Quantitative and qualitative influences of spiritual connection and natural imagery on perception of art in clinical psychedelic dosing settings

Abstract

Psychedelic clinical study environments are frequently visually manipulated, such as art; however, there has been little study of how the art selected for display impacts individual responses to the overall setting. To examine how individual self-identities shape perceptions of art used in a clinical psychedelic dosing environment, this study used a community-engaged mixed-methods approach. Psychedelic society members were recruited to complete an online survey that measured overall reactions and perceived connections of age, gender, racial/ethnic, and religious/spiritual self-identities to 15 art objects. A multivariate-linear regression model of these responses identified religious/spiritual identity as the dominant connectivity factor influencing art reaction among these participants. Selected survey participants then completed focus groups, from which nine qualitative themes related to art preferences were identified, including preference for natural elements and images. Finally, members of a non-psychedelically oriented community interest group completed the survey and provided preference scores for an expanded art library to assess generalizability of qualitative and quantitative findings. Spiritual/religious connectivity was found to be less associated with art preferences for the non-psychedelically affiliated group members, while the presence of natural elements still corresponded with positive responses to art. These results suggest that while religious/spiritual self-identity has a strong impact in predicting variance in dosing environment reactions among individuals with prior psychedelic interests, the inclusion of art focused on natural themes may be a meaningful future approach to facilitate positive receptions among broader populations.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-025-12613-3.

Introduction

Psychedelic clinical trial study populations to date have not been representative of the overall United States population. Since 1993, approximately 85% of such participants identify as Non-Hispanic White^1,2. Younger individuals, those with prior psychedelic use, and/or non-religious beliefs have been found to be more favorable to psychedelic therapy trials³. These enrollment biases run the risk of masking important findings by overgeneralizing observations from non-representative studies. This issue may be particularly impactful for trials of psychedelic compounds, where extra-pharmacologic factors incorporated into the study design have been reliably observed to influence participant outcomes^4,5.

The ‘set and setting’ theory suggests that the subjective and behavioral effects of psychedelics are dependent on the internal ‘mindset’ (e.g. personality, preparation, expectation, intent) and the external ‘setting’ (e.g., physical and sociocultural environment) present during the dosing session⁶. Previous research has found that psychedelic use in designed ‘settings’ is associated with beneficial effects, including prolonged abstinence from smoking and better overall psychological wellbeing^7–11. Likewise, certain psychological states, such as ‘awe’ and the ‘mystic state,’ have been reported to enhance therapeutic outcomes within psychedelic-assisted therapy^12–14. In order to help participants achieve a therapeutically productive mindset, these trial settings typically include supportive staff to guide individuals through the dosing process, as well as environmental modifiers like music^15–17. Among calls to increase study rigor and specificity regarding the impact of discrete components of set and setting¹⁸, field-wide reviews of materials and methods have now begun to be implemented¹⁹, along with development of consensus guidelines on Reporting of Setting in Psychedelic Clinical Trials (ReSPCT)²⁰. Nevertheless, some components of setting have received comparatively little research attention despite their widespread inclusion in trial settings and inclusion in reporting guidelines, such as décor and art.

Importantly, while art and other environmental modifiers are often deployed uniformly across all study participants at a given site, a growing body of research has begun to identify how psychological constructs, personality traits, and social and contextual factors modulate therapeutic outcomes for psychedelic studies^{8,10,12–14,21–25}. Since patient self-identities are intrinsically non-uniform, this creates a scenario where a uniform environment may foster a therapeutic mindset in one individual or social group while fostering a non-therapeutic mindset and/or promoting negative outcomes in another. This challenge has long been observed in non-psychedelic psychotherapy, where racial social identity predicts differential therapeutic alliance-outcomes amongst US minority populations when compared to White counterparts^26,27. As such, the American Psychological Association has recognized the importance of fostering multicultural competency within psychotherapy practice, including development of the ADDRESSING model to engage with self-identities held by patients²⁸. Differential impacts of racial and religious social identities on behavioral outcomes have also recently been discussed and observed in the specific context of psychedelic use^29–31. For example, psychedelic use by Black and Hispanic individuals appears less impactful on psychological distress in comparison to use by White individuals^32,33. Separately, a decreased likelihood of committing violence was identified among those individuals who both use psychedelics and have strongly-held religious beliefs³⁴. Thus, there is a need to investigate how individual self-identity dimensions (race/ethnicity, age, gender, and spirituality/religion) are perceived to support connections to art and décor used in clinical psychedelic dosing settings, and how such connections may relate to overall positive or negative perceptions of the art and décor itself.

