Psychedelic Experiences After Bereavement Improve Symptoms of Grief: The Influence of Emotional Breakthroughs and Challenging Experiences

Grief is a common response to bereavement that for a minority of people becomes prolonged and impairing, increasing risk for physical and mental health problems including depression, suicidality and higher mortality. Earlier research indicates about 10% of adults exposed to nonviolent bereavement develop prolonged grief disorder (PGD), with substantially higher rates following unnatural losses; the COVID-19 pandemic has further amplified concern about grief-related morbidity. Available treatments such as Prolonged Grief Disorder Therapy (PGDT) produce statistically significant but modest effects and require lengthy, manualised programmes, and pharmacological options have shown limited efficacy. This study set out to examine whether psychedelic experiences following bereavement are associated with changes in grief symptoms, and whether two acute-trip attributes — emotional breakthroughs (intense overcoming of difficult feelings) and challenging experiences (acute unpleasant cognitive, emotional or physiological reactions) — relate to symptom change. Low and colleagues surveyed recreational psychedelic users who recalled a psychedelic episode after bereavement, predicting overall reductions in grief severity and that emotional breakthroughs would predict larger improvements while challenging experiences would predict smaller improvements or worsening of grief symptoms.

Participants were recruited via Amazon Mechanical Turk and had to be aged 18 or older and to have used a psychedelic substance after experiencing grief symptoms following the death of a loved one. The University at Albany Institutional Review Board approved the protocol. Participants were paid US$1.00 if they passed embedded attention checks and completed the survey. After excluding respondents who failed attention checks (n = 2904), the final analytic sample comprised 363 participants. The sample was 52.9% male, 46.6% female and 0.3% not reporting sex; ages ranged from 18 to 71 years (M = 37.12, SD = 11.14). The majority identified as White (77.4%), with smaller proportions identifying as Black/African American (6.3%), Hispanic/Latinx (6.1%), Asian/Pacific Islander (5.2%), multiracial (4.1%), Native American/Alaskan Native (0.3%) or not reporting ethnicity (0.6%). Procedure: participants were asked to recall one specific psychedelic episode that occurred after bereavement (if multiple, the episode with the greatest impact) and to answer all items with that event in mind. They reported event characteristics including substance type, prior psychedelic use, how long ago the event occurred, whether they intended to address grief with the substance and whether the experience occurred alone or in a group. The most commonly reported substances were psilocybin (30.3%), LSD (23.4%) and MDMA (18.7%); 50.1% had used the same substance previously and 61.1% had prior experience with any psychedelic. Seventy percent of events occurred within the prior five years, 84.8% of participants reported using the psychedelic with the intention to address grief, and 57.6% had the experience alone. Measures: Emotional breakthroughs were measured with the Emotional Breakthrough Inventory (EBI), six items rated on visual analogue scales (0–100) summed to a 0–600 total (M = 382.67, SD = 122.57; Cronbach's alpha = .83). Challenging experiences were assessed using a subset of the Challenging Experience Questionnaire (CEQ), using three subscales (insanity, fear and grief) comprising 14 items rated 0–5 and summed to a 0–70 total (M = 29.40, SD = 18.90; Cronbach's alpha = .96). Grief severity was measured with an adapted Prolonged Grief 13 Revised (PG-13-R) administered twice, once retrospectively for the period before the psychedelic episode and once for after the episode; eleven items rated 1–5 were summed to create pre- and post-scores (alphas = .91 and .92). The PG-13 time criterion was omitted. Participants also reported functional impairment (yes/no) before and after the psychedelic experience. Analytic approach: missing values were under 1% and judged to be missing completely at random; skewed variables (age, EBI) received square-root transformations and standardisation and Mahalanobis distance testing indicated no outliers. Change scores were computed by subtracting post-psychedelic grief scores from pre-psychedelic scores (positive values indicate improvement). Statistical tests included paired-samples t-tests for pre–post grief comparisons, Pearson correlations, multiple linear regression to test whether EBI and CEQ predicted grief-change while controlling for age, sex, intention to address grief, time since event and baseline grief severity, and independent-samples t-tests comparing classic psychedelics to other psychedelics on key variables. Binary covariates were coded as −.5 and .5 and continuous covariates were median-centred to reduce inference errors.

