While numerous studies in the last several years have promoted the effectiveness of psychedelic-assisted therapy, a recent study published in the Journal of Psychedelic Studies introduces a note of caution, underlining several potential risks that accompany the acclaimed benefits.
In a world where mental health struggles loom large and traditional treatments often fall short, psychedelic-assisted therapy has been heralded as a promising new frontier. This approach, which incorporates substances like psilocybin—the psychoactive component in “magic mushrooms”—with psychotherapy, has shown remarkable potential in treating a range of psychiatric disorders, from depression to PTSD.Â
However, a recent empirical study by researchers from Sweden and Iceland suggests that this innovative treatment is not without its risks.Â
Researchers carried out semi-structured interviews with eight Scandinavian therapists who used a controlled regimen of psilocybin dosing combined with psychotherapy sessions to treat patients. The objective was to understand therapists’ perceptions of the potential short-term and long-term adverse effects associated with psychedelic-assisted psychological interventions.
Following the interviews, researchers performed a qualitative thematic analysis of the therapists’ responses to pinpoint consistent patterns and themes in the adverse effects reported by patients undergoing psychedelic-assisted therapy.
In their findings, researchers identified three consistent themes associated with short-term adverse effects, which included “negative reactions,” “undesirable processes in the therapeutic relationship,“Â and “difficult self-experiences.“Â
Clients reported a range of “negative reactions“Â immediately following a psilocybin therapy session. These included physical reactions like nausea and headaches or cognitive and emotional responses such as intense anxiety, fear, paranoia, disorientation, or intense painful emotions.Â
Several of the psychedelic-assisted therapy providers interviewed said that this voluntary exposure to painful emotions was likely necessary to achieve positive long-term treatment outcomes.Â
“From our side as facilitators, if someone starts crying or screaming, we see it as something positive,“Â a respondent was quoted in the study. “It may sound sadistic, but when we talk to participants, many are there because they have some form of emotional blockage, so they also want to cry or scream.“Â Â
The study also revealed that the intense emotional and perceptual shifts induced by psilocybin can also complicate the therapeutic relationship. Five therapists reported maladaptive psychological exchanges between therapist and client, ranging from undue attachment to outright hostility, thereby disrupting the treatment dynamic.
In one instance, a therapist noted, “The patient may believe that they are in love, for example, or that the therapist is a demi-god or some kind of divinity. Or a villain!“Â
During psychedelic-assisted therapy, therapists also observed various challenging “self-experiences“Â that could pose significant short-term difficulties.
These experiences include frightening self-experiences triggered at the onset of psilocybin dosage, which can provoke deep existential fears in patients. Additionally, patients may encounter “revealing self-experiences“Â where they are confronted with profound, sometimes traumatic, unconscious realizations about themselves.Â
While these intense self-experiences are considered beneficial for long-term therapeutic outcomes, the therapists interviewed expressed concern over the difficulty in moderating these experiences during treatment. This inability to modulate the effects of powerful psychoactive substances poses a notable short-term risk.
Perhaps more concerning are the long-term effects highlighted by the study.Â
Some clients found themselves “destabilized“ or struggling with their sense of self and altered perceptions of the world long after undergoing psychedelic-assisted therapy. This prolonged feeling of psychological instability can lead to challenges in everyday functioning or make it difficult for patients to maintain an optimistic worldview.Â
“If I try to quote what they usually say, they express, ‘What I used to consider important is no longer important; I would like it to still be important,‘” one therapist said. “And ‘now I don’t care about those superficial and silly things that I used to get a lot out of in my previous life, and now I don’t get anything out of it anymore.‘”Â
Some of the insights gained during psychedelic-assisted therapy, while potentially transformative, could often leave clients feeling unmoored and incapable of integrating these new understandings into their daily lives.
Complications arising from the treatment relationship between patient and therapist were also identified as a significant long-term concern. Emotional dependencies, persistent attachments, and even romantic feelings towards the therapist can be heightened during psychedelic-assisted therapy. “While this desire can be related to dependency, it can also stem from romantic transferences and blurred professional boundaries,“ the study authors wrote.Â
Finally, the researchers pointed out various “undesirable outcomes“Â that can emerge from psychedelic-assisted treatment. These outcomes range from extended periods of “ontological uncertainty“Â and sleep-related issues, such as nightmares, to the exacerbation of existing conditions like anxiety and feelings of hopelessness.Â
One therapist from the study observed that inadequate social support following treatment, often due to weak social networks, can intensify feelings of loneliness and worsen symptoms of depression.
It’s important to note that the adverse effects found in this recent research are not exclusive to psychedelic-assisted therapy. Traditional psychotherapeutic approaches also carry risks of adverse outcomes, such as dependency on the therapist or aggravation of symptoms.Â
However, the intensity and unpredictability of the experiences induced by psychedelics demand a unique set of precautions and a thorough understanding of potential risks.
The study calls for a robust framework of support around psilocybin-assisted treatments. Pre-treatment assessments and post-treatment support must be enhanced to safeguard client welfare, a sentiment echoed by the therapists interviewed. The nuanced nature of each client’s reaction to psilocybin underscores the need for personalized treatment plans and careful monitoring.
As the body of research on psychedelic-assisted therapy continues to grow, researchers say both the medical community and prospective clients must keep a balanced view of its potential.Â
The potential for significant therapeutic breakthroughs with psychedelics must be balanced against the risk of substantial challenges. Recent research suggests that the path to healing through psychedelics is not necessarily straightforward but complex and fraught with risks, necessitating careful and knowledgeable management.
“Be cautious of unverified claims that psilocybin is a cure-all for psychological disorders,“ study author Jón Ingi Hlynsson, a clinical graduate student at the University of Iceland, told PsyPost. “Psilocybin induces a potent altered state of mind, and it’s not self-evident that consuming psychedelic mushrooms is beneficial for everyone.”
“Our study suggests that potential negative effects of these substances, especially for vulnerable individuals seeking psychotherapy, are not yet fully understood. While existing research presents promising findings, we need to exercise caution before endorsing psilocybin as a viable treatment for mental disorders. The potential adverse effects of these treatments are still understudied.”
Tim McMillan is a retired law enforcement executive, investigative reporter and co-founder of The Debrief. His writing typically focuses on defense, national security, the Intelligence Community and topics related to psychology. You can follow Tim on Twitter: @LtTimMcMillan.  Tim can be reached by email: tim@thedebrief.org or through encrypted email: LtTimMcMillan@protonmail.comÂ