Influence of Context and Setting on the Mental Health and Wellbeing Outcomes of Ayahuasca Drinkers: Results of a Large International Survey

This survey (n=6877) of ayahuasca drinkers investigated the influence of context and setting on mental health and wellbeing outcomes. A combination of motivation, ceremony, and support variables predict these outcomes in a new model proposed in this paper.

Abstract

“Ayahuasca is a traditional plant decoction containing N,N-dimethyltryptamine (DMT) and various β-carbolines including harmine, harmaline, and tetrahydroharmine, which has been used ceremonially by Amazonian Indigenous groups for healing and spiritual purposes. Use of the brew has now spread far beyond its original context of consumption to North America, Europe, and Australia in neo-shamanic settings as well as Christian syncretic churches. While these groups have established their own rituals and protocols to guide use, it remains unknown the extent to which the use of traditional or non-traditional practices may affect drinkers’ acute experiences, and longer term wellbeing and mental health outcomes. Hence, this study aimed to provide the first detailed assessment of associations between ceremony/ritual characteristics, additional support practices, motivations for drinking, and mental health and wellbeing outcomes. The paper uses data from a large cross-sectional study of ayahuasca drinkers in more than 40 countries who had used ayahuasca in various contexts (n = 6,877). It captured detailed information about participant demographics, patterns and history of ayahuasca drinking, the setting of consumption, and ritualistic practices employed. Current mental health status was captured via the Kessler 10 psychological distress scale and the mental health component score of the SF-12 Health Questionnaire, while reported change in prior clinically diagnosed anxiety or depression (n = 1276) was evaluated using a (PGIC) Patient Global Impression of Change tool. Various intermediate outcomes were also assessed including perceived change in psychological wellbeing, number of personal self-insights attained, and subjective spiritual experience measured via the spirituality dimension of the Persisting Effects Questionnaire (PEQ) and Short Index of Mystical Orientation. Regression models identified a range of significant associations between set and setting variables, and intermediate and final mental health and wellbeing outcomes. A generalized structural equation model (GSEM) was then used to verify relationships and associations between endogenous, mediating and final outcome variables concurrently. The present study sheds new light on the influence of ceremonial practices, additional supports and motivations on the therapeutic effects of ayahuasca for mental health and wellbeing, and ways in which such factors can be optimized in naturalistic settings and clinical studies.“

Authors: Daniel Perkins, Violeta Schubert, Hana Simonová, Luís F. Tófoli, José C. Bouso, Miroslav Horák, Nicole L. Galvão-Coelho & Jerome Sarris

Notes

“This enabled the recruitment of a very large number of respondents (n = 10,836) that had consumed ayahuasca in traditional, religious and non-traditional settings in more than 50 countries. For the present publication, only participants who had consumed ayahuasca with two or fewer groups were included in the analysis (n = 6,877).“

In half the cases, the participants consumed ayahuasca in relationship to an ayahuasca church, 20% in a traditional context. More than 60% were university educated.

Summary

INTRODUCTION

Ayahuasca is a traditional plant decoction made from the Banisteriopsis caapi vine and Psychotria viridis Ruiz and Pav or Diplopterys cabrerana (Cuatrec.) B. Gates that contains DMT and harmala alkaloids that can produce powerful changes in awareness and consciousness.

Ayahuasca was originally used by Indigenous cultures in the Amazon basin in traditional medicine, but has since been adopted as a religious sacrament by a number of Brazilian syncretic religions, and has since been widely adopted as part of Indigenous styled neo-shamanic ceremonies taking place in countries across the world.

Ayahuasca has captured the Western imaginary as a potential therapeutic agent, and its traditional ceremonial practices provide an important space for encouraging the introspection and emotional connection necessary for therapeutic progress.

The theory of “set and setting” acknowledges the influence of non-drug/material factors on psychological and medical outcomes effected by material interventions, and is well established in the case of psychedelic therapies and interventions.

Analysis Framework

We included several demographic and ayahuasca drinking history variables as covariates to attempt to reduce confounding, and assume that set and setting may influence mental health and wellbeing via an effect on intermediate outcomes as well as directly.

Demographic and Ayahuasca Drinking Variables

We obtained demographic information from participants, including age, sex, highest level of education, and country of residence, as well as information about ayahuasca drinking history and patterns of use. We also created a variable to identify most drinking occurring within a traditional ayahuasca use country.

Respondents were asked whether they had consumed ayahuasca in a ceremony with one or more traditional shaman, with the UDV, Santo Daime or Barquinha churches, or in any other context. They were also asked to rate their experience of six different support, safety and preparation activities.

Mental Health, Wellbeing and Spirituality Variables

Several standardized research instruments were used to detect the impact of ayahuasca consumption on mental health and spirituality. The MCS of the SF-12 instrument, the K10 Psychological Distress Scale, and the PWG were used to measure change in psychological wellbeing after ayahuasca consumption.

