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Experiences of psychedelic drug use among
people with psychotic symptoms and disorders:
Personal growth and mystical experiences
JOSEPH T. LA TORRE
1,2
p, JADE GALLO
3
,
MEHDI MAHAMMADLI
4
, DANIEL ZALEWA
5
and
MONNICA T. WILLIAMS
2,6
1
Department of Psychiatry and Behavioral Sciences, Center for Novel Therapeutics in Addiction
Psychiatry, University of Washington, School of Medicine, Seattle, WA, USA
2
School of Psychology, University of Ottawa, Ottawa, ON, Canada
3
Teacher’s College, Columbia University, New York, NY, USA
4
Laboratory for Psychedelic Clinical Research, School of Psychology, University of Ottawa, Ottawa,
ON, Canada
5
University of New Haven, New Haven, CT, USA
6
Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
Received: November 16, 2023 •Revised manuscript received: May 28, 2024 •Accepted: June 5, 2024
Published online: July 31, 2024
ABSTRACT
Individuals with a history of psychotic experiences and disorders such as schizophrenia, and mood
disorders with psychotic features tend to be excluded from psychedelic-assisted therapy research and
treatment programs, despite minimal research demonstrating heightened risk of adverse effects for this
group. Participants (n5100) were asked to complete an online, retrospective survey that asked about
psychotic experiences and/or diagnoses and one memorable psychedelic experience, along with mental
health histories, dose used, set and setting, and other relevant variables including whether they mixed
their psychedelic with other substances. Respondents also completed pertinent psychometric ques-
tionnaires and answered questions regarding the impact of their psychedelic experience on their well-
being, mental health, relationships, spiritual beliefs, and aspects of their life. Thematic inductive analysis
was used to identify recurring themes. Most respondents (n588) stated that their psychedelic expe-
rience resulted in some degree of personal growth. Many also described mystical-type experiences,
increased levels of contemplation and spirituality, improved insight, symptomatic improvements, and
feelings of love and appreciation following the experience. Most described overall positive experiences,
however, 11% (n511) described overall negative experiences, which included symptom exacerbation,
dysphoria, and terror, and a slightly larger portion described mixed-type experiences.
KEYWORDS
psychosis, schizophrenia, psychedelic-assisted therapy, psychotic disorder, bipolar, first episode psychosis,
trauma, psychedelics, MDMA, psilocybin, LSD, qualitative research, phenomenology
EXCLUDING THOSE WITH PSYCHOSIS FROM PSYCHEDELIC RESEARCH
Today, individuals with histories of psychotic experiences and conditions are regularly
excluded from clinical research with psychedelic compounds, despite a lack in modern
findings demonstrating an increased safety risk for this population (La Torre, Mahammadli,
Faber, Greenway, & Williams, 2023). To understand why, it is crucial to revisit the first wave
of psychedelic research—a time characterized by a fervent pursuit of researching how psy-
chedelics could assist in psychotherapeutic processes during the early to mid-twentieth cen-
tury until the War on Drugs called such research to a close (Dyck, 2008;Swanson et al., 2018).
Journal of Psychedelic
Studies
8 (2024) 3, 357–367
DOI:
10.1556/2054.2024.00348
© 2024 The Author(s)
ORIGINAL RESEARCH
PAPER
pCorresponding author. Department of
Psychiatry and Behavioral Sciences,
Center for Novel Therapeutics in
Addiction Psychiatry, University of
Washington, School of Medicine,
Seattle, WA, USA.
Tel.: þ1 343 463 0116.
E-mail: jlato009@uottawa.ca
Throughout these years, a great deal of research was con-
ducted, including trials examining LSD and mescaline ther-
apy for individuals with schizophrenia, however, findings
were highly varied, possibly due to lack of scientific rigor
(Rucker, Iliff, & Nutt, 2018).
Indeed, scholars agree that research carried out during
the first wave of psychedelic research often lacked standard
methodological elements such as being double-blind,
incorporating psychometric testing and control groups, and
usually leaving out key information in publications such as
dose used, and descriptions of protocols (Rucker et al.,
2018). During this era, psychiatric diagnoses were also
conceptualized differently, and people diagnosed as
‘schizophrenic’during this period, may not have been
diagnosed as such today, making it difficult to draw con-
clusions from this older body of research. Furthermore,
many of the studies from this time were unethical,
frequently following no proper structure regarding dosage,
frequency of administration, nor providing follow-up care
(e.g., Strauss, de la Salle, Sloshower, & Williams, 2022).
Early psychedelic experiments were also conducted on
unwilling participants at times, namely BIPOC who were
incarcerated, and people who were hospitalized for mental
health reasons, with some researchers irresponsibly adminis-
tering extremely high doses of LSD to participants in inap-
propriate set and settings (Dore et al., 2019;La Torre et al.,
2023;Strauss et al., 2022). Additionally, it was during this time
that psychedelics were modeled as ‘psychotomimetic’,or
drugs that mimicked psychotic symptoms in users, which in
turn led to the idea that individuals with histories of psychosis
may experience symptomatic exacerbation as a result of
psychedelic drug administration (Swanson, 2018). Campaigns
and propaganda from the War on Drugs however may have
held the most significance in preventing the scientificpursuit
of exploring psychedelic therapy for individuals with psy-
chotic disorders by promoting the notion that drugs such as
LSD are dangerous and cause people to go “insane”(Carhart-
Harris & Goodwin, 2017;Dyck, 2008;Friesen, 2022).
