Cultural Humility and Psychedelics: A Framework Analysis of Psychedelic-Assisted Therapy Manuals and Practice Guidelines

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Bell, Bianca R. Watt, Arturo S. Lopez Flores, Stephanie R. Rodriguez, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5908748/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Cultural biases within healthcare systems result in inequitable treatment, harms, and mistrust—particularly for individuals with marginalized identities. Cultural humility training is dynamic, reflective, and emphasizes person-centered care and mutual respect. Psychedelic-assisted therapy (PAT) is an emerging modality for treating psychiatric disorders. Practice manuals and clinical guidelines are crucial for standardizing PAT and for attending to PAT’s unique sensitivity to set and setting, including cultural aspects of care. Methods This study investigates the integration of multicultural principles into PAT by analyzing open-source PAT manuals/guidelines against the Multicultural Guidelines established by the American Psychological Association (APA) in 2017. Using framework analysis, two pairs of reviewers assessed the alignment of the PAT manuals/guidelines’ language with the APA guidelines and evaluated their applicability for training therapists to conduct PAT with cultural humility. Results Results revealed that while the five manuals/guidelines analyzed exhibit varying degrees of alignment with the guidelines, none provide teachable instructions for delivering culturally responsive care. Conclusions Our findings highlight significant gaps in PAT practice manuals and guidelines and underscore the need for a more comprehensive approach to training PAT facilitators. Addressing these shortcomings is essential for advancing equitable PAT for diverse populations. Future efforts should prioritize integrating cultural humility into PAT frameworks to optimize therapeutic outcomes for all. Psychedelic psychotherapy psychedelic-assisted therapy (PAT) cultural humility mental health equity culturally responsive care therapeutic frameworks ethical considerations Background Cultural biases and cultural misalignment within healthcare systems lead to treatment inequities, iatrogenic harms, and mistrust. 1 – 5 While training in cultural competence has aimed to address these issues, it is traditionally geared toward social majorities (e.g., white, heteronormative) learning about ‘other’ social groups (e.g., Black/African American, LGBTQ+). The concept of ‘competence’ implies mastery over a fixed and uniform set of knowledge, rather than reflecting the intersectional multicultural reality of an increasingly diverse population. Competence training centers an in-group/out-group perspective, which can magnify power imbalances between patients and providers. Thus, cultural competency has been found to paradoxically foster implicit bias and stigma. 6 In response to an urgent need to deliver more culturally attuned healthcare, Tervalon and Murray-García (1998) coined the term ‘cultural humility’ as an alternative to ‘cultural competence’. Humility acknowledges that ‘we don’t know what we don’t know’. Cultural humility reflects a dynamic person-centered approach, recognizing patients’ own expertise in the social and cultural context of their lives. Cultural humility training also encourages providers to reflect on their own beliefs, values, and biases (explicit and implicit)—building self-awareness around their own cultures’ impacts on patients. While cultural competence training is content-oriented and aims to enhance provider confidence, cultural humility training is process-oriented and promotes individualized and adaptable patient-provider partnerships. By implementing cultural humility into practice, providers can mitigate the negative effects of bias on healthcare outcomes. Since its inception, the practice of cultural humility has been adapted by various healthcare professionals, including psychotherapists and social workers. 7 – 9 In Western psychotherapy frameworks, psychological disorders are often understood through universal principles, leading to a one-size-fits-all approach to treatment. 10 – 12 This narrow perspective overlooks the direct influence of a patient’s culture and identity on their symptomology and presentation. 10 , 13 , 14 Psychotherapy is increasingly recognized as a cultural construct, where culture is central to treatment interventions. This has led governing bodies, such as the American Psychological Association (APA), to create multicultural guidelines for psychologists. 10 , 15 , 16 This approach acknowledges that health beliefs, practices, and responses to psychotherapy are shaped by cultural values of both psychotherapist and patient. 16 Recognizing culture as integral to successful mental health interventions helps psychotherapists tailor care in ways that respect and incorporate patients’ cultural backgrounds, thereby enhancing treatment effectiveness. 16 Empirical research has supported the use of psychedelics (e.g., psilocybin, LSD, MDMA, and ketamine) in the treatment of psychiatric disorders—such as depression, PTSD, and substance use disorders. 17 – 20 Natural psychedelics have been used as ‘plant medicines’ by Indigenous societies for millennia in sacred ceremonial and healing contexts. 21 In contemporary clinical and research settings, psychedelics are commonly paired with a framework of psychotherapy or psychological support delivered by mental health professionals, also known as psychedelic-assisted therapy (PAT). 21 – 24 Psychedelics can lower psychological defenses and magnify sensitivity to subtle relational cues within the patient-therapist relationship. 25 , 26 This can contribute to enhanced therapeutic alliance when PAT is facilitated from a stance of unconditional positive regard and careful attunement. 27 Conversely, psychedelics can leave patients more vulnerable than usual to therapist mis-attunement, invalidating biases, and microaggressions. While psychedelics can accelerate rupture and repair and other transference-countertransference processes, this requires a trauma-informed approach and a high degree of cultural humility to minimize harms and maximize therapeutic outcomes. 28 The earlier wave (1940s to 1980s) of structured scientific inquiry into psychedelics, including research conducted by the United States government, was tainted by ethical violations and serious harm to participants. 23 , 29 , 30 This was evidenced in various cases; one notable example is the unethical use of frequent and large dosages of LSD on incarcerated individuals without their informed consent. 23 Psychedelics were also administered in combination with conversion therapies targeting lesbian, gay, bisexual, transgender, and queer people (LGBTQ) 31 – 33 . Conversion therapy has since been identified as an unethical and harmful practice by all major mental health professional organizations. 34 – 36 Such practices, documented in several studies, underscore a history of exploitation and highlight the importance of conducting modern psychedelic research within a framework of cultural humility to ensure the safety of patients and research participants. A growing body of literature has raised concerns over the lack of diversity, equity, and inclusion in modern-day clinical trials for psychedelic-assisted therapy (PAT). 