When the therapist hallucinates: AI, psychedelics, and the risks of unsupervised digital mental health care.
Michael R MacIntyre
Digital health 2026 DOI: 10.1177/20552076261429341 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Altered states of consciousness |
| Keywords | Artificial intelligence Digital psychotherapy Generative ai chatbots Psychedelics Therapeutic boundary violations Unsupervised digital therapy |
| Key findings | The convergence of psychedelic therapeutics and generative AI creates an unregulated frontier in mental health care, disrupting traditional safeguards and posing risks of inadequate monitoring, unsafe crisis response, and blurred therapeutic boundaries with AI chatbots. |
Abstract
As direct-to-consumer ketamine prescriptions obtained via telehealth in the United States, along with psychedelic support, proliferate, some patients are turning to general-purpose chatbots as de facto "therapists" in unmonitored settings. These AI-guided altered-state sessions carry significant ethical, clinical, and legal risks. Current AI tools are not licensed professionals, lack consistent reliability, and cannot provide emergency support. Combined with mind-altering drugs, their unpredictability can precipitate harm rather than relieve distress. The convergence of these innovations (psychedelic therapeutics and generative AI) creates an unregulated frontier in mental health care. Traditional safeguards in psychedelic therapy rely on "set and setting," a supportive mindset and environment guided by trained humans. When that role is replaced by AI, both are fundamentally disrupted. Clinicians should recognize that patients are already experimenting with AI in this way, often without disclosure or oversight. When screening for psychedelic use or discussing at-home treatment, providers should anticipate the risks of inadequate monitoring, unsafe crisis response, and blurred therapeutic boundaries with AI chatbots. Even if clinicians do not endorse or recommend AI tools, they may bear responsibility once patient use is known. Providers should therefore counsel patients about these dangers, document safety discussions, and routinely ask about AI use as part of risk assessment.
Comparable studies
Other narrative reviews on altered states of consciousness, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| The Subjective Effects of Psychedelics Are Necessary for Their Enduring Therapeutic Effects. | 2020 | Review | |
| Psychobiology of Altered States of Consciousness. | 2005 | Review | |
| Intrinsic Brain Activity in Altered States of Consciousness | 2008 | Review | |
| Dynamic functional connectivity and brain metastability during altered states of consciousness | 2017 | Review | |
| A default mode of brain function in altered states of consciousness. | 2013 | Review |
Citations in the library
Cites 6
- The Therapeutic Potential of Psychedelic Drugs: Past, Present, and Future. Neuropsychopharmacology April 26, 2017
- Constructing drug effects: A history of set and setting Drug Science, Policy and Law 2017
- Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. Journal of Contextual Behavioral Science 2020
- Reconsidering evidence for psychedelic-induced psychosis: an overview of reviews, a systematic review, and meta-analysis of human studies. Molecular Psychiatry March 1, 2025
- Adverse psychiatric effects of psychedelic drugs: a systematic review of case reports. Psychological Medicine November 20, 2024
and 1 more in the library