While data and information on psychedelics and psy-
chosis from this time tended to be problematic, some recent
research has come to light that documents the occurrence of
psychedelic-induced psychosis as a rare but possible risk of
psychedelic use. A study published by Evans et al. (2023)
describes a range of challenging experiences individuals can
have following naturalistic psychedelic dosing experiences,
such as diverse physiological reactions and adverse effects, as
well as psychological, emotional, and spiritual issues like
existential crisis, psychotic episodes, and depressive episodes.
In the sample of 608 individuals, only 5% (29 individuals)
reported a sense of going through a psychotic episode
following psychedelic drug use, making it the rarest adverse
event out of all those reported. At the same time, an epide-
miological study of naturalistic psychedelic use in Norway
found that among individuals with mental health diagnoses,
those with psychosis reported a worsening of their condition
the most from their use (7.7%), further highlighting potential
issues for this population, particularly when psychedelics are
used recreationally (Kvam et al., 2023).
Taken as a whole, it is possible that some individuals
with psychotic conditions and experiences could benefit
from psychedelic-assisted therapy (PAT), particularly when
the protocol is highly supportive (La Torre et al., 2023). This
would not be unfounded considering that in some Indige-
nous societies, people with psychotic tendencies, such as
having belief in supernatural phenomena or experiences of
novel perception such as voice-hearing, often partake in
psychedelic plant ceremonies (Bathje, Majeski, & Kudowor,
2022). Some may also even hold roles as shamans and cer-
emony leaders due to the belief that such individuals hold
unique spiritual abilities, rather than being seen as patho-
logically ill like in Western society (Winkelman, 2021).
Furthermore, it is important to acknowledge the impact
of excluding people with psychotic conditions from psy-
chedelic research negatively affects several highly vulnerable
communities including individuals who have psychotic dis-
orders comorbid with difficult-to-treat anxiety, depression,
PTSD, and other problems. While PAT may be able to
resolve many other symptoms these individuals have, the
possibility of having a concurrent psychotic disorder makes
it unlikely for them to be enrolled in psychedelic clinical
research or future psychedelic treatment programs. Although
not a classic psychedelic, some research reports individuals
with these conditions responding well to ketamine, sug-
gesting that it may be worthwhile to carry out more psy-
chedelic research for this group. In particular, Ekstrand et al.
(2022) found that administering ketamine to a sample of
individuals with depression, which included participants
with psychotic features and/or psychotic symptoms, resulted
in statistically significant decreases on the Montgomery
Åsberg Depression Rating Scale (MADRS) with no occur-
rences of psychotic symptom exacerbation being reported.
Another study by Ye and colleagues (2005) found similar
findings with administering ketamine to individuals with
chronic schizophrenia, significantly reducing scores on both
the Calgary Depression Scale for Schizophrenia (CDSS) and
the Positive and Negative Syndrome Scale (PANSS).
Aside from these studies and instances of clinicians
exploring PAT for psychosis in clinical non-research settings,
investigating psychedelic treatment is nearly nonexistent for
this population (Ekstrand et al., 2022; Ye et al., 2005). The
widespread exclusion of this group also has a direct impact on
Black and Latinx Americans, who are overdiagnosed with
psychotic disorders at a rate twice that of White Americans
and therefore are being systematically excluded from the psy-
chedelic movement (Akinhanmi et al., 2018;Faber, Khanna
Roy, Michaels, & Williams, 2023;Muroff, Edelsohn, Joe, &
Ford, 2008). Indeed, it is highly likely that this overdiagnosis is
one of the many contributing factors that plays a significant
role in the demographic imbalance being observed in psyche-
delic research today alongside racial bias, and barriers created
by systemic racism (De la Salle, Davis, Gran-Ruaz, Davis, &
Williams, 2022;Fogg, Michaels, de la Salle, Jahn, & Williams,
2021;George, Michaels, Sevelius, & Williams, 2020).
With all of this considered, more research must be
conducted to determine the overall benefit-to-risk ratio of
PAT for individuals with psychotic symptoms and disorders.
358 Journal of Psychedelic Studies 8 (2024) 3, 357–367
METHOD
Study design
The study employed a mixed method, cross-sectional,
retrospective survey design, which was phenomenological
and epidemiological in nature. Recruitment included posting
recruitment ads specifying the study’s purpose, inclusion,
and exclusion criteria and occurred over approximately nine
months. Following collection, data was cleaned and analyzed
using thematic inductive content analysis to produce themes
and exemplary quotes. Statistical observations that captured
relevant data regarding changes or lack of changes after
psychedelic use regarding drug use, growth, cognition,
spirituality, and behavior were also reported.
Procedure
Participants in the study were recruited from various social
media platforms such as Instagram, Facebook, and TikTok,
with the primary source being Reddit, and more specifically,
Reddit sub-communities (also known as ‘subreddits’)
focused on distinctive themes related to psychotic disorders
or symptoms, psilocybin, LSD, and other relevant topics.
Recruitment ads with a characterization of the study goals,
inclusion and exclusion requirements, such as having a
disorder that features psychotic symptoms such as bipolar
disorder, psychotic depression, psychotic personality disor-
ders, or experiences that resemble symptoms such as
perceptual distortions, and psychotic experiences and a link
to a Qualtrics
TM
(Provo, USA) survey, were posted regularly
and frequently. Upon clicking the link, participants were
asked to provide informed consent that had to be affirmed
before proceeding.
