Addiction or a way of self-awareness? Many people think about this issue quite often and perhaps quite long. When we talk about psychedelic substances, it is usually very difficult to distinguish between the dependency and a unique way of self-awareness. Why? Very often because we have little information and have hardly ever heard or known that there are specific safety and behavior rules with psychedelic substances. Those, unlike alcohol and nicotine, which are legally allowed and common substances, have a much more complex subjective effect, and therefore «taking shrooms» –is not the same as having an evening beer – it can be both the most terrible and the most wonderful experience of your life. That's why I'd like to talk about a therapeutic approach, which should result in a deep path to self-awareness with a personal transformation, not just another way to «grasp» the alternative reality, have fun chatting and view how the objects around start to «swim».  

Why am I so confident about it? My name is Anton Kurapov, I hold a PhD in Psychology and work as a cognitive psychologist and researcher at the Departments of Psychology at the University of Salzburg (Austria) and Taras Shevchenko National University of Kyiv (Ukraine). Currently, I study mental health, digital interventions, and psychological trauma of varying severity(including post-traumatic stress disorder, PTSD), along with a variety of treatments. Today, psilocybin is one of the most effective methods of treating anxiety and depressive disorders, as well as PTSD, which is very necessary for us at this difficult times. In this article, I aim to provide an overview of psilocybin as a substance, its legal status, therapeutic potential, but most importantly – detailed safety protocols based on the latest scientific research, including randomized controlled trials (RCTs).

Fig. 2. The main world centers for the study of psilocybin. See the annexes for the list and names of the centres.

To put it very briefly, today we have the following picture:

1. Depression: Studies have shown that psilocybin can lead to a significant reduction in depression symptoms, with effects lasting up to six months after one treatment session and can have a strong antidepressant effect.

2. Anxiety: Psilocybin has been found to reduce anxiety, especially in patients with life-threatening conditions such as cancer. 9 10

3. Addiction: : Previous studies suggest that psilocybin may help reduce craving and improve results in people with alcohol and nicotine addiction 11.

No! If you review any of the sources cited in this article, everyone points out that further research is still necessary, even though it is already abundant in quantity. Then what is the problem? The first problem is the purely scientific nature for the description of the effects of psilocybin: due to the need for systematization, details are often lost in scientific conclusions, which, in the case of psilocybin, represent precisely that entire spectrum of subjective experiences in an altered state of consciousness. Simply put, it is scientifically difficult to describe in accessible language what exactly a person experiences during psilocybin sessions, and therefore these aspects are often neglected. However, it is relatively easy to scientifically show the effects due to changes in other conditions (in experimental studies, these effects are called dependent variables), and that is why most studies focus on therapeutic effects rather than subjective experiences (they are often called «mystical experiences» in this context) because they are easier to describe.

When we talk about the scientific method and RTC, the question of safety arises: all research is conducted in a highly controlled environment, where participants are under the supervision of at least two qualified psychologists and one doctor. Also, not all participants calmly endure the session: many have psychotic episodes, so the presence of nearby specialists helps them to avoid negative consequences.12. That is why psilocybin is not recommended for use by people with a history of mental illness, such as schizophrenia, bipolar disorder, psychosis, or other serious mental illness. This is due to the risk of exacerbating the symptoms of these disorders, which may include paranoia, hallucinations, and increased anxiety. In addition, psilocybin can be dangerous for individuals with serious cardiovascular disease due to its effect on heart rhythm and blood pressure (although not very significant). Pregnant women and individuals taking certain medications, such as antidepressants or antipsychotics, should also avoid using psilocybin because of the potential for unwanted interactions.

Back in the distant 60s of the 20th century, the pioneers of psychedelics derived a formula called set & setting (setting/mood and environment), which is still relevant for both recreational (for fun) and therapeutic use (for treatment and or deep self-knowledge). Accordingly, there are a number of rules that must be followed when undergoing psilocybin sessions. The scientific approach in RTC includes several important stages:  

1. Screening and Selection: Participants are scrutinized to exclude those with a history of psychosis, bipolar disorder, or other serious mental illness. An exclusion criterion can also be a common disease such as flu, a sore throat, a stuffy nose, pain in the joints, muscles, stomach, etc.

2. Controlled environment: Psilocybin sessions are conducted in a controlled, supportive environment, often with a therapist or guide providing support and reassurance.

3. Preparation and integration: Participants undergo preparatory sessions to establish expectations and reduce anxiety. After integration sessions, therapists help them process and understand their experiences.

4. Dose control: Doses are closely monitored and individualized based on factors such as body weight and sensitivity to psychedelics. Typical doses in research settings range from 20 to 30 milligrams of pure psilocybin.

5. Monitoring: During and after the session, the vital signs and psychological reactions of the participants are carefully monitored to ensure their safety.

Usually, it is almost impossible to find such a highly controlled environment outside the institutions from Figure 2. Therefore, in the context of set & setting, we`ll consider a standardized protocol and review the main comments on each item.

