How Academy Members Are Integrating Psychedelics to Ease Distress
Catherine Arnold
For patients facing serious illness, some of the deepest suffering cannot be measured on a numerical scale.
Some patients experience anxiety that does not respond to conventional treatment, as well as a deep sense of demoralization, isolation, and loss of meaning. Palliative and hospice care have long recognized treatment of this existential distress as central to whole-person care. Now, an emerging field of research is asking whether psychedelic-assisted therapy (PAT)—a structured protocol that combines the administration of a psychoactive compound with guided professional psychotherapy before, during, and after the experience1-3—might offer a way to help some patients address these challenges.
Clinical studies in PAT have shown promising results in treating anxiety, depression, and existential distress related to life-threatening illnesses. Notably, these therapeutic benefits often endure long after a single session. A landmark 2016 study4 from Johns Hopkins University, for example, demonstrated substantial and sustained reductions in distress among patients with cancer for up to 6 months after a single dose of psilocybin, the compound in “magic mushrooms”—a finding reinforced by a growing body of subsequent research.1-3
As clinical evidence for these subjective transformations continues to grow, hospice and palliative care clinicians may face the task of learning how to evaluate, understand, and eventually integrate this emerging modality into standard care.
How Does It Work?
Stacy Fischer, MD, science advisor to the American Academy of Hospice and Palliative Medicine (AAHPM) and a palliative care physician, professor of internal medicine, and director of clinical trials at the University of Colorado Denver Center for Psychedelic Research, notes that preparation is very important. The other clinicians interviewed for this article agree.
A psychedelic experience can bring challenging or uncomfortable thoughts and emotions to the surface, as documented in multiple clinical trials.2,5,6 For that reason, preparation is an essential leg of the treatment model. In Dr. Fischer’s clinical trials, patients participate in three preparatory sessions in relaxing circumstances before the dosing day to establish trust with their facilitators, map out what they might encounter, and learn to navigate feelings of wanting to control the experience.
“Those who feel controlling may not have a good experience through psychedelics—we try to talk people through the need to surrender,” Dr. Fischer explains.
Follow-up integration sessions—the first occurring within 24 to 48 hours to engage patients while their minds are most receptive—give patients space to reflect on emerging imagery and emotions, explore those insights, and integrate them into daily life.
“I think the integration portion of the trial is where the magic happens,” Dr. Fischer notes. “After someone takes a psychedelic, they have a period of neuroplasticity, so they can make gains in therapy in ways they may not have in the past. As Michael Pollan [MA, cofounder of the UC Berkeley Center for the Science of Psychedelics] coined it, it’s how to ‘change your mind’—an opportunity for real growth.”
In palliative care, where distress often centers on existential meaning rather than standard psychiatric conditions, this therapeutic container allows patients to explore profound themes of connection and mortality.
In palliative care, where distress often centers on existential meaning rather than standard psychiatric conditions, this therapeutic container allows patients to explore profound themes of connection and mortality.
“People report an ineffable experience—that everything is connected in the universe,” Dr. Fischer says. “Being part of something bigger can resolve some of those entrenched feelings of existential distress—that there is something bigger than us, and death may not be the end. And it doesn’t have to fit into a purely religious context.”
Who Might Benefit?
Determining patient candidacy requires careful clinical screening, notes Dr. Fischer.
Ali John Zarrabi, MD FAAHPM, emphasizes evaluating psychological readiness when considering who is most cut out for PAT. “Patients who might be best suited have some degree of openness, curiosity, intention to look inward, and a desire for connection—to something within themselves or perhaps the great beyond. Openness to experience, however that may unfold, is key,” says Dr. Zarrabi, an internist and palliative medicine physician at Emory Healthcare who investigates PAT for patients facing complex suffering and demoralization from terminal diagnoses. His work, such as this 2026 review,7 highlights how psychedelic-induced states of consciousness can evoke a profound sense of awe, connectedness, and altered time perception, ultimately helping patients reclaim meaning and dignity near the end of life.
Stephen Meyer, MD HMDC FAAHPM, a palliative care physician at Grand Strand Health Physicians in Myrtle Beach, SC, and chair of AAHPM’s Safe Use of Psychedelic-Assisted Therapies Forum, similarly emphasizes screening and context.