To directly address this gap in research, we undertook a community-engaged, human participant, mixed-methods research study (Fig. 1) testing the hypothesis that racial and ethnic self-identity would be the dominant domain influencing individual reactions to art and décor displayed in the dosing environment^26,27,29,35. Overall, this study used a multi-phasic design, with a survey development phase (Phase 1), an explanatory sequential mixed methods phase (Phase 2), and a generalizability phase (Phase 3).

Fig. 1.

Study Phases and Demographic Shifts. (A) Flowchart describing phases and sub-phases of the research project with associated sample size (B) Maximal proportion of non-Hispanic White participants (NHW) for each phase. *Varies by survey object. a, b,c, d – participant number and demographic data correspondences for each stage across panels A and B.

Methods

Study design and participants

In Phase 1, to first evaluate the performance of our data collection instrument on examination of art preferences and self-identity domain connectivity, participants from a local psychedelic society (n = 44) were enrolled between October to December 2020. Here, the pilot survey contained repeated five-question items that assessed the participants’ overall preferences for, and perceived self-identity connections to images of, 14 discrete art and elements displayed within the University of Wisconsin-Madison psychedelic dosing environment, along with one external art element and one image the dosing environment itself, as it appeared during clinical trial data collection between 2014 and 2022 (Fig. 2; Supplementary Table S1)^36–44. The percentage of individuals reporting a connection between these items and their self-identity was recorded across the domains of race/ethnicity, age, gender, and religion/spirituality. The participant first responds to a yes/no question on whether they had a connection to the respective art image for each self-identity domain (“Does this object seem to connect with any of the following aspects of your self-identity?”). If selected yes, an additional question prompt will appear asking the degree to which the art image connects to the respective self-identity domain on a visual analogue scale (VAS) (How much do you consider this object to connect to the “X” aspect of your self-identity?). Race/ethnicity and religion/spirituality were each measured as joint domains, rather than measuring religion and spirituality separately, for example.

Fig. 2.

Example Art Items and Question Battery for Survey. (A) Numbered images 01–16 showing the pictures of the art objects and the dosing room image presented in the final survey used in Phase 2 and 3. Object 00 was removed from the dosing room after Phase 1, which was then replaced by Object 01 for Phase 2. (B) Example five-question battery as presented in the finalized survey. This battery was repeated for each object, for a total of 16 presentations. For the actual participant survey, [X] was replaced by the appropriate object number for each presentation and ‘Image Shown Here” was replaced by individual objects from panel A.

In Phase 2, participants from a second set of psychedelic societies were then engaged for the explanatory sequential mixed methods portion of the study, where we amended the survey instrument from Phase 1 for quantitative data collection which immediately prompts response to the degree of connection between these objects and their self-identity on the VAS. Participants who completed pre-screening (n = 153) were then invited to complete the survey from May to June 2022 (Supplementary Figure S2). To capture a sample with racial demographics more representative of the overall United States population, we then purposefully sampled participants (n = 19) from this phase to join focus groups that used a semi-structured script to assess their perceptions of the dosing setting and individual art objects (Supplementary Table S3).

For Phase 3, we then sampled individuals from the Community Advisors on Research Design & Strategies (CARDS) group to triangulate our qualitative themes using quantitative methods, in a preliminary effort to assess generalization of Phase 1 and 2 findings beyond individuals belonging to psychedelic social groups. Within this survey we asked them to review 65 digital images of art pieces from the Chazen digital art library (Madison, Wisconsin) and the University of Wisconsin-Madison Art Exchange (2021) and rank their reactions to each image on a 5-point Likert scale.

