Background: Positive emotional experiences during psychedelic therapy may play a key role in facilitating treatment outcomes, yet little is known about the effects of psychedelics on specific positive emotions or their relative importance.
Methods: Two studies examined links between acute positive emotions and mental health outcomes. Study 1 was a prospective observational study of individuals planning to use psychedelics (N=359), assessing well-being at baseline and four weeks after use. Study 2 was a clinical trial comparing psilocybin with escitalopram among individuals with major depressive disorder (N=59). Participants completed two dosing sessions (25 mg or 1 mg psilocybin) and measures of mental health at baseline and three weeks after their second session. In both studies, participants retrospectively rated seven acute positive emotions (ecstasy, self-compassion, compassion, gratitude, love, awe, peace) experienced during dosing. MANOVAs evaluated dose-related differences in emotions, correlations examined associations with mental health, and mediation models tested whether emotions accounted for psilocybin's effects (vs. escitalopram) on mental health improvements.
Results: Across studies, higher doses were associated with greater levels of all positive emotions. In Study 1, self-compassion, compassion, gratitude, love, and awe correlated with change in well-being. In a model including all emotions, only self-compassion predicted well-being, even when mystical experience or positive mood were included. In Study 2, self-compassion, compassion, awe, love, and peace correlated with reductions in depression. Several emotions mediated treatment outcomes (depression, suicidal ideation, anxiety, and well-being), with the strongest evidence for self-compassion as an independent mediator above mystical experience and positive mood.
Conclusions: Positive emotional experiences, especially self-compassion, appear to play an important role in facilitating improvement in mental health following psychedelic use. These findings highlight positive emotions as therapeutic mechanisms. Deliberate focus on the experience and integration of specific positive emotions may help guide the therapeutic process, refine psychotherapeutic components of psychedelic-assisted interventions, and optimize treatment outcomes.