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Cognitive Therapy and Research
https://doi.org/10.1007/s10608-025-10588-z
REVIEW
Metacognitive Feelings ofEpistemic Gain are Central
totheUnderstanding ofPsychedelic‑Induced Mystical‑Type
Experiences
FedericoSeragnoli1,2· FabiennePicard2· GabrielThorens2· AlbertBuchard2· MeganGeyer1· AngelaAbatista3·
PolinaPonomarenko4· CyrilPetignat3· MarcoRiccardi5· MaëlleBisson2· LucienRochat2· LouisePenzestadler2·
DanieleZullino2· JoëlBillieux1
Accepted: 17 February 2025
© The Author(s) 2025
Abstract
Purpose Despite the presence of mystical-type experiences in psychedelic-assisted therapy (PAT), an understanding of the
cognitive processes involved is still lacking. Guided by theory and empirical research, we hypothesized a cognitive-grounded
perspective based on current metacognition models to promote the understanding of the psychological processes involved
in mystical-type experiences induced by psychedelic substances.
Method The definition of metacognition is reviewed, with a particular focus on its role in psychotherapy and how it is used
to understand altered states of consciousness such as meditation, lucid dreaming, and ecstatic epilepsy. We theoretically
posited that metacognition is affected by psychedelic substance intake. We used metacognition models to understand the
noetic facet of the mystical-type experience potentially induced by psychedelics, focusing on insight processes and proposing
a specific definition of the “Aha!”/ “Eureka!” experience as a metacognitive feeling of epistemic gain.
Results We hypothesized that the noetic feature of the psychedelic-induced mystical-type experience might account for the
activation of procedural, performance-based, outcome-related metacognitive feelings, which are metacognitive feelings of
epistemic gain.
Conclusions We review the potential implications of this framework within PAT in relation to clinically relevant aspects
such as therapeutic preparation, intention setting, and outcome and integration; the use of music; traumatic memory recall;
therapists’ self-experience; suggestibility; and spiritual bypassing. Ultimately, we describe different lines of further research.
Keywords Psychedelic· Mystical experience· Metacognition· Noetic feeling· Insight· Psychedelic assisted therapy·
Meaning
Metacognition andPsychedelics
“Over the history of science, stylistic preferences for
one term over another often prevail at the expense of
mutual understanding and knowledge acquisition. This
is the case for metacognitive studies” (Proust, 2019,
p. 309).
When facing new phenomena, scientists often analyze
and try to understand them from what is already known.
For psychedelic-induced altered states of consciousness, this
strategy has resulted in considering the psychedelic-induced
altered state of consciousness through the lens of psychotic
experiences and naturally occurring mystical-type experi-
ences (Doblin, 1991). In this article, we embrace another
perspective by accounting for mystical-type experiences
through the lens of cognitive sciences, specifically focusing
on metacognition. Before elaborating on how metacognitive
processes could be involved in psychedelic-induced mys-
tical-type experiences, it is worth briefly mentioning why
such an account has not been formulated before.
First, psychedelic research is a recent area of inquiry,
mostly devoted to clinical applications for mental health
purposes (Nutt & Castle, 2023; Seragnoli etal., 2024), and
it remains in its infancy regarding the analysis of the psycho-
logical mechanisms affected by these substances (Bogens-
chutz & Forcehimes, 2017). For a similar reason, the study
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Cognitive Therapy and Research
of psychedelics is not well embedded with other disciplines
such as cognitive sciences (Kelly etal., 2021).
Second, research into metacognition has followed two
major, almost parallel paths, one within the domain of
developmental psychology, and the other within a specific
subfield of cognitive psychology: the experimental study
of human memory (Koriat, 2007). This approach has hin-
dered the development of a clear and consensual definition
of metacognition and promoted various paths of disjoint
research in this field (Proust, 2019).
Third, there are historical reasons for the lack of inter-
disciplinary dialogue in research on psychedelic-induced
mystical-type experiences (Mosurinjohn etal., 2023), as
some researchers felt the research was subject to strong cul-
tural taboos related to this theme, whereas others relied on
parapsychology and pseudoscientific theories to investigate
it (Kohav, 2020; Wahbeh etal., 2022a, 2022b). Our view is
that psychedelic-induced mystical-type experiences should
be investigated from a naturalistic cognitive science per-
spective and that this endeavor has the potential to advance
our understanding of the mind and of psychedelic-induced
altered states of consciousness, which ultimately might
result in disentangling key processes at play in psychedelic-
assisted therapy (PAT).
Metacognition asaWay toStudy
Consciousness
One of the most fascinating yet empirically underexplored
facets of the human mind is its ability for self-referential
capacity, called “self-awareness” or “meta-awareness.” In
the history of psychology, many attempts have been made
to describe (Geary & Xu, 2022) and retrace the origin of
this ability (Leary & Buttermore, 2003), and in the last two
decades, the study of metacognition has aided this endeavor
(Proust, 2019). At its origin, metacognition was mostly
conceived as declarative only and related to language skills
and metamemory (Flavell, 1979), but it is now considered
to also include a procedural or non-conceptual facet that is
independent from the declarative facet and from language
acquisition (Beran, 2012). The declarative facet is related to
concepts about how the mind works, strategies, heuristics
or scripts to guide behavior and epistemic beliefs on how
knowledge is formed, whereas the procedural facet concerns
the monitoring and control of one’s own cognitive activity
(Fig.1). In this sense, metacognition can be conceptualized
on a semantical and informational level and on an experien-
tial and affective level (Koriat etal., 2008).
Metacognition is defined as the awareness and capac-
ity for manipulation of one's own thought processes or the
ability to reflexively represent oneself as an agent (Dehaene
etal., 2017). It is a higher order cognitive skill that involves
both thinking about thinking and the ability to monitor and
control one’s own cognitive processes (Proust, 2013). In this
sense, metacognition can be considered a supracategory that
embeds the notion of meta-awareness, which is the capac-
ity of people to monitor their own states of mind (Schooler
etal., 2011; Schraw & Dennison, 1994). Metacognition
research relates to the study of the knowledge people have
about their own cognitive process and the functioning of
their minds and how they retrieve and use that knowledge to
understand, monitor, and control cognitions (Koriat, 2007).
In cognitive neuroscience, the same distinction is made
between meta-knowledge, that is, how subjects understand
themselves, and meta-control, which is mobilized when sub-
jects are confronted with a cognitive task (Fleur etal., 2021).
Fig. 1 The two facets of metacognition: the declarative facet revolves
around the long-term knowledge we have on how cognition func-
tions and is semantically based; the procedural facet revolves around
the tracking and manipulation of cognition and is experienced based
(e.g., memory retrieval tasks, Stroop tasks)
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Cognitive Therapy and Research
Complementary to other unconscious or automatic
processes involved in modifying behavior (e.g., maintain-
ing balance, adjusting hand movements), metacognition is
implicated in evaluating and controlling epistemic states in
reasoning. Metacognition thus concerns knowledge-related
aspects of cognition, such as decision making, memory rec-
ollection, or problem solving. An important consideration is
that metacognitive evaluations do not foresee the potential
outcomes of physical actions, such as grabbing or catching.
Instead, metacognition focuses on cognitive actions, such
as remembering or deciding. Therefore, metacognition is
not involved in the resolution of conflicts between sensory
inputs, nor does it supervise or control sensorimotor activity
by managing perceptual affordances. Its unique role involves
identifying and integrating relevant knowledge, which can
be understood as cognitive affordances (Proust, 2023; Ver-
vaeke & Ferraro, 2013), into current or future decisions and
cognitive actions (Goupil & Proust, 2023).
Research linking psychedelics and metacognition is still
in its infancy. Currently, we lack studies that have assessed
the direct effect of psychedelics on metacognition measures
(Doss etal., 2024a, 2024b; Mograbi etal., 2024). Neverthe-
less, two studies have shown an effect of MDMA and keta-
mine on metacognitive processes of monitoring and control
in a memory retrieval task (Mograbi etal., 2024). Other
studies have considered forms of “metacognitive illusions”
(i.e., false attributions induced by the feeling of insight) in
examining insight phenomenology related to psychedelic-
induced altered states of consciousness (McGovern etal.,
2024). Moreover, one study indirectly focused on metacog-
nitive processes by showing that psilocybin and 2C-B dis-
torted episodic familiarity in a memory retrieval task after a
phase of emotional episodic memory encoding (Doss etal.,
2024a).
Procedural Metacognition: Monitoring andControl
Whereas declarative metacognition pertains to knowledge
about one’s cognitive function, procedural metacognition
concerns the actions one uses to optimize cognitive pro-
cesses (Beran, 2012). In particular, the procedural facet of
metacognition is divided into two functions: monitoring and
control. Monitoring corresponds to awareness about what
is going on in one’s cognitive system from an introspective
point of view, for example, the extent to which one under-
stands a scientific paper one is reading or whether it is neces-
sary to go back and read it again for a better understanding.
Control defines mental actions that can be undertaken and
sustained, requiring proactive cognitive effort, such as shift-
ing the inner focus of attention back from inner thoughts
to one’s own breath during a mindfulness exercise (Braver,
2012). Crucially, this is not only a top-down regulation of
cognition that starts from declarative conceptual strategies
and scripts that one learns to apply in a given context (“in
order to focus on my reading, I need to switch off my smart-
phone notifications”) – a bottom-up procedural non-concep-
tual regulation is also involved. As developed later in this
work, this regulation process occurs first from non-conscious
evaluation processes and then expresses itself by triggering
metacognitive feelings at the level of the person’s awareness.
In fact, previous research on primates shows that non-human
animals can pursue informational goals and monitor their
own success without being able to express their mental states
semantically (Proust, 2019), showing that procedural meta-
cognition is unrelated to language acquisition (Proust, 2010).
In summary, feelings associated with cognitive processes
related to reasoning are constitutive elements of conscious
decision-making. Metacognitive processes unconsciously
form these subjective feelings and consciously evaluate
whether they are accurate or misleading. Investigating the
monitoring and control functions of metacognition thus con-
tributes to an understanding of the function and activity of
meta-awareness (Koriat, 2007).
The difference between declarative and procedural
aspects of metacognition is particularly relevant from a psy-
chotherapeutic perspective and should thus be considered
in the context of PAT. An overarching goal of psychother-
apy is for patients to better understand themselves, acquir-
ing new declarative concepts and fostering an improved
understanding of their own cognitive functioning (Miller,
2016). It is indeed at the very core of patients’ motivation
for undergoing psychotherapy that they acquire skills to face
challenges with new ways of feeling, thinking, and behav-
ing. In this sense, psychotherapy should support patients
to enhance their ability to identify and be aware of “bad
habits,” as well as to improve their emotional regulation and
behavioral control under stressful or distressing situations.
Crucially, such abilities are directly dependent on how we
define them and declaratively assess them in the therapeuti-
cal context, but they must be learned from a pragmatic pro-
cedural perspective. This explains why cognitive behavio-
ral therapy approaches integrate many techniques, bringing
people to test their own emotional procedural competences
and experiment with them (Borkovec etal., 2003), to rely
on exposure to emotional avoidance (Foa etal., 2003), or
to implement role-playing exercises (Bennett-Levy etal.,
2009). In this context, PAT is able to provide a very intense
subjective experience through an experiential exercise that
is an inherent and central part of the clinical work(Zullino
etal., 2025).
