Compared with 30 attendees of peer‑support groups, 30 people who had taken ayahuasca scored lower on the Present Feelings Scale of the Texas Revised Inventory of Grief and showed benefits on some psychological and interpersonal measures. Qualitative reports described emotional release, recall of biographical memories and experiences of contact with the deceased, providing preliminary evidence that ayahuasca may have therapeutic potential in grief treatment.
The death of a loved one is ultimately a universal experience. However, conventional interventions employed for people suffering with uncomplicated grief have gathered little empirical support. The present study aimed to explore the potential effects of ayahuasca on grief. We compared 30 people who had taken ayahuasca with 30 people who had attended peer-support groups, measuring level of grief and experiential avoidance. We also examined themes in participant responses to an open-ended question regarding their experiences with ayahuasca. The ayahuasca group presented a lower level of grief in the Present Feelings Scale of Texas Revised Inventory of Grief, showing benefits in some psychological and interpersonal dimensions. Qualitative responses described experiences of emotional release, biographical memories, and experiences of contact with the deceased. Additionally, some benefits were identified regarding the ayahuasca experiences. These results provide preliminary data about the potential of ayahuasca as a therapeutic tool in treatments for grief.
Grief after the death of a loved one is a near-universal human experience that can include shock, numbness, difficulty accepting the loss, bitterness, identity disturbance, and problems moving forward. When grief symptoms persist for at least 6 months with significant functional impairment they are described as prolonged grief disorder (PGD). Conventional interventions for uncomplicated bereavement—pharmacotherapy, counselling, peer-support groups and psychotherapies—have shown limited empirical support in systematic reviews, even though peer-support groups are often valued by bereaved people for enabling memory-sharing, reducing isolation, and addressing spiritual issues. Individual responses to loss vary widely depending on factors such as personality, attachment, number and type of losses, social support, health and cultural identity, which motivates exploration of additional therapeutic tools for bereavement care. This study, led by Gonzalez and colleagues, set out to explore the potential effects of ayahuasca on grief. Specifically, the researchers compared people who had used ayahuasca during their grieving process with people who had attended peer-support groups, using standardised measures of grief and experiential avoidance plus an open-ended question to capture participants' subjective accounts of ayahuasca-related experiences. The aim was to generate preliminary data on whether ayahuasca experiences might influence grief severity and related psychological and interpersonal domains, and to identify salient experiential themes that could inform future therapeutic protocols.
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The researchers conducted a mixed-methods, cross-sectional study using an online survey platform. Recruitment targeted two groups: people who used ayahuasca during grieving (recruited via ICEERS' blog) and people who attended peer-support groups (recruited via social media pages of bereavement organisations and by pencil-and-paper collection at one hospital-based peer group). The survey was available in Spanish and English. Eligibility required loss of a first-degree relative (spouse, parent, child or sibling) within the preceding 60 months. To increase homogeneity, participants with very low scores on the TRIG Past Feelings Scale below the minimum observed in the ayahuasca group were excluded. Individuals with >25% incomplete answers were also excluded. After exclusions, the sample comprised 60 participants: 30 in the ayahuasca group and 30 in the peer-support group. Measures included a bespoke General Characteristics Bereavement Questionnaire (30 closed questions and one open-ended question for the ayahuasca group about how ayahuasca influenced grief), the Texas Revised Inventory of Grief (TRIG) with Past and Present Feelings subscales to assess grief level, and the Acceptance and Action Questionnaire-II (AAQ-II) to assess experiential avoidance. The study protocol received ethics approval and participants provided informed consent. Quantitative analyses were performed in SPSS 15.0. Group comparisons used t tests or Mann–Whitney U tests for continuous variables and chi-square or Fisher's exact tests for categorical variables, with p < .05 considered significant. Qualitative data from the single open-ended question were analysed using directed content analysis. Two authors coded independently, identified meaning units, condensed and grouped them into subthemes and themes using both inductive and deductive steps, and resolved disagreements by consensus. Units were counted at the respondent level to avoid weighting longer narratives more heavily; the qualitative dataset yielded 180 independent meaning units and eight participants reported aspects from more than one ayahuasca experience.
