Effects of psilocybin therapy on personality structure
Open accessAbstract
Objective: To explore whether psilocybin with psychological support modulates personality parameters in patients suffering from treatment‐resistant depression (TRD). Method: Twenty patients with moderate or severe, unipolar, TRD received oral psilocybin (10 and 25 mg, one week apart) in a supportive setting. Personality was assessed at baseline and at 3‐month follow‐up using the Revised NEO Personality Inventory (NEO‐PI‐R), the subjective psilocybin experience with Altered State of Consciousness (ASC) scale, and depressive symptoms with QIDS‐SR 16. Results: Neuroticism scores significantly decreased while Extraversion increased following psilocybin therapy. These changes were in the direction of the normative NEO‐PI‐R data and were both predicted, in an exploratory analysis, by the degree of insightfulness experienced during the psilocybin session. Openness scores also significantly increased following psilocybin, whereas Conscientiousness showed trend‐level increases, and Agreeableness did not change. Conclusion: Our observation of changes in personality measures after psilocybin therapy was mostly consistent with reports of personality change in relation to conventional antidepressant treatment, although the pronounced increases in Extraversion and Openness might constitute an effect more specific to psychedelic therapy. This needs further exploration in future controlled studies, as do the brain mechanisms of postpsychedelic personality change.
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A single PAP session has been found to decrease neuroticism and increase both extroversion and openness when personality was assessed using NEO-PI-R at 3 months of follow-up.
“A single PAP session has indeed been found to decrease neuroticism and increase both extroversion and openness when personality was assessed using the Revised NEO Personality Inventory (NEO-PI-R) at 3 months of follow-up. 57”
From The revival of psilocybin between scientific excitement, evidence of efficacy, and real-world challenges (2024) · cites this paper as [57]
The Results (‘Personality changes from baseline to 3-month follow-up’) report decreased Neuroticism and increased Extraversion and Openness on the NEO-PI-R. However, the Methods (‘Study procedure’) specify two psilocybin dosing sessions one week apart, not a single session. (LLM, conf=0.92)
Experimental — accuracy not yet measuredThe possibility of long-lasting personality effects may raise ethical issues.
“On the other hand, the possibility of long-lasting personality effects may raise ethical issues. 32,57”
From The revival of psilocybin between scientific excitement, evidence of efficacy, and real-world challenges (2024) · cites this paper as [57]
The Discussion reports that a psychedelic experience can lead to lasting personality changes, supporting the premise of the sentence. It does not discuss whether those changes raise ethical issues; that implication is not supported by this source. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe use of open-label and crossover designs, as well as a single-dose protocol, was frequently noted.
“In terms of study design, the use of open-label 25,39,57,78-81 and crossover designs, 31-33,74,80 as well as a single-dose protocol, 31,33,39,72-77 was frequently noted.”
From The revival of psilocybin between scientific excitement, evidence of efficacy, and real-world challenges (2024) · cites this paper as [57]
The Methods > Participants section identifies this as an open-label feasibility study, supporting its inclusion among the open-label designs. The Methods > Study procedure section describes two sequential psilocybin dosing sessions, not a crossover design. The single-dose part of the citing sentence does not cite this paper. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThere are clear limitations such as small sample sizes with lack of diversity among participants and potential selection biases.
“Concerning the recruitment phase, there are clear limitations such as small sample sizes 25,31-33,39,57,60,72-74,77-81 with lack of diversity among participants 32,33,39,57,60,72,75-79 and potential selection biases. 26,31,39,72-74,76”
From The revival of psilocybin between scientific excitement, evidence of efficacy, and real-world challenges (2024) · cites this paper as [57]
The Discussion describes the sample as modest, and the Results report 19 complete datasets, with 6 women and 13 men (page unavailable). The Discussion also suggests a potential selection bias: people less open to experience may have been less likely to volunteer. The copy does not establish a broader lack of participant diversity beyond the reported sex distribution. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIngestion of a psychedelic drug can induce rapid and persisting changes in personality traits, particularly reductions in neuroticism, in both healthy and clinical populations.
“It has been repeatedly found that ingestion of a psychedelic drug can induce rapid and persisting changes in personality traits, and particularly reductions in neuroticism, in both healthy and clinical populations (24, 35–41).”
From Decreases in State and Trait Anxiety Post-psilocybin: A Naturalistic, Observational Study Among Retreat Attendees (2022) · cites this paper as [37]
The Discussion (page not supplied) reports a significant reduction in Neuroticism three months after psilocybin therapy in patients with treatment-resistant depression. It also describes lasting personality changes in healthy volunteers, but those findings concern Openness, not reduced Neuroticism. The paper therefore does not support the claim that reductions in Neuroticism occur in both populations. (LLM, conf=0.88)
Experimental — accuracy not yet measured
In patients with moderate or severe, unipolar treatment-resistant depression, psilocybin given twice, 1 week apart, increases Openness and Extraversion at a 3 month follow-up.
