The rapid expansion of psychedelic research has opened significant pathways of opportunity in treating mental health disorders. Participants in recent clinical trials consistently report mystical-type experiences during dosing sessions, and some scholars posit that such experiences themselves help mediate clinical improvements in depression, PTSD, anxiety, and substance use disorders. These reports are in keeping with the historical reality that the use of psychedelic substances and plant medicine has been tied to spiritual experience and shamanic ceremonial practice. Professional clinical chaplains are trained and experienced in providing spiritual and emotional support for people encountering illness, life change, and trauma. They regularly assist participants who seek to make meaning of their experiences in the context of their own beliefs and spirituality. This article argues that as subject matter experts in spirituality and health, chaplains are an asset to psychedelic assisted therapies and should be utilized in research trials and clinical practice, especially given a relative lack of training in spirituality and religion among interprofessional practitioners. We offer this set of competencies for chaplains to provide high quality, safe, and ethical care in the context of psychedelic medicines. These competencies include spiritual and religious care, spiritual inquiry, empathic presence, ethical engagement, and advocacy. We recognize that chaplains will need to pursue specialized education and supervised experience beyond their standard professional requirements, and pathways of personal preparation are discussed. The presence of qualified chaplains will help ensure that participants navigate non-ordinary states of consciousness with safety, sensitivity, and insight regarding improvement and growth.

Studies examining the effects of religious/spiritual practices have not sufficiently investigated the role of their underlying meaning-making frameworks in driving their effects. Across three experiments, we examined whether increasing the psychological salience of Shabbat among Jews had a greater impact-on feelings of security, positive and negative emotions (Study 1), prosocial emotions (Study 2), and transcendence (Study 3)-than primes of a nonreligious vacation day or a routine workday. We examined whether this effect was moderated by level of religiosity and attachment to God. Participants (n = 240 for each of the three studies) were administered surveys on religiosity/spirituality and randomized to reflect on experiences of Shabbat or the two secular analogs. Then, outcome measures were administered. Consistently, the Shabbat prime led to more favorable outcomes than the two control groups (d range = .43-.53), except for negative emotion and distress while witnessing others' suffering. Outcomes did not differ between control conditions. Group differences were not moderated by interaction effects with experimental condition and general religiosity or religious attachment. Across three experiments, priming participants to reflect on Shabbat yielded consistently more favorable psychological outcomes than secular analogs. Effects of ritual behavior may be enhanced by processes of religious meaning-making beyond ritual behavior alone. Heightening the symbolic and emotional salience of meaning may reinforce the potential benefits of religious practices or spiritual exercises.

Research has established that life stress may elevate the likelihood of challenging experiences with psychedelics, which may be linked to poorer outcomes from psychedelic use. Studies have highlighted the importance of therapeutic support, but questions remain about the type of effective support and its specific contribution. We examined the contribution of therapeutic-like contexts and support on the relationship between life stress and challenging psychedelic experiences and between challenging experiences and psychological outcomes. An online survey was conducted in an international sample (N = 1,867) of psychedelic users. Statistical analyses were conducted to examine the moderating roles of therapeutic-like context and support on presumed links between life stress and challenging psychedelic experiences and between challenging experiences and outcomes. Data generally supported theorized associations among stressful life events, challenging psychedelic experiences, therapeutic-like context/support, and psychological outcomes. Therapeutic-like context mitigated the association of stressful life events with challenging experiences and the association of challenging experiences with coping, but not other associations. Interaction effects indicated that the degree of therapeutic-like support moderated the association of challenging experiences with valence, impact on coping, and impact on well-being. In other regression models, therapeutic-like support maintained significant independent effects, but interaction effects were not found. Therapeutic-like context and support were found to moderate links between life stress and challenging psychedelic experiences and between challenging experiences and outcomes. These findings may be relevant to clinical uses of psychedelics in therapeutic contexts and harm reduction practices in naturalistic contexts.

