In an online survey of 231 ayahuasca users, self‑reported childhood trauma was not associated with greater challenging experiences during acute ayahuasca effects nor with differences in posttraumatic growth, and acute challenging experiences were not linked to increased posttraumatic growth; this suggests childhood trauma may not predict poorer response to ayahuasca as it does for some other interventions.
Challenging experiences in ayahuasca use, childhood trauma, and posttraumatic growth have not been investigated systematically. This study aimed to explore whether a self-reported history of childhood trauma was associated with challenging experiences during acute ayahuasca effects and whether such challenging experiences were associated with beneficial long-term outcomes measured by posttraumatic growth. For this study, 231 individuals (mean age 40.29, 48% women) completed an online survey about traumatic experiences in childhood, challenges during acute ayahuasca effects, and perceived benefits of those challenges. This study found that people with histories of childhood trauma were not at greater risk of adverse or challenging experiences during acute ayahuasca effects than people without histories of childhood trauma ( r = .080, p = .281, 95% CI [–.066, .223]). Additionally, there was no difference in posttraumatic growth among those who had history of childhood trauma versus those who did not ( r = –.016, p = .837, 95% CI [–.166, .135]). People who have experienced more challenges during acute ayahuasca effects did not experience more ayahuasca-related posttraumatic growth ( r = .137, p = .076, 95% CI [–.014, .281]). These findings are important, as they may indicate that childhood trauma exposure does not pose the same risk for a poor treatment response to ayahuasca, as it predicts in other forms of intervention.
Ayahuasca, a traditional Amazonian plant-based psychedelic, has become increasingly used in Western contexts for mental health and well-being. The introduction notes that challenging acute effects—commonly nausea, vomiting and psychological distress such as anxiety, disorientation or paranoia—are reported by a notable minority of users, and that many Western users seeking ayahuasca have past psychological vulnerabilities. Previous research and theory suggest that prior life adversity, especially childhood trauma and attachment insecurity, can alter psychedelic trajectories: some studies report heightened therapeutic responsiveness, others increased risk of adverse outcomes. Attachment dimensions (anxiety, avoidance, disorganisation) have been linked to differing psychedelic experiences in prior work, and childhood trauma is a known risk factor for adult psychopathology and attachment disruption, making trauma-exposed people a substantial subgroup among ayahuasca users. This study, led by Cassidy and colleagues, aimed to examine two linked questions: whether a self-reported history of childhood trauma is associated with more challenging experiences during acute ayahuasca effects, and whether such challenging experiences are associated with greater long-term perceived benefit operationalised as posttraumatic growth (PTG) related to ayahuasca use. The authors hypothesised that (a) childhood trauma would correlate with more challenging acute effects, and (b) those challenging experiences would be associated with higher ayahuasca-related PTG. Establishing these relationships is positioned as relevant to assessing risks and potential benefits of ayahuasca among trauma-exposed, high-needs populations.
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This was a cross-sectional online survey study conducted via Qualtrics, recruiting participants between 9 November and 6 December 2021. Recruitment targeted online forums and networks (Reddit, Facebook, Twitter, LinkedIn), ayahuasca-related organisations and community newsletters; participants self-selected into the study. Inclusion criteria were age 18 or older and having taken ayahuasca at least once with a noticeable effect. No direct payment was offered; participants could choose a charity to receive an anonymous donation as indirect compensation. Measures comprised a demographics questionnaire (age, race/ethnicity, gender, education, income, psychiatric diagnoses, medication and psychotherapy history, lifetime substance use, and number of ayahuasca experiences), the Childhood Traumatic Events Scale (CTES) to assess exposure to trauma before age 17 across six event types (sum of event types used in analysis), the Challenging Experiences Questionnaire (CEQ; 26 items) to measure the intensity of challenging phenomena during or immediately after a psychedelic experience, and a modified Post-Traumatic Growth Inventory (relabelled a-PTGI) to capture perceived positive changes attributed to ayahuasca experiences. The CEQ total ranges from 0 to 130 and the a-PTGI from 0 to 105; specific item wording was adjusted to emphasise ayahuasca-related changes. Procedure involved informed consent followed by the questionnaires, optional provision of an email for study results or future contact, and provision of crisis support contact details at the end of the survey. The Institutional Review Board of The New School deemed the study exempt from review. For analysis, data were cleaned for duplicates, invalid or implausible responses. Primary analyses began with bivariate correlations to test associations between CTES and CEQ, and between CEQ and a-PTGI. Further, hierarchical regression models examined whether demographic, diagnostic and treatment history variables altered associations among the key variables. The authors report that the effective sample size varied across analyses due to missing data; exact per-analysis sample sizes are provided in the results where available.
