Participant Screening

For any given individual, many personal factors can inform or detriment psychological outcomes of the psychedelic therapy. It is important to screen patients on a several criteria, and based on these, decide whether or not psychedelic therapy is appropriate. Screening criteria can also help inform the course of the therapy.

Informed consent & protecting facilitators

Screening serves both to defend the guide from any personal liability or danger, as well as to help participants avoid risks and manage personal expectations for the therapy. Some participants turn to psychedelic therapy out of desperation, while others arrive at the drugs randomly for recreational purposes. Whatever the case, users should be well-educated about potential effects of psychedelic drugs in order to meaningfully give informed consent when ingesting them.

Screening serves both to defend the guide from any personal liability or danger, as well as to help participants avoid risks and manage personal expectations for the therapy. Some participants turn to psychedelic therapy out of desperation, while others arrive at the drugs randomly for recreational purposes. Whatever the case, users should be well-educated about potential effects of psychedelic drugs in order to meaningfully give informed consent when ingesting them.

If you have made yourself available as a psychedelic guide or therapist, do not hesitate to set boundaries on what kind of patients you provide therapy to. Psychedelic guides are often held liable for psychological harm or physical danger, and must act with discretion when determining the best interest of all parties. Although psychedelic advocates hope to make psychedelic medicine available for a diversity of mental disorders, it is wise to exercise prudence in admitting certain patients for psychedelic therapy, so guides can perform with confidence in the treatment and outcome of their patients.

General screening factors

There is no single indicator or pathology that guarantees a negative response to psychedelic drugs. A number of factors such as mental health, life circumstances, family history, and other things should be considered in tandem to determine the best course of therapy. Below are listed some patient disorders and situations that are commonly brought up during screening interviews for patients of psychedelic therapy:[1]

  • Age: in most situations for liability reasons, the participant must be a legally consenting adult. It is usually advised and adolescents forgo psychedelic use due to its potential impact on brain development. The brain does not finish developing completely until age 25. The prefrontal cortex, which implicated in long-term decision as well as developmental pathways of addiction, is among the parts of the brain to mature; it is conventional wisdom to avoid drugs at early ages and attempt to preserve these neural structures. MDMA, cannabis, and stimulants have all been shown to effect adolescent development in a manner which can predispose adolescents to substance use problems in adulthood. Anecdotally, psychedelics are sometimes reported to have exerted considerable influence on one’s adolescent development.[2][3]
  • Life stability: the goal of psychedelic is to focus on an inward psychospiritual process. If the participant is overly worried by life stressors or big plans during their session, it may disrupt them from trusting in themselves and the therapy. In clinical sessions, it is sometimes recommended that candidates do their best to ensure that not major life events will take place for several months before and after the psychedelic trip. A stable domestic situation will supports a safe opportunity for self-exploration, as well as a familiar environment to return to for integration. Similarly, patients are often advised not to make any major decisions for several days or weeks during the integration period following a psychedelic experience
  • Indications of instability or violence: if the psychedelic candidate currently shows intention or inclination to harm themselves, others, or causing physical destruction, this should be taken as a sign of emotional instability and potentially violent impulses
  • Self-awareness and accountability: participants should have a good ability take responsibility for their actions and self-reflect on emotions, thoughts, and beliefs. A participant who is too attached to their own model of reality, or who has difficulty taking in new information, may lead struggle during a session. Patients should be encouraged to approach the psychedelic experience with openness and curiosity.

Medical risks

The following conditions may present physiological risks. Psychedelic use alongside any of the following conditions should be considered with utmost care:

  • Pregnancy: female candidates who are pregnant or breastfeeding should not ingest psychedelic drugs.
  • Dementia: users suffering from dementia may be unable to give informed consent. Additionally, psychedelic treatment for dementia is little-researched.
  • Epilepsy or non-epileptic seizures: psychostimulants including LSD, MDMA, and potentially other psychedelics, lower the seizure threshold and may increase seizures in vulnerable individuals.[4][5][6]
  • Active alcohol withdrawal: due to increased the risk of seizures.[7]
  • Cardiovascular disease, hypertension, or high blood pressure: 5-HT2B agonists, including psychedelics and MDMA, may increase risks of heart disease, specifically valvulopathy.[8][9][10][11]
  • History of brain injury or stroke: these may increase the likelihood of unexpected reactions, and should not be combined with psychedelics unless the underlying neurological risks can be medically assessed.

