Depressive DisordersSubstance Use Disorders (SUD)Palliative & End-of-Life DistressAnxiety Disorders

Awe: a putative mechanism underlying the effects of classic psychedelic-assisted psychotherapy

This review paper (2018) presents a theoretical framework that awe is an underlying mechanism that, as a part of the psychedelic experience, promotes ego dissolution (small self, unitive experience).

Authors

  • Peter Hendricks

Published

International Review of Psychiatry
meta Study

Abstract

A psychological model of classic psychedelic-assisted psychotherapy informed by contemporary scientific data is presented in this paper. It is suggested that classic psychedelic-occasioned mystical experience is characterized by profound awe, a discrete emotion experienced in the presence of a vast stimulus requiring accommodation of mental structures. Awe, in turn, promotes the small self, a construct that, in the extreme, is analogous to those of unitive experience and ego dissolution. The small self is conceptualized as key to understanding the downstream effects of mystical experience occasioned in the context of classic psychedelic-assisted psychotherapy. With this novel theoretical framework in mind, a number of clinical implications and recommendations are provided so as to advance this incipient field of study.

Available with Blossom Pro

Research Summary of 'Awe: a putative mechanism underlying the effects of classic psychedelic-assisted psychotherapy'

Introduction

Hendricks situates the paper in the context of a renewed scientific interest in classic psychedelics (notably psilocybin) after decades of limited research. Earlier clinical and observational work indicates that classic psychedelics, when administered in controlled therapeutic contexts, can produce enduring positive changes across psychological and behavioural domains and show initial signals of efficacy for conditions such as depression, end-of-life distress and addiction. Despite accumulating clinical data and convergent neurobiological hypotheses (for example, changes in default mode network connectivity), Hendricks notes a gap in psychological-level explanations for how psychedelic-occasioned mystical experiences produce lasting benefit. The primary aim of the manuscript is to propose a psychological model that identifies the emotion awe as the principal mechanism underlying the salutary effects of mystical experiences occasioned by classic psychedelic-assisted psychotherapy. To support this proposal, Hendricks compares the core features, predictors and outcomes of awe and psychedelic-occasioned mystical experience, considers potential overlapping neural and molecular mechanisms, and outlines clinical implications and recommendations for advancing research and practice in this area.

Expert Research Summaries

Go Pro to access AI-powered section-by-section summaries, editorial takes, and the full research toolkit.

See Pro PlansAlready have an account? Sign in

Full Text PDF

Full Paper PDF

Create a free account to open full-text PDFs.

Create Free AccountAlready have an account? Sign in

Study Details

References (50)

Papers cited by this study that are also in Blossom

Does psychedelic drug use reduce risk of suicidality? Evidence from a longitudinal community-based cohort of marginalised women in a Canadian setting

Argento, E., Strathdee, S. A., Tupper, K. et al. · BMJ Open (2017)

48 cited
The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms

Barrett, F. S., Bradstreet, M. P., Leoutsakos, J. M. S. et al. · Journal of Psychopharmacology (2016)

Classic hallucinogens and mystical experiences: phenomenology and neural correlates

Barrett, F. S., Griffiths, R. R. · Current Topics in Behavioral Neurosciences (2017)

Validation of the revised Mystical Experience Questionnaire in experimental sessions with psilocybin

Barrett, F. S., Johnson, M. W., Griffiths, R. R. · Journal of Psychopharmacology (2015)

Neuroticism is associated with challenging experiences with psilocybin mushrooms

Barrett, F. S., Johnson, M. W., Griffiths, R. R. · Personality and Individual Differences (2017)

78 cited
Qualitative and quantitative features of music reported to support peak mystical experiences during psychedelic therapy sessions

Slevc, L. R., Barrett, F. S., Robbins, H. et al. · Frontiers in Psychology (2017)

Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study

Bogenschutz, M. P., Forcehimes, A. A., Pommy, J. A. et al. · Journal of Psychopharmacology (2015)

Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences

Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S. et al. · Journal of Psychopharmacology (2016)

Double-blind comparison of the two hallucinogens psilocybin and dextromethorphan: similarities and differences in subjective experiences

Carbonaro, T. M., Hurwitz, E., Johnson, M. W. · Psychopharmacology (2017)

102 cited
Psilocybin with psychological support for treatment-resistant depression: six-month follow-up

Carhart-Harris, R. L., Bolstridge, &. M., Day, C. M. J. et al. · Psychopharmacology (2017)

Show all 50 references
Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study

Carhart-Harris, R. L., Bolstridge, M., Rucker, J. et al. · Lancet Psychiatry (2016)

1174 cited
Psychedelics and connectedness

Carhart-Harris, R. L., Erritzoe, D., Haijen, E. C. H. M. et al. · Psychopharmacology (2017)

The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs

Carhart-Harris, R. L., Leech, R., Shanahan, M. et al. · Frontiers in Human Neuroscience (2014)

Neural correlates of the LSD experience revealed by multimodal neuroimaging

Carhart-Harris, R. L., Muthukumaraswamy, S., Roseman, L. et al. · PNAS (2016)

Pahnke’s ‘Good Friday Experiment’: a long-term follow-up and methodological critique

Doblin, R. · Journal of Transpersonal Psychology (1991)

‘Hitting highs at rock bottom’: LSD treatment for alcoholism, 1950-1970

Dyck, E. · Social History of Medicine (2006)

90 cited
Safety and efficacy of lysergic acid diethylamide-assisted psychotherapy for anxiety associated with life-threatening diseases

Gasser, P., Holstein, D., Michel, Y. et al. · Journal of Nervous and Mental Disease (2014)

594 cited
LSD-assisted psychotherapy for anxiety associated with a life-threatening disease: a qualitative study of acute and sustained subjective effects

Kirchner, K. · Journal of Psychopharmacology (2014)

389 cited
Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer

Griffiths, R. R., Johnson, M. W. · Journal of Psychopharmacology (2016)

Psilocybin occasioned mystical-type experiences: immediate and persisting dose-related effects

Griffiths, R. R., Johnson, M. W., Richards, W. A. et al. · Psychopharmacology (2011)

Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors

Griffiths, R. R., Johnson, M. W., Richards, W. A. et al. · Journal of Psychopharmacology (2017)

393 cited
Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance 14 months later

Griffiths, R. R. · Journal of Psychopharmacology (2008)

Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance

Griffiths, R. R., Richards, W. A., Mccann, U. et al. · Journal of Psychopharmacology (2006)

Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer

Grob, C. S., Danforth, A. L., Chopra, G. S. et al. · JAMA Psychiatry (2011)

Hallucinogen use predicts reduced recidivism among substance-involved offenders under community corrections supervision

Hendricks, P. S., Clark, B., Johnson, M. W. et al. · Journal of Psychopharmacology (2014)

89 cited
The relationships of classic psychedelic use with criminal behavior in the United States adult population

Hendricks, P. S., Crawford, M. S., Cropsey, K. L. et al. · Journal of Psychopharmacology (2017)

Classic psychedelic use is associated with reduced psychological distress and suicidality in the United States adult population

Hendricks, P. S., Thorne, C. B., Clark, B. et al. · Journal of Psychopharmacology (2015)

345 cited
Psilocybin, psychological distress, and suicidality

Hendricks, P. S., Johnson, M. W., Griffiths, R. R. · Journal of Psychopharmacology (2015)

84 cited
Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction

Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P. et al. · Journal of Psychopharmacology (2014)

Long-term follow-up of psilocybin-facilitated smoking cessation

Johnson, M. W., Garcia-Romeu, A., Griffiths, R. R. · The American Journal of Drug and Alcohol Abuse (2016)

562 cited
Human hallucinogen research: guidelines for safety

Johnson, M. W., Richards, W. A., Griffiths, R. R. · Journal of Psychopharmacology (2008)

