Psychedelic Identity Shift: A Critical Approach to Set And Setting
This analysis of the therapeutic frameworks used in psychedelic-assisted treatment (for smoking cessation specifically) finds that suggestions from the framework map onto outcomes (and the language used by participants) from the study. This has broader implications for psychedelic-assisted therapy, as suggestions (in the therapeutic framework) can be used for various purposes (positive and negative).
Authors
- Albert Garcia-Romeu
- Matthew Johnson
- Neşe Devenot
Published
Abstract
While the literature on psychedelic medicine emphasizes the importance of set and setting alongside the quality of subjective drug effects for therapeutic efficacy, few scholars have explored the therapeutic frameworks that are used alongside psychedelics in the lab or in the clinic. Based on a narrative analysis of the treatment manual and post-session experience reports from a pilot study of psilocybin-assisted treatment for tobacco smoking cessation, this article examines how therapeutic frameworks interact with the psychedelic substance in ways that can rapidly reshape participants' identity and sense of self. We identified multiple domains relating to identity shift that appear to serve as smoking cessation mechanisms during psilocybin sessions, each of which had an identifiable presence in the manualized treatment. As psychedelic medicine becomes mainstream, consensual and evidence-based approaches to psychedelic-assisted identity shift that respect patient autonomy and encourage empowerment should become areas of focus in the emergent field of psychedelic bioethics.
Research Summary of 'Psychedelic Identity Shift: A Critical Approach to Set And Setting'
Introduction
Psychedelics re-emerged in clinical research after decades of prohibition and are now being investigated for rapid, sustained effects on mood, anxiety, and addiction. Prior work highlights the importance of set (mindset) and setting (context) and links intense subjective experiences—often described as mystical-type or ego-dissolving—to therapeutic benefit. However, the literature and popular accounts frequently underplay the distinct therapeutic frameworks, manuals, and behavioural techniques that accompany dosing in clinical trials, reducing treatment to a drug plus generic ‘‘supportive’’ context. The authors argue this omission obscures how psychotherapy and preparatory materials can shape the phenomenology of psychedelic sessions and thereby influence outcomes. This article examines that interaction by comparing the treatment manual used in a Johns Hopkins open-label pilot of psilocybin-assisted smoking cessation with 43 written session narratives produced by the study's 15 participants. Ahmad and colleagues aim to identify how explicit therapeutic techniques—particularly cognitive behavioural therapy (CBT)-derived modules, guided imagery, and mnemonic devices—may prime identity change during psilocybin sessions. They further situate these observations in relation to PRIME theory from the smoking-cessation literature and to neuroethical debates about interventions that alter personality or selfhood, arguing that psychedelic-assisted identity shift warrants focused ethical and empirical attention as the field scales up.
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Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- Authors
- APA Citation
Devenot, N., Seale-Feldman, A., Smith, E., Noorani, T., Garcia-Romeu, A., & Johnson, M. W. (2022). Psychedelic Identity Shift: A Critical Approach to Set And Setting. Kennedy Institute of Ethics Journal, 32(4), 359-399. https://doi.org/10.1353/ken.2022.0022
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Pronovost-Morgan, C., Greenway, K. T., Roseman, L. · Nature Medicine (2025)
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Argyri, E. K., Evans, J., Luke, D. et al. · SSRN (2024)
Turkia, M. · Psyarxiv (2023)
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