Participants’ Experience of Psychedelic Integration Groups and Processes: A Qualitative Thematic Analysis

Abstract

Background:

Psychedelics such as psilocybin, lysergic acid diethylamide, and 3,4-methylenedioxymethamphetamine are increasingly recognized for their potential therapeutic benefits in treating complex and chronic mental health conditions. Growing public interest in psychedelics may drive increased consumption outside of medically supervised clinical trials. Correspondingly, legality issues and potential risks of unregulated use underscore the need for structured aftercare support, including psychedelic integration groups, to reduce harm potential.

Methods:

This study utilized a cross-sectional, observational, online, anonymous survey with 65 participants who used psychedelics and attended psychedelic integration groups. Participants provided qualitative data on their experiences via open-ended questions. Employing a deliberate analytic strategy, responses were subsequently analyzed using thematic analysis to identify key patterns and themes.

Results:

Three primary themes and associated subthemes emerged from the data: (1) reasons for attending psychedelic integration groups, (2) utility of psychedelic integration groups, and (3) adverse factors influencing participants’ experience of the group.

Discussion:

The study underscores the therapeutic potential of psychedelic integration groups in providing essential community support and facilitating the processing of psychedelic experiences. However, it also highlights significant challenges, such as managing group dynamics and ensuring facilitators are adequately trained. These findings suggest that while integration groups can mitigate some risks associated with psychedelic use, research is needed to optimize their structure and effectiveness. Specifically, future studies should explore the development of standardized protocols and facilitator training programs to enhance the safety and efficacy of these groups. This research is crucial to inform policy and practice, ensuring that individuals seeking integration support and aftercare following psychedelic use have access to well-designed and delivered interventions.

Introduction

Psychedelics are a class of psychoactive compounds known to induce profound alterations in perception, mood, and cognitive processes.¹ Classical psychedelics include 4-phosphoryloxy-N,N-dimethyltryptamine (psilocybin), lysergic acid diethylamide (LSD), and N,N-dimethyltryptamine (DMT). Additionally, nonclassical psychedelic compounds such as ketamine, a dissociative anesthetic, and 3,4-methylenedioxymethamphetamine (MDMA), an entactogen, are often grouped with these substances due to their psychoactive effects and hypothesized therapeutic potential.² Positive outcomes associated with psychedelic use may include beneficial changes in emotional processing,³ enhanced self-compassion,⁴ and increased psychological flexibility.⁵ For years, psychedelics have been utilized in various nonmedical contexts, including “underground” or “retreat” therapeutic practices,⁶ spiritual ceremonies,⁷ and recreational environments.⁸ However, increased public and scientific interest in psychedelics largely stems from their potential therapeutic benefits in the treatment of complex mental health conditions, including treatment-resistant depression,^9,10 anorexia nervosa¹¹ and post-traumatic stress disorder (PTSD).¹²

The medical application of psychedelics involves the adjunct delivery of psychological support or psychotherapy.^13,14 This approach encompasses preparatory and integration sessions, providing guidance and a structured framework for leveraging the potential therapeutic effects of psychedelics.¹⁵ Despite the growing interest, psychedelics remain illegal in most countries.¹⁶ However, the acceleration of psychedelic research has led to increased media coverage, spurring public interest in their therapeutic utility.¹⁷ Correspondingly, concerns have been raised about potential harm to individuals accessing unregulated psychedelic retreat centers or self-administering psychedelics for mental health issues.¹⁸ Preliminary, promising data from clinical trials can mislead the public, posing ethical concerns and health risks.¹⁹

Adverse events associated with psychedelic use may include psychological distress, anxiety, paranoia, and derealization,²⁰ highlighting the necessity of harm reduction strategies and education to mitigate risk.²¹ Adverse reactions can be acute or prolonged, depending on numerous factors including dosage, setting, and individual psychological dispositions.¹⁸ For example, intrapersonal factors including personality traits such as neuroticism or absorption may influence the nature of psychedelic experiences, ranging from positive mystical-type experiences to challenging episodes, including intense fear and/or psychotic-like reactions.^20,22,23 In response, psychometric measures such as the Challenging Experience Questionnaire²³ and a wide range of aftercare practices, known as “psychedelic integration,” have emerged.²⁴ Integration practices and aftercare aim to support individuals to understand their experiences, address psychological distress that may arise, facilitate emotional processing, and translate insights into positive life changes. With a phenomenology that spans both intrapersonal and interpersonal dimensions, psychedelic integration should ideally encompass both aspects. Intrapersonal integration focuses on the self, alleviating adverse symptoms, exploring personal insights, and enhancing daily functioning. In contrast, the interpersonal lens addresses the challenges of reconciling psychedelic content within broader social, familial, and cultural contexts, highlighting the potential for both collective benefit and harm. Therefore, typical integration practices include artistic expression, mindfulness meditation, and journaling and discussing the psychedelic experience with a therapist, peers, or within psychedelic support and harm reduction groups.²⁴ Recently, there have been calls for empirical studies evaluating psychedelic integration practices.²⁵ However, recommendations for examining group-based psychedelic integration practices and processes have largely been overlooked, underscoring the need for investigations to address this gap in the literature.