Like other clinicians interviewed, Dr. Meyer advises against administering PAT to individuals with bipolar disorder, schizophrenia, serious heart conditions, or other conditions that could increase the risk of adverse reactions to the psychological openness induced by psilocybin or other psychedelics.
Meyer observes that PAT is particularly well suited for broadening the perspectives of patients with serious illnesses who experience profound isolation.
“My cancer patients tell me they can’t connect with others around them—that anticipatory grief makes them feel disconnected,” Dr. Meyer says. He recalls a patient whose quality of life and spiritual outlook transformed following a dosing session: “He felt we’re all connected to God after that, and he regained his faith.”
The Importance of Set and Setting
Across the accounts of all four clinicians interviewed for this article, one foundational concept surfaced repeatedly: set and setting. Set refers to the patient’s internal mindset—their expectations, emotional baseline, spiritual framework, and intentions. Setting denotes the physical, sensory, and interpersonal environment in which the session occurs.
“Set and setting are critically important,” Dr. Zarrabi says. “Across all these palliative studies, we’re applying set and setting through individual or ceremonial formats, employing the use of nature—like fresh flowers or a retreat center in the woods—and the use of music. We refer to music often as ‘the third person in the room.’ It is a core part of the experience and thoughtfully curated.”
In most PAT clinical trial settings, rooms feature soft lighting, comfortable couches or sleeping bags, eye shades, and preselected music playlists designed to guide the patient inward. The therapeutic facilitators who guided the preparation sessions remain present for the entire dosing period—often lasting up to 8 hours—offering a grounding presence.
“Set is about addressing their emotional state, their fears, and their cultural or spiritual framework,” Dr. Meyer says. “Having two facilitators to one patient ensures that if any emergencies arise, the patient is never unattended. If someone starts crying, you allow them to process and only intervene if necessary.”
This careful curation highlights why PAT cannot be treated as a standard pharmaceutical intervention. It is not simply a drug acting on a receptor, but a medicine operating within a structured container of relationship, atmosphere, and intention.
It is not simply a drug acting on a receptor, but a medicine operating within a structured container of relationship, atmosphere, and intention.
Implementation Challenges in Modern Care
The qualities that make PAT unique also pose practical challenges. Research protocols typically require roughly 20 total hours of therapy across preparation, dosing, and integration. Many protocols utilize a cotherapy model featuring two trained clinicians—a structure that provides optimal safety but presents significant staffing and financial hurdles for routine clinical practice.
“The cost of this from person-power alone is not nothing,” Dr. Fischer notes. “In the research world, the FDA has required two therapists working in tandem. That’s not practical in the real world. We need additional research to understand how much therapy is necessary, whether sessions can be shorter, or if group models can be used.”
Dr. Fischer also underscores the operational divide between academic medical centers and community providers: “I’m working in an academic medical center with an investigative pharmacy. How will this be done in smaller settings without such support? If PAT becomes legal nationally, how will small home hospices manage drug handling and scheduling?”
Dr. Zarrabi acknowledges that PAT will also require slowing down, something modern medical care doesn’t typically support.
“We have an increasingly transactional, quick, and efficient system through which we deploy health care and palliative care. PAT requires relationship building. The human-to-human connections were often what people took away from our studies. For us to do PAT well, we need to do the root of palliative care: being present, creating space, and remaining warm-hearted to whatever may arise,” says Dr. Zarrabi.
This approach also changes how clinicians think about the medicine itself.
“PAT and its acronym suggest something other than giving a pill to cure anxiety,” Dr. Zarrabi explains. “We’re prescribing experience and relationships. Palliative care often focuses on treatments that are anesthetic—numbing or dulling pain. But these agents are aesthetic—they create a sense of awe, catharsis, and altered perception. How do we train interdisciplinary teams to curate spaces for aesthetic experiences when our healthcare treatment is fundamentally centered on anesthetic care?”
“How do we train interdisciplinary teams to curate spaces for aesthetic experiences when our healthcare treatment is fundamentally centered on anesthetic care?”
Where Palliative Care Fits
Despite these operational hurdles, the core philosophy of PAT aligns naturally with hospice and palliative care. Both models center on interdisciplinary care, addressing distress that spans physical, emotional, social, and spiritual domains.