Statistical analysis

Statistical and comparative analyses using the data collected were performed using GraphPad Prism version 10, Microsoft Excel, and Stata 17.0 (StataCorp, LP, College Station, TX, USA). Multivariate linear regression and dominance analysis using Stata package domin was used to quantify the relationship of the independent variables (reported connection of object to age, gender, race/ethnicity, spirituality/religion) to a participant’s art reaction for each object presented (dependent variable)⁴⁵.

Using focus group transcriptions from NVivo Transcription v12 (Lumivero), qualitative themes were developed using the conventional content analysis inductive approach described by Hsieh and Shannon⁴⁶. CE, RG, and SJL developed the codebook with RG and SJL additionally completing a data verification process to ensure reliability of data collected. Finally, CE, RG, SJL, and CJW came together to finalize the codebook to then generate the sub-themes and themes. During qualitative analysis, CJW presented current themes to members of the participating psychedelic societies for member checking with no requested alterations.

Ethical approvals and guidelines

This study protocol (#: 2021 − 1587) was reviewed and approved by the University of Wisconsin – Madison Minimal Risk Research Institutional Review Board. All research was performed in accordance with relevant national and institutional guidelines and regulations. Informed consent was obtained from all participants. Consent for the survey was obtained through REDCap, where participants were emailed a link to the survey which contained consent language and a verification of consent prior to launching the survey. Ongoing consent for participation within the focus groups was re-confirmed orally prior to the focus group start using a standard script. Qualitative methods are reported following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines⁴⁷.

Extended methods

Additional information regarding detailed recruitment methods, data collection, analysis, and statistical approaches used for each phase are provided in the Supplementary Material.

Results

Phase 1: survey development

Detailed demographic characteristics of enrollees in Phase 1 are reported in Supplementary Table S4. Consistent with prior psychedelic research studies, the vast majority (93.2%) of individuals responding to the pilot survey were non-Hispanic White (NHW). A majority were female, half were 50 years old or younger, and a plurality (34.1%) of individuals self-identified as atheist/agnostic. The number of responses varied by the object analyzed (n = 44–48), as some participants dropped out before answering objects regarding all the presented images. Approximately half of the art objects were perceived more positively than neutral (Fig. 3A).

Fig. 3.

Local psychedelic society members’ overall reactions and perceived self-identity connection to art objects and dosing room. (A) Object responses are ordered from highest to lowest reaction from left to right with total sample size below. One-sample t-test vs. 50. For (B), the distribution of perceived self-identity average art responses rate. RM one-way ANOVA. Tukey’s post-hoc analysis. Distribution of perceived self-identity connection in psychedelic society cohort #1 in (C) dosing room and (D) art objects. (A, C, D) all use a 101-point visual analogue scale ranging from 0 to 100, with scale labels shown directly on the figure axes. * - p < 0.05. ** - p < 0.01. *** - p < 0.001. **** - p < 0.0001. Data shown as mean ± SEM.

In Phase 1, a yes/no question needed to be answered regarding each self-identity dimension for each object; a VAS follow-up was only presented following a ‘yes’ response. There was a significant main effect of identity on opt-in response rate (F(1.562, 23.43) = 40.59, p < 0.0001), with significantly higher rates of endorsement for connection to religion/spirituality in comparison to the other identities (Fig. 3B). For the dosing room image, the VAS was presented directly, so all individuals had to provide degrees of perceived connection to each dimension. Connection to race/ethnicity had the highest level of perceived connectivity to the room, and responses were well distributed across the full scale (Fig. 3C).

When providing responses for self-identity connection to any other object, participants tended to have a greater connection to the objects than average (Fig. 3D), with very few reporting connections lower than 50. Considering the more complete and less biased dataset generated by using the VAS upfront, the yes/no questions were eliminated in subsequent phases.

Phase 2: explanatory sequential mixed methods

Quantitative analysis

Detailed demographic characteristics of survey participants in Phase 2 are reported in Supplementary Table S5. For Phase 2 of the study, the expanded geographical scope that was used to recruit participants yielded a lower percentage (70.8%) of individuals identifying as NHW and a higher percentage (42.1%) endorsing the ‘Other’ category for religious/spiritual identity (where “spiritual” was the most common answer).

