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Towards psychedelic apprenticeship: Developing a gentle touch for the mediation and validation of psychedelic-induced insights and revelations


Abstract and Figures

A striking feature of psychedelics is their ability to increase attribution of truth and meaningfulness to specific contents and ideas experienced, which may persist long after psychedelic effects have subsided. We propose that processes underlying conferral of meaning and truth in psychedelic experiences may act as a double-edged sword: while these may drive important therapeutic benefits, they also raise important considerations regarding the validation and mediation of knowledge gained during these experiences. Specifically, the ability of psychedelics to induce noetic feelings of revelation may enhance the significance and attribution of reality of specific beliefs, worldviews, and apparent memories which might exacerbate the risk of iatrogenic complications that other psychotherapeutic approaches have historically faced, such as false memory syndrome. These considerations are timely, as the use of psychedelics is becoming increasingly mainstream, in an environment marked by the emergence of strong commercial interest for psychedelic therapy. We elaborate on these ethical challenges via three examples illustrating issues of validation and mediation in therapeutic, neo-shamanic and research contexts involving psychedelic use. Finally, we propose a pragmatic framework to attend to these challenges based on an ethical approach which considers the embeddedness of psychedelic experiences within larger historical and cultural contexts, their intersubjective character and the use of practices which we conceptualise here as forms of psychedelic apprenticeship. This notion of apprenticeship goes beyond current approaches of preparation and integration by stressing the central importance of validation practices based on empathic resonance by an experienced therapist or guide. 3
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Towards psychedelic apprenticeship: Developing a gentle touch for the mediation and
validation of psychedelic-induced insights and revelations
Christopher Timmermann1, Rosalind Watts1 and David Dupuis2
1Centre for Psychedelic Research, Division of Brain Sciences, Department of Medicine,
Imperial College London
2Department of Anthropology/Hearing the voice, Durham University
Corresponding author: Christopher Timmermann. 160 Du Cane Rd, Hammermsith
Hospital, Imperial College London, W12 0NN, London. E-mail: c.timmermann-
Accepted for publication in Transcultural Psychiatry journal (December 2020)
This preprint has not yet undergone copy-editing
A striking feature of psychedelics is their ability to increase attribution of truth and
meaningfulness to specific contents and ideas experienced, which may persist long after
psychedelic effects have subsided. We propose that processes underlying conferral of
meaning and truth in psychedelic experiences may act as a double-edged sword: while these
may drive important therapeutic benefits, they also raise important considerations regarding
the validation and mediation of knowledge gained during these experiences. Specifically, the
ability of psychedelics to induce noetic feelings of revelation may enhance the significance
and attribution of reality of specific beliefs, worldviews, and apparent memories which might
exacerbate the risk of iatrogenic complications that other psychotherapeutic approaches have
historically faced, such as false memory syndrome. These considerations are timely, as the
use of psychedelics is becoming increasingly mainstream, in an environment marked by the
emergence of strong commercial interest for psychedelic therapy. We elaborate on these
ethical challenges via three examples illustrating issues of validation and mediation in
therapeutic, neo-shamanic and research contexts involving psychedelic use. Finally, we
propose a pragmatic framework to attend to these challenges based on an ethical approach
which considers the embeddedness of psychedelic experiences within larger historical and
cultural contexts, their intersubjective character and the use of practices which we
conceptualise here as forms of psychedelic apprenticeship. This notion of apprenticeship
goes beyond current approaches of preparation and integration by stressing the central
importance of validation practices based on empathic resonance by an experienced therapist
or guide.
1. Introduction
Psychedelics are known for inducing a multifaceted range of effects in human experience,
ranging from visual imagery to high-order phenomena such as ego-dissolution and mystical-
type experiences (Griffiths et al., 2008; Nour et al., 2016; Preller and Vollenweider, 2016).
While research employing psychedelics has generated a growing body of knowledge
concerning the psychological and biological mechanisms associated with low-level effects
(i.e. visual imagery; De Araujo et al., 2012; Carhart-harris et al., 2016; Kometer and
Vollenweider, 2016), phenomena associated with more abstract (or ‘high-level’) experiences,
such as achieving psychological insights and enhanced attribution of meaning, are less
understood. In this paper we propose that psychedelic-induced insights and revelations act as
a ‘double-edged sword’: while these revelations may drive important therapeutic benefits and
increases in well-being (Watts et al., 2017; Carhart-Harris et al., 2018a; Davis et al., 2019),
they may also serve as mechanisms for experiences associated with high levels of
psychological distress (e.g. troubling revelations). Furthermore, we argue that psychedelic-
induced insights may result in significant modifications in worldviews and beliefs, which
carries significant bioethical implications. These ethical issues are bound to become
increasingly relevant, as the use of psychedelic substances is rapidly achieving mainstream
status, especially in the context of the emergence of commercial interest for psychedelic
therapy, the so-called psychedelic science ‘renaissance’, and ritualistic uses in secular and
Evidence has highlighted the central importance that both mystical-type and psychological
insight experiences have for improvements in depression, addiction and psychological
distress associated with terminal illness, during psychedelic therapy (Garcia-Romeu et al.,
2014; Griffiths et al., 2016; Belser et al., 2017; Watts et al., 2017; Carhart-Harris et al.,
2018a; Roseman et al., 2018; Davis et al., 2019). We propose that a common mechanism
underlies both of these experiences (i.e. mystical-type effects and psychological insights): the
striking subjective feeling of gaining unmediated knowledge and revelations (i.e. their noetic
quality; see Pahnke and Richards, 1970; Shanon, 2005). While commonly associated with
mystical-type experiences, we propose noetic feelings occur in relation to a wide range of
contents, including those pertaining to psychological, spiritual or metaphysical themes. This
We use the ‘neo-shamanic’ term in a descriptive way to refer to contexts which employ practices and
discourses that integrate indigenous practices and Western psychotherapeutic elements (Scuro and Rodd, 2018).
article reflects on ethical considerations associated with such acts of knowing during
psychedelic experiences, as the perceived validity of psychedelic experiences may result in
significant psychological, social and epistemological issues. We illustrate these issues
through three examples associated with use of psychedelics in different contexts: 1)
autobiographical insights observed in a clinical trial using psilocybin for the treatment of
depression 2) neo-shamanic practices in the Peruvian amazon, and 3) ‘metaphysical’ insights
and revelations occurring in naturalistic and controlled research environments. Finally, we
outline a framework to navigate the delicate terrain of psychedelic knowing, rooted in
experiential and embodied ways of apprenticeship. Forms of psychedelic apprenticeship may
find expression in different instances, such as the opportunities for psychedelic therapists to
deepen their therapeutic work, the development of models which highlight the need for
nuanced forms of preparation and integration of psychedelic experiences and research which
fosters detailed phenomenological inquiry. We propose that forms of psychedelic
apprenticeship may provide significant benefits to attend challenges associated with the
mediation of psychedelic experiences, especially considering the tension between these issues
and the rapidly accelerating interest to develop psychedelic medicines for large populations.
Mediation of revelations and insights
As mentioned above, we propose is that 1) psychedelics are prone to induce insights (or more
broadly instances of knowing) and 2) the contents of these revelations are broad-ranging; i.e.
they may range biographical events to metaphysical ‘revelations’ (see Grof, 1975; Strassman,
2001; Shanon, 2005 for phenomenological examples). Importantly, the revelatory facet
concerning the knowledge experienced during psychedelic states is usually imbued with a
sense of authority and heightened validation, which however is subjectively felt as intuitive
and unmediated (Pahnke and Richards, 1970; Shanon, 2005). Furthermore, the consequences
of these experiences may carry over long after the pharmacological effects of the substances
have subsided. For example, these experiences may be labelled as one of the top-five most
meaningful experiences in users’ lives (Griffiths et al., 2011), consistent with neurobiological
evidence showing long-term changes in brain function (Barrett et al., 2020) and structure
(Bouso et al., 2015; Ly et al., 2018).
