Abstract Adolescent refractory mental health disorders are rising globally, contributing to long-term morbidity and substantial societal burden. Conventional psychotropic medications and psychotherapeutic approaches sometimes fail to provide adequate relief, necessitating an interest in novel investigational interventions. Classic psychedelic compounds—Psilocybin, Lysergic Acid Diethylamide (LSD-25), and Dimethyltriptamine (DMT)—administered within Psychedelic Assisted Therapy (PAT) frameworks have shown strong efficacy in adults with refractory psychiatric conditions. However, adolescents remain excluded from clinical trials. Concerns regarding the safety of classic psychedelic use in adolescents are justified and must be contextualized within limitations of existing evidence. Available data are observational and underpowered to detect long-term outcomes. While adult studies suggest low physiological toxicity, minimal dependence liability and a wide therapeutic index, these findings cannot be directly extrapolated to adolescents undergoing neurodevelopment. This commentary advocates for cautious, ethically grounded consideration of controlled research involving classic psychedelic compounds in adolescents with refractory mental health disorders.
Abstract Background and aims In the past 10 years, several publications have made the dubious assertion that Amanita muscaria is commonly used for suicidal purposes, though no primary sources are cited. Despite scientific advances in understanding A. muscaria 's pharmacology, discussion of this psychoactive mushroom in academic publications continues to be shrouded in bias and myth. The present review investigates assertions of the mushroom's use in suicide and aims to illuminate the origins of these claims. Methods An extensive review of the English and German literature was conducted to identify possible trends or instances of the use of this mushroom for suicidal purposes. In addition to a review of popular field guides, mycological texts, and ethnographic accounts, searches for relevant publications were conducted using Google Scholar, PubMed, Science Direct, and Zobodat. Results The present review found insufficient data to suggest any historical or contemporary trends that warrant claims that A. muscaria is commonly or effectively used as a suicide agent, nor did it find evidence that A. muscaria is sufficiently and reliably lethal to warrant its use in suicide. Instead, the review found a pattern of bias in the literature, in the form of Amanitaphobia, when the dangers of A. muscaria ingestion are addressed. Conclusions Claims that A . muscaria is commonly consumed for purposes of committing suicide are not supported by verifiable or documented trends in the English or German literature, instead such claims appear to be supported by Amanitaphobia; a bias against A. muscaria based on its perceived dangers and deadliness.
Abstract Background and Aims Music has been associated with psychedelic experiences throughout human history, from ancient shamanic healing rituals to contemporary psychedelic-assisted therapy (PAT), and is considered integral for positive therapeutic outcomes. Yet optimized protocols and best practice standards for the use of music in PAT are lacking. Methods This interdisciplinary literature review identifies the role, characteristics, hypothesized mechanisms, and relevant contextual factors of music associated with (1) modern PAT practices, (2) traditional entheogenic rituals, and (3) musically-induced peak experiences. Results The findings reveal conflicting musical features across these three contexts. Modern PAT music is designed to mirror the subjective intensity of drug effects with a peak phase marked by simplicity, consistency, and slow tempo. Entheogenic ritual music exhibits simple compositional forms with elements of rhythmic complexity, constancy with subtle variations, and fast tempo. Peak experience-inducing music is complex, surprising (with large dynamic changes), and fast. These differences in music may be due to differences in the assumed role of music and the associated non-ordinary state of consciousness. Conclusions Preliminary recommendations for clinical PAT practice include: tailoring music to the drug, the individual, and the desired experience; drawing on mechanism-based theories from music psychology; and considering the ethics of integrating Indigenous musical practices. In general, there is a dearth of research directly comparing different types of music during PAT, particularly along key dimensions such as familiarity, complexity, and constancy, suggesting a need for further experimental studies with diverse populations.
