Dr Peter Sjöstedt-Hughes, Lecturer at Exeter University, has proposed incorporating metaphysical philosophy into psychedelic therapy to help improve therapeutic outcomes.

Sjöstedt-Hughes suggests that psychedelic therapy may gain more advantage by extending its scope into metaphysics, helping patients better integrate and understand psychedelic-induced metaphysical experiences.

Such improved outcomes may be seen if patients undergoing this therapy “are provided with an optional, additional, and intelligible schema and discussion of metaphysical options at the integrative phase of the therapy.” 

In the paper, Sjöstedt-Hughes puts forward this schema as the “Metaphysics Matrix” and an accompanying “Metaphysics Matrix Questionnaire (MMQ)” which can be utilised by therapists and researchers as a tool for the quantitative measurement of a psychedelic experience.

The paper ‘On the need for metaphysics in psychedelic therapy and research’ has been published in Frontiers in Psychology.

What is metaphysics?

While mysticism deals with understanding the universe through direct experience, such as revelation, metaphysics is a branch of philosophy that deals with understanding the fundamental nature of reality through logic/argument.

Sjöstedt-Hughes writes that “metaphysics is not mysticism” but there is overlap: “[…] metaphysics is broader and its positions can be logically deliberated — as such metaphysics can encompass mystical experiences induced by psychedelic intake yet metaphysics can also ground those experiences in a manner that can be more intelligible, comprehensive, viable, and acceptable to participants than that which the framework of mysticism alone can offer.”  

The Metaphysics Matrix

A number of clinical trials investigating psychedelic-assisted psychotherapy for the treatment of mental health conditions, such as anxiety and depression, report that participants who undergo a “mystical experience” during a psychedelic session often have higher levels of sustained therapeutic outcomes.

In clinical trials, mystical experiences are measured by different scales including the Mystical Experience Questionnaire (MEQ), the Hood Mysticism Scale (HMS), the Hallucinogen Rating Scale (HRS), the Five Dimensions Altered State of Consciousness Questionnaires (5D-ASC) and Eleven Dimensions Altered State of Consciousness Questionnaires (11D-ASC).

Sjöstedt-Hughes writes: “Data derived in this manner is obviously limited and abstract not only because psychedelic experience need not be “mystical,” but also because the definition of “mystical” could be expanded to include other criteria […] 

“With regard to psychedelic-assisted psychotherapy […] speaking about mystical experience per se will not be sufficient to provide a meaningful explanation of the significance of such experience to a person, for the simple reason that mystical experience is the phenomenon to be explained — mystical experience is the explanandum rather than the explanation. 

“It is metaphysics that is the means of explanation, the explanans of the mystical explanandum.”

The Metaphysics Matrix has been designed to provide a “menu” of metaphysical options that may help people to “frame, make sense of, and give significance to, their experiences”, and would be another tool in the belt of therapists to better understand these experiences.

Image provided by Dr Peter Sjöstedt-Hughes.

Such experiences could be understood through metaphysical systems such as Neutral Monism, Pantheism, Panpsychism, Animism, Substance Dualism, and Idealism, says Sjöstedt-Hughes. 

Some examples provided include the common experience of the Universe being God – which can be understood in the context of Pantheism – or of all matter having a basic form of sentience – such as plants having a basic drive or process – which can be understood in the context of Panpsychism. 

Image provided by Dr Peter Sjöstedt-Hughes.

Additionally, enabling people who have had these experiences to understand them within these frameworks may make them less likely to dismiss the experiences as delusional, says Sjöstedt-Hughes.

“ […] Relatedly, that the worldview hitherto adopted by the participant is but one metaphysical position amongst others,” he writes. 

Sjöstedt-Hughes commented: “This is a conjecture that hasn’t been tested but can be tested – offering a patient an additional and optional discussion in the integrative phase of psychedelic-assisted psychotherapy. 

“Giving them this Metaphysics Menu for integration may extend the long-term benefits of psychedelic therapy and beyond because there’s a number of studies that seem to show that certain peak psychedelic experiences have the longest and most beneficial health outputs results.

“If in the integrative phase [of therapy] one looks at that experience and starts to frame it intelligibly, then the conjecture is that the participant will not in a few weeks after that, think it must have been a delusion – they will say that we don’t know what reality is. 

“Therefore, we can’t dismiss something as a delusion necessarily. By doing that it might extend the significance of that experience for the person.

“When we use Mysticism Scales, by definition, mystery can’t explain itself. Metaphysics, however, incorporates those experiences and offers an explanation to what they mean. For example, the relation between oneself and the universe.”

Sjöstedt-Hughes points out that in practice, one of the immediate issues is the practical issue of implementation of Metaphysics Integration, suggesting this could be supported through resources such as a handbook or practitioner training.

He further concludes the integration would need to be “further bridged by the therapist to the participant’s life, concerns, values, aims, and outlook.”

The Metaphysics Schema is already being utilised in studies taking place at Ohio State University, US, and Exeter University, UK.