Most of the objects received a positive response on average, except for Object 10 (Fig. 4A). All identities had a high response rate (defined as providing any value > 0) for endorsed connectivity (Fig. 4B), but there were significant differences between their magnitudes (F(2.424, 94.52) = 2.980, p = 0.0457), with religion/spirituality having a higher response rate than all others. The distribution of responses for self-identity connection to the dosing room was comparable to that from the pilot phase, but notably, race/ethnicity connection dropped to the lowest level overall in this more racially/ethnically diverse sample (Fig. 4C). Regarding connections to individual objects, spiritual/religious connectivity was the strongest for most objects studied (Fig. 4D). For shared objects, instrument reliability was high across Phases 1 and 2, and sensitivity analyses indicated minimal impact of non-response bias on connectivity measures in Phase 2, following instrument adaptation (Supplementary Figure S6).

Fig. 4.

Remote psychedelic society members’ overall reactions and perceived self-identity connection to art objects and dosing room. (A) Object responses from psychedelic societies are ordered from the highest to lowest reaction from left to right with total sample size below. One-sample t-test. For (B), the proportion of participants endorsing a perceived self-identity connection (> 0) for each art object. RM one-way ANOVA. Tukey’s post-hoc analysis. Distribution of perceived self-identity connection in Phase 2 for (C) dosing room and (D) art objects. (E) Coded map of dominance analysis of multivariate linear regression model for Phase 2. (A, C, D) all use a 101-point visual analogue scale ranging from 0 to 100, with scale labels shown directly on the figure axes. Columns indicate object ID and rows indicate factor analysis, where each colored square indicates the type of dominance of factor i over factor j. *p < 0.05. **p < 0.01. ***p < 0.001. ****p < 0.0001. Data shown as mean ± SEM.

We next sought to describe the relationship between connection to self-identity domains and overall reaction using multivariate linear regression analysis for each object (Supplementary Tables S7 and S8). The model multivariate linear regression successfully fit all art objects except 3, 10, and the dosing room, and a dominance analysis revealed that connection to religious/spiritual self-identity had complete dominance (the strongest form) in predicting art preference over all other self-identity connections for all objects except for Object 10 (Fig. 4E; Supplementary Table S9).

Qualitative analysis

Given the unexpected quantitative findings based on our initial hypothesis, focus groups were used to provide additional context for the findings. Detailed demographic characteristics of focus group participants in Phase 2 are reported in Supplementary Table S5. Notably, further enrichment of this population for individuals holding a racial/ethnic identity other than NHW was successful, with 61.1% of individuals in this study phase meeting that definition.

Conventional content analysis identified five major themes relating specifically to the art objects displayed in the dosing room: (1) art impacts mind-body comfort, (2) proclivity towards nature or naturalistic elements, (3) narrative engagement with art, (4) interest in intentions behind art selection, and (5) attention to aesthetics. Qualitative analysis also identified an additional four major themes related to the dosing room itself: (6) comfort within the dosing room, (7) natural mood of the room, (8) presence of living items and nature when inside an enclosed space, (9) holistic design of the room. All these major themes were touched on by at least one individual from each racial/ethnic group, regardless of the order of data collection. No new codes and no new themes emerged from later focus groups; this lack of novel codes was used as a stopping rule to indicate saturation for the purposes of this study (Supplementary Table S10). Sample quotes were selected to document support for the identified themes and subthemes from participants across these focus groups (see quotes in Supplementary Table S11).

Participants from the focus groups regularly noted the potential comfort that would be elicited from the art objects and dosing room. Physical comfort was noted as a sub-theme within theme 6 (Physical comfort’), such as the perceived pleasance of what it would be like to lay on the pictured couch. However, elicitation of mental comfort was also commonly stated, where one participant commented on such a feeling when viewing Object 5: ”…everything feels calm and inviting, I don’t know if it’s sunrise or sunset, but they both look… whether it’s coming, sun’s going up or going down, it looks nice and inviting and feels like a very calm story.”

Notably, interaction with art in relationship to oneself through ‘autobiographical reflection ‘was noted as subtheme 3.1, supporting the concept that variable self-identity is a crucial factor in the generation of responses to the displayed elements of the psychedelic dosing setting. For instance, while Object 10 on average was slightly negatively received (Fig. 3A), one participant noted a positive personal connection to this object due to their own personal history with an environment that the picture reminded them of: “The one on the left for me, I kind of like the gray… maybe there’s a storm coming. I lived near Lake [NAME] for many, many years, and saw the moods of that lake and, you know, how it can change. It’s a little cold, but, moody in a sense.”

