LSD selectively increased social adaptation to others’ opinions when those opinions were similar to one’s own, accompanied by increased medial prefrontal cortex activity during social feedback. Pretreatment with the 5‑HT2A antagonist ketanserin abolished these effects, implicating stimulation of 5‑HT2A receptors in LSD’s modulation of social feedback processing and behaviour.
Adapting one’s attitudes and behaviors to group norms is essential for successful social interaction and, thus, participation in society. Yet, despite its importance for societal and individual functioning, the underlying neuropharmacology is poorly understood. We therefore investigated its neurochemical and neural correlates in a pharmacological functional magnetic resonance imaging study. Lysergic acid diethylamide (LSD) has been shown to alter social processing and therefore provides the unique opportunity to investigate the role of the 5-HT2A receptor in social influence processing. Twenty-four healthy human volunteers received either (1) placebo + placebo, (2) placebo + LSD (100 µg), or (3) the 5-HT2A receptor antagonist ketanserin (40 mg) + LSD (100 µg) at three different occasions in a double-blind, randomized, counterbalanced, cross-over design. LSD increases social adaptation but only if the opinions of others are similar to the individual’s own. These increases were associated with increased activity in the medial prefrontal cortex while participants received social feedback. Furthermore, pretreatment with the 5-HT2A antagonist ketanserin fully blocked LSD-induced changes during feedback processing, indicating a key role of the 5-HT2A system in social feedback processing. Our results highlight the crucial role of the 5-HT-system in social influence and, thus, provide important insight into the neuropharmacological basis of social cognition and behavior.
Adapting one's attitudes and behaviours to group norms is central to social interaction, yet the neuropharmacology underpinning social influence processing in humans is poorly understood. Previous neuroimaging work has implicated frontal regions and reward circuitry, including the medial prefrontal cortex (mPFC) and ventral striatum, in responses to mismatches between personal and group opinions. While dopamine and oxytocin have been linked to aspects of social adaptation, the role of the serotonin (5-HT) system—particularly the 5-HT2A receptor—remains unclear. Classic psychedelic lysergic acid diethylamide (LSD) acts at multiple serotonin and dopamine receptor subtypes and is known to alter social cognition and brain connectivity, offering a pharmacological tool to probe 5-HT2A contributions to social influence. Duerler and colleagues set out to test whether LSD modulates behavioural adaptation to group opinion and the neural processes that support it, and whether any LSD effects depend on 5-HT2A receptor stimulation. They used a double-blind, randomised, placebo-controlled, within-subject crossover design to compare placebo, LSD (100 µg), and ketanserin (40 mg, a selective 5-HT2A antagonist) pre-treatment followed by LSD. The main behavioural metric was the Weight of Advice (WOA) score, which quantifies change toward a presented group norm; functional MRI (fMRI) was used to identify brain regions whose activity during social feedback and decision-making was altered by LSD and by ketanserin pre-treatment.
