New research featured in the journal Psychoactives on over 1,600 ayahuasca users reveals a complex and highly individual integration process that calls into question the dominance of one-on-one psychotherapy. Instead, the study recommends incorporating communal settings and practices, hinting at a broader understanding of healing and integrative experiences that transcends the traditional Western therapeutic model.
The study focused on users of the Amazonian plant brew ayahuasca and offered a compelling look into the multidimensional process of incorporating these transformative experiences into daily life.
The research arises out of a collaborative effort from an international team of researchers led by Tessa Cowley-Court from the University of Melbourne in Australia. The authors write:
“These findings suggest that integrating ayahuasca experiences can be challenging and take considerable time, though working through integration challenges may facilitate positive growth. Findings also challenge the role of individual psychotherapy as the primary integration tool in Western psychedelic therapy, suggesting that communal and somatic elements may also be useful.”
Ayahuasca, a hallucinogenic brew with similarities to psilocybin and LSD, has a rich history of medicinal use spanning thousands of years. It recently gained traction among Western practitioners for treating depression, anxiety, substance misuse, and eating disorders.
The process of ingesting ayahuasca can unleash a torrent of experiences that can be challenging, as can the following weeks and months after ingestion. In addition, the subsequent integration of these experiences — the translation of insights into personal growth — can also be a significant challenge.
The current work aimed to explore how experiences of taking ayahuasca were integrated in the weeks and months following ingestion. The authors used data from the Global Ayahuasca Project to accomplish this goal. This project collected data through anonymous online surveys in six languages (English, Portuguese, Spanish, German, Italian, and Czech) from 2017 to 2019.
To be included in the current study, participants had to be at least 18 years of age and had to have participated in an ayahuasca ceremony at least once. The authors included 1630 responses to the open-ended prompt, “Please add anything you would like about your integration experiences below.”
Three major themes emerged from the data: an appraisal of the integration experience, beneficial integration tools, and integration challenges.
About 15% of participants (249 individuals) wrote about their appraisal of the integration experience, with 84 finding the integration process easy and reporting no problems, 117 describing integration as challenging, and 48 reporting that the integration process was ongoing for them.
Among participants who characterized integration as challenging, approximately 33% reported a positive overall experience. A small percentage mentioned negative or unresolved integration experiences. Many respondents expressed ambivalence about whether the integration process was ultimately positive or negative.
The respondents cited several tools that facilitated their integration process. These ranged from “ongoing personal practices” like yoga and meditation (389) to seeking support from community leaders and professionals (143). Advice from professionals and leaders was generally regarded as secondary to participants’ personal practices.
Many stressed the importance of connecting with others (378). However, some participants believed that the ayahuasca experience was too personal to be fully understood by someone else, even those who also participated in the ceremony. However, they also acknowledged the importance of being able to speak freely about their experience without fear of judgment.
Participants also wrote about creating space for processing their experiences (87). This commonly involved taking time off from work and other responsibilities. Eighty-six respondents described the importance of having an interpretive framework (such as psychology, spirituality, or religion) to help make meaning of their ayahuasca experience. Twenty-six people wrote about putting insights from their ayahuasca experience into practice by making positive life changes (for example, being kinder to themselves and quitting bad habits). Fifty-six participants described other less common tools, such as using other substances (like LSD), acupuncture, massage, and abstaining from things like meat, alcohol, sex, and media.
Despite these helpful tools, the integration process was not without its difficulties. One hundred eleven reported feeling that others did not understand their experience. For some, this was a general sense of not being understood by society or culture. For others, it was not being understood by people close to them. Sixty-three people reported problems with going back to their old life with the insights gained from their ayahuasca experience. Forty-four described experiencing a lack of support resources for those trying to integrate ayahuasca experiences. Twenty-eight people endorsed having challenging cognitive and sensory experiences.
The authors drew several noteworthy conclusions from this data. They highlighted the unique and individual nature of integration, its extended timeline, and the potential inadequacy of individual psychotherapy. Instead, practices like yoga, prayer, and community engagement emerged as central to participants’ integration experiences.
These findings not only deepen our understanding of the psychedelic integration process but also challenge the current Western therapeutic model. The data suggests that while one-on-one psychotherapy can be beneficial, it might not be sufficient or even the most effective method for everyone.