14 , 37 – 41 Researchers have highlighted the underrepresentation of racially minoritized and LGBTQ + communities in these trials and have created studies that focus on minority inclusion in psychedelic research. 42 , 43 In addition to participant diversity, researchers investigating PAT have recognized the gaps in the development of multicultural applications of PAT and have taken steps to create guidelines and frameworks to address the unique needs and experiences of diverse populations, though more work is still needed to make this practice generalizable to all settings involving PAT. 44 – 47 Practice manuals and guidelines have been integral in standardizing PAT across studies, research sites, and therapy teams, and serve as a basis for fidelity assessment and clinical consultation. Given the amplification of relational dynamics with PAT and the context of historical harms, the field would benefit from the thoughtful incorporation of multicultural perspectives and principles in PAT manuals to safely address the needs of diverse populations. Significant gaps remain in both the current literature and practice of PAT, particularly concerning the integration of multicultural frameworks into treatment protocols and manuals. This paper aims to investigate the adherence to multicultural guidelines in open-source PAT manuals and guidelines and explore the applicability of PAT manuals and guidelines for training mental health practitioners to engage through a culturally responsive lens. Methods Selection of PAT Manuals for Inclusion We conducted a search on 04/11/2024 in Google Search using the terms: ‘psychedelic therapy manual’, ‘MDMA therapy manual’, ‘psychedelic therapy professional guidelines’, and ‘psychedelic therapy ethical guidelines’. Selection criteria included: 1) available in English, 2) open-source materials (items behind a pay wall or available only for purchase were not considered), 3) PAT manuals or guidelines that referred to the administration of a psychedelic substance in conjunction with psychotherapy in the treatment of a psychological disorder in a clinical or research setting, 4) published 2017 or after (this decision was made because the APA’s Multicultural Guidelines were published in 2017). 16 Articles, reviews, letters, notes, editorials, dissertations, books, and other forms of media were excluded. From the Google Search results, two authors (AB, CS) independently screened the first fifty titles from each search term and identified documents that met our selection criteria. These searches resulted in a sample of manuals and guidelines that both authors agreed met the inclusion/exclusion criteria for the analysis. Selection of Multicultural Guidelines We chose the Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality, 2017 (i.e., Multicultural Guidelines ) by the five-member Task Force on Re-envisioning the Multicultural Guidelines for the 21st Century , appointed by the Board for the Advancement of Psychology in the Public Interest (BAPPI), and adopted by the APA Council of Representatives , as the framework of our analysis due to the guidelines being developed to provide psychologists with a framework of ‘multiculturally competent services’ in practice, research, consultation, and education. 16 From the Multicultural Guidelines document, a list of guidelines were extracted for analysis (see Table 1 ). 16 Data Analysis We conducted a framework analysis using Microsoft Excel to analyze the identified PAT manuals and guidelines in comparison with the guidelines listed in the APA’s Multicultural Guidelines . 48,49 Two pairs of reviewers were assigned to compare the PAT manuals and guidelines against the ten Multicultural Guidelines (see Table 1 and Table 2 ) . The reviewers were paired based on their educational qualifications and experience with PAT. The first pair of reviewers (AB and BW), who have master’s level of graduate education but no experience facilitating PAT, examined whether the language used in the PAT manuals aligned with the ten Multicultural Guidelines' standards for psychotherapists. The second pair (SR and DS), both of whom have PhDs and experience facilitating PAT, assessed whether the manuals provided instructions for psychotherapists to meet these guidelines. When a reviewer identified text in the manuals that aligned with a guideline, they would extract the sample text and enter it into a Microsoft Excel sheet as a code. This code would then be utilized to create a count for both the guideline met and the instance. After individual coding, each pair of reviewers met synchronously to review their codes and resolve any discrepancies. Disagreements were addressed through discussion, and if a consensus could not be reached, a third reviewer (CS) was consulted to make the final decision. Once the coding discrepancies were resolved, the codes were organized into matrices for further analysis. These matrices allowed us to systematically compare the content of the PAT manuals and guidelines against the APA’s Multicultural Guidelines . The results that emerged from this analysis provided insights into how well the manuals aligned with the Multicultural Guidelines and where potential gaps exist in addressing multicultural considerations. Results The PAT treatment manuals identified for analysis include: The Yale Manual for Psilocybin-Assisted Therapy of Depression ( Y-PAT ), first edition published August 2020, using Acceptance and Commitment Therapy as a therapeutic frame 50 , and A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder ( MDMA-TM ), version 8.1 published August 2017 by the Multidisciplinary Association for Psychedelic Studies. 51 The PAT professional practice guidelines identified for analysis include: An Expert-Informed Introduction to the Elements of Psychedelic-Assisted Therapy ( EI-PAT ), first edition published August 2022 52 , and the Professional Practice Guidelines for Psychedelic-Assisted Therapy ( PPG-PAT ), first edition published August 2023 53 , both by BrainFutures, in addition to the MDMA-Assisted Psychotherapy Code of Ethics ( MAPS-COE ), version 2 published September 2019 (see Table 2 ). 54 Similarities in Language The PPG-PAT guidelines used language consistent with 8 out of the 10 guidelines outlined in the Multicultural Guidelines , across 11 instances in its content for psychotherapists practicing PAT. Specifically, guidelines 1, 2, 3, 5, 6, 7, 9, and 10 were reflected in the PPG-PAT text (see Table 3 ). The MDMA-TM manual used language consistent with 7 out of the 10 guidelines outlined in the Multicultural Guidelines , across 32 instances in its content for psychotherapists practicing PAT. In the MDMA-TM , guidelines 2, 3, 4, 6, 7, 8, and 10 were reflected in the MDMA-TM text (see Table 3 ). The MAPS-COE used language consistent with 6 out of the 10 guidelines outlined in the Multicultural Guidelines, across 9 instances in its content for psychotherapists practicing PAT. In the MAPS-COE guidelines 1, 2, 3, 4, 5, and 6 were reflected in the MAPS-COE text (see Table 3 ). The MAPS MDMA-TM and MAPS-COE are intended to be used together, in which case they collectively cover all Multicultural Guidelines except for 9. The Y-PAT manual used language consistent with 5 out of the 10 guidelines outlined in the Multicultural Guidelines, across 