Personality, Psychopathology, Life Attitudes and Neuropsychological Performance among Ritual Users of Ayahuasca: A Longitudinal Study

This longitudinal field study (n=242) assessed personality, mental health, life attitudes, and neuropsychological performance in a large number of long-term ritual ayahuasca users and control participants that were matched for age, sex, educational level, and religious background. Long-term ayahuasca use indicated a lower presence of psychopathological symptoms, better performance in neuropsychological tests, higher degrees of spirituality, and better psychosocial adaptation as reflected by some attitudinal traits such as Purpose in Life and Subjective Well-Being, and benefits on mental health were still observable in a one-year follow-up.

Abstract

“Introduction: Ayahuasca is an Amazonian psychoactive plant beverage containing the serotonergic 5-HT_2A agonist N,N-dimethyltryptamine (DMT) and monoamine oxidase-inhibiting alkaloids (harmine, harmaline and tetrahydroharmine) that render it orally active. Ayahuasca ingestion is a central feature in several Brazilian syncretic churches that have expanded their activities to urban Brazil, Europe and North America. Members of these groups typically ingest ayahuasca at least twice per month. Prior research has shown that acute ayahuasca increases blood flow in prefrontal and temporal brain regions and that it elicits intense modifications in thought processes, perception and emotion. However, regular ayahuasca use does not seem to induce the pattern of addiction-related problems that characterize drugs of abuse.

Methods: To study the impact of repeated ayahuasca use on general psychological well-being, mental health and cognition, here we assessed personality, psychopathology, life attitudes and neuropsychological performance in regular ayahuasca users (n = 127) and controls (n = 115) at baseline and 1 year later. Controls were actively participating in non-ayahuasca religions.

Results: Users showed higher Reward Dependence and Self-Transcendence and lower Harm Avoidance and Self-Directedness. They scored significantly lower on all psychopathology measures, showed better performance on the Stroop test, the Wisconsin Card Sorting Test and the Letter-Number Sequencing task from the WAIS-III, and better scores on the Frontal Systems Behavior Scale. Analysis of life attitudes showed higher scores on the Spiritual Orientation Inventory, the Purpose in Life Test and the Psychosocial Well-Being test. Despite the lower number of participants available at follow-up, overall differences with controls were maintained one year later.

Discussion: In conclusion, we found no evidence of psychological maladjustment, mental health deterioration or cognitive impairment in the ayahuasca-using group.”

Authors: José Carlos Bouso, Débora González, Sabela Fondevila, Marta Cutchet, Xavier Fernández, Paulo César Ribeiro Barbosa, Miguel Ángel Alcázar-Córcoles, Wladimyr Sena Araújo, Manel J. Barbanoj, Josep Maria Fábregas & Jordi Riba

Summary

Abstract

Ayahuasca is an Amazonian psychoactive plant beverage that induces intense modifications in thought processes, perception and emotion. Regular ayahuasca users showed higher Reward Dependence and Self-Transcendence and lower Harm Avoidance and Self-Directedness than non-ayahuasca users, and showed better performance on several neuropsychological tests.

Introduction

Ayahuasca is a psychotropic tea obtained from two plant species native to the Amazon Basin. It is used by 20,000 regular religious ayahuasca users in twenty-three countries, and has recently been declared part of the National Cultural Heritage of Peru.

No plants containing DMT are controlled under the 1971 Convention on Psychotropic Substances. However, B. caapi contains harmala alkaloids that reversibly block the metabolic breakdown of DMT, leading to psychoactivity.

Ayahuasca induces a modified state of awareness, increased insight and intense emotions, which are accompanied by moderate increases in blood pressure, elevations of blood cortisol and prolactine and lymphocyte redistribution.

The increasing number of individuals using ayahuasca on a regular basis has raised public health concerns. However, a neuroimaging study using SPECT found no changes in reward-related regions in long-term members of the ayahuasca religions, nor did it observe the deleterious psychosocial effects commonly associated with drugs of abuse.

Despite the above findings, the continued use of ayahuasca may have an impact on personality, general mental health and cognition. A study was conducted to evaluate personality, life attitudes, mental health and neuropsychological performance in a relatively large number of ritual ayahuasca users and their matched controls.

Methods

1. Participants

Ayahuasca-using participants were recruited after a meeting with members of several Brazilian ayahuasca churches. Control subjects were recruited to match the age, sex and educational level of ayahuasca users.

