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Tripping over the other: Could psychedelics
increase empathy?
EMILY BLATCHFORD
1
p, STEPHEN BRIGHT
1,2
and
LIAM ENGEL
1
1
School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
2
National Drug Research Institute, Curtin University, Perth, Australia
Received: February 28, 2020 •Accepted: July 05, 2020
Published online: September 5, 2020
ABSTRACT
There is increasing evidence that psychedelic-assisted psychotherapy is effective for a range of psy-
chological conditions. There are likely numerous mechanisms of action that contribute to these clinical
effects. One such mechanism of action might involve psychedelics increasing levels of empathic
functioning. This paper synthesises research concerning the relationship between psychedelics and
empathy, emphasising neuroscientific and clinical contexts. We conclude that neuropsychological and
clinical evidence imply psychedelics could lead to increased empathic functioning. The effects of psy-
chedelics on the 5-HT system, default mode network, neural connectivity and ego dissolution are
implicated in these changes. Changes in empathic functioning also likely relate to increases in the
personality trait of openness associated with psychedelic drug use, which is well documented. Increased
empathic function likely has clinical implications, leading to increased social connectedness as well as
prosocial attitudes and behaviours more broadly.
KEYWORDS
psychedelic, empathy, altruism, openness, default mode network, ego dissolution
INTRODUCTION
Classic psychedelics provide unique effects on human subjective experience (Bright & Wil-
liams, 2018) by affecting the serotonin (or 5-hydroxytryptamine [5-HT]) system, primarily as
5-HT
2A
receptor agonists (Forstmann & Sagioglou, 2017). Examples of psychedelics include:
(i) psilocybin, commonly found in Psilocybe and Panaeolus species of mushrooms;
(ii) lysergic acid diethylamide (LSD), a synthetic ergotamine derivative;
(iii) dimethyltryptamine (including N,N-dimethyltryptamine [N,N-DMT] and 5-methoxy-
N,N-dimethyltryptamine [5-MeO-DMT] which are different alkaloids), found in a va-
riety of different species in the plant and animal kingdoms;
(iv) ayahuasca, traditionally a combination of two plants, Psychotria viridis which contains
N,N-DMT and Banisteriopsis caapi, containing monoamine oxidase inhibitors that
make the N,N-DMT orally active; and
(v) mescaline, found primarily in Lophophora and Trichocereus species of cacti (Barbosa
et al., 2016).
Psychedelics alter visual (e.g., altered colours and shapes) and psychological (e.g., mood
and cognition) perception (Forstmann & Sagioglou, 2017). The psychedelic-induced “state”is
characterised as consisting of a sense that all things are one, feelings of ineffability, an
intuitive belief that the experience has provided objective truth about reality or transcendence
of time and space (Elsey, 2017). Other elements of the psychedelic-induced state may include
creativity, enhanced self-reflection or ego dissolution (Elsey, 2017). Ego dissolution is defined
as the feeling that one’s self is disintegrating or that the border between one’s self and the
external world is dissolving (Lebedev et al., 2015).
Journal of Psychedelic
Studies
4 (2020) 3, 163–170
DOI:
10.1556/2054.2020.00136
© 2020 The Author(s)
RESEARCH ARTICLE
*
Corresponding author. Edith Cowan
University, 270 Joondalup Dr,
Joondalup, Perth, WA, Australia. Tel.:
þ61 481 515 370.
E-mail: e.blatchford@ecu.edu.au
The potential benefits of psychedelics and psychedelic-
assisted psychotherapies are receiving increased attention
due to a recent international resurgence in psychedelic
research. Clinical and neuropsychological evidence suggests
psychedelics may have capacity to facilitate social func-
tioning. For example, Schmid and Liechti (2018) found that
for participants who received 200
m
g of LSD, self-reported
altruism ratings, as measured by the Persisting Effects
Questionnaire, had significantly increased at 1- and 12-
month follow-ups. Furthermore, Griffiths et al. (2018) found
that participants given a high dose of psilocybin exhibited
significantly greater increases in prosocial attitudes and be-
haviours than participants given a low dose of psilocybin,
measured by the Persisting Effects Questionnaire six months
following the dose. There is also mounting evidence sug-
gesting psychedelics might have therapeutic efficacy (for
review, see Nichols, 2016). In particular, when psilocybin has
been administered in a clinical context, it has produced
clinical improvements in major depressive disorder (Car-
hart-Harris et al., 2018), anxiety (Griffiths et al., 2018; Ross
et al., 2016), obsessive-compulsive disorder (Moreno, Wie-
gand, Taitano, & Delgado, 2006), and addiction (Bogen-
schutz et al., 2015; Johnson, Garcia-Romeu, Cosimano, &
Griffiths, 2014; Johnson, Garcia-Romeu, & Griffiths, 2017).