Discussion of spiritually/religiously and racially/ethnically relevant content was also sufficiently prevalent to form distinct sub-themes within themes 3 (spiritual and religious symbolism’) and 4 (cultural appropriation of art and competency of therapist’), providing further perspective on the importance of these dimensions of self-identity. Interestingly, in the study sample, only those of Non-Hispanic White and Hispanic/Latino focus groups noted concern for cultural appropriation and competency of the therapist sub-theme. Here, a participant noted the concern of Object 8 being portrayed in the dosing room: “The one on the left; that banner is really specific to certain types of Indigenous cultures. Right. So, I think it’s kind of like, it depends. Is the practitioner who’s using this office space… do they belong to this Indigenous culture collective”.

While this participant felt Object 8 was potentially inappropriate for the dosing room depending on how it was originally intended to be used, another participant felt differently and possibly even appropriate: “I like that… Native American seems familiar, you know? That’s something that I think all people are non-hostile toward. Even sympathetic… and recognize them as, like, they had some wisdom.”

Lastly, the participants noted a preference for nature-like elements across both the dosing room and the art objects in themes 2, 7, and 8, where elements such as wood, warm tones, or plants elicited contributed to this nature theme. However, this generalization may be limited, as synthetic representations may not cause the same response as bona fide natural elements, such as for Object 15: “I like the imagery, but I can really relate it to anything. I mean… has a connection to nature, but it looks a little synthetic to me.” Further detailed descriptions of each identified theme and subtheme, along with their relationship with individual objects, are available in Supplementary Note 1.

Phase 3: generalization

To evaluate whether the qualitative results were unique to members of psychedelic societies, we used the Phase 2 instrument to survey a non-psychedelic affiliated community interest group (CIG). Detailed demographic characteristics of enrollees in Phase 3 are reported in Supplementary Table 12. Notably, the identities of individuals in the CIG were also distinct from those in the other quantitative portions of the study, as well as in most psychedelic clinical trials to date, across several dimensions. A large majority were older than 50 years of age (70%), held a Black/African American identity (70%), and/or held a Christian religious identity (70%).

The survey responses for the CIG were then compared to those from the focus group participants from Phase 2. Despite the differences in demographics and group affiliations between Phase 2 and 3 participants, there was no significant difference found between the groups regarding the overall reaction to each art object and the dosing room (p = 0.1041; Fig. 5A). However, comparing perceived connection to individual self-identities between the Phase 3 CIG and Phase 2 focus group participants, there was a significant interaction found (F(3,45) = 31.75; P < 0.0001), with the CIG members reporting significantly less perceived connection of the art objects and room to their religious/spiritual self-identity (Fig. 5B).

Fig. 5.

Triangulation of findings and themes to a non-psychedelic community interest group. Comparison between participants from Phase 2 and Phase 3 of averaged (A) overall reaction (Unpaired t-test) and (B) self-identity connection across art objects in survey. Two-way ANOVA. Sidak’s posthoc analysis. (C) Contribution of elements in art to overall art reaction. 2 (Love it), 1 (Like it), 0 (Neutral), −1 (Dislike), −2 (Offensive). Two-way ANOVA. Sidak’s posthoc analysis. (A, B) all use a 101-point visual analogue scale ranging from 0 to 100, with scale labels shown directly on the figure axes. * - p < 0.05, **** - p < 0.0001. Data presented as mean ± SEM.

Considering that affinity for images of nature, preference for a natural mood, and inclusion of living items constituted one-third of the themes identified in the qualitative portion of Phase 2, we evaluated if a similar affinity existed within the CIG sample by measuring whether the presence of specific depictions (plants, landscape, person, animal, or manmade object) within a piece of art impacted the average overall art reaction for individuals within the CIG. The images used for this approach were drawn from an expanded art library created for flexible display within the dosing room (Supplemental Table S13). A significant interaction between inclusion/exclusion and artistic element type (F(4, 315) = 3.246, p = 0.0125) was found. Specifically, the art objects in this library that included a plant and/or landscape element elicited a more positive reaction from CIG members on average than those which did not (Fig. 5C).