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Design and participants: This was a double-blind, randomised, placebo-controlled, within-subject crossover study with three experimental sessions separated by at least two weeks. Twenty-five healthy volunteers were recruited and screened for medical and psychiatric health; one participant was excluded for excessive head motion, leaving 24 subjects (18 males, 6 females; mean age 25.25 years, SD = 3.72) in the analyses. Exclusion criteria included current or past psychiatric disorders, substance dependence, certain medical conditions, left-handedness, poor German, MRI contraindications and prior significant adverse reactions to hallucinogens. Drug conditions and timing: Each participant received, across sessions, (1) placebo + placebo (Pla), (2) placebo + LSD (100 µg oral), and (3) ketanserin (40 mg oral) + LSD (100 µg oral). The pretreatment capsule (placebo or ketanserin) was given 60 minutes before the second capsule (placebo or LSD). The social influence paradigm was administered during fMRI acquisition 330 minutes after the second capsule. Subjective effects were assessed with the 5D-ASC and PANAS questionnaires; the 5D-ASC was administered 720 minutes after dosing to capture retrospective altered-state effects. Behavioural task (Social Influence Paradigm, SIP): While in the scanner participants rated street-art pictures for aesthetic quality on a 0–100 scale (initial rating R1). After each R1, a group rating (FB), presented as the average of 70 prior participants and algorithmically shifted relative to R1, was shown to create three conflict conditions: No Conflict (NC), Low Conflict (LC), and High Conflict (HC). Participants then provided a second rating (R2). Each condition was presented 20 times per session for a total of 60 trials, across two runs. The primary behavioural outcome was the Weight of Advice (WOA) score, defined as the absolute change from R1 to R2 divided by the absolute distance between R1 and FB; WOA ranges from 0 (no adaptation) to 1 (full adjustment), with values >1 indicating movement beyond the group norm. fMRI acquisition and analysis: Events (picture presentation, R1, FB, R2) were modelled as blocks and convolved with a canonical hemodynamic response function. FB and R2 events were categorised into NC, LC, and HC. First-level contrasts computed per subject and treatment included HC > LC, HC > NC and LC > NC for both FB and R2. Group-level contrasts compared Pla, LSD and Ket + LSD using paired t-tests. Analyses focused on five pre-specified regions of interest (ROIs) implicated in social influence: mPFC, lateral orbitofrontal cortex (OFC), inferior frontal gyrus, right nucleus accumbens, supplementary motor area (SMA) and precuneus. Small volume correction (SVC) with 10-mm spheres around published MNI coordinates was applied, and peak-level familywise error (FWE) correction was used at p < 0.05. Behavioural data (R1 and WOA) were analysed via repeated-measures ANOVA with treatment and condition as within-subject factors; significant effects were followed by corrected pairwise comparisons. Exploratory Pearson correlations probed relationships between WOA change (Pla–LSD) and personality measures (NEO-FFI Big Five and Social Responsibility Scale subscales). Results from subjective measures are reported in supplementary material but were summarised as showing ketanserin blocked LSD subjective effects.
Subjective effects: Retrospective measures indicated that ketanserin fully blocked LSD-induced subjective effects assessed with the 5D-ASC and PANAS (detailed figures reported in supplementary material). Initial ratings (R1): A repeated-measures ANOVA showed a significant main effect of treatment on initial picture ratings (F(2,142) = 6.12, p < 0.01). Pairwise comparisons (Bonferroni-corrected) indicated significant differences between LSD and Pla, and between LSD and Ket + LSD; Pla and Ket + LSD did not differ significantly. Weight of Advice (WOA): A treatment × condition repeated-measures ANOVA revealed a significant interaction (F(2,46) = 4.47, p < 0.05). Sidak-corrected contrasts showed that in the Low Conflict (LC) condition participants adapted more under LSD than under Pla (p = 0.01). Within the LSD session, adaptation was greater in LC than in High Conflict (HC) (p = 0.01). There was no significant LC vs HC difference within the Pla condition (p = 0.1). No further significant between- or within-treatment differences survived correction. fMRI—Placebo condition: Under placebo, the HC > LC contrast during feedback elicited greater BOLD in mPFC (MNI x = -3, y = 47, z = 25), SMA, right nucleus accumbens and precuneus (all p < 0.05 FWE after SVC). HC > NC during feedback showed greater SMA activity, and HC > NC during R2 showed increased activity in the angular gyrus. fMRI—Placebo vs LSD: Comparing Pla to LSD for HC > LC during feedback, Pla produced greater mPFC BOLD (x = 0, y = 59, z = 19). Conversely, LSD produced greater mPFC activity for LC > NC during feedback (x = -9, y = 62, z = 25). There were no significant treatment differences during the decision-making phase (R2). Extracted beta values from the mPFC ROI indicated main effects of drug (F(2,94) = 5.02, p < 0.01) and condition (F(2,94) = 3.89, p < 0.05) and a drug × condition interaction (F(4,188) significant at p < 0.005). Simple effects showed an increase from LC to HC in Pla (p < 0.001) and an increase from NC to LC in LSD (p < 0.001). fMRI—Ket + LSD vs LSD: For HC > NC during feedback, Ket + LSD produced higher BOLD than LSD in lateral OFC, inferior frontal gyrus and nucleus accumbens (p < 0.05 FWE after SVC). For LC > NC during feedback, LSD showed greater mPFC and inferior frontal gyrus activation (p < 0.05 FWE after SVC). For HC > NC during R2, Ket + LSD showed higher medial and lateral OFC activity compared to LSD. fMRI—Ket + LSD vs Placebo: No significant differences were observed between Ket + LSD and Pla in any contrast after SVC correction. Correlations with personality: A significant negative Pearson correlation was observed between Neuroticism (NEO-FFI) and the LSD-induced change in WOA (Pla–LSD) (r = -0.55, p < 0.01), indicating greater adaptation after LSD in participants with higher neuroticism. A positive correlation was found between the SRS subscale "Fulfilling Expectations" and WOA change (r = 0.45, p < 0.03), and Neuroticism and Fulfilling Expectations were negatively correlated (r = -0.455, p < 0.03). No significant correlations were found between extracted beta values and personality traits or WOA within individual treatment conditions.