While the feelings of veracity associated with specific contents experimented during
psychedelic experiences may be felt as unmediated, recent evidence show that similar
feelings can be artificially (i.e. contextually) induced via experimental manipulation with
(Preller et al., 2017) and without the administration of psychedelics (Laukkonent et al.,
2020). The heightened state of suggestibility induced by psychedelics (Carhart-Harris et al.,
2015) provides fertile ground for this character of certainty to be directed by the context in
which these experiences occur. Furthermore, noetic experiences tend to have an unqualified
character: information is received and believed without a subjective need of external
validation or evidence (hence they are felt as direct and ‘unmediated’ ways of knowing;
James, 1902 and see Shanon, 2005 for a detailed decription during psychedelic states). This
unmediated character, combined with a wide range of evidence resonant with the notion that
psychedelics are able to enhance meaningfulness (Studerus et al., 2010), provides fertile
ground for problematic issues associated with validation of the information attained to arise.
Furthermore, the picture becomes even more complex when taking into account the positive
or negative epistemic consequences that these experiences may have (see Letheby, 2016 for a
nuanced take on epistemic risks and bennefits of psychedelic experiences).
Importantly, while there may be a felt lack of mediation underlying these experiences, forms
of mediation are always at play, consistent with evidence stressing the importance of how
context influences a psychedelic experience (Metzner et al., 1965; Carhart-Harris et al.,
2018). Furthermore, we argue that processes of mediation and validation are not constrained
to acute effects experienced in a psychedelic session, but rather extend in time before and
after the session. Therefore, forms of mediation and validation of psychedelic insights are
subjected to broader contexts occurring in wide-ranging temporal scales and not limited to
the acute psychedelic session. Importantly, alterations of levels of suggestibility induced by
psychedelics may be conceived as opportunities for forms of mediation and validation at
varying temporal scales. (Figure 1)
Figure 1. Opportunities for mediation and validation at different temporal scales. A psychedelic
experience is embedded in varying temporal scales, which presents different opportunities for stronger or
weaker forms of mediation. The level of transparency of each of the borders within the concentric circles outline
the degree to which the corresponding instances are permeable for interventions of mediation/validation.
In the following section we will look at examples of knowledge gained during psychedelic
experiences which have led us to consider specific issues around the mediation and
2. Examples of psychedelic-induced revelations
Biographical revelations in therapeutic contexts
Prevailing models of psychedelic therapy rest on the assumption that psychedelic-induced
insights about the self (psychological and biographical information) arise from ‘intuitive
knowing’, or some form of ‘inner intelligence’ (Grof, 1975; Richards, 2016). Often patients
will have a strong ‘felt sense’ that their insights are true and real for them, although this is
difficult and often unnecessary to prove. However, when an insight relates to biographical
revelations, the issue of validity may become very important and preoccupying. For example,
a woman with a scar on her hand may receive the insight that her now deceased mother put a
cigarette out on her hand when she was an infant. The insight feels true, but whether or not it
is believed holds serious consequences for the woman’s life. These instances are quite
frequent in psychedelic therapy, and the way they these insights are ‘held’ by the session
facilitators can have important consequences for the patient. Patients primed to believe that
everything they see or feel will be ‘the Truth’ may feel preoccupied by any strange or
upsetting revelations they might encounter. At the same time, trusting ‘the inner healing
intelligence’ is a foundational principle in many models of psychedelic therapy, and the
frequent experience of patients and therapists alike is that insights received do hold some
important ‘realness’, and are coming from a place of ‘deep knowing’. How to hold this space
of gentle agnostic respect for the messages that arise is one of the challenges of psychedelic
We present the case of a participant in a recent psilocybin trial in which a distressing
revelation of a biographical event presented issues regarding its validity (i.e. difficulties in
determining whether or not the biographical event actually took place). The internal
negotiation regarding the validity of the insight had implications for the patient’s therapeutic
process; extended integration therapy (described below) was required to enable at least partial
resolution of the issue. This revelation occurred during a psilocybin session in a clinical trial
in which a medium-high dose of psilocybin was administered (25 mg), alongside therapeutic
support from a psychiatrist and psychologist. The session content focused mainly on a
confrontation with a cruel creature which the participant took to represent one of his parents.
As the battle with the monster subsided, the participant had an experience in which he felt
himself to be an infant whose parent was attempting to smother him with a pillow:
It’s my mum. (…). It feels like a pillow over me. No it couldn’t have been that. Did you
really not want me that badly?
This initial revelation was then scrutinised by the participant thoroughly after the effects of
psilocybin had subsided. Immediately after the session, the participant expressed the
emotional intensity of the contents experienced and questioned whether the experience
corresponded to a true memory. In the two months after the session, communications from
the participant to the study team revealed that he was experiencing remission from depression
and was relatively untroubled by the ‘memory’. However, six months after the session, the
participant described that the depression had returned and reported being now,
understandably, quite preoccupied and confused about whether or not the suffocation event
had happened to him.
So it’s (about) trying to move on, it’s all very well people saying ‘it’s all totally symbolic’,
I don’t think it is. When it happened it felt more real than the here and now (...) I do think
that something must have happened. Something pretty severe in my childhood for this
treatment to take me back there (…) But what do you do with it? Do you just deal with it?
This quote illustrates ethical issues which can accompany psychedelic-induced biographical
insights in therapeutic contexts by displaying the participant’s distress concerning the
revelation of biographical event, facilitated by psilocybin intake, which might or might not
have taken place. The participant describes thinking that the psilocybin session had probably
revealed to him a previously unknown traumatic event, and that the alternative explanation -
that the noetic character of psychedelic experience had apportioned misplaced validity to a
symbolic scene - is less convincing. He accentuates that the experience ‘felt more real than
the here and now’.
Due to the participant’s ongoing distress about the veracity of the scene, the study team
referred him for 10 sessions of extended ‘Integration’ with a specialist therapist. Integration
refers to sessions performed in a therapeutic or counselling format focusing on the contents
that emerge during a psychedelic session. The participant reported that these integration
sessions allowed him to reframe his experience in a new way.
That information (revealed in the smothering scene during the session) was so new and
quite useful, you need to make sense of it. Integration for me is as important as set and
setting. It’s important getting to the point of having revelations. Regardless of whether it’s
true or not, that information needs to be understood by your consciousness, it’s going to be
rattling around: did it happen, didn’t it happen, and that’s not the point at all. This message
has come along, (so) what does it mean?
Integration may provide support in the process of becoming aware of new information, in
which the role of a guide or therapist is crucial. From this perspective, knowledge gained
during experiences may be subjected to a process of intersubjective mediation (see Varela
and Shear, 1999), which in this context may have significant role for therapeutic outcomes.
We will return to how this process may be inserted within practices that enhance the process
of validation and mediation of psychedelic experiences in the last section.
While the process of integration may be helpful with dilemmas of validity in individual
therapeutic process in western contexts, other challenges may arise in other scenarios in
which the mediation process is more strongly directed. We now turn to our second example,
in which the psychedelic experience occurs in a neo-shamanic centre.
Revelations in neo-shamanic contexts
In this example we refer to the ritual use of ayahuasca as administered in the numerous neo-
shamanic1 centres that have recently appeared on the edge of the Peruvian Amazon
metropolitan areas in the context of the emergence of ‘shamanic tourism’ (Labate and
Jungaberble, 2011). These reception centres are most often based on the partnership of
Westerners and mestizo or indigenous locals, and offer to an international clientele the
opportunity to participate in ritual activities inspired more or less freely by the practices of
the Peruvian mestizo shamanism, such as the ritualized use of the psychedelic brew
Based on an ethnographic survey conducted between 2008 and 2013 in Takiwasi, a well-
known centre of the area, Dupuis (2020) has proposed that contents of ayahuasca experiences
(and associated revelations) arise from an interaction between the psychopharmacological
effects induced by ayahuasca and the social context surrounding its use (verbal exchanges,
ritual interactions, etc.), which strongly influence the phenomenological features of the
psychedelic experience. During these retreats, visual and auditory imagery perceived by the
participants are indeed progressively perceived as acts of communication of supernatural
beings (i.e. voices’ and ‘visions’) postulated by the cosmology of the institution. Cultural
background and social interactions result here in a socialisation of hallucinations’ (Dupuis,
2020), a social learning not only shaping the relationship to the psychedelic experience, but
also its very phenomenology.