Sixty participants met inclusion criteria (30 ayahuasca; 30 peer-support). Demographic characteristics were comparable between groups; no significant differences emerged for age, sex, university degree or religion. Time since death did not differ significantly (ayahuasca: mean 33.17 months, SD 18.64; peer-support: mean 28.10 months, SD 20.87; p = .224). The reported number of significant losses was similar (ayahuasca mean 2.93, SD 2.20; peer-support mean 3.00, SD 1.82; p = .887). Within the ayahuasca group, the mean number of ayahuasca sessions judged by participants to have direct relevance for their grief was 6.07. Intentionality regarding grief varied: 60% (18/30) took ayahuasca with the intention of addressing grief, 20% were unsure and 20% reported that grief-related content emerged spontaneously. Most ayahuasca participants (83.3%) judged their ayahuasca experience to have had a very positive influence on their grieving process; the remainder (16.7%) rated it as positive. Peer-support participants reported a mean duration of group attendance of 12.18 months (SD 9.5); 56.7% rated this as having a very positive influence and 43.3% as positive. On outcome measures, the Present Feelings subscale of the TRIG showed a statistically significant difference favouring the ayahuasca group (p < .001), indicating a lower current level of grief in that group. The AAQ-II (experiential avoidance) did not differ between groups (p > .05). When participants were asked about psychological and interpersonal dimensions influenced by the intervention, the ayahuasca group reported greater perceived benefits on multiple items: preoccupations with thoughts and memories (p < .01), ability to forgive oneself and others (p < .05), self-conception (p < .01), re-coding life history (p < .01), ability to make sense of life (p < .01), and integration of a transcendental dimension of life and death (p < .01). The extracted text does not clearly report the means and standard deviations for TRIG or these item-level comparisons, only the p values and direction of effects. Qualitative analysis of responses from the ayahuasca group identified two overarching themes: the content of the ayahuasca experience and the benefits related to grief. Within content, subthemes were emotional release, biographical memories, contact with the deceased, and miscellaneous experiences (e.g. purging). Almost all respondents who answered the open question (22 of 23) described an emotional dimension to their experience; about one-third (8/23) described confrontation with grief and suffering. Biographical memory re-experiencing was reported by several participants (6/23) and was described as enabling new meaning-making about personal history. Notably, over half of respondents (15/23) reported direct experiences of contact with the deceased—communication, farewells, or sensing the deceased's presence—which participants linked to resolution of unfinished issues or renewed connection. Reported benefits clustered into six subthemes: positive feelings (acceptance, tranquillity, gratitude), forgiveness and family healing, reorganisation of identity and sense of self, changes in internal representation of the deceased with maintenance of connection, changes in global beliefs (spiritual or existential shifts), and personal growth. Participants provided narratives of profound change, including redefined relationships with the deceased (e.g. viewing the deceased as a spiritual guide), increased self-understanding, and valuing relationships and life in new ways. The qualitative dataset included isolated reports of archetypal visions and one reported psychosomatic improvement (e.g. resolution of chest pain), categories that emerged inductively from the narratives.