Abstract Background and Aims Psilocybin-assisted psychotherapy (PAP) is a novel, transdiagnostic treatment in which the 5-HT2A receptor agonist psilocybin is combined with psychotherapy. Studies to date have evaluated PAP's effects on depression, substance use, and end-of-life adjustment. Relatively less attention has been given to its effects on anxiety symptoms, which are highly comorbid with other psychiatric conditions and are a leading cause of global disability. This review systematically evaluated evidence for PAP's effects on anxiety symptoms across diagnoses, with attention to variations in interventional components across studies. Methods A systematic review was conducted following PRISMA guidelines. Searches were completed in six databases and independent reviewers screened records. Study quality was assessed and data extracted on participant demographics and intervention features. Random-effects models estimated within- and between-group effects from baseline to primary endpoint. Results Twenty-five studies were determined eligible for inclusion. Considerable heterogeneity was observed in psychotherapy format, dosing, session structure, and outcome timing. Pooled results showed a large within-groups effect on anxiety after controlling for measurement artifacts (Hedge's g = 0.96) and a small between-groups effect (Hedge's g = 0.48). High heterogeneity persisted even after controlling for the influence of different anxiety measures and moderators related to intervention formulation and delivery. Conclusions PAP shows promise for reducing anxiety across primary diagnoses. However, variability in study quality, interventional design, sample representativeness, and high heterogeneity warrant caution in interpretation. More rigorous, high-quality trials with diverse populations are needed. Implications and directions for future research are summarized.
Abstract Background and aims In contemporary psychedelic science, integration is a central construct for describing how individuals process psychedelic experiences and translate insights into their lives (Bathje et al., 2022; Smith et al. 2024). Yet this term emerges from Western therapeutic paradigms and may not resonate with Indigenous peoples who have stewarded what has been called “psychedelic medicines” for generations. Starting from the question “Is there integration in Indigenous contexts?”, this article examines why integration is largely a foreign concept among Amazonian Indigenous peoples and what this reveals about different ontologies of self, healing, care and world. Methods The analysis draws on a decade of collaborative ethnographic work with Indigenous peoples in the Brazilian Amazon, particularly the Yawanawá and Huni Kuin. Methods include collaboration in different initiatives, observation, dieting, ceremonial participation, and dialogues with Indigenous spiritual leaders and non-Indigenous participants, interpreted alongside literature on psychedelic integration, Gregory Bateson's “ecologies of mind,” Félix Guattari's “ecosophy”, and relational-ontological anthropology. Results Among the Yawanawá and Huni Kuin there is no emic equivalent to Western integration. Ritual life is organised around community, extended “family” (including more-than-human beings), mesenai (care and respect), dreams, chants, art and embodied practices. Mind, body, spirit, and nature form a communion ecology; imbalance among them causes illness. Indigenous medicines such as ayahuasca ( uni and nixi pae in Yawanawá and Huni Kuin cultural nominations respectively) are teachers, and healing is relational rather than primarily intrapsychic. Conclusions Integration is needed mainly in Western contexts that are marked by dualisms and social and ecological disconnection. Rather than exporting integration to Indigenous worlds, psychedelic science should learn from Indigenous relational ontologies, ecosophical configurations, and care practices, developing pluriversal integration frameworks that emphasise responsibility, reparation, embodiment, and ecological reciprocity.
Background The Pivotal Mental States (PiMS) construct posits that psychedelics and other stress-inducing practices, such as fasting and hypoxia, can evoke transformative mental states through increased serotonin receptor activation in the brain. These states are associated with enhanced cognitive flexibility, accelerated associative learning, and psychological insights that may catalyze meaningful behavior change. While PiMS primarily conceptualizes transformation within the domains of brain and mind, emerging evidence from psychedelic research suggests that psychedelics also exert profound effects on the body, pointing to the possibility that transformation occurs in psychological and bodily dimensions. Aims This paper introduces the novel construct Pivotal Physical States (PiPS), conceptualized as the somatic counterpart to PiMS. We propose that, like the mind, the body can enter a 'pivotal state' in response to acute stressors, including but not limited to psychedelic substances. Methods We synthesize interdisciplinary literature to build a theoretical foundation for PiPS, focusing on the peripheral serotonin system as well as other somatic trigger points and their downstream physiological effects. Discussion Psychedelics and other stressors may set the stage for pivotal states that span the mind-body continuum. This dual action may have the potential to facilitate profound psychological and physiological recalibration in either a positive or negative direction, depending on several moderators. Together, PiMS-PiPS may guide a more integrated view of transformation that invites new interdisciplinary research and innovative therapeutic applications. Future work should prioritize empirical validation of the PiPS construct.