Recent years have seen a revival of neurobiological, psychiatric, and psychological research into psychedelics (i.e., 5-HT 2A receptor agonists), their effects on sensory perception, mood, and thought, their associated risks, and their therapeutic potential. However, evidence-based explanatory models are still nascent, and there is a need for comprehensive, widely agreed-upon theoretical frameworks to explain the underlying processes and mechanisms of change. This dissertation describes a relational psychedelic science informed by attachment theory, one of the most enduring and influential psychological theories that “reaches from the biological depths of our being to its furthest spiritual reaches” (Holmes, 2014, p. 83). Decades of research support the role of attachment to the many fields relevant to psychedelics, including lifespan development, self-regulation and related cognitive processes, interpersonal relationships, psychotherapy, and neuroscience, not to mention the religious, spiritual, or mystical experiences that often characterize psychedelic phenomenology. First, I outline how, within a broader contextual-experiential model of psychedelic drug effects, an attachment theory framework may help integrate key findings and concepts from the growing body of psychedelic literature and generate testable hypotheses (Article 1). Second, I present findings from a survey study of a psychedelically experienced international Jewish sample on the link between attachment dimensions and psychedelic phenomenology (Study 1/Article 2). The study found consistent links between recollections of insensitive caregiving in childhood and the strength of psychedelic phenomenology (e.g., mystical and challenging experiences). Third, I report on the initial validation of a novel self-report instrument designed to measure empirically established general change mechanisms of psychotherapy and the type of experiences that catalyze psychotherapeutic change, much of which are relational, in the context of psychedelics (Study 2/Article 3). Results indicate that effective treatment involving psychedelics may draw on “common factors” of effective psychotherapies, with synergistic interactions of attachment-related phenomena and change processes theorized to culminate in “corrective experiences.” Fourth, I examine the potential dual role of therapeutic relational support in enabling therapeutic processes with psychedelics by buffering the potentially detrimental effect of life stress on psychedelic experiences and by mitigating the impact of challenging psychedelic experiences (Study 3/Article 4). I conclude with a discussion of future directions for a relational, attachment-informed psychedelic science, as well as its relevant clinical implications. 

Under de senaste åren har det skett ett uppsving för neurobiologisk, psykiatrisk och psykologisk forskning om psykedelika (dvs. 5-HT 2A-receptoragonister), deras effekter på sinnesförnimmelser, humör och tankar, de risker som är förknippade med dem och deras terapeutiska potential. De evidensbaserade förklaringsmodellerna är dock fortfarande i sin linda, och det finns ett behov av lämpliga teoretiska ramverk för att förklara de underliggande processerna och mekanismerna för förändring. Denna avhandling beskriver en relationell psykedelisk vetenskap som inspirerats särskilt av anknytningsteorin, en av de mest bestående och inflytelserika teorierna inom psykologi som ”sträcker sig från de biologiska djupen av vårt varande till dess yttersta andliga räckvidd” (Holmes, 2014, s. 83). Årtionden av forskning stöder anknytningens roll för de många områden som är relevanta för psykedelika, inklusive livsloppsutveckling, självreglering och relaterade kognitiva processer, interpersonella relationer, psykoterapi och neurovetenskap, för att inte tala om de religiösa, andliga eller mystiska upplevelser som ofta kännetecknar psykedelisk fenomenologi. Först skisserar jag hur, inom en bredare kontextuell-erfarenhetsbaserad modell av psykedeliska terapieffekter, anknytningsteori kan hjälpa till att integrera viktiga resultat och begrepp från den psykedeliska litteraturen och generera testbara hypoteser (artikel 1). För det andra presenterar jag resultat från en enkätstudie av psykedeliskt erfarna judiska studiedeltagare om kopplingen mellan anknytningsdimensioner och psykedelisk fenomenologi. Studien fann konsekventa positiva samband mellan minnen av icke-lyhörd omvårdnad i barndomen och psykedelisk fenomenologi (t.ex. mystiska och utmanande upplevelser) (artikel 2). För det tredje rapporterar jag om den första valideringen av ett nytt självrapporteringsinstrument som är utformat för att mäta empiriskt etablerade allmänna förändringsmekanismer för psykoterapi och den typ av upplevelser som katalyserar psykoterapeutisk förändring, varav mycket är relationellt, i samband med psykedelika (artikel 3). Resultaten tyder på att effektiv behandling som involverar psykedelika kan dra nytta av ”gemensamma faktorer” för effektiva psykoterapier, med synergistiska interaktioner av anknytningsrelaterade fenomen och förändringsprocesser som kan kulminera i ”känslomässigt korrigerande erfarenheter”. För det fjärde undersöker jag den potentiellt dubbla roll som terapeutiskt relationsstöd kan fylla för att möjliggöra terapeutiska processer med psykedelika genom att buffra den potentiellt skadliga effekten av livsstress på psykedeliska upplevelser och genom att mildra effekterna av utmanande psykedeliska upplevelser (artikel 4). Jag avslutar med en diskussion om framtida riktningar för en relationell anknytningsgrundad psykedelisk vetenskap och relevanta kliniska konsekvenser.

