Self-Care Practices with Psychedelics - A Qualitative Study of Users’ Perspectives

Earlier research has reported promising clinical results for psychedelics as adjuncts to psychotherapy across conditions such as post-traumatic stress disorder, treatment-resistant depression, substance use disorders and anxiety in life-threatening illness, and qualitative work has begun to characterise subjective mechanisms that may underlie therapeutic effects. The concept of self-care—broadly the individual's intentional actions to promote health and well-being across physical, psychological, social and professional domains—has not been systematically linked to psychedelic use, despite its relevance for both harm reduction and therapeutic implementation. This study set out to explore, from users' perspectives, how psychedelic experiences intersect with self-care. Specifically, the investigators asked which dimensions and mechanisms of self-care participants identify in relation to their psychedelic use, what needs psychedelics address, and how experiences relate to participants' healthy functioning or well-being. The authors used a phenomenological approach to elicit rich, subjective descriptions of these phenomena in naturalistic settings.

A phenomenological epistemology guided participant selection, data collection and analysis in order to prioritise lived experience and the meanings participants attach to psychedelic use. Inclusion criteria required prior psychedelic use; participants were recruited by a snowball strategy supplemented with convenience sampling. Four people were recruited from the first author's informal network, additional participants were suggested by interviewees, one participant referred the research team to the Psychedelic Society of Porto, and six people responded to an online advertisement. Nineteen participants in total were included; the extracted text reports that all were Caucasian. Data were collected between January and May 2019 via in-person, semi-structured interviews conducted by the first author, with durations ranging from about 40 minutes to 3 hours. One sentence in the extraction appears incomplete regarding steps taken to make participants comfortable; the text does not fully report that detail. Interviews comprised two parts. The first elicited open-ended, free-ranging descriptions of participants' psychedelic experiences with minimal interviewer intervention, with follow-up prompts about substances and motivations when needed. The second part focussed participants on the concept of self-care: participants offered their own definitions, then the researchers provided a working definition (actions to promote health and well-being across various dimensions) to establish common ground. Topics then included whether participants used psychedelics with self-care intentions, whether self-care occurred serendipitously, how psychedelics supported or impaired self-care, meanings attributed to self-care experiences, and effects on life trajectory. Audio recordings were transcribed and analysed in NVivo. Analysis used inductive content analysis informed by phenomenology: the first author identified patterns and generated themes, categories and subcategories; meaning units were coded according to mutual exclusivity and homogeneity criteria so each unit mapped to a single category; other authors reviewed and discussed coding until agreement. The team reported using the COREQ checklist to enhance trustworthiness.

