A Qualitative Study of Intention and Impact of Ayahuasca Use by Westerners

Interest in psychedelics has resurged in recent years, and ayahuasca in particular has attracted attention for its reported therapeutic and spiritual effects. Bathje and colleagues note that, unlike other psychedelics more commonly captured in national surveys, ayahuasca use is difficult to quantify at scale; nevertheless, media and online activity suggest growing interest accompanied by concerns about tourism, appropriation of indigenous practices, and variable quality of facilitation. Prior empirical work on ayahuasca has associated its use with diverse outcomes — improvements in psychological wellbeing, reductions in substance use, enhanced creativity and spirituality — but qualitative research specifically exploring intentions for use and sustained impacts remains limited. This study set out to document Western participants' self-stated intentions for attending facilitated group ayahuasca ceremonies and the enduring impacts they attributed to those experiences. The researchers focused on ceremonies conducted in shamanic, neo-shamanic, spiritual, or religious group settings and aimed to capture outcomes reported as sustained over time, along with contextual factors such as set and setting that might shape those outcomes. The project therefore seeks to add qualitative depth to understanding how intentions, contexts, and experiences interact to produce longer-term change.

This was a retrospective qualitative study of 41 Western participants who had attended at least one facilitated group ayahuasca ceremony. Participants were recruited via announcements at ayahuasca-related venues and online forums (including a Reddit group), through in-person psychedelic discussion groups, documentary screenings, and by snowball sampling. Inclusion criteria required participants to be aged 18 or older and to have used ayahuasca in a facilitated group context; the sample spanned seven countries across four continents (United States, Canada, Mexico, Colombia, Australia, Italy, United Kingdom). Data were collected through semi-structured telephone interviews that emphasised two core domains: participants' intentions for using ayahuasca and the impacts they perceived in themselves or via feedback from others. Interviews were transcribed in real time (rather than audio-recorded) to protect confidentiality; demographic and drug-history questionnaires were stored separately from interview transcripts. The interview guide was minimally modified after the fifth interview by adding one open-ended closing question. For analysis the investigators used a phenomenological method labelled Sort and Sift, Think and Shift. This iterative approach involved six phases: data inventory (assigning short monikers to participant responses), written reflections and memoing, reflective diagrams, categorisation and consensus-driven code generation, bridging across interviews to identify cross-cutting stories, and preparing data presentation. Codes and themes were developed by consensus among the study team to capture both primary impact domains and contextual themes such as intention and set/setting.

Eleven principal themes described sustained impacts participants attributed to facilitated group ayahuasca experiences, with three additional contextual themes (intention, set and setting, and comparisons to other modalities). Sample characteristics included varied prior psychedelic experience; 53.7% (n = 22) had used ayahuasca 1–10 times, 24.4% (n = 10) 11–25 times, 14.6% (n = 6) 26–49 times, and 4.9% (n = 2) more than 50 times (mean uses = 13.87, SD = 15.1). Median time since most recent use averaged about 13 months (mean 13.34 months, SD = 18.12), with most participants describing effects they considered sustained. Intentions: Nearly all participants entered ceremonies with healing or growth-focused intentions. Reported reasons included improving mental health (n = 17), enhancing relationships (n = 9), self-understanding (n = 6), treating physical ailments (n = 5), boosting creativity or career (n = 4), managing substance use (n = 1), and seeking spirituality or a new experience (n = 3). Participants commonly reported that intentions were fulfilled directly or indirectly; some experienced benefits in domains different from their original intent. Mental health: Change in mental health was a prominent impact (n = 27). Subthemes included decreased reliance on psychotropic medications (n = 3), improvements in specific conditions such as depression (n = 8), anxiety (n = 8), and trauma-related symptoms (n = 5), enhanced emotional understanding or regulation, and instances of acute post-use mental health symptoms. Two participants reported significant adverse psychiatric outcomes: one described a prolonged low‑grade psychotic-like syndrome that required antipsychotic treatment and resolved over months (potentially consistent with Hallucinogen Persisting Perception Disorder as discussed by the researchers), and another reported sexual assault that occurred during a ceremony. Substance use: Eleven participants reported reductions or cessation in substance use, including alcohol (n = 5), cannabis (n = 8), and other substances such as opiates, stimulants and nicotine (n = 4). Explanations varied from feeling substances were no longer necessary to spiritual or physiological shifts reducing desire or effect. Physical health and somatic experience: Nine participants reported lasting improvements in physical symptoms, with five noting pain reduction and four reporting recovery from illnesses they associated with ayahuasca. Ten participants described changes in somatic awareness or relationship to their bodies, such as decreased bodily stress, increased energy, or relief of motor symptoms. Self-care, creativity, career, and self-related changes: Eleven participants adopted enhanced self-care practices (more meditation, yoga, dietary changes, mindfulness). Thirteen described career or creative shifts, including 12 who changed career paths (often from corporate roles into helping professions or creative work) and several who reported improved work performance or access to creative expression. Twenty-five participants reported enduring changes in self-relationship, including greater authenticity, self-understanding, perceived efficacy for change, a new stance toward thoughts (observing the mind), and stronger trust in intuition and purpose. Attitude and interpersonal effects: Twenty participants reported attitude shifts (acceptance, gratitude, hope), and 28 reported improved interpersonal functioning, including new or deeper community connections, improved specific relationships, better understanding of attachment dynamics, increased empathy, and greater capacity to love and connect. Connection to nature, prosocial concern, and spirituality: Ten participants described an increased connection to nature. Eleven reported a heightened concern for the greater good, including environmental or social-justice motivations and action. Sixteen participants reported significant spiritual changes, ranging from mystical or transcendent experiences to shifts toward greater spirituality or alterations in belief systems (for some this included moving from atheism to spiritual orientation or adopting shamanistic/plant-spirit beliefs). Comparisons to other modalities and set/setting: Twenty-four participants compared ayahuasca favourably to psychotherapy, psychiatric medication, and mind–body practices; many described it as an accelerated form of therapeutic insight, while acknowledging the need for integration. Participants emphasised the critical role of set and setting (the individual's mindset and the ceremony environment, respectively) in shaping outcomes, warning that poor settings can cause harm. Reported harms included the single account of sexual assault and the psychotic-like adverse event; participants also highlighted the importance of facilitator skill, music (icaros), helper support, diversity, and post‑ceremony integration.