9 instances in its content for psychotherapists practicing PAT. In the Y-PAT , guidelines 1, 2, 3, 5, and 6 reflected in the Y-PAT text (see Table 3 ). The EI-PAT guidelines used language consistent with 5 out of the 10 guidelines outlined in the Multicultural Guidelines , across 8 instances in its content for psychotherapists practicing PAT. The EI-PAT , guidelines 1, 3, 4, 8, and 9 were reflected in the EI-PAT text (see Table 3 ). Teaching Applicability Among the five PAT manuals and guidelines, the coders (SR and DS) assessing teaching applicability were unable to identify provided instructions for psychotherapists to meet any of the Multicultural Guidelines created by the APA. Discussion In this paper, we examined the degree to which five open-source PAT manuals and treatment guidelines incorporate language consistent with the APA’s Multicultural Guidelines . All five manuals display varying degrees of alignment with the Multicultural Guidelines , but they differ in the specific guidelines they emphasize. Despite the presence of language consistent with the Multicultural Guidelines in these manuals, the study notes a crucial gap: none of the manuals provide clear, teachable instructions for facilitators on how to deliver PAT from a culturally informed perspective. Research manuals often prioritize standardized protocols, versus a flexible approach, to ensure reproducibility across sites and studies. Researchers also must balance broad generalizability against specialized approaches for specific patient populations, and there is often an inverse relationship between accessibility and safety in pioneering work. Nonetheless, prioritizing standardization and generalizability to the detriment of intersectional awareness may inadvertently overlook the expertise and clinical nuance required for culturally responsive care. The spirit of cultural humility, as opposed to cultural competence or no attention to cultural aspects, can be implemented within any PAT clinical or research team with the proper attention and practice. It is also possible to standardize a process-oriented, client-centered approach involving therapist self-reflection that is generalizable across a wide array of patient populations and clinical and research settings. One reason the manuals and guidelines may lack teaching applicability could be the assumption that all practitioners engaging in PAT already possess the necessary training and foundational skillset to practice cultural humility, with the PAT manuals and guidelines simply acting as supplemental materials for learning a new therapy modality. However, PAT requires a particular attention to cultural humility beyond what is required in other clinical work due to the amplification and acceleration of relational processes, so the assumption that practitioners will get crucial cultural humility training elsewhere could be made explicit and resources provided; otherwise, manuals could provide more instructional guidance in cultural humility to practitioners and emphasize the importance of this approach with PAT. Many notable clinicians and researchers are directly challenging the existing paradigms in PAT clinical research by enhancing recruitment and retention of diverse participants (e.g., Black/African American and LGBTQ+) and modifying study protocols for specific marginalized populations. 39 – 46 In contrast, the present study highlights strengths and limitations in existing open source manuals and guidelines in an effort to increase cultural humility across PAT clinical and research settings. Limitations A significant limitation of the study is the small number of available manuals and guidelines, as it did not include those behind paywalls or for purchase (e.g., published books) 55 , 56 or proprietary materials (e.g., from pharmaceutical companies conducting psychedelic therapy trials and not available to the public). 57 This restriction may have excluded manuals with important multicultural considerations that align well with the APA’s Multicultural Guidelines . Future studies could aim to include a broader range of manuals and guidelines as the psychedelic medicine field continues to develop to provide a more comprehensive view of the methodologies used in different PAT contexts. Conclusion Our study highlights the strengths and gaps regarding the inclusion of multicultural guidelines in PAT manuals and guidelines. The lack of actionable guidance indicates that while the PAT manuals and guidelines acknowledge the importance of cultural awareness, they fall short in equipping therapists with concrete skills or strategies to work within diverse cultural contexts effectively. The merging of PAT and cultural humility is relatively new, and there is more work to be done to provide accessible (i.e., open source) resources that are culturally applicable to everyone. Abbreviations PAT Psychedelic assisted therapy APA American Psychological Association LSD Lysergic acid diethylamide MDMA 3,4-Methyl enedioxy methamphetamine BAPPI Board for the Advancement of Psychology in the Public Interest LGBTQ+ lesbian, gay, bisexual, transgender, and queer people PTSD Posttraumatic stress disorder Multicultural Guidelines Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality MAPS Multidisciplinary Association for Psychedelic Studies EI-PAT An Expert-Informed Introduction to the Elements of Psychedelic-Assisted Therapy MAPS-COE MAPS MDMA-Assisted Therapy Code of Ethics PPG-PAT The Professional Practice Guidelines for Psychedelic-Assisted Therapy Y-PAT Yale Manual for Psilocybin-Assisted Therapy of Depression MDMA-TM A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder Declarations Acknowledgements Thank you to Jenna Kachmarik for your support and feedback during the preparation of this manuscript. Availability of Data and Materials The guidelines used and analyzed during the current study are publicly available. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests All authors declare that they have no competing interests. Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Funding This study was supported with funding from the Steven & Alexandra Cohen Foundation, Dr. Bronner’s Family Foundation, and the Lars Reierson Psychedelic Medicine Innovation Fund. Author Contributions Conceptualization: AKB and CSS. Analyses: AKB, BW, SRR, DTS. Recommendations: AKB, BW, ALF. Review and Editing: AKB, BW, ALF, SRR, DTS. Supervision: SRR and CSS. All authors read and approved the final manuscript. References Institute of Medicine Committee on U, Eliminating R. Ethnic Disparities in Health C. In: Smedley BD, Stith AY, Nelson AR, eds. 