EMBARK model · Atlas

1. Introduction

Version followed: the EMBARK model as published by Brennan & Belser in Frontiers in Psychology (2022, open access), with the training and fidelity structure from Brennan, Field, Schon, Inamdar & Kelman (2025). The book-length depression manual (Brennan & Belser, EMBARK Psychedelic Therapy for Depression, Oxford University Press, 2024) is known here only through publisher and retailer descriptions, so its session agendas and worksheets are NOT reproduced here [uncertain]. EMBARK is sometimes dated to 2021; the sources show training launched by the sponsor in late 2021 (press release) and the model first published in June 2022 [source: Brennan & Belser 2022; uncertain for the 2021 date].

EMBARK is a framework for psychological support during psychedelic-assisted treatment, not a stand-alone therapy and not a drug protocol. It was built by William (Bill) Brennan and Alexander (Alex) Belser at Cybin, Inc., for Cybin-sponsored trials and for training "session monitors"/study therapists. The authors call it "transdiagnostic" and "trans-drug": one shared map (six clinical domains plus four care cornerstones) that each trial adapts to its medicine and diagnosis by adding indication-specific evidence-based techniques [source: Brennan & Belser 2022; Brennan et al. 2025]. The acronym gives the six domains: Existential-Spiritual, Mindfulness, Body Aware, Affective-Cognitive, Relational, Keeping Momentum [source: Brennan & Belser 2022; alexbelser.com].

Core idea of change: psychedelic states can open several distinct routes to improvement (mystical/meaning experiences, decentred awareness, somatic release, approach to avoided emotion and revision of beliefs, corrective relational experience, and behaviour change afterwards). Because nobody can predict in advance which route a given person will take, the therapist prepares the participant for all six, stays agnostic during the session, and then integrates whichever domains actually emerged, anchoring gains with tools from established therapies (e.g. Rumination-Focused CBT and MBCT for depression) [source: Brennan & Belser 2022]. The 2024 book is described as linking the model to twelve proposed mechanisms of change; those twelve were not seen [source: Bokus book page; uncertain].

Not for independent use with illegal substances. EMBARK as published describes support inside regulated clinical trials. Nothing here covers doses, sourcing, administration or medicine-session medical procedures, which belong to the trial protocol and medical staff. A therapist without a legal programme can still use the EMBARK map for preparation-style psychoeducation, harm reduction and integration with clients who have had or plan psychedelic experiences elsewhere (see 5.9) [synthesis].

Legal and regulatory status (as of the sources' dates, 2024–2026). United States: MDMA remains federally Schedule I; the FDA declined to approve MDMA-assisted therapy for PTSD with a Complete Response Letter on 9 August 2024 and asked for another Phase 3 trial; psilocybin services are legal under state programmes in Oregon (Measure 109) and Colorado (Proposition 122, which also covers DMT, ibogaine and mescaline but not MDMA); Utah allows limited pilot programmes for drugs in Phase 3 testing [source: LegalClarity 2026]. Psilocybin's federal status is not stated in the sources; it remains a federally controlled substance outside research [uncertain]. Australia: since 1 July 2023 psychiatrists approved under the TGA Authorised Prescriber Scheme can prescribe MDMA for PTSD (and the same change covered psilocybin for treatment-resistant depression), with ethics-committee backing [source: LegalClarity 2026; detail on psilocybin indication uncertain]. Canada: case-by-case access via Health Canada's Special Access Program [source: LegalClarity 2026]. EU/UK: not covered by the sources [uncertain]. The EMBARK-linked medicines CYB003 (a deuterated psilocin analogue, Phase 3 for major depressive disorder) and CYB004 (a DMT analogue, Phase 2 for generalised anxiety disorder) are investigational only [source: Brennan et al. 2025].

2. Framework

EMBARK uses the three-phase structure common to psychedelic-assisted psychotherapy; what is specific to it is that each phase is organised by the six domains [source: Brennan & Belser 2022].

Phase 1 - Preparation

Goals: build rapport and trust; explain what to expect before, during and after the medicine session (including aftercare and practical requirements); explore and articulate intentions; teach a skill set covering all six domains so that the participant has tools ready whatever arises [source: Brennan & Belser 2022].
Session count: three preparation sessions has been the standard in EMBARK protocols to date, but the authors say this may change per protocol [source: Brennan & Belser 2022]. In the University of Washington clinician trial whose therapists were EMBARK-trained, two preparation sessions were reported [source: Fred Hutch 2025; Brennan et al. 2025].
Format: individual, in person; therapists follow fixed manual tasks but may bring in their own preferred interventions if they meet the manual's criteria (e.g. invite an attentive state, do not clash with the participant's religious beliefs, are trauma-informed) [source: Brennan & Belser 2022].
Move on when: rapport and informed consent are established, intentions are articulated, the participant has practised the core skills (mindfulness, somatic awareness, self-soothing, approach stance) and touch preferences have been discussed. These readiness criteria are inferred from the stated aims; the published article gives no formal checklist [synthesis].