Psychedelic support groups, often referred to as psychedelic integration groups (PSIGs), are community-based meetings where individuals discuss their experiences with psychedelics.²⁶ These groups typically consist of structured discussions, peer support, or workshops, providing a safe setting for individuals who have had psychedelic experiences to share their reflections and challenges. Groups are often facilitated by individuals with experience delivering psychedelic sessions, or by mental health professionals, providing guidance and resources to participants.²⁶ Importantly, individuals using psychedelics may experience feelings of isolation or alienation after undergoing a profound and potentially transformative experience, particularly if they lack supportive individuals who can offer understanding and acceptance.²⁷ PSIGs may mitigate harm by facilitating a meaningful sense of social support.

However, little is known about why individuals attend these groups and how attendees perceive the utility and/or the challenges associated with their attendance. This gap in the literature limits providers’ ability to offer optimal care and hinders prospective group participants’ ability to make informed decisions about their attendance. Correspondingly, qualitative research methods are vital in reducing harm associated with drug use by providing insights into users’ experiences, behaviors, and social contexts.²⁸ Qualitative methodologies may help researchers understand the nuanced reasons driving drug use, identify risk factors, and uncover protective behaviors. This in-depth, contextual knowledge may allow for the development of tailored harm reduction strategies that resonate with users’ lived experiences.²⁹ Additionally, qualitative research can highlight the effectiveness of existing interventions, informing policymakers about best practices.³⁰

Our study addresses this gap by providing in-depth insights into the experiences of individuals attending PSIGs. Via an online, anonymous survey, we explored participants’ perspectives on their reasons for attending, the utility of these groups, and the challenges associated with participation. Using thematic analysis,³¹ we systematically identified and analyzed recurring patterns within the data, synthesizing diverse perspectives into coherent, data-driven themes. By understanding the role of PSIGs, this research aims to contribute to the growing body of knowledge on harm reduction practices in the context of psychedelic use,³² offering valuable insights for enhancing aftercare support and improving safety for users.

Materials and Methods

The cross-sectional, observational survey study intended to explore the attitudes and experiences of individuals with self-reported use of psychedelics and subsequential attendance of PSIGs or harm reduction groups.

Participants and recruitment

Participants were eligible if they were adults (18 years or older), fluent in the English language, reported use of psychedelics, and attended or considered attending a PSIG. To minimize the risk of participants providing invalid responses for monetary gain, the information sheet clarified that there were no material benefits for participating. The study was promoted online through social media platforms (such as Facebook, Reddit, and Twitter) and newsletters related to psychedelics. Viewers of the advertisement were encouraged to share the survey link with their networks. The advertisement stated that the study was intended to “help us better understand individuals’ experiences of attending psychedelic integration groups, specifically what they perceive as helpful and unhelpful in the context of harm reduction.” The generic term “psychedelics” was used in the advertisement, seeking responses in relation to a range of psychedelics and affiliated compounds (e.g., LSD, psilocybin, ayahuasca, DMT, 5-MeO-DMT, mescaline, ibogaine, cannabis, ketamine, and MDMA). Participants entered the survey by clicking on a link on the advertisement. The sample size was not determined a priori (i.e., by considerations of statistical power). Of 100 participants who completed the survey, 87 indicated that they used psychedelics, while 65 reported attending PSIGs. Only those who attended PSIGs were counted in demographics (n = 65). Participants were also asked to select out of 10 substances they had used (Table 1). The most used substance reported was psilocybin (96.9%), followed by marijuana (76.6%), MDMA (67.2%), and LSD (48.4%). The least commonly used substance was mescaline (4.7%). The average number of substances used was 4, with a maximum of 8 substances for 7.8% of respondents. Participants were invited to provide a text response describing their use of psychedelics and experience of attending PSIGs. No qualitative responses were excluded or altered.

Table 1.

Experience of Psychedelics

Marijuana	49 (76.6%)
Psilocybin	62 (96.9%)
LSD	31 (48.4%)
DMT	17 (26.6%)
Ayahuasca	32 (50.0%)
Mescaline	3 (4.7%)
MDMA	43 (67.2%)
Ketamine	23 (35.9%)
5-MeO-DMT	8 (12.5%)
Other	7 (10.9%)

DMT, N,N-dimethyltryptamine; LSD, lysergic acid diethylamide; MDMA, 3,4-methylenedioxymethamphetamine.