Increases in empathy may contribute to the therapeutic
action of psilocybin and other psychedelics.
Empathy forms a crucial component of human re-
lationships and is an important predictor of a well-func-
tioning society (Pokorny, Preller, Kometer, Dziobek, &
Vollenweider, 2017). It is hypothesised that there are two
key components to empathy: (i) cognitive empathy, which is
defined as being able to understand the emotional or mental
state of another person without necessarily sharing the state;
and (ii), emotional empathy, which is defined as being able
to share the emotional state of another person (Pokorny
et al., 2017). People with poor empathic functioning have
difficulty understanding and sharing in reciprocal social
interactions, which can lead them to being more vulnerable
to social withdrawal, which increases the risk of developing a
psychological disorder. Indeed, deficits in empathy have
been reported among people with a variety of psychological
conditions, including borderline personality disorder
(Dziobek et al., 2011), bipolar disorder (Shamay-Tsoory,
Harari, Szepsenwol, & Levkovitz, 2009), psychopathy (Blair,
2005), and major depressive disorder (Cusi, MacQueen,
Spreng, & McKinnon, 2010). For example, Cusi et al. (2010)
found that, in comparison to matched controls, patients with
major depressive disorder reported lower levels of empathy.
Empathy also plays a fundamental role in all helping
relationships, and is important for professionals, such as
social workers and psychologists, who care for others in their
work. Empathy allows practitioners to communicate
empathic understanding whilst maintaining emotional
resilience (Grant, 2014). Empathy is an essential component
of the therapeutic alliance (Nienhuis et al., 2018), which is
one of the strongest predictors of success within psycho-
logical therapy (Degeorge, 2008). In a meta-analysis of 59
studies which incorporated 3,599 clients, Elliot, Bohart,
Watson, and Greenberg (2011) found client, therapist and
observer-rated empathy were moderately strong predictors
of therapy outcome, mean weighted r50.31, P< 0.001, 95%
CI [0.28, 0.34].
Psychedelic-assisted psychotherapy has been found to be
effective for a range of psychological conditions including
major depressive disorder (Carhart-Harris et al., 2018),
anxiety (Griffiths et al., 2018; Ross et al., 2016), obsessive-
compulsive disorder (Moreno et al., 2006), and addiction
(Bogenschutz et al., 2015; Johnson et al., 2014; Johnson et al.,
2017). Further, neuropsychological and clinical evidence
implies psychedelics could lead to increased empathic
functioning. The effects of psychedelics on the 5-HT system
(Harmer et al., 2003), default mode network (Carhart-Harris
et al., 2015; Muthukumaraswamy et al., 2013), neural con-
nectivity (Cabanis et al., 2013) and ego dissolution (Taglia-
zucchi et al., 2016) are implicated in these changes.
Therefore, this paper aimed to consider if the positive out-
comes that have been observed in recent studies of psy-
chedelic-assisted psychotherapy (for review, see Bright &
Williams, 2018) are due to increased empathy produced by
the psychedelic drug.
