This qualitative study (n=9) explored how people in Brazil described ceremonial ayahuasca use in relation to suicidal thoughts and behaviour. Participants reported that the experiences helped them strengthen psychological wellbeing and reduce suicidality, particularly in neoshamanic settings.
Aim
This study aimed to explore the experiences and perceived effects of ayahuasca ceremonies on suicidality.
Method
We conducted in-depth qualitative interviews with nine participants from the North and Southeast regions of Brazil. These participants were part of a larger cohort and were selected to explore their perspectives on how ceremonial experiences with ayahuasca in neoshamanic contexts influenced the reduction of suicidal ideation and behavior.
Results
The interviews yielded three main thematic categories related to the therapeutic process of ceremonial ayahuasca use on suicidality: (1) motivations for seeking ayahuasca; (2) post-ayahuasca strategies for strengthening psychological well-being; and (3) the psychedelic experience and its perceived health benefits.
Conclusions
Our findings suggest that the ceremonial use of ayahuasca within neoshamanic traditions can have positive effects on suicidality. Furthermore, these practices may represent emerging and promising psychedelic-assisted care models that may be particularly valuable for communities lacking access to advanced medical treatment.
Papers cited by this study that are also in Blossom
Aday, J. S., Mitzkovitz, C. M., Bloesch, E. K. et al. · Neuroscience and Biobehavioral Reviews (2020)
Agrawal, M., Richards, B. D., Richards, W. A. et al. · Cancer (2023)
Barbosa, P., Mizumoto, S., Bogenschutz, M. P. et al. · Drug Testing and Analysis (2012)
David, J., Bouso, J. C., Kohek, M. et al. · Frontiers in Psychiatry (2023)
Suicidal behaviour is presented as a complex public health problem that includes suicidal ideation and suicide attempts, with substantial global mortality and notable burden in Brazil. The authors note that established risk factors include mental disorders such as depression and substance use disorder, but that access to effective care is uneven. They frame the paper within growing evidence that psychedelics can produce lasting psychological change when used in supportive settings, and they specifically highlight ayahuasca as a substance with emerging therapeutic potential for depression, hopelessness and substance use problems. At the same time, they emphasise that psychedelic clinical research has often lacked ethnoracial diversity, and that high treatment costs and concentration of services in wealthier regions limit access. Against this background, Santos and colleagues set out to explore how people in neoshamanic ayahuasca settings in Brazil describe the relationship between ceremonial ayahuasca use and suicidality. The study aims to understand participants’ motivations for seeking ayahuasca, how they integrated the experience afterwards, and how they perceived its effects on suicidal thoughts and behaviour. The authors present this as a qualitative contribution to suicide prevention research, grounded in community-based psychedelic practices in underrepresented regions and populations.
Santos and colleagues conducted a qualitative, descriptive, exploratory multiple case study. The work formed part of a broader master's research project on ayahuasca as a strategy for self-care in mental health. From a purposive sample of 58 adults who had used ayahuasca in neoshamanic contexts for health-related reasons, the authors selected nine participants for in-depth analysis because they reported a prior history of suicidal ideation or suicide attempts. The final sample included five men and four women, aged 28–59 years, from Rondônia and São Paulo. Recruitment proceeded through three neoshamanic groups. Group leaders first received an explanation of the study and gave formal permission for recruitment. They then nominated people who had sought the group mainly for health-related rather than religious reasons. The researchers contacted nominated individuals by telephone, explained the study, and obtained consent via a Google Forms informed consent form. Participants then completed a self-administered questionnaire on sociodemographic and mental health information. Data were collected through synchronous semi-structured interviews conducted by the first author using Google Meet or WhatsApp video calls. Interviews lasted about 40 minutes, were audio recorded with consent, and were transcribed verbatim. The interview guide covered motivations for ayahuasca use, patterns of use, physical and mental health experiences, ritual context, spirituality, healing, and current mental health and quality of life. Participants also spontaneously discussed suicidality without being directly prompted. The extracted text indicates that the researchers used content analysis with pre-analysis, coding/categorisation, and interpretation to identify factors related to ayahuasca’s perceived benefits. Pseudonyms were used to protect anonymity. The study received ethics approval from the Federal University of Rondônia. The neoshamanic settings themselves were described briefly in the background information: ceremonies involved preparatory orientations, facilitator presence throughout, and time for sharing afterwards. Practices varied somewhat across groups, including differences in screening and support, and one group in São Paulo also offered psychotherapy and other complementary therapies.