Materials, procedures, and measures

The survey was developed using a literature review and consultations with subject matter experts to address gaps in psychedelic use and integration group research. The feedback refined the questionnaire, and open-ended questions were used to gather detailed qualitative data, focusing on nuanced experiences rather than standardized scales. The questionnaire was available online for about 12 months. Written in plain English without medical terminology, it covered respondents’ mental health history, details of psychedelic use (e.g., substances, settings, reasons), outcomes (e.g., adverse effects, perceived benefits), and experiences with and attitudes toward PSIGs (e.g., reasons for attendance, perceived benefits) (see Supplementary Data S1). Self-reported diagnoses of PTSD, depression, and anxiety were used to assess mental health status. Respondents to the online advertisement were directed to an information page detailing the study’s focus on psychedelic use and PSIG experiences. After reviewing this information, respondents completed an online consent form to access the full survey. The survey included questions on demographics, patterns of psychedelic use, PSIG attendance, and perceptions of group helpfulness. Respondents listed the psychedelics used before attending the PSIG without limitation on the number of substances. They also answered open-ended questions about the perceived benefits and adverse effects of psychedelics, reasons for attending PSIGs, and their views on the groups’ effectiveness. The open-ended format aimed to gather a broad range of responses.

Data analysis

Given the novelty of this research area, this study employed a deliberate analytic strategy³³ to guide data analysis by identifying and emphasizing key themes in response to predetermined research questions. This approach helps qualitative researchers navigate their data and select analytical paths throughout the analysis process. Accordingly, we aimed to investigate (1) why individuals choose to participate in PSIGs; (2) the benefits, if any, they derived from attending these groups; and (3) the factors, if any, that were unhelpful or challenging during their participation. Thematic analysis³¹ was employed to analyze participants’ text responses. Authors N.L.M. and T.M. simultaneously examined the text data to develop an initial set of codes. After establishing and applying these codes to the data, they identified and agreed upon a structure of themes and subthemes. This thematic structure was then mapped back onto the original data by N.L.M. and T.M. to verify if the identified themes accurately represented the data and to assess the prevalence of each subtheme. Throughout this process, each theme was further refined, resulting in a final set of thematic labels. To enhance rigor, once themes were defined by N.L.M. and T.M., authors N.Z. and M.S. reviewed the proposed themes, providing additional input before agreeing on the final results of the thematic analysis. Authors S.P., V.W., A.C., and J.R. supervised the work and contributed toward the writing of the article. Due to the open-ended nature of the free-text responses, a wide variety of responses were provided. To understand the data, no responses were discarded prior to analysis, regardless of participants’ interpretations and answers. The extracted themes aimed to capture the broad scope of responses and narrate the data’s content and style. Illustrative quotes were used to highlight specific subthemes, with each quote representing a different participant.

Ethics

The study conformed to the ethical principles of the World Medical Association’s Declaration of Helsinki. The study was approved by King’s College London Research Ethics Committee (HR-22/23-36202).

Results

Demographics

The survey received 100 responses. However, for the purposes of this study, we included data only from respondents who reported using psychedelics and attending PSIGs (n = 65). Respondents’ characteristics are detailed in Table 2. Of these, 58.5% were female, 38.5% were male, and 1.5% were non-binary. Sixty percent of respondents were aged between 35 and 54 years. Most respondents were from the United Kingdom (72.3%) and the United States (7.7%); 67.7% were White, with the next highest ethnicity among participants were Asian or Mixed at 9.2%; 66.2% had completed tertiary education, indicating a highly educated population. Over a third of respondents were in full-time employment. The integration groups also attracted a highly comorbid population; among the 31 participants who responded, the most common diagnosis was depression (25.8%), PTSD/complex PTSD (22.6%), and anxiety (16.1%).

Table 2.

Sample Demographics and General Characteristics of Psychedelic Use (N = 65)