Phase 2 - Medicine session(s)

Goals: a safe, supported, inner-directed experience; therapist responds to what arises using the matching domain's training [source: Brennan & Belser 2022].
Structure: an opening agenda before the medicine session proper with (a) a brief collaboratively designed ritual, (b) an intentions check-in, (c) a brief somatic awareness practice; then responsive, mostly non-directive support [source: Brennan & Belser 2022]. In trial terminology these are the "pre-dose", "dosing" and "post-dose" segments, each of which is fidelity-rated in the Phase 3 programme [source: Brennan et al. 2025].
Number and timing of medicine sessions, the medicine itself and medical monitoring are set by each trial protocol and handled by medical staff; they are deliberately not described here.
Team: the 2022 paper does not specify a two-therapist team; staffing is set per protocol [uncertain].

Phase 3 - Integration

Goals: work with whichever domains emerged; consolidate insight into belief change, emotional acceptance, relational change and concrete action; anchor gains with indication-specific practices [source: Brennan & Belser 2022].
Session count: three integration sessions per medicine session is the EMBARK standard, with more if needed; integration goals are chosen collaboratively from manual-specific lists, guided by a checklist and by what emerged plus the original intentions [source: Brennan & Belser 2022]. The UW trial reported three integration sessions using a psychological-flexibility frame [source: Fred Hutch 2025].
End of treatment: outside referral is required when ongoing support is needed; the authors urge sponsors to fund aftercare beyond the trial [source: Brennan & Belser 2022].

Training and fidelity (for clinicians joining an EMBARK programme)

Original programme (2022-2023 trials): manual review, 12 video modules by subject-matter experts with live Q&A, a 3-day in-person training (including a group Holotropic Breathwork day), clinical-trial/ICH-GCP training, then consultation on the first case and monthly peer consultation [source: Brennan et al. 2025]. The 2022 paper describes a 60-hour curriculum with optional experiential retreat [source: Brennan & Belser 2022].
Phase 3 programme ("EMBARKCT"): prior foundational psychedelic training, a streamlined session-monitor manual, vignette responses, paired role-plays of pre-dose, dosing and post-dose segments, a trainer-scored final role-play for certification, AI-assisted fidelity rating of every session with human oversight, remediation when adherence falls below 80% or a critical item is missed [source: Brennan et al. 2025].
A free 12-module foundational course (EMBARK Open Access, launched April 2023) is hosted at embarkapproach.com [source: Globe and Mail/Cybin press release 2023].

3. Guiding principles

From the published model [source: Brennan & Belser 2022 unless marked]:

Prepare for all six domains, stay agnostic until after the session. Do not decide in advance that the healing will be mystical, emotional or somatic; teach skills for every route and follow what actually happens.
Set aside your own theory of how psychedelics heal. Notice your beliefs (e.g. that a mystical experience is required) and keep them out of how you guide or interpret.
Inner-directed, responsive guidance. During the session the participant's inner process leads; you respond rather than steer.
Approach rather than avoid. Encourage moving toward difficult feelings and beliefs, balanced with self-soothing so the person stays within a tolerable arousal range.
Respect hesitance. A participant's reluctance to confront material is honoured, not overridden (trauma-informed choice).
Pendulation. Alternate engagement with difficult material and self-soothing rather than pushing continuous exposure.
Non-touch first; minimal, consented touch only. Touch is limited to basic supportive contact with few points of contact; consent is checked in preparation, immediately before, and at any time during touch; full-body embraces are excluded.
Therapist presence: CUSHION - Calm, Unhurried, Supportive, Human, Impeccably boundaried, Openhearted, Non-judgmental; cultivated through the therapist's own practice (e.g. mindfulness).
Integration is participant-centred and emergent. Integration goals follow what came up and the person's own intentions, not a fixed curriculum [source: Bokus book description].
Anchor with evidence-based tools for the indication. Each domain borrows techniques from established therapies matched to the diagnosis (CBT, emotion-focused approaches, ACT, MBCT, RFCBT, MBRP, DBT, MI, logotherapy) [source: Brennan & Belser 2022; Brennan et al. 2025].
From intention to action (Keeping Momentum) throughout. Translate intentions into concrete change in individual behaviour, personal context and the wider context, starting in preparation.