Gonzalez and colleagues interpret these findings as preliminary evidence that ayahuasca use during bereavement may be associated with lower current grief (TRIG Present Feelings) and with perceived improvements on psychological and interpersonal domains that matter in grief processes. The investigators note that both groups had similar initial grief (Past Feelings) yet differed on Present Feelings, suggesting a potential role for ayahuasca-related experiences in promoting adaptive regulation of grief. The authors relate the qualitative themes to established therapeutic models. Emotional confrontation under ayahuasca is compared with exposure-based and imaginal revisiting techniques used in grief therapy, while re-experiencing of autobiographical material is likened to narrative and constructivist approaches that aim to integrate life history and reaffirm attachment. Experiences of contact with the deceased are discussed in terms of attachment theory and the continuing bonds construct; such encounters were seen by participants to resolve unfinished business and to foster new internal representations of the loved one, processes the authors link to components of successful grief interventions and to posttraumatic or stress-related growth. Physiological and psychopharmacological mechanisms are also discussed. The paper summarises relevant pharmacology: Banisteriopsis caapi provides beta-carbolines with monoamine oxidase–inhibiting properties and Psychotria viridis supplies DMT, a 5-HT2A agonist implicated in antidepressant and anxiolytic effects and in neuroplasticity (including sigma-1 receptor activation). Gonzalez and colleagues suggest that pharmacological effects, together with ceremonial context (music, ritual), may contribute to therapeutic outcomes. The authors caution about risks and practical considerations. They note reported cases of crisis arising from lack of integration frameworks, the potential for aversive psychological reactions under DMT that can be distressing if not integrated, the absence of clear contraindications with certain clinical diagnoses, cardiovascular concerns (increase in diastolic blood pressure), and interactions with other serotonergic substances. Given these issues, the researchers argue that any clinical model incorporating ayahuasca should consider screening, medical precautions, and structured integration support. Limitations acknowledged by the authors include the cross-sectional, retrospective design that precludes causal inference; small, self-selected and heterogeneous samples; group differences in relationship to the deceased and causes of death (for example, more child losses and violent deaths in the peer-support group) that may influence traumatic grief; recruitment of participants from different populations which may limit comparability; reliance on self-report instruments rather than clinical interviews or formal PGD assessment; and likely positive-response bias in the qualitative sample. The investigators call for longitudinal, randomised, placebo-controlled trials with larger and more homogeneous samples to evaluate causality and generalisability and to develop refined, ethically and medically safe intervention protocols.
The study provides preliminary evidence that people who used ayahuasca during bereavement reported lower levels of current grief (TRIG Present Feelings) than a peer-support comparison group, and that ayahuasca experiences often contained elements—emotional confrontation, autobiographical review, and contact with the deceased—that participants perceived as facilitating adaptation and posttraumatic growth. Gonzalez and colleagues conclude these findings can inform future research and the development of controlled, ethically framed intervention protocols, but emphasise the need for longitudinal and randomised trials to establish efficacy and safety.
Quantitative data analysis. The data were analyzed using the SPSS 15.0 statistics package. Results are presented as means and percentages. Differences between groups were analyzed using a t test in the case of continuous variables (or Mann-Whitney U test) and using a 2 test for categorical variables (in some cases Fisher's test). A value of p < .05 was considered statistically significant. Qualitative data analysis. Qualitative data from the only open-ended question generated a rich amount of data. These data were analyzed with qualitative content analysis. We used directed content analysis-the deductive use of existing theory or prior research to better understand a previously explored phenomenon and establish key concepts or variables as initial coding categories-to validate or conceptually extend a theoretical framework. The first and second authors analyzed the qualitative data from the questionnaires independently. The analysis was performed in several steps. First, the text was read several times, and text relevant to the research was marked. Meaning units were then identified, condensed, and grouped together into subthemes and themes through an inductive and deductive approach. Thus, units were counted at the level of the respondent, so that participants who provided longer written narratives were not given more weight in the analyses. Throughout the analysis, themes and subthemes were discussed between the authors to ensure the results were interpreted as objectively as possible. Any differences were discussed until a consensus was reached. This method leads to a deeper understanding of the results by allowing us to identify the most relevant aspects of the ayahuasca experience. It is important to note that eight participants mentioned aspects from more than one experience with ayahuasca that related to their grief process. Finally, we identified n ¼ 180 independent meaning units across participants' responses.