CLINICAL EVIDENCE
Several researchers have recently found links between psy-
chedelic use and empathy (Dolder, Schmid, M€
uller, Borg-
wardt, & Liechti et al., 2016; Grob et al., 2011; Lerner &
Lyvers, 2006; Mason, Mischler, Uthaug, & Kuypers et al.,
2019; Pokorny et al., 2017). Lerner and Lyvers (2006) con-
ducted a survey of 183 participants from Australia and Israel
with diverse histories of drug use. They found people who
had used psychedelics scored higher in emotional empathy
than people who had not, as measured by the Emotional
Empathic Tendency Scale. While these studies were not
clinical trials, a feeling of oneness with all things could
explain the higher emotional empathy scores. That is, the
feeling of no boundaries between the self and the world, and
that all things were connected could, like the experience of a
close relationship, lead to broader empathic concern. Mason
et al. (2019) considered the impact of psilocybin consumed
in a retreat setting. The authors tested participants’empathy
using the Multifaceted Empathy Test (MET) three times –
the night prior to psilocybin consumption (N555), the
morning after consumption (N550) and seven days
following (N522). The MET required participants to view
photographs of people and rate how much they were feeling
for each individual. Mason et al. (2019) found that
emotional empathy increased the morning following use and
that emotional empathy was retained seven days later,
noting that these differences in empathy were correlated
with wellbeing. Dolder et al. (2016) randomly administered
single oral doses of 100
m
g of LSD to 24 participants, and
200
m
g of LSD to 16 other participants. They found LSD
enhanced emotional empathy, as measured by the MET.
Dolder et al. (2016) found empathogenic effects were
significantly greater in participants receiving the 200
m
g
164 Journal of Psychedelic Studies 4 (2020) 3, 163–170
dose. Similarly, Pokorny et al. (2017) conducted a rando-
mised controlled trial (RCT) where 0.215 mg/kg of psilo-
cybin was administered to 32 healthy human participants.
Pokorny et al. found increases in emotional empathy, as
measured by the MET 160 min after psilocybin adminis-
tration. Grob et al. (2011) administered 0.2 mg/kg of psi-
locybin to advanced-stage cancer patients in a double-blind,
placebo-controlled design. They found empathic rapport
increased through strengthened relationships with friends
and family following the psilocybin dose. Increases in
emotional empathy following LSD and psilocybin adminis-
tration and increased empathy among people who use psy-
chedelics provide direct evidence that the administration of
psychedelics in a clinical context leads to increased empathy.
Levels of empathy have been found to correlate with the
personality dimension of openness (Jolliffe & Farrington,
2006). Openness is one of the big five personality factors and
refers to broad-minded tolerance of others’values and
viewpoints, aesthetic appreciation, sensitivity, imagination
and fantasy (MacLean, Johnson, & Griffiths, 2011). It has
been found to increase following psychedelic administration
in experimental and longitudinal studies. For example,
MacLean et al. (2011) found significant increases in open-
ness following a high psilocybin dose of 30 mg/70 kg. This
increase in openness was sustained at the 16-month follow-
up. This was the first study to demonstrate personality
changes in healthy adults following a single, experimentally
manipulated event. The relationship between psychedelics
and openness has been further explored by Barbosa et al.
(2016), who found that Uni~
ao do Vegetal members in Brazil
who had experienced ayahuasca had higher levels of open-
ness than matched controls with no ayahuasca experience.
Additionally, Lebedev et al. (2016) observed significant in-
creases in openness two weeks after administration of 75
m
g
of LSD to participants. As researchers have found higher
openness among people who use psychedelics, and increased
openness following psychedelic administration, openness
might be an important factor to consider concerning the
relationship between psychedelics and empathy.
NEUROSCIENCE, EMPATHY, PSYCHEDELICS
AND MECHANISMS OF ACTION
There are three inter-related neural mechanisms by which
psychedelics might exert an effect on empathy: (i) an
interaction with the 5-HT system as 5-HT
2A
receptor ago-
nists; (ii) the deactivation of the default mode network
(DMN); and (iii), increasing neural connectivity.
Psychedelics and the serotonin system
Psychedelic drugs could plausibly enhance empathic func-
tioning as 5-HT agonists because 5-HT both plays a role in
moral judgement and behaviour and modulates empathic
responses to the emotional states of others (Harmer et al.,
2003). For instance, 5-HT manipulations have been found to
influence the detection of emotion in faces. Harmer et al.
