Expectations and Motivations for Participation in Clinical Trials Utilizing Psychedelics for Treatment-Resistant Depression: A Qualitative Study.

Abstract

Expectations strongly shape participant experiences in clinical trials, contributing to placebo effects that complicate interpretation of outcomes. While quantitative tools exist to measure expectations, their subjective and multidimensional nature, especially for individuals with treatment-resistant depression (TRD), remains underexplored. This study aimed to explore the motivations and expectations of participants in psychedelic clinical trials. Seventeen semi-structured interviews were conducted with individuals prior to screening for two TRD clinical trials involving 5-MeO-DMT or psilocybin at a German university hospital. Two matched follow-up interviews were also completed after trial participation. Data were analyzed thematically to identify overarching themes and subthemes. Two main themes emerged: motivations and expectations, each with four subthemes. Motivations included hope, demoralization, prior psychedelic experience, and social motivation. Expectations involved anticipated symptom reduction, perceived mechanisms of change during the psychedelic experience, the role of setting, and retrospective expectations. Many participants viewed trial participation as a last resort due to chronic illness and previous treatment failures. In two cases, retrospective accounts suggested that initially cautious expectations were reinterpreted as stronger after participation. Expectations in psychedelic trials are complex and may evolve over time. These findings highlight the need to systematically address expectancy in trial design, informed consent, and interpretation of clinical outcomes, particularly in treatment-resistant populations.