Of N = 343 survey starters, N = 231 participants completed the survey and met inclusion criteria; 160 participants completed all measures and items. The mean age was 40.29 years (SD = 10.76). The sample was predominantly white (77%), non-Hispanic (79%), heterosexual (75%), and 48% identified as women. Educational and income distributions were skewed toward higher levels (32% had a bachelor's degree; 28% reported annual income above 75,000). Most participants (47%) reported a history of depression and 41% reported anxiety; 89% reported no current psychiatric medication use and 74% were not currently in psychotherapy. Lifetime substance use was frequent, with alcohol (98%), caffeine (96%), cannabis (90%) and hallucinogens (87%) most commonly reported. Most respondents (97%) reported using ayahuasca/yage therapeutically; frequency of ingestion varied from a single use (14%) to over 100 times (6%), with 35% reporting two to five ingestions. Childhood trauma and acute/post-acute ayahuasca experiences: 83% of respondents reported at least one type of traumatic event before age 17, with a mean of 2.03 event types (SD = 1.49) on the CTES. On the CEQ (N = 181 respondents), the mean total score was 69.59 (SD = 25.2) out of 130; the most commonly endorsed items included crying (reported to some degree by 90%), awareness of heart beating (81%) and emotional/physical suffering (79%). On the a-PTGI (N = 170), the mean total score was 90.84 (SD = 27.25) out of 105; the most frequently reported area of growth was improved understanding of spiritual matters (endorsed by 96%). Hypothesis testing: Bivariate correlations showed no significant relationship between childhood trauma (CTES) and challenging experiences (CEQ) (r = .080, p = .281, 95% CI not clearly reported in the extracted text), nor between CTES and a-PTGI (r = - .016, p = .837). The correlation between CEQ and a-PTGI approached but did not reach conventional significance (r = .137, p = .076, 95% CI [-.014, .281]). Additional findings included a positive correlation between number of childhood traumatic event types and number of self-reported psychiatric diagnoses (r = .319, p < .001). Number of ayahuasca ingestions correlated positively with a-PTGI (r = .288, p < .001) and with CEQ (r = .226, p < .003). Participants currently in psychotherapy reported less posttraumatic growth (t(168) = 3.61, p < .001); being in therapy was not associated with number of challenging experiences. Regression analyses: The authors constructed hierarchical models to control for demographics (model 1), diagnoses (model 2), treatment variables (model 3) and childhood trauma (model 4). For a-PTGI, model 3 (which included psychotherapy and psychotropic medication use) accounted for significant variance; current engagement in psychotherapy was negatively associated with a-PTGI. A self-reported bipolar diagnosis was associated with less reported growth in one model, but the overall model did not account for significant variance. Adding childhood trauma did not explain additional variance in a-PTGI. For CEQ, age and income were associated with higher CEQ scores in model 1 (younger participants and those with higher income reported more challenging experiences), but the overall model was not significant and subsequent additions (diagnoses, treatment variables) did not change the non-significant pattern. When limiting covariates to those previously associated with CEQ or a-PTGI (age, income, bipolar diagnosis, in psychotherapy), adding CEQ explained significant additional variance in a-PTGI, although the CEQ coefficient itself only approached significance. The authors note that many small associations did not survive correction for multiple comparisons; the negative association between current psychotherapy and posttraumatic growth remained the most robust finding.