The sample comprised nine participants, most of whom were male (5/9; 55%) and from northern Brazil. Mean age was 37 years and mean duration of ayahuasca use was 47 months. Most participants identified as Brown (5/9; 55%), had incomplete higher education, were employed, and were married. All had previously received a psychiatric diagnosis confirmed by a doctor; depression was the most common diagnosis (5/9; 55%), followed by substance use disorder (4/9; 45%). Most were not taking psychiatric medication, and five were in psychotherapy. More than half reported lifetime suicidal ideation that was no longer active, and 45% reported at least one suicide attempt. Content analysis produced three broad themes: motivations for seeking ayahuasca, post-ayahuasca strategies for strengthening psychological well-being, and the psychedelic experience and its health benefits. In the first theme, participants commonly described dissatisfaction with conventional care, including repeated attempts with medication, public services and therapeutic communities that did not bring remission or seemed to worsen symptoms. This dissatisfaction, together with depression or substance use problems, was linked to the decision to seek ayahuasca. Several participants described severe suicidal thinking or attempts before starting ceremonial use. In the second theme, participants stressed the importance of group support and therapeutic integration. Some described the group as a kind of self-help community. They valued the ritual setting, the perceived safety of being monitored by facilitators, practical support during ceremonies, and opportunities to talk afterwards. Participants also said that ayahuasca helped them engage more deeply in psychotherapy or other therapeutic supports offered by the group, which they felt strengthened the benefits of the experience. In the third theme, participants reported self-knowledge, behavioural change, and personal/social transformation. They described greater self-awareness, improved self-image and a better relationship with their bodies. Many reported changes in mood, motivation, lifestyle and health behaviours, including more exercise, improved diet, reduced use of alcohol, marijuana or other drugs, and less suicidal thinking. Participants also described improvements in family relationships, work, finances, home organisation, and a stronger sense of purpose and life satisfaction. The qualitative data therefore consistently portrayed ayahuasca use as associated, in participants’ accounts, with reductions in suicidal ideation and broader improvements in well-being.
The authors interpret the findings as suggesting that participation in naturalistic ayahuasca ceremonies may be linked to reductions in suicidal thoughts and behaviour, especially among people with depression or substance use disorder. They argue that the reported decreases in substance use, improvements in mood and self-esteem, and better functioning in personal and professional life point to a potentially integrative and complementary role for ceremonial ayahuasca in mental health care. They also position the findings alongside previous research indicating that psychedelics can reduce hopelessness and depressive symptoms, and they cite neuroimaging and psychotherapeutic literature to support the idea that acute psychedelic experiences, insight and emotional intensification may contribute to longer-term positive change. The authors further suggest that context matters: preparation, supportive settings, social support, and post-experience integration are presented as important influences on outcomes. They note that the group-based, ritualised and religiously syncretic character of neoshamanic ayahuasca settings in Brazil may lower stigma, facilitate integration into daily life, and potentially broaden access to care for racially marginalised and socioeconomically disadvantaged people. They also mention that five participants used psychotherapy after ayahuasca and perceived this combination as helpful for working through material brought up by the experience. At the same time, the authors are careful to acknowledge limitations. They stress the very small sample size, the exploratory nature of the study, and the possibility of selection bias because group leaders nominated participants, which may have favoured positive accounts. They also note response and recall bias due to retrospective self-report, the absence of validated quantitative measures, and the cross-sectional design. They acknowledge that people who had adverse reactions or left the groups may not have been captured, which could overrepresent benefits. The discussion also notes broader concerns about psychological harms and abuse in some ayahuasca communities, which the authors say future research should be designed to detect. Overall, they call for more diverse and ethically sensitive studies that can capture a wider range of experiences and better understand the role of sociocultural context.
The authors conclude that suicide is a serious and growing public health concern and that their findings raise the possibility that community-based ayahuasca use in Brazil may help expand access to supportive care for diverse populations. They state that, while stronger evidence is still needed, these practices may offer an alternative pathway for mental health support in settings where conventional resources are limited or inaccessible.
This investigation employed a qualitative, descriptive, and exploratory multiple case study design to generate a comprehensive and detailed understanding of the phenomenon under examination. The primary objective was to explore the subjective meanings that participants attributed to their personal experiences. This study represents a focused component of a broader academic master's research project entitled Seeking Ayahuasca as a Strategy for Mental Health Self-Care: An Exploratory Study. The dataset was derived from a purposive sample of 58 individuals who participated in ayahuasca ceremonies within neoshamanic contexts for health-related purposes. From this larger cohort, a subset of nine participants (five men), aged 28-59 years and residing in the Brazilian states of Rondônia (n = 5) and São Paulo (n = 4), was selected for in-depth analysis. These participants were identified based on their self-reported history of suicidal ideation or suicide attempts prior to their involvement in ayahuasca practices.
