Long-term benefits to psychological health and well-being after ceremonial use of Ayahuasca in Middle Eastern and North African immigrants and refugees

Lowe and colleagues frame the study around the high burden of cumulative trauma, psychological distress, and barriers to care experienced by Middle Eastern and North African (MENA) immigrants and refugees. They note that although ayahuasca has been associated in earlier research with improvements in mood, wellbeing, trauma-related symptoms, and self-compassion, there is very limited longitudinal evidence on naturalistic ceremonial use in MENA populations. The paper also situates ayahuasca within a broader discussion of psychedelic-assisted healing and the potential relevance of ceremonial settings, while emphasising that public-health evidence for this type of use remains limited. The study aimed to prospectively assess changes in mental health, wellbeing, physical health, and psychological functioning before and after ceremonial ayahuasca use in a small group of primarily female MENA immigrants and refugees. The researchers also sought to examine whether pre-session mindset factors such as absorption, preparedness, and willingness to surrender were associated with acute psychedelic effects, to characterise negative effects and risks, and to describe participants’ trauma histories and personal backgrounds. In effect, the paper is presented as an exploratory longitudinal survey of naturalistic ceremonial use in an understudied population.

This was a prospective, naturalistic online survey study of adults of Middle Eastern or North African origin who were planning to take ayahuasca outside a clinical research setting. Participants were English-speaking, aged 18 years or older, and excluded if they had experienced a traumatic brain injury. Recruitment was independent of the researchers and occurred through the ceremony organiser. All participants attended the same five-day retreat, which included two consecutive days of ayahuasca ingestion in a group ceremony, along with preparatory activities such as yoga, meditation, breathwork, a sound bath, smudging, and a ritual honouring Pachamama. Integration sessions followed each ceremony and were repeated the next morning. The study used six sequential web-based surveys delivered through Qualtrics XM: an informed consent and demographics survey; a baseline survey completed two weeks before the ceremony; a pre-session survey completed on the day of the ceremony; a post-session survey completed 1 to 3 days afterwards; and follow-up surveys at 2 to 4 weeks and 3 to 4 months. Responses were collected between July and November 2022. Longitudinal outcomes included modified Beck Depression Inventory II (BDI-II) scores for depressed mood, Short State-Trait Anxiety Inventory (STAI) scores for state and trait anxiety, and secondary measures of emotion regulation, self-compassion, shame, cognitive flexibility, physical health, spiritual well-being, burnout, and personality. Pre-session measures also assessed absorption, psychedelic preparedness, surrender, childhood adversity, and PTSD screening. Ayahuasca dose was self-reported in ounces, with approximate categories described as small, medium, or large; no chemical analysis of the brew was performed. Outcomes after the ceremony included mystical experiences, challenging experiences, awe, emotional breakthrough, psychological insight, communitas, and later ratings of meaningfulness, insightfulness, spiritual significance, and behavioural change. The researchers analysed longitudinal measures using Bayesian paired-samples t-tests, with confirmatory classical t-tests when Bayes factors met a prespecified threshold, and also used linear mixed models for overall significance testing. Associations between pre-session variables and acute or longer-term outcomes were examined with Pearson correlations. Measures completed by fewer than 60% of participants at a time point were excluded from analysis.