Background and aims Psychedelic therapies are moving from the margins of medicine into clinical practice, bringing unresolved ethical questions to the forefront. Among them, ketamine-assisted psychotherapy (KAP) has gained the widest medical acceptance, particularly for treatment-resistant depression (TRD). In August 2025, this development reached a new stage as Norway became the first country to approve reimbursement of generic ketamine for TRD. This study uses a principlist framework to examine ethical challenges related to administering KAP during the formative period preceding this policy shift, when provision was largely private. Methods Sixteen physicians and clinical psychologists in Norway were interviewed about ethical challenges in practice. Data were analyzed abductively through thematic analysis, using Beauchamp and Childress' principlist bioethics as a framework. Results Findings are structured around three themes: (1) Access to care , where injustice stemmed from cost, geography, and limits on public communication; (2) Informed consent , where the unpredictability of ketamine's effects complicated autonomy, leading practitioners to rely on flexibility and experiential familiarity; and (3) Therapeutic integrity , where beneficence and non-maleficence depended on sustaining psychotherapy, with risks of fragmented care, unrealistic expectations, and ketamine treated as a stand-alone cure. Conclusions While principlist ethics acted as a useful scaffold, systemic factors such as funding structures and biomedical norms of consent shaped KAP in ways the framework could not fully capture. For KAP to develop into ethically robust psychiatric care in Norway and beyond, it must balance expanded access with the therapeutic depth that grounds the practice, supported by refinement of consent processes.
Abstract The Czech Republic, like many European countries, continues to face significant challenges in treating substance use disorders (SUDs), with high relapse rates and complex comorbidities often linked to trauma and mental illness. Psychedelic-assisted psychotherapy (PAP) has re-emerged internationally as a promising therapeutic modality, although available evidence remains heterogeneous across substances, populations, and study designs. This narrative review critically examines clinical evidence relevant to psychedelic-assisted interventions in SUDs and selected dual-diagnosis populations, with particular attention to evidence quality, safety, and implementation constraints. It also contextualizes recent Czech developments, including ketamine-assisted psychotherapy initiatives, the inclusion of PAP in national addictology guidance, the publication of national psychiatry guidelines for psilocybin-assisted psychotherapy for medical use, and the 2025 legislative reform introducing psilocybin for medical use from January 2026. Across the reviewed literature, the strongest direct evidence for addiction treatment currently comes from a limited number of randomized and controlled studies, while much of the remaining literature remains observational, open-label, historical, or naturalistic. These findings suggest cautious clinical potential rather than established effectiveness across addiction care settings. Recent Czech legal and clinical developments may create a basis for carefully monitored pilot implementation and evaluation, but broader integration will depend on clearer indications, accredited training, longitudinal outcome monitoring, and transparent communication of both potential benefits and unresolved risks.
Background and aims Psilocybin, a psychoactive compound found in fungi commonly referred to as "magic mushrooms," is consumed for both spiritual and recreational purposes. However, psilocybin use in Puerto Rico remains understudied. This exploratory cross-sectional survey aimed to describe patterns of use, motivations for consumption, explanatory factors, personality traits, and sex-gender differences associated with psilocybin use in a convenience sample of adults residing in Puerto Rico. Methods The study recruited 343 respondents through internet-based advertisements to complete an online survey, which included demographic variables, patterns of psilocybin consumption, polysubstance use and the Ten-Item Personality Inventory (TIPI-SPA). Logistic regression models were used to identify significant explanatory factors. Results Within this convenience sample, 52.6% of participants reported lifetime psilocybin use; this figure reflects the recruited sample and should not be interpreted as a population prevalence estimate. Participants largely believed that magic mushrooms were non-addictive (61%) and safe (57%). Curiosity was the primary motivation for use (43%), and most participants reported pleasant or very pleasant experiences (88%). Significant explanatory factors of psilocybin consumption included identifying as male (adjusted odds ratio [aOR] = 6.2; 95% CI: 2.81-14.49), identifying as bisexual (aOR = 3.14; 95% CI: 1.14-9.14), identifying as gay (aOR = 0.14; 95% CI: 0.03-0.54), identifying as non-heterosexual identities (aOR = 4.33; 95% CI: 1.27-16.38), identifying as non-Christian (aOR = 3.76; 95% CI: 1.77-8.37), openness (aOR = 2.09; 95% CI: 1.49-3.0) and agreeableness (aOR = 1.75; 95% CI: 1.20-2.63). Conclusion This exploratory study describes psilocybin use in a convenience sample of adults in Puerto Rico by sociodemographic characteristics, patterns of consumption, sex-gender identity, and personality traits. Findings are preliminary and warrant replication using probability-based sampling designs.