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Psychedelic-Assisted Therapy (PAT) Manuals & Guidelines Organization* Manual Psychedelic Year of Publication BrainFutures Professional Practice Guidelines for Psychedelic-Assisted Therapy (PPG-PAT) Psilocybin, MDMA 2023 BrainFutures An Expert-Informed Introduction to the Elements of Psychedelic-Assisted Therapy (EI-PAT) Psilocybin, MDMA, ketamine 2022 MAPS A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder (MDMA-TM) MDMA 2017 MAPS MDMA-Assisted Therapy Code of Ethics (MAPS-COE) MDMA 2019 Yale The Yale Manual for Psilocybin-Assisted Therapy of Depression (Y-PAT) Psilocybin 2020 *Data are descending alphabetically by organization name MDMA 3,4-Methylenedioxymethamphetamine MAPS Multidisciplinary Association for Psychedelic Studies Table 3 . Comparison of the APA Multicultural Guidelines with PAT manuals/guidelines, Utilizing Framework Analysis Manual Guideline 1 Guideline 2 Guideline 3 Guideline 4 Guideline 5 Guideline 6 Guideline 7 Guideline 8 Guideline 9 Guideline 10 PPG-PAT 2 2 2 0 1 1 1 0 2 2 EI-PAT 1 0 3 2 0 0 0 1 1 0 MDMA-TM 0 5 9 6 0 1 2 1 0 8 MAPS-COE 6 5 2 2 2 2 0 0 0 0 Y-PAT 1 3 2 0 1 2 0 0 0 0 EI-PAT An Expert-Informed Introduction to the Elements of Psychedelic-Assisted Therapy MAPS-COE MAPS MDMA-Assisted Therapy Code of Ethics PPG-PAT The Professional Practice Guidelines for Psychedelic-Assisted Therapy Y-PAT Yale Manual for Psilocybin-Assisted Therapy of Depression MDMA-TM Treatment Manual: MDMA-Assisted Therapy for PTSD Additional Declarations No competing interests reported. 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Watt","email":"","orcid":"","institution":"VA Portland Health Care System","correspondingAuthor":false,"prefix":"","firstName":"Bianca","middleName":"R.","lastName":"Watt","suffix":""},{"id":414728886,"identity":"773a2c92-068b-4d59-991e-467aae989951","order_by":2,"name":"Arturo S. Lopez Flores","email":"","orcid":"","institution":"Oregon Health \u0026 Science University","correspondingAuthor":false,"prefix":"","firstName":"Arturo","middleName":"S. Lopez","lastName":"Flores","suffix":""},{"id":414728889,"identity":"326afbfc-7f35-4515-8e56-54faf4fab0ba","order_by":3,"name":"Stephanie R. Rodriguez","email":"","orcid":"","institution":"VA Portland Health Care System","correspondingAuthor":false,"prefix":"","firstName":"Stephanie","middleName":"R.","lastName":"Rodriguez","suffix":""},{"id":414728892,"identity":"1c9ac493-c102-40ae-901a-7f6611ae4897","order_by":4,"name":"Darron T. Smith","email":"","orcid":"","institution":"University of Washington","correspondingAuthor":false,"prefix":"","firstName":"Darron","middleName":"T.","lastName":"Smith","suffix":""},{"id":414728894,"identity":"704c6ad2-7a24-49c5-83d1-bd96d49f0d6b","order_by":5,"name":"Christopher S. Stauffer","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABJElEQVRIie3QvWrDMBAH8BMCZxF4NfTDr6DgoS24WfsKGWUMmtosWQIZ0lJIF2U39CX6BnUQ2IsfIFsbCp1bsqhbTm4zpCieC9UfJE7DT3cSgI/PH0xYAJS24LiIwa13j+ePDhKtLBHfhDIsWCWAFB2ED+2+I/BDKOsiR4v18suko7Pe4pUSM8hUQKvN5XwA8ZXiTnJcc82EHF+omhMjciRB/ngzz6HfNG4SSdAgdPa0kjiUoNlzrBJ63VDoF1IcIktjycu7JTPsEm7oeTM7TIYSStZ2CSzRSBilMNEQR3npIhHOo5mUY960RZ3gWxKiJjXjTDtJWEj6adJ0xOuKrE06PcEfewPDp6fxw92ti+zSTr13KePOHr/IfuLOHj4+Pj7/KFuZh2B5RJCAPQAAAABJRU5ErkJggg==","orcid":"","institution":"Oregon Health \u0026 Science University","correspondingAuthor":true,"prefix":"","firstName":"Christopher","middleName":"S.","lastName":"Stauffer","suffix":""}],"badges":[],"createdAt":"2025-01-27 01:38:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5908748/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5908748/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96920758,"identity":"0e53732f-ddd9-41ae-9129-64b00ce7c2d3","added_by":"auto","created_at":"2025-11-27 14:15:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":685509,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5908748/v1/976ea750-5771-45a9-9738-d78507487db0.pdf"},{"id":76173776,"identity":"e9921396-360a-4226-bafe-f51bf7656481","added_by":"auto","created_at":"2025-02-13 06:00:15","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16051,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5908748/v1/896990a90d138b2218349882.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cultural Humility and Psychedelics: A Framework Analysis of Psychedelic-Assisted Therapy Manuals and Practice Guidelines","fulltext":[{"header":"Background","content":"\u003cp\u003eCultural biases and cultural misalignment within healthcare systems lead to treatment inequities, iatrogenic harms, and mistrust.\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e While training in cultural competence has aimed to address these issues, it is traditionally geared toward social majorities (e.g., white, heteronormative) learning about \u0026lsquo;other\u0026rsquo; social groups (e.g., Black/African American, LGBTQ+). The concept of \u0026lsquo;competence\u0026rsquo; implies mastery over a fixed and uniform set of knowledge, rather than reflecting the intersectional multicultural reality of an increasingly diverse population. Competence training centers an in-group/out-group perspective, which can magnify power imbalances between patients and providers. Thus, cultural competency has been found to paradoxically foster implicit bias and stigma.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn response to an urgent need to deliver more culturally attuned healthcare, Tervalon and Murray-Garc\u0026iacute;a (1998) coined the term \u0026lsquo;cultural humility\u0026rsquo; as an alternative to \u0026lsquo;cultural competence\u0026rsquo;. Humility acknowledges that \u0026lsquo;we don\u0026rsquo;t know what we don\u0026rsquo;t know\u0026rsquo;. Cultural humility reflects a dynamic person-centered approach, recognizing patients\u0026rsquo; own expertise in the social and cultural context of their lives. Cultural humility training also encourages providers to reflect on their own beliefs, values, and biases (explicit and implicit)\u0026mdash;building self-awareness around their own cultures\u0026rsquo; impacts on patients. While cultural competence training is content-oriented and aims to enhance provider confidence, cultural humility training is process-oriented and promotes individualized and adaptable patient-provider partnerships. By implementing cultural humility into practice, providers can mitigate the negative effects of bias on healthcare outcomes.\u003c/p\u003e \u003cp\u003eSince its inception, the practice of cultural humility has been adapted by various healthcare professionals, including psychotherapists and social workers.\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e In Western psychotherapy frameworks, psychological disorders are often understood through universal principles, leading to a one-size-fits-all approach to treatment.\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e This narrow perspective overlooks the direct influence of a patient\u0026rsquo;s culture and identity on their symptomology and presentation.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Psychotherapy is increasingly recognized as a cultural construct, where culture is central to treatment interventions. This has led governing bodies, such as the American Psychological Association (APA), to create multicultural guidelines for psychologists.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e This approach acknowledges that health beliefs, practices, and responses to psychotherapy are shaped by cultural values of both psychotherapist and patient.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Recognizing culture as integral to successful mental health interventions helps psychotherapists tailor care in ways that respect and incorporate patients\u0026rsquo; cultural backgrounds, thereby enhancing treatment effectiveness.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEmpirical research has supported the use of psychedelics (e.g., psilocybin, LSD, MDMA, and ketamine) in the treatment of psychiatric disorders\u0026mdash;such as depression, PTSD, and substance use disorders.