Childhood trauma, challenging experiences, and posttraumatic growth in ayahuasca use

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.

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.