The four care cornerstones, each with its practical meaning:

Trauma-informed care: apply SAMHSA's principles (safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; cultural, historical and gender issues) plus explicit choice and autonomy; avoid retraumatising the person through procedures, touch or pressure.
Culturally competent care: attend to power, bias, culturally shaped expression of emotion, and the effects of drug-war policing on communities of colour when discussing drug use and safety.
Ethically rigorous care: actively guard against boundary transgressions, exploitation of heightened suggestibility and power differentials; use supervision, peer consultation and self-reflection as routine.
Collective care: attend to structural factors in people's distress and recovery, and press sponsoring organisations to commit resources (e.g. aftercare).

A participant-facing principle used in many psychedelic programmes ("trust, let go, be open") is not given in the EMBARK sources and is not attributed to EMBARK [uncertain].

4. Intervention inventory

The published sources name the interventions below by domain and phase but give them as brief task descriptions; step-by-step instructions and example language are therefore largely my own operationalisation and are tagged [synthesis] where they go beyond the source. All example language is illustrative. The 2024 manual's own agendas are not drawn on here [uncertain].

A. Preparation phase

4.1 Rapport, orientation and psychoeducation

Purpose: build trust and explain what to expect before, during and after the medicine session, including practical requirements and aftercare [source: Brennan & Belser 2022]. Use in the first preparation session and revisit throughout.
Steps [synthesis]: (1) explain the three phases and the role of each team member, including that medical monitoring is the medical staff's job; (2) describe the range of possible experiences across all six domains, including difficult ones, without promising any particular experience; (3) explain the touch policy and the participant's right to stop or change anything; (4) explain aftercare and what happens when the study ends, including referral; (5) invite questions and check understanding in the participant's own words.
Example language (illustrative): "People have very different experiences. Some are about meaning or spirituality, some are mostly in the body, some are emotional or about relationships. We'll prepare you for all of them, and afterwards we'll work with whatever actually came up."
Watch for: expectations of a guaranteed breakthrough or a mystical experience; anxiety about loss of control; misunderstanding of what the therapist will and will not do. Working when the participant can describe the process and their choices accurately.

4.2 Intention exploration (all domains, with Existential-Spiritual focus)

Purpose: clarify what the participant hopes for; in the Existential-Spiritual domain, assess the person's intrinsic motivation for spiritual or existential content and turn it into intentions [source: Brennan & Belser 2022]. Intentions also seed Keeping Momentum.
Steps [synthesis]: (1) ask what brought them and what they hope will be different; (2) explore meaning, values and any spiritual or religious framework in the person's own terms, without introducing yours; (3) help phrase intentions as open, approach-oriented statements rather than demands; (4) note intentions in the record so they can be checked in on the medicine-session day and in integration.
Example language (illustrative): "If this went well, what would you notice in your life a few months from now?" / "Is there anything about meaning, faith or spirituality that matters to you here, or would you rather we leave that aside?"
Watch for: intentions borrowed from media or from the therapist; spiritual pressure in either direction; respect a person with no interest in spirituality (the domain is offered, not imposed). Working when intentions are the participant's own and can be stated in a sentence.

4.3 Mindfulness skills training (Mindfulness domain)

Purpose: teach basic skills for attending to inner experience, noticing symptomatic states (e.g. rumination) with self-compassion [source: Brennan & Belser 2022].
Steps: choose a practice from ACT, DBT or a meditative tradition that invites an attentive state, does not clash with the participant's religious beliefs and is trauma-informed [source: Brennan & Belser 2022]; then [synthesis] (1) teach a short attention practice (e.g. breath or sound as anchor) in session; (2) practise noticing and naming a thought or feeling and returning to the anchor; (3) assign brief daily practice; (4) review difficulty and adapt (eyes open, shorter practice, external anchors for trauma survivors).
Example language (illustrative): "Let's practise noticing what's here, a thought, a feeling, a sensation, and just naming it, then coming back to the sound of the room."
Watch for: meditation-related anxiety, dissociation or trauma re-experiencing; offer eyes-open or movement-based alternatives [synthesis]. Working when the person can notice and name an inner event without being swept away.

