Integrating Psychedelic-Assisted Therapy (PAT) into Neurofeedback and Biofeedback Treatment
Interest in psychedelic-assisted therapies (PAT) has increased dramatically in recent years. The evidence suggests that clinical use of Psilocybin, MDMA, and Ketamine can be effective for treatment-resistant depression, as well as PTSD, addictions, end-of-life anxiety, and obsessive-compulsive disorder (see Andersen et al., 2020 for a review).
It is important to understand that psychedelics themselves cannot provide the cure to personal and mental health difficulties. Instead, what they produce is simply a physiological state of increased brain plasticity. This neuroplasticity can facilitate new ways of thinking, feeling, and behaving for those who use it therapeutically (Carhart-Harris & Friston, 2019). With this understanding, it becomes increasingly important to 1) prepare the brain/nervous system for the shift experienced during a psychedelic session, and 2) to take advantage of the increased flexibility created by the experience. In addition to incorporating targeted psychotherapy, it can also be helpful to include mental state training in the form of neurofeedback and neurofeedback-guided meditation.
Preparation Phase
Having positive psychedelic experiences is associated with specific psychological and emotional states including absorption, openness, acceptance, and surrender. Consequently, it is important to offer preparatory sessions with a trained guide to facilitate the desired states and minimize the undesired ones. These preparation sessions are used to assess a client for appropriateness/readiness, clarify their intentions, manage their expectations, outline the process, and discuss any fears or concerns they might have about working with psychedelic medicines. In addition, this time is important for establishing trust and rapport before entering into a psychedelic state which can feel very vulnerable.
Neurofeedback and neurofeedback-guided meditation (i.e., biofeedback) can assist in the preparation phase by teaching state awareness and mental flexibility. In these practices, the client receives immediate feedback about their brainwave patterns connected to specific states of consciousness. This feedback is typically in the form of auditory or visual changes on a computer screen. Neurofeedback used in conjunction with meditative practices can help the client increase awareness of internal states and learn to intentionally navigate these states of consciousness. As preparation for a psychedelic experience, this type of “inner work” can be a valuable addition.
Integration Phase
As mentioned earlier, the psychedelic experience appears to generate a state of temporary mental flexibility, allowing new ways of perceiving self and others, and our relation to the world. This can be an optimal time to shift maladaptive patterns of thinking, feeling, and behaving, and practicing new patterns. It is as if, the nervous system is more malleable during this time period. Consequently, a series of integration sessions with a trained guide is recommended in the weeks and months following the psychedelic experience. These sessions are designed to facilitate active processing and synthesizing of the experience to help the client identify and enact steps toward implementing insights gained. Traditional neurofeedback as well as biofeedback can both aid in this process. Neurofeedback, by its nature, is designed to shift maladaptive patterns in the nervous system. If these patterns are identified in the Intake/Preparation phase of this work, they can be targeted with neurofeedback in the integration phase when there is more openness to change, potentially increasing the efficiency of the process. During this phase, individuals may become more attuned to their bodily sensations and emotional states. Biofeedback amplifies this awareness by offering concrete feedback on physiological changes that may occur. For example, someone undergoing psychedelic-assisted therapy may observe fluctuations in heart rate or muscle tension and learn to modulate these responses through breathing exercises or mental focus.
As research continues to explore best practices for psychedelic-assisted therapies and as these approaches become more widely available, it will be important to continue to examine the safest, most reliable, and effective ways to integrate therapeutic protocols for optimal benefit. The addition of neurofeedback and biofeedback to the preparation and integration phases of PAT’s is one of the most recent contributions to this process and is already being incorporated into some psychedelic-assisted therapy training programs (e.g., MIND Academy).
References
Andersen, K.A., Carhart-Harris, R., Nutt, D.J., et al., (2020). Therapeutic effects of classic serotonergic psychedelics: A systematic review of modern-era clinical studies. Acta Psychiatr Scand 143: 101-118.
Carhart-Harris, R., & Friston, K. (2019). REBUS and the anarchic brain: Toward a unified model of the brain action of psychedelics. Pharmacol Rev 71: 316-344.