Limited prognostic value of early maladaptive schemas for acute psychedelic experience and symptom improvement
Albert Buchard, Federico Seragnoli, Michel Sabé, Mickael Eskinazi, Tatiana Aboulafia, Leonice Furtado, Jean-François Briefer, Eckhard Roediger, Louise Penzenstadler, Daniele Zullino, Gabriel Thorens
Research Square December 1, 2025 preprint DOI: 10.21203/rs.3.rs-8214817/v1 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort with longitudinal follow-up |
|---|---|
| Sample size | 192 |
| Population | Adults seeking psychedelic-assisted psychotherapy |
| Intervention | LSD-assisted therapy |
| Topics | Anxiety Psilocybin |
| Keywords | Schema genetic algorithms Depression economics Depressive symptoms Young adult Cognitive therapy Clinical psychology Psychotherapist |
| Key findings | Baseline schema burden was linked to cognitive-depressive symptoms but did not predict the quality of the acute psychedelic experience or moderate overall symptom improvement. |
Abstract
Abstract Early maladaptive schemas (EMS) are highly prevalent in patients seeking psychedelic-assisted psychotherapy and correlate strongly with baseline depression and anxiety. This study characterized EMS in 192 adults and longitudinally followed 74 patients receiving psilocybin- or LSD-assisted therapy. We found that baseline schema burden, particularly related to failure and defectiveness, was linked to cognitive-depressive symptoms but did not predict the quality of the acute psychedelic experience or moderate overall symptom improvement. While patients experienced significant reductions in both depression and anxiety symptoms with each session, these changes were dependent on initial symptom severity, not their schema profile. Treatment effects were comparable between psilocybin and LSD. These findings suggest the clinical utility of EMS lies not in patient selection or outcome prediction, but in identifying key cognitive-emotional themes, such as core beliefs about failure, to be targeted during psychotherapeutic integration.
Comparable studies
Other observational and cohort studies on psilocybin for anxiety, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Dynamic coupling of whole-brain neuronal and neurotransmitter systems Healthy humans | 2020 | Observational study | |
| Psychedelics not linked to mental health problems or suicidal behavior: A population study Randomly selected United States adults | 2015 | Observational cohort | n = 135,095 |
| Lasting increases in trait mindfulness after psilocybin correlate positively with the mystical-type experience in healthy individuals Healthy individuals | 2022 | Observational cohort | n = 39 |
| Decreases in State and Trait Anxiety Post-psilocybin: A Naturalistic, Observational Study Among Retreat Attendees Self-reported healthy volunteers attending psilocybin ceremonies | 2022 | Observational cohort | n = 52 |
| Public Interest in Psilocybin and Psychedelic Therapy in the Context of the COVID-19 Pandemic: Google Trends Analysis Google search queries for psilocybin, psychedelic therapy, cannabis, cocaine,... | 2023 | Observational trend analysis |