Mental health conditions

Going over the above factors will give a basic snapshot of the mindset with which the participant approaches psychedelic therapy. In addition to these, several physical and psychiatric conditions should also be considered as presenting considerable risks:

  • Personal or family history of schizophrenic disorders or psychotic symptoms: psychedelics may increase the likelihood of developing schizoid features, or the intensity of pre-existing symptoms.
  • Borderline Personality Disorder, or undiagnosed features thereof: Borderline symptoms often feature instability, desperation, and indications of Complex PTSD.[12] These symptoms should be managed through other therapies before experimenting with psychedelics, which may evoke borderline tendencies
  • Narcissistic or sociopathic tendencies: psychedelics can elevate self-assurance and confidence, and may be associated with ego inflation.[13]
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Works Cited

  1. Haden, M., Ball, M. and Woods, B. (2018). Psychedelic Guide Manual. Vancouver, British Columbia.
  2. Johnson, S. B., Blum, R. W., & Giedd, J. N. (2009). Adolescent maturity and the brain: the promise and pitfalls of neuroscience research in adolescent health policy. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 45(3), 216–221. doi:10.1016/j.jadohealth.2009.05.016
  3. Schepis, T. S., Adinoff, B., & Rao, U. (2008). Neurobiological processes in adolescent addictive disorders. The American journal on addictions, 17(1), 6–23. doi:10.1080/10550490701756146
  4. Burish, M. J., Thoren, K. L., Madou, M., Toossi, S., & Shah, M. (2015). Hallucinogens causing seizures? A case report of the synthetic amphetamine 2,5-dimethoxy-4-chloroamphetamine. The Neurohospitalist, 5(1), 32–34. doi:10.1177/1941874414528939
  5. Fisher, D. D., & Ungerleider, J. T. (1967). Grand mal seizures following ingestion of LSD. California medicine, 106(3), 210–211.
  6. Zagnoni, P. G., Albano, C. (2002, March 19). Psychostimulants and Epilepsy. Epilepsia, 43(2):28-31. https://doi.org/10.1046/j.1528-1157.2002.043s2028.x
  7. LaPlante, E. (2016). Seized: temporal lobe epilepsy as a medical, historical, and artistic phenomenon. Open Road Media. pp 149-150. Retrieved from Google Books.
  8. Hutcheson, J. D., Setola, V., Roth, B. L., & Merryman, W. D. (2011). Serotonin receptors and heart valve disease–it was meant 2B. Pharmacology & therapeutics, 132(2), 146–157. doi:10.1016/j.pharmthera.2011.03.008
  9. Droogmans, S., et al. Possible Association Between 3,4-Methylenedioxymethamphetamine Abuse and Valvular Heart Disease. American Journal of Cardiology. 100(9):1442 – 1445. https://doi.org/10.1016/j.amjcard.2007.06.045
  10. Reid TE, Kumar K, Wang XS. Predictive in silico studies of human 5-hydroxytryptamine receptor subtype 2B (5-HT2B) and valvular heart disease. Current Topics in Medicinal Chemistry. 2013;13(11): 1353–1362. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4086739/.
  11. Huang X.P., Setola V., Yadav P.N., et al. Parallel functional activity profiling reveals valvulopathogens are potent 5-hydroxytryptamine(2B) receptor agonists: implications for drug safety assessment. Mol Pharmacol. 2009;76(4):710–722. doi:10.1124/mol.109.058057
  12. Cloitre M, Garvert DW, Weiss B, Carlson EB, Bryant RA. Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. Eur J Psychotraumatol. 2014;5:10.3402/ejpt.v5.25097. Published 2014 Sep 15. doi:10.3402/ejpt.v5.25097
  13. Nour, M. M., Evans, L., Nutt, D., & Carhart-Harris, R. L. (2016). Ego-dissolution and psychedelics: Validation of the Ego-Dissolution Inventory (EDI). Frontiers in Human Neuroscience, 10, Article ID 269.