Duerler and colleagues interpret their results as evidence that LSD selectively increases adaptation to others' opinions when those opinions are similar to one's own, and that this effect is linked to altered processing in the mPFC during social feedback. Behaviourally, LSD enhanced Weight of Advice in Low Conflict but not in High Conflict situations, suggesting that LSD does not produce a blanket increase in suggestibility; instead, it appears to intensify adaptation to relatively concordant group norms. Neurally, under placebo high-conflict feedback engaged mPFC, SMA, ventral striatum and precuneus—regions previously associated with conflict detection and social influence—whereas LSD shifted mPFC responsiveness toward low-conflict feedback, consistent with a change in how self-relevance or value is assigned to group opinions. The authors propose a mechanistic account in which LSD-induced modulation of self-relevance processing and a loosening of self–other boundaries increases the subjective value of opinions similar to one's own, via mPFC alterations, thereby promoting adaptation when disagreement is modest. In high-conflict situations, by contrast, LSD may reduce sensitivity to social punishment or exclusion—processes that ordinarily motivate conformity—resulting in less adaptation under strong disagreement. Pharmacologically, ketanserin fully blocked LSD-induced mPFC changes during feedback processing and abolished subjective LSD effects, implicating the 5-HT2A receptor in social feedback processing. Changes in social decision-making (the R2 phase), however, were differentially affected by ketanserin and involved OFC and other regions; the authors therefore suggest that decision-making aspects of social influence may be mediated by other neurotransmitter systems, possibly dopamine, given LSD's broader receptor affinity and prior literature linking dopamine to decision processes. Personality appeared to moderate LSD effects: higher baseline Neuroticism was associated with larger LSD-induced increases in adaptation, and lower scores on the SRS "Fulfilling Expectations" subscale predicted greater adaptation after LSD. The investigators note that stimulation of 5-HT2A receptors can attenuate negative affect and fear and enhance openness and empathy, which might disproportionately affect individuals with higher neurotic traits. These personality–effect relationships were presented as exploratory and in need of replication. Limitations acknowledged by the study team include the absence of pharmacological blockade of non-5-HT2A receptors that LSD also engages, the lack of a ketanserin-only condition to isolate ketanserin effects, and the absence of a non-social control task to determine specificity of the observed effects to social contexts. The authors conclude that their data point to a central role for 5-HT2A receptor stimulation and mPFC activity in LSD-modulated social feedback processing, and that social decision-making may involve additional neurotransmitter systems. They suggest these findings are relevant to understanding the neurobiology of social cognition and may have implications for psychedelic-assisted therapeutic approaches under investigation.
