Psychedelic-Assisted Therapy: A Comprehensive Overview

A treatment model, not just a drug

Psychedelic-assisted therapy means giving a psychedelic, usually once to three times, inside a structured course of psychological support. It differs from a daily antidepressant: the sessions are few, long and supervised, and the support around them is part of the treatment. This page is about that model: how it is delivered, who delivers it, where it is lawful and how to judge a provider. For what the research shows in a particular condition, use the conditions hub and the condition pages linked below.

Preparation, dosing session, integration

Research protocols share a three-part shape. Published safety guidelines for psychedelic research describe careful preparation, building trust between the session monitors and the volunteer before the session, a safe physical setting and support from at least two monitors during the session. (Journal of Psychopharmacology, 2008)

Oregon's licensed psilocybin programme turns that shape into rules, so it is a useful concrete example:

• Preparation. A facilitator must hold a preparation session with every client at least 24 hours and no more than 90 days before the client's first administration session, and all forms and written consents must be complete before dosing. (Oregon Secretary of State, current) Every client completes a screening form covering lithium, current treatment, medications, thoughts of harming self or others, psychosis and pregnancy. (Oregon Health Authority, Public Health Division, 2026)
• Administration. Psilocybin may be used only at a licensed service centre, under a facilitator, by adults 21 and over, with no take-home supply. (Oregon State Legislature, current edition; Oregon Health Authority / Oregon Secretary of State, 2025)
• Integration. Facilitators must offer one or more integration sessions afterwards, using a nondirective approach. (Oregon Secretary of State, current)

Sessions can be individual or in a group. Oregon allows group administration sessions with each client's prior written consent, and reported 4,628 individual and 747 group sessions in 2025. (Oregon Secretary of State, current; Oregon Health Authority, 2026) If you are offered a group session, ask how many clients each facilitator will be responsible for.

In trials, the support is often longer. The Johns Hopkins depression trial paired two psilocybin sessions with about 11 hours of supportive psychotherapy, and a two-centre US alcohol trial placed two dosing days inside 12 weeks of manualised psychotherapy. (JAMA Psychiatry, 2021; JAMA Psychiatry, 2022)

What the therapist or facilitator does

During the dosing session the role is mostly watchful and supportive rather than directive: keeping the person physically safe, helping with anxiety and staying present for many hours. Oregon requires a nondirective approach in integration and lets facilitators offer supportive touch only on request and with prior written consent, limited to hugs or hands on the client's hands, feet or shoulders. (Oregon Secretary of State, current)

Training varies by route. Oregon facilitator training programmes must provide at least 128 hours of instruction plus at least 40 hours of practicum. (Oregon Secretary of State, current) Clinical trials use investigators and therapists trained to the sponsor's protocol. Retreats abroad have no common standard, and the Dutch Trimbos Institute notes that nobody checks ceremony intake, aftercare or the number of sober people present. (DRUGSinfo (Drugs Infolijn), Trimbos-instituut)

How it differs from simply taking the drug

The clinical setting changes who takes the drug and under what conditions. Trials exclude people with a personal or family history of psychotic or other severe psychiatric disorders, and they screen for medical risks. (Journal of Psychopharmacology, 2008) Psilocybin raises heart rate and blood pressure during the session. (National Institute on Drug Abuse (NIH); Psychiatry Research, 2024; EMCDDA (now EUDA), via Internet Archive snapshot 2024-06-18) People with bipolar disorder are a particular concern: in a survey of 541 people with self-reported bipolar disorder who had used psilocybin, 32.2% described new or worsening symptoms, prominently mania. (Journal of Psychopharmacology, 2023) Some medicines matter too: reports of lithium taken with a classic psychedelic often involved seizures. (Pharmacopsychiatry, 2021; Oregon Health Authority, Public Health Division, 2026) Never stop or change a prescribed medicine to take part in anything; talk to your prescriber first, and check combinations with the interaction checker.

Unsupervised use carries more risk. In a survey of nearly 2,000 people describing their worst mushroom experience, 11% put themselves or others at risk of physical harm, and risk rose without physical comfort and social support. (Journal of Psychopharmacology, 2016)

The evidence, condition by condition

The condition pages give the full evidence with grades. In brief:

• Psilocybin for depression: several randomised phase 2 trials, including one of 233 people, found larger drops in depression scores than a low dose or placebo. (New England Journal of Medicine, 2022)
• MDMA for PTSD: two phase 3 trials found larger drops in PTSD scores than placebo with therapy, but the FDA declined to approve it in August 2024 and asked for another phase 3 trial. (Nature Medicine, 2021; Nature Medicine, 2023; Lykos Therapeutics (press release), 9 Aug 2024; eCFR (Office of the Federal Register), current)
• Psychedelics for alcohol use disorder: one 95-person randomised psilocybin trial found fewer heavy drinking days than an active placebo. (JAMA Psychiatry, 2022)
• Psilocybin for smoking cessation: one 15-person open-label pilot. (Journal of Psychopharmacology, 2014)
• Ketamine for depression and ibogaine for opioid addiction have their own pages, as does the thin evidence on behavioural addictions.

