A Retrospective Study to Determine the Impact of Psychedelic Therapy for Dimensional Measures of Wellness: A Qualitative Analysis of Response Data

The paper frames wellness as a multidimensional construct that goes beyond absence of disease to include physical, psychological, social and spiritual dimensions. Earlier research and clinical practice largely use categorical diagnostic systems (for example DSM-defined disorders), which the authors argue limit applicability to real-world populations who frequently experience comorbidity (for example chronic pain plus mental health symptoms). Previous studies of psychedelics have reported promise across discrete diagnostic indications (depression, addiction, end-of-life distress, some pain syndromes), but no study to date has evaluated the impact of psychedelic medicines using a dimensional approach to wellness rather than diagnostic categories. Di and colleagues set out to fill that gap by retrospectively examining qualitative reports from people who had self‑administered psychedelic medicines for therapeutic (non‑recreational) reasons within the previous three years. The stated aim was to identify and categorise the range of subjective experiences related to wellness across multiple domains (for example mood, pain, function, spirituality and social connection), using thematic analysis informed by prior qualitative work. Quantitative outcomes were collected but are to be analysed separately; this paper focuses on participants' free‑text comments and their thematic classification.

Using a retrospective design, the study recruited 65 civilian or veteran participants aged 18–99 who self‑identified as having used a psychedelic medicine for therapeutic purposes in the preceding three years. Eligibility excluded people who reported only non‑therapeutic use and active military members. The clinical trial registration is NCT05469243. Demographic and clinical background information was collected alongside several psychometric instruments: the Patient Global Impression of Change (PGIC) covering overall quality of life and subdomains (anxiety, mood, pain, disability), the Pain, Enjoyment of Life and General Activity (PEG) scale, the Hospital Anxiety and Depression (HAD) scale, and a Disability Index (DI). The extracted text notes that scores are reported as how participants felt at the time of reporting and that no pre/post change scores are analysed in this paper. This article analysed qualitative comments supplied by participants. The study team used a modified thematic analysis approach, integrating coding strategies from prior qualitative studies. Two authors (VD, GG) organised and reviewed the comments and applied a primary set of categories developed from earlier work. The main categories were: A) Mysticism/spirituality; B) Functional improvement/self‑awareness; C) Social connection/cultural impact; D) Impact on medical/mental health condition; and E) Neutral impressions, sensations or difficult experiences. Comments could be sub‑categorised when appropriate. The paper indicates that thematic development was informed by previous qualitative literature; Appendix A is referenced for themes but is not included in the extracted text.

Sixty‑five questionnaires were analysed, of which 38 were completed by women; the mean age reported was 45.1 years. Employment status differed by sex in the extracted data: 20 of the 38 women were unemployed or on leave of absence compared with 5 men. Anxiety and depression were the most commonly cited medical conditions. Participants supplied a total of 93 comments that were coded into the predefined thematic categories. Psychedelic agents most commonly reported were psilocybin (51 comments) and ayahuasca (17 comments); other substances appeared less frequently (ketamine 7, LSD 5, ecstasy 3, marijuana 3, methamphetamine 5, ibogaine 1) and 11 participants did not report which medicine they had most recently used. Psilocybin and ayahuasca together accounted for 73.1% of all comments. Average scores on the psychometric measures are described in the extracted text as falling in the mild–moderate range, but no pre/post changes are presented here. Thematic frequencies are reported in several places. Functional improvement and self‑awareness was coded in 35 comments; impact on medical and mental health conditions was also coded in 35 comments; social connection and cultural impact appeared in 14 comments; and neutral impressions, sensations or difficult experiences were coded in 39 comments. The authors note considerable overlap and subcategories within these themes. Reported positive changes included reduced anxiety, reduced pain (general, localized and chronic), increased self‑awareness, improved daily functioning, altered life priorities, enhanced social relationships and spiritual or mystical insights. Some participants reported limited duration of symptom relief and difficulty accessing medicines. Adverse or challenging experiences described included purging, nausea, shaking, transient anxiety and fatigue, confrontation of traumatic memories and other difficult emotions. Selective participant comments included short verbatim quotes: "Mental resolution, removed brain fog, relieved pain in my joints and head, relieved anxiety for up to about a month," and "purging, shaking, crying, spiritual experiences (feeling of being loved, feeling of connection to humanity)".

The discussion frames wellness as a dynamic, multidimensional outcome influenced by individual characteristics, psychophysiology and socio‑cultural context. Di and colleagues interpret the qualitative data as indicating that participants commonly experienced improvements across multiple wellness domains—medical and mental health symptoms, social interaction, spirituality and functional capacity—even though negative or difficult experiences were also reported. The authors emphasise that thematic changes were not confined to a single medicine; similar subjective domains emerged across different psychedelic agents, although the study was not designed to determine class‑specific or medicine‑specific effects. The investigators link their findings to broader limitations in the literature, noting that many prior studies exclude comorbid presentations and therefore have limited external validity. They suggest that a dimensional approach to measuring treatment effects may better reflect real‑world populations. The discussion also highlights the need to develop a standardised language or validated theme set for describing psychedelic experiences, and to study how preparation, expectation, culture and context shape participants' reports. Key limitations acknowledged by the authors include the retrospective design, modest sample size, reliance on self‑report, lack of standardisation or documentation of time since psychedelic administration, absence of pre/post quantitative change scores in this report, and that qualitative data were not gathered via in‑person interviews but via optional free‑text comments. The authors recommend future studies use more structured thematic assessments, larger samples, and investigations linking subjective reports to neurophysiological mechanisms to support personalised treatment planning.

The authors conclude that use of various psychedelic medicines was associated with a broad range of qualitative experiences spanning multiple domains relevant to wellness. They propose that with a validated set of thematic language tools and improved understanding of underlying neurobiology, qualitative and quantitative outcomes might become more predictable, a prerequisite for designing patient‑specific treatment approaches. The extracted text also includes participant testimonies that underscore perceived lasting personal change for some individuals and variability in durability of benefit for others.