Metacognitive Feelings Guide Cognitive Actions
In this article, the term “metacognitive feelings” is used to
account for feelings related to epistemic states and cognitive
tasks (Goupil & Proust, 2023). These feelings are implicated
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Cognitive Therapy and Research
in the modulation and manipulation of cognitions and are
expressed as a function of the monitoring and control pro-
cesses. Representative examples of such feelings include
a tip-of-the-tongue (TOT) feeling, a feeling of curiosity, a
feeling of confusion, a feeling of effort, a feeling of having
learned, a feeling of being wrong, a feeling of having found,
and an “Aha!”/ “Eureka!” feeling (Danek & Wiley, 2017),
which have been considered metacognitive feelings of epis-
temic gain (Sooter etal., 2024). Such feelings, which have
been the focus of extensive research in the last decades, are
triggered during the learning process itself (Arango-Muñoz,
2019). From a cognitive science perspective, within a meta-
cognition framework, reasoning is postulated as being essen-
tially guided by metacognitive feelings (Proust, 2010). The
procedural functions of monitoring and control play a piv-
otal role in cognitive actions, which are typically character-
ized by a tripartite structure: the conception of a hypothesis,
the subsequent verification process, and the appraisal of the
resulting outcomes (Goupil & Proust, 2023). At each stage
in this sequence, metacognitive feelings play a noteworthy
role, as they provide the individual with critical feedback
that contributes to optimizing cognitive conscious and
unconscious regulation. Figure2 depicts a cognitive action
through the steps of goal-related, process-related, and out-
come-related metacognitive feelings, which is based on the
framework proposed by Goupil and Proust (2023).
Metacognitive Feelings: Real‑Time Expressions
ofCognitive Actions
According to Vervaeke and Ferraro (2013), when faced
with a situation requiring a decision or problem-solving,
individuals engage in a so-called cognitive action process.
This process involves for the mind to creating a hypoth-
esis on how to proceed to advance toward a solution, to
monitor the advancement of the action, and to control it
by persevering or bringing adjustments to the application
of the deployedstrategy. While monitoring the cogni-
tive action, the individual experiments with all sorts of
metacognitive feelings related to doubt, confidence, and
sensations of “having found” or learned. During this pro-
cess, individuals switch to different ways of manipulat-
ing the information, at times applying a potential strategy
to attain their goal, and at other times “zooming out” to
consider the result and evaluate a change in their strat-
egy. These activities are metacognitive in nature and stem
from both declarative knowledge and procedural activity
of control and monitoring. It is noteworthy that a recent
preregistered experiment showed that a person can feel
that they are approaching the solution to an ill-defined
insight problem, even without being aware of it (Lauk-
konen etal., 2021), which denotes the empirical possibility
of measuring metacognitive feelings.
Numerous factors have been suggested as potential cues
that trigger metacognitive feelings, including the recogni-
tion of the cue used to prompt memory recall, which gives a
feeling of familiarity; the availability of relevant partial data
about a requested memory target; and retrieval fluency, that
is, the level of ease in accessing information (Reber & Greif-
eneder, 2017). Subjective confidence in the validity of recov-
ered information is also considered to depend on how easily
that information is recalled (Koriat, 2000). More recently,
a study of “Aha!” moments and insight (Tulver etal., 2023)
provided evidence on how to empirically assess and inves-
tigate outcome-related metacognitive feelings of knowing.
In addition, Dehaene etal. (2017) reported experimental
findings related to the information-processing function of
consciousness within the Global Neuronal Workspace the-
ory of consciousness. In particular, for the self-monitoring
aspect of consciousness (e.g., the meta-awareness procedural
facet of metacognition), such findings concern the presence
of metacognitive feelings related to a) subjective confidence
of the accuracy of their inner reasoning, b) TOT feelings, c)
subjective uncertainty regarding declarative knowledge, d)
error detection, and e) social decision making.
Metacognitive feelings arising from the interplay between
control and monitoring processes result in indices that influ-
ence controlled behavior. In line with this view, a causal link
Fig. 2 The variety of metacognitive feelings involved in cognitive actions (adapted fromGoupil and Proust in agreement with the authors, 2023)
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Cognitive Therapy and Research
has been postulated between metacognitive monitoring and
metacognitive control. More precisely, the self-regulation of
behavior (control) is based on judgments about one’s own
knowledge (monitoring) (Koriat, 2000).
Understanding metacognitive feelings thus requires con-
sideration of the various steps of cognitive action and how
they relate to monitoring and control processes. There are
specific metacognitive feelings that stem from monitoring
and control for every step of cognitive action (Proust, 2021).
Metacognitive feelings exist as goal-related predictive feel-
ings for the monitoring process as a feeling of familiarity
and for the control process as TOT feelings. During cogni-
tive action, individuals experiences metacognitive control
feelings, such as feelings of frustration or effort in trying
to retrieve something in memory. At the same time, meta-
cognitive monitoring feelings are expressed as a function
of the inference about the extent to which the individual
is approaching their goal, such as feelings of incoherence,
interest, or confusion. If the goal is not attained, another
cycle is triggered with a new hypothesis to be tested as a
cognitive action. In contrast, if the cognitive goal is attained,
metacognitive control stops. At the same time, metacogni-
tive monitoring feelings of having found are expressed as an
“Aha!”/ “Eureka!” experience, pointing to the coherence and
validity of the outcome obtained by the reasoning process
and giving rise to a positive emotion of satisfaction. This
feeling can be defined as a metacognitive feeling of epis-
temic gain (Sooter etal., 2024).
Metacognitive feelings hence possess a unique function
in the differentiation between an overt, controlled manner of
functioning and a covert, automatic one. They are inherently
unconscious regarding their origin, yet are overt in both their
experiential subjective aspects and outcomes. They serve
within the meta-awareness process of the individual as a
bridge that facilitates the shift from an unconscious, unregu-
lated mode of operation to a conscious, regulated one, serv-
ing as the foundation for controlled action (Koriat, 2000)as
pictured inFig.3.
Metacognitive Feelings inAction: theExample
oftheTOT Feeling
How is it possible to “know that we know something
while being unable to retrieve that information”? Certain
metacognitive feelings have been shown to relate to a subjective
feeling of knowing (Hewitt, 2011; Koriat, 2000; Maril etal.,
2003; Metcalfe, 2000). One of the most common metacognitive
feelingsthat can be experienced in daily life is called the TOT
feeling, which was first described by William James (1890):
“Suppose we try to recall a forgotten name. The
state of our consciousness is peculiar. There is a gap
therein; but no mere gap. It is a gap that is intensely
active. A sort of a wraith of the name is in it, beckoning
us in a given direction, making us at moments tingle
with the sense of closeness, and then letting us sink
back without the longed-for term. If the wrong names
are proposed to us, this singularly definite gap acts
immediately to negate them. They do not fit into its
mold” (p. 542).
Fig. 3 Metacognitive feel-
ings bridge the gap between
monitoring and control of one’s
cognitive action
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Cognitive Therapy and Research
In this example, if instead the correct name is proposed,
the correctness of the name creates an “Aha!”/“Eureka!”
experience, a feeling related to discovering the correct solu-
tion, a feeling of “being right,” of “having found.” In that
case, the control of cognition stops and leaves space for a
positive emotional experience triggered by the successful
completion of the task. In this regard, the TOT feeling con-
stitutes a metacognition-related process that triggers the
three components of cognitive action: setting a goal, control-
ling cognitive effort, and monitoring the outcome (Goupil &
Proust, 2023)as depicted in Fig.4.
The TOT feeling is thus the product of an incoherence
between the subjective confidence of knowing the sought-
after information and the current inability to actively
retrieve it. The TOT feeling is postulated to emerge as a
consequence of implicit/unconscious processing taking
place in an active inference perspective (Friston etal.,
2017a, 2017b), promoting the feeling that “there is some-
thing likely to be retrieved.” Feeling-of-knowing judgments
often predict future retrieval success (Grimmer etal., 2022;
Laukkonen etal.,2023) and are generally considered to be
adaptive heuristics and intuitions: they stem from a rapid
unconscious activity and generate an outcome that can
be monitored and controlled for correctness. Individuals
experiencing a TOT are able to perceive the emergence
of the sought-after information via a meta-awareness state
by judging its imminent retrieval (Grimmer etal., 2022;
Koriat, 2000; Laukkonen etal., 2023). Identifying the cor-
rect semantic information marks the cessation of the think-
ing hunch: the metacognitive volitive effort of control stops
as the goal of the cognitive action is attained. At the same
time, an insight – an “Aha!”/ “Eureka!” feeling – emerges,
tainted by a positive emotional state, signaling the accuracy
of the found solution. As noted by Proust (2019), the phy-
logenetic conservation of this positive emotional valence is
congruent with an evolutionary adaptative function of the
“Aha!”/ “Eureka!” phenomenon. From a naturalistic evolu-
tionary perspective, the agreeable feeling associated with the
“Aha!”/ “Eureka!” experience serves to positively reinforce
and ground the learning process when something important
is understood, enabling a more adaptive relationship with
the environment (Gopnik, 1998;Proust, 2010).
It has been suggested that TOT feelings might correspond
to subjectively felt emotions promoted by an active infer-
ence calculation process going on beyond one’s own meta-
awareness (Seth, 2013). Yet, having an “Aha!”/ “Eureka!”
experience does not always reflect the correctness of the
sought-after result, as it was shown that manipulation of
past knowledge can elicit an “Aha!”/ “Eureka!” experience
Fig. 4 Metacognitive feelings bridge the gap between monitoring and control of one’s cognitive action: the example of the TOT process
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Cognitive Therapy and Research
of insight regarding incorrect information (Laukkonen etal.,
2023) (Fig.4).
In summary, when evaluating the likelihood of success of
a cognitive activity (such as remembering or learning some-
thing), individuals rely on a set of unconscious probability
distributions related to the expected results. Although it has
been suggested that these forecasts are based on subcon-
scious Bayesian calculations within a predictive inference
model (Seth, 2013), at the subjective level, they lead to a
conscious feeling connoted with specific positive or nega-
tive valence, intensity, and motivational pull (such as the
TOT feeling, thefeeling of cognitive effort, or the “Aha!”/
“Eureka!” experience; see Goupil & Proust, 2023).
Metaphors, analogies, and daily life examples are often
used in the context of psychoeducational interventions to
show patients how their behaviors, emotions, and thoughts
work (Mathieson etal., 2016; Stott etal., 2010). The TOT
feeling is a concrete, very common example of how meta-
cognitive feelings work in daily life and how they are felt
within the subjective perspective. It can be used by a thera-
pist to help the patient understand the dynamic process of
metacognitive feelings. This is particularly relevant for the
ideas defended in the current paper, which suggest a con-
nection between metacognitive feelings and psychedelic-
induced mystical-type experiences.
Metacognitive Processes and“Insight”
intheContext ofPsychotherapy
Dysfunctional metacognitive processes play a key role in
the onset, development, and maintenance of psychological
disorders (Sun etal., 2017), including psychosis-related
disorders and experiences (Cotter etal., 2017), anxiety dis-
orders (Gkika etal., 2018; Wells, 2011), substance use and
addictive behaviors (Hamonniere & Varescon, 2018), eating
disorders (Palmieri etal., 2021), obsessive–compulsive dis-
order (Rees & Anderson, 2013), and mood disorders (Hal-
vorsen etal., 2015).
One prominent concept that addresses dysfunctional
metacognitive processes is the cognitive attentional syn-
drome (CAS), which can be viewed as a transdiagnostic
mechanism underlying various forms of psychopathology
(Fergus etal., 2013; Wells, 2011).
The CAS represents a perseverative thinking style in
which one continually engages in dysfunctional and repeti-
tive maladaptive coping strategies, including worrying and
ruminating, while attempting to face adverse cognitions and
emotions (Normann & Morina, 2018). Dysfunctional and
inflexible metacognitive beliefs, such as believing that one
cannot act on one’s thoughts or that worrying helps one to
cope, influence the emergence of CAS (Normann & Morina,
2018; Wells, 2011). These processes can be identified and
modified through metacognitive therapy (Wells, 2011).
