Experiences of psychedelic drug use among people with psychotic symptoms and disorders: Personal growth and mystical experiences

Earlier waves of psychedelic research included experiments with people diagnosed with schizophrenia and related conditions, but those studies were methodologically inconsistent, often unethical, and reported findings that are difficult to interpret by modern standards. During that era psychedelics were framed as "psychotomimetic"—drugs that mimic psychosis—which contributed to the exclusion of people with psychotic symptoms from contemporary psychedelic-assisted therapy (PAT) research. More recent naturalistic and epidemiological work has documented that psychedelic-induced psychosis is possible but appears rare; at the same time some epidemiological data suggest people with pre-existing psychotic disorders may report worsening after recreational use. These mixed signals, together with the systematic exclusion of this group from trials and the disproportionate impact of such exclusions on ethnoracially marginalised populations, leave an unresolved question about the benefit-to-risk ratio of PAT for people with psychotic symptoms or disorders. Torre and colleagues designed a mixed-methods, cross-sectional, retrospective survey to describe how individuals with psychotic experiences or diagnoses remember and interpret a single notable psychedelic episode. The study aimed to characterise phenomenology (including mystical-type experiences), self-reported changes in wellbeing and symptoms, and contextual factors (dose, set and setting, concomitant substance use) that might relate to positive or adverse outcomes, and to identify recurring qualitative themes in participants' accounts. The authors positioned this work as an exploratory step toward understanding whether supervised PAT could be pursued or avoided for this population and what variables warrant further controlled study.

The investigators used a mixed-methods, cross-sectional, retrospective survey with a phenomenological emphasis and supplementary descriptive statistics. Recruitment took place over about nine months via social media (Instagram, Facebook, TikTok) and primarily Reddit subcommunities focused on psychotic symptoms, psilocybin, LSD and related topics. Eligibility required being at least 18 years old, reporting a diagnosis featuring psychotic symptoms or psychotic-like experiences (per DSM-5 symptom domains), and having had at least one psychedelic experience; respondents provided informed consent through a Qualtrics survey. Ethics approval was obtained (university file H-03-22-7959). Participants were asked to recall one memorable psychedelic episode and to provide demographic and mental health histories, details of the psychedelic used (type, dose, route), set and setting, concomitant substance use, and perceived effects on wellbeing, spirituality, symptoms and relationships. The survey incorporated items adapted from an earlier BIPOC-focused psychedelic survey, a shortened version of the Mystical Experience Questionnaire (MEQ-mini, 11 items, with a 0–10 Likert scale), and initially the Community Assessment of Psychic Experiences (CAPE-42) before switching to a brief 7-item psychotic experience checklist to reduce burden. The survey underwent a mid-study revision that shortened completion time from around 45–60 minutes to 15–20 minutes and added items about reasons for dosing and symptom state at the time of use. Data cleaning removed completed responses below 90 seconds and respondents who left less than roughly 70% of key items unanswered. Diagnoses were coded into categories (PSD: psychotic spectrum disorders; PMD: psychotic mood disorders; PPD: psychotic personality disorders; OPD: other psychotic-like disorders; UPD: unspecified psychotic disorder). Dose bands were standardised for LSD (low ≤100 μg, medium 200 μg, high ≥300 μg) and psilocybin mushrooms (low 1–2 g, medium 2.1–3.5 g, high >3.5 g); 8% of participants did not specify dose and 3% left dose blank. Qualitative analysis used inductive thematic analysis: at least two researchers coded responses, met with the principal investigator to reconcile disagreements, applied coding guidelines developed from a preliminary review, and stopped recruitment when no new themes emerged (theoretical and inductive saturation). Reported quantitative results were descriptive; the analysis did not report advanced inferential modelling.

