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Post-Psychedelic Reductions in Experiential Avoidance Are Associated With Decreases in Depression Severity and Suicidal Ideation
Open accessAbstract
Psychedelic therapy shows promise as a novel intervention for a wide range of mental health concerns but its therapeutic action is incompletely understood. In line with acceptance and commitment therapy’s (ACT’s) transdiagnostic model, qualitative research has suggested that reductions in experiential avoidance are an important component of therapeutic outcomes associated with psychedelics. However, limited research has quantitatively explored the association between decreases in experiential avoidance and therapeutic outcomes associated with psychedelics. Therefore, in two prospective studies, using convenience samples of individuals with plans to use a psychedelic, we explored the impact of psychedelic use on experiential avoidance, depression severity, and suicidal ideation, as well as relationships between changes in these outcomes. Participants (Study 1, N=104; Study 2 N=254) completed self-report questionnaires of depression severity, suicidal ideation, and experiential avoidance: 1) before using a psychedelic (in ceremonial and non-ceremonial contexts), as well as 2) 2-weeks and 3) 4-weeks after psychedelic use. Across both studies, repeated measures ANOVAs indicated significant decreases in experiential avoidance, depression severity, and suicidal ideation after psychedelic use. Furthermore, decreases in experiential avoidance were significantly associated with decreases in depression severity and suicidal ideation. These results suggest that psychedelics may lead to significant decreases in experiential avoidance, depression severity, and suicidal ideation. Additionally, these findings imply that reduced experiential avoidance may be a transdiagnostic mechanism mediating treatment success within psychedelic therapy. We conclude that integrating psychedelics with psychotherapeutic interventions that target experiential avoidance (e.g. ACT) may enhance therapeutic outcomes.
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“Second, although two of these studies employed prospective designs, their use of naturalistic, volunteer samples with high rates of attrition (> 50%) may have contributed self-selection and sample biases that limit generalizability (Close et al., 2020; Zeifman et al., 2020).”
From Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca (2022) · cites this paper as Zeifman et al., 2020
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“In particular, across three prospective samples, psychological flexibility showed signs of increasing and covarying over time with clinical outcomes including depression and suicidality (Close et al., 2020; Zeifman et al., 2020).”
From Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca (2022) · cites this paper as Zeifman et al., 2020
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“It has been proposed that they exert their effects through the stimulation of psychological flexibility processes that decrease emotional avoidance and increase approach-oriented emotional coping (Davis et al., 2020; Kashdan et al., 2020; Zeifman et al., 2020)”
From Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca (2022) · cites this paper as Zeifman et al., 2020
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“A few recent studies, including three prospective studies, have suggested that psychological flexibility is a key component in psychedelic-induced outcomes (Close et al., 2020; Davis et al., 2020; Zeifman et al., 2020).”
From Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca (2022) · cites this paper as Zeifman et al., 2020
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“Reductions in experiential avoidance were significantly associated with decreases in depression and suicidality scores [55].”
From The psychological processes of classic psychedelics in the treatment of depression: a systematic review protocol (2022) · cites this paper as [55]
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“Through prospective surveys, Zeifman and colleagues [55] found experiential avoidance (the attempt to avoid or ignore negative or unwanted emotions or cognitions [56];) to be significantly reduced at 2 and 4 weeks after psychedelic use.”
From The psychological processes of classic psychedelics in the treatment of depression: a systematic review protocol (2022) · cites this paper as [55]
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“Consistent with RDoC (24) recommendations, a focus on better defining the neurobiological basis of experiential avoidance and related phenomena would help develop the Frontiers in Psychiatry | www.frontiersin.org 10 validity of the constructs.”
InfluentialNormality Tests for Statistical Analysis: A Guide for Non-Statisticians
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“org 2 More recently, two studies (18, 32) examined the relationship between improved mental health following psychedelic use and decreases on the revised Acceptance and Action Questionnaire [AAQ-II; (33)], a frequently used measure of both experiential avoidance and psychological flexibility.”
BackgroundRush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., Markowitz, J. C., Ninan, P. T., Kornstein, S., Manber, R., et al. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(02)01866-8 · Cited by 3,829
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“, see Research Domain Criteria (RDoC); (24)], optimize therapeutic outcomes, and choice of treatment for clients, as well as guide treatment development, refinement and delivery (25).”
BackgroundGriffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D., Cosimano, M. P., & Klinedinst, M. A. (2016) · Journal of Psychopharmacology · doi:10.1177/0269881116675513 · Cited by 2,201 · cited 2×
“Recent research has indicated that the intensity of “mystical-type” (4, 6, 7, 9, 22) or “peak” experiences engendered by psychedelics (23) is predictive of positive therapeutic outcomes; however, it remains unclear how (i.”
BackgroundMeasuring experiential avoidance: A preliminary test of a working model
Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., et al. (2004) · The Psychological Record · doi:10.1007/bf03395492 · Cited by 2,140
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“Recent research has indicated that the intensity of “mystical-type” (4, 6, 7, 9, 22) or “peak” experiences engendered by psychedelics (23) is predictive of positive therapeutic outcomes; however, it remains unclear how (i.”
BackgroundAcceptance and commitment therapy.
Hayes, S. C., & Lillis, J. (2012) · American Psychological Association eBooks · doi:10.1037/17335-000 · Cited by 1,543
Flagged first, then by citations
Research works printed but not linked: 3
- Hayes, 1994, Content, context, and the types of psychological acceptance, 13
- 2017, Depression and other common mental disorders: Global health estimates.
- 2014, A prioritized research agenda for suicide prevention: an action plan to save lives.
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Items 101–105 of 105
Beyond Connection: Paradoxes of Psychedelic Resonance in Late Modernity
Petrement, M. S. (2026) · Future Humanities · doi:10.1002/fhu2.70031
Karaaslan, F. G., Philippon, C., & Ford, J. A. (2026) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2026.2727014
Psychedelics and suicidality: A double-edged sword - risks, mechanisms, and moving forward
Mallevays, M., & Berkovitch, L. (2026) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2026.113878
Mathai, D. S., Pilecki, B. C., Zaki, H., Morris, T., Morris, M., & Garcia‐Romeu, A. (2026) · Psychedelics · doi:10.1016/j.psyche.2026.100046
Maynard, B. R., Blumhagen, H. M., Matthieu, M. M., Maynard, J. A., & Hyde, R. (2026) · Campbell Systematic Reviews · doi:10.1177/18911803261489560
Metadata
- Authors
- Zeifman, R. J., Wagner, A. C., Watts, R., Kettner, H., Mertens, L. J., & Carhart-Harris, R. L.
- Affiliations
- Imperial College London (GB)
- Heidelberg University (DE)
- Corresponding author
- Zeifman, Richard J.
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2020-08-07
- Volume
- 11
- Pages
- 782-782
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC7438781
- OpenAlex
- W3047886920
- Cited by
- 106
- References
- 98
- Citations by year
- 2026: 13 · 2025: 17 · 2024: 17 · 2023: 17 · 2022: 18 · 2021: 20 · 2020: 4
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Spiral (Imperial College London) (submittedVersion, cc-by)
- Funders
- Canadian Institutes of Health Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- psychedelics, experiential avoidance, depression severity, suicidal ideation, acceptance and commitment therapy, transdiagnostic mechanisms, psychedelic therapy, treatment outcomes
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