The study’s authors argue for an expanded definition of psychedelic integration, which includes facing and working through these challenges and embracing life changes post-experience.
The authors endorse several limitations to the current study. The design used in the current work made it possible for a significant time to have passed between a participant’s experience with ayahuasca/integration and giving their response to the survey question. Life events other than their participation in an ayahuasca ceremony could therefore influence how they remembered their integration process. Participants may have reported difficult experiences in greater detail.
They conclude:
“Our findings suggest participants experience both easeful and challenging sub-processes during what can be a long integration process. We contribute novel findings regarding the challenges faced in ayahuasca integration and the supports that help facilitate the integration process.”
“There was a relatively consistent sentiment that working through integration difficulties can facilitate positive growth—helping to explain prior quantitative findings that participants see post-ayahuasca’ adverse effects’ as part of a process of growth.”
Parallel research on other psychedelics like LSD and psilocybin and their potential therapeutic roles in treating addiction suggests a growing trend. Some psychiatrists are being trained to use MDMA to assist in psychotherapy.
Psychedelic research, however, is not without its controversies. Critics question the validity of such studies and caution against interpreting traditional practices, like ayahuasca ceremonies, solely through a Western biomedical perspective. As some studies have found that ayahuasca does not improve mental health any more than a placebo, it may be that the ceremonial context rather than the substance itself is responsible for the reported growth and improvement in mental health.
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Cowley-Court, T.; Chenhall, R.; Sarris, J.; Bouso, J.C.; Tófoli, L.F.; Opaleye, E.S.; Schubert, V.; Perkins, D. Life after Ayahuasca: A Qualitative Analysis of the Psychedelic Integration Experiences of 1630 Ayahuasca Drinkers from a Global Survey. Psychoactives 2023, 2, 201–221. https://doi.org/10.3390/ psychoactives2020014 (Link)
Great review, I agree that the communal aspect has to come first in order to integrate it’s effects otherwise it’s another selfish endeavor. Anything in group setting needs to be digested together in mutual activities otherwise where is the benefit? Are we not healing each other and learning to live along when we are healing ourselves?
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Thanks for covering this interesting and well made study on psychedelics and the process of integrating these experiences. I think it’s exemplary that the researchers asked people openly about what they found most difficult or beneficial. I have myself made extremely supportive experiences in different groups to find help with distress and suffering but also to share positive things, learnings and so on.
I mention that because it sounds like many participants thought that they would have benefitted from a peer group but couldn’t find any that was safe and supportve to their needs. Here it’s wonderful that there are so many offers online. For example the Creating Our Mental Health group by NY’s East Side Institute or the Copeland Center’s groups on the Wellness Recovery Action Plan are such spaces.
I am not surprised that the finding says that people think that they benefit the most from their personal practices and intentional life changes and talk therapy comes later and is just one of many options. Because this is not just my experience of how to fully recover from actually once severe and chronic mental and emotional suffering. It’s also what overviews of the whole body of research on recovering from mental health problems suggests.
Bessel van der Kolk, one of the leading psychiatrists into what psychiatry calls complex psychological trauma has it in a review of the existing research in The Body Keeps the Score that it is those who do a self-directed recovery journey and commit themselves to a body-centered approach like yoga as their foundational recovery and wellness tool who have the best results. Whereas psychotherapy actually can’t be proved to have any statistically significant positive results for those who suffer most severly mentally. And we all know that psychiatric medication rather helps to chronicify the problems that one is looking for help for. Also David J. Morris in his excellent half journalistic, half autobiographic discussion The Evil Hours. A Biography of Post-Traumatic Stress-Disorder comes to the same finding. That self-direction, yoga are the foundation of those who actually find a way to integrate harmful experiences of violence and overwhelming distress.
I wish that you’d cover more of this kind of literature. I found it really helpful over the past years to find it discussed in your research news that the standard psychiatric offers are of very limited use and often even harmful. But now I think that MIA has made that point and it is more interesting and beneficial to have more studies covered like this one here on psychedelics that can suggest people different ways where they can turn to find support that is worth the term.
As I see it clinical psychology and psychiatry can’t be reformed. It is upon us to build alternative offers and support structures for our peers and fellow human beings outside the field. And for that we need to hear the most about everything that actually works for people in their recovery and learning to lead a satisfying life.
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