Four overarching themes emerged from the content analysis: (1) psychedelic self-care (experiences associated with self-care); (2) psychedelic states (types of effects reported); (3) mechanisms of self-care that arise from psychedelic use; and (4) challenges and difficult experiences and their relation to self-care. Under psychedelic self-care, participants identified components of self-care such as self-awareness, self-knowledge, self-analysis, self-worth and agency, and a broader aim of healthy functioning and well-being. Fourteen participants reported intentionally using psychedelics for self-care and the same number reported serendipitous self-care experiences. Settings for these experiences included ceremonial contexts (most common), recreational events (for example, one participant named Boom Festival), and private settings such as home or nature. The substances most commonly associated with self-care were ayahuasca and psilocybin, followed by DMT and LSD; MDMA, mescaline and salvia were less frequently mentioned. Nearly all participants described some form of preparation, and set and setting were commonly emphasised. The sample was split on using psychedelics while in a negative mood: approximately half avoided doing so, while others used them hoping for answers or relief; some reported mood improvement afterwards while others experienced intensification of adverse emotions. Participants also contrasted psychedelics with other self-care strategies, with some viewing psychedelics as uniquely effective and others pointing to alternatives such as yoga and meditation. Descriptions of psychedelic states included affective amplification, perceptual changes, alterations in volition or control, intense experiences including out-of-body or near-death sensations, ego-dissolution or unity, heightened aesthetic appreciation and a sense of ineffability. Mechanisms of self-care identified by participants clustered around two principal domains. First, changes in the experience of self—self-knowledge, self-awareness and self-analysis—were described as facilitating recognition of needs and prompting behavioural change; participants linked these processes to recovery from substance use, habit change (for example tobacco), and improved self-esteem, self-love, self-confidence and self-acceptance. Second, existential meaningfulness constituted a large code cluster: spiritual or transcendent experiences, shifts in worldview, re-evaluation of life purpose and values, and altered perspectives on death were frequently reported. Additional mechanisms included perspective change, insightfulness, emotional expression, connection to others, empathy and conflict resolution. On downstream functioning, participants commonly reported that psychedelic experiences extended into daily life and catalysed growth, learning or change—described variously as a “fresh start” or “total reset.” Reported changes spanned eating habits, work choices, environmental behaviours, religious orientation, personality and relationships. Reported durations of increased well-being ranged from a few days up to 6 months; two participants associated effects with greater productivity and motivation, and five linked experiences to relief from stress, anxiety or depressive symptoms. All participants reported at least some adverse effects during or after psychedelic use, including confusion, loss of control, panic, paranoia, somatic reactions (for example vomiting) and difficult comedowns. The extraction notes one reported hospitalisation during the psychedelic state. Participants described coping strategies such as seeking social support, using relaxation techniques, cognitive meaning-making, emotional distancing and preventive measures. Thirteen participants reported longer-term difficulties—problems integrating the experience, social isolation or trauma—and one described years of panic attacks and fear of losing control. Eleven participants nevertheless associated difficult episodes with positive developmental outcomes, framing some challenges as a “healing crisis” or a lever for change.

Soares and colleagues interpret their findings as reflecting three broad meanings in how users relate psychedelics to self-care: the psychedelic experience can be an act of self-care when intentional; it can improve subsequent self-care capacities; or it can threaten self-care through adverse effects. They emphasise two primary perceived mechanisms: enhanced self-perception (self-awareness, self-knowledge and self-analysis) and existential meaningfulness (spiritual or transcendent experiences, shifts in values and life purpose). The authors situate these user-reported mechanisms within earlier qualitative findings, noting consistency with reports of increased self-understanding, improved self-worth and reconciliation with existential concerns in both clinical and naturalistic contexts. At the same time, they highlight risks when experiences occur in non-supportive settings or among vulnerable individuals: adverse responses can resemble crises or precipitate longer‑term difficulties. The investigators stress the importance of set and setting—mood, expectations, preparedness, personality, people present, cultural attitudes—and they frame the interaction of substance, person and context in biopsychosocial terms rather than attributing outcomes solely to pharmacology. The discussion also addresses a counterintuitive pattern in which some challenging experiences were described as contributing to later self-care and growth, akin to a ‘‘healing crisis’’; the authors suggest this may reflect the employment of coping and integration strategies that generalise to everyday life. They recommend further research to distinguish adaptive challenging experiences from episodes of mental health decompensation and to clarify the role of difficult experiences in therapeutic outcomes. Limitations acknowledged by the authors include the epistemological constraints of phenomenology (focus on subjective descriptions rather than causal mechanisms), limited generalisability due to the small and heterogeneous sample, reliance on retrospective self-report and language-bound reconstructions of experience, potential sampling bias toward those who identify with self-care, and the fact that time constraints prevented pursuing theoretical or data saturation. Despite these caveats, the authors suggest the findings underline the relevance of addressing self-care in post‑experience integration, and they propose that interventions after psychedelic experiences and harm reduction services could help translate perceived increases in self-care ability into sustained behaviours that promote healthy functioning and well-being.

From users' perspectives in this sample, psychedelic use can function as part of a self-care process for some people. Self-perception and existential meaningfulness emerged as central mechanisms by which psychedelic experiences may support self-care, though experiences can also challenge or impair self-care depending on context and individual vulnerability. The authors note that shifts in self-views and worldviews observed in the narratives may have significant implications for health and well-being.