Metacognitive-oriented psychotherapeutic interventions
also include raising awareness and developing more adaptive
and flexible monitoring-control capacities by using detached
mindfulness and attention training techniques (Murray etal.,
2018; Philipp etal., 2020). Metacognitive therapy has shown
its effectiveness in a wide range of psychological disorders,
even more notably for anxiety and depression (for meta-anal-
yses, see Normann & Morina, 2018; Rochat etal., 2018).
Other psychotherapeutic interventions that directly target
dysfunctional and maladaptive metacognitive processes
include metacognitive training and metacognitively-oriented
integrative psychotherapies (Philipp etal., 2020).
In addition, certain metacognitive processes are involved
and indirectly targeted and fostered in various psychothera-
peutic interventions, independently of the therapists’ theo-
retical approach. For example, decentering is a key meta-
cognitive skill fostered in a wide range of psychotherapeutic
approaches. Decentering corresponds to the capacity to
look at one’s internal mental state from some distance and
“stepping out” of what one is currently experiencing, thus
promoting a shift in perspective (Safran & Segal, 1996).
It allows for realizing that one’s thoughts are not immuta-
ble and do not define the self, which is known to positively
affect mental health (Bernstein etal., 2015).
Moreover, one major objective of psychotherapy is to aid
patients in fostering a new or modified understanding about
themselves, thus gaining insight about their inner function-
ing and psychological problems (McAleavey & Castonguay,
2014). The word “insight” has, however, generated confu-
sion in the literature because it has two different meanings, as
shown in Fig.5. On the one hand, insight can be related to the
introspective ability to coherently assess aspects of one’s own
subjective internal mental state. In this case, the term is used
to evaluate the extent to which patients areawareof their own
mental state and difficulties. This first meaning corresponds to
the “capacity of insight,” as frequently used in psychodynamic
therapeutic approaches (Moro etal., 2012). Such capacity has
typically been found to be impaired in people with severe
mental conditions such as schizophrenia (Baier, 2010). On
the other hand, the word “insight” has been used to describe
the “Aha!”/ “Eureka!” experience, in this case referring to a
feeling and not to a competence. These two types of insight
are likely to overlap when a person involved in introspection
(using their “insight competence”) understands something that
triggers an “Aha!”/ “Eureka!” experience (“insight feeling”
followed by an introspective action). It is thus relevant to dif-
ferentiate introspective phenomena, as they are not all accom-
panied by an “Aha!”/ “Eureka!” experience andvice versa.
An introspective act can lead to the processing of something
well known by the person and thus not likely to generate an
“Aha!”/ “Eureka!” experience (e.g., “I have a problem with
my alcohol consumption”). It is possible, however, to experi-
ence an “Aha!”/ “Eureka!” experience that is not related to
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Cognitive Therapy and Research
one’s own internal subjective situation but rather to an external
situation (e.g.,“I finally understood this thing you are showing
me!”; “here’s how to solve that riddle!”). By distinguishing the
two meanings of the insight construct, it is possible to better
understand the “Aha!”/ “Eureka!” experience as a metacogni-
tive feeling of epistemic gain (Sooter etal., 2024).
Previous research suggests that insight represents one of
the general factors contributing to psychotherapeutic success,
such as therapeutic alliance or non-conditional positive posi-
tioning, and is thus independent from the theoretical approach
of the therapist (McAleavey & Castonguay, 2014; Wampold
etal., 2007). Insight has also been positively associated with
psychotherapeutic outcomes (for a meta-analysis, see Jennis-
sen etal., 2018). This can be explained by the fact that under-
standing oneself helps to foster the sense of agency, as well as
to open new perspectives for identifying and endorsing more
adaptive and beneficial ways of thinking and acting (Jennissen
etal., 2018).
Relevant to our purpose, the “Aha!”/ “Eureka!” experience
has been linked to psychedelic-induced altered states of con-
sciousness (Carhart-Harris & Friston, 2019; McGovern etal.,
2024). In PAT, psychological insight or “Aha!”/ “Eureka!”
experiences have been put forward as one of the main factors
driving therapeutic benefits (Davis etal., 2020; Garcia-Romeu
etal., 2020; Letheby, 2021; Tulver etal., 2023).
Having defined the functioning of metacognition as a
monitoring and control mechanism,with metacognitive feel-
ings being at the interplay of these two aspects, our aim is
now to considertheextentto whichthis framework can be
usefultounderstandaltered states of consciousness.
Metacognitive Feelings intheStudy ofAltered
States ofConsciousness: Meditation, Lucid
Dreaming andEcstatic Epilepsy
The consideration of meditation, lucid dreaming, and
ecstatic epilepsy is relevant for understanding how the pro-
cedural function of metacognition could inform the study of
psychedelic-driven altered states of consciousness.
Mindfulness meditation-based techniques are now widely
used in the context of psychotherapy (Davis & Hayes, 2011;
Germer etal., 2005). It has been argued that mindfulness
meditation can be understood from a metacognitive per-
spective (Jankowski & Holas, 2014). In fact, mindfulness
meditation requires a great deal of activity in the proce-
dural metacognitive control and monitoring processes, and
it has been shown that this meditation affects metacognition
(Jankowski & Holas, 2014) through specific mechanisms
such as improving the inhibition of irrelevant stimuli (Sanger
& Dorjee, 2016). During meditation, individuals constantly
go through the cycle of monitoring their present meta-aware-
ness and, after realizing that the focus of attention is lost,
regain control of it to bring it back to the sought-after target,
whether it be breath, a part of the body, or a loving-kindness
mantra. This interplay between monitoring and control of
one’s own stream of consciousness, which involves concen-
trating attention on something, is the basis of many breath-
ing andmeditation techniques.
This process follows a standard cognitive action model
in which metacognitive feelings are heavily recruited. For
example, while being present and monitoring their mind,
someone can suddenly realize that their focus of attention
has drifted away. This expresses itself as a metacognitive
feeling of incoherence (“oh, something is wrong”), which
makes the individual meta-aware about their ongoing activ-
ity (“I caught myself thinking about grocery but in fact I am
Fig. 5 The term "insight" can refer to both control and monitoring metacognitive processes
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Cognitive Therapy and Research
meditating”) and the related need to bring their attention
back to the target of the meditation (“while I meditate, I
am supposed to keep my attention on my breath”). This in
turn activates the control function of metacognition, creat-
ing a feeling of effort that is related to manipulating one’s
attentional focus. Reallocating attentional focus makes the
individual experience a metacognitive feeling of having
attained the goal, which in turn expresses itself as a positive
feeling of relaxation related to the completion of the cogni-
tive action and gives space to the monitoring process once
again. The extent to which psychoeducation interventions
in metacognitive feelings could be proposed to help people
progress in their meditation practice is outside the scope of
this article.
It is interesting to note here a difference between two dif-
ferent kinds of cognitive actions: Attentional Agency (AA),
defined as the ability to control one’s focus of attention, and
Cognitive Agency (CA), as the ability to control goal/task-
related, deliberate rational thought (Metzinger, 2015). AA
and CA are both processes which underlie the feeling of
being epistemic autonomous agents. As it is shown in Fig.6,
AA comes first, being the founding step for the system to
get meta-aware of the cognitive operations going on, which
in turns make possible to exert CA to deliberately engage in
problem solving. This interplay of different functions shows
the depth of involvement of metacognition in meditation.
A lucid dream is a particular kind of phenomenon related
to a state of consciousness in which a dreaming person
becomes aware of being in a dream while being asleep.
Metacognitive processes have been investigated to shed
light on this particular phenomenon (Kahan & LaBerge,
1994; Kahan, 2001), which has a low random frequency of
occurrence in the overall general population, but can also be
learned and trained for. So-called lucid dreamers use tech-
niques of metacognitive training to trigger meta-awareness
in dreams and take control of their subjective experience
while sleeping. This is achieved by training and developing
behavioral strategies consisting in self-suggestions during
daily waking time in ordinary conscious life and the contem-
plation of one’s own state of consciousness (Dresler etal.,
2015) to develop a chronic specific self-monitoring behav-
ioral script. For example, one of the most basic exercises is
for the individual to count the fingers of their hand at random
times and repeatedly during the day. This habit creates a
script for a cognitive action that can automatically express
itself during dreams. If it does, while dreaming, the person
tries to count their fingers and is not able to. This incoher-
ence triggers a metacognitive feeling of curiosity, driven
to find an explanation for why fingers cannot be counted.
A process-based feeling of incoherence is then felt, which
in turn triggers an outcome-related metacognitive feeling,
namely, an “Aha!”/ “Eureka!” experience, related to the
Fig. 6 Metacognitive feelings bridge the gap between monitoring and control of one’s cognitive action: the example of meditation
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Cognitive Therapy and Research
realization of being in a dream as the reason for why the
fingers cannot be counted. The end of the cognitive action
(“why am I not able to count my fingers? Because I am in
a dream.. Aha!”) leaves the space for a monitoring process
within the dream, which in turns triggers meta-awareness.
These elements are consistent with a predictive processing
perspective of the mind (Sandved-Smith etal., 2021) and
with experimental neuroimagery research that identified
shared neural systems between lucid dreaming and meta-
cognitive functions, in particular in the domain of thought
monitoring (Filevich etal., 2015).
Ecstatic epilepsy is a rare form of focal epilepsy char-
acterized by the subjective experience of an altered state
of consciousness, which may precede the onset of a
tonic–clonic seizure (Gschwind & Picard, 2016). As its
name literally indicates, it consists of a mystical-type expe-
rience characterized by heightened well-being (serenity and
bliss), a feeling of time dilatation, a feeling of enhanced self-
awareness, a feeling of dissolution of boundaries between
the self and surroundings (connectedness), and a noetic feel-
ing of revelation of truth, coherence, and “understanding
of the meaning of life” (Picard, 2023). This experience has
been reliably reported by a specific group of patients hav-
ing similar subjective accounts when describing the typical
onset of their epileptic symptoms. Moreover, these experi-
ences have been sometimes declared by them as having a
transformative effect and cosmic, spiritual, or religious con-
notations (Picard & Craig, 2009). Thanks to the similar tes-
timony of these patients, it has been possible to match their
account with neuroimaging observation techniques, pin-
pointing the particular area where the focal epilepsy symp-
toms seem to originate, namely, the anterior insula. Most
interestingly, this localization has been confirmed by electri-
cal stimulation performed during a presurgical evaluation of
pharmacoresistant epilepsy in a non-ecstatic epileptic case
study report that evoked a mystical-type experience (Nen-
cha etal., 2022). This case study showed that the patient,
who had epilepsy but never experienced this particular set
of symptoms before, felt and reported mystical-type subjec-
tive effects proper to the ecstatic epilepsy phenomenology,
captured by the Mystical Experience Questionnaire (MEQ-
30). This phenomenon was later integrated into a “surprise
processing hypothesis” – based on the pivotal role played
by the insula as a “comparator between predictions and real
inputs” for multisensory integration and interoception (Pic-
ard & Friston, 2014), and in the processing of self-awareness
and uncertainty (Picard, 2023). Within a predictive process-
ing understanding, the computation of uncertainty between
an internal model and external reality performed by the
insula would be expressed as feelings of surprise, which
could regulate learning, updating models and driving cogni-
tive actions. These surprise feelings could be conceived as
metacognitive feelings, resulting from the monitoring and
control of cognitive actions within a predictive processing
understanding of metacognition (Fernández Velasco & Loev,
2024; Foster & Keane, 2015). Moreover, insula activity has
been linked to metacognition in various studies (Fleming &
Dolan, 2012; Seth etal., 2012; Uddin etal., 2017).
