StepWise Protocol

Research into an alternative to high-dose psychedelics where clients gradually self-administer short-acting Low-5 via vape pens, prioritizing autonomy and reducing risk through slow, gentle dosing.

Disclaimer

Limited data exist on Low-5 (low-dose 5-methoxy-N, N-dimethyltryptamine) and its effects on humans. As such, the authors have prepared a harm reduction guide to help improve knowledge of safe practices. Readers should study the guide as a first step before learning about protocols like the one detailed below.

In addition, anyone who uses Low-5 or any psychedelics does so at their own risk. The authors do not recommend using any substance without close medical supervision and, as such, are not responsible for any consequences of the use of psychedelics or substances by readers of this protocol or otherwise. Always adhere to local laws.

Introduction

Through The Pattern Project’s ongoing research into Low-5, a novel protocol for psychedelic-assisted therapy called StepWise was identified in early 2024. This report is based on attendance at a private presentation by one of the developers and trainers of this approach, interviews conducted with four therapists trained in the StepWise protocol, and insights gathered from the OneLight community, a private group on the Wire App of 5-MeO-DMT facilitators. All four interviewed therapists are licensed professionals who remain anonymous to safeguard their privacy.

StepWise involves a therapist supervising a client to self-administer a customizable progression of increasing or decreasing doses of Low-5 using a set of vape pens. This approach contrasts with conventional high-dose methods, which often emphasize peak experiences for therapeutic or spiritual exploration.

This careful layering of the same substance enables clients to increase their dosage at a comfortable and manageable pace. Equally important, clients are encouraged to fully explore the benefits of lower doses without the pressure of reaching a peak experience.

StepWise represents a significant innovation in psychedelic-assisted therapy, partly because its implementation relies on 5-MeO-DMT vape pens, a relatively new technology. Despite its recent emergence, the protocol is gaining traction due to its gentle, short-acting effectiveness. One therapist noted a complete shift in their practice, replacing the use of MDMA and psilocybin with StepWise when working with survivors of sexual abuse. She described StepWise as a groundbreaking advancement in the field, emphasizing its ability to prioritize client safety, autonomy, and depth of therapeutic experience.

All therapists interviewed regarded StepWise as a notable evolution over the still dominant 5-MeO-DMT protocol, commonly characterized by the “handshake, hug, and full embrace” method. Majus OneLight, the originator of the latter approach, also affirmed to The Pattern Project that StepWise is now his preferred protocol.

Key Concepts

While the therapists we interviewed varied in their therapeutic approaches, they all shared the following core principles:

Vape Pen Technology: Low-dose 5-MeO-DMT vape pens ranging from 3% to 20% 5-MeO-DMT.

Client Autonomy: Clients self-administer the vape pen to foster autonomy and control over their therapeutic experience.

Stepwise Approach: This method involves gradually adjusting the dose in timed stages, beginning with the minimal effective dose, based on the patient’s response to treatment. It allows optimal effectiveness while reducing side effects or risks associated with dosing changes.

Pacing: Each inhalation is roughly five to eight minutes apart to allow for a stacking effect. However, all timing is dependent on the client’s state of readiness.

Stacking Effect: The accumulated dose in the client’s system depends on several factors, including 1) the percentage of 5-MeO-DMT in each vape cartridge, 2) the amount of 5-MeO-DMT the vape pen cartridge and battery vaporize, 3) the number of seconds inhaled, and 4) the time interval between doses.

Nervous System Sensitivity: Therapists pay careful attention to avoid over-taxing the client’s nervous system. The goal is for the client to feel safe and comfortable from start to completion.

Dose Impact: The impact of each dose varies depending on several factors, including 1) the amount of 5-MeO-DMT previously consumed in the session, 2) individual physiology, 3) the quality of the therapeutic alliance, 4) the client mindset, and 5) the state of the client’s nervous system.

Extending the Tail: Whether the client steps up to a peak experience or not, stepping down the dose at the tail end of the session is of considerable benefit.

Pairing with Therapeutic Approaches: Aside from working within the above limits, StepWise is well-suited to a broad spectrum of therapeutic approaches.

