An exploratory study of experiences with conventional eating disorder treatment and ceremonial ayahuasca for the healing of eating disorders

Eating disorders (EDs) are serious, often chronic psychiatric illnesses with high morbidity and mortality and only modest outcomes from current treatments, which are marked by high relapse and dropout rates. Earlier research has called for novel approaches and for looking beyond Western modalities; preliminary qualitative work has suggested that ceremonial ayahuasca drinking might be associated with reductions in ED symptoms, improved emotion processing and greater self-love. Ayahuasca is a traditional Amazonian psychoactive brew (containing DMT plus monoamine-oxidase inhibiting beta-carbolines) now used in ceremonial and therapeutic contexts worldwide, and recent neuroscientific and clinical interest has focused on its potential to catalyse rapid and sustained psychological change. Renelli and colleagues set out to explore, using qualitative methods, how people with diagnosed EDs compare their experiences of conventional ED treatments with their experiences of ceremonial ayahuasca drinking. The study aimed to identify perceived therapeutic mechanisms, benefits and risks as reported by participants, and to generate hypotheses about whether and how ayahuasca might serve as an adjunct to established ED care and merit further controlled investigation.

This was an exploratory qualitative study using purposive sampling. Recruitment was via word of mouth, social media, online discussion groups, targeted listservs and a project website. From an initial pool of 21 interviews, 13 participants met inclusion criteria: a professional diagnosis of an ED, experience of conventional ED treatments in North America, and participation in at least one ayahuasca ceremony. The final sample comprised 13 participants (12 women), mean age 30.1 years (range 21–49), with mean reported ED onset at age 14.3 (range 8–24). Diagnoses included anorexia nervosa (n = 8) and bulimia nervosa (n = 5). Reported conventional treatment settings included outpatient (n = 12), inpatient hospital (n = 5), residential programmes (n = 2) and one clinical trial; psychotherapeutic modalities reported included cognitive behavioural therapy, dialectical behaviour therapy, family-based treatment and acceptance and commitment therapy. Participants had attended between 1 and 30 ayahuasca ceremonies, typically in multi-day retreats and guided by trained ceremonial leaders (e.g. shamans or curanderos) rooted in Amazonian traditions (Shipibo or Ashaninka). Time since the most recent ceremony ranged from under one month to up to three years. Data were collected via semi-structured telephone interviews using a schedule adapted from earlier work on ayahuasca and substance use treatment; mean interview duration was approximately 120 minutes (range 68–192 minutes). Interview topics covered ED history, experiences with conventional ED-focused therapies, subjective evaluations of those treatments, and experiences with ceremonial ayahuasca drinking. Ethical approval was obtained from Laurentian University and the University of British Columbia. Thematic analysis was used to identify patterns in participants' accounts. Two researchers independently coded the interviews and developed potential themes; a pattern was defined as occurring in at least six of the 13 participants. Inter-coder reliability was calculated as average percent agreement using a predefined agreement threshold of 80%, and the two coders discussed items failing the threshold to reach consensus. Member checking was used to verify that emergent themes reflected participants' experiences. The investigators initially examined data by diagnosis (anorexia versus bulimia) but report minimal differences and therefore present analyses for the pooled sample.