When a participant comes to the lab for a session with psilocybin, several steps are taken to ensure their safety and maximize the therapeutic potential of the experience:

1. Environment: The session room is designed to be comfortable and relaxing, often equipped with soft lighting, comfortable seats and soothing decor. The goal is to create a safe space where participants will feel calm, homely. Usually, the session starts in bed under a comfortable and warm blanket.

2. Eye Mask and Music: Participants are usually given an eye mask to limit visual distractions and help them focus on themselves. Music plays an important role; specially selected playlists with soothing instrumental tracks are used to support the emotional journey, otherwise the psilocybin experience can become completely unbearable.

3. Therapeutic support: A therapist or guide is present throughout the session. Their role is to provide support, answer questions, and provide assistance if the participant experiences any difficulty, even to help go to the bathroom. The presence of a supporting figure (which the participant can trust) is crucial for maintaining a sense of security.

4. Preparation session:: Before the administration of psilocybin, participants undergo a preparatory session. This session includes a discussion of expectations, guidance on experience management and techniques to overcome any difficult points that may arise, including breathing techniques and conducting preliminary relaxation exercises. Minimal exercise such as yoga or stretching to reduce body and muscle spasms is also done when necessary. Usually, a training session should be done with a psychologist in order to find thoughts, states or feelings that the participant may fixate on during the session, which can also lead to an unbearable emotional experience.

5. Debriefing and Integration: Once the effects of psilocybin have disappeared, participants undergo a debriefing session. This includes discussing their experiences, emotions, and any insights gained. Integration sessions follow days or weeks after, helping participants integrate their experiences into everyday life and understand any kind of deep realizations that could arise. Usually, the integration process can last from a couple of weeks to 6-8 months or even longer. Unfortunately, there is no pattern here and a return to psilocybin experience can happen at any time.

Although psilocybin holds great prospects, it comes not without risks. Some potential side effects include:

• Psychological distress: During the session, some people may experience intense fear, paranoia or hallucinations.

• Physical effects: Psilocybin may cause nausea, dizziness and increased heart rate. These effects are usually temporary and manageable. The use of psilocybin is not recommended if any body pain is present, as experiencing this pain can also significantly worsen subjective experiences during the session.

• Long-term psychological effects: Although this is rare, there is a risk of long-term changes in mood and perception, especially in people prone to mental problems.

Unlike many other illegal substances, psilocybin does not cause addiction, but a person may seek to return to this experience again and again, although most RTC participants claim that they would not like to experience the same stuff again, at least not in the near future. RTCs recommend to use it no more than once every six months, because of it`s active integration processes, especially if it is the first such experience for an individual. Accordingly, in my opinion, psilocybin has enormous potential, particularly therapeutic, and when used correctly, carefully, intentionally, and appropriately, it not only allows one to «rein in» psychological problems, but also to understand oneself far more deeply than one could ever imagine. Anecdotal evidence suggests that one session of psilocybin, under correct conditions of use, can be equated to 1-3 years of psychotherapy.

Remember, this review of security protocols is not a guide or instruction manual. Psilocybin is a very dangerous substance, especially in unprepared hands or heads. Therefore, this review is both an attempt to demonstrate the capabilities of the substance, as well as to warn you of potentially negative consequences.

Psilocybin holds great promise as a treatment for various mental conditions, but it is important to approach its use with caution. Security protocols developed through RTC provide a framework for minimizing risks and maximizing benefits. As research progresses, we can see that psilocybin will likely become a valuable tool in the field of mental health, providing hope to those who haven`t found relief in traditional therapies.

By understanding these protocols and the science of psilocybin, we can better evaluate both its potential and the importance of safe, controlled usage. Regardless of medical or personal purposes, informed and responsible usage is the key to uncovering the benefits of this powerful compound.

Remember, psilocybin is not alcohol, cannabis or amphetamine, it is a compound that has therapeutic potential if used correctly! In all other cases, it is nothing more than a narcotic substance that causes perception disturbances, hallucinations, nausea, dizziness and muscle spasms...

Here are answers to some frequently asked questions about security:

• Can I use it myself?

No, it is strongly inadvisable. It is better for someone to be nearby, at least in the next room.

• Who is a sitter and can my friend be my sitter?

A sitter is a person who provides support during a psychedelic experience. They should be calm, experienced, and well-versed in psychedelics and their potential effects. If your friend has such experience and you trust them completely, then they can be your sitter. However, it is important for this person to have a certain level of competence and training.

• Should a sitter be a psychologist?

Ideally, your sitter should first and foremost be someone you trust — a friend you feel comfortable sharing your experience with. However, when it comes to integration, a professional psychologist is often the most effective choice. A trained psychologist can help reflect your insights back to you in a meaningful way, making it easier to integrate them into your personal experience.

• Do symbols and images have universal meaning during the session?

Most likely not: all symbols have a purely individual meaning, that's why you need a psychologist to deal with it.

• What to do if a person feels sick?

If a person gets sick, the sitter should remain composed and try to calm them down. It is important that a person remains in a safe and comfortable environment. Relaxation techniques, deep breathing, or music therapy can be used to alleviate the condition. If symptoms do not go away or worsen, you should seek medical help immediately.

• How to provide emotional support?