The visitors of this centre attend two-week retreats for the purposes of ‘personal
development’ in which they usually work with personal issues. Usually, approximately 15
visitors attend each retreat, which consist in introductory lectures, ritual activities, the
ingestion of emetic plants (including ayahuasca) and post-session discussions. In the sessions
before and after the ayahuasca ceremonies, participants are introduced to the specific
cosmovision of the centre, which combines neo-shamanic, psychotherapeutic, biomedical and
folk Catholicism elements. Within this framework, the psychological suffering of participants
is frequently understood as resulting from demonic influence or possession (i.e. ‘infestation’).
Retreat participants usually report the perception of demonic evil beings, which they most
often describe as fighting against protective entities such as spirits of nature (e.g. the spirit of
ayahuasca) or entities of the Christian pantheon:
There were all these demons parasitizing me inside, but I saw the ayahuasca that was
chasing them, like a lot of little bright snakes inside my body that were circulating and
cleaning all that up. (...) Later I saw ayahuasca. She was a kind of woman with a snake-like
lower body, showing me how the demons got in, what I had done, and therefore what I had
to do to stop them from entering.
At one point I had a vision with the archangel Saint Michael who was piercing a demon
with his sword, as in the religious images. Later I felt the presence of Christ, who looked
behind my back, where chains were hung connected to a cage. I saw my demons laughing
because I had to drag my cage to move forward in life. They jerked me around all the time,
like they were raping me. (...) When Christ saw the chains and the cage, he said it had
nothing to do here and kicked to kick it all out.
These visionary narratives vividly reflect the cosmology and the specific etiological theory of
the institution, which specifies that the source of illness occurs as a consequence of
possession by demonic beings. Following the initial instances in which ayahuasca is taken,
retreat participants may experience anxiety, uncertainty and misunderstanding, which are
expressed in the post-session discussions. During these discussion groups, it is frequently
suggested to participants (by fellow participants and ritual specialists or facilitators) that
some aspects of their experience reveal the presence of demonic entities (‘infestation
diagnosis’) or benevolent agents (nature spirits, catholic pantheon beings). Group discussions
serve here as practices of mediation in which participants reframe psychological or somatic
issues by adopting specific cultural motifs of ‘possession’, which are then experienced during
subsequent ayahuasca sessions.
During and after the ayahuasca sessions, participants at this centre may be ultimately
recommended to adopt practices to free themselves from parasitic influences and the
corresponding distress associated with them. These techniques involve contracting
relationships with supernatural protective entities (plant's spirits, ancestors, Catholic
pantheon entities) through prayer, participation in Catholic masses or the use of Catholic
artefacts and practices (e.g. exorcism rituals, baptism). The discovery of the demonic
influence will thus lead some participants to a (re)conversion to Catholicism and religious
practice, that is perceived as a means of protecting themselves from demonic influences.
Taking on this framework may be useful for participants, as externalising the source of
distress can have significant therapeutic value. ‘Externalising the problem’ is a tool widely
used in mainstream talking therapy (e.g. White, 2007) to provide people with a sense of
agency, validation, hope, and improved self-esteem. Here the tension between pragmatic and
ethical considerations is rendered clearly. The capacity of psychedelics to facilitate the
appropriation of an etiological or cosmological theory by means of their tangible verification
during the visionary experience acts indeed as a double-edged sword. A possible vector of
therapeutic effectiveness, but also a possible spring of conversion that remains largely
implicit and unconscious (Dupuis, 2018a), and which may be consequently not fully
consented. This case is an example in which heavily directed mediation processes suggest
how deeply the ideology of a context may implicitly influence the psychedelic experience
and its after-effects.
‘Metaphysical’ revelations in research contexts
In addition to revelations occurring in therapeutic and neo-shamanic contexts, psychedelic
revelations featuring ‘metaphysical’ themes (i.e. concerning the nature of reality) may occur
in contexts associated with consciousness research. The validation of these experiences poses
challenges to consciousness researchers attempting to determine invariant features of
psychedelic phenomenology, as well as research subjects attempting to make sense of their
experiences. Importantly, psychedelic use may result in changes in worldviews which persist
long after a session is over (Timmermann et al., forthcoming). We have captured some of
these ‘metaphysical experiences’ in some of our studies employing DMT (see Timmermann
et al., 2018):
I felt the presence of this alien substance. This green, gooey alien substance which is not
organic. (…) Everything is silicon based. Stuff which once was gooey, but now is
fossilised. (…) This fossilised gooey stuff (…) is what reality is. The forests you see on
planet Earth… that’s a beautiful simulation (…) There are humans on these shelves, in very
tight spaces. That’s how I felt. This very, very compressed space. (…) So, finally, I felt, ah,
I got to know what was in that forest (…) Every human body is just on one shelf, and there
is another human on another shelf. And that’s reality. The reason why we are not suffering
is because machines are generating this beautiful reality for us.
For some participants, DMT-induced insights may last long after a session has ended and
may inform on subsequent experiences.
Entering a parallel world, parallel universe. Maybe what we are in the future. Maybe what
we access is our evolution. This is informed by previous experiences, it’s also informed by
what I’ve read, but it is first-hand experience.
While participants may ask to themselves: ‘Did I actually gain some important information
regarding the nature of reality?’, researchers might question the validity of the reports of
participants and what can we learn from psychedelic-phenomenology and ask ‘did the
participant actually experience that?’. Putting it differently, the researcher might question the
validity of first-person reports as valid data to understand the effects of these compounds on
human consciousness.
Among the common biases associated with first-person reports in consciousness research,
psychedelics may be particularly prone to induce a confusion between experience and
representation. Phenomenological research highlights that experiencers’ expectations (which
are shaped by their specific culture milieu), aided by language, may play a pivotal role in the
recollection of an experience (Petitmengin, 2006). Specifically, subjects are mostly aware of
things that are consistent with their representations and beliefs and, in the process of
recollection, the original experience may be deformed through the influence of these beliefs
and representations. Furthermore, psychedelics may be especially susceptible to deformation,
primarily due to their ineffable quality (i.e. inability to express aspects of the experience in
language; Pahnke and Richards, 1970). Furthermore, popular ‘memes’ abound in the cultural
milieu associated with psychedelic drug use and these themes could be having a significant
effect in the contents experimented and recalled during psychedelic experiences.
Some preliminary data we have gathered in ritual settings in Europe reveal that psychedelic
experiences taking place in modern ceremonies (many of them of a secular kind) may
significantly alter beliefs regarding the nature of consciousness and reality. Specifically,
results from a prospective survey reveal that following a retreat involving a psychedelic,
respondents were more prone to endorse beliefs consistent with notions of the existence of
separate realities, mind-body dualism and fatalistic determinism, and these changes remained
significant for at least 6 months. Importantly, we found that the best mediator for these
changes in beliefs was the degree to which participants felt positive emotional synchrony (see
Páez et al., 2015 for details on the construct). This effect was moderated by respondents’ pre-
session scores of peer conformity. These results highlight how the role of intersubjective
factors and social attitudes result in long-term changes in worldviews during psychedelic
experiences (Timmermann et al. forthcoming). While our interest is not to debate the actual
ontological validity of such metaphysical insights, we see the value in a gentle, open space
for participants to examine and revisit these insights in the post-session period. This is
especially relevant considering that these changes in supernatural beliefs were significantly
associated to increases in well-being up to 6 months after the retreat took place, further
stressing pragmatic and ethical tensions - a double-edged sword.
3. Contextual embeddedness of mediation and validation
As seen in the examples above, processes of mediation and validation appear to have a strong
embeddedness within the larger context in which revelations occur, regardless of their
subjectively felt unmediated character. Furthermore, issues of validation and mediation of
psychedelic experiences are further exacerbated by the fact that these experiences have not
been legitimised in the Global North, (i.e. psychedelics are illegal in most Western countries)
which renders the instances for mediation highly unstable. Different institutions, for example
religious traditions and the medical or scientific field are playing a competing role in the
construction, legitimisation and maintenance of new and hybrid practices that are multiplying
around the use of ayahuasca (Dupuis, 2018b). This is especially relevant considering that the
noetic quality may act as a catalyst for each of these institutions’ frameworks to be validated
and legitimised through users’ personal experiences. Furthermore, each of these institutions
have their own aims and ethical issues are expected to arise when these aims are divergent.
These institutional aims represent the staging through which psychedelic-induced revelations
are expressed and played out during a psychedelic session (Figure 2).
