Attitudes and Beliefs about the Therapeutic Use of Psychedelic Drugs among Psychologists in the United States

Psychedelic substances such as psilocybin, LSD and ayahuasca have historically been stigmatised in the United States, but recent clinical research, media attention and broader cultural interest in spirituality and consciousness have shifted perceptions toward viewing some psychedelics as potential therapeutic agents. Clinical trials—particularly with psilocybin—have reported improvements in conditions including cancer-related anxiety and depression, treatment-resistant depression and substance misuse, and investigators have highlighted lasting gains in wellbeing and optimism after treatment. Despite these developments, psychedelics remain Schedule I drugs in the US, stigma persists, and little is known about how clinicians who will deliver mental health care perceive these treatments. Davis and colleagues designed a cross-sectional quasi-experimental survey to assess attitudes toward psychedelics among licensed clinical and counselling psychologists in the US, with a particular focus on psilocybin because of its prominence in current clinical research. The study examined whether clinicians' beliefs about mystical or spiritual experiences differ when those experiences are reported as arising from psilocybin versus naturally (for example, via religion or meditation), whether acceptability of medication-assisted therapies differs when the medication is psilocybin versus opioid agonists, and how psychologists rate the safety and therapeutic potential of several psychoactive substances. The authors framed the work as informing education and training needs for the psychologist workforce as psychedelic-assisted therapies progress toward broader implementation.

This was a cross-sectional online survey conducted between July and August 2020. A commercial database of 27,866 US psychologists' e-mail addresses was used for recruitment; after undeliverable addresses and non-responders were accounted for, 366 licensed clinical or counselling psychologists completed the survey and formed the final sample. Inclusion criteria were age 18+, licensure as a clinical or counselling psychologist in the US, and English fluency. The study received an exemption from the Ohio State University Institutional Review Board, and participants could opt to enter a separate raffle for electronic gift cards; identifying raffle data were stored separately from survey responses. After consenting, participants were randomised to one of two vignette conditions. Each condition presented three vignette sets: (1a) a client reporting a therapeutic experience with psilocybin versus (1b) a client reporting a therapeutic spiritual/religious experience, (2a) a client interested in a psilocybin mushroom experience versus (2b) a client interested in a meditation retreat, and (3a) questions about acceptability of psychedelic-assisted treatment for disorders such as substance use disorder, PTSD, depression or anxiety versus (3b) questions about acceptability of opioid agonist medication-assisted treatment for opioid use disorder. Questions following vignettes were identical across matched pairs to permit between-group comparisons. Measures included a modified Treatment Acceptability Rating Form–Revised for acceptability items (5-point Likert from -2 to 2), bespoke items assessing perceived safety (6-point scale from -3 extremely unsafe to 3 extremely safe) and therapeutic potential (0 to 4) of five drug classes (alcohol, cannabis, psychedelics, cocaine, opioids), and a set of items adapted from prior surveys probing beliefs about psychedelics, personal and peer experience, and self-rated knowledge. Demographic information and professional background were collected. Analyses used descriptive statistics, chi-square tests and t-tests to compare groups on demographics, independent t-tests to compare responses between vignette arms, and repeated measures ANOVAs (with partial eta squared reported) to examine differences in safety and therapeutic-value ratings across drug types. Cohen's d was calculated for effect sizes, post-hoc pairwise tests followed significant ANOVAs, a p-value of .05 defined statistical significance, and all analyses were performed in SPSS v.27. The full survey instrument was noted as available from the first author on request.