A group of religious ayahuasca users were recruited from Ce u do Mapia , a community in the Brazilian State of Amazonas. They attended rituals six times per month and had an average lifetime exposure to ayahuasca of between 360 and 1080 times.

A group of 56 controls was recruited from Boca do Acre, the nearest town to the Ce u do Mapia community. Of the 56 controls, 7 had ever ingested ayahuasca.

The urban sample consisted of 71 members of another ayahuasca religious group called Barquinha, located in the city of Rio Branco. They attended rituals eight times per month and had an average lifetime exposure of 360 to 1440 times.

Fifty-nine urban-based comparison group subjects were recruited from Rio Branco, Brazil, and all signed an informed consent form prior to participation.

The Temperament and Character Inventory (TCI) is a 240 item measure of personality based on the psychobiological model of personality developed by Cloninger and coworkers . It has four primary dimensions: Harm Avoidance (HA), Novelty Seeking (NS), Reward Dependence (RD), and Persistence (P).

The Symptom Check-List-90-Revised (SCL-90-R) is a self-report questionnaire that assesses 9 psychopathological symptomatic dimensions including 90 likert-type items that are scored from 0 to 4. Higher scores imply worse symptomatology.

The Stroop test assesses conflict monitoring and resolution, cognitive tasks involving the anterior cingulate-dorsolateral prefrontal system and the rostroventral prefrontal cortex, and behavior.

A participant is presented with three lists, one containing color names and the other incongruently printed. The number of correctly read and correctly reported items is recorded, and a Resistance to Interference measure is calculated.

The Wisconsin Card Sorting Test (WCST)

The WCST is a test that assesses executive function, and involves the dorso-and ventrallateral prefrontal cortices. It consists of 4 stimulus cards, 64 response cards, and no time limit to perform the test.

The Letter-NumberSequencing (LNS) from the WAIS-III

The LNS is a measure of working memory, involving dorso-, ventrolateral and orbitofrontal prefrontal cortices. Higher scores indicate better performance.

The Frontal Systems Behaviour Scales (FrSBe)

The FrSBe is a rating scale used to measure behaviors associated with damage to the frontal lobes and systems of the brain. It comprises 46 likert-type items with 5 response options.

2.5. Life Attitudes and Psychosocial Well-Being

The spiritual orientation inventory (SOI) is a 85-item self-report questionnaire that assesses the spirituality of those affiliated with traditional religion.

The purpose in life test measures a subject’s perceived ”meaning of life” versus ”existential vacuum” and can range from 20 to 140.

The psychosocial well-Being (BIEPS) questionnaire consists of 13 items and has four dimensions: Self-Acceptance, Autonomy, Psychosocial Bonds, and Projects.

We compared age, years of education, employment status, gender, race, marital status and religion between ayahuasca users and controls.

We performed a longitudinal study of personality, psychopathology, neuropsychology and life attitude variables. We used the data from all subjects available for a given test, and performed a two-way analysis of variance for each variable.

1. Sociodemographic Variables

The Jungle sample consisted of 56 regular ayahuasca users and 56 controls. No significant differences were found in sex, age, years of education or income between ayahuasca users and controls, but the comparison group was more qualified according to the Hollingshead categories.

We found no significant differences between ayahuasca users and controls in terms of sex, age, education, income, employment status or income variables. Most participants were either ”never married” or ”married”.

2. Personality Traits: Temperament and Character Inventory – TCI

The two-way ANOVA on temperament dimensions showed that ayahuasca users had lower scores on Harm Avoidance and Reward Dependence than controls, and higher scores on Fatigability and Asthenia than controls. Despite lower mean values for Novelty Seeking, the overall comparison was not significant.

The effects of ayahuasca use on reward dependence were driven by higher scores in Attachment and Dependence, and by lower scores in Self-Directedness, Cooperativeness, and Self-Acceptance. There were no Group effects found for Congruent Second Nature.

Ayahuasca users showed higher and lower scores on Helpfulness and Compassion than controls, and exhibited higher self-transcendence than controls.

In the second assessment, ayahuasca users had lower scores on Harm Avoidance, no differences were found for Reward Dependence, and significantly higher scores on Self-Transcendence. The effect on Self-Transcendence was mainly driven by significantly lower scores on Anticipatory Worry, Fear of Uncertainly, and Shyness.

Ayahuasca users showed significantly lower scores on all 9 psychopathological dimensions, as reflected by a significant Group effect on Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism.