If respondents indicated that they were not at least 18
years old, never diagnosed with a psychotic disorder or re-
ported a history of psychotic experiences, or never had at
least one psychedelic experience, they were not permitted to
participate in the survey and were redirected to a page
thanking them for their time and explaining their ineligi-
bility to participate. When participants met criteria, they
were asked to report demographic information, mental
health history, information regarding their psychedelic use,
phenomenological information such as mystical elements of
their experience, and other variables of interest such as dose,
features of their set and setting, etc. Using a survey from
Williams et al. (2021) as a template, participants were asked
to keep in mind one memorable psychedelic experience and
complete the survey with this experience in mind. Upon data
collection, the research team met regularly to clean the
dataset, and perform analyses (approved university ethics
file number: H-03-22-7959).
Analysis
The methodology of this paper is a qualitative one with
statistical observations providing supplemental information.
Qualitative analyses utilized an inductive content approach
centered on inductive thematic analysis (Elo & Kyngäs,
2008;Hsieh & Shannon, 2005). With this approach,
respondent data were examined, and common themes were
produced to understand patterns in reports. The analytical
procedure ensured that at least two researchers coded
respondent statements for accuracy; exemplar quotes, the-
matic titles, and descriptions that best represented the
overall sample were selected collectively and subsequently
placed into table format.
Throughout the process of analysis and coding, research
assistants met regularly with the Principal Investigator to
discuss agreement and disagreement regarding overarching
themes, and exemplar quotes. Reaching consensus regarding
analyses was a dialectical endeavor that involved careful
examination of the dataset and in-depth discussions of
participant responses. To ensure validity, coding guidelines
were established following a preliminary review of the data,
during which potential themes were identified. Independent
cross-checking was also built into the process with at least
one research member independently reviewing results. Data
saturation was informed by two models: theoretical satura-
tion and inductive thematic saturation (Saunders et al.,
2018). No novel themes appeared after the second phase of
data collection and so recruitment ended.
Reported statistical observations were selected based
on relevance to the research questions, namely what pro-
portion of individuals reported personal growth due to
their psychedelic experience, distributions and averages of
pertinent measures, percentage of individuals who were
comfortable vs. uncomfortable in their environment during
their experience, diagnostic data, and reported substance
use. Other relevant scores and quantitative data indicative
of changes in cognition, spirituality, and behavior are
also reported. Frequency of adverse events were reported
based on open-ended qualitative responses throughout the
survey.
Measures
The survey comprised items from multiple validated tools,
including a survey developed for investigating psychedelic
experiences among individuals with racial trauma by Wil-
liams et al. (2021), select items from the Mystical Experi-
ences Questionnaire-30 question (MEQ-30; Pahnke, 1969),
and the Community Assessment of Psychic Experiences
(CAPE-42; Stefanis et al., 2002).
Psychedelic use survey. This survey was developed by
Williams et al. (2021) to understand how BIPOC use
psychedelics to treat racial stress and trauma. The survey
begins by asking the respondent to hold in their mind a
single memorable psychedelic experience, and then to
answer questions related to the type of psychedelic taken,
dosage, and method of consumption, followed by ques-
tions about other substances that individuals may have
been under the influence of at the same time either pre-
scribed or recreationally. The measure was adapted for
this study to inquire specifically about psychedelic use
among individuals with histories of psychotic experiences
and disorders.
Journal of Psychedelic Studies 8 (2024) 3, 357–367 359
Community Assessment of Psychic Experiences (CAPE-42).
The Community Assessment of Psychic Experiences (CAPE-
42; Stefanis et al., 2002) is a validated psychometric tool that
explores psychotic-like experiences in a self-report fashion.
The survey consists of 20 questions regarding positive
symptoms of psychosis, and 22 questions related to negative
and depressive symptoms for a total of 42 questions. The
CAPE-42 was not completed by the entire sample as its use
was discontinued upon recognizing that it was highly time-
consuming and too broad. As such, analyses included only
individuals who completed items on the CAPE-42 that
captured experiences that are explicitly psychotic in nature
(see Appendix A), and a short 7-item psychotic experience
checklist took its place approximately half-way through data
collection (see Appendix B).
Mystical Experiences Questionnaire-30 (MEQ-30). The
study implemented a condensed 11-item version of the
Mystical Experience Questionnaire (MEQ-30; Pahnke, 1969)
(see Appendix C), a measure that has been validated to
evaluate the phenomenology of feelings, thoughts, and ob-
servations related to mystical-type psychedelic experiences
in research (Griffiths, Richards, McCann, & Jesse, 2006). To
enhance participant comprehension and reduce survey
duration, slight modifications were made to the wording of
the MEQ-30 items. For instance, “Loss of your usual sense of
time”was adapted to “I lost my sense of time.”Furthermore,
only a subset of items was used from each of the four factors.
Additionally, the Likert scale was modified to a ten-point
scale for greater sensitivity to variations in participant re-
sponses. We refer to our condensed version of the MEQ-30
as the MEQ-mini.
Survey variations
As alluded to above, the present study utilized two slightly
different surveys to collect data from participants. Specifically,
the CAPE-42 psychotic experience questionnaire was dis-
continued in the second version of the survey due to being
highly time-consuming and contained several items that were
not clearly indicative of psychotic experiences such as having
spiritual beliefs and feeling low mood. Approximately half-way
through data collection, use ofthe CAPE-42 was discontinued,
and a short 7-item checklist of typical psychotic experiences
was provided for respondents to select from instead.
The improved survey also asked participants about their
reason(s) for taking the psychedelic, whether they were
experiencing an actively psychotic episode at the time of
dosing, the state of their symptoms during the psychedelic
experience, whether they got better or worse, how they felt
immediately after the experience, and relevant details. The
survey also included a range of minor revisions, such as
allowing participants to skip any item they wished and
changing some wording for clarity and specificity. These
changes significantly reduced the time required to complete
the survey from 45–60 min to 15–20 min. The revised survey
was completed by participants #1-59 in the dataset, and the
first iteration was completed by participants #60-100 (see
Supplementary materials D and E).
