Recent research published in the Journal of Psychoactive Drugs sheds light on the ways psychedelic experiences might influence mental wellbeing. The study suggests that while intense, subjective reactions during psychedelic use—such as emotional breakthroughs or mystical feelings—contribute to improvements in wellbeing, changes in dysfunctional attitudes after the experience play an even larger role.
Psychedelic-assisted therapy has gained attention for its potential to improve mental health, particularly in treating depression, anxiety, and trauma. However, many studies have focused on the immediate, subjective experiences induced by psychedelics, such as feelings of unity or emotional release. Less attention has been given to how these experiences might influence dysfunctional attitudes—rigid, negative thought patterns about oneself, others, and the future. These attitudes are known contributors to mental health challenges and are common targets in cognitive-behavioral therapies.
“Many traditional models of psychotherapy focus on helping people change overgeneralized, rigid thoughts known as dysfunctional attitudes. These dysfunctional attitudes tend to improve in clinical trials of both medication and psychotherapy,” said study author Genevieve S. Falabella, a clinical psychology doctoral student at the University at Albany.
“However, studies on psychedelic-assisted therapy rarely address these classic cognitive models. Instead, psychedelic-assisted therapy research typically focuses on the importance of the intense, subjective experiences that people have during a psychedelic “trip” (e.g., mystical, challenging, or emotional breakthrough experiences) and how these experiences affect outcome.
“Perhaps post-acute changes in dysfunctional attitudes are related to the impact of mystical, challenging, or emotional breakthrough experiences. Therefore, to bridge the gap between psychedelic-assisted therapy and standard cognitive interventions, we aimed to understand how these lasting changes in dysfunctional attitudes compare to the immediate, acute effects of the psychedelic experience in improving wellbeing.”
“This could help to inform and improve psychedelic-assisted therapy. We thought that psychotherapists who might not be fans of mystical ‘trip’ experiences might be more receptive to the idea that dysfunctional attitudes might underlie psychedelic-induced improvements.”
For their study, the researchers recruited 587 adults who had previously used psychedelics and asked them to reflect on their most meaningful psychedelic experience. Participants were sourced through an online research platform, known as Prolific, ensuring they passed attention-check questions to maintain data reliability. The sample predominantly consisted of White, non-Hispanic males, with ages ranging from 18 to 77 years old.
The researchers used a retrospective approach, relying on participants’ recollections of their experiences and subsequent changes. The participants completed several validated questionnaires designed to measure different aspects of their psychedelic experiences and their effects:
- Mystical Experience Questionnaire (MEQ): Evaluated feelings of transcendence, unity, and sacredness during the psychedelic experience.
- Emotional Breakthrough Inventory (EBI): Measured the degree of emotional release and personal insight gained during the experience.
- Challenging Experience Questionnaire (CEQ): Assessed distressing aspects of the experience, such as fear, paranoia, or feelings of isolation.
- Dysfunctional Attitude Scale (DAS): Captured changes in rigid, negative thought patterns about oneself, others, and the future before and after the experience.
- Warwick-Edinburgh Mental Well-Being Scale (WEMWBS): Assessed overall mental wellbeing before and after the psychedelic experience.
The researchers found that both acute and post-acute factors were associated with improvements in mental wellbeing, but their relative contributions differed. (Acute factors refer to the immediate, subjective experiences that occur during the psychedelic session itself, such as feelings of unity, emotional breakthroughs, or challenging moments of distress. In contrast, post-acute factors relate to the changes that occur after the psychedelic experience.)
The most significant predictor of improved wellbeing was post-acute changes in dysfunctional attitudes. Participants who reported shifts in their rigid, negative thought patterns experienced the greatest enhancements in their mental health, suggesting that these cognitive changes are critical for long-term benefits.
Among the acute subjective experiences, emotional breakthroughs emerged as the strongest predictor of wellbeing. These moments, characterized by intense emotional release and new personal insights, were associated with significant improvements.
Mystical experiences, which involve feelings of unity and transcendence, also correlated with better wellbeing, though their impact was smaller compared to emotional breakthroughs. Challenging experiences, such as feelings of fear or paranoia, were linked to smaller improvements and sometimes negative outcomes, though they appeared to still play a role in the overall therapeutic process.
“We found that post-acute changes in dysfunctional attitudes had the strongest association with changes in wellbeing, but acute subjective reactions also played a role,” Falabella told PsyPost. “This result suggests that optimizing both subjective reactions and changes in dysfunctional attitudes might help improve the effectiveness of psychedelic-assisted therapy.”
“However, since the psychedelic experience can be unpredictable and hard to control, focusing on dysfunctional attitudes may be more straightforward. Combining psychedelic-assisted therapy with traditional cognitive therapies could be a simpler and more reliable way to enhance its benefits. In a sense, this work supports other findings that suggest that those who benefit most from psychedelic-assisted therapy are the ones who have the experiences as part of ongoing psychotherapy.”
The study highlights the importance of addressing both the immediate and lasting effects of psychedelic experiences. However, as with all research, it has limitations to consider. In particular, participants were asked to recall past experiences, which introduces the potential for memory bias.
“Our findings are based on data from online self-report surveys, so they should be interpreted with caution,” Falabella said. “To confirm these results, future research should replicate the study in controlled clinical settings and include more diverse groups of participants. We hope our colleagues running clinical trials will consider measuring dysfunctional attitudes as part of their procedures.”
The study, “Acute Psychedelic Reactions, Post-Acute Changes in Dysfunctional Attitudes, and Psychedelic- Associated Changes in Wellbeing,” was authored by Mitch Earleywine, Genevieve S. Falabella, Alyssa B. Oliva, and Fiona Low.
