Psychedelics, placebo effects, and set and setting: Insights from common factors theory of psychotherapy

Psychedelic-assisted treatment is at first glance markedly different in structure and approach from mainstream forms of psychotherapy in the West. A major criticism of clinical psychedelic research rests on the difficulty of executing placebo-controlled studies and distinguishing drug effects from those of the psychotherapeutic container in which psychedelics are typically presented. Detractors also tend to find fault in spiritual or mystical themes that often arise in the context of psychedelic use. Common factors theory of psychotherapy is a useful and extensively studied framework that can help make sense of these issues, and has much to contribute to our understanding of contextual effects that are often discussed in psychedelic literature as set and setting. In this article, we examine four major contextual common factors shared by various healing traditions: 1) the therapeutic relationship; 2) the healing setting; 3) the rationale, conceptual scheme, or myth; and 4) the ritual. We explain how these factors show up in psychedelic-assisted treatment and how they may contribute to therapeutic effects. Lastly, we discuss the implications of these factors for the concept of placebo, and for future research.

Automated summary

Psychedelic-assisted treatment differs significantly from mainstream psychotherapy in the West in structure and approach. Critics point out the challenges of placebo-controlled studies in psychedelic research, as well as the potential overlap between drug effects and the psychotherapeutic container. Common factors theory of psychotherapy is used to understand contextual effects in psychedelic-assisted treatment, focusing on therapeutic relationship, healing setting, rationale or myth, and ritual as key factors that contribute to therapeutic effects and impact the concept of placebo and future research.