Optimizing Outcomes & Mitigating Risk with Tailored PAT Programming: Part 1
GPT Wrappers are out, PAT Wrappers are in
Depending on who you ask, psychedelics are either dangerous substances that will fry your brain or breakthrough therapeutic tools that urgently need to be made legal to stem the mental health and meaning crisis.
Despite my optimism and firmly belonging to the second group, there is a more nuanced way of framing the issue. This is a view that is more common in scientific circles that I think helps inform the challenges of regulation, support, and risk mitigation.
We should think about psychedelics as substances that increase an individual’s capacity for psychological change.
Where ‘psychological’ refers to perception, cognition, action or behavior.
Psychedelic-potentiated changes can be positive or negative and last a short time or a long time, and there’s still a lot left to learn, according to the scientists and longtimers, but an influential determinant of this outcome is the “wrap-around” support.
This has been the model of psychedelic research trials, which employ “wrap-around” programming (aka education, support, and integration). This programming, in some cases, comes from established interventions from related fields.
For example, in an early trial of psilocybin-assisted therapy for smoking cessation, the researchers added psilocybin dosing sessions to an established 15-week program designed to help people quit smoking. This open-label trial achieved an 80% success rate compared to 35% for the 15-week program alone.
The 15-week smoking cessation program itself was a course in Cognitive Behavioral Therapy (CBT) with added education, exercises, and practices tailored to quitting.
Similarly, a study of psilocybin-assisted therapy for alcohol use disorder published last year combined a course of therapy explicitly designed to help people reduce their drinking with psilocybin sessions.
Just like the smoking-cessation trial, the combination of psilocybin plus therapy was more effective than therapy alone.
This may be obvious for people immersed in the field, but as I learn from conversations with newcomers, would-be psychedelic entrepreneurs, and people seeking relief with psychedelics, it often fails to register that the promising outcomes are the result of a combination of psychedelics with intentionally designed programming for tailored for specific use cases.
As naturalistic use continues to skyrocket, clinics, retreats, and therapists—both above and underground—should embrace this approach from psychedelic clinical trials and develop use-case-specific programming in order to improve outcomes, reduce risks, and create environments for iterative improvement.
“PAT Wrappers”
Right now, there are ample resources for psychedelic harm reduction, best practices, and integration. However, as people continue to flock to psychedelics, there is an opportunity for researchers, therapists, coaches, and clinicians to develop niche programming for specific use cases.
This programming provides the conceptual and theoretical framework for preparation, navigation, and integration.
I am calling such programming “PAT wrappers” as a shorthand for their role as “wrap-around” programming for a tailored use case.
PAT, of course, refers to psychedelic-assisted therapy, and I am borrowing the term “wrapper” from the term for software built around OpenAI’s GPT foundational model and therefore called “GPT Wrappers.”
GPT wrappers are designed by third-party developers to provide additional functionality, interfaces, or integrations that enhance or extend the core capabilities of the GPT models.
In other words, I am suggesting there is an analogy to be drawn—the psychedelic experience is the foundational component around which specific programs, methodologies, or systems can be applied that are designed to drive specific change in human psychology.
That 15-week CBT for smokers mentioned above? That is a PAT Wrapper.
Hypothetical: Growth Mindset PAT Wrapper
As a hypothetical example, consider the “growth mindset.”
It is a concept developed by Stanford psychologist Carol Dweck and refers to the idea that abilities and intelligence can be developed through dedication, hard work, and the embrace of challenges.
The growth mindset understands that growth comes through adversity.
This mindset contrasts with a fixed mindset, where individuals perceive their abilities as static and unchangeable. No matter what you do, you are who you are, and that’s just how it is.
According to Dweck’s reserach, people who develop a growth mindset are more resilient in the face of challenges and, therefore, more likely to thrive compared to those who have internalized a fixed mindset.
This concept, the growth mindset, had a significant cultural impact and reception and is an example of a research finding that was commercialized through aspirational appeal and a clear message.
It is based on scientific research that didn’t lead to patents but has been a commercial success; nevertheless—it is an idea with mimetic fitness and caught on in the culture.
The popularity of the growth mindset has led to the creation of a number of interventions designed to impart this trait to students in classrooms, colleges, companies, and online.
Could such a program be the basis of a PAT wrapper?
If we go back to the definition put forward above, psychedelics are tools that increase the capacity for psychological change.
Programs like the 15-week CBT smoking cessation program, or one based on the growth mindset literature—and literally hundreds of evidence-based research interventions from scientists like Carol Dweck—are also aiming to create psychological change.
In other words, this is an example of evidence-based programming designed to impart a desirable, positive trait—what happens when it is paired with psychedelic-assisted therapy?
In Part II, we’ll look at a few more candidates for PAT wrappers and hypothetical structures for preparation, support, and integration based on this model.