Psychedelics,Psychedelic-Assisted Therapy and Employees’ Wellbeing

Abstract

There is a psychedelic renaissance with key drugs that alter perception and mood being given breakthrough therapy status as potential treatments for common mental health conditions. If approved, these drugs may be used alongside psychedelic-assisted therapy (PAT), a therapeutic process supporting learning from taking psychedelics. Nearly 100 companies, mainly across America, Canada, Europe, and Australia, are developing compounds such as psilocybin and lysergic acid diethylamide. This article considers the management research that could influence policymakers’ decisions and support employees undergoing PAT. Firstly, research on economic analyses that could inform policymakers’ approval decisions is outlined. Secondly, research exploring PAT's influence on employees’ wellbeing is noted. Thirdly, research on employees’ experiences of stigma around mental health, psychedelics and PAT is suggested. Developing these inquiries may influence employees’ PAT success and improve global mental health by encouraging successful work participation as a critical determinant of mental wellness.

Introduction

There has been rapid growth in psychedelic research, its accompanying industry, and policy reform since 2018 (Aday et al., 2020, 2023). This interest has translated into over 100 clinical trials globally (Psychedelic Alpha, 2024), producing considerable hype and hope for psychedelic treatments (Yaden et al., 2022). Despite this hope, psychedelics have been prohibited in many countries since the 1960s (Hall, 2022) and have therefore been largely unavailable for medicinal treatments. The regulatory landscape is rapidly evolving, however, with the United States being at the forefront, where key psychedelics are being approved for medicalization (e.g., Oregon legalized supervised psilocybin in 2020), and many states could legalize psychedelics by 2037 (Siegel et al., 2023). In Europe, legislative changes have begun entering policymakers’ agendas, with the European Medicines Agency (2024) starting the process of establishing guidelines for psychedelic therapeutic use. Some countries already allowing the medicinal use of psychedelics include Australia, Denmark, Israel, and Switzerland. Regulatory changes vary, though, and some countries (e.g., Portugal) have also decriminalized the possession and personal use of psychedelics. Other countries, such as Jamaica, have gone further and have legalized the possession, cultivation, and sale of specific psychedelics. Market approval is being sought for essential psychedelic drugs, e.g., Multidisciplinary Association for Psychedelic Studies (MAPS, 2023), now Lykos, is pursuing a license for psilocybin.

Despite the promise of psychedelics and their associated treatments, their emergence as breakthrough therapies and the rapid changes occurring around their legalization, management researchers have not yet explored this phenomenon. This is important given that psychedelics and psychedelic-assisted therapy (PAT) could profoundly affect working lives. Some benefits include the PAT process supporting people in returning to work following mental illness, identifying and repairing the sources of individuals’ workplace trauma, facilitating creativity and learning, and improving work engagement. There are, however, many aspects of psychedelics and PAT regarding working lives that must be learnt about.

While previously, Leon et al.'s (2019) Generative Curiosity piece focused on healthy employees enhancing their performance with nonprescribed stimulants, this article concentrates on employees using legalized psychedelics and PAT as a mental health treatment. Using psychedelic science literature and management research, three avenues of inquiry are presented: economic analyses calculating changes in workforce inclusion after PAT, the potential effects of PAT on employees’ wellbeing, and the stigmatization of psychedelics and mental health. These enquiries produce curiosity in two ways: focusing on whether and how management research can support policymakers’ decisions in developing and adopting PAT and exploring the role and value of work in helping individuals undergoing treatment. This is consequential as 264 million people suffer from mental health conditions globally, and 12 billion workdays are lost annually to depression and anxiety, costing 1 trillion dollars (Christensen et al., 2020). This is novel as psychedelics are highly regulated and stigmatized substances in society and work and are otherwise perceived as threatening to work ethos and normative performance standards.

What are Psychedelics and Psychedelic-Assisted Therapy?