Background This study presents the qualitative findings of interdisciplinary research exploring ayahuasca-induced experiences in two distinct groups in Uruguay: a neo-shamanic group rooted in the Peruvian vegetalismo tradition and a Santo Daime Church. Aims Using interpretative phenomenological analysis, the study examines similarities and differences in subjective experiences during a neo-shamanic ritual and a religious ritual (n = 18). Methods Semi-structured in-depth interviews were conducted with 26 participants of a neovegetalismo group and with 18 participants of Santo Daime. Results Experiences in the neo-shamanic ritual were generally intense, with 145 coded segments categorized into six main themes. Corporal Experiences emerged as the most frequent (69%), followed by Emotional, Sensorial, and Personal Experiences (61% each one), Spiritual & Transcendental Experiences (50%), and Cognition & Volition (19%). In contrast, the Santo Daime ritual, characterized by dance and communal singing rather than deep introspection or visions, was described as gentler (42 coded segments). The most frequently reported themes were Corporal (50%), Emotional (44%), Personal (39%), Sensorial (28%), Spiritual & Transcendental (6%), and Cognition & Volition (1%). Conclusions Findings suggest that ayahuasca-induced experiences are shaped by the interaction between the brew, ritual setting, and participants' mindset, highlighting both recurrent and context-dependent experiential patterns.
Introduction While the relationship between substance use disorders (SUD) and mental health conditions is well established, treatment for these co-occurring conditions is difficult to manage. Research on the potential for psychedelic treatments to address SUD and mental health conditions has recently seen a resurgence. This study aimed to explore narratives on the influence of psychedelics on mental health needs among people who use opioids. Methods We conducted a qualitative study of self-reported experiences and perspectives on using psychedelics to address mental health needs among people participating in opioid-use-related Reddit community forums. We extracted posts that contained key psychedelic terms from the two most subscribed to subreddits dedicated to discussions of opioid use disorder treatment and recovery: r/OpiatesRecovery and r/Methadone from 2018-2021. Content of 113 relevant posts and their comments was analyzed thematically. Results Thematic analysis revealed positive experiences with psychedelics, including symptom relief for anxiety, depression, and PTSD, along with enhanced mood, inner peace, emotional healing, and shifts in perspective. These experiences were linked to reprocessing trauma and disrupting negative thought cycles. Users highlighted the potential for psychedelics to support long-term recovery from opioid use by fostering emotional resilience and clarity. However, concerns were noted regarding the risks of self-administered psychedelic use. Conclusion Self-reported experiences of using psychedelics were generally positive among Reddit users reporting co-occurring opioid use and mental health needs. These findings should be considered exploratory given the unique sample and context of an internet forum. Further research is needed to determine the safety, efficacy, and appropriate integration of psychedelics into treatment to address co-occurring mental health and substance use disorders.
Background and aims: Despite growing popularity and increasing legal access, psychedelic therapy remains financially inaccessible to many. This study was designed to test the feasibility of conducting group psilocybin therapy in low-income adults with depression in Oregon's regulated psilocybin program. Methods: An open label, uncontrolled design was used. After a medical screening visit, participants were enrolled in cohorts of six. Each cohort participated in two 90-min preparation sessions conducted online followed by two psilocybin administration sessions one week apart where they consumed dehydrated and homogenized whole mushrooms, Psilocybe cubensis (B+ strain) prepared in a tea. Two days after each psilocybin administration they had an online, 90-min integration session. Results: We recruited 26 eligible participants, 20 of whom began treatment and 19 completed. No severe adverse events were reported, and participants rated their satisfaction, on average, as 4.8 out of 5, reporting moderate to high benefit and no harm. Exploratory outcomes include Hamilton Depression scores which demonstrated a significant decrease (t = 8.24, p < 0.001) in a paired t-test and a strong effect size (Cohen's d = 1.89). For the same time periods all eight domains of the PROMIS-29 were significantly improved on paired t-tests at p < .01 with effect sizes ranging from 0.667 to 1.774. Conclusions: The study demonstrates the feasibility of group psilocybin therapy in a low-income population with depression. Further research with rigorous comparator groups is warranted to assess if this intervention can be both effective and cost-effective.
