Resources / PTSD / Psychadelic-Assisted Therapy: Answers to Your Important Questions
10 min read
Last updated 5/28/25
By: Kelsey Cottingham, MSW, LMSW
Clinical Reviewer: Jill Donelan, PsyD
Psychedelic-Assisted Therapy: Answers to Your Most Important Questions
Learn how psychedelic therapy works, what the research says, how to access care safely, and understand some of the myths versus facts about this emerging field.
Many people living with conditions like post-traumatic stress disorder (PTSD), depression, or anxiety don’t find relief from traditional treatments like talk therapy or antidepressants. When progress feels minimal or symptoms persist despite trying multiple options, it’s understandable to feel stuck or discouraged.
In recent years, clinical researchers have begun studying a new area of treatment: psychedelic-assisted therapy. This approach, which combines psychedelic medications with psychotherapy under controlled conditions, is being explored as a potential option for people with a variety of mental health conditions, particularly for people with treatment-resistant conditions, especially when traditional treatments haven’t led to lasting relief.1,2
What is psychedelic-assisted therapy?
Psychedelic therapy is a mental health treatment that combines the use of psychedelic substances, like MDMA, psilocybin, or ketamine, LSD, or DMT with psychotherapy. Unlike recreational or unsupervised use, these sessions take place in a controlled, clinical environment with trained mental health professionals who guide the experience from preparation to integration.
The goal isn’t just to induce altered states of consciousness. It’s to support deep emotional processing, increase mental flexibility, and enhance neuroplasticity, allowing patients to revisit and reprocess painful memories in a safe and supported way.2,3
Common questions about psychedelic therapy
Is it safe?
Psychedelic therapy is not appropriate for everyone. People with certain medical conditions, histories of psychosis, or medication interactions may be at higher risk of adverse outcomes. It’s essential to be evaluated by a qualified provider.3
Can psychedelics cause schizophrenia?
There is no evidence that psychedelics cause schizophrenia in people without a predisposition, but those with a personal or family history of psychotic disorders are typically excluded from clinical trials for safety reasons.3 Psychedelic treatment is typically considered only for adults (18+), as these medications may pose more risks when the brain is still developing through childhood and adolescence.
Does insurance cover it?
Most psychedelic-assisted therapies, aside from esketamine, are not yet FDA-approved and therefore not covered by insurance. Esketamine therapy may be covered in some cases, particularly for treatment-resistant depression. Always check with your provider and insurance company for specific policies.2
How do I find care or participate in a trial?
If you’re interested in exploring psychedelic-assisted therapy for PTSD:
- Talk to a licensed mental health provider, especially one trained in trauma.
- Explore ketamine clinics in your area, ensuring they offer integration support.
- Visit ClinicalTrials.gov or MAPS.org to find clinical trials for MDMA or psilocybin.
- Use Psych Hub’s provider directory to locate trauma-informed professionals.
Never attempt psychedelic use on your own for mental health treatment—it can be destabilizing or harmful without clinical guidance.
What conditions can psychedelic therapy treat?
Psychedelic therapy is being studied for a wide range of mental health conditions, including:
- Post-traumatic stress disorder treatment (PTSD)
- Treatment-resistant depression
- Anxiety disorders
- Obsessive-compulsive disorder (OCD)
- Eating disorders
- Substance use disorders (like alcohol use disorder)
- End-of-life anxiety
- Chronic pain and illness-related distress⁸
What does “treatment-resistant” mean?
Sometimes, people try widely used treatments like antidepressants or gold-standard therapies such as CBT, EMDR, or prolonged exposure therapy and still don’t experience meaningful symptom relief. If improvement doesn’t happen after at trying least two other medications, you may be treatment-resistant.1
Being treatment-resistant does not mean:
- That something is wrong with you
- That you aren’t trying hard enough
- That your symptoms are your fault
- That nothing will work
- That you need to try something extreme or experimental2
For example, someone with treatment-resistant PTSD may have worked hard in multiple therapies, taken FDA-approved medications, and still feel stuck, numb, or constantly on edge. For someone with treatment-resistant PTSD, continuing to seek options beyond standard treatments can be a valid and understandable next step. That might include emerging therapies still being studied, like psychedelic-assisted therapy, or other established approaches. What works for one person might not work for another, and that’s okay.2
Psychedelics and trauma
PTSD can profoundly disrupt emotional regulation, memory processing, and a person’s sense of safety. Many people with PTSD struggle with avoidance, emotional numbing, and feeling constantly on edge.