4.4 Somatic awareness training (Body Aware domain)

Purpose: build basic somatic awareness so the person can track and stay with body sensations, a skill used again during the medicine session [source: Brennan & Belser 2022]. EMBARK trains therapists in this without intensive bodywork [source: Brennan & Belser 2022].
Steps [synthesis]: (1) guide a brief scan or a focus on contact points (feet, seat); (2) ask the person to describe a sensation's location, size and quality; (3) identify a neutral or pleasant 'resource' area in the body to return to; (4) practise moving attention between a mildly uncomfortable sensation and the resource (a rehearsal of pendulation, 4.11).
Example language (illustrative): "Where do you feel that right now? What's it like, tight, warm, heavy? And is there somewhere in your body that feels a bit more settled?"
Watch for: rising arousal, numbness or dissociation; slow down and use external grounding [synthesis]. Working when the person can locate a sensation and a resource and move between them.

4.5 Approach stance and self-soothing skills (Affective-Cognitive domain)

Purpose: teach the value of moving toward difficult feelings and beliefs rather than avoiding them, and develop self-soothing techniques for when intensity rises [source: Brennan & Belser 2022].
Steps [synthesis]: (1) explain, using the person's own examples, how avoidance has maintained distress (for depression: habitual emotional avoidance); (2) agree a simple reminder phrase in the person's words for 'moving toward'; (3) build two or three self-soothing options (slow breathing, placing a hand on the chest, a soothing image, asking for the therapist's voice); (4) rehearse both in session with a mildly difficult memory.
Example language (illustrative): "If something hard shows up, one option is to turn toward it and get curious. And if it gets too much, you have your ways of steadying yourself, and you can ask us for help."
Watch for: approach framed as an obligation; trauma survivors who need more stabilisation first. Working when the person can name both a 'move toward' cue and a self-soothing tool.

4.6 Touch consent planning (Body Aware domain; Trauma-informed and Ethically rigorous cornerstones)

Purpose: establish in advance whether and how basic supportive touch may be offered [source: Brennan & Belser 2022].
Steps: (1) state that non-touch support is the default; (2) describe the only touch permitted, basic supportive touch with minimal contact such as holding a hand or a hand on the shoulder, and that full-body embraces are excluded; (3) ask the person's preferences and record them; (4) explain that consent is checked again immediately before any touch and can be withdrawn at any moment during it [source: Brennan & Belser 2022]; (5) agree a simple verbal or non-verbal signal for 'stop' [synthesis].
Example language (illustrative): "We mostly support people without touch. If you'd like, a hand to hold or a hand on your shoulder is possible, and we'll always ask first. You can say no now, or later, or change your mind in the moment."
Watch for: compliance driven by wanting to please; trauma histories involving touch; cultural norms. If consent is ambiguous, treat it as no [synthesis].

4.7 Relational preparation (Relational domain)

Purpose: prepare for the fact that the therapeutic relationship may feel altered (transference, projection, reenactment) and frame such moments as opportunities [source: Brennan & Belser 2022].
Steps [synthesis]: (1) briefly map the participant's characteristic relational patterns (e.g. withdrawing, pleasing, mistrust); (2) let them know they may have strong feelings toward the team and that saying so is welcome; (3) agree how they can ask for contact or space.
Example language (illustrative): "Sometimes people find strong feelings come up about us, trust, anger, needing us close or far away. That's useful, and you can tell us."
Watch for: idealisation of the therapist; fear of being a burden (common in depression). Working when the person can say what they might need from the team.

4.8 Intention-to-action seeding (Keeping Momentum domain)

Purpose: begin translating intentions into concrete change from the start, across individual behaviour, personal context and the broader context [source: Brennan & Belser 2022].
Steps [synthesis]: (1) for each intention, ask what one behaviour would show it; (2) note supports and obstacles in the person's personal context (relationships, work, home); (3) note any wider or structural factors the person wants to engage with; (4) keep this list for integration.
Example language (illustrative): "If this intention came true, what would you be doing differently, at home, at work, with others?"

B. Medicine-session phase

All of the following sit within the trial protocol's safety frame; the medicine, its administration and medical monitoring are medical staff responsibilities.

4.9 Room preparation and collaborative opening ritual (Existential-Spiritual domain)

Purpose: prepare the room in a way that respects possible sacredness and open the session with a brief, collaboratively designed ritual [source: Brennan & Belser 2022].
Steps [synthesis]: (1) agree the ritual's form in the last preparation session, using the participant's own choices and beliefs (e.g. reading a line they chose, a moment of silence, holding a meaningful object); (2) keep it brief and secular unless the participant wants otherwise; (3) do not import ceremonial elements from Indigenous or religious traditions the participant does not hold. The 2022 paper notes the model excludes Indigenous knowledge because of its Western clinical-trial scope [source: Brennan & Belser 2022]. In the UW trial participants brought a personal item representing their commitment to healing [source: Fred Hutch 2025].
Example language (illustrative): "Would you like to begin the way we planned, with your words and a moment of quiet?"
Watch for: the ritual feeling imposed or performative; therapists' spiritual preferences shaping it.