Data cleaning
Any survey that took less than 90 s was immediately
removed from the dataset as we expected that any partici-
pant completing the survey within this time may not have
responded accurately. Next, we removed any participant
who did not complete a significant portion of the survey,
which was approximately less than 70% of the most
important questions in the survey. No remaining participant
took less than 8 min to complete the survey. Participants
who did not report psychotic experience as operationalized
in the study or psychotic condition were removed from the
dataset.
We chose to include two groups in our study: (1) in-
dividuals with psychotic-type symptoms and experiences as
defined by DSM-5 criteria and the four major psychotic
symptom domains (i: delusions; ii: hallucinations; iii: nega-
tive symptoms; iv: thought/language disorder); and (2) in-
dividuals who have received a diagnosis of a psychotic
disorder. Participants who reported diagnoses, as seen in
Table 2, were coded in one of the following ways: PSD
(Psychotic Spectrum Disorder), PMD (Psychotic Mood
Disorder), PPD (Psychotic Personality Disorder), OPD
(Other Psychotic-like Disorder), and UPD (Unspecified
Psychotic Disorder).‘PSD’was operationalized as including
typical psychotic spectrum disorders such as schizophrenia,
first episode psychosis, brief psychosis, and drug-induced
psychosis. ‘PMD’was operationalized as mood disorders
that may feature psychotic psychopathology such as major
depressive disorder with psychotic features, and bipolar
disorder. ‘PPD’was operationalized as a personality disorder
that features psychotic-type symptoms such as schizotypal
personality disorder. ‘OPD’included diagnoses that were not
previously mentioned but featured psychotic-like experi-
ences such as hallucinations, derealization, and other similar
experiences such as borderline personality disorder, disso-
ciative disorder, and psychosis not otherwise specified.
‘UPD’included any response that said they were diagnosed
with a psychotic disorder but did not select which one or
provide a specified diagnosis.
Few participants completed the survey with blatant in-
consistencies and/or nonsensical entries; these and similar
entries were also deleted during the cleaning process. In
addition, responses to the survey question asking about dose
were adjusted based on the guidelines: For LSD, this was
100ug or below as ‘low’; 200ug as ‘medium’; and 300ug þas
‘high.’For psilocybin mushrooms this was 1–2g as ‘low’;
2.1–3.5g as ‘medium’; and 3.5g þas ‘high’. 8% of the sample
did not clearly specify their dose and 3% did not provide an
answer regarding their dose.
RESULTS
Participants
The study consisted of 100 respondents (see Supplementary
material D and E for more details). Details pertaining to
360 Journal of Psychedelic Studies 8 (2024) 3, 357–367
participant demographics and mental health histories were
reported as follows (Table 1).
Table 2 illustrates participant reports of psychotic di-
agnoses or disorders that feature psychotic symptoms
according to the categories outlined above. It is important to
note that not all respondents were diagnosed with a psy-
chotic disorder, and at the same time, some participants
endorsed having more than one psychotic disorder. The
table also illustrates psychotic experiences reported by par-
ticipants in the survey. Many reported having two or more.
In terms of religious/spiritual affiliation, 49% (n549) of
participants reported being religious and/or spiritual, 35%
(n535) reported not being religious/spiritual, and 16%
(n516) reported “other,”usually identifying their specific
tradition in the open response section. The age of partici-
pants ranged from 18 to 62, with the average age being
28.5 (SD 59.76).
Descriptive statistics. Out of the 100 respondents, re-
spondents reported using a variety of psychedelics (see
Supplementary material D). Specifically, 43% (n543) re-
ported using psilocybin, 38% (n538) reported using LSD,
6% (n56) reported using ketamine, 8% (n58) reported
mixing a psychedelic with another psychedelic or MDMA,
2% (n52) reported using DMT, 1% (n51) reported using
ayahuasca and 1% (n51) reported using 2-BOH-CB, a
phenethylamine in the 2-CB family, which generates expe-
riences like psilocybin and LSD (Shulgin & Shulgin, 1990).
Personal growth and setting. 60% (n560) of individuals
reported that their experience resulted in personal growth,
28% (n528) of individuals reported that it somewhat
resulted in personal growth, 9% (n59) of individuals re-
ported that it did not result in personal growth, and 3%
(n53) did not answer (see Supplementary material E). 86%
(n532) of those who used LSD reported some degree of
personal growth, and 92% (n538) of those who used
psilocybin reported some degree of personal growth.
Out of the eight respondents who reported not experi-
encing personal growth, 37.5% (n53) had used psilocybin,
50% (n54) had used LSD, and 12.5% (n51) had used
MDMA. 100% (n54) of those who reported no personal
growth and using LSD reported not being fully comfortable
in their setting (with three indicating ‘somewhat comfort-
able’and one responding ‘no’) in addition to mixing their
psychedelic or MDMA with other substances. The individ-
ual who used MDMA and reported no personal growth
was uncomfortable in their setting. The three who used
psilocybin and reported no growth reported being fully
comfortable in their setting.
No reports indicated that use was conducted under su-
pervision in the context of a clinical trial or with the pres-
ence of a therapist or clinician. A large portion however
directly described naturalistic or recreational use.
