At the Johns Hopkins Center for Psychedelic & Consciousness Research (CPCR), participants in clinical trials for psilocybin, the active ingredient in “magic mushrooms,” have facilitators who stay with them for the entire experience, during which they wear a blindfold, lie on a couch and listen to a curated playlist. Participants also have counseling sessions before and after their psychedelic journeys, and journal throughout the process.

In such a controlled lab setting, center researchers have found psilocybin produces experiences resulting in substantial and sustained personal meaning. It can help treat depression and/or anxiety; has therapeutic effects in people who suffer from substance use disorder; and can help ease existential distress caused by life-threatening disease.

But not everyone is taking psilocybin under such ideal conditions. In order to better understand the risks and effects of recreational use, psychiatric researchers at Johns Hopkins sought to find out if unsupervised users also experience such benefits.

Their study, published September 2023 in Frontiers in Psychiatry, found that use of psilocybin in “naturalistic settings,” i.e., outside of clinical trials in controlled laboratory environments, is also associated with continuing improvements in mental health and well-being on average.

The prospective, longitudinal study — the largest prospective survey on naturalistic psilocybin use to date — found significant improvements in mental health, well-being and psychological functioning. A majority of participants experienced persistent reductions in anxiety, depression and alcohol misuse; increased cognitive flexibility, emotion regulation, spiritual well-being and extraversion; and reduced neuroticism and burnout after psilocybin use. A minority of survey participants reported continuing negative effects such as mood fluctuations and depressive symptoms.

Albert Garcia-Romeu, one of the study’s lead authors and associate director of the CPCR, says national data suggest that recreational psilocybin use is on the rise among adults in the U.S., underscoring the need for such studies.

“If people are taking this at home, at a festival or in some other setting, it’s really difficult to predict what would happen in terms of mental health,” Garcia-Romeu says. “So now, we have a more well-informed picture of what it looks like when people are using psilocybin ‘in the wild.’”

Following an initial survey that included informed consent, demographic information and mental health history, study participants completed five additional anonymous web-based surveys that tracked spiritual and psychological data as well as alcohol and drug use. The timing was relative to the reference psilocybin experience: two weeks before, one day before, one to three days after, two to four weeks after and two to three months after. About 650 of the 2,800 initial participants completed all six surveys. They were collected from July 22, 2020, to July 14, 2022. 

Participants were primarily college-educated white men residing in the United States with a prior history of psychedelic use. Most who filled out the surveys said they were taking psilocybin for mental health reasons.

Garcia-Romeu says these kinds of surveys can also help researchers understand risks of psilocybin use for those who are normally screened out of clinical trials due to cardiac conditions and psychiatric and personality-related conditions. This information can in turn inform harm-reduction strategy.

Sandeep Nayak, medical director at the CPCR and another lead author, says the study helps contextualize clinical trials.

“Clinical trial participants are sometimes having 25 hours of contact with a psychotherapist, so that’s not necessarily comparable” to taking psilocybin outside of a study, Nayak says. “Being able to study psychedelics, not just in the lab, but also outside of it, really does help to start to pin down what is the drug effect and what is the product of mutable contextual changes.”

Forthcoming publications will cover other dimensions of the survey, including areas where data diverge from clinical trial findings and/or widely held beliefs about psychedelics. For example, clinical trial data suggest that psilocybin increases a person’s mind perception, which involves attributing consciousness to various nonhuman entities such as plants, insects and animals.

A paper by Nayak soon to be published in the Journal of Psychoactive Drugs confirms that this was also the case among the survey participants — mind perception increased after their psilocybin experience. However, their metaphysical beliefs and status as atheist or religious believers were almost or entirely unchanged, countering the popular belief psychedelics can result in “conversions” to a belief in God.

Garcia-Romeu says the survey drives home the point that what researchers are seeing in the lab may not always represent “real-world outcomes.”

“What we’re doing here” — the psychotherapy and the physical environment — “is probably pushing the drug effects one way or another in ways that aren’t always clear,” he says.