Reported effects of psychedelic use on those with low well-being given various emotional states and social contexts
Natasha L. Mason, Patrick C. Dolder and Kim P.C. Kuypers
Drug Science, Policy and Law, 2020, Volume 6, 1–11.
Doi : 10.1177/2050324519900068
Background : It has been suggested that the outcome of the psychedelic experience is dependent on set and setting. While scientific research into the therapeutic potential of psychedelics is growing, it is clear that in clinical populations an optimal set and setting will not always be attainable. It was aimed to assess under which emotional and environmental circumstances psychedelic users use psychedelics, and the outcome of use given clinical characteristics, defined as low well-being and higher rates of neuroticism.
Methods : Online respondents (N¼1967) provided information about their psychedelic use, environment they consume the substance in (setting), and mood state pre/post-substance (set). Based on subjective mental well-being, respondents were separated into two groups, those with low (N¼643), and those with normal well-being (N¼1324). Personality traits, with a particular focus on neuroticism, were also assessed.
Results : Findings showed that psychedelics such as lysergic acid diethylamide and psilocybin were most commonly used at home and methylenedioxymethamphetamine (MDMA) in a party/festival setting. In most instances, all substances were used when individuals were in a positive mood, and this remained in general positive, or, when not initially positive, shifted to positive, after use. Individuals with low well-being were more likely to experience a positive mood change after use of lysergic acid diethylamide, psilocybin or MDMA than individuals with normal well-being. Furthermore, as neuroticism scores increased, so did likelihood of positive mood change, as well as likelihood of experiencing negative side effects.
Conclusion : It is demonstrated that psychedelics are used in varying emotional states and environmental settings. Importantly in the light of future clinical studies with patients, individuals with low psychological well-being and higher scores of neuroticism report consuming such substances with positive outcomes.
Keywords : personality, psychedelics, set, setting, well-being
Psychedelic drugs are a class of substances including classic psychedelics, like lysergic acid diethylamide
(LSD), psilocybin, and dimethyltryptamine (DMT) found in ayahuasca, and empathogens, like methylene-dioxymethamphetamine (MDMA). When ingested, they induce profound altered states of consciousness including acute alterations in perception and cognition, and amplified emotional states (Preller and Vollenweider, 2018). Currently, there is a renewed interest in the use of psychedelics in the treatment of certain psychiatric conditions (Carhart-Harris et al., 2016; Carhart-Harris and Goodwin, 2017; Mithoefer et al., 2018; Sessa, 2014). Specifically, recent clinical studies have suggested that LSD (Gasser et al., 2014), psilocybin (Carhart-Harris et al., 2016), ayahuasca (Palhano-Fontes et al., 2018), and MDMA (Mithoefer et al., 2011, 2018) can provide therapeutic relief for those suffering from post-traumatic stress disorder, anxiety, and depression. Importantly, nonpharmacological factors, termed set and setting, have been suggested to mediate the long-term (therapeutic) effects of these substances (Eisner, 1997; Haijen et al., 2018; Hartogsohn, 2017; Kaelen et al., 2018; Leary et al., 1963; Metzner and Leary, 1967).
Set refers to the internal state of the individual taking the substance, including mood, expectations,
intentions, and pre-existing psychological factors, and setting refers to the physical and social environment the substance is taken in (Leary et al., 1963). Previous research with psychedelics suggests that the acute substance experience can be highly influenced by these non-pharmacological factors; studies have suggested that the outcome of the experience can be mediated by trait personality factors (Barrett et al., 2017; Haijen et al., 2018; Studerus et al., 2012), pre-existing psychological well-being (Studerus et al., 2012), mood state prior to substance intake (Studerus et al., 2012), and exposure to highly clinical, experimental settings (Studerus et al., 2012) and music (Kaelen et al., 2018).
With the renewed interest in the use of psychedelics in the treatment of these psychiatric conditions (Carhart-Harris et al., 2016; Carhart-Harris and Goodwin, 2017; Mithoefer et al., 2018; Sessa, 2014), it is important to define the most optimal circumstances for administration of these substances. Specifically, as psychiatric populations are often characterized by low psychological well-being and higher traits of neuroticism (Kotov et al., 2010; Saklofske et al., 1995), two set factors previously suggested to negatively impact the psychedelic experience (Barrett et al., 2017; Studerus et al., 2012), it is important to establish whether psychedelics are still a suitable therapeutic option, not leading to negative mood or (more) negative, unwanted effects. Although current clinical trials are small, including only a small number of highly selected/ screened individuals, there is a wealth of information to be gained from recreational users, who report using the substance in various emotional and environmental circumstances, and for a number of different (therapeutic) reasons (Kettner et al., 2019; Mason and Kuypers, 2018).
The present study was therefore designed to assess under which emotional (set) and environmental (setting) circumstances psychedelic users use such substances, and the outcome of use, per substance, given clinical characteristics, namely low psychological wellbeing and higher traits of neuroticism (Kotov et al., 2010; Saklofske et al., 1995). Psychedelic users were asked what setting they usually used the substance in, and were asked what mood (set) they were in prior to, and after, substance intake. In order to assess outcome of use in individuals with clinical characteristics, respondents’ were divided into normal well-being and low well-being groups, dependent on their World Health Organization (WHO)-5 well-being index score.
Furthermore, personality traits, with a particular focus on neuroticism, were assessed and compared between groups. This study is part of a larger questionnaire, which has previously been published elsewhere (Kettner et al., 2019; Mason and Kuypers, 2018).