“Psychedelic” broadly covers diverse substances that alter perception and mood (Belouin et al., 2022). The focus herein is classic psychedelics, including LSD (lysergic acid diethylamide), psilocybin and DMT (dimethyltryptamine), that demonstrate potential for treating common mental health conditions. Most psychedelic clinical trial activity is occurring in Western countries, including the United States, Canada, Australia, Switzerland, and the United Kingdom (PSYCH Global, 2024). For example, clinical trials are evidencing psychedelics’ effects on depression measures (Aday et al., 2020; Calder & Hasler, 2023; King & Hammond, 2021), with psilocybin-assisted therapy for treatment-resistant depression (Goodwin et al., 2022) and Methylenedioxymethamphetamine (MDMA)-assisted treatment for post-traumatic stress disorder (PTSD) (Mitchell et al., 2023). There remains much to learn about psychedelics’ effects on the brain and peoples’ actions and behaviors (Nutt et al., 2023), but a meta-analysis of studies since 1991 highlights that they can significantly alleviate multiple symptoms of mental health conditions (Bender & Hellerstein, 2022). Studies show psychedelics disrupt brain circuits such as the default mode network (Daws et al., 2022) by allowing individuals to overcome the ruminative thinking patterns underlying mental health conditions. Research is increasingly showing psychedelics’ safety and nonaddictiveness when administered in appropriate sets and settings (Nutt & Carhart-Harris, 2021; Nutt et al., 2021; Rucker et al., 2018). The known medical risks at this stage are minimal and include short-term increases in heart rate and blood pressure (Aday et al., 2023; Bender & Hellerstein, 2022; Tariq, 2023).

Psychedelics differ from conventional mental health treatments such as Selective Serotonin Reuptake Inhibitors (the most common type of antidepressant) that are taken chronically daily to relieve symptoms and normalize mood. Instead, psychedelics are often administered in a few treatment sessions and alongside PAT, which is also evolving. PAT varies across trials and clinical settings (Feduccia et al., 2023) but is broadly understood as the therapeutic support that is provided while ingesting a psychedelic and includes the stages of Preparation, The Psychedelic Experience and Integration (Bathje et al., 2022). PAT harnesses a therapeutic window that is opened in the brain from the effects of psychedelics. Opening this window allows individuals to overcome negative thought processes and self-reflect positively (Yehuda & Lehrner, 2023). Overcoming their negative thoughts can then provide emotional relief for individuals and allow them to address the root causes of their mental illness (Nutt et al., 2021). PAT also critically minimizes the occurrence of adverse psychological events during psychedelic drug treatment sessions (Feduccia et al., 2023). The “integration” stage is critical. It may allow individuals to take on a healthier and more positive outlook on their lives as they translate their psychedelic experience into daily life changes, including at work (Carhart-Harris & Nutt, 2017; Frymann et al., 2022).

Despite research highlighting psychedelics and PAT's promise, amongst psychedelic science, there is caution around the developing evidence base. Specifically, research carries several limitations, including small sample sizes, inherent difficulties in blinding, relatively limited follow-ups, and highly screened treatment populations that may bias results (Bender & Hellerstein, 2022). While there are known medical risks of psychedelics noted above, the nascency of this evidence base means any longer-term side effects and the prospects and recovery profile of patients must be learnt (Nutt et al., 2023). Furthermore, any discrepancies or malpractice that occur in the current drug development landscape could lead to the shutdown of research, a picture of immorality painted around psychedelics and their users and increases in unregulated consumption.

Psychedelics and workforce inclusion

Early indications suggest PAT will be expensive regardless of the treatment set and setting (Marseille et al., 2022; Muthukumaraswamy et al., 2022), and its ability to be scaled up cost-effectively will determine policymakers’ decisions on its market approval and patient uptake (King & Hammond, 2021). Consequently, research on policymakers, payors and insurers’ views suggests PAT will not be adopted without potential downstream medical savings (from averted mental illness following treatment) and demonstrating associated societal benefits (Marseille et al., 2022). With PAT's ability to enact changes in an individual's personality and attitude (Aday et al., 2020), the workplace may be a setting that can demonstrate health, social, and economic benefits to society. Gainful employment can provide individuals with routine and meaningful tasks that boost their confidence, enhance their quality of life and be a central determinant of their wellbeing inside and outside work (Matousian & Otto, 2023). Specifically, evidence is showing that PAT may increase the ability of individuals to engage with previously avoided thoughts and feelings (Frymann et al., 2022; Girn et al., 2020; Yehuda & Lehrner, 2023) and may, therefore, help those suffering from mental health conditions in overcoming their barriers to work participation. Thus, management and economic analysis could establish whether key measures on workforce inclusion and productivity can support the case for PAT's approval and uptake (Marseille et al., 2022) and inform policymakers’ analysis by identifying where the most fruitful returns from their investment lie. This research could, for example, calculate the number of individuals with mental illness who could return to work following PAT, incorporating variables such as changes in absence rates that are measured in days worked following successful treatment.