This research was conducted within a neoshamanic context, reflecting the growing presence of ayahuasca in urban centers. This setting is characterized by non-institutionalized modes of ayahuasca use influenced by multiple traditions, including Afro-Brazilian religions, Spiritism, esotericism, Eastern philosophies and Indigenous or other shamanic practices. We obtained permission to recruit participants from three neoshamanic groups: one located in São Paulo, a highly urbanized state in Southeastern Brazil, and two located in Rondônia, a less affluent Amazonian state in the North. Based on participants' reports, descriptions provided by group leaders and brief, non-systematic firsthand observations conducted in the three groups, the three settings consistently displayed general preparatory and support practices, including pre-ceremony orientations, the continuous presence of facilitators throughout the ritual and structured moments at the end of the session for participants to share their experiences. Participants reported that ceremonies typically lasted several hours and occurred once or twice a week, depending on the group. They also reported that their initial contact with the groups typically occurred through informal social referrals, including recommendations from friends, co-workers and, in one case, a religious leader, who suggested participation as a possible way of addressing personal difficulties. The authors' brief, non-systematic observations and these reports converged in indicating that screening practices varied across groups, ranging from more structured intake conversations to decisions based primarily on leaders' subjective impressions of psychological readiness and the perceived suitability of the experience. Across settings, a support team monitored participants, assisted with basic needs and intervened, when necessary, in situations involving emotional distress, disorientation or other challenging experiences. After the conclusion of the session, facilitators remained available for those who wished to schedule follow-up conversations or seek additional support. In addition to the ayahuasca ceremonies, the neoshamanic group based in São Paulo also offers a range of complementary therapeutic approaches, including psychotherapy.
This study employed a subsample drawn from a broader research project, whose primary inclusion criteria were being 18 years of age or older, seeking an ayahuasca group for health-related reasons and receiving formal approval from the group leadership. For the selection of the present subsample, a specific secondary inclusion criterion was established, a self-reported history of suicidal ideation or suicide attempts. The final sample consisted of nine adults (five men and four women), aged 28-59 years, all of whom reported beneficial effects of ayahuasca on suicidal tendencies in the parent study. All individuals who were invited agreed to participate.
Before data collection, the research protocol was presented to the leaders of selected ayahuasca groups affiliated with neoshamanic contexts. The objectives of the study were explained, questions were addressed and formal authorization was obtained through a signed agreement. Leaders who agreed to participate were then asked to nominate individuals who had sought the group primarily for healthrelated purposes rather than for religious motivations. Following these procedures, the researchers contacted the nominated individuals by telephone to provide a more detailed explanation of the study, clarify any remaining questions and invite them to participate. Upon agreement, participants received a Google Forms link containing the Informed Consent Form (ICF). After providing consent, they were given access to a self-administered questionnaire covering sociodemographic and mental health information, along with other relevant instruments. Subsequently, individual semi-structured interviews were conducted synchronously using either the Google Meet platform or WhatsApp video calls. Each interview lasted approximately 40 min and was audio recorded with the participants' consent. The interview script, adapted from, consisted of open-ended questions designed to explore the following thematic domains: motivations for ayahuasca use, patterns of use including duration and frequency, health-related experiences both physical and mental, the meaning of the ritual context, the influence of ayahuasca on worldview and spirituality, the concept of healing, and the current evaluation of mental health and quality of life. The questions included: "What led you to seek ayahuasca?"; "How long have you been using ayahuasca?"; "What is the frequency of your ayahuasca use?"; "How have your experiences with ayahuasca been, specifically in relation to health?"; "For you, what is the importance of the ritual context?"; "Has ayahuasca influenced the way you view life?"; "What do you understand by spirituality? Did you have this understanding before ayahuasca?"; "What does healing mean to you? Has ayahuasca influenced this understanding?"; "In your perception, how do you currently evaluate your mental health and quality of life?"; "After your experience with ayahuasca, have you noticed changes in your relationships with others, your worldview and your life experience? How are these aspects currently?"; and "What does ayahuasca mean to you today? Would you like to share anything else on this topic? Is there anything you would like to add to this interview?". During the interviews, which were conducted by the researcher (Santos, N.V.M.), participants spontaneously reported narratives involving suicidal ideation and suicide attempts that preceded the initiation of ayahuasca use, even though no direct or indirect prompts regarding this topic were introduced during the interviews. All interviews were transcribed verbatim for subsequent analysis.
