Predictors of attitudes toward psychedelics among psychologists in the USA

Psychedelics such as psilocybin, LSD and DMT have long been highly stigmatised in the United States, yet recent clinical research has produced promising early-stage evidence for therapeutic benefits across conditions including end-of-life anxiety, treatment-resistant depression and some substance use disorders. The introduction situates this changing evidence base against persistent public and professional beliefs that psychedelics are high-risk, noting prior surveys that found substantial proportions of the public and some psychiatrists believe psychedelics increase psychiatric risk or are unsafe even under medical supervision. Because psychologists are likely to have a role in disseminating any approved psychedelic-assisted therapies, understanding variation in psychologists' attitudes is presented as important for anticipating barriers to implementation and for designing stigma-reduction strategies. Luoma and colleagues state that relatively little is known about psychologists' attitudes toward psychedelics specifically. Using a secondary analysis of a survey of 366 US-licensed clinical or counselling psychologists, the study aimed to examine individual difference predictors of attitudes toward psychedelics. Hypotheses focused on demographic and experiential variables: that male gender, residence in politically liberal regions (Northeast/West), greater familiarity with psychedelics, religious non-affiliation, and direct or indirect contact with positive psychedelic experiences would be associated with more favourable attitudes. Training in addictions treatment was examined but not expected to be positively associated with attitudes based on prior uncertainty.

This was a cross-sectional survey of 366 licensed clinical or counselling psychologists in the USA who were at least 18 years old and fluent in English. Participants were recruited from a purchased email list of 27,866 US psychologists; invite emails directed respondents to a Qualtrics survey and offered entry into a raffle. The invitation described the study as examining “perceptions of the use of psychoactive substances in psychotherapy” to minimise selection bias related to psychedelics specifically. The extracted text does not report a survey response rate. The questionnaire collected demographics and background (age, gender/sex, state of residence, years in practice, highest degree, primary theoretical orientation, practice setting), self-rated knowledge about risks and benefits of psychedelics, prior personal psychedelic use and its valence, whether friends or relatives had positive psychedelic experiences and how positive those were, and self-rated background/training in addictions treatment. Two vignette items were included in the survey but were not analysed for this manuscript. The outcome was a latent variable representing overall attitudes toward psychedelics. That latent variable combined three indicators: (1) the mean of seven attitude items adapted from a prior psychiatrist survey (items about risk, safety, legal status, therapeutic promise and need for further research, rated −2 to +2), (2) a therapist rating of perceived therapeutic potential of psychedelics (scale 0 to +4), and (3) a therapist rating of perceived safety of psychedelics (scale −3 to +3). Analytically, the investigators conducted descriptive statistics and inspected variable distributions, then used factor analysis to justify the latent outcome. Region was dichotomised into Northeast + West versus South + Midwest. Religious status was coded as affiliated (e.g. Christian, Buddhist, Jewish) versus unaffiliated (agnostic, atheist, non-religious, spiritual or mixed). Two participants who identified as genderqueer were omitted from inferential analyses because the sample size for that group was too small. The post-registered analytic plan specified a series of structural equation models (SEM) using maximum likelihood estimation with robust standard errors to accommodate some kurtotic predictors. A set of 11 SEMs were run, each modelling a single predictor variable’s association with the same latent attitudes outcome. Effect sizes for chi-square analyses were reported using phi (u in the extracted text).

Measurement checks indicated the three indicators (average of the seven attitude items, therapeutic potential rating, and safety rating) were strongly and positively associated with the latent attitudes variable across models. Planned SEM analyses found several consistent predictors of more positive attitudes toward psychedelics: younger age, male gender, residence in the Northeast or West (versus Midwest or South), greater self-rated knowledge about psychedelics, religious non-affiliation, personal prior psychedelic use, and having a friend or relative who had a positive psychedelic experience. Reported level of training in addictions treatment was the only predictor not significantly associated with attitudes. The authors report effect-size estimates for two particularly salient predictors. Having a friend or loved one with a positive psychedelic experience accounted for 24% of the variance in attitudes, while prior personal psychedelic experience accounted for 18% of the variance. Among the exploratory analyses, prior personal experience and knowing someone with a positive experience were each associated with greater self-reported knowledge: prior personal use was associated with higher knowledge, t(360) = 5.54, p < .0001, d = 0.62, and having a friend with a positive experience was associated with higher knowledge, t(360) = 4.27, p < .0001, d = 0.44. Those who had used psychedelics were much more likely to report that a friend had a positive experience (89%) than those who had not used psychedelics (41%), X2(1) = 68.3, p < .001, phi = 0.43. Other reported statistics: psychologists with past personal use were slightly older (M = 52.6, SD = 12.8) than those with no use (M = 49.2, SD = 13.8), t(359) = 2.21, p = .03, d = 0.25. Older age was modestly correlated with greater knowledge of psychedelics, r(359) = 0.18, p < .001. Regionally, psychologists in the West and Northeast reported past psychedelic use at 35.3% versus 25.2% in the Midwest and South, X2(1) = 4.25, p = .04, phi = 0.11. Men were about twice as likely as women to report prior psychedelic use (43.4% vs 22.8%), X2(1) = 15.9, p < .001, phi = 0.21, and men reported greater knowledge than women, t(358) = 5.95, p < .001, d = 0.65. Religious affiliation was not significantly associated with past use (X2(1) = 2.88, p = .09) or with knowing someone who had a positive experience (X2(1) = 2.40, p = .12). The extracted text does not present full parameter estimates for each SEM in prose, but it reports the pattern of significant associations summarised above.

Luoma and colleagues interpret these findings as evidence that psychologists are not uniform in their attitudes toward psychedelics; attitudes vary systematically by demographic, regional and experiential factors. The authors suggest regional differences (more positive attitudes in the West and Northeast) may reflect broader political or cultural differences and/or greater personal exposure to psychedelics in those regions, and they note the effect size for region was small but potentially meaningful for large-scale education campaigns. Gender differences are considered likely related to greater lifetime use among men in this sample, which aligns with prior surveys of psychiatrists. Age effects were small and somewhat puzzling: although lifetime psychedelic use increased with age in general population data, in this sample younger psychologists reported slightly more positive attitudes even though older psychologists reported more knowledge and higher lifetime use; the authors speculate about possible cohort effects stemming from attitudes formed during the 1970s–1980s. Self-reported knowledge of risks and benefits was associated with more favourable attitudes, and the authors suggest that empirically based educational interventions could shift attitudes. Consistent with the contact hypothesis, indirect contact—knowing someone with a positive psychedelic experience—was a particularly strong correlate, accounting for 24% of variance in attitudes; personal use accounted for 18% of variance. The authors propose that personal stories or case studies could be effective components of stigma-reduction efforts and that clinicians’ exposure to clients who benefit from psychedelic-assisted therapy may progressively improve community attitudes as these treatments become more visible. The discussion lists several limitations acknowledged by the authors: the cross-sectional design precludes causal inference, lack of data on sexual orientation and race/ethnicity, the sample is limited to psychologists so findings may not generalise to other professionals, possible sampling bias from the recruitment method, use of measures that were not psychometrically validated for this context, and arbitrary grouping of states into regions. The authors note the study’s strengths include a relatively large sample size and that these results are novel and in need of independent replication. Finally, they connect the findings to the practical context that Phase III trials are underway and anticipate that dissemination of psychedelic-assisted therapies will require attention to clinician attitudes; they emphasise that contact-based and informational strategies (for example, inclusion of case studies and hosting regional educational events) may help reduce stigma among psychologists.