This is the first study to explore the therapeutic potential of ayahuasca in grieving processes. The findings from this study indicate that people who used ayahuasca reported lower level of grief than people who attended a peer-support group. This result stems from the fact that although both groups were comparable in the level of grief at the moment of death, the level of grief presented in the Present Feelings scale (TRIG) was lower in the ayahuasca group. Also, a significantly greater proportion of ayahuasca participants reported direct benefits on some of the psychological and interpersonal dimensions that are central to grief processes. In this discussion, we elaborate on these findings in terms of the relevant theories, empirical research in the field, and protocols for manuals of treatment, while highlighting the clinical implications of the qualitative results and the theoretical models to which they relate. The scores concerning the Past Feelings scale from the Revised Inventory of Grief are within the range of scores obtained by other studies. Nevertheless, when we compare our results obtained from the Present Feelings scale with those originally obtained by, the peer-support group scored within normal range, while the ayahuasca group scored above this range. Therefore, we questioned how the griever can best get out of this state, as the adaptive model of grief suggests. The adaptive model of grief is focused on identifying key personal growth aspects despite complications. Variables such as positive changes in selfperception, closer family and interpersonal relationships, ability to make sense of the world or a richer existential and spiritual life have been identified as important domains of posttraumatic growth. Our study found differences regarding the impact of both resources (ayahuasca and peer-support group) on self-conception, ability to forgive others, ability to make sense of life, as well as to integrate a transcendent dimension. It is possible that the differences found in these variables might have impacted the scores obtained from the questionnaire. The fact that the peer-support group presented a higher percentage of loss of children, and a higher presence of deaths by homicide, traumatic death and younger age of the deceased did not influence the ability for personal growth. The qualitative analysis of the experiences with ayahuasca reveals that emotional confrontation with the reality of loss is a common experience in the bereaved, including in those who avoided connecting with their feelings. However, despite the pain and sadness that can be felt under the acute effects of ayahuasca, this type of experience often leads to feelings of peace and acceptance of the death. Emotional confrontation is at the heart of the majority of the contrasted models in grief intervention, utilizing techniques such as imaginal revisiting, exposure, retelling the narrative of the death, or written disclosure. Through these techniques, patients are exposed to the most difficult internal pictures, or cognitions, surrounding the death of their loved ones. These techniques are used in order to process the loss at an emotional and cognitive level, promoting mastery of difficult material. Consequently, it increases recognition of the reality of the loss and reduced intrusive memories. Nevertheless, in our accounts, we also find the description of experiences in which the emotional burden of the loss is transferred to an archetype, or is purged, partly relieving this grief. These types of experiences provide a psychosomatic therapeutic value that has not been described by any therapeutic models to date. However, beyond reliving the traumatic experience of the moment of death, several participants mentioned recalling memories they had forgotten or experiencing autobiographical reviews that allowed them to understand specific episodes from another point of view. This type of experience could facilitate the redefinition of their relationship with the deceased and of their own life history. Constructivist grief therapy seeks this same result using biographical techniques, such as narrative writing. Through these techniques, ''significant life chapters'' are captured, where one can trace strands of consistency between the life of the patient and the deceased, in order to reaffirm secure attachment. Furthermore, according to autobiographical memory theorists, the way we compose our life stories is closely related to the way we understand ourselves. Thus, the reconstruction of one's life history can prevent the consolidation of internal, stable and global attributions, in which the trauma will be related to stable characteristics of the self that pertain across situations. Our results reflect this type of process, since most people who recount experiences of biographical memories also allude to experiencing a change in their own identity. As we have seen, under the effects of ayahuasca, people can feel confronted with their emotions and reorganize their identity recalling their biographical memories, not being exclusive categories within the same experience. In either case, these experiences lead to the revitalization of an adaptive regulatory process for the mourner, just as the dual process model predicts. Although this model introduces a dichotomous concept such