“Changes Are Never Linear”: Joost Breeksema on the Human Side of Psychedelic Therapy

Psychedelic therapy should be understood through patient experience rather than only clinical endpoints, because “changes are never linear or predictable.” Joost Breeksema argues that qualitative research and structured support are essential for making sense of challenging or mystical experiences, sustaining gains, and redirecting people to other care when needed. The interview contrasts microdosing and so-called psychoplastogens with psychedelic-assisted psychotherapy, emphasizing that psychedelics can rapidly shift mindsets, values, and worldview in ways that cannot be reduced to symptom relief alone. Breeksema also challenges assumptions that the duration of acute drug effects determines how much psychological support is required, highlighting how intense short-acting experiences like 5-MeO-DMT can create shock that is difficult to integrate without guidance. Breeksema discusses repeat dosing and “Spravato model” approaches, warning that commercial logics may undercut therapeutic depth and ethics. He further connects qualitative evidence to regulators and health economics, suggesting that future evaluation must examine how psychedelic plus psychotherapy produces longer-term benefits and wider life-domain improvements, potentially enabling more sustainable reimbursement models, including non-pharma sponsored or government-backed European trials.