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Sample Dosing - One Hour Peak Experience

• 0 min: 2s inhale on 5% pen

• 4 min: 5s inhale on 5% pen

• 12 min: 5s inhale on 5% pen

• 16 min: 3s inhale on 10% pen

• 23 min: 5s inhale on 10% pen

• 29 min: 5s inhale on 10% pen

• 37 min: 5s inhale on 20% pen

• 43 min: Client takes no dose – Peak Experience

• 59 min: Client begins integration

Preparation Tips

The therapists recommended the following preparation tips:

Clarify Goals: A repeated interview theme was the client's considerable agency throughout the StepWise protocol.

"I always have a detailed chat with my clients to see how comfortable they are and understand what they want from the session. If their goal is to increase the dose for a peak experience, I encourage them to stay open and curious about what might come up during lower or moderate doses since these can also offer great therapeutic opportunities."

Minimize Distractions: Attention to detail is key in minimizing potential distractions. Reports suggest that clients become very aware of the present moment and may become acutely aware of distracting stimuli during their session, such as a ticking clock.

Background Music: If music plays, consider background music that offers a minimalist, soothing backdrop to the therapy session. The volume of the music should not hamper communication between client and therapist.

“I like using music that has long, slow parts with some silence in between. Piano Nocturnes work really well because they’re gentle and reflective.”

"This medicine makes my clients really sensitive to sound and music, which can change how their journey feels. I turned the music off because she said it was making her journey feel too light, stopping her from getting into the harder stuff."

Eye mask: Therapists report that having an eye mask available can be very helpful if the client becomes very sensitive to light or wants help supporting inward focus.

Stopwatch: Therapists used a watch or digital stopwatch (with a lap feature) to keep track of the time between administrations.

Dietary Considerations: Some therapists advised their clients to fast before the session. The shortest recommended time was to fast for at least two hours before the session.

"I advise my clients to opt for a light meal or snack a couple of hours before. Avoid heavy foods that take long to digest. I often suggest sticking to gentle, easy-to-process foods like fruits, simple carbohydrates, and light grains."

Provision for Purging: While purging is uncommon, nausea can occur. It is advisable to have a bucket or plastic bag and paper towels nearby.

Post-Session Nourishment: Some therapists ensure the client brings or has easy access to light refreshments, such as fruit or snacks, available for them once they have ended the protocol.

Step-by-Step Overview

Our research did not yield a standardized therapeutic protocol for a comprehensive StepWise session, as each therapist integrated the approach into their unique therapeutic framework. For instance, some therapists employed a more non-directive stance, allowing clients to engage in autonomous processing and introspection. In contrast, others adopted a more active and directive role, utilizing inquiry, exploration, and guidance to facilitate the client's therapeutic process. Nevertheless, through our qualitative analysis of therapist interviews, we identified the following elements that comprise a safety-oriented StepWise approach.

1. Harm Reduction – Practice

2. Harm Reduction – Check for Extra Sensitivity

3. Ascending Dose

4. Peak Dose

5. Ending or Descending

6. Reactivation and Integration

Harm Reduction – Practice

Clients new to vaping can benefit from precise guidance from the therapists.

"I guide my client while I check a stopwatch to ensure my counting and inhaled dose is precise. I go:

"Alright, start exhaling now... 5, 4, 3, 2, 1...”

"I watch the vape pen light and stopwatch as I count."

“Now inhale [from the pen] for 5, 4, 3, 2, 1.”

“Now withdraw the pen and breathe in more air.”

…And exhale"

One of the therapists we interviewed had had some clients have difficulty inhaling the vapour effectively.

"I've noticed that some of my clients, some with experience smoking, tend to only inhale the vapour into their mouths rather than fully into their lungs. So, I've started having them practice using the vape pen without a cartridge. What's neat is that even without a cartridge, the pen still lights up. I have them repeat this process a few times until we're both confident that they can get the medicine all the way into their lungs."

Another interview subject made it a priority to have the client practice with the actual medicine.

"They may worry, anticipating a wild experience from what they’ve read about high-dose psychedelics. To ease their minds, I encourage them to take a one or two-second dose with my lowest-dose pen for some practice. This allows them to become more familiar with the sensation and helps reassure them that this journey is one where they will remain in control."