4.10 Intentions check-in and brief somatic awareness practice (pre-session agenda)

Purpose: reconnect with intentions and arrive in the body before the session proper [source: Brennan & Belser 2022].
Steps [synthesis]: (1) ask the participant to state their intentions in their own words; (2) remind them of their 'move toward' and self-soothing cues and of the touch agreement; (3) lead a short somatic practice from 4.4.
Example language (illustrative): "Say your intention in whatever words feel right today. Then let's take a minute to notice your feet, your breath, where you are."

4.11 Inner-directed responsive support with domain-matched responses

Purpose: support the participant's inner process; when an event arises, recognise which domain it belongs to and respond with that domain's preparation (e.g. respond to a somatic trauma process with Body Aware interventions) [source: Brennan & Belser 2022]. Participants often wear eyeshades and listen to music in this setting [source: Brennan & Belser 2022; Fred Hutch 2025].
Steps [synthesis]: (1) default to quiet, attentive presence (CUSHION); (2) check in briefly and sparingly; (3) when the person speaks or shows distress, reflect simply and ask what they need; (4) select the domain response: Affective-Cognitive - remind them to welcome the content and use self-soothing as needed; Mindfulness - invite noticing without judgement; Existential-Spiritual - hold space without interpreting; Relational - see 4.13; Body Aware - see 4.12; (5) document notable content for integration.
Example language (illustrative): "I'm right here. You don't have to make sense of it now." / "Can you let it be there, and breathe with it?"
Watch for: therapist over-talking or interpreting; steering toward the therapist's preferred kind of experience; heightened suggestibility. Working when the participant stays engaged with the process and feels accompanied rather than directed.

4.12 Return to the body, zone of optimal arousal and pendulation (Body Aware domain)

Purpose: when clinically indicated, guide the person back to body awareness and help them stay within a "zone of optimal arousal", alternating between embodied engagement with trauma material and self-soothing (pendulation) [source: Brennan & Belser 2022].
Steps [synthesis]: (1) if arousal is climbing, invite attention to a resource area or contact points; (2) when steadier, invite gentle return to the difficult sensation or material; (3) repeat in small swings; (4) offer limited supportive touch only per 4.6 and only with fresh consent; (5) if the person is hesitant, respect it and do not push them back toward the material.
Example language (illustrative): "Let's come back to your hands and the mat under you for a moment... and when you're ready, only if you want, you can notice that feeling in your chest again."
Watch for: prolonged hyperarousal, panic, dissociation, medical signs (alert medical staff per protocol). Working when the person can touch difficult material and come back to a steadier state.

4.13 Relational responses / relational repatterning (Relational domain)

Purpose: treat altered therapist-participant dynamics (transference, projection, reenactment) as opportunities; for depression, offer "relational repatterning" that may counter beliefs driving isolation [source: Brennan & Belser 2022]. The authors note that these moments can help or harm depending on handling.
Steps [synthesis]: (1) notice relational content (e.g. apologising for being a burden, fear of abandonment, anger at the therapist); (2) respond in a way that disconfirms the feared pattern (steady, warm, non-retaliatory, non-intrusive); (3) keep boundaries clear while being warm; (4) record for integration.
Example language (illustrative): "You're not a burden. I'm glad to be here with you."
Watch for: boundary drift, therapist over-involvement or romanticised closeness; consult supervision after any such session.

4.14 Limited supportive touch

Purpose: provide contact support when non-touch support is insufficient and the participant wants it [source: Brennan & Belser 2022].
Steps: (1) try non-touch support first; (2) ask immediately before touch, even if agreed in preparation; (3) offer only basic supportive touch with minimal points of contact (hand-holding, a hand on the shoulder); (4) let the participant initiate or end; check consent at any time during; (5) never full-body embraces [source: Brennan & Belser 2022]; (6) document each instance [synthesis].
Example language (illustrative): "Would you like my hand? ... Let me know if you'd like me to let go."
Watch for: any sign of withdrawal of consent; touch requested for the therapist's comfort rather than the participant's need.

C. Integration phase

4.15 Collaborative integration goal-setting

Purpose: choose integration goals based on what arose in the session and on the participant's stated intentions, from manual-specific lists, guided by a checklist [source: Brennan & Belser 2022].
Steps [synthesis]: (1) invite an open account of the experience without interpretation; (2) together, sort what emerged into the six domains; (3) compare with the original intentions; (4) agree one to three integration goals and which domain tools to use; (5) review at each session.
Example language (illustrative): "Of everything you've told me, which parts feel most alive or most important now? Let's pick where to focus."
Watch for: the therapist privileging dramatic content over what matters to the participant; participants who feel nothing happened (see 5.3).

