A recent study in the Journal of Psychoactive Drugs has shed light on a less discussed aspect of psychedelic experiences: the feelings of shame and guilt that can arise during these journeys. Researchers found that experiencing shame or guilt while using psilocybin, the psychoactive compound in magic mushrooms, is surprisingly common, affecting about two out of every three users. However, the study also offered a positive perspective, indicating that how well individuals process these difficult emotions, rather than the intensity of the feelings themselves, is linked to their wellbeing in the weeks following the experience.
The growing interest in psychedelic substances for potential therapeutic uses has largely focused on the positive outcomes and transformative experiences they can induce. However, researchers recognized that a complete understanding of psychedelics requires acknowledging the full spectrum of experiences, including the challenging ones. Historically, negative experiences, sometimes casually referred to as “bad trips,” have been somewhat sidelined in both public conversation and scientific exploration.
Scientists sought to address this gap in knowledge by specifically examining the occurrence of shame and guilt during psilocybin experiences. They were interested in understanding how often these feelings arise, what factors might predict them, and how these emotions relate to a person’s overall wellbeing after using psilocybin. The researchers hypothesized that while psychedelics are sometimes thought to reduce self-focused thinking, they might also, in some cases, bring feelings of shame and guilt to the forefront. This could be due to the profound self-reflection and emotional intensity that these substances can trigger.
“This work came from me witnessing firsthand the complex ways that psychedelics could affect people — who were sometimes challenged in ways they couldn’t even find language to describe,” said study author David Mathai, the medical director of Sattva Medicine and a clinical assistant professor at Baylor College of Medicine.
“Those experiences reminded me of clients that I have seen working as a mental health clinician in traditional settings who struggled with feelings of shame and guilt. I began to realize this was an underexplored but critically important area when it came to understanding psychedelic use, as well.”
The researchers designed a study that tracked individuals planning to use psilocybin in their everyday lives, outside of a controlled clinical setting. They recruited 679 adults who were proficient in English and at least 18 years old through online advertisements and word of mouth. These participants were asked to complete a series of online questionnaires at different points in time surrounding their planned psilocybin experience. The study was conducted over a period of two years, from July 2020 to July 2022.
The questionnaires were administered at six different time points: two weeks before, one day before, one to three days after, two to four weeks after, and two to three months after their psilocybin use. The initial survey, completed two weeks beforehand, gathered demographic information and used established psychological scales to measure baseline levels of trait shame (a person’s general tendency to feel shame), anxiety (both current and general), depression, past adverse childhood experiences, and cognitive flexibility (the ability to adapt thinking and behavior). Just before their psilocybin experience, participants were asked if they would have a guide or sitter present and completed a questionnaire assessing their level of psychological surrender or anticipation.
In the days immediately following their psilocybin use, participants were asked to rate whether they considered the experience to be ultimately positive or negative. They also completed questionnaires measuring the intensity of any mystical-type experiences and challenging experiences they had.
Crucially for this study, they also filled out a questionnaire designed to assess feelings of state shame and guilt – that is, shame and guilt experienced specifically during the psilocybin session. This questionnaire was slightly modified to directly ask about these feelings in the context of their psychedelic experience. For those who reported experiencing any shame or guilt, additional questions were asked about how long these feelings lasted, how difficult they were, and whether they felt they were able to constructively process these emotions during the session.
Two to four weeks after their psilocybin use, participants were again asked to complete the trait shame questionnaire and to rate any lasting changes in their personal wellbeing or life satisfaction resulting from the psilocybin experience. Finally, two to three months after their psilocybin use, they completed the trait shame questionnaire one last time.
Mathai and his colleagues found that feelings of shame or guilt during psilocybin use were indeed common. Almost 70% of participants reported experiencing either shame or guilt at some point during their session. Specifically, about 56% reported shame, and approximately 52% reported guilt. For a small percentage, about 12%, these feelings were reported at the highest possible intensity. The duration of these feelings varied, but for most, they lasted between 10 minutes and an hour.
Interestingly, the only factor that consistently predicted experiencing shame or guilt was age. Younger participants were more likely to report higher levels of both shame and guilt during their psilocybin experience. Other factors, including pre-existing levels of trait shame, anxiety, depression, or past adverse childhood experiences, did not reliably predict acute shame or guilt during the psychedelic session.
Perhaps the most significant finding was the link between processing shame and guilt and later wellbeing. The study found that the degree to which participants felt they could constructively work through feelings of shame or guilt during the psilocybin experience was a significant predictor of their wellbeing two to four weeks later. In fact, individuals who reported being very capable of processing these emotions during their session actually reported higher levels of wellbeing and mystical experience compared to those who did not experience shame or guilt at all. This suggests that navigating challenging emotions during a psychedelic experience, and finding a way to process them, may be connected to positive outcomes.
“It was surprising to see that individuals who were most able to work through feelings of shame or guilt during psilocybin use had the highest mystical experience and wellbeing ratings, even compared to individuals who did not experience those feelings whatsoever,” Mathai told PsyPost. “It may be that a certain degree of contact with psychologically challenging material during psychedelic use allows for greater overall benefit.”
In terms of longer-term effects, the study found that, on average, psilocybin use was associated with a small but statistically significant decrease in trait shame that was maintained for at least two to three months after the experience. However, it is important to note that this was an average trend. While most participants showed a decrease in trait shame, a notable minority, about 30%, actually experienced an increase in their general level of shame. This highlights the variable nature of psychedelic experiences and their potential impact on individuals.
“There are three main takeaways based on our study aims,” Mathai summarized. “1) Acute feelings of shame and guilt may occur more commonly than people expect during psilocybin use and are very difficult to predict; 2) The ability to constructively work through shame and guilt when they arise seems to predict well being for individuals, rather than the magnitude of those feelings; 3) Psilocybin was shown to decrease trait shame on average but increased shame in some individuals, suggesting the importance of appropriate psychological support for psychedelic use.”
But the study, like all research, includes some caveats.
“Shame is a difficult construct to research, and different ways of measuring it may lead to different outcomes,” Mathai noted. “Unfortunately, we were unable to characterize patients’ specific experiences of shame and what it looked like to work through these feelings.”
Future research could build upon these findings by examining shame and guilt in more controlled clinical trials of psychedelic-assisted therapy.Further research could also explore whether different psychedelic substances elicit different types of challenging emotions and investigate the role of cultural background and diversity in these experiences. Understanding how to best support individuals in processing difficult emotions like shame and guilt during psychedelic experiences could be essential for maximizing the potential benefits and minimizing potential harms associated with these powerful substances.
“An important next step would be to use mixed-methods and qualitative analysis to better characterize shame-related experiences with psilocybin,” Mathai explained. “It would also be valuable to replicate this research in more carefully controlled clinical trial settings.”
“Based on our findings and other emerging research, the activation of challenging emotions and memories with psychedelics could pose a unique and context-dependent learning condition for both therapeutic and detrimental forms of reconsolidation. This is an important consideration that deserves further study as we think about optimal safety and support for psychedelic use. However, it’s also worth pointing out that these types of experiences and their potential outcomes are not likely to be detected by the questionnaires routinely used in psychedelic drug development trials.”
The study, “Shame, Guilt and Psychedelic Experience: Results from a Prospective, Longitudinal Survey of Real-World Psilocybin Use,” was authored by David S. Mathai, Daniel E. Roberts, Sandeep M. Nayak, Nathan D. Sepeda, Amy Lehrner, Matthew W. Johnson, Matthew X. Lowe, Heather Jackson, and Albert Garcia-Romeu.