LSD-induced entropic brain activity predicts subsequent personality change

Lebedev, A. V., Kaelen, M., L€ Ovd En, M. et al. · Human Brain Mapping (2016)

292 cited
Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness

Maclean, K. A., Johnson, M. W., Griffiths, R. R. · Journal of Psychopharmacology (2011)

Factor analysis of the mystical experience questionnaire: A study of experiences occasioned by the hallucinogen psilocybin

MacLean, K. A., Leoutsakos, J. S., Johnson, M. W. et al. · Journal for the Scientific Study of Religion (2012)

350 cited
Peak experiences and the afterglow phenomenon: when and how do therapeutic effects of hallucinogens depend on psychedelic experiences

Majic, T., Schmidt, T. T., Gallinat, J. · Journal of Clinical Psychopharmacology (2015)

Psychedelics

Nichols, D. E. · Pharmacological Reviews (2016)

Psychedelics as Medicines: An Emerging New Paradigm

Nichols, C. D., Nichols, D. E., Johnson, M. W. · Clinical Pharmacology and Therapeutics (2016)

Psychedelics and the science of self-experience

Nour, M. R., Carhart-Harris, R. L. · British Journal of Psychiatry (2017)

Psychedelics, personality and political perspectives

Nour, M. R., Evans, J., Carhart-Harris, R. L. · Journal of Psychoactive Drugs (2017)

164 cited
Ego-dissolution and psychedelics: validation of the ego-dissolution inventory (EDI)

Nour, M. R., Evans, J., Nutt, D. J. et al. · Frontiers in Human Neuroscience (2016)

Antidepressant effects of a single dose of ayahuasca in patients with recurrent depression: a preliminary report

Osório, F. L., Sanches, R. F., Macedo, L. et al. · brazilian Journal of Psychiatry (2015)

420 cited
The association of psychedelic use and opioid use disorders among illicit users in the United States

Pisano, V. D., Putnam, N. P., Kramer, H. M. et al. · Journal of Psychopharmacology (2017)

Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: A randomized controlled trial

Ross, S., Bossis, A. P., Guss, J. et al. · Journal of Psychopharmacology (2016)

Antidepressant effects of a single dose of ayahuasca in patients with recurrent depression a SPECT study

Sanches, R. F., Osório, F. L., Dos Santos, R. G. et al. · Journal of Clinical Psychopharmacology (2016)

380 cited
Exploring the therapeutic potential of Ayahuasca: acute intake increases mindfulness-related capacities

Soler, J., Elices, M., Franquesa, A. et al. · Psychopharmacology (2015)

Prediction of psilocybin response in healthy volunteers

Studerus, E., Gamma, A., Kometer, M. et al. · PLOS ONE (2012)

Increased global functional connectivity correlates with LSD-induced ego dissolution

Tagliazucchi, E., Roseman, L., Kaelen, M. et al. · Current Biology (2016)

Ayahuasca-assisted therapy for addiction: results from a preliminary observational study in Canada

Thomas, G., Lucas, P., Rielle Capler, N. et al. · Current Drug Abuse Reviews (2013)

Hallucinogen use and intimate partner violence: Prospective evidence consistent with protective effects among men with histories of problematic substance use

Walsh, Z., Hendricks, P. S., Smith, S. et al. · Journal of Psychopharmacology (2016)

58 cited
Of Roots and Fruits A Comparison of Psychedelic and Nonpsychedelic Mystical Experiences

Yaden, D. B., Le Nguyen, K. D., Kern, M. L. et al. · Journal of Humanistic Psychology (2016)

90 cited

Cited By (58)

Papers in Blossom that reference this study

Mystical experiences during magnesium-Ibogaine are associated with improvements in PTSD symptoms in veterans

Brown, R. E., Lissemore, J. I., Shinozuka, K. F. et al. · Journal of Affective Disorders (2026)

Ayahuasca-inspired DMT/harmine formulation alters creative thinking dynamics during artistic creation