Psychedelic-assisted therapy and employee wellbeing

The changes in outlook produced by psychedelics and PAT may allow individuals to perceive and encounter work more positively, enable them to take on new and challenging tasks, and ultimately increase their enjoyment. In turn, these elements could benefit individuals’ workplace wellbeing, manifested in how they feel at and about their work and captured by key measures such as workplace meaningfulness and job satisfaction (De Neve & Ward, 2023). Workplace meaningfulness is the extent to which an individual derives purpose and meaning from their role (Pratt & Ashforth, 2003). This may be improved following PAT from potential increases in an individual's sense of self-worth and societal integration from returning to work. Job satisfaction is an individual's positive emotional state based on their job appraisal (Locke, 1976). This may increase following PAT as having a more open mind could allow individuals to perceive their accomplishments more positively.

The potential for PAT to influence employee wellbeing warrants two further pieces of management research. First, research could examine whether PAT can help employees overcome the aspects of work that may have caused their mental illness. For instance, research shows psychedelics could be particularly beneficial in treating PTSD symptoms and those experiencing trauma at work (Henner et al., 2022). While considerable research focuses on military veterans, given the breadth of experiences encompassed within definitions of trauma and the high prevalence of mental illness in society, further studies could explore whether PAT can identify and repair mental illness caused by working in other settings. Second, beyond potentially improving mental health illnesses, research is also showing psychedelics’ positive influence on individuals’ creativity and ability to thrive and flourish and ultimately improve wellbeing (Girn et al., 2020). As work features advance with artificial intelligence and machine use becoming increasingly adopted, individuals may experience less meaningfulness and job satisfaction as machines replace their more conceptually stimulating tasks. Research could, therefore, explore whether psychedelics can help individuals deal with these changes effectively by alleviating the potential effects of having less stimulating work tasks and by allowing them to be creative in new ways.

Work participation, psychedelics, and stigma

Stigma is an attribute that leads to someone being tainted, discounted, and on the receiving end of widespread disapproval from others (Goffman, 1963) and is often directed towards individuals encountering mental illnesses. The process of mental health stigmatization has transpired in workplaces, with individuals receiving adverse reactions toward their condition from fellow workers carrying unfair beliefs and perceptions about them (Hastuti & Timming, 2021). As well as encountering mental illness stigma, an employee undergoing PAT may be stigmatized for their use of psychedelics, which is historically perceived as risky and dangerous (Schlag et al., 2022). Such stigmatization could be worsened by workplace policies broadly problematizing all drug use and users (Smith & Riach, 2016). Employees undergoing PAT may, therefore, feel socially rejected or that their experiences of mental illness are discredited. The consequences of these feelings could be complicated workplace relationships that cause further distress and lead to individuals’ mental illness reoccurring.

This potential for stigmatization leads to two management research avenues. First, research should explore the stigma and negative perceptions resulting from fellow workers’ attitudes toward mental health, psychedelics, and PAT. Subsequently, this should identify any enabling factors that would change negative perceptions so that stigmatization is avoided and the workplace becomes a supportive environment for employees undergoing treatment. This research avenue should also incorporate and address how fellow workers perceive a PAT employee's performance, given that perceptions of performance often cause stigmatization and are a central aspect of workplace drug use policies. Second, self-stigma is the social and psychological impact on someone exposed to stigma. It includes showing whether someone who has been stigmatized has internalized the negative beliefs held about them. With this potential for stigmatization, studies should explore PAT employees’ experiences. This could focus on their perceptions of how their identity is discursively situated and perceived at work and whether this has affected their mental wellness or treatment success. Identifying cases of individuals participating at work without feeling or encountering stigma will present helpful learning opportunities for organizations.

Conclusion

Amidst a global mental health crisis, the development of psychedelics and PAT as potential mental health treatments are essential. This article has explored how management research can contribute to PAT's development and influence working lives. It outlines economic analyses that could inform PAT's uptake. It also suggests that research should be undertaken on the benefits for workplace wellbeing and on the stigmatization of mental health and PAT that may impede individuals’ treatment. Psychedelics will continue emerging as mental health treatments, and the proposed inquiries are only a few possibilities. Management researchers are uniquely positioned to support decisions around their development, approval, and uptake in society while exploring the benefits of psychedelics in improving how individuals think about, perform, feel, and experience work.