4.16 Existential-Spiritual integration

Purpose: explore existential or spiritual experiences, consider what actions they might motivate, and co-create life or spiritual-development plans; options include meaning-oriented psychotherapies, Logotherapy and "Spiritual Guidance" (described as an MI-derived approach) [source: Brennan & Belser 2022].
Steps [synthesis]: (1) explore the experience in the participant's own vocabulary; attribute any metaphysical interpretation to the participant, never confirm or dispute it; (2) ask what values or meanings it points to; (3) if Logotherapy is used, explore sources of meaning (what the person can give, experience, and the stance they take toward unavoidable suffering) [synthesis, general logotherapy knowledge, not from EMBARK texts]; (4) co-write a short plan of meaning-based actions or spiritual practices; (5) refer to the participant's own faith community or a chaplain where appropriate.
Example language (illustrative): "What does that experience seem to ask of you, if anything?"
Watch for: spiritual bypassing of practical problems; grandiosity; distress at experiences that conflict with the person's faith.

4.17 Mindfulness integration with indication-specific practices

Purpose: anchor gains in noticing symptomatic states with self-compassion; for depression, use tools from Rumination-Focused CBT and MBCT to interrupt rumination; for alcohol use disorder the example is MBRP [source: Brennan & Belser 2022].
Steps [synthesis]: (1) identify a recurring symptomatic state (e.g. rumination after a conflict); (2) practise noticing it early and labelling it; (3) for rumination, shift from abstract 'why' thinking to concrete, present-focused processing (as in RFCBT) and use a short breathing space (as in MBCT); for AUD, practise noticing urges and riding them out (as in MBRP); (4) set a regular practice.
Example language (illustrative): "When you notice the 'why me' loop starting, what would it be like to name it, 'ruminating', and come back to what you can actually see and do right now?"
Watch for: practice slipping after the glow of the session fades; adjust frequency and form.

4.18 Somatic integration (Body Aware domain)

Purpose: work with shifts in somatic awareness that occurred; somatic skills may be drawn from MBRP or DBT [source: Brennan & Belser 2022].
Steps [synthesis]: (1) ask what the body felt and what it feels like now; (2) link body states to emotions and triggers; (3) teach or refresh one DBT-style body-based regulation skill or a body-focused mindfulness practice; (4) plan when to use it.
Example language (illustrative): "You said your chest felt open afterwards. Can you find any of that now? What helps you get back there?"
Watch for: somatic trauma memories surfacing after the session; refer for trauma-specific therapy if needed.

4.19 Affective-Cognitive integration: core-belief revision and emotional acceptance

Purpose: use approach experiences from the session to revise core beliefs about self or world and build more lasting acceptance of emotion; in depression, reduce habitual emotional avoidance [source: Brennan & Belser 2022]. CBT or emotion-focused approaches can be used here [source: Brennan et al. 2025].
Steps [synthesis]: (1) identify a core belief that the experience challenged (e.g. 'I am unlovable'); (2) collect the specific experiential evidence from the session; (3) formulate an alternative belief in the participant's words; (4) design small real-life tests of the new belief; (5) practise allowing feelings in daily life rather than avoiding them.
Example language (illustrative): "In the session you felt your grief and you were still OK. What does that say about the belief that feelings will destroy you?"
Watch for: insights that fade without behavioural testing; new negative beliefs arising from a difficult session.

4.20 Relational integration

Purpose: build on felt social connectedness or carry out an autobiographical review of relationships [source: Brennan & Belser 2022]; consolidate any relational repatterning that occurred.
Steps [synthesis]: (1) review what happened between participant and team during the session and what it meant; (2) relate it to patterns in other relationships; (3) map key relationships across the life span (autobiographical review); (4) plan one reconnecting step (contact, repair conversation, group).
Example language (illustrative): "You let us stay with you when you were hurting. Who else in your life might you let in a little more?"
Watch for: dependency on the study team as the trial ends; prepare the transition early.

