Limited prognostic value of early maladaptive schemas for acute psychedelic experience and symptom improvement
Albert Buchard, Federico Seragnoli, Michel Sabé, Mickael Eskinazi, Tatiana Aboulafia, Leonice Furtado, Jean-François Briefer, Eckhard Roediger, Louise Penzenstadler, Daniele Zullino, Gabriel Thorens
Research Square December 1, 2025 DOI: 10.21203/rs.3.rs-8214817/v1 via OpenAlex
Summary
AI-generated from the abstractEarly maladaptive schemas (EMS) are common in people seeking psychedelic-assisted psychotherapy and are strongly linked to baseline depression and anxiety. In 192 adults assessed for EMS and 74 patients followed through psilocybin- or LSD-assisted therapy, baseline schema burden—especially around failure and defectiveness—was tied to cognitive-depressive symptoms. However, schema burden did not predict the quality of the acute psychedelic experience or moderate overall symptom improvement. Patients experienced significant reductions in depression and anxiety with each session, but these changes depended on initial symptom severity, not their schema profile. Treatment effects were similar for psilocybin and LSD. The findings indicate that EMS are useful for identifying cognitive-emotional themes, such as core beliefs about failure, to address during psychotherapeutic integration, rather than for patient selection or outcome prediction.
Study at a glance
| Characteristics | Observational cohort with longitudinal follow-up Peer reviewed |
|---|---|
| Sample size | 192 |
| Population | Adults seeking psychedelic-assisted psychotherapy |
| Intervention | LSD-assisted therapy |
| Topics | Anxiety Psilocybin |
| Keywords | Schema genetic algorithms Depression economics Depressive symptoms |
| Key finding | Baseline schema burden was linked to cognitive-depressive symptoms but did not predict the quality of the acute psychedelic experience or moderate overall symptom improvement. |
Abstract
Abstract Early maladaptive schemas (EMS) are highly prevalent in patients seeking psychedelic-assisted psychotherapy and correlate strongly with baseline depression and anxiety. This study characterized EMS in 192 adults and longitudinally followed 74 patients receiving psilocybin- or LSD-assisted therapy. We found that baseline schema burden, particularly related to failure and defectiveness, was linked to cognitive-depressive symptoms but did not predict the quality of the acute psychedelic experience or moderate overall symptom improvement. While patients experienced significant reductions in both depression and anxiety symptoms with each session, these changes were dependent on initial symptom severity, not their schema profile. Treatment effects were comparable between psilocybin and LSD. These findings suggest the clinical utility of EMS lies not in patient selection or outcome prediction, but in identifying key cognitive-emotional themes, such as core beliefs about failure, to be targeted during psychotherapeutic integration.