(2003) conducted an RCT and found that healthy partici-
pants who were intravenously administered citalopram, a
selective serotonin reuptake inhibitor (SSRI), detected facial
expressions of happiness and fear faster and more accurately
than participants who received a placebo. Additionally, in-
jection of 5-HT agonists such as 5-HT creatinine sulphate
has promoted the release of oxytocin and vasopressin
(Jørgensen, Riis, Knigge, Kjaer, & Warberg, 2003), both of
which are neuropeptides strongly implicated in empathy
(Crockett, Clark, Hauser, & Robbins, 2010). For instance, a
single dose of intranasally administered oxytocin signifi-
cantly increased correct responses to the Reading the Mind
in the Eyes Test (Domes, Heinrichs, Michel, Berger, &
Herpertz, 2007), which measures empathic ability to infer
the emotional states of others (Baron-Cohen, Wheelwright,
Hill, Raste, & Plumb, 2001). The effect of vasopressin may be
explained by its ability to modulate the activation of the
right amygdala, which is involved in empathic functioning.
For example, in an RCT where intranasal vasopressin or a
placebo was administered, participants were asked to explain
how they felt in response to pictorial stimuli depicting
people in different social and emotional situations. Activity
in the right amygdala increased during the processing of
pictures for participants who received vasopressin but not
the placebo (Brunnlieb, M€
unte, Tempelmann, & Heldmann,
2013). Psychedelics may offer similar outcomes to SSRIs,
although through different neurochemical processes. Psy-
chedelics are agonists with a high affinity for the 5-HT
2A
receptor, and SSRIs block the 5-HT reuptake mechanism so
that over time there is more 5-HT at the synapse. Interest-
ingly, many patients in trials of psilocybin for treatment-
resistant depression reported that conventionally prescribed
treatments, such as SSRIs, reinforced a sense of disconnec-
tion with others (Watts, Day, Krzanowski, Nutt, & Carhart-
Harris, 2017). The 5-HT system plays a role in moderating
empathic responses, and psychedelics agonise 5-HT
2A
re-
ceptors. This relationship between psychedelics and the 5-
HT system suggests that psychedelics could play a role in the
moderation of empathic functioning.
Deactivation of the default mode network
The DMN consists of a set of brain regions that are active
during “rest”, or during less demanding tasks (Metin et al.,
2015). Some of these regions include the medial prefrontal
cortex, the posterior cingulate cortex (PCC), and the tem-
poro-parietal junction (Andrews-Hanna, Smallwood, &
Spreng, 2014). As task-related attentional demands increase,
activity within the DMN is decreased. This is referred to as
attenuation (Metin et al., 2015).
The DMN is involved in self-referential processing and
rumination (Nejad, Fossati, & Lemogne, 2013). Self-refer-
ential processing refers to the cognitive process of relating
information to the self, and rumination is a form of self-
referential processing characterised by repetitive thinking
and a focus on negative mood states (Nejad et al., 2013).
Major depression is associated with a bias towards negative
emotional processing and increased self-focus and
Journal of Psychedelic Studies 4 (2020) 3, 163–170 165
rumination (Nejad et al., 2013). Moberly and Watkins
(2008) found that a bidirectional relationship exists between
ruminative self-focus and negative effect. One example of
rumination is reflecting on one’s self in the past (Speth et al.,
2016). Such rumination could involve going over something
that has happened in the past and cannot be changed, which
is unhelpful as it can lead to negative emotions and un-
productive behaviours. Speth et al. (2016) found intravenous
administration of 75
m
g of LSD led to a reduction in the
number of linguistic references to mental time travel to the
past. Mental time travel refers to individuals mentally pro-
jecting themselves backwards and forwards in time, to
recollect components of previous autobiographical episodes
or to imagine future experiences (Speth et al., 2016).
Consequently, Speth et al.’s results suggest that psychedelics
might decrease activity in the DMN, leading to decreased
rumination and focus on the self. In turn, such attenuation
of the DMN may encourage empathy by increasing thought
about others. By discouraging self-centric thinking, psyche-
delic-induced attenuation of the DMN may also encourage
empathy so that people may be more able to appreciate
benefits for others.
The DMN also plays a role in helping individuals
develop a coherent sense of self or ego (Carhart-Harris et al.,
2014). Therefore, decreased activity in the DMN has also
been linked to ego dissolution (Carhart-Harris et al., 2015;
Muthukumaraswamy et al., 2013), which is the feeling that
the border between one’s self and the external world is
dissolving (Lebedev et al., 2015). Ego dissolution is one
explanation for how psychedelic use could increase empathy.
