusto Trindade De Faria, Lucas Queiroz Menezes, Raíssa M. Almeida, Pedro Agrícola, Bruna Santos De Carvalho, Bheatrix Bienemann, Marcelo Falchi-Carvalho, Patrícia Cavalcanti-Ribeiro, Fernanda Palhano-Fontes, Gisele Fernandes-Osterhold, Draulio Barros de Araujo, Nicole Galvão-Coelho
European Archives of Psychiatry and Clinical Neuroscience March 28, 2026 DOI: 10.1007/s00406-025-02188-5 via OpenAlex
Summary
AI-generated from the abstractCognitive-behavioral therapies are being combined with psychedelic substances such as ketamine, psilocybin, and MDMA to treat mental disorders, but the way they are integrated varies widely across studies. A systematic review of 9 clinical trials involving 283 patients found that traditional cognitive behavioral therapy was the most common approach, used in 6 studies, while mindfulness-based cognitive therapy and acceptance and commitment therapy were each used in 2 and 1 studies respectively. The timing of therapy relative to the psychedelic experience—before, during, or after—also differed. The findings highlight the need for more consistent research to clarify how these therapeutic models are best implemented.
Study at a glance
| Characteristics | Systematic review Peer reviewed |
|---|---|
| Sample size | 283 |
| Population | Patients in clinical trials for mental disorders |
| Citations | 1 |
| Key finding | Cognitive-behavioral strategies are incorporated into psychedelic-assisted interventions in diverse ways, but therapeutic approaches remain highly heterogeneous across studies. |
Abstract
The use of psychedelics in the treatment of psychopathologies has been expanding, highlighting Psychedelic-Assisted Psychotherapy (PAP) as a promising resource in mental health care. This systematic review investigates. This systematic review investigates whether and how cognitive-behavioral therapies are integrated with psychedelic substances—both classical and atypical—for the treatment of mental disorders. A PRISMA-based search was conducted across four databases (Embase, PsycArticles, PubMed, and Web of Science) up to May 2025. The review included 9 clinical trials involving a total of 283 patients; these studies used ketamine (n = 5), psilocybin (n = 3), and 3,4-methylenedioxymethamphetamine (n = 1). Among the Cognitive Behavioral Approaches (CBAs) applied, traditional Cognitive Behavioral Therapy (CBT) was predominant (n = 6), followed by emerging modalities such as Mindfulness-Based Cognitive Therapy (MBCT) (n = 2) and Acceptance and Commitment Therapy (ACT) (n = 1). Considerable variability was observed across study designs, particularly in terms of the timing of psychotherapeutic interventions, which occurred before, during, or after the psychedelic experience, with or without concurrent support. The findings indicate that cognitive-behavioral strategies have been incorporated into psychedelic-assisted interventions in diverse ways, across different phases of treatment and with distinct therapeutic purposes. Nonetheless, the therapeutic approaches applied remain highly heterogeneous between studies, highlighting the need for further research to clarify how these models are implemented and characterized in practice.