“In patients with moderate or severe, unipolar treatment-resistant depression, psilocybin given twice, 1 week apart, increases Openness and Extraversion at a 3 month follow-up (Erritzoe et al., 2018).”
From Psychedelics and Neural Plasticity: Therapeutic Implications (2022) · cites this paper as Erritzoe et al., 2018
Some studies showed inconsistent application of correction for multiple testing, no consideration of confounding factors, lack of randomization, and relatively short-term follow-up periods generally between one and 6 months after one or two single active psilocybin treatments.
“In terms of methodology, some studies showed inconsistent application of correction for multiple testing, 26,74 no consideration of confounding factors, 57,78 lack of randomization, 72 and relatively short-term follow-up periods were often observed, 25,26,31-33,39,57,72-81 generally between one and 6 months after one or two single active psilocybin treatments.”
From The revival of psilocybin between scientific excitement, evidence of efficacy, and real-world challenges (2024) · cites this paper as [57]
Open-label studies and two follow-up analyses supported the overall positive findings of RCTs.
“Open-label studies 25,39,57,78-81 and two followup analyses 61,62 supported the overall positive findings of RCTs.”
From The revival of psilocybin between scientific excitement, evidence of efficacy, and real-world challenges (2024) · cites this paper as [57]
These findings on personality changes have been inconsistent across studies.
“Post-psychedelic decreases in neuroticism and increases in extroversion, and openness to experience have also been reported [60, 61]; however, these findings have been inconsistent across studies.”
From The psychological processes of classic psychedelics in the treatment of depression: a systematic review protocol (2022) · cites this paper as [60]
Post-psychedelic decreases in neuroticism and increases in extroversion and openness to experience have been reported.
“Post-psychedelic decreases in neuroticism and increases in extroversion, and openness to experience have also been reported [60, 61]; however, these findings have been inconsistent across studies.”
From The psychological processes of classic psychedelics in the treatment of depression: a systematic review protocol (2022) · cites this paper as [60]
Three months after psilocybin treatment, patients with treatment-resistant depression showed increases in extraversion and openness scores.
“Three months after treatment, patients showed increases in extraversion and openness scores (28).”
From Modulation of Social Cognition via Hallucinogens and “Entactogens” (2019) · cites this paper as [28]
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REBUS and the anarchic brain: Toward a unified model of the brain action of psychedelics
Carhart-Harris, R. L., & Friston, K. J. (2019) · Pharmacological Reviews · doi:10.1124/pr.118.017160 · Cited by 1,180 · see citing works
Predicting responses to psychedelics: a prospective study
Haijen, E. C. H. M., Kaelen, M., Roseman, L., Timmermann, C., Kettner, H., Russ, S., Nutt, D., Daws, R. E., Hampshire, A. D. G., Lorenz, R., et al. (2018) · Frontiers in Pharmacology · doi:10.3389/fphar.2018.00897 · Cited by 417 · see citing works
Self-citationEmotional breakthrough and psychedelics: Validation of the Emotional Breakthrough Inventory
Roseman, L., Haijen, E., Idialu-Ikato, K., Kaelen, M., Watts, R., & Carhart-Harris, R. (2019) · Journal of Psychopharmacology · doi:10.1177/0269881119855974 · Cited by 413 · see citing works
Self-citationEmotions and brain function are altered up to one month after a single high dose of psilocybin.