Characteristic	M (SD)	Range	N (%)
Age	46.0 (12.6)	22–76
18–24			2 (3.1%)
25–34			11 (16.9%)
35–44			18 (27.7%)
45–54			21 (32.3%)
55–64			5 (7.7%)
Over 65			8 (12.3%)
Gender
Male			25 (38.5%)
Female			38 (58.5%)
Non-binary			1 (1.5%)
Country of residence
United Kingdom of Great Britan and Northern Ireland			47 (72.3%)
United States of America			5 (7.7%)
Other			13 (20.0%)
Ethnicity
Asian			7 (10.8%)
Black/African/Caribbean			1 (1.5%)
Mixed			6 (9.2%)
Other			6 (9.2%)
Prefer not to say			1 (1.5%)
White			44 (67.7%)
Sexual orientation
Straight			47 (72.3%)
LGBTQ (lesbian, bisexual, gay, asexual, queer, pansexual)			17 (26.2%)
Prefer not to say			1 (1.5%)
Education level
Completed mandatory education			4 (6.2%)
Completed higher education			18 (27.7%)
Completed tertiary education/university			43 (66.2%)
Employment
Employed (full-time, part-time, self-employed)			50 (76.9%)
Unemployed			4 (6.2%)
Other (student, retired, other)			11 (16.9%)
Formal dx (diagnosis) N = 31
Depression			8 (25.8%)
Anxiety			5 (16.1%)
PTSD/c-PTSD			7 (22.6%)
Social anxiety/Phobias			2 (6.4%)
Other			7 (10.7%)
Number of integration groups
1–3			31 (47.7%)
4–6			20 (30.8%)
7–9			5 (7.7%)
10+			9 (13.8%)

c-PTSD, complex post-traumatic stress disorder.

Context

Participants reported using substances in a wide range of settings (Table 3), most commonly at retreats (66.2%); 61.5% reported psychedelic experiences at home, while only 4.6% of group attendants had used substances in a clinical trial setting and 6.2% as part of a psychotherapy process. Participants also reported using psychedelics socially with friends (64.6%).

Table 3.

Context of Psychedelic Use

Home	40 (61.5%)
Retreat	43 (66.2%)
Psychotherapy	4 (6.2%)
Trial	3 (4.6%)
Underground	24 (36.9%)
Friends	42 (64.6%)
Nature	36 (55.4%)
Parties/Fest	27 (41.5%)
Other (ketamine clinic, cinema)	2 (3.1%)

Qualitative results

Three themes and related subthemes emerged from the thematic analysis and are shown in Figure 1. The core themes were (1) reasons for attending psychedelic integration groups, (2) utility of psychedelic integration groups, and (3) adverse factors influencing participants’ experience of the group.

Fig. 1.

Thematic analysis results.

Core theme 1: Reasons for attending psychedelic integration groups

To establish a foundation for understanding participants’ perceptions and attitudes toward PSIGs, this study explored individuals’ narratives surrounding the decision to attend these groups. The qualitative analysis identified the following three subthemes:

1. Seeking community

2. Deepening learning and promoting insight

3. Psychosocial support due to challenging experiences

Seeking community

Given the potentially intense and transformative nature of psychedelic experiences, participants highlighted the need for community and meaningful relationships, offering validation and empathy. Participants reported a need to meet people who have had similar experiences to help normalize their psychedelic experience, within an explicitly accepting and supportive setting. Participants described a need to share their own experiences and hear others discuss their experiences, fostering a sense of safety and connection to a wider collective.

To make sense of what I experienced and feel less alone in my experience—the experiences I had felt so immense and I didn’t feel people around me understood me.

Deepening learning and promoting insight

Participants reported using the group to deepen their learning and further explore insights associated with their psychedelic experiences, reflecting on novel perspectives by listening to others share their experiences. Participants reported that attending the group helped preserve the personal significance of their experience. This appeared to support a sense of continued, active engagement with a range of meaningful intrapersonal processes catalyzed by their experiences.

Primarily to learn from others, to be part of likeminded people, hear their stories and journey and also share experiences and maybe see them from a different perspective.

Psychosocial support due to challenging experiences

Participants reported attending PSIGs due to psychological distress linked to their psychedelic experiences. Participants described needing support in managing anxiety associated with adjusting to novel perspectives or attitudes toward self, others, and the world. Alongside theoretical discussions concerning psychospiritual states and processes, participants reported needing pragmatic input from others in managing challenging intrapersonal sequalae following psychedelic use.

I was struggling with a challenging psychedelic trip I had had. I had the opportunity to attend a week-long integration workshop, so I went. I was hoping that it would help me work through my challenging trip and deal with some of the aftermath of that trip, which mainly involved anxiety.

Core theme 2: Utility of psychedelic integration groups

This study also sought to understand people’s perceptions and attitudes toward the utility of PSIGs. The majority of respondents found the groups to be beneficial, with over 92% of the 65 participants indicating that PSIGs at least somewhat met their needs and expectations (Fig. 2). Correspondingly, participants described a range of benefits from attending these groups, with this study identifying the following subthemes:

Fig. 2.

Psychedelic integration group: Needs met?

1. Group process and facilitator effects

2. Sharing a “shared” experience

3. Fostering interpersonal bonds

Group process and facilitator effects

Participants highlighted the positive impact of the group process, structure, and facilitator’s interventions. Correspondingly, participants highlighted the significance of group-based prosocial feelings, including acceptance and compassion, contributed toward a sense of trust and openness. These appeared to permit participants to be authentic, speaking openly and benefiting from witnessing others doing so as well.