In particular, the subjective feeling of the ecstatic epi-
lepsy experience could be analyzed from the perspective
of procedural-based, outcome-related metacognitive feel-
ingsof epistemic gain (Sooter etal., 2024). For example,
consider the following subjective account of a patient with
ecstatic epilepsy, who reported what a cognitive action of
problem solving and its associated feeling of having found
can look like in real-life situations (Ernst,2005; subjective
accountreported with written consent from author):
“Indeed, one has (what is sometimes called) an ‘Aha!’
moment when we can suddenly explain several puz-
zling facts simultaneously with the same answer. Sup-
pose I am puzzled when my car drives sluggishly and
pulls to one side, and also seems to be getting poor gas
mileage. If I also notice that my tire is slowly leaking
air, then I will be very confident that the leak explains
everything by making my earlier observations more
coherent. The sense that I had when I was experienc-
ing some of these seizures was not unlike a continuous
series of ‘Aha!’ moments.”
Given what has been expressed so far, we hypothesize
that the study of metacognition is relevant to the understand-
ing of other types of altered states of consciousness such as
those occurring in PAT. In the next sections, we examine the
link between psychedelic-induced mystical-type experiences
and metacognitive procedural processes, with a special focus
on metacognitive feelings of epistemic gain.
The Noetic Facet oftheMystical‑Type
Experience
"Noetic" comes from the Greek noēsis, from which the
word “cognition” itself comes and means "understand-
ing" or "intellectual activity." This term is often used in
philosophical and psychological contexts in different and
noncoherent ways. It may refer to a type of introspective
knowledge, understanding, or intuition that is felt subjec-
tively and is hard to express in words (Cole-Turner, 2021;
Krystal etal., 2023; Metcalfe, 2000; Palitsky etal., 2023;
Yaden etal., 2017a). A noetic feeling might also refer to a
profound sense of understanding or insight that comes from
within the individual and transcends the purely rational
or conceptual declarative function of the mind, for exam-
ple in insight meditation practices (Germer etal., 2005).
“Noetic quality” has been used to define the obviousness of
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Cognitive Therapy and Research
an acquired information (McGovern etal., 2024). “Noetic
quality” is also used to qualify the “realness” of the experi-
ence (Yaden etal., 2017a). To cite another example, this
term has also been used to indicate the difference between
aconsciousnessstate with and without the presence of meta-
awareness (Vandekerckhove & Panksepp, 2009). Addition-
ally, in cognitive sciences, this term can be used to define
monitoring based metacognitive feelings of error or success
(Proust, 2021).
Noetic Feelings are Metacognitive Feelings
ofEpistemic Gain
In the context of cognitive science, noetic feelings can be
conceptualized as a form of feelings of knowing within
metacognitive processes, implicitly signaling mental con-
structs and their attributes to individuals (Beran, 2012;
Dorsch, 2023; West & Conway-Smith, 2019). These feelings
encompass bodily sensations and emotions that guide judg-
ment and decision making across a multitude of contexts
(Damasio etal., 1997; Kahneman, 1973; Proust & Fortier,
2018). Especially during problem solving, noetic feelings
like the feelings of knowing and the “Aha!”/ “Eureka!” expe-
rience of sudden insight act as an embodied cue to guide
people to their goals. These feelings allow for the assessment
of new ideas, confronting them on the landscape of one’s
own prior knowledge, facilitating adaptive actions and guid-
ing the learning process (Laukkonen etal., 2023). In order
to better characterize this feeling and to not indulge in the
use of an ill-defined word, the “Aha!”/ “Eureka!” experience
can be defined as a metacognitive feeling of epistemic gain,
which means a metacognitive procedural-based, outcome-
oriented feeling deriving from thesudden success of a cog-
nitiveaction process.
Metacognitive Feeling ofEpistemic Gain
inPsychedelic‑Induced Mystical‑Type Experiences
In the context of psychedelic therapy research, noetic feel-
ings refer to profound states of consciousness related to
knowledge during which individuals may feel as though
they are gaining direct insight or truth (Cole-Turner, 2021;
Hewitt, 2011; Yaden, etal., 2017a). These feelings can be
profound and life-changing, often described as mystical-type
or spiritual experiences (Griffiths etal.,2006; Griffiths etal.,
2008). Moreover, the noetic quality is used as a label to
describe the insightfulness or spiritual characteristic of the
psychedelic-induced altered state of consciousness, captured
by the widely used Mystical Experience Questionnaire and
the Altered State of Consciousness Questionnaire (Vollen-
weider & Smallridge, 2022). The noetic quality is also used
as a label to indicate the extent to which an experience is felt
as real (Yaden etal., 2017a).
When individuals report mystical-type experiences in
the context of psychedelic-induced altered states of con-
sciousness, other characteristics besides the noetic feeling
are frequently reported: a sense of interconnectedness, tran-
scendence of time and space, deeply felt positive mood, and
a sense of being in touch with an ultimate reality or truth
(Amada etal., 2020; McCulloch etal., 2022; Mosurinjohn
etal., 2023). This subjective experience is associated with
the use of psychedelic substances, but can also be induced by
specific forms of meditation, bodily extenuation exercises,
or breathing techniques (Timmermann etal.,2023). Such
experiences are often described as having a quality of real-
ity felt sometimes more real than reality itself, while also
being difficult to justify or explain in rational terms. In the
study of the factors involved in the effectiveness of PAT, the
mystical-type experience has been found in different stud-
ies to be directly linked to a positive treatment outcome (Ko
etal.,2022). In recent years, calls have emerged for bet-
ter scientific understanding of these individuals’ subjective
experiences in the context of PAT (Palitsky etal., 2023) in
order to unveil the cognitive processes involved and tailor
psychotherapeutic settings and practices accordingly.
In the Western context, the mystical-type experience was
first studied by William James, who wrote about it in his
book “The Varieties of Religious Experience” (1902). The
author laid the basis for the scientific understanding of the
phenomenon in terms of four main features defining this
experience: ineffability, transiency, passivity, and noetic
quality (Mosurinjohn etal., 2023). Concretely, James (1902)
defined these experiences in the following terms:
“Although so similar to states of feeling, mystical
states seem to those who experience them to be also
states of knowledge. They are states of insight into
depths of truth unplumbed by the discursive intellect.
They are illuminations, revelations, full of significance
and importance, all inarticulate though they remain;
and as a rule they carry with them a curious sense of
authority for after-time” (William James, 1902).
William James understood the noetic quality to be a state
related to feelings and to knowledge. He defined the noetic
quality of mystical-type experiences as states of knowledge
and insight into the revelation of some truth that cannot be
expressed in words and which carries a sense of author-
ity.His definition establishes a parallel between mystical-
type experiences and a particular kind of feeling related to
knowledge, which can be seen as a metacognitive feeling of
epistemic gain, like the “Aha!”/ “Eureka!” experience.
James (1902) also pointed out that the noetic quality
does not necessarily lead to new concepts or insights, but
rather offers a deeper understanding of already known ideas,
describing this as a feeling of having “been here before.”
Crucially, recent neuroscientific research on the effects of
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Cognitive Therapy and Research
psychedelics showed that these substances affect cognitive
flexibility and feeling-of-knowing experiences (Doss etal.,
2020). In particular, the episodic autobiographical memory
literature has been linked with the study of the noetic feel-
ing caused by familiarity driven by semantic priming and
fluency (McGovern etal., 2024). Fluency has been specifi-
cally studied as a form of metacognitive feeling because of
the ease of processing and the related concepts of truth and
beauty (Schwarz, 2018). Neuroscience is laying the ground-
work to understand the brain correlates of these states that
are thought to be important to consider for therapeutic
intervention (Krystal etal., 2023). Notably, the feeling of
familiarity is only one of the metacognitive feelings related
to knowledge processing. This points to the fact that there is
a panel of feelings and processes that are yet to be studied
within the empirical analysis of the mystical-type experience
from a cognitive science perspective.
For example, self-transcendence, an emotion studied
within the effects of ego dissolution and oceanic bound-
lessness, is an aspect of the mystical-type experience that
psychedelic substances can induce, and it is a factor widely
investigated to account for this state, especially in the
context of psychotherapy (Jungaberle etal., 2018; Yaden
etal., 2017a, 2017b). Affective regulation researchers have
recently gained interest in understanding the underlying tax-
onomy of self-transcendent states as defined from a subjec-
tive folk perspective. When analyzing the different aspects of
the phenomenology of self-transcendence, researchers have
identified two majorly implicated dimensions that can distin-
guish non-self-transcendent and self-transcendent emotions
on an empirical basis. In particular, the two broad families of
self-transcendent emotions are divided into social emotions,
concerning engagement in prosocial behavior, and epistemic
emotions, which are associated with interest, surprise, men-
tal challenge, and the motivation to engage with and learn
new things (Abatista & Cova, 2023), facets that could argu-
ably be related as expressions of a metacognitive feeling of
epistemic gain.
In summary, noetic feelings reported subjectively dur-
ing a psychedelic-induced mystical-type experience could
be better defined, from a naturalistic perspective, as intense
subjective experiences of a metacognitive feeling of epis-
temic gain: the feeling of knowing and having understood,
also conceptualized as an “Aha!”/ “Eureka!” experience,
sparked by the procedural-based, outcome-related function-
ing of the monitoring facet of metacognition.
Metacognitive Feeling ofEpistemic Gain Within
theREBUS Model ofPsychedelic Action
The RElaxed Beliefs Under pSychedelics (REBUS) model
(Carhart-Harris & Friston, 2019) is a neuroscientific
framework used to understand the effects of psychedelic
substances in the brain and psyche. The main objective of
this model is to account for the brain-mind process as a pre-
dictive processing engine that projects a model of the world
and looks for inconsistencies to trigger a learning action
and better adapt to the demands of the external environ-
ment. Within this learning action, grounding it with the free
energy principle developed by Friston (Friston, 2009, 2010),
the model posits insight as a key phenomenon in psyche-
delic therapy, and defines it as follows: a) novelty seeking,
explorative search, curious behavior; b) unconscious abduc-
tive reasoning processes conducting to “Aha!”/ “Eureka!”
experiences. First, metacognitive feelings can be conceived
from a predictive process perspective as feelings arising to
meta-awareness from the implicit calculations of the brain
while performing a cognitive action (Fernández Velasco &
Loev, 2024). Second, metacognitive feelings are relevant for
understanding the insight process from a subjective perspec-
tive because curiosity can be thought of as a metacognitive
feeling process (Goupil & Proust, 2023) and, as explained
earlier, an “Aha!”/ “Eureka!” experience can be defined as
a procedural outcome-related metacognitive feeling of epis-
temic gain (Sooter etal., 2024;Proust, 2010).
Concerning PAT, the authors propose standard practice to
help patients better go through an altered state of conscious-
ness triggered by psychedelic intake: trust, let go, be open
(Carhart-Harris & Friston, 2019). Carhart-Harris and Friston
describe the insight-related processes as being more effec-
tive if the executive function is suspended. It is thus relevant
to study these processes through the prism of metacognition,
that is, considering the monitoring of cognition, which is
postulated to have a role in making the person more able
to trust and be open to the psychedelic-induced subjective
experience and the resulting metacognitive feelings.