participants. Participants were recruited through advertisements placed at local universities and underwent a screening visit before inclusion into the study. All included subjects were healthy according to medical history, physical examination, blood analysis, and electrocardiography and had normal or corrected-to-normal vision. The Mini-International Neuropsychiatric Interview (MINI), the Diagnostic and Statistical Manual of Mental Disorders, fourth edition self-rating questionnaire for Axis-II personality disorders (SCID-II), and the Hopkins Symptom Checklist (SCL-90-R)were used to exclude subjects with present or previous psychiatric disorders or a history of major psychiatric disorders in first-degree relatives. Volunteers were included when they were between 20 and 40 years of age and willing to abstain from the use of any prescription or illicit drug for a minimum of 2 weeks before the first test day and for the duration of the entire study, and to abstain from drinking alcohol for at least 24 h before test days. Urine tests were used to verify the absence of drug and alcohol use and to exclude pregnancy. Participants were furthermore required to abstain from drinking coffee during the test day and to abstain from smoking for at least 60 min before MRI assessment. Further exclusion criteria included cardiovascular disease, history of head injury or neurological disorders, history of alcohol or drug dependence or abuse, left-handedness, poor knowledge of the German language, MRI exclusion criteria including claustrophobia, and previous significant adverse reactions to a hallucinogenic drug. The initial study population consisted of 25 participants. One participant was excluded due to excessive head movement during scanning (> 3 mm) at the third assessment (Pla). Therefore, the final sample consisted of 24 participants (n = 18 males and 6 females; mean age (M) = 25.25 years; standard deviation (SD) = 3.72 years) which were included in the statistical analyses. Before participating, all participants provided written informed consent after having received detailed written and oral descriptions of the study procedures, as well as details regarding the effects and possible risks of the substances administered in accordance with the declaration of Helsinki. The current data were collected as part of a larger study. The study was approved by the Cantonal Ethics Committee of Zurich (KEK) and the Swiss Federal Office of Public Health (BAG), Bern, Switzerland, authorized the use of LSD in humans. The study was registered at clinicaltrials.gov (NCT02451072). No substantial side effects were recorded during the study. Four participants reported transient mild headaches after drug effects had worn off. One participant reported transient sleep disturbances for the first two nights after drug administration. Participants were contacted again three months after the last drug administration. No further side effects were recorded. Study design and procedure. At the screening visit participants completed the NEO-FFIand the SRSto assess personality traits. The Big Five personality traits Extraversion (M = 3.81, SD = 0.52), Agreeableness (M = 3.92, SD = 0.76), Conscientiousness (M = 4.01, SD = 0.84), Neuroticism (M = 1.66, SD = 0.68) and Openness to Experience (M = 4.01, SD = 0.74) as well as the SRS questionnaire which comprises two subscales fulfilling expectations (M = 4.80, SD = 0.44) and adherence to social rules (M = 3.89, SD = 0.58) were assessed. This study employed a double-blind, randomized, placebo-controlled, within-subject design with three experimental sessions, each separated by at least 2 weeks. At the beginning of each experimental session before drug administration a urine test for drug-screening and pregnancy test was conducted. Each participant received either: (1) placebo + placebo (Pla) condition: placebo (179 mg Mannitol and Aerosil 1 mg po) after pretreatment with placebo (179 mg Mannitol and Aerosil 1 mg po) (2) placebo + LSD (LSD) condition: LSD (100 μg po) after pretreatment with placebo (179 mg Mannitol and Aerosil 1 mg po) (3) ketanserin + LSD (Ket + LSD) condition: LSD (100 μg po) after pretreatment with the 5-HT2A antagonist ketanserin (40 mg po). 60 min after pretreatment with the first capsule (placebo or ketanserin) the second one (placebo or LSD) was administered. The social influence paradigm was conducted 330 min after second drug administration while undergoing the MRI acquisition. To assess the subjective experience after drug intake, the 5D-ASC (a retrospective self-report questionnaire)was administered to participants 720 min after drug treatment. Mood state was assessed using the PANAS. Participants completed the PANAS 10 min before pretreatment with placebo or ketanserin and 720 min after treatment with placebo or LSD to retrospectively rate mood state at the time of peak subjective effects. For details and assessment of subjective effects, see Supplementary Methods.