Suay, D., Aicher, H. D., Singer, B. et al. · Journal of Psychopharmacology (2025)

The phenomenology of psilocybin's experience mediates subsequent persistent psychological effects independently of sex, previous experience, or setting

Tylš, F., Páleníček, T., Klučková, T. et al. · Pharmacological Reports (2025)

3 cited
Insights on Psychedelics: A Systematic Review of Therapeutic Effects

Kugel, J., Laukkonen, R., Yaden, D. B. et al. · Neuroscience and Biobehavioral Reviews (2025)

Co-administration of midazolam and psilocybin: Differential effects on subjective quality versus memory of the psychedelic experience

Nicholas, C. R., Banks, M. I., Lennertz, R. L. et al. · Translational Psychiatry (2024)

Clinically relevant acute subjective effects of psychedelics beyond mystical experience

Yaden, D. B., Goldy, S. P., Weiss, B. et al. · Nature Reviews Psychology (2024)

Psychedelic-assisted psychotherapy: Where is the psychotherapy research?

Aday, J. S., Horton, D. M., Fernandes-Osterhold, G. et al. · Psychopharmacology (2024)

Increases in Aesthetic Experience Following Ayahuasca Use: A Prospective, Naturalistic Study

Aday, J. S., Bloesch, E. K., Davis, A. K. et al. · Journal of Humanistic Psychology (2024)

Effects of Ayahuasca on Gratitude and Relationships with Nature: A Prospective, Naturalistic Study

Aday, J. S., Bloesch, E. K., Davis, A. K. et al. · Journal of Psychoactive Drugs (2024)

15 cited
Reports of self-compassion and affect regulation in psilocybin-assisted therapy for alcohol use disorder: An interpretive phenomenological analysis

Agin-Liebes, G. I., Nielson, E. M., Zingman, M. et al. · Psychology of Addictive Behaviors (2024)

Show all 58 papers
Psilocybin for Opioid Use Disorder in Two Adults Stabilized on Buprenorphine: A Technical Report on Study Modifications and Preliminary Findings

Nicholas, C. R., Horton, D. M., Malicki, J. et al. · Psychedelic Medicine (2023)

Psychedelic Use Among Psychiatric Medication Prescribers: Effects on Well-Being, Depression, Anxiety, and Associations with Patterns of Use, Reported Harms, and Transformative Mental States

Herrmann, Z., Levin, A. W., Cole, S. P. et al. · Psychedelic Medicine (2023)

Effects of ayahuasca on gratitude and relationships with nature: An open-label, naturalistic study

Bloesch, E. K., Davis, A. K., Domoff, S. E. et al. · Psyarxiv (2023)

Self-Transcendent Positive Emotions as a Potential Mechanism Underpinning the Effects of Meaningful Psychedelic Experiences on Connectedness to Nature

Newton, K., Moreton, S. G. · Ecopsychology (2023)

The Canadian Psychedelic Survey: Characteristics, Patterns of Use, and Access in a Large Sample of People Who Use Psychedelic Drugs

Lake, S., Lucas, P. · Psychedelic Medicine (2023)

Ayahuasca in the treatment of bipolar disorder with psychotic features-A retrospective case study

Turkia, M. · Psyarxiv (2023)

Psychedelic replications in virtual reality and their potential as a therapeutic instrument: an open-label feasibility study

Kaup, K. K., Vasser, M., Tulver, K. et al. · Frontiers in Psychiatry (2023)

Psychedelics and psychological strengths

Brasher, T., Rosen, D., Spinella, M. · International Journal of Wellbeing (2023)

Psychedelic Identity Shift: A Critical Approach to Set And Setting

Devenot, N., Seale-Feldman, A., Smith, E. et al. · Kennedy Institute of Ethics Journal (2022)

28 cited
More than meets the eye: The role of sensory dimensions in psychedelic brain dynamics, experience, and therapeutics

Aqil, M., Roseman, L. · Neuropharmacology (2022)