Emotional accompaniment involves the presence of a supportive figure who can provide emotional support, listen, and help process emotional hardships. It is important to create an atmosphere of trust and openness, where the participant can freely express their feelings and thoughts and not be ashamed of any actions! Which ones? For example, croaking or making various sounds.

• What to do if a person is scared?

If a person gets scared, the sitter should remain calm and provide them a safe environment. You can use relaxing music and soft lighting, helping a person focus on their breathing or on other soothing activity. It is important to remind a person that the experiences are temporary and will soon pass. Since a person in this state is very suggestive and trusting, Jaime Fadiman notes that you just simply need to say to a person «Let this experiences consume you, give them freedom, don`t resist, let what happens happen».

• Can psilocybin be combined with other substances such as alcohol or medicines?

No. It is believed that the best experience is pure experience.

• What are the physical preparatory measures before a psilocybin session?

Before a session with psilocybin, it is recommended to follow several physical preparations:

1. Health and wellness: It is important that the participant is in good physical health. Diseases such as flu, sore throat, or other physical ailments can negatively affect the experience.

2. Hydration and food: : It is recommended to consume light meals a few hours before the session and ensure sufficient hydration. However, some practices include a period of light fasting before the session.

3. Rest and sleep: It is important to be well-rested. Lack of sleep or fatigue can increase anxiety or cause negative emotions.

4. Exercise: Light exercise, such as yoga or stretching, can help to relax the body and reduce muscle tension.

• How to choose the right dose of psilocybin?

The correct dose of psilocybin may depend on many factors, including body weight, experience with psychedelics, the purpose of the session, and individual sensitivity to the substance. In general, dosages vary from microdose (0.1-0.5 g dry mushrooms) to low (1-2 g), medium (2-3.5 g) and high dose (over 3.5 g). It is important to start with a lower dose, especially for beginners.

• Are there age restrictions for using psilocybin?

Personally, I don`t recommend it if you're under 24. After 24 - you can use it.

Table 1

List of designations of scientific centers from Figure 2

1. Studerus, E., Kometer, M., Hasler, F., & Vollenweider, F. X. (2011). Acute, subacute and long-term subjective effects of psilocybin in healthy humans: a pooled analysis of experimental studies. Journal of psychopharmacology, 25(11), 1434-1452.

2. Randomised controlled trial (RCT) — is a research design in which participants are randomly assigned to two or more groups. One of these groups receives the study intervention or treatment, while the other (the control group) receives a placebo or standard treatment. This approach allows for an accurate assessment of the effectiveness and safety of the intervention, reducing the impact of external factors and biases on the results. RCTs are the "gold standard" in medical research, as they allow us to assess with great accuracy whether the intervention under study is really effective, minimising the influence of subjective and external factors.

3. Neuroscientifically Challenged (2020, November 18). 2-Minute Neuroscience: Psilocybin [Video]. YouTube. https://www.youtube.com/watch?v=XBEas8MGzd0

4. Pollan, M. (2018). How to change your mind: What the new science of psychedelics teaches us about consciousness, dying, addiction, depression, and transcendence. Penguin.

5. Bonnieux, J. N., VanderZwaag, B., Premji, Z., Garcia-Romeu, A., & Garcia-Barrera, M. A. (2023). Psilocybin’s effects on cognition and creativity: A scoping review. Journal of Psychopharmacology, 37(7), 635-648.

6. 6World Health Organization(WHO). (1993). The ICD-10 classification of mental and behavioural disorders. World Health Organization.

7. Bonnieux, J. N., VanderZwaag, B., Premji, Z., Garcia-Romeu, A., & Garcia-Barrera, M. A. (2023). Psilocybin’s effects on cognition and creativity: A scoping review. Journal of Psychopharmacology, 37(7), 635-648.

8. Li, N. X., Hu, Y. R., Chen, W. N., & Zhang, B. (2022). Dose effect of psilocybin on primary and secondary depression: a preliminary systematic review and meta-analysis. Journal of Affective Disorders, 296, 26-34.

9. Goldberg, S. B., Pace, B. T., Nicholas, C. R., Raison, C. L., & Hutson, P. R. (2020). The experimental effects of psilocybin on symptoms of anxiety and depression: A meta-analysis. Psychiatry research, 284, 112749.

10. Yu, C. L., Yang, F. C., Yang, S. N., Tseng, P. T., Stubbs, B., Yeh, T. C., ... & Liang, C. S. (2021). Psilocybin for end-of-life anxiety symptoms: a systematic review and meta-analysis. Psychiatry Investigation, 18(10), 958.

11. van der Meer, P. B., Fuentes, J. J., Kaptein, A. A., Schoones, J. W., De Waal, M. M., Goudriaan, A. E., ... & Batalla, A. (2023). Therapeutic effect of psilocybin in addiction: A systematic review. Frontiers in psychiatry, 14, 1134454.

12. Yerubandi, A., Thomas, J. E., Bhuiya, N. M. A., Harrington, C., Zapata, L. V., & Caballero, J. (2024). Acute adverse effects of therapeutic doses of psilocybin: A systematic review and meta-analysis. JAMA Network Open, 7(4), e245960-e245960.