MEQ scores. 58 respondents completed all 11 items selected
from the MEQ-30 that the research team chose to incor-
porate into the survey (see Appendix C). Individual total
scores ranged from 1.45 to 10 (range: 0–10), with an average
score of 7.1 (SD 52.00). Out of the 58 respondents, 49
(84.48%) scored higher than an average total score of 5, 20
(34.48%) scored higher than 8, and 9 (15.52%) scored higher
than 9. 22 respondents who used LSD completed the MEQ-
mini that was given, and the average (mean) score produced
was 7.11 (SD 51.97). The average (mean) score was also
7.11 (SD 52.01) for the 24 respondents who reported psi-
locybin use.
Reported changes. Psychological, spiritual, emotional, and
behavioral changes were captured by a range of items
throughout the survey. 67% of the respondents (n567)
reported experiencing deeper levels of spirituality or
Table 1. Participant demographics
Variable Frequency Percentage%
Race White 76 76%
Black 3 3%
Asian 3 3%
Middle Eastern 1 1%
Indigenous 4 4%
Hispanic/Latinx 6 6%
Pacific Islander 1 1%
Mixed Race 6 6%
Gender Male 51 51%
Female 36 36%
Transgender 7 7%
Two Spirit 2 2%
Nonbinary 3 3%
N/A 1 1%
Sexuality Heterosexual 50 50%
Bisexual 31 31%
Pansexual 2 2%
Gay/Lesbian 6 6%
Queer 7 7%
Other 3 3%
Prefer Not to Say 1 1%
Age Range 18–29 69 69%
30–39 19 19%
40–49 9 9%
50–59 2 2%
60–69 1 1%
Table 2. Participant diagnostics
Psychopathology Frequency Percentage%
Diagnosis PSD 34 34%
PMD 35 35%
PPD 6 6%
OPD 9 9%
UPD 5 5%
N/A 13 13%
Symptoms Delusions 98 98%
Hallucinations 73 73%
Negative Symptoms 81 81%
Other 4 4%
Journal of Psychedelic Studies 8 (2024) 3, 357–367 361
contemplation after their experience. 13% (n513) did not
report an increase, 17% (n517) reported no change in their
spirituality or contemplation levels, and 3% (n53) did not
provide an answer to this question.
51% of respondents (n551) reported a better under-
standing of past events, memories, or traumatic experiences
that played a significant role in their lives. In comparison,
29% (n529) answered that they did not, and 19% (n519)
responded, “Somewhat.”
Out of the 77 participants who completed the small
2-item subscale on feelings of love and appreciation
following their psychedelic experience, the mean average
score was 6.25 (range: 0–10; SD 53.02) with 65% scoring
higher than a 5, 48% higher than a 7, and 21% a 10.
75 respondents answered the item asking them to rate
how much their experience helped them feel more resilient
towards life failures (0–10). 66 scored a five or higher,
53 scored a seven or higher, and 22 scored a 10. The mean
average was 6.69 (SD 53.05).
Themes
Participants were asked, “Did your psychedelic experience
result in personal growth?”and were allowed to select “Yes,”
“No,”“Somewhat,”or choose not to answer. They were
subsequently prompted to elaborate on their answer in
100 words or less. 97 participants answered the multiple-
choice part of the question, and 75 of the 100 provided
additional details in the qualitative follow-up open response.
Two or more researchers coded the responses and found
common themes among the sample, including (1) increased
insight and perspective shift, (2) mystical, spiritual, and
religious experiences, (3) improved mental and emotional
well-being, (4) increased appreciation, (5) empathy and re-
lationships, (6) better version and growth, (7) acceptance and
self-love, and (8) negative and mixed-type experiences.
Saturation was determined to be reached based on theoretical
reasoning and thematic induction analysis. This combinato-
rial approach found consistent reporting of positive, mixed,
and negative experiences, and more specific themes recurring
in a predictable and pattern-like fashion (Table 3).
Increased insight and perspective shift. One major theme
respondents described was increased insight, gaining
newfound knowledge, and a shift in perspective that often
led to improved self-awareness. Many statements such as
these were observed in participants and included experi-
encing personal growth due to changes in their outlook or
within themselves and the world around them, seeing
themselves for who they truly were, and becoming more
introspective.
Mystical, spiritual, and religious experiences. Another
significant theme was that respondents’psychedelic experi-
ences featured mystical, spiritual, and religious elements.
These responses involved testimonies describing a range of
experiences, such as interconnectedness, unity, an increase
in one’s faith or religious beliefs, transcendence, enhanced
sensory awareness, and ineffability. These and other similar
statements are representatives of a theme that encapsulates a
deepening of spirituality and faith in a greater power,
mystical experiences such as being interconnected with
other beings and the universe, feeling as if their psychedelic
experience was indescribable, and more.
Improved mental and emotional well-being. Another theme
among participants was related to improvement in overall
emotional and psychological health. This theme emphasized
newfound insights about the importance of caring for oneself
and one’s emotional and mental health. Respondents
frequently reported insight into their maladaptive coping
mechanisms and how modifying such patterns can lead to a
more satisfied life. Further, some participants reported
decreased positive symptoms such as lessened hallucinations
and feeling less paranoid. Several participants also reported
feeling significantly less stress and anxiety after their expe-
rience, and several reported decreased suicidal ideation.
Increased appreciation. Increased appreciation was another
theme that occurred across the responses. These reports
centered around appreciating and valuing the various as-
pects of life, feeling a newfound appreciation of life and/or
nature, and recognizing the beauty of life. Participants
describing these experiences also reported feeling grateful for
personal relationships, having an increased sense of purpose,
appreciating more experiences and opportunities, and
acknowledging the positive aspects of life.