\u003csup\u003e\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Natural psychedelics have been used as \u0026lsquo;plant medicines\u0026rsquo; by Indigenous societies for millennia in sacred ceremonial and healing contexts.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e In contemporary clinical and research settings, psychedelics are commonly paired with a framework of psychotherapy or psychological support delivered by mental health professionals, also known as psychedelic-assisted therapy (PAT).\u003csup\u003e\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Psychedelics can lower psychological defenses and magnify sensitivity to subtle relational cues within the patient-therapist relationship.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e This can contribute to enhanced therapeutic alliance when PAT is facilitated from a stance of unconditional positive regard and careful attunement.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Conversely, psychedelics can leave patients more vulnerable than usual to therapist mis-attunement, invalidating biases, and microaggressions. While psychedelics can accelerate rupture and repair and other transference-countertransference processes, this requires a trauma-informed approach and a high degree of cultural humility to minimize harms and maximize therapeutic outcomes.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe earlier wave (1940s to 1980s) of structured scientific inquiry into psychedelics, including research conducted by the United States government, was tainted by ethical violations and serious harm to participants.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e This was evidenced in various cases; one notable example is the unethical use of frequent and large dosages of LSD on incarcerated individuals without their informed consent.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Psychedelics were also administered in combination with conversion therapies targeting lesbian, gay, bisexual, transgender, and queer people (LGBTQ)\u003csup\u003e\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Conversion therapy has since been identified as an unethical and harmful practice by all major mental health professional organizations.\u003csup\u003e\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e Such practices, documented in several studies, underscore a history of exploitation and highlight the importance of conducting modern psychedelic research within a framework of cultural humility to ensure the safety of patients and research participants.\u003c/p\u003e \u003cp\u003eA growing body of literature has raised concerns over the lack of diversity, equity, and inclusion in modern-day clinical trials for psychedelic-assisted therapy (PAT).\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan additionalcitationids=\"CR38 CR39 CR40\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e Researchers have highlighted the underrepresentation of racially minoritized and LGBTQ\u0026thinsp;+\u0026thinsp;communities in these trials and have created studies that focus on minority inclusion in psychedelic research.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e,\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e In addition to participant diversity, researchers investigating PAT have recognized the gaps in the development of multicultural applications of PAT and have taken steps to create guidelines and frameworks to address the unique needs and experiences of diverse populations, though more work is still needed to make this practice generalizable to all settings involving PAT.\u003csup\u003e\u003cspan additionalcitationids=\"CR45 CR46\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e Practice manuals and guidelines have been integral in standardizing PAT across studies, research sites, and therapy teams, and serve as a basis for fidelity assessment and clinical consultation. Given the amplification of relational dynamics with PAT and the context of historical harms, the field would benefit from the thoughtful incorporation of multicultural perspectives and principles in PAT manuals to safely address the needs of diverse populations. Significant gaps remain in both the current literature and practice of PAT, particularly concerning the integration of multicultural frameworks into treatment protocols and manuals. This paper aims to investigate the adherence to multicultural guidelines in open-source PAT manuals and guidelines and explore the applicability of PAT manuals and guidelines for training mental health practitioners to engage through a culturally responsive lens.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eSelection of PAT Manuals for Inclusion\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a search on 04/11/2024 in Google Search using the terms: \u0026lsquo;psychedelic therapy manual\u0026rsquo;, \u0026lsquo;MDMA therapy manual\u0026rsquo;, \u0026lsquo;psychedelic therapy professional guidelines\u0026rsquo;, and \u0026lsquo;psychedelic therapy ethical guidelines\u0026rsquo;.\u003c/p\u003e\n\u003cp\u003eSelection criteria included: 1) available in English, 2) open-source materials (items behind a pay wall or available only for purchase were not considered), 3) PAT manuals or guidelines that referred to the administration of a psychedelic substance in conjunction with psychotherapy in the treatment of a psychological disorder in a clinical or research setting, 4) published 2017 or after (this decision was made because the APA\u0026rsquo;s \u003cem\u003eMulticultural Guidelines\u0026nbsp;\u003c/em\u003ewere published in 2017).\u003csup\u003e16\u003c/sup\u003e Articles, reviews, letters, notes, editorials, dissertations, books, and other forms of media were excluded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrom the Google Search results, two authors (AB, CS) independently screened the first fifty titles from each search term and identified documents that met our selection criteria. These searches resulted in a sample of manuals and guidelines that both authors agreed met the inclusion/exclusion criteria for the analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSelection of Multicultural Guidelines\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe chose the \u003cem\u003eMulticultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality, 2017\u0026nbsp;\u003c/em\u003e(i.e., \u003cem\u003eMulticultural Guidelines\u003c/em\u003e) by the five-member \u003cem\u003eTask Force on Re-envisioning the Multicultural Guidelines for the 21st Century\u003c/em\u003e, appointed by the Board for the Advancement of\u003cem\u003e\u0026nbsp;\u003c/em\u003ePsychology in the Public Interest (BAPPI), and adopted by the \u003cem\u003eAPA Council of Representatives\u003c/em\u003e, as the framework of our analysis due to the guidelines being developed to provide psychologists with a framework of \u0026lsquo;multiculturally competent services\u0026rsquo; in practice, research, consultation, and education.\u003csup\u003e16\u003c/sup\u003e From the \u003cem\u003eMulticultural Guidelines\u0026nbsp;\u003c/em\u003edocument, a list of guidelines were extracted for analysis (see \u003cstrong\u003eTable 1\u003c/strong\u003e).