Spiritual experiences in psychedelic-assisted psychotherapy: Case reports of communion with the divine, the departed, and saints in research using psilocybin for the treatment of alcohol dependence

Podrebarac and colleagues situate their work within a long history of plant- and fungus-based psychedelic use in indigenous ritual contexts, noting that these practices traditionally integrate spiritual and physical dimensions of healing. Earlier waves of Western psychedelic research in the 1950s and 1960s suggested therapeutic promise—particularly for addictions—though many early studies had methodological limitations. More recent research has renewed interest in psychedelic-assisted psychotherapy, with psilocybin shown to reproducibly occasion profound mystical or spiritual-type experiences and, in some trials, to correlate with sustained improvements in mood, social attitudes, and clinical outcomes such as reductions in anxiety, depression, and addictive behaviours. This paper presents three illustrative case reports drawn from an ongoing double-blind, randomised controlled trial of psilocybin-assisted psychotherapy for alcohol dependence. The authors' stated aim is not to adjudicate the ontological status of participants' spiritual encounters but to describe the range of spiritual phenomena observed (communion with the deceased, encounters with holy figures, and communion with a perceived Divine or universal force) and to consider how therapists might support and integrate such experiences within clinical care. The cases were selected to highlight diversity in spiritual content and to explore elements of spiritual care that may aid therapeutic integration.

The cases come from a multi-site, double-blind, randomised controlled trial (sites: NYU Langone Health and the University of New Mexico) testing psilocybin-assisted psychotherapy for alcohol dependence (ClinicalTrials.gov ID: NCT02061293). Institutional review boards at both sites approved the study. Participants receive a psychotherapy package and are randomised to receive either psilocybin or diphenhydramine (active placebo) in two medication sessions scheduled at week 4 and week 8 of a 12-week double-blind period. In the first session participants receive 25 mg/70 kg (≈0.36 mg/kg) psilocybin or 50 mg diphenhydramine, with the possibility of increasing the dose in the second session to 40 mg/70 kg (≈0.57 mg/kg) psilocybin or 100 mg diphenhydramine depending on response. Following the 12-week double-blind phase, participants are followed through week 36, and those meeting interim safety criteria may be offered an open-label psilocybin session at week 38. Psychotherapy in the parent trial comprises two parallel modalities. META therapy (Motivational Enhancement and Taking Action) is a manualised, evidence-based behavioural intervention addressing alcohol use. PSI therapy (Preparation, Support, and Integration) is intended to optimise the psychedelic experience and its integration; each participant is assigned two therapists, one to lead META and one to lead PSI. Both therapists are present for the two 8-hour medication sessions and are encouraged to participate in other sessions. Integration sessions are client-centred and aim to attend to themes arising under medication, with therapists encouraged to honour participants' "inner healing intelligence." The three cases reported here were chosen to illustrate different spiritual experiences; the blind had not been broken at the time of reporting, and the extracted text does not state the total trial sample size or broader selection criteria for the three cases beyond their illustrative purpose. The intensity of mystical-type experiences is reported using the Mystical Experience Questionnaire (MEQ), a self-report measure commonly used in psychedelic research to quantify the intensity of mystical phenomenology.

The paper presents three individual case reports, each described in narrative detail and accompanied by MEQ scores indicating relatively high intensity of mystical-type experience (Joan MEQ = 0.65; Claire MEQ = 0.75; Francis MEQ = 0.74). Case one ("Joan"): Joan, a white woman in her forties, had longstanding alcohol problems linked to grief and family dynamics and reported drinking about 40 standard drinks per week at enrolment. Psychedelic-naïve before the trial, her stated intention for the first medication session was to connect with purpose. After an initially distressing period of nausea and unsettling imagery, Joan reported perceiving the presence of her deceased mother and later her maternal grandfather. She experienced direct dialogic contact with her mother's presence, received reassurance of love and acceptance, and felt "totally seen." Following the session Joan reported an increased sense of self-compassion, reconnected with Catholic practice, and at 24-week follow-up reported a 50% reduction in drinks per week. Case two ("Claire"): Claire, a white woman in her early forties, drank 19 standard drinks per week at baseline and had prior unsuccessful attempts at treatments such as Alcoholics Anonymous. Her first two medication sessions were cathartic; she described soothing a visionary representation of her alcohol-craving self and maintained sobriety thereafter. In an open-label (third) session she reported an encounter with a "universal power" or life force that she sometimes called "magic" rather than God, describing it as timeless, loving, and ever-present. Months after the final session she described a profound life reorientation, established daily meditation and prayer, engaged with a Unitarian Universalist community, and reported abstinence at the study's final assessment. Case three ("Francis"): Francis, a Hispanic man in his forties who reported 66 standard drinks per week at baseline, experienced a second-session visionary state in which a voice revealed his "Buddha nature" and he travelled mentally down a river to meet a blue-tinted Hindu holy man (sadhu) who called him "my prince" and transmitted a glowing blue pearl into his heart. He described lasting increases in self-compassion and appreciation and said, over a year of follow-up, that the sense of blessing persisted; he reported sobriety at the trial's final visit. Across the cases, participants and therapists attributed therapeutic relevance to the spiritual content of the medication sessions. The authors note that because the double-blind remained intact, it is unknown whether the specific cases received active drug or diphenhydramine during the reported sessions.

Podrebarac and colleagues interpret these cases as illustrative of the heterogeneous, highly individual spiritual phenomena that can arise within psilocybin-assisted psychotherapy for alcohol dependence. They emphasise that participants in these examples attributed meaningful therapeutic lessons to their spiritual encounters and that such insights may play a role in behavioural change during addiction treatment. The paper situates this observation within a broader historical context in which spirituality has long been recognised as relevant to addiction recovery, for example in the traditions of Alcoholics Anonymous. The authors stress clinical implications centred on therapist stance and integration work. They argue that therapists and guides should be flexible, open, and humble in addressing spiritual content, matching participants' language and symbolic frames rather than imposing the clinician's own interpretive paradigms. Interfaith awareness and comfort discussing mystical or sacred experiences are presented as important competencies. Illustrative points include validating experiences that draw on unfamiliar religious traditions (as with Francis) and adopting participant-preferred terminology (as with Claire's use of "magic"). The authors describe spiritual care within their model as inclusive of supportive presence, ritual guidance, and willingness to address spiritual resistance or trauma. Limitations acknowledged by the authors include that the parent trial was still blinded, so some reported experiences might have occurred in participants who received placebo; the authors note that this would not necessarily diminish the clinical relevance of those experiences. They also acknowledge that not all participants report transcendental experiences, and that sessions vary widely in content (autobiographical processing, interpersonal healing, catharsis). The preparatory sessions in this trial did not emphasise spiritual content heavily, so the authors consider these experiences unlikely to be merely primed by preparation. Finally, the authors suggest that if psilocybin becomes an approved therapeutic option, clinicians will need training in spiritually informed care and that psychotherapeutic frameworks that integrate spiritual material—such as Jungian analytical and transpersonal psychology—may offer useful languages and approaches for integration.