Missing values for outcome measures were 1% or less and data were treated as missing completely at random. Square-root transformations were applied to skewed age and EBI distributions; no univariate or multivariate outliers were detected. Grief outcomes: participants reported an average 20.43% improvement in grief symptoms after the psychedelic experience (SD = 38.29). Mean pre-psychedelic grief severity was 33.97 (SD = 9.98, range 10–50) and mean post-psychedelic grief severity was 25.38 (SD = 9.16, range 10–50). A paired-samples t-test indicated this reduction was statistically significant, t(344) = 15.50, p < .05, with a large effect size (Cohen's d = 0.83). Seventy-eight percent (78.3%) of participants reported improvements, 11% reported no change and 10.7% reported worsening of grief symptoms. Reported functional impairment fell from 49.9% before the psychedelic experience to 30.3% after the experience. Associations with acute-trip attributes: mean EBI score was 382.67 (SD = 122.57) and mean CEQ score was 29.40 (SD = 18.90). Improvements in grief symptoms correlated positively with EBI (r(338) = .25, p < .05) and negatively with CEQ (r(326) = −.20, p < .05). In a multiple linear regression predicting grief-change that controlled for age, sex, intention to address grief, time since event and baseline grief severity, the overall model was significant, F(7,311) = 27.91, p < .05, R2 = .39. Significant predictors included sex (coded −.5 for males, .5 for females; t = −2.74, standardized β = −.13, p < .05), baseline grief severity (t = 11.33, standardized β = .58, p < .05), emotional breakthroughs (t = 3.28, standardized β = .15, p < .05) and challenging experiences (t = −8.93, standardized β = −.43, p < .05). Thus, stronger emotional breakthroughs predicted greater symptom improvement while more intense challenging experiences predicted smaller improvements or greater worsening. Comparisons by substance class: independent-samples t-tests comparing users of classic psychedelics (LSD, psilocybin, ayahuasca, DMT, peyote, mescaline) with users of other psychedelics (MDMA, ketamine, Salvia divinorum, PCP, ibogaine, others) found no significant differences in changes in grief symptoms, CEQ scores or EBI scores.

Low and colleagues conclude that, in this retrospective community sample of recreational users, a single psychedelic experience after bereavement was associated with substantial reductions in self-reported grief severity: roughly 78% of participants reported improvement, mean grief severity decreased by about 20% and the pre–post effect size was large (Cohen's d = 0.83). The investigators interpret these findings as preliminary evidence that psychedelic-assisted approaches might warrant further development as interventions for grief, noting parallels between themes reported in prior qualitative work on psychedelic experiences and the core components of Prolonged Grief Disorder Therapy. The authors emphasise that specific acute-trip features appear to matter: higher emotional-breakthrough scores were linked to greater improvement, while more challenging experiences were linked to poorer outcomes. They suggest psychedelic-assisted protocols for grief should foster emotional processing during guided administration and seek to minimise challenging experiences, noting that contextual factors such as set and setting, dose and drug type likely influence outcomes. The paper also points to structured ceremonial contexts (for example, ayahuasca retreats) showing lower proportions of non-response or worsening, which the authors use to underscore the role of context and support. Several limitations are acknowledged. The study used retrospective self-report from a recreational sample, often with prior psychedelic experience, which raises concerns about expectancy effects and recall bias. The investigators did not collect key contextual or clinical details such as the nature of the relationship to the deceased, circumstances of death or comorbid diagnoses, limiting the ability to identify which subgroups are most likely to benefit. Only a subset of the CEQ was used, reducing the granularity of challenging-experience measurement. The sample lacked racial and ethnic diversity (over three quarters White), which limits generalisability, and attention-check exclusions were numerous. The authors call for future controlled research with more diverse samples, prospective designs that measure prior use and expectancies, fuller measurement of challenging experiences, and investigations in structured, supported settings to clarify causality and optimal therapeutic protocols.