\u003csup\u003e16\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a framework analysis using Microsoft Excel to analyze the identified PAT manuals and guidelines in comparison with the guidelines listed in the APA\u0026rsquo;s \u003cem\u003eMulticultural Guidelines\u003c/em\u003e.\u003csup\u003e48,49\u003c/sup\u003e Two pairs of reviewers were assigned to compare the PAT manuals and guidelines against the ten \u003cem\u003eMulticultural Guidelines\u0026nbsp;\u003c/em\u003e(see \u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eand\u003cstrong\u003e\u0026nbsp;Table 2\u003c/strong\u003e)\u003cem\u003e.\u0026nbsp;\u003c/em\u003eThe reviewers were paired based on their educational qualifications and experience with PAT. The first pair of reviewers (AB and BW), who have master\u0026rsquo;s level of graduate education but no experience facilitating PAT, examined whether the language used in the PAT manuals aligned with the ten \u003cem\u003eMulticultural Guidelines\u0026apos;\u003c/em\u003e standards for psychotherapists. The second pair (SR and DS), both of whom have PhDs and experience facilitating PAT, assessed whether the manuals provided instructions for psychotherapists to meet these guidelines.\u003c/p\u003e\n\u003cp\u003eWhen a reviewer identified text in the manuals that aligned with a guideline, they would extract the sample text and enter it into a Microsoft Excel sheet as a code. This code would then be utilized to create a count for both the guideline met and the instance. After individual coding, each pair of reviewers met synchronously to review their codes and resolve any discrepancies. Disagreements were addressed through discussion, and if a consensus could not be reached, a third reviewer (CS) was consulted to make the final decision. Once the coding discrepancies were resolved, the codes were organized into matrices for further analysis. These matrices allowed us to systematically compare the content of the PAT manuals and guidelines against the APA\u0026rsquo;s \u003cem\u003eMulticultural Guidelines\u003c/em\u003e. The results that emerged from this analysis provided insights into how well the manuals aligned with the \u003cem\u003eMulticultural Guidelines\u003c/em\u003e and where potential gaps exist in addressing multicultural considerations.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe PAT treatment manuals identified for analysis include: \u003cem\u003eThe Yale Manual for Psilocybin-Assisted Therapy of Depression\u0026nbsp;\u003c/em\u003e(\u003cem\u003eY-PAT\u003c/em\u003e), first edition published August 2020, using Acceptance and Commitment Therapy as a therapeutic frame\u003csup\u003e50\u003c/sup\u003e, and \u003cem\u003eA Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder\u0026nbsp;\u003c/em\u003e(\u003cem\u003eMDMA-TM\u003c/em\u003e), version 8.1 published August 2017 by the Multidisciplinary Association for Psychedelic Studies.\u003csup\u003e51\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe PAT professional practice guidelines identified for analysis include:\u003cem\u003e\u0026nbsp;An Expert-Informed Introduction to the Elements of Psychedelic-Assisted Therapy\u0026nbsp;\u003c/em\u003e(\u003cem\u003eEI-PAT\u003c/em\u003e), first edition published August 2022\u003csup\u003e52\u003c/sup\u003e, and the\u003cem\u003e\u0026nbsp;Professional Practice Guidelines for Psychedelic-Assisted Therapy\u0026nbsp;\u003c/em\u003e(\u003cem\u003ePPG-PAT\u003c/em\u003e), first edition published August 2023\u003csup\u003e53\u003c/sup\u003e, both by BrainFutures, in addition to the\u003cem\u003e\u0026nbsp;MDMA-Assisted Psychotherapy Code of Ethics\u003c/em\u003e (\u003cem\u003eMAPS-COE\u003c/em\u003e), version 2 published September 2019 (see \u003cstrong\u003eTable 2\u003c/strong\u003e).\u003csup\u003e54\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSimilarities in Language\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe \u003cem\u003ePPG-PAT\u003c/em\u003e guidelines used language consistent with 8 out of the 10 guidelines outlined in the \u003cem\u003eMulticultural Guidelines\u003c/em\u003e, across 11 instances in its content for psychotherapists practicing PAT. Specifically, guidelines 1, 2, 3, 5, 6, 7, 9, and 10 were reflected in the \u003cem\u003ePPG-PAT\u003c/em\u003e text (see \u003cstrong\u003eTable 3\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;\u003cem\u003eMDMA-TM\u003c/em\u003e manual used language consistent with 7 out of the 10 guidelines outlined in the \u003cem\u003eMulticultural Guidelines\u003c/em\u003e, across 32 instances in its content for psychotherapists practicing PAT. In the \u003cem\u003eMDMA-TM\u003c/em\u003e,\u0026nbsp;guidelines 2, 3, 4, 6, 7, 8, and 10 were reflected in the\u0026nbsp;\u003cem\u003eMDMA-TM\u003c/em\u003e text (see \u003cstrong\u003eTable 3\u003c/strong\u003e). The \u003cem\u003eMAPS-COE\u003c/em\u003e used language consistent with 6 out of the 10 guidelines outlined in the\u0026nbsp;\u003cem\u003eMulticultural Guidelines,\u0026nbsp;\u003c/em\u003eacross 9 instances in its content for psychotherapists practicing PAT. In the MAPS-COE\u0026nbsp;guidelines 1, 2, 3, 4, 5, and 6 were\u0026nbsp;reflected in the\u0026nbsp;\u003cem\u003eMAPS-COE\u003c/em\u003e text (see \u003cstrong\u003eTable 3\u003c/strong\u003e). The MAPS \u003cem\u003eMDMA-TM\u003c/em\u003e and \u003cem\u003eMAPS-COE\u003c/em\u003e are intended to be used together, in which case they collectively cover all \u003cem\u003eMulticultural Guidelines\u0026nbsp;\u003c/em\u003eexcept for 9.\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;\u003cem\u003eY-PAT\u003c/em\u003e manual\u0026nbsp;used language consistent with 5 out of the 10 guidelines outlined in the\u0026nbsp;\u003cem\u003eMulticultural Guidelines,\u003c/em\u003e across 9 instances in its content for psychotherapists practicing PAT. In\u0026nbsp;the \u003cem\u003eY-PAT\u003c/em\u003e, guidelines 1, 2, 3, 5, and 6 reflected in the\u0026nbsp;Y-PAT\u0026nbsp;text (see \u003cstrong\u003eTable 3\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The \u003cem\u003eEI-PAT\u003c/em\u003e guidelines\u0026nbsp;used language consistent with 5 out of the 10 guidelines outlined in the\u0026nbsp;\u003cem\u003eMulticultural Guidelines\u003c/em\u003e, across 8 instances in its content for psychotherapists practicing PAT.\u0026nbsp;The \u003cem\u003eEI-PAT\u003c/em\u003e, guidelines 1, 3, 4, 8, and 9 were reflected in the\u0026nbsp;EI-PAT text (see \u003cstrong\u003eTable 3\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTeaching Applicability\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAmong the five PAT manuals and guidelines, the coders (SR and DS) assessing teaching applicability were unable to identify\u0026nbsp;provided instructions for psychotherapists to meet any of the\u0026nbsp;\u003cem\u003eMulticultural Guidelines\u003c/em\u003e created by the APA.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this paper, we examined the degree to which five open-source PAT manuals and treatment guidelines incorporate language consistent with the APA\u0026rsquo;s \u003cem\u003eMulticultural Guidelines\u003c/em\u003e. All five manuals display varying degrees of alignment with the \u003cem\u003eMulticultural Guidelines\u003c/em\u003e, but they differ in the specific guidelines they emphasize. Despite the presence of language consistent with the \u003cem\u003eMulticultural Guidelines\u003c/em\u003e in these manuals, the study notes a crucial gap: none of the manuals provide clear, teachable instructions for facilitators on how to deliver PAT from a culturally informed perspective.