Subjective effects. Detailed results of subjective drug effects assessed with the Altered States of Consciousness (5D-ASC) questionnaire and the Positive and Negative Affect Schedule (PANAS) questionnaire are reported in the supplementary material (Supplementary Results, Figs.and). In summary, all LSD-induced subjective drug effects were blocked by ketanserin.
This study presents strong evidence for the impact of LSD on social influence processing and social decisionmaking and its underlying neuropharmacology by combining pharmacological manipulations with behavioral and neuroimaging methods. Our results show that (1) LSD increases the adaptation to the opinion of others, but only if they are similar to one's own. This was associated with BOLD signal changes in the mPFC. () LSD modulates the mPFC in particular during social feedback processing. (3) Social feedback processing may be dependent on the 5-HT 2A receptor system as LSD-induced effects were blocked by ketanserin, while social decision-making may be modulated by other receptors. (4) The magnitude of LSD-induced changes in social adaptation is associated with personality factors. LSD increases social adaptation to opinions similar to one's own. In line with previous studiesprocessing highly conflicting social feedback was associated with increased BOLD signal in the mPFC, SMA, ventral striatum, and the precuneus under placebo. Differences in behavioral adaptation towards the group norm between high and low conflict conditions did not reach statistical significance in the Pla condition. However, in the LSD condition participants showed an increased adaptation to the group norm in the LC compared to the HC condition. When comparing the BOLD response between treatment conditions, the BOLD signal was increased in the mPFC in response to HC vs. LC in the Pla condition. In contrast, in the LSD condition BOLD signal in the mPFC was increased in response to LC feedback compared to NC, but not in the HC condition. These results are in line with a previous studyreporting that LSD increases suggestibility, but extends these findings by showing that LSD does not induce general increases in social adaptation, but specifically intensifies adaptation to opinions that are similar to the individual's own. The reason for this may be that LSD induces changes in self-relevance processing, potentially leading to an increase in assigned value to opinions which are not in high conflict. At the same time, the need to adapt to avoid social punishment may be diminished in the LSD conditionexplaining a lower adaptation when opinions are in high conflict. Several studies have linked the mPFC to behavior change during exposure to group norm or persuasive messages and posited that this relationship is due to self-related processing via subjective value assignment. Furthermore, previous studies have identified the mPFC as a key region for the integration of reward-, self-, and mentalizing processes during social feedback processing. The integration of information about value in relation to the self has been suggested to be key for attitude or behavior change. Yet, the mPFC cortex has also been associated with salience processing. However, it has been shown that the mPFC consists of several anatomically and functionally distinct regions. While salience processing has mostly been associated with regions such as the dorsal anterior cingulate cortex, the anterior mPFC-overlapping with the regions showing changes in BOLD signal under LSD in this study-has been associated with feedback-related surprise. As previous findings have shown that LSD alters sensitivity to surprising stimulifuture studies are needed to investigate whether the effects observed here are specific to social feedback processing or also occur in a non-social context. Furthermore, the anterior part of the mPFC has been associated with assigning personal significance to stimuli. The serotonin system has been implicated in value-based decision-making. Importantly, LSD has been shown to induce alterations in self-relevance processingand a LSD-induced loosening of self-other boundaries was associated with changes in social interaction. We therefore propose that LSD alters the computation of value assigned to a group norm via increased processing of self-relevance in the mPFC when participants are exposed to opinions not conflicting too much with their own. When opinions of others are similar to one's own they may be processed as more valuable and more self-relevant due to LSD-induced loosening of self-other boundaries. This may lead to a subsequent behavior change towards more adaptation to the group norm when social conflict is low. In the HC condition however, the perception of the discrepancy between one's own and the group norm may cause cognitive dissonance. The dissonance induced by strong disagreement with the group norm elicits a negative tension state and may induce feelings of social rejection. The avoidance of social punishment is one of the main motives for humans to be socially conform. Participants who are more sensitive to social exclusion are more likely to adapt their behavior