The information gathered from the interviews was transcribed and subjected to content analysis following the steps outlined by. This process included (a) pre-analysis, which involved organizing and skimming the collected material; (b) data exploration, in which results relevant to the study objectives were coded and categorized; and (c) processing of the categorized results, which involved inference and interpretation to identify factors related to the benefits of ayahuasca in mitigating suicidal behavior. Pseudonyms were used in the presentation of the results to preserve participant anonymity.
This study was approved by the Research Ethics Committee (Comitê de Ética em Pesquisa, CEP) of the Federal University of Rondônia (Universidade Federal de Rondônia, UNIR) under protocol number 65444522.6.0000.5300 in 2022. All procedures were conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (World Medical Association, 2013), as well as with Brazilian regulations for research involving human subjects, including Resolution Nº. 466/12 (Conselho Nacional de Saúde, 2012) and supplementary guidelines issued by the National Research Ethics Commission (Comissão Nacional de Ética em Pesquisa, CONEP).
We enrolled nine individuals in the study, most of whom identified as male (5 out of 9; 55%) and resided in the northern region of Brazil. The mean age of participants was 37 years (SD = 10.8), and the mean duration of ayahuasca use was 47 months (SD = 21.9). Most participants identified as Brown (5; 55%), a demographic category used in Brazil to denote individuals of mixed racial backgrounds, including White, Black and or Indigenous ancestry. The Brazilian racial classification is historically shaped and does not correspond to any international standard. Most participants had incomplete higher education (5; 55%), were employed at the time of data collection (7; 77%), and were married (5; 55%). Regarding religious affiliation, 33% of participants identified as Evangelical or Protestant. All participants reported a previous psychiatric diagnosis confirmed by a medical professional, with depression being the most common diagnosis (5 out of 9; 55%), followed by SUD (4 out of 9; 45%). In terms of treatment, 67% of participants were not taking psychiatric medication, while five (55%) were engaged in psychotherapy. Additionally, 55% reported lifetime suicidal ideation that was no longer active, and 45% reported at least one suicide attempt. Ayahuasca use time, reported in months, reflects the self-reported duration of participants' engagement with ayahuasca practices at the time of data collection and indicates considerable variability in individual trajectories of use across the sample (Table). The content analysis of the interview reports enabled the identification of key themes related to participants' experiences with ayahuasca. These themes were organized into three main categories: (a) motivations for seeking ayahuasca, (b) strategies for integrating the ayahuasca experience, and (c) psychedelic experiences and their health benefits.
The thematic category "Motivation for Seeking Ayahuasca" revealed the limitations of conventional therapeutic approaches as a primary catalyst for engagement with the neoshamanic context. Participants reported that, prior to ayahuasca use, they had a history of multiple unsuccessful treatment attempts involving diverse approaches and interventions, including admissions to therapeutic communities, pharmacotherapy and care within public health services. The absence of symptom remission or the perceived worsening of clinical symptoms motivated the search for an alternative form of treatment. The analysis indicated that the nine participants who described clinical deterioration accompanied by suicidal behavior had psychiatric diagnoses of either depression or SUD. It is noteworthy that, following their initial ayahuasca experience, participants reported symptom improvement in depressive conditions, SUD and suicidal ideation, as illustrated in the following statements:
"There was no way out. In 2020, I attempted suicide. I took medication and was even hospitalized, but nothing seemed to help." (João) "I was going through a difficult period. I had experienced depression and had thought about killing myself in 2018. It was at that moment that sheappeared in my life." (Joana) "I felt like I was only a shell, empty inside. There was so much sadness, so much pain, so much anguish. Many times, I would stop. As I crossed the highway on my way to work, I would stop the car and imagine throwing myself in front of the trucks."(Bianca) "I was in a deep process of chemical and alcohol dependence, with suicidal thoughts. That was when I said: I need help. This is the path toward suicide, and I am going to take care of myself". (Gustavo)
The thematic category "post-ayahuasca strategies for strengthening psychological well-being" comprised reports on the resources and practices used to enhance self-care, strengthen social bonds and foster therapeutic environments characterized by acceptance, emotional support and mutual understanding. The analysis of this category identified two main subcategories: group support and therapeutic integration.