\u003c/p\u003e \u003cp\u003eResearch manuals often prioritize standardized protocols, versus a flexible approach, to ensure reproducibility across sites and studies. Researchers also must balance broad generalizability against specialized approaches for specific patient populations, and there is often an inverse relationship between accessibility and safety in pioneering work. Nonetheless, prioritizing standardization and generalizability to the detriment of intersectional awareness may inadvertently overlook the expertise and clinical nuance required for culturally responsive care. The spirit of cultural humility, as opposed to cultural competence or no attention to cultural aspects, can be implemented within any PAT clinical or research team with the proper attention and practice. It is also possible to standardize a process-oriented, client-centered approach involving therapist self-reflection that is generalizable across a wide array of patient populations and clinical and research settings.\u003c/p\u003e \u003cp\u003e One reason the manuals and guidelines may lack teaching applicability could be the assumption that all practitioners engaging in PAT already possess the necessary training and foundational skillset to practice cultural humility, with the PAT manuals and guidelines simply acting as supplemental materials for learning a new therapy modality. However, PAT requires a particular attention to cultural humility beyond what is required in other clinical work due to the amplification and acceleration of relational processes, so the assumption that practitioners will get crucial cultural humility training elsewhere could be made explicit and resources provided; otherwise, manuals could provide more instructional guidance in cultural humility to practitioners and emphasize the importance of this approach with PAT.\u003c/p\u003e \u003cp\u003eMany notable clinicians and researchers are directly challenging the existing paradigms in PAT clinical research by enhancing recruitment and retention of diverse participants (e.g., Black/African American and LGBTQ+) and modifying study protocols for specific marginalized populations.\u003csup\u003e\u003cspan additionalcitationids=\"CR40 CR41 CR42 CR43 CR44 CR45\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e In contrast, the present study highlights strengths and limitations in existing open source manuals and guidelines in an effort to increase cultural humility across PAT clinical and research settings.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eA significant limitation of the study is the small number of available manuals and guidelines, as it did not include those behind paywalls or for purchase (e.g., published books)\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e,\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e or proprietary materials (e.g., from pharmaceutical companies conducting psychedelic therapy trials and not available to the public).\u003csup\u003e\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e This restriction may have excluded manuals with important multicultural considerations that align well with the APA\u0026rsquo;s \u003cem\u003eMulticultural Guidelines\u003c/em\u003e. Future studies could aim to include a broader range of manuals and guidelines as the psychedelic medicine field continues to develop to provide a more comprehensive view of the methodologies used in different PAT contexts.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e Our study highlights the strengths and gaps regarding the inclusion of multicultural guidelines in PAT manuals and guidelines. The lack of actionable guidance indicates that while the PAT manuals and guidelines acknowledge the importance of cultural awareness, they fall short in equipping therapists with concrete skills or strategies to work within diverse cultural contexts effectively. The merging of PAT and cultural humility is relatively new, and there is more work to be done to provide accessible (i.e., open source) resources that are culturally applicable to everyone.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003ePAT\u003c/strong\u003e Psychedelic assisted therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAPA\u003c/strong\u003e American Psychological Association\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLSD\u003c/strong\u003e Lysergic acid diethylamide\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMDMA\u003c/strong\u003e 3,4-Methyl enedioxy methamphetamine\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBAPPI\u0026nbsp;\u003c/strong\u003eBoard for the Advancement of\u003cem\u003e\u0026nbsp;\u003c/em\u003ePsychology in the Public Interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLGBTQ+\u003c/strong\u003e lesbian, gay, bisexual, transgender, and queer people\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePTSD\u003c/strong\u003e Posttraumatic stress disorder\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMulticultural Guidelines\u0026nbsp;\u003c/strong\u003eMulticultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMAPS\u0026nbsp;\u003c/strong\u003eMultidisciplinary Association for Psychedelic Studies\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEI-PAT\u0026nbsp;\u003c/strong\u003eAn Expert-Informed Introduction to the Elements of Psychedelic-Assisted Therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMAPS-COE\u0026nbsp;\u003c/strong\u003eMAPS MDMA-Assisted Therapy Code of Ethics\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePPG-PAT\u0026nbsp;\u003c/strong\u003eThe Professional Practice Guidelines for Psychedelic-Assisted Therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eY-PAT\u0026nbsp;\u003c/strong\u003eYale Manual for Psilocybin-Assisted Therapy of Depression\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMDMA-TM\u0026nbsp;\u003c/strong\u003eA Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThank you to Jenna Kachmarik for your support and feedback during the preparation of this manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of Data and Materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe guidelines used and analyzed during the current study are publicly available. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no competing interests. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported with funding from the Steven \u0026amp; Alexandra Cohen Foundation, Dr. Bronner\u0026rsquo;s Family Foundation, and the Lars Reierson Psychedelic Medicine Innovation Fund. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthor Contributions\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization:\u003c/strong\u003e AKB and CSS.\u003cstrong\u003e\u0026nbsp;Analyses:\u003c/strong\u003e AKB, BW, SRR, DTS. \u003cstrong\u003eRecommendations:\u003c/strong\u003e AKB, BW, ALF. \u003cstrong\u003eReview and Editing:\u003c/strong\u003e AKB, BW, ALF, SRR, DTS.\u003cstrong\u003e\u0026nbsp;Supervision:\u0026nbsp;\u003c/strong\u003eSRR and CSS. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInstitute of Medicine Committee on U, Eliminating R. Ethnic Disparities in Health C. In: Smedley BD, Stith AY, Nelson AR, eds. \u003cem\u003eUnequal Treatment: Confronting Racial and Ethnic Disparities in Health Care\u003c/em\u003e. National Academies Press (US) Copyright 2002 by the National Academy of Sciences. All rights reserved.; 2003.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 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Am J Psychiatry Jan. 2025;1(1):126\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1176/appi.ajp.20230884\u003c/span\u003e\u003cspan address=\"10.1176/appi.ajp.20230884\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Psychedelic-Assisted Therapy (PAT) Manuals \u0026amp; Guidelines\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOrganization*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eManual\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychedelic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear of Publication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBrainFutures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003eProfessional Practice Guidelines for Psychedelic-Assisted Therapy (PPG-PAT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003ePsilocybin, MDMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBrainFutures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003eAn Expert-Informed Introduction to the Elements of Psychedelic-Assisted Therapy (EI-PAT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003ePsilocybin, MDMA, ketamine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMAPS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003eA Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder (MDMA-TM)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003eMDMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMAPS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003eMDMA-Assisted Therapy Code of Ethics (MAPS-COE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003eMDMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 276px;\"\u003e\n \u003cp\u003eThe Yale Manual for Psilocybin-Assisted Therapy of Depression (Y-PAT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003ePsilocybin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Data are descending alphabetically by organization name\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMDMA\u0026nbsp;\u003c/strong\u003e3,4-Methylenedioxymethamphetamine\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMAPS\u0026nbsp;\u003c/strong\u003eMultidisciplinary Association for Psychedelic Studies\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e. Comparison of the APA\u003cem\u003e\u0026nbsp;Multicultural Guidelines\u0026nbsp;\u003c/em\u003ewith PAT manuals/guidelines, Utilizing Framework Analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"803\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eManual\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGuideline 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGuideline 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGuideline 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGuideline 4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGuideline 5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGuideline 6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGuideline 7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGuideline 8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGuideline 9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGuideline 10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePPG-PAT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEI-PAT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMDMA-TM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMAPS-COE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eY-PAT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eEI-PAT\u0026nbsp;\u003c/strong\u003eAn Expert-Informed Introduction to the Elements of Psychedelic-Assisted Therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMAPS-COE\u0026nbsp;\u003c/strong\u003eMAPS MDMA-Assisted Therapy Code of Ethics\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePPG-PAT\u0026nbsp;\u003c/strong\u003eThe Professional Practice Guidelines for Psychedelic-Assisted Therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eY-PAT\u0026nbsp;\u003c/strong\u003eYale Manual for Psilocybin-Assisted Therapy of Depression\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMDMA-TM\u0026nbsp;\u003c/strong\u003eTreatment Manual: MDMA-Assisted Therapy for PTSD\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Psychedelic, psychotherapy, psychedelic-assisted therapy (PAT), cultural humility, mental health equity, culturally responsive care, therapeutic frameworks, ethical considerations","lastPublishedDoi":"10.21203/rs.3.rs-5908748/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5908748/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCultural biases within healthcare systems result in inequitable treatment, harms, and mistrust\u0026mdash;particularly for individuals with marginalized identities. Cultural humility training is dynamic, reflective, and emphasizes person-centered care and mutual respect. Psychedelic-assisted therapy (PAT) is an emerging modality for treating psychiatric disorders. Practice manuals and clinical guidelines are crucial for standardizing PAT and for attending to PAT\u0026rsquo;s unique sensitivity to set and setting, including cultural aspects of care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study investigates the integration of multicultural principles into PAT by analyzing open-source PAT manuals/guidelines against the \u003cem\u003eMulticultural Guidelines\u003c/em\u003e established by the American Psychological Association (APA) in 2017. Using framework analysis, two pairs of reviewers assessed the alignment of the PAT manuals/guidelines\u0026rsquo; language with the APA guidelines and evaluated their applicability for training therapists to conduct PAT with cultural humility.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e Results revealed that while the five manuals/guidelines analyzed exhibit varying degrees of alignment with the guidelines, none provide teachable instructions for delivering culturally responsive care.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003e Our findings highlight significant gaps in PAT practice manuals and guidelines and underscore the need for a more comprehensive approach to training PAT facilitators. Addressing these shortcomings is essential for advancing equitable PAT for diverse populations. Future efforts should prioritize integrating cultural humility into PAT frameworks to optimize therapeutic outcomes for all.\u003c/p\u003e","manuscriptTitle":"Cultural Humility and Psychedelics: A Framework Analysis of Psychedelic-Assisted Therapy Manuals and Practice Guidelines","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-13 06:00:10","doi":"10.21203/rs.3.rs-5908748/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4f9e9fc9-e9fc-4441-9bf3-6f1c70088890","owner":[],"postedDate":"February 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-27T08:24:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-13 06:00:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5908748","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5908748","identity":"rs-5908748","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}