If the boundary between the self and others becomes blurred
through ego dissolution, people might better understand or
share the emotional state of another person, leading to an
increase in empathic behaviour.
Researchers have examined brain signals through
measuring neural magnetic fields and blood flow in the
brain and have shown that psychedelics decrease alpha po-
wer in the PCC and in the DMN more broadly. These
changes in brain function have correlated with reports of ego
dissolution and may consequently contribute to empathy
because individuals can feel more connected with others. For
example, following intravenous administration of 2 mg of
psilocybin to participants, Muthukumaraswamy et al. (2013)
conducted magnetoencephalography (MEG) and found that
the magnitude of alpha power decreased in the PCC, which
forms a central part of the DMN. These decreases correlated
with ratings of the item, “I experienced a disintegration of
my ‘self’or ‘ego’” (Muthukumaraswamy et al., 2013).
Further, in an RCT by Carhart-Harris et al. (2015) in which
participants were injected with 75
m
g of LSD, functional
magnetic resonance imaging (fMRI) and MEG scans showed
that LSD decreased activity in the DMN. Specifically, there
were differences in cerebral blood flow, resting state func-
tional connectivity, and blood oxygen level-dependent signal
variance within the DMN after LSD administration
compared to the placebo. Carhart-Harris et al. found that
this DMN disintegration correlated with ego dissolution.
Correlations between ego dissolution and changes in brain
function imply that psychedelics blur the boundary between
the self and other, and that individuals who use psychedelics
might share more due to valuation of benefits to others in
addition to benefits to the self.
Increased neural connectivity
Decreased activity in the DMN appears to be associated with
increased global connectivity among high-level association
cortices rich in 5-HT
2A
receptors and the thalamus. This has
been demonstrated by fMRI following LSD administration
(Tagliazucchi et al., 2016). High-level association cortices are
areas of the cortex that are located between visual, auditory
and somatosensory cortices (Arslan, 2016). Because these
cortices are associated with self-awareness (Craig, 2011) and
emotional processing (Luan Phan, Wager, Taylor, & Lib-
erzon, 2002), it is plausible to assume that increased neural
connectivity resulting from psychedelic use might facilitate
empathy. Self-awareness refers to the ability to recognise
oneself as an individual separate from the environment and
other individuals (Silvia & Duval, 2001). These increases in
neural connectivity might facilitate similar psychological
effects.
Similar to the decreased activity in the DMN, increases in
global connectivity among cortical association regions have
also been selectively correlated with subjective ego dissolu-
tion ratings (Tagliazucchi et al., 2016). Two areas between
which LSD has shown to increase functional connectivity are
the bilateral temporo-parietal junction and the bilateral
insular cortex (Tagliazucchi et al., 2016). The bilateral
insular cortex is related to self-awareness (Craig, 2011) and
the processing of emotional information (Luan Phan et al.,
2002). This increased neural connectivity in the bilateral
temporo-parietal junction and the bilateral insular cortex,
observed by fMRI, has been correlated with ego dissolution
(Tagliazucchi et al., 2016). Luan Phan et al. (2002) con-
ducted a meta-analysis of functional neuroimaging studies
and found that emotional tasks with cognitive demand
particularly involved the insula. More recently, Cabanis et al.
(2013) administered an attributional bias task during fMRI
scanning where participants were asked to decide whether
situations described in sentences were caused by themselves
or by the other person involved (e.g., “The waitress ignores
you at the bar”). Bilateral insular activation was found to
correlate with awareness of personal agency in negative
situations (Cabanis et al., 2013). That is, increased bilateral
insular activity was observed when participants assumed and
accepted responsibility for causing a negative social event,
thus demonstrating a non-self-serving bias.
Neuroimaging studies have found that the parts of the
brain activated by thinking about the self are different from
the parts of the brain activated by thoughts concerning the
future self (Ersner-Hershfield, Wimmer, & Knutson, 2009).
