Using Psychedelics With Therapeutic Intent Is Associated With Lower Shame and Complex Trauma Symptoms in Adults With Histories of Child Maltreatment

Child maltreatment (CM) — including physical, emotional, and sexual abuse as well as neglect — is common and linked to long-term disturbances in self-concept, affect regulation, social cognition, and a range of psychiatric disorders. Healy and colleagues note that maladaptive schemata of self and other formed in development are thought to underpin these difficulties, and that preliminary clinical and anecdotal reports suggest psychedelic drugs can acutely disrupt and potentially reshape those schemata. Prior work has shown associations between CM and internalised shame and altered facial emotion recognition (FER), but the mechanisms by which psychedelics might ameliorate CM sequelae remain unclear. This study set out to examine whether intentional therapeutic psychedelic use (ITPU) is associated with differences in posttraumatic stress symptoms (PTSS), internalised shame, and FER among adults reporting histories of CM. Specifically, the investigators hypothesised that (H1) greater CM exposure would relate to higher PTSS and internalised shame and lower FER accuracy, and that (H2) participants with any history of ITPU would report lower PTSS and internalised shame and show better FER than those without such a history. The analysis also explored whether frequency of ITPU modifies these relationships and examined CM subtypes in relation to outcomes.

This was a cross-sectional, online survey study. Participants were recruited via Reddit, Facebook, and word-of-mouth between 15–24 October 2019; 283 people began the survey and 166 participants aged 18 or older completed it in full and met inclusion criteria (English fluency and self‑reported history of CM). No payment was provided. The Institutional Review Board of The New School deemed the study exempt from oversight. Measures included a demographics questionnaire and a bespoke assessment of history of intentional therapeutic psychedelic use (ITPU), which asked whether participants had ever used listed psychedelic/entheogenic substances with the explicit intention of healing or processing childhood trauma and collected follow-up details (substances, number of occasions, timeframe, setting, perceived impact, and an optional free-text item). CM exposure and severity were assessed with the Childhood Trauma Questionnaire (CTQ). Current posttraumatic symptomatology was measured with the International Trauma Questionnaire (ITQ), which yields PTSD and Disturbances in Self-Organization (DSO, i.e., complex PTSD) scores. Internalised shame was measured with the Internalized Shame Scale (ISS). Facial emotion recognition was assessed using the Reading the Mind in the Eyes Test (RMET); reaction time per item was recorded. Only complete survey responses were analysed. Statistical procedures comprised descriptive statistics, independent-samples t-tests, chi-square tests, and one-way ANOVAs (with Tukey post hoc tests where applicable) to compare ITPU and non-ITPU groups and ITPU subgroups (e.g., number of occasions). Bivariate correlations were used to test associations between CTQ scores (total and subscales) and outcome measures. Linear regression models with interaction terms (CTQ x ITPU, and later a composite emotional abuse/neglect x ITPU5 term) were used to test moderation. Data were inspected for invalid responses and outliers, which were removed as appropriate. The extracted text does not report whether any adjustments for multiple comparisons were applied.