Metacognitive Feeling ofEpistemic Gain Within
theFIBUS Model ofPsychedelic Action
The False Insights and Beliefs Under Psychedelics (FIBUS)
model (McGovern etal., 2024) is an integrated neurocogni-
tive theory which explores the impact of psychedelics in
engendering false and maladaptive insights. In this theory
insight moments or “Aha!”/ “Eureka!” experiences are con-
sidered a special type of problem-solving process involv-
ing the sudden restructuration of a problem accompanied
by satisfaction, surprise, noetic quality and confidence. In
this framework the “Aha!”/ “Eureka!” experience is consid-
ered an heuristic which can guide the person in epistemic
decision making (Laukkonen etal., 2023). This framework
shows that not all the “Aha!”/ “Eureka!” experiences under
psychedelics involves an actual epistemic gain and thus can
potentially lead to the creation of false beliefs. These are
referred to as “metacognitive illusions” and are considered
stemming from the metacognitive process underlying the
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Cognitive Therapy and Research
function of the mind during epistemic decision-making and
the selection of ideas (McGovern etal., 2024). Hence, a
heuristic view of the insight feeling (Laukkonen etal., 2023)
could benefit from a metacognitive integrated understand-
ing of the “Aha!”/ “Eureka!” experience. In particular, the
metacognitive feeling of epistemic gain specific definition
is suited to make the difference between the declarative pro-
cesses related to problem solving, which heuristics are part
of as conceptual strategies, and the procedural processes,
which are related to attentional and cognitive agency (Metz-
inger, 2015) but are non-conceptual abilities. This would
help better define the effect of insights in PAT because it
practically defines the functioning of this particular aspect
of cognitive phenomenology (Bayne & Montague, 2011),
giving a descriptive framework for patients to understand
it. This would consequently, as it is hoped by the FIBUS
model, improve an optimal integration of “Aha!”/ “Eureka!”
experiences in therapy.
Metacognitive Feelings ofEpistemic Gain are
Evoked byPsychedelics
Capitalizing on the conceptual framework developed in
the previous sections, we can now consider the direct link
between metacognitive feelings and the use of psychedelics.
From a subjective phenomenological perspective, there are
similarities between the introspective feelings reported dur-
ing psychedelic-induced mystical-type experiences and
metacognitive feelings reported in cognitive actions. Spe-
cifically, psychedelic intake has the potential to evoke meta-
cognitive procedural, performance-based, outcome-related
feelings of “Aha!”/ “Eureka!” experiences, which we con-
sider as metacognitive feelings of epistemic gain. The next
sections present the arguments to support this assumption.
One of the hallmarks of the mystical-type experience
induced by psychedelics is the feeling of reaching a new
reality that is being revealed, or a new truth that one has
learned; a sensation of interconnectedness; the experience
of having discovered and understood something important
(eureka!). A rational naturalistic way to make sense of
these widespread and common subjective accounts is to
consider that, in daily life, people often already experience
such feelings, although of smaller magnitude (Griffiths
etal., 2008). In fact, whenever a person’s mind triggers a
cognitive action related to the discovery of something that
is hypothesized as being reachable and useful (cognitive
affordance), the cognitive process possibly culminates in a
feeling of having learned or having understood, an “Aha!”/
“Eureka!” experience coupled with a release of tension
and a sense of satisfaction. Conceiving these feelings as
a natural expression of one’s cognitive inferential activity
under the threshold of meta-awareness is coherent from a
neurobiological perspective, according to the activeinfer-
ence functioning of the brain (Friston etal., 2017a, 2017b),
and is likely to be informative about the functioning of the
mind (Dehaene etal., 2017; Thagard, 2014). In this sense,
and because of its neurological hyperconnectivity effect
(Carhart-Harris & Friston, 2019), psychedelic intake could
act as an amplifier for these kinds of feelings: the expres-
sion of metacognitive feelings of epistemic gain would not
be related to a specific cognitive action outcome but would
simply be felt as a result of the massive binding happening
between neural populations (Thagard, 2014; Thagard &
Stewart, 2011) and potentially projected into any possible
representation or target of attention. This would provoke
an important effort from the declarative processes to make
sense of such powerful “Aha!”/ “Eureka!” feelings that
are evoked out-of-nowhere (outside of a cognitive action
sequence scenario), thereby creating the massive availabil-
ity of new potential representations, giving the impression
that all things are interconnected and potentially engender-
ing a profound problem-solving semantic reconfiguration.
In addition, some declarative representations already pre-
sent in memory could finally “make sense,” as they would
be invested with an abundant feeling of epistemic gain
evoked by the substance intake, giving the individual the
impression that they finally really understood with their
“gut,” meaning through an embodied proceduralprocess,
something that they already knew for a long time with
their “head,” meaning within a declarative perspective.
Psychedelic intake creates a massive disruption of cog-
nitive superior executive functions of the brain (Carhart-
Harris & Friston, 2019; Nichols, 2016; Sayalı & Barrett,
2023). This is congruent with positing that there is no
need for a structured cognitive action process in order for
a psychedelic to induce an amplified metacognitive pro-
cedural, performance-based, outcome-related feeling of
epistemic gain. In turn, this amplified “Aha!”/ “Eureka!”
experience could also lead to the alteration of the feeling
of time, affecting the function of coming back to the pre-
sent moment that is felt when a cognitive action process is
normally resolved. This can give rise to the subjective feel-
ing of being in an eternal present moment that transcends
time. In fact, from an interoceptive perspective (Craig,
2009), the passage of subjective time is related to the sali-
ence of the ongoing experience. In this way, the power-
ful salience of a prolonged “Aha!”/ “Eureka!” experience
would increase the number of global emotional moments
incorporated, thus dilating the perceived subjective time.
Additionally, considering the positive valence of
the emotion related to the “Aha!”/ “Eureka!” experi-
ence(Gopnik, 1998), it can be argued that the enhance-
ment of this metacognitive feeling of epistemic gain is at
the origin of the strong positive ecstatic emotions and bliss
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Cognitive Therapy and Research
feelings that are associated with the mystical-type experi-
ence observed in psychedelic-induced alterations of the
state of consciousness.
Overall, as depicted in Fig.7, a parallel can be drawn
between the noetic feeling within the mystical-type experi-
ence induced by psychedelics and the “Aha!”/ “Eureka!”
experience happening within the process of a cognitive
action, which can be defined as metacognitive feeling of
epistemic gain.
Metacognitive Feeling ofEpistemic Gain
inPAT: Therapeutic Implications
Considering the potential presence of metacognitive feel-
ings of epistemic gain in mystical-type experiences, different
hypotheses on how PAT and its different phases and aspects
are impacted are discussed in the next sections.
Psychedelic‑Induced Mystical‑Type Experiences May
Affect Psychotherapeutic Outcomes inPAT
Psychedelic-induced mystical-type experiences have been
studied regarding their impact on and potential benefits
in PAT (Garcia-Romeu etal., 2015; Griffiths etal., 2006,
2008, 2016; Ko etal., 2022) Mystical-type experiences are
deemed central to the psychedelic-induced altered states of
consciousness subjective experience (Passie & Scharfetter,
2018;Barrett & Griffiths, 2017; Richards, 2008), and they
have been proposed to be a significant factor contributing
to the sustained positive effects of psychedelic therapy in
volunteers not affected by mental conditions (Griffiths etal.,
2006; McCulloch etal., 2022). A recent systematic review of
clinical studies found that mystical experience was a signifi-
cant predictor of better clinical outcomes in diverse mental
disorders (Ko etal., 2022). Twelve clinical studies were
included in the systematic review and nine of the 12 stud-
ies independently stressed correlations between the inten-
sity of the mystical experience scores and the reduction of
symptoms in a range of mental disorders, including cancer-
related anxiety and mood disorders (Griffiths etal., 2016;
Ross etal., 2016); treatment-resistant depression (Carhart-
Harris etal., 2018; Roseman etal., 2018); and substance use
disorders, notably alcohol use disorder (Bogenschutz etal.,
2015; Rothberg etal., 2021), tobacco use disorder (Garcia-
Romeu etal., 2015; Johnson etal., 2017), and cocaine use
disorder (Dakwar etal., 2018). Mystical experience scores
were also associated with a reduction in symptoms at follow-
up 6months after the session in six of 12 studies (Bogens-
chutz etal., 2015; Carhart-Harris etal., 2018; Garcia-Romeu
etal., 2015; Griffiths etal., 2016; Johnson etal., 2017; Ross
etal., 2016).
Beyond symptom reduction, psychedelic-induced mys-
tical-type experiences also seem to increase general well-
being and life satisfaction and to induce positive changes
in attitudes and behavior in healthy participants (for a nar-
rative review of the literature, see Kangaslampi, 2023). In
fact, a study conducted with hallucinogen-naïve adults who
reported regular participation in religious or spiritual activi-
ties showed that these experiences were described as being
among the top five most meaningful and transformative
events of their lives (Griffiths etal.,2006; Griffiths etal.,
2008). Some authors have proposed that the reason that mys-
tical experiences are therapeutic is that they allow the person
to embrace a more meaningful and purposeful perspective of
life (Van Elk & Yaden, 2022). More specifically, Davis etal.
(2020) suggest that the impact of mystical experience on the
reduction of depression and anxiety might be mediated by
increased psychological flexibility.
Fig. 7 Phenomenological similarities between the noetic facet of the mystical-type experience potentially induced by psychedelic intake and the
“Aha!”/ “Eureka!” or insight experience, also definable as metacognitive feeling of epistemic gain
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Cognitive Therapy and Research
It has nevertheless been argued that the mystical-type
experience is not essential for psychotherapeutic outcomes
in PAT (Calder etal., 2024; Gasser etal., 2015; Schmid
etal., 2021). Not only is the mystical-type experience not
always present during a psychedelic-induced experience, but
other mechanisms are involved in PAT, such as ego dissolu-
tion and emotional breakthroughs, which have been argued
to play a pivotal role in therapeutical success (Davis etal.,
2020; Kangaslampi, 2020; Roseman etal., 2019).
Finally, the multidimensionality of the mystical-type
experience construct is an obstacle to its precise defini-
tion, conceptualization, and assessment, complicating its
operationalization and study through experimental research
design (Van Elk & Yaden, 2022). Furthermore, an ongoing
debate surrounds the notion that the subjective effects of
psychedelics play a role in their effect on symptom reduc-
tion. Essentially, what has to be elucidated is whether these
subjective effects are the mere epiphenomenal byproduct
of neural mechanisms or whether they play a causal role in
the clinical outcomes observed in PAT (Olson, 2022; Yaden
etal., 2024).
As various factors are involved in therapeutic work and
success (Wampold, 2015), the upshot is that caution is war-
ranted before assigning too much importance to the psy-
chedelic-induced mystical-type experience. This is particu-
larly important to dampen a potential “miracle-like hyped
expectation” of PAT, to help patients focus their effort on
the therapeutic preparation and integration work surrounding
the psychedelic substance (Aicher & Gasser, 2024; Serag-
noli etal., 2024), and to avoid a feeling of failure when the
psychedelic-induced experience is not profound enough.
Whether psychedelic-induced mystical-type experiences
are or are not beneficial for clinical outcomes in the con-
text of PAT, they must be taken into account and integrated
within the therapy, given their potential impact on clinically
and psychologically relevant meta-cognitive processes.
Moreover, taking them into account is likely to highlight
specific phenomena and processes unique to PAT, which
might be absent in other forms of psychotherapy.
Altered States ofMonitoring andControl
As previously seen, consciousness can be operationalized
as metacognitive processes of monitoring and control which
results in metacognitive feelings and in potentially triggering
meta-awareness. Psychedelic intake is apt to induce a change
in the monitoring and control function of consciousness, in
particular causing a disruption in the control function, with
evidence for this being observed both from a neurological
and a cognitive perspective (Gattuso etal., 2023; Vollenwei-
der & Preller, 2020). Regarding the monitoring aspect, it is
defined as the capacity for a person to be in touch with the
present moment and with the ongoing functioning of their
mind. In fact, this is a widespread suggestion used to explain
to patients what to do during the psychedelic therapy intake
session: the patient is invited to let go of control and be pre-
sent to what is happening, subjectively following the natural
neurocognitive effect of the psychedelic intake (Carhart-
Harris etal., 2014). In addition, the patient is invited not
to resist what is happening in the present or to try to find
solutions or to reason and rationalize around it, but rather to
accept and embody (to feel) whatever is happening within
their introspection (Watts & Luoma, 2020). Because con-
trol is abandoned, monitoring is what is left and this can in
turn generate an extremely positive feeling as a (felt-like)
perennial state of being in the present moment and having
solved all cognitive actions, hence having no further need to
provide cognitive effort.