Barrett, F. S., Doss, M. K., Sepeda, N. D., Pekar, J. J., & Griffiths, R. R. (2020) · Scientific Reports · doi:10.1038/s41598-020-59282-y · Cited by 375 · see citing works
Agin-Liebes, G. I., Malone, T., Yalch, M. M., Mennenga, S. E., Ponté, K. L., Guss, J., Bossis, A. P., Grigsby, J., Fischer, S., & Ross, S. (2020) · Journal of Psychopharmacology · doi:10.1177/0269881119897615 · Cited by 360 · see citing works
Andersen, K. A. A., Carhart‐Harris, R., Nutt, D. J., & Erritzoe, D. (2021) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13249 · Cited by 347 · see citing works
Self-citationBreeksema, J. J., Niemeijer, A. R., Krediet, E., Vermetten, E., & Schoevers, R. A. (2020) · CNS Drugs · doi:10.1007/s40263-020-00748-y · Cited by 224 · see citing works
Madsen, M. K., Fisher, P. M., Stenbæk, D. S., Kristiansen, S., Burmester, D., Lehel, S., Páleníček, T., Kuchař, M., Svarer, C., Ozenne, B., et al. (2020) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2020.02.001 · Cited by 183 · see citing works
Psychedelic-Assisted Psychotherapy—A Systematic Review of Associated Psychological Interventions
Cavarra, M., Falzone, A., Ramaekers, J. G., Kuypers, K. P. C., & Mento, C. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.887255 · Cited by 171 · see citing works
Timmermann, C., Bauer, P. R., Gosseries, O., Vanhaudenhuyse, A., Vollenweider, F., Laureys, S., Singer, T., Antonova, E., & Lutz, A. (2023) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2022.11.006 · Cited by 150 · see citing works
Peill, J. M., Trinci, K. E., Kettner, H., Mertens, L. J., Roseman, L., Timmermann, C., Rosas, F. E., Lyons, T., & Carhart-Harris, R. L. (2022) · Journal of Psychopharmacology · doi:10.1177/02698811211066709 · Cited by 141 · see citing works
Self-citationJefsen, O. H., Elfving, B., Wegener, G., & Müller, H. K. (2021) · Journal of Psychopharmacology · doi:10.1177/0269881120959614 · Cited by 127 · see citing works
dos Santos, R. G., & Hallak, J. E. C. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.12.001 · Cited by 111 · see citing works
Does Psychedelic Therapy Have a Transdiagnostic Action and Prophylactic Potential?
Kočárová, R., Horáček, J., & Carhart-Harris, R. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.661233 · Cited by 96 · see citing works
Self-citationGreenway, K. T., Garel, N., Jerome, L., & Feduccia, A. A. (2020) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2020.1772054 · Cited by 94 · see citing works
Psychedelics, Sociality, and Human Evolution
Rodríguez Arce, J. M., & Winkelman, M. J. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.729425 · Cited by 86 · see citing works
Psychedelics and Neural Plasticity: Therapeutic Implications
Grieco, S. F., Castrén, E., Knudsen, G. M., Kwan, A. C., Olson, D. E., Zuo, Y., Holmes, T. C., & Xu, X. (2022) · The Journal of Neuroscience · doi:10.1523/jneurosci.1121-22.2022 · Cited by 82 · see citing works
“In patients with moderate or severe, unipolar treat-ment-resistant depression, psilocybin given twice, 1 week apart, increases Openness and Extraversion at a 3 month follow-up (Erritzoe et al., 2018).”
Kiraga, M. K., Mason, N. L., Uthaug, M. V., van Oorsouw, K. I. M., Toennes, S. W., Ramaekers, J. G., & Kuypers, K. P. C. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.721537 · Cited by 85 · see citing works
The therapeutic potential of psilocybin: a systematic review
van Amsterdam, J., & van den Brink, W. (2022) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2022.2047929 · Cited by 74 · see citing works
Romeo, B., Hermand, M., Pétillion, A., Karila, L., & Benyamina, A. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.03.002 · Cited by 76 · see citing works
Modulation of Social Cognition via Hallucinogens and “Entactogens”
Preller, K. H., & Vollenweider, F. X. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00881 · Cited by 71 · see citing works
Zeifman, R. J., & Wagner, A. C. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.11.001 · Cited by 67 · see citing works
Stauffer, C. S., Anderson, B. T., Ortigo, K. M., & Woolley, J. (2021) · ACS Pharmacology & Translational Science · doi:10.1021/acsptsci.0c00169 · Cited by 65 · see citing works
MDMA and MDMA-assisted therapy
Wolfgang, A. S., Fonzo, G. A., Gray, J. C., Krystal, J. H., Grzenda, A., Widge, A. S., Kraguljac, N. V., McDonald, W. M., Rodriguez, C. I., & Nemeroff, C. B. (2025) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20230681 · Cited by 62 · see citing works
Stressful life events and openness to experience: Relevance to depression
Chiappelli, J., Kvarta, M., Bruce, H., Chen, S., Kochunov, P., & Hong, L. E. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.08.112 · Cited by 48 · see citing works
Weiss, B., Nygart, V., Pommerencke, L. M., Carhart-Harris, R. L., & Erritzoe, D. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.749788 · Cited by 47 · see citing works
Orłowski, P., Ruban, A., Szczypiński, J., Hobot, J., Bielecki, M., & Bola, M. (2022) · Journal of Psychopharmacology · doi:10.1177/02698811221089034 · Cited by 41 · see citing works
Psychedelic-Assisted Therapy for Substance Use Disorders and Potential Mechanisms of Action
Rieser, N. M., Herdener, M., & Preller, K. H. (2021) · Current Topics in Behavioral Neurosciences · doi:10.1007/7854_2021_284 · Cited by 37 · see citing works
Aicher, H. D., Mueller, M. J., Dornbierer, D. A., Suay, D., Elsner, C., Wicki, I., Meling, D., Caflisch, L., Hempe, A., Steinhart, C., et al. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1302559 · Cited by 33 · see citing works
Frymann, T., Whitney, S., Yaden, D. B., & Lipson, J. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.863247 · Cited by 30 · see citing works
Pagni, B. A., Zeifman, R. J., Mennenga, S. E., Carrithers, B. M., Goldway, N., Bhatt, S., O’Donnell, K. C., Ross, S., & Bogenschutz, M. P. (2025) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20230887 · Cited by 31 · see citing works
Johnstad, P. G. (2021) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2020.1842569 · Cited by 29 · see citing works
Kiraga, M. K., Kuypers, K. P. C., Uthaug, M. V., Ramaekers, J. G., & Mason, N. L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.883869 · Cited by 26 · see citing works
“Other studies have shown either no changes in agreeableness post-psilocybin experience in depressed patients (37) or higher agreeableness scores among psychedelics users when compared to the general population (38).”
