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<p>The constructs&#xa0;set and setting refer&#xa0;to sets of factors that&#xa0;are widely thought to&#xa0;strongly influence outcomes from psychedelic psychotherapy (PAT). Elsewhere, we have argued that these constructs, as typically understood, are vague and that their extension is too vast for them to play critical roles in guiding research or clinical practice. Here we argue that confusion about these terms and their relation to placebo interventions makes three sets of ethical issues particularly challenging for set and setting research and clinical practice. These are (1) the requirement for methodological rigor in human subjects research, (2) questions of research priority-setting, and (3) issues related to consent to placebo use in clinical and research settings. First, we briefly summarize the problems caused by conceptual vagueness of the standard definitions of ‘set’ and ‘setting’ and the overextension of these terms and briefly review a methodological reductionist research agenda that we have proposed to help address these problems. Then we show (1) how this agenda helps address the rigor challenges that vagueness about set and setting introduces and (2) how it helps guide research priority setting. Finally, we take up (3) issues of consent to placebo interventions. Misunderstandings about the nature of placebos in the PAT literature suggest psychedelics are “super placebos” that render patients susceptible to placebo effects stemming from set and setting factors. Some proponents of this view suggest that ethical concerns about placebos depend on misunderstanding their nature. After objecting to these claims, we disentangle the role of placebos in PAT generally from that in set and setting interventions specifically and sketch guidance on the disclosure standards for each.</p>

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The Ethics of Set and Setting in Psychedelic Psychotherapy

  • 期刊论文

  • 发表日期：

    2025年7月7日

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  • Kyle R. Patch,
  • William R. Smith

摘要

The constructs set and setting refer to sets of factors that are widely thought to strongly influence outcomes from psychedelic psychotherapy (PAT). Elsewhere, we have argued that these constructs, as typically understood, are vague and that their extension is too vast for them to play critical roles in guiding research or clinical practice. Here we argue that confusion about these terms and their relation to placebo interventions makes three sets of ethical issues particularly challenging for set and setting research and clinical practice. These are (1) the requirement for methodological rigor in human subjects research, (2) questions of research priority-setting, and (3) issues related to consent to placebo use in clinical and research settings. First, we briefly summarize the problems caused by conceptual vagueness of the standard definitions of ‘set’ and ‘setting’ and the overextension of these terms and briefly review a methodological reductionist research agenda that we have proposed to help address these problems. Then we show (1) how this agenda helps address the rigor challenges that vagueness about set and setting introduces and (2) how it helps guide research priority setting. Finally, we take up (3) issues of consent to placebo interventions. Misunderstandings about the nature of placebos in the PAT literature suggest psychedelics are “super placebos” that render patients susceptible to placebo effects stemming from set and setting factors. Some proponents of this view suggest that ethical concerns about placebos depend on misunderstanding their nature. After objecting to these claims, we disentangle the role of placebos in PAT generally from that in set and setting interventions specifically and sketch guidance on the disclosure standards for each.