Psychedelic Identity Shift: A Critical Approach to Set And Setting

This analysis of the therapeutic frameworks used in psychedelic-assisted treatment (for smoking cessation specifically) finds that suggestions from the framework map onto outcomes (and the language used by participants) from the study. This has broader implications for psychedelic-assisted therapy, as suggestions (in the therapeutic framework) can be used for various purposes (positive and negative).


“While the literature on psychedelic medicine emphasizes the importance of set and setting alongside the quality of subjective drug effects for therapeutic efficacy, few scholars have explored the therapeutic frameworks that are used alongside psychedelics in the lab or in the clinic. Based on a narrative analysis of the treatment manual and post-session experience reports from a pilot study of psilocybin-assisted treatment for tobacco smoking cessation, this article examines how therapeutic frameworks interact with the psychedelic substance in ways that can rapidly reshape participants’ identity and sense of self. We identified multiple domains relating to identity shift that appear to serve as smoking cessation mechanisms during psilocybin sessions, each of which had an identifiable presence in the manualized treatment. As psychedelic medicine becomes mainstream, consensual and evidence-based approaches to psychedelic-assisted identity shift that respect patient autonomy and encourage empowerment should become areas of focus in the emergent field of psychedelic bioethics.”

Authors: Neşe Devenot, Aidan Seale-Feldman, Elyse Smith, Tehseen Noorani, Albert Garcia-Romeu & Matthew W. Johnson

Summary of Psychedelic Identity Shift

Psychedelics entered clinical research in the United States in the late 1940s but were placed in the most restrictive Schedule I category by Nixon’s Controlled Substances Act in the early 1970s. Since then, there has been a renaissance of clinical research and greater cultural exploration into this class of substances.

In addition to MDMA, psilocybin, ibogaine, and ayahuasca, other psychedelic drugs have been studied for their therapeutic effects, including obsessive-compulsive disorder, anorexia, and pain disorders. Few scholars have explored the therapeutic frameworks and modalities that are used alongside psychedelics in the lab or the clinic.

This article explores how therapeutic frameworks interact alongside psychedelic medicine in ways that may shape participants’ identity and sense of self. It argues that consensual and evidence-based approaches to psychedelic-assisted identity shift should become a key issue in psychedelic neuroethics.

The authors summarized patient reports from an open-label pilot study of psilocybin-assisted smoking cessation (Johnson et al., 2014). They analyzed the three major themes of identity shift that were primed by the study’s therapeutic framework.

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Commentary Re-analysis Theory Building


Authors associated with this publication with profiles on Blossom

Matthew Johnson
Matthew Johnson is an Associate Professor of Psychiatry and Behavioral Sciences at Johns Hopkins University. His research is concerned with addiction medicine, drug abuse, and drug dependence.

Albert Garcia-Romeu
Albert Garcia-Romeu is one of the principal researchers in the renaissance of psychedelics studies. He is doing his research at Johns Hopkins and focuses on psilocybin and how it can help with treating addiction.

Linked Research Papers

Notable research papers that build on or are influenced by this paper

Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction
This is the first study to use psilocybin and cognitive behavioural therapy (CBT) in concert for smoking cessation in an open-label format. Participants received a moderate (20 mg/70kg) and high (30 mg/70kg) of psilocybin with a 15-week smoking cessation protocol. At the six-month follow-up, 80% of participants were smoking-free.

Long-term follow-up of psilocybin-facilitated smoking cessation
This follow-up study (n=15) found that at 12 months 67% of participants didn't return to smoking (biologically confirmed). This was 60% at an average of 30-month follow-up. This study is the first (very positive) step in seeing if psilocybin-assisted psychotherapy (PAT) may be viable for people to quit smoking.