Being no one, being One: The role of ego-dissolution and connectedness in the therapeutic effects of psychedelic experience

Kałużna, A., Schlosser, M., Gulliksen Craste, E. et al. · Journal of Psychedelic Studies (2022)

35 cited
Self-Entropic Broadening Theory: Toward a New Understanding of Self and Behavior Change Informed by Psychedelics and Psychosis

Dourron, H. M., Strauss, C., Hendricks, P. S. · Pharmacological Reviews (2022)

Awe as a Pathway to Mental and Physical Health

Monroy, M., Keltner, D. · Perspectives on Psychological Science (2022)

106 cited
Pharmacological, Neural, and Psychological Mechanisms underlying Psychedelics: A Critical Review

van Elk, M., Yaden, D. B. · Neuroscience and Biobehavioral Reviews (2022)

Psychedelics, Mystical Experience, and Therapeutic Efficacy: A Systematic Review

Knight, G., Rucker, J., Cleare, A. J. et al. · Frontiers in Psychiatry (2022)

Opening to Awe: Psychedelic-Assisted Self-Transcendence and Positive Adult Development

Arnaud, K. O. S., Sharpe. D. · Journal of Adult Development (2022)

MDMA-assisted therapy for posttraumatic stress disorder: A pooled analysis of ethnoracial differences in efficacy and safety from two Phase 2 open-label lead-in trials and a Phase 3 randomized, blinded placebo-controlled trial

Ching, T. H., Williams, M. T., Wang, J. B. et al. · Journal of Psychopharmacology (2022)

Interest in receiving psychedelic-assisted therapy among marginalized women: Implications and findings from a community-based study in Canada

Argento, E., Goldenberg, S., Deering, K. et al. · Drug and Alcohol Dependence (2022)

4 cited
Group VR experiences can produce ego attenuation and connectedness comparable to psychedelics

Glowacki, D. R., Wonnacott, M. D., Freire, R. et al. · Scientific Reports (2022)

31 cited
Special considerations for evaluating psilocybin-facilitated psychotherapy in vulnerable populations

Ortiz, C. E., Dourron, H. M., Sweat, N. W. et al. · Neuropharmacology (2022)

Naturalistic use of psychedelics is related to emotional reactivity and self-consciousness: The mediating role of ego-dissolution and mystical experiences

Orłowski, P., Ruban, A., Szczypiński, J. et al. · Journal of Psychopharmacology (2022)

Predictors and potentiators of psychedelic-occasioned mystical experiences

Gandy, S. · Journal of Psychedelic Studies (2022)

Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy

Sekula, A. D., Downey, L., Puspanathan, P. · Frontiers in Psychology (2022)

19 cited
Ayahuasca and tobacco smoking cessation: results from an online survey in Brazil

Maia, L. O., Massarentti, C. M., Tófoli, L.F. · Psychopharmacology (2022)

28 cited
MDMA-Assisted Therapy for Posttraumatic Stress Disorder: A Mixed-Methods Case Study of a Participant of Color From an Open-Label Trial

Ching, T. H., Williams, M. T., Reed, S. et al. · Journal of Humanistic Psychology (2022)

7 cited
Psychedelic use is associated with reduced daily opioid use among people who use illicit drugs in a Canadian setting

Argento, E., Socias, M. E., Hayashi, K. et al. · International Journal of Drug Policy (2022)

Psychedelic-Assisted Therapy for Substance Use Disorders and Potential Mechanisms of Action

Rieser, N. M., Herdener, M. ;., Preller, K. H. · Current Topics in Behavioral Neurosciences (2021)

Toward a positive psychology of psychoactive drug use

Arnaud, K. O. S. · Drugs Education Prevention and Policy (2021)

Classic psychedelics in the treatment of substance use disorder: Potential synergies with twelve-step programs

Yaden, D. B., Berghella, A. P., Regier, P. S. et al. · International Journal of Drug Policy (2021)

41 cited
This Is Something That Changed My Life: A Qualitative Study of Patients' Experiences in a Clinical Trial of Ketamine Treatment for Alcohol Use Disorders