“In palliative care, we already see people as complex, whole persons who are emotional and spiritual beings,” Dr. Fischer says. “Chaplains, social workers, advanced practice providers, nurses, and physicians can really integrate to support people as they explore their existential distress. Palliative care teams can refer appropriate patients to psychedelic studies, and we can refer patients who need ongoing support back to the palliative clinic.”
Dr. Meyer envisions collaborative frameworks where psychiatry and palliative care join forces, particularly for homebound patients.
“A lot of our patients are bed-confined, so they won’t be able to go to research settings,” Meyer explains. “I would love to see hospice teams facilitating those sessions in a home environment. If the most forefront suffering is spiritual, a chaplain steps in; if it’s social abandonment, a social worker helps. No single discipline can address every dimension.”
Sunil Aggarwal, MD PhD FAAHPM, a palliative care physician and founder of the Advanced Integrative Medical Science (AIMS) Institute in Seattle, WA, notes that as the field matures, hospice and palliative medicine clinicians will need to build clinical literacy around PAT to guide patients safely, regardless of whether they administer the drugs themselves. “I think it’s important for us to become fluent in this therapy or to find partners in our communities who know what they’re doing.”
Furthermore, because hospice care extends support to families and caregivers, the potential therapeutic role of PAT could eventually inform grief and bereavement care, Dr. Aggarwal observes.
Moving Forward with Preparation
While early research findings are compelling, all four clinicians agree that treatment should be structured.
“My sense of caution as a scientist—I share the enthusiasm, but I want to ensure that science is leading us, not hype,” Dr. Fischer emphasizes.
Dr. Meyer expresses concern that unregulated access to psychedelics could derail PAT. “These are beautiful medicines, but my fear is that individuals with bipolar disorder or bad heart conditions could buy psilocybin thinking it will cure them,” Dr. Meyer warns. “I would never want something as useful as this to gain a bad name because of a lack of safeguards. First, do no harm.”
For Dr. Zarrabi, the need to prepare the workforce is urgent precisely because regulatory landscapes are shifting.
“Approval for psilocybin will likely happen in the near future for depression,” Dr. Zarrabi says. “Without adequate training around supporting these treatments, we’re putting our patients at risk for great harm. In anticipation of those doors opening, the time for taking psychedelics seriously is now. We need to create spaces for continuing education and build training programs for clinicians of any background to support individuals before, during, and after that narrow therapeutic window.”
Ultimately, the most valuable contribution hospice and palliative care offers to psychedelic therapy may be its decades of experience sitting alongside patients in spaces of deep vulnerability. If psychedelic-assisted therapy becomes an established treatment, the clinical wisdom, presence, and relational care of palliative teams will remain as vital as the medicine itself.
References
- Yu C-L, Yang F-C, Yang S-N, et al. Psilocybin for end-of-life anxiety symptoms: a systematic review and meta-analysis. Psychiatry Investig. 2021;18(10):958-967. doi:10.30773/pi.2021.0209
- Fischer S, Beaussant Y, Zarrabi A, Humphreys J, Lewis S. Psychedelic-assisted therapy: clinical, regulatory, and training recommendations for palliative care. J Pain Symptom Manage. 2026;71(6):e1166. doi:10.1016/j.jpainsymman.2026.04.504
- Back A, McGregor B, Thorn L, et al. Group retreat psilocybin therapy for people with metastatic cancer with symptoms of anxiety and depression: safety and efficacy outcomes of a phase 1/2 study. Psychedelic Med. 2026;4(3):209-221. doi:10.1177/28314425251413856
- Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: a randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. doi:10.1177/0269881116675513
- Psilocybin Therapy in Advanced Cancer. ClinicalTrials.gov identifier: NCT05398484. Updated December 4, 2025. Accessed September 11, 2026. https://clinicaltrials.gov/study/NCT05398484
- Wood MJ, McAlpine RG, Kamboj SK. Strategies for resolving challenging psychedelic experiences: insights from a mixed-methods study. Sci Rep. 2024;14:28817. doi:10.1038/s41598-024-79931-w \
- Alexander WB, Hansen ED, Anderson BT, et al. Meaning and psychedelics in palliative care: a narrative review. J Pain Symptom Manage. 2026;71(3):e299-e321. doi:10.1016/j.jpainsymman.2025.10.015
Catherine Arnold is a health and science editor and writer in the Intermountain West, with a strong interest in aging and palliative care.