Discussion

The present study found that the perceived connection of art in a psychedelic dosing setting to discrete elements of an individual’s self-identity can predict the variance in how positively participants respond to a specific piece of art. Despite our original hypothesis of racial/ethnic self-identity connection being the dominant influence, religion/spirituality was identified as the dominant influence on overall reaction to nearly every individual art object. Interestingly, connections to the image provided for the dosing room overall seemed to be more generally spread across self-identities, indicating possible differences in perception of a participant’s relationship to individual parts of the setting, and the overall setting experienced as a whole. While only some racial/ethnic subgroups expressed concerns for cultural appropriation, meaningful interpretation of qualitative observations regarding racial and ethnic differences is limited here by small sample size, and this could be a critical area for future directed study. Furthermore, our findings suggest that perceived spiritual/religious self-identity art connection could be significantly higher among individuals affiliated with a psychedelic society than those who are not. This raises the question of whether this ‘setting’ dimension has played a particularly strong role in framing ‘set’ for those individuals enrolled in psychedelic trials that were recruited from or were otherwise affiliated with psychedelic-focused social groups or subcultures. Likewise, given ongoing research interests in the effects of psychedelics among clergy members⁴⁸, it would be valuable to explore whether spiritual/religions connections to art have a similarly dominant character among individuals who have prior affiliation with religiously- or spiritually-focused subcultures, but no prior psychedelic use.

These findings further point to consideration of how enrollment biases amongst spiritual and religious self-identity among psychedelic study participants may influence study findings. Risks from the influence of this potentially hidden variable are especially notable since: individuals with self-reported religious or spiritual affinity have been found to be more likely to use psychedelics in the first place^8,49; cognitive mechanisms invoking spiritual experience have been invoked as relevant correlative factors with clinical outcomes in psychedelic-assisted therapy trials^50,51; and both historical and contemporary psychedelic studies have been specifically designed to incorporate spiritual attitudes and behaviors as outcome measures^48,52,53. Further, since spirituality and religiosity is a factor associated with health and well-being more broadly^54–56, we suggest that capture and reporting of religious/spiritual beliefs should be routine for demographic tables in psychedelic clinical trials, and that field-wide review of reporting for this demographic factor across studies should be pursued, as has been previously done for race/ethnicity and socioeconomic status^1,57. We also suggest that data capture for this category should include a “Spiritual” category, given the prominent level of spontaneous endorsement for this category amongst psychedelic-affiliated social groups. Furthermore, although religion/spirituality were grouped here and have been previously presented as a shared dimension (i.e., the ADDRESSING model), they may represent distinct constructs in this population, with unique contributions. Using approaches that disambiguate the relationship between participants with varying religious versus spiritual affiliation/connections could help provide important additional insights in the future.

Our qualitative analysis revealed a preference for naturalistic images, mood, and objects in the room such as earth, warmth, and natural tones and living plants. These particular findings are intriguing, given prior evidence that psychedelic experiences have been shown to increase proclivity towards nature^21,58,59, and that those planning to use psychedelics also seek out nature as a dosing setting in an effort to enhance their experience^8,60. Unlike the dominant degree and impact of religions/spiritual connection discussed above, this proclivity for natural elements does not appear to be especially enriched among individuals who are part of psychedelic societies or who represent demographic enrollment biases present in current trial samples.

Although this study was not designed to evaluate the broader appeal of plants and landscapes, the ‘biophilia hypothesis’ provides one possible theoretical explanation, wherein people are posited to be attracted to nature through a genetic and evolutionary basis⁶¹. However, there are other potential explanations for this proclivity towards nature, such as the degree of perceived novelty/familiarity, or complexity/quality of the art⁶². Regardless of the underlying reason for this preference, our findings are also consistent with broader design observations that incorporation of nature in built structures and environments is able to moderately increase positive feelings⁶³. Overall, the use of artistic elements depicting the natural world may be an effective entry point to create connections with psychedelic dosing settings that are comfortable for individuals that have no prior engagement with any psychedelic group, subculture, or microclimate.

