The Impact of Psilocybin Use in Adults with Prior Psychoses: An Interpretive Phenomenological Analysis

Abstract

Psychedelic-assisted therapies have emerged as a promising treatment for a range of mental health conditions, yet individuals with a history of psychosis remain categorically excluded from clinical trials and state-sanctioned therapeutic settings. This qualitative study explores the subjective experiences of adults with prior psychotic symptoms who have used psilocybin, employing interpretative phenomenological analysis (IPA) to examine how they make sense of these experiences. Study findings depict the multivalent nature of psilocybin and psychedelic experiences in this population. While participants reported exacerbations of distress and psychological instability, they also described psychedelics as tools for insight, affect regulation, and psychological integration, with most experiencing both destabilizing and beneficial effects at different points. Core themes include the dual impact of psilocybin as both destabilizing and integrative, the diverse ways in which naturalistic psychedelic use fosters transformation, and differences between the subjective effects of psilocybin and other psychedelics, particularly LSD, in relation to awareness, stability, and insight. Utilizing a psychodynamic lens, this study contributes to the understanding of the relationship between psychedelic states and psychotic symptoms, demonstrating how the impact of psychedelic experiences can be understood in the context of psychological organization and biography. The findings challenge the unqualified exclusion of individuals with prior psychotic symptoms and underscore the need for a nuanced approach to risk assessment in psychedelic-assisted therapy.

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