It was helpful to be able to speak openly, to be seen, heard and understood without judgement. It helped to reconnect with those inner places and to try and make better sense of them or incorporate them better into my life.

Participants described how the group’s structure and facilitator interventions positively contributed to their capacity to make use of the group. Broadly, facilitators’ responsibilities include setting the agenda, structure, and tasks of the group; managing relational dynamics; and guiding discussion topics.³⁴ The overarching aim of the group’s structure and facilitator interventions is to foster a safe and trustworthy environment where participants feel comfortable expressing their experience and concerns. Correspondingly, participants described how the facilitator’s presence and interventions, including embodying beneficial personal values and stances (e.g., kindness, respect, compassion), basic verbal interventions, and encouragement to engage in meaningful “self-integration” activities all supported feelings of safety and openness.

It was helpful to talk to others about my experience without judgment, and to hear the opinions of the facilitators. They also encouraged us to express ourselves in many different ways, including with drawing, movement, writing, and guided daydreaming. Not all of these were helpful, but I think the point was for each person to find the helpful techniques for themselves, so I appreciated the variety.

Sharing a “shared” experience

Participants highlighted the utility of exploring and speaking openly about their experiences with the knowledge that others present have, to some extent, experienced a similar experience. Participants reported feeling validated and reassured when sharing their experiences, normalizing their adverse reactions and mitigating anxieties or concerns about the potential for substantial, long-term harm caused by psychedelic use.

That it was ok that I felt the way I did (lost, sad, confused, sometimes lonely) and that other people had similar experiences of returning to their normal lives.

Fostering interpersonal bonds

Participants reported how cultivating meaningful relationships within the group supported feelings of purpose and belonging. Participants described how reconnecting with individuals who participated in their psychedelic session, building new relationships and offering support to others, facilitated integration. Feeling valued and understood, fostering helpful relationships appeared to support participants gain new perspectives and expand their social network.

The sense that I am part of a community that seeks understanding and healing and support.

Core theme 3: Adverse factors influencing participants’ experience of the group

This study also aimed to investigate participants’ perceptions of factors adversely impacting their experience of attending PSIGs. Despite the positive outlook reported by most respondents, participants highlighted a range of adverse factors creating distress and frustration. These appeared to influence participants’ ability to leverage their attendance toward benefit. This study identified the following subthemes:

1. Adverse interpersonal dynamics

2. Group-based disturbances

3. Facilitator-related grievances

Adverse interpersonal dynamics

Participants described adverse interpersonal group dynamics characterized by dominance and participation inequity, the presence of “psychedelic-naive” members, emotional overwhelm, and peers presenting with significant, trauma-related mental health disturbances, such as suicidal ideation. Participants reported feeling that certain individuals monopolized the discussions, preventing quieter members from having the opportunity to share their experiences. This dominance not only stifled the voices of others but also led to frustration and disengagement among participants who felt their contributions were less valued.

One specific example was a group where a particularly dominant personality and ego were allowed to dominate the whole group. This meant others didn’t have the chance to speak or be “seen.”

The inclusion of individuals who had not used psychedelics and were attending out of curiosity or professional interest further complicated group dynamics. These individuals often steered conversations toward theoretical or hypothetical discussions rather than focusing on actual, lived experiences. This shift was particularly frustrating for those seeking a more experiential and personal sharing environment.

I was particularly annoyed in the second session that someone there had not actually experienced any psychedelics. They were there to “learn” and to find out more. This was a problem as in the smaller group they were quite vocal and the conversation became theoretical and hypothetical instead of actual and experiential.

Additionally, the emotional intensity of listening to others’ challenging psychedelic experiences or traumatic life events could be overwhelming for individuals not seeking formal, in-depth group psychotherapy. This appeared to result in some participants feeling that their own issues were trivial in comparison, thereby inhibiting their willingness to share.

It can be quite triggering and upsetting listening to the trauma and life experiences of others at times. I felt my pain was trivial compared to that of others at times which impacted on my willingness to openly speak at times.

Conversely, some participants expressed concerns about the appropriateness of certain individuals to attend these sessions. Instances where participants exhibited signs of severe mental distress appeared particularly troubling, creating anxiety among members who felt unequipped to provide the necessary support.

Concern on two occasions that someone sounded manic in their expression and description of behaviour and needed therapy instead of integration group. On another occasion, concern about someone’s suicidality.

Group-based disturbances

Participants expressed concerns about the limited time available for sharing experiences during the sessions. The prioritization of individuals with challenging experiences appeared to result in other participants, particularly those wishing to share mystical or positive experiences, feeling overlooked and unheard.