Harm Reduction – Check for Extra Sensitivity

Given that all the StepWise practitioners echoed the need for working with great sensitivity for the client’s nervous system, they all encouraged the harm reduction approach of “going slow and low” when it comes to starting the StepWise protocol, especially since some clients may be extra sensitive to Low-5. Here is how one therapist recommended testing for extra sensitivity:

"I usually start by having my clients take a small, two-second inhale from our lowest potency vape pen. Then, I’ll check in with them to see if they notice any change in how they feel, especially with their eyes closed. If they’re feeling anything stronger than a little calming sensation on these light inhales, we might have a sensitive situation, or maybe they didn’t get the vapour into their lungs."

"If it turns out they’re more sensitive, I adjust accordingly. For instance, instead of five-second doses at first, three seconds. It’s all about meeting the person where they’re at and making adjustments so the experience stays safe and positive."

Ascending Dose

The StepWise practitioners use the steps below as a conceptual template. Based on their reading of the client's response, they vary the strength of the pens they offer, the dosing duration, the intervals between doses, the overall duration, and more.

1st dose:

– The client takes a 5-second inhalation from the lowest dose pen.

– The therapist notes the time of the first dose.

– After 5 to 8 minutes, the therapist gently inquires about the next dose.

2nd Dose: Should the client continue, they take the same dose.

3rd Dose: If the client decides to continue, they take the same dose, or if they prefer, they graduate to a higher dose.

Further Doses: Based on their feelings and goals, the client determines the dose while the therapist keeps time and focuses on the client’s nervous system state.

"I look at body posture, breath patterns, facial expressions, skin condition, and any sounds they make. I trust my intuition, deciding whether to let the client process without interruption, ask them if they need human contact, talk with them, suggest a break or even end early if necessary."

"I like to get into this kind of repeat pattern. Like, “Hey there, it has been so many minutes since your last dose. Would you like to retake the same dose? Coast for a couple more minutes? Decrease the dose? End for the day?” Keep it real simple for them to choose."

"The half-life of 5-MeO is maybe 12 minutes. So, my client can take a bio-break, or stretch or collect themselves as needed. It is ideal if they can keep the break between doses to eight to ten minutes. But then again, what’s the rush?"

Peak Dose

None of the therapists interviewed focused on achieving a peak mystical experience as a primary therapeutic goal. They all aligned on working with the client, respecting their nervous system, at whatever dose the clients felt most fruitful.

"A peak experience frequently has some flavour of ego-dissolution. As well, a deep sense of connection like everything is one. Or they may experience "The Void," a kind of bodiless emptiness. Or maybe it's getting insights from that inner healer, something they didn't know they had in them. Sometimes, it's an emotional release, just letting it all out, or a physical release. I've seen people have a quick coughing fit or even purge—sometimes that helps them feel complete, but not always."

Ending or Descending

Descent Without Further Dosing

As detailed above, the client may stop taking Low-5 at any point in the StepWise protocol. Although stopping may seem counterintuitive, it can foster breakthroughs for clients new to StepWise or those with busy minds.

"I quickly realized that for some clients, deciding that the dosing is done gives them permission to let go of expectations and relax. Letting go of those expectations can be a big release in itself. It allows the mind to settle, deepening the medicine's effect and opening the door for more healing and insights, even as the amount of medicine in them starts to fade."

Getting Back to Normal Too Quickly

When deciding against further Low-5 doses or stepping the doses down, three of our four therapists remarked how the descent phase offers significant potential for healing and integration. This opportunity is also easy to squander.

"Just last week, I was working with someone who went quickly from a profound release of stuck trauma to eating an apple and excitedly recounting their journey. While being able to shift gears is part of the beauty of this approach, the speed of the descent, combined with their busy thoughts, seemed to lessen some of the extra benefits she could have enjoyed while the Five [5-MeO-DMT] was still in her system.“

"From a safety perspective, it's really important to remember that even when clients don't 'feel' the effects of Low-5 anymore, there can still be measurable amounts in their system. For instance, if they inhale 4 milligrams of 5-MeO-DMT, about 2 milligrams could still be in the bloodstream after 15 minutes and around 1 milligram after another 15 minutes. This leftover amount is why it's so important to have caution and support during the descent phase."

"I've seen all sorts of descents. Some people keep processing and getting insights. Others have physical reactions. Some just rest, while others cry—sometimes quietly, sometimes loudly. Some sit up right away and freshen up. Sometimes, people struggle to understand what happened, especially if they faced something they felt was dark or overwhelming. If it feels natural, I do my best to nudge my clients to get the most from their experience."