Interestingly, the same part of the brain associated with the
future self is associated with thoughts about others, namely
the cortical midline structures of the medial prefrontal
cortex (mPFC) and rostral anterior cingulate (rACC). The
relationship between psychedelics and the mPFC and rACC
166 Journal of Psychedelic Studies 4 (2020) 3, 163–170
will likely be an important area for future research con-
cerning the relationship between psychedelics and empathy.
As psychedelics activate and connect brain regions
associated with self-awareness and the processing of
emotional information, which in turn leads to less self-
centric thinking, it is plausible that people who use psy-
chedelics may exhibit enhanced empathic functioning. There
is correlational, experimental and longitudinal evidence that
provides direct links between psychedelic use and empathic
functioning.
CLINICAL IMPLICATIONS
The possibility that psychedelics enhance empathy has im-
plications for applications of psychedelic-assisted psycho-
therapy. The increased empathy occasioned by a psychedelic
experience could be a direct mechanism of action in pro-
ducing some of the positive outcomes reported from psy-
chedelic-assisted psychotherapy. In this respect, psychedelic-
assisted psychotherapy may be useful for psychological
conditions associated with deficits in empathy (Blair, 2005;
Cusi et al., 2010; Dziobek et al., 2011; Shamay-Tsoory et al.,
2009). As the therapeutic alliance is key to good clinical
outcomes (Degeorge, 2008) and empathy is a key part of the
therapeutic alliance (Nienhuis et al., 2018), increased
empathy occasioned by a psychedelic experience could also
provide an indirect mechanism of action in psychedelic-
assisted psychotherapy by enhancing therapeutic alliance.
For example, some training protocols for psychedelic-assis-
ted psychotherapy have required therapists to consume
psychedelics in order to learn how to administer these drugs
(Multidisciplinary Association for Psychedelic Studies,
2020). These experiences may increase the levels of thera-
pists’empathy and thus improve therapeutic outcomes via
strengthening of the therapeutic alliance.
The link between psychedelics and empathy also has
implications for prosocial behaviour. Reduced social con-
nectivity can precipitate and perpetuate a number of psy-
chological conditions, particularly depression (Beck &
Alford, 2009; Hari, 2019). Watts et al. (2017) investigated
whether psilocybin-assisted psychotherapy for treatment-
resistant depression was effective in a qualitative study and
explored the mechanisms of action by interviewing partici-
pants 6 months following treatment (Watts et al., 2017).
Responses were analysed for consistent themes and all pa-
tients who endorsed the treatment’s effectiveness referenced
renewed connections with others. Similarly, Carhart-Harris
and Goodwin (2017) found that people who used psyche-
delics showed significant increases in social connectedness
two weeks after a psychedelic dose. Enhanced connections
with others following psychedelic use might produce greater
concern for others and contribute to psychedelics’influence
on altruism and prosocial behaviour (Schmid & Liechti,
2018; Griffiths et al., 2018). Empathy facilitates emotional
awareness and reduces self-centricity, which in turn, could
lead to prosocial behaviour and social connectivity,
decreasing symptoms of depression as a result. Such
increased empathy could lead to prosocial behaviour by
altering core beliefs about the self, others, the world, purpose
and meaning more broadly.
CONCLUSION
Both neuropsychological and clinical evidence can be used
to suggest that psychedelics could lead to changes in
empathic functioning and increase prosocial behaviour. In-
creases in empathic function and behaviour could be one
mechanism of action that contributes to the positive effects
of psychedelic-assisted psychotherapy. Empathy is impli-
cated in a wide range of mental health conditions and psy-
chedelics may have a similarly wide range of applications.
Future research should consider how different types of
psychedelics compare in their influence on empathic func-
tioning as well as the comparable influence of different use
contexts (i.e. recreational, spiritual, clinical). Greater longi-
tudinal data is also needed to consider the impact of psy-
chedelic use on empathy over time. We also encourage
legislators to consider the potential negative impacts of
psychedelic prohibition which undermines both the under-
taking of psychedelic research and access to pharmaco-
therapies that could improve both individual quality of life
and social cohesion.
Conflict of interest: No specific funding was used to support
this project and there are no conflicts of interest to disclose.
ACKNOWLEDGEMENTS
We would like to thank Ross Hollett for his supervision of
the project from which this review has been drawn.
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