Bathje and colleagues interpret their findings as confirming a wide and multi‑domain range of lasting effects reported by Western participants following facilitated group ayahuasca experiences. They observe concordance with prior quantitative and qualitative research showing improvements in psychological health, reductions in substance use, enhanced spirituality, wellbeing, and interpersonal functioning, and alignments with findings from studies of other psychedelics. The researchers emphasise that impacts often extended beyond participants' original intentions and frequently encompassed several life domains, suggesting systemic or whole‑person effects rather than change limited to a single symptom or diagnosis. In discussing mechanisms, the authors highlight the importance of set and setting — defined as individual attributes, intentions and preparatory practices, and environmental factors such as music, facilitators, helpers, fellow participants and ceremony context — in shaping both beneficial and adverse outcomes. They frame psychedelic experiences as producing a liminal state in which conditioned patterns can be disrupted, allowing an "inner healing intelligence" or emergent insights to guide change; however, they stress that integration and supportive holding environments are necessary to consolidate gains and minimise harm. Risk considerations are described at length. The discussion notes documented medical risks from MAOI interactions and cautions about concurrent antidepressant use, while also recognising gaps in knowledge about effects in populations excluded from trials (for example, those with psychotic or bipolar disorders). Ethical and safety concerns receive specific attention: the authors report incidents of sexual boundary violations and call for stronger ethical standards for facilitators, clear consent and boundary agreements, and support resources for people harmed during ceremonies. They also raise concerns about commercialisation, cultural appropriation and inequities in access and representation. Limitations acknowledged by the researchers include the Western and self‑selected nature of the sample, retrospective design and potential recall bias, and the prevalence of prior use of other psychedelics among participants which complicates attribution. The study team nonetheless note that many participants could identify outcomes they attributed primarily to ayahuasca. Finally, the authors recommend greater incorporation of biopsychosocial‑spiritual perspectives and respectful engagement with indigenous practices in both research and clinical approaches, and call for further work on integration, diversity in settings, facilitator ethics, and evaluation of risks and benefits in broader populations.

The study concludes that facilitated ayahuasca ceremonies can produce diverse, deep, and enduring changes across individual, interpersonal, social and transpersonal domains for many Western participants. Bathje and colleagues suggest ayahuasca shows substantial healing potential when used appropriately and with attention to ethical facilitation and integration, while cautioning about medical and interpersonal risks and the need to respect indigenous knowledge and cultural contexts. They emphasise that reported outcomes appear to reflect not only the pharmacology of ayahuasca but also the broader ceremonial and supportive practices surrounding its use.