The final sample (N = 166) had a mean age of 30.49 years (SD = 9.52) and was predominantly White (90.4%), cisgender (90.4%) and female (60.2%), with substantial representation of non-heterosexual participants (49.7% non-heterosexual; 9.6% transgender). A large majority endorsed at least one psychiatric condition, most commonly anxiety (84.9%) and depression (82.5%). Lifetime substance use was universal in the sample, most commonly caffeine (91.0%), alcohol (89.2%), and cannabis (75.3%). Approximately 31.3% of participants endorsed a history of ITPU. Among those in the ITPU group, 40.4% reported more than five occasions of ITPU (termed ITPU5), 73.1% had used within the past six months, and 75.0% characterised their experiences as exclusively helpful or healing; only 1.9% characterised them as exclusively harmful. Regarding hypothesis tests, CTQ total scores were positively correlated with ITQ PTSD (r = .26, p = .001), ITQ DSO (r = .20, p = .009), and ISS (r = .18, p = .020), supporting parts of H1. No significant relationship was found between CTQ total or subtype scores and RMET accuracy (RMET: r = .23, p = .093), and exploratory checks by emotion valence also showed no CTQ–RMET associations. Comparisons between ITPU and non-ITPU groups partially supported H2. ITQ PTSD scores did not differ by ITPU history (t(164) = -0.430, p = .668). By contrast, ITQ DSO scores were significantly lower in the ITPU group (M difference = -1.63, 95% CI [-3.22, -0.03], p = .046, d = 0.33), and ISS scores were likewise lower in the ITPU group (M difference = -5.72, 95% CI [-11.08, -0.35], p = .037, d = 0.35). No group differences emerged for RMET accuracy. Frequency of ITPU mattered: the ITPU5 subgroup showed larger effects. Comparing ITPU5 to the rest of the sample, DSO scores were lower (t(164) = -3.178, M difference = -3.52, 95% CI [-5.71, -1.33], p = .002, d = 0.66) and ISS scores were substantially lower (t(164) = -3.648, M difference = -13.48, 95% CI [-20.77, -6.18], p < .001, d = 0.80). One-way ANOVAs across ITPU frequency categories supported these trends; Tukey tests indicated ITPU5 differed from lower-frequency groups on ISS and trended toward differences on DSO. Post hoc analyses focused on emotional abuse and neglect (EAN), which showed the strongest associations with outcomes. EAN correlated with DSO (r = .32, p < .001) and ISS (r = .31, p < .001). A moderation analysis found that ITPU5 significantly moderated the relationship between EAN and DSO (interaction DR2 = .036), such that EAN correlated positively with DSO in the non-ITPU5 group (r = .42, p < .001) but not in the ITPU5 group (r = - .18, p = .434). The analogous interaction did not significantly predict ISS variance (DR2 = .011, p = .143). Additional analyses (RMET reaction times, non-intentional psychedelic use, substance type, naturalistic settings) and qualitative results were reported in supplemental materials referenced in the extracted text.

Healy and colleagues interpret the findings as partial support for their hypotheses: CM exposure was associated with greater PTSS (particularly DSO/complex PTSD) and internalised shame, and ITPU — especially repeated ITPU (more than five occasions) — was associated with lower levels of complex PTSS and internalised shame. The absence of associations between CM or ITPU and FER accuracy meant that hypotheses about social-cognitive performance were not confirmed. The investigators caution that cross-sectional, retrospective data preclude causal inference. While the moderation by repeated ITPU might suggest a protective or ameliorative effect of frequent therapeutic-intent psychedelic use on the link between emotional maltreatment and DSO symptoms, longitudinal or experimental designs are needed to establish causality. The authors offer several potential explanations for the null FER findings, including the possibility of alexithymia or a restricted range of FER performance across this high‑trauma sample; they note RMET scores in this sample were similar to those reported elsewhere for alexithymic groups and lower than normative healthy samples. Limitations acknowledged by the authors include the cross-sectional design, reliance on retrospective self-report, limited racial diversity, potential volunteer and social desirability biases, and lack of assessment of concurrent or prior psychiatric treatments that might confound associations. The sample size and composition are also referenced as constraints on generalisability. Given these caveats, the authors recommend longitudinal studies, more racially diverse recruitment, and further investigation of specific substances and settings. In terms of implications, the authors highlight that classic psychedelics (psilocybin and LSD) were the most commonly reported substances used with therapeutic intent in this sample and that ayahuasca/yage emerged as a unique predictor of reduced complex PTSS in supplemental analyses. They suggest these findings align with survey-based literature indicating naturalistic ITPU can yield therapeutic benefits and argue that therapeutic effects were observed in naturalistic settings as well as clinical ones. Finally, the discussion emphasises that ITPU-related reductions were stronger for DSO (disturbances of self-organisation) than for core PTSD symptoms, and the authors propose that psychedelics' capacity to alter the subjective sense of self may make them particularly relevant interventions for disorders characterised by self-disturbance, such as complex PTSD. Representative participant quotes included in the extracted text are used to illustrate perceived transformations in self-concept following ITPU. The authors conclude that their results add to the rationale for further clinical research, including trials that evaluate classic psychedelics for complex PTSD and studies designed to clarify mechanisms related to self-schema revision and social cognition.

Using psychedelics with therapeutic intent was associated with lower levels of complex posttraumatic stress symptoms and internalised shame in adults reporting histories of child maltreatment. The authors suggest psychedelics may be promising clinical agents for conditions in which child maltreatment contributes to psychopathology, but they emphasise the need for longitudinal and controlled research to confirm causality and inform clinical application.