Participants emphasized the importance of relationships and group support, with many acknowledging their benefits. Some referred to the group as a "self-help" community, as illustrated in the following statements: And I go to the meeting at that center,for self-help. That's where my treatment takes place. That's my vision" (José); "It's complemented to the work, and it's like Alcoholics Anonymous, but with this great ingredient, ayahuasca." (João); "I see it as a self-help group. The testimonies have helped people a lot. In fact, I know that my testimonial has helped some people." (Bianca); "That self-help groupis therapeutic. It's not just the tea.". Participants emphasized the therapeutic benefits of ceremonies. The care and support offered in ceremonial settings, which promote collective experiences, were identified as essential to facilitating the therapeutic process. "I think that the context of ritualistictreatment is important, thinking from the perspective of what medicine allows you. This thing of looking at yourself, of looking deeper into your internal issues, of understanding traumas. So, the ritualof being in a safe place with people supporting you, giving you help, there to change your bucket, to bring you a bottle of water, or simply, the environment itself […]" (Luiz).
When you are going through a difficult process and you cannot deal with it; there will be people there who will be able to help you." (Maria).
The reports suggest that participants perceived their ayahuasca experiences as contributing to subsequent psychotherapy sessions, enabling deeper engagement with psychological material explored during therapy. These psychotherapy sessions were conducted at moments separate from ayahuasca use and were provided by mental health professionals affiliated with the neoshamanic group. In addition, the group offered a range of therapeutic interventions beyond psychotherapy, which were tailored according to each participant's individualized treatment plan. For example, for individuals with a history of trauma, such as sexual abuse, psychotherapy concurrent with what one participant referred to as "gynecological therapy" was recommended. "the emotion is so strong during the process that we need this help. So, I think this brings this security to be able to be more immersed in the process. […] I consecrate the tea and do the therapy in the same place. […] These are the two therapies (gynecological and psychological) that I always do after the consecration." (Maria). The following qualitative findings illustrate the experience of integrating psychotherapy with ayahuasca use, highlighting how this combination can catalyze insight processes and support the personal and clinical development of participants. "But it is crucial that people seek and do therapy. It is important to have more knowledge about the mind and how it works. Because it is a set of factors and, in one year, everything changed like this, in my life" (Pedro).
"ayahuasca brought me many benefits. I also believe that it was thanks to therapy, the ongoing support, and the knowledge of the people who guided me along this path." (Luiz)
The category "The Psychedelic Experience and Its Health Benefits" is illustrated through reports that explore the holistic health benefits participants experience, encompassing multiple dimensions of wellbeing. This category included the following subcategories: selfknowledge, behavioral and lifestyle changes, and personal and social transformation through ayahuasca use.
The reports in this subcategory emphasize multiple self-knowledge--related benefits perceived by participants following the acute effects of ayahuasca in ceremonial settings. Some participants described processes of self-discovery facilitated by the psychedelic experience, while others emphasized a profound exploration of the self. Overall, participants reported that the experience led to greater self-awareness, a redefined self-image and, ultimately, the development of an improved sense of self, as illustrated below: "And the biggest part that I won back was myself. Because today I can have, let's say, self-knowledge. I can know myself today. Today, I know where it hurts and why it hurts. Today, I can live in peace with myself" (Carla). "And then I started to understand myself, to know who I am. I started to respect people more, to be a better human being, to do what is right, to not procrastinate about things" (Marcos).
"Ayahuasca helped me with that. I understood that it is not about the world understanding me, but about me understanding myself first and only then understanding the world. I must understand myself first, and ayahuasca showed me that. It saved my life." (Marcos)
All participants attended ayahuasca ceremonies regularly, that is, at least once a week, and reported increased awareness of their actions, emotions and thoughts. This heightened awareness was associated with behavioral changes and the pursuit of a healthier lifestyle, consequently contributing to improvements in quality of life and mental health.
improving the mind will improve the body. […] I am focused because tea gives me this strength. Sometimes, I feel demotivated, which is normal for every human being. But when I drink tea, I feel better. I feel more motivated, more inspired to be resilient, to persist and so on" (José).
One participant reported that using ayahuasca reduced marijuana use, which improved her health: "But since my first consecration with ayahuasca, I broke with this excessive use of marijuana and this cycle of crises. I also no longer had the suicidal thoughts that haunted me during the day. This was, undoubtedly, my biggest impact. My diet changed. I was able to balance my diet, exercise, move around, things that were impossible before". (Maria). "I went through a phase when I thought about suicide and made attempts. And after the ayahuasca experience, we come to value life more. We begin to see life as more vivid, you know, because we can understand things that we once thought we would never be able to understand." (Marcos)
This subcategory details the personal and social transformations experienced by participants in ayahuasca ceremonies. It highlights significant changes in their lifestyles, including family relationships, selfcare practices and social norms, and it is precisely this set of changes that enabled these transformations to exert a meaningful influence on their mental health. The statements below illustrate these transformations: "I had to give up music because it was a trigger for other addictions.
