Epistemic Risk Reduction in Psychedelic-Assisted Therapy.

Belief change is central to therapeutic benefit in psychedelic-assisted therapy, but it poses unique challenges. Psychedelics can cause drastic belief shifts faster than in regular therapy, leading to confusion and disorientation. Hallucinatory experiences often carry a high degree of confidence and noetic certainty despite not necessarily being connected to reality. Telling a patient which beliefs are true is beyond a therapist's competence and risks abuse of authority, especially given the power imbalance and patient suggestibility during altered states. This chapter explores, through a philosophical and epistemological lens, how therapists can help patients navigate epistemic uncertainty around psychedelic insights while preserving autonomy. It argues that dynamically adapting strategies to individual patient needs can significantly reduce epistemic risks.

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Abstract

Belief change is crucial to therapeutic benefit in psychedelic-assisted therapy as well as in more traditional forms of therapy. However, the use of psychedelics comes with a few unique challenges that require extra caution. First, drastic belief changes may occur faster than in regular therapy. Facing radical and transformative insights all at once rather than through a gradual process of discovery and integration can lead patients to a volatile, confusing or disorienting epistemic state. Additionally, we know psychedelic substances generate hallucinatory experiences that come with a high degree of confidence and noetic certainty despite not necessarily being connected with reality. On the other hand, telling a patient which ones of her beliefs are true and which ones are not seems beyond the competence of a psychotherapist, if not an abuse of their authority and power. This is even more dangerous when psychedelics are involved, because power imbalance between patient and therapist is exacerbated by the therapist's role as a guiding figure throughout an intense altered state of consciousness. Because of this suggestible state, the therapist's beliefs might have a disproportionate influence, and even well-intentioned nudging might significantly stray the patient's beliefs.How can a therapist help a patient navigate their epistemic uncertainty around psychedelic insights while preserving the patient's autonomy? This chapter will attempt to answer this question through a philosophical and epistemological lens. We will review different strategies to mitigate epistemic risks in psychedelic-assisted therapy and argue that such risks can be significantly reduced by adapting these strategies dynamically to the individual patient's needs.