People undergoing psychotherapy are generally con-
fronted with declarative knowledge experienced about their
own functioning (Miller, 2016). An often-reported effect
of psychedelic intake is that psychedelics tend to promote
a feeling of “having finally understood” what one already
knew related to elements consciously accessible (e.g., auto-
biographical or episodic memories) but not connected with
each other (Carhart-Harris & Friston, 2019).
As an analogy, the case of split-brain research can be
used (Gazzaniga, 2005). In these experiments, patients who
underwent surgery that severed their corpus callosum and
thereby lost the neural connection between the two hemi-
spheres, had to make sense of what one hand had done
by using the opposite “blinded” hemisphere. When they
had to make sense of why they had done something, their
declarative mind completely and unconsciously generated
an explanation to account for what had already happened.
We can hypothesize about the effects of psychotherapy in
the same way, that after having felt such a powerful meta-
cognitive feeling of epistemic gain, the declarative function
could be pushed to come up with a good enough reason
for why that feeling occurred. Given the intensity of this
amplified “Aha!”/ “Eureka!” experience, the mind could
stretch its imaginative capacity for conjuring novel original
representations, drawing them from prior available knowl-
edge. Accordingly, the potential efficacy of PAT could be
explained by the fact that cognitive restructuration operates
on the declarative process because of the powerful affective
states induced by psychedelics, in particular at the level of
the role of the feelings of epistemic gain and meaning in the
human brain-mind-narrative system, in which metacogni-
tive feelings are an integral part. This hypothesized power-
ful learning process could also explain why people deem
these experiences among the most meaningful of their lives,
feeling a before-after transformative effect (Griffiths etal.,
2006).
Another aspect to be considered is the capacity to create
behavioral scripts that influence meta-awareness. Similar
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Cognitive Therapy and Research
to what is observed in lucid dreams (Dresler etal., 2015;
Filevich etal., 2015; Kahan & LaBerge, 1994; Kahan, 2001),
it is conceivable that psychedelics increase the frequency of
triggering a moment of monitoring and meta-awareness in
the daily waking non-sleep state of consciousness. People
can be trained on metacognitive-informed behavioral scripts,
such as a more mindful attitude acquired in meditation prac-
tice, to enhance their agency and cognitive flexibility in their
daily lives, more frequently expressing the capacity to take
control over their attentional focus and act according to their
values (Metzinger, 2013). This technique can be an impor-
tant integration tool for PAT and could be improved with
informed psychoeducation related to daily felt metacogni-
tive feelings. This hypothesis could explain, from a cogni-
tive process perspective, the fact that people can experience
long-lasting increases in trait mindfulness after psilocy-
bin intake (Singer etal., 2024; Søndergaard etal., 2022),
this being directly correlated with the intensity of the felt
mystical-type psychedelic-induced subjective experience.
A potential explanation for this finding might be that the
deeply felt metacognitive feeling of epistemic gain induced
by psychedelic intake sensitizes the feelings related to con-
trol and monitoring of cognition, increasing meta-awareness
of them on a daily basis by reducing the threshold for experi-
encing them(Berit etal., 2024). A more frequent and intense
increase in metacognitive feeling of epistemic gain could in
turn raise the frequency of meta-awareness being triggered,
bringing the person back to the present moment at the com-
pletion of a cognitive action (Søndergaard etal., 2022).
Metacognitive Feeling ofEpistemic Gain‑Based
Framing ofPAT Preparation andIntention
A specific aspect of being prepared for a PAT session involves
defining the so-called intention of the session (Aicher etal.,
2024; Seragnoli, etal., 2024). Intention can be defined as a
specific goal or desire that guides an individual's therapeutic
process during the psychedelic experience. The patient and the
therapist collaborate to establish a clear and defined intention
in the preparatory sessions prior to the substance consump-
tion session. This intention can consist of a sentence or some
keywords that the patient is often allowed to bring as written
words during the substance session. This method is widely
used in PAT and is conceived as being useful to help people
navigate their experience, facilitate post-session integration,
and give a better understanding of the subjective experience.
From a cognitive science naturalistic perspective, a hypoth-
esis can be made that this procedure consists at its core of a
priming process that is applied to the alteration of the state
of consciousness during the dosing session (Dupuis, 2021).
Crucially, from the metacognitive feeling framework laid out
here, a coherent hypothesis is that the intention is invested by
metacognitive feeling of epistemic gain evoked by psychedelic
intake, making it even more meaningful and having as strong
and durable an effect as the intensity of the “Aha!”/ “Eureka!”
experience occurring in the session. To summarize, the patient
should be able to consider the intention during psychedelic-
altered states of consciousness, to be able to pour a powerful
attribution of metacognitive feeling ofepistemicgain on it, in
order to obtain a consequent directly proportional cognitive
declarative restructuring(Hartogsohn, 2018). The capacity to
prepare patients to exploit this effect has yet to be studied and
could be part of a metacognitive epistemic feeling-based psy-
choeducation intervention as preparation for patients in PAT.
Music inPAT: aMetacognitive Feelings Perspective
Music is commonly used to regulate affective states in daily
life (Saarikallio etal., 2013). It has a central role in PAT and
is used to accompany, modulate, and amplify the subjective
processes unfolding in the psychedelic experience (Bonny
& Pahnke, 1972; Kaelen etal., 2018; O’Callaghan etal.,
2020; Seragnoli etal., 2024). Because metacognition is a
core skill for understanding music and is actively engaged
while an individual listens to music (Hallam, 2001), meta-
cognitive feelings may also be implicated in music process-
ing. In particular, when music is played in the background, it
can enhance or impair processing fluency, thereby affecting
metacognitive feelings of fluency (Schwarz, 2010). Research
also indicates that the positive effect of processing fluency
can be eliminated when participants attribute their positive
affective responses to an external influence, such as back-
ground music (Schwarz, 2018). This means that music can
evoke metacognitive feelings that can foster confrontation
and reduce avoidance-related processes occurring in therapy.
Moreover, from a metacognitive procedural perspective,
it is relevant to consider the role of metacognitive feelings
of epistemic gain related to music. One of the pleasures
derived from listening to music is to feel how the music
unfolds. On the one hand, to know that a particular sound
or playing of an instrument is about to happen creates an
expectation and an “Aha!”/ “Eureka!” experience when it
does happen, which explains in part why the appreciation of
a song can increase the more one listens to it. This process
reflects a cognitive action model, involving goal-related,
process-related, and outcome-related metacognitive feelings
(Schwarz, 2018). On the other hand, listening to unknown
music can lead to feelings of surprise and trigger cogni-
tive actions and “Aha!”/ “Eureka!” feelings related to the
gradual discovery of a newfound melodic pattern (Fernán-
dez Velasco & Loev, 2024). Metacognitive feelings of epis-
temic gain can be modulated differently by familiar versus
unfamiliar music, potentially amplifying or reducing them,
thus influencing the opportunity for new experiences in PAT
(Kaelen etal., 2018).
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Cognitive Therapy and Research
The use of music in PAT is generally calibrated in terms
of the phases of the substance’s effect (pre-peak, peak, come
down) (Jerotic etal., 2024). To what extent the impact of
music on metacognitive feelings depends on the specific
session’s phase remains an empirical question to be studied.
Validity ofMetacognitive Feelings ofEpistemic
Gain: Traumatic Memory Recall inPat
Psychedelic experiences commonly entail the recollection
and reliving of autobiographical memories, particularly
those that carry strong emotional significance, whether posi-
tive or negative (Seragnoli etal., 2024). These memories are
often those that were deliberately avoided or forgotten before
the psychedelic intake (Healy, 2021). According to the Self-
Memory System (Conway, 2005) and the self-model theory
of subjectivity (Metzinger, 2003), it may be that the intake
of psychedelics facilitates new and spontaneous associations
between some elements of the long-term self (consisting of a
basis of autobiographical knowledge and a conceptual self)
and episodic memories, thereby contributing to greater auto-
biographical reasoning, which may result in or be induced by
the psychedelic effect on metacognitive feeling of epistemic
gain.
One issue of PAT is the recalling of forgotten past auto-
biographical memories, which is most important when they
concern traumatic events (Oehen & Gasser, 2022). A com-
mon problem for patients is that, most often for memories
related to childhood abuses, people have no possibility to
verify whether what they have recalled has actually hap-
pened. The intense alteration of the state of consciousness
caused by psychedelics can in fact amplify negative emo-
tions and intensify the subjective perceived psychological
pain. Coupling this with the hallucinogenic property of these
substances, it can be coherently argued that these memo-
ries are not real and instead just a vivid symbolization of
attachment neglect and past emotional distress. Using this
naturalistic framework, it can be understood why it is so dif-
ficult to discern the autobiographical truth in a psychedelic
substance-induced subjective experience: the metacognitive
feeling of epistemic gain could be at the very foundation of
these processes in diverse ways. Feeling the “reality,” the
truth and the “Aha!”/ “Eureka!” experience of having finally
understood and having found a new memory within one’s
own autobiography, could be elicited by a real discovery of
memories and facts driven by the increased flexibility due
to the substance effects, or, conversely, just by a false meta-
cognitive feeling of epistemic gain attribution to a product of
the hallucinatory symbolization (Dupuis, 2021). Given this
framework, the therapeutic approach to this problem would
be for the therapist to always come back to the question not
of the truthfulness of the event itself, which most of the time
cannot be confirmed or denied by the subjective psychedelic
experience, but of the meaning and the feelings associated
with it, which in turn are clear and real for the patient, giving
space and recognition to the patient’s own pain and dignity.
The involvement of metacognitive feelings of epistemic
gain can also be studied in relation to actual re-experiencing
of traumatic memory during PAT. The aversive affective
nature of the traumatic memory which push for recollec-
tion avoidance could be counterbalanced from a positive
feeling associated to a metacognitive feeling of epistemic
gain. Indeed, while remembering and understanding again
a trauma-related contentwhich triggers pain and negative
feelings, someone can still experience amplified positive
feeling through the learning process which they are going
through during the substance session and which could have
been prompted in the setting of the intention. In this case, it
is possible to better navigate a painful memory by having at
the same time an amplified positive feeling related to a dif-
ferent understanding of the situation and its consequences.
Relatedly, metaphors used to explain the capacity of the per-
son to confront one’s own traumatic memory like the helio-
scope effect (Calder & Hasler, 2023) could indeed be used
to understand the underlying cognitive processes at play.
Metacognitive Feeling ofEpistemic Gain Issues
withinPAT Therapists’ Self‑Experience
With the increasing demand for PAT internationally, the
question of whether PAT therapists should have personal
experience with psychedelics has emerged as a significant
point of contention in this field (Aicher & Gasser, 2024;
Golafshani etal., 2024; Jacobs etal., 2024). PAT is a psycho-
therapy that uses a specific pharmacological tool to modify
the standard waking state of consciousness in the individual
as an opportunity to amplify psychotherapeutic processes.
This alteration of the state of consciousness is useful for
therapeutic purposes and can be compared with other thera-
pies such as mindfulness-based cognitive therapy (MBCT)
and hypnotherapy in which self-experience is part of the
therapists’ training. Proponents of self-experience argue
that personal exposure to psychedelics enables therapists to
develop a deeper understanding of the unique phenomenol-
ogy associated with these substances (Guss etal., 2020).