First-line treatments like cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and post-traumatic stress disorder medication like selective serotonin reuptake inhibitors (SSRIs) are effective for some; but studies show that up to half of people with PTSD don’t respond to these treatments or drop out early.14
Memory, emotion, and threat perception
Psychedelics appear to affect parts of the brain that regulate memory, emotion, and threat perception:
- Reduced fear response: MDMA and LSD decrease activity in the amygdala (the brain's fear center), allowing patients with PTSD to revisit traumatic memories without becoming overwhelmed.2,4,5
- Interrupting repetitive thought loops: Psilocybin, LSD, and DMT temporarily disrupt the default mode network (DMN), a brain system that’s often overactive during rumination and self-criticism. Reducing this activity may help people gain distance from unhelpful thoughts and explore new emotional perspectives.6,7,8,9
- Enhanced healing and growth: These substances may also increase levels of serotonin and promote neuroplasticity, helping the brain form new connections that support lasting change.2,10
Storing and accessing trauma
Trauma can interfere with how memories are stored and accessed, making them feel fragmented, emotionally intense, or disconnected from context. Psychedelic-assisted therapy may help reverse these effects in several ways:
- Reprocessing trauma memories: Traumatic memories are often fragmented and emotionally charged. Psychedelics may support memory reconsolidation—revisiting these memories from a calmer, more grounded state and re-encoding them with new meaning.11,12
- Increasing brain connectivity: Psychedelics enhance communication between regions of the brain that don’t usually interact. This can lead to more integrated thinking and a fuller understanding of past experiences. 7,13
- Enhancing emotional flexibility: These brain changes may foster new ways of responding to emotions, allowing people to feel less stuck and more capable of moving forward.9
- Greater connection and trust: Psychedelics can temporarily increase feelings of empathy, emotional openness, and social connectedness, which are often damaged by trauma.4
- Breakthrough emotional insight: Many individuals report that psychedelics help them access buried emotions or insights that traditional therapy hasn’t reached.
- Strengthened sense of meaning: These treatments may facilitate a renewed sense of purpose, helping people reframe their suffering in ways that support healing.
These effects may help trauma survivors feel more connected, supported, and able to engage more fully in their healing process.19 While more research is needed to fully understand these effects, early neuroscience findings are promising.2
To learn more about trauma, visit Understanding PTSD: Symptoms, Causes, and Treatments That Work
What does the latest clinical research say?
As research into psychedelic therapy grows, three compounds—MDMA, psilocybin, and ketamine—have emerged as key players. LSD and DMT also continue to be areas of study. Each one has a different legal status, clinical use case, and research backing, but all are showing promise in helping people recover from trauma-related conditions.
MDMA: Trauma-focused and nearing FDA approval
- What it's used for: Post-traumatic stress disorder treatment (PTSD)
- Key findings: In a 2021 Phase 3 study published in Nature Medicine, 67% of participants receiving MDMA-assisted therapy no longer met the criteria for PTSD after three sessions, compared to 32% in the placebo group.
- Who was studied: Participants included people with severe, long-term PTSD, such as veterans and survivors of childhood trauma or sexual violence.16
- How it may help: Researchers believe MDMA may reduce fear responses and increase feelings of emotional safety, which can support trauma processing.4
- Where it stands: In August 2024, the FDA declined to approve MDMA-assisted therapy and asked the sponsor for additional clinical data. The company is running another phase-3 study and plans to resubmit its application, so any final decision is still at least a year or two away.18
Psilocybin: Emotional reconnection and meaning-Making
- What it's used for: Depression, often in people with trauma histories
- Key findings: In a randomized controlled trial, two psilocybin sessions combined with therapy produced significant and long-lasting reductions in depressive symptoms.18
- Who was studied: People with treatment-resistant depression, many of whom had underlying trauma.