Silo Pharma has announced it has advanced the formulation development for its therapeutic drug, SPC-15, which utilises ketamine.

The liquid nasal formulation will be used in SPC-15’s novel protocol that aims to treat and prevent anxiety, post-traumatic stress disorder (PTSD), and other stress-related disorders. 

Chief Executive Officer of Silo Pharma, Eric Weisblum, stated: “The progress of our feasibility study investigating dose strengths of SPC-15 is a significant advancement in our development work with this pipeline candidate.

“Results of the feasibility study will determine our selection of the manufacturing processes, and we are currently in discussions with potential delivery partners.

“We may also use the feasibility data for upcoming studies related to our SPC-14 therapeutic targeting Alzheimer’s disease.”

The company has stated that the formulation development was in accordance with its sponsored research agreement and option with Columbia University, and that linearity, accuracy, and repeatability were achieved in the feasibility study.

In May 2023, Silo Pharma was awarded a U.S. Patent titled “Biomarkers for Efficacy of Prophylactic Treatments Against Stress-Induced Affective Disorders,” with claims protecting the key technology behind SPC-15 and further drug discovery.

The company is also carrying out a Sponsored Research Agreement with the University of California, San Francisco (UCSF) – Effect of Psilocybin on Inflammation in the Blood – which is investigating psilocybin’s effect on inflammatory activity in humans, with plans to accelerate its implementation as a potential treatment for Parkinson’s, chronic pain and bipolar disorder.

Authorised psychiatrists are now able to prescribe MDMA and psilocybin for PTSD and treatment-resistant depression, respectively, from 1 July.

In February 2023, Australia made changes to its drug scheduling to enable the prescription of MDMA and psilocybin for patients. 

The move was made in light of the current lack of treatment options for patients, with Australia’s Therapeutic Good Administration (TGA) stating that these two conditions are the only ones for which there is currently sufficient evidence for potential benefits in certain patients.

Under the new classification, the substances will change from Schedule 9 which is prohibited substances, to Schedule 8, which is controlled drugs, of the Poisons Standard. 

The decision was made following multiple applications to the TGA to reclassify the substances in the Poisons Standard, as well as public consultation, a report from an expert panel, and advice received from the Advisory Committee on Medicines Scheduling.

The development makes Australia the first country in the world to regulate psilocybin and MDMA as mental health treatments. 

Professor David Nutt, Head of Neuropsychopharmacology at Imperial College, who was involved with advocating to the TGA for the rescheduling, said: “This is a landmark day for the tens of thousands of Australian families who are blighted by depression and PTSD as they will have access to powerful new treatments with unique mechanisms of action. And congratulations to Australia for leading the world in this vital treatment innovation.”

Mind Medicine Australia (MMA), which is currently offering a Certificate in Psychedelic-Assisted Therapies (CPAT) for healthcare professionals training in psychedelic-assisted therapies (PAT), were also heavily involved with rescheduling applications lodged in March 2022 and objections to the interim decision lodged in November 2022. 

Tania de Jong AM, Executive Director of Mind Medicine Australia, which has also arranged for psilocybin and MDMA to be supplied to Australian psychiatrists via a partnership with Optimi Health, stated: “We are so pleased that some of the immense suffering being experienced in families, communities and organisations around the nation can be alleviated through these transformational therapies.”

Professor Chris Langmead, Deputy Director, and Better Medicines Theme Leader of the Neuromedicines Discovery Centre at the Monash Institute of Pharmaceutical Sciences (MIPS), commented: “The TGA’s decision took many by surprise and, understandably, there have been questions from some regarding the timing of the decision. 

“However, whether the sector likes it or not, Australia is now at the forefront of research in this field globally, and we need to seize the opportunity.

“Despite the profound prevalence of difficult-to-treat mental illness throughout the community, very few advancements in new safe and effective treatments have emerged over the last 50 years – this simply isn’t good enough. 

“My hope is that the TGA’s decision will pave the way for the development of new safe, effective and widely accessible medicines to significantly improve the lives of those living with mental illness.”

While the move has been largely welcomed by the industry and advocates of psychedelic medicine, others have suggested it was rushed.

Speaking to Nature, Alan Davis, director of the Center for Psychedelic Drug Research and Education at Ohio State University in Columbus, told the publication that: “It was too soon to make these changes before the research could fully determine clinical efficacy and safety.”

Professor Susan Rossell, of the Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia, and collegues penned a report in May questioning why the TGA did not consult Australian researchers and clinicians with experience in psilocybin-assisted psychotherapy for treatment-resistant major depressive disorder.

They wrote: “While down-scheduling from S9 to S8 may help with the administration of clinical trials, this does not appear to be the motivation behind the TGA decision. Instead, it seems the TGA has yielded to pressure from the public and lobby groups to increase access to these experimental treatments, outside of clinical trials.”

They go on to note that “sufficient levels of evidence have not yet been generated for broad-scale implementation to be justified” and that, while initial results have been promising, “many questions remain” such as best models of care, long-term safety, differentiating patients who will benefit from psychedelics and those who it may be detrimental for.