Psychedelic-assisted therapy has become one of the most talked-about areas in mental health research.
Around the world, scientists are studying whether substances such as psilocybin, the active compound found in certain mushrooms, and LSD could help people with severe depression, anxiety, addiction, and other mental health conditions that have not improved with standard treatment.
Some experts even describe the field as a possible revolution in psychiatry. But researchers also warn that these treatments are not simple miracle cures. While some patients experience major improvements, others see little benefit, and some may even feel worse after treatment.
A new study led by researchers at Charité–Universitätsmedizin Berlin has tried to answer one of the biggest questions in the field: which patients are most likely to benefit from psychedelic-assisted therapy, and which patients may be at greater risk of harm.
The findings were published in the journal Nature Mental Health.
The research team collected information from therapists around the world who regularly work with psychedelic-assisted therapy. The goal was to identify patterns that could help doctors better understand who may respond well to these powerful treatments.
Psychedelic substances have a long and complicated history. For centuries, some cultures used mind-altering plants and fungi in spiritual and healing rituals. In the 1950s and 1960s, scientists also explored whether psychedelic drugs could help treat mental illness. However, strict drug laws later limited most research for decades.
In recent years, interest in psychedelic therapy has returned. Researchers have reported promising results in people with severe depression that did not improve with medication or traditional psychotherapy. Some studies also suggest possible benefits for anxiety disorders, post-traumatic stress disorder, addiction, and end-of-life emotional distress.
Scientists believe psychedelic substances may temporarily change brain activity in ways that make the brain more flexible and open to new emotional experiences. During psychedelic sessions, some patients report intense emotional breakthroughs, powerful memories, or deep feelings of connection and meaning.
One patient described in the study had struggled with severe depression for many years. Standard medications and psychotherapy had failed to improve her condition. She had become unable to feel joy and had been unable to work for a long time.
The woman agreed to participate in a carefully supervised psilocybin session as part of a controlled study. During the session, she experienced powerful emotions that she later described as painful but healing at the same time. She compared the experience to surviving a storm before finally seeing sunlight break through the clouds.
Six weeks later, her depression symptoms had almost completely disappeared according to standard depression tests.
But the researchers also described another patient with a very similar history who had the opposite reaction. This woman experienced the psychedelic session as deeply distressing and emotionally overwhelming. Instead of improving, her depression worsened afterward, and she felt even more hopeless than before.
These very different outcomes raised important questions. Why do some patients improve dramatically while others struggle?
To investigate this, researchers surveyed 158 therapists who conduct psychedelic-assisted therapy in different countries. Some worked legally within clinical studies and regulated medical systems, while others worked in underground settings where psychedelic therapy remains illegal.
The researchers examined many factors, including patient personality, mental health history, social support, therapy setting, preparation, supervision during treatment, and follow-up care afterward.
The therapists agreed on several traits linked to better outcomes.
Patients who had strong emotional support from family or friends appeared more likely to benefit from psychedelic therapy. A stable living environment also seemed important.
Certain personality traits also appeared helpful. Patients who were open to new experiences, emotionally flexible, and able to accept difficult feelings seemed more likely to respond positively.
The researchers also found that people with previous experience with altered states of consciousness, such as meditation or breathing exercises, often handled psychedelic experiences more successfully.
On the other hand, use of substances such as cocaine, amphetamines, heavy alcohol use, or cannabis appeared linked to poorer outcomes.
Therapists also believed personality style mattered. Patients with avoidant, dependent, or compulsive personality styles often seemed better suited for psychedelic-assisted therapy.
Greater caution was recommended for patients with paranoid, schizoid, or schizotypal personality patterns because they may react more unpredictably to altered states of consciousness.
The study strongly emphasized the importance of the therapy environment itself. Psychedelic therapy is not simply about taking a substance. Researchers said treatment success depends heavily on careful preparation, professional supervision during sessions, and ongoing support afterward.
Before treatment, patients should ideally build trust with their therapists, discuss goals, and talk openly about fears or concerns. After the psychedelic session, patients often need time and guidance to process the experience and understand its emotional meaning.
Researchers warned against viewing psychedelic substances as quick cures or using them casually outside professional settings. Therapists working in unregulated underground environments tended to express more optimism about success rates, but researchers stressed the need for scientific caution and safety standards.
Dr. Felix Betzler, who led the study, compared psychedelic treatment to using a sharp blade. In skilled hands, it may help some patients significantly, but it can also cause harm if used improperly or with the wrong patient.
The research team hopes their findings will eventually help create better screening systems to identify who may benefit most from psychedelic-assisted therapy. They also hope to develop digital tools that could predict treatment success more accurately in the future.
Although the field remains controversial, scientists believe studies like this are helping psychiatry move toward more personalized mental health treatment based on individual biology, personality, and life circumstances.
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The study was published in Nature Mental Health.
Source: Charité–Universitätsmedizin Berlin.