Figure 2. Examples of institutional aims for a psychedelic session. Overlaps of aims for a psychedelic
session between three different contexts in which psychedelics are used. Sources of ethical tensions can be
found between specific diverging aims. The aims presented are not meant to be exhaustive, but simply
4. Towards psychedelic apprenticeship: Frameworks for grounded practices
Considering that the subtleties of dealing with psychedelic experiences will continue to
present challenges to facilitators and providers, we outline a coping framework to understand
issues of mediation and validation. These strategies are fundamentally grounded in forms of
apprenticeship, which aims to foster acts of becoming aware of users’ own mental states.
“Introspection is difficult, it demands an apprenticeship, requires
progressive development of a genuine expertise. The greatest difficulty lies
in the fact that this technicality is masked, that it can passed unnoticed due
to the apparent ease with which it is possible to obtain a minimum amount
of knowledge about our states of mind, our thought processes, our
emotions” (Depraz et al., 2003, pp. 154)
Once an experience of insight or revelation has taken place within a psychedelic session, then
the users (or researchers) may be left with the following questions: Are these experiences
real? Did I really re-experience a repressed memory which actually took place? Did I really
meet usually invisible beings as demons, ancestors and plant spirits? Did the participant
really experience that, or are the contents symbolising some emotional truth instead? Could it
be simply experiential noise’? These are questions which do not have straightforward
answers, and we do not intend to try answer them here. We wish, however, to outline 1) the
subtle ways in which these processes of intersubjective mediation and validation may take
place, 2) the role that guides and facilitators have in this regard and 3) examples of practices
and methodologies which may be useful in this process. These three points can be considered
as being part of a process of apprenticeship (Depraz et al., 2003), which can be useful for
users, facilitators and the larger community of researchers and therapists seeking to enhance
awareness regarding the nuances of psychedelic experiences and therapeutic processes.
Intersubjective mediation
Insights initially encountered within a private domain of experience are also embedded in
complex social networks susceptible to intersubjective mediation and validation (Depraz et
al., 2003). The challenges surrounding the validation of information obtained in a psychedelic
session lie in the fact that the position within the social network through which the
information is achieved is closer to a first-person position, when compared to, for example,
scientific insights gained through a method closer to a third-person position which is
validated through a peer-review process practiced by a community of researchers (and thus
inserted in a complex social network). We see as imperative that methodologies dealing with
issues of mediation of psychedelic experiences take into account the possibility of extending
the process of validation of first-person psychedelic-induced insights into a broader
intersubjective milieu beyond the sphere of private experience.
Acts of becoming aware are pervasive to human experience but can also be structured in such
a way that they promote a certain amount of reflection. We consider this to be particularly
important in situations in which gaining knowledge has an apparent unmediated (i.e. noetic)
character. Contemplative practices are other examples of situations that undergo similar
issues of validation, as in these practices, the central importance of first-person experience in
the process of gaining knowledge is also pivotal. While the first step in validation of these
experiences is always private and rooted in a process of intuitive fulfilment (see below and
Depraz et al., 2003) by not subjecting these insights into broader contexts, the process of
becoming aware may be ‘relegated to a vicious privacy or even solipsism’ (Depraz et al.,
2003). As illustrated by the controversies surrounding repressed memories of sexual abuse or
recovered memory therapy (Freud, 1897; Loftus, 1993; Hacking, 1995), many
psychotherapeutic practices aiming to foster self-knowledge through the use of introspective
techniques and interactional devices (e.g. psychoanalysis and clinical hypnosis) have faced
the risk of developing iatrogenic complications such as false memory syndrome. We argue
that the process of psychedelic-induced insights may exacerbate some of these risks due to
their ability to induce noetic feelings and increased levels of suggestibility.
While psychedelic insights and revelations may feel to users as having an unmediated
character, the process of validation can be viewed from a mediated and intersubjective
perspective. For example, all three cases outlined above deal with issues which could be
conceived as tensions between first and third-person validation. In the first example we
presented above, in which the patient experiences revelations that pertain both his subjective
experience (first-person) as well as a potentially real biographical information (verifiable
from a third-person position). In the second example insights occur as part of transmission of
specific motifs corresponding to the institution’s cosmovision (third-person) which are
incorporated into the lived experiences and psychological life of retreat participants (first-
person). In the third example, participants’ psychedelic experiences (first-person) are
validated by researchers (third person) collecting data at an immediate level, and also a wider
community of researchers. These examples stress the flexile nature that psychedelic-induced
insights can take, regardless of their immediate and felt unmediated quality they have when
they occur. Bringing awareness of methods to mediate these insights may be a crucial step to
optimize psychological safety and efficacy, while also developing expertise in the process of
facilitating psychedelic experiences in diverse contexts.
Role of the facilitator: empathic resonance
Expression and validation are processes which imply the insertion of the act of becoming
aware of insights within a socially situated context (Varela and Shear, 1999). The process of
validation usually takes place within an intersubjective continuum: it may occur with a 1st, 2nd
or 3rd person position. From the first-person position, validation occurs via intuitive
fulfilment (no expression necessarily taking place). The second-person position is the one we
are interested here, whereby validation takes place via empathic resonance. In this scenario,
the process of expression and validation takes the form of an apprenticeship: a therapist, a
spiritual facilitator or a guide, has undergone a similar process as the experiencer and thus
can provide gradual orientation to the process of navigating this experiential domain and aid
in assimilating these insights (Depraz et al., 2003).
In the case of psychedelic sessions inserted within a psychotherapeutic process, then (from
the point of view of the experiencer) this process of training may take the form of sessions of
preparation and integration in which there are recursive dynamics allowing for the process of
achieving insights to begin before the actual moment in which the session takes place. By
fostering preparation, setting intentions and expressing expectations before a session, as well
as reflecting upon the experience in an open-ended fashion after the experience has taken
place, then the process of becoming aware aided by psychedelic experiences can become
rooted within the larger social, historical and cultural context in which the user, the guide and
the knowledge on which the practice (therapeutic session, ritual, experiment) is based upon
are all taken into account. While the notion of preparation and integration are becoming
commonplace in different therapeutic frameworks for psychedelic therapy, we would like to
stress here the central importance that a means of validation based on empathic resonance by
an experienced guide/therapist has for this process as this will affect crucial interventions
before, during and after the session. From the point of view of the therapist guide or
facilitator, forms of apprenticeship include instances of therapeutic supervision by more
experienced individuals as well as opportunities of learning associated with their own
experiences involving psychedelics.
Within this framework, it may be important to consider that training of psychedelic therapists
involve opportunities for them to have guided psychedelic experiences within therapeutic
frameworks of mediation. Similarly, in the case of researchers investigating psychedelic
phenomenology, a second-person position of empathetic resonance employing interview
devices that deepen the process of phenomenological enquiry (see Petitmengin, 2006;
Petitmengin et al., 2018) of their research participants beyond the use of psychometric scales
will enable the wider scientific community to learn more regarding the invariants associated
with the psychedelic state of consciousness. We believe that this second-person approach
fosters opportunities to deepen psychedelic knowing for individuals and can guide the
scientific community more widely.
Specific methodologies and practices
1) Detailed phenomenological inquiry
Some techniques may foster better ways to recollect and reflect upon specific experiences
than others. A useful technique we have used in research contexts (see Timmermann et al.,
2019) is the microphenomenological interview (MPI) technique. The MPI consists of a
disciplined approach to re-evoke and recollect past experiences through a mediated (i.e. 2nd
person) approach. The process of mediation consists in techniques aimed to 1) stabilize the
attention of the individual, 2) promote attention to turn from contents (what) to the processes
(how) of experience and 3) help subjects divert the focus from generic to specific dimensions
experiential structures (see Petitmengin, 2006 for details). It has been used in different
research contexts aiming to determine the micro-structures of meditation (Przyrembel and
Singer, 2018), intuition (Petitmengin-peugeot, 1999), mind-wandering (Petitmengin et al.,
2017) and mood disorders (Depraz et al., 2017). We argue that elements from this technique
may be applied in research and therapeutic contexts, both to address issues of determining
invariant structures of psychedelic experiences in consciousness research, as well as for
patients who could benefit from further recollection and exploration of instances of
therapeutic insight (Davis et al., 2019) and emotional breakthroughs induced by psychedelics
(Roseman et al., 2019). These could then provide important valuable therapeutic material to
be used within patients’ broader therapeutic processes. Detailed and mediated
phenomenological inquiry, could allow users express more and better by minimising the
influence of previous knowledge on the recollection of the subject’s experience (Depraz et
al., 2003).