"So, I mean, for those who had this thought, today being back with my family, being able to have a home to go to-because I even lived on the streets! -, having a home and a family to take care of, is amazing, something from another world." (João) "I started drawing again, I started writing again, I changed jobs, I started to organize my finances better -right because the money stopped going to other places, so I started to have better financial health. My house started to be cleaner, more organized. So, I also got my libido back.libido in terms of the will to live, right, the pleasure of living. […] A greater serenity to solve things.".
"Ayahuasca helped me with that. I understood that it is not about the world understanding me, but about me understanding myself first and only then understanding the world. I must understand myself first, and ayahuasca showed me that. It saved my life. Even me, a child who was so troubled, who never had a father, who always had a mother with whom living together was difficult, who never fit into the school system or into society's standards… It saved my life!" (Marcos)
This study's findings suggest that participation in naturalistic ayahuasca ceremonies can be linked to mitigation of suicidal thoughts and behavior. These observations point to the possibility of an integrative and complementary role for such practices in addressing complex mental health issues. All participants reported having been diagnosed with either depression or SUD at some point in their lives. Among those with a history of SUD, several described a reduction or cessation in the use of substances such as alcohol, cocaine/crack, and marijuana following their experiences with ayahuasca. Participants with a background of depression reported perceived decreases in anhedonia, as well as improvements in mood, self-esteem, and interpersonal functioning in both personal and professional domains. While exploratory in nature, the findings of our study are consistent with emerging research suggesting that psychedelics may offer therapeutic benefits in the treatment of such conditions. For example, recent research demonstrated the efficacy of ayahuasca in reducing long-term feelings of hopelessness and depression along with enhancing mindfulness, cognitive flexibility, and emotional regulation. Neuroimaging studies further support our findings, indicating that ayahuasca modulates brain activity in regions associated with introspection, mood, and emotional processing. The acute effects of ayahuasca and other psychedelics, encompassing perceptual alterations such as illusions, synesthesias and spatiotemporal distortions, cognitive changes including altered thinking and deepened introspection, and affective effects such as euphoria and emotional intensification, together with subjective experiences of spiritual connection and transformative insights, are increasingly recognized as predictors of positive clinical outcomes. Accordingly, the present results provide further evidence supporting the therapeutic potential of ayahuasca in the treatment of a variety of psychiatric conditions. Our findings indicate that the ceremonies use of ayahuasca may be associated with reductions in depressive symptoms, relief from suicidal ideation, and perceived improvements in well-being among individuals with a history of SUDs. These preliminary observations point to the potential relevance of indigenous ayahuasca-based healing practices as complementary approaches in the broader landscape of psychedelicassisted care, particularly for populations with limited access to formal clinical trial settings. Notwithstanding these findings, it is important to emphasize that ayahuasca may not be uniformly beneficial and has been associated, in some cases, with adverse psychological outcomes. Individuals may experience no therapeutic effect or even a worsening of mental health symptoms, including increased emotional distress or exacerbation of suicidal ideation. Although such outcomes were not reported in the present sample, they have been documented in the broader psychedelic literature, including recent systematic reviews of adverse events associated with classic psychedelics. Importantly, these risks appear to be closely related to contextual and interpersonal factors, such as the quality of preparation, the characteristics of the setting, the availability of social support, and the presence of post-experience integration processes. These elements are discussed in detail in the following sections. Notably, six participants in the study self-identified as Black or Brown, suggesting that the ritualized use of traditional therapies within neoshamanic settings may promote the inclusion of racially marginalized and socioeconomically disadvantaged individuals in emerging therapeutic practices. This dynamic points to a potential democratization of access to psychedelic-assisted care, which has historically been restricted to privileged social groups due to financial barriers and limited accessibility. Another valuable observation from our study is the connection between religiosity and ayahuasca experiences in neoshamanic contexts, as the participant's experiences were influenced by various religious and healing traditions. This finding seems to reflect the central role of religion in Brazilian culture, renowned for its significant religious diversity. The unique form of religiosity of neoshamanic groups may mediate the search for ayahuasca experiences among parts of the Brazilian population, softening moral objections and reducing the stigma traditionally associated with psychedelics. This religiosity may also play a role in facilitating the integration of these experiences into daily life. Further research is needed to explore these religious dynamics and their relationship with ceremonial psychedelic use. The analysis of participants' reports underscores the relevance of post-experience integration and support strategies following ayahuasca use in promoting mental health. This is particularly significant given that the consumption of brew typically occurs in natural settings embedded within social, ceremonial, or ritualistic contexts, often aimed at fostering psychological well-being. Previous studies have shown that individuals involved in ayahuasca groups tend to report improved mental well-being, a finding echoed in our data through participants' emphasis on the importance of group support in their healing processes. Further, our findings align with prior research suggest that the therapeutic benefits of ayahuasca are mediated by a combination of factors, including the availability of social support, the quality of preparation, and the inclusion of complementary therapeutic practices. Additionally, our findings suggest that the motivations and expectations guiding