The final dataset comprised 100 respondents aged 18–62 (mean 28.5, SD 9.76). Substance use reported for the memorable episode was heterogeneous: 43% used psilocybin, 38% used LSD, 6% used ketamine, 8% mixed a psychedelic with another psychedelic or with MDMA, 2% used DMT, 1% used ayahuasca and 1% reported 2‑BOH‑CB. No responses described supervised administration within a clinical trial or with a therapist present; most accounts were naturalistic or recreational. Responses to whether the episode resulted in personal growth were: 60% (n = 60) "yes," 28% (n = 28) "somewhat," 9% (n = 9) "no," and 3% did not answer. (An inconsistency in the extracted text later refers to eight participants reporting no growth; the source does not clearly resolve this discrepancy.) The investigators noted that 86% of LSD users and 92% of psilocybin users reported some degree of personal growth. Of the small set reporting no growth, the authors observed that most had either been uncomfortable in the setting and/or had mixed substances during the episode; specifically, they report that 6 of 8 (75%) non-growth cases met one or both of those criteria, although the precise denominator is unclear from the extraction. Fifty-eight respondents completed all 11 MEQ-mini items; total MEQ scores ranged from 1.45 to 10 on the 0–10 scale (mean 7.1, SD 2.00). Among those 58, 84.5% scored above a mean total of 5, 34.5% scored above 8, and 15.5% scored above 9. Mean MEQ scores were similar for LSD (n = 22; mean 7.11, SD 1.97) and psilocybin users (n = 24; mean 7.11, SD 2.01). Reported changes following the episode included increased spirituality/contemplation in 67% (n = 67), processing of traumatic memories in 70% (n = 70), and improved understanding of past events in 51% (n = 51). On a 0–10 scale, mean scores for feelings of love and appreciation (n = 77) were 6.25 (SD 3.02) with 65% scoring >5; resilience to life failures (n = 75) had a mean of 6.69 (SD 3.05) with 66 scoring ≥5. Inductive thematic analysis of 75 open-ended follow-ups produced eight recurring themes: (1) increased insight and perspective shifts, (2) mystical, spiritual and religious experiences, (3) improved mental and emotional wellbeing, (4) increased appreciation of life, (5) greater empathy and changes in relationships, (6) becoming a better version of oneself, (7) acceptance and self‑love, and (8) negative and mixed-type experiences. Most qualitative reports were positive and described enhanced insight, meaningful or ineffable experiences of unity or transcendence, reduced stress or suicidal ideation in some cases, and improved interpersonal awareness. A minority described adverse or mixed outcomes—reports of terror, dysphoria, beliefs of dying or permanent damage, and in two instances participants attributed psychedelics to catalysing or causing psychosis. The authors emphasised that adverse effects often co-occurred with positive effects and that reported harms were more common in contexts involving concomitant substances or uncomfortable settings.

The researchers interpret their findings as showing that people with psychotic symptoms or diagnoses do use psychedelics naturalistically and, in this sample, most reported experiences that they judged to be growth-inducing, spiritually meaningful, and occasionally associated with symptomatic relief. They frame the qualitative and descriptive results as indicating that psychedelic experiences in this population are multidimensional and distributed along a spectrum from positive to mixed to negative, rather than uniformly harmful or beneficial. An observed, preliminary pattern linked negative or non-growth outcomes with concomitant drug use and with being uncomfortable or unfamiliar in the dosing environment; however, the study authors emphasise that these are descriptive observations and call for more robust statistical testing before inferring causal relationships. They also highlight that mystical-type experiences were common (MEQ-mini mean ≈7.1), and many participants reported increased spirituality, processing of trauma, improved resilience and greater appreciation—outcomes the authors suggest could be relevant targets if supervised PAT were to be studied in this population. The discussion is candid about limitations that constrain interpretation: the sample lacked ethnoracial diversity and overrepresented positive psychotic symptoms, respondents were self-selected which may bias toward more transformative experiences, the data are retrospective with varying recall intervals (some reports dated several years back), the MEQ-mini was an unvalidated abridgement, the original CAPE-42 was discontinued mid‑study and replaced with a shorter checklist, and a typographical error mislabelled schizoaffective disorder during data collection. The investigators also note uncertainty about temporal sequencing in some responses—whether psychotic symptoms preceded or followed psychedelic use—and the inclusion of borderline personality disorder (which sometimes presents psychotic features) complicates diagnostic homogeneity. Given these caveats, the authors recommend larger, prospective, and controlled studies to determine safety, efficacy and to develop tailored PAT protocols for people with psychotic symptoms, particularly examining the role of set, setting and concomitant substances.

Torre and colleagues conclude that their sample described three broad outcome types—positive, mixed and negative—with most participants reporting some degree of personal growth, insight and mystical-type experiences following a memorable psychedelic episode. A small proportion reported worsening symptoms or adverse reactions, and the causes of such outcomes remain unclear due to confounding by setting and concomitant substance use. The authors suggest that supervised clinical use of psychedelics alongside psychotherapy could be explored for people with psychotic symptoms, but they emphasise that larger, rigorously designed studies are required to assess safety and efficacy and to inform tailored PAT protocols for this population.