Opponents of self-experience argue that personal use of
psychedelics is unnecessary and may even be harmful in the
context of therapy (Emmerich & Humphries, 2023). Moreo-
ver, it was also argued that considering self-experience as
necessary in the context of PAT contributes and perpetuates
ableism in medicine by excluding professionals who would
not be able to consume a psychedelic substance because of
their susceptibility and/or medical history profile (Golaf-
shani etal., 2024). It has, for example, been suggested that
because of the intensity and the potential change in beliefs
associated with psychedelic intake, self-experience could
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Cognitive Therapy and Research
promote cognitive distortions or dysfunctional beliefs (e.g.,
paranormal beliefs) around the principles and factors of the
therapeutic process of PAT, giving rise to questionable ethi-
cal practices for therapists and research in this field (Wahbeh
etal., 2022a). Hence, the study of metacognitive feeling of
epistemic gain can be important to consider both for the
opportunities and the risks associated with self-experience
for therapists.
On the one hand, using this naturalistic framework could
help therapists better understand these subjective feelings
in order to support the integration process of their patients.
A broader argument can be considered that applies to the
debate about the phenomenology of the daily subjective
experience (Nagel, 1974) and the extent of understanding
that a therapist can have of a patient’s mind, which goes far
beyond the noetic debate, opening up the neurophenomenol-
ogy approach (Sandved-Smith etal., 2021; Timmermann
etal., 2023, 2022). William James described the ineffability
of the mystical-type experience as follows:
“ […] The subject of it immediately says that it defies
expression, that no adequate report of its contents can
be given in words. It follows from this that its quality
must be directly experienced; it cannot be imparted or
transferred to others. In this peculiarity mystical states
are more like states of feeling than like states of intel-
lect. No one can make clear to another who has never
had a certain feeling, in what the quality or worth of
it consists. One must have musical ears to know the
value of a symphony; one must have been in love one’s
self to understand a lover’s state of mind. Lacking the
heart or ear, we cannot interpret the musician or the
lover justly, and are even likely to consider him weak-
minded or absurd. […]” (William James, 1902).
On the other hand, powerful psychedelic-induced mys-
tical-type experiences lived by therapists could represent
a risk ranging from creating cognitive bias and distorted
expectations to the process of PAT (Forstmann & Sagioglou,
2021; Kious etal., 2022; Thorens etal., 2023) to unethical
practices tainted by the exaltation of narcissistic traits or
sectarianism, which can be extensively found in the history
of this discipline, by therapists who believed that they had
finally found the tenets of the “real and true psychotherapy.”
A naturalistic metacognitive-based understanding of the
metacognitive feelings of epistemic gain within mystical-
type experiences potentially caused by psychedelic sub-
stance intake could help therapists better integrate their own
subjective experience, if they go through self-administration
of a psychedelic in a supervised psychotherapeutic training.
Suggestibility andSectarianism:
Psychedelic‑Induced Altered States ofBelief
Transmission andFluency Appraisal
Fluency is defined as a metacognitive feeling that affects
learning and knowledge acquisition (Proust, 2021; Reber &
Greifeneder, 2017). Fluency as a feeling is the familiarity
with which information is perceived and the ease with which
it is processed. The feeling of fluency is routinely reassessed
by a learner during information processing. In particular,
fluency is felt when a new fact is well anchored to pre-exist-
ing facts, it is congruent with them, and it permits many
new apparently anchored and coherent associations among
pre-existing facts (Rajaram & Geraci, 2000). This process
follows the dynamic of concept learning, which is the acqui-
sition of a pattern-based internal model of the world. The
formation of concepts offers an advantage in terms of the
quantity of information at one’s disposal to predict future
events more efficiently (Goldstone etal., 2018). In contrast,
the feeling of fluency is disrupted or absent if a new fact is
incoherent in the context of prior knowledge. Considering
this, fluency has been studied in the context of beauty and
aesthetic appreciation, given the subjective affective nature
of these assessments (Schwarz, 2018).
To minimize cognitive effort to reach an epistemic goal,
the system uses cues related to feelings of fluency to quickly
form logical reasoning and beliefs in order to orient itself
coherently in the semantic space. The cognitive system is
normally efficient at managing the massive amounts of infor-
mation being processed at any given time, flexibly shifting
the investment of limited working memory capacity. This is
the origin of routinely used reasoning shortcuts, also referred
to as cognitive biases or heuristics. In this sense, the “Aha!”/
“Eureka!” experience can be considered to be a heuristic that
guides decision-making processes (Laukkonen etal., 2023),
showing how a person can intuitively orient themselves to
reach an epistemic objective.
From an individual perspective, the metacognitive
feeling of epistemic gain supports the feeling of fluency,
thereby increasing the possible amount of treated informa-
tion (Wolk etal., 2004). In turn, this can explain why psy-
chedelic-induced metacognitive feelings of epistemic gain
could affect the processing of suggestibility related to the
therapeutic intention primed prior to the therapy session, as
previously described. Suggestibility, the tendency to comply
with suggestions from others, has been studied as a factor
potentially involved in PAT efficacy(Hartogsohn, 2016). In
their study, Szigeti etal. (2024) found that the suggestibility
trait (defined as the tendency to act or accept suggestions
based on the input of others) of participants was predic-
tive of psilocybin efficacy but not of escitalopram. A pos-
sible hypothesis put forward by Szigeti etal. (2024) is that
“[…] high suggestibility could imply elevated attunement to
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Cognitive Therapy and Research
acute insights, and influence from therapy personnel […]”
(p. 1722). Consistent with our hypothesis, future research
could test whether metacognitive feelings of epistemic gain
mediate the relationship between individual differences in
suggestibility and the effect of psychedelics.
Psychedelics have been studied as tools for belief trans-
mission in the context of ritual and religious use (Dupuis,
2021) and have been historically used in traditional cere-
monies (Kettner etal., 2021). Unfortunately, psychedelics
have also been associated with dangerous sectarian practices
(Paglia, 2003; Richardson, 1979; Tramacchi, 2000). From
a group perspective, the impact of metacognitive feelings
of epistemic gain in perceived fluency could in part explain
psychedelic-induced cognitive influences in cult collective
contexts (e.g., sectarianism) (Marinacci, 2023), particularly
during socially mediated processes of epistemic formation
imposed by an authoritative persuasive figure (e.g., guruism)
(Sperber, 2010). A metacognitive-informed understanding of
the way in which beliefs are transmitted in social contexts,
whether religious, cultural, or sectarian, can be a key ele-
ment for a truly interdisciplinary understanding of the use
of psychedelics and their culturally mediated mechanisms
(Fortier, 2018).
Integrating the effects of metacognitive feelings of epis-
temic gain with information processing in social interactions
can thus improve our understanding of the impact of cultural
values and narratives operating in the variety of settings used
for psychedelic substance intake, while at the same time
keeping a neurocognitive model that underlines these pro-
cesses (Nardou etal., 2023).
Spiritual Bypassing Grounded: Metacognitive
Feeling‑Based Integration Guidelines
The hallucinatory quality of psychedelic-induced altered
states of consciousness can induce a very wide range of per-
sonal explanatory narratives to make sense of what is expe-
rienced. Among these, one can include metaphysical beliefs
about the nature of reality, encountering God or entities, or
even unverifiable facts about childhood trauma. These new
narratives can have powerful impact on one’s world-view
and mental health, sometimes beneficial, but sometimes
also damaging or delusional, ranging from pseudo-science
to parapsychology (Wahbeh etal., 2022a). This problem is
commonly known in the psychedelic research field as “spir-
itual bypassing” or “woo-woo” effects (Carhart-Harris &
Friston, 2019). The powerful metacognitive feeling of epis-
temic gain triggered by psychedelics can induce the person
to adopt dogmatic beliefs or have the impression to finally
understand the “ultimate Reality.” This could be explained
because of the bursts of a too-intense metacognitive feeling
of epistemic gain, which could induce the person to try to
make sense of it with an important enough matching seman-
tic representational object(Clément, 2003).
It could be possible to implement forms of psychoeduca-
tion in PAT with the goal of giving patients a naturalistic
framework about how to recognize and interpret mystical-
type experiences stemming from psychedelic intake, com-
paring the metacognitive feeling of epistemic gain to those
same feelings being experienced in daily life activities. One
important aspect to be highlighted in such psychoeducation
is the bodily sensations of these feelings, corresponding to
a sense of positive affect, satisfaction, and release from cog-
nitive frustration. This type of psychoeducation would be
important during the post-experience integration sessions to
mediate the new beliefs and cognitive restructuring that the
patients went through. Instead of focusing on the veracity of
visions or ideas about absolute truths (e.g., God) that have
been felt as “revealed” in the context of the psychedelic-
induced experience, the therapist could let the patient focus
on the revelation “Aha!”/ “Eureka!” experience itself. Where
else in daily life does the patient usually feel this kind of
feeling of meaning and bliss? When performing what kind
of activities? The patient could thus be supported in real-
izing when this feeling is evoked in daily life by the contact
with something important, good, coherent or useful to one’s
own personal appreciation and taste for life (e.g., spiritual
practice, playful activities, sport, creative expression, work-
related tasks, learning activities). This approach is a natu-
ralistically grounded way to be able to make sense of and
accompany people in integrating mystical-type and spiritual
experiences that can result from PAT sessions, which is an
important issue in this type of psychotherapy (Dupuis, 2021;
Sjöstedt-Hughes, 2023). It also highlights the importance of
affording an intense subjective meaningful experience, also
called “portentousness” (Krystal etal., 2023), which is an
integral part of PAT, the intensity of which is related to the
establishment of cognitive behavioral learning acquisition.
These peak experiences can help recalibrate the predic-
tive processing active inferencefunction of the metacogni-
tive system, which is dysregulated in various psychopatholo-
gies, making it more able to express coherent subjectively
felt insights (Carhart-Harris & Friston, 2019). Psychedelics
can in fact reopen the social reward learning critical period
(Nardou etal., 2023). From this perspective, the regulation
of the metacognitive feeling of epistemic gain could also
be impacted because of the social cognition aspects of the
interactive nature of the different phases of PAT: therapeutic
preparation and intention setting; suggestibility; traumatic
memory recall. In this way, the reopening of the social
reward learning critical period could reflect for the person
an improvement in the regulation of socially induced meta-
cognitive feelings of epistemic gain.
The extent to which extra-pharmacological factors,
such as the PAT set and setting, can be used to increase
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Cognitive Therapy and Research
the probability of affording an intense metacognitive feeling
of epistemic gain experience could be specifically studied.
Moreover, in people coming back to their day-to-daylife
activitiesafter having done a PAT session, integration tools
could be developed to better support the patient to recognize
mentally and/or bodily such short daily moments of “Aha!”/
“Eureka!”.
Moreover, the ongoing integration work for the patient
could also be invested by this framework by letting the
patient learn how to better recognize this metacognitive
feeling of epistemic gain in daily life and then discuss it in
the ongoing therapy. In this sense, this approach could be
particularly fruitful because it operationalizes a clear aspect
of the subjective experience, that can be taken as a concrete
principle to ground mindfulness-like skill training for daily
life purposes. A metacognitive epistemic feeling oriented
psychotherapeutic intervention, inscribed in a PAT cognitive
behavioral informed therapy, would consist of helping the
patient focus on finding, training, and amplifying the meta-
cognitive feeling of epistemic gain in day-to-day life. The
extent to which various practices could be integrated in such
an approach would be important to understand (Vervaeke &
Ferraro, 2013)
Further Lines ofResearch
From a cognitive science perspective, ways could be found to
precisely assess metacognitive feelings of epistemic gain and
to explore the impact that psychedelics could have in their
expression, appraisal, and modulation, which has been done
but only to a certain extent (Laukkonen etal., 2023). Other
paradigms can be considered in which a method for seman-
tically elicited false insight has been developed (Grimmer
etal., 2022). It is argued that a true understanding of these
processes requires grounding in a solid cognitive framework
of consciousness. Metacognition is useful to bridge the gap
between a neuroscientific understanding of the activity of the
brain and personal subjective narratives (Peters, 2022). By
creating empirical hypotheses at the level of metacognitive
feelings that can be measured and manipulated experimen-
tally, it is possible to lay out valuable experimental settings
for a renewed understanding of the psychophysics of the
subjective experience (Peters, 2024).