individuals toward ayahuasca use (setpsychological factors), together with aspects of the reception, physical environment, and presence of others (key elements of the settingenvironmental factors), may influence how the experience is subjectively perceived and interpreted. These elements appear to play a meaningful role in shaping the effect of the experience and may be worth considering by the groups that facilitate such practices. While our results resonate with existing literature emphasizing the relevance of set and setting in psychedelic experiences, they should be interpreted within the contextual and methodological boundaries of this study. Moreover, the importance of structured group management, including clear protocols for preparation, monitoring, and integration, has been highlighted in recent research as a potentially valuable approach to promoting safety and positive outcomes in psychedelic contexts. Furthermore, participants reported receiving concurrent therapeutic support in other settings. Five of the participants indicated that they had undergone psychotherapy following their ayahuasca experiences. They claimed that using brew facilitated their understanding of the content explored in conventional psychotherapy. This observation aligns with the findings of, who reviewed the impact of psychedelics on the psychotherapeutic process. Participants' reports suggest that using ayahuasca in a group setting offers advantages when conducted in a safe and properly monitored environment. The importance of a supportive atmosphere, empathetic listening, and interpersonal relationships fostered in these groups was emphasized. When facilitated by a qualified professional, such dynamics can lead to positive therapeutic outcomes. Additionally, the implementation of group-based therapeutic strategies in healthcare has several benefits, including the reduction of costs associated with psychedelic therapy. This financial efficiency increases accessibility to innovative treatments, particularly in developing countries where resources are often limited. The present qualitative findings suggest that participants perceived the ceremonial use of ayahuasca as being associated with improvements in several aspects of their health and well-being. Participants reported advancements in self-knowledge, significant behavioral changes, enhanced lifestyle choices, and better interpersonal relationships. These findings align with previous studies, highlighting the connection between the psychological, social, environmental, and physical aspects of well-being influenced by this experience. Current research suggests that psychedelic experiences facilitate insights into psychosocial, emotional, and spiritual health. When combined with therapeutic processes, they can lead to positive changes in values and behaviors, ultimately improving individuals' overall quality of life. The participants in this study had received treatments available in the conventional biomedical private and public healthcare network prior to their ayahuasca experiences; however, they reported a limited response to these therapies. This finding emphasizes the need for alternative therapeutic approaches, as patients seek improved quality of life and overall well-being. Similarly,found that individuals who died by suicide often had previous hospitalizations in psychiatric services or had received treatment for mood disorders and substance use disorders. These findings indicate a pressing need to implement educational programs addressing these issues within curricula. Moreover, it is crucial to provide health professionals with ongoing education about approaches to suicidal behavior, as current strategies are only partially effective. This care is vital, considering that the history of suicide attempts, especially among those with psychiatric comorbidities, is a significant risk factor for future attempts. This study offers preliminary insights into the possible benefits of engaging with ayahuasca in ceremonial contexts for individuals with a history of suicidal behavior. While not intended as a substitute for clinical interventions, our findings suggest that participation in ayahuasca ceremonies may be experienced as therapeutically meaningful by some individuals. In this regard, the contemporary religious syncretism present in Brazil-particularly through the accessibility of ayahuasca in neoshamanic groups-may provide a context that some individuals perceive as supportive of self-care, especially when conventional treatments have proven insufficient. Further research involving more diverse samples and taking into account the complexity of socio-cultural and ritual contexts is needed to deepen the understanding of this phenomenon. Despite the insights offered, this study has important limitations that should be acknowledged. The small sample size (n = 9) limits the generalizability of the findings and emphasizes the exploratory nature of the research. Additionally, the sampling strategy may have introduced selection bias, as group leaders were responsible for identifying potential participants. This process may have favored the inclusion of individuals with more positive views of ayahuasca or those who had experienced favorable outcomes, potentially excluding more critical or ambivalent perspectives. The study is also subject to response and recall biases, given that the data rely on retrospective self-reports of emotionally significant experiences. Furthermore, because no validated quantitative measures were used, the interpretations are based exclusively on participants' subjective narratives, which may reflect influences unrelated to ayahuasca use itself. Finally, the cross-sectional design may have missed individuals who experienced adverse reactions and subsequently distanced themselves from ayahuasca communities; such individuals are often lost to follow-up in naturalistic studies, potentially contributing to an overrepresentation of perceived benefits. This limitation becomes particularly relevant in light of documented concerns regarding sexual, moral, and financial abuse within certain ayahuasca communities (Dobkin de. Such abuses, often perpetrated by facilitators or leaders, raise critical questions about power dynamics, participant vulnerability, and the silencing of dissenting narratives. These issues have been addressed in recent efforts to develop community-based guidelines for the prevention of abuse in ayahuasca contextsand are also discussed in critical ethnographic and clinical literature (Dobkin de. Together, these concerns underscore the importance of future research adopting ethically sensitive designs capable of capturing a broader range of experiences-including those of individuals who may have been marginalized, harmed, or excluded from these ceremonial networks.