Only enough time for a few people to share their stories. Priority understandably was given to those with challenging experiences but it meant I didn’t get to hear about peoples mystical experiences.

Some participants highlighted a sense of rigidity and a lack of a clear structure within the sessions. These participants felt that the absence of a defined plan or goals, combined with the facilitators’ control over time distribution, led to a feeling of being constrained and not given enough space to express themselves freely.

Control, rigidity, no plan or goals, no clear steps in the process.

Lastly, some participants highlighted differences between online and in-person attendance. Some described feeling disconnected in the virtual format, potentially inhibiting participants from discussing deeply personal experiences. Additionally, the geographical distance of some participants made it difficult for them to attend in-person sessions, leading to issues with accessibility and engagement.

Being online was challenging as I felt a bit disconnected which wasn’t ideal for discussing such personal things. But it was better than nothing for a group that was geographically spread out.

Facilitator-related grievances

Participants also highlighted a range of grievances associated with the group’s facilitator approach during PSIGs. Some participants described a desire for facilitators to have broader theoretical and clinical knowledge. This broader expertise was seen as crucial for effectively addressing the diverse needs of the group and providing more comprehensive support. Moreover, some participants felt that facilitators should offer more direction during group discussions, highlighting frequent silences and confusion as barriers to productive sessions.

More direction with the whole group discussions may be useful, there were many silences which made discussions difficult to gain momentum.

Participants also expressed concerns about the facilitators’ expertise regarding distressing psychospiritual states and experiences, which left some participants feeling unsupported. Inversely, participants also raised concerns about facilitators introducing spiritual concepts that were misaligned with their own beliefs.

Sometimes the facilitators introduced some spiritual concepts that I was not on board with, but this was not often and I could overlook it.

Discussion

To our knowledge, this study presents the first qualitative investigation of participants’ perceptions of and attitudes toward PSIGs. These groups, designed to support individuals following psychedelic experiences, are gaining popularity both online and in person.²⁶ Here we expand on our findings and, given the novelty of this investigation, offer suggestions for future research directions.

Reasons for group attendance and beneficial effects

The findings on motivation for attendance reveal key themes: seeking community, deepening learning and promoting insight, and requiring psychosocial support due to challenging psychedelic experiences. Insufficient social support generally increases the risk of adverse physical and mental health outcomes, whereas high levels of social support and cohesion, fostering feelings of belonging and safety, may protect individuals from illness and stress.^35,36 Across clinical, recreational, and ceremonial settings, psychedelic literature underscores the importance of a favorable context and psychological support for positive outcomes.³⁷ Conversely, psychedelics may enhance individuals’ capacity and need for connectedness.³⁸ Paradoxically, the profound nature of psychedelic experiences can contribute to increased isolation or existential confusion and potential psychiatric destabilization among users.²⁷ Correspondingly, participants emphasized the utility of the group in facilitating meaningful relationships with like-minded individuals who offer understanding, validation, and empathy. Comparative studies between PSIGs and other types of support groups (e.g., those for chronic illness or grief) could provide insights into the unique needs and benefits for individuals attending PSIGs. Participants also sought PSIGs to continue reflecting on novel perspectives and deepen their learning. As individual integration practices are thought to improve outcomes,³⁹ future studies could investigate the mechanisms by which group discussions and experiences help retain and deepen psychedelic-related insights.

Most participants reported that PSIGs were helpful, highlighting the positive impact of the overall group process, facilitator interventions, and fostering interpersonal bonds. Broadly, group process refers to the tasks, interactions, and behaviors that occur within a group. Resulting in a specific social ambiance, it encompasses the way group members relate to one another and collaborate to accomplish the group’s agreed upon goals.⁴⁰ Group process is influenced by various factors, including individual personalities, group norms, leadership and facilitation styles, and the context in which the group runs.⁴¹ These findings are consistent with the broader literature on the benefits of group processes in psychotherapy, which emphasizes the therapeutic utility of group cohesion and the cultivation of a shared narrative.⁴² However, group psychotherapy and PSIGs serve distinct purposes. Group psychotherapy focuses on addressing mental health issues through shared therapeutic experiences guided by a licensed therapist, employing established psychotherapeutic methods, including cognitive-behavioral therapy and psychodynamic practices to promote change.⁴³ Conversely, leveraging the positive impact of discussing shared experiences with others who have had similar experiences, PSIGs aim to help participants process insights and emotions from psychedelic experiences and integrate them into daily life.²⁶ Furthermore, PSIGs often use basic mindfulness techniques and journaling to help participants contextualize their psychedelic experiences and promote personal growth. Correspondingly, nonclinical and peer-led group-based interventions, including Narcotics Anonymous, Alcoholics Anonymous, and gender-specific support groups, leverage prosocial feelings such as belonging, trust, and empowerment to facilitate recovery and growth.^44–46 Active participation in these group-based interventions fosters confidence, promotes accountability, and encourages personal growth for participants.⁴⁷ Taken together, future studies could explore the effectiveness of PSIGs compared with group psychotherapy, individual psychotherapy, or no psychotherapy following psychedelic experiences. Researchers may also seek inspiration from nonclinical, peer-led group interventions to inform best practices and promote ethical standards.