It might be relevant to distinguish two different aspects
of mystical-type experiences covering spiritual experiences
in the field of consciousness studies (Freimann etal., 2024).
On the one hand, the feeling of truth has been related to
fluency of processing information (Schwarz, 2018), and on
the other hand the sense of reality, which has been studied
in the context of schizophrenia or psychedelic-induced hal-
lucinations and is prompted by a variety of other processes
(Fortier, 2018). These two facets of mystical-type experi-
ences should be investigated and assessed separately, as they
are supported by different sets of properties and functions of
the neurocognitive system.
From a neurocognitive perspective, it may be possible to
define a neural signature for the “Aha!”/ “Eureka!” experi-
ence. This could potentially be done by studying fluency
processes (Oppenheimer, 2008) and memory formation and
recall (Doss etal., 2020). In fact, metacognitive feelings
are useful to qualify the subjective experience related to a
memory retrieval task when it is likely to create an “Aha!”/
“Eureka!” experience. Accordingly, it has been hypothesized
that the subjective fluency feelings originating from a variety
of cognitive processes could be attributed to a metacognitive
feeling that cues the information processing (Alter & Oppen-
heimer, 2009). Moreover, a recent study indicated that psilo-
cybin may impair one's understanding of their own memory
(metamemory) for negative and neutral memories, while
enhancing it for positive memories (Doss etal., 2024b). This
observation could be explained by the potential increase of
the positive affect generated by an amplified metacogni-
tive feeling of epistemic gain induced by the success of the
retrieval cognitive action.
Metacognitive feelings can be linked directly to the
neural aspects of the reasoning and creative process as
structural–functional modules composed of assemblies
of neurons, called semantic pointers, which discriminate,
manipulate, and orchestrate the organization and unfold-
ing of cognitive representations (Thagard, 2014). From this
perspective, it is reasonable to hypothesize that the greater
functional activation of psychedelic-induced neurological
effects could activate an increased number of semantic point-
ers, which would engage in a wider than usual interactive
competition, triggering a more intense than usual “Aha!”/
“Eureka!” experience (Thagard, 2014) potentially inducing
a fact-free learning experience (Friston etal., 2017a, 2017b).
The study of metacognitive feeling of epistemic gain can
point to a better understanding of the effect of psychedelic-
induced altered states of consciousness in the study of crea-
tivity and creative thinking (Jia etal., 2019). The massive
amount of hyperconnectivity induced by psychedelics in the
brain (Carhart-Harris etal., 2014) can in turn create massive
abnormal excitatory and binding activity in semantic point-
ers in neural networks, which would then trigger the “Aha!”/
“Eureka!” experience (Thagard & Stewart, 2011). Given
the intensity of the psychedelic-induced “Aha!”/ “Eureka!”
experience, an increase in creativity could be hypothesized
as a form of sensitization of daily life felt metacognitive
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Cognitive Therapy and Research
feeling of epistemic gain that orient people in tasting and
exploring new and original ideas. If the threshold for a meta-
cognitive feeling of epistemic gain to be triggered has been
lowered, then the person could more easily be affected by it
in daily life, expressing more original behaviors and seman-
tic explorations.
This could also provide a coherent cognitive explanation
for the increase in the openness personality trait, as assessed
by the NEO-Personality inventory that measures the Big
Five model of personality traits (Costa Jr. & McCrae, 1995),
after psychedelic intake (MacLean etal., 2011) given that
multiple items of the openness facet measures metacognitive
feelings of epistemic gain.1 The extent to which the process
of creativity in daily life could be better understood from a
subjective perspective by experiencing peaks of psychedelic-
induced metacognitive feeling of epistemic gain could be a
promising future line of research.
Another neurocognitive approach consists of consid-
ering similarities between the mystical-type experience
features shared by psychedelic subjective experience and
the ecstatic epilepsy account of mystical-like experiences
(Picard & Kurth, 2014; Sooter etal., 2024). As described
in more detail earlier, mystical-type experiences proper to
ecstatic epilepsy are associated with abnormal activity in the
anterior insula, which is involved in predictive processing of
interoception (Seth etal., 2012) and cognition (Uddin etal.,
2017). These seizures potentially disrupt the insula's evalu-
ation function, leading to the unique experiences observed
during ecstatic epilepsy, which can be interpreted as process-
based, outcome-related metacognitive feeling of epistemic
gain as a result of a predictive processing understanding of
metacognition (Fernández Velasco & Loev, 2024). From a
metacognitive perspective, a disruption in the normal control
of cognitive action processing would leave the person in a
monitoring stance, characterized by a mystical-like state, as
an “Aha!”/ “Eureka!” experience that lasts more than just a
moment. Moreover, the insula is a key region for self-aware-
ness and the subjective feeling of the passage of time (Craig,
2009) and an alteration of the anterior insula in individuals
with epilepsy has been linked to a change in meta-awareness
(Picard & Craig, 2009).
From this perspective, another venue to study PAT mech-
anisms is to consider that the anterior insula is involved in
detecting salient events and initiating appropriate cognitive
control responses, acting as a hub for mediating interactions
between networks involved in external attention and meta-
cognitive processes of monitoring and control (Menon &
Uddin, 2010). It also plays a role in goal-directed cognition
and switching between different brain networks, contributing
to meta-awareness of affect and somatosensation, and facili-
tating integration between affective, sensory-motor process-
ing and general cognition (Chang etal., 2013).
Salience refers to the quality of being noticeable or stand-
ing out, and it is often defined by both low-level sensory
features (e.g., color or intensity) and high-level cognitive and
affective processes (e.g., emotional relevance) (Parr & Fris-
ton, 2019). Aberrant salience, where insignificant stimuli are
given undue significance, is implicated in conditions such
as psychotic disorders (Kapur, 2003). Salience detection
involves the integration of internal and external stimuli to
prioritize information that is meaningful or behaviorally rel-
evant and can constitute an epistemic gain. In neuroscience,
the salience network, which includes key nodes in the insu-
lar cortex and anterior cingulate cortex, plays a critical role
in detecting behaviorally relevant stimuli and coordinating
neural resources to respond to these stimuli. In particular,
it serves to redirect attention and to better invest cognitive
resources, consequently activating metacognitive processes
of monitoring and control (Goupil & Proust, 2023).
To sum up, salience has the capacity to trigger metacog-
nitive processes of monitoring and control, consequently
triggering meta-awareness and making the individual able
to take active conscious control of their cognitive effort.
Psychedelic-induced metacognitive feelings of epistemic
gain could re-calibrate the role of the insula in daily sali-
ence processing, most importantly in social reward learning
(Nardou etal., 2023), thereby affecting the process of PAT.
Overall, the study of metacognitive feelings would be
helpful in augmenting the depth of analysis of the first-per-
son perspective experience, informing phenomenological
cognitive inquiry on non-sensory mental states like thoughts
or wishes (Bayne & Montague, 2011; Metzinger, 2015), as
well as neurophenomenological approaches that have been
recently put forward in the study of altered states of con-
sciousness in meditation and psychedelics (Timmermann
etal., 2023; Varela, 1996).
Lastly, it is important to highlight that the study of the
overlapping of the mystical-type experience and the meta-
cognitive feeling of epistemic gain process is in no way
undermining the dignity and personal meaning of people
having deep experiences in PAT. On the other hand, one
will always need to go through a rational analysis, an experi-
mental corroboration and a peer-review process, in order to
consider the actual epistemic value of an “Aha!”/ “Eureka!”
experience on our collective way of understanding reality
(Jopling, 2001).
1 Items concerned includes the following: “ I often enjoy playing
with theories or abstract ideas”; “I enjoy solving problems or puz-
zles”; “I enjoy working on ‘mind-twister’-type puzzles”; “I have a lot
of intellectual curiosity.”.
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Cognitive Therapy and Research
Conclusion
The aim of this work was to pave the way for the genera-
tion of novel working hypotheses to be empirically tested
in the field of consciousness studies in relation to the link
between metacognition and psychedelic-induced altered
states of consciousness. This article was generated because
we observed a lack of clear understanding of mystical-type
experiences in psychedelic-induced alteration of conscious-
ness and the call for it to be addressed (Krystal etal., 2023).
Metacognition can be used to holistically operationalize
consciousness functioning because of its declarative and
procedural aspects. Although declarative metacognition
consists of knowledge about cognitive strategies and how
cognition function, procedural metacognition plays a crucial
role in guiding internal cognitive actions through monitor-
ing and control mechanisms. From a subjective perspective,
the dynamic interplay of monitoring and controlling one’s
own cognition is felt through metacognitive feelings. In
particular, psychedelic-induced alteration of consciousness
may have the potential to induce powerful “Aha!”/ “Eureka!”
experiences, by amplifying so called procedural-based,
outcome-related metacognitive feeling of epistemic gain.
The use of a cognitive framework to understand the noetic
quality of the mystical-type experience induced by psych-
edelics can be fruitful to better define and examine important
aspects related to PAT research and clinical applications,
including spiritual bypassing, integration work, intention
setting, sectarianism, use of music, traumatic recalling and
self-experience in psychotherapists. Ultimately, a cogni-
tively informed understanding of the psychedelic-induced
subjective statecould help patients better integrate and
use the transformative, insightful, and meaningful “Aha!”/
“Eureka!” feelingsexperienced during PAT, as they may
be better able to recognize these meaning feelings daily
(Gopnik, 1998; Preller etal., 2017; Hartogsohn, 2018)and
be inspired by them to achieve a personal positive meta-
aware existential evolution, in keeping with their own taste
for life.
Acknowledgements We thank the people interested by the topic of
altered states consciousness studies, who participated in debates around
this topic years before this publication, which would not now exist
without them.
Author Contributions FS: Conceptualization; Writing—original draft.
JB, FP, GT: Supervision; Writing—review & editing. MG, AA, MB,
PP, CP, MR, MB, LR, LP, ZD: Writing—review & editing.
Funding Open access funding provided by University of Lausanne.
Data Availability No datasets were generated or analysed during the
current study.
Declarations
Competing Interests The authors declare no competing interests.
Consent for Publication During the preparation of this work the
author(s) used ChatGPT in order to improve the readability and lan-
guage some sections of the manuscript. After using this tool/service,
the author(s) reviewed and edited all content improved as needed and
take(s) full responsibility for the content of the published article.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article’s Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article’s Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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FedericoSeragnoli1,2· FabiennePicard2· GabrielThorens2· AlbertBuchard2· MeganGeyer1· AngelaAbatista3·
PolinaPonomarenko4· CyrilPetignat3· MarcoRiccardi5· MaëlleBisson2· LucienRochat2· LouisePenzestadler2·
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* Federico Seragnoli
federico.seragnoli@hug.ch
Fabienne Picard
fabienne.picard@hug.ch
Gabriel Thorens
gabriel.thorens@hug.ch
Albert Buchard
albert.buchard@hug.ch
Megan Geyer
megan.geyer@unil.ch
Angela Abatista
angela.abatista@unige.ch
Polina Ponomarenko
polina.ponomarenko@unifr.ch
Cyril Petignat
petignat.cyril@etu.unige.ch
Marco Riccardi
marco.riccardi01@universitadipavia.it
Maëlle Bisson
Maelle.Bisson@hug.ch
Lucien Rochat
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Louise Penzestadler
Louise.Penzenstadler@hug.ch
Daniele Zullino
Daniele.Zullino@hug.ch
Joël Billieux
joel.billieux@unil.ch
1 University ofLausanne, Lausanne, Switzerland
2 University Hospital ofGeneva, Geneva, Switzerland
3 University ofGeneva, Geneva, Switzerland
4 University ofFribourg, Fribourg, Switzerland
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