Classic psychedelics have long been used in religious and healing rituals. A recent wave of scientific research has examined the acute effects of psychedelics, including how experiences with them are often described as spiritual, religious, or mystical. However, research has paid insufficient attention to the role of psychedelic experiences in the context of religious/spiritual development. In two studies, we examine religious and spiritual changes related to psychedelic use. In Study 1, using data from multiple birth cohort studies—the 1958 National Child Development Study and the 1970 British Cohort Study (for both, N > 11,000)—we examined the relationship between lifetime psychedelic use and religious affiliation, including religious changes (i.e., de/conversion or switching) and beliefs. In Study 2, we examined prospective changes in self-identification as religious and spiritual over a 2-month period among people who reported psychedelic use in a representative sample from the United Kingdom and the United States (N = 9,732). In Study 1, religious affiliation in childhood and adulthood were associated with reduced likelihood of psychedelic use. Also, lifetime psychedelic use was associated with greater likelihood of stable nonaffiliation with religion and with religious disaffiliation. lysergic acid diethylamide use predicted switching between religions as well. In Study 2, psychedelic use was not related to changes in religiosity or spirituality. Notably, psychedelics’ associations with religious changes did generally not differ from other illicit substances. We discuss our findings by highlighting the context-dependence of psychedelics and their effects and relating them to secularization-related trends.

This fiction article is about trauma and grief, resilience and the celebration of life. It also addresses the role psychedelics can play in bringing about change in our traumatized society by inspiring us and showing us how to use the present as a possibility for fundamental transformation. It is written in the form of a short story to exemplify how these substances work and underline the critical importance of challenging protocols and conventional ways of thinking, and opening up a space for the unexpected. The story discusses societal trends, either already noticeable or hoped for, in the aftermath of the terror attack on the Nova music festival in Re'im, Israel, on October 7, 2023, where roughly two-third of the partygoers were under the influence of psychedelics. Lilla, our fictitious main protagonist, first describes her experience on that day, at the interface of psychedelics and trauma. This part of the story is influenced by observations from our clinical work with survivors as well as by preliminary insights from our phenomenological study. She then goes on to share her fears, thoughts and visions, initiating a discussion on psychedelics and society. Read through the lens of Walter Benjamin's historical materialism, dialectics between past and present, old and new, we believe that insights from psychedelics can provide a critical view of society while allowing us to envision how this moment can be seized as an opportunity, right now, for creating a break in the continuum of history!

Background: Therapeutic and salutogenic effects of psychedelic drugs have been attributed to psychotherapeutic or psychotherapy-like processes that can unfold during the acute psychedelic experience and beyond. Currently, there are no psychometric instruments available to comprehensively assess psychotherapeutic processes (as conceptualized by empirical psychotherapy research) in the context of psychedelic experiences.

Aims: We report the initial validation of the General Change Mechanisms Questionnaire (GCMQ), a self-report instrument designed to measure five empirically established general change mechanisms (GCMs) of psychotherapy—(1) resource activation, (2) therapeutic relationship, (3) problem actuation, (4) clarification, and (5) mastery—in the context of psychedelic experiences.

Methods: An online survey in a sample of 1153 English-speaking and 714 German-speaking psychedelic users was conducted to evaluate simultaneously developed English- and German-language versions of the GCMQ.

Results: The theory-based factor structure was confirmed. The five GCMQ scales showed good internal consistency. Evidence for convergent validity with external measures was obtained. Significant associations with different settings and with therapeutic, hedonic, and escapist use motives confirmed the hypothesized context dependence of GCM-related psychedelic experiences. Indicating potential therapeutic effects, the association between cumulative stressful life events and well-being was significantly moderated by resource activation, clarification, and mastery. Factor mixture modeling revealed five distinct profiles of GCM-related psychedelic experiences.

Conclusion: Initial testing indicates that the GCMQ is a valid and reliable instrument that can be used in future clinical and nonclinical psychedelic research. The five identified profiles of GCM-related experiences may be relevant to clinical uses of psychedelics and psychedelic harm reduction.