2) The Accept Connect Embody approach
The initial psilocybin for depression study at Imperial College, from which the clinical case
example above was a part, provided the basis for the development of a clinical model, which
was adopted in the second psilocybin for depression study. This model is called ACE, which
stands for, ‘Accept, Connect, Embody’ (Watts and Luoma, 2020). Based on Acceptance and
Commitment Therapy (ACT; Hayes et al., 2006) and the Psychological Flexibility Model
(PFM; Hayes et al., 2006), the model maps three key mechanisms of psychedelic therapy:
acceptance of emotion, connection to meaning, and a level of processing that occurs in the
whole body, rather than just cognition. The ACE model can be applied in flexible ways and
can suggest a way forward at times when a participant feels ‘stuck’, or at an impasse.
Validation dilemmas, of the type discussed above, can lead to such an impasse: the
participant is confused, the therapist-guide has no answers, and both can search for clarity
about the objective truth as the only way to proceed. As this objective truth is elusive, it may
be more prescient to consider what is ‘helpful’ rather than what is ‘true’- this is a
foundational concept in contextual behavioural science, upon which ACT and the PFM are
based. The ACE structure offers the following methodology in cases of validation confusion,
with suggestions here for ways to introduce the exercises to a patient.
A: Accept: We could try to explore this more deeply if we disengage from thoughts about
whether it is true or not, just for now. If we let go of trying to find the answer for a while, we
can look at what you saw/felt as valuable information in its own right, which could be helpful
to you in your life, regardless of whether it actually happened. Are you willing to lie down,
and revisit the scene you saw? If the scene/impression you saw/felt/thought were true, what
emotion would be elicited? Can you let this emotion grow in you, and sit with it for a while.
Where do you feel it in your body? Let the feeling grow, get bigger, and let me know what is
happening and if you would like some support, (ways of supporting each individual will have
been discussed before the psychedelic session (e.g. hand holding, soothing words, music). If
there is anger, shame, fear, disgust, etc., any feelings that feel really painful to bear, keep
breathing into the places that you feel these feelings, and remember that painful feelings are
an important guidance system. Stay with the feelings, keep breathing and remember that you
are safe now. As the feeling develops, keep focusing on where you feel it in your body and
notice if the sensations are changing. Keep breathing gently into the places you feel these
C: Connect: Now that you have been with these feelings, try to connect to your ‘observer
self’. This the part of you who is always watching your experiences, and doesn’t get damaged
by them. A bit like the way the sky doesn’t get damaged by the weather; no matter how
stormy, even the biggest flash of lightening doesn’t burn the sky. So, connect to that part of
you that witnessed that scene or impression, and connect to the part of you that has just
experienced these strong feelings in your body. Just take a few moments now to breathe, and
listen to this piece of music, and just reflect on 1) Why do you think you saw that scene, what
was it trying to teach you/show you? 2) What do you think these emotions and sensations you
just experienced were trying to show you? What is the meaning here? 3) What does this all
teach you about what really matters to you? Those painful feelings- what do they show you
about what you need in order to feel safe or what you value.
(If the scene relates to an event in infancy): what would your observer self say to you as a
child? Imagine you could visit that scene, what would you do or say to all the people
involved? What does this tell you about the values you hold? You might like to consider some
action which you can do, to honour these values you hold as an adult. Examples include: a
ritual to honour the positive values that grew in them as a result of some of the painful
feelings they have felt in their life; writing a letter to some of the individuals involved in the
scene- their own infant self, a caregiver, etc. Such letters are recommended to be written for
creative purposes, not to be sent - after all this exercise is exploration ‘as if’, there is no final
judgement about whether anyone actually harmed them.
E: Embody: It may be that some individuals feel that these explorations are not satisfactory
and they still wish to pursue the truth. Presumably, if it is possible to seek external
verification, they will do so (i.e. asking someone who was there at the time). If this is not
possible, then they can engage in the following somatic enquiry exercise to obtain some sense
of what feels true for them. This exercise involves listening to two pieces of music. Music
choices are at the discretion of the therapist:
Lie down, and then I will play you the first piece of music. Bring your attention to your
breath. Then, go back to that scene/impression you saw or felt. Feel whatever emotions come
up. Then, hold the idea that it is true, that it really happened. Breathe, follow the music. Let
whatever emotions and sensations develop. Just be there. Then you will listen to the second
piece of music, going back to that scene, but this time holding in mind the idea that it did not
happen, and is symbolic. (Conduct the exercise).
What happened in your body in the first and second piece of music. Do you get some gut
feeling’? Did it feel truer to you that it really happened or was it symbolic? This exercise
cannot tell you which is true. It is intended to help you tune in to your own ‘inner
intelligence’ as a way of finding some understanding, and peace. Remember to hold any
insights lightly.
3) Accumulated know-how
We would like to also mention practices, such as those used by therapists, facilitators and
mestizo/indigenous shamans which have formed valuable psychedelic know-how employed
to this day in psychedelic use. These have not emerged from a structured theoretical
framework defined a-priori, but rather have been developed based on the embodied practice
of shamans, psychotherapists, researchers and experiencers (see Naranjo, 1974; Grof, 1975;
Shulgin and Shulgin, 1995; Shanon, 2005; Johnson et al., 2008; Beyer, 2011; Meckel Fisher,
2015; Richards, 2016 for examples). Among these practices we highlight the use of
structured instances surrounding the psychedelic experience (e.g. preparation and integration
sessions), psychological support during dosing sessions, the use of the ritual setting and tools
as music and perfumes to foster safety and enhance therapeutic intentions and detailed
attention to users’ experience (Dupuis, 2020). All these instances may provide opportunities
for experiences to be expressed, reflected upon and validated in an intersubjective way, in
which the role of the guide or facilitator is consistent with the notion of empathic resonance
we mention above. We believe that this know-how, resonant with the term of apprenticeship
outlined above, have yielded important foundations to deal with issues of mediation and
Under this view of apprenticeship, acts of becoming aware are not constrained to the
experiencer, but also involve the guide, as the evaluation and results from her intervention
will result in the development of learning instances, which are part of the construction of an
embodied ‘know-how’ rooted in experiential guiding and facilitating of sessions or
therapeutic processes. Under the specific context of psychedelic therapy in the West, we
consider these forms of experiential and embodied learning a crucial element in the
development of therapeutic abilities and validation of phenomenological data for research
purposes. These instances of learning can be further promoted through the use of their own
process of development of therapeutic abilities and continuous instances of supervision,
among many others. In wider temporal and spatial scales, this recursive process of learning
involving experiencers and facilitators may provide the wider communities of psychedelic
experiencers, facilitators and researchers instances to develop knowledge (a ‘know-how’)
regarding psychedelic experiences and therapeutic processes. Using this framework of
apprenticeship, further practices and methods can be developed and formalized into specific
interventions which foster recursive forms of experiential inquiry and acts of reflection.
(Figure 3)
Figure 3. A framework for psychedelic apprenticeship. Modification of Figure 1, illustrating the experiencer
(concentric circles), the guide (small circle), examples of interventions currently employed in some forms of
psychedelic use as forms of mediation and validation (red) and their bi-directional impact (green). Also
illustrated are the social positions of each of these actors (purple) and their insertion within a broader
community. Finally, the ensuing dynamics of these practices promote instances of becoming aware for
experiencers, guides and the wider community (yellow).
5. Conclusion
Ethical know-how for psychedelic practices: Developing a gentle touch for the mediation and
validation of insights and revelations
The act of knowing during psychedelic experiences can be thought of as analogous to the act
of knowing and other acts of becoming aware which depend on (at least on first instance)
intuitive (or unmediated) evidence. Intuitive acts carry with them a sense of novelty, which is
lived as an emergence of content which is unpredictable and thus presents a discontinuity in
experience. This moment of intuitive fulfilment can be optimised by a double movement
consisting of both passive acceptance as well as the holding the grasp of such an experience
in a light-handed fashion so that instances are generated which may allow for contents to
have an open-ended aspect to them (Depraz et al., 2003). We have proposed in this article a
framework which may aid in the process of mediation and validation of psychedelic insights
after outlining some specific issues which may arise in different contexts. Our proposed
framework aims to present the characteristics of the context, the role of the facilitator and
specific methodologies which can aid in the development of a gentle touch when it comes to
psychedelic insights. We aim to do this not for the sole purpose of dealing with issues of
validation, but also for enhancing opportunities and developing practices required to navigate
the subtleties of the psychedelic experience. Under this notion we echo the sentiment that,
like contemplative practices, psychedelic experiences require a degree of discipline
embedded in forms of apprenticeship to manage these risks during the process of
transformation of the subject that engages with them.