BackgroundWeiss, B., Sleep, C., Miller, J. D., & Campbell, W. K. (2023) · Journal of Personality Disorders · doi:10.1521/pedi.2023.37.2.131 · Cited by 15 · see citing works
Psychedelic Psychiatry and the Consult-Liaison Psychiatrist: A Primer
Barnett, B. S., & Greer, G. R. (2021) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.jaclp.2020.12.011 · Cited by 13 · see citing works
Dressler, H. M., Bright, S. J., & Polito, V. (2021) · Journal of Psychedelic Studies · doi:10.1556/2054.2021.00157 · Cited by 14 · see citing works
Assessing potential of psilocybin for depressive disorders
Kozak, Z., Johnson, M. W., & Aaronson, S. T. (2023) · Expert Opinion on Investigational Drugs · doi:10.1080/13543784.2023.2273493 · Cited by 11 · see citing works
Johansen, L., Liknaitzky, P., Nedeljkovic, M., Mastin-Purcell, L., & Murray, G. (2022) · Systematic Reviews · doi:10.1186/s13643-022-01930-7 · Cited by 11 · see citing works
“Post-psychedelic decreases in neuroticism and increases in extroversion, and openness to experience have also been reported [60, 61]; however, these findings have been inconsistent across studies.”
ResultScala, M., Fabbri, C., Fusar-Poli, P., Di Lorenzo, G., Ferrara, M., Amerio, A., Fusar-Poli, L., Pichiecchio, A., Asteggiano, C., Menchetti, M., et al. (2024) · CNS Spectrums · doi:10.1017/s1092852924002268 · Cited by 9 · see citing works
“, 60, 73-77 73-77 Open-label studies 25,39,57,78-81 and two follow-up analyses 61, 62 supported the overall positive findings RCTs.”
Influential
- Authors
- Erritzoe, D., Roseman, L., Nour, M. M., MacLean, K., Kaelen, M., Nutt, D. J., & Carhart‐Harris, R. L.
- Affiliations
- Centre for Neuropsychopharmacology Division of Brain Sciences Faculty of Medicine Imperial College London London UK
- Imperial College London (GB)
- King's College London (GB)
- Sherman CT USA
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2018-06-19
- Volume
- 138
- Issue
- 5
- Pages
- 368-378
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- PMC
- PMC6220878
- OpenAlex
- W2807534705
- Cited by
- 267
- References
- 77
- Citations by year
- 2026: 21 · 2025: 28 · 2024: 36 · 2023: 52 · 2022: 48 · 2021: 38 · 2020: 28 · 2019: 11 · 2018: 5
- FWCI
- 24.04
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Spiral (Imperial College London) (submittedVersion, cc-by)
- Funders
- Wellcome Trust
- Alexander Mosley Charitable Trust
- National Institute for Health and Care Research (ACF-2013-21-501, ACF-2016-17-005)
- Medical Research Council
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Paranormal Experiences and Beliefs
- Keywords
- psilocybin, treatment-resistant depression, personality change, Big Five personality traits, neuroticism, extraversion, openness to experience, altered states of consciousness, psychedelic therapy, supportive therapy, insightfulness, antidepressant effects
- MeSH terms
- Neuroticism, Adult, Extraversion, Psychological, Female, Follow-Up Studies, Hallucinogens, Humans, Male, Middle Aged, Personality, Psilocybin, Depressive Disorder, Treatment-Resistant
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