The ritual use of ayahuasca during treatment of severe physical illnesses: a qualitative study

Severe physical illnesses (SPI) such as cancer and other life‑threatening or disabling conditions often provoke intense psychological distress, including high rates of depression and anxiety. Previous trials with classic serotonergic psychedelics (for example, LSD and psilocybin) have shown benefits for anxiety and depression in the context of life‑threatening illness, and a growing body of work has suggested therapeutic potential for ayahuasca, a traditional Amazonian brew whose active constituents include DMT and β‑carbolines. Despite increasing use of ayahuasca in Brazil and preliminary reports that ritual ayahuasca experiences may improve coping and well‑being in people with physical illnesses, the psychological mechanisms by which ritual use might influence patients' understanding of and relationship to their illness remain poorly articulated. This study, conducted by Oliveira and colleagues, aimed to explore how ritual ayahuasca use during the treatment of SPI may shape the way people understand and relate to their illness. The investigators used qualitative methods to elicit participants' subjective accounts, with the stated goal of identifying psychological processes—such as changes in meaning, emotional processing, or outlook on life and death—that could help explain reported therapeutic effects and inform further clinical research in this area.

The researchers used a retrospective, exploratory and descriptive qualitative design. Participants were purposively sampled for ‘‘intensity’’—that is, selection favoured individuals who had experienced a notable impact of ayahuasca on their illness experience. Inclusion required at least one ayahuasca ceremony after diagnosis of an acute, prolonged or chronic physical illness usually considered life‑threatening or potentially highly disabling. Secondary aims of sampling were to achieve heterogeneity in disease type and gender, and to include people whose first ayahuasca experience occurred both before and after diagnosis. Recruitment drew on the authors' networks in ayahuasca communities and social media; screening was conducted by an informal telephone interview and sampling continued until the authors judged thematic saturation had been reached. Data were collected by the first author through single, semi‑structured in‑depth interviews (average two hours) conducted between May and November 2018, usually in participants' homes or in a private meeting room. Interview topics covered the subjective impact of diagnosis, subjective effects of ritual ayahuasca experiences and their influence on illness understanding, and behavioural changes following ritual use. Interviews were audiorecorded with consent, transcribed, and pseudonyms used in reporting. The study received ethical approval from the University of Campinas ethics committee. Analysis followed an exploratory, inductive thematic approach at the semantic level. The first author manually coded transcripts and generated themes, subthemes and topics; co‑authors reviewed the thematic structure. Trustworthiness strategies included peer discussion within the research group, presentation of findings at scientific meetings, and adherence to the COREQ checklist. The authors note that they all have personal experience with ayahuasca and backgrounds in mental health, which informed recruitment and analysis.

Fourteen participants were interviewed (7 women, 7 men), aged 24–61, living across seven cities in four Brazilian states. Medical conditions represented a range of severe physical illnesses including cancer, HIV infection, rheumatological, neurological, gastrointestinal and dermatological disorders. Regarding ritual exposure, four participants were established ritual users, three had participated in a few rituals, and seven had their first ayahuasca experience after diagnosis. Reported frequency of use ranged from sporadic to weekly, and ritual settings included institutional ayahuasca religions (Santo Daime, Barquinha, União do Vegetal) and independent neo‑shamanic groups. Most participants were employed or studying, most used public medical services, all received some form of therapy in addition to medical care, and overall educational level was high. Thematic analysis yielded eight themes grouped into three overarching topics: Mental health; The place of illness; and The place of being. Under Mental health, two themes emerged. ‘‘Introspection, thought and emotion’’ described a deep inward state during the ayahuasca experience characterised by emergence and processing of autobiographical material, memories and affect. Participants described a form of ‘‘self‑therapy’’ in which compassionate re‑appraisal, catharsis and access to difficult content occurred, often followed by positive feelings such as peace, trust and gratitude; one participant called the process ‘‘self‑therapy.’’ A second theme, ‘‘ayahuasca as a facilitator,’’ captured participants' accounts that the brew catalysed or accelerated psychological learning and therapeutic change that might otherwise have taken much longer. Within The place of illness, four themes were identified. ‘‘Conceptions about the origin of the illness’’ described how participants came to attribute emotional, spiritual or behavioural meanings to disease onset. ‘‘Resignification and acceptance of illness’’ referred to re‑attributing positive or transformative meaning to illness (for example, seeing it as a gift or learning opportunity) and to reductions in victim mentality; one participant said that after ayahuasca ‘‘I understood that I did not need to see the disease as an enemy.’’ ‘‘Perspective change’’ captured reports that illness ceased to be the central defining feature of life, allowing a more distant or balanced view. ‘‘Perception, self‑care and treatment management’’ encompassed reported increases in body awareness leading to changes in self‑care and different approaches to medical treatment, including both enhanced adherence and, in some cases, decisions to avoid particular interventions. The Place of being included themes related to existential change. In ‘‘death: fear, acceptance and meaning’’ participants reported that ayahuasca amplified illness‑related reflections on mortality and often reduced fear of death, facilitating acceptance. The ‘‘life: priorities and habits’’ theme summarised reported lifestyle changes—diet, activity, substance use and relationship priorities—often framed as seeking balance. From these themes the authors constructed a hypothetical explanatory model in which the ayahuasca‑induced introspective state (Mental health) facilitates processing of psychoemotional content, leading to resignification of illness (The place of illness) and, ultimately, changes in existential position and behaviour (The place of being). The authors also noted instances where ritual experience influenced concrete treatment decisions for better or worse, and they highlighted that such decisions may carry important clinical consequences.

Oliveira and colleagues interpret their findings as indicating that ritual ayahuasca use may facilitate acceptance of severe physical illness through multiple interrelated psychological mechanisms. They argue that the introspective state reported by participants increases recall and reprocessing of autobiographical memories, often producing emotional catharsis and emergent positive affect, with associated reductions in anxiety and depressive symptoms. The investigators identify ‘‘resignification’’—the re‑attribution of new, often growth‑oriented meanings to illness—as a key mechanism linking ayahuasca experience to greater acceptance and potentially to improved treatment engagement. The authors situate their results alongside prior work on psychedelics and life‑threatening illness, noting similarities in mechanisms such as trauma reconciliation and decreased death anxiety. They emphasise that ritual ayahuasca experiences appeared to act as catalysts for psychological processes that may otherwise be triggered by illness alone, and that individual motivation and context shaped outcomes. The discussion explicitly acknowledges that placebo or symbolic effects could contribute to reported benefits: ritual and drug together carry symbolic meaning, and pharmacological and placebo effects are not mutually exclusive. The authors cite evidence that supportive environments can inflate placebo responses and note a recent controlled trial finding antidepressant effects alongside placebo effects. Practical implications discussed include possible enhancement of body awareness and self‑care, lifestyle changes, and altered treatment decision‑making; the latter may be beneficial when it increases adherence but potentially harmful if it leads to refusal of indicated treatment. The authors therefore recommend cautious interpretation. They acknowledge important limitations: purposive recruitment likely favoured participants with positive experiences, retrospective self‑report is subject to recall and confirmation biases, and the sample cannot support causal claims. For future work they recommend a staged research programme—prospective observational studies, proof‑of‑concept open‑label trials, and ultimately randomised placebo‑controlled trials using standardised protocols—to clarify efficacy, mechanisms and safety, as well as studies that disentangle ritual/contextual from pharmacological contributions.