This process of apprenticeship is intimately linked to a notion of ethics which (for the most
part) denotes ethical action as the result of an embodied practice (i.e. ethical know-how;
Varela, 1999), rather than a set of clearly delineated rules determined a priori. While it can be
said that safety aspects associated with ingestion of psychedelics do require a set of principles
which have been also prescribed a priori (see Johnson et al., 2008 for an example), it is
important to note that these principles have been in large part derived from the embodied
practice involving psychedelics both within and outside sanctioned environments and the
assimilation of these precepts as guidelines for good practices are consistent with this notion
of ethical know-how or apprenticeship. From the point of view of the psychedelic
experiencer, these precepts will help, but will not carry the bulk of the chore at hand, as
evidence is consistently showing that it is through experience that the desired therapeutic
effects associated with psychedelics occur (Garcia-Romeu et al., 2014; Roseman et al., 2018;
Davis et al., 2019). It is in the experience where the epistemological challenges we outline
above will occur, and it is in a progressive engagement with the process of experience that
the subject will eventually learn to navigate the subtleties of the psychedelic space. We argue
that this process is recursive and can be aided by contextual devices and practices, some of
which we have outlined above. It is in this process that experiencers will become acquainted
with the dynamics of knowing and ‘letting-go’, which appear to be so crucial not only for
psychedelic experiences and psychotherapy processes, but also in the contemplative
traditions which have inspired this notion of ethical know-how (Varela, 1999).
To conclude, we argue that forms of psychedelic apprenticeship are required to be grounded
on experiential forms of ‘know-how’, which foster the development of devices that allow
recursive forms of experiential inquiry. This is especially relevant considering the illegality
of many Western settings, the increasing demand for psychedelic therapy (see Nutt et al.,
2020 for an up-to-date overview) and the exponential increase in interest associated with
psychedelics in current times.
“Talk alone will certainly not suffice to engender spontaneous non-egocentric
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against taking fixed views and concepts as reality. We simply cannot overlook
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... Although this term was sometimes associated with the counter-culture, it is currently used in the academic and scientific language. Today we can find multiple research studies to evaluate the neurobiological and therapeutic effects of the use of psychedelics and also the ethical and epistemic consequences necessarily linked to them [1][2][3][4][5][6][7]. ...
... Some of such rare studies [5,17,18], in the more general intentions of the authors, lead to "outline a framework to navigate the delicate terrain of psychedelic knowing" [5], and take as one of their cases studies the small therapeutic community of Takiwasi, located in the Peruvian Amazon. Takiwasi is an NGO rehabilitating substance use disorder and integrating Western scientific with Amazonian traditional vegetalista medicines. ...
... Some of such rare studies [5,17,18], in the more general intentions of the authors, lead to "outline a framework to navigate the delicate terrain of psychedelic knowing" [5], and take as one of their cases studies the small therapeutic community of Takiwasi, located in the Peruvian Amazon. Takiwasi is an NGO rehabilitating substance use disorder and integrating Western scientific with Amazonian traditional vegetalista medicines. ...
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This article aims to analyze how Western researchers can be influenced by their epistemic and ethical foundations, which are also expressed through a culturally shared idea of therapy, and how this influence can significantly hinder the understanding of a different cultural reality and its resources in terms of knowledge and practices. While examining a collection of research cases in the field of psychedelic therapy, the present paper focuses on the obstacles created by ethical and epistemic conflicts in the mind of researchers with Western scientific training and their consequent difficulty in exploring the situations induced by psychedelic substances in a context of articulation and integration between their therapeutic know-how and that of a spiritual hundreds-year-old psychedelic tradition like Amazonian mestizo vegetalismo. Such obstacles may offer a chance to increase awareness of the cultural bias and limitations of the scientific gaze and highlight the importance of therapeutic and research contexts in which declared independence, neutrality and effectiveness of human alert thinking as undebatable ethical and epistemic value are under discussion.
... The influence of psychedelics on releasing constraints in the MTL has been linked as a potential source of purported autobiographical memories and insights experienced during psychedelic ingestion (Carhart-Harris, Friston, and Barker 2019. Psychedelic-induced biographical memories and insights at times display a striking sense of veridicality (Timmermann, Watts, and Dupuis 2022), potentially explaining the feelings of familiarity that are reported. Girn et al. argue that interpreting the brain action of psychedelics should be approached with an overarching macroscale, complex systems perspective rather than a narrow lens on specific brain regions (Girn et al. 2023). ...
... In essence, the neural pathways associated with familiarity are modulated by DMT but are decoupled from a primary experience that would typically induce such a familiarity response. The misattribution of aspects of the psychedelic experience has been documented previously (Timmermann, Watts, and Dupuis 2022) and it is likely that DMT exacerbates this process due to the intensity of psychedelic effects it induces. The subjective effects of the psychedelic experience have been previously labeled as "epiphenomenal by-products" (Aqil and Roseman 2023;Olson 2021;Sanders and Zijlmans 2021); however, recent arguments caution against this approach and recommend valuing the phenomenological features in order to facilitate and/or potentiate therapeutic effects (Aqil and Roseman 2023;Breeksema and van Elk M 2021;Cherniak et al. 2022;Yaden and Griffiths 2021). ...
... The subjective effects of the psychedelic experience have been previously labeled as "epiphenomenal by-products" (Aqil and Roseman 2023;Olson 2021;Sanders and Zijlmans 2021); however, recent arguments caution against this approach and recommend valuing the phenomenological features in order to facilitate and/or potentiate therapeutic effects (Aqil and Roseman 2023;Breeksema and van Elk M 2021;Cherniak et al. 2022;Yaden and Griffiths 2021). The value of these subjective experiences and leveraging them in skillful psychedelic clinical practice is a complex matter and beyond the remit of this report [see (Timmermann, Watts, and Dupuis 2022) for further discussion]. ...
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This study investigated the sense of familiarity attributed to N, N-dimethyltryptamine (DMT) experiences. 227 naturalistic inhaled-DMT experiences reporting a sense of familiarity were included. No experiences referenced a previous DMT or psychedelic experience as the source of the familiarity. A high prevalence of concomitant features discordant from ordinary consciousness were identified: features of a mystical experience (97.4%), ego-dissolution (16.3%), and a "profound experience of death" (11.0%). The Sense of Familiarity Questionnaire (SOF-Q) was developed assessing 19 features of familiarity across 5 themes: (1) Familiarity with the Feeling, Emotion, or Knowledge Gained; (2) Familiarity with the Place, Space, State, or Environment; (3) Familiarity with the Act of Going Through the Experience; (4) Familiarity with Transcendent Features; and (5) Familiarity Imparted by an Entity Encounter. Bayesian latent class modeling yielded two stable classes of participants who shared similar SOF-Q responses. Class 1 participants responded, "yes" more often for items within "Familiarity Imparted by an Entity Encounter" and "Familiarity with the Feeling, Emotion, or Knowledge Gained." Results catalogued features of the sense of familiarity imparted by DMT, which appears to be non-referential to a previous psychedelic experience. Findings provide insights into the unique and enigmatic familiarity reported during DMT experiences and offer a foundation for further exploration into this intriguing phenomenon.
... When an idea or problem solution appears, it can produce a distinct and powerful phenomenology-a feeling of profound understanding and truth known as insight moments (Ohlsson, 1984;Metcalfe, 1986;Weisberg, 2006). This phenomenology may be a defining feature of psychedelic experiences (Garcia-Romeu et al., 2019;Watts et al., 2017), and could play a foundational role in how psychedelics (i.e., hallucinogenic 5-HT2A agonists) change beliefs (Timmermann et al., 2022;Laukkonen et al., 2020;. Psychedelics are increasingly recognised for their potential to restructure maladaptive beliefs underlying mental illness (Luoma et al., 2020;McCartney, McGovern, & De Foe., 2022a;Penn et al., 2021). ...