Empathy and relationships. A less prominent but still
widely reported theme was empathy and personal relation-
ships. Several participants described realizing ways they were
engaging in relationships, and how their psychedelic expe-
rience generated increased empathy, heightened emotional
intelligence, and care for others. Some participants also
described being to recognize faults in their relationships and
ways to move forward.
Better version and growth. Another less common theme
was the better version and growth of an individual, where
testimonies from participants centered around personal
development, self-improvement, and/or feeling like oneself
again. This theme was established from expressions of self-
reflection, goals, aspirations, and taking steps toward bet-
tering oneself.
Acceptance and self love. The final positive theme discov-
ered was that of acceptance and self-love where participants
expressed acceptance of oneself, reality, the world, and
things beyond control, as well as compassion for oneself and
self-love. Themes related to acceptance varied with some
participants reporting acceptance of death, self-acceptance,
and accepting their fear and pain. Some also described
increased self-compassion.
Negative and mixed-type experiences. While most partici-
pants reported overall positive psychedelic experiences that
resulted in personal growth, mystical-type experiences, and
increased insight, several individuals reported that their
362 Journal of Psychedelic Studies 8 (2024) 3, 357–367
Table 3. Qualitative responses describing growth or lack of growth from reported psychedelic experience
Theme Description Exemplar quotes
Increased Insight and
Perspective Shift
Psychedelic use led to increased understanding,
insight, self-awareness, more objective thinking
and viewing of the world, increased
introspection, spawned realizations, learning
life lessons, and/or shift in perspective
P10: I saw myself as I really was
P42: I realized how I want to be happy and how to let go
of things that bother me
P65: I felt I was able to see perspective on certain
situations clearer…
P90: [it] made me a lot more introspective in the long run
Mystical, Spiritual, and
Religious Experiences
The psychedelic experience resulted in becoming
religious, seeing things as temporary, seeing
everyone as one, a feeling of interconnectedness
with the world, similar transcendent
experiences, unable to explain in words and
experiences of ineffability.
P33: There is control beyond our understanding
P22: [I] became religious…
P87: I have changed since then, feeling more of a “one-
ness”with all other living beings, more mindful of how
my own thoughts affect me and how my actions affect
others and myself
P55: I’ve learned many valuable life lessons that I can’t
put into words
Increased Mental and
Emotional Wellbeing
Reports of symptomatic relief in domains such as
rumination, overthinking, catastrophizing,
suicidality, and hallucinations, increased joy/
peace/calmness, and decreased fear of death
P20: I felt I understood things more and I also chose not
to kill myself (during the trip) so I chose life
P12: I feel like my mind has started expanding a little bit,
taking me out of rumination and constant loops and
catastrophizing
P64: It helped me realize that it’s okay that fear and pain
are a part of me. It let me connect with the traumatized
part of myself and feel compassion for myself which I
hadn’t done before. It was one of the only times that
crying felt liberating instead of shameful
Increased Appreciation Increased feeling of life, appreciation for life,
increased appreciation for nature, mentioning
increased possibilities in the world
P47: …it made me really appreciate the life I have and
being sober
P63: It turned me away from pessimism and nihilism and
materialism. And find value and beauty in all things,
especially nature
P90: …made me much more appreciative of nature
Empathy and
Relationships
Becoming more caring, wanting to help people,
more consideration for others, understanding,
focus on external relationships
P23: I realized I had a deep far reaching empathy that I
did not realize I had and I realized how I have been
neglecting personal relationships
P52: I felt more open to forgiving my husband…
P32: Eventually it lead to me realizing I was the problem
in my own relationship and changing who i was for the
better
Better Version and Growth Individuals describe becoming better versions of
themselves, feeling more like themself,
mentioning specifically ‘growth’, and feeling
compassion for myself
P6: I think I was able to tap into and be a better version of
myself. At least for the moment
P16: I’m just a better person than I was 2 years ago
P19: ….I always grew a little bit from each [psychedelic]
experience in some way
Acceptance and Self-love Acceptance of self, acceptance of one’s reality,
acceptance of the world, acceptance of things
beyond control, loving oneself, and self-love
P53: More self-acceptance and acceptance of my
experiences.
P95: I realized I had a lot of love in me, including for
myself (I never tapped into the latter previously)
P44: I think it helped me be more in the moment and
accept whatever comes in life which has been very
useful so far
Negative and Mixed-type
Experiences
Reports of negative experiences, terror, fear,
symptom exacerbation, beliefs that use led to
permanent damage, drug misuse/abuse, and
various other adverse effects that are either
reported alone, or alongside statements of
positive growth and change
P24: It has made me realize the patterns and problems in
my life. I wouldn’t be aware of them if I didn’t take
drugs. However, it also made me really too self-aware
in a crazy level, made some of my symptoms stronger
such as intrusive unwanted thoughts and guilt
P68: It has made me completely dependent on someone
else. Unable to trust reality and my mind to grasp
what’s true.
P78: [I] gained [a] permanent trip, Lost suicidal ideation.
Growth in some ways hinders others.
Journal of Psychedelic Studies 8 (2024) 3, 357–367 363
experience‒in part of in whole‒was challenging, negative,
and harmful. Some described experiences of terror and
dysphoria, with two stating that their psychedelic experience
catalyzed or caused their psychosis. Some reported that
during their psychedelic experience, they believed they were
dying, while others stated they thought they would never
become sober again. Reports also included the belief that
their psychedelic experience caused irreversible damage.
