Provider perspectives on challenges in treatment during psychedelic therapy.
David A Bender, Sandeep M Nayak, Joshua S Siegel, David J Hellerstein, Baris C Ercal, Eric J Lenze
Psychopharmacology October 27, 2025 Peer reviewed DOI: 10.1007/s00213-025-06907-7 via PubMed
Summary
Providers administering psychedelic treatments like psilocybin and LSD encounter various challenges, including intense dysphoria (42% of respondents), disappointment with the intervention (25%), and re-engaging with traumatic experiences (17%). Out of 40 surveyed providers, 70% believe that individuals with PTSD or prior trauma need extra psychological support, recommending an average of 9.8 hours of support for those with serious mental illness undergoing psychedelic therapy for the first time. This highlights the need for improved psychological support protocols.
Study at a glance
| Design | qualitative study |
|---|---|
| Sample size | 40 |
| Population | psychedelic treatment providers from various educational backgrounds and countries |
| Key finding | Psychedelic providers report significant challenges during treatment, including intense dysphoria and the need for additional support for individuals with PTSD. |
Abstract
Psychedelic treatments are considered to involve unique treatment challenges relative to other psychiatric interventions, though these are typically not explored in detail within clinical trial reports. To determine the types of challenges that providers encounter while administering psychedelic drugs in research settings and to assess provider opinions on safeguards that may be pursued to improve outcomes. An anonymous survey was distributed via email to contacts listed on clinicaltrials.gov. for clinical trials of psilocybin and LSD, personal contacts of authors, and through snowball sampling. Free response items were reviewed using qualitative thematic analysis. 40 qualified respondents completed the survey. Respondents came from varying educational backgrounds (42.5% M.D./D.O., 57.5% other degrees) and practiced in at least 4 countries, 11 U.S. states, and 16 institutions. Respondents had overseen a total of 1656 psychedelic sessions (average = 41.4). Thematic analysis of free response descriptions pertaining to challenges in psychedelic therapy produced 11 distinct themes, with the most commonly reported challenges being intense dysphoria during treatment sessions (42% of respondents), disappointment with the intervention (25% of respondents), and re-engaging with traumatic experience (17% of respondents). 70% of respondents felt that individuals with PTSD or prior trauma warrant additional psychological support. Respondents recommended 9.8 h of total psychological support for individuals with serious mental illness receiving psychedelic treatment for the first time. Psychedelic providers encounter a variety of challenges over the course of psychedelic treatments. These potentialities should be considered during the development of psychological support protocols for clinical trials and any future clinical guidelines.