Psychedelic-assisted therapy is attracting growing attention from scientists, doctors, and patients searching for better mental health treatments.
Substances such as psilocybin, found in certain mushrooms, and LSD are now being studied in clinical trials for conditions including depression, anxiety, addiction, and trauma.
Supporters of the approach believe psychedelic therapy could transform psychiatry. But researchers also warn that the treatment does not work the same way for everyone. Some patients improve dramatically, while others experience emotional distress or worsening symptoms.
A new international study led by Charité–Universitätsmedizin Berlin has now taken a closer look at what separates successful treatment experiences from harmful ones. The research was published in Nature Mental Health.
The study focused on understanding which types of patients may respond best to psychedelic-assisted therapy. Scientists hope this information could help doctors safely guide future treatment decisions.
Psychedelic substances affect perception, emotions, and consciousness. During treatment sessions, patients may experience vivid thoughts, emotional breakthroughs, powerful memories, or altered feelings about themselves and the world around them.
Researchers believe these experiences may temporarily increase the brain’s flexibility, making it easier for people to break out of harmful thought patterns linked to depression and other mental illnesses.
Interest in psychedelic therapy has grown rapidly because some patients with severe treatment-resistant depression have shown remarkable improvements after only one or two guided sessions.
However, scientists have also learned that the treatment can be emotionally intense and unpredictable.
The study described two women with very similar backgrounds. Both had severe long-term depression that had not improved despite years of medication and psychotherapy.
One woman underwent a supervised psilocybin session and later described it as difficult but deeply healing. Her emotional numbness lifted, and six weeks later she showed no measurable signs of depression on standard medical tests.
The second woman had a very different experience. She felt emotionally overwhelmed during the session and described it as inner torture. Her depression did not improve. Instead, she became even more hopeless afterward.
The dramatic difference between these cases led researchers to ask an important question: can doctors predict who is likely to benefit from psychedelic therapy before treatment begins?
To explore this issue, researchers surveyed 158 therapists from around the world who regularly conduct psychedelic-assisted therapy. Some therapists worked within legal clinical studies, while others practiced in underground settings outside formal regulation.
The scientists collected information about patient personality traits, mental health history, therapy settings, social support, treatment preparation, supervision during sessions, and follow-up care.
Several clear patterns emerged.
Patients with stable lives and strong support from family and friends appeared more likely to benefit from psychedelic therapy. Emotional support may help patients process difficult experiences that arise during treatment.
Certain personality characteristics also seemed important. Therapists reported better outcomes among patients who were emotionally open, curious about new experiences, and able to accept uncomfortable emotions instead of resisting them.
Previous experience with meditation, controlled breathing exercises, or other altered states of consciousness also appeared helpful because these individuals may feel less frightened by unusual mental experiences during psychedelic sessions.
In contrast, ongoing use of substances such as cocaine, amphetamines, alcohol, or cannabis appeared linked to poorer treatment outcomes.
The study also suggested that some personality types may face greater risks during psychedelic therapy. Therapists advised caution with patients who have paranoid, schizoid, or schizotypal personality traits because altered states of consciousness may increase confusion, fear, or emotional instability in some cases.
The findings highlight how complicated psychedelic therapy truly is. Researchers stressed that treatment success depends not only on the drug itself but also on the environment, emotional preparation, therapist guidance, and follow-up support afterward.
This concept is often described in psychedelic research as “set and setting.” A patient’s mindset, emotional expectations, surroundings, and relationship with the therapist can strongly influence the experience.
Before treatment sessions, researchers recommend that patients spend time building trust with therapists and discussing goals, fears, and expectations. After the session, careful follow-up care is important to help patients understand and integrate what they experienced emotionally.
The researchers also warned against the growing trend of unregulated psychedelic therapy outside medical settings. Therapists working underground often reported more optimistic expectations for treatment success, but scientists emphasized the need for stronger safety standards and scientific oversight.
Dr. Felix Betzler, who led the study, explained that psychedelic substances can be powerful tools but also carry risks. He compared them to sharp instruments that must be used carefully and appropriately.
The researchers believe their findings represent an important step toward more precise and personalized psychiatry. Instead of offering psychedelic therapy broadly to everyone, doctors may eventually use screening tools to identify patients who are most likely to benefit safely.
The team also hopes to develop digital prediction tools in the future using data collected from therapists and patients.
Although psychedelic-assisted therapy remains controversial, scientists agree that interest in the field will likely continue growing. At the same time, they stress the importance of balancing hope with caution.
The study shows that psychedelic therapy may offer life-changing benefits for some people with severe mental illness, but it is not without risks. Careful patient selection, professional supervision, and strong follow-up support may be essential for making these treatments safer and more effective.
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The study was published in Nature Mental Health.
Source: Charité–Universitätsmedizin Berlin.