DISCUSSION
Overall, psychedelic clinical trials continue to exclude in-
dividuals with personal or familial histories of psychopath-
ological psychotic experiences and disorders, despite a lack
of evidence demonstrating that psychedelic treatment may
not be beneficial to this group. A cross-sectional survey was
designed to ask individuals with psychosis and psychotic
disorders about their psychedelic use to determine if there
may be reason to implement or avoid psychedelic care and
research in this group. Results indicate that individuals
with psychotic experiences and conditions use various psy-
chedelic drugs naturalistically with diverse outcomes
and most of the sample reported that their psychedelic
experience resulted in some personal growth. Many
also report mystical-type experiences, increased insight,
improved mood, appreciation for life, and symptomatic re-
lief, although a small portion reported negative experiences.
An initial analysis shows that negative experiences (oper-
ationalized as respondents that said their psychedelic expe-
rience did not result in personal growth) seems to be
associated with concomitant drug use and/or use in unfa-
miliar or uncomfortable settings. In particular, of the 8 re-
spondents that reported not experiencing personal growth
from their psychedelic experience, 6 (75%) fell into one or
both of these categories. However, further more robust
statistical testing must be done to verify the possibility of a
correlation between these variables and experiences.
Statistical observations
The study collected data from a total of 100 participants with
psychotic experiences and/or disorders, demonstrating that
psychedelic drugs are used by this population. Of the 100,
43% (n543) reported using psilocybin mushrooms, 38%
(n538) reported using LSD, 8% (n58) reported mixing a
psychedelic with another psychedelic or MDMA, 6% (n56)
reported using ketamine, 2% (n52) reported using DMT,
1% (n51) reported using ayahuasca, and 1% (n51) re-
ported using 2-BOH-CB (see Supplementary material D).
Regarding personal growth, minimal variation was
observed across drug categories with 86% (n532) of those
who used LSD reporting some degree of personal growth
resulting from their experience compared to 92% (n538) of
those who used psilocybin mushrooms. Of the 8 who re-
ported no growth from their experience, 4 reported using
LSD, 3 reported using psilocybin mushrooms, and one re-
ported MDMA, suggesting that LSD could be associated with
more negative experiences in this population, however more
research must be carried out to make this determination.
Average scores from the MEQ-mini demonstrated that
moderately intense mystical-type experiences were relatively
common, with an average total score of 7.1 (SD 52.00)
among the 58 who completed all items. Furthermore, 70%
(n570) of participants reported that their psychedelic
experience helped them to process traumatic events and
memories while 67% (n567) reported a deepening of
spirituality or contemplation following their experience.
More than 60% also indicated that their experience resulted
in increased feelings of love and appreciation, and improved
resilience against life challenges.
Thematic analysis
Thematic analysis indicates that the sample primarily
experienced positive experiences, which featured moments
of insight, increased awareness, spiritual and mystical ex-
periences, improved mood, heightened empathy, disruption
of maladaptive behaviors, appreciation of life, personal
growth, self-love and appreciation, and improved relation-
ships. At the same time, several individuals reported expe-
riencing euphoria and insight accompanied by distressing
moments, which were described as adverse and mixed ef-
fects, replicating findings from (Morton et al., 2023). These
trends suggest that psychedelic experiences reported by this
sample may occur along a spectrum and continuum, and are
suggestive of the non-binary nature of such experiences.
More research must be done to determine whether this
population experiences negative and mixed experiences at a
greater rate or frequency compared to other diagnostic
groups, as well as if negative effects and consequences are
more severe.
Study limitations
The study has several limitations. For one, the study is
somewhat limited in terms of diversity, given that ethno-
racial diversity is limited and that significantly more in-
dividuals describe positive symptoms of psychosis than
negative symptoms. In addition, it is worth noting that the
sample may not represent the broader population, given that
those who took the time to respond to the survey may feel
more strongly that their psychedelic experience was trans-
formative, in either a positive or negative way, potentially
biasing the results. Additionally, some participants combined
their psychedelics with other drugs ranging from alcohol and
caffeine to benzodiazepines and cannabis, which may have
also affected reported experiences in a range of ways.
Further, the authors recognized a typo in the survey that
mislabeled ‘schizoaffective disorder’as ‘schizoaffective per-
sonality disorder.’During data cleaning, individuals select-
ing “schizoaffective personality disorder”were assumed to
have meant “schizoaffective disorder”and were labeled
accordingly (PSD rather than PPD). Overall, this error is
postulated to not have had a significant impact on results
and findings as the study looked at psychosis as a whole
rather than individual psychotic diagnoses. Another similar
364 Journal of Psychedelic Studies 8 (2024) 3, 357–367
limitation is that individuals with BPD were included in
our sample, which, although sometimes includes psychotic
symptoms in presentation, is not traditionally understood as
a psychotic condition.
One noteworthy methodological limitation is that survey
respondents recounted experiences that occurred one or
more years ago, with some being as many as six years ago.
However, while such extended periods of time elapsing may
distort memories significantly, it is also worth considering
that psychedelic experiences can be extremely important life
events comparable to the birth of children (Griffiths et al.,
2006;Healy, 2021). Given the magnitude and significance of
these experiences, it is possible that participants may have
been able to recall them more accurately compared to a
mundane event from so long ago. Other limitations include
a lack of consistent specification on part of the survey as to
whether psychotic symptoms or disorders reported occurred
prior to or after reported psychedelic use, and use of an
unvalidated version of the MEQ.
