Shame, Guilt and Psychedelic Experience: Results from a Prospective, Longitudinal Survey of Real-World Psilocybin Use
Amy Lehrner, Heather Jackson, David S. Mathai, Daniel E. Roberts, Sandeep M. Nayak, Nathan D. Sepeda, Matthew W. Johnson, Matthew X. Lowe, Albert Garcia‐romeu
Journal of Psychoactive Drugs February 7, 2025 DOI: 10.1080/02791072.2025.2461997 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Prospective longitudinal study Peer reviewed |
|---|---|
| Sample size | 679 |
| Population | Adults planning to use psilocybin in naturalistic settings |
| Intervention | psilocybin |
| Duration | 2-4 week follow-up for well-being; 2-3 month follow-up for trait shame |
| Topics | Psilocybin |
| Keywords | Shame Hallucinogen Clinical psychology |
| Citations | 11 |
| Key findings | Acute shame or guilt during psilocybin experiences was common (68.2%), and the ability to work through these feelings predicted later wellbeing, while psilocybin on average produced a small decrease in trait shame maintained 2-3 months after use. |
Abstract
The classic psychedelic psilocybin has attracted special interest across clinical and non-clinical settings as a potential tool for mental health. Despite increasing attention to challenging psychedelic experiences, few studies have explored the relevance of shame-related processes with psychedelic use. This prospective, longitudinal study involved sequential, automated, web-based surveys that collected data from 679 adults planning to use psilocybin in naturalistic settings at timepoints before and after psilocybin use. State and trait shame and feelings of guilt were collected using validated measures and assessed alongside other measurements of psychological health. Acute feelings of shame or guilt during psilocybin experiences were commonly reported (68.2% of users) and difficult to predict. Ratings of participant ability to constructively work through these feelings predicted wellbeing 2-4 weeks after psilocybin use. Psilocybin on average produced a small but significant decrease in trait shame that was maintained 2-3 months after use (Cohen's dz = 0.37). Trait shame increased in a notable minority of participants (29.8%). The activation of self-conscious emotions with psychedelics deserves further attention as a challenging experience subcategory that may be relevant to psychological outcomes. Such experiences could pose a unique and context-dependent learning condition for both therapeutic and detrimental forms of shame-related memory reconsolidation.
Comparable studies
Other observational and cohort studies on psilocybin, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms. Patients with treatment-resistant depression | 2017 | Observational cohort | n = 19 |
| Psychedelic effects of psilocybin correlate with serotonin 2A receptor occupancy and plasma psilocin levels Healthy volunteers | 2019 | Observational cohort | n = 8 |
| Increased spontaneous MEG signal diversity for psychoactive doses of ketamine, LSD and psilocybin Humans | 2017 | Observational study | |
| Classic psychedelic use is associated with reduced psychological distress and suicidality in the United States adult population. USA adult respondents from the National Survey on Drug Use and Health (2008-2012) | 2015 | Observational cohort | n = 190,000 |
| Prediction of Psilocybin Response in Healthy Volunteers Healthy volunteers | 2012 | Observational cohort | n = 409 |
Citations in the library
Cited by 11
- Recalled childhood trauma and post-psychedelic trajectories of change in a mixed-methods study Scientific Reports November 27, 2025
- Acute subjective effects of psychedelics in naturalistic group settings prospectively predict longitudinal improvements in trauma symptoms, trait shame, and connectedness among adults with childhood maltreatment histories. Progress in Neuro-Psychopharmacology and Biological Psychiatry April 2, 2025
- The emotional architecture of the psychedelic brain Trends in Cognitive Sciences August 18, 2025
- Difficulties following naturalistic psychedelic use and associations with adverse childhood experiences. International Journal of Drug Policy December 13, 2025
- The experience of recalled trauma during psychedelic experiences and perceived links to subsequent extended difficulties: A mixed-methods study Research Square August 21, 2025
and 6 more in the library
Cites 45
- Quality of Acute Psychedelic Experience Predicts Therapeutic Efficacy of Psilocybin for Treatment-Resistant Depression Frontiers in Pharmacology January 17, 2018
- Validation of the revised Mystical Experience Questionnaire in experimental sessions with psilocybin Journal of Psychopharmacology October 6, 2015
- Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences Journal of Psychopharmacology August 31, 2016
- LSD-assisted psychotherapy for anxiety associated with a life-threatening disease: A qualitative study of acute and sustained subjective effects Journal of Psychopharmacology November 11, 2014
- Predicting Responses to Psychedelics: A Prospective Study Frontiers in Pharmacology November 2, 2018
and 40 more in the library