For how to read these trials, including blinding problems and why early results often shrink, see psilocybin clinical trial results.

Lawful routes today

As of October 2026:

• Clinical trials. Psilocybin, DMT and ibogaine are Schedule I, so a registered trial is one of the few lawful ways to receive them as treatment in most of the US. (Legal Information Institute (Cornell) reproducing the U.S. Code, current) Browse recruiting trials.
• Esketamine and ketamine. Spravato nasal spray was approved for treatment-resistant depression in 2019 and is given only in certified settings with at least 2 hours of monitoring. (U.S. Food and Drug Administration, Drugs@FDA, 5 Mar 2019; U.S. Food and Drug Administration, Drugs@FDA, 2026; U.S. Food and Drug Administration, REMS@FDA, 24 Jun 2026; U.S. National Library of Medicine, DailyMed (Janssen label), 24 Sep 2026) Other ketamine for depression is off-label; the FDA has said ketamine is not approved for any psychiatric disorder. (U.S. Food and Drug Administration, 10 Oct 2023) Spravato is a monitored drug treatment, not a psychotherapy package. See the ketamine therapy guide.
• Oregon and Colorado. Oregon licenses service centres and facilitators, and reported 5,935 clients in 2025. (Oregon Health Authority, 2026) Colorado issued its first healing centre licence on 31 March 2025. (Colorado General Assembly, 23 May 2023; Colorado Department of Revenue, Natural Medicine Division, 2 Apr 2025) These are state programmes, not FDA-approved treatment, and psilocybin stays Schedule I federally. (Legal Information Institute (Cornell) reproducing the U.S. Code, current text) The legal psilocybin guide lists every licensed centre.
• Medical programmes abroad. Authorised psychiatrists in Australia may prescribe psilocybin for treatment-resistant depression; the Czech Republic allows psilocybin in Ministry-licensed psychiatric hospitals from 2026; Germany runs a compassionate-use programme at two clinics. (Therapeutic Goods Administration, 2023; Therapeutic Goods Administration, current page; Federal Register of Legislation (Australian Government), 30 Sep 2026; e-Sbirka, Ministry of the Interior of the Czech Republic, 5 Aug 2025; Central Institute of Mental Health (ZI) Mannheim, 31 Jul 2025; The Lancet Psychiatry 13(2):91-93 (online 18 Sep 2025), Feb 2026)
• Retreats. Retreats in places such as Jamaica or the Netherlands are not medical treatment. The Trimbos Institute says advertising truffle ceremonies as treatment for mental health problems is not allowed and not correct. (DRUGSinfo (Drugs Infolijn), Trimbos-instituut) Check any country with is it legal.

What it costs

There is no single price. ICER put Spravato's announced list price at $32,400 a year in 2019 and judged it low value for money at that price. (Institute for Clinical and Economic Review, 20 Jun 2019) Oregon does not require service centres to report what sessions cost. (Oregon Health Authority, 2026) For trials, ask whether taking part costs anything, which travel or lodging costs are reimbursed and what your insurance covers. (National Institute on Aging (NIH), current page) Published retreat prices are collected in the psilocybin retreat cost guide and the Q4 2026 report.

Ethics and boundaries

People in a psychedelic session are suggestible and vulnerable, and misconduct has occurred even inside sponsored research. In May 2019 MAPS announced that Richard Yensen and Donna Dryer, a married couple who were co-therapists in one of its MDMA trials, had committed ethical violations: a participant moved to where they lived, kept receiving therapy from them, and her relationship with Yensen became sexual. MAPS calls sexual contact between therapy providers and participants "unethical conduct of sexual abuse". It barred both from its activities in 2018, reopened its review in 2021 after a reporter viewed session videos, notified the FDA and Health Canada, and provisionally found they had substantially deviated from the treatment manual. (Multidisciplinary Association for Psychedelic Studies, 24 May 2019) ICER later cited concerns about trial design and conduct alongside unblinding in its 2024 review of MDMA-assisted therapy. (Institute for Clinical and Economic Review, 27 Jun 2024)

Outside research, Chacruna's community guide warns that sessions alone with a healer have been a common context for sexual abuse, and that sexual contact during or right after ceremonies is not acceptable. (Chacruna Institute for Psychedelic Plant Medicines, 2018) Oregon bans romantic or sexual contact between facilitators and clients during services and for one year after the last session. (Oregon Secretary of State, current)

How to judge a provider

Ask, and expect clear answers in writing:

• Is this lawful where it happens, and under which licence or trial registration?
• What medical and psychiatric screening happens before dosing, and who reviews it?
• How many trained people are present for the whole session, and what is the emergency plan?
• What is the policy on touch and on contact after treatment, and how do I complain?
• How many preparation and integration sessions are included, and what does each cost?

Walk away from anyone who promises a cure, asks you to stop a medicine without your prescriber, or discourages you from bringing a support person. The screening checklist covers the medical questions.