to fit in with others. Furthermore, it has been shown that avoidance of social punishment has an effect on conformity behavior even in the absence of a social punishment stimulus. This may explain why participants adapt their opinion more strongly to the group norm in the placebo condition when exposed to high conflict. However, the motivation to avoid social rejection or punishment may be diminished in the LSD condition because other studies have linked stimulation of the 5-HT 2A receptor to reduced reaction to social exclusion and social pain. Therefore, the need to conform to avoid social punishment may have been reduced in the LSD condition leading to less adaptation when exposed to highly conflicting opinions. LSD modulates the mpfc during social feedback processing. The paradigm employed in this study allowed to measure changes in BOLD signal during two time points associated with different cognitive processes: (1) while participants received social feedback and (2) when they subsequently rated the stimuli (social decision-making). Our fMRI data reveal that LSD-induced changes in BOLD signal in the mPFC in the LC condition occurred during social feedback processing and not during social decision-making. Therefore, LSD seems to increase adaptation to other persons' opinions due to alterations in feedback processing rather than social decision-making. This is in line with our interpretation outlined above suggesting that LSD changes the value assigned to the opinions of others via alterations in self-relevance processing associated with alterations in activity in the mPFC. Social feedback processing may depend on the 5-HT 2A receptor system. LSD-induced changes in the mPFC during social feedback processing were fully blocked by the 5-HT 2A receptor antagonist ketanserin. Furthermore, no differences in BOLD signal were found between Pla and Ket + LSD during feedback processing. This indicates that LSD-induced changes in social feedback processing depend on the 5-HT 2A receptor system. Regarding social decision-making, our fMRI data showed that Ket + LSD compared to LSD increased the BOLD signal in the medial OFC extending into the mPFC and the lateral OFC. Ketanserin blocked LSD-induced 5-HT 2A receptor stimulation, however LSD has affinity at various serotonin and dopamine receptorsand animal studies showed that dopamine receptor stimulation may contribute to the effects of LSD. It is therefore conceivable that these changes in brain activity during social decision-making are modulated via dopamine rather than 5-HT systems, in particular since previous results have implicated the dopamine system in decision-making processes. Our results are also in line with previous findings showing that decision-making is a cognitive domain not influenced by stimulating the 5-HT 2A receptor. Therefore, social feedback processing and socially influenced decision-making are potentially modulated by two different neurotransmitter systems, i.e. the 5-HT 2A and potentially the dopamine system respectively. the magnitude of LSD-induced changes in social adaptation is associated with personality. Our results show a negative correlation between the Big Five personality trait Neuroticism and LSDinduced adaptation to social norms. Neuroticism is characterized by a tendency to experience negative affect and is associated with psychiatric diseases such as depression and anxiety disorders. Participants with higher scores in Neuroticism show a greater change from Pla, i.e. they adapt more strongly after LSD administration. As outlined above, stimulation of the 5-HT 2A receptor has been shown to attenuate negative emotion and fear processing, while at the same time enhancing empathy, heightening positive moodand leading to increases in the personality trait openness. LSD may therefore have a particularly strong impact on participants with a tendency to negative and anxious affect, perhaps by reducing these feelings and rendering them more open to social interaction and the opinions of others. Yet, we show that LSD increases social adaptation in particular when the conflict with the group norm is low, and that reduced rejection sensitivity may prevent participants from adapting their opinions to strongly differing group norms. However, in participants with high baseline neuroticism and anxiety this latter effect may be diminished or not strong enough to overcome fear of rejection resulting in increased adaptation across conflict conditions. Furthermore, we found a positive correlation between the personality trait "Fulfilling Expectations" and LSD-induced changes in social adaptation. Participants with lower scores adapted more strongly after LSD. Additionally, "Fulfilling Expectations" was negatively correlated with Neuroticism. It is therefore conceivable that LSD has the strongest impact on social cognition in participants who show low sociability and high Neuroticism before administration, potentially by increasing empathy and decreasing anxiety. However, given the exploratory nature of this analysis, these results need replication in future studies.
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