Generally, participants also strongly expressed that a positive experience was associated with a sense of physical and mental comfort in the room. There are many other elements not studied directly here that are likely to contribute to that comfort, including tactile, olfactory, and auditory elements, and continued study of the impact of social identities on reception of these elements is suggested. The impact of shared or disparate social identities on interpersonal factors is another important dimension for additional study, as participants noted the role the facilitator may play in creating that sense of comfort, and therapeutic alliance with the therapist during psychotherapy is known to mediate therapeutic outcomes⁶⁴.

Limitations

There are several significant limitations intrinsic to interpretation and generalization of this study’s findings. As briefly noted above, the present study was not sufficiently powered for subgroup analyses that may have further contributed to the interpretation of the results regarding specific differences in art perception between groups holding different self-identities. This limitation also includes understanding of the quantitative impact of intersectional identities (i.e., NHW/Agnostic or Black/Christian) on the outcomes studied, as certain combinations of identities may be more prevalent or impactful on the measured outcomes than others. Similarly, the sample size from Phase 3 is that of a pilot effort (n = 8–10), thus generalization analyses need to still be conducted larger representative cohorts to support current findings. Furthermore, no information regarding prior psychedelic use from participants was gathered, so interpretations regarding the impact of previous exposure to psychedelics on these outcomes are not possible. Another limiting consideration is that art from only a single clinical dosing site was included, and there was only one piece of art that had a negative reaction overall. Considering that the regression model used could not fit this object, the validity of this approach for identifying how self-identity connections contribute to perceptions of disliked art objects should be treated as unknown. From a methodological standpoint, the use of the VAS theoretically holds a statistical advantage over simpler scales such as the Likert scale 5-or 7- point, as it mimics a continuous-like variable. However, studies that have directly compared the Likert scale and VAS generally recommend Likert scales due to interpretability and accessibility^65,66. While this concern did not arise in our focus groups or follow-up interviews with the CIG the value of alternative scales may be considered for future questionnaire refinements. Finally, potential impacts of selection bias should be considered in interpretation of these findings, due to the unknown reasons for loss of individuals between pre-screening, survey completion, and focus group completion.

Conclusions

This work demonstrates that individual perceptions of art displayed in a psychedelic dosing setting can be quantifiably correlated with perceived connections to at least a subset of an individual’s social self-identities. Importantly, this relationship may be especially driven by only certain types of self-identity, such as religious or spiritual identity, and may be contingent on whether individuals align with a psychedelically-oriented subculture. This specifically includes connections to the visual artistic elements of this setting that have previously received minimal formal study, despite being a common environmental manipulation. The findings underscore the importance of considering social identity factors in creating accessible spaces for studying psychedelic assisted therapy and interpreting trial outcomes using representative samples. While natural depictions or living items may broaden accessibility, even elements merely suggestive of religious/spiritual iconography may create reinforcing biases that increase acceptability and dominate mindset framing for those individuals already engaged with psychedelic subcultures. While causality regarding the relationship between self-identity connections and art reactions cannot be inferred from this study design, future experiments incorporating prospective manipulations of art and décor hold the potential to improve therapeutic outcomes by maximizing connections between participants’ salient self-identities and the clinical psychedelic dosing setting itself.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

SJL: Investigation, methodology, formal analysis, visualization, validation, and writing— original draft. CE: Investigation, methodology, formal analysis, writing—review and editing. NK: Investigation, data curation, writing—review and editing. OS: Methodology, writing—review and editing. CJW: Investigation, methodology, formal analysis, data curation, visualization, oversight, and writing— original draft. All authors have given approval to the final version of the manuscript.

Funding

This research was funded by the Wisconsin Alumni Research Foundation’s Understanding and Reducing Equalities Initiative (MSN251969). SJL training funding was provided by the Neuroscience Training Program (T32NS105602-04) and TL1 Predoctoral program (NIH NCATS TL1TR002375 & UL1TR002373). 

Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at the University of Wisconsin - Madison.

Declarations

Competing interests

CJW discloses the receipt of funding from Psilera Inc. and free research materials from the Usona Institute to study the application of psychedelics as treatments for psychiatric disorders – these groups had no direct influence over the contents of this study or manuscript. All other authors have no disclosures to report.