Suicide remains a serious and growing public health concern. Emerging research suggests that psychedelic substances, including ayahuasca, may hold therapeutic potential for individuals experiencing suicidal thoughts and behaviors. Within this context, our findings point to the possibility that community-based use of ayahuasca could contribute to expanding access to supportive care for diverse populations. While more rigorous investigation is needed, such practices may represent an alternative pathway for promoting mental health in settings where conventional resources are limited or inaccessible.
This study highlights how qualitative accounts of ayahuasca use can inform collaboration across psychology, psychiatry, anthropology, and public health. By linking participants' experiences of suicidal behavior with contextual factors such as preparation, setting, and integration, the findings underscore the value of integrating experiential data with clinical assessment and sociocultural analysis. Such approaches may inform the development of safety-oriented practices and more contextsensitive and culturally informed models of mental health care in psychedelic research.
We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper, we present a qualitative study of individuals who frequent ayahuasca-based religions and who reported positive effects on their prior history of suicidal behavior. This is significant because it addresses a possibility that has been scarcely investigated in recent studies on the therapeutic potential of psychedelics. We believe that this manuscript is appropriate for publication by Journal Psychedelics because of its originality and relevance to the field. Our study explores an innovative approach to suicide prevention, analyzing participation in ayahuasquero groups as a self-care strategy accessible to socially vulnerable populations. The results suggest that this practice may be a protective factor against suicidal behavior, presenting a new angle for the prevention and treatment of this complex issue.
Create a free account to open full-text PDFs.
Domínguez-Clavé, E., Soler, J., Pascual, J. C. et al. · Psychopharmacology (2018)
Greenway, K. T., Garel, N., Jerome, L. et al. · Expert Review of Clinical Pharmacology (2020)
Gukasyan, N., Nayak, S. · Preprints (2020)
Hinkle, J. T., Graziosi, M., Nayak, S. et al. · JAMA Psychiatry (2024)
Murphy-Beiner, A., Soar, K. · Psychopharmacology (2020)
Nichols, D. E. · Pharmacological Reviews (2016)
Palhano-Fontes, F., Barreto, D., Onias, H. et al. · Psychological Medicine (2018)
Pasquini, L., Palhano-Fontes, F., Araújo, D. B. · Journal of Psychopharmacology (2020)
Perkins, D., Opaleye, E. S., Simonová, H. et al. · Drug and Alcohol Review (2021)
Perkins, D., Pagni, B. A., Sarris, J. et al. · Frontiers in Pharmacology (2022)
Perkins, D., Ruffell, S. G. D., day, K. et al. · Frontiers in Neuroscience (2023)
Perkins, D., Schubert, V., Simonová, H. et al. · Frontiers in Pharmacology (2021)
Pontual, A. A. D. D., Tófoli, L. F., Corradi-Webster, C. M. et al. · Frontiers in Psychology (2022)
Reiff, C. M., Richman, E. E., Nemeroff, C. B. et al. · American Journal of Psychiatry (2020)
Rodrigues, L. S., Rossi, G. N., Rocha, J. M. et al. · European Archives of Psychiatry and Clinical Neuroscience (2021)
Santos, R. G., Landeira-Fernandez, J., Strassman, R. J. et al. · Journal of Ethnopharmacology (2007)
Soler, J., Elices, M., Franquesa, A. et al. · Psychopharmacology (2015)
Trope, A., Anderson, B. T., Hooker, A. R. et al. · Journal of Psychoactive Drugs (2019)
Zeifman, R. J., Dos Santos, R. G., Sanches, R. F. et al. · Psychopharmacology (2020)
Weissman, C. R., Zeifman, R. J., Yu, D. et al. · Journal of Clinical Psychiatry (2022)