Importantly, both group psychotherapy⁴⁸ and psychedelic literature⁴⁹ recognize the impact of therapists’ or facilitators’ interventions on individual’s experiences and outcomes. Studies evaluating the influence of different facilitator attributes (e.g., credentials, clinical skills and experience, personal values) on the quality of group interactions and outcomes could inform the development of future training programs for providers facilitating PSIGs. Additionally, as PSIGs lack a cohesive theoretical or clinical framework, studies could investigate whether certain types of group activities (e.g., meditations, role playing, creative expression, cognitive-behavioral techniques) are more effective in promoting outcomes.

Adverse factors influencing participants’ experience of the group

Despite positive experiences, participants also identified several adverse factors influencing their experience of attending PSIGs, including overdominance of individuals in group discussions, inclusion of psychedelic-naive members, emotional overwhelm, and facilitator-related grievances. In group psychotherapy, prospective participants are carefully selected and screened to establish their suitability for participation.⁵⁰ Parameters often assessed include evaluating motivation, interpersonal skills, psychological stability and mindedness, specific therapeutic needs, cultural factors, and social support. In this study, several participants reported perceiving the participation of psychedelic-naive participants and overly dominant personalities as disruptive. These challenges highlight the need for careful participant screening and selection, with studies needed to identify participant characteristics informing suitability and support facilitators’ management of adverse group dynamics. These findings also suggest that facilitators are required to skillfully prevent the monopolization of conversations, balancing the need for diverse perspectives without promoting adverse reactions, including heightened anxiety, alienation, and interpersonal conflicts.

PSIGs are not formally recognized as clinical interventions in mental health. However, our study suggests that participants may have a mental health diagnosis or face significant psychosocial distress exacerbated by their psychedelic experiences. The ambiguity between formal clinical interventions and social or peer support interventions can make it challenging for facilitators to manage participants experiencing significant psychiatric destabilization or crisis. Some participants expressed concerns and emotional overwhelm when listening to individuals presenting with significant distress. This highlights the importance of informed consent and education surrounding the potential utility and challenges associated with attendance. PSIG providers should consider developing and disseminating participant information sheets to enhance transparency, trust, and informed decision-making.

These participants also highlighted limited time for sharing, and frustration when the facilitator prioritized those with challenging experiences, leaving others feeling overlooked. Given the heterogeneity in participants’ backgrounds, needs, and experiences, future research should investigate the role of facilitators in managing acute psychological crises during integration sessions. Studies evaluating the necessary training and protocols to equip facilitators to manage severe distress effectively will enable the implementation of standardized operating procedures across PSIGs, improving care and outcomes for participants.

Correspondingly, participants underscored the need for facilitators to possess broader theoretical and clinical knowledge, emphasizing that such expertise is essential for addressing the diverse needs of the group and offering comprehensive support. This aligns with existing literature that highlights the importance of evaluating facilitators or therapists’ competence in psychedelic clinical trials.⁵¹ Participants in this study desired more facilitator direction during group discussions, noting that frequent silences and confusion hindered productivity. This lack of structure can impair group cohesion and individual outcomes, as guided facilitation is vital for maintaining discussion momentum and participant engagement.^34,42 Conversely, some participants felt discomfort when facilitators introduced conflicting spiritual concepts. This highlights the need for facilitators to adopt a neutral stance on spiritual matters and be sensitive to diverse beliefs, ensuring an inclusive environment.⁵² Given psychedelics’ capacity to increase suggestibility and vulnerability,^53,54 facilitators should be trained to navigate these differences without imposing their views. Future research could support the development of comprehensive training programs for facilitators that encompass both theoretical knowledge and practical skills in handling a wide range of psychological and psychospiritual issues. Additionally, implementing structured facilitation techniques and clear session goals could enhance group dynamics and outcomes. Research into the optimal balance between guidance and participant autonomy in these settings would further refine facilitation strategies. Emphasizing the importance of cultural and spiritual sensitivity in facilitator training could also address the diverse needs of participants more effectively. Correspondingly, future research should also consider enculturation processes and belief transmission within psychedelic settings. Studies that elucidate how cultural narratives influence individual and collective experiences and beliefs,⁵⁵ along with the mechanisms by which these beliefs are disseminated within communities,⁵⁶ may assist facilitators of PSIGs in refining group protocols and tailoring interventions to mitigate the potential for ontological and epistemic harms.