Respondents were asked whether they had experienced depression or anxiety at the time of consuming ayahuasca and were given a patient Global Impression of Change measure to assess any perceived effects of ayahuasca drinking.

The spirituality dimension of the Persisting Effects Questionnaire (PEQ-S) was applied to assess subjective spiritual experiences that are commonly reported during psychedelic experiences, and the intensity of mystical experiences was explored using the Short Index of Mystical Orientation (SIMO).

Statistical Analysis

Pearson’s 2 test and one-way ANOVA were used to assess differences between categorical and continuous variables, and linear and stereotype logistic regressions were performed using STATA 16.

A final model was identified using the GSEM function in STATA 16, which combined generalized linear models and structural equation modeling to provide a high predictive ability.

Exploratory Factor Analyses were undertaken to identify relevant dimensions of respondent motivations, ceremony characteristics, and support activities. Three motivations factors, two ceremony characteristic factors, and two factors relating to preparation safety and support were obtained.

RESULTS

Participants’ motivations for using ayahuasca were similar across traditional and non-traditional contexts, and across Brazil and other Latin American countries, but differed substantially from the ayahuasca church context. The highest motivation score was for self-knowledge, and the highest ceremony characteristic score was religious use of hymns.

Multivariate Models

Table 4 reveals that therapeutic motivations were most consistently associated with the six ayahuasca drinking intermediate outcomes, including subjective spiritual experience, self-insights, experiencing extreme fear, integration difficulties, and a close ayahuasca community.

Of the ceremony characteristics, support and safety were significantly associated with all outcomes in a beneficial direction. Non-traditional ceremonies were associated with increased self-insights and higher SIMO score, but also increased likelihood of experiencing extreme fear and integration difficulties.

Preparation activities score was highly significantly associated with all outcomes (except extreme fear), including a greater number of self-insights, stronger spiritual experience based on the PEQ-S and SIMO score, closer ayahuasca community, and reduced integration difficulties.

Models relating to mental health outcomes (PWG, SF-12 MCS, K10, and PGIC) are presented in Table 5 and reveal that therapeutic motivation was associated with higher reported growth in PWG, but poorer current mental health.

The characteristics of the ceremony were associated with psychological wellbeing, current mental health, and improvement in prior anxiety or depression. The preparation activities score was positively associated with psychological wellbeing, current mental health, and improvement in prior anxiety or depression.

Proposed Model

The effects of motivations, ceremony characteristics and additional supports on mental health outcomes are presented in Figure 2. The primary outcome, reported growth in psychological wellbeing, is highly predictive of current mental health status.

DISCUSSION

Ayahuasca is a traditional Amazonian psychoactive brew used in naturalistic settings. The effects of different ceremonial practices have not been previously explored.

There is considerable fluidity in ceremonial practices across reported contexts of use, with traditional practices being commonly reported in non-traditional contexts, and non-traditional practices being commonly reported in ayahuasca churches.

Ayahuasca ceremonies were associated with greater number of self-insights, stronger subjective spiritual experience, higher psychological wellbeing growth, and higher SF-12 MCS, K10, and PGIC, but also increased integration difficulties, extreme fear, and poorer current mental health.

The support and safety score was the only variable significantly associated with all intermediate and mental health outcomes, and in a therapeutically beneficial direction. Non-traditional practices were also associated with intermediate benefits, but also a slight increase in integration difficulties, with no detectable effects on final mental health outcomes.

The importance of adequate preparation activities was highlighted via the significant association between this item and all intermediate and final mental health outcomes, except extreme fear. Religious or spiritual counselling was also associated with better mental health outcomes.

Body therapies such as yoga or tai-chi may work synergistically with ayahuasca by supporting somatic awareness and greater connection to bodily sensations and subtle messages.

Our study shows that aspects of the acute experience, additional supports, and individuals motivations affect the mental health and wellbeing of ayahuasca drinkers, and that these factors are also strong predictors of current mental health status.

This study has several strengths, including a large sample size, international cross-cultural sampling frame, and inclusion of ayahuasca drinkers from a range of different contexts of consumption. However, several limitations are also important to note, including the use of a non-random, self-selected sample and self-report data collection instrument.

In addition to the specific practices of ayahuasca use, there are potentially other aspects of the ceremony and additional supports that are of equal or greater importance to the experience and mental health and wellbeing outcomes of ayahuasca drinkers.

We found that setting (ceremonial practices and additional supports) and set (individual motivations) had significant effects on drinkers’ acute experiences, likelihood of experiencing difficulties with integration, and longer term wellbeing and mental health outcomes.

AUTHOR CONTRIBUTIONS

DP coordinated the study, VS designed the paper, and HS conducted the data analysis. All authors reviewed and edited the manuscript.