The sample (N = 366) was primarily middle-aged (mean age 50.3, SD = 13.6), female (69%), highly educated (95% PsyD or PhD) and experienced (mean years in practice 17.4, SD = 12.8). Cognitive Behavioural Therapy was the most commonly reported orientation (74%), private practice the most common setting (43%), about half identified with an Abrahamic religion (51%) and 21% reported no religious affiliation. Randomisation produced vignette groups that did not differ significantly on demographic variables. Responses to the first vignette pair (client reporting a psilocybin experience versus a spiritual/religious experience) showed near-universal willingness to explore the client's report further (95.1% for psilocybin; 97.3% for spiritual/religious). However, participants were far more likely to warn clients about risks when the experience involved psilocybin: 76.2% said they would likely or definitely warn about psilocybin risks compared with 23.8% for a spiritual/religious activity (Cohen's d = 1.37). Greater concern was also expressed for general safety and risk of psychosis after psilocybin than after a spiritual event (for example, 20.5% vs 3.8% rated themselves very or extremely concerned about general safety; 15.5% vs 2.2% for psychosis risk; Cohen's d range = 0.33–0.64). Despite these concerns, many clinicians nonetheless considered the psilocybin-related experience to be therapeutically beneficial (84.0%) and genuinely spiritual (73.9%). In the second vignette pair (psilocybin mushroom experience versus meditation retreat as a coping strategy for depression related to a life-threatening illness), participants were substantially more likely to warn about psilocybin (92.4% vs 42.5%) and to indicate a need to seek additional consultation (84.3% vs 44.8%). They were also more likely to refer the client elsewhere (40.0% vs 8.3%) and to advise against trying psilocybin (92.4% vs 42.5%); between-group effect sizes for these contrasts were large (Cohen's d range = 0.97–1.53). Both groups were similarly likely to help clients identify educational resources and to explore pros and cons (high endorsement across both arms). When comparing acceptability of psychedelic-assisted therapy (for substance use disorders, PTSD, depression or anxiety) versus standard medication-assisted treatment for opioid use disorder, responses were markedly less favourable for psychedelics. Only 22.2% of participants reported being open to or favourably disposed toward psychedelic-assisted therapy, versus 74.5% for medication-assisted treatment (Cohen's d = 1.26). Comparable gaps emerged for perceived acceptability (22.2% vs 76.3%; d = 1.23), reasonableness (28.1% vs 80.1%; d = 1.86), and confidence in effectiveness (8.7% vs 39.8%; d = 1.08). Repeated measures ANOVAs showed a significant main effect of drug type on perceived safety (F(3.2, 1153.8) = 309.65, p < .001, partial eta squared = .46). Post-hoc comparisons indicated cannabis was rated safest (M = 1.0, SD = 1.3), followed by psychedelics (M = -0.2, SD = 1.6) and alcohol (M = -0.5, SD = 1.5), with opioids (M = -1.0, SD = 1.5) and cocaine (M = -2.1, SD = 1.0) rated as least safe. For perceived therapeutic potential there was also a significant main effect (F(3.1, 1104.8) = 383.98, p < .001, partial eta squared = .52); cannabis (M = 2.0, SD = 0.9) and psychedelics (M = 1.9, SD = 1.1) were rated roughly equivalent and higher than opioids (M = 1.3), alcohol (M = 0.5) and cocaine (M = 0.4). On beliefs about psychedelics, 47.9% endorsed that psychedelic use increases risk for subsequent psychiatric disorders, and 34.6% believed psychedelics increase risk of neurocognitive impairment; 30.7% felt psychedelics should remain illegal for recreational use. Yet 55.4% judged medically supervised use as not unsafe, 84.7% supported further scientific inquiry, and 30.2% believed psychedelics should not be illegal. Regarding personal exposure, 29.4% reported past personal use of psychedelics (most of those rated their experience as somewhat or very positive), 55.1% reported friends or relatives with positive experiences, and 68.5% had worked with at least one client who talked about psychedelic experiences in treatment. Only 3% had read Michael Pollan's popular book on psychedelics, and the plurality (43.5%) described their knowledge of psychedelic risks and benefits as only "somewhat" adequate.

Davis and colleagues interpret their findings as indicating cautiously favourable but cautious attitudes toward psychedelic experiences among US psychologists: many participants acknowledged potential therapeutic value and supported further research, yet substantial concern remained about psychiatric and neurocognitive risks. The pattern—high willingness to explore reported experiences combined with a much greater tendency to warn clients about psilocybin than about analogous spiritual or meditative experiences—was viewed as reflective of lingering stigma toward psychedelic substances. The study team compared their sample to previously published surveys of psychiatrists and palliative care clinicians, noting broadly similar trends but some differences in risk perception; psychologists in this sample were described as marginally more favourable in risk-adjusted therapeutic valuation than psychiatrists in an earlier study. The authors discuss literature suggesting that adverse events can occur in meditation practice and psychotherapy as well as in naturalistic psychedelic use, and they note that contemporary clinical trials of psychedelics report few serious adverse events when adequate screening and attention to set and setting are used. Challenging acute experiences under psychedelics can nevertheless occur and may be therapeutically meaningful if properly supported. From these observations the authors conclude there is a need to improve education and training for psychologists about the relative safety profiles, risk mitigation strategies and therapeutic potential of psychedelics. They emphasise that many participants reported limited knowledge and a desire to seek consultation, implying training gaps. A number of limitations are acknowledged: potential sampling bias due to the low proportion of invitees who completed the survey, reliance on self-report which may be subject to social desirability bias, limited generalisability beyond psychologists to other professions, and the possibility of increased Type I error because of multiple statistical tests. The researchers also note that the sample size provided adequate statistical power and relatively stable parameter estimates. Finally, they suggest that as clinical evidence and public interest grow, psychologists—given their expertise with mental health issues—are well placed to support clients who have psychedelic experiences, contribute to harm reduction and guide ethical implementation of such treatments.