as that of oscillation, it takes into account the natural fluctuation that occurs in the grieving process between loss-oriented coping (such as crying about the deceased or yearning for the person) and restoration-oriented coping (such as developing new identities). With the aim of accompanying this process, modules for narrative reconstruction have recently begun to be included in the cognitive behavioral therapy protocols. Thus, in addition to the emotional confrontation that exposure to the traumatic memory involves, the experience facilitates its integration into the individual's life history, including psychodynamic references to the subjective personal meaning of the event for the patient, associated with their past experiences. However, it is possible that the greatest therapeutic impact of ayahuasca comes from the experiences of contact with the deceased, as they promotes a new representation of the loved one and facilitate maintenance of the bond through the establishment of a new relationship. This type of experience has also been described in a case of grief resolved spontaneously under an altered state of consciousness induced with ketamine. Attachment theoryand the construct of continuing bondsare an underlying component of bereavement and an important element of coping with the grief. Furthermore, these experiences permit the resolution of outstanding issues, such as saying goodbye to the loved one or communicating matters that were left unsaid. Unfinished business is thought to be one possible manifestation of difficulties in the continuing bond, being one prominent risk factor for developing PGD and lowered meaning made of the loss. For this reason, various forms of imaginal psychotherapeutic dialogues with the deceased have been incorporated into the cognitive behavioral therapy protocols, in the constructivist model, through the writing of letters to the deceasedor in integrative cognitive behavioral therapy, through the empty chair technique.has identified including confronting painful aspects and allowing reconciliation and integration of the new and changed relationship to the bereaved among the ''ingredients'' of successful intervention of grief therapy. The benefits obtained through the experiences of grief with ayahuasca are similar to those described in cases of posttraumatic growthor stress-related growth. These terms refer to positive psychological change that goes beyond adaptation, and it is an experience of improvement that for some people is deeply profound. For this reason, based on the model of growth in the context of griefand in the theory of shattered assumptions (Janoff-Bulman's, 2010), constructivist therapy has developed a meaningoriented approach to grief therapy to reaffirm or reconstruct a world of meaning that has been challenged by loss. The benefits discovered in our reports, such as acceptance, changes in identity, changes in global beliefs, personal growth, changes in family bonds, valuing relationships and spirituality, are ways of bringing meaning to stressful life experiences. However, as far as our knowledge reaches, other benefits such as forgiveness of oneself, or of others, as well as the change in the internal representation of the deceased, have been scarcely described in the literature as such. Several studies of Western people who have used ayahuasca show that these types of benefits are common after experiences with ayahuasca, especially those related to changes in the way one relates to oneself or promoting ''self-acceptance,'' feeling more loving and compassionate in their relationships, gaining a new perspective on life and spiritual development. Furthermore, we cannot ignore that ayahuasca is a natural compound that has antidepressant and anxiolytic effects mediated by the agonist action of DMT on 5-HT 1A/2A/2C receptors (Dos. In addition, the intake of ayahuasca is usually carried out as part of a ritual or ceremony where the use of music and singing is common. Performing a ritual that symbolizes the passage from one phase to another, as well as the use of music therapy, is also beginning to be incorporated into more current treatment protocols. However, despite these benefits, there are risks to be considered when planning a therapeutic model for grief with ayahuasca. First, several cases have been described of crises caused by the lack of a theoretical model or worldview that supports the integration of these experiences. Additionally, the active component of ayahuasca, DMT, is capable of inducing aversive psychological reactions that resolve spontaneously in a few hours. Such experiences can be traumatic if not properly understood and integrated. Secondly, there is a lack of knowledge about clinical diagnoses with which ayahuasca could be contraindicated. Thirdly, ayahuasca increases diastolic blood pressure, so extreme caution should be taken in those suffering from cardiovascular problems or diseases that may affect the heart. Finally, potential adverse health effects can be derived from the use of ayahuasca in combination with other serotonergic substances. Nevertheless, we believe that if the risks mentioned above are considered, new treatment protocols for grief where ayahuasca is integrated as a therapeutic tool could be successful.
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