Predicting Who Does Well on Psychedelics
1 May 2024
Introduction
In the field of psychedelic research and treatment, we are often inundated with warnings and contraindications regarding the use of these substances. Psychotic reactions, personal or family histories of psychosis, certain personality disorders, bipolar conditions, and suicidal behaviours are all red flags. Physical conditions like some cardiac issues, liver diseases, neurological disorders, and pregnancy also warrant caution.
These restrictions are prudent, particularly in contexts prone to reckless behaviour. However, focusing solely on the negatives can be disheartening. Let’s flip the script and explore the personal attributes that might predict a positive and productive psychedelic experience.
While my professional interest is in non-therapeutic psychedelic research—studying psychedelic effects on those not psychiatrically unwell—these criteria may equally apply to individuals with psychiatric histories. Indeed, as you read through this it may seem, from a therapeutic perspective, that the people most amenable to psychedelic therapy are those least likely to need it. My prediction is that with further research we will learn that psychedelic therapy is more effective in the treatment of mild states of psychological and spiritual distress, confusion and challenge, as opposed to its use in the treatment of severe psychiatric illness. If this does prove to be the case, then ultimately such an outcome will make this document more relevant for all those chosen and encouraged to explore psychedelic experiences for whatever relevant and ethical reason. Time will tell.
So here are my thoughts, based on my clinical observations and discussions with other researchers.
1. Curiosity
Curiosity is the driving force behind the desire to learn and experience new things. It involves asking questions, seeking answers, and making connections. Curious people retain a sense of wonder and a desire to learn throughout their lives.
Curious individuals are more likely to have positive psychedelic experiences. They can remain fascinated even during challenging moments, exhibiting resilience and a spirit of adventure.
Key Points:
Deep curiosity implies resilience and a willingness to learn.
A curious person views challenges as opportunities for growth.
Positive psychedelic experiences are more likely for those with an ongoing determination to learn about themselves and the world.
2. Good Social Supports
Social relationships, whether with family, friends, or community, are crucial for a positive psychedelic experience. People who live with others and invest emotionally in their lives and individuals who receive love and support in return for their emotional investments, are usually better equipped to handle the challenges of psychedelic experiences.
Psychedelics may not directly solve social isolation, but they can facilitate therapeutic self- discovery. Those with strong social supports can navigate psychedelic experiences more effectively.
Key Points:
The mind of someone who connects effectively with others is generally more resilient and stable.
Emotional generosity and interpersonal connections aid in managing psychedelic experiences.
Supportive relationships provide a safe environment post-experience.
3. The Scaffolding of Belief
Having a philosophical, ideological, or religious belief system provides a mental structure to navigate challenging psychedelic experiences.
Some famous psychiatrists such as Carl Jung and Victor Frankl have emphasised the importance of meaning in life, and in a psychedelic setting, a sturdy and supportive belief system appears to be valuable. Related to this is the observation that religious individuals are generally less prone to mental ill health. Belief systems offer insight, coping mechanisms, and fallback positions during difficult moments. They help individuals make sense of profound experiences.
Key Points:
A belief system supports navigation of non-ordinary states of consciousness.
It provides a framework for interpreting and integrating experiences.
Those without such a system may struggle to make sense of their experiences.
4. Mindfulness
Mindfulness involves observing one’s own awareness from moment to moment, as well as witnessing one’s thoughts, emotions, and sensations as they pass through one’s conscious focus. It is a hard skill to master for most of us, but there are many different mindfulness approaches available to suit individual differences. Persisting with mindfulness practice despite mental turbulence and distractions, generally bears fruit in the long term.
Mindfulness is really a study in self-examination and control over the mind’s wanderings. It becomes a valuable tool in navigating psychedelic experiences.
Key Points:
Mindfulness is the objectification of subjectivity.
It involves observing the mind’s focus and flow without being swept away.
Practiced mindfulness can help manage and interpret psychedelic experiences.
5. Psychotherapeutic Engagement
The direct scientific study of psychedelic effects should always involve subjects taking psychedelics in the presence of a therapist or guide. The relationship between the subject and guide is crucial.
Ideally subjects need to be prepared and supported by a therapist or guide before, during, and after the experience. And it is generally accepted that a positive relationship between the subject and the guide or therapist, enhances the psychedelic experience.
Some individuals may struggle to form a trusting and positive relationship with a guide or therapist for various reasons. If we accept that experienced and suitable guides are good at forming therapeutic or bonding relationships, then individuals who struggle with such bonding may not be suitable for a psychedelic experience.
A skilled therapist or guide should, early on in this process, be able to determine the appropriateness of the guide-subject relationship. Subjects who at the suggestion of the guide or therapist make a genuine effort to co-operate with learning new tasks and exploring new concepts between therapy sessions, are probably going to do better than individuals who just want to go along for the ride without making an effort to bond or do their therapeutic homework.