... The powerful mediatory role played by insight in cognition, beliefs, and behaviour is what motivates the current piece. In particular, the fact that insight moments can often be wrong or misleading due to cognitive or environmental factors (Grimmer et al. 2022a;Tulver et al. 2023;Webb et al. 2021), necessitates appraisal of how psychedelic-induced insights could also proliferate false or maladaptive beliefs (see Timmermann et al., 2022 for case studies of psychedelic-induced maladaptive, or potentially false, insights). We thus sketch a candidate framework for how psychedelics engender belief changes via soliciting insight moments. ...
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Psychedelics are recognised for their therapeutic potential and ability to re-orient beliefs. However, the prospect that psychedelics can induce false or maladaptive beliefs has been under- considered. Here, we review experimental work on false insights and false memories. We then connect this to insights and belief formation under psychedelics using active inference. We propose that the acute plasticity associated with psychedelics increases the quantity and precision of insights and thence beliefs, including false ones. We offer directions for future research in minimising epistemic harm during psychedelics. Ultimately, knowing how psychedelics solicit false insights and beliefs is crucial if we are to optimally leverage their therapeutic potential.
... When memories of prior trauma are activated in this process, without the development of new associations or effective reconsolidation, some users may even endure a form of "retraumatization" (52,76). Attention to appropriate therapeutic setting, support and integration may be pivotal in this regard, but some challenging trips may be just "bad" and have in some cases predicted negative long-term outcomes (22,35,38,77,78). We should work toward minimizing such drug reactions, but we should also work to destigmatize and reduce further shaming of individuals who have these challenging journeys. ...
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Introduction: The classic psychedelic psilocybin has attracted special interest across clinical and non-clinical settings as a potential tool for mental health. However, despite increasing attention to challenging psychedelic experiences, few studies have explored the relevance of emotionally painful, shame-related processes with psychedelic use. Methods: This prospective, longitudinal study involved sequential, automated, web-based surveys that collected data from 679 adults planning to use psilocybin in naturalistic settings at timepoints before and after psilocybin use. State and trait shame and feelings of guilt were collected using validated measures and assessed alongside other measurements of psychological health. Results: Participants were primarily college-educated, White individuals residing in the United States with a prior history of psilocybin use; mean age = 38.9-41 years. Most users (89.7%) described their experience of psilocybin as positive, though acute feelings of shame or guilt were commonly reported (i.e., 68.2% of users) and difficult to predict. Ratings of participant ability to constructively work through these feelings predicted wellbeing 2-4 weeks after psilocybin use. Psilocybin on average produced a small but significant decrease in trait shame that was maintained 2-3 months after use (Cohen’s dz = 0.37; adjusted p <0.001). Trait shame increased in a notable minority (29.8%) of participants. Discussion: The experience of self-conscious emotions with psychedelics has been explored minimally, but further study in this area may have far-reaching implications for psychological health. The activation of shame-related experiences with psychedelics may pose a unique and context-dependent learning condition for both therapeutic and detrimental forms of shame-related memory reconsolidation.
... The risks associated with the possibility of suggestive influences involved in the change of values highlight the need for epistemic responsibility, enhanced informed consent, and further inquiry into the wider epistemic and moral context for psychedelic use, as Smith and Sisti (2021), Langlitz et al. (2021), and Letheby (2021) have already advocated. Moreover, Timmermann et al. (2022) proposed psychedelic apprenticeship, entailing practices of intersubjective guidance, validation, and inquiry into the sometimes-controversial knowledge gained during psychedelic. This is also highly relevant for value changes. ...
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Psychedelic experiences have been shown to both facilitate (re)connection to one’s values and change values, including enhancing aesthetic appreciation, promoting pro-environmental attitudes, and encouraging prosocial behavior. This article presents an empirically informed framework of philosophical psychology to understand how self-transcendence relates to psychedelic value changes. Most of the observed psychedelic value changes are toward the self-transcendent values of Schwartz’s value theory. As psychedelics also reliably cause various self-transcendent experiences (STEs), a parsimonious hypothesis is that STEs change values toward self-transcendent values. I argue that STEs indeed can lead to value changes, and discuss the morally relevant process of self-transcendence through Iris Murdoch’s concept of “unselfing”. I argue that overt egocentric concerns easily bias one’s valuations. Unselfing reduces egocentric attributions of salience and enhances non-egocentric attention to the world, widening one’s perspective and shifting evaluation toward self-transcendent modes. Values are inherently tied to various evaluative contexts, and unselfing can attune the individual to evaluative contexts and accompanying values beyond the self. Understood this way, psychedelics can provide temporarily enhanced access to self-transcendent values and function as sources of aspiration and value change. However, contextual factors can complicate whether STEs lead to long-term changes in values. The framework is supported by various research strands establishing empirical and conceptual connections between long-term differences in egocentricity, STEs, and self-transcendent values. Furthermore, the link between unselfing and value changes is supported by phenomenological and theoretical analysis of psychedelic experiences, as well as empirical findings on their long-term effects. This article furthers understanding of psychedelic value changes and contributes to discussions on whether value changes are justified, whether they result from cultural context, and whether psychedelics could function as tools of moral neuroenhancement.
Background: There exists an underexploited opportunity to develop innovative therapeutic approaches to SUDs based upon the complementarity between modern and traditional health systems.Objectives: Illustrate the feasibility and potentiality of such an approach through the comprehensive description of Takiwasi Center's treatment model and program, where health concepts and practices from traditional Amazonian medicine work synergistically with modern psychotherapy and medicine in an intercultural dialog to assist in the rehabilitation of people suffering from SUDs.Methods: The description was built from a review of the literature, institutional data, participatory observation and unstructured interviews with staff, researchers and patients during treatment.Results: Since the foundation of the Takiwasi Center in 1992 in the peruvian Amazon, more than a thousand patients with different socio-cultural, ethnic and religious backgrounds have received residential treatment. We present how traditional Amazonian medicine techniques and health concepts cooperate to complement modern psychology in a therapeutic community setting and propose some hypotheses about the neurobiological, psycho-emotional and spiritual healing mechanisms triggered by the program to help people identify and heal the roots of their substance misuse and addictive behavior. We also summarize quantitative outcomes during treatment showing significant improvements in a wide variety of mental health indicators.Conclusion: Takiwasi Center's program is an option for people seeking non-conventional treatment who are sensitive to traditional Amazonian medicine practices and ready to explore the roots of their addiction. From this intercultural approach, some lessons could emerge toward a broader understanding of SUDs that may result in better patient care.
Psychedelic substances have a long history of use in traditional healing and religious ceremonies worldwide and are increasingly being investigated for their possible therapeutic usage. However, there is still a lack of consensus regarding how best to characterize the psychological effects of psychedelics and how they bring about the positive therapeutic outcomes observed in clinical studies. The aim of this article is to review available evidence from quantitative and qualitative studies on psychedelic-assisted therapy, as well as neurobiological studies, in relation to the hypothesis that psychedelics facilitate the emergence of emotionally charged unconscious material, originally proposed by pioneering psychedelics researcher Stanislav Grof. The reviewed process studies of therapeutic mechanisms in psychedelic-assisted therapy and qualitative studies of treatment participants clearly indicate that the psychedelic experience is associated with the subjective experience of having increased access to and awareness of emotions, memories, and perceptions that are normally avoided or outside of conscious awareness. Brain-imaging studies point to several different neurobiological effects of psychedelics that might be related to these subjective psychological experiences. Available evidence also indicates that this process might constitute an important therapeutic mechanism in psychedelic-assisted therapy, worthy of further investigation.
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A rapid review synthesizing published research on the possible therapeutic applications of psychedelics.