Background and Purpose: Music plays a central role in psychedelic-assisted therapy, yet few methodologies exist to create and assess therapeutic playlists. This study aimed to illustrate a methodology for developing and evaluating a music playlist for a clinical psilocybin trial using an integrative framework grounded in theory, intentionality, and metrics. Methods: A playlist was designed based on clinical experience, phenomenological data, and therapeutic goals across pre-peak, peak, and post-peak phases of psilocybin administration. Each track was evaluated using Spotify's Application Programming Interface (API) metrics (Beats Per Minute, Danceability, Energy, and Valence). In addition, an exploratory human-rated measure of Transcendence was created and included to capture aspects of musical depth not represented by existing API metrics. Together, these tools provided a proof-of-concept model for how intentional playlist design may be supplemented with objective and experiential metrics in future psychedelic-assisted therapy research. Results: Most musical features followed the hypothesized emotional arc of the psilocybin experience represented in prior literature. Some deviations occurred, including misclassification of nature-based tracks as high-energy by the Spotify API, highlighting the limitations of algorithmic classification. Transcendence ratings suggested continued emotional depth in the music during post-peak phases. Conclusions: This proof-of-concept model demonstrates the value of combining intentional playlist design with exploratory use of algorithmic and experiential metrics. While Spotify metrics may lack stability and generalizability, the integrative approach offers a transparent example that future researchers may adapt and refine for their own clinical and cultural contexts.
Background and aims: Ibogaine, one of the oldest psychedelic alkaloids introduced to Western society and medicine, has a largely overlooked history prior to Howard Lotsof's accidental identification of its anti-addictive properties in the 1960s. This manuscript explores some previously hidden aspects of ibogaine, with a focus on the entangled cultural, colonial, and scientific histories related to its early development from plant and ritual remedy to commercialized pharmaceutical before the 1960s. Methods: The article is primarily based on a non-systematic literature review of various discoveries found in historical sources. In structuring the findings, we outline three main and somewhat overlapping phases of ibogaine's historical trajectory before the 1960s: i) the colonial appropriation and classification of ibogaine-containing plants from the Congo Basin during French colonial rule, ii) the isolation of ibogaine from the Tabernanthe iboga plant in 1900 and the early pharmaceutical research on its effects and uses, mainly in the French scientific community, and iii) the commodification of ibogaine in several pharmaceutical products and their international diffusion throughout the 20th century. Drawing on a historiographical approach rooted in postcolonial perspectives on colonial botany, biopiracy, and the intellectual property system, our analysis foregrounds the power-relations that have structured each of these three phases of ibogaine's early development, use, and commercialization as a pharmaceutical. Results: Throughout this historical investigation, we present evidence that ibogaine was commercialized in several retail medicines beyond the well-known Lambar & egrave;ne. These included Drag & eacute;es Nyrdahl, Grains des An & eacute;miques, Sys & eacute;ros, Viris Lucet, Ibobiose, and Iperton. We further present discounted records documenting local uses of iboga in the Congo Basin, alongside early scientific publications on ibogaine, both of which served to guide and contextualize the medical research conducted during the early and mid-20th century. These findings complicate simplified narratives of the drug discovery of ibogaine, underscoring the critical role of indigenous medicinal knowledge in contributing to and shaping subsequent scientific understanding. Moreover, we identify evidence that ibogaine was first used in Mexico in 1913 for the treatment of a substance use disorder - a finding that challenges established historiographies and compels a revision of the dominant account of the 'discovery' of ibogaine's anti-addictive potential. Conclusions: The article uncovers a range of previously overlooked historical sources that broadens the understanding of ibogaine's international trajectory and its embeddedness in various cultural, colonial, and scientific contexts. By illuminating ibogaine's multifaceted past, we seek to deepen the understanding of its contemporary framing and contextualize its potential future use in Western medicine. This historical inquiry contributes to a more nuanced and comprehensive account of ibogaine's past and its evolving place at the intersection of pharmacological and cultural histories and changing power dynamics. Among other things, we complicate unilinear accounts of who 'discovered' the anti-addictive effects of ibogaine, and we provide historical grounds for recognizing the people of the Congo Basin as both knowledge and resource providers of ibogaine's early development and commercialization as a pharmaceutical.