Cassidy and colleagues interpret their findings as indicating that self-reported childhood trauma, measured as the number of trauma types on the CTES, was not associated with increased risk of challenging experiences during or immediately after ayahuasca ingestion as measured retrospectively by the CEQ. This non-association persisted after adjustment for demographic, diagnostic and treatment variables. By extension, the authors suggest that childhood trauma may not predispose people to worse immediate experiences with ayahuasca, nor to greater or lesser ayahuasca-related posttraumatic growth compared with people without childhood trauma history. The discussion situates these null findings within prior literature that reports mixed relationships between adversity, attachment, and psychedelic outcomes. The authors note small associations seen for other variables: a history of bipolar disorder and current engagement in psychotherapy were associated with lower self-reported posttraumatic growth, older age with fewer challenging experiences, and higher income with more challenging experiences, but most of these associations were small and did not survive multiple-comparison correction. The observed negative relationship between being in therapy and reported growth is highlighted as potentially meaningful and deserving of further study. Cassidy and colleagues also point to the possibility that challenging acute experiences may be related to later growth in particular subgroups (for example, those not in psychotherapy or older participants), noting that the CEQ–a-PTGI correlation approached significance and that larger samples may detect effects that this study could not. Several methodological limitations are acknowledged that constrain interpretation: reliance on retrospective self-report susceptible to recall and selection biases, inability to infer causality, lack of assessment of adverse outcomes beyond the immediate ingestion period or of benefits beyond PTG, limited sample diversity, and insufficient power to examine differential effects of specific trauma types. The authors further note the absence of measures of integration practices, attachment orientation and dissociative symptoms, each of which may moderate psychedelic trajectories or better capture unintegrated trauma. Finally, they identify potential protective or facilitating contextual factors—such as ritualised community settings exemplified by the Santo Daime tradition—that may influence both reduced psychopathology and successful integration, and thereby affect outcomes. The authors conclude that future research should recruit more diverse samples, assess integration and attachment, distinguish trauma types, and employ prospective designs to clarify mechanisms linking challenging psychedelic experiences and longer-term growth or harm.
The study concludes that, in this sample, a history of childhood trauma was not associated with greater acute or immediate challenging experiences during ayahuasca use, nor with differences in ayahuasca-related posttraumatic growth. Similarly, having experienced challenging ayahuasca sessions was not associated with greater posttraumatic growth in the aggregate analyses. While longer-term risks and benefits were not assessed, the authors suggest these data do not indicate that ayahuasca is immediately more distressing for people with childhood trauma histories. Planned future work will examine attachment as a predictor of psychedelic outcomes and investigate integration and memory reconsolidation as potential mechanisms for successful posttraumatic growth following psychedelic use.
Descriptive statistics for all variables were carried out. Data were checked for outliers, duplicates, and invalid responses. All invalid and duplicate data points were manually removed along with random, straight-line, and abnormally fast responses. As a first analysis, bivariate correlation analyses were used to explore the relationships between childhood trauma exposure (CTES) and the occurrence of challenging experiences after ayahuasca ingestion (CEQ) and between challenging experiences after ayahuasca ingestion (CEQ) and the level of perceived benefit of the challenging ayahuasca experiences (a-PTGI). Following bivariate correlations, we examined the association between key study variables after accounting for demographic and treatment histories.
