Mechanisms of integration in psychedelic-assisted therapy

Psychedelic pharmacotherapies combined with structured psychotherapy have shown promise in the treatment of several psychological conditions. This type of therapy is known as psychedelic-assisted psychotherapy (PAP) and includes three phases: preparation, in-session support, and integration. The purpose of this review was to identify randomized controlled trials (RCTs) that used psychedelics to treat a psychological condition and to summarize the literature on changes that may be associated with clinical outcomes, as measured with MRI and various psychologically based tools. Psychedelics were administered in 17 RCTs, and 16 of these did so within a PAP framework. A total of 19 studies were identified that looked at MRI or psychological outcomes during the integration phase. Changes in brain networks during integration were identified but were not consistent between studies because of small sample sizes and inconsistent methodology. Some evidence suggests that changes in the executive control network may occur after psychedelic administration. Psychological changes after psychedelic administration were related to cognitive flexibility and personality traits such as openness and neuroticism. Overall, studies in this field should be repeated with a greater number of participants and other MRI-based techniques. Introduction: In recent clinical trials, psychedelic-assisted psychotherapy (PAP) led to symptomatic improvement among people with several psychiatric conditions. PAP has three distinct phases: preparation, support during psychedelic administration, and integration. The purpose of this scoping review was to identify randomized controlled trials that used PAP and synthesize the research base related to neuronal networks and neural function as measured with neuroimaging during the integration period and to link these findings to psychological changes after PAP. Methods: PubMed and ProQuest databases were searched using key words. Inclusion and exclusion criteria were used to determine whether an article would be reviewed. The authors specifically focused on articles that used neuroimaging or reported a psychological outcome one day or more after psychedelic administration. Results: Most articles used functional magnetic resonance imaging (fMRI) and, in particular, resting-state fMRI to assess functional connectivity. Results generally reported changes in higher-order networks, although the direction of change in strength of connectivity was variable. Themes related to psychological findings were linked to increases in psychological and cognitive flexibility, increased openness, and decreased neuroticism after psychedelic treatment. Discussion: In general, more consistent methodology across the field should be applied to make progress in understanding network-based changes underlying clinical improvements after PAP. Limited evidence suggests that changes in the executive control network, and in its integration with other networks, may result in greater cognitive flexibility during the integration period. Introduction : Des essais cliniques recents montrent que la psychotherapie assistee par les psychotropes (PAP) entraine une amelioration des symptomes chez les personnes atteintes de divers troubles psychiatriques. La PAP comporte trois phases distinctes : la preparation, le soutien pendant l'administration des psychotropes et l'integration. Cette evaluation de la portee avait pour but, d'une part, d'isoler les essais cliniques randomises utilisant la PAP et de synthetiser les travaux fondamentaux sur les reseaux neuronaux et la fonction neuronale mesuree par neuro-imagerie pendant la periode d'integration ; et, d'autre part, de lier ces resultats aux changements psychologiques observes apres la PAP. Methodologie : Les bases de donnees PubMed et ProQuest ont ete fouillees a l'aide de mots-cles. Des criteres d'inclusion et d'exclusion ont servi a determiner si un article etait retenu pour l'etude. Les auteur(e)s se sont concentre(e)s sur les articles qui rapportent l'emploi de la neuro-imagerie ou un resultat a caractere psychologique un jour ou plus apres l'administration des psychotropes. Resultats : La plupart des travaux releves ont utilise l'imagerie par resonance magnetique fonctionnelle (IRMf) et, en particulier, l'IRMf au repos pour evaluer la connectivite fonctionnelle. Les resultats ont generalement rapporte des changements dans les reseaux des fonctions superieures, bien que la direction du changement dans la force de la connectivite varie. Les themes des resultats a caractere psychologique ont ete associes a l'augmentation de la flexibilite psychologique et cognitive, a une ouverture accrue et a la diminution du nevrosisme apres le traitement aux psychotropes. Discussion : En general, l'ensemble du domaine profiterait de l'application d'une methodologie plus coherente pour mieux comprendre les changements dans les reseaux qui sous-tendent les ameliorations cliniques post-PAP. Certaines donnees suggerent que les changements dans le reseau de controle des fonctions executives et dans son integration avec d'autres reseaux peuvent entrainer davantage de flexibilite cognitive pendant la periode d'integration.