Mollaahmetoglu, O. M., Keeler, J., Ashbullby, K. J. et al. · Frontiers in Psychiatry (2021)

Increases in Psychological Flexibility Mediate Relationship Between Acute Psychedelic Effects and Decreases in Racial Trauma Symptoms Among People of Color

Davis, A. K., Xin, Y., Sepeda, N. D. et al. · Chronic Stress (2021)

Using Psychedelics With Therapeutic Intent Is Associated With Lower Shame and Complex Trauma Symptoms in Adults With Histories of Child Maltreatment

Healy, C. J., Lee, K. A. · Chronic Stress (2021)

Cross-sectional associations between lifetime use of psychedelic drugs and psychometric measures during the COVID-19 confinement: A transcultural study

Bouso, J. C., Révész, D., Ona, G. et al. · Frontiers in Psychiatry (2021)

26 cited
Future Directions for Clinical Psilocybin Research: The Relaxed Symptom Network

Lewis-Healey, E., Laukkonen, R., Van Elk, M. · Psyarxiv (2021)

1 cited
Effects of psilocybin microdosing on awe and aesthetic experiences: a preregistered field and lab-based study

Van Elk, M., Fejer, G., Lempe, P. et al. · Psychopharmacology (2021)

42 cited
Naturalistic Use of Mescaline Is Associated with Self-Reported Psychiatric Improvements and Enduring Positive Life Changes

Agin-Liebes, G. I., Lancelotta, R., Uthaug, M. V. et al. · ACS Pharmacology and Translational Science (2021)

Combining Psychedelic and Mindfulness Interventions: Synergies to Inform Clinical Practice

Payne, J. E., Chambers, R., Liknaitzky, P. · ACS Pharmacology and Translational Science (2021)

55 cited
Neural and subjective effects of inhaled N,N-dimethyltryptamine in natural settings

Pallavicini, C., Cavanna, F., Zamberlan, F. et al. · Journal of Psychopharmacology (2021)

The potential synergistic effects between psychedelic administration and nature contact for the improvement of mental health

Gandy, S., Forstmann, M., Carhart-Harris, R. L. et al. · Health Psychology Open (2020)

Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies

Breeksema, J. J., Niemeijer, A. R., Krediet, E. et al. · CNS Drugs (2020)

Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

Wolff, M., Evens, R., Mertens, L. J. et al. · Frontiers in Psychiatry (2020)

Classic psychedelics as therapeutics for psychiatric disorders

Nichols, C. D., Hendricks, P. S. · Handbook of Behavioral Neuroscience (2020)

Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety

Davis, A. K., Barrett, F. S., Griffiths, R. R. · Journal of Contextual Behavioral Science (2020)

From Egoism to Ecoism: Psychedelics Increase Nature Relatedness in a State-Mediated and Context-Dependent Manner

Kettner, H., Gandy, S., Haijen, E. C. H. M. et al. · International Journal of Environmental Research and Public Health (2019)

131 cited
Embedding existential psychology within psychedelic science: reduced death anxiety as a mediator of the therapeutic effects of psychedelics.

Moreton, S. G., Szalla, L., Menzies, R. E. et al. · Psychopharmacology (2019)

47 cited
Exploring ayahuasca-assisted therapy for addiction: A qualitative analysis of preliminary findings among an Indigenous community in Canada

Argento, E., Capler, R., Thomas, G. et al. · Drug and Alcohol Review (2019)

72 cited
Narrative identity, rationality, and microdosing classic psychedelics

Webb, M., Copes, H., Hendricks, P. S. · International Journal of Drug Policy (2019)

Psychedelic microdosing benefits and challenges: an empirical codebook

Anderson, T., Petranker, R., Christopher, A. et al. · Harm Reduction Journal (2019)

Your Personal Research Library

Go Pro to save papers, add notes, rate studies, and organize your research into custom shelves.

See Pro PlansSign in