4.21 Keeping Momentum action planning (three spheres)

Purpose: move from intentions to concrete actions in three spheres - individual behaviour, personal context and broader context, with collective action an option at the broader level [source: Brennan & Belser 2022].
Steps [synthesis]: (1) individual: one or two specific behaviour changes with when and where; (2) personal context: changes in relationships, work, home or routines that will support them; (3) broader context: structural factors (e.g. workplace conditions, community, advocacy) the person chooses to engage with; (4) anticipate obstacles and plan responses; (5) review progress at each integration session.
Example language (illustrative): "What's one thing you'll do this week, one thing around you that needs to change to support it, and is there anything bigger you want to be part of?"
Watch for: over-ambitious plans; collective-action suggestions coming from the therapist's politics rather than the participant.

4.22 Ending, aftercare and referral

Purpose: close the trial-based treatment safely; make outside referrals when ongoing support is needed [source: Brennan & Belser 2022].
Steps [synthesis]: (1) review gains, remaining symptoms and risk (trials train therapists in the C-SSRS) [source: Brennan & Belser 2022]; (2) summarise tools in a written plan; (3) arrange referral to ongoing therapy, medication review or peer support; (4) give crisis contacts.
Example language (illustrative): "Let's put together what you want to take with you, and make sure you have support lined up after the study."

D. Therapist-side practices

4.23 Cultivating CUSHION presence

Purpose: develop the therapist presence the model requires: Calm, Unhurried, Supportive, Human, Impeccably boundaried, Openhearted, Non-judgmental, through self-directed practices such as mindfulness [source: Brennan & Belser 2022].
Steps [synthesis]: (1) a brief personal centering practice before each session; (2) after each session, rate yourself on each CUSHION quality and note lapses; (3) bring lapses to supervision.
Watch for: impatience, wanting the participant to 'have' a certain experience, boundary looseness.

4.24 Bracketing therapist beliefs, supervision and fidelity review

Purpose: notice and set aside your own beliefs about how psychedelics heal; maintain ethically rigorous care through supervision, peer consultation and self-reflection [source: Brennan & Belser 2022]; in trials, sessions are fidelity-rated and remediation is triggered by low adherence or a missed critical item [source: Brennan et al. 2025].
Steps [synthesis]: (1) write down your own assumptions about mechanisms before starting; (2) after sessions, check whether they shaped what you said; (3) attend monthly peer consultation; (4) review recordings against the protocol's fidelity checklist where one exists.
Watch for: interpreting participant experiences in your preferred framework; touch or contact beyond policy; secrecy about session events.

Some trainees in the original programme took part in a day of group Holotropic Breathwork as experiential training [source: Brennan et al. 2025]; this is a training element for therapists, not a participant intervention, and has its own contraindications (e.g. cardiovascular disease, epilepsy, pregnancy, glaucoma, psychosis history, recent surgery) [synthesis: contraindications not from the EMBARK sources].

5. Handling problems

The EMBARK sources address difficult in-session experiences, touch, boundaries, aftercare and therapist fidelity; most other problem-handling below is my own synthesis and is marked.

5.1 Eligibility and screening (before anything else)

EMBARK itself is a support model; eligibility is set by each trial protocol. The CYB003/CYB004 exclusion criteria are not drawn on here [uncertain]. Trial therapists are trained in the C-SSRS, adverse-event documentation and Basic Life Support [source: Brennan & Belser 2022].
[synthesis] Exclusions commonly published by psychedelic trials, which a clinician should expect and respect: personal or close family history of psychotic disorders or bipolar I disorder; current active suicidal intent or recent serious attempt; significant cardiovascular or other medical conditions as judged by the medical team; pregnancy; certain current medications; current substance use disorder (depending on the study); and inability to give informed consent. Medical screening and decisions are the medical team's responsibility.

5.2 Overwhelm and difficult experiences during the session

Source guidance: recognise which domain the event belongs to and apply that domain's training; use the reminders built in preparation (move toward, self-soothe); use pendulation and trauma-informed responses; respect hesitance about confronting material [source: Brennan & Belser 2022].
[synthesis] Practical sequence: (1) slow your own pace; brief, calm voice; (2) orient to safety and presence ("I'm here, you're safe in this room"); (3) offer the agreed self-soothing cue; (4) ground in contact points; (5) offer limited supportive touch only with fresh consent; (6) if distress escalates or medical signs appear, alert the medical team at once per protocol; (7) document and plan an earlier integration contact.

5.3 'Nothing happened', disappointment or stuckness in integration

[synthesis] Normalise that benefit does not depend on a dramatic experience (consistent with EMBARK's agnostic stance [source: Brennan & Belser 2022]); explore subtle shifts across all six domains (body, attention, relationships); move to Keeping Momentum work on what the person can change now; review whether expectations were set too high in preparation.

