Core Psilocybin-Assisted Psychotherapy (PAP) Framework

How clinical studies are structured and what we’re learning about this approach

Essential Structure of a Psilocybin Session

Most clinical studies follow a 3-phase model:

• Preparation

  • Several sessions with a therapist before the psychedelic experience

  • Build trust, set intentions, and prepare mentally/emotionally

• Dosing Session

  • Held in a safe, supportive space

  • Two trained facilitators (usually of different genders) are present throughout

  • Lasts 6–8+ hours

• Integration

  • Follow-up sessions to process the experience

  • Helps with emotional healing, personal insight, and behavior change

The Therapy Team

• Each session includes two trained facilitators (called a dyad)

• Facilitators come from diverse backgrounds: therapists, nurses, chaplains, life coaches, social workers

• Training focuses more on psychedelic support skills than formal licenses or degrees

Psychotherapy Style

• Most studies use a non-directive approach (client leads, facilitators support)

• There’s no universal manual yet, but this approach allows for flexibility

• So far, no single therapy style has proven more effective—what matters most is connection and safety

Research Gaps in Current Studies

• Many studies don’t clearly report how many therapy sessions were done or who the providers were

• This makes it harder to replicate or train new facilitators

• There’s a push for better documentation and transparency in future research

What the Studies Show

Major Depression (Davis et al., 2021 – JAMA Psychiatry)

• Compared 25mg psilocybin to a placebo (niacin)

• Just one session led to significant, lasting improvements in depression

• No serious side effects reported during 6-week follow-up

Cancer-Related Anxiety/Depression (Griffiths et al., 2016)

• Participants received low and high doses in a crossover format

• The high-dose group had up to 90% remission from depression/anxiety

• Effects were long-lasting and meaningful

Meta-Analysis Findings (2024 Review)

• Most trials used client-led, non-directive therapy

• No major difference in outcomes between different therapy styles

• Emphasized the need for standardized training and protocols moving forward

Why the Therapist Relationship Matters

• Strong connection with facilitators before the dosing session leads to deeper emotional breakthroughs

• Deeper experiences = better mental health outcomes after 6 weeks

Safety & Best Practices

Who’s Eligible?

• People with conditions like depression, PTSD, OCD, or anxiety—especially if other treatments haven’t worked

• People are usually excluded if they have:

  • A history of psychosis or bipolar disorder

  • Uncontrolled medical issues

  • Immediate family with psychotic disorders

During the Session

• Held in a comfortable, calm space

• Participants are monitored for 6–8 hours post-dose

• Vital signs and emotional state are continuously checked

• Support protocols in place for anxiety or medical issues

Key Takeaways

• The preparation → dosing → integration structure is used in nearly all psilocybin studies

• Emotional safety and support matter just as much as the medicine itself

• Strong therapist connection, proper screening, and integration all contribute to better outcomes

• While results are promising, the field still needs better consistency and inclusion moving forward

References

1. Davis et al. (2021) – JAMA Psychiatry

2. Griffiths et al. (2016) – High vs. low-dose trial for cancer-related depression/anxiety

3. Horton et al. (2021) – Systematic review of therapist roles and structure

4. 2024 Bayesian Meta-Analysis – Frontiers in Psychology

5. PubMed, Liebert Publishing, Psychiatry Online – Multiple peer-reviewed articles on PAP methods and trial outcomes

6. Akjournals – Research on safety and exclusion criteria

7. Lippincott Journals – Cancer anxiety and depression studies