Therapeutic frameworks in integration sessions in substance-assisted psychotherapy: A systematised review.

Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance-assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integration sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematised review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed-methods investigations, treatment manuals, study protocols, quasi-experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until 11 November 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcomes have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic-experiential tradition. While integration is regarded as crucial for the safe application of SAPT, there is currently an insufficient evidence base to suggest that any type of therapy is effective for guiding integration sessions. A systematic investigation of different therapeutic frameworks for integration and additional therapy-related factors is needed.

Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy-A systematized review.

BACKGROUND: Clinical trials are currently investigating the potential of substance-assisted psychotherapy (SAPT) as treatment for several psychiatric conditions. The potential therapeutic effects of SAPT may be influenced by contextual factors including preparation prior to and integration after the substance-assisted therapy sessions. AIMS: This systematized review outlines recommendations for current practice in preparatory sessions in SAPT including safety measures and screening procedures, preparation of set and setting, session contents, methods, and roles, prerequisites, and appropriate conduct of therapists. METHODS: A systematized review of the literature was conducted based on PRISMA guidelines. MEDLINE (OVID), PsycINFO (OVID), and Cochrane Library were searched and clinical trials, treatment manuals, study protocols, case studies, qualitative studies, descriptive studies, theoretical papers, reviews, book chapters, and conference proceedings published until February 1, 2022 were retrieved. RESULTS: The final synthesis included k = 83 sources. Information about safety measures including screening of participants, set and setting, contextual-, physiological-, and psychological preparation, roles, competencies, prerequisites, and characteristics of the therapists, and the establishment of a therapeutic relationship were summarized and discussed. CONCLUSION: It is concluded that there is a consensus in the literature about the importance of adequate preparation before the administration of psychoactive substances in SAPT. However, the extent and approaches for these sessions vary across different models and there is a need for timelier and more rigorous qualitative and quantitative investigations assessing different approaches and techniques for the optimal preparation of clients in SAPT.

Current Perspective on the Therapeutic Preset for Substance-Assisted Psychotherapy.

The present narrative review is the first in a series of reviews about the appropriate conduct in substance-assisted psychotherapy (SAPT). It outlines a current perspective onpreconditions and theoretical knowledge that have been identified as valuable in the literaturefor appropriate therapeutic conduct in SAPT. In this context, considerations regarding ethics and the spiritual emphasis of the therapeutic approaches are discussed. Further, current methods, models, and concepts of psychological mechanism of action and therapeutic effects of SAPT are summarized, and similarities between models, approaches, and potential mediators for therapeutic effects are outlined. It is argued that a critical assessment of the literature might indicate that the therapeutic effect of SAPT may be mediated by intra- and interpersonal variables within the therapeutic context rather than specific therapeutic models per se. The review provides a basis for the development and adaptation of future investigations, therapeutic models, training programs for therapists, and those interested in the therapeutic potential of SAPT. Limitations and future directions for research are discussed.

The effect of approach/avoidance training on alcohol consumption is mediated by change in alcohol action tendency.

Training people to respond to alcohol images by making avoidance joystick movements can affect subsequent alcohol consumption, and has shown initial efficacy as a treatment adjunct. However, the mechanisms that underlie the training's efficacy are unknown. The present study aimed to determine 1) whether the training's effect is mediated by a change in action tendency or a change in selective attention, and 2) whether the training's effect is moderated by individual differences in working memory capacity (WMC). Three groups of social drinkers (total N = 74) completed either approach-alcohol training, avoid-alcohol training or a sham-training on the Approach-Avoidance Task (AAT). Participants' WMC was assessed prior to training, while their alcohol-related action tendency and selective attention were assessed before and after the training on the recently developed Selective-Attention/Action Tendency Task (SA/ATT), before finally completing an alcohol taste-test. There was no significant main effect of approach/avoidance training on alcohol consumption during the taste-test. However, there was a significant indirect effect of training on alcohol consumption mediated by a change in action tendency, but no indirect effect mediated by a change in selective attention. There was inconsistent evidence of WMC moderating training efficacy, with moderation found only for the effect of approach-alcohol training on the AAT but not on the SA/ATT. Thus approach/avoidance training affects alcohol consumption specifically by changing the underlying action tendency. Multiple training sessions may be required in order to observe more substantive changes in drinking behaviour.