5.4 Resistance, ambivalence and non-adherence to practice

[synthesis] Use MI-consistent responses (the model lists MI among domain tools for AUD and the MI-derived Spiritual Guidance [source: Brennan & Belser 2022]): reflect ambivalence, ask permission before advice, link practices to the person's own intentions; shrink homework to something feasible; drop practices that clash with the person's beliefs and choose an alternative that meets the same aim.

5.5 Ruptures and relational difficulties

Source: relational events can benefit or harm depending on handling [source: Brennan & Belser 2022].
[synthesis] Name the rupture early and non-defensively, take your share, invite the participant's view, and repair; in integration, link it to their relational patterns only if they find that useful. If the participant felt pressured, misunderstood or touched without consent, treat it as a safety and ethics matter (5.7), not only a therapy process.

5.6 Distressing post-session sequelae

[synthesis] Persistent anxiety, low mood, intrusive memories, derealisation or disturbing spiritual interpretations after a session: increase integration contact, assess risk (C-SSRS), use grounding and somatic skills (4.12, 4.18), report adverse events per protocol, and refer for psychiatric or trauma-focused care when symptoms persist. Any emergent psychotic or manic symptoms require urgent psychiatric assessment.

5.7 Boundary, suggestibility and ethics problems

Source: ethically rigorous care addresses boundary transgressions, suggestibility and power differentials through supervision, peer consultation and self-reflection; touch is restricted as described [source: Brennan & Belser 2022]. In the Phase 3 programme, a monitor who harms a participant or poses a safety risk is escalated to the site principal investigator and removed, with certification revoked [source: Brennan et al. 2025].
[synthesis] Red flags in your own or a colleague's practice: extending touch beyond policy, contact outside sessions, secrecy, romantic or spiritual-teacher dynamics, interpreting experiences to fit a belief system. Report through study channels and professional bodies as required by your licence and jurisdiction.

5.8 Therapist overload with the six-domain model

Source: the authors acknowledge the six domains and broad competencies may be daunting, and streamlining is ongoing; the Phase 3 programme uses a streamlined manual and fidelity checklists [source: Brennan & Belser 2022; Brennan et al. 2025].
[synthesis] In practice: during the session rely on presence plus three moves (move toward, self-soothe, return to body); reserve the full domain map for preparation and integration planning; use supervision for domain selection.

5.9 Clients who use psychedelics outside legal programmes

[synthesis] EMBARK sources do not address this. A clinician's role is harm reduction and integration support, never facilitation: assess mental-health history, risk and medications; explain in general terms that psychiatric and other medicines can interact dangerously and that people with psychotic or bipolar vulnerability face higher risk; encourage medical review before any decision; discuss safety planning (trusted sober support, avoiding driving, crisis contacts); do not advise on substances, amounts, sourcing or settings; document carefully and follow local law and your licensing board's guidance. Afterwards, the integration tools in 4.15-4.21 can be used to work with what the person experienced.

5.10 Cultural and spiritual mismatch

Source: culturally competent care attends to power, bias and cultural expression of emotion; mindfulness practices should not clash with religious beliefs; the model excludes Indigenous knowledge by design [source: Brennan & Belser 2022].
[synthesis] Ask how the person's culture and faith frame altered states; never borrow ceremony from traditions you do not belong to; refer to the person's own faith or community leaders where they want that.

5.11 End of trial and loss of support

Source: aftercare beyond the trial is a stated concern; outside referrals are required when support is needed [source: Brennan & Belser 2022].
[synthesis] Plan the ending from the first integration session; give a written plan; confirm the referral has been taken up.

Sources

Sources:

Books and papers cited:

Brennan, W., & Belser, A. B. (2022). Models of psychedelic-assisted psychotherapy: A contemporary assessment and an introduction to EMBARK, a transdiagnostic, trans-drug model. Frontiers in Psychology, 13, 866018.
Brennan, W., & Belser, A. (2024). EMBARK Psychedelic Therapy for Depression: A New Approach for the Whole Person. Oxford University Press. (Descriptions only [uncertain].)
Brennan, W., Field, M., Schon, C., Inamdar, A., & Kelman, A. (2025). Psychedelic training program development: lessons from the evolution of the EMBARK program. Frontiers in Psychology, 16, 1637887.
Back, A. L., et al. (2024). Psilocybin therapy for clinicians with symptoms of depression from frontline care during the COVID-19 pandemic. JAMA Network Open. (Described via Fred Hutch summary [uncertain].)

Further reading (not drawn on): the Google Books preview of the 2024 book, the JAMA Network Open and PubMed pages for Back et al. 2024, ClinicalTrials.gov protocols for CYB003/CYB004, and embarkapproach.com training materials.

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