The mechanisms of psychedelic therapy

Three theories of psychedelic therapy are critically examined. The Molecular Neuroplasticity Theory, which attributes benefits to a drug-driven molecular process independent of conscious experience, is weakened by evidence that mystical-type experiences correlate with positive outcomes, indicating psychological mechanisms are involved. The Metaphysical Belief Theory and Metaphysical Alief Theory better account for this correlation by positing that a transcendent 'Joyous Cosmology' encountered during the experience drives change. However, these theories fail to explain why patients can meet psychometric criteria for a mystical-type experience without having a non-naturalistic metaphysical hallucination; more naturalistic experiences of ego dissolution and connectedness can also satisfy those criteria. The argument concludes that lasting benefits arise from a genuine psychological factor that correlates with mystical-type experience but is independent of non-naturalistic metaphysical ideations.

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Abstract

‘The mechanisms of psychedelic therapy’ presents arguments against three theories of psychedelic therapy. The Molecular Neuroplasticity Theory ascribes therapeutic benefits to an experience-independent molecular mechanism. This theory is undermined by the correlation between ‘mystical-type experiences’ and beneficial outcomes, which suggests that genuinely psychological mechanisms are involved. The Metaphysical Belief Theory and the Metaphysical Alief Theory fare better on this count: both ascribe beneficial outcomes to the transcendent vision of a ‘Joyous Cosmology’ supposedly encountered in the mystical-type experience. However, these theories struggle to account for the fact that some patients satisfy psychometric criteria for a mystical-type experience without undergoing a non-naturalistic metaphysical hallucination. The psychometric criteria can also be satisfied by more naturalistic experiences of ego dissolution and connectedness. The conclusion is that psychedelics cause lasting benefits via some genuinely psychological factor that (i) correlates with the construct of a mystical-type experience, but (ii) is independent of non-naturalistic metaphysical ideations.