Variability in outcomes and subjective effects of psychedelic use in psychotic populations: Case-based evidence from naturalistic settings
Joseph la Torre, Jade Gallo, Matteo Buonaroti, Monnica Williams, Michel Sabé, Nathan Sackett
Psychedelics May 14, 2026 DOI: 10.1016/j.psyche.2026.100021 via OpenAlex
Summary
AI-generated from the abstractPeople with histories of psychotic symptoms who used psychedelics in naturalistic settings reported both benefits and harms. Benefits included personal growth, insight, increased spirituality, and symptom reappraisal. Challenging experiences and adverse effects also occurred, especially when set and setting were unfavorable. The findings question the categorical exclusion of this population from psychedelic research and therapy, and call for more holistic, ethically guided study of psychedelic-assisted therapy for this underserved group.
Study at a glance
| Characteristics | Case series Qualitative Case report Peer reviewed |
|---|---|
| Population | Individuals with histories of psychotic symptoms and experiences |
| Keywords | Qualitative research Categorical variable Naturalism Naturalistic observation Suggestibility |
| Key finding | Both benefits and adverse effects were reported by individuals with psychotic symptoms who used psychedelics naturalistically, with challenging experiences more likely under unfavorable set and setting. |
Abstract
This paper presents qualitative data reported by individuals with histories of psychotic symptoms and experiences who engaged in naturalistic psychedelic use compiled as a case series. Through detailed first-person narratives, we explore how both classic and non-classic psychedelic experiences were subjectively experienced and integrated by individuals in this population, which is usually excluded from psychedelic research. Selected cases illustrate potential benefits—including individual growth, insight, increased spirituality, and symptom reappraisal—as well as challenging experiences and adverse effects, particularly when the set and setting are unfavorable. These findings contribute to the ongoing debate over the categorical exclusion of people with psychotic conditions and symptoms from psychedelic treatment and research and call for more holistic, ethically guided inquiry into the benefits and risks of psychedelic-assisted therapy (PAT) for this underserved, stigmatized, and pathologized subpopulation.