Fifteen participants provided informed consent. Survey completion ranged from 14 to 15 participants across time points. The mean age was 30.1 years, most participants were female, most lived in the United States, and most held at least a bachelor’s degree. Participants were largely Arab, Middle Eastern, or North African, and all spoke Arabic and English. Most identified as immigrants or refugees, and most reported prior trauma exposure, previous mental health diagnoses, and prior psychedelic experience, although most had not previously used ayahuasca. Common traumas included sexual assault, child abuse, physical assault, serious accidents, natural disasters, and life-threatening illness; many participants linked these to threats of death, serious injury, or sexual violence. Before the ceremony, participants commonly reported self-exploration, mental health, and therapy-related intentions. Most reported good sleep, no alcohol or other drug use immediately beforehand, and no physical ailments on the day of the ceremony. The average dose was medium-to-large on both ceremonial days, and more than half reported taking more than one dose per day. The ceremony was held in a darkened indoor room with a ceremonial guide, helpers, a therapist, and a translator present. Most participants reported that both the guide and the ceremony had a significant positive impact on their experience. For primary outcomes, depression decreased substantially from baseline to 2 to 4 weeks after the ceremony. Mean modified BDI-II scores fell from 19.0 at baseline to 6.0 at 2 to 4 weeks, and the Bayesian analysis provided substantial evidence for improvement (BF10 = 21.72); the paired t-test was also significant with a large effect size. Anxiety showed a similar short-term improvement: state anxiety decreased from 45.9 to 33.6, with substantial Bayesian evidence (BF10 = 7.07). However, neither depression nor anxiety showed clear evidence of lasting change at 3 to 4 months, and scores at 2 to 4 weeks versus 3 to 4 months also did not show convincing change. Among secondary outcomes, cognitive reappraisal increased modestly at 2 to 4 weeks, with weak Bayesian evidence and a significant paired t-test. Self-compassion increased at both 2 to 4 weeks and 3 to 4 months, with significant paired t-tests at both follow-ups and medium effect sizes. Shame decreased over time, with weak evidence for a short-term decrease and substantial evidence for a longer-term decrease reported in the text. By contrast, there was no evidence of longitudinal change in spiritual well-being, cognitive flexibility, physical health, or personality. The Copenhagen Burnout Inventory was not analysed because completion rates were too low. Acute psychedelic effects were generally positive. The mean Mystical Experience Questionnaire score was 0.75, and 60% met the study’s criterion for a complete mystical experience. Mean scores for emotional breakthrough, psychological insight, awe, and communitas were also reported as high. Pre-session preparedness and mindset measures were related to several acute outcomes: mystical experience scores were associated with Psychedelic Predictor Scale set and setting scores and with Tellegen Absorption Scale scores; psychological insight was associated with Psychedelic Predictor Scale set and State of Surrender; awe was associated with Psychedelic Predictor Scale set; and communitas was associated with Psychedelic Predictor Scale setting. State of Surrender was not significantly associated with mystical experience in the reported analysis. Changes in depression and anxiety were linked to certain acute effects. Communitas was significantly associated with later change in depression at 3 to 4 months, although the authors note that this would not survive correction for multiple comparisons. Awe was strongly associated with reductions in both state and trait anxiety at 2 to 4 weeks. Challenging Experience Questionnaire scores were low. Most participants rated the overall experience as positive or extremely positive. At follow-up, most participants still described the ceremony as among the top 10 most meaningful, spiritually meaningful, and psychologically insightful experiences of their lives, although these proportions were lower by 3 to 4 months than at 2 to 4 weeks. Many also rated it among their most psychologically challenging experiences. Behaviourally, most participants reported positive changes, particularly improved relationships, better diet or nutrition, improved work or career life, increased exercise, and reduced alcohol or drug use. Most participants described the experience as beneficial, and nearly all reported that it had led to positive and desirable changes in their wellbeing or life satisfaction. Adverse effects were reported but were mostly short-lived. During and shortly after the ceremonies, some participants reported nausea, vomiting, lack of appetite, fatigue, restlessness, headaches, and physical pain; a minority reported persisting lack of appetite or fatigue after 24 hours. No participant sought medical care, though some sought psychological support from the therapist, helpers, or other participants. At 2 to 4 weeks, a minority reported confusion, disorientation, hallucinations, mood fluctuations, fear, anger, or headaches; at 3 to 4 months, persisting negatives included loneliness, depressive thoughts, lowered motivation, and mood fluctuations. Most participants reported no persisting negative effects at either follow-up.

The authors interpret the findings as preliminary evidence that ceremonial ayahuasca use was associated with improvements in mental health, wellbeing, and psychological functioning in a group of primarily female MENA immigrants and refugees. They emphasise short-term reductions in depression and anxiety, alongside increases in self-compassion and cognitive reappraisal, and they note that many participants also reported durable positive behavioural changes. In their view, the low rate of lasting adverse effects suggests that ceremonial use in a monitored setting may represent a relatively low safety risk for this population. The paper places these findings in the context of earlier research showing that ayahuasca and other classic psychedelics may reduce depression and anxiety and may enhance self-compassion and emotion regulation. The authors also argue that the high prevalence of trauma in the sample makes the observed changes particularly relevant, because trauma processing and reconceptualisation may be an important pathway to improved wellbeing in migrants and refugees. They suggest that ceremonial ayahuasca could have therapeutic potential for MENA populations exposed to trauma before, during, and after migration. The authors highlight several potential mechanisms. They argue that pre-session mindset and preparedness mattered: Psychedelic Predictor Scale scores, absorption, and surrender were related to acute mystical, insight, and awe-related effects. They further propose that communitas, or a sense of togetherness and shared humanity, may help explain changes in depression, while awe may be linked to reductions in anxiety. They also present self-compassion and shame as plausible psychological pathways through which ayahuasca might influence mood and resilience. Limitations are emphasised. The sample was very small and relatively homogeneous, which limits generalisability. Data were collected online rather than in person, so responses could not be verified and may have been affected by response bias. The study also lacked an experimental control group, making it impossible to rule out alternative explanations for change. The authors therefore describe the findings as preliminary and call for further research in controlled settings and in broader, less homogeneous samples. They also note that additional studies are needed to clarify the durability of antidepressant and anxiolytic effects and to determine whether repeated use is needed to sustain benefits.

The authors conclude that ceremonial ayahuasca use in this small group of MENA immigrants and refugees was associated with significant improvements in mental health, wellbeing, and psychological functioning, together with mostly positive behavioural changes and few lasting adverse effects. They state that these preliminary findings suggest naturalistic ayahuasca use may have therapeutic potential for MENA populations affected by migration-related trauma.