Shame, guilt and psychedelic experience: Results from a prospective, longitudinal survey of real-world psilocybin use
This prospective, longitudinal study (n=679) examined the effects of psilocybin use on emotional experiences, particularly feelings of shame and guilt. The study found that while most participants had positive experiences with psilocybin, acute feelings of shame or guilt were common (68%), and the ability to work through these feelings positively correlated with well-being in the weeks following use. On average, psilocybin resulted in a small but significant decrease in trait shame, which was maintained for 2-3 months after use, though in a minority of participants (30%), trait shame increased.
Authors
- Matthew Johnson
- Albert Garcia-Romeu
- Sandeep Nayak
Published
Abstract
Introduction
The classic psychedelic psilocybin has attracted special interest across clinical and non-clinical settings as a potential tool for mental health. However, despite increasing attention to challenging psychedelic experiences, few studies have explored the relevance of emotionally painful, shame-related processes with psychedelic use.
Methods
This prospective, longitudinal study involved sequential, automated, web-based surveys that collected data from 679 adults planning to use psilocybin in naturalistic settings at timepoints before and after psilocybin use. State and trait shame and feelings of guilt were collected using validated measures and assessed alongside other measurements of psychological health.
Results
Participants were primarily college-educated, White individuals residing in the United States with a prior history of psilocybin use; mean age = 38.9-41 years. Most users (89.7%) described their experience of psilocybin as positive, though acute feelings of shame or guilt were commonly reported (i.e., 68.2% of users) and difficult to predict. Ratings of participant ability to constructively work through these feelings predicted wellbeing 2-4 weeks after psilocybin use. Psilocybin on average produced a small but significant decrease in trait shame that was maintained 2-3 months after use (Cohen’s dz = 0.37; adjusted p <0.001). Trait shame increased in a notable minority (29.8%) of participants.
Discussion
The experience of self-conscious emotions with psychedelics has been explored minimally, but further study in this area may have far-reaching implications for psychological health. The activation of shame-related experiences with psychedelics may pose a unique and context-dependent learning condition for both therapeutic and detrimental forms of shamerelated memory reconsolidation.
Research Summary of 'Shame, guilt and psychedelic experience: Results from a prospective, longitudinal survey of real-world psilocybin use'
Introduction
Classic psychedelics such as psilocybin produce profound shifts in affect, perception and cognition, and individuals often characterise these shifts as deeply meaningful. Earlier literature has documented a spectrum of psychedelic experiences from intensely positive to psychologically challenging, and scholars have debated whether difficult experiences reflect modifiable contextual factors (set and setting) or user vulnerability. Despite growing attention to challenging affects such as fear and grief, comparatively little research has examined shame and guilt in the context of psychedelic experiences, even though these self-conscious emotions are implicated in a wide range of psychological disorders and have distinct appraisals and behavioural tendencies (shame involving a negative view of the self, guilt involving appraisal of a specific wrong). The introduction also distinguishes state-shame (acute, context-specific) from trait-shame (a more stable predisposition), noting that both may be relevant to outcomes after psychedelic use but have been underexplored empirically. Mathai and colleagues set out to address this gap using data from a larger prospective, longitudinal online survey of naturalistic psilocybin use. Their specific aims were to: 1) characterise acute shame and guilt experienced during psilocybin sessions and identify general predictors of those experiences; 2) test whether acute shame or guilt and the ability to process them predict wellbeing 2–4 weeks later; and 3) examine whether trait shame (measured with the External and Internal Shame Scale) changes after psilocybin use over a 2–3 month window. The authors framed the study as exploratory but focused on whether acute self-conscious emotions may be activated by psilocybin and whether their processing relates to longer-term psychological outcomes.
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Study Details
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- APA Citation
Mathai, D. S., Roberts, D. E., Nayak, S. M., Sepeda, N. D., Lehrner, A., Johnson, M. W., Lowe, M. X., Jackson, H., & Garcia-Romeu, A. (2025). Shame, guilt and psychedelic experience: Results from a prospective, longitudinal survey of real-world psilocybin use. Journal of Psychoactive Drugs, 1-12. https://doi.org/10.1080/02791072.2025.2461997
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