This study primarily aimed to explore the relationships between childhood trauma and challenging experiences during or immediately following ayahuasca ingestion. Our data revealed that the total number of types of traumatic events during childhood as measured by the CTES was not correlated with challenging experiences during acute ayahuasca effects as measured retroactively with the CEQ. This relationship was not modified by accounting for a host of demographic or treatment variables. Even though childhood trauma might theoretically render people more vulnerable to having adverse experiences during ayahuasca effects, we did not find that to be the case. This may mean that people with histories of childhood trauma are not at greater risk of adverse or challenging experiences during the influence of ayahuasca as compared to people without histories of childhood trauma. This finding may also indicate that people with histories of childhood trauma do not necessarily derive more benefit from ayahuasca use than people without childhood trauma history, nor do they appear to experience immediate difficulties at a higher rate. These findings are important, as they may indicate that childhood trauma exposure does not pose the same risk for a poor treatment response to ayahuasca as it predicts in other forms of intervention. A few variables were associated with lower posttraumatic growth: history of a diagnosis of bipolar disorder and current engagement in psychotherapy. The latter finding suggests the possibility that the psychological benefit of ayahuasca is most present among people who are not otherwise engaging in mental health supports. Older age was related to fewer challenging experiences with ayahuasca, whereas higher income was associated with more challenging experiences. However, most of these associations do not withstand correction for multiple comparisons, and the effect sizes were small, but as the study was not designed to specifically test these demographics in relation posttraumatic growth or challenging experiences, conclusions should be tempered. Only current engagement in therapy survives correction for multiple comparisons. We provide these interpretations as they may be useful avenues for investigators. This study also aimed to investigate challenging experiences during acute ayahuasca effects and long-term outcomes expressed in either posttraumatic growth or, potentially, re-traumatization and worsening of symptoms. Our findings are consistent with some studies that have found a correlation between such challenign experiences and post-traumatic growthwith some studies indicating the contrary. While the correlation we report was not significant, the magnitude of the effect size suggests that larger studies may yield positive results in the relationship between challenging experiences and posttraumatic growth. In our sample, an association was only evident after accounting for variables such as treatment history, diagnoses, and demographic factors, such that the association was more evident among participants who were not in current psychotherapy and who were older. Encountering problematic psychological material is often viewed as a beneficial and learning opportunity; in a recent study by, the extent to which participants were able to constructively engage with experiences of shame or guilt during psilocybin effects was predictive of well-being 2-4 weeks after the experience. This ability may be correlated with the psychological maturity of the person and their experience with psychedelics, with the most experienced and adaptable users potentially benefiting from challenging experiences most. Integration plays a pivotal role in psychedelic outcomes and assessing integration could be helpful in identifying psychedelic-related factors leading to posttraumatic growth. Interestingly, people who used ayahuasca in the framework of the Santo Daime movement scored significantly lower on psychopathology measures compared to controls or the general populationwhich may be the result of a specific ritualized community setting that provides the right conditions for successful integration. On the other hand, as previously discussed, the ayahuasca experience could induce the reexperiencing of traumatic event which, without successful integration, can result in worsening of distress and loss of function. In our study, currently being in psychotherapy had negative relationship with posttraumatic growth which may corroborate the potential re-traumatization explanation. The most important limitations of this study which may have affected the validity and generalizability of the findings include its reliance on retrospective self-reporting with lower reliability and validity of autobiographical memory, proneness to selection and recall biases, and inability to establish a true causal relationship. Further, the study did not examine adverse effects beyond the immediate ingestion period, or benefits besides posttraumatic growth. Future studies of this kind should attempt to recruit more intersectionally diverse samples including race, economic resources, sexual orientation, and gender compared to this predominantly heterosexual, white Caucasian sample, especially given our findings demonstrating age and income differences. Our study was not powered to examine the effects of different types of adversity on the phenomenology of acute ayahuasca effects, so future studies also need to address the potential difference between the types of experienced trauma and their implications for challenging psychedelic experiences. Another limitation was that this study did not explicitly assess whether participants had integration opportunities after their psychedelic experiences, which may be an important factor that needs to be addressed in future studies, nor did we measure participants' attachment orientation. Dissociative symptoms were not assessed in this study and, potentially, could have better captured the level of unintegrated trauma because dissociation is often blocking access to the traumatic event. Interestingly, no correlation has been seen between self-reported traumatic events and dissociative symptoms. Self-reported dissociative symptoms, therefore, could have had a more direct relationship with ayahuasca-related adverse events compared to self-reported traumatic events-future studies need to address this.
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