Table 3.

Expert reported strategies for promotion psychological mechanisms of action during preparation, dosing, and integration sessions.

Mechanism	Preparation	Dosing	Integration
Psychological flexibility	Identify clearly defined treatment goals that are collaboratively developed between therapist and participant. Conceptualize treatment objectives using ‘healing’ language, instead of ‘curative’ language. Introduce ACT concepts (e.g., the hexaflex) and strategies. Practice mindfulness and acceptance of challenging emotions	Limit engaging in direct intervention. Be aware of avoidance behaviors. Provide gentle encouragement to promote acceptance and openness to experience. Encourage relaxation techniques to promote present moment awareness. Note areas where psychological flexibility occurs (to discuss in integration)	Explore ‘values’ themes which may have occurred during dosing and integrate these into the participants life. Discuss new perspectives of the self that may have emerged during dosing. Discuss new behaviors that align with functional changes in ‘values. Include defusion and acceptance to promote openness and flexibility. Promote regular mindfulness practice
Self-compassion	Establishing a good therapeutic alliance and build trust. This may enable exploration of difficulties in receiving encouragement or validation. Inner child visualization exercises Somatic strategies to promote calmness when engaging in confronting material Supporting the view that all emotions and parts of the self are welcome	Provide a non-directive compassionate presence Encourage the client to be accepting of the experience Discourage avoidance of difficult emotions Avoid being complicit with the client in the avoidance of difficult emotions or behaviors	Inquire about emotions that may be labeled as undesirable or ‘unpopular’. This may further demonstrate acceptance Encourage journaling of experience Talk therapy to further address self-compassion
Mystical experience	Inform participant that they may undergo a mystical experience Provide education about what the experience could be like Familiarize participant to the room in which dosing will occur Discuss the participants spiritual life, values, and experiences Discuss spiritual materials (e.g., books or music) that the participant feels a connection with and may wish to have with them in the dosing session	Be nondirective Curate a safe and supportive environment Encourage the participant to ‘let go’ and accept whatever experience they are having Discourage fixation on external stimuli Incorporate spiritual materials and music Do not attempt to invoke the experience through the setting you provide -this may result in avoidance of ‘unacceptable’ parts of the self	Discuss and process the experience in a way which welcomes and values the experience Assist participant in developing a therapeutic narrative for their experience Discuss if / how the experience has altered the participants world view Mindfulness practice Engagement with spiritual communities
Self-transcendence	Inform participant that they may undergo self-transcendence during dosing. Provide education about what the experience might be like Provide psychoeducation and exercises which introduce the concept of the ‘observer self’ from ACT, as well as introducing the ‘conceptualized self’ and the challenges that an overattachment to this self can create	Encourage deep noticing, awareness and introspection. Gently guide participant toward an expansive sense of self	Utilize experience of self-transcendence to support the concepts discussed in ACT. Provide further ACT to encourage psychological flexibility
Meaning enhancement	Discuss participant’s symptoms and experiences of depression, including specific changes they wish to experience because of treatment Introduce the concept of being open to changes in perspectives throughout the treatment which may amplify a sense of ‘meaning’	Provide nondirective support which allows personal significance to emerge without therapist interference	Consider and process insights that emerged during dosing
Cognitive reframing	Build rapport and strong sense of trust with participant. Incorporate psychotherapy approaches and strategies that focus on self-narratives, such as CBT or ACT Discuss notable challenges that the client is processes that may be maintaining depressive symptoms, toward increasing accessibility of the issue during dosing. Aim to increase willingness to work with any unpleasant facets of the self that may emerge.	Provide a ‘safe container’ for the participant and support as needed. Demonstrate acceptance toward whatever the participant experiences.	Discuss participant’s perspectives and attitudes prior to dosing and how these may have changed. Consider how alterations in thought, attitudes and beliefs can be maintained and be applied practically (possibly through ACT or CBT strategies) Implement behavioral activation strategies to engage with pleasurable and meaningful activities.
Awe	Introduce personalized materials or experiences that evoke a sense of awe in the participant (e.g., music, art or nature)	Include materials (e.g., music or photos of nature) that are ‘awe inspiring’ to the participant in the dosing room	Encourage further exposure to stimuli (e.g., nature, music, art), which may reinvoke a sense of awe
Memory reconsolidation	Develop strong rapport and trust Education on the possibility of challenging memories being re-experienced during dosing session and therapeutic ways of managing this (e.g., acceptance) Education on stress and the way it may present in dosing session	Encourage acceptance of experience, while also providing a safe environment if the participant feels unable to engage with challenging memories	Encourage journaling about what was experienced during dosing and what it meant for the participant Incorporate somatically informed therapy and strategies (e.g., body scans) to explore how they body may hold trauma
Ego dissolution	Inform participant that they may undergo ego dissolution. Provide education about what the experience could be like	Encourage acceptance and ‘letting go’. Discourage focus on the self	Encourage exposure to awe-inspiring stimuli, including nature, music, art or other personally significant stimuli or experiences.