Key Points:
A trusting and insightful relationship with the guide is essential.
Motivation and willingness to do the therapeutic work predict positive outcomes.
6. Affective Flexibility
Affective flexibility is the ability to adapt one’s emotions and behaviours to different situations effectively. It involves the skills of being able to recognize and manage emotional responses appropriately, as well as maintaining awareness and acceptance of one’s emotional state without being overwhelmed.
In a psychedelic journey, emotional flexibility helps navigate the profound affective fluctuations and changes that often occur. It is a key component of psychological resilience.
Key Points:
Affective flexibility involves acknowledging and managing emotions adaptively.
It aids in coping with stress and adversity during psychedelic experiences.
Emotionally flexible individuals are less likely to suffer severe psychological distress.
7. Avoid Intellectualizers
Intellectualizers over-analyse emotions rather than experience them. They use logic and concrete reasoning to avoid emotional distress. Such individuals may appear calm and in control on the surface, but often struggle internally with limited emotional insight. Such a defence mechanism can be counterproductive during psychedelic experiences.
Thus in psychedelic states, while emotional flexibility is advantageous, over-intellectualization can hinder the experience and limit personal growth.
Key Points:
Intellectualization distances individuals from emotional experiences.
It limits real insight and empathy for oneself.
Letting go of excessive intellectualizations is advantageous for a positive psychedelic experience.
Practical Implications for Researchers and Participants
Understanding who might fare better under the influence of psychedelics has practical implications for both researchers and participants in psychedelic research and treatment. By considering the attributes discussed, researchers can better select participants and tailor their approaches, while patients and participants can make more informed decisions about their readiness and suitability for psychedelic experiences.
For Researchers and Therapists
1. Participant Selection:
Utilize screening tools to assess curiosity levels, social supports, and existing belief systems.
Evaluate participants' mindfulness practices and emotional flexibility through questionnaires and interviews.
Avoid selecting participants with strong tendencies toward intellectualization without addressing these tendencies first.
2. Preparation and Integration:
Provide preparatory sessions focusing on mindfulness practices and emotional awareness exercises.
Discuss and reinforce the importance of having a supportive social network.
Explore participants’ belief systems and provide guidance on integrating their experiences into these frameworks.
Establish a strong therapeutic relationship before the session to ensure a trusting and supportive environment.
3. Session Environment:
Create a safe and comfortable setting that encourages exploration and emotional expression.
Have experienced guides or therapists present to support participants through challenging moments.
Use music, art, or nature elements to enhance the sensory experience and promote a sense of wonder and curiosity.
4. Follow-Up and Support:
Conduct follow-up sessions to help participants integrate their experiences into their daily lives.
Encourage continued mindfulness practices and emotional awareness exercises.
Provide resources for building and maintaining social connections and support networks.
For Potential Patients and Participants
1. Self-Assessment:
Reflect on your level of curiosity and willingness to explore new experiences.
Evaluate the strength and quality of your social support network.
Consider your belief systems and whether they provide a sense of meaning and stability.
Assess your mindfulness practices and emotional flexibility.
2. Preparation:
Engage in mindfulness and meditation practices to enhance self-awareness and emotional regulation.
Build and strengthen your social support network by nurturing relationships with family, friends, and community.
Explore and deepen your belief systems, whether they are philosophical, ideological, or religious.
Avoid relying solely on intellectual analysis and practice allowing yourself to fully experience emotions.
3. During the Experience:
Insist upon a safe and comfortable environment for your psychedelic experience.
Have a trusted, guide or therapist present to support you.
Embrace the experience with an open mind and a sense of curiosity.
Allow yourself to fully experience and process emotions without over-analysing or suppressing them.
4. Integration:
Reflect on your experience and its implications for your life and beliefs.
Continue mindfulness practices to maintain emotional awareness and flexibility.
Seek support from your social network and continue to discuss and integrate your experiences with your guide or therapist.
Use your experience as a catalyst for personal growth and self-discovery.
Conclusion
Predicting who does well on psychedelics involves a nuanced understanding of various personal attributes. Curiosity, strong social supports, belief systems, mindfulness, psychotherapeutic engagement, affective flexibility, and the ability to avoid excessive intellectualization are key factors. By considering these attributes, researchers can better select and prepare participants, while potential patients and subjects can make more informed decisions about their readiness for psychedelic experiences. Ultimately, these insights contribute to safer and more meaningful psychedelic journeys, fostering healing, personal growth and self-discovery.
Important Post-Script
This document is a work in progress. It is by no means finished or final and I am open to any suggestions, criticisms or changes you, the reader, might wish to proffer.
It has been written simply to begin an important conversation for those of us interested and working in this field. With time, further research and experience, I am sure it will be modified and refined.
By Dr Nigel Strauss