A Transformative Trip? Experiences of Psychedelic Use

Psychedelics have received renewed scientific, regulatory, and public attention because of promising therapeutic applications and a narrative that they can produce rapid, profound changes in how people think and act. Neitzke-Spruill and colleagues frame this paper around L.A. Paul’s philosophical account of "transformative experiences," which distinguishes epistemic transformation (gaining knowledge that can only be acquired through having an experience) from personal transformation (substantial change to one’s point of view, core preferences, or sense of self). The authors note that, despite theoretical overlap between psychedelic experiences and Paul’s notion of transformation, no prior study has empirically assessed whether people regard their psychedelic experiences as epistemically and personally transformative according to Paul's criteria, nor systematically examined how retreat participants make decisions to pursue such experiences. This study sets out to fill that gap by interviewing individuals who attended psychedelic retreats to determine whether their self-reported experiences meet Paul's criteria for transformative experience and to explore related neuroethical questions. In particular, the investigators examine participants’ reports about (1) novel insights or knowledge attributable to psychedelics, (2) changes in identity, values, beliefs, desires, or behaviour, (3) how participants described their experiences using everyday language, and (4) whether participants felt able to make informed decisions to attend retreats. The analysis also considers implications for consent and for concerns about psychedelic-facilitated moral psychopharmacology.

The study used qualitative interviews with people who had attended at least one psychedelic retreat. Eligibility required participants to be 18 or older, English-speaking, and to have attended a domestic or international retreat. Recruitment combined convenience and purposive sampling: some participants were identified through the research team’s networks and a Psychedelics listserv, and others responded to flyers circulated by retreat organisations. Interested individuals completed an online interest form and were invited to an interview; participation was voluntary and compensated with a US$50 online gift card. The Baylor College of Medicine Institutional Review Board approved the protocol and the study obtained a certificate of confidentiality. Data collection involved semi-structured, in-depth interviews conducted in person or via Zoom between June and October 2023. The interview guide covered psychedelic use history, retreat characteristics, motivations for attending, subjective qualities of the experience, impacts of the experience, and views about policy. Specific items probed whether participants learned things through their experience that could not have been attained otherwise, whether they felt like a different person afterwards, whether they perceived changes to identity/values/beliefs/desires/behaviour, and whether they considered the experience "transformative." Interviews were professionally transcribed and de-identified. For analysis, the coding team applied qualitative content analysis with both inductive and deductive phases. An initial coding scheme was developed from emergent themes; transcripts were coded individually, then compared in team meetings to reach consensus. Transcripts and codes were uploaded to Dedoose for management. In the deductive phase, two coders examined excerpts to identify instances of epistemic transformation (novel understanding or realizations attributed to the psychedelic experience) and personal transformation, operationalised across five domains: identity, values, beliefs, desires, and behaviour. Coding disagreements were resolved by consensus and validated by two additional team members. The authors acknowledge there are no objective criteria for transformation and therefore based their operationalisation on an interpretation of Paul’s framework.