CONCLUSION
Analyses suggest that the sample describes three types of
experiences overall: positive, mixed, and negative, which
replicates similar previous findings among a sample of in-
dividuals with bipolar disorder describing their experiences
with psilocybin-containing mushrooms (Morton et al.,
2023). Consequently, psychedelic experiences are best
described as multidimensional or spectrum-like. Most of the
sample reported some degree of personal growth, experi-
ences of insight, and mystical-type experiences with varying
ranges of intensity, while a small proportion of the sample
reported negative experiences and adverse effects such as
worsening symptoms. However, it is unclear precisely what
may lead to such events as confounding variables such as
comfortability in setting and concomitant use of substances
obfuscate results. In addition, adverse effects commonly
occur alongside positive effects, which may indicate a more
extensive, generalizable trend for other groups, including
healthy normals and those with anxiety, depression, and
other conditions.
Overall, given the abundance of positive survey reports
regarding naturalistic psychedelic use, it is possible that
supervised clinical use of psychedelics in tandem with psy-
chotherapy could be an effective modality for treating both
psychotic symptoms and comorbid symptoms of other
problems like anxiety, depression, and substance use disor-
der for this population (La Torre et al., 2023). This is
especially true given that negative and adverse experiences
occurred when individuals used psychedelics in environ-
ments that have been demonstrated to be problematic for
psychedelic use such as outside of a supervised, familiar, and
safe setting. Nevertheless, more research with larger samples
must be carried out to conduct statistically significant ana-
lyses to make further determinations regarding the possible
efficacy and safety of PAT for this group, as well as develop
recommendations for tailored PAT protocols.
Disclosure: This study was conducted as part of the disser-
tation for Joseph La Torre’s Ph.D. in Psychology at the
University of Ottawa.
Conflicts of interest: The authors declare that the research
was conducted in the absence of any commercial or financial
relationships that could be construed as a potential conflict
of interest.
Funding: This research was undertaken, in part, thanks to
funding from the Canada Research Chairs Program, Cana-
dian Institutes of Health Research (CIHR) grant number
950-232127 (PI M. Williams), the Usona Institute Graduate
Fellowship (J. La Torre), and PsyDao (J. La Torre).
Authors’contribution: JL and MW conceptualized the study
and wrote parts of the manuscript; JG and MM helped
develop the survey and draft the ethics review application;
JL and JG distributed the survey across various social media
platforms; JG, MM, and DZ helped to interpret results,
create tables, and write the manuscript.
Data availability: Due to privacy concerns and agreements
surrounding confidentiality, the raw dataset cannot be
shared. As per agreement with the respondents, any data not
included in the paper must remain private and is subject to
deletion from any hardware or cloud-based storages upon
the completion of the study.
ACKNOWLEDGEMENTS
We would like to thank Dr. Timothy Michaels, Dr. Yarissa
Herman, Dr. Anne Vallely, Dr. Cary Kogan, and Dr. Alfonso
Corona for their input, suggestions, feedback, and mentorship.
SUPPLEMENTARY MATERIALS
Supplementary data to this article can be found online at
https://doi.org/10.1556/2054.2024.00348.
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Appendices
Open Access statement. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License
(https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided
the original author and source are credited, a link to the CC License is provided, and changes –if any –are indicated.
Appendix A. Questions from the CAPE-42 to identify possible psychotic experiences
Symptom category Sub-category Selected questions
Delusions Perceptual Delusions Do you ever feel as if things in magazines or on TV were written especially for you?
Do you ever feel as if some people are not what they seem to be?
Do you ever feel as if there is a conspiracy against you?
Do you ever feel that a double has taken the place of a family member, friend,
or acquaintance?
Ideas of Reference Do you ever feel as if people seem to drop hints about you or say things with a
double meaning?
Do you ever feel that you are being persecuted in some way?
Do you ever think that people can communicate telepathically?
Grandiose Delusions Do you ever feel as if you are destined to be someone very important?
Do you ever feel that you are a very special or unusual person?
Do you ever feel as if the thoughts in your head are being taken away from you?
Do you ever feel as if the thoughts in your head are not your own?
Negative Symptoms Do you ever feel that you are not a very animated person?
Do you ever feel that your emotions are blunted?
Do you ever feel that you have no interest in being with other people?
Do you ever feel that your mind is empty?
Hallucinations Auditory Do you ever hear your own thoughts being echoed back to you?
Hallucinations Do you ever hear voices when you are alone?
Do you ever hear voices talking to each other when you are alone?
Visual Hallucinations Do you ever see objects, people, or animals that other people cannot see?
Appendix B. 7-Item symptoms checklist to identify psychotic symptoms
Symptom category Selected questions (Yes or No response)
Hallucinations 1. Hear voices or see things other people do not
2. Smell or feel things other people do not
Delusions 1. Feel as if you are an extremely important or special person
2. Feel as if others are conspiring or plotting against you or that people are out to get you
3. Feel as if you can read other people’s minds or that they can read yours
4. Feel as if ordinary things such as a song on the radio or a billboard are speaking to you
Negative Symptoms 1. Feel as if you are disconnected or detached from your body
Appendix C. 11 Items of the Mystical Experiences Questionnaire-mini (MEQ-mini)
Factor Items
Mystical During the psychedelic experience, I saw a higher power
During the psychedelic experience, I became one with the ultimate/true reality
During the psychedelic experience, I experienced unity with ultimate reality
During the psychedelic experience, I felt free of personal limitations allowing me to be
greater than myself
Positive Mood During the psychedelic experience, I felt more peaceful
During the psychedelic experience, I felt joyful
During the psychedelic experience, I felt amazing
Space/Time Distortion During the psychedelic experience, I lost the sense of time
During the psychedelic experience, I lost the sense of space
During the psychedelic experience, I felt the world had no space boundaries
Ineffability During the psychedelic experience, I cannot fully describe the experience in words
Journal of Psychedelic Studies 8 (2024) 3, 357–367 367
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