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Psychiatry and Behavioral Health

Importance of Integrating Spiritual, Existential, Religious, and Theological Components in Psychedelic-Assisted Therapies

To identify the key insights or developments described in this article

1 Credit CME

JAMA Psychiatry

Published Online: May 31, 2023

Special Communication

Article Information and Disclosures

Roman Palitsky, MDiv, PhD^1,2;

Deanna M. Kaplan, PhD^1,2,3;

Caroline Peacock, DMin, LCSW, MDiv^2,4;

Ali John Zarrabi, MD^1,2,5;

Jessica L. Maples-Keller, PhD^1,6;

George H. Grant, MDiv, PhD^1,2,7;

Boadie W. Dunlop, MD^1,6;

Charles L. Raison, MD^1,2

Author Affiliations

¹Emory Center for Psychedelics and Spirituality, Emory University, Atlanta, Georgia
²Department of Spiritual Health, Emory University Woodruff Health Sciences Center, Atlanta, Georgia
³Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
⁴Winship Cancer Institute, Emory University, Atlanta, Georgia
⁵Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
⁶Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
⁷Nell Hodgson School of Nursing, Emory University, Atlanta, Georgia

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Abstract

Importance Mounting evidence supports the role of spiritual, existential, religious, and theological components in mediating psychedelic-assisted therapy, yet integration of these elements into the clinical setting is lagging

Observations Although psychedelic-assisted therapy commonly produces spiritually, existentially, religiously, or theologically relevant experiences for patients, these have not been systematically integrated into the psychotherapies that accompany therapeutic uses of psychedelics. As a key feature and potential mediator of therapeutic effects, evidence-based psychedelic-assisted therapies should include these topics in the treatment model. Research across multiple diagnostic targets and treatment contexts suggests that spiritually integrated psychotherapies are effective, feasible, and produce add-on benefits in spiritually, existentially, religiously, and theologically relevant outcomes, which are particularly germane to psychedelics. Established standards in spiritually integrated psychotherapy may be fruitfully applied to psychedelic-assisted therapy. Objectives for spiritually, existentially, religiously, and theologically integrated psychedelic-assisted therapy based on these standards and informed by considerations specific to psychedelics are recommended.

Conclusions and Relevance Spiritual, existential, religious, and theological topics’ integration in psychedelic-assisted therapy is needed to ensure culturally competent, evidence-based treatment aligned with the highest standards of clinical care. Neglecting to address these topics can detract from cultural competence, contribute to risks for patients, and potentially undermine treatment success.

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Article Information

Accepted for Publication: April 6, 2023.

Published Online: May 31, 2023. doi:10.1001/jamapsychiatry.2023.1554

Corresponding Author: Charles L. Raison, MD, Spiritual Health, Emory University, 1440 Clifton Rd, Woodruff Health Sciences Center, Room 108, Atlanta, GA 30303 (charles.l.raison@emory.edu).

Author Contributions: Drs Palitsky and Raison had full access to all of the information in the study and take responsibility for the integrity of the study and the accuracy of the analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Palitsky, Zarrabi, Grant, Raison.

Drafting of the manuscript: Palitsky, Kaplan, Zarrabi, Maples-Keller, Raison.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: Palitsky, Grant.

Supervision: Palitsky, Peacock, Raison.

Other: Maples-Keller.

Conflict of Interest Disclosures: Dr Maples-Keller reported grants from Multidisciplinary Association of Psychedelic Studies and personal fees from COMPASS Pathways outside the submitted work. Dr Dunlop reported grants from Compass Pathways, Usona Institute, and Boehringer Ingelheim and personal fees from Otsuka, NRx Pharmaceuticals, Sage, Cerebral Therapeutics, and Myriad Neuroscience outside the submitted work. Dr Raison reported personal fees from Emory Healthcare during the conduct of the study and personal fees from Usona Institute, Novartis, and Sage/Biogen outside the submitted work. All authors on this manuscript are affiliated with Emory University’s Center for Psychedelics and Spirituality, among other affiliations. This center was formed in part to investigate and address how psychedelic care can respond to the increasing evidence of the relevance of spiritual, cultural, and existential issues to PAT. The present manuscript represents concerns and arguments that emerged out of deliberation on this topic by the authors, and may represent an intellectual conflict of interest because of our affiliation with the center and its mission. No authors receive financial benefit from this affiliation. No other disclosures were reported.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.