Approach-alcohol action tendencies can be inhibited by cognitive load.

RATIONALE: Dysregulated alcohol consumption has been attributed to an imbalance between an approach-alcohol action tendency and executive control processes. However, which specific executive control processes are involved is not known. One candidate executive process is interference suppression, which refers to the suppression of task-irrelevant information through the active maintenance of task-relevant information or a cognitive load. OBJECTIVE: The present study aimed to (1) establish whether alcohol action tendency can be inhibited by interference suppression through the use of cognitive loads and (2) to assess whether individual differences in the degree of interference suppression from cognitive loads is related to individual differences in the ability to regulate alcohol consumption. METHOD: Two groups of social drinkers (total N = 58) who differed in their ability to regulate their alcohol consumption completed a novel cognitive load variant of the approach avoidance task (AAT) and an alcohol taste test. RESULTS: Results indicated that (1) there was a relationship between alcohol bias on the AAT and alcohol consumption under low load, but not high load, consistent with the hypothesis that the action tendency would be inhibited through interference suppression, and (2) this effect of load was not modified by drinking group, with both groups demonstrating equivalent ability to inhibit the action tendency. CONCLUSIONS: The present findings suggest that alcohol action tendency can be inhibited through interference suppression, and that this is effective even for those that have difficulty regulating their alcohol consumption.

Alcohol-related biases in selective attention and action tendency make distinct contributions to dysregulated drinking behaviour.

AIMS: To assess whether alcohol-related biases in selective-attention and action tendency uniquely or concurrently predict the ability to regulate alcohol consumption. DESIGN AND PARTICIPANTS: Two groups of undergraduate social drinkers (total n = 55) who differed in their ability to regulate their alcohol consumption completed a novel Selective-Attention/Action-Tendency Task (SA/ATT), which assessed separately alcohol-related biases in selective attention and action tendency. SETTING: University of Western Australia, Australia. MEASUREMENT: Dysregulated drinking was operationalized as a self-reported high level of alcohol consumption on the Alcohol Consumption Questionnaire, and a high desire to reduce consumption on the Brief Readiness to Change Algorithm. Selective attention and action tendency were assessed using the SA/ATT, working memory was assessed using the operation-span task and participant characteristics were assessed using the Alcohol Use Disorders Identification Test (AUDIT) and Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). FINDINGS: Results indicated that (i) there was no significant association between alcohol-related biases in selective attention and action tendency, r = 0.16, P = 0.274, and (ii) biases towards alcohol, in both selective attention, ß = 1.01, odds ratio = 2.74, P = 0.022, and action tendency, ß = 1.24, odds ratio = 3.45, P = 0.015, predicted independent variance in dysregulated-drinker status. CONCLUSION: Biases in selective attention and action tendency appear to be distinct mechanisms that contribute independently to difficulty regulating alcohol consumption. Treatment components that could be combined to target both mechanisms could enhance treatment outcomes for alcohol-use disorders.

The interaction of approach-alcohol action tendencies, working memory capacity, and current task goals predicts the inability to regulate drinking behavior.

The inability to regulate alcohol consumption has been attributed to an imbalance between stimulus-driven behavioral biases, or action tendencies, and the ability to exert goal-directed control, or working memory capacity (WMC). Previous research assessing the interaction between these variables has not considered the effect of whether individuals' current goals or task demands require goal-directed control. Our aim was to examine the potential interaction of appetitive action tendencies and the ability to exert control over these action tendencies as a function of whether task demands require applying control for successful task completion. Two groups of social drinkers (n = 40 per group) who differed in their ability to regulate their alcohol consumption completed a novel variant of the Approach-Avoidance Task (AAT), which separately assessed approach and avoid trials. The approach and avoidance responses differentially require goal-directed control, depending on whether the task-relevant response is incongruent with the stimulus-driven action tendency. Results indicated that (a) group differences in AAT indices were only observed on trials that required an avoidance movement, which are trials where the task-relevant response would be incongruent with an approach action tendency, and (b) the extent of the group differences for these avoidance trials was moderated by individual differences in WMC, such that problem drinkers with lower WMC showed greater behavioral bias toward alcohol than those with higher WMC. These findings suggest that difficulties in regulating alcohol consumption arise from a complex interaction of action-tendencies, WMC, and current goals or task demands.