The results of the second assessment showed that ayahuasca users had lower scores on 7 of the 9 dimensions compared to the control subjects, except for Somatization and Depression, where there was no significant Group effect.

4.2. The Wisconsin Card Sorting Test (WCST)

Ayahuasca-using subjects had a significantly lower number of total errors, persistative errors, non-perseverative errors, and failures to maintain set than non-using subjects.

In the second assessment, total errors were lower and non-perseverative errors were lower, but perseverative errors only showed a trend to significance.

4.3. The Letter-NumberSsequencing (LNS) from the WAIS-III

Ayahuasca users scored significantly higher on this task than their controls, but the interaction between Group by Sample and Overall Effect was not observed.

4.4. The Frontal Systems Behaviour Scales (FrSBe)

In the second assessment, ayahuasca users had lower values on the total FrsBe score, on Apathy/Akinesia, Disinhibition/Emotional Dysregulation and Executive Dysfunction.

5.1. The Spiritual Orientation Inventory (SOI)

Ayahuasca users showed significantly higher scores on all 9 components of the SOI, with differences being larger in the Urban sample than in the Jungle sample.

The pattern of results remained unchanged in the second assessment, with higher scores on all components in the ayahuasca-using subjects.

5.3. The Psychosocial Well-Being (BIEPS)

Ayahuasca users had higher values on the global BIEPS score, and a significant Group by Sample interaction was found for Projects. No Group effect was found for the Autonomy dimension.

1 Personality

The TCI was used to assess personality. Ayahuasca users showed higher scores on Reward Dependence (RD), Persistence (PR) and Harm Avoidance (HA) than urban counterparts, probably reflecting the strength in personality required to undergo regular ayahuasca sessions for long periods of time.

Ayahuasca users scored significantly higher in Self-Transcendence (ST) than controls, and had lower Self-Directedness (SD) than controls. However, there were no differences between ayahuasca users and controls in Cooperativeness (C), suggesting that ayahuasca users share personality traits with the long-term users.

In a study of 15 long term urban ayahuasca users, Grob et al. found lower scores on NS and HA and no differences in RD compared to 15 matched non-users, in line with our own results. However, the higher RD scores in our study may reflect the difference in environment mentioned above.

2 Psychopathology

Ayahuasca users scored significantly lower on all nine dimensions of the SCL-90-R than non-users, suggesting either a low potential for psychopathology or a self-selection bias. Similar findings have been reported in the literature. A study with 32 long term US ayahuasca users showed significantly lower scores than normative data for 7 of the 9 dimensions, and a study with teenage members of an ayahuasca church showed a tendency to an improvement in some measures of psychopathology.

Though there are case reports of psychiatric complications following ayahuasca intake, long-term users do not show higher psychopathology. Some experienced users even show reduced scores of panic and hopelessness while under the effects of the tea.

The self-assessment nature of the SCL-90-R may have introduced a bias, but the PST subscale was always higher than 3 – 4. The neuropsychological assessment also supported the validity of the present findings.

3 Neuropsychological Functions

We found no evidence of neuropsychological impairment in the ayahuasca-using group, and they scored better than their respective comparison groups in general terms. These results are more in line with prior observations in users of psychedelics, and do not fit the hypothesis of potential frontal impairment secondary to 5-HT2A receptor activation.

The lack of cognitive impairment in ayahuasca users can not be attributed to a lack of sensitivity of the neuropsychological tests administered, as they were sensitive enough to differentiate between users and non users. However, the detection of differences between users and non users is known to be influenced by several factors. Motivation may be a factor in improving performance of drug users in neuropsychological tasks.

The Frontal Systems Behaviour Scale can detect prefrontal deficits in non-addicted and addicted polydrug users. Ayahuasca subjects had lower scores on this measure.

4. Life Attitude and Psychosocial Well-being

Ayahuasca users showed higher scores on the SOI and TCI, and in a previous report, ayahuasca users scored lower on the Addition Severity Index. This data points at better general mental health and bio-psycho-social adaptation in the ayahuasca-using group compared to the control subjects.

Limitations

The present study has several limitations, including the fact that groups were not matched in premorbid IQ. In addition, the self-selection bias may have influenced the results, and future studies should include people who used ayahuasca regularly in the past but decided to discontinue its use.

Conclusion

The impact of long-term ayahuasca use on mental health was assessed from various perspectives. Ayahuasca users showed a lower presence of psychopathological symptoms compared to controls, and showed better psychosocial adaptation.