Limitations

This study has several limitations. First, the sample size of 65 respondents limits the generalizability of the results. The demographic skew toward a highly educated, predominantly White population from the United Kingdom and the United States further limits the applicability of the findings to more diverse populations. Another limitation is the cross-sectional design, which captures participants’ experiences and attitudes at a single point in time, precluding any assessment of changes over time or causality. Additionally, the reliance on self-reported data introduces potential biases, such as recall bias, which may affect the accuracy of the responses provided.⁵⁷ Furthermore, the broad and open-ended nature of the survey questions, while aimed at capturing diverse experiences, may have resulted in varied interpretations, making it challenging to draw specific conclusions. The heterogeneity in the types of psychedelics used and the settings in which they were consumed adds another layer of complexity, as different substances and environments can yield vastly different psychological effects.³⁷ Potentially reflecting the novelty and exploratory nature of this study, it is worthy to note that these limitations are typical for qualitative studies.⁵⁸ Building on these findings and utilizing mixed-methods methodologies,⁵⁹ future studies could use larger, more diverse sample sizes and longitudinal designs; include control groups; and incorporate standardized scales to improve outcomes for PSIG participants.

Conclusions

This study reports findings from the first qualitative investigation exploring participants’ perceptions of PSIGs. The therapeutic potential of psychedelics in treating complex mental health conditions generates scientific interest, potentially leading to increased use among individuals suffering from mental health conditions or interested in personal growth.⁶⁰ However, the lack of a clear legal framework and standardized guidelines poses risks for those seeking therapeutic benefits outside of clinical research settings.²¹ This study highlights the need for aftercare support and the potential benefits and challenges associated with attending these groups. PSIGs may serve as useful platforms for harm reduction via fostering community, enhancing learning, and offering psychosocial support due to adverse reactions to psychedelic use. Future research should focus on short- and long-term quantitative and qualitative investigations, evaluating the safety, acceptability, and effectiveness of PSIGs in mitigating harm and promoting beneficial outcomes for participants. This research will allow for the optimization of group processes and facilitation techniques and the development of specialized training programs for facilitators and improve informed consent processes for prospective participants.

Authors’ Contributions

N.L.M., R.H., V.W., and J.R. contributed to study conceptualization. N.L.M. contributed to methodology, data curation, data analysis, writing, drafting, preparation of tables and figures, and revision of the article and substantially to the discussion. The first draft of the article was written by N.L.M. T.M. contributed to the writing of the introduction and supported literature search, data curation, and data analysis. N.Z. and M.S. contributed to data validation, the article, and the preparation of the tables, figures, and Supplementary Data S1. R.H. contributed to study conceptualization and execution and to the discussion. S.P. contributed to the Research Ethics Committee and the discussion. A.C., V.W., and J.R. supervised the work progress, reviewed, and edited the article, proofread the article, and contributed to the discussion. All authors have approved the final article.

Disclaimer

Compass Pathways PLC did not contribute to the content and views expressed in this publication and did not financially support the preparation of this publication. Any contribution to this publication made by T.M. was done outside of his employee capacity at Compass Pathways PLC.

Author Disclosure Statement

All authors aside from T.M. declare the following:

• No shareholdings in pharmaceutical companies.

• No shareholdings in companies developing psychedelics.

• J.R. and N.L.M. provide services for the psychoactive trials group at King’s College London. The psychoactive trials group at King’s College London receives grant funding (received and managed by King’s College London) from Compass Pathways, Supporting Wounded Veterans, Multidisciplinary Association for Psychedelic Studies, Beckley PsyTech, and National Institute for Health Research.

• J.R. is supported by the UK National Institute for Health Research (NIHR) via Clinician Scientist Fellowship Awards to J.R. (CS-2017-17-007) and by the NIHR Biomedical Research Centre at South London, Maudsley National Health Service Foundation Trust, and King’s College London. J.R. has attended trial-related meetings paid for by Compass Pathways, Ltd.; he has consulted for Beckley PsyTech and Clerkenwell Health; and he is employed by Sapphire Medical Clinics, a private medical clinic.

• A.C. has received honoraria for presentations and/or serving on advisory boards from the following pharmaceutical companies: Janssen, Lundbeck, Allergan, and Livanova.

• N.L.M. has received consulting fees from Compass Pathways PLC, Small Pharma Ltd, and Beckley Psytech Ltd. Carolina Maggio has received consulting fees from Beckley Academy, Entheon Biomedical, and Compass Pathways.

• T.M. is a current or past employee of subsidiaries of Compass Pathways PLC and owns shares, share options, and/or restricted share units in Compass Pathways PLC.

Funding Information

This study did not receive any specific funding.