Sample and context: The team contacted 37 interested people and completed 26 interviews (response rate 70.2%). Participants were predominantly female (n = 20) and White (n = 17); five identified as Hispanic or Latino and one as Asian or Asian-American. The mean age was 48 years (SD = 14.3), range 30–79. Retreat experience varied: 13 participants had attended only one retreat, while 13 had attended two or more; among the latter group, eight reported attending four or more retreats. Reported substances included ayahuasca, psilocybin, 5‑MeO‑DMT, DMT, mescaline, LSD, MDMA, ketamine, and others, with ayahuasca and psilocybin most frequently discussed. Eleven participants (42%) attended retreats where ayahuasca was the main offering and seven (26%) attended psilocybin retreats. Motivations for attending clustered into seven categories: personal development (81%), self‑medication for conditions such as depression, anxiety, trauma, addiction or grief (73%), curiosity (35%), peer influence (31%), spiritual/religious reasons (23%), relationship insight (19%), and professional training (8%). Epistemic transformation: Twenty participants (77%) reported experiences consistent with epistemic transformation, meaning they described novel understandings or realizations that they judged could only have been gained through the psychedelic experience. Reported phenomenology included visionary and somatic phenomena (e.g. encounters with younger selves, reliving trauma, meeting deceased persons, faux‑labor), and participants frequently emphasised the heightened subjective reality or ‘‘felt’’ quality of insights. Six participants (23%) did not report epistemic transformation. Personal transformation: Using the five predefined domains, nearly all participants reported at least one form of personal change; only one person (4%) reported none. Behavioural changes were most common (n = 19, 73%), followed by changes in desires (n = 18, 69%), values (n = 13, 50%), identity (n = 12, 46%), and beliefs (n = 10, 38%). Four participants (15%) described changes across all five domains, while others described varying numbers of change types (six described four domains, five described three, three described two, and seven described one). The authors note considerable overlap: all twenty participants who reported epistemic transformation also reported at least one personal change. Language and self‑labelling: When asked whether they would describe their experience as "transformative," sixteen participants did so. Some participants who did not use the word nonetheless said the experience allowed them to become a "better version" of themselves, or to experience a "reset" or a new perspective. Reported positive self‑changes included greater openness, authenticity, empathy, calm, and capacity for self‑care; a minority described returning to a prior or ‘‘revealed’’ identity rather than becoming a wholly different person. Information seeking and informed decision making: Most participants (n = 21, 80%) said they had access to sufficient information and felt able to make an informed decision to attend a retreat. Sources of information included scientific articles, podcasts, books, documentaries, social media, and conversations with retreat organisers; six participants explicitly credited retreat staff for providing preparatory information. Two participants (8%) indicated they did not feel technically to have provided informed consent in a formal sense, and responses were missing for two others. Transformative agency and variation in outcomes: Many participants described attending retreats as a deliberate, intentional process aimed at self‑change; for some, preparatory work (research, tapering medications, setting intentions) and post‑retreat supports contributed to sustained changes. Reported outcomes ranged from substantial life changes—such as reduced substance use, altered relationships, pursuing new education/careers, and greater assertiveness—to cases where intended changes did not persist because participants returned to prior life patterns or experienced challenging ("dark") ceremonies. Some participants reported negative or difficult experiences ("bad trips"), yet still described subsequent change, sometimes ambivalently. The extracted text does not provide systematic measurement of adverse events or objective verification of reported changes.

Neitzke‑Spruill and colleagues interpret their findings as supporting the claim that psychedelic experiences can meet Paul’s dual criteria of epistemic and personal transformation. The majority of participants reported novel, embodied insights they believed could not have been attained without the psychoactive effects of psychedelics, and nearly all reported at least one domain of personal change, with behavioural change being most prevalent. The authors highlight subjective embodiment—the way insights are felt and given personal value—as central to epistemic transformation, and they emphasise the role of intentional, agentic seeking in shaping whether and how experiences translate into lasting change. The investigators situate these empirical findings within neuroethical concerns. They argue that the apparent importance of subjective, personally meaningful content lends support to the view that acute subjective effects matter for therapeutic benefit, rather than neurobiology alone. At the same time, the authors raise ethical questions about using psychedelics as moral psychopharmacological agents, given heightened suggestibility and strong context dependence of effects; these features heighten the need to protect autonomy and to avoid undue influence. To address such risks, they advocate centring the person—supporting individual transformative agency—in models of psychedelic‑assisted therapy and neuroethical inquiry, drawing on ideas such as agential moral neuroenhancement. Regarding consent, the authors report most participants felt able to make informed decisions after information‑seeking and preparatory contact with facilitators, but they caution that consent processes should temper expectations and fully inform prospective users about the range of psychoactive effects, the potential for profound self‑change, and the possibility of unsettling experiences. Key limitations are also acknowledged: a convenience sample that was majority White and female limits generalisability; reliance on retrospective self‑report prevents objective verification of the durability of changes; the lack of standardised, objective criteria for epistemic and personal transformation required the research team to operationalise Paul’s theory in a particular way; and heterogeneous drug histories and retreat settings restricted comparisons across substances or contexts. The authors recommend further research on how psychotherapeutic approaches, integration supports, and social resources can assist individuals pursuing transformative change, and they call for normative work to guide responsible clinical and societal integration of psychedelics.

The authors conclude that psychedelics’ vividly embodied, non‑ordinary effects can constitute transformative experiences and facilitate transformative change for many users. Given the growing clinical use and public acceptance of psychedelics, they argue there is an urgent need to interrogate related neuroethical issues—particularly those concerning agency, autonomy, and the prospect of moral psychopharmacology—and to develop norms for appropriate circumstances of psychedelic transformation to guide responsible integration into society.