Thirteen participants provided accounts contrasting conventional ED treatment with ceremonial ayahuasca drinking. From the thematic analysis, the investigators identified five central themes plus an additional theme about integration with psychotherapy. Theme 1 — Ayahuasca is an effective form of healing from an ED: Several participants described rapid and substantial reductions in ED thoughts and behaviours after ayahuasca ceremonies, with one participant reporting remission. Some informants perceived ayahuasca as producing therapeutic change more efficiently than conventional therapy; one participant compared a single medicine experience to many years of psychotherapy. Short illustrative quotes included statements such as "ayahuasca has definitely changed some huge, big chunks of it" and "in the time since ayahuasca, I haven't struggled [with ED symptoms]". Theme 2 — Ayahuasca allows for deep healing: Participants reported that ceremonies accessed root causes of their EDs and provided deeper insight than they had achieved in conventional programmes. A physician participant characterised conventional approaches as "top-down" symptom management, whereas ayahuasca work was described as a ‘‘bottom-up’’ process that reached core issues and appeared to rewire or resolve underlying problems. Theme 3 — Ayahuasca allows for processing intense emotions and/or memories: Multiple participants recounted being able to access and process unresolved grief, shame and intergenerational patterns during ceremonies. Although experiences could be emotionally painful and challenging, several participants said they emerged feeling considerably lighter or relieved. The compulsory, inescapable nature of the medicine experience during ceremony was reported as a feature that forced confrontation and processing in ways conventional treatment did not. Theme 4 — Ayahuasca supports embodiment of love, self-love and self-care: Participants described shifts from intellectual acceptance of self-compassion to felt, embodied convictions of being lovable and worthy; one said that ayahuasca moved insights "from your brain to your heart" so they became enduring. Theme 5 — Ayahuasca provides a spiritual component to healing/recovery: Many participants experienced spiritual or existential effects—connections to a greater force, soul-level work or spiritual meaning—not typically encountered in their conventional ED treatment, and they framed this spiritual dimension as an important resource for recovery. Additional theme — Bridging ayahuasca with modern psychotherapy: About half the participants recommended combining ceremonial ayahuasca with access to conventional psychotherapeutic support and nutritional rehabilitation (e.g. refeeding). Informants suggested that formal integration and support for processing and for medical/nutritional needs would enhance safety and the therapeutic potential of ayahuasca-based work. Analyses disaggregated by diagnosis (anorexia versus bulimia) showed minimal differences, so results are presented for the total sample. The extracted text does not report the exact average inter-coder agreement percentage, only that a threshold of 80% agreement was used and themes not meeting the threshold were discussed to consensus.

Renelli and colleagues interpret participants' accounts as indicating that ceremonial ayahuasca drinking was perceived by some people with EDs to produce rapid, deep and broad therapeutic shifts across symptom reduction, emotional processing, self-compassion and spiritual growth. The investigators note that reduction or cessation of restricting, binging and purging—the behavioural hallmarks of ED recovery—was commonly reported following ayahuasca experiences, and that some participants considered the changes more efficient than conventional therapies. This aligns with prior reports in the ayahuasca literature that the medicine can surface memories and emotions for reprocessing and provide new insights into maladaptive behaviours. The authors highlight the potential importance of emotion processing, given the central role of emotion regulation in the development and maintenance of EDs, and suggest that ayahuasca-facilitated processing might free patients from using ED behaviours as maladaptive coping. They also link the spiritual experiences reported by participants to broader psychedelic literature (for example psilocybin studies) in which spiritual meaning is associated with sustained positive changes; the paper notes research associating higher spirituality with lower ED symptom levels and suggests this as a potentially relevant mechanism. At the same time, the investigators emphasise caution. They discuss several safety and practical concerns specific to people with EDs: potential cardiovascular and electrolyte risks, interactions with contraindicated SSRIs, and the activating effect of pre-ceremony diets and purging patterns on food preoccupation. The authors propose that clinical use, if pursued, should treat ayahuasca as a short-term or sporadic adjunct to conventional ED care—embedded within medical monitoring, psychotherapy and nutritional support—rather than as a stand-alone ongoing medication regimen. They draw an analogy to controlled, limited-session models such as MDMA-assisted psychotherapy for PTSD. The paper calls for therapeutic integration: many participants wanted conventional psychotherapeutic supports for preparation and integration, and some suggested exploring ‘‘healing by proxy’’ where caregivers participate in ceremonies to gain insight into family dynamics. Legal and policy barriers to researching and providing ayahuasca in Canada, the United States and Europe are noted as obstacles to safe clinical investigation. Finally, the authors suggest that, regardless of whether ayahuasca proves clinically useful, ED services might develop psychotherapeutic tools inspired by reported ayahuasca effects, such as exercises to cultivate self-compassion, experiential emotion-evocation techniques and spirituality-focused interventions.

This qualitative study presents accounts from 13 individuals with ED histories who had participated in conventional ED treatments and in ceremonial ayahuasca drinking. Participants reported that ayahuasca ceremonies led to deep shifts in ED symptoms, emotional processing, self-love and spiritual meaning, and that these changes were sometimes perceived as more efficient than those achieved in conventional therapy. The investigators do not advocate replacing established treatments; rather, they recommend further careful research—including controlled clinical trials—and dialogue between ED clinicians and indigenous healers to explore integrative approaches that could combine the strengths of both systems for some patients.