- How it may help: Psilocybin-assisted therapy may help individuals gain new emotional insights, reconnect with a sense of meaning, and reframe distressing experiences.19
- Where it stands: Psilocybin-assisted therapy is not FDA-approved, but legal state-regulated treatment programs currently exist in Oregon and Colorado.20
Ketamine: Rapid relief for depression and suicidality
What it's used for: Depression, suicidality, and trauma-related anxiety
- How it’s used today: Ketamine is currently offered in clinics across the U.S., typically in the form of IV infusions or nasal spray (esketamine). Esketamine is FDA-approved for treatment of treatment-resistant depression. Ketamine, meanwhile, is a legal–but not FA-approved–way to treat depression and suicidality. 2
- How it may help: Randomized trials show that a single 40-minute IV infusion can cut depression scores within 24 hours,21 and intranasal esketamine can reduce suicidal thinking within four hours.24 Researchers think the brief dissociative state gives people distance from overwhelming thoughts, making it easier to re-engage with therapy once mood lifts.
- Limitations: The effects are often short-lived, and multiple sessions may be needed to maintain progress.
- Where research is headed: Studies continue to explore how ketamine might be paired with therapy to support long-term mental health outcomes.
LSD: Enhancing insight and emotional flexibility
- What it's used for: Anxiety, depression, and substance use disorders
- Key findings: Small modern trials and lab studies indicate LSD can boost brain-plasticity markers and elicit vivid emotional insights—changes linked to lower anxiety and depressive symptoms in research volunteers. 22, 23
- Who was studied: Participants have included people facing life-threatening illness, adults with long-standing depression, and healthy volunteers exploring self-awareness and emotional resilience.2,22
- How it may help: LSD may facilitate profound emotional breakthroughs, increased openness, and a shift in perspective that helps reduce mental health symptoms.
- Where it stands: LSD is not currently FDA-approved, but interest in its therapeutic applications continues to grow as new trials emerge.22
DMT: Brief but intense therapeutic potential
- What it's used for: Depression, PTSD, and anxiety (under investigation)
- Key findings: Because DMT acts within seconds and wears off in under 30 minutes, trial teams see it as a way to deliver a short, focused therapeutic session that still produces the intense introspection seen with longer-acting psychedelics.23,24
- Who was studied: Research is ongoing and includes small clinical trials involving individuals with depression and anxiety.23,25
- How it may help: The compound can induce vivid, immersive states that appear to loosen rigid thought loops and spark rapid emotional insight, effects theorized to interrupt depressive rumination and enhance psychological flexibility.24
- Where it stands: DMT remains a Schedule I drug with no approved medical use. Clinical trials are ongoing in the United States, Canada, and the U.K., but it is still in the earliest stages of evaluation.23
Why professional guidance matters
Psychedelic experiences can bring up intense emotions, memories, and insights. While this can be therapeutic, it can also be destabilizing, especially for people navigating trauma.14 That’s why professional support with a trained therapist is essential.3
Trained clinicians help ensure that:
- You’re properly screened for any medical or psychiatric risks
- The experience is emotionally safe and supported
- You have time to reflect and integrate what comes up in session 3,15
Therapy sessions include preparation before the dose, therapeutic presence during the experience, and post-session integration. This structure increases the likelihood of meaningful and lasting benefits and reduces potential risks.3
How to access psychedelic therapy
As of 2025, most psychedelics remain illegal at the federal level in the United States—but there are several notable exceptions and evolving pathways:
- Ketamine & esketamine: Available now
IV ketamine infusions are offered off-label in many clinics, and the FDA-approved nasal spray esketamine (Spravato®) can be prescribed for treatment-resistant depression.2
- MDMA: Still waiting on the green light
Strong phase-3 data were not enough for a 2024 approval; the FDA asked the sponsor to run another study, so a final decision is now at least a couple of years away.17
- Psilocybin: State-run programs only
Oregon has operated licensed psilocybin service centers since 2023, and Colorado’s voter-approved program is set to launch in 2025.28
- More states on deck
Legislatures in California, Connecticut, New Jersey, and Washington are debating bills or psychedelic-assisted treatment pilot programs that would open tightly regulated access, but none have passed yet.28
What to expect during treatment
While specific treatment protocols vary depending on the psychedelic used (e.g., MDMA, psilocybin, ketamine, LSD, or DMT), most clinical models include structured preparation, therapeutic support during the dosing session, and post-session integration. These components aim to enhance safety and optimize therapeutic outcomes.
