A scoping review of variations in psychedelic interventions for psychological suffering associated with the end of life.

A scoping review of 59 studies on six types of psychedelic substances for end-of-life psychological suffering found extraordinary variety in how these interventions are studied. Case study designs were most common. Interventions ranged from dosing alone to preparation, dosing, and integration, or dosing with psychotherapeutic support outside the tripartite model. Most studies reported challenging experiences, with many considering them therapeutic. Outcome measures spanned biopsychosocial-spiritual domains, with affective and cognitive-affective sub-domains most often assessed. Neurobiological mechanisms were reported in 54% of studies, psychological in 51%, and spiritual in 44%, indicating diverse therapeutic processes. The variability reflects an early, exploratory phase and differences in beliefs about how these interventions effect change.

Study at a glance

Abstract

Psychedelic substances are recognized for their potential to ease psychological suffering linked to end-of-life issues, yet policy remains restrictive. The wide range of both substances and therapeutic approaches used in end-of-life populations has not been adequately covered by reviews to date. To identify and learn from the variety that exists within the research on therapeutic psychedelic interventions reported in populations coping with psychological suffering associated with life-threatening illness and the end of life itself. Following Arksey and O'Malley's (2005) framework for scoping reviews, updated methodological guidance, and the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for scoping reviews guideline, data extracted from selected studies covered intervention details, substances used, participant characteristics, measured outcomes, and theorized mechanisms. Fifty-nine studies on six types of psychedelic substances for end-of-life issues were identified, with case study designs most common. Interventions were categorized into dosing alone, preparation/dosing/integration, and dosing with any psychotherapeutic support not provided within the tripartite model. Most studies reported challenging experiences, with a large proportion considering them therapeutic. Outcome measures spanned biopsychosocial-spiritual domains, with affective and cognitive-affective sub-domains most often assessed; neurobiological mechanisms were reported in 54 % of studies, psychological in 51 %, and spiritual in 44 %, indicating diverse therapeutic processes. There is extraordinary variety in how psychedelics are studied to address the experience of psychological suffering associated with end-of-life concerns. The variability in psychedelic research reflects an early and exploratory phase, differences in beliefs about how therapeutic psychedelic interventions effect change, and the genuine richness in possibilities for therapeutic psychedelic interventions.