Step-Down Descent

Clients' rapid return to feeling normal can be abrupt. Some therapists avoid this rushed return and choose to extend the descent.

"He had a peak experience with the higher pen, and then ten minutes later, he stepped down to the medium pen. He repeated that twice, every few minutes, before moving to the low-dose. It took about as much time as the ascent, giving him the space to ease out of the experience. Usually, due to time limits, we do a couple of lower doses before wrapping up, but this extended descent worked well.

Reactivation and Integration

Reactivation

Regarding the phenomenon of Reactivation—a term used to describe the brief re-experiencing of psychoactive effects following a high-dose 5-MeO-DMT session, often occurring hours or days after the initial experience²—our sources indicate that such occurrences are rare when following the StepWise protocol. Consequently, some therapists proactively inform clients about the possibility of reactivations as a potential after-effect.

“I call reactivations ‘Night School’ when I’m talking to clients. They can catch you off guard, but also a chance to get extra insight or healing—like the work keeps going, even when you’re not expecting it.”

Integration

Multiple sources for this report discussed how Low-5's short-acting characteristic provides a unique advantage for integration, even during the descent phase.

"As a practitioner of IFS , my focus during integration is to help clients connect with their parts while the experience is still fresh. I might ask, 'What parts of yourself came forward during your journey?' or 'How do your parts want you to keep working on this after today?' The goal is to make sure every part has a voice and feels heard before the session ends."

"With StepWise, I’ve noticed that my clients are able to express their thoughts and emotions with a remarkable level of openness while on a wide range of doses. This creates an opportunity for integration to happen right there in the moment. Together, we work on connecting the dots in a way that feels meaningful.”

"I see two kinds of integration with StepWise. For people who have deep, hard-to-describe peak experiences, the process is similar to how we integrate with other psychedelics like mushrooms. For those who chose to dose at a lighter level, Integration is about making sense of these realizations as they happen."

“Usually, it is more about piecing together smaller insights over time instead of dealing with one huge, intense experience all at once.”

Discussion

Comparative Analysis of the StepWise Protocol

Acknowledging Limitations

This report offers an initial exploration of the StepWise protocol based on a limited number of interviews and secondary sources. While the findings highlight its potential for therapeutic use, the small sample size and reliance on narrative accounts underscore the need for broader research to validate the protocol’s safety and efficacy. The lack of clinical research on Low-5 or StepWise limits conclusions about its therapeutic efficacy and safety, especially compared to therapies like MDMA and psilocybin, which have a far more extensive research base.^3-5

Potential Advantages of StepWise

StepWise appears to be gaining a toe-hold within the psychedelic therapy community. It may address an unmet need in the therapeutic space: a gentler, shorter-acting, and highly manageable approach to psychedelic-assisted therapy. Below are specific advantages:

1. Short Duration: Unlike many traditional psychedelic therapies, which typically require a full day, StepWise sessions offer the flexibility of varying durations. Three or four doses taken a few minutes apart may suffice for a first-time client. Alternatively, another client might commit to a two—or three-hour time frame. This shorter and adaptable approach may enhance clinician workloads, accommodate more clients, and ultimately lower overall patient therapy costs.

2. Anxiety- and Trauma-Sensitive Approach: Interview subjects reported StepWise to be well-suited for individuals with trauma histories, anxiety, or previous difficult psychedelic experiences. Its flexible, gradual dosing offers a safer-feeling alternative to intense, longer-acting psychedelics like MDMA or psilocybin.

3. Harm Reduction in Dosing: The ability to adjust doses in real-time minimizes the risk of overwhelming the client. Unlike conventional psychedelics administered in fixed doses, StepWise enables therapists to adapt the experience to the client’s readiness, potentially mitigating severe adverse effects. However, this conclusion is based on anecdotal reports and requires further validation.

4. Enhanced Client Autonomy: StepWise fosters a sense of empowerment by requiring clients to control dosing decisions and self-administer. This autonomy may be particularly beneficial for trauma survivors, supporting their sense of agency in a therapeutic setting.

5. Immediate Integration Opportunities: Low-5's short-acting nature enables clients and therapists to begin integration within the same therapy session. This real-time weaving of reflection and processing into the experience may lead to a more coherent therapeutic narrative.