1. Assessment and preparation
You’ll meet with a trained therapist to review your medical history and prepare emotionally for the experience. The therapist may spend multiple sessions helping you build trust and clarify intentions for treatment.3
2. Dosing session
You’ll take the psychedelic compound (oral, nasal spray, or IV) in a calm, supportive setting. A therapist or therapy team will stay with you the entire time, usually for 4–8 hours. You may experience visual imagery, emotional shifts, memory recall, or deep insights.3
3. Integration
After the session, you’ll meet with your therapist to reflect on the experience. This step helps you process what came up and apply those insights to your daily life.3
4. Follow-up
Most models include 2–3 dosing sessions and multiple integration sessions over the course of treatment. Long-term benefits often come from combining the psychedelic experience with continued therapy and support.2,16
Risks, contraindications, and safety considerations
While many people tolerate psychedelic therapy well in clinical settings, it’s not appropriate for everyone. Here are some important considerations to discuss with your mental health provider:
- History of psychosis: A personal or family history of psychotic disorders such as schizophrenia or schizoaffective disorder may increase risk.
- Bipolar I disorder: If you have a history of manic episodes, particularly if they have not been effectively managed with treatment, psychedelic therapy may require careful consideration and monitoring.
- Medication interactions: Some common mental health medications, such as antidepressants (e.g., SSRIs or MAOIs), may interact with psychedelics in ways that require medical supervision or adjustment.
- Cardiovascular health: Heart conditions that could be worsened by elevated blood pressure or heart rate may make treatment riskier.
- Pregnancy and breastfeeding: The safety of psychedelic therapy during pregnancy or while nursing has not been established.
Common but manageable side effects of psychedelics may include:
- Nausea or vomiting
- Dizziness or dissociation
- Temporary anxiety or emotional discomfort
That’s why proper screening, preparation, and supervision are essential.2,3
Barriers to access and the need for culturally sensitive care
Psychedelics have been used since ancient times in many cultures for healing and spiritual rituals, however the use of psychedelics in western medicine is relatively new. For many people, especially those from historically marginalized communities, systemic and cultural barriers make it difficult to pursue or trust these treatments.
Despite growing interest and evidence of therapeutic benefit, several systemic and cultural barriers limit access to psychedelic therapy:
- Cost: Many psychedelic-assisted treatments, especially ketamine, are not covered by insurance and can be financially out of reach.
- Geographic availability: Access to legal psychedelic therapy is currently limited to a few states, with sparse provider networks in rural and underserved areas.
- Legal status: Because many psychedelics remain federally illegal, access varies widely by state and is often limited to clinical trials or special programs.
- Mistrust of medical systems: Historical and ongoing harms in psychiatry and medicine have led to deep mistrust, particularly among BIPOC, LGBTQIA+, and low-income communities.26,27
To ensure equitable access and care, psychedelic therapy must be:
- Trauma-informed: Grounded in consent, transparency, and client empowerment
- Culturally responsive: Reflective of diverse lived experiences and inclusive of non-Western healing traditions
- Equitably accessible: Supported by sliding-scale options, training for diverse providers, and outreach to marginalized communities
A growing number of grassroots organizations such as the People of Color Psychedelic Collective and Fireside Project are working to address these gaps and shape a more inclusive future for psychedelic healing. 26,27
For a list of free, accessible resources visit, Free Crisis, Traumatic Event & Trauma Resources for Everyone
The bottom line
Psychedelic-assisted therapy is not a miracle cure, but it may represent a new area of exploration for people with PTSD who haven’t found relief through conventional treatments. With professional support and continuing research, these therapies may offer another tool in the broader effort to address trauma. With professional guidance, these therapies can help trauma survivors reconnect to themselves, find meaning in their experiences, and move forward with renewed hope.16
If you’re struggling with PTSD, or another mental health condition and curious about next steps, explore more resources here or talk with a licensed mental health provider.
This content is for informational purposes only and does not constitute medical advice.
Sources
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