Where PAREA is heading: from psychedelic to experiential treatments

by Tadeusz Hawrot

Jorm Sangsorn | Shutterstock.com

As this field evolves, I feel I’m gaining another layer of clarity around psychedelics and PAREA’s direction. It feels as though the focus is gradually shifting from psychedelic to experiential.

It is important to research different mechanisms of action, including neuroplastogens, which could bypass the subjective experience altogether and work at a purely biological level. That may well produce another class of antidepressants. The more options the better. There is no single best approach for everyone.

But I do not know any civil society organisation set up to advocate for antidepressants, and PAREA will certainly not become one.

We stand for the meaning people can derive from the psychedelic experience - an opening for emotional release, insight, perspective, awe, regained self-respect and love, and sometimes a renewed sense that life can carry meaning again. We stand for mental health care that does not reduce people to molecules, but recognises the meaning that can emerge from experience when it is held in the right context, with the right support, and integrated into a person’s life.

We stand for delivery, not just the drug. For therapy, support, community, and the quality of the container. We stand for mental health care that is done with people, not to them, and that helps them recover agency, reconnect with their own capacity for healing, and engage with insight, choice, and responsibility rather than outsourcing recovery to a pill or an expert.

And we stand for choice. Some people will benefit from antidepressants and other established or emerging treatments. But choice in mental health care also means making room for approaches that help people engage more deeply with themselves and their lives.

This matters especially in depression, which is shaped by psychological, social, and environmental factors at least as much as by brain chemistry.

It is no coincidence that by far the largest share of phase 2 and 3 psychedelic trials focus on depressive disorders, with treatment-resistant depression, or perhaps more plainly, depression that existing treatments fail to shift for some people, being the largest category.

And there is probably a reason why many people on a third or fourth SSRI are still not getting better. For many of them, putting another molecule into their bodies may not make much difference.

Understanding how adversity shapes mental health, and moving towards trauma-informed care, can. The evidence is already substantial, and more keeps coming.

It is well established that adverse childhood experiences, or ACEs, are significant risk factors for major depressive disorder - MDD. ACEs account for an estimated 54% of the risk for MDD and have been linked to greater severity, recurrence, persistent symptoms, and poorer treatment response.

That is why a new study caught my attention: Adverse Childhood Experiences and Treatment-Resistant Depression. And this is not a small or marginal piece of work. It is the largest population-based study to investigate the association between ACEs and TRD. The researchers looked at records from 17,814 Swedish twins born between 1959 and 1992. They found that adverse childhood experiences were associated with higher odds of treatment-resistant depression. Physical neglect and sexual abuse showed the strongest associations, with roughly 5- to 6-fold higher probability of TRD. The study’s takeaway was not that biology does not matter, but that adversity matters profoundly, and that it should be taken seriously in prevention and clinical assessment.

None of this should really surprise us.

If early adversity shapes emotion regulation, resilience, stress response, and vulnerability across the life course, then it should not surprise us that some people do not respond to third- or fourth-line antidepressant treatment. In such cases, simply offering another molecule may not be enough. What may be needed is care that helps people process experience, reconnect meaningfully with themselves, and address root causes rather than endlessly cycling through symptom management.

There is something unsettling about mental health systems responding to this kind of adversity mainly by medicating people.

This is where psychedelics may be different, if they are delivered within a proper framework of care. This is where the experiential side becomes so important, with psychedelic treatments becoming part of a broader move towards experience-mediated, trauma-informed, context-aware mental health care.

Coming back to the clarity I am gaining as I evolve together with this field, psychedelics remain central to our work. But I am also looking for a slightly different and less charged framing than “psychedelics” for PAREA’s policy and advocacy work, and for the narratives we build and use.

Right now, these two speak to me the most:

1.      Experience-mediated mental health treatments

2.     Experiential mental health treatments

This reframing feels clearer, broader, and more useful for policy and advocacy than “psychedelic” alone. It leaves room for the field to evolve, while holding on to what I think matters most: not just what a treatment does to the brain, but what it makes possible in human experience.

Curious whether that framing resonates with others.