6. Low or No Aftereffects: Practitioners report minimal to no negative aftereffects compared to other psychedelic therapies, which often include fatigue, nausea, or transient anxiety. However, more research is needed to confirm these observations and identify factors contributing to this distinction.

7. Application Across Multiple Sessions: Unlike all-day transformational psychedelic therapies that require extensive preparation, recovery, and integration, StepWise’s shorter format may make it suitable for ongoing, recurring therapy sessions. Each session can include time for integration and partnership between client and therapist.

Potential to Improve Accessibility: The combination of shorter sessions, lower costs, and reduced resource requirements may make StepWise more affordable and accessible than longer-duration therapies. These advantages could increase access to psychedelic-assisted treatment, especially for individuals who cannot commit to all-day sessions.

Limitations of StepWise

1. Regulatory Uncertainty: Although 5-MeO-DMT is unregulated in Canada,⁶ its status in other countries varies significantly. This limits StepWise’s global applicability and complicates its integration into formal therapeutic frameworks.

2. Lack of Clinical Evidence: Compared to MDMA, ketamine, or psilocybin, 5-MeO-DMT lacks a robust body of empirical research.^7-9 StepWise has no established clinical studies, making it challenging to conclude its safety, efficacy, or comparative benefits. This gap highlights the need for formal research to substantiate anecdotal claims.

3. Complexity in Execution: Managing multiple vape pen doses, tracking intervals, and ensuring precise vaporization require technical skill and careful monitoring. This operational complexity could pose barriers to adoption among less experienced practitioners or clinics with limited resources.

4. Therapeutic Depth: Critics argue that some of the transformative potential of psychedelics stems from intense or challenging peak experiences.¹⁰ StepWise’s gradual, incremental dosing may blunt clients’ access to these deeper insights, potentially resulting in less profound therapeutic outcomes for specific individuals.

5. Scalability and Standardization: While StepWise’s short duration may improve accessibility, the lack of standardized training, dosing protocols, and regulatory clarity could hinder widespread implementation. Standardization efforts will be necessary to ensure consistent quality of care and minimize variability across practitioners.

6. Vaping Technology Risks: The reliance on vaporized administration introduces potential health concerns, such as risks related to improper inhalation techniques or the quality of vaping devices and cartridges.¹¹ Ensuring safety in these areas will require careful oversight and further study.

Future Research Directions

Future studies need to strengthen the evidence base for Low-5 and StepWise and focus on the following:

1. Safety and Efficacy: Conducting clinical trials to compare StepWise with existing psychedelic-assisted therapy protocols.

2. Diverse Populations: Exploring its effectiveness for a range of clients, including those with trauma, anxiety, or treatment-resistant mental health conditions.

3. Different Therapeutic Approaches: Future research should investigate whether StepWise is more effective when paired with specific therapeutic modalities such as Cognitive, Psychodynamic, or Trauma-Oriented approaches.

4. Long-Term Outcomes: Research is required to assess the lasting effects of StepWise on psychological well-being, emotional regulation, and client satisfaction.

5. Mechanisms of Action: Investigating how StepWise’s stacking and step-down phases interact with neurobiological and somatic processes.

6. Standardization: Developing training programs and dosing guidelines to ensure consistent application across practitioners and settings.

Conclusion

From its inception, Low-5 intrigued The Pattern Project for its potential to make psycholytic (low-dose, “talk”) therapy more manageable and effective.¹² The introduction of the StepWise protocol represents an innovative addition, offering a new approach to psychedelic-assisted therapy. With its emphasis on brief sessions, client autonomy, and real-time dose adjustments, StepWise challenges traditional paradigms of high-dose psychedelics such as ketamine, MDMA, or psilocybin. While still in its earliest stages, this protocol holds great promise for certain clients, and initial evidence suggests it may even prove superior for those seeking a gentler, more controlled therapeutic experience.

That said, StepWise is still in its very early days. A rigorous study is required to validate its efficacy and understand its full potential. If proven effective, the protocol’s broader scalability and adoption will depend on further research, standardization, and practitioner training. With these developments, StepWise could emerge as a cornerstone in next-generation psychedelic therapies, offering a nuanced, client-centred, and highly customizable approach to healing.

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