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Can the use of psychedelic drugs induce lasting changes in metaphysical beliefs? While it is popularly believed that they can, this question has never been formally tested. Here we exploited a large sample derived from prospective online surveying to determine whether and how beliefs concerning the nature of reality, consciousness, and free-will, change after psychedelic use. Results revealed significant shifts away from ‘physicalist’ or ‘materialist’ views, and towards panpsychism and fatalism, post use. With the exception of fatalism, these changes endured for at least 6 months, and were positively correlated with the extent of past psychedelic-use and improved mental-health outcomes. Path modelling suggested that the belief-shifts were moderated by impressionability at baseline and mediated by perceived emotional synchrony with others during the psychedelic experience. The observed belief-shifts post-psychedelic-use were consolidated by data from an independent controlled clinical trial. Together, these findings imply that psychedelic-use may causally influence metaphysical beliefs—shifting them away from ‘hard materialism’. We discuss whether these apparent effects are contextually independent.
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The use of psychedelics in the collective rituals of numerous indigenous groups suggests that these substances are powerful catalysts of social affiliation, enculturation, and belief transmission. This feature has recently been highlighted as part of the renewed interest in psychedelics in Euro-American societies, and seen as a previously underestimated vector of their therapeutic properties. The property of psychedelics to increase feelings of collective belonging and transmission of specific cultural values or beliefs raise, however, complex ethical questions in the context of the globalization of these substances. In the past decades, this property has been perceived as problematic by anticult movements and public authorities of some European countries, claiming that these substances could be used for "mental manipulation." Despite the fact that this notion has been widely criticized by the scientific community, alternative perspectives on how psychedelic experience supports enculturation and social affiliation have been yet little explored. Beyond the political issues that underlie it, the re-emergence of the concept of "psychedelic brainwashing" can then be read as the consequence of the fact that the dynamic through which psychedelic experience supports persuasion is still poorly understood. Beyond the unscientific and politically controversed notion of brainwashing, how to think the role of psychedelics in the dynamics of transmission of belief and its ethical stakes? Drawing on data collected in a shamanic center in the Peruvian Amazon, this article addresses this question through an ethnographic case-study. Proposing the state of hypersuggestibility induced by psychedelics as the main factor making the substances powerful tools for belief transmission, I show that it is also paradoxically in its capacity to produce doubt, ambivalence, and reflexivity that psychedelics support enculturation. I argue that, far from the brainwashing model, this dynamic is giving a central place to the agency of the recipient, showing that it is ultimately on the recipient's efforts to test the object of belief through an experiential verification process that the dynamic of psychedelic enculturation relies on. Finally, I explore the permanence and the conditions of sustainability of the social affiliation emerging from these practices and outline the ethical stakes of these observations.
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Psychedelic assisted therapy comprises three stages: Preparation, Psychedelic Session, and Integration. Preparation is key for maximising the potential of a beneficial psychedelic experience and integration is important for prolonging improvements. The psychological flexibility model (PFM) appears to be a promising one to guide psychedelic preparation and integration. This paper proposes a model that utilises the PFM as informed by a previously published qualitative study of patient accounts of change processes in psilocybin therapy that identified themes of acceptance and connection as associated with positive outcomes. This new model, the ACE (Accept, Connect, Embody) model presents the six psychological flexibility processes, renamed and rearranged in an acceptance triad (defusion, present moment focus, willingness) and a connection triad (self as context, values, committed action). This paper describes the ACE model and how it is being used in an ongoing trial of psilocybin treatment for major depression. It also describes qualitative evidence supportive of the idea that psychological flexibility may be key to characterizing the processes of change involved in psilocybin assisted therapy for depression. These and other results suggest that psilocybin may be specifically increasing psychological flexibility and point to the possibility that psychotherapy approaches incorporating the PFM may serve as a means to deepen and extend the benefits of psilocybin treatment, thus bridging the experiential gap between a potent inner experience and an outer life better lived.
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Although the effects of so-called "psychedelic" or "hallucinogenic" substances are known for their strong conditionality on context and the culturalist approach of hallucinations has won the favor of anthropologists, the vectors by which the features of visual and auditory imagery are structured by social context have been so far little explored. Using ethnographic data collected in a shamanic center of the Peruvian Amazon and an anthropological approach dialoguing with phenomenology and recent models of cognition of Bayesian inspiration, I draw here some leads in order to shed light on the nature of these dynamics that I call "socialization of hallucinations". Distinguishing two levels of socialization of hallucinations, I argue that cultural background and social interactions not only organize the relationship to the hallucinogenic experience, but also to its very phenomenological content. I account for the underpinnings of the socialization of hallucinations proposing candidate factors as the education of attention, the categorization of perceptions and the shaping of emotions and expectations. Considering psychedelic experiences in the light of their noetic properties and cognitive penetrability debates, I show that they are powerful vectors of cultural transmission. I question the ethical stakes of these observations, at a time when the use of psychedelic is becoming increasingly popular in the global North. I finally emphasize the importance of better understanding the extrapharmacological factors of the psychedelic experience and its subjective implications, and sketch out the basis for an interdisciplinary methodology in order to do so.
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Learning to see the invisible. Visionary learning and socialization of hallucinations in a shamanic centre in the Peruvian Amazon In the debate between Claude Lévi-Strauss and the Wasson couple, Claude Lévi-Strauss presents the hallucinogenic experience as strictly informed by culture. Although this thesis is widely shared by anthropologists, they have remained silent on how shared representations of a social group structure the effect of hallucinogens. This article aims to outline some ideas to shed light on the nature of this operation, which I propose to refer to as the “socialization of hallucinations”. To this end, I rely on ethnographic data collected in Takiwasi, one of the main shamanic centres in the Peruvian Amazon, which offers to an international clientele practices inspired by the region’s Métis shamanism, as the ritualized use of the psychotropic brew ayahuasca. The stereotypical nature of the visual hallucinations reported by the participants in these practices appears to be the result of a progressive learning process, the driving forces of which I am trying to analyse here. I thus show that the discursive and pragmatic interactions framing the consumption of hallucinogen gradually lead to the shaping of expectations and the education of the participant’s attention, whose visionary experience is thus organized according to the schemes proposed by the social group.
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Psilocybin is a classic psychedelic compound that may have efficacy for the treatment of mood and substance use disorders. Acute psilocybin effects include reduced negative mood, increased positive mood, and reduced amygdala response to negative affective stimuli. However, no study has investigated the long-term, enduring impact of psilocybin on negative affect and associated brain function. Twelve healthy volunteers (7F/5M) completed an open-label pilot study including assessments 1-day before, 1-week after, and 1-month after receiving a 25 mg/70 kg dose of psilocybin to test the hypothesis that psilocybin administration leads to enduring changes in affect and neural correlates of affect. One-week post-psilocybin, negative affect and amygdala response to facial affect stimuli were reduced, whereas positive affect and dorsal lateral prefrontal and medial orbitofrontal cortex responses to emotionally-conflicting stimuli were increased. One-month post-psilocybin, negative affective and amygdala response to facial affect stimuli returned to baseline levels while positive affect remained elevated, and trait anxiety was reduced. Finally, the number of significant resting-state functional connections across the brain increased from baseline to 1-week and 1-month post-psilocybin. These preliminary findings suggest that psilocybin may increase emotional and brain plasticity, and the reported findings support the hypothesis that negative affect may be a therapeutic target for psilocybin.
Sacred Knowledge is the first well-documented, sophisticated account of the effect of psychedelics on biological processes, human consciousness, and revelatory religious experiences. Based on nearly three decades of legal research with volunteers, William A. Richards argues that, if used responsibly and legally, psychedelics have the potential to assuage suffering and constructively affect the quality of human life. Richards’s analysis contributes to social and political debates over the responsible integration of psychedelic substances into modern society. His book serves as an invaluable resource for readers who, whether spontaneously or with the facilitation of psychedelics, have encountered meaningful, inspiring, or even disturbing states of consciousness and seek clarity about their experiences. Testing the limits of language and conceptual frameworks, Richards makes the most of experiential phenomena that stretch our conception of reality, advancing new frontiers in the study of belief, spiritual awakening, psychiatric treatment, and social well-being. His findings enrich humanities and scientific scholarship, expanding work in philosophy, anthropology, theology, and religious studies and bringing depth to research in mental health, psychotherapy, and psychopharmacology.
After a legally mandated, decades-long global arrest of research on psychedelic drugs, investigation of psychedelics in the context of psychiatric disorders is yielding exciting results. Outcomes of neuroscience and clinical research into 5-Hydroxytryptamine 2A (5-HT2A) receptor agonists, such as psilocybin, show promise for addressing a range of serious disorders, including depression and addiction.