Background and aimsIncreased connectedness has been proposed as one mechanism through which psychedelics might reduce death anxiety. This study examined whether changes in connectedness-across intrapersonal, interpersonal, and transpersonal domains-were associated with changes in death anxiety following a significant psychedelic experience.MethodsA retrospective cross-sectional survey was conducted with 106 adults (M-age = 31, SD = 10.25) who reported perceived changes before and after a meaningful psychedelic experience. Participants completed measures of connectedness to self, others, and the world, fear of death, death avoidance, and mystical experience strength, retrospectively reflecting on the three months prior to their experience and the three months after.ResultsSignificant decreases were observed in both fear of death and death avoidance, as well as significant increases in all three subscales of connectedness. Increases in connectedness to self, others, and the world were each associated with reduced fear of death, but only connectedness to self and others were related to lower death avoidance. Mystical experience was positively associated with increases in all three domains of connectedness and lower fear of death but not death avoidance.ConclusionsThese findings support a relationship between connectedness and death anxiety following a psychedelic experience, both of which were associated with mystical experiences. Prospective and qualitative studies are needed to clarify causality and underlying mechanisms, and to determine whether such changes are psychologically adaptive reflections of acceptance or expressions of denial.
Background and aims: An increasing number of individuals seek psychedelics for mental illness, and when seeking psychotherapy in the aftermath, psychotherapists have an ethical duty to attempt to reduce harms and maximise benefits from these experiences. The Internal Family Systems (IFS) model of therapy is sometimes chosen as the therapeutic approach in psychedelic-assisted psychotherapy. This qualitative, exploratory study aimed to understand the extent to which IFS therapy can support clients in the integration of their psychedelic experiences. Methods: In-depth interviews were conducted with four individuals who attended IFS therapy as part of their psychedelic integration. Data were analysed using an Interpretative Phenomenological Analysis. Results: Psychedelic integration was described as a transformational process that begins with preparation, takes time, needs space and attention, and that can be challenging. Finding people to integrate with and someone to talk to were reported as important practices to support integration. Participants also alluded to a transformational process when describing their experiences of IFS therapy as "a pathway towards wholeness". Their testimonies shed light on ways IFS therapy supported them: IFS creates "a forum to take those parts seriously", gives a language to narrate internal experiences, is not only a talking therapy, and is "all about self-love". Most participants however warned that one can "lose sight of where that Self might be". The therapeutic relationship also emerged as an important enabling factor. Conclusions: This study provided initial insights into ways IFS therapy can support psychedelic integration. IFS offers tailored interventions to revisit psychedelic experiences, find meanings and work through difficulties encountered during the integration process. Further phenomenological research is warranted to elaborate on the emerging themes identified in this study through the inclusion of more diverse experiences, perspectives on IFS, and participant backgrounds.
The aim of the paper is to complement Sartre's concept of enchanted consciousness. The first section of the paper studies the contradictions inherent in Sartre's mescaline experiment and the limits of his phenomenological analysis of hallucination. The second section argues that Benny Shanon's phenomenological cognitive psychology, which is based on the typology of ayahuasca hallucinations, can contribute to the phenomenological analysis of hallucinations and reveal some aspects of the enchanted consciousness that Sartre failed to discover. The third section examines the phenomenon of double bookkeeping, which originated in phenomenological psychiatry, and illustrates the characteristics of the delusional world. The fourth section expands the idea of enchanted consciousness through Shanon's study on ayahuasca hallucinations and provides a comparison between the pathological double bookkeeping and the so-called psychedelic bookkeeping. Finally, the last section actualizes Sartre's views on hallucination and offers a new way to define captivated consciousness through psychedelic double bookkeeping.
