Why the Reset Persists: Durability and Failure in Psychedelic-Assisted Therapy

Psychedelic-assisted therapy has produced strong empirical results across depression, anxiety, addiction, and end-of-life distress, but the field’s leading mechanistic model leaves several important questions unanswered. The Relaxed Beliefs Under Psychedelics (REBUS) model, developed by Carhart-Harris and Friston, explains the acute pharmacological action of psychedelics in terms of precision-weighting relaxation within a predictive processing hierarchy. What REBUS does not fully explain is why the therapeutic revision persists after the drug clears the system, why individual responses vary so widely under the same pharmacological conditions, what ego dissolution consists of at the architectural level, how set and setting shape outcomes mechanistically, or why trauma-related conditions respond differently than non-trauma depression. This paper applies the Coherence Engine framework, a general architectural theory of consciousness developed through phenomenological observation and described in full elsewhere (Sowell, 2026), to psychedelic-assisted therapy. The relevant architectural components are summarized and then used to address each of these gaps. The framework extends to addiction through a three-layer model distinguishing identity, behavioral/cognitive, and physiological components, with implications for why different compounds, including ibogaine, work for different addictions. Architectural accounts of OCD, end-of-life anxiety, eating disorders, and the strengthening of fragile identity structures are also developed. The framework does not replace REBUS but provides the architectural context within which REBUS operates, generating nineteen testable predictions that REBUS alone cannot produce. Implications for clinical protocol design, patient selection, integration practice, and conditions under which psychedelic therapy should not proceed are described as hypotheses derived from the architecture.