Background and aims: Emerging research indicates that psychedelics may have therapeutic potential by fostering meaningful experiences that act as in fl ection points in people ' s narratives of personal development. However, psychedelic research has largely failed to address pertinent developmental considerations. We investigated whether attachment -related variables were associated with psychedelic experiences and whether psychedelic experiences moderated expected links between perceived attachment history and current adult attachment orientations. Methods: We administered an online survey to an international Jewish sample ( N = 185) with psychedelic experience. The survey included measures about recollection of attachment interactions with parents (perceived attachment history), adult attachment orientations (anxiety, avoidance), and psychedelic phenomenology (mystical experiences, challenging experiences, emotional breakthrough, ego dissolution, sensed presence) associated with respondents ' most memorable psychedelic experiences. Results: Perceptions of an insecure attachment history were positively linked to all measures of psychedelic phenomenology ( r ' s = 0.19 - 32, p ' s mostly < 0.01). In contrast, adult attachment orientations were unrelated to psychedelic phenomenology. Also, psychedelic phenomenology mostly did not moderate the links observed between perceptions of an insecure attachment history and adult attachment orientations. Conclusions: Our findings suggest that perceptions of early attachment experiences may be relevant to psychedelic phenomenology. However, subjective experiences associated with naturalistic psychedelic use do not typically attenuate links between a perceived insecure attachment history and attachment insecurity at present.

Learning ObjectiveAfter participating in this CME activity, the psychiatrist should be better able to:center dot Explain current understanding of how religiosity, spirituality, and meaning-making (R/S/M) affect patients with psychiatric diagnoses.Learning ObjectiveAfter participating in this CME activity, the psychiatrist should be better able to:center dot Explain current understanding of how religiosity, spirituality, and meaning-making (R/S/M) affect patients with psychiatric diagnoses.IntroductionR/S/M generally protect against suicidality and suicide. Thus far, reviews on the topic have largely been descriptive, and there are no meta-analyses focused on psychiatric patients. This study systematically evaluates all empirical evidence on R/S/M's potential influences on suicidality for psychiatric patients and recent suicide attempters.MethodsA systematic PROSPERO preregistered search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was performed in MEDLINE and PsycInfo. Quantitative studies until 31 December 2022 on R/S/M and suicidality in psychiatric populations and recent suicide attempters were selected; psychological autopsy studies were excluded.ResultsThe search identified 4,374 studies for screening. This resulted in 108 eligible studies for the systematic review and 75 studies for the meta-analysis, including 231 effect sizes (ES) and 17,561 subjects. Research focused mainly on the emotional, moral, and ritual aspects of R/S/M. Most research was cross-sectional; repeated R/S/M assessments were rarely reported. A combined significant and negative ES (Fisher Z = -0.13, p = .006, equivalent to Cohen's d = -0.26) was found for all good- and fair-quality studies.ConclusionOverall, R/S/M was associated with lowering suicidality. Maladaptive-distressing dimensions of R/S/M correlated with higher rates of suicidality (e.g., religious struggles). The explanatory value was limited by the predominantly cross-sectional nature of ESs.Registration and fundingPROSPERO registration 2023 CRD42023398692; there was no funding involved.

In this chapter, the authors synthesize the relational developmental perspective of attachment theory with a neuroscientific model: the RElaxed Beliefs Under pSychedelics (REBUS). This synthesis, the authors argue, can serve as an organizing framework for psychedelic science. Attachment theory posits that people develop internal working models (IWMs) of relational experiences with close others. These IWMs function as predictive models (“priors”) that, for better and for worse, contribute to people’s social and emotional worlds and organize how they navigate them. Effective psychedelic interventions may work by inducing a hyper-plastic neural state that, supported by corrective relational experiences (with therapists, God, or others), facilitates rapid and deep learning. This can include revision of IWMs toward greater security and other psychological transformations. Based on the attachment-REBUS synthesis, the authors describe three main proposals to guide future research. First, individual differences in attachment security predict the phenomenology of psychedelic experiences and processes related to their integration. Second, increasing attachment security may be a clinical outcome of efficacious psychedelic therapy. Third, among other process-level mechanisms, the clinical utility of psychedelic treatment involves attachment-related dynamics (e.g., connectedness to others and God, alleviation of attachment-related worries and defenses). Finally, the authors provide words of caution and future directions.